LONDON MEDICAL GAZETTE. YOL. XIX. (VOL. I. FOR THE SESSION 1836-37.) - - - WILSON AN1) SON, PRINTERS, 57, SKINNER-STREET, LONDON. < THE HOtttlOtY MEDICAL GAZETTE; BEING A OTee&lp Sournal OF MEDICINE AND THE COLLATERAL SCIENCES. VOL. XIX. (VOL. I. FOR THE SESSION 1836-37.) LONDON : PRINTED FOR LONGMAN, REES, ORME, BROWN, GREEN, <$f LONGMAN, PATERNOSTER-ROW. 1837. Digitized by the Internet Archive in 2019 with funding from Wellcome Library I H ISTOR iCAL ] \ MEDICAL J <'/£3r https://archive.org/details/s2id13404530 THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOyRINM. OF i¥irttrtnc attJj ffie Collateral Emitted. SATURDAY, OCTOBER 1, 1836. LECTURE S ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine , By William Cummin, M.D. INTRODUCTORY LECTURE. Gentlemen, — The subject of the course of lectures on which we are about to en¬ ter, is one which, for variety, interest, and importance, is second to none other taught in the schools. An assertion of this kind in the outset, may possibly risk the raising of expectations which it may not be so easy in the sequel to realize: but it is pro¬ per, at all hazards, that the fact should be fairly stated. Definition. — Forensic medicine, in its literal sense, signifies medicine, or medical science, adapted to the forum or court of jus¬ tice; but its actual import may be more largely described. As at present generally understood, it comprehends all that medi¬ cal knowledge which is available for the ascertainment of facts required in the ad¬ ministration of justice, and that informa¬ tion which is requisite for the construction of certain laws. An unexceptionable defi¬ nition cannot readily be given. I might quote to you the various forms in which the best authorities, both at home and abroad, have endeavoured to describe and to define the object of this study; but it would not be a very profitable mode of spending our time ; the terms already em¬ ployed may perhaps be deemed sufficiently clear and adequate for every purpose. As an art, forensic medicine assists in law¬ making as well as in the administration of the laws ; it comes in aid of the legis¬ lator as well as of the judge; its mission, accordingly, must be considered as of no mean importance. 461. — xix. Other appellations. — The distinctive ap¬ pellation of Forensic medicine — medicina forensis — has been sanctioned by Latin writers for more than a century, and has been freely adopted in various countries ; particularly in Italy and Spain. As a synonym, Legal medicine — medicina legalis, medecme legale — is used principally by our French contemporaries, and is, perhaps, in some degree, a preferable term to that used among us, as more obviously imply¬ ing an immediate relation to law. The Juridical or Judicial medicine of some au¬ thors, though it approach in signification to the Gerichtl'che Medicin, G. Arzneikunde , G. Arzneiwissenchaft, of the Germans, can¬ not be considered as a very correct title ; for medical men are never called on to de¬ clare what is or is not the law ; their busi¬ ness in courts of justice is simply to ascer¬ tain facts whereby the law, as interpreted by the proper authorities, may be duly administered. But what shall we say of Medical jurisprudence? — an unfortunate misnomer, which has obtained a footing in this country, and which began to be employed before the subject it was intended to denote was rightly understood. Medical juris¬ prudence is synonymous, or identical, with medical law; using the term law in its ordinary sense of legal science. Now who shall say that medical law and legal medi¬ cine mean the same thing? Might we not as well assert that the chestnut- horse and the horse-chestnut are equivalent ? But whatever be the appellation we give this study — whether forensic, legal, or juridical medicine — its nature and objects are easy to be recognized. It ministers to certain necessities of man as a member of society, just as clinical medicine does to his wants as an individual. That the duty of the medical practitioner is not confined to the sick chamber has long been known ; the medical man has also to attend the court of justice; and though the period is not far distant when medicine used to be de¬ fined simply and exclusively as the art of B 2 DR. CUMMIN ON FORENSIC MEDICINE. curing or preventing disease, such a defi¬ nition is now generally admitted to be incomplete, for it does not embrace the practitioner’s duties in aid of the construc¬ tion and administration of the laws. History. — This, gentlemen, is no mere modern or new-fangled application of medical science ; it is nearly as old as clinical medicine itself. It is not unrea¬ sonable to suppose that mankind possessed some degree of medical knowledge even before they were collected into communi¬ ties : but it is not possible to believe that this event took place, and that laws were instituted for the governance of society, without the aid of some degree of medical skill in their formation, and some also in having them properly executed. A rapid glance at the history of forensic medicine will not here be out of place : it will show at how early a period medico-legal questions began to be entertained, also what sort of questions have principally occupied the attention of legislators and jurists, from the most ancient date up to the present time. But it were not pos¬ sible (nor perhaps desirable, if possible) to enter largely into historical detail within the limits of an opening lecture : so that I shall have to refer you, for the principal facts and dates, to the Tabular View of the History and Literature of Forensic Medicine here drawn up for your inspec¬ tion [see the Table subjoined to the lec¬ ture]. I have divided the whole series of events into two periods ; in the first of which, the principles of the art may be recog¬ nized as existing, though not practised by a separate order of practitioners, or, in¬ deed, by medical men at all, as was the case with clinical medicine itself in the beginning : the second period commences about the early part of the sixteenth cen¬ tury, when, by a special ordinance of the German Emperor, the intervention and assistance of medical witnesses, in certain specified cases occurring in courts of jus¬ tice, were provided. Period 1. — In relation to the first period I shall be very brief. We find, in the sacred books of Moses, the first written rudiments of forensic medicine. There are there stated certain distinctions to be observed with regard to wounds — homicide — violation — criminal abortion — diseases and disqualifi¬ cations — the proofs of virginity, &c. found¬ ed on medical principles, and to be ascer¬ tained by the inquiries of persons compe¬ tently skilled. But the earliest special tract extant on a medico-legal subject is that of Galen, on the detection of persons who feign disease : this was produced in the second century of our sera *. In the laws of the ancient Greeks and Romans there are many medico legal provisions to be detected; yet, passing over several centuries, when we come to the great wmrk of Justinian, the Corpus Juris Civilis , we are surprised to find in it no ordinance expressly requiring reference to be made to medical practi¬ tioners, and that, although the medici of the period were not an obscure nor an unprivi¬ leged class. The presence of midwives, indeed, was distinctly enjoined in exe¬ cuting the law de ventre inspiciendo ; but there are several of the enactments which could not possibly be put in force with any regard to justice without the inter¬ vention of medical witnesses, — the lex Aquilia , for example, which ordered that damages should be paid for personal injuries, — and the Lex Cornelia de sicariis et venejicis, which took cognizance of homi¬ cide by weapons or poison. It is a curious fact in the history of legislation, that at the very time Justinian in the East was intent on giving the world a body of laws that should concen¬ trate all the civil wisdom of the age, the warlike nations in the north-western parts of Europe were engaged in a similar, but, of course, a far more rude, design. Before the election of the Merovingian kings, the most powerful tribe, that of the Franks, appointed four venerable chieftains to compose the Salic laws, and their labours were approved in three successive assem¬ blies of the people. Somewhat later, the customs of the Ripuarians were tran¬ scribed and published; and the Visigoths were among the latest to secure for them¬ selves one of the principal benefits of civilized society. The institutions of these untutored tribes have come down to us, and are found to contain several ordinances which must have given considerable lati¬ tude to medical authority in courts of justice. The capitularies also of Charle¬ magne, founded on the Salic and Ripua- rian laws, are understood to go still further, and to render the evidence of medical men, in certain cases, indispensa¬ ble. But the decretals of the Popes sanc¬ tioned a superior and more express discre¬ tion : in one of them, an ordinance of Innocent the Third, of the date 1209, it is distinctly provided that in a case of homi¬ cide by alleged wounds, there should be procured the testimony, or the judgment, rather, of experienced practitioners — ut peritorum judicio medicorum talis percussio assereretur, fyc., an expression , by the way, which corresponds with that of Baldus, the celebrated jurisconsult of Perugia, who, in his commentary on the Pandects has said, that medical men were no common witnesses — they had rather a judgment to deliver, than their simple testimony. * See Medical Gazette, vol, xYii. p. 980. INTRODUCTORY LECTURE. ’ 3 Period 2.— But I must hasten to the second period of our medico-legal history, marked by the famous ordinance of the Emperor Charles the Fifth. Various circumstances conspired to this important enactment : anatomy had now for some time been freely practised, and the superior value of medico-legal testimony, founded on the necroscopic appearances, had be¬ gun to be understood. Criminal codes had been drawn up by the bishops of Wurtzburg and Bamberg, in which the importance of medical evidence was not overlooked. With such aids to its com¬ pletion and success was the Halsgerichtsord- nung, or grand criminal constitution of the empire, composed, and first published in the year 1533. I refer you to the historical table for the heads of the particular clauses which are of a medico legal nature, only taking occasion here to observe, that by this ordinance, the presence of medical practitioners, in their respective grades, was secured in courts of justice, whenever their evidence was required for judicial purposes. Legal medicine in France. — France fol¬ lowed the example of Germany : the reports and opinions of medical men were held to be indispensable in criminal pro¬ cesses relating to personal injuries, suspi¬ cious deaths, questionable suicides, &c. ; and several French documents are extant, which were drawn up at a very early date in such circumstances. Ambrose Pare, that illustrious old surgeon, was decidedly the earliest writer of a treatise for the guidance of medico-legal practitioners. His book of Reports, some portions of which seem to have appeared as early as 1575, contains a variety of precepts and maxims relating to some of the most important questions in legal medicine. On wounds, as inflicted before or after death — on the signs of suf¬ focation, particularly in infant children — on the proofs of virginity, with reference to defloration— on impotence — on lesions of the viscera, and on various kinds of death, there are many sound rules pre¬ scribed. But it was not in this hook alone that Pare treated of medico-legal subjects: in several other parts of his works we find notices of a smilar description. In his 24th book he mentions the signs of preg¬ nancy ; in the 25th he gives some curious instances of feigned disorders, and of the methods by which they were detected ; and in his 21st book he lays down certain principles relating to poisons, in order, as he says expressly, that the surgeon might be enabled to distinguish by cer¬ tain signs the proofs of poisoning, and to give a faithful report thereof to the judges when required so to do. The ardour with which Forensic medi¬ cine has been pursued in France in later times, and the advanced state to which the study has been brought in connexion with the names of Louis, Chaussier, Fodere, Orfila, and others, are facts too well known to require dwelling on in this rapid sketch. In Italy. — Ttaly may boast of having pro¬ duced some of the earliestsystematiewriters on forensic medicine; and BaptistaCodron- chi, of Tmola, is probably entitled in great measure to that precedence which has generally been awarded to bis countryman Fedeli. Codronchi, in 1597, published at the Frankfort press, his tract entitled Methodus testificandi, in which, as he says himself, some very difficult but most in¬ teresting questions are treated : among these are feigned diseases, real maladies or injuries forming grounds of excuse or disqualification, suspected poisoning, wilful abortion, legitimacy, virginity, im¬ potence, pregnancy, &c. ; in short, his little book is a collection of medico-legal topics very remarkable for their date, though not discussed in any regular order. In his preface he speaks confidently, and, to all appearance, correctly, of his being the first to proceed in this track, and to set the example of a better kind of testimony than had been in use theretofore. Five years later appeared the well- known work of Fortunato Fedeli, De Relationibus Medicorum, Palermo 1602, in which there is certainly a wider range of subjects than is found in Codronchi’s treatise. But the author seems to have had no idea of having been anticipated by any one. With conscious pride he says id equidem profited possum, similis arguments opus nusquam untea quod sciam in lucent venisse. Fedeli obtained quite as much reputation as he merited by this book, a book remarkable, no doubt, for the period in which it appeared ; but con¬ sidering the crude nature of its contents, the Aristotelic formality with which it is composed, and the superstitious errors with which it abounds, one cannot readily assign a reason for its continuing to be so long looked upon as an authority. It went through three or four editions, and seventy years after its first appearance was thought worthy of being re-produced by a learned professor of Leipsic. But the great medico legal luminary of the Italians was Paulo Zacchia, a man of great learning, singular talent, and sound judgment. He was the great authority of his day; and there has scarcely been a writer since on Forensic medicine, who has not, more or less, availed himself of the rich treasures of that amazing performance, the Quastiones Medico - legates (1621 — 1651). As may rea- dily be imagined, however, from the date at which it was produced — when the cir¬ culation of the blood had only recently been 4 DR. CUMMIN ON FORENSIC MEDICINE. announced tb the world, this voluminous work abounds with matter which at pre¬ sent is of very little practical utility : ana¬ tomy, surgery, physiology, chemistry, and therapeutics, have all been greatly altered and reformed since it wras written ; and the digressions, poetical passages, quota¬ tions from old histories, samples of the Aristotelian philosophy and Galenism, which prevailed at that period, have ren¬ dered it now rather a source of recreation than of profitable research. In Germany. — Germany, though the source and birth-place of Forensic medi¬ cine, and in later times so productive of great names in connexion with the study, yet seems to have done little or nothing in a systematic way till nearly a century after Italy. It was not totally idle, how¬ ever, in cultivating particular branches of the subject. The hydrostatic test, for ex¬ ample, by which the question of the re¬ spiration of the new-born child, in refe¬ rence to the charge of infanticide, is sought to be determined, was contrived in Germany towards the latter part of the seventeenth century. Carl Rayger suggested, and John Schreyer employed it for forensic purposes. Other perform¬ ances likewise of the Germans, about this time, were fraught with utility : on wounds — on the proofs of homicide — on deflora¬ tion — and on alleged sorcery, writings of considerable value were produced. But it was in the subsequent century that bril¬ liant progress was made among the Ger¬ mans in Forensic medicine : then it was that they attained that mastery which they still continue to hold. It would occupy more time than we can at present afford even to enumerate the labours of Bohn, Teichmeyer, Hebenstreit, Haller (for Hal¬ ler taught Forensic medicine), Ploucquet, Daniel, Metzger, Platner, and a host of others, who contributed to raise the science to a degree of importance previously little to be anticipated. But we shall have ample opportunities of adverting to the peculiar services and merits of the German jurists hereafter. In England. — When from this review of the progress of Forensic medicine on the continent, wre turn our eyes to what has taken plaee in England at an early date, we find almost a complete blank — scarcely a trace of the least at¬ tention having been paid to it ; and morbid anatomy itself in a deplorable degree of backwardness. When the young Prince Henry, the hope of the nation, died in 1607, and it was popularly be¬ lieved for a time that he had been poi¬ soned through the contrivances of the favourite Somerset, it became, of course, an object with the physicians who attend¬ ed the Prince in his last illness to give a sufficient account of the appearances no¬ ticed after death. The pains taken to do this may be estimated from the steps adopt¬ ed by Sir Theodore Mayerne, the first phy¬ sician in ordinary to his Majesty, and in his time reckoned to be at the head of the profession. We find in his works a mi¬ nute account of the last illness and death of Henry, drawn up both in French and Latin; to which is appended the certifi¬ cate of the King and Lords in Council, attesting the satisfactory nature of the narrative, and acquitting Sir Theodore of all blame in the transaction. But the de¬ tails of the post-mortem report are miserably meagre, and utterly unsatisfactory in a medico-legal point of view. It should be recollected that, at the time referred to, Harvey was pursuing those investigations wdiich have since immortalized him, and shed so much glory on his country. I must be permitted to dwell for a mo¬ ment on the name of Harvey, which it is gratifying to be able to connect with the history of Forensic medicine in England. That illustrious man, however little motive there was in his time for attending to such observations, did not allow at least one phy¬ siological fact, bearing on a vitally impor¬ tant question of Forensic medicine, to escape him. It w7as known to Galen that the lungs of the foetus w7ere red, heavy, and dense, and that they afterwards became white, light, and of more deli¬ cate texture. Harvey, however, went much farther. The physician of Per- gamus made no inference of medico¬ legal diagnosis ; he did not even say that the change was produced by respiration; nay, he gives us to understand that the change in colour and texture is a sort of vital process that spontaneously takes place preparatory to the process of respi¬ ration. Now our great physiologist not only noticed the fact of change of colour in the foetal lungs, but stated the true cause of the change, and suggested that this phenomenon might serve to distin¬ guish whether the mother had brought forth stillborn offspring, or issue that had breathed after birth. The passage in which this remark oc¬ curs should be highly prized by English medical jurists. It will be found in the 70th Exercitation, De Generatione Animalium : — “ In embryone hoc tem¬ pore dissecto,” says Harvey, speaking of the foetus that has completed the fifth month of intra-uterine life, “ interiora omnia distincta et perfecta conspiciuntur : pimsertim ventriculus, intestina, cor,renes, pulmones ; qui etiam in lobos divisi san- guinolenti apparent, formamque debitam nacti sunt. Color autem his rubicundior est, quam iis qui aerem aliquando inspira- runt ; quod pulmones, ab eo dilatati, al- INTRODUCTORY LECTURE. 5 bedinera induant. Eoque indicio facile inter- noveris , materne vivum , ati mortuum fcetum pepererit : illico enim ab inspirato aere, mutatur pulmonum color; qui, etiam post repentina fata, idem permanet.” The work from which this passage is taken was first published in 1651, and the fact which it announces was probably observed several years previously. Now the tests for infanticide did not begin to be inquired into, even in Germany, until nearly thirty years after the date just mentioned. I must pass over a whole century from this time before I can find any thing else particularly deserving .of notice in the proceedings of practitioners and writers in Great Britain. The two Hunters at length contribute indirectly to the study : John Hunter, by his researches relative to the treatment of the drowned; and Wil¬ liam, by his embryology, and his remarks on the signs of child-murder; in which latter, however, he shews himself to be very imperfectly acquainted with the in¬ vestigations of his predecessors and con¬ temporaries. At the time that William Hunter stated his objections to the hy¬ drostatic test, Haller and Morgagni had already pronounced their opinions upon it, had discussed the arguments pro and con , in respect to its value, and decided in its favour provided it were discreetly applied. Ploucquet, also, and Daniel, had publish¬ ed their remarks on that test, and sug¬ gested others of their own in emendation of it ; but Hunter seemed to know nothing of these things. In fact, though his tract on Child-murder is still referred to as an authority, particularly by members of the legal profession, its author, when it was produced, was nearly a century behind his time, for he stated not one medico-legal objection that had not been proposed and canvassed above at least 80 years before. It was subsequent to the publication of Hunter’s tract that the first systematic treatise on legal medicine was produced in this country. This was an abridged translation of Faselius’s Elements, by Dr. Samuel Farr, which appeared in 1788, — the original work of Faselius being at that time above tw’enty years old! Yet such was the compendium which sufficed in England up to the present century, when a few elementary works began to make their appearance at intervals. Of late, indeed, there is not so much room to complain : we can even boast of having some very respectable treatises on Forensic medicine in our language. The late Dr. Gordon Smith produced works of considerable value, in his Principles, and his Analysis of Medical Evidence. Paris and Fonblanque contributed much to the advancement of the study, by their popular and interesting volumes ; anct Dr. Beck sent us from beyond the Atlantic a most important production, which has become naturalized amongst us — constituting, in¬ deed, at present our best book of Elements, and one that is eminently serviceable to the medico-legal practitioner. It is now more than thirty years since an event occurred which ought to have had, as, indeed, it has had, a considerable influence in the promotion of Forensic medicine in this country. Through a strong recommendation to Government, a professorship of Medical Jurisprudence and Police was founded in the University of Edinburgh, in 180J: but for several years after, though the chair was occupied by a very able professor (the late Dr. Duncan), little attention w as paid to the sub¬ ject : nor did the emoluments of the appoint¬ ment much exceed the salary allowed by the crown. Of late, however, the study has been more successfully pursued, because patronized by authority; it has been enjoin¬ ed in the curricula of several of our medical corporations: first in Edinburgh University partially; then, in 1829, in the College of Surgeons in Ireland; in 1830, by the So¬ ciety of Apothecaries in London; and in 1831, by the College of Surgeons in Edin¬ burgh. The London College of Physi¬ cians also, in their new curriculum, have adopted Forensic medicine; though, strangely enough, the London College of Surgeons have not yet thought proper to admit it, notwithstanding that it has be¬ come almost popularly and familiarly re¬ cognized as a department of the highest importance to the practitioner. Itidispensable to British practitioners. — The peculiar position in which medical prac¬ titioners in this country are placed, in respect to the legal tribunals, must neces¬ sarily lead to such a recognition ; for there are not here — as there are in France, Italy, Germany, and other countries — persons specially appointed to the discharge of medico-legal functions ; consequently, in the event of medical evidence being required amongst us, any practitioner in any manner connected with the case, or perhaps having no anterior cognizance of it whatever, may be called upon to act in the capacity of a medical jurist. But our laws, perhaps it may be sup¬ posed, areof a different character from those of other countries : we do not here take cognizance of those minutiae on w hich the decision of cases in the foreign courts de- pends. In other words, it may be at¬ tempted to be alleged that medical aid is not essentially necessary for the adminis¬ tration or composition of British law. If such an assertion be seriously made, it can easily be shown to be inconsis¬ tent both with truth and fact. We have G DR. CUMMIN ON FORENSIC MEDICINE- only to appeal to the history of our laws — criminal, ecclesiastical, and civil — to see how the matter really stands. The laws of England, like our lan¬ guage, may be traced to various sources ; they are the concentrated wisdom, not only of our own ancestors, but of those of other and more ancient nations. Our civil and canon law, which prevails in the ecclesias¬ tical and certain other courts, is almost wholly borrowed from the codes of Justi¬ nian and Theodosith, and from the Decre¬ tals of the Popes ; while our common law, based on the enactments of our Ethelberts, our Alfreds, and our Edwards, has been en¬ riched by the experience of ages, and may fairly lay claim to the designation which has by some been accorded to it — namely, that of being the perfection of human reason. Now the civil law, already noticed in speaking of the Corpus Juris and the Decretals, contains many provisions of a medico-legal nature : these provisions have, many of them, been transmit¬ ted to us in their original integrity ; and I can give you, as an example, the practice followed when it is necessary to ascertain pregnancy, in the conduct of civil suits. The writ called, after the Roman law, de ventre inspiciendo, is issued, and a jury of discreet and experienced persons is called upon to execute it. In criminal cases, when pregnancy is pleaded in bar of execution, a jury of matrons must give a verdict on the plea : but the usual practice has for some time been to sub¬ stitute certain professional examiners in¬ stead. I might refer to many of our ancient statutes in like manner, to show that they c ntain clauses, the administration of which can only be, as it commonly has been, properly effected by medico legal assistance. Take the statute 25th of Ed¬ ward ILL c 2, concerning the crime of high treason, in compassing or imagining the death of the king — violating certain females of the royal family — slaying the judges, &c. The application of this sta¬ tute has rarely taken place, nor could it well be conducted, without medical evidence being tendered. Or take the laws of May¬ hem, or maiming, which were very an¬ cient, or the Coventry act, according to which the guilt of the accused depended on his having, with a certain intent, inflicted peculiar wounds — such as slitting the nose, cutting out or disabling the tongue or any member: medical evidence was here also absolutely necessary. It is certainly true, that in these, or any other of our laws, there has rarely, if ever, been any mention of medical referees. But this is only consis¬ tent with the cautious reserve so remarka¬ ble in ourlegislation, which always chooses to leave as much as possible to the discre¬ tionary management of its functionaries; nor is the necessity for medico-legal aid by any means lessened owing to that circum¬ stance. A better example of the cautious policy to which I allude cannot be afforded, than that which we find in the statute which I hold in my hands. It is the 9 Geo. IV. chap. 31, commonly called Lord Lansdowne’s Act. Itconsists of thirty-eight sections, consolidating our statute law rela¬ tive to offences against the person ; and though full five-and-twenty of those sec¬ tions are of a medico-legal nature, or re¬ quiring the evidence of medical witnesses, in order that the provisions of each should be duly satisfied, several of them requiring the substantiation of facts only to be ascertained by the examination of competent medical men, there is not one word, from beginning to end, explicitly referring to professional testimony : the nature of the proofs required, however, can leave no doubt as to the persons by whom those proofs are to be ascertained. But the practice of our courts puts the matter beyond a question. Though there are among us no recognized medical jurists — no special class of medical referees — we find few trials in which persons discharg¬ ing such functions are not specially re¬ quired to be present, and called upon to elucidate, by their opinions, the difficul¬ ties that may arise. Observe the busi¬ ness on circuit : in almost all the cases occurring at the spring and summer as¬ sizes, the testimony of members of the pro¬ fession is deemed of vital importance ; the medical man seems to be the very hinge on which each case turns, the arbiter by whose decision the matter (frequently matter of life and death) is determined. Look, again, to that more ordinary and familiar court, the Coroner’s — the impor¬ tant originator of further proceedings — where almost the entire business (with the exception, indeed, only of treasure trove, and wreck cases) consists of matter of medico-legal investigation. In few and rare instances can a Coroner’s inquest be properly conducted without medical tes¬ timony; yet — and it is a good illustration of the non-intervention principle of our laws — though there are probably not less than five or six thousand inquests held by coroners annually, throughout the coun¬ try, in almost every one of which medical evidence is indispensably required — it has been left entirely to the discretion of the co¬ roner to procure that evidence ; there is no medical man on whom he is specially au¬ thorized to call ; he must exercise his inge¬ nuity to obtain what hedeemssufficienttes- timonv, and has been frequently reduced to great difficulties in this respect, having had (until the passing of the new Medi¬ cal Witnesses’ Act) no remuneration to INTRODUCTORY LECTURE. 7 offer to the professional man for the trouble of attending. We thus see how, both by the construc¬ tion of our law and the practice of its functionaries, we are all involved largely in the duty of aiding the furtherance of justice. There can be no evasion. The law requires the ai dance of medical skill, that it may be duly administered, and that skill it may require at the hands of any practitioner in the kingdom. The legislature presumes every practitioner competent to act in a medico-legal capa¬ city; nor may any medical man, however conscientious or scrupulous, excuse him¬ self on the ground of his not being a me¬ dical jurist; when summoned, he must only make the best figure he can in ex¬ ercise of the important functions de¬ manded of him, or otherwise plead igno¬ rance, and suffer accordingly in the public estimation. Duties of medical jurists. — It is on most occasions a critical office to discharge well the duties of a medical jurist. Let us take a view of what is usually imposed on the practitioner, when called upon in this capacity. Suppose a case of alleged •poisoning to be investigated, and that there is a party accused of that crime. The referee must in such a case bring to the investigation several requisites of a special sort. He must have a general knowledge of the effects of poi¬ sons : he must be able to distinguish the effects of poison from those of natural disease; he must be familiar with the morbid appearances produced by poison, and in nowise confound them with those resulting from other causes. By com¬ petent chemical skill he must be able to give convincing evidence of the particular deleterious substance wherewith the mis¬ chief has been done ; and finally, he must be prepared to have his opinions and his processes strictly scrutinized, and to give a clear account of them viva voce before a legal tribunal. Or, suppose another common case. The body of a new-born infant is found under suspicious circumstances. It will rest on the evidence of the professional examiner whether or not an indictment for murder shall be preferred against a suspected party. The competent medical jurist will in such a case proceed most cautiously and deliberately : he will examine the body, both externally and internally, with reference to several tests Whereby the fact of live or still birth may be ascertained ; and supposing the former to be made out, he will then endeavour to determine the cause of death. All the apparent lesions will have to be narrowly noticed ; the ap¬ pearances of disease or of wilful injury must be distinctly appreciated; the phe¬ nomena of asphyxia by drowning, strang¬ ling, and so forth, must be carefully dis¬ criminated ; and any suspicious-looking fluids in the stomach or bowels must be chemically analyzed. In most cases of alleged unsoundness of mind,— a subject of so much interest and importance both in our civil and criminal courts of justice, — the medical referee has the arduous task imposed upon him of stating publicly his deliberate opinions respecting the existence or non-existence of such a state of mind as is consistent with responsibility for imputed crime, or competency to the management of pro¬ perty. He must be able to distinguish the merely eccentric individual from the per¬ son of positively unsound mind: he must define, describe, and show himself ac¬ quainted with the peculiarities consti¬ tuting the various kinds of mental aliena¬ tion : and here again I need not add the perils that lie in wrait for the professional witness who is not perfectly prepared for the task, — the misadventures that have oc¬ curred are matter of common notoriety. So again with respect to wounds or other personal injuries, the skill of the medical jurist will often be exercised. The question may be as to the consequence of the alleged injury — whether, in case death has followed, such a result was to be con¬ sidered as inevitable or accidental; and cases of this kind sometimes involve some of the most complicated inquiries. Special education and discipline necessary. — Without a previous and an especial disci¬ pline in the inquiries relative to which he may have to appear in a court of justice, the medical.witness must not be surprised to find himself in an awkward, if not a very dangerous, situation. Even the ablest practitioners, -—men the most distinguish¬ ed in particular departments of medical science, — have been foiled and humiliated when they have ventured unprepared to give medical evidence. The case of John Hunter will serve as an illustration. On the trial of Donellan, in 1781, for poison¬ ing the young baronet, his brother-in-law, the great physiologist wras summoned as a witness, being presumed to be well acquainted with the action of poisons on the animal economy. I shall not trouble you with the examination and cross-examina¬ tion of Mr. Hunter, but the judge’s re¬ marks must not be omitted: — “For the prisoner,” said his Lordship, “you have had one gentleman called, W'ho is likewise of the faculty, and a very able man. I can hardly say what his opinion is, for he does not seem to have formed any opinion at all of the matter. He at first said he could not form an opinion whether the death was or was not occasioned by the poison, because he could conceive that it might be DR. CUMMIN ON FORENSIC MEDICINE. ascribed to other causes. I wished very much to have got a direct answer from Mr. Hunter, if I could, what upon the whole was the result of his attention and application to the subject, and what was his present opinion, but he says he can say nothing decisive.” I am aware that attempts have been made by some of the ardent admirers of John Hunter to defend the evidence he gave on this trial; but there, is reason to believe that this is more than that eminent man himself ever ventured to do. On the contrary, he seems to have ever retained an unpleasant consciousness of the un credita¬ ble iigure he made on the occasion, and to have regretted that he had not previously taken the trouble to make himself better acquainted with the points on which he was examined. The candour, indeed, which he displayed subsequently, ought to go far towards disarming censure, wffiile it conveys to us a lesson not to be lightly prized. He used ever to lament, as wTe are inform¬ ed by Sir Astley Cooper, that he had not made more preparation for this trial : “ he found himself a good deal embarrassed on the occasion ; the lawyers took advantage of his embarrassment, and he used to ex¬ press his regret publicly in his lectures, that he had not given more attention to the subject, before he ventured to give an opinion in a court of justice.” This re¬ gret on the part of Mr. Hunter must have been purely for having so perilously risked his reputation, and at the same time so little served the cause of truth; for if he had given the requisite attention to the subject, he could only have come to the same conclusion as the other witnesses. Let me be permitted to give one other example. If the most distinguished ability as a teacher of anatomy could constitute all that was requisite for a medical jurist, this was to be found in the late Mr. Joshua Brookes. Yet some circumstances which occurred in the spring of the year 1829, put his qualifi¬ cations in this respect to the test. An el¬ derly gentleman, a Mr. Neale, was found dead on the floor of his chamber; and a soldier, who had been with him the even¬ ing before, and who, there was reason to believe, had robbed him, was suspected to have been the cause of his death. The question was, whether the deceased had died a natural death, — as by apoplexy, for instance, — or had been murdered. The body was examined by Mr. Brookes, and an account of the appearances, signed by him and two other medical gentle¬ men, submitted to the coroner and his jury. A more unsatisfactory document cannot well be conceived issuing from men of medical education : it was, how¬ ever, sufficient to lead to a verdict of wilful murder against the soldier. But the transaction had caught the atten¬ tion of the public, and luckily, also, of some well-informed members of our profession. The matter was taken up by the medical societies of the metropolis, and discussed in the journals, promptly and impartially*. Mr. Brookes had time to reconsider the circumstances of the case: he was examined again, a week after, at the Old Bailey, when the evidence he gave was directly the reverse of what he had previously given, and in con¬ sequence the prisoner was acquitted. It was creditable, no doubt, to Mr. Brookes to unsay what he had said before, when he became convinced of bis error : but consider the appearance of all this before the public, — consider the jeopardy in which truth and justice were placed, — and what might not have been the result had there been no opportunity of retracting the original statement ! We see, then, that however the magis¬ trate or the judge may presume medical men in general, and the more eminent among them in particular, competent to the business of forensic medicine, practi¬ tioners themselves may not so safely form the same opinion, unless they be fully con¬ scious of sufficient preparation. Necessity for a distinct course. — But how is that preparation to be effected ? May it be attained in the course of the ordinary education for clinical prac¬ tice ? It is not very possible nor probable that it should. In the departments of practical medicine, surgery, midwifery, chemistry, anatomy, and materia medica, much information may undoubtedly be gathered which shall afterwards serve in the investigation of wounds, pregnancy, poisoning, and other subjects of Forensic medicine ; but the special application of those branches can scarcely be expected to be entered upon by their teachers, who have already quite enough on their hands. Or if one or two of them should find time for such application, the others certainly cannot: while at all events the student is sent about gathering his medico-legal prin¬ ciples. There is no other feasible means save making this department of knowledge a special study, — a study which is to suc¬ ceed to the student’s attendance on the other branches of medical education, making this the complement and the completion of them all. There is even a positive necessity for such a course, because many of the subjects comprehended within the range of Foren¬ sic medicine are not treated of elsewhere. Extent and variety of Forensic medicine. — If we advert to the extent and variety of topics which come within the province of * See Medical Gazette, vol. iii. p. 578. INTRODUCTORY LECTURE. 9 legal medicine, it is impossible not to be struck with the changes which some of these have undergone in course of time, some having become immeasureably low¬ ered in the scale of relative importance, and others absolutely extinct. To give one instance : time was when Demo - noiogy and Witch ruft were prime ob¬ jects of attention to the bar, the bench, and the medical profession, in this coun¬ try. Some of our ablest judges were per¬ suaded that supernatural powers of mis¬ chief were possessed by certain persons in the lower classes of society, and that they were often exercised with malicious inten¬ tions and fatal effect. The character of Sir Matthew Hale is stained by such a weakness: this great man tried prisoners who were arraigned on the charge of witch¬ craft ; and on one occasion fortified his impressions of their guilt by appealing to one of the most learned physicians of the day, Sir Thomas Browne, wdio happened to be in court. It is lamentable to add, that the infatuated opinion then uttered, cost two unfortunate women their lives. In Catholic countries, and where reli¬ gious fanaticism much prevails, questions of alleged miracles often come before the authorities. Hence the consideration of miracles is still entertained by certain foreign medico-legal waiters. In the work of Zaccliia, we find that the first con¬ sultation in which that distinguished ju¬ rist was engaged before the Rota, was to determine whether or not the re¬ moval of epilepsy, in a certain case, was to be attributed as an instance of miracu¬ lous power to a reputed saint, whom it was intended to canonize ? Tortosa, who belongs to the present century, devotes special chapters to miracles, magic, and the possessed ; and Martini, one of the most eminent Italian professors of the present day, does much the same. In his Medicina Forensis, published so late as 1832, he treats of miracles, demoniacs, sorcerers, witches, and the bewitched. On the debt- turn conjugate, also, Martini gravely devotes a chapter to an enumeration of the cir¬ cumstances under which the debtor may be occasionally excused. If froni these and similar inquiries the present advanced state of civilization in this country has wholly delivered us, it may still be doubted w hether, upon that account, the circle of our medico-legal re¬ search is much contracted : the progress of knowledge, keeping pace with social im¬ provement, has given rise to several other subjects of investigation, not less curious, perhaps, wThile they have far more serious claims on our attention. Toxicology may be cited as an example — a department of medical science which can scarcely be said to have originated anterior to the present century: the subtlety of research, how¬ ever, and the accuracy of the conclusions w hich Forensic Medicine can boast of, in connexion with this department, have al¬ ready attained a perfection, which it would have been deemed by the medical jurists of the generation gone by, chimerical, if not preposterous, to hope for. Conciuijon. — I find that I must here con¬ clude, though a number of interesting- points would still deserve to be no¬ ticed. But perhaps all has been said that was absolutely essential for an opening lecture. It was my purpose to give a succinct account of the nature and the im¬ portance of Forensic medicine; and I have done this, or attempted to do it, chiefly by tracing the art from its origin. In the rapid and necessarily superficial sketch presented to you, it may be discerned at how very early a date of human society this application of medical know¬ ledge was found requisite, and from its progress, it may be inferred howr much the widely extending relations of society will in future render its assistance still more and more needed. On the actual prowess — the triumphs — of legal medicine, I have dwrelt but little, partly because the details can be better appreciated as we proceed in the course, and partly because, to say the truth, though there are bright and beautiful tints in the picture, there are also dark spots — deplorable blemishes. I might bring be¬ fore you instances in which medical men, by the conscientious and able discharge of their duty as professional witnesses, have vindicated the purity and honour of per¬ sons unjustly charged with crime, have rescued the innocent from impending ruin, and by detecting guilt in its most secret recesses, have brought the criminal to de¬ served punishment. But it would be to abuse your good faith, were I, at the same time, to withhold examples of quite an opposite description, and to omit to mention in how many instances great opportunities have been lost, positive and irretrievable mischief has been done, by incompetent or reckless medical referees. That upon weighing the good against the bad, the former should be found considera¬ bly to preponderate, is gratifying as it is certain ; but it wrouldbe unjustifiable hence to insinuate that the bad instances are weightless, or only as a feather in the scale. It is but too true, nor can it be too early impressed on those entering upon the study, that the practice of legal medicine involves a heavy responsibility, and that it is attend¬ ed with anxieties and difficulties w'hich do not usually fall to the lot of the ordinary praetitioner. The consolation, however, is, that if the danger be great, the glory is not incommensurate, and that, in the very endeavour to achieve success, we may hope to obtain that most enviable of all prizes — therespect and approbation of our fellow citizens. [ Tabular View , fyc. 10 DR. CUMMIN ON FORENSIC MEDICINE TABULAR VIEW OF THE HISTORY AND LITERATURE of FORENSIC MEDICINE. PERIOD I. In which the Principles existed and were recognized without a distinct order of Practitioners. From the earliest Date to the Sixteenth Century. B. C. (2000) ASSYRIANS and EGYPTIANS. The custom of exposing the sick publicly {Herod, i. 197, and Strabo,) must have led to many observations of a medico-legal kind. In Egypt, the kings themselves practised dissection, in order to discover the cause of death ( Plin . xix. 26.) Pregnant women were respited from punishment. 1722 1604 1451 884 536 430 400 S25 300 330 60 44 A. D. 19 54 75 180 438 450 HEBREWS. The midwife who attended Tamar {Gen. xxxviii. 28) exercised a proper medico-legal discretion. Shiphrah and Puah consulted by the king of Egypt respecting infanticide, as a measure of state policy ( Exod . i. 15.) Moses issues several medico- legal ordinances for investigating questions of homicide, the nature of wounds, violation, virginity, personal disqualifications, &c. : in fact, the chapters in the Pen¬ tateuch, on these subjects, contain the first written rudiments of forensic medicine. GREEKS. Lycurgus ordains that the destruction of infants be regulated by certain persons, appointed to determine the question of weakliness or deformity. Pythagoras ; embryology — climacteric years. Democritus ; signs of defloration — signs of death. Hippocrates, in various parts of his writ¬ ings, touches on medico -legal subjects, parti¬ cularly on seven and eight months’ births, on superfetation, &c. Aristotle, in his Hist. Animal, (vii. 4, &e.) states the doctrine of uncertain length of ges¬ tation in the human female; signs of preg¬ nancy, &c. Theophrastus, on poisons: author of the cele¬ brated work on Characters. B. C. 680 451 (350) ROMANS. Numa ordains that the csesarean opera¬ tion be performed on women who have died pregnant of a living foetus. The lex talionis, one of the laws of the Twelve Tables, implies a certain kind of medical knowledge for its due adminis¬ tration. The jus honorarium gave a discretion¬ ary power ( medico-legal ?) of levying damages in proportion to the injury. Case of extensive poisoning by Roman matrons ; above 150 of them punished. Cicero {pro A. Cluentio, and ad Herenn .) alludes to the signs of poisoning commonly noticed on the dead body. Julius Ceesar assassinated; medico-legal opinion of Antistius, that one wound alone, of the three-and-twenty, was mortal. Germanicus dies, as it is supposed, from poison : the appearances about the body favour the popular supposition.— (Sueton. Calig. 1.) Agrippina, with Locusta’s assistance, procures several deaths by poison. — (Tacit. Ann.) Quintilian mentions the necessary proofs of poisoning {Declam, xv.) Pliny the elder, also, and Seneca, touch on the same subject. Galen — the first who wrote expressly on a medico-legal subject — on Feigned Diseases, and the means of detecting them. He also noticed the change produced in the fetal lungs at birth — the vitality of seven months’ and the mortality of eight months’ births— the signs of poisoning, and some circumstances connected with legitimacy. WESTERN EMPIRE. The Theodosian Code compiled : its en¬ actments remain in force for a time. FRANKS and VISIGOTHS. The Salic and Ripuarian laws (enacted between a.d. 422 and 490) contain several provisions, requiring medico-legal assist¬ ance for putting them in practice : thus, in cases of wounds, homicide, poisoning, and the like, punishment was inflicted, or pecuniary penalties assessed, according to EASTERN EMPIRE. Justinian’s great work, the Corpus Juris Civilis, completed. It contains many laws based on medical principles, some of them expressly “on the authority of Hippocrates.” The lex Aquilia, and lex Cornelia de sica- riis et venejxcis, also the principles laid down respecting retarded births and super- fetation, and more especially the enactment de ventre inspiciendo, et de custodiendo partu, require medical aid for their adminis¬ tration ; in the latter enactment, the presence of midwives is enjoined, if necessary. the amount of crime in the guilty party, which was ascertained in some instances by a sectio vulnerum. at Amalfi in the year 1 137 : upon this event, ; tance throughout Europe, and commentators The Corpus Juris , however, in the course of a few centuries, became obsolete, and had fallen into total oblivion in the West, when a copy of the Digest was accidentally found at once the Civil Law met with universal accep* gan to abound. INTRODUCTORY LECTURE 11 A. D. 790 GERMAN EMPIRE. Charlemagne, improving on the laws of the Franks, enacts his Capitularies, several of which virtually require the intervention of medical assessors. JURISDICTION of THE CHURCH. 1151 1209 The Decretals, or body of Canon Law, reduced to order by Gratian the Monk. They receive successive additions for some centuries. Among them are many enact¬ ments, in which the necessity of medico¬ legal interference is plainly implied. Innocent III. decrees that in a case of homicide by wounds, medical evidence, or, as it is expressed, judicium peritorum medicorum, shall be obtained, for the better administration of justice. A.D. 932 1036 1140 1206 ARABIANS. Rhases (Arrhasi) of Bagdad— the most original of the Arabian writers — treats of medical impostors, and the means of detect¬ ing them ; on poisons also. His chief work, Elchavi, or the Continent. Avicenna (Ebn Sina) ; the most famous of the physicians of the East, accounted ano¬ ther Galen, and celebrated for his sagacity. Avenzoar (Ebn Zohr) of Seville 3 touches on the subject of impotence, &c. Averrhoes (Ebn Itoschd) of Cordova. 1238 1315 1370 1492 1503 1502 1507 GERMANY and ITALY. The Emperor Frederic II. issues some ordinances of a medico-legal characters patronizes the schools of Italy 3 and sanctions the occasional practice of human anatomy. Mondini de Luzzi dissects publicly the bodies of two women at Bologna. This may be considered as the era of the commencement of practical forensic medicine. Mondini publishes a treatise on descriptive anatomy, illustrated with woodcuts. Baldus de Ubaldis, in his Commentary 011 the Pandects, points out the superiority of medical evidence. Medical men, he says, are no common witnesses— proprie-non sunt ttstes, sed estmagis judicium quam testimonium . — ( Digest . ii. Tit. 12.) Santes Ardoyni, and Cardinal PonzeUi, write on poisons : the work of the former is very complete for the time in which it was composed r the morbid appearances produced by poisons are said to be described in it from actual observation. Death of Pope Alexander VI. by poison 5 his son, Caesar Borgia, escapes. The Bishop of Wiirtzburg’s Ordinances. The Bishop of Bamberg’s Criminal Con¬ stitutions. Both these codes were revised, and incorporated in the Const. Crirn. Caro¬ lina, presently to be noticed. A.D. 1374 1418 FRANCE. The University of Montpellier procures leave to dissect human bodies, for instruction in anatomy. Valescus de Tharanta treats of poisons. 1533 1564 1594 1638 1663 1667 1677 1682 1691 1701 PERIOD II. In which Forensic Medicine becomes a distinct Profession, practised in several countries by a special order of Medical Men. From the year 1533 to the present time. GERMANY. The Emperor Charles V. promulgates the great Criminal Code of the Empire— the Constitutio Criminalis Carolina, — certain articles of which expressly enjoin the magistrates to call in medical persons to give their evidence touching questions at issue. Thus, Arts. 35 and 36 relate to con¬ cealed delivery and child-murder, and ordain that the evidence of midwives and physicians shall be procured in such cases ; Art. 147 is on wounds proving mortal, regarding which surgeons and other skilful persons are to decide whether death eusued in consequence of the injury 3 Art. 33 relates to assassination; Art.'Al restricts and regulates the sale of poisons 5 Art. 44 relates to witchcraft; Art. 59 provides a mitigation of the torture in the case of feeble persons 5 Art. 119, on the crime of violation 3 Art. 109, on magic 5 Art. 130, on poisoning, and its punishment; Art. 131, the question of live or still birth, with reference to concealed delivery ; Art. 133, on criminal abortion, making a distinction in the crime, according as the foetus is quick or not 5 Art. 135 relates to suicide, whether effected with design of escaping punishment, or in insanity 5 Art. 134, the responsibility of physicianskilling their patients ; Arts. 149 and 164 authorize medico¬ legal inspection of the dead body before burial, in cases of suspected homicide; and Arts. 179 and 219 point out how the proofs of unsound mind are to be ascertained in questionable cases. The chief parts of this celebrated Code have been adopted by most of the Continental states in reform¬ ing or revising their Statute-books. It now only remains to give a list of the principal persons who have distinguished themselves in connexion with Forensic Medicine. Wier ; witchcraft, hymen, &c. Libavius ; bleeding of the corpse in pre¬ sence of the murderer. Sebiz ; wounds, virginity. Bartholin ; observes the phenomenon of the lungs of the still-born sinking, while other lungs float in water. Swammerdam explains why this is so. Rayger proposes the hydrostatic test. Schreyer actually practises the test for judi¬ cial purposes. Zeller writes against the test; and some of the faculties declare against it, — some, however, for it. Ammann; Praxis vuln. lethal. I 1701 1704 1704 1706 1720 1722 1723 1725 1731 1733 1736 1746 1753 Valentin ; Pandectm medico-legales. Bohn; De officio me did, clin. et foretisis ; on wounds, the test of infanticide, &c. Becker 3 on death by drowning — sine pota aqua. Zittman ; Med. forensis, h. e. responsa , tyc, Schurig ; Spermatologia, Cynacol. S>-c. Teichmeyer; Instit. med. legalis vel for. Goelicke; Medicina forensis. Alberti; Systema jurisy. medicos. Richter 3 Digesta tried, s. decisiones. Troppaneger ; Decisiones med. for. Hoffman ; on poisons, wounds, &e. Eschenbach; Med. legalis brev. thesibus. Hebenstreit 3 Anthropologia forensis. 12 DR. CUMMIN ON FORENSIC MEDICINE. 1756 Boerner ; Instit. med. leg. 1804 1767 Faselius ; Elem. med. forens. 1808 1768 Kunnegiesser , Instit. med. leg. 1810 1775 Daniel (sen.) ; Sarnm. med. gutacht. 1812 1777 Ploucquet; Abhandl. ub.todesarten. Camper; on infanticide. 1813 1778 Baumer ; Med. forens. 1814 1780 Daniel (jun.) ; Comment .; 1784, Bibl. staats. 1816 1781 Plenk ; Elem. med. et. chip, forens. 1817 1782 Haller; Vorlesungen (posthumous.) 1819 1782- -4 Uden and Pyl; Magazin f. d.ger. aw. 1821 1785- -91 Schlegel ; Collectio opusnul. — 1793 Metzger ; Kurzgef. system ger. arzn. 1827 — Coder; An fangsgrunde d. staats . 1828 1795 Fahner ; Voltst’dnd. syst. d. ger. aw. 1831 1796 Muller; Entwurf d. ger. aw. 1833 1802 Schraud ; Elementa med. forens. 1835 " Roose ; Grundriss med. ger. vorlesungen. 1836 Schmidtmu.ler ; Handbuch d. staatsarzn. Knape and Hecker ; Krit-jahrb. d. stauts. Masius ; Lehrbuch d. ger. ak. Henke ; Lehrb. d. ger. med. ; 1816, Abhandl. Wildberg; Handbuch ; 1824, Lehrbuch. Bernt; Systemat. handb. d. ger. ak. Klose ; System, d. ger. physik. Sprengel ; /nstit. med. forens. Platner ; Quoestiones med. forens. Blende ; Ausfuhrliches Handb. d. ger . med. Meckel; Lehrb. d. ger -.med. Henke ; Zeitschrift fur. d. staats . Niemann ; Taschenbuch d. ger. aw. Klug; Auswahl med. ger. gutachten. Wildberg; Magazinf.d.ger.aw. _ Bischoff; Merkwurd . crim-rechts-f alle. Joerg; Faetuslunge in geborn. kinde. Schneider & Schurmayer ; Ann. d. ges. staats. FRANCE. 1582 Ambrose Par£ ; Rapports— impostors — poi- 1801 sons — wounds — suffocation, Ac. The 1805 earliest writer after the C. C. C. 1808 1589 Pigray ; saves fourteen persons who were 1813 condemned as witches. 1813 1598 Pineau ; signs of virginity. 1606 Henry IV. appoints one or two surgeon- 1819 jurists for every town in France. 1821 1611 Tagereau ; impotence. — 1651 Gendry ; Moyens de rapporter. — 1677 Actual congress abolished. 1823 i684 Blegny ; Doctrine des rapports. 1704 Devaux; V Art de faire Its rapports. 1824 1740 Bruhier ; V Incertitude des signes de la mort. 1829 1750 Petit ; retarded births, & c. 1830 1763 Louis ; hanging, drowning, signs of death, Ac. 1833 1789 Chaussier ; Observations chirurg. leg. 1834 1799 Fodere ; les Lois eclair ees. 1835 1801 Belloc ; Cours de mfd. legale. 1836 Mahon ; Mfdecine legale , et Pol. mfd. Vign6; la Medecine legale. [additions.) Marc ; Autopsie cadauerique (Rose, with Foder6 ; Traite de med. if gale. Ballard ; Principes de med. legale (Bletzger, with notes.) x Lecieux, Sec. (Chaussier,) Quatre theses. Biessy ; Manuel de med. legale. Briand ; Manuel de mfd. legale. Capuron ; Med. Ifg. des accouch. Orhla; Legons de med. leg. — Toxicol. &c. Esquirol ; strangulation, insanity, &c. Chaussier; Recueil de memoir es. f Leuret, Marc,&c. {Ann. d'hyg; etdemfd. leg.) Sedillot ; Manuel de med. leg. Velpeau; Embryologie. Trebuchet ; Jurispr. de la mfdecine. Brierre de Boismont; Manuel de med. leg. Devergie ; Med. leg. theoret. et pratique. ITALY 1597 Codronchi ; Methodus testificandi — feigned 1806 Sidoti ; Medicina forense. diseases, wounds, &c. 1811 Bene; Elementa medic. forens. 1602 Fortunato Fedeli; the first systematic writer 1818 Barzelotti ; Medicina legale. — De relationibus medicorum. 1819 Zacintho ; Rejlessioni med.-legale. 1616 Liceti ; on monsters, &c. 1822 Grottanelli ; Ricerche medico-J'orense. 1621 Zacchia; Qucestiones med. leg. : first complete 1832 Martini ; Elementa med. for . is c. edition in 1651 . 1761 Morgagni ; De sedib. et cans, morborum. 1780 Testa ; Della morte opparente. SPAIN. 1789 Caccia ; (Jsservaz. mcdico-legali. 1801 Tortosa ; Instituzioni di med. for. 1795 Vidal ; Cirurgia for. o arte do liacer relac. 1806 Celoni ; Chirurgia forense. 1796 Del Valle ; Cirurgia forense gen. y par tic. GREAT BRITAIN. 1650 Harvey; notices the effects of respiration 1805 on the colour of the lungs. 1815 1664 Charleton ; Disquisit. anatom, physicce ; 1816 death by lightning. 1817 1671 Coventry Act (22 Ch. II. c. 1.) 1821 1702 Mead ; Poisons. 1823 1735 Prosecutions for witchcraft abolished ( 9 1825 Geo. II. c. 5.) 1828 1776 Hunter, J. ; on death by drowning. 1829 1783 .Hunter, W. ; on signs of child-murder. 1830 1788 Farr; Elements med. jurisp. 1793 Baillle; Morbid anatomy. 1800 Johnston; Med. jurisp. on madness. 1831 1803 Ellenborough Act (43 Geo. III. c. 58.) 1832 1803 Percival ; Medical ethics. 1834 A Professorship of Bled. Jurisp. and Police instituted in the Univ. Edinb. 1836 Duncan, &c. ( Edinb . med. and surg. jourti.) Bartley; Treatise for. med. Male ; Epitome jurid. or for. med. Haslam ; Med. jurisp. of insanity. Gordon Smith; Principles forens. med. Paris and Fonblanque ; Med. jurisp. Beck ; Elem. med. jurisp. 1st Engl. edit. Lansdowne Act (9 Geo. IV. c. 31.) Forsyth ; Synopsis med. jurisp. Regulation for attendance of medico-legal lectures adopted by Soc. of Apoth. and Coll. Surg. Edinb. Amos; Lect. med. jurisp . (Med, Gaz.) Ryan; Manual med. jurisp. Chitty ; Treatise med. jurisp. Taylor; Elem. med. jurisp. MR. LLOYD ON THE TREATMENT OF NiEVI MATERNI. 13 OBSERVATIONS ON THB TREATMENT OF VASCULAR NiEVI MATERNI. By E. A. Lloyd, Assistant-Surgeon to St. Bartholomew’s Hospital, Surgeon to Christ’s Hospital, &c. The disease termed vascular naevus maternus is, I believe, as its name would imply, always a congenital affection : at all events, I never met with a mor¬ bid structure of precisely similar cha¬ racter, which had commenced after birth ; not that I know of any reason why such a case should not occur. Such naevi, however, at the time of birth, are almost uniformly of small size, — so small as in some instances nearly to escape detection ; and even at this period they are remarkable for their extreme vascularity ; in fact it is that chiefly which renders them distinguish¬ able. But those which at birth are mere specks, as it were, sometimes become in the course of a few weeks, or even days, of considerable bulk, so as to constitute a formidable disease. They are liable to extend in every direction ; and the larger the size they have acquired, the more are they likely to increase. I have many times seen them projecting as much on the inner as on the outer surface of the cheeks, lips, and eye-lids ; and in more instances than one I have observed the bones of the head and face implicated in the disease. They have also been met with occupying a large portion of a limb, and extending deeply between the muscles. Mr. Langstaff removed (after death) the leg of a child affected with disease of this kind : he afterwards injected it, and, on dissec¬ tion, found large portions of the dis¬ eased structure situated beneath the adipose membrane, and implicating in a greater or less degree the fascia and several of the muscles. A child about three months old, in the hospital, under Mr. Abernethy’s care, died from haemor¬ rhage arising from a large naevus in a state of ulceration, which occupied the front and a considerable portion of one side of the face, and which, at the pe¬ riod of birth, was very little larger than a pin’s head. It is therefore of great consequence to subject such cases to treatment at an early period ; and certainly not a mo¬ ment should be lost as soon as they are observed to be increasing. Moreover, as a surgical operation is generally re¬ quired for the cure of the disease, and as such operations, when performed on very young children, are always at¬ tended with more or less danger, it is important that in every case the opera¬ tion should be as simple arid little pain¬ ful as possible. In effecting the cure it is also desirable that means should be employed by which the least degree of deformity will be produced, and espe¬ cially if the head, face, neck, or arms, be the seat of the disease. To point out means by which these objects may be, in my opinion, most effectually attained, is the purpose of this communication. When any of the ordinary modes of treatment are employed for the removal of naevi of large size, very serious con¬ sequences sometimes ensue. If the dis¬ eased structure be excised, very profuse, and in some cases fatal, haemorrhage takes place. Mr. Lawrence states, in a fiaper published in the thirteenth vo- ume of the Transactions of the Royal Medical and Chirurgical Society, part ii., page 422 — “ The profuse bleeding at- tendent on the removal by the knife of even small naevi, is often alarming, and certainly dangerous, in the young pa¬ tients who are the most frequent sub¬ jects of the operation.” An infant who was born with a large naevus, which was excised by Mr. Wardrop, expired from the profuse bleeding which took place during the operation. Speaking of the destruction of naevi by caustic, Mr. Lawrence observes — “ It would probably be as dangerous as excision, though in a different way, in those of larger size.” A case in which caustic potash had been applied to one of these tumors, situated on the chest, ended fatally, under the observation of Baron Boyer. Wedelius mentions a case in which the naevus turned can¬ cerous on the application of “ aqua fortis*.” But I may add, that modern surgeons will not be deterred from em¬ ploying the remedy by any apprehen¬ sion that such an effect will be pro¬ duced. When naevi are treated by ligature, very alarming symptoms are liable to come on. Of this point, likewise, proof is to be found in Mr. Lawrence’s paper, referred to above. He states, in detail- * Vide Heister’s Surgery, vol. i., p. 344. 14 mr. Lloyd’s observations on the ing the particulars of a case treated in this manner, “ The infant seemed to suffer considerably when the ligatures were tied, the process being attended with considerable stretching and drag¬ ging of the surrounding skin, which was thrown into several large folds. For thirty-six hours the child was rest¬ less, crying almost incessantly, and oc¬ casionally convulsed.” In a case of th e same kind, which I had myself an opportunity of watching, exceedingly severe symptoms followed the operation, and continued for more than two days, so that the poor little sufferer’s life was despaired of. Mr. Langstaff also in¬ formed me, that in a case of large noevus treated by him in the same man¬ ner, such violent constitutional disturb¬ ance was excited, that the child’s life was for some time in the greatest dan¬ ger. I may also add, that the treatment by ligature, severe as it is, will not always, as will be seen by and by, prove successful as a remedy for naevi. The same, too, may be said of their treatment by excision. I have known them recur after having been excised by the most experienced operators. I witnessed a case of the kind in Mr. Abernethy’s practice. The nsevus was situated on the sternum, a situation most favourable for the operation. In fact, such is their nature, that whatever may be the operation performed, I be¬ lieve it will be invariably found, that if the smallest portion of the morbid struc¬ ture be left behind uninjured, it will act as a “ punctum saliens” (if I may use the expression), from which disease, perhaps more formidable than was ex¬ cised at first, will be reproduced. Another objection to all the modes of treatment adverted to above, is the un¬ sightly scar which is in all cases left be¬ hind. And this objection likewise ap¬ plies to the treatment of large ntevi, by vaccination, a plan of treatment free from danger, it is true, but which is also very likely to fail. With a view to obviate, as far as I was able, the inconveniences detailed above, I was induced to employ a mode of treatment, which, to me, was perfectly novel, as applied to ntevi. A few years ago I made a brief state¬ ment of my plan of treatment at one of the meetings of the “ London Medi¬ cal Society,” and it was subsequently noticed, though in a very imperfect manner, in some of the publications of the day. But it has been no where, as far as I have seen, accurately or com¬ pletely described ; and as I have subse¬ quently had repeated opportunities of employing* it, and with g'reat success, I feel it incumbent on me, without any further delay, to place the following succinct account of it before my profes¬ sional brethren. And it is the more necessary that T should do so, because, in a new edition of a surgical work since published, the plan is adverted to as possible to succeed, without (in ignorance no doubt) the slightest refer¬ ence to its author, or even the most dis • taut intimation that it had been ever attempted. The plan to which 1 allude, and to describe which it will be my principal object on this occasion, consists of the injection into the substance of ntevi of a stimulating, and, in some cases, almost an escharotic liquor. The success which occasionally attended the vaccination of such tumors had, I considered, esta¬ blished the principle that they might be cured by exciting in them inflammation, or that condition of a part, be it what it may, that sometimes leads to its absorption. To effect this end, I had tried various means ; but as they were not generally successful, it is not worth while to detail them here. The failures in such instances having arisen, as it appeared to me, from the means em¬ ployed not producing a sufficient degree of inflammation ; and having met with a very large pulsating neevus, so situated that it could not, without the utmost danger, be removed by the knife, by the ligature, or by caustic, I resolved to put to the test the plan adverted to above. I considered it a fair opportunity to adopt this mode of treating it, because in this case the morbid structure, of which by far the greater part was subcutane¬ ous, was soft and sponge-like — indeed so soft, that when pressed between the finger and thumb, the intervening sub¬ stance seemed to shrink away; but in an instant, the pressure being removed, it re- appeared of its former size, and as erectile as ever. The nsevus, which, as I stated, was of very large size, was situated on the left side of the face, ex¬ tending from the angle of the lip, w here it commenced, upwards to the temple, and transversely from the nose almost to the ear: moreover, portions of it occupied the eye-lids, projecting irregu- larly like varicose vessels, from their TREATMENT OF VASCULAR NAS VI MATERN'I, 15 inner surfaces, and its boundary was altogether very irregular. The whole thickness of the check was in some parts made up, as it were, of the nsevus, the dis¬ eased structure beingvisible, and project¬ ing as well on the inner as on the outer surface. It was, however, only at parti¬ cular points that the skin and inner membrane of the cheek participated in the disease, as over the greater portion of the tumor they were unchanged in struc¬ ture. But even where the skin and membrane of the mouth were unchang¬ ed, the purple colour of the subjacent disease was very visible. The nsevus, w hen first observed at the birth of the child, was not larger than the point of a quill. It began to enlarge very shortly after birth ; and at the time it was placed under treatment, it was increas¬ ing rapidly. The treatment of it was peculiarly difficult, in consequence of its great extent, and the irregularity of its boundary. The treatment consisted in injecting into the subcutaneous por¬ tions of the diseased mass a liquid com¬ posed of spt. eetheris nitrici and nitric acid ; and in applying to the more super¬ ficial portions, or to such portions of the skin as w ere in a morbid state, the con¬ centrated nitric acid. The injection did not enter very readily — by no means so readily as might have been expected, therefore much could not be accom¬ plished at once, arid the progress of cure was of necessity slow ; but by persever¬ ing in the same means, one portion after another of the disease was removed, till the g’reater part had entirely disappeared. At this period the child was taken ill with the measles, which unfortunately proved fatal to it. It may be said, therefore, that the case is not com¬ plete ; but it should be borne in mind that to the extent to which the remedy had been applied, it w7as successful, and thus its efficacy was established as far as it could be by a single instance. I had no opportunity of examining after death the parts that had been operated on. One of the next cases that I operated on, was in a patient of Mr. Austin, surgeon, of Red Lion-street, Clerken- well. The child was a few months old. The nsevus was situated on the fore¬ head, prominent, about the size of half a walnut, principally subcutaneous, and was increasing. I injected it five times. The liquid, which was the same as was employed in the former case, passed freely into its substance, and in about seven weeks time the cure was accom¬ plished. The effect of the injection was hardening of the part into which it entered, and as the hardness subsided the disease disappeared. Mr. Austin lately afforded me an opportunity of seeing the child, who is now about nine years old. The case is very satisfac¬ tory, the operation having’ been per¬ formed so long’ ago, and not a vestige of the disease remaining. That which was the cutaneous portion of the naevus is now7 quite white, and looks like a small cicatrix. Another case, which I also injected in the same manner successfully, was brought to me at my own house, by the late Mr. John Wood, wrbo had been house-surgeon to St. Bartholomew’s Hospital. The neevus was situated on the cheek, and it was one of the cases treated in the hospital by means of the needle and ligature, and had been con¬ sidered cured ; but unfortunately it reap¬ peared. By the same treatment, too, I suc¬ ceeded in curing one of the largest sub¬ cutaneous nsevi that I ever saw : it w as of the size of a very large orange, extending from above the angle of the jaw downwards, almost to the clavicle, and deeply into the substance , of the neck ; projecting also from the sur¬ rounding’ surface more than three inches. The mother lately said it w;as larger than the largest orange, and I believe she may be right. The skin covering it was for the most part healthy, except at its most promi¬ nent part, where it put on the usual deep red and vascular appearance of cutaneous nsevi. In texture it so much resembled a sponge, that when grasped in the hand it could be diminished to nearly half its size. The child resided a short distance out of town (Walworth) ; but I got it brought to the hospital on the operating day, when it was ex¬ amined by all the surgeons of the hos¬ pital who were present, and also by many visitors, who all agreed that they knew of no means by which the disease could be successfully treated. The ap¬ plication of caustic was quite out of the question ; and the same may be said of the ligature, and also of excision, as they could not possibly have succeeded, from the great magnitude of the disease and the depth to which it extended. The cure occupied about nine months, and the injection was at first sometimes 16 MR. LLOYD ON THE TREATMENT OF NA2VI MATERNI. thrown in twice a week, but generally only once, and occasionally not oftener than once a fortnight. T^o unpleasant symptom followed at any time. Sal volatile was the liquid generally in¬ jected, and sometimes in an undiluted state. At first the superincumbent skin did not contract so fast as the tumor became absorbed, so that it hung like a pouch partly emptied, pendulous on the side of the neck. The red part, or that portion of the skin which was implicated in the disease, entirely lost its apparent vascularity, became white and shrivelled, without any topical application being made to it, and assumed very much the character of an old cicatrix. The rest of the skin (that covering the great bulk of the tumor) was of natural co¬ lour and texture. I lately saw the child, who is nearly five years old : he was four months old at the time that the treatment was commenced. There is not a vestige of the disease remaining, and the skin is as closely adapted to the subjacent parts as on the opposite side of the neck. A very fine child, on whom I ope¬ rated in the same manner, for a very large naevus on the face, between three and four years ago, was lately brought to me by its mother, to show me how completely the disease had been cured. It was situated on the left side of the face, occupying the greater part of both the eyelids, a considerable portion of the cheek, and the whole of the cor¬ responding side, as well as the front, of the nose. When I first took the case in hand, the child was three months old, and a most disgusting object: it is now a very nice looking child, and it requires very close inspection to discover that the disease had ever existed. I have subsequently treated many other cases of naevi of various sizes, and in various situations, by injection, without the occurrence, in a single in¬ stance, of an untoward symptom, and generally with complete success. I have cured several situated on the head, three on one child, and some very large ones on the trunk and limbs; but as the preceding cases are sufficient to prove the efficacy of the plan, under different and very formidable circumstances, it would be unnecessarily occupying time to give others in detail : I shall therefore pro¬ ceed to describe more particularly the course I pursue in performing the ope¬ ration. I shall also point out, as clearly as I am able, the variations which it is necessary to make in the treatment of different cases, as that which is most applicable to one is not always equally so to others ; and I shall at the same time point out the great advantages which, in certain cases, I consider this plan of treatment pos¬ sesses over every other. I shall, more¬ over, subjoin a few general observations on the nature of nsevi, and on some other modes of treatment which I have found it advisable to employ, under particular circumstances and in particu¬ lar cases. For the injection of nsevi it is neces¬ sary to have a syringe with tubes of different dimensions, capable of being changed at pleasure. This is the case because nsevi are of different sizes : into those of larger size the injection enters more readily if projected in a larger stream ; in those whose size is smaller, it answers better for the stream to be in proportion small. The point of the tube should be introduced through an aperture in the skin, at some little dis¬ tance from the disease, as there is then greater facility in compressing the nse- vus, so as to prevent haemorrhage. It is easy to prevent a single drop of blood being lost; and after the injection has properly taken effect, it rarely happens that there remains any disposition to haemorrhage. Before injecting it the naevus should be compressed, so as to empty it of its blood, and the pressure should be kept up till the instant that the fluid is projected by the syringe. The fluid should be retained in the naevus for from five to ten minutes. This, of course, is easily effected by making pressure along the track w hich had been occupied by the tube of the syringe. It is not always equally easy to in¬ ject naevi, as they differ materially in their texture : some of them which are of a spongy structure, and of a mode¬ rate size, can be injected with facility and at once ; but this is seldom the case with larger ones. There are naevi so solid in their substance, that, whether they be large or small, it is exceedingdy difficult to inject them at all. Before it can be accomplished, it is requisite to puncture them in various directions ; but it should be done from a single point, so that the punctures shall pro¬ ceed like radii towards one-half of the MR. LLOYD ON TIIE TREATMENT OF NiEVI MATERNI. 17 circumference of a circle. It is likewise sometimes extremely difficult to excite in them the necessary degree of inflam¬ mation, — so difficult, that the operation is often obliged to be repeated several times, and this notwithstanding a very stimulating fluid has been employed. Moreover, a naevus may be too large, as in the cases I have adduced, to be treated all at once in the manner de¬ scribed above. If so, it must be divided into different sections, one, two, three, or more ; and each section must be made the subject of a separate operation. But to inject the whole of even the more spongy nsevi, if of moderate size, it is sometimes necessary to introduce the syringe at various points. When a naevus has been large, I have thrown the injection into three different parts on the same day ; but, generally, I only make one attempt on the first occasion. By operating on only one part at first, I ascertain with less chance of inconve¬ nience whether the liquor employed is too strong or too weak, and thus ob¬ tain information which enables me to proceed with more certainty in the sub¬ sequent steps of the operation. Until a person has practised the ope¬ ration a few times, it will be better that during the act of injection pressure should be made around the naevus, as otherwise the liquid will be liable to be forced into the contiguous cellular tis- sue, m which it would be pretty sure to excite inflammation, and consequent suppuration. For the purpose of mak¬ ing the pressure, the rim of the cover of a pasteboard or wooden pill-box, an¬ swers very well. The covers, as is well known, can be procured of almost any size ; and a notch can be easily cut in them for the admission of the point of the syringe. When a naevus is well injected it feels tense, and loses much of its spongy character; its colour likewise becomes changed, varying in some degree ac¬ cording’ to the nature of the fluid em¬ ployed. The change of colour is not always very considerable, as but little of the injection usually passes into the cutaneous portion of a naevus, although the subcutaneous part of it shall be readily and fully injected. The injec¬ tion is known to have taken effect by the tumor becoming incompressible, which in some cases it does in an hour or two, but in others a day or two will 4G1. — xix, sometimes previously elapse : after which it is rare for the disease to in¬ crease; but its subsequent absorption is sometimes very slow. I am not prepared at present to re¬ commend the exclusive employment of any one liquid as an injection for naevi. The spirit of nitric tether, with the ad¬ dition of a small proportion of strong nitric acid, I have used oftener than any mther ; about one part of the lat¬ ter to from ten to fifteen of the former. The spirit, ammonite aromaticus has been most efficient in some cases in which other liquids had failed. I have also employed successfully solutions of chloride of lime, of sulphate and acetate of zinc, of muriate of ammonia, of hy- driodate of potash, &c, 1 have never used wine for the purpose; but Mr. Stanley employed it in a naevus seated on the lip, and, as he informed me, with success. The.chief advantages of the plan of treatment which I have been recom¬ mending are, that it is applicable to neevi so large, and so situated, as to be wholly irremediable by any other means ; that it occasions no deformity (a point of some importance when the part affected is the head, face, neck, or arm of a female), the small mark re¬ maining where the syringe enters being at a subsequent period scarcely discerni¬ ble ; that it produces very little pain, much less than any of the other modes most relied on; and that there is no constitutional disturbance of any conse¬ quence resulting from it. I have stated, that from the effect which sometimes followed the vaccinat¬ ing of these tumors, I was led to adopt the practice of injecting them ; but I should also state, that having previ¬ ously investigated most attentively their nature and habits, if I may use the term, I had arrived at the conclusion that they were only to be cured by means which would effect the complete removal or annihilation of the morbid structure: and 1 may add, that, to be competent to determine what plan of treatment is most applicable to nsevi, it is indispensable to be acquainted, as far as possible, not only with their structure, to investigate which so much pains has been taken, but also more par¬ ticularly with the nature of the con¬ nexion that subsists between them and the surrounding parts. From in- C 18 MR. LLOYD ON THE TREATMENT OF NJ5VI MATERNI. attention in this respect, the most erroneous opinions have been enter¬ tained. Some surgeons still suppose (of which I have lately had evidence) that noevi consist of an enlarged artery, or vein ; and in accordance with this opinion is their practice : they endea¬ vour to compress the enlarged vessel, so as to prevent the transit of the blood through it, expecting by that means to remove the disease. For this purpose a ligature has been some¬ times put on what has been supposed to be the principal vessel supplying the morbid part; and 1 was shown, not long ag’o, an instrument which had been ingeniously enough constructed to effect the same end. I believe, however, it w ill be found, that, both in their pathology and treat¬ ment, such practitioners are g'reatly mistaken: indeed, I do not hesitate to say, that, as regards the more common forms of naevi materni, they certainly are in error. Their mistake, no doubt, arises from the success which has been known to attend a similar mode of prac¬ tice in true cases of “ aneurism by anastomosis a disease comparatively very rare. In the nsevi under consideration, there is a morbid structure to be got rid of ; a structure not dependent, for its nou¬ rishment and vitality, upon a single vessel, but capable at all times of de¬ riving sufficient blood for its subsis¬ tence, and also for its growth, from any of the vessels of the parts with which it is in immediate connexion. In Mr. Langstaff’s case, to which I have ad¬ verted, “ the naevus was principally supplied with blood from the muscular branches given off by the anterior tibial artery, which were greatly enlarged, and extremely numerous; it was also assisted by the external articular and the arteries given off by the popliteal, previous to its division into the three arteries of the leg.” I knew a case in which the diseased structure was nearly separated by incision from the sur¬ rounding’ parts, and a ligature applied to every vessel that bled, but without the least permanent change in the con¬ dition of the disease. Another case, too, w as treated on the same principle w'ith caustic; a deep slough having been formed all round the naevus, which w'as of very large size, so as almost completely to separate it from the body, and yet no good resulted ; for after the slough came awray, the parts re-united, and the disease remained as vascular and disposed to increase as ever. It follows, therefore, that it is no more reasonable to expect a naevus will be got rid of by merely obstructing the circula¬ tion through the principal vessel that supplies it, than w ould a fatty or any other tumor. To afford even a chance of success to any operation of the kind, the flow of blood to the contiguous parts must likewise be cut off, or at all events very much diminished. In fact, the only means that can be depended on, for the effectual removal of the morbid structure, are such as at once destroy its vitality, or such as, operating more gra¬ dually, occasion its absorption : and of all the means that have been recom¬ mended to effect its annihilation by the latter process, injection is, I believe, the most to be depended on. By that means a greater or lesser degree of in¬ flammation may be excited in it, the effect of which is to change its texture, converting what was a spongy into a solid substance. In this state its vascu¬ larity certainly becomes diminished ; but as its vitality remains, the cause of its subsequent absorption is not quite apparent. If, however, I might ven¬ ture an opinion, I would say that it is thus brought very much into the condi¬ tion of a foreig’n body, so that it be¬ comes an irritant to the surrounding parts, and, perhaps, in some deg’ree, to the general system ; the absorbents, con¬ sequently, are roused into action, by which, in a longer or shorter time, its removal is accomplished. Although my advocacy of injection is so decided, yet I wish to guard against its being supposed that I altogether re¬ pudiate all the other plans of treatment which have been recommended with the same object in view. I am well aw^are that there are many other means besides injection, by wdiich that change in the condition of the part conducive to absorption may sometimes be very satisfactorily brought about. The principal of them are the combined use of pressure and cold ; the insertion of the vaccine virus at different points of the skin covering’ the naevus: one or more setons made to pass directly through the morbid structure itself; and the repeated application of tarta- rized antimony, as well as of various MR. LLOYD ON THE TREATMENT OF NiEVI MATERNI. 19 other stimulating* substances, to the whole surface of the morbid growth. Acupuncturation has moreover been recommended by Dr. M. Hall, and also by Professor Lallemand, of Montpelier. 1 have several times attempted to cure the disease by this mode, but have never succeeded. For my own part, I must say 1 should have been surprised if there had been a different result ; be¬ cause I have seen noevi not only punc¬ tured in the manner recommended, but also a most stimulating fluid injected into the punctures, and yet a sufficient degree of inflammation not produced. This has been particularly the case in noevi of more solid texture. As, how¬ ever, the treatment has, in the able hands alluded to above, proved successful in a few cases, it may be considered right to give it a further trial : and the same may be said of all the measures just ad¬ verted to. There is likewise another plan, em¬ ployed, 1 believe, first by myself, by which I have succeeded in curing the disease; and as it operates principally by exciting the absorbents into action, 1 shall avail myself of this opportunity to describe it. In this plan, the advan¬ tages attending the use of pressure and of the seton are combined. By the means made use of, partial strangula¬ tion of the part is effected. Ligatures are passed through the substance of the tumor, by means of which, and pieces of bougie applied on each side, as in the quilled suture, the circulation of the part is placed under complete con¬ trol. In this manner, therefore, perfect strangulation of the part might be pro¬ duced, and its consequent death; but the object is to employ only such com¬ pression as will excite that degree of in¬ flammation in it which is required to oc¬ casion its absorption. The pressure can be increased or diminished with the greatest facility, according to circum¬ stances ; and even after having been remitted, or rather intermitted, for a few days, it can be again applied, if care be taken not prematurely to withdraw the ligatures. If no more pressure be employed than is really requisite, there will be very little pain occasioned by it ; but, on the contrary, if too much force be employed, suppuration will be pro¬ duced, and consequently there will be attendant a greater or less degree of pain and constitutional disturbance. I had recourse to this plan of treat¬ ment in a large neevus on the head of a child between three and four months old. The tumor projected full half an inch from the surface, and in its trans¬ verse diameter it measured nearly two inches. In twenty-four hours time the operation was followed by such inflam¬ mation and swelling, that it was neces¬ sary to loosen the ligatures. A slight degree of fever ensued ; a small collec¬ tion of pus also formed, which was dis¬ charged through a small opening in the centre of the tumor. After this every thing went on well, and the disease gradually disappeared. It w'as not ne¬ cessary to repeat the operation. I have not yet had sufficient experience on the subject to justify me in giving a decided opinion on it; but from what I have seen I am inclined to believe that it is a plan of treatment which will be found very efficient in a large proportion of the subcutaneous vascular noevi. I should consider it especially applicable to such as may be situated on the cheeks or lips, as well as to those cases in which the disease projects decidedly beyond the surrounding natural surface — to those cases, in fact, in which exci¬ sion, caustic, and the ligature, have been recommended as means by which the entire neevus and the superincum¬ bent skin should be completely de¬ stroyed. A great advantage of this plan of treatment is, that it cures the disease like injection, without occasioning any deformity : the large scar which remains after m,ost of the other modes of treat¬ ment being almost as great a blemish as the disease itself. It will also, I sus¬ pect, be found a much more efficacious mode of treatment than the seton, as usually employed. But in cutaneous nsevi — that is, in those which are seated principally in the skin, as well as in smaller ones of subcutaneous growth, the treatment by caustic is in many cases especially applicable. In the former I prefer the concentrated nitric acid as the remedy ; in the latter the potassa fusa. And if, in the use of these means, proper care and caution be observed, they will, I believe, never fail. Moreover, they would be applicable to the greater number of cases that occur, if employed at a sufficiently early pe¬ riod, inasmuch as, as has been stated before, a very large majority of noevi 20 FUNCTIONS OF THE MUSCLES AND NERVES OF THE EYE-BALL. are, at the time of birth, very small. I have, however, from the want of proper care and caution in the use of these means, seen much mischief ensue. I have observed the skin destroyed far beyond what was the intention of the operator; so that, after the cure of the disease, a cicatrix remained, so large as to constitute of itself a degree of de¬ formity greater almost than the original disease. It is hardly possible to keep an infant quiet while any thing is done to it which occasions pain. I therefore, be¬ fore making use of either the potash or acid, always apply a thick coat of seal¬ ing wax varnish to the parts surround¬ ing the ncevus. By this simple con¬ trivance I am able to confine the action of the caustic to the necessity of the case, and at the same time to operate with greater freedom. To some sur¬ geons who are not much in the habit of using the stronger caustics, it may ap¬ pear that I am recommending' an unne¬ cessary precaution ; but I feel pretty confident that if they make trials with and without it, they will readily admit the advantage of my plan. A singie application of the potash is sometimes sufficient, especially if it be used in the form of paste, as recommended by Mr. Abernethy for the making of issues; but it is g’enerally necessary to repeat the acid several times. I have found that it is generally better to prevent suppuration, if possible, in which case the destroyed part will be thrown off as a scab, and the consequent scar will be less. This can in most cases be accom¬ plished by keeping- the part exposed, and occasionally wetting it w ith a spi¬ rituous lotion, containing also mucilage of acacia and oxide of zinc. I have cured between tw-o and three dozen nsevi by these means ; but it would be unnecessarily occupying* the time of the reader to detail any of them, as it would be little more than repeating the description of the plan which I have been just giving. The caustic potash has been so strongly recommended by Mr. Wardrop, and the nitric acid has been so long em¬ ployed by different practitioners, that I claim no merit for adding- my testimony in their favour. My only object in no¬ ticing them has been to suggest a more judicious and a safer mode of using’ them, and to recommend their employ¬ ment at the first moment after birth that a nsevus is observed to be increasing'. I should have stated, that the cuta¬ neous portion of a rnevus will some¬ times, though rarely, remain after its subcutaneous parts have entirely disap¬ peared. In that case I apply to it con¬ centrated nitric acid, or the caustic potash, by which means every vestige of the disease is readily and easily re¬ moved : indeed, I believe whenever the cutaneous portion is large, this would be the better practice, as the skin which is the seat of a neevus not being of its natural texture, will never, of course, have quite its natural appearance : it will appear thinner than healthy skin, shrivelled, and more loosely attached. The scar left, too, after the healing of the wound occasioned by the caustic, if properly employed, is never so large as the original mark. Sept. 24, 1836. ON THE FUNCTIONS OF THE MUSCLES AND NERVES OF THE EYE BALL. To the Editor of the Medical Gazette. Sir, In the Medical Gazette of Septem¬ ber 24th, will be found a communication from my colleague, Mr. Walker, of Manchester, on the Functions of the Muscles and Nerves of the Eye-Ball ; in reference to which I have considered it my duty to trouble you with the fol¬ lowing remarks. A paper by Mr. Walker, containing similar views to those published in the Gazette, wras read at the last meeting of the British Association, held at Bristol. After Air. Walker had sent this paper to Bristol, he read a copy of it to me ; when I was much surprised to find that the explana¬ tion given by him of the functions of the muscles and nerves of the eye-ball vyas, with one exception — viz. the ac¬ tion of the superior oblique muscle — similar to my views on this subject, communicated to Mr. Walker some years since, contained in my Introduc¬ tory Lecture for 1834 (which Air. Walker had an opportunity of deli¬ berately perusing), and further ex¬ plained in a paper read by me to the Manchester Medical Society, Novem- ANALYSES AND NOTICES OF BOOKS. 21 ber 4 th, 18)5. To this may be added, that I had previously informed Mr. Walker that my views on this subject were sent for insertion in the last volume of the Transactions of the Provincial Medical and Surgical Association, but that, in consequence of being’ too late, the paper would not appear until the publication of the next volume. Whe¬ ther Mr. Walker has made sufficient acknowledgment in his paper, of the use he has made of the discoveries of another, can only be decided when an opportunity is afforded of comparing the papers ; but when the foregoing circumstances are considered, would it not have been more courteous in him to have reserved his observations until after the publication of his colleague’s remarks on the same subject? I am, sir, Yours respectful Ivy R. T. Hunt. Manchester, Sept. 20, 1836. ANALYSES and NOTICESof BOOKS. “ L’ Auteur se tue a allonger ce que le lecteur se tue a abreger.” — D’Alembert. De la Prostitution de la Ville de Paris , consideree sous le Rapport de VHy- (jiene publique , de la Morale , et de V Administration. Par A. J. B. Pa¬ rent- Duchatelet, Membre du Con- seil de Salubrite, Medecin de l’Ho- pital de la Pitie, &c. Deux Tomes. Bailliere. This is one of the most remarkable books we have met with of late. It abounds with information of a singular kind, interesting at once to the physio¬ logist, the moralist, and the medical statistician. The labour which it cost the author must have been immense: he was engaged upon it for several years, and after all, unfortunately, did not sur¬ vive to see it laid before the public. Parent- Duch atelet died in March last, at the comparatively early age of 45, exhausted by the toils of incessant re¬ search. As we intend to bring this work on more than one occasion before the reader, we shall limit ourselves for the present to a brief notice of its contents. The chapters of the first volume com¬ mence with generalities respecting the number of prostitutes in Paris, the parts of France from which they gene¬ rally come, the families they usually spring from, and the causes lead¬ ing to their ruin. The characteristic manners and habits of these unhappy females are then treated of : after which we have a sketch of their chief pecu- liarilies„ taken in a physiological point of view. The several arrangements of medical police and hygiene adopted with regard to the prostituees in Paris, are noticed at much length ; and we are next presented with such a picture of the mode in which the various maisons in that regularly- profligate capital are managed, as we might ex¬ pect from the author had he been assist¬ ed in his explorations by another Diable boiteux. An ample account is given in the second volume of the sanitory regula¬ tions observed with respect to (he JiUes publiques ; the hospitals for the treat¬ ment of syphilis are described ; and the houses of correction, with the several methods of punishment followed in each, are afterwards noticed. Certain details of a curious nature, but most important in relation to state-measures and admi¬ nistrative policy, form the conclusion of the work. The whole is said to be founded on documents the most authentic, procured, in fact, in the government offices of France; and no pains seem to have been spared by the author to supply, by actual observation and personal inquiry, all the knowledge which in that way could be obtained for the completion of his extraordinary undertaking. A very striking peculiarity of the work is the propriety and decency with which every question is discussed: we believe that notwithstanding- the deli- cate nature of very many of the subjects touched on, there is not the least impu¬ rity in the author’s mode of handling them ; his language, though free and unfettered, contains no expression cal¬ culated to give offence to modesty or good taste. Among the points noticed in the phy¬ siological portion of the work are, the embonpoint of most of the prostituees , the peculiar voice which many of them have, their infecundity, their stature, the prevailing colour of their 22 FACTS VERSUS FALLACIES. eyes and hair, &c. It might at first seem that it were impossible to avoid fanciful speculation in treating- of such matters, but, on turning- to the chapters referred to, we find that all rests on ob¬ servation and the official returns. MEDICAL GAZETTE. Saturday , October 1, 1836. ** Licet omnibus, licet etiam mihi, dignitatem Artis Mediate tueri ; potestas modo veniendi in publicum sit, dicendi periculum non recuso.” Cicbro. FACTS versus FALLACIES: BE TNG A FEW HINTS TO STUDENTS ON THE OPENING OF THE SESSION. Of all the qualities which the stu¬ dent needs to possess, who visits the metropolis with a view of pursuing- his professional education, there is none that he will find more requisite, even at the very first step, than caution. He should know that there are those abroad who lie in wait for his credulity, and that he must be particularly on his g-uard against volunteer g-uides. We feel obliged to give this hint, in limine , on observing the recent conduct of our dishonest contemporary — the Lancet. With this brief admonition to our young friends — to be cautious under whose guidance they place themselves — we dispense with giving further advice: in the remarks which follow, we appeal to their reason and understanding. There are two signs by which the dishonest proceedings of the party in question may be discovered and un¬ masked — first, the gross partiality with which he cries up a certain set of teachers ; and secondly, the falsehoods and lying statements with which he en¬ deavours to carry on his work of decep¬ tion. As to the first, it is so gross, that none but the most simple and inexpe¬ rienced can be deceived. The trick is perfectly well understood about town, and is only adapted to catch the novices who are very fresh and green from the country. To so shameless and brazen a pitch is the system now carried, that all the walls in the neighbourhood of London might as well be chalked with the emphatic puffing of — • Try Wakley’s Matchless. But the honour¬ able member for Finsbury has always some such respectable scheme on his hands, and is now only doing that for the Gower-street speculation which he lately used to do for that bantling of his in Lancaster Place. His Colle¬ gium Wakleyanum has been wholly exploded, or abandoned of late, to make way for his new favourites of “ Uni¬ versity College.’’ All this is so palpable and notorious, as not to require dwelling upon. But the systematic attempt of the Lancet to mis¬ lead the young men who arrive in Lon¬ don about this season, and to injure all the other medical schools of the metro¬ polis, to the teachers in which he is personally hostile, is so replete with falsehoods and wilful misrepresentation, as to require a special exposure. The last number of the journal just named contains what the Editor is pleased to call a “ resume of admonitory com¬ ments in referring to which he says — “ Neither there nor in this place, how¬ ever, shall we attempt to institute any comparison into the respective merits of the various establishments or teachers. The invidious nature of such an under¬ taking — the task which such an inves¬ tigation must impose — would require nerves of iron for its execution, with strict impartiality ; and, at last, great injustice might be done,” — et cetera , et cetera , et cetera. After this declaration of the under¬ taking being “invidious,” and of there being a risk of doing “ great injustice,” we felt confident that the “ comparison” FACTS VERSUS FALLACIES. 23 was to be made, and some mystification attempted : nor were we deceived ; for at page 19 the mask is thrown aside, and as pretty a specimen presented to ns of adulation of one party, and mis¬ representation of others, as any one could desire to see. The object is to represent the school of University College, Gower Street, as by far the cheapest in London ; and the mode of effecting this, is by taking the North London Hospital, and set¬ ting it in the foreground of the school to which it belongs. Now^ if all that a pupil bad to do in London were to at¬ tend an hospital, this would be very fair ; but as it happens that he has cer¬ tain lectures to attend also, it is quite clear that the only honest and rational method of calculating the comparative expenses of different schools, is to take the amount of fees for the lectures and hospital attendance together. If this be done, the account will stand very differently from that into a belief of which our dishonest contemporary en¬ deavours to betray the pupils. At once the simplest and most gene¬ rally applicable comparison between the different schools is, to ascertain for what sum at each the pupil may attend, during an unlimited period, all the lec¬ tures required by the College of Sur¬ geons and Society of Apothecaries. The calculation stands thus : — £ 5. Aldersgate School . 46 4 Webb Street . 52 10 Westminster School . 52 10 Middlesex Hospital ........ 53 H St. Thomas’s Hospital . 55 13 St. George’s Hospital . * 56 14 King’s College . 63 0 London Hospital . 63 0 St. Bartholomew’s Hospital • • 65 2 Guy’s Hospital . 66 3 University College . 74 10 [For farther details, see the table which follows the present article.] 1 his requires no comment : as regards lectures, the University College is the most expensive school in the metropolis, whether for the shortest attendance re¬ quired by the corporate bodies, or for an unlimited period ; for the latter, the dif¬ ference between it and some of the best private schools is nearly thirty pounds, while for the former it exceeds that sum. Now let us inquire into the facts con¬ nected with hospital attendance, and here we admit in limine , that a cer¬ tificate of having attended the medical and surgical practice at the “ North London” may be procured on terms— such as we trust will never be the case at any other hospital in the metropolis. Let us explain. When young gentlemen come to London they have enough to do, Hea¬ ven knows; one lecture following after another from morning to night in such rapid succession, as necessarily to leave but a very short space in the forenoon, during which even the most zealous can be in the wards of their hospital. Heretofore no pretence was ever made of attending both the medical and sur¬ gical practice at the same time ; and at the other hospitals the regulation of at¬ tending each separately still prevails. But the conductors of the North London Llospital do, what we cannot venture to designate as it deserves: they give certi¬ ficates of one year’s attendance on both the medical and surgical practice toge¬ ther ! at the expiration of twelve months after the payment of 21/. into the bands of their treasurer. Long may the North London Hospital stand alone in this respect, and may its conductors find consolation in the praises of the Lancet for this adoption of the “ certifi¬ cate system !” Considering the smallness of its size, and the necessarily very limited field of observation it affords, we have no doubt the North London is a very good hospi¬ tal ; but he who says “it stands for¬ ward from the rest in bold and brilliant relief,” knows nothing about the 24 FACTS VERSUS FALLACIES. others of which lie so confidently speaks ; for it so happens that he has been excluded from some, and has not the entree to any ; a circumstance which it is just possible may somewhat prejudice his opinion. By far the most common hospital at¬ tendance now adopted by pupils, is one year of the medical (which frees them for eighteen months), and one of the surgical practice— -this qualifying for their examinations. Assuming* the above as an average, we now return to our comparison of expenses. If the pupil takes his ticket at the North Lon¬ don Hospital, for themedical and surgical practice separately, the sum is 154 15s. each — making 31/. 10s. ; but we shall suppose that he takes out both at once, in such manner as to enable him to at¬ tend during tw'o successive years — and for this he pays 26/. os. The Lancet, for its own purposes, has chosen to institute an especial compa¬ rison between its favoured institution and three others — never mentioned with¬ out some misrepresentation — viz. St. Bar¬ tholomew’s, Guy’s, and St. George’s. We shall take the same, and in the same order. The paragraph is not very in¬ telligible — indeed, is scarcely English; but we shall quote it verbatim, to show the extent of the deception which it is attempted to practise : — “ But suppose we compare the 26/. 5s., charged at the North London Hospital, with the sums charged at the other hos¬ pitals for attendance to pupils who are not dressers. The charge, even then (the attendance, also, on the surgical practice being* limited to twelve months) will be more than 30/. higher at St. Bartholomew’s (for instance) and more than 24/. higher at Guy’s Hospital (as another instance), and more than 51/. higher at St. George’s, (perpetual there to both) than the charge at the North London Hospital.” Now, instead of following this calcu¬ lation, which we submit is nearly unin¬ telligible, we shall compare things w hich are similar, and which w ill afford useful information. We suppose that, as is usually done, the student wishes to attend the medical and surgical practice for the periods required by the College of Surgeons and Society of Apothecaries respectively — viz. eighteen months and one year. At St. Bartholomew' ’s a pupil may attend the medical practice for a year and a half, and the surgical prac¬ tice for ever, for 42/. But this sum, instead of being “ more than 30/.,” is only fifteen guineas above what he would pay at the North London hospital, containing only one-fourth the num¬ ber of beds. At Guy’s, the fee is within one shilling of being the same as at St. Bartholomew’s, wdiile the pupil has the advantage of attending also the surgical practice at St. Thomas’s. Come we now to St. George’s ; and here we particularly solicit the attention of the reader, because, when it is mentioned by our contemporary, a more impudent fabri¬ cation than usual is alw'ays sure to follow. It is intended to convey the idea, not only that St. George’s is enormously dearer than the North London, but that it is even more expensive than St. Bartho¬ lomew's or the Borough hospitals. Now the fact is, that a pupil may attend the surgical practice of St. George’s Hos¬ pital, for a year, for 21/., and the me¬ dical practice, during eighteen months, for 16/. 16s. ; or, if he take the medical ticket first , he may then attend the surgical practice for four guineas less; being, in all, 33/. 12s. But it would cost him 26/. 5s. at the North London hospi¬ tal ; so that the difference for the attend¬ ance required by the College of Surgeons and Society of Apothecaries, is only seven guineas ! ! ! — and setting aside the great disparity in the size of the hospitals, the St. George’s surgical pupil has the privilege included of acting as a dresser for three months. Ag’ain: taking* a general vie w of all the expenses, we find that the sum required FACTS VERSUS FALLACIES. 25 for attending' the lectures, and the hospital practice required by the College of Surgeons and the Society of Apothe¬ caries, at St. Bartholomew’s, amounts to 107/. 2s. ; at Guy’s, to 108/. 4s. ; at St. George’s, to 90/. 6s. ; at University College, to 100/. 15s. So that the whole expense at the magnificent establish¬ ment of Guy’s, and including the prac¬ tice of two great hospitals, exceeds the North London Hospital School, and its hundred beds, by only 71. 9s., and at St. Bartholomew’s, only by 6/. 7s., while at St. George’s Hospital the expense, in¬ stead of being greater, is less, by 10/. 9s. So much for the veracity and fair dealing of our advocate for Gower Street and its hospital. A word more, and we have done. If we turn for a moment from his exertions in favour of that establishment, to the men connected with it, or the man rather, who forms the special subject of his laudation, we must acknowledge at least the gratitude of the worthy editor, however we may wonder at his consistency and discrimi¬ nation. Mr. Liston, the present idol of Wakley’s attachment, is, we believe, the only person of any standing in the profession in London, who is desirous of the good opinion of the honourable member for Finsbury ; he has not been ashamed to be present at, and to take part in, meetings where Wakley has been prominent : hence, naturally, the reciprocal feeling on the part of the latter. The great attraction now at the North London Hospital is Mr. Liston : Mr. Liston is all in all, just as it used to be with Dr. Elliotson, who at present seems to be completely thrown over¬ board. Why is this? Not one little word even of passing courtesy is ex¬ pended on the Doctor, who could once boast the warmest support of the wor¬ thy Finsburian. How are we to account for this phenomenon ? Are we right in attributing it to the mortal hatred that subsists between Dr. Elliotson and the great surgeon of the North ? We doubt not we have hit the mark, as the partici¬ pation of feuds and fancies is one of the signs of firm and steady friendship: the idem velle and idem nolle is here com¬ plete ; and long may it subsist in its beautiful harmony and concord ! A word, however, on the consistency of the thing. Mr. Liston is held up as the model of surgeons — the greatest after Sir Astley Coop t, and so forth. How is this, when we have Mr. Law¬ rence still amongst us in all his pristine vigour and ability, who was once vest¬ ed with the championship by the same discriminating judg*e, nor was stript of it, that we are aware, for any deficiency or inferiority of skill? But Mr. Law¬ rence shook off the patronage of Wak¬ ley, and hence the rival that has been set beside his throne. But Mr. Wardrop, poor man ! what has he done to merit this unceremonious set down from the post of honour? Has he no means of intercepting the favours which are now so thickly bestowed on his brother surgeon ? Or are his inter¬ cepted favours exhausted, and his means of paying due homage to his patron extinct ? Whatever be the cause, it is clear that the once celebrated Mr. Wardrop is no longer a star in the ascendant, and that, though he would want some little support in resuming his difficult task of lecturing again in an obscure quarter, he can no longer reckon on more than a little “Flint praise” from his quondam panegyrist ! Be warned in time, all ye who aspire to the good opinion and the graces of our respectable contemporary. Let the things that have been be a warning to you ; and wait but a little, we advise you, to observe the career of the present protege of the North London Hospital. [Table, fyc. 26 0 AMOUNT OF FEES AT THE METROPOLITAN SCHOOLS. O o CO ' H o o Ol X o CO i-H — i rH l-H rH i-H •pnoj, T CO 03 03 03 03 QJ o •33J rn a a a a a a a a a uoiiBinoujBjy o a o a o a o a o a o G O a o a o a o a 01 •UOlltiUltUOU w B 10U 3 ABU 03 03 03 03 03 03 03 03 QJ QJ o P PJ a a a a a fl a r-H Ol|A\ 0SOl[^ 110 o o o o c o o o o O saSuiuao jad a a a a a a a a a a H ^Btioiiippv cn CO X H H H - Hi H H O •oupip 1 -aj\I oisuaaoj L. 3 H CO H H H ** H H H H CC H CO H H H H H H X O •iuujog; ►4^ H X H H H TF X X CO *0 X tO O o 'AiajtMpiw L. 5 X •o *o X *o X to O •B3ip CO T^l H X *o H X X H X o •31 BU3|BJ\[ L. 4 X h •rr X X H X Tji 03 co CO X X X X cc o 00 X X o •Xajsiuiaqo rH ►4^ X X X X 00 o CC X X o pH rH CO to *o X to *o to X *o to o •iUaS.ins »o X *o *o to X *o t' »o X CO CO X X X X X X l> i- X o •auioipaxvr 3*'° X X X X X X r- X X . ‘O e 3 fed w (h 03 -a < 03 03 (-> -M XI X 03 O O CS • i-H Ch co O a x 03 cn 03 X • r— ' P=H CD *CD C3 £ c X H m e3 • rH X co O a co *03 fed Ih O 03 o co 03 bo 03 o O fed a • r—* a c3 *£< CD c a a o -d a o H ks +-« • rH Oh cn O a CO % 03 a o X CO a CO g3 H-> * rH X CO C a ^CD 6 03 fad *o O CO S-i 03 > a o rd a o bo a 3 c3 S a 03 .10 O 3 a 3.2 P HH> *3 U 03 3 Q o o « ■h a 2 ~ C c0 O „ •a a <0 3 feiS 0) -* £•2 a o> cd 6 K Ol •* a) 0) 7; C3 O ^ *5 N S3 * O H a a o o CJ T3 S O o ^ >- aT o -Z ^ a H bn p, co Qj H S3 S3 o w a 3 3 03 H 2| O) o A o CO CO 5 V H ^ OJ *_> o o ^2 X o> o» CD £ H> C <3 6 • o> W ££ O CO o CD G« Sj O h r-< a> A * ON THE PRESENT STATE OF IRISH MEDICAL CHARITIES, 27 REMARKS ON THE PRESENT STATE OF IRISH MEDICAL CHARITIES. To the Editor of the Medical Gazette. Sir, The late Report of Dr. Borrett on the state of the medical charities of Ireland, published in the pages of your valued journal, must be viewed by English prac¬ titioners with surprise and astonishment. The existence of such a state of medical affairs has now been incontrovertibly esta¬ blished, and with a greater degree of weight and confidence than could be at¬ tached to the report of any local practi¬ tioner, the value of which, as prefatory to a more extensive investigation of the sub¬ ject, is too obvious to require my dwelling on. Abuses the most extensive, negli¬ gence the most culpable, have been clearly proved ; and I trust on a more general re¬ view of the subject, to a portion of which it is possible Dr. Borrett’s ambulatory commission did not extend, to demonstrate as clearly, that professional treatment, in¬ ferior to that of the darkest ages, or medico chirurgery in its earliest infancy ever produced, is daily practised at our dispensaries, an epitome of wrhieh I think indispensably necessary to a just appre¬ ciation of, and a more intimate acquaint¬ ance with, the inutility and really injuri¬ ous operation of those charities, although apprehensive, in this age of professional attainment, it might be viewed as the creation of fancy. If an opinion relative to the civilization of Ireland, and its degraded position in the scale of social existence (as advanced in a learned editorial article in a late number of the Medical Gazette), is to be based on the state of her medical charities, the estimate, without any great stretch of pri¬ vilege, must be extended to parties who, as members of an enlightened, a learned profession, support but indifferently enough its character for respectability or learning; for, after a most extensive and intimate survey of the state of our dis¬ pensaries, I am firmly convinced their de¬ based state cannot be attributed to the condition of the applicants, or solely to the careless indifference of the managers, but is to be chiefly imputed to the physi¬ cians and surgeons of those establish¬ ments, who could in a very considerable degree, if not altogether, counteract the negligence and supineness of the moral governors, were they to rouse themselves from that state of apathy and indifference to the comforts and healthful existence of the people committed to their charge, that so suddenly and incorrigibly usurps the place of an ephemeral zeal, w hich scarcely forced them through a hurried and imper¬ fect education. Were they lovers or cul¬ tivators of science, and acquainted with medicine and surgery in their present ad¬ vanced state, they could never hope to combat disease without the aid of those valuable medicines whose character prac¬ tical experience haslong since established, or those active remedies which modern discoveries have placed at our disposal. But slaves to a wretched empiricism, and prepossessed with a fatal but convenient faith in the powers of a single medicine, or twro at most, being sufficient for the radical cure of every disease, they slumber iD unlettered ease, satisfied with, nay, con¬ ceiving more than sufficient, that know¬ ledge hastily acquired during a few win¬ ter seasons of metropolitan residence. This is sufficiently evident from the paucity, the unvariedness, and vile description of the medicines usually found in those hovels, which are so badly calculated to afford relief to the unfortunate applicants; some of whom, being a certain description, of farmers recommended by their landlords, or any other subscriber, are not altogether uneducated, who, to a person familiar or intimately acquainted with their habits, manners, and dispositions, which cannot be acquired without a residence amongst them, appear shrewd, intelligent, and dis¬ criminating, appearing quite as conver¬ sant with ordinary acquirements and newspaper intelligence as their superiors* This description equally applies to the tradespeople, and extends, with some limi¬ tation, even to day-labourers, all of whom occasionally become the subjects of dis¬ pensary relief, are living on terms of most intimate intercourse and familiarity, dis¬ cussing medical affairs when grouped around their firesides as freely as politics, drawing their conclusions after their own peculiar fashion, but, of a truth, seldom erroneously ; canvassing the merits and demerits of the dispensary doctor and his practice with as great a degree of freedom and warmth as those of the Prime Mini¬ ster, and, if w'orthy of such feeling, be¬ stowing on him all that sincere and ar¬ dent affection so characteristic of the Irish¬ man. When illness invades the habitation of one of those people, or the member of a family becomes the subject of accidental and severe injury, recourse is immediately had to his own resources or those of his friends, and a variety of domestic reme¬ dies indigenous to the country, or pro- 28 ON THE PRESENT STATE OF IRISH MEDICAL CHARITIES. cured at a sufficiently low rate from tlie shop of an apothecary in some neighbour¬ ing town — medicines usually had recourse to on the invasion of every disease — are freely administered, as it may suit the wish of the sufferer, or accord with the views of some old crone pretending to su¬ perior and mysterious skill in those mat¬ ters, but, as often happens, without suc¬ cess. Long-continued disease, and conse¬ quent loss of employment, involve the unhappy sufferer, and perhaps a numerous family, in unparalleled and hopeless desti¬ tution. Now the victim of despair, appli¬ cation is made to the local dispensary; but what relief can be afforded from its resources ? None. The patient submits to a repetition of drenching with a farrago of rotten trash, remedies superior to which he has already used, and places reliance on advice equally rotten, musty, and inef¬ fectual-advice emanating from the head of some Esculapius, whose intellect, from a long oblivion of medico- chirurgical mat¬ ters, and a diligent pursuit of other ob¬ jects, has been rendered rusty and thread¬ bare. Professional incapacity, as usual, ends in failure of success; and this so very frequently occurring, begets a distrust and want of confidence on the part of the ap¬ plicants in our dispensaries, which fully accounts for the infrequency of attendance on advertised days, mentioned in Dr. Borrett’s report. Numbers of those fan¬ cied incurables might be daily seen mi¬ grating to the habitations of other distant practitioners, whose more successful prac¬ tice and superior attainments have esta¬ blished for them a respectable reputation, most of those invalids returning restored to health, and rendered useful members, if not to society at large, at least to their own immediate friends. I have known numerous instances where those people walked one hundred miles for relief, and successfully, submitting to ope¬ rations with a heroism instigated alone through a determination to rid themselves of disease at all hazards— diseases not comprehended, and operations wdiich could not be performed, at the district dispen¬ sary. Even while the writer was penning this article, a young man wras brought to him from a distance of thirty miles with fracture of the humerus, extending into the elbow-joint, passing during his jour¬ ney through a country containing six dis¬ pensaries; and W'hen inquiry was insti¬ tuted of his father w-hy he did not seek assistance at one of those institutions, he unhesitatingly declared he considered the injury of too serious a nature to commit to the management of a dispensary doctor. Such are the impressions on the minds of the people, such their faith in the relief and assistance afforded at our medical charities, where they witness disease, ex¬ cept of the most ordinary nature, allowed to commit unrestrained its destructive ra¬ vages ; indeed, with such evidences before them, any other feeling would pourtray an obtuseness of intellect which does not form a feature in our national character. What more successful result could be an¬ ticipated, when the medical attendant, viewing his dispensary appointment as a snug sinecure, an unalienable property, spends his days without restraint, indulg¬ ing in the allurements of the Irish chase; and a prince of good fellow's, devoting his nights to potations of the native, enliven¬ ing the festive board, or delighting the members of a union hunt with the variety and melody of his songs, and shallowmess of his wit; loudly expatiating on the pro¬ perties of the Irish fox hound, depicting the beauties of a previous chase, and de¬ scribing the various incidents of superior jockey ism and hairbreadth escapes during their last run, from the moment reynard first breaks cover, to the death, with a de¬ light and vividness of description, that proves this to be his dearest, his all-absorb¬ ing study. A devotion to such pursuits must alien¬ ate their minds from a close attention to the arduous duties of a profession; and the more usual result is, for those gentle¬ men still holding their dispensary appoint¬ ments, to settle themselves in life as farmers — to be seen from morning to night directing the movements of the plough, or as amateur cattle feeders, horse jobbers, and road makers, to be seen at every coun¬ try fair anxiously learning the prices of swine and black cattle, attending with punctuality every turnpike meeting, and, with an ill timed zeal, aping the ostensi¬ ble public character at the sacrifice of the professional, to the no small amusement of the country gentry, w'ho are unavoida¬ bly driven to the conclusion that his skill and taste lie more in the Macadamizing some public highw'ay than in the practice of medicine. To dw'ell much longer on this subject, would be, 1 fear, to trespass on your indul¬ gence, and the patience of your readers, the field for investigation being a most ex¬ tensive one: wrere I to treat of the manage¬ ment, or rather mismanagement, of every local dispensary, it would afford matter for a report too voluminous, as a single article, for the pages of your very valuable journal. And as the medical management of the Infirmaries of Cork has received a well-merited eulogium in the report of Dr. Borrett, to which the writer can bear ample testimony, the medical officers of those establishments being gentlemen of ON THE PRESENT STATE OF IRISH MEDICAL CHARITIES 29 respectability and acquirements, leaving them and the charities whose destinies they wield, to enjoy the honuors of a well- earned and richly-merited reputation, I shall, for the present, as a melancholy contrast, direct your attention to the abject state of an unfortunate and fallen brother, as a view of its medical operations will elucidate what must be the state of those charities in more retired districts, and ena¬ ble your readers to appreciate the subject with greater clearness and justice. I am now about to bring under review an hos¬ pital (not a county hospital) combining in one establishment a dispensary, fever hos¬ pital, with a wing of the building set apart more especially for surgical cases, altogether well calculated, from its archi¬ tectural arrangements, to meet the object for which it was destined, and, under better auspices, might be rendered a valua¬ ble establishment, spreading its sanative influence over a wide extent of country, and conferring blessings which would prove incalculable; but withering under the deleterious influence of a blind and besotted party spirit, which, ever reckless of evil consequences when goaded by the ungenerous desire of supporting some favoured object, in open violation of the claims, the calls of humanity, in this instance, benumbs the feelings of all parties to the sacred duty imposed on them, of rendering the hospital committed to their trust extensively useful to the suffering applicants, and causes them to rest satisfied that every thing connected with the establishment should savour of indolent inactivity, and to permit those funds committed to their charge— funds more than sufficient to meet every exigency, and for one of the most sacred purposes — to be frittered away without credit to the establishment, or benefit to the public. The financial arrangements of such an hospital are much to be deprecated; but when, to perfect the picture of ruin, pro¬ fessional incapacity must be added, an ac¬ cumulation of evil is heterogeneously amassed, the extensively felt, and destruc¬ tive effects of which, must be apparent to every individual. Here all is empty parade, and within its walls the usual em¬ pirical routine of treatment is adopted, in short, being a soil congenial to the growth of the principle of infallibility: in one or two remedies, every disease incident to human nature is encountered with the same all-powerful drench, quantities of which, from an old crock, are daily ladled out to the various applicants, with bowels already too much relaxed from a diet of potatoes, sour milk, and salt fish, or from a too free use of some domestic purge, previous to application : is it to be won¬ dered that patients indiscriminately sub¬ jected to such a regimen, without any ap¬ preciable benefit, should fly from the dia¬ bolical mixture, as they call it, to seek that relief from the house of some private practitioner, which the believer in one universal remedy was unable to afford? The natural result is a disinclination on the part of the people, except in cases of the most urgent and extreme necessity, to apply for relief, or enter the wrards of such an hospital; and when unavoidably forced to become interns, a want of confidence and distrust on the part of the patients in the medical attendant exists, but little calculated to afford relief to one party, or satisfaction to the other, every circumstance concurring most effectually to frustrate the benevolent intentions of the charity. The medical treatment of this hospital must be too apparent, from the general tenor of this paper. Of its surgical ar¬ rangements I sha.ll give but a brief sketch, in which I have to present the subjects of simple fracture of the middle third of the thigh, as recovering with considerable shortening and a bowed state of the limb, causing a deformity which renders the un- happy sufferer ever aftemards a cripple; fracture of the fibula, recovering with a lameness, and evil consequences resulting from the maltreatment of such an accident ; fracture of the clavicle, treated with a pad placed on the jn’ominent end of the frac¬ tured bone, and the other arrangements quite in keeping with such erroneous view's; dislocation of the lower head of the tibia forward, undetected, or at least no attempt made at reduction, and the injury left to the unaided operations of nature ; disease of the eye, very preva¬ lent amongst the poor, totally neglected and misunderstood, left to run its fearful course unchecked, and to terminate with most melancholy and wretched results; the operations of surgery never performed, and those whose diseases require operation left to pine in suffering or seek assistance as chance might direct, or the reports of some distant and more gifted practitioner might attract them. Such is an epitome of the practice of an hospital in the South-West of Ireland; and blush, oh, ye monopo¬ lizing guardians of Irish surgery, who up¬ hold the principle that all appointments of trust and consideration are to be com¬ mitted to your safe keeping, to the exclu¬ sion of all other surgeons, that such prac¬ tice could emanate from one of your boast¬ ed Licentiates ; and turn with disgust from the page, as I do from the subject, that in this age of professional advance¬ ment such practice could emanate from the veriest tyro. During this posture of affairs, I fear the endeavour to reform the Irish medical charities will prove a Her¬ culean labour, However, as the spirit of 30 THE MEETING AT CAMBERWELL. reform is beginning- to dawn on us, we anxiously look forward to the result of the late investigations as leading- to that reform wrhich is so imperatively called for; some such measure having been long and severely felt as indispensable to the establishing our Irish Dispensaries on a more respect¬ able and useful footing. Hibernus.* Co. Cork, Sept. 19, 1836. ORIGIN OF THE LATE CAMBER¬ WELL MEETING. LETTER FROM MR. CRISP. To the Editor of the Medical Gazette . Sir, For many reasons I feel reluctant to enter into a correspondence with Mr. J. F. Hulbert ; but I am compelled to reply to the misstatements contained in his letter, published in your last number, and I cannot better refute his assertions and insinua¬ tions than by giving a brief account of the origin of the meeting which took place at Camberwell ; and it is as follows : — The Poor-Law Commissioners recom¬ mended the Governors and Guardians of the poor of Camberwell (Peckham and Dulwich are both in this parish) to abo¬ lish the parochial surgeons, and form a medical club in their stead. The said Governors and Guardians (without first consulting the medical men) framed a set of rules, and sent them to all the practi¬ tioners in the parish. In this prospectus it is stated, “ that the poor will have the satisfaction of feeling that they will no longer be supported by charity [a blank space is left for donations and subscrip¬ tions], either in sickness or in health, and they will then become independent. All domestic servants whose wages do not exceed 121. are to be physicked for 4s. per annum. A mechanic receiving 35s. per week, to payjtor himself and wife, 5s. yearly. A single man, earning 25s. per week, 4s. &c. &c. &c. The medical attendant to find medicines. No person whose wages exceed the above shall become a member, except consent in writing be expressly given by the managing Committee.” [This Committee is composed solely of eight clergymen.] A few gentlemen, the greater number of whom, I have since learnt, acted without at all considering the matter, sent in their names as supporters of the scheme (con¬ ditionally, however). The Governors and Guardians next in¬ * We have altered the signature for a reason which our correspondent will understand.— E. G. vited the medical practitioners of the dis¬ trict to meet them at the Poor Plouse (September 7th) ; but the former, thinking that the affair principally concerned them¬ selves, retired into an adjoining room, and, after discussing the subject, it was agreed that the meeting should be ad¬ journed till the following Tuesday, when the medical men residing in the Camber¬ well district and its neighbourhood should be invited ; and a note to this effect was given, by Mr. Bristowe, the chairman, to Mr. Manico, the secretary : but, bv some unaccountable accident, the word neighbour¬ hood was omitted. Before these circulars were sent out, I had been invited ; and as I heard that it was the wish of all present at the late meeting that the practitioners in the neighbourhood should attend, I men¬ tioned the circumstance to a few friends, and also to Mr. Waterworth (who, on a late occasion, took the chair at Mr. Hul- bert’s house), whom I knew to be favour¬ able to the plan, and requested him to make it known to the gentlemen whose opinions coincided with his own. And now, sir, on referring to the list, it will be found that twenty one of the gen¬ tlemen are residing in the Camberwell district ; and I may add that all the dissentients spoke on the occasion alluded to, but only seven of the majority expressed their opinions : it is true that the former said but little, but I presume that they brought forward every argument they could adduce in support of their cause. I have, sir, in conclusion, to complain of Mr. Plulbert’s somewhat invidious mode of writing. I wish he would be personal enough to state names, and I dare assert that the gentlemen who descended to per¬ sonalities are prepared to justify them¬ selves for so doing, and to prove the cor¬ rectness of every statement they made. I am, sir, Yours respectfully, E. Crisp. Walworth, Sept. 27, 1836. ( Prospectus .) CAMBERWELL INDEPENDENT MEDICAL CLUB. STEWARDS. The Rev. John George Storie, Vicar of the parish; Rev. H. Melvill ; Rev. II. W. C. Hyde; Rev. S. Smith; Rev. E. Lilley; Rev. M. Anderson; J. T. Allen, Esq.; I/. B. Allen, Esq.; C. Baldwin, Esq.; Mr. S. Beale; J. Brett, Esq.; T. B. Bur- bidge, Esq.; J. Capes, Esq.; Mr. J. Deacon; C. Dodd, Esq.; R. A. Gray, Esq.; C. Harden, Esq.; R. Hieliens, Esq.; W. Hichens, Esq.; Mr. G. Marshall; A. Nairne, Esq. ; J. Pew, Esq., R. Pope, THE MEETING AT CAMBERWELL 31 Esq.; S. Pope, Esq.; E. Puckle, Esq.; S. Richardson, Esq.; R. Thomas, Esq.; J. Williamson, Esq. Treasurer, . — Honorary Secre¬ tary, ' . — Collector, Mr. T, Prebble, 13, Southampton street. The attention of the working and labour¬ ing classes is called to the formation of a medical club in this parish — the objects of which are, that all the poor families may have medical and surgical attendance and medicine during sickness, without recourse to parochial aid. The poorer classes, who are invited to belong to this club, will have the satisfaction of feeling that they will be no longer supported by charity , either in sickness or health, and will then become independent. It is intended to discontinue the attend¬ ance of the present parochial medical officers, as regards the parish engagement, and no medical relief after 25th March next will be afforded out of the workhouse ; it is therefore deemed advisable to form the club immediately, that it may come into full operation at Lady-day next. The principle upon which the club is founded, is, that all the labourers should belong to it, and each will have annually to subscribe accord¬ ing to family, as under mentioned— the payments to be made half-yearly. The following medical gentlemen have consented to attend the members and their families when ill, viz. : — - * * *. The inhabitants generally are reminded that the formation of this club will save the parish several hundred pounds per annum, besides having the effect of restor¬ ing to the English peasantry a feeling of independence, and creating a proper dread and di like, as well of a parish workhouse, as parochial relief. RULES OF THE CLUB. I. The members shall consist of la¬ bourers and servants in agriculture, or in handicrafts and trades, both male and female, strictly belonging to the working classes. But no domestic servant receiv¬ ing more than twelve pounds annual wages, nor any artizan, handicraftsman, or other workman, receiving more than one pound five shillings per week wages, or whose earnings, together with those of his chil¬ dren under sixteen years of age, exceed thiny-five shillings per week, shall be per¬ mitted to be a member of this club, except consent in writing shall be expressly given by the stewards. II. Each member, on admission, shall pay six months’ subscription in advance, and shall then be entitled to the benefit of the club ; and the same amount shall be paid half-yearly in advance, at Lady-day and Michaelmas; and the accounts of the club shall be annually balanced at Christ¬ mas. III. Members may be admitted at any time, on paying the full subscription for the current six months in advance: the next payment becoming due at the ensuing Lady- day or Michaelmas, as the case may be. IV. Every individual without a child, shall pay annually, 4s. ; eveiy widow or widower with one child, 5s. ; every man and wife, 5s.; every man and wife with one child, 6s.; every man and wife with three children, 8s.; every man and wife with four children, 9s.; every man and wife with five children, 10s.; and be en¬ titled to receive all requisite advice and medicine from such one of the medical attendants as the member may select. V. The children of members above sixr teen years of age (unless they be idiots or helpless cripples) shall not be included in the subscription of the family, but must pay for themselves as independent members. VT. The wife of a member may be at¬ tended during her confinement, on paying to the Collector of the Club ten shillings one month before the time at which she expects to be confined ; and may select her own medical attendant from the gen¬ tlemen before named. VII. A man and his wife may be per¬ mitted to subscribe for themselves alone, but not for their children alone, nor for any child separately ; if they subscribe for any one child under sixteen years of age, they shall subscribe for all their children under sixteen who may reside under their roof, according to Rule IV. VIII. Any member may be permitted to subscribe for bis aged and infirm parent or parents (if unable to support themselves, and residing with their son’s or daughter’s family) on the terms prescribed for a man and his wife and children under sixteen; that is, counting the parents as children. IX. No candidate who is actually ill, or any one of whose family is ill at the time of his or her application, shall be admitted a member, unless he or she pro¬ cure two healthy persons to enter at the same time, each paying the current half year’s subscription in advance; or unless he or she pay such admission fee as the medical attendant shall deem an adequate consideration for the attendance and me¬ dicine which such candidate, or any part of his or her family, may require in his, her, or their then illness. After admission on such terms, the annual payments shall be the same as those required for other members of the Club. X. Each member shall on entrance, and also at the time of paying his subscription, name the medical gentleman by whom he 32 BILLS OF MORTALITY.™ METEOROLOGICAL JOURNAL. wishes to be attended for the ensuing half year, and no member shall be at liberty to change his medical attendant, except at such time. XL Sick members shall furnish their own bottles and bandage's ; and when able shall attend on the medical man, who will visit them at their own houses when they are unable so to attend. XII. Habitual drunkards, and persons notoriously addicted to profligate habits, or who are knowm to be idle and disorder¬ ly, and individuals convicted of felony, shall not be admitted members of the Club, or if admitted, shall not be allowed to continue members. XIII. Every dispute or disagreement wrhich may arise shall be referred for arbi¬ tration to the stewards, and their decision thereon shall be final. XIV. The name, age, and residence of each member, shall, on admission, be entered in a book by the collector, with the name of the medical attendant whom the member may then select, and this re¬ gistration shall be renewed every six months, when the member pays his sub¬ scription. XV. All subscriptions shall be paid to the collector on the days named in Rule II.; and if any member shall fail to pay his or her subscription for the space of one fortnight after cither of such days, he or she shall ceace to be a member; and no mem¬ ber w^hose subscription is in arrear shall be entitled to receive medical aid from the Club. Any person thus disqualified, may, at the discretion of the stewards, be permitted to renewr his subscription, and to become a member, on payment of a fine of one shilling, and conforming to the Rules II. and III. XVI. The subscriptions of members shall be paid over by the collector to the treasurer as they are received, and the stewards will settle with the medical gen¬ tleman wdiom the members have respec¬ tively elected to attend upon them, every six months, by paying the amount of sub¬ scriptions received under Rule IV. WAX MODELS OF SURGICAL ANATOMY. We have seen two very fine models, just imported by Mr. Schloss, of Great Russell Street, which we think are wrell deserving the notice of the profession. One repre¬ sents the male pelvis, viewed laterally, shewing the urinary and genital organs, with the parts affected in inguinal and femoral hernia. The interior of this model displays the pelvic viscera in situ , together with the kidney and ureter, the course of the abdominal aorta, of the common inter¬ nal and external iliac vessels, with the distribution of their branches, the abdomi¬ nal rings, with the spermatic vessels and vasa deferentia. The second model presents a side view of the male pelvis, shewing the reflection of the peritoneum around the viscera. Here, also, we have an excellent represen¬ tation of the descent of a large scrotal hernia, dissected and slit open, so as to display its coverings and contents. Models of this kind must be invaluable to teachers of surgery; w'hile, as specimens of art, they must secure the admiration of all who inspect them. COLLEGE OF SURGEONS. LIST OF GENTLEMEN WHO RECEIVED DIPLOMAS IN SEPTEMBER. John Charles Langmore, Finsbury Square. Thomas W. L. Martyr, London. James Surruge, VVincanton. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Sept. 27, 1836 Age and Debility . 20 Apoplexy . . 3 Asthma . . 10 Cancer . . 1 Consumption . £6 Convulsions . 17 Dentition orTeething 1 Dropsy . . 6 Dropsy on the Brain 9 Fever ... 2 Fever, Scar-let . 2 Heart, diseased . 2 Inflammation . 11 Bo\vels& Stomach 2 Brain . . 2 Lungs and Pleura 2 Insanity . . 1 Jaundice . . 1 Liver, diseased , 4 Measles . . 6 Mortification . 1 Paralysis . . 1 Rheumatism . 1 Smali-pox . . 7 Sore Throat and Quinsey . . 1 Stone & Gravel . 1 Thrush . . 1 Unknown Causes 10 Casualties . . 9 Decrease of Burials, as compared with > r(. the preceding week . . I 00 NOTICES. Mr. May’s letter is an advertisement. “Medicus.” — A letter professing to state facts should always be authenticated. By the way, the letter signed Medicus, to w hich our notice of last week referred, wras dated from the Borough. “A Camberwell Practitioner,” too late for this number. “ T. G.’s” letter also reached us too late. 'I he Aylesbury “ Handbill,” given in a recent number, was stated, by mistake, on our wrapper, to be put forth by one of the surgeons of the Bucks Infirmary. To several correspondents we have apo¬ logies to offer for the temporary postpone¬ ment of their papers. Next week we trust to make amends. Wilson & Son, Printers, 57,Skinner»St. London, THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOTMAL OF fflt'bmnt anti tl)t Collateral &im\it$+ SATURDAY, OCTOBER 8, 1836. LECTURES ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine , By William Cummin, M.D. Lecture II. On Medical Evidence in general — Coroners ’ and other Courts — Mode of Examining' Wit¬ nesses — The Sy ting System — Quoting Autho¬ rities — Question of Privilege — Conduct of Medical Witnesses. Before we enter on the consideration of those special questions which consti¬ tute the main business of Forensic Medi¬ cine, it mav be well to dispose of certain generalities connected with the subject. From what was stated in the last lecture regarding the nature and objects of this study, it will have been gathered that one of the chief ends of medico-legal proceed¬ ings is the giving of evidence in courts of justice: it would seem, therefore, ad¬ visable, in the first place, to take a view of those relations in which the medical practitioner stands, in respect to our legal tribunals. COURTS OF JUSTICE. The courts of justice in which the presence of medical witnesses is most usually required, are those of a criminal jurisdiction — as the coroner’s, and the oyer and terminer sessions, — or those for the redress of civil injuries — such as the com¬ mon law courts, and the ecclesiastical. Of the former, or criminal kind, that which makes by far the most frequent de¬ mand on our services, is the coroner’s court. Coroner’s Court. — The circumstances un¬ der which a medical man may be sum- 4G2. — xix. moned to appear in this court are either general — such as might lead to the attend¬ ance of any other witness, to depose, for instance, to certain matters of fact of which he may happen to be cognizant — or special, as when he is expected to give his professional opinion. This is likely to be understood henceforth better than it has been hitherto. Until recently there was no difference observed betwixt summoning a medical, and any other witness. The pro¬ fessional man, when called upon, came, of course, but he frequently exercised a dis¬ cretion : he answered all ordinary ques¬ tions, and acted in every respect as a com¬ mon witness ; but when asked his opinions, or requested to open a body, or to analyze toxicologieally the contents of the sto¬ mach, he usually declined, till he was assured of a remuneration for his medico¬ legal services. This, however, was what the coroner had it not always in his power to give, and much unseemly squabbling was the consequence — the medical man in¬ sisting on his fee, and the coroner en¬ deavouring to extort the witness’s opinion without one. The case is now altered. A recent enactment (6 and 7 Will. IV. c. 89) secures to medical witnesses a fee of one guineafor simple attendance, and two where a post-mortem inspection, or a chemical analysis, is required. But the medical man must take care that he is specially summoned on these occasions, for an ordi¬ nary subpoena leaves him only in the con¬ dition of an ordinary witness, when he may seek in vain for his fee. The special summons runs in this form : — By virtue of this my order, you are required to appear before me and the jury, on such a day and hour, to give evidence touching the cause of death of * * *, and to make, or assist in making, a post-mortem examina¬ tion of the body, with [or without] an analysis, [as the case may be] and to report thereon at the said inquest. Signed by the coroner. There are some points connected with D 34 DR. CUMMIN ON FORENSIC MEDICINE. the coroner and his court, to which medi¬ cal men in general do not sufficiently at tend. The coroner is an officer of much power and authority. He has an extensive discretion in summoning witnesses, and ample means of enforcing their attendance. He sits as a judge, and if the finding of the jury lead to ulterior proceedings, he binds over the parties who have given evi¬ dence, to be forthcoming, and to repeat their testimony at the next assizes. His court, though it frequently be not a very showy one, the jury consisting in gene¬ ral of persons from the humblest classes of society, is essentially of high im¬ portance. In most cases of felony, such as manslaughter and murder, the initiative is taken in this court, and the person of the party, who by the inquisition is found guilty of the crime, is secured and com¬ mitted for trial. A medical man not duly impressed with these facts, is likely to fall into a serious predicament. He is summoned, we shall suppose hastily, and attends, it may be for the first time, in such a court. He finds the jury a set of very humble individuals, assembled perhaps in an ale-house. The circumstances are any thing but imposing. He is off his guard, and gives evidence, pro¬ bably, very different from what he would have given, had he attached more import¬ ance to the proceedings. In due time, another scene follows. The witness has been bound over to appear at the assizes, and has had an opportunity in the in¬ terval of deliberately forming his opinions of the case. He then appears before a very different tribunal, and is anxious, no doubt, to make a respectable figure before the bench, the bar, and the neighbouring gentry who fill the court. His examination proceeds, and he utters his sentiments with a becoming caution : he has probably forgotten or thought no more of the obscure scene of the inquest, and the evidence he gave on that occasion. But the judge is watching him ; the depo¬ sitions given at the inquest are before his lordship, and are narrowly compared with the present testimony of the witness. In accordance, too, with the new Prisoners’ Counsel Act (6 and 7 Will. IV. c. 114), those depositions are also in the hands of the prisoner’s advocate. It may well be conceived in how peculiar a situation the medical man is placed, should his second thoughts prove at variance writh those hastily given in the first instance, and espe¬ cially if through his means the prisoner have been thrown into gaol, perhaps for months, on a charge of which it now turns out that he is not guilty. Nor will the compunction of the medical witness be lessened by the consideration, that, had he died between the inquest and the trial, his depositions might have led to the con¬ demnation of the accused ! Courts of Oyer and Terminer. — By this title we are to understand those courts of commission, or assize, in which crown cases, such as treasons, felonies, and mis¬ demeanors, are disposed of. Medical evi¬ dence is frequently required in such cases, but the professional witness has no ex¬ press or special summons : he is sub¬ poenaed, and obliged to appear, under a heavy penalty; when in cour', he must “ true answer give to all such questions as are put to him,” nor has he any claim to remuneration for his time and trouble in attending. An act, however, was passed a few years since (7 Geo. IV. c. 6-1), by which witnesses for the prosecution, in all cases of felony, are entitled to their rea¬ sonable expenses : in prosecutions, also, for certain misdemeanors, the same indul¬ gence is granted ; the misdemeanors be¬ ing enumerated in the 23d section, — among which we find assault with intent to com¬ mit a felony, riot, breaches of the peace, wilful and indecent exposure of the per¬ son, &c. ; cases in which medical testimony is often required, but without any special privilege or immunity for the professional witness. Courts of Common Taw and Equity. — In these courts, constituted for the redress of civil injuries, the witness is differently cir¬ cumstanced from what he is in criminal cases. Where a civil suit is pending, such as an action for damages, a witness need not obey the subpoena unless his reasonable expenses be previously ten¬ dered. He must be compensated for his trouble and loss of time in going to, stay¬ ing at, and coming from the place where his testimony is to be given; otherwise he need not appear: or if he does come into court, he may refuse to give evidence until his reasonable demand be satisfied. His demand, however, must be very reasonable, for a shilling is the stated viaticum (a sum fixed at a time wdien money bore perhaps twenty times its present value) if the wit¬ ness reside within the bills of mortality, and be summoned to give evidence within the same. Whether medical men have a right to compensation for the sacrifice of professional emolument, incurred by their absence from home, is by no means a settled point : there are some cases re¬ ported in which they have been put on the same footing as attornies, but even the attornies’ right has been shaken by some still more recent decisions. Ecclesiastical Coui'ts . — The only other courts which I shall notice at present, are those which take cognizance of inju¬ ries of an ecclesiastical nature. Here ques¬ tions relating to the validity of marriage and the grounds of divorce are enter- medical evidence. 35 tamed; cases which call into requisition the evidence of medical referees perhaps more frequently than the public are aware of. Many of the circumstances submitted to the profession, in cases of this kind, would doubtless scandalize public decency. But, on the other hand, there is much to regret; it is to be feared that justice suf¬ fers; and, at all events, it cannot but be prejudicial to medico-legal science, as well as to the practice of the bar itself, that reports of some of the most remarkable cases should not in some shape be pre¬ served. The sanctions for attendance here are similar to those used in the common law courts; but in their dealings with medical witnesses, the parties engaged in suits ecclesiastical are understood to be bounteous, as, indeed, might be expect¬ ed from the suitors in a court where few, save the wealthiest, can venture to litigate. MEDICAL EVIDENCE. We shall now suppose the witness in due attendance, sworn in the usual man¬ ner, and prepared to tell the u whole truth.” May he always do so ? Does the discretion of revealing the entire truth rest with him ? The sifting system. — The freedom of a wit¬ ness in an English court of justice is greatly circumscribed. He is subjected, it is true, to several processes, such as those of exa¬ mination, cross examination, and re-exa¬ mination, besides, most likely, being ques¬ tioned by the bench and jury, — all with the express or ostensible design of eliciting the truth. But does it follow, after all, that the whole truth is elicited ? To war- rant such a supposition we should be sa¬ tisfied that the examining parties are fully capable of appreciating the extent of knowledge of the witness, which, where the latter is a man of science, it is not always easy for them to be. That the case is often otherwise we may be readily in¬ duced to believe, from the circumstance of able witnesses sometimes feeling obliged, through conscientious motives, to submit further information to the court after all the processes of silting them have been finish¬ ed. How many men, in such a situation, would feel deterred from volunteering one word in addition to what had been wrung from them in the ordeal they had undergone ! Much has been said of the excellence of the methods adopted in our courts for ob¬ taining evidence, and Blackstone has Placed in a strong point of view the supe- riority of parole over written testimony. he open examination of w itnesses viva vocef says the learned judge, “ is much more conducive to the clearing up of truth than the private and secret examination taken down in writing before an officer, or ms clerk, as in the ecclesiastical courts, and all others that have borrowed their prac¬ tice from the civil law,— where a w itness may frequently depose that in private wffiich he wrill be ashamed to testify in a public and solemn tribunal. There, an artful or careless scribe may make a wit¬ ness speak what he never meant, by dress¬ ing up his depositions in his own forms and language; but he is here at liberty to correct and explain his meaning, if misun¬ derstood, which he can never do after a written deposition is once taken. Besides, the occasional questions of the judge, the jury, and the counsel, propounded to the witnesses on a sudden, will sift out the truth much better than a formal set of in¬ terrogatories previously penned and set¬ tled; and the confronting of adverse wit¬ nesses is also another opportunity of obtaining a clear discovery, which can never be had upon any other method of trial. Nor is the presence of the judge, during the examination, a matter of small importance; for, besides the respect and awe with w'hich his presence w ill naturally inspire the witness, he is able, by use and experience, to keep the evidence from wan¬ dering from the point in issue. In short, by this method of examination, and this only, the persons who are to decide upon the evidence have an opportunity of ob¬ serving the quality, age, education, under¬ standing, behaviour, and inclinations of the witness ; in which points all persons must appear alike, w'hen their depositions are reduced to waiting, and read to the judge in the absence of those who made them ; and yet as much may be frequently collected from the manner in which the evidence is delivered, as from the matter of it.” All this must be admitted to be just and true in respect to the mode by which the knowledge of mere matter of fact may be arrived at; but it may be fairly ques¬ tioned whether the sifting method here described is best adapted for eliciting valuable scientific opinions. I am by no means disposed to advocate the course pursued in France and some parts of Germany, of drawing up medico¬ legal evidence wholly in writing — a sys¬ tem the palpable abuse of which is so clearly shewn in the lengthened and pro¬ lix documents to which it often gives rise, amounting sometimes to the pro¬ duction of controversial pamphlets ; but I do say, that the opposite practice which prevails amongst us, of confining the pro¬ fessional witness to mere verbal statements , controlled, too, by men of a different pro¬ fession, and who are acknowledged not to be, generally speaking, persons of very ex¬ tensive scientific attainments, is a course extremely open to objection. Citing of authorities. — But this is not all : the medical witness is subject to still fur- 36 DR. CUMMIN ON FORENSIC MEDICINE. ther restriction on another point: lie isoften prevented from citing authorities. He may not state the opinions of the greatest names in medicine in corroboration of his own — no vouchers, whether ancient or modern, for the correctness of his asser¬ tions, may be tendered, if it so please the bar and the bench. It is not easy to con¬ ceive any thing more absurd or unfair than this; for, in the first place, it is perfectly ridiculous to expect a medical man, in giving evidence, to state nothing but what he knows through his own experience : were professional witnesses always limited to this, their utility in courts of justice were scanty indeed, — for who could, or should, venture to offer an opinion on any difficult point of diagnosis or practice that has not been adopted from, or con¬ firmed by, the experience of others ? If given as purely his own, all rational men must know what value ought to be set upon it. Nor is the unfairness — the injustice of the practice — less striking : for the members of the legal profession should, of all men, be aware, and are aware, that individual opinion is worth nothing unless it be shown to be in accordance with prece¬ dent, and consistent with reason, that is, as the lawyers usually understand it, consist¬ ent with the expressed sentiments of the Cokes, the Hales, and the Eldons, of their profession. This wTas well pointed out on one occa¬ sion by a medical witness whose quota¬ tion of authorities was demurred to. At the trial of Mr. (afterwards judge) Cow- per, for the murder of a lady who was found drowned, Dr. Crell, among other witnesses, was called upon for his opinions as to the likelihood of death being caused by drowning, little or no water having been found in the body. “ My own opinion,” said Dr. Crell, “is, that a very small quantity of water, not exceeding three ounces, is sufficient to drown any body ; and I believe that the reason of the suffocation, or of any persons being stifled under water, is from inter¬ cepting of the air, that the person cannot breathe, without which he cannot live. I shall give you the opinion of several old authorities on the point.” The judge (Baron Hatsell) : “Pray, Doctor, tell us your own observations.” “ My Lord, it must be reading as well as a matfs own experience that will make any one a phy¬ sician; for without the reading of books of that art, the art itself cannot be at¬ tained to. Besides, my Lord, I humbly conceive that in such a difficult case as this, wre ought to have a great deference for the reports and opinions of learned men ; neither do I see any reason wfliy I should not quote the fathers of my profes¬ sion in this ease, as well as you gentlemen of the long robe quote Coke upon Little¬ ton in others.” And, accordingly, he pro¬ ceeded to cite the authority of Ambrose Pare on the point in question ; nor was such evidence in this instance refused. On the other hand, w'hen at the trial of Donnal (in 1817), Dr. Nfeale quoted the celebrated chemist Thenard, the judge (Abbott) objected, saying — “ We cannot take the fact from any publication ; we cannot take the fact as related by any stranger .” But there seems to be no fixed rule on the subject: while some judges have thus prevented, others have permitted the citing of published opinions, and have sometimes themselves appealed to au¬ thorities — to Dr. William Hunter, for in¬ stance, or to Llaller, or Mead. Nay, on one occasion, w'hen a medical witness flippant¬ ly uttered an opinion in court to the effect that the information in certain medical w'orks on a particular subject was good for nothing — “ that the writers of books would advance any thing,” — the judge (Dal¬ las) reprimanded him, and said thathewmuld not sit in a court of justice and hear science reviled, and the recorded researches of the medical W’orld represented by igno¬ rant tongues as leading only to uncer¬ tainty*. The objection commonly urged by lawyers seems to amount to this, that opinions and statements laid down in books, however eminent the authors, are only like so much hearsay evidence, not sworn to, and there¬ fore not legally admissible. The unrea¬ sonableness of such a doctrine is obvious ; for w7ho shall assert that the deliberately published opinions of a respectable author are in any manner the weaker for not be¬ ing confirmed by an affidavit ; or that his statements are the less to be relied on for not being sanctioned by an oath ? Some wrnuld even hold the very reverse. In Scotland a greater latitude is allowed to professional witnesses : authorities are permitted to be freely quoted ; and Dr. Beck informs us that in America no objection to such a course has ever been made. “ There is scarcely a case of any note,” says he, “ where medical testimony has been required, in which frequent reference has not been had to medical wrorks. They are quoted and commented upon by the bench, the bar, and the professional wit¬ nesses.” Notes to aid the memory. — There is ano¬ ther point on which the practice of our English courts is better defined, and appa¬ rently founded on more just principles. I allude to the notes which the medical witness is sometimes permitted to make use of. It is agreed that wffiere those notes * Amos i Medical Gazette, vol. vii. p. 613.- EVIDENCE OF DYING DECLARATIONS. 37 have been made immediately upon the oc¬ currence of the facts to which they refer' they may be used in evidence, for the ex¬ press purpose of refreshing the witness’s memory. Thus the account of a ’postmortem examination drawn up by the witness at the time it was made, or the memoranda noted down presently after a trans¬ action in which he has been engaged, are admissible afterwards in evidence. But where a person summoned to give his testimony in a court of justice relative to incidents that have happened, perhaps many years previously, sits down and compiles a written statement of what he knows or recollects of the matter, he will not be allowed to avail himself of such statement at the trial. Want of attention to these points has often led witnesses into unpleasant diffi¬ culties: ridicule and reprimand, too, have been the lot of some who have come into court confidently relying on the complete proofs they had to bring forward, these proofs being probably memoranda neither made by themselves, nor under their in¬ spection. It is not absolutely necessary that the memoranda alluded to should be noted in one’s own hand; but in such case it is indispensable that the witness should have personal cognizance of the act of making them. If they be entries in regis¬ ters which are adduced, the witness must either have made them himself, have seen them made, or be able to produce the par¬ ties by whom that office has been per¬ formed. All this is calculated to inculcate the importance of carefulness on the part of our profession, and to recommend the practice of keeping journals or memoranda of the transactions in which we may be person¬ ally concerned. As we are interested in the peace and security of families — as we are friends to humanity and justice — and as we value our own reputation, we are called upon not to omit so simple, yet so important a custom. Even a prescription book has sometimes been serviceable in the absence of other documents. Mr. Amos informs us that in a case in which he was engaged, where the trial was concerning a will, a physi¬ cian was able to throw great light upon the inquiry by means of a book in which he copied all his prescriptions, and which enabled him to trace the progress of the testator’s health at a distance of more than a dozen years, when otherwise it is probable that his memory might have af¬ forded him no assistance*. Evidence of dying declarations, of which medical men frequently become the depo¬ sitaries, can scarcely be given in an unex- * Medical Gazette, vol. vii. p. 547* ceptionable manner if the witness have neglected to take a contemporaneous note of them in writing. That hearsay evil deuce is not admissible in our courts, is the general rule; but there is a marked exception in the case of dying declara¬ tions. What a person utters in his dying moments, or when he entertains a con¬ sciousness of approaching dissolution, is valid as evidence upon trials for murder. The principle is a just one, for it implies that the awful situation of thedying indivi¬ dual is equivalent to the sanction of an oath, and that the absence of sublunary interest, on passing into another world, dispenses with the necessity of a cross- examination. But it must clearly appear that such is the condition of the party; if there be hope, however faint, of recovery, — if there be expectation that the adop¬ tion of further remedies may prolong life, the declarations will be rejected. This was the case in respect to Mr. Scott, who was shot in a duel. The surgeon who attended him on his death-bed was about to give the dying declarations of his pa¬ tient when the trial came on at the Old Bailey; but inquiries were first made as to the precise state of the patient, and whether any conversation had passed from which the sense he entertained of his situation could be inferred. The witness said, “ The deceased asked me if his wound was necessarily mortal? — upon which I told him that his case was one of extreme danger; but that there had been instances where persons had recovered under such a wound. The deceased then said, ‘ I am satisfied.’” The declarations were overruled by the judges, inasmuch as the language of the surgeon had pro¬ bably kept alive in his patient’s mind some hopes, however faint, of recovery. And in another case, where the dying declarations had already been duly taken, but the patient afterwards wished that more medicine might be sent for, they were rejected, because not made after all expectation of life was extinct. One or two other hints on the subject of dying declarations may be added — name¬ ly, that these forms of testimony should al¬ ways be purely voluntary, and thatthe dying person ought not to be induced to supply matter of accusation against living parties. The interrogations also should not be of a leading kind, or such as require from the declarator only a simple expression of assent or dissent — a yes, or a no ; for this may be fairly construed into a prompting of statements in which, though the patient may have acquiesced, he cannot be sup¬ posed to have felt any adequate concern. Besides, such a practice of questioning is only allowed in open court, under certain precise restrictions. 38 DU. CUMMIN ON FORENSIC MEDICINE. Question of privilege. — Having thus no¬ ticed the extent to which medical testimony is received as evidence, and the limitations to which it is usually subject, it may be interesting to inquire whether medical men have any peculiar privileges in courts of justice. In the first place, may they de¬ cline to give such evidence as would appear to compromise the honourable confidence reposed in them by families ? Are they privileged not to divulge secrets profession¬ ally and confidentially communicated to them ? This question has been decided in the negative. In the case of the Duchess of Kingston, who was tried for bigamy, in the year 1776, the professional attendant of her grace, Mr. Caesar Hawkins, endea¬ voured to evade some questions put to him, on the ground that if he answered them, he would dishonourably betray his patient. But it was held by the House of Lords, in the language of Lord Mansfield, “ that a surgeon has no privilege, when it is a mate¬ rial question in a civil or criminal cause, to know whether parties were married, or whether a child was born, to say that his introduction to the parties was in the course of his profession, and in that way he came to the knowledge of it. If a sur¬ geon was voluntarily to reveal those secrets, to be sure he would be guilty of a breach of honour, and of great indiscretion ; but to give that information in a court of jus¬ tice, which by the law of the land he is bound to do, will never be imputed to him as any indiscretion whatever.” Other decisions have since corroborated this view of the question; and it is now generally under¬ stood that professional confidence, as a ground of secrecy, can only be urged in the case of counsel, solicitors, and attor¬ neys, when employed as such, — on the principle that in such circumstances they become identified with their clients. There is one privilege, however, which medical men possess— namely, that of not being obliged to state any thing that may criminate themselves. All witnesses, in¬ deed, by the laws of England, are entitled to the same right of reserve; but peculiar indulgence in this respect seems to be extended to our profession. It is well known that a medical man who at¬ tends a party engaged in a duel, and is present at the combat, though only in his professional capacity, is considered in the eye of the law as an accessary, and may be put on his trial for murder. After the fatal duel between Col. Montgomery and Capt. Macnamara, in 1803, a surgeon of eminence who had attended one of the parties professionally, was arrested and sent to Newgate, by a warrant from the civil power, as a principal in the alleged murder, having been present on the occasion, and antecedently privy to it: nor was he liberated from prison till the grand jury were satisfied that there was no sufficient ground for the indictment. But it rarely happens that the law, in this respect, is severely administered : the more ordinary, practice is to dispense with the evidence which the medical attendant could give in such cases. On the trial of Mr. Patmore, second to Mr. Scott already mentioned, the sur¬ geon who attended the deceased at the duel, was summoned to identify the prisoner then in the dock, arraigned for murder. And he would have heedlessly done so, had he not been humanely warned by the judge not to expose himself to a criminal prosecution, by answering ques¬ tions which might compromise his safety. A few years since, at the trial of the seconds of Sir John Jeflcott, who shot Dr. Hennis, of Exeter, in a duel, a physician who was on the ground with the party, being called upon to give evidence, declined to do so, and the judge (Patteson) said he could not compel him. CONDUCT OF MEDICAL WITNESSES. I have already alluded to the im¬ portance of circumspection on the part of medical men in giving evidence — no matter how humble the court may be in which it is tendered : for if it lead to the committal and subsequent trial of the prisoner, the depositions will be forthcom¬ ing, and contrasted with the mature testi¬ mony of the witness. But there are some other hints respecting conduct, which it may be well to observe. Self-possession. — We should bewrare of being over-officious, or too profuse in giv¬ ing our testimony, for thereby we expose ourselves to the imputation of some motive, perhaps of a personal nature, in the issue of the cause. Nor, on the other hand, should we be too reserved — too costive, in our information, for this throw's us from Scylla into Charyb- bis, and we become liable to the suspicion either of shallowmess, or a design to con¬ ceal from the court some important parti¬ culars. The golden medium, in this as in most other things, is to be preferred. We should reply freely and cheerfully to the questions proposed to us, with self-pos¬ session, but with perfect submission to the tribunal before which we stand. Self-pos¬ session is necessary, for the consequence of its absence may be serious. “A scientific wdtness,” says Dr. Paris, “ fully acquainted with the subject in dispute, and by his particular knowledge well qualified to inform the court on the most important points, is too frequently render¬ ed miserable to himself, and absolutely ineffective to the ends of justice, by the diffidence which a man of real CONDUCT OF MEDICAL WITNESSES. 39 acquirement generally feels, when im¬ pressed at once with the novelty of his situation, a sense of the importance of the duty which he is about to perform, and a consciousness that the truths he is about to utter may be obscured, suppressed, or perverted, by technicalities for which he is unprepared with any defence : we do not mean to arraign the present forms of examination in general, when we assert that some abuse in practice too frequently places the witness in as painful a situation as if he were himself a criminal.” Technical terms to be avoided. — But it is not of the technicalities of the law alone of which the medical witness had need to be apprehensive ; those of his own profession, if not guarded against, will most probably entrammel him quite as much. Both for counsels’ sake, who are said to be generally “ very shal¬ low men of science,” and for our own safety, which so much consists in the inte¬ grity of our reputation, we had better ab¬ stain from the use of terms purely medical, where we can find others more popular that are at all suited to our purpose. The a ’.vice of my learned friend, Mr. Amos, on this point, is excellent. “ When in the "wit¬ ness-box, drop as much as possible the language which is known only to scientific men, and adopt that which is in popular use. If you have occasion to speak of a person fainting, do not say, as I have heard it said, that you found the patient in a. state of syncope; and you must not expect a court of justice to understand you if you talk of a person being comatose, and of the appearance of his stomach after death being highly vascular , or of your having discovered poisonous ingredients in his intestines by means of a delicate test. The judge and counsel are generally very shallow men of science, and it is a great advantage for them to raise a laugh at persons whom they would repre¬ sent to be using hard names for common things. Veterinary surgeons are a great game for counsel; and I remember, in particular, a veterinary surgeon, who, when cross-examined by Serjeant (now Baron) Vaughan, was so unfortunate as to make use of the term suspensory ligament , which the serjeant interpreted into the ‘hangman’s noose.’ In general the wit¬ ness is called upon to define, as he goes along, the technical terms which he em¬ ploys, and it is ludicrous sometimes to hear the words of which an explanation is gravely demanded. I have heard a learned chief-justice ask what the witness meant by an injection, where the context would seem scarcely to leave a loophole for doubt : the reply, howrever, that it wras a clystei- appeared satisfactory to his lordship; not, perhaps, because the Greek name was more intelligible than the Latin, but that the former was the more common, and it was probably the wish of the court to discounte¬ nance all technicality. Of the opening for ridicule afforded by the use of cer¬ tain terms, I cannot give you a better in¬ stance than one which was lately related to me by a friend learned in the law. A conceited shallow witness, a member of our profession, in undergoing the ordeal of cross examination, on a recent occasion, happened to drop, among other ill-assorted terms w hich he seemed proud to use, the word dyspepsia; the counsel, who was a wrag, immediately seized on it, and raised roars of laughter at the witness’s expense, by putting to him a question w hich he was unfortunately unable to answrer — “ Unde derivatur dyspepsia, Doctor? Eh, Doctor, unde derivatur dyspepsia ?” Ought witnesses to be made up Jor the occa¬ sion ? — A general subject of complaint brought against medical witnesses, is the contradictory nature of their opinions, as given in courts of justice. Much of this, no doubt, is owing to the difficulty of the questions on which those opinions have to be delivered: but perhaps still more to the witness’s wrant of preparation. Of the necessity for individual preparation there cannot be a doubt, when it is con¬ sidered that the professional man is not called upon to testify to mere matter of fact : he has an opinion to deliver, and will be expected to state publicly the grounds of that opinion. Nor does there seem to be much more question regarding the propriety of joint preparation, when two or more witnesses are to be examined, touching the same subject of inquiry. Of the correctness of this position we have a strong proof in a case related by Dr. Per- cival. “ Several years ago, a trial of con¬ siderable consequence occurred, relative to a large copper- work; and two physi¬ cians of eminence were summoned to the assizes to bear testimony concerning the salubrity or insalubrity of the smoke is¬ suing from the furnaces. The evidence they offered wTas entirely contradictory. One grounded his testimony on the gene¬ ral presumption that the ores of copper contain arsenic, and consequently that the effluvia proceeding from the roasting of them must be poisonous, because arseni¬ cal. The other had made actual experi¬ ments upon the ore employed in the works under prosecution, and on the vapours which it yielded: he was thus furnished with full proof that no arsenic wras disco¬ verable in either. But the affirmative pre¬ vailed over the negative testimony, from the authority of the physician who de¬ livered it: an authority which he probably would not have misapplied, if he had 40 DR. CUMMIN ON FORENSIC MEDICINE- been antecedently acqnainted with the de¬ cisive trials made by his opponent.” That medical men are expected to make due preparation for giving ample and sa¬ tisfactory testimony, is certain, at least in some instances, from the fact of the judge who has to try particular cases, having given directions to medical witnesses to make certain experiments on animals pre¬ viously to the day of trial ; a fact which serves to establish the principle, if, in¬ deed, there could be any reasonable doubt of the excellence of the practice. The only point in connexion with the subject, on which a question can feasibly be raised, is as to the extent to which the minds of the witnesses should be made up anterior to the trial ; for some have advised that they should come to a fixed decision, so as to prevent the possibility of differing when the investigation came on in public. But even were this practicable, it seems doubtful how far it were just and proper; for what would it amount to other than to inquire with a foregone conclusion, and thus to make a mockery of justice ? The practice usually observed with re¬ gard to medical witnesses in courts of justice, allowing them to remain dur¬ ing the trial, while other witnesses are secluded till called to give their testimony, is a still further proof of the wish of the court to obtain consistentevidence from the medical men. But it is curious to observe, that, in Scotland, the profes¬ sional witnesses are secluded during the trial, for the very same purpose. “ In the Scotch courts (says Mr. Alison, in his Practice of the Criminal Law) it is usual, when one medical man begins to give an opinion on the case, to cause the other medical men to retire. The reason of this is, that it has been found, by experience, that medical men, even of experience and information, are generally so prone to con¬ tradict each other, or to adhere to the side on which they are cited, that it is never safe to let them hear each other’s testi¬ mony. The proper way to do, therefore, is to allow the medical men who are to be examined as to opinion, to hear the whole evidence relating to the facts, whether from the ordinary or the medical witnesses, and to remove them as soon as medical opinion is about to commence ” Of the mischievous absurdity of ven¬ turing into court to give evidence with¬ out previous preparation, I cannot close this part of my remarks without offer¬ ing one or two examples. A man was indicted at the Assizes at Chelmsford, in March 1822, for having administered copperas to two women. The women had drunk two or three cups of tea, which tasted bitter, and in the evening were taken ill with a violent vomiting. Next day their tea was still bitter, and some copperas was found on a plate in the house. One of the women suffered from the effects for about a month afterwards. It was attempted to be proved on the trial that copperas was a deadly poison , as laid in the indictment. A chemist of the town gave it as his opinion that the substance was not, properly speaking, a deadly poi¬ son, for the stomach would reject a dose sufficient to produce death before it would have that effect, and probably it would require two ounces, dissolved in water, to produce serious consequences; but still he did not think it would cause death. A physician, however, of Chelmsford, gave it as his opinion that two drachms of copperas would cause death. But on his cross examination, it turned out that he was confounding copperas with verdigris; and he was obliged to confess his ignorance that copper did not enter into the com¬ position of the poison alleged in the in¬ dictment ! This, it may be said, was an instance of pure indolence : the blunder of the phy¬ sician was, perhaps, wholly attributable to his having gone into court without giving the sligh test attention to the point on which he was to be examined. But I shall now show that too much care cannot be be¬ stowed on preparation, and that even the most expert cannot calculate upon having it all their own way on these occasions. In the example I am about to adduce, we find a chemist of the highest reputation unexpectedly called upon to put forth his best abilities in his cross-examination by counsel. The gen¬ tlemen of the bar, it may be observed, are sometimes more than a match for the most intelligent witnesses who come before them; being often crammed for the purpose: and the conflict under such circumstances is always unequal. The professional witness is held to be fair game; and he is supposed to have no cause to grumble, as he is attacked on his own ground, and with weapons like his own. On the other hand, the counsel, whatever be the issue of the con¬ test, comes off scatheless: and he has no risk of character to apprehend even from an exposure of gross ignorance in his cross examination. At the trial of Stewart and his wife, in 1829, for the murder of a man, by giving him laudanum in strong ale, Dr. Ure, who had attended the post-mortem examina¬ tion of the body, was summoned as a wit¬ ness for the prosecution. The Doctor was positive as to the presence of opium in the contents of the stomach, from having relied on perchloride of iron as a test for meconic acid, and procured what he conceived to be the characteristic cherry red colour. He ON THE THERAPEUTICAL EFFECTS OF IODINE. 41 did not know at the time (though, by the wav, the fact was then far from new, Tiedemann and Gmelin having published it some years before) that the test he employed was rendered doubtful by the circumstance that human saliva contains a substance — the sulpho-cyanuret of potas¬ sium — which strikes the same red colour with the same salt of iron,— as indeed it is now perfectly well ascertained that there are other matters which might easily hap¬ pen to be present in the stomach— such as mustard, &c. — which would also render the test fallacious, in consequence of their presenting a similar appearance. Dr. Ure, however, not being acquainted with the fact respecting the saliva, was taken wholly by surprise when the counsel for the prisoners urged upon him the inefficacy of his salt of iron test, since sulpho- eyanic acid also struck a cherry red colour, when treated with perchloride of iron. In a paper in Brande’s Journal for 1830, Dr. Ure adverts to the facts of the case, and the objection raised by his cross - examiner: — “I was not then aware (says he) that this curious acid (the sulpho-eyanic) existed in the saliva, and I thought it merely a ruse de plaideur .” There is reason to believe that the “ inge¬ nious counsel” was primed for the occa¬ sion, by a rival chemist of Glasgow ; and probably the point urged might have had much weight, had not the medical witnesses been agreed, that, whatever ambiguity might attend the test em¬ ployed, the characteristic smell of opium given out by the contents of the stomach, was too perceptible to leave any doubt on their minds. The moral circumstances of the case, besides, were very strong; so that the prisoners were found guilty, and exe¬ cuted. General demeanour. — A few words on the general demeanour of witnesses, and I have done. It has been already seen how many difficulties beset the path of the professional man in coming in contact with our legal tribunals, and I have just no¬ ticed some of the perplexities and annoy¬ ances which may await him in court. It is scarcely surprising that the apprehen¬ sion of the sort of treatment which they have reason to expect, should render most men “ tremblingly alive ” to their posi¬ tion, and that some should even be be¬ trayed into intemperate or indignant sal¬ lies : but Dr. Haslam’s suggestions are well deserving of consideration : — “Thelawyer’s object is the interest of his employer, and, for the fulfilment of his duty, he is fre¬ quently compelled to resort to a severity of investigation which perplexes the theo¬ ries, but more frequently kindles the irritable feelings, of the medical practitioner. The distrust on the part of the lawyer, however unpalatable, is fully justified, most wit¬ nesses going into court with the precon¬ ceived intention of proving to a certain ex¬ tent ; and those most conversant in the history of human testimony have been ex¬ tremely scrupulous of admitting it as a uniform truth until it has been carefully sifted. Guarded with these precautions, and armed with professional experience, the medical practitioner may approach the tribunal of justice with confidence, and advantage to the cause of truth. How¬ ever dexterous he may shew himself in fencing with the advocate, he should be aware that his evidence ought to impress the judge, and be convincing to the jury.” Unhappily there are but too many in¬ stances on record of this disposition on the part of medical men to fence with the gen¬ tlemen of the bar : in some cases a contest in “ the flowers of Billingsgate” has been attempted ; the result has always been to be deplored. But I shall forbear to bring such examples before you, however power¬ fully they might serve as a warning to remain on all such occasions cool, steady, and collected ; and to impress you with the necessity of keeping your temper. To the danger of assuming an affected manner, or the appearance of false dignity, I need hardly advert ; it is hazardous at any time to venture before the public out of one’s proper character; in a court of justice it may be ruinous. In short, the golden rule of conduct seems to be — to preserve our natural manner — to have just so much confidence as may arise from the consciousness of being not unprepared — and, above all things, to be calm. ON THE THERAPEUTICAL EFFECTS OF IODINE, 7 i GIVEN IN VERY LARGE DOSES, In the forms of Iodide of Starch, Hy dr iodic Acid , and Iodide of Potassium. By Andrew Buchanan, M.D. Junior Surgeon to the Glasgow Royal Infirmary. In a former number of this journal (vol. xviii. p. 515) I pointed out a new me¬ thod of administering’ iodine, by means of which it may be given with safety in doses much greater than by the ordinary modes of administration. I likewise described the principal physiological effects resulting from the use of iodine in such doses. I am now to attempt the more difficult task of forming an estimate of the virtues of iodine in the cure of disease, in so far as the observa- 42 DR. BUCHANAN ON THE tions made in the surgical wards of the Glasgow Infirmary enable me to do so. The principal surgical diseases in which iodine was prescribed were sy¬ philis, sibbens, scrofula, ulcers depend¬ ing upon constitutional causes, noli me tangere, cancer, and tumors. It was also tried in lepra, psoriasis, ichthyosis, impetigo, and porrigo, diseases not usu¬ ally treated in the surgical wards, the patients being in the hospital for other diseases, or having been taken in for the express purpose of trying the efficacy of the remedy. Of 37 patients to whom, on looking over the hospital journals, I find iodine was administered in one or other of the methods described above, it would be useless to give the cases of the whole, because several of them, from the ambi¬ guous nature of the diseases with which they were affected, from other medicines having been previously employed, or from the iodine not being fully tried, do not furnish any satisfactory conclusions. I shall mention only those cases in which the disease was clearly marked, and the efficacy of the iodine fairly tried. Secondary Syphilis. I shall first mention four cases of se¬ condary syphilis. Archibald M‘Gillivray, set. 24, shoe¬ maker. January 7th, 1836: Contract¬ ed syphilis about three years ago. Since this, secondary symptoms have been ob¬ stinate, notwithstanding four or five complete courses of mercury, two of which he underwent in this hospital. About a year ago a node formed on each tibia, and some time afterwards one appeared on the ulna of the right arm. An eczematous eruption broke out on the face in July last: it was removed by means of sarsaparilla and mercury, but reappeared about three weeks since on left superciliary ridg'e and chin. The node on left tibia becoming painful, red, and fluctuating, eight days since he had it laid open by a free crucial incision. On admission the wound has an un¬ healthy appearance ; granulations are glassy, and discharge consists of brown pus, tinged with blood. Surface of tibia is bare, rough, and irregular, in centre of wound, for the space of about half an inch in diameter ; and a probe passes outwards beneath the integuments for a short distance. General health good. Jan. 8th. — Sumat ter indies Iodidi Amyli, ^ss., ex haustu Decoct. Aven. Curet. Ulcus, Ung. Oxid. Hydr. Ruhr. 13th. “Iodine agrees well, and urine strongly impregnated with it. Augeat. dosis Iodid. Amyl. ad^j. ter in¬ dies. 20th. — Fresh eruptive patches on nose and right leg ; node on left tibia and right ulna diminished in size, and free from pain. Medicine agrees well, only it renders him costive, for which he has had a laxative several times. Feb. 20th. — About eight days ag’o salivation and swelling of the face came on. Since yesterday has spat upwards of a pint of saliva, which is as strongly impregnated with iodine as the urine. Two small ulcers on inside of left cheek ; nodes gone, and eruption where ulce¬ rated has now healed ; sore of leg looks better, but there is still bare bone in the centre of it. Ossi nudato adhibeatur Acid. Muriatic. Dilut. March 12tb. — Salivation subsided soon after last report, and sore of leg healed very speedily after the bare bone had been dissolved away by the mu¬ riatic acid. Dismissed cured. James Kilpatrick, set. 34, flesher. March 30th : About three months ago observed several warty excrescences forming around anus ; his attention be¬ ing’ called to them in consequence of the irritation they produced. A week or two afterwards observed purulent matter exuding from below' prepuce, and, on examination, he found superfi¬ cial ulceration behind corona glandis. On admission ulceration is still found in this situation ; discharge is thick pus. Prepuce is somewhat swollen, and ori¬ fice contracted. On scrotum, body of penis, inside of thighs, and around anus, is an eruption of ulcerated patches, which appear to have commenced in slightly elevated round spots, about half an inch in diameter ; these became ex¬ coriated on the surface, and, by coales¬ cing, have assumed irregular forms in several places. The discharge is thin and sero-purulent ; parts are the seat of considerable itchiness; throat is in a state of superficial ulceration, and right tonsil is much enlarged. Scattered over the body and upper extremities are a few blotches of a coppery hue. Had THERAPEUTICAL EFFECTS OF IODINE. 43 gonorrhoea about three yrears ago, but denies ever having had chancres before. Never used mercury. March 31st. — Sum. ter indies Iodid. Amyl. 3SS. Ficis circa anum et ulceri- bus scroti adhib. Vapor Iodinii, et postea Ung Periodidii Hydr. April 29th. — The dose of iodid. amyl, was increased to one ounce, but it was found to occasion looseness of bowels ; he has therefore taken it for the most part in 3ss. doses. All the symptoms of the disease for some time gone. Dismissed cured. In the two following cases the iodine was given up, and mercury substituted, on account of the venereal eruption not going away, but, on the contrary, fresh patches of it appearing. I would not now, however, consider this a sufficient reason for stopping the iodine. In the case of M‘Gillivray, detailed above, in which a complete cure was ultimately effected, fresh patches of the eruption came out when the patient was fully under the influence of the medicine. Dr. Lawrie informs me that he has so often made the same observation, that he considers the fresh eruption as by no means an unfavourable symptom ; and he has further remarked, that it is only in cases of syphilis that any eruption shews itself under the use of iodine. David Struthers, ret. 32, weaver. De¬ cember 21st, 1835: Surrounding anus and between nates is a collection of small round superficial ulcers, slightly raised at their margins. The discharge is thin, sero-purulent, and irritating; intervening integuments red and tender. Several ulcers of a similar character are scattered over scrotum and integuments of penis. Contracted sores from impure con¬ nexion about ten weeks ag*o ; these are still open behind glans, near left side of frrenum. Disease appeared around anus about nine weeks ag’o ; and about a fortnight ago a lichenous eruption broke out over arms and body, accom¬ panied by itching. No treatment. Sum. ter indies Iodid. Amyl. 35s. 27 th. — Med icine agrees well. Urine abundant, and becomes as black as ink on addition of starch and nitric acid. I ngeat. dos. ad Jj. ter indies. January lltli. — For fifteen day’s took oiij - °f iodid. amyl, daily: it appeared to render bowels costive, requiring the use of castor-oil. Stools somewhat whitish. Took last dose on the morn¬ ing of 6tb instant ; tinge of iodine con¬ tinued in the urine till fifth day after. Little change upon eruption or sores. Rep. Iodin. sed Sum. solummodo, 3SS. ter ind. Curent. Ulcera Ung. Iodin. February 2d.— Iodine has agreed bet¬ ter in diminished doses. Ulcer around anus nearly healed, but little change on blotches of the skin, and two new ones have appeared on scrotum. Omit. Iodin,— Sum. Pil. Hydr. ij. V. et i. M. 16th. — Cured. The other case is that of a mail (James Hare, Ward No. 12), who was admitted for strumous sores in the groin, originally excited by venereal infection. He was put upon the beau¬ tiful new salt of iron, discovered by Mr. Graham — the peroxalate of iron and potass ; which appeared to act very effectually as a tonic, and was given in gradually increased doses, till he took of it gr. xv. twice a-day. He was next tried with iodide of starch, which was given at first in very small doses, as he was one of the first patients to whom it was prescribed. The dose was gradu¬ ally increased, and when he was fully under the influence of the medicine, a copious eruption of blotches took place all over his body. The iodine was in consequence intermitted, and first sar¬ saparilla and afterwards mercury sub¬ stituted ; under which remedies the cure was effected. Sloughing Sores of Penis. Four bad cases of this kind were treated with iodine, and all of them did well. These patients wrere Smith, M Kittrick, Norie, and Macdonald ; all of them in Ward No. 7. The two first used the iodid. of potassium, in 3,j* doses ; the tvvo last the iodid. of starch, in ^j. doses. It is to be remembered, however, that strong nitric acid as a caustic, opium, and other remedies, were also employed ; whence it is very difficult to estimate the value of the iodine. I shall not, therefore, insert these cases, but merely say that my im¬ pression was in favour of the utility of the iodine. In an exceedingly^ severe case which I saw in private, along with Dr. Black, Kent-street, the iodid. of potassium seemed also to be of service ; but the 44 DR. BUCHANAN ON THE strong- nitric acid being here likewise employed, there was the same room for scepticism. The only other case of syphilis to which I shall advert is that of M‘Gregor, (Ward No. 7); in w hich mercury was prescribed in the first instance, and to it the cure was undoubtedly to be ascribed. I only mention this case to illustrate the effects of iodid. of potassium introduced by inunction. An ointment was formed, containing 3j. of iod. potassii to jj. of lard. With this ointment the patient was directed to smear over the whole surface of the body. He used ^ss. of the ointment at night, and the other Jss. next morning. At the hour of visit, no iodine could be detected in the urine. He was in consequence directed to rub in a whole ounce of the ointment that evening and next morning. In the urine passed in the morning before the second inunction, there was merely a trace of iodine, while in that passed after mid-day it w'as exceedingly abun¬ dant. Sibbens. Considering the efficacy of iodine in syphilis, it w-as natural to infer, from the analogy of the two diseases, that it would likewise prove an useful re¬ medy in sibbens. It was accordingly tried in the following case, and the re¬ sult was highly satisfactory. Hugh Macgregor, set. 33, farmer, Balqhuidder. April 12th : On left side of isthmus of throat, occupying both pillars and the intervening space, and stretching over front of uvula, is a patch of superficial ulceration, with slightly elevated edges and indolent surface, covered with a yellow exuda¬ tion. Uvula is much relaxed, and from part of the velum on the left side being destroyed, it inclines to the right. Parts in the neighbourhood of sore are of a dusky-red colour. Ulceration ap¬ peared about 3^ months ago, and w-as treated with mercury, with good effect. It did not continue well, however, above a fortnight ; ulceration reappearing and spreading- to a greater extent than be¬ fore. Denies all syphilitic taint, and attributes his complaint to eating from the same dish and smoking the same pipe with an infected person. About ten years ago was much troubled with cynanche tonsillaris, advancing on the last attack (seven years ago) to suppu¬ ration. Sum. Iodid. Amyl, ad ^ss. ter indies. 15th. — Augeat. dos. Iod. Amyl, ad Jj* ter indies. May 4th. — Dismissed cured. Scrofulous Affections of Joints and Bones. The most formidable diseases of the scrofulous kind which come under the cognizance of the surgeon, are the af¬ fections of the joints. The most com¬ mon of those affections is that which originates in the ends of the bones form¬ ing the articulation, by the deposition of tuberculous matter in their cancel¬ lous structure. In one case of this kind, the iodide of potassium was prescribed, in the dose of 3ij. daily; but, in conse¬ quence of tbe medicine disagreeing, it was intermitted before any judgment of its efficacy could be formed. It will be seen, however, below, that in diseases of the same nature, only existing in bones not entering into the formation of any large joint, the iodine was decid¬ edly useful. In tbe scrofulous thicken¬ ing of the synovial membrane, another disease of the joints not less intractable, and in this part of the country little less frequent than that just mentioned, the trials made of the iodine were unavail¬ ing, as illustrated in the following case. Jane Montgomery, oet. 12. January 19th : Right knee-joint is much swollen, measuring* fully an inch in circumfe¬ rence more than left. Form of joint is lost, the shape of patella being* ob¬ scured in consequence of surrounding tumefaction. Above patella, and also on inside of knee, opposite head of tibia, there is evident fluctuation. These fluctuating swellings do not communi¬ cate with each other. There is also a fluctuating* spot, small in size, on the outside of head of tibia. Limb par¬ tially flexed, and any attempt at exten¬ sion produces pain. Little or no un¬ easiness is felt on pressing the articu¬ lating surfaces together, nor does pres¬ sure on the extremities of the bone ex¬ cite much pain. Complaint is of about twelve months’ duration, and has been treated with counter-irritants, with re¬ lief to the pain, but without benefit to the swelling-. General health impaired ; occasional night sweats ; pulse 124. Feb. 2d. — A blister applied over joint, with diminution of pain ; tongue clean ; appetite improved. Sum. Iodid. Amyl. 3ij. ter indies. 18th. — Little change upon knee; elastic swelling oil the outside of it less THERAPEUTICAL EFFECTS OF IODINE. 45 distinct, while that over inner head of tibia has more feeling’ of fluctuation. Pulse averages about 125, appetite good, tongue clean. Less pain of knee ; medi¬ cine agrees well, and urine strongly im¬ pregnated with it. 24th. — • Three days back, much increase of pain of knee, with increased swelling, and redness of surface ; pulse 144; tongue clean, but appetite im¬ paired. Leeches twice applied to knee, and iodine stopped. 28th. — On 25th, at a consultation, it was recommended to delay amputa¬ tion, and to puncture the fluctuating tumor over head of tibia. This was accordingly done, and about 3ss. of curdy matter discharged. March 15th. — Amputation was deter¬ mined on at another consultation, but the parents refusing’ to give their per¬ mission, the girl was removed at their desire. The following case was one of those in which the virtues of iodine were most remarkably exemplified. It will assist the mind in forming an idea of the appearance of the diseased parts, to men¬ tion that several medical gentlemen, who saw the case when first admitted, thought that partial amputation of the hand was the only remedy likely to be of any use. John Elliot, set. 24, sadler: Aug. 4th. Twelve months ago an abscess formed on back of hand, above the thumb, which burst some time after, giving exit to a considerable quantity of pus. About same time an abscess formed over ball of right thumb, which was opened. On admission, there exists over hand a large strumous-looking ulcer, inter¬ sected by undermined bands of skin, and secreting thin unhealthy pus. Hand is the seat of considerable aching pain. Through a part of this ulcer metacarpal bone of index finger is detected in a carious state ; over ball of thumb are also two openings of the same character, but through neither of these is bone found bare. Left knee-joint measures an inch more than right in circumference. Swell¬ ing principally confined to the bursa above patella; there is apparently but little affection of the synovial membrane around the knee; head of tibia is the ^eat of a good deal of pain, especially when pressed upon. General health pretty good ; diathesis strumous. Sum. 01. Ricini, Jj. ; et parti genu dolenti adhibeatur Empl. Mel. Vesie. Aug. 16th. — Knee much improved by blister; little change in sore of hand. R Iod. Potassii, 3j. ; divid. in pulv. xij. Sum. j. ter in dies. R Todinii, gr. x. Axungias, ^j. M. Fiat ung. quo caret. Ulcus. Aug. 19th.— Augeat. dos. Iod. Potass, ad gr. x. Sept. 10th. — Iodine ointment not ap¬ plied, sores having been dressed with a poultice all along. Has taken iodid. potassii in gradually increased doses, and for a fortnight has taken 3j. daily; medicine found in large quantity in his urine. Sore nearly healed ; no carious bone discharged. Continue. Sept. 14th. — Sores quite healed; dis¬ missed, cured. In the two following cases the use of the iodine was conjoined with a local application, which appears to me to be of much service in the treatment of many cases of carious bone. I allude to the application of diluted muriatic acid used altogether as a chemical remedy, for the purpose of dissolving- away the exposed bone. In this way portions of bone which are keeping up a lingering disease may be removed more speedily than by any other means, save excision. I have already men¬ tioned one instance of an obstinate sore upon the tibia, which was cured by means of the acid very speedily, and certainly with far less pain to the patient than could have been accomplished by the saw or the gouge. I have found an acid of the strength of the acid, muriatic, dilut. of the Pharma¬ copoeias, to have a solvent powrer suffi¬ ciently energetic, and at the same time to occasion very little irritation of the soft parts in the neighbourhood. It may be conveniently applied by means of a long- glass tube, which should be about half an inch in diameter, and drawn out at the lower end, so as to be little thicker than a probe ; or it may be applied by means of an apparatus like that used in the laboratories for washing precipitates from the sides of the funnel. John Kenney, set. 16, piecer. Feb. 6th : About 10 months ago, after a slight injury, right foot became swollen, but without pain, redness, or constitutional affection. A short time afterwards, small abscesses formed on outside of dorsum, and on the sole. Some were opened 46 DR. BUCHANAN ON IODINE. by puncture, and others allowed to burst spontaneously. Since this they have assumed an indolent character, shewing no disposition to heal, and discharging’ thin sero-purulent matter. Through two of those, on the dorsum, diseased bone can be detected. Into one of those on the sole, probe can be passed 1^ inches without detecting bone. The others are more superficial, extending but a short way beneath surface. Experi¬ ences no pain or uneasiness in the foot. A small sinuous abscess of a strumous character exists on neck, beneath left angle of the jaw, discharging thin mat¬ ter, mixed with curdy flakes. Probe passes for about an inch under integu¬ ments, which are red and thin. Gene¬ ral health somewhat impaired, with occasional rigors, but, he says, no night sweats. Pulse 108 ; tongue clean. At a consultation held upon this case, partial amputation of the foot was re¬ commended, but I preferred trying the effect of medicine in the first instance. Half an ounce of the liquid hydriodic acid was prescribed three times a day, and soon after the local application of the dilute muriatic acid was begun. In the course of three weeks the diseased bones were partially dissolved and sof¬ tened, but the fever did not abate, and the boy’s friends, apprehensive of an operation, had him removed frorn^ the house. Ann M‘Eachern, set. 27, March 16th : On left forearm are situated several ulcers, varying in diameter from half an inch to an inch and a half. The largest, situated on the anterior aspect, presents an indolent disc, covered with pale flab¬ by granulations. Edges are sharp, and slightly elevated. The others have thin slightly-livid margins, and are with¬ out any appearance of granulations : the discharge which issues from them concreting into yellowish green scabs. Through one, situated over lower third of ulna, probe passes, detecting rough bone, and in June last, a frag’ment of bone, about two inches in length, was discharged from this spot. Skin of nearly whole of forearm is altered in appearance, from the cicatrization of former ulcers. On left clavicle is a large narrow sore of a similar character, with large one on forearm. Those on the arm are of several years’ duration; that on the clavicle appeared about six weeks ago, from the bursting of a small abscess. Right knee-joint is somewhat swollen, swelling being soft and fluctuating, and presenting itself principally on either side of patellar ligament and tendon of rectus femoris. •Patella is raised from the condyles. Mo¬ tion of joint is unaffected, and disease is productive of little or no uneasiness. It appeared about a year ago, without evident cause. General health pretty good. Sum. ter indies lodid. Amyl. 0*9 moniacal salts . ) Alkaline salts • • • * . 3*5 Earthy ditto . 0*4 Traces of lithic acid and vesical mucus. 1000 0 The constitution of healthy urine may be rep resell ted by the same formula, as follows : — Water . 933*0 Urea . 30-1 Extractive soluble in wrater, 1 and extractive soluble in al- f jg ^ coliol and water — ammo- f niacal salts . . . j Alkaline salts . 16 0 Earthy salts . 10 Lithic acid and vesical mucus* • 1*0 10000 It w ill be remarked on examining* these analyses, that the diseased speci¬ men is entirely wanting in the extrac¬ tive soluble in alcohol and water, and that the extractive soluble in water only, is in very small proportion. The urea, if taken in relative quantity to the solid constituents of the diseased urine, will be seen to exceed by far the proportion which that principle bears to the quan¬ tity of solid matter in the healthy fluid. The proportion of alkaline salts, if taken in relation to the propor¬ tion of solid matter, will be nearly normal. Th is diseased specimen is therefore to be regarded as a dilute urine, in which the urea has entirely supplied the place of the extractive soluble in alcohol and water; and, in part, that soluble in wa¬ ter only. The urea obtained during this examination was so pure, that it crystallized from the first alcoholic solution in perfectly white four-sided prisms. The proportion of solid matter in healthy urine is 67 grs. in 1000 grs. 30*1 (or less than half) being* urea, The solid matter of the diseased speci¬ men under consideration forms 15 grs. only, in the 1000 grs., 10*2 (or more than two-thirds) being urea. This diseased condition of urine is nearly allied to that mentioned by Dr. Prout in his work on the Urine, &c. ; differing only in possessing a very light specific gravity. I am not aware that the entire absence of the extractive so¬ luble in alcohol and water has ever, till now, been shewn in the analysis of dis¬ eased urine. 54 EXTRAORDINARY VERDICT OF A CORONEr’s JURY. EXTRAORDINARY VERDICT OF A CORONER’S JURY, IN A CASE OF SUSPECTED POISONING. To the Editor of the Medical Gazette. Sir, Having just perused the leading* arti¬ cle in your number for the 13th instant, T am induced to send you the following* account of an occurrence which came under my observation in this neighbour¬ hood. If it possesses no other value, it will at least prove that there is urgent necessity for the community and the legislature to view with suspicion and distrust the published reports of co¬ roners ; and that it is incumbent on them to demand an increased efficiency from these persons, as well as the medi¬ cal witnesses, in the discharge of their important duties. On the 28th of last June a surgeon of this place was requested to accompany a medical man, to examine the body of a servant girl, 16 years of age, who had died under suspicious circumstances. The previous evening she retired to bed in perfect health and excellent spirits, about ten o’clock, after making a supper of boiled milk. She was said to have been unusually cheerful in the evening*, and had been dancing. About twelve o’clock her mistress was disturbed by her moans, and noise produced by vo¬ miting, and went to her assistance. She was vomiting, and appeared very faint, and said she suffered severe pain at the pit of the stomach. She was conveyed to a window, and being some¬ what refreshed, back again to bed, — grew worse and worse, and died, in the arms of her mistress, about four o’clock, before medical assistance could be ob¬ tained. The stomach, with its contents, was removed ; the former presented such decided characters of the effects of arsenic, that any one having an eye practised in the morbid appearances produced by this poison, would have drawn that conclusion; and this was declared by one who saw it, without any acquaintance with the history of the case. The tests for arsenic in the hands of these medical men, — the gentleman who made the cadaveric inspection, and two others to whom he had given por¬ tions of the contents of the stomach, — were perfectly satisfactory. From the sulpburet of arsenic obtained, splendid coatings of the metal were procured, and from this, brilliant crystals of arse- nious acid. From the quarter of a grain of arseniuret of copper I succeeded in deriving a sufficient number of crys¬ tals to form a conclusive opinion of the presence of the poison. The fact of the presence of arsenic was made known by the surgeon before mentioned to the coroner, — a non -pro¬ fessional individual, but one who has long held the office, — who expressed great dissatisfaction to him on account of his having presumed to examine the body before the inquest had been held, — became extremely indignant, — assert¬ ed that he wras liable to an action for daring*, without his authority, to exa¬ mine the body,— and so on. At the inquest, this individual, from whose lips the coroner had heard, as a positive certainty, that the poor girl was destroyed by arsenic, was not called ; and from the (I suppose) coro¬ ner’s account, which appeared in the Stamford Mercury, which I shall ex¬ tract, it is probable that the jury were kept in complete ignorance of it. Extract from the Stamford Mercury of July 8, 1836. “ On Thursday, the 30th ult., an in¬ quest was held at Swinethorp, before ft. Bunyan, gent., coroner, on the body of Sarah Maltby, aged 16, who died suddenly, on the Tuesday morning previous. It appeared that the deceased was servant to Mr. Bottomlev, and had retired to rest in apparent good health. At about 12 o’clock she w*as seized w ith a violent pain in her stomach ; her mis¬ tress got up, and took her to the win¬ dow*, and, after remaining there for some time, she somewhat recovered, and again retired to rest ; but, about four o’clock in the morning, she was found dead in bed. Verdict — ‘ Died sud¬ denly.’ ” I shall not encroach upon your useful time, sir, by making any comment upon the inaccuracies of the statement of the circumstances which is placed before the public ; the object is percep¬ tible. — I am, sir, Your obedient servant, Indicator. London, Aug. 20, 1836. HOMOEOPATHY AND ITS LATE DOINGS. 55- ANALYSES and NOTTCESof BOOKS. u L’Auteur se tue a allonger ce que le lecteur se tue a iibieger.” — D’Alembert. The Botanist ; containing accurately coloured Figures of tender and hardy Ornamental Plants, ivitli Descrip¬ tions. Conducted by B. Maund, F,L S., assisted by Professor Hen- slow. 4to. To be continued Monthly. No. T. Since botany, which, as some are of opinion, never should have been di¬ vorced from medicine, of which it has been aptly styled “the hand-maid,” has been again included in the curriculum of medical education in this country, various works have appeared, calcu¬ lated to assist the student in acquir¬ ing- a knowledge of the principles of the science. Something- was still want¬ ing-, which, by appealing to the cor¬ poreal as well as the mental eye, should take captive, as it were, two senses at once, and so ensure the entrance of knowledge hy two loop¬ holes. A work with pictorial illustra¬ tions could alone do this. Such a one appears likely to be supplied by that of which we have copied the title above. A good introductory notice explains the nature of the assistance it is calculated to afford ; the plates are well engraved, and most exquisitely coloured, while the descriptive letter-press conveys much scientific and popular information respecting the plants delineated. The great peculiarity of this work seems to be, that the objects figured are not, as in other works, regarded as isolated in¬ dividuals, but as members of the vege¬ table kingdom, having- affinities to other individuals. It therefore leads to the consideration of the principles of the natural method of botany, and induces the reader to take comprehensive views of the plants which come before him, in respect to their organization and physiology. On this account, medical students are likely to feel more interest¬ ed in it, and it will constitute a valuable companion for them, when pursuing their studies, and a pleasing manual to refer to when settled in practice, and residing, as many will be, if not altoge¬ ther in the country, at least in houses with gardens attached, where, dur¬ ing their hours of leisure, they may enjoy a delightful recreation in the cul¬ tivation of many of the elegant pro¬ ductions of nature, of which they might, perhaps, never have heard, but for such a work as this ; the cheapness of which puts it within the reach of every one. To such of our readers as already possess a taste for botany, no further recommendation is necessary ; while, for those who are yet unacquaint¬ ed with it, we do not know any work better calculated to inspire a love for it, and gratify it when awakened. | MEDICAL GAZETTE. Saturday , October 8, 1836. ** Licet omnibus, licet etiam ntihi, dignitatem Artis Medicos tueri ; potestas modo veniendi in publicum sit, dicendi periculum non reeuso.” ■Cicero. HOMCEOPATHY AND ITS LATE DOINGS. The death of Malibrau, lamented as it is by the community at large, and as it must be by a great portion of the civi¬ lized world, has pjroved, it would seem, rather a God-send to a small knot of ignorant but mischievous pretenders: mem by whom any kind of notice, even though originating in a calamity itself, must be esteemed as a positive benefit. The disaster to which we regret to have to allude has conferred a transient noto¬ riety, however unenviable, on the homceo- patliic practices; audit was amerechance that it did not do more. Homoeopathy wanted but another step to put it on a footing with the hygeian quackery — the publicity of a coroner's inquest ; a distinction which it had just now nearly obtained. We do not mean to impugn the judg¬ ment of those gentlemen — the commit¬ tee at Manchester — who decided that an inquest in Madame Malibran’s case would have been improper, or might fairly be dispensed with. But we ob¬ ject to such a decision in the abstract: 56 HOMOEOPATHY AND ITS LATE DOINGS. strict justice would demand, that if the Morisoniafi manslaughters be exposed and punished as they deserve, the Hah- nemannian doing’s, which also deal in¬ sidiously and destructively with human life, should certainly not be screened. Some gentle reader may, perhaps, suppose that we are too severe on the disciples of Hahnemann : that, at the worst, they are but harmless quacks; and that their doses being' infinitely small, are capable, accordingly, of doing infinitely little mischief. We deny the inference, and must insist on the cor¬ rectness of our principle. The doses, we will suppose for argument sake, are in themselves perfectly innocuous ; yet such doses, when given at a moment when energ'etic practice is required, are fraught with dang’er ; and when an ig¬ norant practitioner, professing homoeo¬ pathy, rashly takes upon him the re¬ sponsibility of a critical case, Hinging away the moments that are most pre¬ cious, and on the right employment of which the balance of life or death turns, we say that such a practitioner is guilty of a great crime, and merits the sternest visitation of the law. In acute disease, and cases similar to that of the unfortu¬ nate Malibran, the expecting practice, as it has been called, or the “ leaving all to nature” — even if homoeopathy were as harmless as that — wTere to throw over¬ board our helm, sheet anchor, and all that might contribute to our safety, and to trust to the mercies of a provi¬ dence that ever frowns on the inactive. In the most stupidly savage state of society, nothing more barbarous could be done. When the means of depletion, or lowering the system, on the one hand, or those of stimulating it, on the other, offer the only hope of preserva¬ tion, homoeopathy — taking even the most favourable view of it — sits still and does nothing, — while it promises as much as, nay, more than, if the rules of art, de¬ rived from the soundest experience, were duly put in practice. But homoeopathy does not even pos-, sess this negative quality on which to rest its defence. It plays upon the imagination of its dupes: it works upon them by certain pretended latent affini¬ ties, as Mesmerism used to do in the golden days of animal magnetism : and in this employment of a powerful in¬ strument, for good or evil, it but too of¬ ten operates mischievously on suscepti¬ ble constitutions. It may happen, by its intrinsic inertness, to do no harm, but the chances are almost wholly against such a result. Here, then, is a system, pretending to belong to medicine, to be itself medi¬ cine re-organized and reformed — yet playing in the dark, practising secretly, and now and then vaunting of the in¬ effable virtues of imperceptible particles of matter. How long is medical science, extended and enlightened as it has been of late years, to afford the passport of its name to audacious adventurers thus using' it for the vilest purposes ? And will a community, ever professing* to enjoy the benefits of diffused informa¬ tion, always remain blind to such palpa¬ ble fraud ? It will, no doubt, be said by some of the brazen impostors who support the scheme, that all this is set forth in igno¬ rance : that Hahnemannism has not got O fair play: that prejudice is strong against it, and it has never obtained a trial. This is all false : the system (sys¬ tem !) is perfectly well known as far as it is intelligible : its principles (!) are as thoroughly understood by the gene¬ rality of well-informed medical men, as by the homoeopaths themselves : but what is better still, the fruits of the sys¬ tem, as they occasionally come before the public, are closely observed and ap * predated. Hare they deny, too, that they have had fair trial — when, not to HOMOEOPATHY AND ITS LATE DOINGS. 57 speak of others, Andral, in the largest and best appointed hospital in the French metropolis, afforded every oppor¬ tunity to the cleverest of the homoeopaths, and found that they failed to make good their pretensions P But what right have they, we would ask, to claim such an indulgence ? What have they done to entitle them to so much confidence as to have the lives of patients committed to them for ex¬ periment? Let them give us the gua¬ rantee of even one physician of emi¬ nence, who will assure us that we can conscientiously trust to Hahneman- nism in any one case. They have no such surety to offer. Yet here have these medical St. Simonians been for years endeavouring to make a stand, and have produced, after all, nothing better than their Belluomini (by importation), and their Quin : we had almost for¬ gotten — their Uwins, save the mark ! When we inquire for their literature, — their knights of the pen — we find their champion in the person of a wor¬ thy son of the church, whose talent for invective and the misapplication of texts of scripture, forms his chief claim to public attention. We have had a specimen of him, and can truly say that we congratulate Habnemannism on the possession of such a mild, meek, dis¬ creet, and sagacious partisan. There have been others also, who, like Dr. Uwins, have favoured the world with a silly pamphlet, or a set of apocryphal cases, from time to time ; hut they have all long since gone down the channel into the sentina of oblivion ! And these are the creatures that talk of the envy and prejudice of the medi¬ cal profession, and who call for a fair trial. It is likely they will have this ; perhaps sooner than they could wish. Let them only get possession of another case like the recent one — let the treatment be, as much as possible, like that applied to the unfortunate Malibran — let the remedies be kept se¬ cret, and the assistance of eminent practitioners be declined — let only this be done — the catastrophe will be certain, — and we shall warrant them publicity enough. The public will have a right to learn then, who are they that, under the g*uise of authorized practitioners, tamper with the lives of the liege sub¬ jects; and the coroner will take care to investigate the matter fully. Nor will it serve the turn of those who may them shrink from the consequences of their doings, to induce the nearest relative of the deceased to quit the kingdom, and to enjoin that the body shall not be meddled with — save for the purpose of burying it with all privacy and despatch. Such things as these cannot again occur. Homoeopathy must have a trial; it must have, it has a right to have, the same publicity and attention as has been bestowed on its rival system — that of Morison. Since the preceding remarks were written, a letter from M. Belluomini, the homoeopath who attended Madame Malibran in her fatal illness, has ap¬ peared in the newspapers. The Doctor, among' other weak and silly things, says, that after a careful examination, he found that “ the viscera of the chest and abdomen had not been attacked with malady,” — and yet that “ the first effect of the medicines was to allay the cough a little and again, that “ some hours after, the fever increased, and the cough and delirium returned.” We should infer from his account (and un¬ fortunately we have no other) that the ill-fated lady had inflammation of the chest, and was suffered to die homce op at hie ally . Dr. B., we should further observe, carefully concealing his treatment, says, “ I immediately set to work to administer to the patient those remedies which I thought desira¬ ble ;” but not a word as to what they 58 'ACCIDENTS IN MINES. were. He did not wish to meet the highly respectable medical men pre¬ viously in attendance : “ I do not think it necessary,” was his answer on being asked to do so ! So much for homoeopathy, and its fair and open dealings. AMOUNT or FEES AT DIFFERENT MEDICAL SCHOOLS. From the note which follows, it will be seen that some gentlemen have mis- tmderstood the table of fees inserted at page 26 of our last number. We did not compare the amount charged at different schools for the shortest period which will enable a pupil to apply for ■examination at the College of Surgeons or Society of Apothecaries, but our calculation referred to unlimited attend¬ ance, because we knew that the great majority of pupils take perpetual tickets for most, of the courses, viz. Anatomy, Medicine, Surgery, and Midwifery ; and we therefore thought that the most useful table to them would be one show¬ ing the expense of unlimited attendance on all the lectures entering into the curricula of the Corporate Bodies. But if, instead of taking perpetual tickets, they confine themselves to the courses absolutely required, then the amount will be somewhat less than in our table. Thus, as stated by Mr. Bayntin, at St. Bartholomew’s Hospital, it becomes reduced to 57 /. 155.; and we may add, that at Guy’s the reduction is to 56/. 145. ; at London Hospital, to 50/. ; at St. George’s, to 49 guineas ; the Aldersgate School, 35 guineas, &c. &c. Our object was to refute the misre¬ presentations in the Lancet, as to the alleged cheapness of University Col¬ lege, which we demonstrated unan¬ swerably to be by much the dearest school in Loudon. According to the present calculation (*. e. of the expense of those lectures merely which the cor¬ porate bodies require), the amount is not less than 67/. 125. to pupils 'who have not a nomination, and 63/. 25. to those who have. But for Mr. Wakley’s advocacy, this disparity might have escaped notice : so much for having an indiscreet friend ! To the Editor of the Medical Gazette. Sir, In the tabular view of the Amount of Fees at the different Schools for attend¬ ance on the Lectures required by the College of Surgeons and Society of Apothecaries, you have stated the amount of fees at the Medical School of St. Bartholomew’s Hospital to be 65/. 25. ; whereas by the Prospectus of the School it appears that the total expense for the above purposes is 57/. 155. As this inaccuracy is likely to mislead, 1 write to request that you will correct it in your next number. — I am, sir, Your obedient servant, W. J. Bayntin, Curator of the Museum. St. Bartholomew’s Hospital, Oct. 6, 1836. ACCIDENTS IN MINES, FROM EXPLOSIONS OF FIRE-DAMP. The public attention is eyer and anon painfully called to this subject ; yet it is surprising with how little effect. No steps are taken by government for af¬ fording protection from the frequent loss of life which occurs in the coal districts, nor do the mine-ow'ners profit in the least by the sad experience they ob¬ tain so constantly, of the inefficient means which they have hitherto em¬ ployed for preventing accidents. Only last week a fresh explosion of fire-damp destroyed eleven persons, at Newxastle- under-Line, where the work w'as being carried on with common candles : the verdict of the coroner’s jury was, “Acci¬ dental death,” How that can be called accident , of which the probabilities are so manifest, is to us an enigma. It is nearly a year since wre made some remarks on this subject, suggest¬ ing that a regvilarly organized board of visitors, or commissioners, appointed at the Home Office, should superintend the safety of the mining districts; and we insisted on the speedy adoption of those lamps which had been proved to be per¬ fectly secure. The government has re-- PROJECTED POOR-LAW CLUB AT CAMBERWELL. 59 mained supine in the matter, notwith¬ standing- the strong- representations con¬ tained in the Report of the Parliamen¬ tary Committee: but we are glad to find that a proper spirit has begun to prevail, touching the necessity of guarding more effectually against the explosive gases met with in the collieries. The insecurity of the Davy-lamp in currents of inflammable air (the very emergency in which its services would be most needed), has been demonstrated to the conviction even of the most incredu¬ lous ; and the superior merits of that lamp which stood every test and ordeal to which it was submitted, in presence of the Parliamentary Committee — wre mean that of Messrs. Upton and Ro¬ berts — are now almost universally ac¬ knowledged. We have derived much satisfaction from the perusal of the subjoined letter from Dr. l ife, of Newcastle: it will be recollected that this gentleman, last year, wrote a pamphlet on the fatal ac¬ cident which had shortly before occurred at Walsall, and by which above 100 lives were lost in a moment*. Among the preventives which he then suggest¬ ed, the construction of perfect Davy- lamps was dwelt on as of paramount importance. Dr. Fife, at that time, im¬ plicitly believed in the perfection of the Davy, if it were only properly made and duly attended to. He even challenged the statement of any well-authenticated case tending to invalidate his opinion. Let us now see his present impressions as expressed in the following letter to the Editor of the Newcastle Journal. We have only to add, that we think the Doc¬ tor’s candour does him great credit: — In reading the Courant of the 3d inst., my attention was arrested by the sub¬ joined passage in the report of the “ Natu¬ ral History Society,” read at its seventh anniversary meeting. The report con¬ cluded by enumerating the papers which had been read at the several meetings dur¬ ing the year, and the investigation which had been made of the Minhig Gas in this district, in consequence of its having been alleged to be of so highly explosive a nature as that the Davy Lamp was not a sufficient protection against it. The re¬ sult of the examination was, “that no free hydrogen was found, or any other highly explosive gas, against which the lamp in question was not a sufficient protection.” To the last sentence of the above extract I shall at present confine myself. As to the constitution and properties of the gas met with in our mines, I believe these were perfectly analysed and as thoroughly un¬ derstood by the illustrious Davy as by any modern chemist ; consequently the non¬ existence of free hydrogen cannot be regarded as a new discovery. Again, as to the high or low explosive power of any gas of our mines, I believe he was also fully aware that the explosive or detonat¬ ing power existed only when such gas was diluted to a certain point with atmosphe¬ ric air, and that when the dilution was either above or below such point, that eminent man knew', though inflammable, the mixture would not explode. He was also aware that a certain degree of at¬ mospheric pressure wras essential to deto¬ nation. I come now to the most im¬ portant part of the extract, viz. the asser¬ tion “ that no gas existed in mines against w'hieh the Davy Lamp was not a sufficient protection.” Had this statement been made prior to the publication of the evi¬ dence taken and the experiments made before the parliamentary committee “ on accidents iu mines,” I should have been less surprised ; as it is, I am at a loss to conceive upon wrhat grounds any scientific body could advance such a statement, as the fallacy of the Davy Lamp is by that evidence and those experiments fully esta¬ blished. At the time of the parliamentary investigation, no one could believe more firmly in the security of the Davy Lamp than I did; I am now, however, not only from the testimony of practical miners and the experiments of scientific chemists, but also from the repetition of those experi¬ ments myself, fully convinced of my error, and conceive it to be my duty to endea¬ vour to correct the propagation of an un¬ founded assertion, the only tendency of which would be to give unwarrantable confidence to the miner, and possibly lead to farther sacrifice of valuable lives. George Fife, M.D. Eldon-Square, Sept. 15, 1836. PROJECTED POOR LAW CLUB AT CAMBERWELL. To the Editor of the Medical Gazette . Sir, From the great impartiality with which your journal is conducted, I am induced to send you a few lines respecting the medi¬ cal club intended to be formed in the parish of Cambenvell. According to the Poor Law Amendment Act, no further medical relief w ill be given * See Medical Gazette, vol. xvii. p. 146. 60 NEW FARTHING CLUB ; OR to the poor of this parish after the 25th of March next, (except in the workhouse) : to avert the evils of such a measure, it was recommended by the Board of Guardians, that an independent medical club be form¬ ed to attend the poorer classes, for such small sums as they, with the annual sub¬ scriptions, might be able to afford. With this object in view, a meeting of the resi¬ dent practitioners was called, in order to make rules for carrying it into effect, and to divide the parish into districts, leaving the poor the option of selecting any one of the medical men of the district to attend them, upon subscribing a small sum to the club, which sum was to be paid whether ill or well, the scale of charges varying ac¬ cording to the number of the family. Judge, then, of the surprise, not to say indigna¬ tion, of the resident medical practitioners who were favourable to the measure, upon entering the room, to find it occupied almost entirely by medical men collected from different parts, the majority having no connexion whatever with Camberwell, and whose avowed object was a determina¬ tion, as one of them expressed it, to crush the measure ; applying to those who were willing to lend their support, terms of no measured censure, and making up by cla¬ mour what they were deficient in argu¬ ment; in fact there was not a single argu¬ ment against the principle * the only word that could be heard ‘ ever and anon 5 above the din and confusion that prevailed, were black sheep, degrading y lowering the dignity and honour of the^ profession ; and some gentleman went so far as to talk of post¬ ing the names of all who were favourable to the measure ; no doubt, in order that “ we petty men should walk under his huge legs to find ourselves dishonourable graves,” and with a view that we might be denounced by our brother practitioners. After witnessing such a scene as this, pray spare us from hearing any more of the cant about the liberality and honour of the profession. In conclusion, allow me to transmit the names of those who “(to their praise be it spoken)” are willing to lend their assistance to the much abused medi¬ cal club. Practitioners favourable to the forming of the Club. Mr. Bean, Mr. Wm. Bean, Mr. Tobias Browne, Mr. John Browne, Mr. Forbes, Mr. Flower, Mr. Hughes, Mr. King, and Mr. Young. Unfavourable. Mr. Bowen, Mr. Bristowe, Mr. Massey, and Mr. Scrimshire. It is proper to state that I confine my¬ self to the Cambemoell district, leaving out the Peckhum and Dulwich districts; also the Walworth, Blackfriars’ Road, London Road, Kent Road, Trinity Street, Union Street, Blackman Street, and Newington, thinking it absurd to suppose that any of the medical men residing in the omitted districts would be appointed to attend the Camberwell district. In order to guard against any misappre¬ hension, I beg to observe that the names stated as favourable, are those given in to the Guardians, as fully agreeing to the principle; and it was their intention to have made some required alterations in the scale of remuneration, as well as to have excluded domestic servants in situation, and to have reduced the scale of eligible members, from those receiving 35s. a week down to 25s. Other alterations, especially that regarding midwifery cases, were in contemplation to be proposed at the very meeting when the operation of crushing was so powerfully applied to the system by the practitioners of Walworth and neighbour¬ hood. After this plain statement, I confess that notwithstanding all that has yet been said or written on the subject, I cannot see why the medical men of Camberwell should allow themselves to be dictated to by those in no way connected with the Camberwell district, and suffer them to decide the question whether it is expedient to form a Medical Club or not. I trust the medical men of Camberwell will assert their independence by deciding this ques¬ tion for themselves. By inserting these remarks, you will greatly oblige A Camberwell Practitioner. Oct. 3, 1836. NEW FARTHING CLUB; OR ME¬ TROPOLITAN INFINITESIMAL DISPENSARY. ( From the Medico- Ch'rurgical Review .) A prospectus of this important institution has just reached us. It is to be under the direct patronage of a Prince of the Blood, a distinguished Earl, and many of the nobility and gentry. Its own merits, however, will insure it universal approba¬ tion and support. The superintendence of the Dispensary is placed in the hands of four of the most experienced homcepa- thists of this country. It is on a plan so much superior to the penny-clubs now spreading over the country, that it will soon supersede them all. The subscrip¬ tion is to be only one farthing per head per annum ! We may calculate that, taking the rich with the poor, there is an expen¬ diture, in London, of twenty shillings per METROPOLITAN INFINITESIMAL DISPENSARY. 61 head, on medical attendance and medicines — and as the Metropolitan Dispensary will do away entirely with the heavy fees and long bill of physicians, surgeons, (except¬ ing for operations), apothecaries, and che¬ mists, the saving to the public of this capital will be more than a million an¬ nually ! ! There can be no doubt that the whole population will subscribe at once ; but, under such patronage, a charter of in¬ corporation will certainly be obtained next session, and thus its success will be secure. Four homoeopathic laboratories are to be established, namely, at the Chelsea Water Works, on Primrose Hill — at the New River Head — at South Lambeth — and at Hampstead. From these sources infinitesimal doses of the choicest ho¬ moeopathic remedies will be daily issued, not only for the cure, but for the preven¬ tion of all diseases. Thus it is calcu¬ lated that, when scarlatina breaks out, a daily solution of twenty grains of bella¬ donna in the Chelsea reservoir, will pro¬ tect all individuals (within the range of that company) against the scarlet fever, besides curing those who have actually caught the disease. If cholera re appears, a lump of camphor is to be thrown into each of the four reservoirs, the. emanations from 'which will soon check the Asiatic pestilence *.” The great beauty of the infinitesimal system is this, that each remedy will only grapple with, or prevent, those diseases that are of its own nature — “ similia similibus curantur.” Thus a few grains of aconite daily dissolved in each of the reservoirs, will cure or prevent all the aconite diseases of this overgrown metro¬ polis, without producing any effect on those in health, or diseases or remedies The saving of money will be the smallest part of the benefits which must flow from this most fortunate discovery. In a few years, all diseases, excepting those resulting from casualties, will dis¬ appear, or nearly so, and the value of life will be so enhanced, that the insurance offices will be able to reduce their pre¬ miums nearly one-half ! The grief, anxiety, and sorrow of families, for the loss of children, &c. will be prevented, as all people will then die the death of Nature, far beyond the obsolete boundary of three score years and ten. It is true, however, that there is no un¬ mixed good in this world. Certain orders of society, now flourishing, will be re¬ duced to beggary. The Apothecaries’ Company (who are getting up a petition modifying any other * See Dr. Uvvins’s pamphlet. to parliament against homoeopathy) will be ruined by the “ atomic doses” of the Infinitesimal Dispensary. The College of Physicians, being ruined already, thinks it useless to remonstrate. The College of Surgeons, though they will still have the monopoly of operations, are preparing, nevertheless, to petition the legislature; because they well know that, though sur¬ gery is their 'profession , physic is the best part of their practice. The apothecaries may, of course, shut up shop — and all those drug-palaces, whose windows, at night, look like constellations of etherial fire — “flammisque imitante pyropo” — must be converted into gin-shops or soda- water manufactories. It is to be hoped that government may, in charity, grant a free passage to Australia for, at least, twenty thousand allopathics, who will thus be thrown out of work in this metro¬ polis. These are little specks of evil attendant on a public — a universal blessing. The homoeopathic superintendants have hu¬ manely determined to station one of their eleves, with a few small vials and pots, some miles beyond Oxford, in order to medicate the stream of the Thames, for the benefit of the University, Maidenhead, Windsor, Kingston, Richmond, and the various towns along the river as far as Gravesend. It is calculated that a scruple of oxvmuriate of mercury, and three pints of fluid extract of sarsaparilla, thrown into the Thames at Fulham, will prove a powerful alterative for all those who drink the water supplied by the Chelsea and South Lambeth Companies. A much smaller quantity will do for the New River Head. Infinitessimal Dispensaries will, without doubt, be established in all the great cities and towns of England. And, as the present race of practitioners will certainly be the last of their kind, so our great medical schools, and even our hospi¬ tals, will shortly vanish from the scene. Homoeopathic doses of medicine will na¬ turally require but “ atomic doses” of the science on which medicine depends. In¬ deed, wre see no reason why, on the homoe¬ opathic system, we should undergo the drudgery of studying anatomy, physiology, therapoeia, or chemistry. A very few me¬ dicaments, divided and subdivided into inappreciable tenuity, are endued with the powrer of penetrating the most minute tis¬ sues of the human fabric — with the in¬ stinctive sagacity — the more than chemical affinity, of searching out, seizing, and coalescing writh their “ similitudes” in these remote recesses, — and there neu¬ tralizing their morbid qualities, and ex¬ pelling them ultimately from the body! If this be not the millennium of medicine, 62 REGISTRATION OF BIRTHS AND DEATHS. we can form no idea of what a milennium is ! Homceopathy has, we conceive, brought us to the verge of this happy epoch ; and the infinitessimal physician is entitled to the infinite gratitude of man¬ kind ! P.S.— We have just learnt a piece of curious information. It is this: Ever since the new Poor Law Act came into operation, a celebrated homoeopathist of this metropolis has been giving lectures on the infinitessimal art, to pupils who have “ passed the Hall,” and who are qualify¬ ing for the office of “ contract doctors” throughout the provincial districts. We have now a solution of the low rales at which these undertakers contract to attend the sick poor. The homoeopathic system will enable these practitioners to beat the allopath res clean out of the field ! The training requires about six weeks, and the whole apparatus medica- minum consists of a few bottles of medi¬ cated mustard seed, labelled “ homoeopa¬ thic pills.” Our informant shewed us a single formula, and the mode of prepara¬ tion is the same in all. Five grains of extract of aconite are dissolved in a pint of distilled water, and the solution is poured off clear. Into this is put a pint of white mustard seed. In a few hours the seeds swell and absorb the whole of the solution. They are then spread out in the open air, when they soon shrink back to their original dimensions, being, how¬ ever, impregnated with the aconite, and fit for use. The dose is from 1 to 10 of these aconite pills. The mustard seed is medicated or imbued with alll other arti¬ cles of the homoeopathic pharmacopoeia in the same way. The cost of physicking a large parish on the “ atomic plan,” will, it is supposed, not exceed half a crown per annum. CHEAP PHYSIC AT AYLESBURY. To the Editor of the Medical Gazette. Sir, In the Medical Gazette of the 10th itist. I perceive a letter of a correspon¬ dent who signs himself “ An Observer,” and who affects disgust with my circular of terms; but Sufferer, I conceive, would have been a more appropriate cognomen. Permit me, Mr. Editor, to observe, had the waiter been a mere observer, and actu¬ ated by impartial feelings, he would have preceded his sarcasm by a candid avowal of the degraded state of the profession, in this quarter long ere the “ Hand Bill” appeared. In my opinion, the base mo¬ tive of revenge, or self-interest, prompted the “ Observer” to attack me individually , and allow others to pass with impunity, who had lessened the independence of the profession far more than I have. As an instance, I transcribe the following from the parish minute book : — “ We engage to attend the poor of Aylesbury in the town, and all adjacent towns and villages within ten miles, in every case of sickness and surgery — to furnish trusses, bandages, and leeches — to include all the midwifery cases — and to return any money for attendance on extra paupers, or fee due to us for attendance on coroners’ inquests, for the sum of forty pounds, from April 10, 1835, to April 10, 1836, payable by equal quarterly pay¬ ments. (Signed) - & - , Surgeons. The population of Aylesbury consists of 5000 inhabitants, and the pauperized state of this county is well known ; the reader will therefore readily perceive that the above paltry stipend is infinitely less lucrative than my system of charges. I remain, sir, Yours respectfully, J. A. Marshal. Aylesbury, Sept. 27, 18 6 . REGISTRATION OF BIRTHS AND DEATHS. To the Editor of the Medical Gazette, Sir, It is a well-known fact, that, from the to¬ tal want of accurate information regarding the causes of deaths in this country, the science of medical statistics is retarded in its progress. It is therefore extraordinary, that now an opportunity is offered to the medical profession to ensure the most accurate reports, by taking the registra¬ tion into their own hands, they should, (as has in many instances been the case) refuse to fulfil the duties of registrars under the new act. The refusal must arise either from the apprehension that the trouble wrould far exceed the remuneration, or from not having considered the important aid it is now in our power to give to science. If the former be the objection, it has probably been overlooked, that no per¬ son can obtain burial without the regis¬ trar’s certificate. This will ensure him immediate information of every death, without having to seek for it; and in the case of births, children unregistered within six months will not be legal inheritors of property. There can, therefore, be no doubt of the registrar having notice of all births, save those, perhaps, of the absolute pauper, and of them intelligence can be readily obtained from the relieving officer of the district. In the latter case, were the registration in the hands of our pro- NEW METHOD OF PRESERVING DEAD BODIES. 63 fession, tlie following facts, important to the public health, might be established. The number of deaths by diseases known to attend particular profes¬ sions and trades. The number, and nature, of the fatal diseases of particular districts or localities, in comparison with other districts. The rare fatality of some, and the frequent fatality of other, mala¬ dies. The remuneration (payable from the Board of Guardians) is 2s. 6d. each for the first twenty entries in every year, and Is. each for every succeeding entry, with an additional 5s. for the registration of every birth of which the registrar has not had notice within forty-two days. But it ought not to be considered in a pecuniary point of view, so much as a means of advancing medical science. In foreign states, where the registration of births and deaths is chiefly confined to medical men, the most beneficial results are known to ensue, while, as I have before said, our statistics are notoriously defi¬ cient. — I am, sir, Your obedient servant, T. G. September 28, 1836. CASE OF ANEURISM OF THE THO¬ RACIC DUCT. surrounding organs. How often it is com¬ pressed in the scrofulous and consumptive, by enlarged glans, tumors, &c. ! But these compressions are not attended by corresponding dilatations, as is the case with arteries and veins. Dr. A. has seen a case in which the thoracic duct, in the middle of its course, had been reduced by pressure to such a small calibre, that it would not admit even a bristle. In ano¬ ther case the canal was altogether oblite¬ rated ; but in neither was the calibre of the canal below the narrowed part altered by the compression. (See also Rokitanski, Austrian Annals, vol. xvii. p. 441.) The cause of this absence of dilatation in cases of compression lies, doubtless, in the na¬ ture of the fluid, in the weakness of its current, and also in the fact that there must be more branches of the thoracic duct anastomosing with the venous system than is generally supposed. A proof of this is, that in children in whom the cali¬ ber of the duct has been materially nar¬ rowed, no emaciation has followed in con¬ sequence. Wutzur has discovered a branch of the thoracic duct leading into the vena azygos. The most frequent cases of dila¬ tation of lymphatic vessels are those in which they contain tuberculous, scrofu¬ lous, and cancerous matters. Numerous descriptions of such cases are found in the works of Cruveilhier and Carswell. — Han- noversche Annalen , and British and Foreign Medical Review. By Dr. Albers, of Bonn. The patient, a man of fifty one, died of abscess of the liver. On examining the body after death, Dr. Albers found, in the region of the solar plexus, amongst several hard cartilaginous tumors, an elastic soft one, with a half-transparent tegument. It was knotty, and about the shape of a fig. At first he took it for an hydatid; but it was soon discovered that it was bound by membranous bands in several places, and that a canal led into it, both above and be¬ low. It contained a quantity of fluid lymph, in which flaky matter was sus¬ pended. The internal surface of the tumor wras smooth and uniform. A sound could be passed up the canal, both superiorly and inferiorly. In the latter direction its course was followed, and it soon became evident that the tumor was an aneurism of the thoracic duct. Its parietes were thicker and firmer than those where the duct had not lost its nor¬ mal calibre. l)r. Albers has only seen one similar case, viz. a dilatation of the cysterna chyli, found at the examination of a dropsical patient. It is singular that the thoracic duct is not oftener affected by the diseases of NEW METHOD OF PRESERVING DEAD BODIES. By Dr. Tranchina, of Palermo. The results of this method were first pub¬ lished in the Sicilian journal Fa Cerere , in May, 1834 ; but the actual process was first made known and openly practised by the author, on the 11th May, 1835, in the military hospital, Della Trinitd , at Naples. I he operation consists in the injection of the body, through the carotid artery, with a solution or mixture of two pounds of arsenic in twenty or twenty-four pounds of water, or spirit of wine, coloured with a little red lead or cinnabar ; and in the in¬ troducing, by means of a trocar, into the abdominal cavity, the same solution, in cases w here putrefaction had made some progress. In some cases it appears also that the solution is injected into the anus, nostrils, &c. By this process the body is kept fresh, flexible, without smell, and of its natural colour, during more than two months; after which it gradually dries, hardens, becomes of a darker colour, and can be preserved for years. For this dis¬ covery, the great importance of which is self-evident, and for its public disclosure. Dr. Tranchina has been presented, by the 64 BILLS OF MORTALITY.— METEOROLOGICAL JOURNAL King of Naples, with the sum of 3000 ducats, has been raised to the dignity of knight of the order of Francis I., and ap¬ pointed military surgeon of the second class. — British and Foreign Medical Review , Oct. 1836. CHAR1NG-CRGSS HOSPITAL. A meeting was held in Great Windmill Street, on Monday, for the ostensible purpose of expressing the opinion of the medical public with regard to the recent transactions at the Charing-Cross Hospital. The chair was taken by Dr. Birkbeck, but lie was not supported by any such numbers, or by such members of the profession, as to give weight to the proceedings. Reso¬ lutions were passed condemnatory of the plan on which the hospital is conducted, and much disapprobation expressed of Mr. How ship’s conduct in giving Mr. Pettigrew 500/. ; but we are not aware of any censure having been passed on the latter for accepting it. We quite agree with the resolution declaring the office of “ Director” an ab¬ surdity, but the time and manner in which public attention has been directed to the subject give it all the air of private pique. We cannot compliment any of the parties on the figure they make, and would advise them not to intrude themselves upon the public unless they have something to ad¬ duce much more to the point than any thing which has yet appeared. APOTHECARIES’ HALL. LIST OF GENTLEMEN WHO HAVE RECEIVED CERTIFICATES. September 29, 1836. William Ralph Peck, Kimbolton. Edward. George Baron, Hull. John Dickinson, Plunder Bridge. H enry Richard Smith, Newark. Robert Norton, Nailsworth, Gloucestershire. Robert Baget, Shrewsbury. Joseph Glover, York. Frederick Hanham, Bath. William James Clark, Skipton Bridge, Yorkshire. Richard Ley, Newton Abbott. Richard Thomas Morris, near Wigan, Lancashire. William Foster, Royal Navy, Yarm. Robert Fothergill, Bedale, Yorkshire. Charles Bruorton, Salisbury, Wilts. George Eveleigh. Mathew Moorhouse, Holmfirth, Yorkshire. William Marsden, Thornhill, Frederick Heald, Wakefield. James Naylor, Preston, Lancashire, Joseph Parkin, Workington, Cumberland. Charles Frederick Jenkins, Thames Ditton. Allen Joseph Taylor, Morpeth, Northumberland, Thomas Wright, Wolverhampton. Henry Poole Palmer, Winterbourne, Bristol. Alexander Wright, Birmingham. James Cowherd, Kendal. Thomas Truran, Exeter. William Field, Tong. Francis Harold Duncombe Lewis, London. Thomas Mackenzie Smith, Bideford, Devon. James Barton Nottage, Lancaster. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Oct. 4, 1836. Age and Debility . 34 Inflammation .. 15 Apoplexy 5 Bowels & Stomach 5 Asthma 5 Brain 9 4 Cancer • 2 Lungs and Pleura 7 Childbirth . i Insanity • 1 Consumption . 55 Liver, diseased 4 T Convulsions 30 Measles . o 7 Croup • • • 1 Mortification • 4 Dentition or Teething 8 Paralysis . • 5 Dropsy 12 Rheumatism • i Dropsy on the Brain 8 Scrofula • 2 Dropsy on the Chest 1 Small-pox . 9 10 Epilepsy 1 Sore Throat and Erysipelas . 2 Quinsey . 9 1 Fever . . . 9 Thrush 9 1 Fever, Scarlet 2 Tumor . • 2 Fever, Typhus 4 Worms • 1 Gout . . . 1 Unknown Cause s 3 Haemorrhage 2 Heart, diseased . 1 Casualties • 8 Hooping Cough . 1 Increase of Burials, as compared with the preceding week METEOROLOGICAL JOURNAL. Kept at Edmonton, Latitude 51° 37' 32" N. Longitude 0° 3' 51" W. of Greenwich. Sept. 1836. Thursday . 22 Friday . . 23 Saturday . 24 Sunday . . 25 Monday. .26 Tuesday . . 27 Wednesday28 Thk rm o meter. from 30 to 55 50 63 51 67 50 68 56 67 55 65 49 58 Barombter. SO* 1 5 to 30 10 29 92 29 92 30 02 30 01 30-04 30-10 30 06 29-92 29-76 2975 2965 29-53 Prevailing winds, W. by S., and S.W. Except the 24th, 25th, and afternoon of the 26th, generally cloudy ; rain on the 23d and 28th. A little thunder in the morning of the 28th. Rain fallen, -275 of an inch. The sudden and great change in the tempera¬ ture from the 22d to the 23d, is worthy of parti¬ cular remark. Thursday . 29 Friday. . . 30 Oct . from 49 to 60 29 28 to 29-26 42 52 2932 29 50 Saturday . 1 36 53 29 38 30 04 Sunday . . 2 39 52 2915 29 28 Monday . . 3 41 50 29-86 29.35 Tuesday . 4 30 53 29-41 29-51 Wednesday 5 32 55 29-72 29-88 Prevailing Winds, W. by S. and N.W. - - r — / / - - - j o — - — J - - - with frequent rain. Rain fallen, 1 inch, and -825 of an inch. Charles Henry' Adams. NOTICES. Introductory Lectures. — We really cannot make room for “ Introductory Lec¬ tures.” Such addresses we presume to have been heard by the only parties to whom they can be useful j — we mean the pupils at the several schools: for others they do not possess sufficient interest to warrant us in giving them insertion. Mr. Walker’s reply has been received. Wilson & Son, Printers, 57, Skinner* St, London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOURNAL OF iWetuctne anti tlie Collateral J>ctencesi. SATURDAY, OCTOBER 15, 1836. LE CTURE S ON FORENSIC MEDICINE; Delivered at the Alder sgate School of Medicine, By William Cummin, M.D. Lecture III. On Age , medico -legally considered — Mode of ascertaining the Age from Physical Appear¬ ances — Age of the Foetus — Growth of the Embryo — Periods of Human Life — Infancy. The first subject of a special nature to which I shall call your attention, is Age. The consideration of age is an element in almost every investigation undertaken by the medical jurist. Whether his inquiries be relative to tbe living or the dead — whether his object be to ascertain the identity of an individual, or to appreciate the extent and nature of personal injuries — or whether his researches bear on questions of violation, pregnancy, parturition, steri¬ lity — in all these, and a number of other instances, which I need not stay to enu¬ merate, as you will be better prepared to estimate their importance hereafter, age requires to be duly considered. Legal distinctions respecting Age. — - Our laws are precise regarding certain epochs of life : there are certain ages to which particular rights and responsibili¬ ties belong. A male at twelve years old may take the oath of allegiance ; at fourteen he is at years of discretion ; may consent or disagree to marriage, may choose his guar¬ dian, and make a valid will of his personal property : at seventeen he may be an execu¬ tor, and at twenty-one is at his own disposal, with a perfect power to do as he pleases with his estate, both personal and real. A female at seven may be betrothed or given in marriage ; at nine she is entitled to dower ; at twelve is at years of maturity, 463. — xix. and therefore may consent or disagree to marriage; if proved to have sufficient discretion, she may at this age also be¬ queath her personal estate : at fourteen she is at years of legal discretion, and may choose her guardian ; at seventeen may be an executrix; and at twenty-one may dis¬ pose of herself and lands. Again, with respect to criminal liabilities and immuni¬ ties, a person under twenty-one (being in the eye of the law an Infant) is privi¬ leged as to common misdemeanors, so as to escape fine, imprisonment, and the like : in the case, however, of any notorious breach of the peace, such as riot or battery, he is liable to suffer the prescribed penalties, if he be above fourteen. A felonious crime still further abridges the privilege of age : for infants of ten have been hanged for murder — the evidence of malice having been clearly made out : and it is only under the age of seven that a person cannot be guilty of felony; for then it is considered that a felonious discretion is almost an impossi¬ bility in nature. In all such cases, where there is no do¬ cumentary evidence of age to produce — a circumstance far from uncommon in a country like this, so negligent hitherto in respect to registries of birth, and even of baptism — there is obviously no other resource than to ascertain the fact by reference to physical peculiarities. And here the assistance of the medical jurist is required. Other occasions of inquiry as to Age. — Among the qualifications and disqualifica¬ tions for military and naval sei'vice , age forms a special object of inquiry. Itis a highly im¬ portant element in the selection of recruits ; and we even find twenty fixed as a minimum, in a late order from the Horse Guards, relative to recruiting for service in tropical climates. Mr. Marshall justly observes on the subject, that “ as the exact age of men in this country cannot commonly be easily or satisfactorily ascertained, the surgeon who inspects a recruit should be F 66 DR. CUMMIN ON FORENSIC MEDICINE authorized to estimate the age by physical appearances.” In effecting policies of Life assurance, I need scarcely remind you that much de¬ pends on the age of the insuring party, the premium being almost wholly regu¬ lated with reference to that point; and it may be your duty, as medical officers either of the company or the applicant, to take care that there be no error or fraud committed in this respect. Thus it is evident how very properly the discussion of age should take precedence of other questions forming the subject of a course of Forensic medicine ; and it shall be my aim, in the present lecture, to point out to you the mode in which the physical proofs and evidence of age may be ascertained. Definition. — Age, as the term is commonly used in legal medicine, implies the time of life — the period of human existence which one has attained, or in which an individual lives. Object. — The determination of age is sometimes attended with difficulty. In certain cases it can be pretty exactly effected, as in the infantile or foetal periods; but, in general, we can do no more than come to certain average results: we cannot pretend, for instance, to fix the age of an individual, except in very pecu¬ liar circumstances, to the day, week, or perhaps month, which he has reached; but what we design to do, and, in general, can do, is to determine the period up to which he has lived — each period or portion of life being distinguished from other portions by a particular set of developments which pro¬ duce marked changes in the person. An acquaintance with the laws of growth necessary. — For a task of this kind, we must be prepared by being acquainted with the laws of growth. Now, these laws can only be fully appreciated by taking a view of them as they may be oberved in opera¬ tion, from the very earliest point at which they can be traced. In order to have a complete survey of the changes oc¬ curring in the course of time in the human being, we must therefore begin with the foetus, and even the embryo, and carry our observation through all the sub¬ sequent stages of existence to maturity and decline. AGE OF THE FOETUS. I must premise that it will be necessary to be much more full and minute in treat¬ ing of the first periods of life than those which will subsequently engage our atten¬ tion. The reason is this — that so many purely medico legal questions relating to pregnancy, prolicide, &c., are chiefly de¬ pendent on the appearances indicative of age, which are observed in the expelled ovum or foetus. We shall, therefore, com¬ mence with intra-uterinelife : and in doing so, wrill freely avail ourselves of the most authentic sources of information which have of late been opened to us. Earliest appearance of the ovum and embryo . — According to some of our ablest English obstetricians, nothing like an ovum, con¬ taining a definable embryo, can be detected in the uterus before the 20th or 22d day after conception. Haller says that the embryo is not perceivable till after the loth or 20th day. Of this period it is generally admitted that several days are consumed before the ovum reaches the uterus. In rabbits, three days elapse, and in the bitch, from six to eight, while the ovum is being carried along the fallopian tube to be deposited in the uterus. Is it likely that it should be less in the case of the human female, wrhere there are so many disturbing causes, physical and moral, to interfere ? And if this be so, what are wre to think of the story published by the late Sir Everard Home, in the Phi¬ losophical Transactions for 1817 ? Sir Everard Home's eight-day case — A female servant, aged 21, left her master’s house in the forenoon of the 7th January, 1817, and returned in the evening, com¬ plaining of illness. It was her regular time for being unwell, but no catamenial discharge took place. She continued me¬ lancholy and ill, and on the 13th had a fit of epilepsy, followed by delirium. She died on the evening of the 15th. On examining the body after death, the uterus, according to Sir Everard, appeared to be impregnated. The organ was removed and put in spirit. In its interior, to¬ wards the os tineas, was observed, after a close search, a small body — a corpuscle — so small, that Mr. Bauer, the microscopist, compared it to the egg of an insect : it re¬ quired an excellent instrument to find out what it wms — and behold it was an embryo ! But the whole narrative is ques¬ tionable. There is no sufficient evidence that the woman w'as pregnant, and even if she had conceived, it is scarcely probable that the ovum could have reached the womb. Besides, the human ovum is spherical — not like a minute grain of bar¬ ley, as represented in the plate attached to Sir Everard’s paper: nor would it have required the aid of a microscope to examine it even at the earliest. The additional absurdity of supposing it an embryo, des¬ titute of its envelopes, crowns the whole. In short, though this case has been implicitly received by several authors, it has, on the other hand, been generally scouted by competent judges. The state of the female, who w'as, probably ow ing to some accidental cause, labouring at the time under suppression of the menses, is sufficient to account for the appearances noticed in the interior of the womb: and AGE OF THE FCETTJ'. 67 there is every reason to believe with Vel¬ peau, that wliat Sir Everard Home took to be an embryo, was nothing else than a particle of mucus ! M. Velpeau's case of twelve days. — Velpeau, one of our ablest authorities on the subject of embryology, tells us thathe has had on three occasions an opportunity of examining the ovum when it could not have exceeded twelve days from conception. Its bulk was then about that of a moderate sized pea. In two of these instances he could not satisfy himself that he really detected an embryo in the interior. But the third case he considers as probably the most remarkable ever met with. Here are figures of the ovum entire, and laid open ; they are drawn of the natural size — fig. 2 being a little spread out. Fig. 1, and Fig. 2 .—An Ovum and Embryo of twelve days. The history of this ovum is curious, andis thus related by M. Velpeau. A midwife who attended his lectures— as many intelli¬ gent females in the French metropolis do, in order to prepare themselves for subse¬ quent practice, — happened to be at her menstrual period, and just as it ceased, her husband returned from a journey which had detained him from home for six weeks. No matrimonial intercourse occurred till the following day: and exactly on the thirteenth day after, she aborted of the ovum in question — so that it could 7iot have been more than 12 days old. She sent it immediately to M. Velpeau, who values it, very properly I think, as one of the most precious that has ever fallen into the hands of an embryologist- In the details which I am now about to give you, it is not my intention to present anything like a complete account of the structure of the embryo : my principal object is to call your attention to the size and proportions of the ovum and its contents, at different periods of intra-uterine life : so that should you be called upon as medical jurists to state your opinion of the age of an expelled ovum or foetus, you may be able, with some confidence, to do so. At the twelfth day, then, the ovum, which is about the size of a pea, is per¬ ceived to be covered with a villous shaggy outer coat, the chorion : the flocculent part, which becomes more circumscribed subsequently, being that which forms an attachment to the decidua, and constitutes the placenta. The embryo at this period, as represented in the above figure, is semi¬ lunar in shape, and rounded pretty equally at both ends. The globular appearance in the second compartment of the opened ovum (and d in fig. 3) is remarkable : it is the umbilical vesicle — an organ pecu¬ liar to the embryo in tlie first few months of its development. Three weeks to a month. — About the 21st day the ovum appears to be as large as a hazel nut. When laid open, as in the an¬ nexed figure, (fig. 3,) it looks, of course, much larger. Fig. 3. — Ovum and Embryo at 21 days — the Embryo seen through the Amnios. The embryo now measures two or three lines in breadth, and probably its length, were it straightened out, would be from three to five, or about half an inch. The different parts of the face become distinguishable at different periods. The aperture of the mouth is seen very early — say from the 12th to the 20th day. The nose, or at least the nostrils, at about 30 days: the prominence, not till five or six weeks, perhaps. The eyes are observable by the fourth week, if not earlier. The rudiment of the ear may be perceived as early as the 30th day : but that part un¬ dergoes no remarkable development for six or seven weeks. Towards the expiration of the first month, the ovum has attained the size of a large nutmeg. From, four to six weeks. — The ovum about the sixth week is nearly as large as a hen’s egg; and the embryo is about an inch in length. The extremities sprout forth from the trunk like vegetations, all about the same time. At from thirty to forty days the fore-arm and the leg may be distin¬ guished, and the points of the fingers and toes are to be perceived. The foot is even now distinct from the hand, evidently dis¬ playing what is to be its future function — to form the pedestal of the figure. It is remarkable, that about the expiration of the sixth week a point of ossification may be detected in each half of the lower jaw ; as also in each clavicle. Two months. — The embryo, or, as it now begins to be more properly called, the foetus, measures above an inch and a half in length ; it weighs about half an ounce. 68 DR. CUMMIN ON FORENSIC MEDICINE. Rudiments of the lungs are visible in the interior, and there are points of ossifica¬ tion in the frontal bone and some of the ribs. The placenta has assumed a distinct form, and the umbilical vessels become tortuous. The sex is scarcely yet distin¬ guishable. Fig. 4. — Foetus of about ten weeks , somewhat magnified by the spirit in which it is preserved. Three months. — The foetus is now nearly three inches long, and weighs about an ounce and a half. The fingers are very distinct. The eye-lids are formed, and the membrana pupillaris is perceptible. The ventricles of the heart are separated ; the sexual parts prominent ; the umbilical vesicle has disappeared. Fig. 5. — Foetus between three and four months, as seen preserved in spirit. Four months. — Above six inches long, and three ounces in weight. The nails begin to be observable ; there is meconium in the duodenum ; some points in the sacrum ossified ; the mouth large and open ; the skin of a pinkish hue. Five months. — The foetus has now at¬ tained the length of about seven inches, and it weighs about seven ounces. The head and heart both comparatively very voluminous; the kidneys large ; the gall¬ bladder distinct ; rudiments of the teeth may be detected, and there is a point of ossification in the calcis. Six months. — Above ten inches in length, and the average weight a pound. The membrana pupillaris is still observable ; feet of a purplish red colour; a sebaceous secretion begins to be formed on the skin ; a few silvery hairs are observed on the head ; a serous but not bitter fluid in the gall-bladder ; the testes close by the kid¬ neys; meconium in the small intestine; ossification in different parts of the sternum. Chaussier’s rule of admeasurement. — It is worth observing, that about this time the middle point of the whole length is usually found at thelower extremity of the sternum, whenceitgradually descends in the succeed ing months, till, at the mature period, it reaches the umbilicus. For this character in the foetal growth we are indebted to M. Chaussier, who founds upon it the practi¬ cal rule, — to take the length of the foetus, and then observe to what point half that length reaches : if it extend to the lower end of the sternum, it has attained its sixth month; if the navel, the ninth ; and so for the intermediate spaces. But it is right to add, that competent authorities have questioned the correctness of this rule : among others Mende, in his Ausfuhr - liches Handbuch (which, by the way, con¬ tains the most elaborate account I have seen of the growth of the foetus), asserts, that however plausible it may appear, it is not to be always relied on. “ The mid¬ dle point,” says he, “ by no means corre¬ sponds to the same part of the body in foetuses of the same age : a fact for which we might be prepared by considering that the several sizes of the foetus depend, now on its large head and neck, now on the trunk, and again on the magnitude of the limbs. This I have verified by numerous measurements, taken with great care and pains; and the conclusion I have arrived at is, that the directions laid down by Chaussier are uncertain for practical pur¬ poses, and more particularly for those of the medical jurist.” Seven months. — - Length above twelve inches ; weight from three to four pounds. The skin firm, of a pink colour, and co¬ vered largely with the sebaceous coat. 1 he membrana pupillaris generally disap- PERIODS OF HUMAN LIFE. 69 pears in the course’of the seventh month; the eye- lids are no longer glued together; the nails do not reach the ends of the fingers. In the astragalus there is observed a point of ossification ; the meconium dif¬ fused through the whole length of the in¬ testine ; the left lobe of the liver almost as large as the right. The lungs of a reddish brown colour, and of a compact liver¬ like structure, occupying the sides and back part of the chest ; the testes have de¬ scended a little from the kidneys; the brain comparatively firm, but without any observable deposition of white substance. Eight months. — The foetus now measures from fourteen to sixteen inches in length, and weighs commonly about four or five pounds. The nails have reached the tips of the fingers; the quantity of sebaceous matter deposited on the skin is considera¬ ble ; a point of ossification may be noticed in the last vertebra of the sacrum. The brain presents an appearance of convolu¬ tions ; but still there is no white sub¬ stance. The testes have reached the in¬ guinal rings. At nine months , or mature. — The length of the mature foetus averages above eighteen inches, and the ordinary weight is between six and seven pounds. Half the length reaches to the umbilicus, or very nearly. There is more or less hair on the head, — sometimes an inch long. An abundant deposition of sebaceous matter is observed on the skin, and appears to be propor¬ tionate to the development of the lympha¬ tic system in the foetus. The lower limbs are longer than the upper ; though, mea¬ sured from the arm-pits to the tips of the fingers, and from the groin to the toes, the reverse would seem to hold. The feet are a sixth of the whole length of the body. The cartilage of the ear is completely formed ; there is a point of ossification at the inferior extremity of the femur; the os hyoides not ossified; some appear¬ ance of white substance observable in the brain. The liver reaches the um¬ bilicus ; the testes have usually pass¬ ed the rings, and descended into the scrotum ; meconium is found in the rec¬ tum. The following are the principal measurements of the head, according to Devergie and Velpeau : — French In. Lin. Occipito frontal diameter 4 3 Occipito-mental . 5 0 Fronto-mental . 3 6 Bi-parietal, or transverse 3 4 Bi-temporal . 3 0 Greater circumference, or occipito-mental .... 14 0 Transverse . . 10 6 Engl. In. 4-52 532 3-71 3-54 3-19 14-91 11 18 Let us now sum up the various points to be attended to in collecting the proofs of foetal age. Nor can we do better than follow the order recommended by M. De¬ vergie. First, examine the annexes of the foetus, or, in other words, the ovum itself, independent of the foetus : observe the pla¬ centa as to its shape and consistence; the state of the membranes ; the umbilical vesicle, if it be present ; the funis, as to its length and degree of torsion. Secondly , examine the foetus and its organs ; weigh it; take its length ; observe to what point half the length reaches, and note the in¬ sertion of the umbilicus. Let the skin be inspected as to its colour, consistence, and sebaceous coat ; observe the nails, the eyes and eye-lids, and the presence or absence of the membrana pupillaris; the nose, mouth, and ears; the abdomen, and the state of the digestive tube ; the liver and gall-bladder; the kidneys and renal cap¬ sules ; the testes or uterus; the heart, with reference to the development of its cavi¬ ties; the arteries connected with it; the ductus arteriosus; the lungs; the larynx and bronchia. The muscular system ; the state of the bones, as to the progress of ossification ; and, lastly, the extremities, with a view to the comparative develop¬ ment of their several parts. Such are the leading characteristics by means of which wTe are to form an opinion of the age of an embryo or foetus. Where the object is to ascertain the age of a liv¬ ing foetus — of course, in utero matris, the inquiry becomes equivalent to that for ascertaining the period of pregnancy; but this we reserve for a future lecture. Nor let it be supposed that such researches are merely curious ; they are, in reality, im¬ portant and necessary; for both in a civil and criminal point of view the life of a child, even before birth, is an object of protection with our laws : it is avenged if injury be offered to it; an infant yet unborn is capable of inheriting an estate, and of becoming a legatee, from the mo¬ ment it is ascertained to be alive. PERIODS OF HUMAN LIFE. The periods into which the life of man has been portioned out are in great measure arbitrary. The gradations by which they pass into each other are im¬ perceptible, though the consequent changes are manifest enough. And it has long been popular, as well as convenient, to make a distinction in those periods, or ages, as they have been called. Threefold division. — Some of the oldest authorities, — and Aristotle among the number, — thought fit simply to distin¬ guish the stages of our mortal career into those of growth, perennity, and 70 DR. CUMMIN ON FORENSIC MEDICINE. decline, not perceiving', or not caring to notice, that, strictly speaking, no such period as that to which they attached the quality of durability existed, — there being, in fact, no moment during the existence of our corporeal system in which we can be said to be stationary. Letting this pass, however, the threefold division ap¬ pears to have been early supplanted by another, which seemed more practical. The Seven ages . — As early as the time of Hippocrates, we find man’s life por¬ tioned into seven ages. Both Hippo¬ crates and Proclus subdivide the period of growth just mentioned into infancy, boyhood, and puberty — that of peren- mty into youth and manhood — and that of decline into senescence and decrepitude. Thus we have the autho¬ rity of distant ages, and of the father of physic, for that division of human life which is popularly recognized amongst us, and which must popularly prevail as long as the writings of our great dramatist are extant — that is to say, as long as our language is understood. You are all no doubt familiar with the beautiful descrip¬ tion which Shakspeare has given of the Seven Ages, in the second act of “ As you Like It.” It should be mentioned, that attempts have from time to time been made by modern writers to introduce other more brief and comprehensive divisions than those they already found in use: Esehen- bach and Haller, and Bernt, for example, adopt a three!' old partition; Hebenstreit, Ludwig, and Hen ke, recognize/our periods; Plounquet^re ; Orfila also Jive ; Teiehmey- er, Wildberg, Meckel, and Mende, six ; Griiner seven ; and Metzger eight. But those who adopt less than six are obliged to subdivide the early periods, thus virtually employing a larger number. I shall only add, that Zacchia, Tortosa, Fodere, and Plenk, are among those who are decidedly for seven ages. Suppose, then, we adopt this popular, and let me also call i t physiological arrange¬ ment, what are the limits by which each period is to be defined ? Mere too we shall find a sevenfold order the most satis¬ factory, easy to be remembered, and suited in every respect to medico-legal purposes. The first age commences at birth, and runs on to the 7th year; the second, or boyhood, from that to the 14th; the third, or puberty, from the 14th to the 21st; youth, or juvenility, to about 35 ; manhood, from that to about 56 ; senescence, or old age, to 84 : after which decrepitude closes the scene. Now it is curious, and worth observing, that all these numbers are multiples of seven. The enumeration may be more striking when arranged thus: — Infancy . 0 to 7 Boyhood . 7 to 14 Puberty . 14 to 21 Youth . 21 to 35 Manhood . 35 to 56 Senescence . 56 to 84 Decrepitude . 84 to 0 Climuctericul years. — In noticing this coincidence — this curious harmony of numbers — I may take occasion to re¬ mark one or two other multiples de¬ noting epochs, to which great importance has been from the earliest times attached. Both 7 and 9 have long been held as mystic numbers : and peculiar influences have been attributed to those years marked by their special multiples. The three most critical epochs in the life of man were supposed to be the seventh return of the seventh anniversary, the ninth of the ninth, but above all, the ninth re¬ currence of the seventh. The first of these, the 49th year, was called the lesser climacteric — the second, the 81st, the grand climacteric — the third, however, or the 63d year, obtained, par excellence , the denomination of the climacteric year. A vfigoK\as, another epithet bestowed upon the latter, originated in the supposed effi¬ cacy of this mystical number in breaking down the constitution of man. Sir Thomas Browne, in his Enquiries into Vulgar and Common Errors, notices this superstition, and attributes it to the understanding which £; ascribeth unto many things far larger horizons than their due circum¬ scriptions require, and receiveth them with amplifications which their reality will not admit ;” upon which he proceeds to pour out a profusion of learning in dis¬ proof of the common opinion. Richerand also notices the subject in his Erreurs populaires. But the impression has been somewhat revived of late, under the patronage of our learned president of the College of Physicians. Sir Henry Hal¬ ford, in an ingenious paper, has shown that there exists a disorder to which men are subject about the time of their reaching their 63d year. It is attend¬ ed, he tells us, with well-marked symp¬ toms, and a peculiar breaking up of the constitution, which is frequently fatal, from not being well understood by practi¬ tioners : he calls it the climacteric disease : you will see his account of it in his collec¬ tion of Essays and Orations, I shall now request your attention to some remarks on the subject of each period of life separately, in the order just now selected. Infancy. Mith regard to the period of infancy, the chief question with which the medical jurist has to deal is — how is he to ascer- = IX 7 = 2X7 = 3X7 = 5X7 = 8X7 = 12X7 INFANCY. 71 tain the age of an infant within the lirst months, weeks, nay, days, of its extra- uterine existence ? The circumstances under which we maybe required to find an answer to this question are of frequent occurrence. I have already alluded to its connexion with cases of infanticide, and shall have again occasion to recur to that fact when treating of child-murder more at large. But suppose, for the pre¬ sent, a child found alive , exposed, and sus¬ picion resting on some female who is re¬ ported to have given it birth and then abandoned it. If the exact age of the infant can be ascertained, and there be no corresponding signs of recent delivery about the woman, the fact is strongly in favour of her innocence, in spite of all moral or circumstantial evidence to the contrary : if, on the other hand, the signs correspond, there will be a presumption of guilt. It will be convenient to subdivide the period of infancy into two well-marked stages— first, that from birth to the first eruption of the teeth; and second, the period of dentition, during which the temporary teeth are produced, and com¬ prehending the interval which occurs be¬ fore the permanent teeth are completed. (ti). First infancy. — What are the signs of a new-born infant’s age ? Our first proceeding with a view to satisfy this in¬ quiry should be to examine the umbilicus : to see whether the cord or any remnant of it be present, and what may be its con¬ dition. The umbilical cord, it is known, does not come away, in the generality of instances, till the fourth or fifth day after birth. An obvious inference, therefore, from its presence, would be, that the in¬ fant cannot have lived five days. We then proceed to examine the" state of the cord, in order that we may be able to approximate still further to the date of birth : now this we are enabled to do by attending to the valuable obser¬ vations and rules laid down by M. Billard, and which are thus practically summed up by Orfila and Devergie: — In the infant just born the cord is fresh and firm, bluish, and rounded off; there is blood also in its vessels. The first perceptible change that occurs after it has been divided and tied, is its shrinking {Jietrissure) : this proceeds from its extremity, where the ligature is, to its base at the umbilicus, and is observ¬ able in general before the lapse of a few hours. When this process is complete, which it generally is by the close of the second day, the cord is quite soft and flaccid, and a well-marked congestion is perceived around the umbilical ring. The next phenomenon to be noticed is the drying up of the cord. It becomes brown and semitransparent, losing the gelatine which it contains. As its membranes collapse it becomes flattened, and its inte¬ gument assumes the colour of parchment. This withering ( desiccation ) commences on the first or second day, and is generally completed by the third. It has been at¬ tempted to establish a distinction as to this process, according as it may have oc¬ curred during life or after death; there being, according to some observers, ap¬ pearances of inflammation about the um¬ bilical ring in the former case, and not in the latter; but such appearances are not sufficiently constant to warrant any positive conclusion from the fact of their presence or absence. The next phenomenon to be noticed is the fall of the cord, which takes place on the fourth or fifth day. Its base dwindles by degrees; the umbilical arte¬ ries give way ; but the vein lasts some¬ what longer. When this occurrence is at¬ tended with inflammatory action about the umbilicus, the traces of such inflam¬ mation continue till the tenth or twelfth day after birth, the epoch at which cica¬ trisation is effected. As to this latter phe¬ nomenon (i cicatrisation ), though it com¬ monly occurs at the epoch just mentioned, yet, when the cord is thin, it sometimes takes place earlier — that is to say, in less than ten days. A temporary umbilical cica¬ trix is first formed, which, in the course of about forty days, gives place to the per¬ manent one. The next sign indicative of the new¬ born infant, is the desquamation of the cuticle ; an appearance which is very different from the peeling off of the epidermis from putrefaction. The de¬ squamation alluded to has not been observed to take place sooner than twenty- four hours after birth ; and it is at its height by the third or fourth day. The process usually commences on the abdo¬ men, and then extends successively to the chest, arm pits, and groins, the back, the extremities, the feet, and the hands. In some children the epidermis comes oft' in the shape of powder — not in scales. If, then, on examining an infant, the de- squamation be observed, it may be presumed to have been born a day at least. When we have an opportunity of in¬ specting the body after death, there are other proofs of early age to be gathered. The ductus arteriosus wdll be perceived, at least contracted, in a child that has sur¬ vived birth, even though it w-ere but for a very short time. The foramen ovale, also, wdll probably be found to have undergone a change in size and figure; and the ductus venosus will perhaps be observed to have sustained an alteration in form. But all these appearances we shall have a bet¬ ter opportunity of noticing when we come 72 DR. CUMMIN ON FORENSIC MEDICINE. to treat the subject of infanticide, some of the proofs of which depend on the oc¬ currence of those changes in the circulatory apparatus. Among the signs of age of the new born, we ought not to omit those deriva¬ ble from the state of the alimentary canal : but they will require only a brief no¬ tice. If the stomach be empty, or contain only a little mucus, while the large intes¬ tine is still charged with meconium, and the bladder filled with urine, death has probably occurred immediately after birth, — if it be not, indeed, a question whether the infant were not still-born. If, on the other hand, the stomach contain milk, or other alimentary matter, and both bladder and intestine be empty, the child undoubt¬ edly lived for a time. The meconium, it must be recollected, is lodged in the large intestine for some time previous to birth. It is expelled presently after birth. Now the tube has been protected during the de¬ tention of the meconium, by a layer of mucus of considerable thickness and con¬ sistency. The layer is not removed imme¬ diately on the expulsion of the meconium; in some cases it is no longer observable after the first day ; but in general we need not expect to find it wholly gone till four days after birth : and when we see it, we may observe that it has contracted a green¬ ish hue. From these facts, M. Billard derives a practical rule: — “ If the colon be found of a deep and uniform greenish hue, the meconium has been only recently expelled ; the infant must be then one day, and may be at most three days, old. But should the colon have an irregular spotted appearance, the meconium has been still less recently expelled, and the infant is probably three or four days old.” It is right to add, however, that these indica¬ tions are by no means as valuable as those to be procured from the state of the funis. There are other well-known signs of early infancy, which need not detain us in pointing them out. I allude to the ex¬ treme softness of the bones of the head, the open state of the fontanelles, the downy face of the infant, its feebleness, and inferior size. At a period a little more advanced, we may avail ourselves of several moral circumstances in forming our estimate of the age; such as the smiles of the infant, the early dawnings of the deve¬ lopment of the mind, and the distinctness with which certain desires and wants are expressed. But we must be cautious, as medical jurists, how we derive more than collateral evidence from such phenomena. (/>.) Period of first dentition. — At length the teething period arrives about the sixth or seventh month, and is generally ushered in with a copious flowing of saliva from the mouth. The infant, too, mani¬ fests a certain restlessness, and is ever anxious to rub the gums. The order in which the teeth are cut is worth attending to, although the exact date of the successive appearance of each tooth cannot be precisely stated. First the middle incisors of the lower jaw are observed ; then those of the upper to cor¬ respond ; then the remaining incisors in like manner — first below, then above. Next appear the first molars of the lower jaw, then the opposite ones of the upper. The canine teeth follow ; after which the second molars, until the whole twenty milk- teeth, constituting the temporary set, have been produced. The process is generally completed towards the end of the second year*. The following may be considered as an approximation to the average epochs of the appearance of the milk-teeth : — The two middle inci-^ & t0 7 raonths. sors, trom . S The two lateral ineisors, 6 to 9 — Two first molars . 8 to 15 — Two canine teeth . 15 to 18 — Two second molars .... 1 8 to 24 — But there is usually a great diversity in different children, with respect to the time of cutting their teeth. Some are born with their incisors above the gums ; others have no teeth at all till the end of the second year ; and persons have been known who lived many years without having ever had a tooth. Growth of the bones.— I have already no¬ ticed some of the earliest epochs at w hich the osseous system begins to be developed, and shall now put together what further points remain to be considered in con¬ nexion with infancy. I am anxious to be¬ speak your attention to this subject, though it may seem somewhat burthensome to the memory, because it is from the progress of the bony structures (thanks to the re¬ searches of Beclard) that we may derive some of our best and surest indications of age at every period, but particularly in those of early life. About the 5th month of infancy, a trace of osseous deposit may be observed in the cuboid bone of the tarsus. The branches of the os hyoides are now7 ossified, and somewhat later the lower apophysis assumes the same state. At six months, an osseous point is found in the anterior arch of the atlas, and the great wings of the sphenoid bee one united with the body of that bone. At tw7elve months, or thereabouts, the middle of the coracoid process of the scapula is generally found to be ossified : osseous points are also found in the heads * See Medical Gazette, vol. xiii. pp. 160 and 237. DIt. GRIFFIN’S MEDICAL PROBLEMS. 73 of the long bones, the tibia and femur in particular ; and the vertebrae have some considerable changes operated on them. There is a point, for example, in the first coccygean vertebra ; and the two osseous points in the posterior arch of each ver¬ tebra become united. The pieces of the temporal bone are firmly joined. At the age of two years, the epiphyses of the metacarpal and metatarsal bones are ossified: and an osseous germ is found at the lower extremity of the radius. At 2-§ years, the patella becomes ossified, and so does the lesser tuberosity of the head of the humerus. At three years, the first molars of the second dentition make their appearance, and about six months later the second mo¬ lars of the same set. At four , the great trochanter and pyra¬ midal bone of the carpus, also the second and third cuneiform bones, become ossi¬ fied. Between four and five years, the upper extremity of the fibula, the epiphyses of the phalanges, the trapezoid, and the semilunar bodies, exhibit a bony structure. At six years, the pisiform bone is form¬ ed, and the constituent pieces of the ossa ilia are separated merely by a very thin cartilaginous layer : the descending branch of the os pubis, and the ascending one of the ischium meet. Numerous changes also in the progress of the bony formation now occur in the vertebral column : but I find my limits will not allow of their enumeration. We shall complete our view of the re¬ maining ages in next lecture. MEDICAL PROBLEMS. By William Griffin, M.D. Limerick*. HOW ARE NEURALGIC AFFECTIONS TO BE DISTINGUISHED FROM INFLAMMATORY? In treating- of peritoneal and enteric inflammations, Dr. Abercrombie states, as conclusions from facts, “ that exten¬ sive and highly dang-erous inflammation may exist in the intestinal canal, with¬ out obstruction of the bowels, and it may go on to a fatal termination, while these are in a natural state, or easily re¬ gulated by mild medicines, through the whole course of the disease.” “ That extensive and fatal inflamma¬ tion may be goingon with every variety in the pulse; it may be frequent and small, it may be frequent and full, or * This article, which has appeared in the Dublin Journal of Medical Science, we republish at the request of the author, who has corrected several errors which had crept into the original impression.— Eo, Gaz. it may be little above the natural stan¬ dard through the whole course of the disease.” “ That extensive inflammation may go on without vomiting and without constant pain ; the pain often occurring in paroxysms, and leaving long inter¬ vals of comparative ease.” “ Keeping in view these sources of uncertainty (he says), our chief reliance for the diagnosis of this important class of diseases, must be on the tenderness of the abdomen. This symptom should always be watched with the most anxious care, whatever may he the state of the bowels or of the pulse , or the ac¬ tual complaint of pain , and though the tenderness itself should be limited to a defined space of no great extent.” Whatever the experience of the pro¬ fession may have determined with re¬ spect to the greater part of these con¬ clusions before the appearance of Dr. Abercrombie’s work, I believe it has been always in accordance with the opinions of that distinguished physician on the importance which should be at¬ tached to the presence or absence of ab¬ dominal tenderness in cases of suspected inflammation ; but Dr. Abercrombie was very well aware, when he gave such just weight to this symptom as a means of diagnosis, that in itself it w as far from conclusive, and derived its value chiefly from the existence of many other corroborating signs. He states, indeed, distinctly, in another part of his w ork, “ that pain increased upon pressure does not appear to be a certain mark of in¬ flammation in the bowels, for it occurred in Case XXIV. (related by him), in which there was no inflammation ; and in several other cases it was met with before, probably, inflammation had commenced. From various observations, he states, he is satisfied that intestine which has become rapidly distended is ainful upon pressure ; it is, however, a ind of pain which, hy attention , can yenerally be distinguished from the acute tenderness of peritonitis.” Th is point of diagnosis applies alto¬ gether to the discrimination of cases of ileus from those of inflammation, and even as such, is, it would appear, often of doubtful value ; but in what light must we view it, in reference to those frequent neuralgic affections, which, whether hysterical or the results of irrita¬ tion of the spinal cord, are often esta¬ blished suddenly, with little preparatory disorder, and with no distension of the 74 DR. GlUFFIN’s MEDICAL PROBLEMS. intestinal canal to account for the acute tenderness on pressure ? No medical man is now ignorant of the fact, that the contents both of the thorax and ab¬ domen, as well as their parietes, are subject to attacks of a violent pain of a nervous or spasmodic character, jet with acute soreness to the touch, as in pure inflammations. These are so widely separated from the latter in their nature, and require such a very different, 1 might almost say opposite, mode of treatment, that a correct diagnosis be¬ comes a matter of still greater interest than in cases of ileus. There are few instances of ileus in which one effective bleeding might not be of effective ser¬ vice, while there are few of hysterical pseudo-peritonitis, or enteritis, or of similar affections arising from irritation of the cord, which might not be made worse, or indefinitely protracted by it ; yet we find in our best elementary works on this subject a most perplexing’ indefiniteness, a diffuseness of descrip¬ tion, and a labouring at discrimination, wholly unworthy of the present im¬ proved state of medical science, and unnecessary, if any real or essential difference of character could be pointed out. It is, indeed, because there is an essential agreement in all material points, that our attention is directed to the attitude, the expression of counte¬ nance, the manner of complaining, and even the temper of patients, although there must be sometimes very considera¬ ble differences as to all these in indivi¬ duals similarly affected, and in any case no slight degree of experience is re¬ quired to form a proper estimate of their value. We are told that one affection is frequent, the other rare in compari¬ son — that females are more liable to it than the other sex, and those of seden¬ tary habits in towns, than those leading- active lives in the country; all of which might be very useful information, so far as it tended to corroborate features of a more marked expression, but is essen¬ tially loose and vague if considered by itself. Again, we are reminded of one or two truisms; that if a disease has lasted long and done no mischief, or if it has been aggravated by an anti¬ phlogistic treatment, its character is not inflammatory. We may thus ar¬ rive at a correct diagnosis about the time the complaint ought to be cured and forgotten. But the climax of our difficulties on this subject is displayed in the admissions of experienced phy¬ sicians, that their practice, when in doubt, is to run the risk of erring on the safe side, and treat the disease as inflam¬ matory ; — perhaps a judicious plan enough under the circumstances, but certainly not so consolatory to the pa¬ tient, nor, as I have elsewhere re¬ marked *, very creditable to medical science. It may be questioned, too, whe¬ ther a rule of the kind with young phy¬ sicians would lead only to errors on the safe side. I have seen one valuable life lost, and others endangered, by such practice, and sometimes the antiphlo¬ gistic treatment vigorously adopted ; not, indeed, where doubts existed in the mind of the practitioner, but where the cases were altogether mistaken. I am far from assuming to myself a perfect freedom from perplexity in all possible cases simulating inflammations of internal organs which may come be¬ fore me, but with the facts I have stated impressed on my mind, 1 cannot but feel that the experienced physician is usually too well satisfied with that in¬ definable power of recognizing or iden¬ tifying diseases almost unconsciously acquired in the course of long practice. In reflecting on the melancholy steps by which it is attained — on the sad, thoug’h perhaps excusable, errors com¬ mitted — he consoles himself with the conviction that such experience only could gift him with a knowledge which neither books nor lectures had taught him, when he should rather feel that the true reparation to his conscience, the real duty he had to perform in acquit¬ tance, was to prevent the occurrence of such mistakes with others, by analyzing the characters of those perplexing- dis¬ eases, and endeavouring to trace the sources from which his late discrimina¬ tion was derived. It is not enough for a practitioner in a difficult case to be assured he is himself capable of deter¬ mining its nature ; he should consider whether his knowledge or ability admits of being communicated toothers; and when he believes it is, but not until then, he may also believe that he has acquired information of infinitely greater value to the public than any thing it could have suffered from his early mis¬ takes. I have been led to indulge in these obse.vations in consequence of the ap¬ parent inattention with which a sug- See Treatise on Functional Affections of the Spinal Cord. DR GRIFFIN*S MEDICAL PROBLEMS. 75 gestion with respect to the diagnosis of neuralgic affections, proposed by me some years since, was received by the profession : I then stated, that in any doubtful cases I believed if tenderness on pressure at the portion of the spinal column corresponding icitli the disturbed organ existed, it might be considered decidedly neuralgic; but if no such symptom was found, it was probably inflammatory. The suggestion was then offered rather as a result of indi¬ vidual observation, which I was anxious should be tested by the universal expe¬ rience of the profession, than with a view of claiming attention for an incon¬ trovertible fact; but I have since so re¬ peatedly derived ready assistance in simulated inflammation, by assuming it as such, and have had the diagnosis so invariably borne out by the result, that I do not now hesitate to assert, it is almost the only single symptom upon which a young practitioner can rely without danger. Without entering into the queslion of the nature of spinal irritation, which I have discussed at large in anotherplace, I may be permitted to claim the reader’s attention to two points connected with it, which must be regarded as physiolo¬ gical facts. That the spinal cord, as the experiments of Le Gallois have shown, is composed of portions inde¬ pendent of one another in their powers and functions, being centres from which the nervous actions of corresponding parts of the body emanate, and to which they tend ; and, secondly, in conform¬ ance with the well-known law, by which the pain and tenderness arising from disorder at the origin or trunk of a nerve, is referred to, or felt at its extre¬ mity, that affections of the spinal cord are not usually recognizable by pain at the part diseased, but at the termina¬ tions of the nerves in distant organs arising from it. From these facts there is one undeniable inference in deter¬ mining the diagnosis of cases re¬ sembling inflammation, — that wherever spinal tenderness exists, we must at all events set down pain and tenderness (the two most important symptoms in assisting us to detect internal inflamma¬ tion) as wholly valueless; inasmuch as, whether there be inflammation or not, these are not peculiarly the results of it, but may arise also from the tender state of the cord. I might perhaps go much farther, and assume, that where spinal tenderness exists, there also exists a state of the system scarcely compatible with acute inflammation. If, then, pain and soreness on pressure, those supposed characteristics of inflam¬ mation, are of all others the most equi¬ vocal symptoms, belong as certainly to irritative as to inflammatory affections, and almost necessarily exist if there be acute spinal tenderness ; what is to be our guide in deciding the diagnosis when called to a person suffering with violent pain of side, feverishness, dif¬ ficulty of respiration, and soreness of the intercostal muscles ; or with violent pain in the abdomen, accompanied by exquisite tenderness to the touch, and perhaps constipation and vomiting — if we do not examine the spinal column P We want to ascertain the simple fact in the first instance, of whether the pain is in the viscus supposed to be affected at all, or whether it be merely in the tho¬ racic or abdominal parietes. And since the patient shrinks and complains on pressure in both cases, what, 1 ask again, is to be our guide, if we do not examine the spinal column ? Are we to depend upon speculations on the attitude, ex¬ pression of countenance, temper or man¬ ner of a patient, when we can at once lay a finger on the spine, and detect both the cause and nature of his com¬ plaint. If in the former case we find acute tenderness of some of the dorsal ver¬ tebrae, or in the latter of some of the lumbar, I do not hesitate to say, the one is not pleuritis, nor the other enteritis, nor will either bear large depletion with impunity. The pain and tenderness are merely referred to the extremities of the spinal nerves, ramified through the in- tercostals or abdominal muscles, from the affection of the corresponding por¬ tion of the spinal column, and indicate nothing- whatsoever of the state of the viscera internal to them, which usually excites so much alarm. If these are facts, and I believe few will deny them to be so, on examining for themselves, is it not absolutely leading the young practitioner into those mistakes w hich we so much deprecate, to associate pain and tenderness on pressure so exclu¬ sively in his imagination with inflam¬ matory diseases ? Is it not strange too, that cases are every day published in our periodicals, with dissertations on the difficulty of their diagnosis, w ithout the slightest allusion to the spinal cord, the 76 DR. GRIFFIN’S MEDICAL PROBLEMS. state of which, in every case of presumed inflammation, our present knowledge of physiology must show us the necessity of ascertaining *. One would suppose where the obscurity of the diagnosis is ofteu so undeniable, that any adventi¬ tious light which could be brought to bear upon it would be sought for with avidity, but this, every day’s experience assures us, is very far from the reality. As illustration is very generally more impressive than argument, I shall offer two or three cases to the consideration of the reader. A young woman, aged 25 years, was attacked with pain in the bowels at night after a feeling of chilliness. She took some essence of peppermint and went to bed, but the pain gradually in¬ creased, and at tw o o’clock in the morn¬ ing she took twenty drops of laudanum. At seven o’clock, the pain still con¬ tinuing, she took castor oil, with ten or fifteen drops more of the laudanum, by the directions of an apothecary, and soon after ten drops were repeated in a saline draught. I saw her at one o’clock, and found her writhing with pain, chiefly round the umbilicus and to the right side. It became more violent by fits like colic, though never entirely subsiding, and during the intervals of comparative relief, she sometimes threw her arms about restlessly, sometimes lay as if insensible, w'ith the eyes turned * There was a paper from Dr. Samuel Cusack in one of last year’s Dublin Medical Journals, “ On certain Nervous Affections occurring prin¬ cipally in Females.” It was an essay, in fact, on the treatment and diagnosis of those chronic pains below the mammae, or between the false ribs and ileum, so often mistaken for phthisis, pleurisy, liver complaint, &c., to which public at¬ tention has been directed of late years by several writers, as instances of spinal irritation. Dr. Marshall Hall described them long since in his work on Diagnosis, and more at large in his work on the Diseases of Females. Mr. R. P. Player published a letter on the subject as long ago as 1821. Dr. Brown, of Glasgow, published pre¬ cisely similar cases in 1828, demonstrating the connexion of the pain with the spinal cord, and since then we have had essays from Dr, Darwall, of Birmingham ; Mr. Teale, of Leeds ; and Dr. Marshall, of Manchester ; all pointing out the nature of those pains, and the little connexion they had with a.disease of the viscera apparently affected. It is of course open to any physician to publish cases and observations in support of par¬ ticular views, however frequently placed before the public already by others ; but it seems singu¬ lar Dr. Cusack should conceive it necessary in 1834 to publish an essay on these affections, not only without the slightest allusion to their pos¬ sible connexion with the state of the spinal cord, but without the least mention of any of those writers, to whom we are indebted for- both the descriptions which he gives, and a diagnosis so much more accurate than his, in its not omitting - an examination of the vertebrae. up and the lids half open. Her com¬ plaints were low, scarcely audible, her respiration painful when deep ; turning from side to side increased her pain, although when the paroxysm occurred she turned sometimes on her face. There w as excessive tenderness of the abdomen, the least pressure making her scream. She had been constantly vomiting for the last few hours. The castor oil had operated once scantily ; her pulse was but little quickened, and there was no heat of skin. Here was a case of constant pain in the abdomen, chiefly about the umbili¬ cal region, liable to severe exacerba¬ tions, attended by exquisite tenderness on pressure, vomiting and constipation, and continuing for twenty-four hours. I am convinced that almost any young physician would have felt great dif¬ ficulty, indeed almost an impossibility, of determining, from a consideration of the symptoms, that the complaint was not inflammatory , and I believe that the great majority of either young or expe¬ rienced ones would at once infer the existence of inflammation, and bleed. I say so from having witnessed it, and from having early in my own professional life always prescribed in such cases with timidity, as if I felt that all consideration of the symptoms led to little better than conjecture. I had now, however, new ground for a diagnosis in the state of the spinal co¬ lumn, on examining’ which my mind was set at rest. As soon as I pressed on the upper lumbar vertebrae the girl started violently, caught my hand, and complained that I had hurt her dreadfully : the pressure, she said, had increased the abdominal pain : she had never had any hysterical attack in her life. I ordered the abdomen to be fo¬ mented freely, and gave her five grains of calomel with half a grain of opium, directing five grains of aloes and five of extract of henbane, to be taken every two hours. The calomel and the first dose of the aloetic pills remained on the stomach, but the succeeding’ doses were rejected; a purgative draught was also thrown off : she then got a purgative enema, which was repeated in an hour, but both passed off without any appearance of faeces. The vomit- ing, pain, and tenderness of abdomen, continued very severely throughout the evening. At night she got a turpentine enema, and was placed in a hot bath, DR. GRIFFIN’S MEDICAL PROBLEMS. 77 which gave some relief, and procured a scanty evacuation. The pain, however, soon recurred, and she was ordered a grain of opium, to he repeated every hour until it should subside. The bowels were freely moved soon after taking1 the first dose, but she did not experience any considerable relief until she had taken the third, after which she fell into a sound sleep, and in the morning was in every respect improved. The pain had altogether subsided, and the exqui¬ site tenderness was now felt in the right epigastric region only. She had threat- enings of a return of the attack in the course of the day, but it was readily subdued by a repetition of the opiate. On the following morning there was scarcely any pain or tenderness, and if the complaint had been inflammatory, I would now have left the patient’s bow els perfectly at rest. But believing it to be an affection of the spinal cord, arising from disorder of the digestive functions, I ordered another dose of castor oil, which operated freely, and w as followed by no recurrence of the attack. Mrs. - , ag’ed 30 years, of a full habit, complained of pain in the right iliac region, which gradually increased until the whole of the abdomen became sore to the touch ; on the third day she took castor oil, which operated Treely, but gave no relief. I saw her on the fifth day, when she complained of being much w’orse, and directed her to get to bed, to have the bowels fomented, and to take pills of aloes and henbane every second hour until relief was obtained. In the morning I received a letter, stat¬ ing that she had been in agony all night, was much swelled, had not had her bowels moved for three days, and was now feverish and throwing every thing off her stomach. I became ex¬ cessively alarmed, and regretted I had not bled her on the night before. On arriving at her residence, I found her complaining of violent pain all over the abdomen, but most acutely in the right iliac region, and almost down to the pubes on that side. There was fulness of the bowels, and the greatest tenderness on pressure. She could not bear the slightest touch in the iliac re¬ gion, and one spot she described as ex¬ quisitely sore. It was on this account, !)erhaps, that she bore the weight of my land laid flat, and pressed very gradu¬ ally, better than pressure with the points of the fingers, as, in the former case, the pressure on the most painful spot was not so direct. Her pulse was ninety- six, her skin feverish, and tongue white ; she had nausea and occasional vomiting*, and could not turn or move in the bed, without considerably increasing her suf¬ ferings. The only symptom that could lead me for a moment to doubt that I had here a case of very serious inflam¬ mation to deal with, was the expression of the countenance, which did not be¬ tray the deep anxiety and distress I have usually seen in the inflammation of vital organs, although her own descrip¬ tion of her suffering was sufficiently alarming. The treatment of the case with deci¬ sion and confidence now depended alto¬ gether on the examination of the spine. If I found a state of increased sensibility and excitement of that part of the cord which gave origin to the lumbar nerves, the pain and tenderness of abdomen would be accounted for, and I need not infer a more alarming cause for them. If, on the other hand, there was no spinal tenderness, the existence of acute inflammation was almost certain, and the most active treatment was demand¬ ed. On pressing the spinal column, as soon as 1 reached the lumbar vertebrre she started and screamed aloud. She also felt excessive pain on my touching the sacrum, or making* pressure behind the trochanter, or at the front of the hip-joint in the groin. I therefore un¬ hesitatingly concluded it was one of those nervous affections simulating in¬ flammation, in which the progress of the case fully bore me out. A few leeches were applied to the most painful part of the abdomen, and a grain of opium was directed every second or third hour until there was some abatement of pain. She was also directed, as soon as the vomiting abated, to resume the pills of aloes and henbane, and take a dose of castor-oil. She got considerable re¬ lief, but passed a restless night. In the morning she took the aperient medi¬ cine, which operated freely, and now had pain occasionally only, and at long in¬ tervals; the vomiting had ceased, but the soreness of the abdomen was still exquisite in the right ileum and groin, and she screamed when I pressed on the vertebra, or immediately behind the trochanter. Fomentations were now directed ; belladonna plasters were af¬ terwards laid over the painful parts, and the opium pills were g’lven every fifth or sixth hour. She spent the day well, but the pain recurred in the night very 78 DR. GRIFFIN’S MEDICAL PROBLEMS. severely, and was relieved by the ano¬ dynes. Next morning1 the bowels were agained moved, but the soreness on ressure, or on moving much in the ed, still continued. The case went on in this way for several days, abating very gradually, but the soreness of the abdomen and of the hip-joint was not perfectly removed until she was for some days driving out in her carriage. I attended this lady afterwards for an attack of acute bronchitis, which was of a similar character in its advanced stag-es. The cough, oppression, and ex¬ pectoration, were evidently the result of nervous irritation, and required tonics rather than the continuance of any an¬ tiphlogistic treatment. She told me that in a former illness, which she called inflammation of the lungs, the doctor had bled and, 1 believe, blistered her more than once ; that she was going- on from bad to worse, with incessant cough and debility, until at last, in de¬ fiance of all advice, she took a glass of pure wine, which cured her like a . charm. I mention this, not that one can infer much from such loose state¬ ments, but because it gives some idea of the irritability of her nervous system. Mrs. - , of a delicate nervous ha¬ bit, after a natural labour, had internal haemorrhage, with pallid countenance, cold clammy sweats, chilliness, and an almost imperceptible pulse at 156. The haemorrhage ceased on the extraction of several clots with the hand, but the de¬ bility continued to an alarming degree for several hours. She had large doses of laudanum, with dilute sulphuric acid, through the night, which seemed to re¬ lieve her much ; but in the morning the debility was still great, the pulse weak at 130, the features sunk, and the re¬ spiration much hurried. On the follow¬ ing evening she had a severe rigor, and was soon after attacked with pain and tenderness in the uterine region, exces¬ sive pain in the head, brow, and eyes, with sickness of stomach and vomiting. There were thirst and heat of skin, and the pulse became rather hard at 140; the tenderness on pressing over the uterus was considerable, the pain constant, the lochia diminished. On examining the spine, there w;as found acute tenderness of the lumbar vertebrae, upon which it was assumed to be a case of nervous irritation, and not inflam¬ mation. A dose of calomel w ith ex¬ tract of henbane was given, fomenta¬ tions were applied to the lower part of the abdomen, and she got diaphoretics at intervals. Under this simple treat¬ ment the symptoms declined, and on the succeeding night she felt quite relieved ; the lochia and secretion of milk becom¬ ing abundant, and the pulse soft at 125. After the lapse of some days she was up and well. Mrs. M - , a married woman, aged 26 years, had very severe flooding in her lying'-in. On the fifth day after, she w'as seized with pains in the abdo¬ men, attended by excessive soreness to the touch, and fever. She got castor oil on the sixth day, which operated twice without giving much relief. In the evening she had a slight rigor, and felt very weak. The milk had left her from the first moment of the attack, and the lochia had nearly ceased. I saw her for the first time on the night of the seventh day from her delivery, and found her lying on her back, with her knees up, complaining much, and inca¬ pable of the least motion on turning to one side or the other w ithout the great¬ est torture. The pain was constant, but w'as increased to an excessive de¬ gree at intervals ; coughing wras very distressing to her, and the least pressure on any part of the abdomen made her scream. Slow, steady, cautious pressure with the flat of the hand was unbeara¬ ble, but she could stretch down her limbs without increasing her sufferings. Her countenance, which was pale from the flooding, had an expression of dis¬ tress, and the brows were knit as with pain. The skin was warm, the tongue moist and white, and the pulse weak, at 112. There was excessive tenderness of all the lumbar vertebrae. The abdo¬ men was fomented, and she got two grains of calomel and a grain of opium every third hour. After the second dose the pain abated, and she got a good deal of sleep; but in the morning the symp¬ toms returned, and the pills wrere re¬ sumed with the same good effect as before. The tenderness of abdomen w'as now rather less, though the bowels ap¬ peared more full, not having been moved for the last forty- eight hours ; she could turn from side to side with less suffering ; the pulse still 112, and the skin warm and moist; she took cas¬ tor oil, and afterwards pills of aloes and extract of henbane every second hour, which operated freely ; she passed a to¬ lerable night and seemed easier, but got the pain more violently than ever on to DR. GRIFFIN’S MEDICAL PROBLEMS. the following- morning-, when it was re¬ lieved by forty drops of laudanum ; it continued in the intervals of these pa¬ roxysms, but not severely. In the evening- the paroxysm recurred, and was again relieved by the laudanum. Not¬ withstanding- these recurrences she felt herself on the whole much better, could turn from side to side with more free¬ dom, and wished for nourishment; she complained of some headache. She was now directed to take three grains of sul¬ phate of quinine three times a day, and to repeat the laudanum if seized with the pain. I also allowed her to get a little chicken broth or beef tea. She passed a good night, and although the pain recurred at intervals on the follow¬ ing- morning-, it was much less severe; she threw up some aloetic and henbane ills which she had taken to free the ow-els ; the abdomen, though still pain¬ ful on pressure, was much less tender; the soreness of the spine was nearly gone, and her milk was returning. As her bowels had not been moved for the last thirty-six hours, she got some cas¬ tor oil, and the quinine and broth were continued ; she complained much of headache. The pain recurred again violently in the night, soon after which the flooding returned for a short time, and then ceased. The pain was relieved by a grain of opium ; felt much better through the day, and ate a little meat without permission ; the soreness of the abd omen almost gone, and none what¬ soever of the spine ; her headache was better; she continued her quinine and nourishment, and was well in a few days* *. V * The above ease, at the first moment I was called to it, so perfectly answered the descrip¬ tions given of simple peritonitis (see Abercrombie on the Viscera, p. 151), and so truly resembled the cases of that disease which had fallen within my own experience, that I watched its progress with much anxiety. I was, indeed, somewhat distrustful of the diagnosis ; fur although the extreme tenderness of spine would fully account for the tenderness of abdomen, the great torture experienced on the least motion from side to side was a symptom more characteristic of true peri¬ tonitis than of a neuralgic affection ; the progress of the complaint, however, fully satisfied me of its nature. I believe there is no practical physi¬ cian will assert that a case of acute peritonitis would have been arrested by the treatment adopted, which was, in fact, little else than pal¬ liative. It was only on the first day of my at¬ tendance that the opium, combined with calomel, was given with any regularity, five grains having been taken within twenty-four hours ; for al¬ though the pain recurred with equal violence, subsequently she had seldom occasion to take an I might multiply cases of this nature to an extent that would be tiresome, without making the point much clearer. Perhaps it may be said, that an expe¬ rienced eye would have detected some anomalous symptoms in all of these, which would have led to doubts of their inflammatory nature. I am not dis¬ posed to deny that much may be in¬ ferred in such attacks from the sudden¬ ness with which violent symptoms su¬ pervene, the absence of deep distress and anxiety of countenance, and, above all, from a freedom in the movements of the lower extremities unusual in acute abdominal inflammations. There was, indeed, at least one of these discrepan¬ cies observable in a greater or lesser degree in each of the cases detailed ; but how are young practitioners to form a diagnosis on such grounds? People suffer similar degrees and kinds of pain with very dissimilar degrees of fortitude ; and, at all events, any reasoning- on such signs must be founded on compa¬ risons, which, to be worth any thing, would imply an experience no young practitioner can be supposed to possess. In all acute inflammations of vital organs, I believe that no spinal tender¬ ness will be found, except where it ex¬ isted previous to the supervention of the attack*, or where the spinal cord itself happens to be the seat of such inflam¬ mation. In all neuralgic affections, on the contrary, tenderness of some portion of the spinal column, usually that cor¬ responding to the affected organ , may be detected, except in some rare cases, in which it seems probable the gangli¬ onic nerves alone are concerned. As these cases must still present a difficulty in their diagnosis, we must rest con¬ tented with those general characteristics, which, however vague or liable to lead us into error, are all we have to g'uide us, and all we have hitherto had to de¬ termine our opinion in that large class of neuralgic affections, for the detection of which I have here been offering a new, and I believe less doubtful sisn. opiate more than once or twice in the day. I may, however, point out one symptom in which the case differed from peritonitis--the ease and freedom with which she could stretch down her limbs. In spinal affections the least motion of the spine, especially turning or twisting motion, will sometimes increase the abdominal pain, but it scarcely ever occasions difficulty or uneasiness in the motions of the lower limbs. * Some writers on spinal irritation state that they have found spinal tenderness, with inflam¬ mation of liver. 80 DR. BUCHANAN ON THE The observations offered respecting1 the diagnosis of cases resembling- acute inflammations, apply with almost equal truth to those resembling chronic dis¬ eases ; I mean those pains affecting the chest, and attended by cough and per¬ haps oppression, leading to apprehen¬ sions of phthisis — the side, between the false ribs and ilium, suggesting affec¬ tions of the liver or bowels — or the pubic region simulating disease of the womb or ovaries. It is, however, wholly unnecessary to extend this paper to an unreasonable length on the subject of those nervous affections, the nature and diagnosis of which I have discussed so fully in another place ; I need only re¬ mark, that deducing inferences from acute or chronic pain, apparently affect¬ ing any viscus, without examining- the state of the spinal cord, seems to me little less absurd than omitting to exa¬ mine the state of the hip-joint in those painful affections of the knee, the na¬ ture of which is not immediately ob¬ vious. In either case the disease may not exist at all in the part apparently affected; and the real source of the pain can only be ascertained with certainty by an examination of the origin of the nerves distributed to it, or of any organ with which the part affected may be supposed to sympathize. ON THE THERAPEUTICAL EFFECTS OF IODINE, GIVEN IN VERY LARGE DOSES, In the forms of Iodide of Starch, Hy dr iodic Acid, and Iodide of Potassium. By Andrew Buchanan, M.D. Junior Surgeon to the Glasgow Royal Infirmary. [Concluded from p. 47. J Noli me tanyere. Under the head of noli me tangere and lupus, surgeons comprehend ceitain ulcerative affections of the nose, the in¬ tractable nature of which seems to have suggested the first name, while the se¬ cond is expressive of the wide-spreading destruction of parts which they not un- frequently occasion. There appear to be three distinct affections to which these names are often indiscriminately applied. The first seems to have its seat in the bones and cartilages of the nose. The ulcers of the surface occur only on the nose, or on parts in the im¬ mediate vicinity, being apparently a mere secondary affection, excited and kept up by the deep-seated irritation. The other two diseases have their seat in the cutaneous tissue; the evidence of which is, that they often affect other parts of the skin, as well as that covering the nose. The one appears to be a disease of the strumous kind ; it comes out in the form of papulae and small pustules* having irritable inflamed bases, which speedily become the seat of ragged su¬ perficial ulcers. The other is the can¬ cer of the skin, which, while it may occur in other situations, is very often observed on the nose. The two following cases are exam¬ ples of the first and second of these dis¬ eases. In the first a complete cure was effected under the use of iodine. It ought, however, to be borne in mind, that in such cases, on the diseased bones, which are the great source of irritation, being discharged, a spontaneous cure is often effected. In the strumous disease of the skin the benefit obtained was much less considerable. Agnes M‘Ilwee, set. 12, spinner. Ja¬ nuary 7th : Left half of upper lip is the seat of an irregular unhealthy ulcera¬ tion, with thin edges, no granulations, and pretty deeply excavated in several places. Discharge is thin and serous, concreting- into yellowish scabs. Inte¬ guments stretching from nose upwards and outwards towards right malar bone, are red and chapped. Disease appeared about twelve months ago, healed spon¬ taneously, and reappeared six weeks since, cold weather seeming to be its exciting cause. Three years ago ulceration of throat attacked her, and ended in complete de¬ struction of velum palati, and partial destruction of roof of mouth. Several pieces of bone were discharged, and there is now an oval opening into nos¬ trils, the posterior part of septum of which is destroyed. No pain in dis¬ eased parts ; glands under angle of jaw considerably enlarged. General health pretty good No treatment. 8th. — Sum. ter indies Iodid. Amyl. 3j. m. s. 13th. — Little change on symptoms. Augeat. dos. Iod. Amyl. ad. ^ss. ter in¬ dies. 27th, — Ulcers of lip every where ON THE THERAPEUTICAL EFFECTS OF IODINE. 81 cicatrized, except a stripe along1 margin of mouth, which is covered with a dry scab. A considerable portion of septum and maxillary bone have been removed, and there is no longer any discharge from nose. Medicine agrees well. Feb. ‘23d. — Dismissed cured. Ann Smith, set. 17, weaver: March 6th. — About six years ago, observed a small excoriation, discharging a thin serum at lower part of septum of nose. It remained stationary for two years, when discharge became more consistent, and a scab formed, and since that time superficial ulceration and scabbing have been spreading, till now the tip also, and septum of the nose, are involved. The scabs are of a yellowish-green co¬ lour, and on separating, leave the subja¬ cent parts in a state of ulceration. About 12 months ago, small papulae formed upon left cheek; they discharged from their summits thin purulent mat¬ ter, which concreted into scabs of the same character as those on nose. About nine months since a similar eruption ap¬ peared on each side of neck, and there is now a stripe of superficial ulceration, covered with green scabs, extending from lobe of ear downwards to near cla¬ vicle. Right cheek became affected six w eeks ago. Back of neck is swollen, and indurated from about the 3d to the 7th vertebra, swelling extending the whole breadth of neck. It is attributable, apparently, to the irritation of a seton inserted in May last, and follow'ed by an attack of erysi¬ pelas. General health not much affected ; catamenia absent for nine months. Was a patient in this house in May and June last, when Nitr. Argenti, and other local applications, were of little service, the cure being apparently affected by the attack of erysipelas. R lodid. Plumb. 3j. ; Axungiag, Jj. M. F. unguent maculis impetiginosis ad- hibendum. Sum. Iodid. Amyl. Jss. ter indies. April 28th. — Dismissed, considerably improved. Cancer. A very complete trial was made of the hydriodic acid in a case of cancer of the mamma, but unfortunately with no other result than that which has hitherto followed every attempt to find a remedy for that terrible disease. It is needless 463. — xix. to insert the case at length. The woman was 40 years of age, and the tumor of 3 years’ standing. She came into the hospital for the purpose of having it- re¬ moved. The operation was prevented by an attack of erysipelas, which came on the very day fixed for performing the operation. On the subsidence of the erysipelas, several lymphatic vessels were found, hardened like whip cord, and an enlarged gland above the clavi¬ cle. All thoughts of excision w ere there¬ fore abandoned, and the patient put upon the liquid hydriodic acid. It should have been mentioned in the former part of this paper, that the strength of th is liquid acid is exactly the same as that of Coindet’s tincture of iodine, if, in preparing the latter, the quantity of alcohol be determined, as I believe is commonly done, not by weight, but by measure. In that case an ounce of either preparation contains Qij. of iodine. Of the liquid acid the patient took Jss. three times a day, equivalent to 3j* of iodine, commencing on the 13th Febru¬ ary, and continuing without any inter¬ mission till 26th March. She took, therefore, in all, upwards of ^v. of iodine. The effects of this very large quantity upon her complaint may be judged of, from the report made on the day the medicine was inter¬ mitted. March 26th. — Has used hydriodic acid since last report; no change in glands of axilla, and above clavicle. Tu¬ mor of mamma larger, and ulceration deeper, more extensive, and very foul. Little change in pain, though for the last two days it has been aggravated. Pulse 84; general health pretty good. Dismissed, with advice. Tumors. Mrs. Gibson, aet. 34. August 8th : Seven months ago, leg became affected with considerable pain and erysipela¬ tous redness; this shortly afterwards subsided, and upper part of leg began to swell : since then it has gradually increased to present size. On admission, calf of leg measures two inches more than opposite one in circumference. On internal side it is pretty hard, and unyielding ; at external part it is soft and elastic, but no fluctua¬ tion can be recognized in it. Tumor is somewhat, though not very, moveable; seems to arise deep among’ the muscles, and does not appear to be attached to G 82 DR. BUCHANAN ON IODINE. any of the hones. Says it is the seat of constant pain, sometimes lancinating. Dismissed cured. This patient was put upon gr. xv. of the iodide of potassium daily, and di¬ rected to rub frequently the leg with an ointment containing the same medicine, and to abstain from motion. Under these means the swelling gradually dis¬ appeared ; and when she left the hos¬ pital on the 2d October, there was no vestige of it remaining. Nothing could be more unexpected than the issue of this case, and it excited much surprise in all who witnessed it. The fact that at a consultation, held after her admission, several of the gen¬ tlemen were of opinion that the limb would ultimately require amputation, shows that the tumor was one of no trifling description. It is right, however, also to mention, that the cure was not permanent, as will be seen from the following report, taken on the readmission of the patient into the hospital on the 20th December. This report I insert, as marking the peculiar nature of the disease, as upon that peculiarity, there can be little doubt, depended altogether the efficacy of the remedies employed. Dec. 20th. — Leg continued free from swelling and pain for about a month after dismissal. About this time, after exposure to cold, began to experience lancinating pains in the part formerly affected, which became soon after swol¬ len, and gradually increased to the same size as at former admission. Continued the iodine for some time after being dis¬ missed ; but she has undergone no treatment for the last six weeks. Being at present in the ninth month of preg¬ nancy, she is dismissed with advice till after delivery. Lepra and Psoriasis. John M‘Lellan, setat. 32, labourer. Jan. 17th : Extremities are the seat of a scaly eruption, which commenced about two years ago around knees and elbows, in the form of roundish patches, slightly elevated, and surmounted by shining white scales. These have now coalesced into large blotches, rough, red, and scaly, with occasional small fissures scattered through them. Experiences no uneasiness from complaint. General health good. Sum. Iodid. Amyl. ^ss. ter indies. Jan. 24th. — Spots on skin somewhat less red and scaly. Iodine does not produce costiveness, and in other re¬ spects agrees well. Augeatur dosis ad ^j* Feb. 23d. — Patches on arms and trunk gone for some time, and natural texture of skin restored. Still a little redness, and some vestiges of spots on lower limbs. Has taken since the 18th ult., ^xcvi. of the iodide of starch, equi¬ valent to 1 iiv . 3vi. gr. xxiv., or 2304 gr. of iodine. The medicine gave the usual tinge to the secretions, but did not pro¬ duce costiveness, nor any other incon¬ venience. Feb. 26th. — Dismissed cured. In another case of psoriasis some be¬ nefit was derived from the iodine, but it was by no means so marked as in the preceding case. A full trial of it was not made, as the patient was remitted to the physician on my ceasing to take charge of the surgical wards, in May last. In the case of Purdie, (ward No. 8.) admitted for an ulcer of the leg, but also affected with lepra of twelve years* standing, the iodine appeared to be of service. She commenced the use of the iodide of starch in the dose of 3SS. three times a day on the 12th January, and on the 13th February the eruption was nearly gone. But as the disease usually got better in the spring, the amendment may have been owing to the season as much as to the remedy. I may further mention, that in a case of lepra which I treated in private with the iodide of starch, in the dose of a tea-spoonful three times a day, a cure was effected in about six weeks. Ichthyosis. Donald M‘ Donald, set. 19, shoe¬ maker. — Nine days ago, and three after impure connexion, observed some small pustules on glans ; they were at the time productive of no uneasiness, and were in consequence neglected. Five days ago, after a debauch, observed pre¬ puce to be swollen and painful, and next day complete phymosis came on. Swelling gradually extended upwards, till the whole penis became affected. On admission, swelling is so great, that glans cannot be uncovered. Penis is of dusky red, and prepuce is beginning to assume a livid appearance at its upper part. Glands in groin are very slightly enlarged ; some fever: pulse 90; tono'ue white. & Whole body, but particularly front of HOMCEOPATHY UNPHILOSOPHICAL AND QUACKISH. 83 thighs and legs, is the seat of a scaly eruption. Scales on thighs and knees are small, thick, of a greenish colour, and closely set, somewhat resembling shagreen in appearance; in other places they are larg'e, thin, and light coloured. On desquamating, skin is left rough and tender. This eruption he avers appeared three days after connexion. Denies previous infection. Has been using mercury for the last four days, and his mouth is slightly affected. Circundetur penis cataplasmate. Utatur Mistura emeto-cathartica m. s. March 12th, day after admission, fore part of prepuce gave way by sloughing, and glans protruded through opening. Fore part of prepuce removed by knife, and leeches applied to penis, with barm poultice. Sloughing quite stopped, cut surface having a healthy aspect. General excoriation of surface of glans, and one small elevated sore; no discharge from urethra ; skin as at admission. Sum. Iodid. Amyl. ^ss. ter indies. 15th. — Medicine agrees well. Augeat. dosis ad. Jj. 25th. —Wound from circumcision now healed. Still superficial ulceration of glans, to which solution of Nitr. Argenti has been applied. Scabs on limbs some¬ what less dense. Iodine agrees well, and urine deeply tinged. Utat. Bain. Calid. Calore grad. 110 ad 120. 26tb. — Could not endure bath hotter than 105°. Neither in perspiration from forehead, nor in water of bath, could any iodine be detected. April 28th. — Skin now well ; penis completely cicatrized. Dismissed cured. It is necessary to state, with respect to this patient, that he came into the hospital for the venereal affection first described, and that no reliance can be placed on the very improbable account given of the origin of his cutaneous disease, as he spoke and understood English very imperfectly, and varied in his statements every time he was inter¬ rogated. I conclude the subject of cutaneous diseases by saying that, in a case of impetigo sparsa, a cure was effected under the use of the liquid hydriodic acid, internally, and the citron ointment as an external application, and that no benefit was derived from the iodide of starch in a very obstinate case of porrigo favosa. HOMCEOPATHY UNPHILOSOPHI¬ CAL AND QUACKISH. To the Editor' of the Medical Gazette. Sir, The essence of the inductive philosophy of Lord Bacon has been truly said to consist in ascertaining the universality of a fact. This was the method which this illustrious philosopher, “ The great deliverer, he from whom the gloom Of cloistered monks, and jargon-teaching schools. Led forth the true philosophy," recommended us to pursue in our in¬ quiries after truth. Prior to his time, the logic of Aristotle held an usurped dominion over the kingdom of science, and the syllogism w as universally consi¬ dered a tribunal, from whose decisions there could be no appeal. All the errors which have crept into science — all the false conclusions which have been deduced from the investiga¬ tions of particular branches of know¬ ledge — have originated in a neglect of the important rules laid down by the author of the Novum Organum. There is not a more remarkable instance on record of the folly of generalizing from a few particulars, than that exhibited by Hahnemann and his followers. From the examination of a few insignificant facts as the basis, they have created a mighty superstructure, which is desig¬ nated by them, with pomp and parade, “ the science of homceopathy !” If the principle which the homoeopa- thists consider to be unequivocally esta¬ blished be founded on a logical deduc¬ tion from admitted premises, the whole system of medical treatment adopted by “ allopathists” must be founded in error. Once admit the truth of the homoeopa¬ thic theory, and the science of medicine must undergo a revolution ! Before I consent to remodel the whole fabric of medicine, and to abandon the principles which I have been taught to consider to be founded on a correct view of the character of disease, I naturally ask myself a few questions. In the first place, is such a medical change ne¬ cessary ? Is our present system, as taught in the schools, so grossly imper¬ fect as to require such a thorough rege¬ neration as the homoeopathists would lead us to believe? Every practitioner must admit that there are diseases which frequently baffle the united skill of phy¬ sician, surgeon, and apothecary, and 84 HOMCEOPATHY UNPHILOSOPHICAL AND QUACKISH. that the science of medicine, as at present established, is justly called an “ uncer¬ tain ” science, and this uncertainty must exist, so long as medical men have to deal with living beings. If the liomoeo- pathists can make medicine an exact science, and can point out to me a more successful mode of treating’ those diseases which are considered by us, under cer¬ tain circumstances, as incurable, I will willingly consent to throw aside all my preconceived ideas, and confess myself a proselyte to homoeopathy. If I am travelling one road to a certain point, and a man comes up to me and recom¬ mends me to change my route, I natu¬ rally ask him to point out to me the ad¬ vantages which T am to derive from the chang'e? — if there are none, I prefer following the dictates of my own judge¬ ment. What has been said by Paley of religion, may not inaptly be applied to physic. A man is at liberty to think as he pleases on the subject of religion ; but he ought not to be allowed, by the magistrate, to teach to others doctrines at variance with the established creed of the land, and inimical to the divine word of God. With regard to physic, Morison, Eady, and the Homoeopathists, may imagine they have discovered a “ royal” and a rail-road to health ; but they are not at liberty to compel others to travel this road, when it is certain it will tend to their destruction. Government ought to have it in their power to put a stop to the practice of men, when that practice can be proved to be detrimental to the public good. In the case of the much-lamented death of Madame Malibran, as you justly observe, the treatment adopted during one short hour, in her precarious state, may have made the difference be¬ tween life and death. The danger aris¬ ing from the practice of homoeopathy is similar to what is likely to accrue from any other description of quackery. It is not that there is any thing perni¬ cious in the medicines they administer, but the evil lies, as Sir Gilbert Blane observes, in the false confidence which is inspired , to the exclusion of other and better remedies *. I speak, sir, from personal observation of the evils result¬ ing from their tampering with the life of a fellow creature. Not many months ago, I was called in to a serious case of inflammatory disease, in consultation * Medical Logic. with a gentleman who was treating the case homceopathically. It was not long ere I perceived that the patient’s life was in jeopardy, and I feel assured, that if active remedies had not been had recourse to, the patient would have been lost. A practitioner is called in to a serious case of enteritis; carrying' out the homoeopathic principle, arsenic and powerful stimuli ought to be adminis¬ tered, because, when these medicinals are taken in a state of health, symp¬ toms similar to those arising* from in¬ testinal inflammation are produced ! “ Similia similibus curanturf say the homoeopathists. Need I say what w ould be the consequence of this treatment ? — death, as a matter of course, in ninety- nine cases in a hundred. I will suppose another case: — A man has taken arsenic, or laudanum, for the purpose of putting an end to his exist¬ ence, and stupor, or acute gastric in¬ flammation, is the consequence. If the homoeopathists practised the doctrines they taught, they would administer small doses of the very drug with which the patient had been poisoyied ! Iodine I have found to be almost a specific in certain cases of secondary syphilis, and in a variety of cutaneous affections ; but I never yet saw* symp¬ toms resembling, in the remotest degree, syphilis, arise from the exhibition of iodine to a person with an indurated liver. In opposing homoeopathy, I would not run into the opposite extreme, and consider the beneficial effects of a medi¬ cine to increase in a ratio with its dose; neither will my credulity allow me to believe that a millionth part of a grain of calomel, given every two hours, will impede the disorganizing progress of an acute attack of iritis : the idea is preposterous ! I cannot bring myself to believe that these practitioners act up to their own principles. They may talk and write about their surprising cures, and per¬ suade the credulous that they were treated homoeopathically, but it is my firm conviction, that, should one of these practitioners be attacked with in¬ flammation ot the brain, or by any other serious organic disease, he would quickly abandon his own crude notions, and submit himself to the ordinary mode of treatment. This is the best mode of testing a man’s belief in a particular doctrine. It may be said that a man MR. BULLOCK’S CASE OF POISONING BY FISH. 85 may “ know the right, and yet the wrong pursue,” and that lie may preach, and yet not have the moral courage to practise ; but he who knows any thing of disease, will not, if life be sweet to him, trifle with himself by neglecting the surest mode of arresting its progress. I remain, sir, Your obedient servant, Forbes Winslow, Member of the Royal Colley of Surgeons, London. 48, Hertford-street, May Fair, Oct. 8, 183(5 CASE OF POISONING BY FISH. By Henry Bullock, M.R.C.S. Eleanor Merwick, oetat. 39, of good general health, partook, in common with her family, at dinner, of muscles, which had nothing peculiar either in their smell, taste, or general appear¬ ance, at one o’clock, on Thursday, Sep¬ tember 22, 1836. Her account is, that having eaten about a dozen, she, in about a quarter of an hour after, expe¬ rienced g'reat uneasiness, and a sense of weight at the epigastrium, which con¬ tinued increasing for about an hour, when a sensation of numbness and tightness of the surface generally su¬ pervened, immediately followed by the formation of large, red, and white pro¬ minent patches upon various parts of the body, accompanied by an intolerable itching and a very tormenting heat, while the eye-lids and face were enor¬ mously swollen and red. Two hours having elapsed, and the intensity of the preceding symptoms rather increasing than diminishing-, she was seized with a violent suffocating dryness of the throat, and with oppression at the chest, attended with the most urgent dyspnoea; her eyes were also suffused and discharging copiously, and she complained of cramp in the calves of the legs. About this time I saw her, when the pulse was rapid and the tongue crimson, whilst her body was literally covered by this violent form of urticaria, so that she appeared to be suffering the most extreme agony. I directed her immediately to drink largely of milk, and to repeat it at short intervals. In about an hour the symp¬ toms began to abate, the heat and irri¬ tation of the skin first subsiding; the breathing* was next relieved, and all the symptoms gradually and rapidly dis¬ appeared, so that at seven o’clock, after having slept half an hour, she awroke, being perfectly well, and has continued so ever since. It is to be remarked that this woman was the only one of the party who suffered from the effects of the meal, and that she had experi¬ enced a similar attack twelve months since, after eating muscles. In this case, it would appear that the poisonous effects of the muscles arose from idiosyncrasy, since the patient had previously suffered a similar attack from the same exciting cause ; also from the remainder of her family having eaten of the same food with perfect impunity. The treatment adopted w as that usually pursued at St. Thomas’s Hospital with universal success. Mohring De Mytilorum, See. has relat¬ ed several cases precisely similar to the above, with one exception, namely, that the chest symptoms preceded the cutaneous irritation, and all his patients recovered under the use of emetics, which appears to be the practice recommended by Beck, and most authors. A number of cases, how¬ ever, are recorded in the Gazette de Saute , relieved by aether, the eruption having given place to the most urgent asthma. Dr. Dulong has also given aether, but in his case slight mention only is made of a very temporary and partial eruption, with swelling of the eye-lids and face. The asthma was distressing. From the reported cases in which aether has been employed, and from what we know of its action upon the system, it would appear applicable only at a later period of the disease, and in those cases in which the dyspnoea is the most prominent feature. The treatment by milk exemplifies the efficacy of a remedy, the mildest, perhaps, employed in medicine, and peculiarly successful, at the same time possessing many advantages in these cases, over the use of emetics, both as it greatly shortens the duration of the disease, and consequently the anxiety and physical sufferings of the patient. It is perhaps difficult to explain the modus operandi of this remedy. Is it not highly probable that the irritating matter in the stomach combines with the milk in coagulating, and that in consequence of this chemical change it 86 PHYSIOLOGY OF THE NERVES AND MUSCLES OF THE EYE-BALL. is rendered insoluble, and hence becomes innocuous, in a manner somewhat ana¬ logous to the action of albumen on cor¬ rosive sublimate ? St. Thomas's Hospital, Oct. 10, 1836. PHYSIOLOGY OF THE NERVES AND MUSCLES OF THE EYE-BALL. To the Editor of the Medical Gazette . Sir, The polite manner in which Mr. Hunt accuses me of literary dishonesty, and the courteous terms in which he charges me with a want of courtesy, must have a powerful effect in restraining me from any undue severity in my remarks upon bis letter, dated Sept. 26. It will be well known to many of the readers of the Medical Gazette, that I have, on several occasions, addressed them on the subject of the nerves of the face and of the eye : more recently my attention has been directed to the nerves of the eye-ball in particular. With re¬ spect to the paper which was read at the late meeting of the British Association, the object of it was to give what I hoped would be considered a complete explanation of the physiology of the nerves and muscles of the eye-ball, which 1 believed had not hitherto been done. With that object in view, I was anxious to ascertain what was the pre¬ cise condition of the state of our know¬ ledge on this subject up to the present period. In so doing, I gave a brief abstract of all that I knew, and men¬ tioned the various views and opinions of different individuals, as far as my know¬ ledge extended ; pretending to have discovered nothing myself, but simply endeavouring to draw conclusions from tb ese various sources that should be rational and satisfactory. In the course of my inquiry, I thought it right to mention a view which had been promulgated by Mr. Hunt, and which I regarded as a very rational view, otherwise I should certainly not have brought it forward as I have done. This view of Mr. Hunt’s, how¬ ever, I could not consider but as still leaving the matter far from being set¬ tled, and very imperfect. So far as adopting that solitary view goes, my explanation accords with Mr. Hunt’s, but no farther ; and that view I have attributed to him in, what I thought, very distinct terms. What were the words which I made use of? — “ I can¬ not close this paper without observing that my colleague, Mr. Hunt, first sug¬ gested the probability that the com¬ plexity of the nerves of the orbit wras connected with the varied motions of the two eyes which T have pointed out.”’ Who, that reads the foregoing para¬ graph, can doubt “ whether (in Mr. Hunt’s words) Mr. Walker has made sufficient acknowledgment of the use he has made of the discoveries” of Mr. Hunt ? Discoveries ! — what has Mr. H. discovered? Did he discover the oblique muscles, or the fourth and sixth {>airs of nerves ? — or does he pretend to iave discovered, that, w hen we look at an object laterally, one eye is turned inwards and the other outwards ? If he does, he may rest assured that no one, either in or out of the profession, will ever acknowledge any such claims. Mr. Hunt has the merit of being the first to suggest what I have above at¬ tributed to him, and that is all that he can lay claim to ; and it has been willingly and properly acceded to him. It may suit Mr. Hunt’s purpose to say that my views are similar to his “ with one exception, viz. the action of the superior oblique muscle.” Mr. Hunt very well knows, however, that there is something more than this : he know's that some important conclusions were draw n relative to the fourth nerve ; that the superior oblique w as considered as the antagonist of the external rectus in one eye ; and that these muscles were associated in the action of the two eyes, when directed laterally. In short, if Mr. Hunt had said that my view's were dissimilar to his, “ with one ex¬ ception,” &c., he would then have stated exactly what is the case. Mr. Hunt, to the best of my recollec¬ tion, not only argued that the superior oblique turned the eye outwards and downwards, but farther, that he was the discoverer of this action. Whether he still reckons this as one of his disco¬ veries, 1 know not ; I only know that it was first suggested by Albinus, and is now maintained by Sir Charles Bell and many others. So far from Mr. Hunt’s view settling* this question, in¬ deed, 1 do not believe that he offers a single reason for the fact, that the supe- ANALYSES AND NOTICES OF BOOKS. 87 rior oblique has a separate nerve as well as the external rectus. Having- thus, as I trust, fully an¬ swered the charge of appropriating Mr. Hunt’s discoveries, I will proceed to make a remark or two on his other accusation — of want of courtesy. Does Mr. H. consider that, because he, two years ago, offered a suggestion in his introductory lecture, and last year read a paper before the Medical Society, in which he repeated the sugg-estion — does he suppose that the subject of the physiology of the muscles and nerves of the eye-ball is therefore to be laid under a ban, to be tabboed, and that no one must approach it until he repeats the suggestion in some other form? Was it not sufficiently published by being delivered in a public lecture-room, and proclaimed to a meeting of a public society, for me to allude to in reading a paper before another society, or in ano¬ ther lecture-room ? That it has been published at this time in the Medical Gazette, Mr. Hunt may thank him¬ self: it was owing to the representa¬ tions he thought proper to make amongst the profession here, that 1 was induced to request ycu to give it a place in your columns, in order that the profes¬ sion might judgefor themselves whether or not I had done an act of injustice, and with them I willingly leave it for decision. — I have the honour to be, sir, Your very obedient servant, John Walker. Manchester, Oct. 4, 1836. ANALYSES and NOTICESofBOOKS. 41 L’Auteur se tue a allonger ce que le lecteur &e tue a abreger.” — D’Alembert. The Hum an Brain : its Configuration , Structure , Development , and Phy¬ siology ; illustrated by references to the JServous System in the lower orders of Animals. By Samuel Solly, Lecturer on Anatomy and Physiology in St. Thomas’s Hos¬ pital, &c. &c. With Twelve Plates. The title of this book amply points out the nature of its contents. The subjects embraced in it are of wide extent, and include some of the most obscure ques¬ tions in physiology ; we may add, that they have been treated by Mr: Solly in a manner that reflects the highest credit upon his industry and talents. He has presented us with an useful summary of the most valuable results that have been recently obtained by the several ana¬ tomists and physiologists, at home and abroad, who have cultivated this sub¬ ject ; this by itself is an acceptable offering to the profession, but we have besides numerous important observations of the author’s own, both on the struc¬ ture and physiology of the brain. When we cast even a cursory g’lance over the names of the writers whom Mr. Solly is called upon to quote, we cannot but perceive that it is essentially a new department of physiology of w hich he treats, — that it is one which has risen up as a distinct inquiry in the present day. So long as it was con¬ sidered that the brain itself was the primary part to be investigated, and that it was the source of a nervous power common as regards the nerves of the body, no progress could be made; but when it was announced that a certain series of nerves, arising from a particular tract of the brain, were endowed with properties perfectly dis¬ tinct in their nature from another series arising from a different tract, then the investigation assumed a new character. It is obvious what the next step in the progress must be. As the tracts of nervous matter prolonged from the brain, or towards the brain, were proved to give origin to nerves possessing distinct endowments, the inference was drawn, that these tracts themselves must like¬ wise be distinct in their nature from each other. Hence the chief objects of interest became, on the one hand, to as¬ certain with accuracy the proper func¬ tions of the several nerves, by observing the organs which they supplied by judicious experiments ; and, on the other hand, to trace through the brain the columns of nervous mat¬ ter with which they were connected at their roots. By these means, and with the assistance of pathology, which, in a subject like this, may be regarded as taking the place of expe¬ riment, it was reasonable to expect that we might acquire some distinct know¬ ledge of the uses of the parts situated deeply in the brain. Comparative ana¬ tomy w'ould also lend us most valuable assistance. But it is obvious that the foundation of all reasoning on the func- 88 ANALYSES AND NOTICES OF BOOKS. tions of the tracts in the brain, must be a correct knowledge of the particular uses of the nerves which arise in groups or in succession from the different subdivisions of the cerebral mass. Such considerations have led us to examine with peculiar interest that part of Mr. Solly’s work w hich treats of the functions of the individual nerves ; and we have been g-ratified by finding that he presents a very correct account of them. We have also been pleased to per¬ ceive a liberal spirit displayed by him in bestowing credit where it is due upon those gentlemen who have contributed most to improve our knowledge on these points. There are some mistakes, how¬ ever, in regard to those to whom we are indebted for some of the discoveries alluded to. In particular, it has sur¬ prised and disappointed us to find no notice taken of the labours of an ana¬ tomist who exhibited great zeal and intelligence in prosecuting these in¬ quiries at their commencement; — wre allude to the late Mr. John Shaw, whose loss to science, at the time when engaged in those very pur¬ suits, and when he had begun to gain a high reputation, was univer¬ sally deplored by the profession. By those who will take the trouble of looking back to the numerous papers which this gentleman published on the nervous system, at the first promul¬ gation of the discoveries in question, it will be found that he did much more, by his dissections in human as well as comparative anatomy — by his experiments and his writings — to ad¬ vance our knowledge of this branch, than any of the persons, with one single exception, whose names it is usual to bring forward as meriting especial distinction. With regard to the roots of the spinal nerves, for example, Mr. John Shaw repeated the experiments which had originally been performed by Sir Charles Bell, confirmed their results, and exhibited them publicly to his class in Great Windmill-Street, two years at least be¬ fore M. Magendie had thought of put¬ ting himself forw ard as an original ex¬ perimenter on the nerves. Mr. Shaw w as likewise the author of a paper, which attracted much notice at the time, presenting, among other sub¬ jects, a full account of the experiments on the roots of the spinal nerves ; and in which paper he anticipated the de¬ scription of the same experiments, by M. Magendie, by several months. As this paper was delivered to the Medico- Chirurgical Society, some time elapsed after it was read before its publication ; yet, notwithstanding this, it preceded the memoir of M. Magendie. It was entitled, “On Partial Paralysis,” and was distin¬ guished from M. Magendie’s memoir by other and more important circumstances than merely that of being first before the ublic. It not oqly contained, as we ave stated, an accurate account of the distinct properties belonging to the an¬ terior and posterior roots of the spinal nerves, and a detailed description of the experiments which established these facts, but it embraced observations of equal interest upon numerous other nerves : for example, it contained proof of the fifth pair of the brain cor¬ responding, in structure and functions, with the spinal nerves, while it showed the distinction between this class of double nerves and the portio dura, the ninth, &c. But Mr. Shaw did not limit himself to the illustration of the natural functions possessed by the nerves alluded to; the subject was, even at that time, so much advanced, that, as the title of the paper indicates, he could give pathological observations in addi¬ tion, founded upon these new inquiries. These illustrations were of the highest importance. The nature of the ques¬ tions discussed may be judged of by the title affixed to one of the divisions of the paper, which is this : — “ Why should Sensation remain entire in a limb when all Voluntary power over the action of the muscles of the limbs is gone ? or why should Muscular power remain when Feeling is gone ?” We have only to remark, that the explana¬ tion which Mr. Shaw has given of these remarkable occurrences, is as full and satisfactory as any that could be presented at the present day, after sixteen years’ acquaintance with the subject. Now' when, at a subsequent period, M. Magendie came into the field, and related the same experiments on the spinal nerves as if they were original, he might not have been aware of Mr. Sha w’s paper: but what principally astonishes us, is, that M. Magendie should have been adopted as an autho¬ rity, w hen his paper evinced most de¬ cidedly that he was far behind in his knowledge of the subjects for which he was quoted. Although he presented his MR. SOLLY ON THE HUMAN BRAIN. 89 experiments on the roots of the spinal nerves so late, he described them as quite isolated, having1 no connexion with, and receiving- no confirmation from, any others. He does not once refer to the fifth pair as a corre¬ sponding nerve that might illus¬ trate their functions, or to the portio dura and ninth pair that might be shown to differ from them. He does not pretend to explain paralysis of any kind from his experiments : indeed he refers to them as so recently performed, that this could not be expected ; and so far is he from leading us to suppose that he had ever before succeeded in obtaining the same results, that he ac¬ knowledges that he had been baffled in his previous experiments. But there is the strongest reason, independently of ail th ese arguments, for rejecting- M. Magendie altogether as an authority upon the experiments in question. If those who quote him had perused his second paper, published only two months after the first, or any of his subsequent publications, they would have seen that he had completely changed his views respecting the functions of the roots of the spinal nerves, and expressed opinions diametrically opposed to those now gene¬ rally adopted. In his second paper, M. Magendie maintained that neither of the two roots of the spinal nerves is ex¬ clusively for motion or sensation — that each of them is compound : that the an¬ terior root, although principally for mo¬ tion, is subservient also to sensation ; and the posterior root, although principally for sensation, is subservient also to mo¬ tion : that the same root, in short, may transmit an influence outwards to the muscles, to cause muscular contraction, and also convey a sensation inwards. Such are his most matured opinions. But it is to be remarked that, although they are his deliberate opinions, he has never made a single attempt to corroborate them by any experiments besides those on the spinal canal: he has never thought it worth his while to examine whether the same characters belong to the corresponding nerves of the brain or not. Things, indeed, have turned out so extremely favourable to this physio¬ logist, that, as it were, in spite of him¬ self, and by the most singular good fortune, he has enjoyed the reputation of entertaining opinions quite different from those set down in his books. This misrepresentation of his views, instead of inflicting injury, has contributed to magnify his fame : the misconception as to the real views which he advocates, has been a principal cause why so few authors (M. Muller, of Berlin, we be¬ lieve, is the only one) have undertaken to controvert them, and show their ut¬ ter groundlessness ! We may be allowed to give another instance, suggested also by reading the work before us, of an occasion in which Mr. Shaw ought to have been quoted in preference to any other writer, and his authority joined to that of Sir Charles Bell. The points of which we are now treating may perhaps be thought by some to be matters indifference ; but how can medical men be encouraged to prosecute their profession scientifically, if they do not see that their just claims to celebrity will be protected ? When Sir Charles Bell announced in his first paper to the Royal Society, that the fifth pair was the only nerve of the encephalon that resembled the spinal nerves, he founded this opinion upon its being the sole nerve of the brain which had two roots, with a ganglion upon one of them, like those nerves. It was his chief object, in reference to this class of nerves, to prove that from their possessing two roots, of distinct anato¬ mical appearance, they had two dif¬ ferent properties — viz. sensation and motion ; whilst the other nerves of the brain having only single roots, were endowed with one property alone. We may conjecture that the principal inten¬ tion of his experiments upon the nerves of the face, was to establish this impor¬ tant position — that the fifth pair, which has a double root, gives both motion and sensation ; while the portio dura, w hich has a single root, gives only motion. This distinction had necessarily to be drawn between these nerves, before any other conclusions could be arrived at regard¬ ing them. Now it so happened, that altboug-h he announced the fifth pair to be the nerve of sensation, and likew ise of motion, to the muscles of mastica¬ tion, the experiment which he per¬ formed to confirm this view of its double functions did not bear him out. It is obvious that he w-as misled by having a false notion as to the ultimate distri¬ bution of part of the motor root; for he affirmed that the infra- orbitary branch conferred motion upon the lips as they are concerned in mastication, but was not further a motor nerve. M. Magen- 90 AN HOMCEOPATHIC APOLOGIST. die, while repeating1 these experiments upon the nerves of the face, was the first who exposed this error of putting- forward the infra-orbitary branch as an example of a part of the fifth pair hav¬ ing the power of motion ; and he shewed, on the contrary, that this parti¬ cular branch had only one of the pro¬ perties attributed to it by Sir Charles Bell — viz. that of sensation*. He thus destroyed the only experimental proof at that time given of the fifth pair pos¬ sessing two functions, in virtue of its double root ; and it is evident how ex¬ tremely careless he was, and how little master of the subject, from his not being1 at all conscious of the serious blow that he had thus inflicted upon the principle which was the very foundation of all the new views on the nervous sys¬ tem. The most important thing at that period to establish or controvert, he might have known was, whether the spinal nerves and fifth pair acquired their distinct powers of motion and sen¬ sation in virtue of their double roots ; and when he had proved that the only branch of the fifth offered by Sir Charles as an example of the compound nature of the fifth, was not a compound nerve, but a simple one only, wras it not strange that he should have let the matter rest at this stage? But such is the fact; and nothing further did he attempt at any subsequent period, either with the view' of confirming or invalidating his original statement. Had we relied, therefore, upon this gentleman for de¬ ciding w hat was the true nature of the fifth pair, we might have waited to the present day. He was content, at that time, with leaving it to be supposed that this nerve was for sensation alone, and had no pow er over the muscles of mas¬ tication. Now it was Mr. John Shaw who rescued the subject from the state of error in which it might have remained, if it had been left to the superintend¬ ence of M. Magendie. He selected for experiment a division of the fifth pair, situated more deeply than those branches that had been previously experimented upon, and composed, without doubt, of the tw o conjoined roots. This was the inferior maxillary division of the fifth ; * “ Le resultat que nous avons obtenu s’accorde parfaitement avec celui qne nous venons de rap- porter, a 1’ exception toute fois de l’influence de la section de sous orbitaire sur la mastication, in¬ fluence qui n’a pas et6 evidente pour moi.’’ — Journal dc Physiologic, 1821. and by performing his experiments upon it, he at once set the question at rest between M. Magendie and Sir Charles Bell. When he had succeeded in show¬ ing, on the living animal, that this was both a muscular and sensitive nerve, he conclusively proved that the latter gen¬ tleman had been correct in his general inference, and that it was a nerve of motion only to the muscles engaged in mastication, and to none others. We have been led into this discussion by the perusal of the work before us ; for here, we contend, was an im- jortant fundamental fact in the physio- ogy of the nervous system, established experimentally by Mr. Shaw, when the truth was in imminent danger of being obscured by the experiments of M. Ma¬ gendie ; and for this service we owe both respect and gratitude to his me¬ mory. The first part of Mr. Solly’s volume relates to comparative anatomy, in w hich a succinct, but, as it appears to us, very clear and satisfactory, description is given of the nervous system in different classes of animals, illustrated by nume¬ rous engravings. The author then passes on to the human brain and its mem¬ branes, and afterwards to the dissection of the cerebrum and spinal cord. The fourth part is occupied by the nerves, and the fifth by the cerebral circulation. The development of the brain, its phy¬ siology and pathology, complete the essay ; and the w hole forms a vo¬ lume highly creditable to the author and to the school which has the ad¬ vantage of his services as a teacher. MEDICAL GAZETTE. Saturday , October 15, 1836. “ Licet omnibus, licet etiam mihi, dignitatem Artis Medicce tueri ; potestas modo veniendi in publicum sit, dicendi periculum non recuso.” Cicero. AN HOMCEOPATHIC APOLOGIST. Even as wre expected, so has it come to pass. Quackery moves in an orbit well defined and palpable, nor does it require any great astronomer to deter¬ mine its place at any given moment. Th e same beaten path has been traversed AN HOMOEOPATHIC APOLOGIST. 91 for ages: jet, to the unreflecting por¬ tion of the community, the common course pursued is as much a mystery as it was to the first observers. Homoeo¬ pathy, though following Morisonianism in quick succession, and in a very analogous career, will still, no doubt, dupe some people: nor will the simi¬ larity between the passive destructive¬ ness of the one, and the manslaughtering tendency of the other, be speedily per¬ ceived. But dear-bought experience will most likely remove the veil at last. We pointed out the benefits which even the death of Malibran would be sure to confer on the homoeopaths: their mystery would be talked of, and at least their existence would obtain publicity. It was natural too, to suppose that their chiefs (if they had any such in this country) would stand forth in defence, and take up the cause with promptitude and vigour. We suspected, however, that the means of doing this w ere wanting* ; that their powers in the field of literature were, like their doses of medicine, infinitessimally small, and only likely to operate, if at all, through the effects of the imagination. Nor have w7e been deceived, or disap¬ pointed. The doughty champion who has stepped forward to advocate the principles of the old physician of Dessau, is the famous Dr. Uwins, who, though “ striking too short at Greeks,” has ventured to take homoeopathy under his feeble protection. There would be nothing offensive in this little display of zeal — for new converts are always celebrated for their activity — had the Doctor only shown some spirit of fair dealing* in his pro¬ ceedings ; but in taking up the cause of Hahnemannism, and failing to get a hearing for his controversial denunci¬ ations, he fastens, with a despairing tenacity, on an individual whom he supposes, or affects to suppose, to be an assailant of his. In a letter to the Times , Dr. Uwins undertakes to defend himself from what he conceives to be an attack on him in this journal ; and he pretends to have discovered the author, whom he mentions by name — Dr. James Johnson. How blind do angry feelings make a man ! We believe there is not anindividual con¬ nected with themedical profession in this country, save Dr. Uwins himself, who would have made so silly a blunder. H e has had, it appears, what he calls “ battles of brains,” with Dr. J. John¬ son, at some of the medical societies; and having come off smarting, proba¬ bly, or only second best, fancies he detects in every opponent of his newly- adopted system, his quondam antago¬ nist. Hence, on finding homoeopathy treated with a becoming severity in the Medical Gazette, his short-sighted spite leads him to imagine that the Editor of this journal can be no other than Dr. James Johnson ! But, after all, what does this amount to ? Howr miserable and contemptible must the advocates of a (so-called) sys¬ tem be, who have none except poor Dr. Uwins to set in the fore-front of the battle ; he, too, having no resource, save, in the absence of argument, to attempt personal invective ! His object, however, has, no doubt, been attained. He has had the oppor¬ tunity, as we guessed that he or some of his brother Hahnemannians would be delighted to have, of advertising him¬ self in connexion with the new doctrines. But so it has been w ith the Doctor on other occasions, and so, no doubt, it will be again. As it was the reflection that “ allopathic carriages were in the market at a large discount,” which operated so powerfully in inducing him to see what was in homoeopathy, so we shall not be surprised, ere long, consistently with his usual choppings and changes, to find him in the ranks of the Hygeists — and then let the Lynches, and Morison himself, look to the supremacy. The Doctor is a facetious man, and can easily w rite upon any doctrine with that sort 92 ADVANTAGES OF SMALL HOSPITALS ; OR, of point which so finely finishes off his letter in the Times ; “ Dr. Hahnemann, against whom ? Dr. Cullen— Hoffman — Gregory? No, against Dr. J. John¬ son! ! Risus, indeed.” Risum teneatisP say we ; and it is all we can find breath to say — for surely the Doctor will be the death of us ! MEDICAL EVIDENCE IN A CASE OF ALLEGED INFANTICIDE. It is with some hesitation we make the following extract. But we shall ab- stain from comment, partly because it is scarcely necessary, as the inconsistency which we would expose must be suffi¬ ciently palpable to the reader, and partly because we do not wish to assume as correct a report which, in its present state, can reflect so little credit on the medical witness. W have already, on several occasions, endeavoured to point out the propriety o m d cal gentlemen, who give their testimony in public, taking care that the opinions attributed to them in the newspapers be correctly stated. If they cannot easily effect this, the professional journals are open to them to save them from injustice. In the present i stanc we th'nk some ex¬ planation would be expedient, in order to reconcile, or to set rig-fit, the obvious absurdities and contradictions which have appeared in the most widely circu¬ lated, and, we should add, trustworthy, of our public vehicles of intelligence. The Times of October 12th contains an account of a coroner’s inquest, on the body of a new-born child, sup¬ posed to have been murdered. A verdict of “ Wilful Murder” was returned against the father and mother. The medical evidence was as follow s : — Mr. Thomas Porter, surgeon, 145, Bishopsgate - Street, stated, that the mother said she heard the child cry. Witness examined the body, which pre¬ sented the well-formed appearance of a full-grown child, and the chest was well filled. The lungs bore the usual appearance of having been distended with atmospheric air, which would not have been the case had the child not breathed. There were no appearances to account for death. He could not say that it died of suffocation , nor that it had not. The lips were slightly livid. He could not give a decided opinion of the cause of death. It might have died from natural causes before being put into the cesspool, as from not having- proper assistance ; but witness could not say whether death was the effect of natural causes or of violence. By a Juror. — The child 7night have been drowned before being put into the cesspool. Mr. Porter afterwards observed on the probability that the child was suffocated as soon as born. ADVANTAGES OF SMALL HOS¬ PITALS; OR, CERTIFICATES Versus KNOWLEDGE. In controversial writing, nothing is more satisfactory than to find your op¬ ponent proving the accuracy of what you have advanced, even at the very moment he is attempting- its refutation. Thus the Editor of the Lancet, working- in his vocation, opens the flood-gates of his abuse against us, for representing- the North London Hospital as a small one, and then, wdth the utmost na vete, he adds, “ the pupils will soon far exceed the number of those who can be ade¬ quately accommodated .” Now this ad¬ mission, coming from such a quarter, convinces us of what we had previously heard — namely, that between the small¬ ness of the wards and the numbers wffio are crowded into them, many students can literally see nothing but the heads and shoulders of those before them. Again : we reprobated the practice of taking a fee for attendance on both the medical and surgical practice together, on the ground that the pupil could not possibly give his mind to such a multipli¬ city of subjects. Here, too, our worthy contemporary steps forward in corrobora¬ tion of our statements : — “ The amount (says he) of facts for observation and reflection , always within the walls of the hospital , must invariably be greater CERTIFICATES VERSUS KNOWLEDGE. than the mind of any student can grasp and control .” Rather a slip, that, eh! Master Wakley; and yet you are so much a friend to the “ certificate system,” (provided it be practised in Govver-street,) that you approve of and commend an arrangement which solemnly certifies to that having been done which you thus admit no student is capable of doing! ! ! The fact is, that in his anxiety to fulfil the business of his vocation, there is no contradiction in terms — no misrepresen¬ tation (for an instance see next page), and noabandonmentofhisovv n professed prin¬ ciples, into which he is not betrayed. The object is to throw dust in the eyes of the public, and particularly of pupils and their friends, by putting forward the cheapness of the North London Hospital, to hide the dearness of University College. And weregret to add,tbatthose connected with the School have not thought it be¬ neath them to do the same. We chal¬ lenge any one of them to tell us why else the advertisements which emanate from University College, invariably an¬ nounce the hospital fees , and as invaria- bly suppress those of the medical school attached to it P — We pause for a reply. But while we have demonstrated in former numbers that the education, tak¬ ing lectures and clinical practice toge¬ ther, is considerably more expensive than at most of the large hospitals, we deny that the “ North London,” by itself, is cheap — if the object be to learn. It is cheap only where the party limits his views to the price at which a certifi¬ cate may be purchased, of having done that which the patron (we fear we may not add Saint) of the hospital informs us is beyond the grasp “ of any student.” We call upon the College of Sur¬ geons, and the .Society of Apothecaries, to look to this : it is their bounden duty to refuse those certificates which include medical and surgical practice simulta¬ 93 neously ; and this, too, at a time when the student is overwhelmed with lec¬ tures. Such an idea only requires to be brought before any intelligent person to be scouted ; and yet this “ certificate system” is practised in Gower-street, and approved by one who professes to be the enemy of every abuse ! But not only does our consistent Editor back up this disreputable pro- ceed.ng; he goes farther, and argues in favour of small hospitals, as if they were actually superior to larg*e ones ! And how does the reader conjecture tli is is done? Why, by adducing* the names of certain distinguished foreign¬ ers, who were physicians or surgeons of small hospitals. Thus, because Scarpa and Richter, after many years of labour in but a limited field of obser¬ vation, attained important results; there¬ fore they would not have made the same advancement if their means of in¬ vestigation had been more extensive ! Blockhead ! he does not see that the minds of such men overcome the disad¬ vantages under which they are placed ; and that their genius shines forth, not in consequence of their hospitals being small, but in spite of it. Besides, what parallelism is there between two or three instances of men becoming distinguished after many years of the most assiduous observation and study at hospitals of small size, and the education of young gentlemen who have but a short time to devote to clinical attendance, and for whom it is there¬ fore of the greatest importance to wit¬ ness disease in such varied forms as may render them familiar with its mul¬ tifarious aspects, before they engage in the responsible duties of their profession. Who but a special pleader would com¬ pare things so utterly dissimilar? — who but a hack, driven on by the spur of his party, w'ould plunge into such pal¬ pable and stupid contradictions ? As to the honourable member’s abuse 94 PUFFING OF THE LANCET FOR THE GOWER -STREET HOSPITAL. of the Medical Gazette, it is very natu¬ ral ; for, to say truth, we have been rather a sharp thorn in his side. Another gross instance of that kind of literary fraud with which we have so often occasion to stigmatize our dis¬ honest contemporary, occurs in the Lancet of this day (Oct. 15th.) In the Gazette of October 1, in reference to his puffing of the North London Hos¬ pital, and hatred of all others, we said — “ the trick is perfectly well understood about town, and is only adapted to catch the novices who are very fresh and green from the country.” Now Mr. Wakley separates this entirely from the context, alters the typography, and, wholly omitting its application as a caution against his own knavery, g'ives it as a general description of “ the me¬ dical students of the present session” applied to them by the Medical Gazette. This is false. But we repeat, that his trickery and his motives are so well known here, that no student who had been even a few weeks in London would incur any risk of being taken in by them ; and we believe we may add, that, thanks to this journal, there are now very few in any part of the country who are such “ novices” as he evidently takes them to be. THE LANCET’S PUFFING OF THE GOWER-STREET HOSPITAL. To the Editor of the Medical Gazette. Sir, A letter, of which the under-written is a copy, was sent to the Editor of the Lancet two weeks ago, and has been left unnoticed by that very impartial journalist: perhaps you may think it and the inclosed worthy of a place in your Gazette ; if so, you will greatly oblig'e, sir, Your obedient servant, Guvensis. October 11, 1836. To the Editor of the Lancet. Sir, — In drawing up your Comparative Table of Fees for Medical and Surgical Hospital Practice, I am sorry to observe that you have departed from your usual candid and impartial manner of noticing the various hospitals and schools of medi¬ cine in this metropolis, and that instead of allowing the student, as heretofore, to exercise his own unbiassed opinion in the choice of a school in which to prosecute his studies, you have thrown a heavy weight into the scale in favour of the North London Hospital. You say that this hospital is the cheapest. Now, sir, the number of beds in the North London Hospital, is, or was, 120; and for these the pupil’s fee, for twelve months’ medi¬ cal and surgical practice, is 21/. At Guy’s Hospital, the medical and surgical beds amount to 540, and the surgical beds of St. Thomas’s, which are also free to the Guy’s students, to 300, making, in all, 870 beds ; and for these the fee is 41/. 2s. A very simple rule will show which is the cheapest. The manner, too, in which you have conferred the puff oblique on Mr. Liston, is by no means what we might expect from the Lancet ; a work which has all along decried puffing in every shape. This gentle side- wind for Mr. Liston, and the more direct blast of the Toronto Li¬ centiate, are from the same quarter of the compass — if not from the same point. Yours, Guyensis. P.S. — I rely upon your candour for the insertion of these remarks. September 27, 1836. To the Editor of the Lancet. Sir, When I found it necessary to conclude my last letter to you byremarking, that for its insertion I must rely upon your candour, I evidently hinted Jat the recep¬ tion which I supposed you would give it, and anticipated your refusal to insert it. You have not disappointed me. There was a time when such a letter would have been thankfully received; and had I not known that the affected libera - lity of the Lancet had long ago given place to an open avowal of favoritism, I should have appealed neither to your candour or sincerity. In this opinion I am by no means sin¬ gular ; your characteristic generosity is now pretty well understood; and when you had ai rived at a certain degree of no¬ toriety by moderate and plausible means, PROPOSED POOR-LAW CLUB — CONDUCT OF ITS SUPPORTERS. 95 you thought it would be advantageous to try the other side of the question. I need not tell you that you have been deceived : he who makes it the whole study of his life to deceive the world, will one day be-* come cunning enough to deceive himself; and such is now your case. You began in deceit, and have finished in shame. You decried puffing, and have now become the veriest puff-maker that ever evaded the stamp duty. But was it necessary, in leaving your old friends, to take up with your old enemies? We know your desire for change ; but why be-praise and be-laud those whom you have so strenuously con¬ demned ? Had your voice been less heard, you might have passed unnoticed; and had your pretensions to impartiality been less, your present turpitude would be over¬ looked. Have you so soon forgotten that “ the system of election in the institution in Gower street is in no respect different from that of the most rampantly corrupt medical monopoly in London ?” vide Lan¬ cet, August 27, 1836; four weeks from which time you declare the same institu¬ tion to be the best and cheapest in Lon¬ don. May I ask you what has now be¬ come of Stinkomalee ? Has it become so buoyant from your inflation as to have risen into those clouds of ignorance which have ever hovered over it since it was built? Be careful, dear sir, in your puff¬ ing, or you will one day blow it away. I intend to dip here and there into your last two years’ labour, and have no doubt that I shall find a few proofs, such as even you will find it difficult to answer or set aside. Mr. Liston and your other Scotch friends, — of whom, by the by, I wish you joy, — will inform you that facts — - “ Are sturdy ehiel-, that winna ding, An* dar’na be disputed.” Oct. 11, 1836. Guyensis. PROPOSED POOR-LAW MEDICAL CLUB AT CAMBERWELL. To the Editor of the Medical Gazette. Sir, As you have given insertion to the anony¬ mous and flowery communication of a “ Camberwell Practitioner,” you will, I am sure, allow me a brief space for reply in your next number. This champion of medical clubs has made a map of Camber¬ well to suit his own purpose, and, al¬ though he is such a stickler for parishes and districts, he has introduced into his list the names of two gentlemen (Messrs. Flower and Young) who are residing in the parish of Lamhetli. This, T think, needs no comment. But, sir, will this “ Camber¬ well Practitioner” throw off the mask, and enlighten us by his arguments in favour of the system ? Can he show us how this innovation will benefit the poor man ? — and can he also show that it will not tend to injure and degrade our profession ? The most potent argument brought for¬ ward by one of the clubbists, at the meet¬ ing alluded to, was the following : — “ If, gentlemen, you reject this proposal (he should have said mandate), the Poor-Law Commissioners will send young men from the hospitals to take charge of our poor.” To what a state are we fallen ! I am, sir, Yours respectfully, E. Crisp. Walworth, October 10, 1836. [Should the “ Camberwell Practitioner” reply to this or the following letter, or both, (as we think he is called upon to do) he must give his name. — Ed. Gaz.] CONDUCT OF THE SUPPORTERS OF THE PROPOSED POOR-LAW CLUB. To the Editor of the Medical Gazette. Sir, Permit me, through the medium of your widely circulated journal, to request the “ Camberwell Practitioner,” who favoured us with an account, in your last number, of the proceedings at the late meeting held in the vestry hall of this parish, to have the goodness to forward his name. I certainly do not think it was exactly right that any remarks made upon the meeting, con¬ nected as it was with the interests of every surgeon in Camberwell, should have found a place in your journal, without the author’s name. In my opinion, there has not been a more shameful motion started since surgery has been considered a pro¬ fession. It is not sufficient that Forbes, Bean, Browne, and Flower, have the largest and most respectable practices in Camberwell, but they must concert measures for taking the very bread out of the mouths of the poorer class of surgeons ? “ After this, pray let us hear no more about the cant of liberality and honour of the profession,” when the above-mentioned gentlemen have condescended to put their names to such an odious piece of busi¬ ness. By inserting these remarks, you will greatly oblige Your obedient humble servant, T. Bowen, Surgeon, &c. Sonthampton-Street, Camberwell. 9G BILLS OF MORTALITY. - METEOROLOGICAL JOURNAL PROJECTED POOR-LAW CLUB AT CAMBERWELL. REPLY FROM MR. HULBERT. To the Editor of the Medical Gazette. spared myself and your readers this communication, but for the futile charge brought against me, as regards the mis¬ statements contained in my former letter. I am, Sir, Yours very respectfully, Sir, Engagements, and correspondence of a different nature, having so occupied my time as to induce me to delay addressing you until the present occasion, I shall now be more brief than was intended when your last week’s number came under my observation ; premising also, that I have neither time nor inclination to notice any similar remarks to those which have led to this communication. Like your correspondent Mr. Crisp, “ I feel reluctant” to enter into a controversy respecting the subject upon which we have recently respectively addressed you ; but his assertion of being compelle I to reply to the misstate merits contained in my letter of the 2’2d ult. requires me not to pass over the same unnoticed. How he has been compelled to make what every reader of your journal may consider a voluntary statement, I am at a loss to determine ; unless it has been the result of his acting under the direction of those gentlemen to whose conduct I alluded, and whose opportune and spirited manner of u redeeming the honour of the profession” was assuredly very singular, and may be viewed (by them) as a superior method of supporting professional dignity to the wigs and gold- headed canes of by¬ gone days. This supposition is strengthened by his concluding paragraph, wherein the important information is given, that “ the gentlemen who descended to personalities are prepared to justify themselves for so doing, and to prove the correctness of their statements.” Their method of justifying themselves I must leave to themselves; but their proving the correctness of every statement they made will, in my opinion, be difficult, as I am not without facts of sufficient force to subvert several of the statements made upon that occasion; but to bring them forward will be unnecessary, as the letter in your last number, from “ A Cam- benvell Practitioner,” (who is unknown to me) substantiates the correctness of the statement I gave you, and which Mr. Crisp’s letter has by no means invalidated. In conclusion, as Mr. Crisp has ex¬ pressed a wish that I would “ be personal enough to state names,” I do assure you that I feel no reluctance in complying with his w7ish, and will therefore name the following Mr. Crisp, Mr. Boddy, Mr. E. Evans, Mr. Hooper, &e. I consider it unnecessary to make any further comment ; and should have J. F. IIULBERT. 6, Trinity Square, Southwark, Oct. 13lh, IBS . NEW MEDICAL BOOKS. The Human Brain ; its Configuration, Structure, Development, and Physiology. By Samuel Solly. With 12 plates. 12mo. 12s. 6J. Facts and Cases in Obstetric Medicine; with Observations on some of the most important Diseases incidental to Females. By J. T. Ingleby. 8vo. 9s. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Oct. 11, 1836. Abscess . . 2 Age and Debility . 36 Apoplexy . . 7 Asthma . . 17 Cancer . . 1 Childbirth . . 5 Consumption . 74 Convulsions . 33 Croup ... 2 Dentition or Teething: 1 Dropsy . . 26 Dropsy on the Brain 4 Dropsy on the Chest 1 Epilepsy . . 1 Erysipelas . . 1 Fever ... 3 Fever, Scarlet . 2 Fever, Typhus . 1 Gout . . . 1 Increase of Burials, a the preceding wee Heart, diseased . S Hooping Cough . 4 Inflammation . 26 Bowels& Stomach 1 Lungs and Pleura 1 Insanity . . 2 Liver, diseased . 9 Measles . . 11 Mortification . 6 Paralysis . . 8 Scrofula . . 2 Small-pox . . 8 Sore Throat and Quinsey . . 2 Thrush . . 1 Unknown Causes 12 Casualties . 6 s compared with ? METEOROLOGICAL JOURNAL. Kept at Edmonton, Latitude 51° 37' 32" N. Longitude 0° 3' 51” W. of Greenwich. Oct. 1836. Thursday. 6 Friday . . 7 Saturday . 8 Sunday . . 9 Monday. . 10 Tuesday . . 11 \Veduesdayl2 Thermometer. from 38 to 57 51 60 52 58 43 55 46 58 51 57 42 5 Barometer. 29-82 to 29 58 29-42 29 37 29 35 29-35 29-31 29-36 29-28 29-33 29-12 29 34 29-51 Stat. Prevailing winds, W. by S., and S.W. Except the 9tli and 11th, generally cloudy, with frequent and heavy showers of rain; lightning in the East ou the evening of the 9th. Charles Henry Adams. ERRATA. In Mr. Bennett’s paperon the otic ganglion, in our last volume, p. 690, for “males” read moles ; for a “ sinus connexion” read a direct connexion ; and, for “ Savant” read Savart. Wii.son & Son, Printers, 57, Skinner* St, London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY J©aJMAL OF il-Ietucutf anti the Collateral JS>rt'm«3. SATURDAY, OCTOBER 22, 1836. LE CTURE S ON FORENSIC MEDICINE; Delivered at the Aldei'Sgate School of Medicine, By William Cummin, M.D. Lecture IV. Further consideration of Age — Boyhood — Puberty — Manhood — Senescence, and Decre¬ pitude. Legal distinctions, and physical and moral peculiarities of each period. Stature and proportion of the Body at Adult Age — Whether the Stature may be determined from the dimensions of a particular part. Having treated in the last lecture of In¬ fancy, or the first period of human life, we shall now proceed to the consideration of the other ages. Boyhood. Legal distinctions. — I have already noticed certain epochs belonging to the several periods of life, which are particularly re¬ cognized by the laws. The following may be added as specially relating to the age of boyhood or girlhood. An infant of tender years being prosecutrix in a trial for carnal knowledge, the whole of her tes¬ timony, recently given, seems admissible, because it is of the highest importance to ascertain the accuracy of her recollection. Under eight, or above suteen, no infant is to he apprenticed to a chimney-sweeper; or if he be, no settlement is conferred. Before the age of nine no infant is to be bound as a parish apprentice ; and children under nine years [3 and 4 Will. IV. c. 103] may not be employed in the factories, ex¬ cept it be in those for the manufacture of silk. The carnal knowledge of a female infant under ten years is a capital offence. To force or decoy away any child under 464.— xix. ten from its parents, or guardians, with in¬ tent to deprive such parents, or guardians, or to steal any article about its person, is punishable by transportation, or imprison¬ ment with hard labour: an exception, however, is made in favour of the father of an illegitimate child. Carnal know¬ ledge of a female between ten and twelve , even with consent, is punishable with im¬ prisonment and hard labour. Under thir¬ teen, certain hours of work are prescribed in factories and mills — viz. not on an ave¬ rage more than eight hours a day (except¬ ing in manufactories of silk, where ten hours are allowed). Between thirteen and eighteen, not more than twelve hours’ work daily is permitted. Finally, unless great weakness of intellect appear, children are liable to punishment for crimes of com¬ mission after the age of seven ; but by no means for a rape, or sexual crime, under fourteen. It must be obvious that these regula¬ tions respecting age cannot but sometimes give occasion to inquiries, for the satis¬ faction of which the services of the medi¬ cal jurist are necessary. Physical characters. — The body during th.s period grows considerably : the limbs lengthen, compared with their previous condition ; the voice is sharp, and of much the same volume in both sexes. There is a remarkable disposition for bodily exer¬ cise and motion. The milk teeth, or those of the first dentition, have fallen about the commencement of boyhood. The fourh molars make their appearance between the eighth and ninth year, and remian permanent. The incisors, canines, and first and second molars of the second den¬ tition, issue from the gums between ten and eleven, in lieu of the milk teeth, which have disappeared. Growth of the bones. — The olecranon pre¬ sents an osseous germ between the seventh and ninth year. The scaphoid bone of the carpus becomes ossified at the same period, and the two osseous points at IT 98 DR. CUMMIN ON FORENSIC MEDICINE- the Tipper extremity of the humerus form a union. At twelve, the pisiform body of the carpus ossifies, and there is an osseous point detectable towards the inner margin of the trochlea of the hume¬ rus. At nine, the three primitive points of the os innominatum, which afterwards constitute the ilium, ischium, and pubis, are found in the lower part of the pelvis. The three bones of the innominatum may still be separated at thirteen, but soon after, they become firmly united : an osse¬ ous point is found in the lesser tuberosity of the head of the femur, and the neck of the latter bone is now ossified. The carti¬ lages of the larynx are said to become osseous as early as the termination of boy¬ hood, — first the cricoid and thyroid, and then the arytenoid structures : but these changes most usually occur at_ a much later date. Puberty. We now come to that period of life in which great and important changes are wrought in the system. About the age of fourteen in the male, and sometimes earlier in the female, the body begins to present a series of developments which are characte¬ ristic. The general growth is remarkable, but especially so that of ^he generative parts. Of the latter, I shall take occasion to speak more particularly, when treating of sex : at present I confine myself as much as possible to the general developments, physical and moral. Legal distinctions. — But first let us ob- serve, that there are certain distinc¬ tions made by law regarding this age, which merit the attention of the medical jurist. Puberty is, in law, supposed to exist at fourteen in males, and at twelve in females : which latter supposition seems to be borrowed from the Roman civil law, and to be founded on what is usually ob¬ servable among females in the East ; but it is certainly too early for the generality of the sex among us. Males after fourteen may marry, with consent (which is essential up to twenty-one), or by banns not prohibited. Both sexes, between the ages of fourteen and twenty-one, are liable to be punished for offences of commission, but not for those of omission, save where the liabi¬ lity is specially provided for. They cannot he sued on contracts, except for necessa¬ ries. The abduction of a female, under sixteen, without consent of parents, is a misdemeanor punishable with imprison¬ ment. I have already mentioned*, that at seven¬ teen a male or female may become an exe¬ cutor : I shall now add, that he or she cannot act as such until the age of twenty- one ; though, if an infant under seventeen be named executor jointly with an adult, he must in an action be joined as a co¬ plaintiff. With regard to labour in the factories, under the provisions of tire act already re¬ ferred to [3 and 4 Will. IV. c. 103], no person under the age of eighteen is to work at night, or more than tw elve hours during the day. There is still a severity in this enactment, as it leaves persons unpro¬ tected before they have attained the period of confirmed health and strength, an event which does not usually arrive until about the age of twenty-three. Physical characters. — The physical changes which occur in both male and female be¬ tween the fourteenth and twenty-first year, are very remarkable, and characteristic of that particular period of life. But they take place successively, and are dif¬ fused over the greater part of the in¬ terval. There may, in fact, be marked out an early, a middle, and a final, stage of puberty, during which, beside the develop¬ ment of the sexual apparatus, the follow¬ ing appearances are usually observable. In the male the chest becomes expanded, and the shoulders broader; the voice, hi¬ therto feminine or girlish, first cracks (as it is commonly called), and then settles into a steady grave tone ; the person be¬ gins to be furnished with hair on various parts; and the beard grows, first downy, and then gradually more firm and strong. In the female the breasts become enlarged, and various changes of the person con¬ nected with sexual development may be observed. The voice alters likewise, but not to such an extent as in the male. In both there is an enlargement of the capa¬ city of the larynx; but the rima glottidis, which in the male increases in size in the proportion of 5 to 10, is augmented in the female only as 5 to 7. The muscular sys¬ tem usually receives large accessions. But all these characters of the period between fourteen and twenty one, must be noticed as having an especial relation to sexual development ; for w'here this does not take place, owing to constitutional tardiness, castration, or other obstacles, the boyish character still prevails. Bernt, in his Sammlung gerichtl. Medicin, gives an ac¬ count of a journeyman tailor, twenty-four years of age, w'ho was still a mere boy, pu¬ berty having never operated its peculiar changes upon him. And other examples are of no rare occurrence. Moral peculiarities. — But the effects on the mind are not less remarkable than those on the body. The habits of thought and action, through wrhat Fodere calls “ the tyranny of the generative organs,” all un¬ dergo a change. The male, who differed as little hitherto in manner as in bodily con- * Medical Gazette, p. 65 present volume. PUBERTY. 99 formation from the female, now becomes more rough and masculine — the female more modest and feminine. It was the individual, in fact, who lived hitherto in both sexes ; the species begins to be deve¬ loped now. At the risk of anticipating another part of the course, I am induced to bring to your notice certain peculiarities affecting the female at this period of life, and having es¬ sential reference to Forensic medicine The approach of puberty and menstruation is attended in some females with such a disturbance of the mental faculties, as to raise a question of criminal responsibility. “ The crisis of the commencement of the menstrual function,” says Fodere, “ is some¬ times retarded, and the interference which then occurs produces several alterations in the system — in the cerebral functions more particularly: for a sort of temporary de¬ mentia occasionally takes place, the exist¬ ence, or the possibility of which, may, in certain circumstances, demand the atten¬ tion of the medical jurist.” A remarkable instance of this kind oc¬ curred not long ago in Sussex. A girl, aged sixteen, set fire to her master’s house. She had previously borne a good character, had stolen nothing, and, in short, com¬ mitted the crime without apparent mo¬ tive. She was brought to trial at the Lewes assizes. Her master was anxious to save her life; and a gentleman at Brighton, from motives of humanity, un¬ dertook her defence. It appeared that she had been a patient in the Chichester Infir¬ mary in the course of the preceding year, when she was afflicted in succession with low fever, measles, scarlatina, and strong symptoms of phthisis. She had never menstruated : had always been of a reserv¬ ed, taciturn disposition, and had conducted herself in an eccentiie manner on several occasions. The counsel argued that under such circumstances, the act for which she was tried, was probably committed in a state of imbecility, or delusion, in which she could not be considered as a morally responsible being. To confirm this view, he called two medical men, Dr. King, of Brighton, and Mr. Pitt, a sur¬ geon, to give their opinion as to the effects which illness, together with the non-ap¬ pearance of the catamenia, might have on her mind ; and whether insanity, under any form or degree, ever happened under such circumstances. The testimony of the me¬ dical witnesses was so strongly in favour of this presumption, that the judge and jury expressed themselves satisfied, and acquitted the girl. JPlatner, in his Qucestiones Medicines Fo~ rensis (De vetiia JEtatis ), gives a case in some respects so like this, that I cannot prevail on myself to pass it by unnoticed. A girl, only fourteen years of age, the daughter of poor parents, who w’ere obliged to send her out to service to pro¬ cure a livelihood, became remarkable for her ill-temper and obstinacy. She was ill-growTn and feeble for her age, and conceived a mortal hatred for the task¬ work imposed upon her. One evening, after much sullenness, she hastily finished her supper, and set fire to her master’s barn. She took lighted coals from the kitchen fire, and put them under the straw ; but never attempted to make her escape or to conceal herself during the confusion that ensued. When the con¬ flagration was suppressed, without being at all questioned on the subject, she volunteered to assert her innocence. But ■when taken before the magistrate, she fully confessed her guilt, alleging, as her only excuse, the severity of the labour she daily endured : though how this was to be lightened by setting fire to the barn, she neither could tell, nor could the magis¬ trate understand. No malice could be imputed to the girl : her disposition wras generally benevolent, and even her master and mistress could not but give a good character of her in other respects. A plea of insanity was thought of, but it was deemed impossible to render it valid, since no other overt act, or word, indi¬ cative of deranged intellect, could be ad¬ duced. Her defence was then rested on the fact, that though in point of age, as legally determined, she was within the verge of responsibility, yet as her physical development was retarded, and in reality she was still a child in respect to her moral nature, she could not be justly arraigned for what she had done. The Leipsic faculty were consulted on the case, and all the circumstances fully in¬ vestigated. The signs of puberty were wanting, and there appeared to be no in¬ dication of the commencement of the catamenia. The memory was not de¬ ficient, nor was there any want of con¬ nexion in the girl’s ideas ; but there was a manifest absence of that judg¬ ment and steadiness of attention, with¬ out which there can be no choice as to what is to be desired and what shunned, nor any understanding, or power of ob¬ serving, laws either natural or civil. A report to this effect w7as draum up, and it seems to have procured an acquittal. In another case, also related bv Platner, (De excusatione JEtatis ,) and which was almost identical with the preceding, a girl of fourteen, but of retarded growth for her age, was excused on that ground from the consequences of the crime of arson; but on a subsequent trial for a re*. 100 DR. CUMMIN ON FORENSIC MEDICINE. petition of the offence, she was capitally condemned and punished. Osseous system during puberty. — The bones undergo remarkable changes during this period. The coracoid process of the sca¬ pula, at fifteen, becomes united to that hone above the glenoid cavity, and several irregular osseous points may be observed at its summit. There is also an osseous point at the inferior angle of the scapula. Between fifteen and sixteen, the epiphysis of the olecranon forms a junction with the rest of the bone. At sixteen, the cartilage which binds round the os innominatum of the pelvis exhibits some bony deposits, and the epicondyle of the humerus ossifies. Between sixteen and seventeen, the five epi¬ physes of the phalangettes of the toes are united to the bones ; and at seventeen the same occurs with respect to the posterior epiphyses of the phulangines of the same parts. At eighteen, the epitrochlea and the three epiphyses of the superior extremity of the femur, become conjoined with the hone ; the toes also present still further de¬ velopment in their bony structure. About nineteen, there is observed an osseous germ at the sternal extremity of the clavicle: the fourth coecygean vertebra is ossified; and there is union of the inferior extremity of the femur, and the two extremities of the humerus with the body of their respective bones. At twenty or twenty-one, the first piece of the sternum is usually found united with the other portions of that hone. The sphenoid also is observed to be in close union with the occipital. The fifth molar teeth — the dentes sapientice — commonly appear from the eighteenth to the twenty-fifth year. But there is much diversity in this respect, for some persons have them not till very late in life. Dr. Hamilton mentions a man who died at eighty cutting his wisdom teeth. One thing, however, is pretty usual with re¬ spect to these teeth, that as they are commonly the last to appear, so they are generally the first to decay. Youth or Juvenility. Let us now direct our attention to that period of life— youth, juvenility, or adult age— in which the system reaches its genith ; when both mental and bodily vigour attain a degree of perfection which the subsequent ages at best only serve to concentrate. Legal distinctions. — After the age of twenty one, and until that of sixty, males are liable to serve as jurors. In the church, no person is to be ordained dea¬ con until he has attained the age of twenty-three complete ; nor priest until he has completed twenty four. That males and females, on attaining the age of twenty one, are sui juris, at their own dis¬ posal, and in full possession of the rights and responsibilities of members of society, has already been mentioned. Physical and moral indications. — Our best means of judging of the age of an indivi¬ dual at this period of life are far from be¬ ing exact. Of the living we must form our estimate from the general appearance, and the expression of the features — mak¬ ing all allowance for labours undergone, climates visited, peculiar diet, trade or profession, 8tc. Beside this, Fodere thinks we have no good physical sign, save the stiffness of the beard ; nor moral, except the superior steadiness and prudence exhi¬ bited in this period above that which wrent before. Of women it is perhaps more dif¬ ficult still to form a correct opinion of the age, as at this period, owing to their pecu¬ liar destiny, they enjoy a remarkable im¬ munity from those changes commonly at¬ tendant on the lapse of time. But in judging of the dead we may have recourse to the osseous system, which, as in the other ages, will present us with a few peculia¬ rities that may assist us. Osseous development. — About the twenty - fifth year the points which crown the transverse and spinous processes of the vertebrae become united ; as, also, do the epiphysary points of the ribs. From twenty five to thirty, the first sacral vertebra forms a union with the rest. And this, perhaps, with the mere exception of the bony union which takes place between the ensiform cartilage and the sternum, and that between the coccyx and the sacrum (both which phenomena usually occur be¬ tween the fortieth and fiftieth year), may be considered as the age in which the growth of the bones is complete. As to the teeth, it has been sometimes thought that it might be possible, from a close observation of their wear and tear, to gather some clue to the exact age of the adult individual. But this method, so successfully pursued by veterinarians, and others conversant with the lower animals, cannot be applied to the human subject. The teeth vary very much in different in¬ dividuals, and are of a very fragile and de¬ caying nature in persons of weakly con¬ stitutions: all men, besides, do not em¬ ploy their organs of mastication alike ; some use them but little, bolting their food with impunity; others employ their in¬ cisors where the molars are commonly used, and vice versd ; others, again, owing to the unevenness of their jaws, one pro¬ jecting beyond or beside the other, cannot use the corresponding parts of oppo¬ site teeth, and therefore wear them late¬ rally ; others, in fine, are in the habit of grinding their teeth in their sleep ; so that, YOUTH OR JUVENILITY. 101 on the whole, it must be evident that no certain characters can be detected in the condition of the teeth which can much serve the purpose of the medical jurist. Proportions of the skeleton at different ages — Having noticed the successive changes that take place in the osseous system, from its commencement to its completion, we may here pause to take a survey of the proportions which the parts of the skeleton bear to each other at different ages. M. Sue, so long ago as the year 1755, made a series of interesting observations on this subject, and most of the continental After this the proportions do not vary, except it be in consequence of old age giving a curve to the spine. It will be observed, therefore, that when the os¬ seous system has attained its full mag¬ nitude, the skeleton is exactly halved at the symphysis pubis; and putting this in connexion with the fact mentioned in last lecture, that the middle point of the whole length is, at birth, at the navel, and that at the sixth month of gesta¬ tion it coincides with the lower extremity of the sternum, we become acquainted with the peculiarity, which, when once known, is easily retained in the memory, — namely, that the middle point of the length, during the period of growth, from the embryo state to adult age, traverses from above the abdominal extremity of the sternum down to the symphysis pubis, where it stops. But it must be recollected that this is the condition of the normal development of the bony structures. Where physical causes have operated to interfere with the growth, the results are strikingly different. The trade, or occupation, in which an individual may have been engaged during early life, may be an impediment. One instance of this kind may be found in the labour of the facto¬ ries, as it used to be exacted of young per¬ writers have adopted his conclusions. His method was to measure the subject from the crown of the head to the sole of the foot; he then measured the trunk, from the crown to the symphysis pubis. In taking the length of the upper extremi¬ ties, he measured from the prominence of the acromion to the end of the middle finger; and in measuring the lower, he took from the symphysis pubis to the sole. The following are some of his chief re¬ sults, communicated to the Royal Academy of Sciences : — sons still growing. A remarkable example was mentioned in the evidence before the Parliamentary Committee, on the Factory question, in 1832. The witness, a medi¬ cal man, showed how some of the opera¬ tives whom he bad examined in the facto¬ ries, must have lost, during their growth, a full foot of their entire stature,— and, as it would appear, through suppression of the growth of the lower limbs. He proved it in this way: it is known that when we extend our arms horizontally and laterally from the trunk, the distance between the tips of the fingers of each hand is equal to the whole length of the person. Now some of the factory work¬ men could with their extended arms reach over a space measuring six feet, while their stature did not exceed five. The deficiency he attributed to their standing constantly for fifteen hours or more in the day at work, during that period of life when the bony system is in a state of growth *. It is to be regretted that in this case the witness did not state the comparative lengths of the trunk and lower extremities. Still, however, the illustration is valuable, coming, as it did, from a quarter in which the researches of M. Sue appear to have been unknown. Age. Six weeks . Three months . Six months . Seven ditto . Eight ditto . Nine ditto . One year . Three years . Ten ditto . Fourteen ditto . Twenty to twenty-five .. Length of body. Trunk. Ft. In. Lin. Ft. In. Lin. 0 0 16 0 0 7 0 3 0 0 2 1 0 9 0 0 5 8 1 0 0 0 6 5* 1 2 n 0 8 H 1 6 0 0 10 0 1 10 6 1 1 6 2 9 0 1 7 0 3 8 6 2 0 0 4 7 0 2 4 0 5 4 0 2 8 0 Upper extretn. Lower extrem. Ft. In. Lin. Ft. In. Lin. 0 0 5 0 0 4 0 1 1 0 0 11 0 3 7 0 3 4 0 5 10 0 5 9 0 6 8 0 6 6 0 8 0 0 8 0 0 9 0 0 9 0 1 2 0 l 2 0 1 7 0 1 8 6 2 0 6 2 3 0 2 6 0 2 8 0 * Medical Gazette, vol. xi. p. 597. 102 DR. CUMMIN ON FORENSIC MEDICINE. An unhealthy or diseased condition of the bones in early life may also materially affect the proportionate lengths, as found on measuring the adult skeleton. Rickets has this effect in a remarkable manner. In a curious paper on this subject by Mr. Alexander Shaw (Med. Gaz. vol. xvi.), the author says, “ that the rickety skeleton has a nearer resemblance, in its relative proportions, to the skeleton of the child, than to that of the adult.” And it is worth observing, that in these cases it is generally the bones of the lower limbs that suffer. “ The pelvis and bones of the lower extremity,” says Mr. Shaw, “ fall short to the extent of about one-third of their natural dimensions ; while the skull, the spinal column, and the upper extre¬ mity, only suffer a loss amounting to about one-thirteenth of their natural size.” In persons who are very tall, or who exceed considerably the ordinary height, it will generally be found that the length of the lower extremities, measured after M. Sue’s method, exceeds considerably that of the trunk. In fact, there is here a deformity the reverse of that resulting from rickets, or from premature exertion in a standing posture. Mr. Shaw tells us, that he took the measurements of a gentle¬ man who stood six feet four and a half inches, and compared them with those of another gentleman whose height was five feet eight : the result was, that in the part of the body above the pelvis there was scarcely an inch of difference between the two individuals; while in the part On inspection of the last column we per¬ ceive that the stature may be either 1 met. 64 cents. (5 feet 4^ inches English) or 1 m£.. 77 cents. (5 feet 9£ inches English) giving a difference of Jive inches between the extremes. Yet M. Orfila, contemplat¬ ing his tables with some complacency, says that he is convinced of the possibility in the greater number of instances, of reaching from the spine of the ilium to the heel, there was a difference of no less than eight inches ! This will account for the unsatisfactory conclusions arrived at by those who have attempted to ascertain the human struc¬ ture from detached parts of the system. In the case of animals, for obvious rea¬ sons — such as their comparative immunity from disease, their attitude not being erect, &c. — the dimension of any one bone may conduct us pretty correctly to those of the whole figure. But the sta¬ tistical data gathered by Orfila and others with a view to arrive at the structure of man in a similar manner, afford no pros¬ pect of medico-legal utility. We find in the Traite des Exhumations juridiques, by Orfila and Lesueur, two tables — one giving the measurements of fifty-five re¬ cent subjects, including those of the femur, tibia, fibula, humerus, cubitus, and radius; the other stating the lengths of the same parts in twenty skeletons. But when we come to inquire what is the stature corresponding to a particular bone, we find that we may be left in doubt whether the person to whom it be¬ longed was only five feet four, or five feet nine or ten in height ! M. Devergie shows the fallacy of the method by drawing up a table, of which this is a copy. He takes the tibia as the bone from which we may be desirous of drawing an inference, stating its length at 37 centimetres (1454 in. Eng.), as he finds that to be set down as the length of the tibia in about 12 of the 51 subjects. arriving at the truth, if we avail ourselves of his results, especially if we take the femur or the humerus as our standard. On consulting his tables, however, with refer¬ ence to these bones, thinking it possible that M. Devergie’s instance of the tibia might be partial, we find the facts to stand thus : — Tibia. Femur. Lower Ex¬ tremities. Upper Ex¬ tremities. Trunk. Stature. cents. cents. cents. cents. cents. m&tr. cents. 37 44 85 75 85 1 70 37 46 87 78 86 1 73 37 46 87 78 86 1 73 37 46 85 72 84 1 69 37 45 84 76 80 1 64 37 45 81 75 85 1 66 37 45 83 75 86 1 69 37 45 84 77 86 1 70 37 44 85 75 85 1 70 37 45 88 78 89 1 77 MANHOOD — SENESCENCE. 103 Femur. Stature. Humerus. Stature. 45 1-68 32 1-73 45 1-69 32 1-68 45 1 70 32 1 73 45 1 64 32 1-6S 45 T67 32 1-70 45 1-66 32 1-69 45 1-69 32 1-70 45 1-70 32 1-66 45 1-68 32 T68 45 1-70 32 1-69 45 1 77 32 1-80 45 1-75 32 1-64 1 So that we should be still more unfortu¬ nate with these parts than with the tibia, being left in doubt respecting the stature corresponding to the humerus to the extent of above six and a half inches, and with re¬ gard to the femur, Jive. Manhood. Physical appearances. — Although the period of manhood is not characterized by any of those well-marked and positive signs which it would be peculiarly the province of the medical jurist to determine, still there are appearances sufficiently indi¬ cative of the time of life. This is the From this statement we may draw the curious inference, that for every two inches of height the measurement round the chest increases one inch. If the men, who were six feet one inch high, had been as large in proportion to their height, as the men who were five feet five, they would have measured 43-4 inches round the chest, in¬ stead of 42 4. Mr. Marshall, to whom we are indebted for this observation, gives several others of a similar kind in his book on the Enlisting, Discharging, and Pensioning of Soldiers. I may add'to the statement in the table, relative to the ave¬ rage thickness round the chest, that the extremes of the measurement of all the Scotch regiments of local militia were as follows Three men were only thirty-three inches, and nineteen thirty-four; three were forty-seven, and one man J'orty-eight, inches round the chest. Senescence. Physical characters. — Our means of judg¬ period when, if ever, the system attain* its perennity : it is mature, and preserves its high condition for several years. Some" times the person grows more stout, and of fuller habit. The features are more deeply set, and the forehead bears traces of care. Women, especially those who are mothers, exhibit much the same per¬ manence of general appearance, and un¬ dergo little or no change until the cessa¬ tion of child bearing. Upon the occur¬ rence of this epoch, which commonly dates about the forty-fifth or fiftieth year in this country, it frequently bappens'tlmt the mental powers become developed to a high degree of perfection. Of the moral qualities, however, of either sex, it is unnecessary for me to speak, as they are too various and diversified for the pur¬ poses of the medical jurist. Height and proportion in mature manhood. — The first portion of this period of life — from the age of thirty-five to forty — may be considered as that in which the body is in its full vigour and prime proportion. Here is a table of the heights of the men of a Scotch militia regiment, with a statement of the average circumference of the chest corresponding to each grade of stature. ing the age in this period of life are far from exact. Some, who are actually be¬ tween fifty and sixty, &re as hale and vi¬ gorous, and have as few marks of the imprint of time upon them, as many who are not yet forty; while, on the " other hand, as Byron has said, — - - - - - “ There is an order Of mortals on the earth, who do become Old in their youth, and die ere middle age. Without the violence of warlike death ; Some perishing of pleasure — some of study — Some worn with toil — some of mere weariness — Some of disease — and some insanity — And some of withered, or of broken hearts.” The skin and lineaments of the visage betray manifest signs of advancing age. The person generally becomes meagre, and loses its erect aspect : not unfre- quently, however, a high degree of embon- pomt, or rather obesity, prevails. A dimi¬ nution of vigour and activity is more or less observable. As to grey ness of the hair, baldness, wrinkles, sunken eyes, and decayed teeth and jaws — observations Strength. Stature. Number of men. Mean circumference of Chest. ft. in. ft. in. inch. 5 4 and 5 5 79 387 5 6 .. 5 7 221 392 686 5 8 .. 5 9 245 40-5 5 10 .. 5 11 107 417 6 0 • • 6 1 34 42-4 104 DR. GRIFFIN’S MEDICAL PROBLEMS. founded on sitch characteristics as these, unless several of them be taken in com¬ bination, can scarcely avail for medico¬ legal purposes. Decrepitude. The period of decrepitude— “ last scene of all, that ends this strange eventful his¬ tory — second childishness, and mere obli- livion, — sans teeth, sans eyes, sans taste, sans everything,” — that age which is usually described as commencing about the eighty first or eighty-fourth year, — I cannot help observing that it appears to be considerably antedated. We can scarce¬ ly call to mind the advanced ages of Goethe, Rentham, and some others, who have recently died, possessing to the last the highest vigour of intellect ; nor can we reflect on the many distinguished persons still living, who have passed far beyond the “ threescore and ten,” and even the “ fourscore, ” allotted to the more strong among the sons of men, without being impressed with the idea that there must be some real improvement in the habits of life in latter times, which preserves the stamina, and keeps the “ mens sana in corpore sano,” up to an age described by our predecessors as the mere wreck of human nature. Physical characters. — The state of the os¬ seous system is at this time characteristic. •The bones of the head are very solidly united, but they are thinner than in earlier life. The lower jaw has the appearance of great wear and tear, the teeth have in ge¬ neral all disappeared, and the alveolar pro¬ cesses are wanting. But, with all their solidity, the bones are very deficient in gelatinous or animal matter; whence they are more friable and dry. The spinal co¬ lumn is usually more or less curved. The larynx is completely ossified, and so are the cartilages of the ribs. These signs, however, of very advanced age, are appli¬ cable to a period embracing many years of life — the interval is large in which they are observable : so that we are obliged to gather more exact information, if it is to be had, from moral or collateral circum¬ stances. I shall here close my remarks on age. A multitude of other considerations, which have sometimes been looked upon as con¬ nected with the subject, might easily have been introduced, and probably would have served both to amuse and instruct you : but I have thought it right to omit all such as do not immediately belong to our province ; and most of those to which I allude have certainly more relation to natural history, or to medical police, than to Forensic medicine. MEDICAL PROBLEMS. By D. Griffin, M.D. HOW ARE WE TO DISTINGUISH SYMP¬ TOMATIC FROM IDIOPATHIC INTERMITTENT ? In the month of March some years since, when intermittent fever was very prevalent in the country, James M‘Na- mara, a healthy young- man, 21 years of age, was attacked with fits of shiver¬ ing, accompanied by pain in the left side of his head ; these fits were suc¬ ceeded by heat of skin and quickness of pulse, of some hours’ continuance, and ended in profuse perspirations. At first the paroxysms came on rather irregu¬ larly, but afterwards they occurred on every second day, for the most part at the same hour, and with increasing se¬ verity. AV hen I was called to see him, he had been suffering in this way about eight days ; the paroxysm had just then gone off, and left him in a low, weak state, with slow feeble pulse, and some headache, which was worst at the left side, but was no where very severe. Tongue whitish ; face pale, and covered w ith a clammy sweat ; the bowels had been tolerably free all through, and he had scarce any thirst except during the fit. I ordered him a drachm of the compound powder of jalap immediately, and a tea-spoonful of Peruvian bark three times a day. On the 25th the fits of shivering were repeated once or twice; but the bark being continued, they went off, and did not return for some days. On their recurrence I was again called to see him ; the fits of shi¬ vering were much more irregular than before. For the last four or five days he had pain in the vertex, and that which he had in the left side of the head was very severe about the left mastoid process and ear. He could get no sleep, and suffered much during the last two or three nights; but there was no tendency to delirium. His pulse was 95, and hard ; his tongue whitish; and there was very little thirst. His face looked pale, was covered with a clammy sweat, and had an expression of great anxiety. There was a tumor over the mastoid process at the left side, which was soft, puffy, and fluctuating', on opening* w hich, a quantity of extremely 105 DR. GRIFFIN’S MEDICAL PROBLEMS. foetid brownish pus sprang’ out with great violence, and much relief. The hone was carious to the extent of about a shilling. As this patient lived at a considerable distance from me, I found it impossible to see him every day, or, indeed, at all as often as might he wished. After the opening of the tumor he got a purga¬ tive, and had relief from the paroxysms for a day or two ; but they came on ag'ain with more than usual severity, and occurred daily instead of every al¬ ternate day ; they were also much more regular than before, the cold fit com¬ mencing exactly at noon, lasting about half an hour, preceded by a hot stage of somewhat longer duration, and ter¬ minating in profuse perspiration. I saw him in one of the intermissions : the pain in the head was trifling*, and there was no thirst nor heat of skin ; the face was pale, the tongue slightly white, the bowels free, and the pulse calm, at about 75. As these paroxysms bore a perfect re¬ semblance to regular intermittent fever, of which there had been for some months a g’ood deal in the country — as the in¬ termissions were so perfect, the pain so trifling, and above all, as it had before yielded to the influence of bark, I was not at all convinced that the symptoms depended upon suppuration within the head. I had never seen the sbiverings attendant on internal suppuration so perfectly periodical ; and there was no improbability in the coexistence of such an abscess as I described with idiopa¬ thic ag’ue. I determined, therefore, on trying the bark again : the subsequent history of the case proved, that though it once more gave very unaccountable relief, it was a remedy entirely inappli¬ cable, and convinced me of the great necessity there is for minute inquiry in cases so very insidious as these are. The discharge from the wound, which had been a good deal for some days, be- g*an to diminish considerably ; the fits also disappeared, the intermission last¬ ing from the 3d to the 6th of April. He was then attacked with pain in the head, very severe in the vertex and mas¬ toid process, and attended with violent shivering fits frequently in the day ; great thirst, heat of skin, vomiting, and delirium; no drink remained on his stomach. His face was flushed, his pulse hard, at 110, and he was very restless. The pupils of the eyes were not dilated, but he lost his sight in the night for about ten minutes. The case was at this period evidently hopeless, unless something* further was done. I had brought no instruments for trephin¬ ing with me, and the place was many miles from my residence; but at all events the necessity for it did not seem very apparent, as the matter wras flow¬ ing* with sufficient freedom from the opening near the mastoid process. The only other obvious indication w as to di¬ minish the inflammatory action; ancl with this view i took twenty-six or twenty-eight ounces of blood from the arm : the vomiting ceased soon after¬ wards, and he seemed somewhat re¬ lieved. It was then late at night ; and on my return next morning, I found he had expired about three o’clock. There was no examination of the body : an application for that purpose is seldom successful with people of this class in the country, and was not in this in¬ stance made, as I knew it would be useless. Some time afterwards a boy, 10 years of age, was brought to me by his mo¬ ther. He appeared very ill, and the resemblance the attack bore to that just related was very remarkable. She said he w'as seized at first with pain in the head, accompanied by frequent irregu¬ lar fits of shivering. In about a wreek from their commencement these assumed a more regular character, occurring pre¬ cisely every second day, and followed by a hot and sweating stage, as in the case of intermittent fever. He had been affected in this way about a fortnight : when T saw him his pulse was 95, and weak, his tongue w hitish, his face pale, anxious, and covered with a cold per¬ spiration. The skin was cool, but he had much thirst, and was very feeble ; his bowels w^ere rather confined, and he had lost his appetite. Again looking* on it as a case of ague, I ordered him half a drachm of pulv. jalap, comp., and some pills of sulphate of quinine, three times a day. The mother returned to me in four or five days to say that he was much bet¬ ter, the fits had gone off, and his strength w as improving ; the thirst and debility were much less, and he was altogether so much better, that she thought he only wanted something to restore his strength. A repetition of the medicine was accordingly ordered. In about a week from this time she came ag’ain, to inform me that he had got a return of the shivering fits; that they 10G DR. GRIFFIN’S MEDICAL PROBLEMS. now came on every day, sometimes two or three times ; that he had been twice growing1 gradually worse since their recurrence, and was at last very bad ; she said that he had great oppression, with delirium, much restlessness, and excessive thirst; that he had been deli¬ rious the whole of the previous evening, and all night, and that he had refused drink since morning. The oppression was hourly increasing, but he was still able to speak when she left him ; she also mentioned that he had complained much more than usual of his head the last four or five days, and that there was a tumor behind his left ear; she now also, for the first time, told me that he had been long subject to an occasional suppuration in his left ear. I went home with her to see him, but he had just ex¬ pired as I entered the house. On look¬ ing at the body it appeared to be much wasted. The tumor was situated ex¬ actly above the mastoid process, as in the other case, and was soft and fluctu¬ ating. I was anxious to examine the head, but knew it would be quite use¬ less to make application for leave to do so. There cannot, however, I think, be a doubt that there was matter under the skull, and that it had made its way th rough, as in the former case. I shall give one instance more of this formidable affection, which, though not attended by ague, nor by any external appearance of abscess, proved on a post¬ mortem examination to have been ex¬ actly of the same nature. Mary Cronon, a married woman, aged 24 years, applied at the Dispensary, complaining of a pain in her ear. The case was looked upon as one of common cold, and did not attract any particular attention at the time. The sunk and distressed expression of her countenance alone a little surprised me ; but I attri¬ buted it to her having been deprived of sleep for two or three nights. Some days after her husband called on me, to say that she had no relief from the vio¬ lent pain, but was much worse, and unable to leave her bed. On calling at the house I found her in a most deplo¬ rable state. The pain had extended from the ear to the back of the head ; the countenance was heavy and stupid ; the pupils greatly dilated ; the skin warm, and covered with clammy perspi¬ rations ; the tongue white ; the pulse small and very feeble, at 110; and there were constant retching and distressing- thirst. On pressing the right hypo- chondrium she complained of pain. I had now no doubt of the nature of the case, but it appeared to have passed the period at which bleeding could be of any avail. The head was shaved ; cold lotions were applied to the fore part, and the whole occiput was blistered ; active purgatives were also ordered. She grew more listless and heavy on the follow¬ ing day, and was in some degree deaf, but was sensible ; and when spoken to in a loud voice, answered questions dis¬ tinctly. The skin was cold, and covered with clammy moisture; she complained of the intensity of the pain in the head, and, for the first time, in the back of the neck ; she took drink well, but the retch¬ ing continued at intervals. In the even¬ ing she roused herself up, apparently excited by a strong presentiment of her approaching dissolution ; called her friends about her ; said she felt she could never recover, and in a very affecting manner recommended her little child to the care of her mother and husband. As if she had then ac¬ complished all that she could have any concern for in life, she sunk back into the same listless state as before, equally indifferent to the cries of her infant or the complaints of her family ; she moved on the pillow with caution, com¬ plaining dreadfully of the back of the neck, and now and then sawing the air to and fro with her hands: she suffered intensely whenever her head was raised to give her drink, and at night had in¬ voluntary evacuations. I saw her, for the last time alive, on the following¬ morning; she was lying on her side, frothing at the mouth, with a cold, clammy skin, ghastly expression of countenance, the lips pallid, and the eyes filmy; her pulse still distinct, at 95 ; she spoke rationally, and com¬ plained of the pain in the neck when questioned. Anxious to ascertain whe¬ ther she could swallow, T had her raised to g'ive her some drink, to which, how¬ ever, she strenuously objected, exclaim¬ ing, “ ’twill choke me, ’twill choke me !” She was, however, induced to make the attempt, and had such dif¬ ficulty that it was near suffocating her; her head was laid back on the pillow, and she expired in about half an hour. The examination w as made three days after death. There was unusual dif¬ ficulty in detaching the cranium, from the close adhesion of the dura mater; the pia mater was not particularly vas¬ cular ; there were about two ounces and 107 DR. GRIFFIN’S MEDICAL PROBLEMS. a half of water in the lateral ventricles; the choroid plexus and velum interposi- tum were unusually pale; the pineal gland was very soil, and contained none of those gritty particles commonly met with. On raising* the tentorium, the cerebellum w as found covered by a layer of thick pus, which extended over the upper surface as far forward as the cavernous sinus, into which it had passed through the aperture in the dura mater which transmits the filth pair of nerves; it had also insinuated itself into the meatus auditorius interims. The pia mater and arachnoid membrane invest¬ ing the cerebellum were highly vascu¬ lar, and spots of extravasated blood were observable ; this w?as also the case at the base of the cerebellum and the commencement of the medulla oblon¬ gata, though no matter w as found there. The quantity of matter on the whole amounted to something more than an ounce. The substance of the brain and cerebellum differed little from the natu¬ ral state ; no other morbid appearances were found excej)t in the liver, which was considerably puffed out below the ribs, with a round thickened margin : it was of a bluish colour, and its substance was of a soft spongy texture. She had never complained of her side until after she was attacked with pain in the ear. The cases of this description recorded in medical writings are very numerous, and many of them have been found to resemble intermittent fever so strongly, that their real nature was entirely un¬ suspected until the progress of the dis¬ order disclosed it, though generally at a period too late for relief; it is, therefore, a matter of the utmost consequence to be able to distinguish them in the early stage of their attack, the only time we can hope to find our efforts available. Unfortunately, however, in diseases such as these, which are not always very rapid in their progress nor con¬ stantly acute in their course, it seldom happens that we are consulted early enough to have it in our pow er to pre¬ vent the occurrence of suppuration, and as the only rational practice, if the symptoms indicate that it has occurred, would be to trephine as soon as we can ascertain the seat of the matter, it would he a vast advantage to be able to tell when this has happened. We are much in want of facts on this subject, and it would require considerable experience in cases of this kind to be able to deter¬ mine v;hat connexion the rigors , or in¬ termitting paroxysms , have with the actual existence of suppuration. In the present state of our knowledge, how¬ ever, their occurrence is the first circum¬ stance that usually leads us to suspect that it has occurred, but we see that in their close imitation of a much less serious malady, they are, in some in¬ stances, likely to deceive us. The pain in the head in itself, except when fixed to one spot, cannot give any particular indication, as in common colds, in dis¬ ordered stomach, and in the parox¬ ysms of all intermittents,it is very severe. It is probable that more may be gather¬ ed from observing the changes of coun¬ tenance closely, than from any other symptom whatsoever. It will, I be¬ lieve, almost always be found, that even where the intermission is com¬ plete in other respects, the countenance bears evident signs that the patient is labouring* under a serious and danger¬ ous disease. In the advance of the dis¬ order it becomes still more indicative of the deadly mischief which is going on w ithin ; the face and forehead are covered with a cold and clammy sweat; the features are sunk and ghastly, and there is on them an expression of ex¬ treme distress and suffering. These signs are not altogether peculiar to the cases before us, but, I think, may be ob¬ served in all instances, whether chronic or acute, in which matter is forming beneath the skull. I should, perhaps, except some of those in which this state of things has arisen from external in¬ jury, as I think I have seen some in w hich this expression was not strongly marked, or was altogether wanting. It seems probable that in the instances given the inflammation was neither violent nor extensive in its first attack, but that it was confined to a small spot which suppurated after the inflamma¬ tion had lasted some days, and, by pouring out matter, separated the dura mater in its immediate neighbourhood ; this in its turn becoming inflamed, added to the quantity of confined mat¬ ter and to the severity of the symptoms, and, at length, from the continuance of this process, and the impossibility of the matter finding an outlet, the inflamma¬ tion became very extensive and intense, adding every hour to the urgency of the symptoms and the certainty of the event. This view of the circumstances seems to be supported by the fact well known to medical men, that diseases so serious and dangerous as these, very 108 AS PRACTISED BY ON LITHOTRIPSY, often have their origin in the simple and apparently trifling fact of a child having a purulent ear, and leads us to perceive, in the strongest manner, the great difference there is with regard to the event, between the brain, when any part of it or its membranes is in a state of suppuration, and other parts of the body. The bony covering which is placed round it, to protect it from in¬ jury, is, when suppuration occurs in the brain, the main cause of destruction. In any other organ of the body, even in many of those which are concerned in the most important vital processes, large abscesses frequently are formed, and many of the persons affected with them escape, and even enjoy perfect health afterw ards ; but in the brain, the smallest abscess occurring, even so small a one as sometimes in slight cases of whitlow separates the nail from the finger, is obviously attended with the utmost dan¬ ger to life, and must necessarily prove fatal except in the small number of those cases which come within the reach of surgical aid, and the still smaller number in which the matter is absorbed. Hence it should be a constant rule of practice in the treatment of diseases of the brain, never to admit even a hazard of inflammation , however slight or cir¬ cumscribed, , terminating by suppuration. In other organs, if it occur, there is still some hope left ; in the brain there is virtually none *. [To be continued.] ON LITHOTRIPSY, AS PRACTISED BY THE LATE PHILIP FERNANDEZ, ESQ. ( From a Correspondent.) In recording the death of this estimable young surgeon, which occurred on the 18th of September, 1836, we take the op¬ portunity of laying before the medical public an account of an improvement which he had effected in the practice of lithotrity. The attention of Mr. Fernandez had been directed to lithotrity by one of those apparently casual circumstances w hich so often form an cera in life. An operation requiring much self-posses¬ sion and very careful dissection, which he had performed with great dexterity, having' been mentioned to Sir Benjamin Brodie, the friend and ready patron of every pupil of rising merit, he offered to present him with a crushing instru¬ ment, should he be inclined to practise lithotrity. The offer was accepted, and Mr. Fernandez, with that unwearied zeal w hich formed so bright a part of his professional as well as private cha¬ racter, took every opportunity which the dead-house of a considerable parish infirmary afforded of practising' the ope¬ ration. By repeated experiments he worked out the principle which enabled him to seize the smallest portion of stone in the bladder of the living body, twenty- eight times out of thirty, in the shortest space of time possible. In h is first operation, he seized and crushed the stone in minutes. He lost time, indeed, by following the re¬ commendation of a friend, and endea¬ vouring to grasp the stone between the blades of his instrument; for he found that at each attempt it escaped. He came, therefore, to the conclusion, that, in this method, success would depend upon accident; nay, more, that the at¬ tempt to grasp the stone pushed it away from the operator. The failure of what would seem, at first sight, to have been the obvious and natural method of seizing the calculus, confirmed the truth of the theory of the operation, which frequent meditation and practice on the dead body had led him to entertain, and at which he bad arrived by what deserves to be called a surgical analysis ; whence he had educed the simple and beautiful principle on which his future success depended. He saw that when the bladder was in¬ jected tbe surface would no longer be ru¬ gous, butsmooth, and that the stone would consequently be sure to roll to the low¬ est spot. He made it a rule in his ope¬ rations, therefore, to come exceedingly close to the stone (whether before or be¬ hind, mattered not) without touching it; and then, having first opened bis instru¬ ment, he gently pressed the part. The spot touched being thus made the lowr- est part of the bladder, tbe stone uni¬ formly rolled into the instrument, and he had nothing to do but to close it and crush the calculus. Twenty-eight times out of thirty did this method succeed, as we have al¬ ready stated, and the stone was seized in half a minute, to the no small sur¬ prise of the by-standers ; and thus, in our opinion, has Mi-. Fernandez removed the grand difficulty of this operation. * Dublin Journal of Medical Science. 109 THE LATE PHILIP FEHNANDEZ, ESQ. It should, however, be remembered, that an instrument powerful enough to crush a mulberry calculus is still a desi¬ deratum in surgery. Fortunate, indeed, it is for the world, when an operator can thus explain the grounds of his success, so that those results which at first seemed the exclu¬ sive reward of individual tact, may be¬ come the heritage of mankind. Nor does this hope that litbotrity has now been deprived of its chief difficulty, rest solely on the probability of the theory and the success of its promul¬ gator; for the same effects have fol¬ lowed in other hands. By this method, Mr. Robert Bloxam, of Ryde, cleared the bladder of a stone in two sittings, with the same facility as Mr. Fernandez ; and another opera¬ tion, left unfinished by the deceased, W’as easily completed by Mr. H. W. Rumsey, of Chesham. Th us, then, were these two gentlemen enabled to lithotritize with all the skill of adepts, without any previous oppor¬ tunities of practice, simply by following tbe instructions of the lamented subject of this notice. May we not, then, claim for Mr. Fernandez, too early snatched away from the affections of his friends, a por¬ tion of that praise which is awarded to those who, by adding to the stores of ehirurgical knowledge, have diminished the sufferings of mankind ? His second operation was rendered more complicated by the extreme small¬ ness of the orifice of the urethra, which required division, the intervention of spasm and haemorrhage ; yet, even with these difficulties to contend against, the first sitting was completed in five minutes. Let us now detail a few other points relating to this operation, which were the subjects of his investigation. 1st. Concerning* sounding. Mr. Fer¬ nandez conceived that it w as possible to draw an imaginary line from some given point, varying with the position of the patient, so as to intersect the fundus of the bladder, and consequently lead to the stone itself. By availing himself of this, he became so dexterous that it has happened in a few instances, where sounding was really difficult, that he instantly succeeded in striking the stone. Guided by this imaginary line, he found on one occasion, in his early practice, the stone lodging in the curvature of the instrument. He explained this circumstance in accordance with the theory which we have previously given, by supposing that by his having pressed a little in front of the stone, he had lowered that spot sufficiently to cause it to roll into the hollow of the sound. He thought, too, that in cases where the presence of stone was suspected, the surgeon might do better than strik¬ ing the parietes of the bladder at ran¬ dom : he preferred sweeping its cavity transversely, and forward, and back¬ ward ; and this he was in the habit of doing, whether he used a flexible or stiff instrument. IF hen this method had failed, he was too cautious to feel perfectly satisfied of the non-existence of a calculus, if the symptoms were prominent, till he had placed the patient on a lithotritic bed and sounded again, in the injected bladder. He thought that if a calculus existed, it must then necessarily be de¬ tected. As the most eminent surgeons have sometimes overlooked the existence of a stone, this hint is submitted to their consideration. It was the intention of Mr. Fernandez to have injected bladders of various sizes and shapes — to have made casts from them, and to have embellished his projected work on Lithotrity with drawings from these casts. The utility of such delineations to the young operator cdnnot be doubted, as they would have shown what position the stone is likely to take up, according to the irregularity of the cavity in which it is lodged. IF hether the deceased’s method of sounding may turn out so satisfactory to others as it was to himself, and the ac¬ tual cause of his dexterity, or whether the more perfect method of sounding in an injected bladder, in suspected cases of stone, as he recommended, may ren¬ der the decision of the question of its existence more perfect, remains to be confirmed by others. His method of lithotritizing stands on an immoveable basis ; and the adaptation of the sim¬ ple truth of a stone’s necessarily falling, in an injected bladder, to the fundus, to the important purpose of seizing it with facility in the manner described, must be considered as the effort of a mind of the same quality as that which forms the distinguishing* feature of our greatest discoverers. 110 MEDICAL EVIDENCE IN A CASE OF SUSPECTED INFANTICIDE. MEDICAL EVIDENCE IN A RECENT CASE OF SUSPECTED INFANTICIDE. LETTER FROM MR. PORTER. To the Editor of the Medical Gazette. Sir, I feel highly obliged by your courtesy in calling’ my attention to a report which appeared in the Times newspa¬ per of the 12th instant, and which pro¬ fesses to give a detail of the evidence taken at a coroner’s inquest, held at Bishopsgate Workhouse on the 11th instant. As I do not generally read the Times , I was not aware of the in¬ sertion, and, in all probability, would never have been made acquainted with it, had you not drawn my attentionto it. That it is a correct report, I think no liberal person would for a moment sup¬ pose ; — what with omitting words neces¬ sary to the proper reading of a sen¬ tence, and substituting’ others, the evi¬ dence is, in many parts, any thing but what it ought to have been ; and, to convince yourself and your readers to what extent a report of this kind may be varied by the reporter, I beg to re¬ commend a perusal of a report which appeared in the Morning Chronicle of the same date. I feel the full force of your observa¬ tions respecting the propriety of medi¬ cal practitioners taking care that the opinions attributed to them in the news¬ papers be correctly stated ; but, sir, with due deference to your opinion, I fancy this, in most instances, would prove no easy matter, and I think that those gentlemen who are in the habit of being called upon to attend coroners’ in¬ quests will bear me out in this assertion. Evidence is put into their mouths which they do not always utter; questions are so shaped with regard to probabilities, and are often so edged by collateral circumstances, that whilst you are di¬ recting your attention and framing your answer to meet one part, a reporter places what you have said to a different account. With respect to the report in question, I could have wished, since the case must go before another tribunal, that it had not been necessary for me to go into it at this time ; but as it has been allowed to go forth in an imperfect and very incorrect state, I think I am justi¬ fied in endeavouring to counteract its effects, and which can only be done by giving ajust one. To the best of my recollection, my evidence was as follows: — 1 yesterday, between one and two o’clock, received an order to attend F. Douglass, at 2, Sweet-Apple Court. I found her in bed, and, upon examination, I ascer¬ tained that she had been recently de¬ livered. I inquired what had become of the child : she said it had been put away. I then desired her to be cau¬ tious, and asked if it was born alive. She said it was. I inquired how she knew ; when she said she heard it cry. (It may be necessary to state that this took lace before the child had been found), subsequently examined the body, which presented the appearance of a well-formed child at the full period of pregnancy ; the head well covered w ith hair, the nails perfect, and the chest well expanded. The lung’s gave the usual evidence of having been distend¬ ed, which must have been writh atmos¬ pheric air, as the child had recently been born, and could not have been the case unless the child had breathed. They (the lungs) w’ere crepitous, and, on being cut into, air, mixed with frothy fluid, issued from the cells. There were no external appearances to account for death. The following part of the deposition was in the shape of answers to questions put by the coroner, or jurors : — It is barely possible it might have died from natural causes before being* put into the cesspool. It might have died from not having proper assistance, if the position in which it was born was unfavourable. I cannot say that death was the effect of natural causes ; there were no external appearances except slight lividity of the lips. Would not say that it had died by violence, nor that it had not. Two sons of Flail, ag’ed 15 and 13, were then called, who deposed to the following effect : — They lived with their father, and slept in the same room on Monday night; they were awakened dur¬ ing the night by the illness of the young woman Douglass, wdio complained of pain in the stomach. There was no urinary utensil in the room ; but there was a pail which is kept by their father, who is a shoemaker, and used by him in his trade; it generally contains wa¬ ter. The young woman got up and sat on this pail for some time, and was then helped into bed by their father, THE LATE MADAME MAL1BRAN. Ill who afterwards lighted a candle and g'ave it to the younger boy to light him down stairs, whilst he carried the pail, which was covered over, and emptied it into the cess-pool. On hearing the above evidence, I then stated that in all probability the child was horn whilst the woman was sitting on the pail ; that she, not being* aware of the actual state of the labour, probably mistook the pressure caused by the child for an inclination to relieve her bowels, and desired to he placed upon the pail ; in which case, as soon as the child’s head w;as protruded it would cry. In a few seconds another pain would expel the shoulders, and then the whole body ; on which it would fall into the pail. Now if the supposi¬ tion be correct that the pail contained water, it would immediately be drown¬ ed ; and even if there were only the discharges incidental to labour, they might, at the bottom of a narrow vessel, he sufficient to suffocate the child, aided by a favourable position, with the face downwards. My opinion is, that the child died soon after birth, from suffoca¬ tion; but whether that was accidental or otherwise, I cannot say. For reasons before stated I shall ab¬ stain from making any comment on the above ; but it may not be improper to observe, that incases of this kind, when public excitement generally runs high, it behoves the medical practitioner to be very guarded in his evidence ; and if there be any room for doubt, surely the accused ought to have the benefit of it. I have the honour to be, sir, Your very obedient servant, Thomas Porter. 145, Bishopsgate-street, Oct. 16th, 1836. THE LATE MADAME MALIBRAN. To the Editor of the Medical Gazette. Sir, Permit me to make a few7 observations, suggested by your remarks on the death of Madame Malibran. By so doing, I am far from washing to add to the irri¬ tation which this catastrophe has occa¬ sioned, — of which, be it said, en passant, I have had personal proof. Irom having formerly attended upon that unfortunate lady, and from the similarity of the first syllable of my name, I have been mistaken for her late medical attendant, and have been ex¬ ceedingly annoyed in consequence, to the great amusement of my professional friends, but little to my own satisfac¬ tion. Neither have I any intention of casting imputations on Madame Mali- bran’s medical advisers. Her Manchester physicians are men of such w ell-know n talent, that were I myself in danger, I should feel much reassured in seeino* them at my bed-side. As to her homceo” patbic physician, I think that if a man practises openly a system fully ex¬ plained to the public, and himself be¬ lieves in his own creed, however absurd it may appear to us, he is con¬ scientiously exonerated from its conse¬ quences*. To you, sir, who so well fulfil the office your epigraph sets forth — “ Dignitatem Artis Medicos tueri ” — it belongs to overturn this new ephemera ; a private individual, without the privilege of using the emphatic “ we ” of criticism, might be suspected of personal motives, if he at¬ tacked the homoeopaths. As far as I can judge by the reports of the case which have reached London, and to which I apply the intimate knowledge I possess of Madame Mali- bran’s constitution, I think her death to be in a great measure due to the deplet¬ ing system which it was very natural her first adviser should have adopted, not knowing the peculiarity of her ner¬ vous system, and for which they had not opportunity of compensating after¬ wards. A few details will prove this. Dramatic genius arises in a great measure from deep feeling ; and this great tragic actress, for such she was above all, having, in the pursuit of her vocation, accompanied by gTeat private sorrow’s, over excited her nervous sys¬ tem, was subject to fits of hysteria akin to epilepsy, and to attacks of catalepsy, such as I have never seen elsewhere, and hope never to see again. For example ; having been one day informed (falsely as it proved) that her brother was killed at A1 giers, her whole frame became im¬ moveable, and as suddenly as if she had been converted into a statue by the wand * We are not aware that M. Bellnomini has fully explained the practice he adopted : we know of no intimation of his treatment more spe¬ cific, than that he “ administered to the patient those remedies which he thought desirable.” — Ed. Gaz. ]I2 MR. KIDGELL’s CASE OF DISLOCATION OF THE ELBOW -JOINT. of an enchanter. She remained stand¬ ing1 for two hours, neither hearing nor seeing any external object. Waking from this trance when her attendants were off their guard, she unconsciously precipitated herself down a flight of stone stairs, cutting herself severely in her fall. Being taken up, she re¬ mained inanimate and motionless, until, in the middle of the night, she was seized by an automatic move¬ ment, when she began to roll over and over from right to left ; such a motion as Magendie, if l remember right, de¬ scribes as taking place when the cere¬ bellum had been pierced in a certain direction. Now, sir, for this malady, which J called my lamented friend, the late Dr. Maton, to witness, from expe¬ rience of her constitution, no depleting remedy was applied, except a few leeches, in spite of the violent blow on the head. A day afterwards Madame Malibran insisted upon fulfilling her duties at the King’s Theatre — was lifted into her carriage, not being able to stand — was taken out in the same man¬ ner — was dressed, w hile sitting, for her part in the Semiramide ; and when the moment came that she was to appear, to the unutterable astonishment of her friends she rushed on the stage, and drew down thunders of applause by her unrivalled acting and singing. Every time she came off the stage she retched violently, till the blood came ; and soon after the performance was over, relapsed into her insensibility. On other occa¬ sions, when other persons would have required bleeding, she recovered without it; and, on all occasions of illness, her frame required artificial support to a most unusual extent. The last time I was called to her (the 23d April, 1833), it w'as for a severe sore-throat. I ordered some leeches to be applied in the evening. Being’ obliged to go out of town, I did not call again in the evening, as I had pro¬ mised to do, before the application of the leeches. In my absence, a homoeo¬ pathic physician was called, and attend¬ ed her ever after. She then wrote to me to say that she had recovered with¬ out the application of the leeches, and, whenever I happened to see her, she laughed at my sanguinary system of allopathy , w hilst I treated homoeopathy, which had taken so ample a possession of her fancy, with similar irreverence. I think, sir, these observations may be useful in practice, and will illustrate how’ cautious we must be in treating pa¬ tients, in the vocation of our lamented cantatrice, by depletion, when we are not aware of the peculiarities of their nervous system. There may, however, have been reasons arising from the pe¬ culiar situation of Madame Malibran, when at Manchester, fully authorizing the means adopted by her first able me¬ dical attendants. — I remain, sir, Your obedient servant, Henry Belinaye. 17, George-Street, Hanover Square, October 20, 1836. DISLOCATION OF THE ELBOW- JOINT. To the Editor of the Medical Gazette. Sir, Having read in a late number of your excellent journal some very interesting cases of injuries to the elbow-joint, by Mr. Collier, I am reminded of an un¬ common accident, to which I was called about twelve months since, in the person of a young lady, who was thrown from a gig, in consequence of the horse fall¬ ing, and was precipitated with great violence to the ground. On my arrival, about two hours after the accident, my attention was directed to the left elbow, which received its in¬ jury by the carriage during the fall, and, I have reason to believe, by the weight of the body falling upon the hand. There was total inability of the limb, which was slightly bent, and pinnated, but an attempt at flexion, or extension, produced great agony. The joint was much swollen and deformed, but after some little time I discovered that the head of the radius wras partially dislocated forwards ; and on grasping the condyles of the humerus, and parti¬ ally extending the forearm, I perceived also a decided crepitus at the internal condyle, which proved to be an oblique fracture of that bone. The reduction wras accomplished by fixing the humerus steadily, and making extension from the wrist, by which means the radius wras brought into its proper situation; at the same time due compression was made at the fractured condyle. I immediately applied a band¬ age around the arm, bent the limb at a right angle, placed on a long splint, FRESH ILLUSTRATION OF THE NEW POOR-LAW SYSTEM, 113 had recourse to leeches, saturnine lotions, and the antiphlogistic treatment, and at the expiration of one month I commenced passive motion. I have the satisfaction of adding, that although the elbow remains partially anchylosed, it is sufficiently useful for the common purposes of life. Should you d^em the above case wor¬ thy of publication, it is at your service, and I remain, sir, Your obedient servant, S. W. Kidgell. Pangbourn, Berks, Oct. 7, 1836. MEDICAL GAZETTE. Saturday , October 22, 1836. ** Licet omnibus, licet etiam mihi, dignitatem Artis Medicce tueri ; potestas modo veniendi in publicum sit, dicendi periculum non rectiso.” Cicero. FRESH ILLUSTRATION OF THE NEW POOR-LAW SYSTEM. The Poor-Law potentates have made an example of one of their officers : they have cashiered him publicly — pour encourager les autres. But what a farce is this that they have attempted to play ! In the sight of an offended community, well acquainted by this time with the thorough inhu¬ manity which clings to their pro¬ ceedings, they have had recourse to the most shallow trickery: with their character for narrow-souled tyranny branded on their front, they have ventured to try a delusion on the public — to create, if possible, a belief that they are actuated sometimes, if not by clemency, at least by stern justice, in the discharge of their duties. A poor wretch loses her life through the criminal inefficiency of the sys¬ tem adopted by the functionaries of the amended Poor-Law : public indig¬ nation is anticipated : they fasten on one of their degraded officials — unfortu¬ nately a member of our profession : they exercise their inquisitorial powers 464. — xix. over him: make him their scape-goat, and fancy they have thereby exculpated themselves from every imputation. The thing is too gross. We protest that we are wholly free from any partial feeling in this matter. We have no sympathy whatever with the medical man who has been victim¬ ized for the expected benefit of his employers. He was probably a con¬ tractor for pauper medical attendance, and undertook to supply his medicine and advice at the lowest possible rate; otherwise we are satisfied he would not have obtained the appointment. At all events, in accepting the terms of the guardians, he undertook duties and an amount of responsibility which a con¬ scientious practitioner would have shrunk from. He has forfeited, more¬ over, our good opinion, in submitting' to treatment derogatory to the respectabi¬ lity of the profession ; and has lowered himself in our estimation, by the pitiful concessions and mean promises which he tendered, of being no more guilty of such high crimes and misdemeanors, if their honours would but let him off this once. Yet the injustice of the case is too manifest to be obscured by the de¬ merits of the sufferer. The circumstances have appeared in the newspapers : they may, however, have escaped the notice of some of our readers, and it may be as well to state them briefly. On Wednesday, the 3d of August last, at three o’clock in the afternoon, ap¬ plication was made to the relieving’ O officer of Harpenden, for a medical at¬ tendant for Mrs. Howe, a poor woman, aged 40, who was very ill. An order was granted, and forthwith taken by the applicant to the medical attendant; but the latter received no intimation of the urrrencv of the case: he was not told that Mrs. Howe had small-pox. The part of the parish where the patient resided wras five miles 114 FRESH ILLUSTRATION OF THE NEW POOR-LAW SYSTEM. from the residence of the medical prac¬ titioner, and it was only the same day that that officer had gone his rounds in Mrs. Howe’s neighbourhood. Not un¬ til nine or ten o’clock on Friday morn¬ ing did he visit the woman, in obedience to the order, and then he found her dangerously ill with confluent small¬ pox. She had, it seems, been nine days ill previous to his attendance. The medical man desired the persons who were with Mrs. Howe to send imme¬ diately to his house for medicines, ac¬ quainting them with the dangerous condition of the patient. It was not till Saturday noon that a person called at St. Alban’s for the medicines ; but the patient was already dead : she had expired at six o’clock that morning. Such are the plain facts — damning enough, in all conscience, of the system under which they occurred. A woman, after struggling for nine days with the fever of variola, of the worst kind, ob¬ tains, through the circuitous route of an application to a parish relieving officer, a visit at last from the medical man whose duty it is to attend. He lives five miles off’, and urges the friends of the patient to send immediately for the necessary medicines. This is neglected, and the wretched patient dies without any medical succour having been ad¬ ministered to her. What worse could have befallen her in the most unci¬ vilized country? Yet here is England, and its amended Poor-Law system ! But if any thing can be worse than the system, it is the conduct of the functionaries who uphold it. We just now complained of the injustice exer¬ cised by them in this case towards their medical officer : we have a few more words to say on the subject. It was unjust, we assert, to visit with so much severity (if dismissal from their service be really a severity) the medical attend¬ ant who failed to undertake a five miles’ journey at a moment’s notice, in order to see a patient, of the nature or urgency of whose case he received no intimation. This, however, is not the worst. It has never been the practice for parish surgeons to send their medicines : to expect it to be done in the present case — a distance of five miles — was unreasonable : to make it a charge of breach of contract, was iniquitous. Yet what says Mr. Secre¬ tary Chadwick in his sentence of con¬ demnation ? “ The Commissioners con¬ sider that the reason assigned is insuf¬ ficient, inasmuch as the circumstances under which the pauper was found, her dangerous illness, and the previous neglect (or inadvertence, as the officer represents it), prescribed a deviation from the ordinary practice of waiting until the medicine was sent for by the parties.” How easy it is to preach, even when we forget to practise ! The humane Commissioners, of whose humanity we have never yet had a practical instance, think that the stateof the unhappy pauper should have quickened the zeal of their officer : and because he did not exhibit more bowels than they ever showed, they have dismissed him. The most disgusting part, however, of thetransaction isthe meanshufflingprac- tised by the Commissioners, to transfer the blame to the medical man which so evidently belongs to themselves and their system of conduct. Let the case be a warning to con¬ tractors ; let those who have the am¬ bition to hold the high post of medical officer to a Board of Guardians, be aware of what awaits them should any untoward accident bring the system of relief into discredit. Fulfilment of their contract will be insisted on to the letter; and no emergency occurring in private practice may be pleaded in ex¬ cuse for a neglect of the contract duty. Hear one or two of the interrogatories which we meetvvith in the present case • SIR WILLIAM KNIGHTON. 115 “ But you are aware that your con¬ tract is to attend to the parish people, independently of your practice ? — -This unfortunately happens to be a solitary case. If 1 had had any idea of the wo¬ man’s illness, many medical men near me would have gone to see her. “You are in any circumstances respon¬ sible; but in that case, if you had been aware of her illness, and you had not attended, you must be aware what a heavy responsibility, legally as well as morally, you would have incurred : but since you cannot tell with regard to any case that it may not be a dangerous case, you must be aware that it is clearly expected that the attendant should he prompt. And all the instructions you may have received from the Assistant Commissioners, the Guardians, or other persons in authority, must have led you to believe that the attendance under this new Poor-Law would be required to be much more rigid than that required by the parochial officers under whom you have heretofore served. You say you have been accustomed to attend the parish poor for a number of years?* — Yes, for thirty years''' The whole case is pregnant with a moral lesson ; and if contractors will not mark, learn, and inwardly digest it, they must be lost to all power of ordi¬ nary perception. They see here a prac¬ titioner of thirty years' standing, per¬ fectly familiar with the mode of con¬ ducting parish medical relief, yet upon the occurrence of an accident calculated to excite public displeasure, the ho¬ nourable Commissioners sacrifice him, and throw him overboard ! SIR WILLIAM KNIGHTON. The newspapers have already made known the decease of the late Sir Wil¬ liam Knighton ; and although he had long abandoned medical practice, we think it incumbent upon us to place in our pages some record of one who once belonged to our profession, and whose career has been, in several respects, so remarkable. Sir William Knioditon orio-inally en- tered the medical profession as appren¬ tice to an apothecary at Tavistock; and after a residence of a few months in London, returned to that town to settle as a general practitioner. This, how¬ ever, not proving agreeable to his taste, or satisfactory to his ambition, he soon returned to London, and settled as ail accoucheur. The College of Physi¬ cians having admonished him for prac¬ tising as a physician without a degree, he went to Edinburgh, where he re¬ mained two seasons; and having ob¬ tained a degree from the Archbishop of Canterbury, was admitted a licentiate. From this time, he remained in Lon¬ don till 1810, when he accompanied the Marquis of Wellesley to Spain, and returned with him when the mission was^ at an end. On this nobleman re¬ tiring from office, he asked his late Majesty to appoint Knighton one of his physicians. Soon after this he became acquainted with Sir John M‘Mahon, by whom he was speedily admitted to terms of intimacy; and they continued on the most confidential footing until the death of the lat¬ ter, who made Sir William his executor. Among the papers which thus came into his possession were some relating to certain private affairs of the late King. Instead of endea¬ vouring' to turn this circumstance to any profitable account, Knighton in¬ stantly carried the documents to Carlton House, and placed them at once, w ith¬ out comment or condition, in the hands of the rightful owner. From that hour may be dated his admission to Royal favour: the Prince Regent, struck at once with the importance of the benefit and with the delicate manner in w hich it had been conferred, appointed Knigh¬ ton to an important office in the duchy of Cornwall; — in 1813, raised him to the baronetage ; and, at a later period, presented him with the grand cross of the Guelphic order. His reputation was now at its zenith, and his business continued very exten¬ sive till the removal of Sir Benjamin Bloomfield, w ho had succeeded Sir John M‘Mahon in the office of Private Se¬ cretary. On the elevation of this g’en- tleman to- the peerage, and his mission to Sweden, Sir William Knighton, who had previously been a frequent visitor, now became an inmate, at Carlton Palace, was invested with the offices of Private Secretary and Privy Purse, — appointments which he retained till the death of George IV. “ • • Before his connexion with the court, Ilf) HOMCEOPATHY. Sir William Knighton practised chiefly, though not exclusively, as an accou¬ cheur. He is said to have been ex¬ tremely cautious of his reputation — always calling in additional advice whenever there was any manifest danger; and succeeded in amassing a very la,rge fortune by his original pro¬ fession. From the time of his accepting the appointments above mentioned, he of course wholly abandoned practice; hut he still retained an intimacy with several members of the medical profes¬ sion, some of whom were indebted to him for many acts of kindness and con¬ sideration. He had latterly suffered from em¬ barrassment of the breathing and op¬ pression about the chest, which proved to be dependent upon enlargement of the heart, and ended in dropsical effu¬ sion into the right pleura and pericar¬ dium, which proved fatal on Tuesday, the 1 1th instant, in the 60th year of his age. Sir William Knighton was unques¬ tionably a man of excellent talents, but he was still more conspicuous for his fine sagacity and knowledge of the world. His success in life was re¬ markable, but such was at one time his interest at court, that it is quite certain he might have commanded almost any thing which the highest influence in the empire could bestow ;— yet he never sbewred himself either avaricious or greedy of honours. He was scrupu¬ lously punctilious in all the observances and etiquettes of society ; but, amid the polish which his manners and character received from the circumstances into which be was thrown, he still retained unimpaired the impress of his early friendships. HOMOEOPATHY. / ( From a Correspondent .) During the last two sittings of the London Medical Society, the disciples of Hahnemann have had field-days, or rather nights. The homoeopathic ora¬ tors were three — Dr. Uwins, Mr. King- don, and Mr. Headland. They all pro¬ fessed themselves not to be homoeo¬ paths, while they advocated the practice and defended the doctrines of Hahne¬ mann ! Dr. Uwins, how ever, when this inconsistency was alluded to, at the close of the debate, acknowledged that he was in a state of transition between allopathy and homoeopathy ; but that he was in a fair way to a full adoption of the new light. The homoeopathic orators did not practise as they preach on this occasion : they dealt in most enormous allopathic doses of verbiage, but no substantial facts — no rational arguments. They monopolized two- thirds of the time during both nights. The allopathic speakers w?ere — Dr. Clutterbuck, Dr. Johnson, Dr. Rees, Dr. Stewart, and Mr. Clifton. If we can form any judgment of the sense of a most crowded audience by the hearty plaudits which attended and followed the observations of the allopathists, and the peals of laughter which constantly interrupted and sometimes drowmed the statements of the Hahnemannians, we should fairly conclude that there was not in the room a single disciple of the “Novum Organon” except the three speakers above mentioned. The speeches of Dr. Rees and Dr. Johnson caused great merriment by the ridicule with which they covered the principles and practice of homoeopathy ; while Drs. Clutterbuck and Stewart, in conjunction with Mr. Clifton, demolished the crazy fabric ofHahnemannism by unanswera¬ ble arguments. The President himself (Dr. Whiting), at the close of the de¬ bate, which he never interrupted in its course, declared his opinion that the homoeopaths did not adduce one single fact, either in Mr. Kingdon’s long paper, or in any of their speeches, which could fairly be considered as evidence in favour of the new doctrine. Dr. Clutterbuck then proposed a re¬ solution — that the society, after a pa¬ tient hearing of homoeopathic doctrine and practice, did not consider either of them to be worthy of the slightest atten¬ tion from a body of enlightened prac¬ titioners. The homoepathists loudly ob¬ jected to the proceeding ; and Mr. King- don having- pathetically remonstrated against it, as calculated to do him a personal and professional injury, as the author of the paper, and consequently the cause of the discussion, several allopathists interfered, and prevailed on Dr. Clutterbuck to withdraw his motion. It was quite clear that not more than three or four hands would have been held up in favour of the infinitessimal system. It would have been wise, however, in the society, either to have declined the DR. SEYMOUR ON RHEUMATISM. 117 subject of discussion at first, or to have come to some official conclusion at the end. The homoeopath ists, acting’ on their usual tactics, will magnify this discussion into one of the greatest triumphs which Hahnemann has yet ob¬ tained in any country ! What ! the oldest Medical Society in this metropo¬ lis arguing the topic for two whole nights, and coming to no conclusion at last, leaving the homoeopaths master of the field, — as far as length of speeches, at least, is a criterion ! ! This is the very course they will pursue, and pro¬ bably this was the very object they had in view when they entangled Mr. Kingdon in their web, and drew him into the snare, without any hut honour¬ able intentions in his own breast. The orators themselves, however, will long remember the miserable display which they made, and the unenviable position in which they now stand before the eyes of their professional brethren. CLINICAL LECTURE ON RHEUMATISM. Delivered at Si. George's Hospital, OctA'3, 1836, By Dr. Seymour. Various forms of the Disease ; Diffuse and Bur¬ sal Rheumatism ; Metastasis'— Transference of the former to the Heart, of the latter to the Brain. Remedies: Bleeding, Guaiacum, Op'um, Calomel, Col ch cum. — Rheumatism connected w th the Po:son of Lead. — Case of Vomica bursting into the Pleura — very large Liver — Gall Stones. I have been in the habit for many years past of giving clinical lectures at this sea¬ son ot the year. These lectures are simply and solely intended for the use of those students who are beginning for the first time, or nearly so, to attend hospital prac¬ tice. [n order to enable them to under¬ stand the view s I entertain in treating any disease, I shall describe the disease, and then explain the reasons why particular remedies have been prescribed. I shall place myself as much as possible in the situation I myself was, when a student — desirous of knowing why such and such a remedy was ordered. This is the intention which I wish to fulfil ; and I address you, not with the view of making a great dis¬ play, but of making you comprehend, as nearly and as clearly as possible, the de¬ sign with which medicines are prescribed for diseases, the nature of which I shall explain. There were not many cases admitted on Wednesday last under my care, or any pre¬ senting great variety ; but there were some which will lead us to make a few observations on a most important disease — rheumatism. Rheumatic pain is a vague expression. “ I think,” to use the language of the lower classes, “ I have got the rheuma¬ tics,” means simply that the patient has pains in his limbs. Indeed, I am not sure whether the expression used by the higher classes of society is not equally vague. “ I have got the rheumatism,” is a complaint we hear every now and then, as applied to wandering pains. Rheumatism has been divided into acute and chronic ; and then there is also rheumatism arising from specific poisons, and rheumatic pains resulting from the introduction of certain metallic fumes into the body. These pains may be produced by the fumes of arsenic; and there is a particular kind of rheumatism — if so it may be called — from the poison of lead. Of the latter there are two specimens in the house, and these, therefore, will give me an opportunity of speaking to you of this disease, and of illustrating my remarks by the cases. The most severe form, however, of rheu¬ matism is the acute species, rheumatic fever , as it is generally termed ; and of this we have two very excellent specimens at pre¬ sent — the cases of Eliza Young, in Crale Ward, and Jane Vaughan, in Roseberry Ward. This disease is one which it is of very great importance in practice that you should understand. There are two kinds of acute rheumatism : sometimes they oc¬ cur together, and in other cases separately. The cases before us are of the latter de¬ scription. In one of these patients the muscles, the aponeuroses, and the liga¬ ments of the joints, at the extremities principally, are inflamed. The other is a case in which there is effusion into the cavities of the joints, more especially the wrist, hip, and knee. It will be of great importance to bear in mind, that the two kinds of acute rheu¬ matism may occur together or separately,, because the treatment and phenomena are of an entirely different character. The acute disease which affects the muscles, aponeuroses, and ligaments, with redness and swelling, is very apt to shift from one limb into another. We have a striking instance of it in the ca^e of Ann Young : when she was taken into the hospital the pain was in the right hand; but when I saw her the next day it had left the right 1 18 dr. Seymour's clinical lecture hand, and was seated in the left ; and to¬ day there is no pain at all; it has disap¬ peared. Sometimes it shifts from one hand to the other in a very short space of time, almost in a moment; certainly in the course of half an hour. I have seen it suddenly leave one hand entirely, and af¬ fect the foot. This form of rheumatism, for distinction sake, is termed diffuse rheumatism, in contradistinction to that which is generally attended with the effu¬ sion of fluid. Diffuse rheumatism is apt to leave an external, and affect an internal, part ; or the latter becomes affected without any apparent diminution of the symptoms in the former; or the disease commences in the two parts simultaneously. The affec¬ tion may occur in these three forms, but it most frequently happens that the pain in the extremities subsides when the internal viscus is attacked : when these symptoms take place it is called metastasis. I am not going to enter into any hypothetical views as to whether or not there really is such a thing as metastasis from an external to an internal part; I am merely speaking of the phenomenon as it exists. The internal viscus, which is almost ex¬ clusively affected, at least so far as my experience goes, in diffusive rheumatism, is the heart; though the lungs are said to be sometimes implicated. What takes place is the pouring out of lymph upon the opposite surfaces of the pericardium, by which they are glued together, and the heart is impeded in its functions. In some eases the heart recovers its action, but in others it does not. The effusion occa¬ sionally takes place in great abundance, so that lymph is thrown out over the sur¬ face of the heart, and is sometimes mixed with pus, and in other cases, though rarely, with blood. This is the condition which is found when sudden death super¬ venes on an attack of rheumatism, or rheumatism of two or three days’ duration. J nis, however, is fortunately an uncom mon occurrence ; I do not know that I ever saw a case, though I have read of such, and no doubt they are sometimes met with. Most frequently rheumatism attacks the heart in the course of the dis¬ ease, and, so far as we can judge, the ef¬ fect takes place which I have just men¬ tioned — the glueing together of the peri¬ cardium and the heart, and the patient recovers, as it were, with a crippled heart — a heart unable to execute its movements. By degrees the cavities enlarge, the circu¬ lation becomes interrupted, dropsy* super¬ venes, and at some distance of time the patient dies. Sometimes, on recovering from the rheumatism, the patient is af¬ fected with palpitation; a second attack takes place — for it is remarkable how con¬ stitutional it sometimes appears to be — and lymph is again thrown out; so that, after death, we may sometimes count the older and later lamina of lymph which have been deposited during successive attacks. This is the most important view wrhich you can take of rheumatism. You are not, however, to suppose that this often hap¬ pens ; on the contrary, it only occurs in certain cases, generally where the disease has been neglected in the first instance. When the disease has once taken place, though the patient may experience palpi¬ tation, distress, and all the inconveniences arising from it, yet he may live for many years, and be liable to successive attacks, until they are so severe as to cause the heart greatly to enlarge, and sooner or later dropsy ensues. Here is a drawing [presenting it] taken from a boy 13 years of age, who died of rheumatism of the heart after repeated attacks. Between the layers of the pericardium, that portion which is reflected over the heart, and that wdiich is opposite, there is an enormous quantity of lymph deposited, which has become organized through the disease hav¬ ing been of long standing. The danger, then, in acute rheumatism consists in this affection of the heart; and when a man dies under it, the disease will generally be found to have terminated in this way. There are, however, other ter¬ minations. The disease may sometimes end in suppuration ; but this is not very common; and I have never seen but one case. It much more frequently terminates in a deposition of lymph in the muscles, aponeuroses, and ligaments of the joints, so as to rentier these parts inflexible. The two cases under consideration are in the early stage of the complaint: one patient has been ill for a fortnight, and the other, according to her own account, has only suffered from rheumatism two or three days. The great object in the treatment of this disease is to extinguish the complaint without the changes taking place to which I have referred — the attack of an internal viscus. The treatment divides itself ac¬ cording to the form w'hich the disease has assumed, and the part which has become attacked. Sometimes where the heart is not affected, as in the cases up stairs, there is great pain, which is sometimes in¬ creased and sometimes diminished by heat, affecting generally the hands and feet, some¬ times the shoulders and knees; a very quick pulse, a furred tongue, and considerable heat < f skin are present — in fact, fever. Blood, when drawn early in the disease, is generally much buffed and cupped; as much so as in any febrile disease with which I am acquainted. For instance, Vaughan, who ON RHEUMATISM. 119 has only been labouring under the attack a few days, was bled as soon as she came in, and the blood was buffed and cupped. The disease still being severe, I had the venesection repeated, and the blood was again as much cupped as in inflammation of any serous membrane. I must, how¬ ever, warn you, that experience has shewn that it is not good practice to continue bleeding in the same proportion as in in¬ flammation. You may go on bleeding a rheumatic patient, where the blood is buffed and cupped, with the hope of di¬ minishing it, and yet you will find it pre¬ sent till death ensues. But, on the other hand, I should warn you against with¬ holding the use of the lancet in the early stages of the disease. There was no ques¬ tion in the profession discussed so much as the propriety of bleeding in rheuma¬ tism, especially after Dr. Hay garth’s pa¬ per. It was looked upon by some physi¬ cians that bleeding, notwithstanding the state of the blood, was the cause of the transference of the disease to the heart. I can only state, from my own experience, after many years spent in this hospital, and the practice which I have seen in other places, that if in cases of acute rheu¬ matism, with symptoms such as I have described, where there is much inflamma¬ tion, with a quick pulse, and great heat of skin, you do not use the lancet early, you will have cause to repent it; though the time will come when it would be highly improper to resort to it. It is a severe form of the disease where we are obliged to have recourse to it; and in Vaughan’s case I have been compelled to bleed twice. She is a young woman, very robust ; and the relief has been commensurate to the loss of blood. Young had been bled be¬ fore she came in, and it was not a case for me to resort to it. The pulse was 100; the patient was not strong, indeed she was pale from the loss of blood ; and there was no heat of skin. At first one hand was swollen : subsequently the other became affected ; and to day I find, after the treat¬ ment adopted, that neither hands are swollen, and the rheumatism is subsiding with great rapidity. There are various modes of treatment on which physicians have determined, for the cure of diffusive rheumatism in which the heart has not become diseased, and the affection is in its early stage. The treatment I have been in the habit of pur¬ suing, is to exhibit (after bleeding, where that is requisite) the guaiacum mixture. This is prepared by rubbing down guaia¬ cum with gum arabic, and then adding to it cinnamon water, and sugar. If you mention this to persons who have not tried it, they will tell you that rheumatism is an acute disease; thinking you mean the ammoniacal tincture (a medicine much in use in chronic cases); but this tincture is of a stimulating nature. The mixture which I have mentioned has a powerful effect in relieving the rheumatic symp¬ toms ; at least, in my experience it has been very great. I must have seen fifty cases cured by this method, and cured as quickly as by any other means which I have either used or witnessed. An ounce and a half of the mist, guiaci of the Pharmacopoeia may be given every four hours, together with barley water. The medicine determines to the skin, produc¬ ing a sudorific effect on that organ, and likewise acts on the bowels. Sometimes it acts too powerfully on the latter, and then it is necessary to give a grain of opium at bed-time. Under this treatment, com¬ bined with the use of the lancet, and keeping the patient on low diet, I have, in a great number of instances, seen the se¬ vere form of acute rheumatism give way. I have never, in a single instance, to the best of my recollection, seen metastasis occur in the progress of the cure. I am not telling you of a newr or recent prac¬ tice, for these are the remedial means which I have pursued for eight or nine years. 1 first learned this method in Edinburgh, w'here I found it more resorted to than auy other mode of treatment in the clinical wards of the hospital. 1 do not know that it wall cure a patient more quickly than calomel and opium, but calo¬ mel and opium make the mouth sore and affect the bow7els, whereas this is attended by no such consequences. When the wo¬ man was admitted, who had been ill a fortnight, I had some fear of an affection of the heart, and I administered calomel and opium; but finding that that w^as not the case, I changed the medicine, and to¬ day the report is as satisfactory as it can be. There is no swelling of the hands, the tongue is moist, there is much perspi¬ ration from the medicine, the bowels are open, and the pulse 106. The other case is more severe ; but as it is only of two days’ standing, I have not yet ascertained the effect of the medicine. She still con¬ tinues under treatment, and you will have an opportunity of observing its influence upon the disease. This is a form of the complaint in which the heart has not become affected — in which we have the patient in the acute stage ; and I can recommend this practice as being as certain of curing the disease as any particular mode of treatment is in any other affection. But suppose the case comes in with the heart already attacked — then this treatment is not sufficient. The patient, in this case, should be bled ; but in a small quantity, and in the recumbent posture, because syncope is apt to take 120 dr. seymour’s clinical lecture place. Considerable doses of calomel and opium should then be given, the object of which is to arrest the progress of the depo¬ sition of lymph; and if exhibited in suf¬ ficient quantity, it frequently produces this effect. I have seen patients in the most perilous condition, with a disposition to syncope, with a quick and irregular pulse, and sinking of the countenance, put under the operation of five grains of calomel undone grain of opium three times a-day, with the effect, in four or five days, of di¬ minishing all the symptoms. These are cases which I have witnessed over and over again. The quantity of mercury which may be given during the disease, without doing more than arresting the symptoms, is quite remarkable. I remem¬ ber a case which I saw, under the late Dr. Young, in which the patient took ten grains of calomel daily, in acute rheuma¬ tic pericarditis, for fifteen or sixteen days, and never at any time did the mouth be¬ come sore. This is one of the instances in which I have frequently had occasion to point out the effect of medicine on disease. If the patient were in health, a fiftieth part of the mercury would produce consti¬ tutional effects ; but here the power of the remedy is expended on the disease. This is well known in many cases, but it cannot be better illustrated than in this instance. I have spoken of two forms of rheuma¬ tism-mere diffuse rheumatism, and dif¬ fuse rheumatism transferred to the heart. Where no transference has occurred (I use that term because it is a simple word, though the disease may occur without any evidence of the transference), and, in the second form, where it has already taken place, various persons have different me¬ thods of treatment : some treat the acute form with bleeding and antimonials, others with calomel and opium, and it is a com¬ mon practice with some to exhibit colchi- cum, combined with Dover’s powder, as a sudorific. It sometimes happens that this disease lasts a great length of time; the heart is not attacked, and yet the patient does not recover. This constitutes what is called an obstinate case, and presents itself once, perhaps, in twenty or thirty instances of the affection. The patient has perhaps been bled, taken colchicum, and also calo¬ mel and opium, and yet the disease rolls on; and in other instances he has not taken any of these things — he has not taken medicine at all, in any considerable quantity — and the disease is still severe. The patient, in such a case as this, com¬ plains of violent pain, the surface is pale, and, in addition to that, there are constant sweats breaking out over the body, which are of an acid character, and accompanied with acute pain. The pain is aggravated by warmth, rather than relieved by it. When such is the case, we have a remedy the effect of which is quite magical : a grain of opium, administered every four hours, will sometimes entirely cure this form of the disease in a way hardly cre¬ dible. Some years ago, I saw a case which might be called one from consti¬ tutional disease: it occurred in a lady, thirty-five years of age, who was at¬ tacked with severe rheumatism in the sum¬ mer. The case was the more alarming from the fact that she was one of a family three of whom died of rheumatic pericar¬ ditis in early life ; but she never had any symptoms of the disease till she was thirty five. She was bled, and the usual remedies were applied, with some measure of relief ; but still the disease went on, and neither calomel and opium, nor guaia- cum nor colchicum (for the case was treated, in the first instance, as an inflam¬ matory disease), was of the smallest ser¬ vice. A consultation was held, and I met Dr. Nevinson, who recommended, as the patient had been ill a month and the dis¬ ease had but little abated in violence, though it had sometimes left her fora few hours, that a grain of opium should be given several times a-day, which had the desired effect. Some of you have seen cases in the hospital treated in the same way, and with the same success. The cases where you must have recourse to it, are where the pain is very severe — where it has continued some time, is not re¬ lieved by warmth, and is accompanied by this acid perspiration. I should say something on the employ¬ ment of colchicum. Colchicum has been considered useful in rheumatism, and I will describe the particular form in which it is beneficial — viz. synovial rheumatism. It may sometimes be of service in the dif¬ fuse form, but it as often fails ; I think, oftener In cases where the heart is at¬ tacked, I have, in my experience, had to repent its employment. It knocks down the vital powers, and the pulse becomes exceedingly irregular, so that it is best not to give it in this form of the disease; but in another variety it is very useful. In the diffuse form I have seldom seen the good effect of colchicum. Once, in a se¬ vere form, complicated with effusion into the joints, the expressed juice, with opium, was of great benefit : but in no other form is it so useful and decidedly benefi¬ cial, as in synovial rheumatism. I stated that there were two kinds of rheumatism — that it affects the muscles and the joints ; and these may occur toge¬ ther or separately. In the cases under consideration there is no effusion into the joints; but in a case up stairs, fluid has been rapidly effused into them, without ON RHEUMATISM. 121 affecting- the muscles or tendons. When this is the case, there is a difference in the symptoms, which 1 shall point out; a difference in the march of the complaint and in the method of cure. By making this distinction, you simplify the practice very materially. In synovial rheumatism the lancet is not so much required as in the diffuse kind; and here colehicum, as I have said, is exceedingly beneficial. I have seen it in many cases. I had a case last summer, entirely cured, in a very short space of time, by colehicum alone. There are va¬ rious forms in which it may be employed. Haifa drachm of the vinum coichici may be given in camphor mixture, and half a scruple of magnesia is generally added. Some suppose, from the acidity that is present, that there is a separation of the colehicum wine and a throwing down of a sediment, on which its benefit depends; and this is prevented by the magnesia. This may be given twice a day, or three grains of the acetic extract with five grains of Dover’s powder. In the majority of instances you will relieve this form of the complaint. I told you that the march of the disease was different, and I will explain why. This form is sometimes transferred to an internal viscus; but the cases in which this takes place do not bear the proportion of one to forty, compared with the trans¬ ference of diffuse rheumatism to the heart ; and when an internal organ does become affected, it is the brain, and not the heart. This is worth bearing in mind. Unfortunately, it is not uncommon to see rheumatic pericarditis; but fortunately it is very uncommon to see affection of the brain from the transference of synovial rheumatism. I have only, in my own experience, seen five cases — four in private practice and one in the hospital; whereas, in the same space of time, I have seen fifty cases of the other form of the disease. This shows you how very important it is to comprehend it. A case of the transfer¬ ence of synovial rheumatism to the brain, took place in the hospital last spring. A man came into the hospital, in whom some of the joints were as large as a child’s head, from effusion, and he was in a per¬ fectly cachectic state of body : there was a white tongue, with little appetite, and no fever. He had taken colehicum for some time, without manifest advantage. I thought the best plan appeared to be to put him on a tonic medicine, as he was in such a cachectic state, and to bring up the constitution so that he might bear other remedies. For this purpose he was ordered bark, and I gave him a little meat, but no porter — nothing stimulating : indeed the lull diet of the hospital is not so much as persons cat in ordinary life, in health. He appeared to be somewhat better. I one day observed the knees becoming flac¬ cid, and, in fact, they were reduced one- half in size. He was attacked with vio¬ lent pain in the head, there was palsy on one side, and within the space of thirty-six hours he died. Upon opening the body, it presented a remarkable appearance. Over the left hemisphere of the brain there was de¬ posited a thin layer of green purulent matter, so as to cover it over, and some fluid w7as found in the ventricles. Never at any period before or during the attack was there any symptom of that increased action which generally precedes a para¬ lytic attack. Here was one form of rheu¬ matism transferred to the brain. In using the word transference, let me again men¬ tion that I only wrish you to understand it in the common acceptation of the term : I am by no means giving it as my opinion that the disease is transferred from one situation to another, but that upon the cessation of it in the joints this affection takes place in the brain. This is as clear as I can make the subject. The two dis¬ eases may occur together or separately, and there is a distinction in the symptoms, the treatment, and the termination. The remedies which are applicable to the one are not so applicable, if applicable at all, to the other. But you may have compli¬ cated cases, in which there is diffused in¬ flammation, together with effusion into the joints; and in these cases, adding to the ordinary treatment some preparation of colehicum is generally of great service. You will watch the cases to w'hich I have referred, and I think you will see that the cure will be very rapid. There is a case in Crayle Ward of a w'oman w ho came in with rheumatism of the joints, and I point out the case in order to show you one of the terminations of this synovial rheumatism. She en¬ tirely recovered with the exception of one knee-joint. You will sometimes have this occur: the patient will recover wdth the exception of one joint, which is more in¬ flamed than the others, and some stiffness remains. The case is now nearly cured, and will, I have no doubt, get perfectly well. There is also a case in the hospital, under my care, of chronic rheumatism. It is one in which a slight acute attack has passed over, but there is still great difficulty in moving the limbs, from some remains of pain in the joints. It is the case of an old woman in Roseberry Ward. She is 70 years of age, and laboured under fever from cold, since which time she has had diminished power of the lower extre¬ mities. This is marked to show that it does not depend on an affection of the brain, but on rheumatism, which has 122 DR. SEYMOUR ON RHEUMATISM. ended by impairing the powers of motion. It affected her hands and knees. As the bowels were not opened, I ordered her to be purged, and then to be placed in the vapour bath. This leads me to mention the great utility, in some cases, of this practice. The being able to administer these baths readily, is one of the greatest modern improvements. There is one up¬ stairs, in addition to which they may be brought to the bed of the patient, and copious perspiration may be readily excited. They are an excellent substitute for the external use of Bath water, which is so effectual in most cases. In the chronic form of the complaint, the fever having disappeared, the warm and the vapour baths are useful ; but be¬ cause they are serviceable in rheumatism, have a care not to recommend them in the acute form, for, so far from being appli¬ cable to it, on the contrary fatal results may take place. I have known disease of the heart ensue after a blunder of this kind; and I have known them bring on a state of great excitement and fever, instead of the febrile action being diminished. The bath acts as a stimulus in the acute form of the disease, and is therefore contra¬ indicated. In the chronic form, where the parts have lost their elasticity, and where fever no longer remains, to such a condi¬ tion are they applicable. There were also two other cases ad¬ mitted, to which, being of a different kind, I shall call your attention. They are cases arising from the introduction of a morbid poison into the system — the poi¬ son of lead. One case is that of a man named Claney, a coach -pain ter, who is lying in York Ward. He has been sub¬ ject to the complaint for six years. The joints are neither affected with redness nor swelling; the bowels are constipated, and there is a cachectic state of the counte¬ nance, arising from his employment. He has been under medical treatment, with¬ out relief, for many weeks. The other is the case of Redding, in Hope Ward, who is suffering under a more advanced form of coliea pictonum, with slight palsy of the hands. I will explain what is the effect of lead taken into the constitution. What is the first impression, I cannot exactly say, but the symptoms which follow are, pains of the limbs, loss of appetite, great degenera¬ tion, as it were, of the general health, and the patient looks as if there was no red blood in the body. If he still continue to work at his employment, contraction takes place in the muscles of the abdomen, and probably in the muscular coat of the intestines, and the bowels are drawn back, so that when you place your hand in that region, you appear almost as if you touched the spine. There is obstinate constipation under this form of the dis¬ ease. This, as I have said, is termed coliea -pictonum . The word pictonum has been first derived from the inhabitants of Poitou, a province of France, and the dis¬ ease was first described by the physician to Cardinal Richelieu, in the time of Louis the Thirteenth. It was proved to depend upon acid wane being made in leaden vessels. The wine dissolved a small part of the oxydized lead, and the persons who drank of it were affected with the disease. As it occurs in persons who work in lead, and very frequently in painters, it is some¬ times supposed that pictonum is the Latin for painters. This is the most general form of the disease, and then it is termed painter’s colic. If the patient has suffered one or two attacks, and still continues to work in lead, after a time palsy of the ex¬ tensor muscles of the fore arm takes place, and the hands drop. If even after the restoration of these the man still remains in the same employment (and what this poor man told us is often the ease — that if lie did not work in lead he had no other means of obtaining subsistence) various symptoms take place— epileptic fits, and an affection of the bronchi, with expec¬ toration, very similar to phthisis. Some¬ times, likewise, there is effusion into the joints, which is called rheumatism from the poison of lead. I remember having in the old hospital three cases at one time in one ward, in which there was synovial rheumatism arising from the poison of lead. In a very old wrork, called Mus- grave on Rheumatism, you will see several cases well described. At the present time we have only two cases, one labouring under general pains from the poison of lead, and the other suffering under colic ; and we have the commencement of palsy, the bowels very costive, the extensors of the fore- arms paralyzed, the abdominal muscles drawn in, and of course when there is an endeavour to make the bowels operate, there is very great pain. In this instance the cure is most gene¬ rally allotted to some purgative, combined with opium, to relieve the spasm, and fol¬ lowed up by castor oil, which is, of all other remedies, the one best adapted to effect a passage in such cases as the dry belly ache in the West Indies, where the disease arises from making rum in vessels with leaden cramps, and in Devonshire, from making cyder in such utensils. After a free passage has been obtained, the warm bath should be used; and when the pa¬ tient’s health becomes better, great stress has been laid on the use of balsam of Peru, and consequently lam in the habit of giving it when convalescence is commencing. It strengthens the muscular fibres which have been affected. You will be enabled to watch these two MORE PLURALIST LECTURERS. 123 cases, and I have no doubt that they will both recover. In the worst case the palsy has not gone to a great extent. Some recommend placing the hands on a splint, so as to give support to the extensor mus¬ cles. I have seen this practice pursued, and I think with some good effect. It was recommended by the late Dr. Pember¬ ton, of this hospital. You will find in the Transactions of the College of Physicians some interesting papers on the effect of the poison of lead, by the late Sir George Baker, who took great pains in investi¬ gating the Devonshire colic, and discovered that it was owing to this solution of lead, effected by the action of a vegetable acid upon the troughs in which the cyder was made. I think that I have laid before you a good number of points for your considera¬ tion as you go round the wards. I have explrined my reasons for the remedies which have been laid down, and the gene¬ ral circumstances in the cases to which your attention should be directed. On Friday next I shall take up some other point, describing, in the first instance, what has been the progress in those diseases to which your attention has now been called. Before you leave me, I beg your atten¬ tion to some morbid appearances brought for your inspection. The patient in whom these wrere found wras under the care of my colleague, Dr. Macleod. You will see the account of the symptoms dur¬ ing life in his case book, and he will readily aff ord you any further information. There is a vomica in the right lung, which has perforated through the pleura, pouring out fluid into the right cavity of the chest, through the aperture, which is rather larger than the circumference of a split pea. There were found no less than 126 gall-stones in the gall-bladder, which you see here — one nearly as large as a walnut, the others much smaller. When these little bodies are pressed forward, so as to obstruct the duct, jaundice often takes place, wfith violent pain at the epi¬ gastrium and in the back, with frequent vomiting, and a slow pulse. This consti¬ tutes what is termed bilious colic. The liver, you will also observe, is double its natural size, and, in fact, occupied a large portion of theabdomen,reachingto thecrest of the ilium ; and yet there was no dropsy. The worst cases of ascites, as I shall have occasion to showr you, do not arise from enlarged livers, but in consequence of the liver being uniformly contracted, often to half its natural size, and the peritoneal coat is usually thickened in patches. I have thought it desirable to give you an opportunity of examining these appear¬ ances, though I must refer you to the phy¬ sician under whose care the patient w as for an account of the symptoms during life. ST. GEORGE’S HOSPITAL. Ligature of the External Iliac Artery. On Thursday last (20th), the external iliac was tied, at St. George’s Hospital, by Mr. Walker, for femoral aneurism. The ope¬ ration was very skilfully performed, and there is every reason to expect that the patient will do well. UNION OF THE EASTERN WITH THE GENERAL PROVINCIAL ASSOCIATION. To the Editor of the Medical Gazette. Sir, The tone of your remarks upon my last communication induces me to give you early intimation of the fulfilment of my wishes with regard to .the junction of the Eastern Provincial Medical and Surgical Association with the General Provincial Association. This, I consider, was effected on Wed¬ nesday last, at a meeting of the Council of the late Eastern Society, in Norwich, when it was unanimously resolved, that “ its members do immediately join the parent Society, on the terms proposed by the Council of that body, through Dr. Has¬ tings.” Thus one hundred and sixty, or seventy, members will be at once added to this ex¬ cellent, useful, and flourishing Society; and I feel convinced the South of England will speedily imitate our example, and that the practitioners of England will be connected in one great and powerful body, admirably adapted to defend the profes¬ sion from all the attacks which individuals, or the legislature, may make upon its re¬ spectability or rank, and to promote its scientific and successful cultivation. Hoping that you will take an early op¬ portunity of making this junction known to your numerous readers, in any way most congenial to your feelings, I remain, sir, Yonr obedient servant, J. Godwin Johnson. G4, St. Gilcs’s-strcet, Norwich, Oct. 14, 1836. MORE PLURALIST LECTURERS. To the Editor of the Medical Gazette. Sir, In the last number of his journal, that most disinterested and impartial person 124 POOR-LAW MEDICAL CLUBS. the honourable M. P. for Finsbury, has attacked the Aldersgate School on the plea of some of the teachers lecturing on more than one branch. They do so ; but had not Mr. Pereira’s admirable lectures been published in the Gazette, and had not Dr. Cummin’s, which promise to be equally valuable, been now' in progress, I dare be sworn Mr. Wakley’s virtuous in¬ dignation would have slumbered. As, however, he has mooted the subject, I must request him to look at home; and he will find in his own school in Gower- street, precisely what he condemns elsewhere. With his usual dishonesty he misrepresents facts, — separating and announcing as distinct courses what is given in one and the same course in every school in London. Such, for example, as Therapeutics, which he makes a distinct course from Materia Medica; Theory of Physic distinct from the Prac¬ tice, and so on of others; — the purpose being to make it appear that there are twice as many courses as lecturers ! Now, sir, according to Wakley’s method of reckoning, his new protegd — his Magnus Apollo (for the present season) — lectures on five different subjects; and according to the most favourable mode of reckon¬ ing, does actually give three totally dis¬ tinct courses ; thus : — Therapeutics • • • • Dr. A. T. Thomson ! Materia Medica . .Dr. A. T. Thomson ! ! Medical Jurispr. . Dr. A. T. Thomson ! !! Toxicology . Dr. A. T. Thomson !! ! ! ClinicalMedicine,Dr. A.T. Thomson ! ! !!! “ There’s a display for you!” {Vide Lancet.) Again, his pet, Dr. Grant, stands much in the same predicament as his colleague, Dr. Thomson, as appears by the published advertisements — thus : — Comparative Anatomy . Dr. Grant. Zoology . Dr. Grant. Geology (a part of the course), Dr. Grant. Fossil Zoology (separately ad- ? T vertised) . £ L)r ’ 'jrant* Not to mention — Physiology (at his own house), Dr. Grant. nor his engagements to lecture at other schools. So much for Wakley’s impar¬ tiality ! “ They who live in glass houses,” Mr. Editor; — but the proverb is rather musty. Your obedient servant, An Aldersgate Pupil. October 17, 1836.1 CAMBERWELL PRACTITIONERS AND THE POOR-LAW ME¬ DICAL CLUB. To the Editor of the Medical Gazette. “ All seems infectious that the infected spy. As all looks yellow to the jaundiced eye.” Sir, It is not my intention to follow a late cor¬ respondent of yours through the elegant terms of his vocabulary; it is quite evi¬ dent that he is a “ stickler against the clubbists.” I am sure that you will not feel surprised that I have no desire to see my name put forward with, probably, the title of knave or king of clubs in your next number. I would willingly shield myself from that honour; but, in deference to your opinion I will throw off the mask, and will ask any unprejudiced mind to view the situation of those two practi¬ tioners (Messrs. Flower and Young, of Camberwell Green, the latter a partner of Mr. Forbes), each paying rates to the collector (Mr. Prebble, of Camberwrell), whether they may not fairly be termed Camberwell practitioners. I think the letter in the same column, from Mr. Bowen, sufficient to set that matter at rest. And now to the question — “ Can he show us howr this innovation will benefit the poor man ?” I reply, certainly not; as there is nothing so impervious to argu¬ ment as the blindness of jirejudice — “ A man convinced against his will, Is of the same opinion still but I presume there are many cool and reflecting minds to whom I may address myself w ith more prospect of success. Is it, I ask, no benefit to a poor man to have placed within his reach the option of se¬ lecting, from the general practitioners of a neighbourhood, his own medical attendant, and not be compelled, for fear of incurring to him a ruinous bill, to have recourse to the parish surgeon ? „ Ask the man of principle, whom a re¬ verse of circumstances has driven to the threshold of despair, and who is but a fewr stages removed from the workhouse, with a wife or some of his children lying on a bed of sickness, whether he feels it a benefit to be able to avoid this first step to pauper¬ ism (viz. having recourse to the parish sur¬ geon), but to have placed within his reach a number of practitioners, upon whose kindness and attention he has a positive claim ? and I fear not to hear his reply. I venture to say there are but few medical men so “ fallen,” as to consider them¬ selves degraded by attending this man’s family, or to be scared from their duty by POOR-LAW MEDICAL CLUBS. 125 having applied to their name the paltry term clubbist. I envy not the feelings of such men. Yes ; there are those, consti¬ tuting, too, a numerous class of pro¬ fessional men, who consider it no degra¬ dation, no dishonour to the professional character, to lend their assistance in en¬ deavouring to raise the moral condition of the poor, by cherishing that feeling of in¬ dependence which has been too much neglected, and which, I had almost said, was a national blessing ; and they are not to be deterred in contributing their mite to this object, from a feeling that had they acted differently, they might perhaps have screwed out the last shilling from the wretched sufferer. True it is, that wre may occasionally get a bill of two or three pounds from the honest and industrious poor; who, if we could witness the de¬ privation both themselves and families endure rather than apply to the parish sur¬ geon, it would add but a fresh proof, if any were wanting, that it needs no argument from my pen to convince the spectator of this scene; that it is indeed a benefit , and will be felt and estimated as such by the poor ; and that it will not , cannot , tend to injure and degrade the profession. With such an object in view, let us lay aside all party feelings; and if we are not able to appreciate or feel that it is a benefit to the poor, we are at full liberty to decline giving it our support; but let us have the modesty not to apply to those who differ from us in opinion terms of the grossest abuse ; and pray let us hear no more about “ shedding the last drop of blood in the cause.” The plan has also the further recommen¬ dation of acting on the principle that the man who does the work shall have the pay. Now it is a well-known fact, that hitherto the profession generally have been in the habit of giving their advice and medicine to many of the poorer classes in their re¬ spective neighbourhoods ; considering the parish surgeon, from the extent of his dis¬ trict, the numerous calls to which his situation subjects him, the addition of his private practice — to say nothing of the prejudice too often entertained against him ; these, with other causes too nume¬ rous to mention — such as the repeated applications made to private practitioners by women in a state of actual labour, who, either from aversion to the parish surgeon, her own neglect in not applying for an order ; the fear lest, when it is obtained, he will not attend himself, but send some youth ; these, with other reasons which my time will not permit me to enumerate, cause a considerable number of midwifery cases to be thrown upon the hands of pri¬ vate practitioners, who do not receive even the small sum to which the parish sur¬ geon is entitled for his attendance — to say nothing of the answers she some¬ times receives to her application dur¬ ing her hour of trial ; one desiring her to apply to the parish surgeon, another asking who is to pay me if I come. In the meantime she is perhaps confined, and the child or children, as it may be, for want of timely assistance, are dead, and the life of the woman endangered. To remedy these evils, “ let the man who does the work have the pay.” I shall not stay to inquire whether to such poor it will be a “ benefit ,” or to ask the medical man whether, by being paid, he feels degraded. For myself, I have given to the plan much of calm and quiet deliberation, and per¬ ceive it in active, useful, and unopposed, operation in many of the provincial dis¬ tricts ; and however strongly this measure may be opposed by some, there are not wanting from among the ranks of the pro¬ fession many who think, under judicious limitations, the proposed measure may be usefully, nay, profitably, adopted ; by the poor man, as a means to obtain assistance suited to his circumstances — by the practi¬ tioner, as obtaining small but certain remu¬ neration. And now a few wrords as to the in¬ terest of the medical man ; and on this head I need only ask the practitioners living in the immediate neighbourhood of a dispensary, with the abuses to which it is subject, whether it is not a far more objectionable measure, and fraught with much greater danger to the interests of the private practitioners, and much more likely to take the bread out of the mouths of the poorer class of surgeons, than the formation of a Medical Club, with the “ concerted measures of the Forbes’s, the Beans, the Brownes, and the Flowers ” of any district ? I feel satisfied that had Mr. Bowen been acquainted with more than the mere names of those persons he has mentioned, he would never have im¬ puted to them being actuated by such unworthy motives. I have now only, in conclusion, to call your attention to an advertisement, in which I find that it is intended to try the effect of a good dinner upon the general practitioners of Southwark and its vicinity, to cultivate among themselves that unani¬ mity and good feeling so essential at the present period, in consequence of the many recent attempts to injure and degrade the profession, — at which, doubtless, many good things will be both said and swallowed ; and though I leave them to the enjoyment of this method of “ mutual protection ,” with the cheers, the triumph, and the hollowest exultation, and though no garland flaunt around my recreant head, I shall rest con¬ tented with the homely and humble festal 126 PROCEEDINGS IN CAMBERWELL. board of co operation in a good cause, and be solaced by the recollection of my humble but well-meant endeavours, and in the satisfaction arising from the possession of the “ mens conscia recti.” With these hurried remarks, not intend¬ ing again to trouble you on this sub¬ ject, and thanking you for your impartial conduct, I take my leave, “ throwing off the mask,” and avowing myself a “ Cam¬ berwell Practitioner” — J. S. Flower, Surgeon. Camberwell Green, Oct. 17, 1836. PROCEEDINGS IN CAMBERWELL. REPLY TO MR. HULBERT. To the Editor of the Medical Gazette. Sir, I readily comply with Mr. Hulbert’s re¬ quest; and as this matter concerns the profession generally, and especially the practitioners in this district, you will, I trust, give insertion to all my statements, as I am prepared to prove their correct¬ ness. I will pass over the “ wigs and gold- headed canes of antiquity,” and also the letter of the “ Camberwell Practi¬ tioner’’ (which appears to be Mr. Hulbert’s chief prop), and only allude to one insi¬ nuation contained in his letter, viz. “ that I am acting under the direction of others.” Such an inuendo would excite anger in my mind, if I believed that any individual except Mr. Hulbert could entertain the same opinion ; but as it emanates from him alone, I can readily excuse it. “ II y a des reprochesqui louent, et des louanges qui medisent.” And now for my justification of the per¬ sonalities T am accused of. At the Camberwell meeting Mr. Hul¬ bert made the following statement: — “ I am sure I do not wish to act in opposi¬ tion to my professional brethren.” Now, sir, from the whole tenour of Mr. H.’s pro¬ ceedings, I thought that he was not ac¬ tuated by this feeling; and the following circumstances induced me to form that opinion: — Mr. Hulbert came into this neighbourhood a few months since, I be¬ lieve, a perfect stranger. I had the honour, on the 4th of August, to receive a circular from him, inviting the “ clerical and me¬ dical professions, and others, to attend a meeting at the school-room in this parish, for the purpose of hearing Air. Smith, on the subject of “ Self-supporting Dispen¬ saries,” J. Callaway, Esq. in the chair. A very small number of these circulars, how¬ ever, reached the members of the latter profession; and Air. Hulbert’s excuse for this omission was, “ that his boy was un¬ able to find the residences of the medical men, and therefore returned the circulars.” This meeting was adjourned till Sep¬ tember the 7th, when I found Air. LI. sid¬ ing with men who characterized the mem¬ bers of our profession “ as gross and mer¬ cenary conspirators; who told us to read our bibles, and mark well the story of the good Samaritan ; that we were only a fraction of the community, and must yield to the public good,” &c. Mr. H. after¬ wards wrote to the Editor of the Surrey Standard, calling his account of the meet¬ ing impartial, when he knew that the reporter only crane the arguments of those who were favourable to the plan. At a subsequent meeting, when a large body of medical men were present, a letter was read bv Air. Hulbert’s son, from Mr. Hawes, AI P., stating, “ that if the medi¬ cal practitioners were consulted, that this Dispensary could not be formed; but he (Air. H.) recommended its formation with¬ out paying any regard to their opinions.” After the above, I think that I was justi¬ fied in descending to personalities ; and, when speaking of the clubs and dispen¬ saries, I thought it desirable that the gen¬ tlemen present should know how these things were managed in the borough of Southwark and its vicinity; and T made the following observation: — That Mrs. Hulbert was in the habit of walking about from morning till night recommending the “ Self-supporting Dispensary;” and on that very day she had called upon a lady in Trinity Square, and, amongst other ad¬ vantages, had held out as an inducement, that the servants might become members.” But, sir, this remark was levelled at Mr. H., and not at the lady, as I presumed that she acted according to her husband’s directions. And, lastly, to shew that the general practitioners in this neighbourhood are somewhat interested in Mr. H.’s move¬ ments, I may state that a handbill (printed in the same type and character as those issued by Alessrs. Eady and Co.) has been circulated, addressed to the industrious mechanics and working classes of the bo¬ rough of Southwark and its vicinity; the writer of which (after speaking ci la Row¬ land “ of a discerning public, and promis¬ ing these said industrious mechanics, that, under the Divine blessing, all their ills will be removed,”) offers them physic, &c. for Id per week ; male servants to pay 7s. per annum ; female, 5s. do. &e. “ Persons desirous of becoming free members may apply for information to Air. Hulbert, 6, Trinity Square, any morn- NEW REGISTRATION OF BIRTHS AND DEATHS. 127 ing between the hours of 10 and 12, Sun¬ days excepted ” I must apologize for having occupied so large a space in your journal, but I have, in self-defence, been obliged to enter into the above explanation. Yours respectfully, E. Crisp. Walworth, Oct. 18, 1836. NEW REGISTRATION OF BIRTHS AND DEATHS. To the Editor of the Medical Gazette. ■ - “ O miseri, quee tanta insania, cives ? Creditis avertos hostes ? autulla putatis Dona carere dolis Danaftm > - - - equo ne credite, Teucri, Quicquid id est, timeo Danaos, et dona ferentes.” Virg. Sir, I was much gratified by your remarks in the Gazette of the 3d instant, on the “ dainty device of Mr. Secretary Chad¬ wick, and his employers, for degrading the profession into a Company of Parish Clerks.” I felt persuaded that the tone and spirit of your observations would be justly appreciated by every one anxious for the interests and character of the pro¬ fession. The Poor Law Commissioners, it seems, have very generously offered to the worst- paid and hardest-worked officers of the Unions — members of a profession they have sought every opportunity to insult, injure, and degrade — the very lucrative and hghly dignified office of subordinate, or dis¬ trict, registrar of births, deaths, and mar¬ riages, “ when these duties are not incon¬ sistent with their engagements, and they may be disposed to perform them !” Dis¬ creet, delicate, generous men, with large salaries, “ small brains, and no bowels !”- Such conduct of the Commissioners, whose general treatment of the profession has deservedly excited in the minds of all its respectable members feelings of unqua¬ lified disgust, being characteristic, is not much to be wondered at ; but I am sur¬ prised that your correspondent, T. G., should think it “ extraordinary” that me¬ dical men have, in so many instances, refused the very respectable office of subor¬ dinate registrar, encumbered as it is with duties, and productive as it is of emolu¬ ments, so well suited to the taste, time, attainments, and expectations, of a parish clerk. I confidently believe that he will hear of many more instances of men, who, considering what is due to their profession, and to the cool impudence of the Somer¬ set House triumvirate, and their scribe, will have rejected this contemptible offer. If the medical profession is to be bene- fited, we may be sure it will not be at the hands of the Poor Law' Commissioners, but by the united exertions of its own members ; nor is it necessary for the ad¬ vancement of the statistics of medicine, that medical men should accept the prof¬ fered honour. It was very wrell known that the “ bait” would be taken only by those who cherish and are charmed with the ‘‘credit” of an appointment by a Board of Guardians — Mr. Chadwick’s neophytes, the “wider field officers”* of the Poor-Law Com¬ missioners. * A correct registration of the number and causes of deaths may be effected, and all the desired advantages derivable there¬ from may be obtained, by the medical pro¬ fession, without a voluntary and spiritless submission on its part to more injustice and new indignities. Let the Commissioners and the Guar¬ dians appoint their relieving officers — per¬ sons in their estimation perfectly qualified to judge of the degree of illness of paupers, and of the necessity of medical aid, or any other persons whose engagements are not incompatible with the duty, and let them procure from the friends of the deceased, in w7riting, under the hand of the medical attendant, a statement of the known or supposed cause of death. Any respectable scribe may transfer this to his register. To this it must come, if accuracy be in¬ tended, appoint whom they may. A dis¬ trict registrar, even if a medical man, could not, unless omniscient, ascertain with the requisite precision the known or supposed cause of death without a direct or indirect appeal to such medical autho¬ rity. T. G.’s wonder, I think, should cease or abate on further consideration; for he needs not to be assured that the medical profession are fully aware of the ceaseless endeavours of the Poor-Law' Commis¬ sioners to degrade general practitioners into a race of petty pedlars and parish clerks, and they, consequently, are able to appreciate their present politeness. The profession can, and assuredly will, afford their efficient aid in promoting the objects of the Registration Act, as far as they are, or ought to be, concerned ; but they are not to be expected to seek degradation, or voluntarily suffer injustice, upon even so specious a pretext. — I am, sir, Your constant reader, J USTITIA. Camberwell, Oct. 19, 1836. * Vide First Annual Report of Poor-Law Com¬ missioners. 128 BILLS OF MORTALITY. — METEOROLOGICAL JOURNAL DR. UWINS AND DR. J. JOHNSON. To the Editor of the Medical Gazette. Sir, Upon mutual explanations being given, Dr. Uwins has entirely absolved me from the charge of having written the article copied from the Gazette into the Times, and, consequently, has absolved the Editor of the Gazette from the charge of breach of veracity. This absolution (grounded, however, on the charge being owing to a mutual misapprehension), was publicly given in the London Medical Society last Monday night. I have written to the Times; but as some delay may take place in the appearance of my letter, I request you will give these few lines a place in your next number. — I am, sir, Your most obedient servant, James Johnson. Suffolk Place, October 19, 1836. APOTHECARIES’ HALL. LIST OF GENTLEMEN WHO HAVE RECEIVED CERTIFICATES. October 6th, 1836. Samuel Lees, Ashton under Lyne. Frederick Hawthorn, Uttoxeter. Reuben Booth, Aurington, Lancashire. George Kidgell, Wellington, Somersetshire. John Malborough CowelL,Faircloth, St. Stephen’s. Edward Des Forges, Hull. Henry Adnah Bellard, Hull. George Whittingham. Henry Davis, Pendnck, Worcestershire. ' George Frederick Meadows, Woodbridge Suffolk. Jeffery Strudwick Johnson, Peterborough. William White Williams, Dursley, Glostershire. Frederick Broadhurst, Bath. October 8th, 1836. John Thomson, Dalton, Yorkshire. James Harridge Ford, Rayleigh, Essex. Francis Allday, Birmingham. Joshua Paynter, Pembroke, S. Wales. G. Nicholas Dangerfield, Churcham, Glosters’ ire. J. Ludford White, Stoke Golding, Leicestershire. October 13th, 1836. Charles Ray. Thomas Southam Burman, Stratford-on Avon. Allen France, Honley, Yorkshire. James Askey Wood, Uttoxeter, Staffordshire. James Walford Tillett, Colchester. Henry Weeks, Barnstaple, Devon. R. Robinson Alderson, Everingham, Yorkshire. William Kaye Jackson, Denby, Yorkshire. John Thomas Dolman, York. Hugh Birt, Storrington, Sussex. Thomas Booth, Bradford, Yorkshire. Adoniali Vallack, Kingsand, Plymouth. Marc Anthony Bazille Corbin, Guernsey. Samuel Day Fereday, Gornal, Staffordshire. NEW MEDICAL ROOKS. T. B. Curling on Tetanus ; being the Jacksonian Prize Essay for 1834. 8vo.8s. Elements of the Practice of Medicine. By Dr. R. Bright and Dr. Thomas Addi¬ son. Part I. 8vo. 4s. Guy’s Hospital Reports. Vol. I. 8vo. 13 s. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Oct. 18, 1836. Abscess . • 1 Age and Debility . 21 Apoplexy . . 1 Asthma . . 8 Cancer . . 3 Childbirth . . 2 Consumption . 34 Constipation of the Bowels . . 1 Convulsions . 17 Croup . . . J Dentition or Teething 1 Diarrhoea . . 1 Dropsy . . 6 Dropsy on the Brain 6 Epilepsy . . 1 Fever ... 5 Fever, Scarlet . 3 Fever, Typhus . 1 Haemorrhage . 1 Decrease of Burials, as the preceding week Heart, diseased . 1 Hooping Cough . 4 Inflammation .. 12 Bowels & Stomach Lungs and Pleura Insanity . . Liver, diseased , Measles . . Mortification . 1 Paralysis . . 1 Scrofula . . 3 Small-pox . . 1 Sore Throat and Quinsey . . 1 Spasms • . 1 Thrush . . 1 Unknown Causes II Casualties . 5 compared with > , on METEOROLOGICAL JOURNAL. Oct. 1836. Thursday . 13 Friday . . 14 Saturday . 15 Sunday . . 16 Monday . . 17 Tuesday . . 18 Wednesday 19 The rmome ter. from 48 to 60 50 58 48 61 40 59 48 63 52 63 51 59 Barometer. 29- 06 to 29 35 29 62 29 87 29 79 29 86 30 12 30-12 30 09 30-09 30- 07 30-05 30-09 30-29 Prevailing winds, S.W. and W. by N., Generally cloudy, with rain at times. Rain fallen, *25 of an inch. NOTICES. “ R.” 1. No law, right, or charter, would be violated. If the party did not pretend to be a Doctor, he would not come under the jurisdiction of the College of Phy¬ sicians; if he did not dispense medicines, the Society of Apothecaries could not in¬ terfere with him. He would be quasi a Surgeon, and the Royal College of Lin¬ coln’s Inn have not the power to question any one. — 2. The proposed University is not to interfere with the College of Phy¬ sicians, which cannot be superseded unless by a special act of Parliament, — a mea¬ sure which there is no reason to suppose will be attempted, and if attempted, would certainly fail in the upper House. — 3. Not till after the meeting of Parliament. — 4. In the Medical Gazette for Sept. 17, 1836. We must decline the publication of Mr. Marson’s letter. Charing Cross Hospital. — We under¬ stand that this hospital has been struck off the list of those recognised by the College of Surgeons. The P.S. from Camberwell came too late. W i eson & Son , Printers, 57> Skinner-St. London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOURNAL OF iffleti trine anil tlie Collateral ^>riences(. SATURDAY, OCTOBER 29, IS3G. LE CTURE S ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine , By William Cummin, M.D. Lecture V. On Sex , medico-legally considered — Importance of the subject: 1. Normal development — Characteristics of the Male and Female Fi¬ gure — Male and Female Skeleton. 2. Ab¬ normal development— in the Male — in the Female — ivhere the Sexual Characters are mixed. Hermaphrodism — remarkable cases — all resolvable into Androgynous and Gy- nundrous varieties. Concealed Sex — some modern instances. Sex, like Age, is a subject of wide extent and application. It not only forms an element in other medico-legal inquiries, but frequently becomes an independent question. As medical jurists you may be called upon to give evidence as to the sex of an individual — infant or adult— living or dead ; nay, the sex of the foetus may sometimes be a moot point. It may also be necessary sometimes to identify the supposed remains — the mutilated relics, of a person long missing. It may be that only the bones are found. Here the sex requires to be clearly ascer¬ tained : we must be assured that we do not take the bones of a male for those of a fe¬ male, and vice versd. Legal distinctions. — In the case of a new¬ born child, the determination of the sex may be of vital importance, if it be the issue of parents possessed of real or landed property : its right of succession mainly depends on its sex; and should it die, the disposal of that property, which it 46o. — xix. would have enjoyed as a male, must be arranged in accordance with the evidence of the sex. The interests of many ex¬ pectant relatives may be at stake. In reference to tenancy by the courtesy, the right of the father to possess a life interest in the real property belonging to his wife, may depend on the ascertainment of the sex of their new-born infant. For if the wife be tenant in tail male, and de¬ livered of a son born alive, the husband’s right is secured ; whereas, if she have only a daughter, the husband is not entitled to be tenant by the courtesy, because such issue was excluded from succession by the nature of the tenure. This is a fact which ought to be fixed in the memory of every practitioner who happens to be present at the birth of a child belonging to persons of property ; indeed, in every case it would be proper for the accoucheur to note the cir¬ cumstances of the birth, particularly with regard to the sex of the infant. But I shall have occasion to revert to this subject more fully hereafter. Again, at an age more advanced — child¬ hood— the arrangements regarding the education and future prospects of the young person are essentially founded on an understanding of the sex : it would be a serious mistake to give (as has been done) the education of a female to one who should afterwards prove to be a male. Dr. Beck cites a case in which a physician was consulted by the relatives of a young no¬ bleman of doubtful sex, who, if a male, would inherit a considerable estate, but to which he could have no right if he be¬ longed to the other sex. Now, in ordinary cases, it may seem to be a very simple affair to determine the sex — whether the subject be an infant, an adult, or merely a skeleton. But we shall see that difficulties may sometimes arise; and this not only where the sexual charac¬ teristics are abnormal, but even where they are normally developed. K 130 DR. CUMMIN ON FORENSIC MEDICINE. 1. NORMAL DEVELOPMENT. Suppose, in the first place, that the sexual parts and other peculiarities of the male or female are normal. No difficulty, of course, will present itself to us, provided we be allowed the opportunity of personal inspection — more particularly if the sub¬ ject be an adult, or have attained the age of puberty. The ordinary sexual charac¬ ters of individuals at the different periods of life need not detain us. Sex before birth. — But there are one or two cases, even in the normally developed con¬ dition, in which it may not be very possible to speak without deliberation regarding the sex. There is a period, for example, in intra uterine life, when the sex is by no means determinable. The foetus, up to a certain age, possesses no distinctive sexual parts : those that are observed might prove, upon further development, to belong either to the male or female. If we examine the foetus, or embryo, as early as the fifth or sixth week after conception, we shall find that the rudiments of the genital organs have not yet made their appearance ; and that it is not till somewhat later that a little tubercle becomes visible ; which tubercle may prove subsequently to be ei¬ ther a clitoris or a penis : as yet, at all events, there are neither labia nor a scro¬ tum. This condition holds for the first fifty-five days, according to Velpeau. At from eight to ten weeks, the tubercle undergoes further development. Around its base there arises a fold of integument, the rudiment of the future prepuce ; and a little furrow is perceived on its lower part, which soon after forms the urethra. This furrow, which remains unclosed for some time in certain foetuses, extends to within about a line of a little prominence, — the anal tubercle : for as yet the anus is imperforate, and merely presents the ap¬ pearance of a slight elevation. In short, it is probably not till about between the second and third month that any thing can be positively stated relative to the sex of the normally developed foetus. Sex of the new-born child. — It may hap¬ pen that at a much later period — that of birth — doubts may be entertained whether the sex be ascertainable ; for the testes may not yet have passed through the abdominal rings, and the scro¬ tum may be imperfectly formed. The progress of the descent of the testes is curious. From their original situation, a little in front of the kidneys — where also the ovaries are primarily situated — they descend by about the seventh month to¬ wards the inner ring, carrying before them the fold of peritonaeum, which afterwards constitutes the tunica albuginea. In the eighth, they enter the passage, and during the ninth are generally deposited in the scrotum. Upon an examination of ninety- seven infants at birth, Wrisberg found that in sixty-seven both testes had reached the scrotum ; in seventeen, one or both were still in the canal; in eight, one tes¬ tis, and in three, both testes still remained in the abdomen. At later periods. — Let me now call your attention to some other cases of possible difficulty in determining the sex, although there be nothing abnormal about the proper characteristics, so far as they are developed. Suppose we have to examine a skeleton — one that probably belonged to a person not yet adult. In such a case, though we may be possessed of the elements for determin • ing the age, the sex is by no means so well marked as to be readily distinguished. The skeletons of infants and young per¬ sons of either sex, have few or no pecu¬ liarities by which the necessary investi¬ gation may be guided. We must here call to our aid whatever external circum¬ stances may be available for the informa¬ tion which we seek. But when wre have to examine what ap¬ pears to be an adult skeleton, with re¬ ference to sex, there are several characters of wdiich we may avail ourselves. Let us first take a view of the female as distin¬ guished from the male figure. The adult figure in both sexes. — There is, in general, more plumpness in the female form than in the male. The muscles are smaller, and less strongly marked; the integuments are more abun¬ dant, and softer; and the cellular sub¬ stance is more largely provided with a supply of fat. The nails are smooth and semi-transparent, the hair of the head fine and long ; and that on other parts of the body comparatively scanty. The proportions also present some re¬ markable contrasts. Thus the female is usually not so tall as the male ; half her length corresponds to the upper part of the symphysis pubis, wdrile, in the man, the half is situated at the middle of the symphysis. In the female, accord¬ ingly, the lower extremities are compara¬ tively shorter than in the male. The head is generally smaller; the lower jaw and chin less marked and prominent. The teeth, smaller and whiter, sometimes do not exceed the number of twenty-eight. The neck slender, with little or no pro¬ jection of the larynx. The trunk some¬ what longer, enlarged in its upper and anterior part by the prominence of the breasts, and the position of the arms, which are in closer contiguity with the sides than they are in man. The poste¬ rior aspect of the trunk presents a furrow, extending to the sacrum ; w hile the la- NORMAL DEVELOPMENT. 131 tcral parts usually exhibit a depression on either side, from the ribs to the hips, pe¬ culiar to the female, more especially as modified by the civilization of the present day. The chest of the female has a larger antero-posterior diameter than that of man; but a smaller bi-costal or transverse diameter. The hips and upper part of the thighs, comparatively more round and extended ; the knees are more inclined in¬ wards ; the leg is shorter, and the foot more small and delicate. The shoulders are narrower than the hips ; while the re¬ verse holds in well-formed men. The arm and fore arm are more round, but less marked, than in the male; the hand is smaller, and the fingers more tapering. Bones of either sex . — - With regard to the osseous structure, it may be observed that there are some very striking pecu¬ liarities belonging to the bones of the female ; they are less firm, and lighter than those of man. The flat bones are thinner, and the short ones more cel¬ lular or spongy ; the long bones are more smooth and tapering, nor are there perceived on them those rough lines or ridges, which result from the repeated and more powerful action of the muscles in the male. The apophyses, which afford at¬ tachments to the muscles and ligaments, are but feebly marked : the joints are gene¬ rally less large, but more flexible, than in the male. The ligaments and cartilages are more pliant, and continue so for a longer period. And, in short, we every where discover in the general structure traces of a more delicate conformation. Male and female skeleton. — But to come more particularly to the parts of the skele¬ ton : — The cranium of woman is smaller, more oblong, and less depressed on the sides than that of man; the face more oval; the frontal sinuses less developed ; the nasal apertures smaller; the jaws, with the alveolar arches, are shorter and more elliptical; and the chin is not usually prominent. The shape of the chest has been already noticed ; but it may be added, that the sternum is shorter and more convex ; the xyphoid cartilage is thinner and more flexible, and remains unossified for a longer time than in the male. The ribs are also more delicate and uniform; the cartilages which join them to the sternum are longer and more elastic, and their dorsal articulation less compact : thus the female chest is comparatively more largely endowed with the power of expansion and contraction than the male. The pelvis. — Both the shape and size of the pelvis are remarkable. Here are repre¬ sentations of the male and female pelvis, showing the distinctive characters. Fig. G. — Female pelvis. ' The ossa ilia in the female (fig. 6), it will be observed, are more spread out, or verging to the horizon, than in the male. The sacrum is more capacious and concave ; the pubis less elevated, and its ascending branches forming a less acute angle; the ossa isehia wider apart; the subpubic foramina larger, more oblique, and approaching a triangular shape. The various symphyses of the pelvic bones are less compact than in the male, and allow more motion. The following are the dia¬ meters of a well-formed, we may call it a Standard, female pelvis : it may be ob¬ served, by the way, that they are con¬ siderably larger than those of the male : — Fig. 7. — Male pelvis. Of the inlet, the antero posterior diameter measures 4 in. 4 lin. English ; the trans¬ verse, o in. 5 lin. ; and the oblique, 5 in. Of the outlet, the antero-posterior dia¬ meter measures about 5 in. ; and the trans¬ verse, 4 in. 4 lin. The cotyloid cavities of the female pel¬ vis are more distant from each other than those of the male, giving rise to a remarkable difference in the position and appearance of the femurs ; these bones being in woman much more oblique from without inwards than in man. The neck of the thigh-bone is more "transverse, and the trochanters more apart, than in man. The inner condyle, also, is DR. CUMMIN ON FORENSIC MEDICINE. 1 $1 larger, and a little longer, than the exte¬ rior, which gives rather a peculiar aspect to the female knee. The chest, as seen from behind, is nar¬ rower and less convex in the female than in the male ; it is shorter, also, so that there is a greater space between the ribs and the crest of the ilium. In fine, the vertebral column is more flexible, and somewhat longer, compara¬ tively, than in man. The vertebras are less compact ; the spinous processes less prominent; the transverse more turned backward. The body, or anterior portion of the vertebrae appears (to Soemmering) to have more height; but at all events the intervertebral cartilages, especially in the lumbar region, are thicker, softer, and everyway larger, during pregnancy. Illustrative case. — By way of illustration of the remarks just made, [ may refer to a case hereafter to be more fully noticed. A parcel of bones, forming a skeleton, having been disinterred a year or two since in Paris, one of the first questions which the medico¬ legal examiners proceeded to solve was, whether these were the bones of a male or a female? I quote from the Amiales cP Hy¬ giene (tomexi. 137) that part of the official report relating to this subject: — “The bones are small and delicate; those of the extremities not at all curved by muscular motion : the marks of the insertion of the muscles are few and faint. The cranium is small, and oblong from front to rear. The ossa innominata are largely spread out; the eavity of the pelvis not deep; the anterior of the sacrum concave; the subpubic holes triangular ; the cotyloid cavities wide asunder: finally, the upper strait of the pelvis presents exactly the diameters usu¬ ally found in well- shaped females. So that, putting all these characters together, there cannot be a doubt but that this is the skeleton of a woman.” II. ABNORMAL DEVELOPMENT. We have next to consider how the sex may be determined in persons who have an abnormal development of the generative organs. Here we may have consider¬ able difficulties to contend with in our inquiries, especially if the individual be living, as we are thereby in great measure precluded from an internal examination. Sometimes the male organs may be so formed as to simulate at first view those of the female: the female organs, again, may have such a conformation as to mis¬ lead a superficial observer, and induce him to believe them male. But this is not all : there may be an actual mixture of the male and female organs in the same per¬ son, giving rise to the supposition of hermaphrodism. We shall consider these varieties in order. 1. Abnormal development of the male.— Some men have the orifice of the urethra opening, not at the usual place — at the extremity of the glans — but somewhere beneath it, — perhaps as low down as the root of the penis. Such persons are called Hypospadians ('TTroo-Tvadiai, — imperfect be¬ ings, (nradcovesy with the orifice, Wo, beneath)-, and their true sex is apt to be confounded owing to this additional cir¬ cumstance in some of them, the penis being wholly imperforate, resembles an enlarged clitoris ; and in such cases it commonly happens that the orifice of the urethra being beneath, the scrotum is divided, forming two distinct sacs, with a testicle in each, thus presenting the ap¬ pearance of enlarged labia. Suppose, now, in a person of such a conformation, that the testes have not descended or emerged from the abdominal rings (as happens in some men), and let the penis be diminutive, it will be easily understood how striking may be the resemblance to the female organs. When the orifice of the urethra hap¬ pens to be any where above the usual place, either on the glans or on the dorsum, or even the abdomen, the person so formed is termed an Epispadian (E7npearance was much more that of a man than of a woman. He was about 35 years of age, and pretended to have strong sexual propensities— for the male*. 2. Abnormal development of the female. — We have next to consider w hat are the circum¬ stances and external characters of struc¬ ture which may render a female liable to be confounded with the male sex. In the first place, the clitoris may be excessive in its dimensions, when it will resemble an imperforate penis. Fig. 8. — Abnormal Sexual Development in a Female Infant. Here is the representation of an en¬ larged clitoris in a child that lived many weeks. It was not till after death that the mistake was discovered : the in¬ fant having been baptized as a boy. The uterus (C C), by which the prepara¬ tion is partly suspended, serves to show the sex. The clitoris (A) b ars a close re¬ semblance to the penis of a male child of the same age, except that the prepuce does not completely cover the glans. At the extremity of the glans there is a sul- * An account of this person, with, an engrav¬ ing, is given in the Edinburgh Medical and Sur¬ gical Journal for 1835, vol. xliii. 134 DR. CUMMIN ON FORENSIC MEDICINE. cus, but it terminates in a cul-de-sac, and does not form the entrance of the urethra*. In the next place, the general appear¬ ance of the person may be more or less masculine; as in a case observed by Beclard, where the resemblance in struc¬ ture went so far as that the urethra ran for some distance along the lower surface of the clitoris; rather a rare variety. This person, however, (her name was Marie- Madeleine Lefort) had a decided vagina, menstruated, and moreover had the sexual desires of a female. _ In cases where females labour under that distressing malformation, ecstrophia (e| and arrQears of his life, his memory, which had been always very good, failed him : he became altered, and gave up his wax embossing. His death occurred rather suddenly.” I shall pass over most of the details of the anatomical inspection : but some pas¬ sages relating to the genital organs in par¬ ticular, cannot be omitted. “ The mons veneris is slightly arched, and but scantily provided with hair. The length of the penis to the corona glandis is two inches : the glans measures nine lines. The corpora cavernosa are moderately developed, be¬ ing eight lines in perpendicular diameter, and four transverse ; separated, too, by a septum. But there is no corpus spongio¬ sum. The urethra, constituting a sort of semi-canal by folds continued from the labia, at its commencement about the root of the penis, is surrounded by the prostate gland, which body is decidedly firm, though not very thick. The length of the vagina is two inches and eight lines ; its width anteriorly ten lines, and posteriorly * See also Medical Gaz. vol. xviii. p. 217. six. It terminates in a sort of spongy tissue, from four to six lines in length, which is, in fact, the closed orifice of the uterus. This organ, though lying between the bladder and rectum, is rather turned towards the left side; it measures two inches three lines in length, but is very narrow in proportion. The cervix and fundus may be distinguished. The cavity of the uterus very small, scarcely ad¬ mitting a large quill, widening, however, towards the fundus. Both the fallopian tubes open regularly into the womb — the left an inch shorter than the right : their canal very narrow, but perfect. Upon the right side, close to the abdominal end of the fallopian tube, there is a small Hat oval body, about the size of . an almond, and corresponding in structure to a testi¬ cle. On the left side, however, a small body similarly placed, exhibited traces of the texture of an ovary.” The Professor’s opinion, in conclusion, is, that this was an instance of a mixture of the sexes — “ that there was a union of the male and female characteris¬ tics in the development of the indivi¬ dual. The principal male peculiarities in Durrgfe were the withered testicle, the penis, and the prostate gland; while on the other hand, the uterus, the vagina, the fallopian tubes, and the ova¬ rium like body found on the left side, all bespeak the woman.” M. Bouillaud’s case. — About three years ago M. Bouillaud read before the Paris Academy of Medicine a curious account of what he called “ a new and singular va¬ riety of hermaphrodism.” It was the case of an individual who died of cholera in La Pitie, and whose body, on examination after death, exhibited very anomalous ap¬ pearances. Nothing more was known of the person but that he was a widower, 62 years of age, a dram-drinker, a hatter by trade, and Yalmont by name. He had no relations or friends, nor could anything be gathered as to his habits of life, propensi¬ ties, manners, or intellectual capacity : “ as if nature,” says M. Bouillaud, “ were in some sort ashamed to reveal the mystery of so strange an aberration.” The condition of the genital organs will be readily understo* d from the figures here displayed. But first let us describe the ex¬ terior. In the region of the sexual parts there was a penis of moderate size, termi¬ nated by a well- formed glans and prepuce. The opening, however, of the urethra was not exactly at the summit, but a little below the usual situation. The scrotum small, commencing as high up as the prepuce, and divided symmetrically by a raphe ; but no testicles contained within. The mons veneris was rather round and plump. In the pelvis were two ovaries (1 1 and 1 2, fig. 9.), 136 DR. CUMMIN ON FORENSIC MEDICINE. Fig. 9. similar to those of a girl of fifteen or six¬ teen years of age. M. Bouillaud, however, contends that the texture of these bodies was intermediate between that of ovaries and testicles — rather fibrous than vesicu¬ lar. The uterus (10) in its usual place, opening into a vagina (8), about two inches long; this passage contracts (lo) about the neck of the bladder, and runs into the urethra. A regularly-formed prostate gland (2, 2, in fig. 10) is observed about the commencement of the urethra. No ejaculatory ducts could be observed ; and, like the testicles, the vesiculte semi- nales and vasa deferentia are wanting. “ No external female organs.” Other characteristics noted in this re¬ markable person were, that the stature was short, the body plump, the hands and feet small, the pelvis shallow, and wider than is usual in man ; the mammary glands much developed, and the nipple of the common size in healthy females. M. Bouillaud thinks that this individual was a sort of mezzo-termine, or juste milieu , between man and woman, — a real herma¬ phrodite, however incomplete. But I should be strongly disposed to differ from him — the female organs being so very pre¬ dominant throughout, and those attribut¬ able to the male so very open to question. In fact, with the exception of the doubtful testes, and the prostate (which some re¬ cent anatomists do not consider as exclu¬ sively peculiar to the male), all the rest were the parts of a female abnormally de¬ veloped, or of a gynandrous individual. If we only imagine the clitoris large, the urethra carried along it to the glans, and the labia closed by a raphe, we come very near a similar conformation. I have mentioned the case, however, under the head of mixed development, partly through deference to the authority of M. Bouillaud, and partly because the external appearances were so equivocal; for Val- mont, during life, must have greatly puzzled a medical jurist, had he been sub¬ mitted for personal inspection. Dr. Handy's case. — There is not, perhaps, any case on record, more nearly approach¬ ing the state of genuine hertnaphrodism, than that described by Dr. Handy, in the New York Medical Repository. This gentleman saw, at Lisbon, a person twenty- eight years of age, of a masculine and dark aspect, furnished with some beard, but having the larynx, voice, and manners of a woman. The external genital organs of both sexes were present. Those of the male were well proportioned, and apparent¬ ly complete, with the exception of the urethra, which seemed to terminate at about a third of its length. The female organs were well formed, save that the labia seemed smaller than natural. The thighs were not large : nor were the hips broad. This person menstruated regularly, and * Fig. 10 CONCEALED SEX. 137 was twice with child, miscarrying on both occasions — once in the third, and the second time in the fifth month. It would have been well in this case to have ascertained, had there been an opportunity, the condition of the internal genital organs. Externally, nature seems to have gone to the furthest limit which she ever allows herself in varying the structure of the human being; and had we merely been permitted a casual in¬ spection, without a history of the person, particularly with reference to the men¬ strual function and the pregnancies, we might probably have been much at a loss in giving an opinion. Practical rules. — This suggests the impor¬ tance of having some practical rules where¬ by we may be guided in our investigation of such cases. When the person to be examined is mere¬ ly a hypospadian, or has the male organs malformed in the superficial resemblance of those of the female, — also where the individual presents an enlarged clitoris, or other malformation of the female at first sight simulating the male parts, — in such cases there cannot be a great deal of dif¬ ficulty if we only use ordinary care in making our inspection. But when the organs are obviously mixed, much em¬ barrassment may be experienced. The following are the practical precepts given by M. Marc, and recommended by Orfila: — 1. The examination of all the external organs must be performed with exacti¬ tude and caution : every opening is to be sounded, to ascertain its depth and direc¬ tion — taking care to use no force. 2. The whole exterior of the body must be inspected, with a view' to determine the prevailing character, and hence the pro¬ bable sex. This, however, will often re¬ quire time: we cannot immediately be come acquainted with the tastes, habits, and propensities of the individual under examination ; and care must be taken in this respect not to confound the habits which may have originated in the arti¬ ficial position held by the party in society for those that result from organic struc¬ ture or development. 3. Ascertain whether from any opening, especially about the sexual parts, there be any -periodical sexual discharge, — a circum¬ stance of great importance, and which will be of itself almost decisive as to the feminine nature of the person examined. 4. When the individual submitted to our scrutiny is very young — suppose a new-born child with irregular sexual organs — nothing is more likely to mislead than precipitation. We must avoid haste by all means. Perhaps the utmost we can, or ought to do, m the first instance, would be to give a formal notice of the dubious nature of the case, and to take time — years, if necessary, in order to be able to observe the progressive develop¬ ment of the physical and moral charac¬ teristics : this we should deliberately do, rather than hazard any opinion which subsequent facts may stultify. 5. No attention ought to be paid to the declarations of the individual himself, or of persons who have ties of relationship with him : at all events it will be neces¬ sary to weigh well such declarations, in order that we may form a correct judg¬ ment of the possible motives by which they may be dictated. Legal distinction respecting hermaphrodites. — Let it not be supposed for a moment that the subject of hermaphrodites is one of merely physiological interest, or of only a speculative value to the medical jurist. As medical men professing to be ac¬ quainted with the proper objects of Fo¬ rensic medicine, w'e may be called on in the courts, civil or ecclesiastical, to give our opinion regarding the true sex of a reputed hermaphrodite. The law, in fact, recognises the existence of such beings, and it is expressly stated by the highest legal authority (Coke, Little¬ ton), — “ An hermaphrodite, which is also called androgynus, shall be heire, either as male or female, according to that kind of the sexe which doth prevaile. Hermaphro • dita tarn musculo quam feminre cornparatur, se¬ cundum prevales; entiam sexiis incalescentis. And accordingly it ought to be baptized.” Such is the view taken bv lawyers of the subject : but wre see how far from being satisfactory it is; “ according to the sexe that doth prevaile ;” — why this is the very point at issue — it comprehends the whole matter of inquiry, leaving it abundantly open to the discussion of the medical jurist. CONCEALED SEX. I have given several instances, in the course of this lecture, of the sex being mistaken — particularly in the cases of Derrier, Marie-Marguerite, and others. I should leave the subject incomplete were I to omit noticing that there are instances also in which the medical jurist may have to consider the question of concealed sex. But a very few words will suffice for the purpose. There can be no difficulty when the examiner has a fair opportunity of making the requisite inspection. Al¬ most all the extraordinary examples of concealed sex on record, have been cases in which a personal examination has been carefully avoided. The person named Lavinia Edwards, a man of abominable character, who, for some years, used to dress as a female, is said to have deceived 138 DR. GRIFFIN’S MEDICAL PROBLEMS. several who were in the habit of seeing him; nor was the real state of the case as¬ certained till after his death. At the coro¬ ner’s inquest on the body (in January, 1833), some of the most revolting disclo¬ sures took place. Some curious instances of female sailors — young women putting on male attire, going to sea, and remaining for months undiscovered by their messmates, have of late excited a good deal of public atten¬ tion. There have been also some extraor¬ dinary cases of women-husbands. In Jan. 1829, there was an inquest held in one of the Borough hospitals, on a person of the name of James Allen, aged 42, a sawyer, who was killed by accident while at work. This person was a well- formed female, and had been married for twenty-one years. The wife gave evidence at the inquest; she was an industrious hard-working wo¬ man, deplored greatly the loss of her hus¬ band, and protested that she was not aware of his being of the same sex as herself — though she had her suspicions of his virility. The Chevalier d’Eon was another re¬ markable example of concealed sex. He had changed from male to female, and from female to male attire, several times during his life, and maintained a high de¬ gree of respectability in both characters. Bets to a large amount were laid as to his real sex, and even lawsuits were instituted upon the issue. It was not till his death, which happened in 1810, at the age of 82, that the mystery was revealed : it was then ascertained that the Chevalier was really a man, and not distinguished by any her- maphroditical peculiarity. I have lately seen an excellent portrait of him in female attire; he had handsome features, and made a very good subject for the artist. You will find in the Tatler, No. 226, a very amusing account of a Doctor Young, who practised physic about the beginning of the last century, in London. The Doctor was a woman who dressed as a man ; was twice married and had children, himself and his wife being occasionally confined about the same time. The paper is attri¬ buted to Addison, and has all the air of being an authentic narrative. But in all these instances there have been secrecy, and more or less of mystery. The first step of the medical jurist would, of course, be to remove obstructions to the right comprehending of the matter in question; and probably this is all that would be required. Should there be any ambiguity in the case, arising from sexual malformation, or mixture of the essential characters, it would then be necessary to apply the principles already laid down. MEDICAL PROBLEMS. By D. Griffin, M.D. HOW ARE WE TO DISTINGUISH SYMP¬ TOMATIC FROM IDIOPATHIC INTERMITTENT ? [Concluded from p. 108.] It seems evident, that nothing' but a very clear understanding of the real nature of the affection, and that at an earlyT period of the illness, would have saved the patient in the first of these cases. It may perhaps appear that at the time the abscess was first opened, the trephine ought to have been used, and a more free opening given to the matter; but, independent of objections on anatomical grounds, arising from a consideration of the parts among which the suppurating portion of the brain was situated, it must be remembered that the bone had become carious. The matter had worked its way through it, and on opening the abscess had flowed out freely with all the relief that could be expected from any operation. In the third case, if the woman had been largely bled on the first moment of her applying at the dispensary, and other active measures adopted, the suppuration of the parts would perhaps have been prevented. When I saw her on her bed, and ascertained the real nature of the attack a few days after¬ wards, I believe that to a certain extent it had already taken place, and that all remedies were useless. My brother mentioned to me that he visited a boy similarly affected. He found him in a chair, hanging over the fire, with his head resting on his hand ; he had a dull, depressed look ; the iris was slug¬ gish in its movements, and somewhat dilated, and he complained of dreadful headache, which had commenced by pain in the ear a few days before. He was immediately bled and leeched, got saline purgatives with tartarized anti¬ mony, and had his head shaved and blistered. He nevertheless went on from bad to worse, and died in eight or ten days, like the others, comatose and paralytic. With regard to the diagnosis, as it refers to intermittents, more may gene¬ rally be gained by taking notice whe- DR. GRIFFIN’S MEDICAL PROBLEMS. 139 ther the symptoms correspond in every particular with the apparent disease, than by other means. Thus, for in¬ stance, if it is observed that the parox¬ ysms are in any degree irregular, it will lead to suspicion, because the irregular and complicated intermittents are not so numerous as those in which the parox¬ ysms return at regular periods. If there be, besides this, a fixed pain in any part of the head, with restlessness, want of sleep, complete loss of appetite, and constant whiteness of tongue, it be¬ comes still more probable, however per¬ fect the remissions, that the symptoms are dependent on disease within the head ; and if with these circumstances there is observed such a state of coun¬ tenance as we have described, the nature of the case can no longfer admit of question. There were two very remarkable cir¬ cumstances in these cases ; one of them I have partially alluded to, and the other I have until now omitted to notice. The first was the close resemblance the paroxysms which occurred in them bore to those of regular intermittent, and the second, their having been relieved by the bark and sulphate of quinine. With regard to the former of these circum¬ stances, it is necessary to mention, that the paroxysms came on for some time in both of the cases with considerable regularity. There was also a great likeness in the circumstances of the paroxysm ; each fit was not merely an attack of shivering rigor, such as occurs commonly as a symptom of the formation of matter in internal parts, and which goes off after a few minutes; each attack was begun by a long-con¬ tinued and severe rigor, which was fol¬ lowed by a regular hot stage that lasted some time, and ended in profuse perspiration, bringing with it for the time all the relief that would have occurred in regular intermittent ; and this is another circumstance in which the resemblance to these diseases was extremely striking. The intermission was usually as perfect as it would have been in any one of them. The face was pale, the pulse calm, the thirst gone. The patient complained but little, and the only point on which they seemed to differ was that the patients could get but little sleep, and that when once the rigors had completely set in, the appe¬ tite never returned in the intervals. It appears difficult to account for this great resemblance between two affec¬ tions that are in other respects so dis¬ similar, but the difficulty will not per¬ haps continue, if we pay attention to the following circumstances : — When the symptoms of diseases, which are very different in their nature, bear any resemblance to each other, it sometimes happens, from the great dif¬ ference there is in the diseases which produce them, that the symptoms them¬ selves are supposed to be also in their nature dissimilar. We are apt to associ¬ ate them w ith the causes from which we think they arise, and to imagine a dif¬ ference in the former, because there is one in the latter. This association, how¬ ever, is very mischievous in medical practice, and we should ever be watch¬ ful not to be misled by it. In a science surrounded with so much obscurity as that of medicine, it ought to be our constant effort to form habits of analyz¬ ing the process by which w?e have ar¬ rived at the opinions we find ourselves to hold ; to observe whether they are founded in reason or probability, and to be ever on our guard against that not unnatural, but most delusive principle of assimilation, which makes us jump at conclusions almost without our con¬ sciousness, and which, in circumstances like these especially, has a strong ten¬ dency to lead us astray. We ought, in short, always to take care to distinguish the symptoms which are the facts of the case from the causes of them, which are almost always matter of opinion that may be well or ill founded, and re¬ member that the causes being unlike does not necessarily make the symp¬ toms different. The contrary conclusion, if adopted, would tend to puzzle us in the commonest cases, and would make the consideration of all obscure ones exceedingly difficult; but more than all this, it is not borne out by facts. For independent of the proofs of this that might be drawn from a considera¬ tion of other affections, intermittent fever itself is seen in connexion w ith a variety of causes, and though the in¬ fluence of marsh affluvia is perhaps the most frequent one, it often occurs in situations where the existence of this agent cannot even be suspected : they are said to be produced by sympathy and by contagion. “ Two children,” says Mr. John Hunter, had an ague from worms, which was notin the least relieved by the bark, but by destroying 140 DE. GRIFFIN’S MEDICAL PROBLEMS. the worms they were cured.” “ We have in like manner,” he says, “ agues from many diseases of particular parts, more especially from the liver and spleen, and from an induration of the mesenteric glands.” One of the conti¬ nental writers gives an instance of an intermittent produced by repelled herpes, and another of one which was produced by suppressed lochia. But these paroxysms are capable of being produced by other causes also. The application of caustic to strictures in the urethra, it is well known, has frequently brought them on, and in some cases even with the utmost seve¬ rity. I remember Mr. Kirby’s speaking of a case in which he made use of caus¬ tic, in which its application was followed by paroxysms so severe and intractable, that the patient lost his life by it. Mr. Kirby was never an advocate for the use of caustic in such cases afterwards, which, though from motives different from his, seems to have been since al¬ most entirely abandoned. Now since no difference can be shown in any tiling but the cause of these paroxysms, it is perhaps too much to assume that they are of a different na¬ ture in all these distinct cases. Indeed, when we consider the number of agents which are capable of producing them, it is obvious that the immediate cause of these paroxysms lies not in any par¬ ticular organic lesion, but has its origin in some disturbance of the nervous sys¬ tem, and in the nature of the laws which govern it both in health and dis¬ ease. It seems probable, too, that the action of the (so-called) remote causes, consists in producing the peculiar state of that system which is always present with these paroxysms, and the existence of which is indicated by them ; and that the paroxysms themselves have no more connexion with marsh miasmata, than they have with any of the other causes which occasionally give rise to them, or than any one symptom of any disease has with the remote cause which pro¬ duced such disease. This conjecture as to the identity of the state which ex¬ ists in diseases so very different in con¬ nexion with these paroxysms, seems to be confirmed by the fact of their having been benefited by the bark. The reason why the effect of the bark could not be permanent is evident. We frequently see it mentioned in medical writings, that the shivering? from internal suppuration have often been mistaken for those of intermittent fever, and treated accordingly ; but surely it would have been more practi¬ cal, as they are sometimes capable of imitating them so perfectly, to point out to us some means of making the dis¬ tinction. The suppression of the paroxj’sms in our two first cases, by quinine, while the disease which occasioned them went on to a termination uninfluenced by the remedy, shows that the paroxysm was merely a symptom, and not even an essential symptom of the disease ; it is of consequence, then (and this con¬ clusion may be regarded as of general application), in drawing inferences from the subdual of symptoms by any remedy, to consider whether such symptoms are essential or not, whether they are sym¬ pathetic affections which might exist without the local disease, or with a very dissimilar one, or whether they are ne¬ cessary and inevitable attendants on it; which arise, and live and die with it. I remember a case in which a long-con- turned and obstinate pain in the head, after having’ been relieved by solution of arsenic, w;as followed by hemiplegia; another was related to me, in which, after violent hectic with harassing cough was allayed by quinine, an ex¬ tensive tubercular cavity appeared in the lungs after death ; and a third, in which a similar cough, after being per¬ fectly appeased by quinine, henbane, and cicuta, was succeeded by haemop¬ tysis. The great mistake we are apt to make about intermittent fever, is in tbe dis¬ position to regard it as an idiopathic disease, rather than as a symptom ; yet, as the former, we meet with it very sel¬ dom in ague districts, while, as the lat¬ ter, it falls under our notice every day. It is met with in the form of hectic fe¬ ver ; it is met with from irritation in the urethra ; it is met with in spinal irrita¬ tion, in hysteria, and as an attendant upon abscesses in the viscera. It is, in fact , symptomatic oj various diseased conditions, and bears the same relation to idiopathic intermittent that sympto¬ matic inflammatory fever does to the idiopathic continued fever. The former may arise from local inflammation, from disordered bowels, from worms, from nervous irritation, &c. The latter is almost always produced by marsh miasma, or contagion. 141 INDISCRIMINATE EMPLOYMENT OF ERGOT OF RYE. In conclusion, I may remark that the diagnosis of diseased conditions of the system, indicated by paroxysms of in¬ termittent fever, deserves more consi¬ deration than those who have not fallen,, upon such cases as I have related, are likely to bestow upon it. A close study of it, with all its doubts and difficulties, can alone prevent us from confounding- a very treacherous and fatal disease with one that, in these countries at least, is seldom attended with danger. If the experienced practitioner gives himself the habit of regarding parox¬ ysms of intermittent fever as a symp¬ tom sometimes indicating a state immi- nently hazardous to life, at other times by no means so, his first care will al¬ ways be to observe what degree of evi¬ dence there is for the existence of the most dangerous state with which they are so often found connected. In this disposi¬ tion of mind, he will seldom be inclined to overlook any means w hich the case may afford for obtaining an insight into its real nature, or to undervalue any testi¬ mony that may be present for the ex¬ istence of the latter condition *. * It is singular how protracted some of those cases of intermittent fever dependent on internal suppuration are. My brother tells me he was late¬ ly called to see a patient in consultation, who had been attacked with daily paroxysms of ague from a few days after her lying-in, which took place about three weeks before. The only circum¬ stances in which it could be at all said to differ from regular quotidian, was, that the paroxysms sometimes, though rarely, occurred twice in the day. The patient had no apparent complaint with which the affection could be connected, when my brother saw her ; but, from the sunk expression of countenance, the dull expression of eye, and excessive debility, he had little doubt that suppu¬ ration had taken place in some internal organ. There was no soreness of abdomen, no uneasiness in the hepatic region; there was no cough; the lungs sounded well ; and the respiration was clear and natural when examined by the stethoscope. As he could not learn that there had been any symptoms of uterine or other local inflammation, and there appeared to be so much obscurity about the case, he r. commended the continuance of the quinine, wine, and broth, which she had been already taking; believing, on the one hand, that there was a fare possibility of its being a case of idiopathic ague, and that at all events support was requisite ; and, on the other, that if the affection was symptomatic of suppuration in some internal viscus, it would under any treat¬ ment prove fatal. The quinine suppressed the paroxysm once or twice for a day only, when it recurred again, and after lingering for a week or ten days longer, the woman died. On examina¬ tion, about four ounces of matter were found effused in the cellular substance, which had formed a sac round it, close behind the right ova¬ rium, resting on the sacrum; the fallopian tubes at both that and the opposite side were full of pus, and there was about an ounce of it in the fundus of the uterus, which was all through lined with a black, gangrenous-looking slough. Here was a case of ague, undistinguishable from regular quotidian, continuing for a whole month, and yet occasioned by internal suppuration.— Dubl. Jour n. Med. Science . INDISCRIMINATE EMPLOYMENT OF ERGOT OF RYE. To the Editor of the Medical Gazette. Sir, The following- case, shewing the ill effects of ergot of rye, has recently come under my notice. Perhaps it is of suffi¬ cient importance to be made public, as I am informed that the exhibition of the secale cornutum is very frequent with th ose practitioners who contract for pa¬ rochial attendance. In the year 1835, Mrs. - , aged 35 years, was taken in labour with her sixth child. A medical gentleman who attended the poor of the parish was sent for, but finding the c-ase proceeding slowly, blamed them for sending for him so early. The pains were natural and regular. Notwithstanding this, he g’ave her the ergot of rye, which was fol¬ lowed by the most excruciating pains, one of them lasting’ for full two hours. Through the action of the drug, the head was expelled, and remained in that position an hour, or thereabouts. When the body was born, the foetus was dead ; nor did the pains cease on the expulsion of the child; they continued, more or less, for four days. In conse¬ quence of such treatment, Mrs. - made her case known to a respectable inhabitant, who promised to assist her in obtaining my attendance on her then expected confinement. Sept. 25th, 1836, at 4 o’clock, a. m., I was sent for, and found the liquor amnii had escaped, the head presented ; the os uteri was not fully dilated. The pains regular, ex¬ tending-round her; these continued till 7 o’clock. Thinking they might last three or four hours longer, I returned home. At 8 o’clock I was again sum¬ moned; the pains had changed: the head had descended into the first outlet of the pelvis. I waited till half past 10 o’clock, the pains becoming very severe and powerful ; nevertheless, the head remained fixed, or in a state of arrest. The os uteri was now fully dilated, and I determined on delivery with the for¬ ceps, which was accomplished, but not without great compression of the head, and much traction. As in the former instance, so in the latter, the foetus was of an unusually larg’e size, certainly as large, if not larger, than any I had soen, after having’ practised midwifery 142 PUBLIC INSTRUCTION IN FRANCE. nearly 20 years. On inquiring- of the mother whether she had suffered more this time than during- her last labour, she stated that her present suffering's had not been half so severe as when she had taken the powder, or rather infu¬ sion. The mother and child are doing well. The ergot of rye, though known as a therapeutic remedy in France as early as the beginning of the last century, has only of late years been brought into general use in this country. Nearly all the writers on its effects admit of irregu¬ larity as to its action. Dr. Blundell, in his lecture on Lingering Labour, makes the following remark, which is worth attending to. “ The secale cornutum is likely enough to destroy the fetus, if you use it — not in the lingering cases which we are now considering — but when the birth is delayed in consequence of increased resistance, rigidity, narrow¬ ing, or an unfavourable position of the head. In cases like these, if the secale cornutum be exhibited, and have a very lively effect, it may force the child down among the bones of the pelvis, where it may die by compression ; not to mention that under the circumstances stated, there must be no small risk of rupturing the uterus.” — I remain, sir, Yours most respectfully, John Grantham. Crayford, Kent, Oct, 3, 1836. BARON SLOET’S METHOD OF TREATING EPILEPSY. To the Editor of the Medical Gazette. Sir, Baron A. Sloet van Oldruitenborgh, having communicated to me the remedy which he has employed against epilepsy, I wish to publish the prescription in your journal, in order that other indi¬ viduals may have an opportunity of try¬ ing its efficacy ; and more especially in consequence of the Baron himself be¬ ing anxious to give it publicity. I am informed that the Baron’s family ha\^ kept the prescription a secret for more than two centuries; and he states that he has given it during forty years to a great many epileptic persons, and that he has cured the greatest part of them. The particular ingredients are not un¬ known, and consist of Pul v. Corticis Radicis Dictamni Albi (Fraxinella), lb. j.; Pulv. Zedoariae, jiss. From this the patient is to take a pow¬ der of two scruples, more or less, ac¬ cording to the judgment of the physi¬ cian, in aqua florum tiliae. He has in¬ creased the number of the powders to four in the day, but in those cases the zedoary has been reduced to one-half. The Baron has also employed the dictamnus albus in the convulsions of children, with advantage. He recom¬ mends the dictamnus albus from Crete, in preference to that which grows in Italy, because the latter has no strength whatever; and he attributes the neglect of this remedy to persons having pre¬ scribed the pseudo-dictamnus instead of the real dictamnus. The occasional employment of leeches ano, lavements, and aperients, are ad¬ vised. I need not enumerate the dif¬ ferent articles of diet which he prohi¬ bits, as it will be sufficient to state gene¬ rally in a medical journal, that the pa¬ tient should avoid whatever appears to interfere with the process of digestion. I remain, sir, Amur obedient servant, C. J. B. Aldis, M.A. M.B. The Hague, Oct. 14, 1833. [A young officer was sent home from Bombay seven years ago labouring un¬ der epilepsy ; the fits came on at least once in two months, and had endured several years : he consulted several of the most eminent practitioners in Edin¬ burgh and London, without relief. He then went to Holland, and remained about four months under the care of Baron Sloet ; from which time he never had any return of the fits, and has been able to continue his profession in Tndia ever since. A relation of his under nearly similar circumstances, w7ent in consequence to the Hague, and w-as also cured. In both instances the parties were bound by solemn promise not to reveal the nature of the remedy. — Ed. Gaz.] PUBLIC INSTRUCTION IN FRANCE. [The following document was drawn up by an intelligent English ^student in Paris, at the request of one of our most distinguished hospital surgeons here, by whom it has beenj forwarded to the Medical Gazette.] Every kind of instruction in France PUBLIC INSTRUCTION IN FRANCE. 143 is under the immediate superintendance of government. One of the Ministers, named the “ Ministre de l’lnstruction Publique,” takes the charge of all. L' ensemble of these institutions bears the name of University. No person can teach any of the dif¬ ferent sciences or letters without having previously taken his degrees at the University. The University is engaged in teach¬ ing* Les Sciences Naturelles — Les Sci¬ ences Theologiques — Les Sciences Me¬ dicates — Legislation — and Les Belles- Lettres ; — from whence five grand divisions, known under the name of — 1. Faculte des Lettres. 2. Faculte de Droit. 3. Faculte de Theologie. 4. Faculte des Sciences Physiques. 5. Faculte de Medecine. Medical instruction includes three large Facultes, each sharing equal rights in point of law ; but that of Paris is considered by far the best. There is one Faculte at Paris, another at Montpellier, and a third at Stras¬ bourg. Almost every provincial town has a school, called secondary. The secondary schools teach Ana¬ tomy, Surgery, and Medicine, and are only intended to instruct young men who aspire to become what are here termed Offieiers de Sante. Each Faculte is composed of a great number of professors, who teach the dif¬ ferent branches of medicine. All their lectures are public and gra¬ tuitous; notwithstanding, in order to ob¬ tain the degree of M.D., young men are obliged to pay (under the name of “ inscriptions”) fifty francs every three months during four years, amounting to 800 francs, or 32/. Each pupil is compelled to undergo five examinations (during these four years), which are in the order as follow : 1st Examination — Sciences Acces- soires *. 2d ditto — Anatomy and Physiology. 3d ditto — Pathology. 4th ditto — Legal. Medicine and Mid¬ wifery. 5th ditto — All or every thing that concerns Medicine and Surgery, and more particularly Clinical Instruction at the bed-side of the patient. And, lastly, each candidate for the degree of M.D. must compose a th esis, chosen by himself. Each examination costs the candidate 50 francs, and the Thesis 50 francs more — total, 300 francs. Thus the whole amount of expense is 1100 francs, or 44/. The Examiners are all Professors of the Faculte. Each Professor has a fixed salary of 6000 francs, or 240/. per annum ; in addi¬ tion to which they equally divide the perquisites of each examination, which amount to about 240/. more per annum. All theoretical instruction is given in a most magnificent amphitheatre, where 1500 students can be admitted. Any individual may enter, on presenting a card from a physician or surgeon. Practical instruction in surgery and medicine is delivered in the hospitals, where the physicians and surg*eons de¬ vote daily two hours in the wards of the sick, and afterwards retire to the operat¬ ing theatre, to deliver one hour’s lecture on the most interesting cases in the dif¬ ferent wards. For the accessory sciences, chemistry in particular, pupils are admitted into the large laboratories at the Ecole Pra¬ tique, where every advantage is offered for manipulating. Botany is taught in a splendid bota¬ nical garden belonging to the School of Medicine, admittance to which is al¬ ways gratuitous and public. Pathological anatomy is taught from amongst the numerous collections of the Faculte. Practical anatomy is taught in beau¬ tiful, long, airy, and well-lighted rooms, (Clamart), where upwards of 2000 bo¬ dies are distributed annually for dissec¬ tions and operations. Pupils can dissect during six months for 4/. Pupils may perform all the operations on the dead body twice over, and attend a course of lectures on surgery, for 25 francs (1/.), during the whole of the summer months. Independent of this general instruc¬ tion, to which all pupils are admitted, the School of Medicine provides or gives a special instruction to 120 young stu¬ dents, who are called “ etudiants de l’ecole pratique.” These students ob¬ tain this privilege by concours. All pupils are admitted. These students have the advantage of dissecting with much greater facility than other stu¬ dents; their dissections cost nothing. * Including Chemistry and Mathematics. 144 ANALYSES AND NOTICES OF BOOKS. An institution exists in Paris, called “ ^Administration generale des Hopi- taux,” belonging' altogether to the city of Paris ; not under the control of “ la Faculte deMedeeine.” This institution requires a certain number of young men to attend upon the patients of the different hospitals (they are what in England are called “ dressers.”) In return for their services they receive a moderate salary, and partial board and lodging; but are amply supplied with opportunities for distinguishing them¬ selves in their profession. The salary is about 16/. per annum; in some 20/. For the “ dressersbips” of the different hospitals there are young* men of two classes, known under the name of ex- terries, 400 in number, and who are named by concours, 100 per year; their duty is to attend to the patients, dress them, &c. They receive no payment, but have the right “ de concourir pour etre internes .” Les internes , 80 in number, are obliged to follow the surgeons and phy¬ sicians during their visits in the wards ; to assist them in their operations; to in¬ spect the faithful execution of the sur¬ geon or physician’s prescriptions ; and, finally, in the absence of the surgeons, to direct whatever treatment they think most proper. If required, they may perform any operation in the absence of the surg*eon : thus performing* the duties of an assistant-surgeon in our English hospitals. Independent of the instruction that the internes and externes possess, with reference to the treatment of diseases, “ 1’ Ad ministration generale des Hopi- taux,” about four years ago, directed the construction of a most magnificent establishment (entirely and purposely for them), where anatomical instruction is afforded them decidedly with profu¬ sion. This establishment is called the Anatomical School of CJamart, where upwards of 2000 bodies are annually provided for them. I have obtained information from the first authority on this subject in Paris, namely, the “ Prosecteur” of all the Pa¬ risian hospitals, that no less than 5000 bodies are provided annually for dissec¬ tion in the two anatomical schools of Clamart and the Ecole Pratique. Organization of the Parisian Hos¬ pitals. The hospitals belong to the city of Paris. The inhabitants provide yearly a fund of 11,000,000 francs for their support. There are upwards of twenty esta¬ blishments appointed to receive sick persons, including hospitals for infirm, old, and mad persons. Each establish¬ ment is governed by a “ Directeur,” who receives a salary of from 3000 to 5000 francs per annum. The “ Directeur” of each hospital is obliged to g’ive an account of his con¬ duct to an “ Administrateur generale,” who receives a salary of 12,000 francs a yea”. This “ Administrateur,” on the other hand, furnishes every necessary informa¬ tion of what passes in the different hos¬ pitals, expenses, &c. &o. to a “ Con- seil generale, formed of negotiants and respectable inhabitants of Paris. This general Council is compelled to enregister its decisions by the Municipal Council; and, finally, the Minister of the Interior inspects these decisions. The surgeons of the hospitals are no¬ minated by concours. Every surg’eon is admitted who has taken his degrees, whether at home or abroad. The jury is composed of eight hospi¬ tal surgeons ; and the “ Administra¬ teur” presides also on the occasion. The nomination of the successful can¬ didate is confirmed by the “ Minister de l’instruction publique,” and the Council. The professors of the Faculty are also elected by concours. The jury is composed of two-thirds of the professors of the Faculty, and of one-third members of the “ Academie de Medecine.” ANALYSE Sand NOTICES of BOOKS. “ L’ Auteur se tue a allonger ce que le lecteur se tue a abreger.” — D’Alkmbert. A Treatise on Tetanus ; being the Essay for which the Jacksonian Prize for the Year 1834 was awarded by the Royal College of Surgeons, London. By Thomas Bltzard Curling, As¬ sistant-Surgeon to the London Hos¬ pital, and Lecturer on Morbid Ana¬ tomy. 1836. To this Essay, as appears by the title, the Jacksonian Prize was awarded ; and MR. CURLING ON TETANUS. 145 from the research and discrimination which it displays, we have no doubt that the decision was a just one. On such a subject much of absolute novelty cannot reasonably be expected ; and we look principally for proofs of the author laving- made himself master of all that las been recorded on the subject, and laving- drawn judicious inferences from he data thus collected. It is in this point )f view that we think Mr. Curling’s ?ssay deserving- of especial commend a- i°n : it displays great industry, and the ndustry of an intelligent mind ; so that f the reader do not rise from its perusal lith all the knowledge of tetanus rvhich he could wish, at least he may be issured that he has had placed before lim all that our imperfect art has yet nade out regarding this obscure and n tractable disease. There do not appear to he any grounds >n which a correct estimate can be bunded as to the frequency of tetanus, is compared with other diseases, or of he proportion of cases in which it oc¬ curs after wounds — nor even of its iverage rate of mortality. It seems, lowever, to be well ascertained that it upervenes more frequently after wounds eceived in battle than in the injuries >f civil life ■ — probably from the sub- ects of the latter being less ex- >osed subsequently. In a table given >y Mr. Curling, and which contains he history of 128 cases, it is remark-, ible that in sixteen only did the disease [ccur in females ; and that in these only bur died, — being a mortality of but ►ne-fourth ; while of the remainder, .mounting to 112 males, sixty-six terished, being more than one-half. Che great majority died before the ightb day. One case is mentioned, on he authority of Wepfer, in which teta- ius proved fatal in three minutes ; and ne by Professor Robinson, in which be patient was dead in a quarter of an our. On the other hand, a case is elated by Morgagni, in which death id not take place till more than aree weeks from the onset of the btanic symptoms. As to the interval between the receipt of the injury and ae attack of tetanus, it is generally not bss than one, nor more than two w eeks ; bough instances are recorded in which aree, four, and even more weeks have itervened. 1 The chapter on the Pathology of Te- fnus is elaborate and interesting, i 465, — xix. Many eminent continental writers, in¬ cluding Larrey, Recamier, Frank, and Brera, have maintained that inflamma¬ tion of the brain or spinal cord is the cause of the disease. Now this doc¬ trine is combated at considerable length, and, in our opinion, very satis¬ factorily, by Mr. Curling ; wdro, with¬ out denying that inflammation is some¬ times coincident with tetanus, yet holds and proves that this disease is frequently present where nothing whatever of in¬ flammatory character is observed dur- inglife, or of the consequences of that action are to be detected after death. He also points out the distinction which it is essential w-e should make between pure tetanus and the spasmodic affec¬ tions which accompany certain inflam¬ mations of the nervous centres — espe¬ cially of the spinal marrow. In the advanced stage the distinction becomes easy, because paralysis usually takes the place of spasm, which is never the case in true tetanus. The general result of our author’s investigations leads him to infer that tetanus is a purely functional disease, the nature of which is hitherto undis¬ covered ; that it is distinct from in¬ flammation, and accompanied by no organic changes peculiar to itself; that the seat of the morbid action is the tractns motorius , the superior part being most frequently affected ; that this teta¬ nic irritation directly interferes with no organ except the muscular system, the other parts which suffer being impli¬ cated only in a secondary manner. The treatment occupies many pages, but records little more than the results of unsuccessful experiment. Several well- authenticated cases are referred to, m which the patients recovered, although no lemedies of any kind w7ere adopted. In those where the patients recovered under particular methods of treatment, it is far from being always clear that the recovery was a cure. As to local interference, the general evidence is against the removal of the injured part, even where this is practi¬ cable. Larrey is the chief authority in its favour, but the English army sur¬ geons, by whom it was fairly tried, did not find it answer. Sir James M^Grigor, I)r. Ilennen, and Mr. Guthrie, relate’ numerous instances in which it was adopted without the least advantage. The only modification of this treat¬ ment, which Mi-. Curling regards as L 146 ROW AT APOTHECARIES’ HAIL. deserving of farther trial, is the division of the nerves, where this can feasibly be done. As to the general treatment, purga¬ tives are recommended, so as thoroughly to clear the primes vice : a whole list of narcotics is disposed of in a sentence; and the accounts of mercury stated to be “ far from favourable — in all which we cordially agree with the author. In estimating the effects of blood¬ letting, it is of course important to attend to the distinction above men¬ tioned, so that inflammation producing spasm may not be confounded with pure tetanus. In the former, venesec¬ tion may be required, as in any other inflammations; but it appears from the table, that of twenty-six cases of tetanus in which bleeding was employed with other remedies, thirteen died, — giving us the usual average, and therefore affording no very encouraging pros,- pect : at the same time we think Mr. Curling expresses himself too strongly when he says, “ in the human sub¬ ject I hold it to be dangerous in the highest degree.” We believe, from what we have seen, that in some cases of pure tetanus, bleeding, if practised with dis¬ cretion, is beneficial. Probably more cases of tetanus have been treated by opium than any other remedy, and perhaps the greatest num¬ ber of recoveries on record are where this medicine had been exhibited ; but the circumstance above mentioned will prevent us from attributing' too much importance to its influence. The quan¬ tity sometimes given will admit of no other explanation than that it remains inactive and unacted upon in the sto¬ mach. Thus Mr. Pereira, in his valua¬ ble lectures on Materia Medica, pub¬ lished in this journal, mentions an instance in which the immense quan¬ tity of four pounds, seven ounces, and six drachms of laudanum, together with six ounces, four drachms, and forty-five grains of solid opium, were administered within ten days! Of all the remedies, however, em¬ ployed against tetanus, tobacco is that which appears to us most deserving of further trial ; and we are pleased to find our opinion corroborated by that of our author. It is very true that on turning to the table we find that out of nineteen patients to whom it was ad¬ ministered, only nine recovered ; but the fact is, that in several, if not all the fatal cases, there were obvious circum¬ stances to render the cause of failure apparent. Thus in one it was not adopted till the patient was in articulo ; in two others it was barely tried, not being’ persevered in ; in another there was organic disease of the brain ; in one the remedy was carried too far, and tlm patient’s death evidently hastened, if not actually caused, by its overwhelm-, ing effects. It is an agent of prodi¬ gious power, and must not be lightly meddled with ; it ought, therefore, to be administered under the immediate super¬ intendence of the medical practitioner. Cold affusion is another powerful means of making' an impression on the nervous system, and one which has repeatedly been eminently serviceable in tetanus ; but, like tobacco, it requires discrimination, as patients have some¬ times been killed by it. Thus Mr. Morgan relates an instance in which he directed a man with tetanus to be plunged into a cold bath ; the symp¬ toms disappeared on the instant, but he was taken out dead. This, however, was an extreme case, and is not to be taken as an illustration of what gene¬ rally occurs. The best examples of success from the cold affusion are some in which wane was simultaneously ad¬ ministered rather freely. Dr. Currie’s cases, in which four or five bottles of Madeira were drunk every day by the tetanic patient, are too well known to require notice. A case is given, which occurred in the London Hospital, in August, 1835, under the care of Mr, Scott, in which porter and ale w^ere freely given, the latter to the extent of eight pints in the day ; no intoxication was produced, and the patient re¬ covered. From the specimen of Mr. Curling which this volume affords, we can sincerely say w7e shall be glad to meet with him again. MEDICAL GAZETTE. Saturday , October 29, 1836. «* Licet omnibus, licet etiara mihi, dignitatem Artis Medicos tueri ; potestas modo veniendi in publicum sit, dicendi periculum non recuso.” Cicero. ROW AT APOTHECARIES’ HALL* Such is the title of a notice in the Times of Saturday; from which, and other sources of a private nature, *ve ROW nT APOTHECARIES’ HAI L. 147 learn that an affray took place on the 21st, being- the last day appointed for the registration of pupils. It has always been our effort to take as impartial a view as possible of the unfortunate differences which so fre¬ quently occur between the Worshipful Society and the medical students. We have never been led, like our contem¬ porary, to hold that because the pupils were more numerous, and could pur¬ chase more copies of our journal, they must therefore be right in every thing they did ; neither on the other have we been so wedded to the powers that be, as to think them infallible in all their proceedings. Between the contending parties (for such there is too much appearance of their being), we have endeavoured to hold the balance with a faithful hand — and so shall we now. We do not think the young gentle¬ men who presented themselves to resds- ter their tickets were justified in any violent or riotous behaviour; but still less do we think the authorities at the Hall were warranted in adopting the jourse which is described in the Times. ft is quite well known that the pupils — >°me from ignorance of its necessity, ;ome from procrastination, and some rom not having had the money sooner —postpone both taking out their tickets md having them registered till the last noment. This may be indiscreet, but uch is the fact, and experience had hown the authorities at Blackfriars hat it was so. how we are given to nderstand, that this season, instead f any additional facility being- afford- d, the hours of registration were ac- ually curtailed. But however this may F> it; was quite apparent, before the 21st, lat a large number of the pupils in Lon- on had not registered ; and conse- acntly, in our opinion, it would have ion no more than proper to have made fine arrangement to meet and obviate je inconvenience which must necessa*- rily arise. Nothing of thiskind, however, appears to have been thought of; and accordingly, when the last day came, there was a rush of pupils to the Hall. The crowd was great, and the time short; many, therefore, began to fear that they would be excluded altogether, and hence we have no doubt that they became impatient. What was the con¬ sequence ? Why, that beadles and con¬ stables, armed with sticks and staves, were called upon to restrain them; which they did by beating about their heads, and, if the report be true, felling several of them to the ground. We take our information on this point from the Times. “The constables (we are told) were obliged to hammer their pericraniurns with their staves,” so that “a few of the young gentlemen had their polls brought into resounding collision with the pavement, and were much sober¬ ed thereby.” Now, from the manner in which the Society of Apothecaries and their regulations have at different times been spoken of in that which is very justly called “ the leading journal,” we feel convinced that there is no hostile feeling toward them in that quarter, and consequently that there was no inten¬ tion of bringing discredit upon them by this report. We trust, indeed, it would be doing injustice to any member of the court to suppose that the flippant paragraph to which we now allude emanated from one of them ; but we are by no means so well satisfied that some or the subordinates did not re¬ solve to take time by the forelock, and transmit to the newspapers such an account or this aflair, with those whom they designate “ hot-headed Escula- pian tyros,” as might have the ap¬ pearance of the whole blame having rested with them, and that in fact they did require to have “ their polls brought into collsion with the pavement,” before they could be sufficiently “ sobered.” I he only instance in which any thing 148 A REVEREND H0M(E0P4THIST. of a similar kind has ever occurred within our own recollection — we mean in which constables have been employed against any member of the profession in any of our public establishments — was when Leadbitter was called upon to thrust Mr. Wakley forth from the Col¬ lege of Surgeons : but here there was no “ hammering of the pericranium,” nor any “ collision with the pavement,” but the “hammering” was of quite another part, as it came into “ collision” with each successive bench during his reluc¬ tant and somewhat undignified descent; — the honourable M. P. being merely dragged out by the heels in rather an unparliamentary fashion, and deposited with “ g’entle violence,” in the street. Altogether, the present is a different affair, and we think some explanation is requisite. If true, it will be but an un¬ satisfactory piece of news for parents in the country, to read that some of their sons were beaten on the head by consta¬ bles, when they went to register at the Hall. Again, if the account be exagge¬ rated, it was the duty of the authorities whose conduct was thus impeached to see that a contradiction or explanation wras immediately made public. As it was, we perceive the registra¬ tion could not be completed, and that the time was extended in consequence to the 26th. We trust that effectual means will be taken by the worshipful Court to prevent any risk of a like scene being again repeated. A REVEREND HOMCEOPATHIST. The bomoeopatbists continue to demon¬ strate their indifference to our criti¬ cisms — by almost daily letters in the newspapers. We have had four from Dr. Uwins; and, on his epistolography being exhausted, the pen has been taken up by the Rev. Thomas Everest, Rector of Wick war. We regard these two antagonists with very different feel¬ ings. Dr. Uwins is merely weak — * Mr. Everest is ignorant, vituperative, and vain ; pronouncing an opinion ex cathedra on the science of medicine, of which he evidently knows nothing, and most irreverently, if not profanely, dishonouring the Scriptures, by wrest¬ ing them, on all occasions, to the pur¬ poses of angry controversy on matters wholly unconnected with the duties of his sacred calling. He formerly com¬ pared Hahnemann to our Saviour, and now likens himself and his inane efforts to propagate homoeopathy to the mighty works of St. Paul, in support of Christi¬ anity ! With an audacious disregard of truth, he represents the medical man who opposes the doctrines of the Ger¬ manic visionary as a “ merchant of mi¬ series,” whose only motive is the fear lest he should get fewer “ of those ras¬ cal counters, with which agony fees his unwholesome palm,”! — and then, in a paroxysm of most unchristian zeal, exclaims — “ cleave the leprosy of Ge- hazi to him for ever ! !” We reprint his communication to the Times, and shall subjoin the passage in the Gazette which -has called it forth, because even now that his letter of reclamation lies before us, we find it impossible to give any character of it more appropriate than that which was published by anticipation. “ When wTe inquire for their literature, we find their champion in the person of a worthy son of the church, whose talent for invective and the misapplication of texts of Scripture, forms his chief claim to public attention. We have had a specimen of him, and we can truly say we congratulate Hahnenannism on the possession of such a mild, meek, dis¬ creet, and sagacious partiasn.” To the Editor of the Times. Sir, In a late number of your journal you inserted an article from the Medical Gazette which contains a charge against me. It is with great reluctance that I reply to it ; but now that I have CHARING “CROSS HOSPITAL. 149 seen Dr. Uwins’s letter, I think it right to make a few observations on the sub¬ ject, convinced as T am that your gen¬ tlemanly feeling- and sense of justice will not refuse to let him who has been attacked be heard in reply. Touching the death of poor Malibran, as it is not my province, so it is not my intention to say anything. Any impar¬ tial person must come to the inevitable conclusion, that death under homoeopa¬ thic treatment is very rare, judging from the delight with which the medi¬ cal men have seized this opportunity to threaten Dr. Belluomini with the tread¬ mill. As to myself, in the first place I beg’ to tender my thanks to the Editor of the Medical Gazette, for having excul¬ pated Dr. Johnson from the charge of having’ written the article in question. Conceived as it is in the worst taste, it is quite refreshing to learn that Dr. Johnson is himself mistaken in assert¬ ing that he did write it. In the next place, I would beg to as¬ sure that respectable editor, that his arguments against homoeopathy are as devoid of novelty as they are of reason¬ ing. There was one Demetrius, in olden times, who anticipated him. He collected the craftsmen, and to all Paul’s arguments they gave no other answer than shouting together at the top of their voices, “ Great is Diana of the Ephesians:” and when Paul argued, they put him in the stocks ; when he entreated to be heard, they stopped his mouth by shutting him up in prison — a wonderful plan, doubtless, for deciding disputed questions; but it is singular that our worthy editor did not recollect that it was not successful. I pity the editor of the Gazette much for the loss of his temper — more for the loss of his practice; but I see no necessity for his being vulgar. That the present absurd practice of physic is coming to an end, there is no doubt. Why cannot this editor adjust his robe i round him, and fall gracefully, instead of spluttering like a cudgelled cockney? He calls me (among others) a brazen impostor. I have no objection what- i ever to his using that or any other simi- ! lar arguments against homoeopathy, for I am conscious of its injustice. “ Suf- ’ fering is the badge of all my tribe.” I ! pray to God that he will enable me to : pass my very humble life in humble efforts to do «ood to my species, even though “ the Edomites and the Israelites, the Moabites and^Hagarens, Gebal and Ammon and Amalek, cast their heads together” to abuse me for it. I remain, sir, Your very obedient servant, Thomas R. Everest. Wick war Rectory, Oct. 17, 1836. By the way, the term “brazen impos¬ tor” was not applied to the reverend gen¬ tleman, whom, till now, we have looked upon but as a wrong-headed fanatic ; as, however, he takes the designation to himself as peculiarly his own, we beg to stand corrected, freely admitting that he must know his claim to it better than we can be supposed to do. CHARING-CROSS HOSPITAL. We continue to receive statements and counterstatements about the recent pro¬ ceeding's at the Charing-Cross Hospi¬ tal ; but we cannot devote our pages to a discussion involving so much of indi- vidual misconduct, and so little of gene¬ ral interest. We may, however, ob¬ serve, that the Committee have pub¬ lished what appears to us a complete refutation of certain charges brought against them by the medical officers whom they dismissed. But this same document passes en¬ tirely sub-silentio that which impar¬ tial persons will consider as by far the gravest offence. It is this: — Re¬ port says, that in order to procure the recognition of the hospital by the Col¬ lege of Surgeons, the requisite number of individuals — namely, one hundred— were actually got into the house, and were seen by the deputation from Liu- coln’s-Inn fairly laid out and comforta¬ bly tucked up under the bed-clothes. But here the compliance with the conditions of the College seems to have ended: the number of patients straightway pro¬ gressively diminishing, it is said, even down to sixty ! Now this is either true 130 MEETING OF GENERAL PRACTITIONERS. or false. If false, why has such an alle¬ gation been passed over, to refute others of comparatively li' tie importance ? If it be true, the deception practised in¬ volves the good faith of all the officers of the establishment; and the only pru¬ dent course is to avoid all discussion, so as to take the chance that in time it may he forgotten. Meanwhile, we know that the hospi¬ tal was in the list of the recognized, and is there no longer. MEETING OF GENERAL PRAC¬ TITIONERS. A large body of gentlemen belonging to the Association of General Practi¬ tioners dined together on Thursday last, at the Bridge House Tavern. The card of invitation which they had the polite¬ ness to send us, owing to some mistake, did not reach us until too late to make any arrangement for being present. Under these circumstances we copy the following- report from the Times of yesterday - ‘‘ The dinner of the Association of the Medical General Practitioners took place yesterday at the Bridge House Tavern, on the Southwark side of London Bridge. The members, friends, and visitors of the Association, mustered to the number of 100 persons ; and at six o’clock the dinner was served ups Mr. G. Webster was the chairman on the occasion. The Non nobis was sung, on the removal of the cloth, by Messrs. Broadhurst, Fitzwilliam, and other professional singers. After which, the chairman proposed the health of the King, the Queen, the Princess Victoria, and the rest of the Royal family, all which were drunk with the greatest loyalty and enthu- siani. The healths of the army and navy were then drunk, and the usual national songs sung on Such occasions were given. On the toast of “ success to the Associa¬ tion” which the company were assembled to commemorate, being proposed, the Chairman took occasion to advert to the state of the medical profession generally, and particularly to the situation of that portion of it which consisted of general practitioners. Certain persons had been pleased to call the general practitioners the subordinates of the medical profession. It was true the general practitioner did not ride about the town in an elegant cha¬ riot, and pocket the guineas of his patients, nevertheless his labours were most useful, and it was necessary he should be a man of education and character. He (the Chair¬ man) was glad to see assembled around him on the present occasion so many gentlemen of respectability in the profes¬ sion. It augured well for the future bene¬ fit of the society, and it proved that that branch of the profession to which they belonged, and of which he also was a humble member, were at length resolved to exert themselves for the preservation of their rights. The medical profession of England was at the present moment in an anomalous situation. It was not only assailed without by the Eadies, the St. John Longs, and the Morisons, but it was in a degree distracted by the practices of those by whom it ought to be supported. In addition to the quackeries of other arts, homoeopathy had been added to the list — a system of mysticism imported from Ger¬ many — a system founded on mystery. Mr. Webster then expatiated on the abuses arising from the manner in which the services of general practitioners were at present remunerated, and exhorted the company to use their exertions to bring about a better state of things. He hoped this meeting would form a nucleus, around which a much larger association would grow. The roots were already planted in the metropolis, and it would not be long before the whole country would be shadow¬ ed with the branches. The health of ‘ Hr. James Johnson, and success to the medical press,’ was then drunk with great applause. Hr. J. Johnson returned thanks. A great number of toasts more imme¬ diately connected with the medical pro¬ fession were then drunk. An excellent song, written expressly for the occasion by Mr. Hudson, on the delusions of Homoeo¬ pathy, wras sung, and received con amove by all present, and the festivity of the evening w-as kept up till a late hour.” HR. CHAMBERS. The Queen has been pleased to appoint Dr. W. F. Chambers to be one of’ her Majesty’s Physicians in Ordinary. — London Gazette. JARBIN HES PLANTES. The g-arden so called in Paris has been progressively increasing- during the last forty years, and has now reached the extent of 84 acres. It contains 526,000 specimens of the three king¬ doms of nature, among which are 10,000 different species of plants* 151 dr. Seymour’s clinical lecture. CLINICAL LECTURE, Delivered at St. George’s Hospital, Oct. 21, 1836, By Dr. Seymour. Rheumatism — Paralysis from Lead — Fungus Hcematodes of the Stomach — Epilepsy — P ara- plegia. RHEUMATISM. The two cases of rheumatism of which I spoke in my last lecture, have proceeded quite satisfactorily, and the patients are nearly convalescent. The woman (Young) is, in point of fact, quite well; there is no symptom whatever remaining of the rheu¬ matism. This has taken place in one week, so that no practice could be more efficient than the one which was adopted. The other case, which occurred in a wo¬ man named Jean Vaughan, and who was a great deal worse than Young, is likewise nearly convalescent : nothing remains but some slight pain about the shoulder and hips; the swelling and redness have entirely disappeared, and her hands, which were so much swollen as to prevent her using them without great dis¬ tress, are likewise quite well. The only alteration in the mode of treatment was, that I was obliged to give her one or two doses of aperient medicine. I found that the guaiacum mixture did not act suffi¬ ciently on the bowels; it was omitted for a day or two ; her bowels were then opened freely, after which we resumed the use of the mixture, and the issue has been such as I have stated. PARALYSIS FROM LEAD. The cases of poisoning from lead are essentially chronic in their nature, but those of which 1 spoke in my last lecture are better. Claney, who is suffering under disease of six years’ standing, has less pain, and is taking nourishment. There is still necessity for continuing the daily exhibi¬ tion of castor oil, to relieve the spasm of the muscles of the abdomen, under which he labours. The other is a case which will require weeks instead of days, before we can expect to see any decided altera¬ tion. However, the last report is, that the muscles of the abdomen have become relaxed ; the appetite is improved, but the castor oil acts imperfectly ; he was obliged to take several doses before we got any evacuation at all. FUNGUS HjEMATODES OF THE STOMACH. I now come to speak of a very important case, at present in the hospital — that of J. Wilson. Almost the first day of the ses¬ sion you saw in the dead-house the post¬ mortem examination of a man named Hewitt, who laboured under fungoid dis¬ ease of the stomach. A great many of you had an opportunity of seeing this man. He laboured under sickness, with occasional vomiting; great pain in the re¬ gion of the stomach for a year and a half previously ; and he came into the hospital in the last stage of the disease. When the body was opened, the whole of the pylorus was surrounded with fungus haematodes, deposited between the coats, so that the passage became compressed, and the pas¬ sage of the ingesta was obstructed. The food was tolerably well digested, but it was accompanied with pain. The present patient complains of pain in the abdomen, at a spot midway between the umbilicus and the ribs, on the left side. This is rather a remarkable position for the pyloric orifice of the stomach, but it is the less remarkable, because it not unfrequently occurs that this is the part referred to by the patient in such diseases. On making pressure externally, there is pain over an extent about the size of a small apple. This arises from the tumor growing externally, and pressing on the peritoneum and the parts adjacent. In¬ ternally on taking food, there is no pain and no vomiting. When you read in books of persons labouring under cancer of the stomach, the symptoms desrribed are these: — As soon as the patient swallows food a burning sensation is felt, and soon after the food is returned, at first unalter¬ ed, but subsequently mixed with a bitter or sour fluid. After a time every thing taken is vomited, and then the patient brings up matter not only a little changed, but a quantity of matter resembling coffee- grounds. In this way the disease goes on, until death ensues. These are the symp¬ toms named in books as the most import¬ ant symptoms of cancer of the pylorus, but there is another disease which goes under that name, which is of a very different character, viz. the fungoid disease, of which I am now about to speak. Some¬ times the internal membrane is not affect¬ ed, but between the coats is deposited an enormous quantity of the same sort of matter which is found in the brain, the lungs, the liver, and the kidneys, and is termed fungus hsemotades, or encepha- loid disease. The present case is a very well marked instance of the affection. Sometimes this fungoid matter exists in a very considerable quantity, and some¬ times, as in the case before us, it is bare¬ ly appreciable by the external touch. Some years ago I saw a gentleman who had been for years past losing flesh: though he had a very fair appetite, still his food did not seem to nourish him, but his general aspect indicated that he labour¬ ed under a malignant disease. Not being 152 DR. SEYMOUR’S CLINICAL LECTURE. able to detect any particular appearances, I requested him to lie in bed, that I might have an opportunity of examining his body. Midway between the umbilicus and the ribs of the left side was an enor¬ mous tumor, so large that I found he could scarcely have buttoned his breeches without perceiving it, and yet he had no vomiting, no pain in the part; his ap¬ petite was tolerably good, and never at any period during his illness did he reject his food. Here is a case, [presenting a specimen] where one half of the stomach is occupied by a fungoid growth, leaving the pylorus tolerably free. The speci¬ men having been in spirits for a long time, has shrunk. Although the fungoid mass occupied so large a portion of the stomach, yet the patient went on to the last hour much as ordinary persons do, in respect to food. How does it happen that in certain cases termed cancer there is pain and vo¬ miting, while in other cases these symp¬ toms are absent? In the great majority of instances there is a difference in the disease. In cancer of the stomach there is thickening and ulceration of the coats of that organ, whereas fungus hsematodes is a new structure. In the latter case the tumor is very compressible, so that when food is taken into the stomach, it is pushed through the pylorus, the passage itself be¬ ing left tolerably free. That is the case in the specimen on the table— the pylo¬ rus is not contracted. Here are some drawings by Cruveilhier, [exhibiting them] very beautifully executed, of true cancer. In such cases the patients become extraor¬ dinarily thin, and there is always pain and vomiting. Sometimes patients become so excessively thin, that you can feel the hardened portion through the abdominal parietes, but that is not commonly the case. Here is a case [referring to a drawing] where the lower half of the pylo¬ rus is scirrhous: it is like a case which I saw of Dr. Chambers’s, in which the whole stomach was in this state. Here is a drawing of a case resembling as nearly as possible that of the patient up stairs : there is a fungoid growth, which may not be appreciable externally, but it surrounds the pylorus, and is deposited in the coats. Another remarkable coincidence oc¬ curs : although there is no vomiting, there is another symptom — pyrosis, or water- brash. Where the growth is large, as in the specimen before you, the membrane secretes this water, and it is a symptom of the disease. In the present case there is no vomiting when food is taken into the stomach, nor is there any pain ; but on pressing externally, pain is experienced, because pressure is made on the fungoid growth, and the peritoneum in the same part intervenes ; and there is also present this symptom of water- brash. I should beg you to observe, that although the water-brash may exist without organic disease, yet its presence is always suspi¬ cious, and it becomes essentially necessary to examine into the condition of the liver and the stomach. The water-brash con¬ sists in the bringing up, every now and then, of a small quantity of clear water. In a private case which I had under my care for two years, the only inconvenience which the patient suffered, was, that his mouth filled with cold water, so that he was obliged to leave the room and eva¬ cuate it several times in the day : the water was tasteless. In the present case, the pa¬ tient represents the fluid as sometimes salt and sometimes bitter, and it comes up in small quantities. In many cases of this description this is a morbid symptom; but I do not mean to say that the moment you see it you are to conclude that the patient labours under cancer. I remember seeing the case of a patient, in Middlesex Hospital, who spat up a quart of water in a day, which had some acidity. When she died, it was found to arise from an enormous liver, in which thei’e were tuber¬ cles of this fungoid disease. It is a symp¬ tom of disease of the stomach, or viscera; and where a person’s looks indicate the existence of organic disease, it is to be looked upon with suspicion. It occurs in Scotland as a functional disease of the stomach, and is supposed to arise from eat¬ ing vegetable food. How far that is true I cannot say ; but in the present instance we look upon it as a symptom of deep- seated organic disease. The practice in this case has been to place the patient on nourishing diet ; and I will explain why I ordered the following medicine : — twenty drops of liq. potassae; half a scruple of canella alba, and ten drachms of infus. cascarilla. Looking at the case, in the first instance we should say that it was produced by inflammation, or increased action going on, and that sti¬ mulating remedies should be avoided ; but in fungoid diseases we do not find that to be the case, and there is no medicine with which I am acquainted that will diminish the symptoms so much as this. I do not know that carminative medicines are at¬ tended with any other effect than the relief of the symptoms. Some patients will take brandy and water better than any thing else; and as it is a mortal disease, the patient should be made as comfortable as possible. Whether liq. potassse acts on this as on tumors of a sus¬ picious nature, it is impossible to say. I have seen patients take this remedy for many weeks, with an improvement of the general health, and certainly a delay of the dr. Seymour’s clinical lecture. 153 fatal symptoms ; and this has induced me to give it in the present instance. If there had been a gnawing pain in the stomach, the medicine would have been ill applied, and I should have given something which would relieve that dreadful distress on taking food, which always occurs in true cancer of the stomach. The principal re¬ medies to be looked to for the relief of pain are the absorbents, such as magnesia, or a saline draught. Ten grains of mag¬ nesia several times in the day will sometimes work wonders; or equal parts of magnesia and subnitrate of bismuth. In the case which you saw after death, the man was frequently relieved for many weeks by the sub nitrate of bis¬ muth, and wras rendered a great deal more comfortable. I have seen this happen in many cases. The dose is ten grains of the subnitrate of bismuth and magnesia, and this may be given three or four times a day. It is not the magnesia alone which produces the good effect, for I have been obliged to have recourse to the bismuth where magnesia has failed ; so that the bismuth has some specific action. Professor Odier, of Geneva, first employed it, and it became very popular in the north of Europe, especially in cases of cardialgia: the Emperor of Russia mgde him a pre¬ sent of a diamond ring. It was then used here, and not being found to answer in all cases, it seemed for some time to be laid aside ; but the employment of it is again revived. It relieves pain, whether arising from functional or organic disease, and more especially where there is this secretion of mucus from the stomach, in a greater degree than any other remedy with which I am acquainted. The next best remedy for the relief of the pain is prus¬ sic acid ; and I know that in the new Pharmacopoeia we shall have a formula for its preparation. One of the evils at¬ tendant on this medicine is, that it decom¬ poses very readily, and therefore we are uncertain as to its strength. In the usual form, two to three minims of Scheele’s medicinal acid, at the utmost, exhibited several times a- day, will relieve the pain. In the present instance the object is, if possible, to diminish the growth of the tumor, to nourish the patient, and to give him those medicines which will cause a diminished secretion from the fungoid mass. With regard to the external pain on pressure, a blister has been applied, and ordered to be dressed with mercurial ointment, wdiich is found the most effec¬ tual in these cases. The pain, however, arises from the external growth of the tu¬ mor and pressure upon the part, and not from the interior of the stomach. A word with regard to the position in which the tumor is found. You are aware that the (pylorus is generally situated above the umbilicus, towards the right side, but here it is midway above the um¬ bilicus, towards the left side. How comes it in this situation ? The mass has in¬ creased in this direction, and become ad¬ herent. Sometimes I have seen it drag down twro or three inches below the umbili¬ cus; and in one instance it was so large and low, that it was believed to be a lodg¬ ment of faeces in the colon, having caused adhesion. An opening was made (after consultation) by a very celebrated surgeon, and a small quantity of matter was let out, which appeared to have been contained in the tumor. Here [presenting it] is the preparation. This is a very interesting case, and I re¬ commend you to examine it; but I beg that you will not make hard pressure, on account of the pain to which it gives rise. Having seen one of these cases, you will never forget it. These tumors, which come in this particular part of the body, are very different from what, under cance¬ rous disease, you would expect to be the case : this man may live for many years. The constitutional symptoms are extreme sensibility in every part of the body, and the pulse continues at about a hundred till the near approach of death. Some¬ times a small quantity of fluid collects in the peritoneum, but not often. It not un- frequently happens that the veins absorb a certain poi’tion of the mass ; and it like¬ wise not unfrequently occurs that the liver has a similar deposit in it of fungoid mat¬ ter. I have nothing farther to say upon the case, than to advise you to watch it, because, although it is impossible to re¬ store the man to health, yet it is interest¬ ing in a scientific point of view7. To see the symptoms during life, and to be able to test them after death, is of great impor¬ tance to men of our profession. EPILEPSY. There are three cases in the house, of the same disease (speaking from the ex¬ ternal appearances), although they have probably arisen from very different causes. The first is the case of Gibbons, in Crale Ward; the second a boy, named Higgins, in Hope Ward ; the third has only been under my care a few days, having come to me from the surgeons’ ward. Gibbons’s case is perhaps the most re¬ markable. She is at present, to all ap¬ pearance, in perfect health, and is about 24 or 25 years of age. About two years since, she was attacked with epileptic fits. Epilepsy is defined to be “ convulsions, ending in sleep the patient falls down, and foams at the mouth. There are a 154 dr. Seymour's clinical lecture* great number of symptoms which occur in particular persons. After remaining strongly convulsed and foaming at the mouth, for a period varying from five mi¬ nutes to half an hour, the fit goes off, and the patient falls into a profound sleep. In the case of Gibbons the fits are very short, and she is attacked without any warning. In the great majority of instances the pa¬ tient is warned by a sensation in the head, or a ereeping sensation up the finger, or arising from the foot, or sometimes in the belly: and when it reaches the head, the patient falls down in a fit. Tills aura has been termed aura-epileptica. I do not think that it is present in any of these three cases. In a woman twenty-four years of age, suffering under such a slight form of the disease, we should naturally look to the uterine organs as the cause. There being no fall, no blow, nothing which could immediately call attention to disease of the brain, and there being no particular affection of that organ instanced by double vision or half vision, or palsy in any part of the body, the first thing in such a case is to inquire whether any part at a dis¬ tance is suffering from deranged func¬ tion ; because (more particularly) the uterine organs being affected, parts situated at a distance sympathise with them. Thinking it very likely that this was the case here, I made inqui¬ ries as to the menstruation, and found that it was not very regular. As the fits were very slight, and were unaccompanied by warning, or by violent pain (for there was no pain, and no tangible symptom of or¬ ganic disease), I endeavoured to treat it as an hysterical affection dependent on the condition of the uterus. She wras conse¬ quently ordered to take large doses of as- safoetida, to be cupped on the sacrum im¬ mediately before the return of the period, and she afterwards used the cold shower- bath. There was some relief at first; the fits only occurred at the interval of a fort¬ night, and then again they became fre¬ quent. Subsequently to this she took vale¬ rian, but still without any good effect. Steel, in small does, was tried, but it was obliged to be given up. She has been bled and cupped repeatedly for the com¬ plaint, without the smallest good effect. I held a consultation upon the case with Dr. Chambers, who recommended large doses of ammonia: itwras tried, but with¬ out advantage. Sulphate of zinc was then used, but that also failed. Not finding that the ordinary remedies of a depleting, evacuating, or stimulating kind, were beneficial, I had recourse to what is sometimes very serviceable — rubbing the spine with a strong lini¬ ment (ext. bellad. in eamph. lin.) This is a great remedy with some persons^ when hysteria goes to a great extent. As the woman has been here many wreeks, no method has been left untried. Since I have resorted to this rubbing in, I think the fits have declined a little, and I wish it to be continued, to see whether those consequences will take place which 1. have sometimes heard of in private practice. These cases are all well worthy of your observation, because it is one of the most difficult diseases we have to treat ; and if, on inquiry, you should find any mode of treatment followed by success, you will have numbers of instances in which to em¬ ploy it in future life. These cases some¬ times require to be very long under treat¬ ment, because there is a long interval be¬ tween the fits. The next case is that of Higgins, who labours under a very remarkable form of the disease. He wras a cow-keeper, and he says that the man who was over him was very harsh, and beat him a good deal, but it does not appear that he beat him about the head. He is a great, thick, fat fellowq about twenty years of age, and of a plethoric habit of body. It is remarkable that the fits came on but once a month, and he says it is always at the full moon. The theory of the influ¬ ence of the moon upon disease and mania, has long since been abandoned by all sen¬ sible men ; but the only fits he has had have come on at the end of a month. I do not believe that the moon has any thing to do with them, but I do believe that there is, in a great number of cases, a peri¬ odicity. The disease first comes on at the end of a month, and then it does not oc¬ cur again for a month ; and when the ha¬ bit is once acquired, there is often a perio¬ dicity observed. In certain maniacal cases, persons will be for a fortnight what is called high — difficult to manage; and then for a fortnight they will be low — that is, melancholy — and the change will take place at the same time to an hour ; say at eleven o’clock at night. I knew one in¬ stance of a young lady who was deranged for many years, and w7as in these particu¬ lar circumstances. She was in a house where the observations could be made with the most perfect accuracy. When I found her gay and lively, the nurse would say that she w as within two days of becoming low ; and to the day, almost to the hour, the change used to take place. There are circumstances w hich are observed likewise in nervous pain of the face : it will go on for three or four days, and then intermit. Intermittent pain of the head is very common, though it does not arise from marsh miasmata ; and there may bean in¬ termission of pain arising from organic dr. Seymour's clinical lecture. 155 disease of the head. Where there is a re- gular intermission, arsenic will frequently remove it, even where it depends on orga¬ nic disease. This boy tried a great many things be¬ fore he came into the house; and, among others, he had recourse to charms. Many of you have seen him; he is a good-na¬ tured-looking lad, with an abundance of red hair, and is rather a short fat person. Thirty unmarried ladies (for if there had been a married one it would have broken the spell) combined together to buy him a silver ring, to wear on his left hand, for the purpose of breaking off the fits. This, gentlemen, is “ the march of intellect.” He has desisted from the use of the ring, but with considerable difficulty. He asked one gentleman whether he did not think that there was something in it. Charms have been from all eternity used for curing this disease, and often with effect, because the minds of individuals will sometimes exercise over these inter¬ missions a considerable degree of influ¬ ence. Epileptic persons who have warn¬ ing of the attack^ will sometimes be able to stop it. I remember a boy telling me that when the fit was coming on, he bit his tongue, and the pain kept off the fit. A ligature placed round the limb, or the putting on of a tourniquet, will some¬ times stop the fit where there is warning. Undoubtedly there is no disease where charms have been so much resorted to as this complaint, more particularly because it has been supposed to be an infliction of Providence, and hence it has been called morbus sacer. The Druids allotted to it the inisletoe, the inisletoe being sacred to the gods, and therefore being the best to be employed in keeping off a divine infliction. Dr. Baillie states that he has seen epilepsy cured the most frequently by the nitrate of silver, then by oleum succinum, and thirdly, by the viscus quercus, or misletoe ; so that whether the Druids gave a good guess, or were informed that it would cure the disease, Dr. Baillie, a man of un¬ doubted sagacity, had some confidence in this medicine. On the 2d October this patient had a fit, and it recurred three times that day. When he first came in* I had him bled, and put him on antispasmodic medicines ; his head was kept cool, and his bowels regularly purged. I believed that there was only some fulness of the vessels of the head ; he was evidently fond of employing the functions of the stomach ; and I thought by these means, and a low diet, I should keep off the fit. However, on the 2d October, the day that he expected the fit would appear, he had a severe attack, which lasted some considerable time, and was accompanied by a violent pain in the head, by great stupor, and which left him very ill after it He was again bled two days afterwards, but the blood was neither buffed nor cupped ; there was no trace of inflammation, nor has been any whatever in the interval. Since that time there has been no fit, and he is, to all appearance, in perfect health. All that is done by me at present, is to keep him on low diet, to put him in the shower-bath, keep his head cool, and his bowels freely open. I be¬ lieve that there is no evidence whatever of organic disease. If the periodicity of the disease should still continue, I shall be obliged to try him with arsenic in the interval of the fits, for the purpose of keeping off the intermission observed in the disease. Of the last case, I can give you but little information at present: for the patient has only just been put under my care. He says that the disease arose subsequently to a fall, and if so, there is, in all probability, some organic disease in the brain. The case has been sent to me from Sir Benja¬ min Brodie, as not being a surgical case. 1 suppose, therefore, that there is some mistake in the man’s statement, or Sir Benjamin’s attention has not been drawn to the fall. The difficulty is increased by the man stuttering so as to make it impos¬ sible for him to convey an intelligible an¬ swer. 1 have desired that the history of the case may be obtained from his friends. He says that the disease is of about two years’ duration ; that it immediately suc¬ ceeded the fall upon his head ; and that he has had several fits a day, at intervals, since that time^ We muct endeavour to make out whether there is any injury of the brain, before we can proceed in* the treatment with any hope of success. Epilepsy may certainly arise spontane¬ ously, without any organic disease. You are aware that the greatest people of anti¬ quity were subject to this very complaint, and which, in some instances, was sup¬ posed to be a proof of increased, rather than of diminished, faculties. Julius Caesar, every one believes to have been a man of superior talent, and yet he was subject to epileptic fits. Mahomet was subject to the same description of fits, and yet he was in possession of his faculties nearly to the last moment of his life — never, except during the fit, having shewn any thing but a knowledge of mankind, and their wants and wishes. A great many other persons have been subject to this particular complaint, without its shortening their lives, or impairing their reason ; and consequently, it is certain that there are cases arising from functional de¬ rangement. Children are sometimes at 156 dr. Seymour's clinical lecture. tacked with epilepsy from teething, or irritation in the bowels. s Adults are lia¬ ble to it — and particularly females, from a derangement of the uterine system. Still, however, there are a great number of cases in which epilepsy appears to depend on organic disease of the brain, and like¬ wise where it ends in stupidity, fatuity, or madness. In all cases we must determine what is the condition of the brain. Where it arises in children from teething, and in certain cases even where it occurs at the period of menstruation, the cure is not very difficult ; and there are cases in which the prognosis may be quite favoura¬ ble. It will sometimes arise from the pre¬ sence of worms. One of the worst cases that I ever witnessed — varying from epi¬ lepsy to catalepsy — occurred in a young lady affected with lumbrici; and yet lum- brici exist in many cases, without pro¬ ducing any obvious bad effect. The treatment in the first case — that of the female— has been to endeavour to regu¬ late, as far as possible, the uterine system, active remedies having been employed be¬ fore. In the case of the boy, the object is to reduce the state of the plethora to the standard of health, and then to try to prevent the intermittent attacks from coming on regularly. And in the third case, we must ascertain whether there has been any blow which has caused organic disease of the head. A great many observations have been made as to what part of the brain is most generally affected in epilepsy, and there are a number of disputes on the subject. Sometimes it has been thought that a small portion of bone deposited in the falx, and irritating the brain, has been the cause. [ remember a case of this kind, which was discovered on opening the body after death, but where there was not more bone deposited in the falx than I have seen in many cases without such a result. Some persons have attributed it to bodies of the nature of hydatids, which are found in the plexus clioroides; but in general, though not always, you will find the orga¬ nic disease in the cerebellum. Some re¬ markable observations were made on the subject by two physicians in Germany — the Wenzels. They agreed, together with other medical men, to seek through¬ out the district round them for cases of epilepsy, to watch them, and when the patient died to examine the brain by the side of a healthy brain, so that they might more correctly see what was amiss. They published their work some years ago, in which I think thirty cases, with the post¬ mortem examinations, were mentioned ; and in every one of these there was more or less disease of the cerebellum. There is not the least ground for doubting the statements of these gentlemen ; for either they were impostors, which we cannot be¬ lieve, or the cases occurred. Assuming the latter to be correct, though it bv no means proves that epilepsy, as an organic disease, may not arise from other parts besides the brain ; yet it proves that it is very frequently, and most frequently, de¬ pendent on an organic alteration of that most important portion of the brain. There is no evidence in anyxof the cases before us of organic disease, which is ma¬ nifested in the interval, where that is the case, by other affections. If the patient see double, or half an object — if he remain after the fits in a state of stupor for a length of time, and the mind gradually declines, the fits becoming more frequent as he advances in life, we may believe that there is organic disease ; and such cases, as far as I know, are absolutely incurable. A great many counter-irritants have been recommended in this disease, one of which is tartar emetic ointment applied to the head, which will bring out pustules. Two drachms of tartar emetic may be combined with an ounce of hog’s lard; and a bit about the size of a nutmeg may be rubbed over the head morning and evening. Some persons have great faith in this remedy. The late Dr. Jenner had a decided opinion in its favour, in cases of disordered intellect. He states that mak¬ ing an eruption at a distance is the way to cure the complaint. One of the causes alleged as productive of epilepsy all over the continent is the repercussion of a cu¬ taneous eruption ; and nothing is more common than to hear of the cessation of some eruptive disease preceding the epi¬ leptic attack. I presume that these were the cases in Dr. Jenner’s mind when he recommended this medicine. He has pub¬ lished several cases of mania which were cured by this remedy. His work, which was published in 1822, is very difficult to be obtained. He shews that many dis¬ eases of the brain arise after persons have been accustomed to some habitual erup¬ tion, which has ceased. I saw the book fifteen or sixteen years back, but since that I was unable to obtain a copy. I tried the Medico-Chirurgical Society, the College of Physicians, and the British Museum, but it was not to be procured. I then wrote to Dr. Jenner’s friend and executor, Dr. Baron, of Cheltenham, and he has let me see it. In the book are re¬ lated, as I have said, many cases of tartar emetic ointment being rubbed on the skin having cured mania, the affection, in some instances, having supervened on the cessation of some habitual eruption. It was Dr. Jenner’s practice to rub it on the TREATMENT OF FRACTURE BY A BONE-SETTER. 157 arms or legs. He recommends keeping- up the eruption for the space o" three weeks. I am inclined to think that, if in some of these cases I am not successful by other means, I shall give it a fair trial. These cases, then, you will bear in mind. Read the symptoms as well as you can for yourselves, and observe the medicines pre¬ scribed, the object of which will be pointed out in future lectures, or at the bed-side of the patient. In this way you will get a complete history of the cases ; and if you only discover what has had a great repu¬ tation, but will not cure the disease, even that will be a great matter. PARAPLEGIA. Before concluding I will call your at¬ tention to a case of paraplegia in Cam¬ bridge Ward, which 1 hope is going on well under the employment of tincture of cantharides. It is a curious and interest¬ ing case, and is worthy of your obser¬ vation. The patient labours under palsy of the hands and feet (diminished sensibility and motion), and some few weeks ago was to¬ tally unable to walk across the ward. There was pain of the head, and as it was not relieved by bleeding and every medi¬ cine which was administered, there was every reason to fear some organic disease of the brain. He took mercury, and sub¬ sequently strychnine, in such large doses, that 1 was afraid to give it any longer; and I then put him upon thirty drops of tincture of cantharides thrice daily. He is now able to walk with a stick, and feels his ankles and knees getting better. The only method of explaining the effect of the cantharides is by supposing that effusion goes on for a time in the brain and spinal marrow, and this is relieved by the diuretic effect, which is also the means of keeping down the effusion. Dr. Baillie has stated that in some cases paraplegia may be oc¬ casioned by these causes ; and if the Doc¬ tor be right, there is a clue to the action of the tincture of cantharides, which does not produce any good effect, so far as I know, except where it acts as a diuretic. The case has been a long time in the house, and I shall not enter into the whole of the history from the beginning; but since the patient has been put on this medicine the relief has been so great, that I should recommend you to watch the case for yourselves, as being one of those instances which, under ordinary circum¬ stances, may be considered a great cure. Having adverted to some cases in which all our remedies fail, it is a comfort to find that the art of medicine has some re¬ sources in the most severe forms of dis¬ ease. TREATMENT OF FRACTURE BY A BONE-SETTER. coroner’s inquest. The most important inquest which, has taken place in Lincoln for some years, was held at the County Hospital on Wed¬ nesday last, commencing at four o’clock in the afternoon, and continuing until ten at night. It was held before Mr. James Hitchins, coroner, and a highly respecta¬ ble jury of sixteen citizens, on view of the body of John Scott, then lying dead in the hospital. — After viewing the body, the coroner addressed the jury, stating that in a town like Lincoln, it was impossible they could come to an inquest without receiv¬ ing some intimation on the subject they were to decide upon, and he was aware there were various rumours afloat on the present occasion. He felt quite confident, on looking at the respectable jury assem¬ bled, he need not tell them they must be guided by the evidence alone, throwing all reports to the winds. After a few other observations the inquest proceeded. William Bourn resided in Lincoln, and saw a man drive up to the Adam and Eve, in the parish of St. Margaret, on Thursday last, about half-past four in the afternoon; he was driving a three- horse van, belonging to Mr. Dawson, of With- call, in which were eight rams. In at¬ tempting to pull up against the Adam and Eve, the van got master of the horses, which becoming unmanageable, threw over the vehicle, and pitched out both the man and the rams, just opposite the office of Frederick Burton, Esq., solicitor. The driver was thrown against the wall, but got up directly. Witness asked him why he drove so quick ? to which he replied that his master ordered him to drive fast. He then said, “ Oh dear, sir, my arm is broken.” Witness recommended him to go to Mr. Mason, the bone-setter, which he did. Saw the deceased again at ten o’clock that night, at the Adam and Eve inn ; he said he had got his arm set, and felt rather more easy; he had it in a sling, and had a bandage round his chest which confined his arm, and which he stated was tight. Did not see him again till he went to the hospital. Thomas Hallofield, a stone-mason, re¬ siding in Eastgate, Lincoln, who saw the accident, corroborated the statement of the former witness, and added, that de¬ ceased got into his cart, at his invitation, and rode down as far as Mr. Mason’s resi¬ dence. Was at the Adam and Eve that night, W'hen Mr. Mason came to visit him. Mr. Samuel Hadwin, house-surgeon of the hospital, stated that on Friday morn- 158 TREATMENT OF FRACTURE BY A RONE-SEI TER. ing, the 7th inst., about one o’clock, the deceased came to the hospital, having his right arm in a sling made with his hand¬ kerchief ; there was another bandage round his elbow. Witness began to un¬ wrap them. Deceased told him that the arm was very badly injured, and that Mr. Mason said the bones protruded. Hearing this, witness desisted, and had him con¬ veyed into a ward of the hospital, where he was undressed and put to bed. He then began to unwrap his arm. Beneath the handkerchief which he removed, wit¬ ness found a bandage which had been saturated with blood, but which was then dry and hard, and was bound several times round the elbow joint. Some por¬ tion of the bandage adhered so firmly, that it was necessary to cut it off. Immediatey over the outer surface of the elbow joint, there was a large piece of leather, spread with some adhesive plaster, adhering very firmlv to the skin, the removal of which caused great pain. At the back of the el¬ bow joint, witness perceived a cut about an inch in extent, covered by lint. The neighbourhood of the joint was excessively swollen, and full of pain, extending into the elbow joint. The man’s arm was placed in a convenient position on a pillow, and leeches and other applications were resorted to. After this he expressed him¬ self relieved. Medicine was also admi¬ nistered. The deceased, when he first came into the hospital, stated that he was in very great pain. Coroner. — From the examination of the arm, was the treatment which had been pursued, do you think, correct ? Witness. — It was diametrically opposite to what I should have adopted. Witness continued. — Saw deceased again on the Friday evening, when he expressed himself more free from pain than he had been : the treatment which had been adopted was continued. On the next day, deceased stated that he had passed a tole¬ rable night, and the distension above the elbow joint did not appear so great as be¬ fore ; leeches were applied, but the dimi¬ nution was not striking. It was consider¬ ed by the surgeon of the month (Mr Hew- son) necessary to bleed the man copiously : this was done, and medicines were admi¬ nistered, which had their expected effect, and he continued much the same until the evening. — On the following morning, wit¬ ness found the deceased’s arm, from the hand to the shoulder, very much distended: the remedies were continued. In the mid¬ dle of the day the man complained of ex¬ treme pain in the arm ; more leeches w ere applied, and the arm was steeped for a considerable time in warm water: from these means he derived great relief. In the evening, he complained of restlessness, and appropriate remedies were administered.— On Monday morning, between seven and eight o’clock, deceased’s arm was found to be in a state of mortification. At the direction of the surgeon for the month, a consultation was called of the surgeons to the establishment, who assembled at 10 o’clock. The patient wras apprised of his danger, and that his death wras inevitable, unless an operation was performed by the removal of the limb, and that even after that the chance of a favourable result was so trifling that they could hardly recom¬ mend it. This the surgeons themselves communicated to the poor man, but he decided to have the operation performed without delay. The arm was then re¬ moved at the shoulder joint. — Deceased’s countenance after the operation was more favourable than before it, and he stated to witness that he felt more comfortable since the removal of his arm : he appeared to be in a much better state the whole of the day than any professional man acquainted with his previous state could have expected. On the following morning, unfavourable symptoms re-appeared ; he then sank ra¬ pidly, and died at 4 o’clock in the after¬ noon, being sensible to the last. Coroner. — There is one portion of your evidence, stating that the treatment which deceased received prior to his coming into the hospital was diametrically opposite to that which you would have pursued. What do you mean by that ? Witness — It was decidedly opposed to all practice of surgeons, and to the first prin¬ ciples of surgery. Coroner. — Is it your opinion that from the arm’s being treated in the way you have described, mortification would be hastened ? Witness. — Decidedly. I should say, that if the party who bound up the arm wished to produce mortification, he took the very means he should have adopted for that purpose. Coroner.— -Was it possible for mortifica¬ tion to ensue from the wound itself? Witness. — I think it possible that the in¬ jury itself might have produced mortifi¬ cation, even though it had been attended to by the surgeons of this institution ; but the probabilities are that it would not. Juror. — Do you think Mr. Mason treat¬ ed this case as a fracture, or a wround ? Witness — I do not know ; his treatment is so much at variance with every princi¬ ple of surgery. Coroner. — By whom was the operation performed ? Witness. — By Mr. Hewson. Coroner. — Was it performed in a skilful manner — as it ought to have taken place ? Witness. — Certainly: it wras performed as skilfully as possible. CAMBERWELL PRACTITIONERS AND THE MEDICAL CLUB SYSTEM. 159 Coroner. — Was Mr. Hewson at all ner¬ vous ? Witness. — He was not. Coroner. — My reason for asking' that question is, because it is stated in the town that he was so nervous as to be obliged to call for assistance. Witness. — I was at Mr. Hewson’s elbow for the whole time, and there was not the slightest trepidation, nor did he ever re¬ quire assistance. Juror. — Did the patient die from the operation, or from mortification having entered into his frame ? Witness.- — l am positive he died from mortification. Mr. Hewson, Mr. Kent, Mr. Kowett, and Mr. Franklyn, surgeons, were succes¬ sively examined, as well as Mr. Mason. The jury ultimately returned a verdict of accidental death. — Lincoln Mercury. CAMBERWELL PRACTITIONERS, AND THE MEDICAL CLUB SYSTEM. To the Editor of the ULedical Gazette. “ Candor dat viribus alas.” Sir, I was not Quixotic enough to wage war with a shadow, and therefore felt anxious that the writer who called himself a “ Cam¬ berwell Practitioner” should come out of his hiding-place: and before I attempt to grapple with his arguments, I must be allowed to make a few observations with regard to the misstatements in both his letters. I again repeat that Messrs. Flower and Young are residing in the parish of Lambeth, and their paying for a Camberwell gas-light does not make them parishioners : it would be as fair to say that a man living in Holland Street must necessarily be a Dutchman! What Mr. Flower means by “ gross abuse f I know not, but I assert that the language he describes was not used at the meeting alluded to ; there was no “ din and confu¬ sion the gentlemen who put their signa¬ ture to the paper wrere not called “ black sheep ;” not a word was said about posting their names ; and no individual was bold enough to offer to shed one single drop of blood in the cause: and will your readers believe it, sir, that, notwithstanding these asser¬ tions, Mr. Flower was not at the meeting ; and as I have before said, though such a stickler for parishes and districts, is nothimself living in the parish of Camberwell. I will briefly recapitulate Mr. Flower’s arguments in favour of this system, to “avert the evil of such a measure” as the one produced by the Poor-Law Commis¬ sioners: these said Commissioners' how¬ ever, are kind enough to recommend a remedy ! — “ Timeo Danaos et dona feren- tes.” 1st. This system will improve the moral condition of the poor, and make them independent. 2d. It will prevent their having recourse to the parish-surgeon, through fear of a ruinous bill; and under this plan, they will have the option of selecting their own medical attendants. 3d. That it cannot degrade or injure our profession. 4th. That those who do the “ work will have the pay,” and youths will not be sent to attend the poor women when in labour. 5th. That a dispensary is a far more ob¬ jectionable establishment. 1. The very basis of the system is un¬ stable and rotten, for it is founded in an untruth. The members of these clubs are told that they will become independent , when, in fact, they are in a state of depen¬ dence ; but the great evil of the scheme is, that it holds up a bait for the upright man to leave the path of honesty and inde¬ pendence, and walk in that of pauperism. The dishonest man cannot be compelled to pay towards the club, and he will continue to cheat the members of our profession, many of whom are not ( considering the sphere in which they move ) so independent as the provident mechanic who receives 35s., or even 25s., per week. 2. Medical practitioners in this neigh¬ bourhood are not in the habit of sending ruinous bills to the poor; and I defy Mr. Flower to bring forward a single instance in Camberwell of a poor man who has been ruined in consequence of being compelled to pay a long bill ! The poor will not be able to select their own medical attend¬ ants, as the majority of the medical men refuse to act. 3. Is it not degrading to a member of our profession to attend a mechanic earn¬ ing 25s. per week for a less sum than the village farrier wouldexpect for physicking his pig? And if this principle be once generally established, shall we not be in¬ jured by a higher grade adopting the same method for securing cheap medical at¬ tendance ? When these clubs were first formed, those only were admitted as mem¬ bers whose wages did not exceed 10s. or 14s. per week, but now individuals sub¬ scribe who receive three times that amount ; and is it not fair to suppose that the scale will gradually increase ? 4. Here is the whole gist of the argu¬ ment ; for although benevolence is placed in the foreground, yet the “ non-remuneration ” 160 BILLS OF MORTALITY.— METEOROLOGICAL JOURNAL occupies the most prominent part of the picture. With regard to youths being sent to cases of midwifery, I apprehend that those young gentlemen (who have attended 1 c- tures, &c.) are quite as competent to un¬ dertake the case as the parish midwife; and without this practice, let me ask, how are they to obtain that knowledge so necessary to make them efficient practi¬ tioners ? 5. The same argument which Mr. F. applies to dispensaries is equally applica¬ ble to these clubs. “ Suo sibi gladio hunc jugulo .’’ Many who now pay 3/. and 4/. yearly for medical attendance, and will not go to a dispensary, would, I believe, belong to this club. T contend that in London and its environs it is impossible to ascertain the amount of a man’s wages; they may when he joins the club be 25s. per week, and the following month he may receive 40s. — although I admit that the plan may be practicable in a coal¬ mine. The great cause of the misery amongst the lower orders of the metropolis does not originate in ruinous medical bills, but in the licensed “ gin palaces” — “ Where sit, involved and lost in curling clouds Of Indian fume, and guzzling deep, the boor, The lackey, and the groom ; the craftsman there Takes a Lethean leave of all his toil ; Smith, cobbler, joiner, he that plies the shears, And he that kneads the dough ; all loud alike, All learned, and all drunk.” Leaving Mr. Flower to the enjoyment of his “ homely and humble festal board of co-operation in a good cause,” free from the “ hollowest exultation,” and graced with a “ mens conscia recti,” I remain, sir, Yours respectfully, E. Crisp. Walworth, October 24, 18116. P. S. I am living in Walworth, and practise in Camberwell ; therefore I am a Camberwell Practitioner .- and this will probably apply to all the gentlemen who were at the meeting (according to Mr. Flower’s argument). APOTHECARIES’ HALL. LIST OF GENTLEMEN WHO HAVE RECEIVED CERTIFICATES. October 20th, 1836. Edmund Thomas Halliday, Warminster, Wilts. Alexander Pauli, Truro, Cornwall. Thomas Maitland, Tiverton, Devon.. Giles Symonds Roper, Mappercombe, Dorset. Henry Rogers Burton, Market Harborough. Richard Grimbly, Banbury, Oxfordshire. William Derry Pearce, Launceston, Cornwall. John Potter Sargeant, Leicester. George Arthur Smith. Frederick Walter. George Wilson, Leeds. Sackvllle Lupton, Thame, Oxon. John Pechey, Isleham, Cambridgeshire. Robert Druitt. John Cartwright. Edward Foot, Salisbury, Wilts. NEW MEDICAL BOOKS. An Account of the Watering Places on the Continent, and their Mineral Springs. By Edwin Lee. Post 8vo. 7s. 6d. Practical Demonstration of the Human Skeleton. By Geo. Elkington. 12mo. 7s. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Oct. 25, 1836. Abscess . • 2 Age and Debility . 41 Apoplexy . . 10 Asthma . . 6 Cancer. . . 1 Childbirth . . 2 Consumption . 69 Convulsions . 13 Croup ... 2 Dentition orTeething 4 Dropsy . . 18 Dropsy on the Brain 13 Dysentery . . 1 Erysipelas . . 1 Fever ... 9 Fever, Scarlet . 1 Fever, Typhus . 2 Gout . . . 1 PItemorrhage . 2 Heart, diseased . 3 I-Ioopinor Cough . 2 Indigestion . . 1 Inflammation . 24 Bowels& Stomach 2 Brain . . 2 Lungs and Pleura 5 Insanity . . 6 Jaundice . • l Liver, diseased . 1 Measles . . 10 Mortification . 7 Paralysis . . 3 Rheumatism • 1 Small-pox . . 5 Spasms . . 1 Thrush . . 1 Tumor . . 2 Unknown Causes 39 Casualties . 12 Increase of Burials, as compared with > ^ the preceding week METEOROLOGICAL JOURNAL. Oct . 1836. Thursday . 20 Friday . . 21 Saturday . 22 Sunday . . 23 Monday. . 24 Tuesday . . 25 Wednesday26 I Thermometer. from 32 to 56 36 54 41 55 32 57 41 54 46 52 46 54 Barometer. 30-34 to 30-28 30-23 30-22 3029 30-30 30-29 30-28 30-29 30-25 30-18 30-14 30-11 29-98 Prevailing- winds, W. by N. and W. by S. Cloudy , except the 20th, 22d, and afternoon of the 23d : a little rain on the evening of the 25th. Charles Henry Adams. NOTICES. “ R. H. B.” will excuse us. His letter is an advertisement. “ Medicus.” — We cannot take the same view of the conduct of the party aggrieved, as our correspondent does. In compliance with the repeated appli¬ cation of several correspondents, we shall reprint in next number our abstract of Mr. Kiernan’s Researches on the Structure of the Liver ; the number in which it originally appeared having been long since out of print. The papers of Dr. Ogston, Mr. Skey, Mr. Robson, Mr. Collier, Mr. Hunt, Mr. Thompson, “ M. I.,” and other correspon¬ dents, in our next. Wilson & Son, Printers, 57>Skimier-St. London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOTOGML OF iRetitcme aitii tOe Collateral Jbritttws* SATURDAY, NOVEMBER 5, 1836. LECTURES ON FORENSIC MEDICINE; delivered at the Aldersgate School of Medicine, By William Cummin, M.D. Lecture VI. Jther Medico-legal relations — Human and Comparative Structure — National peculiari¬ ties — Varieties of the Human Race — Form of the Head — Form of the Pelvis in different Rations — Family Varieties — Supernumerary Fingers and Toes. Identity — Legal dis¬ tinctions : 1. Identity of Living Persons — Family Likeness — Accidental Resemblances — Remarkable cases of controverted or mistaken Identity. There are other relations, beside those of Age and Sex, in which individuals may be viewed and distinguished medico le- gally. Some of these I shall introduce to your notice in the present lecture ; others I am obliged altogether to omit. Normal human structure. — The subject of disinterments alone suggests several in¬ quiries which it would demand a certain degree of skill in human anatomy, and par¬ ticularly in osteology, to satisfy. Without a competent knowledge of this kind, su¬ tures might be taken for fractures, and fissures and foramina, for the effects of violence. For example, in a case cited by Dr. Paris, a man wras accused of having murdered his step-daughter, by boring a hole in her skull with an awl. The body was exhumed after two years and a half sepulture, and an inquest held. Upon in¬ spection of the head, a small hole was discovered near the ear, and the jury returned a verdict of wilful murder. It happened, however, that the circum¬ stances of the case excited the attention of Mr. .Sheldon. He obtained access to the ! 46G. — xix. skull, and on viewing it, declared that the hole which was supposed to have been made with an awl, was only a natural opening, a foramen for the passage of a vein, and he pointed out the enamel-like structure of its sides, very different from the appearance of an aperture made by force. In confirmation of what he stated, he produced a dozen or more human skulls, having in them similar perforations, vari¬ ously situated. The consequence was, that when the assizes took place, the grand jury ignored the bill. Comparative structure. — Again, our skill in comparative osteology may be tested, where it may be necessary to distinguish the remains of a human subject from those of animals. Suppose only a few detached bones are found, we must show whether they be those of the human species, or be¬ longing to brutes. The long bones of qua¬ drupeds, and particularly the humerus, have sometimes confounded inexperienced observers. Strange mistakes, too, have hap¬ pened among those w'ho ought to have known better. The bones of elephants have been deliberately taken for those of giants; and it required the ability and authority of a Cuvier to prove that Scheuchzer’s Homo di- luvii testis was only in reality a gigantic salamander. But perhaps the most amus¬ ing blunder of the kind w?as that commit¬ ted by the savans who examined the bones found in the grand sarcophagus of the se¬ cond pyramid. Belzoni and others thought they had here the mortal relics of King Cephrenes : but Mr. Clift undeceived them ; he showed that the precious remains wrere only those of an ox ! To attempt to lay down, however super¬ ficially, the principles by which you should be guided in investigations of this sort, would carry me far beyond the legitimate objects of my course. You must depend on your resources as human and compa¬ rative anatomists; and the more minutely and exactly you are acquainted with the details of both departments of knowledge, M 162 DR. CUMMIN ON FORENSIC MEDICINE. the greater of course will be your advan¬ tages as medical jurists. National peculiarities. — But there are cer¬ tain other circumstances connected with the structure of the individual, which are both curious and legitimately within the province of legal medicine. I allude to national and family peculiarities of the human form. Let us suppose a case — and experience has shewn that it is something more than ideal. A stranger from a foreign land pre¬ sents himself, claiming to be considered as one in whom long absence from his native shores has operated great changes : his aspect is that of one of another race : doubts are entertained of his identity : and it is the interest of those who possess that property of which he may be the right¬ ful owner, to be duly satisfied as to his pretensions. In such circumstances it may devolve on the medical jurist to determine whether certain physical appearances ob¬ served in his bodily structure, and sup¬ posed to be indicative of an alien origin, are congenital or have been acquired. Again, in cases of disinterment, when the remains must be identified, the deceased may have been a native of a distant clime ; here it will be a part of your duty to note, among other points, the characteristic size, shape, and proportion of certain, parts of the body. Should any of you practise in India, or in our distant settle¬ ments, it is by no means unlikely that you may be charged sometimes with such an inquiry as — whether, in a given case, the bones discovered are those of a European, a Negro, or a Hindoo ? It will be proper, therefore, to point out some of the principal differences of struc¬ ture which characterize the VARIETIES OF THE HUMAN RACE. In the remarks which I have to make on this subject, I shall chiefly follow Cuvier, availing myself at the same time of the learned researches of Dr. Prichard. Mankind is characterized by unity of species. By the term species, we imply separate and distinct origin, evinced by the constant transmission of certain pecu¬ liarities of organization. But there are varieties of mankind — understanding by that term certain diversities in individuals and their progeny, which are observed to take place within the limits of species. Differ¬ ent species, in fact, do not intermingle or propagate, while varieties may, and do. Cuvier has adopted a threefold division of the varieties of the human species ; Blumenbaeh a fivefold: while Prichard differs from both, in maintaining that there are seven distinct varieties. Fun¬ damentally, I believe there is no material difference between these able authorities : they all seem to admit a threefold primary division, — as nearly as possible agreeing with Cuvier’s Caucasians, Mongolians, and Ethiopians. Forms of the Head. The sketches here before you will serve to give a good general idea of the form and proportions of the head, by which the three principal varieties are distinguished. Professor Camper was the first who at¬ tempted to point out certain characteristic differences of the heads of men, and also of animals. His method was the well-known one of taking thefacial angle — by imagining a line drawn from the meatus auditorius to the base of the nose, and another touching at once the prominent centre of the fore¬ head, and the most projecting part of the upper jaw-bone — the head being viewed in profile. In the angle formed by these two lines he conceived to consist the distinc¬ tions not only between the skulls of the several species of animals, but also those which are found to exist between different nations. Blumenbaeh, in the course of his long and constant study of skulls procured from all quarters of the globe, became convinced that Camper’s method was very imperfect : he adopted, in conse¬ quence, another and more satisfactory mode of proceeding. His plan is to view the skull vertically, or with the vertex upwards, and then to observe its relative proportion of breadth. In comparing and arranging skulls, according to the varieties in their shape, we ought, he thinks, to survey them in that method which pre¬ sents at one view the greatest number of characteristic peculiarities. “ The best way of obtaining this end is to place a se¬ ries of skulls with the cheek-bones in the same horizontal line, resting on the lower jaws; and then viewing them from be¬ hind, and fixing the eye on the vertex of each, to mark all the varieties in the shape of parts which contribute most to the na¬ tional character, whether they consist in the direction of the maxillary and malar bones, in the breadth or narrowness of the oval figure presented by the vertex, or in the flattened or vaulted form of the fron¬ tal bone.” This is called the vertical me¬ thod. Dr. Prichard, however, gives the pre¬ ference to a mode of examining the skull first pointed out by Mr. Owen. It is the reverse of the vertical method: the skull is viewed from the base; and, as Dr. Prichard says, “ the relative propor¬ tions and extent, and the peculiarities of formation of the different parts of the cranium, are more fully discerned by this mode of comparison, which has hitherto been much neglected, than by any other method.” But obviously we cannot do better than FORMS OF THE HEAD. 163 avail ourselves of every possible view of done, we shall be satisfied that all the va- the skull and its proportions— to survey it rieties in the form of the human head may in all directions, as well laterally as ver- be referred, on a general comparison, to tically, and from the base. When this is the three following classes. 11. — Head and Skidls of the Caucasian variety. 1 . The Caucasian variety. — This form of head is distinguished for its beauty, according to our European notions. It is that which characterizes the appearance of the Geor¬ gians and Circassians, in the neighbour¬ hood of Caucasus, whence the human race is supposed to have so largely spread in the infancy of the world. It includes all the Europeans, with the exception of the Laplanders, the western Asiatics, and the northern Africans. The complexion is more or less white, the cheeks having a florid hue - the hair long, soft, and of a variety of tints — black, brown, chesnut, red, white, &c. The skull is of the symme¬ trical or oval form ; the forehead is more expanded than in the other varieties, “while the maxillary bones and the zygomatic arches/’ says Dr. Prichard, “ are so formed as to give the face an oval shape, nearly on a plane with the forehead and cheek-bones, and not projecting towards the lower part, as in other varieties of the human skull. The cheek-bones neither project outwards and laterally, nor forwards. The upper maxillary bone has the alveolar process well rounded, the anterior portion having a curve in a perpendicular direction. This gives a perpendicular and not a projecting position to the front teeth, to which the lower jaw and its teeth correspond.” Fig. 12. Head and Skulls of the Mongolian variety. 2. The Mongolian variety is- characterized by the marked projection of the cheek¬ bones, the broad face, the small and oblique eyes, the straight black hair, the scanty beard, and the olive complexion. This race includes the eastern Asiatics, the Laplanders in Europe, and the Esqui¬ maux in North America. The skull is of the broad square character : it is pyramidal, according to Dr. Prichard. “ The cheek¬ bones,” says this author, in his excellent work on the Physical History of Mankind, project from under the middle of the orbit, and turn backwards in a large arch or segment of a circle, the lateral projection of the zygomas being so con¬ siderable, that if a line drawn from one to the other be taken as a base, this will form with the apex of the fore¬ head a nearly triangular figure. The orbits are large and deep ; the upper part of the face is remarkably plane and flat, — the nose being flat, and the nasal bones, as well as the spaces between the eye¬ brows, nearly on the same plane with the cheek bones.” 3. The Ethiopian variety, or that of the Negro, is remarkable for the blackness of the complexion, the woolly frizzly hair, the broad flat nose, the prominent muzzle, and the large lips by which it is characterized. The Africans to the south of the Atlas 164 DR. CUMMIN ON FORENSIC MEDICINE. Fig. 13. — Head and Shull of the Ethiopian or Negro variety. chain belong; to this variety. The skull is narrow and elongated ; “ the principal characters are referrible to the idea of lateral compression; the temporal muscles having a great extent, rising very high in the parietal bones, and being very large and powerful, subject the head to a force producing the effects of lateral compres¬ sion and elongation. The cheek-bones project forward and not outward ; the upper is lengthened and projects forward, giving to the alveolar ridge and to the teeth a similar projection. From the shape of the upper jaw alone would arise a diminution of the facial angle.” This is the form of skull which Dr. Prichard terms prognathous , from the projection of the jaws. Hardness and other peculiarities of the skull. • — A striking character in the skull of the African Negro is its great hardness, density, and weight. It is frequently found to have a whiteness and compactness of tex¬ ture, which give it the appearance of ivory or even of marble, rather than of bone. Nor is this condition of the cranium un¬ accompanied by a corresponding pecu¬ liarity in the skeleton generally. The hones of Negroes are usually much heavier than those of other men. The crania of Europeans differ greatly as to thickness and weight, those being usually found the heaviest which belonged to persons of dis¬ eased constitution. In the American na¬ tions, particularly those of the South, the skulls have been observed to be par¬ ticularly light. A remarkable fact respecting the Ethio¬ pian skull has been observed by Mr. Owen ; namely, the approximation made in its structure to that of the troglodyte. In several Negro skulls, and in one of an Australian savage, Mr. Owen noticed the juncture of the temporal and parietal bones, and consequently the complete separation of the sphenoid from the parietal, which in European and most African skulls meet for the space of nearly half an inch, a process of the sphenoid bone extending upwards to join the lower anterior angle of the parietal. The same structure was observed in six out of seven young chimpanzees. But it is worth adding, that the orang resembles man in this particular : in seven out of eight crania of young orangs the sphenoid joined the parietal bone, as it commonly does in human skulls. The Pelvis in different Races. Some of the principal diversities of figure in the different races of men may now be briefly noticed ; and first with regard to the pelvis, — for on the shape of this part the form of the body in great mea¬ sure depends. In the Negro. — The loins and hips are more slender in the Negro, and the pelvis narrower than in Europeans. The female negro, however, is supposed to have a very capacious pelvis, — though the evidence of that fact seems chiefly to rest on the cir¬ cumstance that Negro women are said to have easy labours. Vrolik, who has bestowed much attention on the struc¬ ture of the pelvis as indicative of na¬ tional varieties, observes that the pelvis of the male Negro, in the strength and density of its substance, and of the bones which compose it, resembles tbe pelvis of a wild beast; while, on the contrary, the pelvis of the female in the same race combines lightness of substance, and delicacy of form and structure : no¬ body, in fact, on a first view, would sup¬ pose it to belong to the same nation as the corresponding part in the skeleton of the male. Yet the pelvis of the Negress has an elongated character, which likens it to that of the simiae. The ossa ilii have a pecu¬ liar configuration. The summit of the inclined plane, which in the European is in the middle of the crest of the ilium, between the anterior and upper spine and the posterior and upper tubero¬ sity, is situated in the Negress immediately above the posterior and upper tuberosity; being thus as remote as possible from its situation in the European. The anterior upper spines are placed lower in relation VARIETIES OF STRUCTURE AFFECTING FAMILIES. 165 to the cotyloid cavities, and are also less prominent. The anterior and lower spines are nearer to the edge of the cotyloid cavity than in the European pelvis, in which a greater distance is here to be ob¬ served. The length of the antero-poste- rior diameter, at the inlet, is great in comparison with the transverse. In the Hottentot. — In the Bushman and Hottentot females, the breadth of the pel¬ vis is about half an inch less than the pelvis of European women. The height is, on the contrary, much more considera¬ ble than in the latter; the ilia reach up beyond the level of the half of the fourth lumbar vertebra. The neck of the thigh¬ bone in the Bushman female is shorter than in Europeans, or even than in Negroes, and it has a more oblique direc¬ tion. In the Javanese. — M. Vrolik describes the pelvis of the Javanese as peculiarly light, small, and nearly circular in its upper cavity. He gives figures of this part in the male and female. From a first or hasty view of these, he says, any per¬ son would suppose himself examining the bones of a very young person, and nothing but the observation of those decisive cha¬ racters indicative of full maturity would be capable of dissipating the impression. The muscles and their attachments are also inferior in every respect to those ob¬ served about the pelves of Negroes, Euro¬ peans, and Hottentots. Professor Weber reduces all the various shaped pelves to four : 1. The oval form, where the antero¬ posterior diameter in the male is 3 in. 9 lines, and the transverse 4 in. 3 lines. This is the form of pelvis which is most frequently met with amongst Europeans. 2. The round form : this appears to be rather a modification of the oval, the con¬ jugate diameter being somewhat longer than in the preceding form. It is said, however, to be the most frequent shape in the American nations. 3. The square form of pelvis— where the upper opening forms nearly a perfect square — the transverse diameter, however, somewhat longer than the conjugate; this is chiefly met with in people resembling the Mongolians. 4. The wedge shaped or oblong pelvis, where there is an appearance of compres¬ sion on both sides, so as to be narrower laterally than from front to rear. The conjugate diameter exceeds the transverse by some lines. It is said to be characte¬ ristic of the races of Africa. It is right, however, to add, that Pro¬ fessor 'Weber is by no means so sanguine as M. \ rolik, as to the possibility of dis¬ tinguishing varieties of the human species by the character of the pelvis. His deli¬ berate opinion is, that every form of the pelvis which deviates from the ordinary type, in whatever race it may occur, fipds its analogues in other races of mankind. Other parts of the skeleton in different races. — There have been found six lumbar ver¬ tebrae in some Negro skeletons. But Dr. Prichard says he has seen the same va¬ riety in an European ; and Mr. Owen has noticed an approximation to it in an Aus¬ tralian skeleton. The chest is often more arched and expanded in the Negro than the European. Soemmering notices a curious circumstance in connexion with this fact — namely, that in Negroes the eighth rib, or first false one, more nearly approaches the sternum than in Euro¬ peans : in one instance he found eight ribs attached to that bone. It is proper to mention that the same variety of structure has been met with in Europeans. A certain peculiarity is said to have been observed in the fore-arm of the Negro, that part being longer, in proportion to the humerus and the stature, than in Euro¬ peans. But the authority for this fact is rather doubtful ; nor is the difference of length, even on the shewing of the assertors, very considerable. The Lascars and Indian sailors who visit England occasionally, are observed to have slender and elongated limbs. Length of the arms and legs, and smallness of the hands and feet, have been remarked as characteristic of the Hindoos. The na¬ tives of Van Diemen’s Land, and of New Holland, are likewise small in stature, with long and slender legs. The bones of the leg in Negroes, accord¬ ing to Soemmering, appear to be bent out¬ wards, under the condyles of the femur, so that the knees stand further apart, and the feet are turned more outwards, than in Europeans. The observation is confirmed by Mr. Lawrence’s account of the east of a Negro in the museum of the College of Surgeons: — “The tibia and fibula are more convex in front than in Europeans. The calves of the legs are very high, so as to encroach upon the hams. The feet and hands, but particularly the former, are flat ; the os calcis, instead of being arched, is continued nearly in a straight line with the other bones of the foot, which is re¬ markably broad.” The foot of the black is commonly observed to be very large, and the hand to be remarkably thin ; the fin¬ gers and toes at the same time possessing great flexibility. Varieties of Structure affect ing Families. Peculiarities of structure which are he¬ reditary in some families, are well deserv¬ ing the attention of the medical jurist; they are excellent marks by which to de¬ termine the identity. 166 DR. CUMMIN ON FORENSIC MEDICINE. Among these, supernumerary fingers and toes are not unfrequently met with. Maupertins stales that there were two fa¬ milies in Germany distinguished through several generations by sjx fingers on each hand, and the same number of toes on each foot. Jacob Rnhe, a surgeon, was one of this stock. His mother had married a man of the ordinary make, and bore him eight children, four of them partaking of her peculiarity. Ruhe transmitted his supernumerary members to his offspring. Dr. Prichard cites from the Edinburgh Medical and Surgical Journal a very cu¬ rious example of this peculiarity. In a family at Iver the individuals for nine ge¬ nerations had perfect thumbs, but instead of fingers had only the first phalanx of each, and the first and second joint of the ring finger of the left hand; these rudi¬ ments of fingers having no nails. It is added, that it was the women only who had the misfortune of entailing this defect upon their offspring, which they did al¬ most uniformly. These must be considered as curious instances of variety of structure, not re- ferrible to any original difference trans¬ mitted from first parents, but arising in breeds previously destitute of any such character; and when once arisen, becom¬ ing permanent in the stock. They serve to throw some light on the origin of the three varieties of the human race already described. Sir Anthony Carlisle, in the Philosophi¬ cal Transactions for 1814, gives an ac¬ count of a family in which six fingers on each hand, and six toes on each foot, were transmitted through four generations. The originator of the peculiarity was a female of this conformation: she had ten children like herself, and an eleventh, who only differed from her in having one hand na¬ turally formed. Fig. 14. Here is a representation of the feet of a young man who was not long since a patient of Mr. Arnott’s in the Middlesex Hospital. He had seven toes on the left foot, and six on the right. Each of the toes had the proper num¬ ber of phalanges, provided with dis¬ tinct tendons. There were, however, but five metatarsal bones; two toes being arti¬ culated td the first metatarsal bone of each foot. In the left foot there were, besides, two toes articulated to the last metatarsal, as represented in the drawing. The hands of this person were furnished originally with fourteen fingers, but two of them had been cut off from each hand in infancy. It is remarkable, that the patient had five brothers and four sisters, all of whom, with the exception of one sister, had the sextuple peculiarity on their hands and feet ; the said sister, however, having had seven toes on one foot, and six on the other. The peculiarity in this instance also seems to have descended by the female side. IDENTITY. We may now' proceed to a subject more immediately practical— that of identity — in the discussion of which we shall see how the various peculiarities respecting Age, Sex, and the other relations already treated of, may be rendered available for the purposes of medico-legal research. The aid of the medical jurist is sometimes required to elucidate difficul¬ ties arising from a confusion of per¬ sons, and in the absence of moral and IDENTITY OF LIVING PERSONS. 167 circumstantial evidence of a satisfac¬ tory nature, the proofs of identity shall rest altogether on the physiological facts which the medical man can supply. The determination of questions of this na¬ ture is generally fraught with public good, as it always is with interest for the public. It reveals impostors, or it enables the rightful owners of property to become the actual possessors: it rescues the innocent, while it brings his guilt home to the cri¬ minal. The question of Identity may be raised either with reference to living parties, or to persons found dead. In coroners’ in¬ quests, the very first step of the proceed¬ ings consists in identifying the body, or such remains of it as are forthcoming. When the Dowager Marchioness of Salis¬ bury was burnt to death lately, in the great fire at Hatfield-house, after digging for several days incessantly in the ruins, some of her remains were found; these were identified by the jaw-bone, in which were certain golden sockets for her artifi¬ cial teeth. Another legal arrangement connected with this subject is, that where a prisoner after conviction escapes and is re-taken, a jury shall be empanelled to try the col¬ lateral issue, namely, the identity of his per¬ son, and not whether he is guilty or inno¬ cent, for that is supposed to have been fully tried before. I shali divide the subject of Identity as it relates to the living and to the dead. Identity of Living Persons. Family likeness is a thing of ordinary occurrence: the only wonder is that it is not oftener carried to such an extent as to confound identity. Instances, how¬ ever, are occasionally met with in which brothers are so alike as to defy distinction. The following case, related by Risdon in his History of Devon, is worth quoting for its singularity : — “ Nicholas and Andrew Tremayne were twins, and younger sons of Thomas Tre¬ mayne, Esq. of Cullorcumbe, in this county. They were so like in all their lineaments, so equal in stature, so colour¬ ed in hair, and of such resemblance in face and gesture, that they could not be known the one from the other — no, not by their parents, brethren, or sisters, but privately by some secret mark, or openly by wear¬ ing some several coloured riband, or the like, which in sport they would sometimes change, to make trial of their friends’ judg¬ ment, which would often occasion many mirthful mistakes. Yet somewhat more strange it was, that they agreed in mind and nfiection as much as in body ; for what one loved the other desired; so, on the contrary, the loathing of the one was the dislike of the other. Yea, such a con¬ sideration of inbred power and sympathy was in their natures, that if Nicholas was sick and grieved, Andrew felt the like pain, though they were far distant and remote from each other ; this, too, with¬ out any intelligence given to either party. And what is farther observable, if Andrew was merry, Nicholas was so affected, al¬ though in different places, which they could not long endure to be, for they ever desired to cat, drink, sleep, and wake to¬ gether. So they lived, and so they died. In the year 1564 they both served at Havre de Grace, where they differed, indeed, in outward circumstances, one being a cap¬ tain of horse, the other a private soldier. Being both to the last degree brave, they put themselves into posts of greatest ha¬ zard. At length one of the brothers was slain, and the other instantly stepped into his place, and there in the midst of dan¬ ger, no persuasion being able to remove him, he also was slain.’’ But not only individuals of the same family, but persons no way related, have borne an extraordinary resemblance to each other. I shall not waste your time in recounting any of the old stories to be met with in books relative to this subject — many of them bordering on fable; but I may cite a few instances which have a more immediately medico- legal import. A gentleman of the name of Douglas had a narrow escape of being tried for his life some years ago, in consequence of the strong likeness he bore to Page the high¬ wayman. He was committed to prison on the positive oath of a person whom Page had robbed. Mr. Amos relates a remarkable case which occurred under his own observation at Warwick a few years ago. “ A man was indicted for burglary, accompanied with great violence and cruelty, and the prisoner’s person was identified by the woman whose house was robbed, and who described particularly the clothes he had on. Being told that the prisoner’s life depended on the evidence she was giving as to his identity, the witness turned round towards the box, and having sur¬ veyed the prisoner very deliberately for some minutes, said ‘ that, is the man.’ On this one of the principal officers of the Birmingham police said, that he thought she was mistaken, and that she had been deceived by the appearance of another prisoner, who had had sentence of death passed on him the day before for another burglary, very like this in its circum¬ stances, and that he was led to think so, as well from the strong resemblance be¬ tween the two persons as from the circum¬ stance that the dress the woman described was precisely the dress of the other man ; 168 DR. CUMMIN ON FORENSIC MEDICINE. whereas the prisoner, who was a bad cha¬ racter, and had been for some time under the surveillance of the police, never wore such a dress. The other man was then produced in court, and the likeness ap¬ pearing very remarkable, the jury ac¬ quitted the prisoner; though at one period of the trial nobody in court thought that there was the slightest chance of the pri¬ soner escaping being executed Cases are very numerous illustrative of the mode in which identity of the living has been contested and ascertained. One or two of these I may cite for you by way of example. The first is that of Baronet — a remarkable case from the Causes ctlebres, frequently quoted, and which for that reason I shall despatch briefly. Remi Baronet was born in the year 1717, in the diocese of Rheims. At the age of 25 he left his home to seek a liveli¬ hood, and it was not till twenty-two years afterwards that he returned to his native village to look after some little property which he had heard he was entitled to. In the meantime his sister, the widow La- mort, was in possession : she disputed the claim of the new comer — denied that he was her brother — and charged him with being an impostor. She went further. There was a man in the neighbourhood whose son was absent for many years. The woman Lamort, through the agency of her friend the Cure, succeeded in per¬ suading this man that Baronet was his son, and he was induced to recognize the claimant. Babilot was the name of the old man who claimed Baronet for his son. In short, the widow conducted her plot so cleverly, that the unfortunate Baronet was condemned to the galleys for life, as an impostor. On passing through Paris, on his way to the place of punishment, he was visited eagerly by the sister of the younger Ba- bilot, the man wrho he was supposed to be. But the woman, the moment she saw him, denied that he was her brother : he wras a much older man, she said ; nor wras he as tall as her brother, nor so w ell made. How'ever, two years of the sentence ex¬ pired in the labour of the galleys, when, at length, people began to think that it was possible the decision had been too hasty. An order for the revision of the sentence was procured, and the medico-legal investigation of the matter wTas com¬ mitted to the celebrated Louis. He, upon examining the circumstances on all sides, found that there w'ere five capital points of distinction between the two men. 1. Baronet — the rightful claimant — if he were forthcoming, should be 66 years old; * Medical Gazette, vol. viii. p. 36. and the age of the convict appeared to amount to that number (here you will observe that the point of age was the first taken into account) — wrhile Babi¬ lot should be no more than 46. 2. Ba¬ bilot was a straight handsome man, and had been a soldier. Baronet was round- shouldered, and not much above five feet high. 3. It was known that Babilot had a naevus maternus on his thigh ; this Ba¬ ronet had not. 4. Baronet was lame, had clumsy feet, and large ankles ; Babilot was just the reverse. And 5. Both Baro¬ net and Babilot were known to have scars on their cheek and throat : but Baronet, in addition, had one on his eye-browr, which corresponded with the appearance of the convict. The consequence of this wTell-eonducted inquiry wras, that an act wras passed to re¬ verse the sentence of the condemned claimant: the widow was deprived of the property, and Baronet was reinstated in all his rights as a good citizen. The newspapers last year contained a short account of a case of mistaken identity, in some respects very like that just quoted. A man w'as hanged eight years ago, as Daniel Savage, the murderer of a female. The brother of the murdered woman was the only witness to identify the accused, and his evidence was vague. He had observed a cut on the cheek of the murderer, and there was found one on the chin of the prisoner. After sentence, up to the last moment, the convict persisted in declaring his innocence. It appears that the real name of this person w as Ed¬ mund Pine — that he was subject to epilep¬ tic fits— and was of weak mind. When apprehended and examined before the magistrates, he was asked was he Daniel Savage ; he answered “ yes ;” and gave the same answer to every question put to him. Furthermore (as in the Baronet case), the sister of the real Daniel Savage was ad¬ mitted to see the prisoner, when in his cell under sentence of death ; but on see¬ ing him, she immediately exclaimed that that wras not her brother. A lamentable case of a similar descrip¬ tion occurred in this country in the year 1749. One Richard Coleman was exe¬ cuted for a rape and murder committed on a woman named Ann Green. Cole¬ man was convicted on the dying declara¬ tions of the prosecutrix ; but his innocence was fully established two years after his execution, when another person wras hang¬ ed for the same offence, upon the clearest evidence. The fatal mistake was ob¬ viously one of identity, such as persons are very liable to fall into when their senses are confused by bodily suffering, or the heat of passion. Fodere relates a curious case, which MINUTE ANATOMY OF THE LIVER. 169 shews how cautious we ought to be in ad¬ mitting even the evidence of eye-witnesses under certain circumstances. Two soldiers who were drunk got into a scuffle writh some townspeople in the street: one of them presently left the ground, and his companion who remained happened to kill a man. Both soldiers were taken up, and a number of eye-witnesses designated as the murderer the man who withdrew. Justice was unable to come at the truth — yet the alleged murderer was condemned to be executed, and would have been so, had not the prisoners, in their respective hopes of obtaining mercy, where there was so striking a wrant of positive and consecu¬ tive evidence, confessed themselves which was the real criminal. A CONCISE AND POPULAR VIEW OF THE MINUTE ANATOMY of the LIVER ; AS DESCRIBED BY F. Kiernan, Esq. F.R.S. ( From his paper in the Philosophical Transac¬ tions, with the approbation of the Author*.) We have already laid before our readers Mr. Kiernan’s elaborate and valuable paper, but we have received from so many correspondents applications for explanations of particular points, that we are quite satisfied some difficulty is found in fully understanding1 the author’s views. We have endeavoured to give the chief points in a detached form, in such manner as we hope w ill render the importance of Mr. Kiernan’s investiga¬ tions more generally appreciated, still, however, referring to the paper itself, as contained at pages 324, &c. of vol. xv., for more complete and satisfactory details. We may add, that the present abstract has been seen by Mr. Kiernan, who has permitted us to express his ap¬ proval of its accuracy. Surfaces of the Liver. — The liver has three surfaces— viz. 1st, the external , commonly so called ; 2dly, the canals or erforations which contain the larger ranches of the portal vein, hepatic ar¬ tery, and hepatic duct, and called the * And now reprinted at the request of several correspondents, who were unable to procure our abstract in a separate form, or without purchas¬ ing the volume (xv. Med. Gaz. 480) in which it originally appeared.— Ed. Gaz. portal surface ; 3dly, the canals which contain the hepatic veins — the hepatic- venous surface. Substance of the Liver. — This is made up of lobules, vessels, nerve, and cellular tissue prolonged from the cap¬ sule of Glisson. Lobules of the Liver.- — These are small bodies, based on certain branches of the hepatic vein, and bounded by a fine cellular expansion and plexus of vessels. The subdivisions of the hepa¬ tic vein are likened to the branches of a tree, and the lobules to leaves with¬ out foot-stalks resting- upon them, as in fig. 1, which represents a magnified longitudinal section of a small hepatic Fig. 1. appearance (1) h). The lobules are packed close toge¬ ther, but being of various shapes, and generally more or less rounded, they leave interstices between them, which are called the interlobular spaces (fig-. 3, b), while the part where the flat sur¬ faces appear to touch, are called the interlobular fissures (fig. 3, c ). The lobules constitute the secreting portion of the viscus ; each has its own system of vessels, and may be regarded as an independent gland. Vessels of the Liver. — These are 170 MINUTE ANATOMY OF THE LIVER. the hepatic vein, the hepatic artery, and vena portae ; to which may be added the hepatic duct. Hepatic Vein. — The larger branches of this within the liver are called hepa¬ tic-venous trunks; the smaller branches, on which the bases of the lobules rest, centre. The branches of the vena portae running between the lobules are called the interlobular veins (fig. 7, h h b). The minuter ramifications within the lobule are called lobular venous plexuses (fig. 7, c c c), and these last, inosculate towards the centre with the mtrerlobular Fig. 3. are called swMobular veins : each lobule, where it rests on the sublobular vein, is perforated by a minute ramule; and this little vessel, which occupies the centre of the lobule, is called the intra- lobular vein (see fig. 1, e e ). ‘ When the lobule is cut across, this vein is seen to ramify from the centre towards the circumference (see fig. 2, b , c ). The Fig. 2. intralobular vein of one lobule has no communication with that of another, but returns its blood exclusively into the sublobular vein. Hepatic Artery. — This artery, which follows the ramifications of the portal vein and hepatic duct, is distributed ex¬ clusively on the vessels and other tex¬ tures of the liver, for their nourishment. Its blood is then collected by minute veins, and carried into ramifications of the portal veins, where, being now ve¬ nous blood, its farther course becomes the same as that of the vena port®. Portal Vein. — The ultimate destina¬ tion of this is the spaces and fissures between the lobules, whence it is distri¬ buted to each particular lobule ramify¬ ing from the circumference towards the Fig. 7. ramules of the hepatic vein (fig. 7, d d). The mterlobular veins of one lobule communicate freely with those of the adjoining lobules ‘(fig. 7, a a : three lobules are here represented). The larger branches of the portal vein are not in contact with the interlobular spaces on the surface of the portal canals, but are surrounded by a capsular investment, in common with the hepatic aitery and duct. In such situations the three vessels just named send forth branches, which form plexuses in the sheath surrounding them ; and these are called the vaginal branches and Fig. 4. MINUTE ANATOMY OF THE LIVER. 171 plexuses. They in turn give origin to zxterlobular branches. The smaller portal branches are in contact with the interlobular spaces, except where the duct and artery (which always accompany them), interpose. From that part of the circumference of each vein w hich is in direct contact with the inter¬ lobular spaces, interlobular veins are given off directly , but at the other part vaginal branches first arise. — See fig-. 4, which represents a transverse section of such a portal canal, containing1 the vein (a), the duct ( d ), and the artery ( e ). On one side the interlobular branches are seen arising- from the vein directly ( b ), while on the other side vaginal branches are seen to arise (c), and afterwards to subdivide. Hepatic Duct. — The lobular plexuses of the portal vein (see fig-. 7) are accom¬ panied by ducts, to carry away the bile Fig. 6. as it is secreted. These are seen with a microscope as minute yellow points when a lobule is cut across, and consti¬ tute the acini of Malpighi. — Fig. 6, b b , interlobular ducts ; d , lobular bi¬ liary plexuses ; e, intralobular or hepa¬ tic vein. Capsule of Glisson. — This is a cel- lulo-vascular membrane, in which the vaginal, interlobular, ' and lobular branches of the portal vein, hepatic duct, and hepatic artery, divide and sub¬ divide: it lines the portal canals, enters the interlobular fissures, and forms the capsules of the lobules ; nay, it enters the lobules with the blood-vessels : and these several parts of the capsule are called vaginal , interlobular, and lobular por¬ tions respectively. The portal canals, then, are' occupied by the portal vein, hepatic artery, biliary duct, absorbents, nerves, and the cap¬ sule of Glisson. A general idea of the arrangement may be gathered from the Fig. 5. b g h above cut, which represents a longi¬ tudinal section of a small portal vein b , the vein, which occupies by much the largest space ; y, the duct; h, the artery — all of which are seen giving off vagi¬ nal branches; the fine tissue of the capsule investing the whole. Sometimes one set of the vessels above described is in a state of congestion; sometimes another. When the intra- lobular veins are congested, the centre of each lobule appears of a more or less dark red, while the circumference is of a yellow colour: when the interlobular veins are congested, the circumference is dark and the centre lighter. The former is called hepatic venous conges¬ tion, the latter portal venous congestion. Both may exist together, and then the liver shews an uniformly dark colour. In hepatic venous congestion, which is by much the most common, the dark portions are detached ; but in portal congestion they may be continuous. Considerable modifications take place in the aspect of the mottled appearance, according as one or other of these forms of congestion preponderates, and accord¬ ing as it is general or partial ; but no such thing exists as the medullary, cor¬ tical, red, yellow, or other analogous substances, described by previous anato¬ mists (by all of them, indeed, except Professor Miiller, of Berlin), and on the supposed existence of which Andral has based his morbid anatomy of the liver. 172 DR. OGSTON*S STATISTICS OF STATISTICS OF SUICIDE IN ABERDEEN. Bv Francis Ogston, M.D., &. c. ( For the Medical Gazette.) In Aberdeen, from 1826 to 1835 inclu¬ sive, the histories of fifty-two persons have been learned, who, in this period, have seriously attempted suicide : of th ese, thirty-eight have been actual sui¬ cides. Contrary to what might have been expected, the number of serious attempts was the same in females as in males. The fatal cases amongst the former amounted to sixteen, while, amongst the latter, we find twenty-tw o instances of the same. In men, we thus perceive that the actual were, to the attempted suicides, as 22 to 26, or as 1 to 1*18 ; in females, as 16 to 26, or as 1 to 1*62. Taking the returns of the census of 1830, as the mean of po¬ pulation during the ten years fixed upon (which gives the amount of the inhabitants of Aberdeen, including Old Macbar, at 58,019), we have thus one attempt at suicide annually in every ll,157-5 inhabitants, including stran¬ gers who hacr resided here for short pe¬ riods. Calculating in the same way, there would be one actual suicide in every 15,268-15; a result which, com¬ pared with other places, cannot be con¬ sidered otherwise than as very favour¬ able for Aberdeen. But if we exclude strangers who have not had other than temporary residence, the result will be still more flattering ; affoiding only one attempt at self-destruction annually, in every 14,168-29 of the fixed inhabitants, and one actual suicide yearly in every 20.006 55 of the same. As, however, instances occur which cannot be known, particularly in families amongst the better classes, th& former calculation must be nearer the truth. We are not aw-are of any bills of mortality being kept in Aberdeen prior to 1833. In that year, an account of the deaths for eight months are in our possession. Taking the average of these, which gives one death in forty-seven inhabitants yearly, we have one actual suicide in 318-94 deaths. We shall arrange the details which w'e have collected, connected with these cases, under different heads : — 1. Age and Sex. The average age of 52 attempted suicides . 36*19 years. The ditto ditto of 26 male attempted ditto . . 4T15 — The ditto ditto of 26 female ditto ditto . . 3F28 — The ditto ditto of 22 male actual ditto . 43-22 — The ditto ditto of 16 female ditto ditto . 34 25 — Tiie ditto ditto of 4 male incomplete ditto . 29'75 — The ditto ditto of 10 female ditto ditto . 26"40 — Or arranging them in quinquennial periods, we have — Of A ttempted Suicide. • Of A ttempted Suicide. Cases. Males. Females. From 16 to 20 inclusive . 5 1 4 — 21 to 25 di Lto . 12 4 8 — 26 to 30 ditto . 11 5 6 — 31 to 35 ditto . 4 2 2 — 36 to 40 ditto 4 3 1 — 41 to 45 ditto . 2 1 1 — 46 to 50 ditto . 3 2 1 — 51 to 55 ditto . 3 3 0 — 56 to 60 ditto . 5 2 3 — 6 1 to 65 ditto . * 1 1 0 — 66 to 70 ditto . . 2 2 0 — 16 to 70 ditto . 52 26 26 SUICIDE IN ABERDEEN. 173 Of Actual Suicide. Cashes. Males. Females. From 16 to 20 inclusive . 2 1 1 OI /Ii’Ha . . . • • • 7 3 4 • - ^.1 LU CllLLW . - 7 3 4 ■ tO ou ditto oi qk a;++r> ................ 3 1 2 - — • o 1 tO ut) OHIO * * 4 3 1 — ou tO 4U ditto •••*•••••••• 2 1 1 - 41 tO <1 0 ClltlO . . . . 3 2 1 _ 51 to 55 ditto . 3 3 0 4 2 2 - * OU IU UU UIllU . . £? 1 dUtA . . 1 1 0 ■ ■ ■ 0 1. to uo ditto * 2 9, 0 — oo to 7 u ditto •••• •••«••••• 38 1 22 16 — lo to /yj ditto ••••••••*•• The ag’e at which the greatest num¬ ber of attempts at self-immolation hap¬ pens, is thus from 21 to 25 inclusive ; next in frequency are the five years from 26 to 30. The periods at which the greatest proportion of actual suicides take place, are from 21 to 30 inclusive. Amongst the men, the greatest number of attempts are from 26 to 30 ; amongst the women, from 21 to 25 inclusive. It is worthy of remark, that after the age of 35 (with one exception), no ineffectual attempt was made; and that a difference is observable in this respect betw een the sexes, fewer failures occurring in men than in women. 2. Mode o f Death. — Attempted Suicide. By Drowning . — Poison . — Hanging . . — Cutting Instruments ••• — Fire-Arms . — Strangulation . — Precipitation . — Exposure to Cold - ••*••• Total ■ Cases. Male. Female. 19 7 12 11 2 9 9 6 3 6 6 0 3 3 0 2 1 1 1 0 1 1 1 0 52 26 26 Actual Suicide. By Drowning • • * * * . — Hanging . — Poison . — Cutting Instruments • •• — Fire-Arms . — Strangulation . — Precipitation* . . — Exposure to Cold . Total- Cases. Male. Female. 13 6 7 9 6 3 6 2 4 3 3 0 3 3 0 2 1 1 1 0 1 1 1 0 38 22 16 From these tables we perceive that The poison selected w as laudanum, ex¬ attempts to take life by fire-arms, and cept in one case, where corrosive subli- by cutting instruments, are confined, as mate was swallowed. The throat was might have been anticipated, to males, cut in five out of the six attempts by — poison and drow ning being the modes cutting- instruments, most frequently chosen by the females. DR. OGSTON’s STATISTICS OF 3. Assigned Cause. 1 Cases. Male. Female. Fatal. Uncom¬ pleted. Love disappointments . 11 3 8 6 5 Family quarrels . 8 3 5 8 0 Mental depression . 6 2 4 4 2 Insanity . 9 6 3 6 3 Melancholy . * . 4 2 2 4 0 Deranged affairs . 4 4 0 4 0 Intoxication . 2 1 1 0 2 Detection in theft . 1 1 0 1 0 Religious melancholy . 1 0 1 1 0 Drunken quarrel . 1 0 1 0 1 Temporary excitement . . 1 0 1 0 1 Dissipation . 1 1 0 1 0 Poverty . . . 1 1 0 1 0 Dread of punishment . 1 1 0 1 0 Cause unknown . 1 1 0 1 0 Total . . 52 26 26 38 14 4. Occupations. — 1. Females. Cases. Fatal. Uncom¬ pleted. Prostitutes .... . . 11 5 6 Manufactory servants . 4 2 2 House servants . 2 2 0 Paupers . 2 2 0 Farm servant . 1 0 1 Dress maker . l 1 0 Tradesmen’s wives . 3 3 0 Unknown . 2 1 1 Total . 26 16 10 2. Males. Cases. Fatal. Uncom¬ pleted. Weavers . . . . . 4 3 1 Soldiers (including 1 pensioner) . 3 3 0 Labourers . 3 2 1 Shoemakers . . . 2 2 0 Wrights . . 2 1 l Tinsmiths . 2 1 1 Blacksmith . 1 1 0 Hairdresser . . . 1 1 0 Seaman . . . 1 1 0 Carter . * . 1 1 0 Painter . 1 1 0 Teacher . 1 1 0 Baker . . . 1 l 0 Shopkeeper . . . 1 1 0 Writer . . . 1 1 0 Unknown . 1 1 0 Total . 26 22 4 SUICIDE IN ABERDEEN 175 5. State — Married or Single. , Of the attempted suicides, 19 were married, 2 were widows, 1 was a wi¬ dower, and 30 were single. Of the state of one of these last, there was doubts. Of these, 12 men were married, 1 was a widower, and 13 were unmar¬ ried. Of the women, 6 were married, 2 were widowers, and 18 were single. Or, the married (including widows and wi¬ dowers) were to the unmarried as 22 to 30, or as 1 to U36. The married men (including the widower) and the single men were in equal numbers, while the married women (including the widows) were only to the unmarried females as 8 to 18, or as 1 to 2 25. Of the whole number of attempted suicides, it was known that 26 had no children, and that 16 had families. The average number of children amongst these, was 3 to each. 6. YEARS. 1. Attempted Suicides. Male. Female. Total Cases. 1826 . ...1 3 4 1827 . ...2 1 4 1828 . .. .3 2 5 1829 . 2 3 1830 . . . .2 3 5 1831 . 3 7 1832 . 3 4 1833 . ...2 6 8 1834 . 1 6 1835 . ...4 2 6 From 1826 to ) - - - — 1835, inclu-J sive. - 26 26 52 2. Actual Suicides. Males. Females. Total Cases . 1826 . ... 1 2 3 1827 . ...3 0 2 1828 . 1 4 1829 . 1 2 1830 . 2 4 1831 . 2 6 1832 . 2 3 1833 . 4 5 1834 . 0 4 1835 . 2 5 From 1826 to J _ — _ 1835 inclu¬ sive. > 22 16 38 The yearly average of the first table is 5'2 ; of the first five years of the same, 4*2; and of the last five years, 6 2; shewing thus an average of the attempts at self-destruction in this city. The second table exhibits also an in¬ crease of actual suicides, the annual average for the 10 years being 3 8 ; the average yearly number for the first five years, 3 ; and of the last, 4 6. 7. MONTHS. 1. Attempted Suicides. Cases. Cases. January ••• • 4 July . 8 February •• 4 August • • • • 9 March • • • • 4 September* • 2 April . 2 October • • • • 6 May . 1 November • • 2 June . 6 December • • 4 21 Total .... 52 2. Actual Suicides. Cases. Cases. January...* 4 July . 3 February • • 3 August • • • • 6 March • • • * 3 September*. 1 April . 2 October .... 6 May . 1 November . . 2 June . . 4 December . . 3 17 T otal .... 38 From both tables, it will be seen that the last six months of the year predo¬ minate over the first, while August stands highest in each, and May lowest. 8. DAY OF THE WEEK. 1. Attempted Suicides. Cases. Cases. Sunday * * • • 8 Thursday . . 6 Monday • * * - 9 Friday • • * • 1 1 Tuesday-*** 7 Saturday . . 4 Wednesday 5 Unknown •• 2 2. Actual Suicides. > Cases. Cases. Sunday • • • • 6 Thursday • • 4 Monday • • • • 8 Friday •••• 6 Tuesday** •• 7 Saturday * * 4 Wednesday 2 Unknown • • 1 A reason may be assigned for Fridays standing so high in the first table. Tradesmen’s wages are usually paid 176 STATISTICS OF SUICIDE IN ABERDEEN. here on the Thursday night, after which scenes of intemperance are very com¬ mon. Many also receive their weekly pay on Saturday night, which is also often a period of drunkenness and riot, Sunday being* occasionally spent in the same manner. Two of the week-day cases oc¬ curred on days of public worship, and must therefore be added to the religious festivals, in both tables. The cases were arranged according to the days of the month in which sui¬ cides were attempted, or actually perpe¬ trated ; but no generalizations could be obtained from these, the instances being pretty equally divided amongst the dif¬ ferent days. It may deserve notice, that of 43 cases of attempted suicide, in which an approximation to the time was obtained, 29 took place in the hours from noon to midnight, and only 14 between mid¬ night and noon Of 32 cases of actual suicide, 20 were accomplished during the former, and only 12 during the lat¬ ter twelve hours. 9. Religion. Our information on this subject, and that which next follows, is less complete, and less to be trusted, than on the points which precede, and must therefore be received with caution. Of the 52 per¬ sons who attempted suicide, 14 attended no church ; 13 frequented the Esta¬ blished Church ; 2 the Methodist Cha¬ pel ; 2 the Episcopalian Churches ; and 1 the Relief. Of 20, nothing was known in this respect. On a very rough estimate (the respective numbers being unattainable at present with any thing like rig*id accuracy), the attempts at self- immolation would be as 1 to 1384 of those attending the Established Church ; as 1 to 900 Episcopalians; as 1 to 300 Methodists; as 1 to 1000 of the Relief Churches; and as 1 to 633 of those at¬ tending no church. This last calcula¬ tion assumes, that one-half of those of whom no information was obtained at¬ tended no church. 10. Place of Nativity . Of 41 attempted suicides, occurring amongst the resident population — 33 were natives of Aberdeen. 2 were from the south of Scotland. 2 were from the county of Aberdeen ; and of4 the native place was unknown. Of the attempted suicides, occurring amongst those who had no permanent residence in Aberdeen — 3 were from the south of Scotland. 2 were from the county of Aberdeen. 1 was a native of England. 1 wras from Kincardineshire. 1 was a native of Elgin. 1 was from Morayshire ; and of 2 the native place was unknown. 11. Habits. Of the state of 30 out of the 52, whose situation was ascertained previous to the attempt, 20, or two-thirds, were intoxi¬ cated (1 from laudanum), and the re¬ mainder sober : 17 had the character of habitual drunkards, and an equal num¬ ber of temperate persons. 12. Postmortem Appearances. We had an opportunity of being pre¬ sent at eight of the postmortem exami¬ nations in the above cases of actual suicide. Independent of tbe morbid appearances peculiar to tbe mode of death, the following were observed : — 1. The skull in one instance was very thick, and nearly globular; in a second it was also very thick, but much flat¬ tened at the sides; while, in a third, it was very thin, with the processes and ridges on its interior unusually sharp and prominent. 2. Different morbid appearances were met with in the brain and membranes. In one case this viscus was very firm, and less dark-coloured than usual. In another instance the brain was very firm ; in a third, soft, with bony concre¬ tions in each choroid plexus. In a fourth the arachnoid was thickened and opaque, and tbe cerebellum softened. In a fifth case serous cysts existed in each choroid plexus, while both tha- lami, one corpus striatum, and the sep¬ tum lucidum, were broken down into a hard pulp. In a sixth the arachnoid was thickened, with effusion under¬ neath, while the co-mutual surfaces of the hemispheres adhered ; the brain ge¬ nerally being firm, but the fornix softened. 3. The following was tbe state of tbe heart in two cases: — In one the left ventricle was flaccid and attenuated ; in the other it was loaded with fat, its right auricle and ventricle were attenu¬ ated, and its left ventricle hyper¬ trophied. 4. In one case the lungs were emphy¬ sematous ; and in another, generally HYDRATED TRITOXIDE OF IRON AN ANTIDOTE TO ARSENIC. 177 hepatized, with a bony concretion in the substance of one lobe. 5. In two cases the liver was hyper¬ trophied ; in one being* of immense size. In a third the left lobe was softened. 6. In one case the stomach was con¬ tracted almost to the diameter of the duodenum. 7. In one instance the ileum was closely and permanently contracted ; and in another the larger intestines were also unusually contracted, the mucous coat being in both instances softened. 8. In one case the os tincae was found closed by glutinous matter; the uterus was as large as in the fifth month of pregnancy ; its interior was filled with a downy vascular growth ; the fallopian tubes were closed at each extremity, and distended in their middle by a serous fluid ; both ovaria were the seats of serous cysts as large as a walnut. This occurred in a prostitute. 9. In one case the spleen was soften¬ ed. One woman was deaf, and another blind. In six cases the attempt noted was the second, and in one the third. Aberdeen, Oct. 15, 1836. ON THE HYDRATED TRITOXIDE OF IRON AS AN ANTIDOTE TO ARSENIC. 7o the Editor of the Medical Gazette. Sir, Dr. Bunsen’s discovery of the efficacy of the hydrated tritoxide of iron as an an¬ tidote to arsenic, seems to have received in this country scarcely the attention which its importance deserves. It is for the purpose of bringing it again be¬ fore the profession that I send you the following narrative : — On Wednesday, September 7tb, 1836, a man bought a quarter of an ounce of arsenic, and about two o’clock in the afternoon mixed it in a teacup with a quantity of water, stirred it round two or three times rapidly with a tea¬ spoon, and immediately swallowed it ; a portion, not more than a quarter of the whole, remained at the bottom of the cup. He then walked out with a person who had unsuspectingly wit¬ nessed the proceeding, and who was quite incredulous till the man’s altered countenance confirmed his positive as- 466. — xix. sertion that he had taken poison. Nearly a quarter of an hour elapsed be¬ fore he began to feel sick ; he then in¬ troduced his fingers into his throat to excite vomiting, and with some dif¬ ficulty got up a mouthful of a clear fluid. Having reached a house in the neighbourhood, he complained of vio¬ lent pain and retching ; got some salt and water, which he immediately re¬ jected with two or three pieces of potatoe, hut the stomach still retained its other contents. Mr. Sharp, Mr. William Furnival, and myself, saw him soon after three. He was sitting on a chair, with a w ild and anxious expression of countenance, and his eyes were blood-shot; he was perfectly collected, and spoke correctly; had burning pain about his stomach and belly, wffiich was sw elled so as to have burst the buckle of his belt ; vio¬ lent beating at the heart, and an acid taste in his mouth. A pint or two of warm water was thrown into the stomach by means of the pump, and on reversing the action of the instrument, a few ounces of fluid came back easily, but the tube became choked up, and was of necessity with¬ drawn. This was followed by a pretty copious rejection of fluid mixed with potatoes, pieces of which had got into the tube of the pump, and prevented its action. On being cleaned, it was ag*ain introduced, and another portion of warm water injected, but the pump, when re¬ versed, still refused to act, and was finally withdrawn. The sickness had ceased, and could not be renewed by tickling the fauces. He felt something better after the vomiting. It will not be thought irrelevant to say a few words on the state of the man at this moment. He had in the morn¬ ing drunk a glass of rum and several glasses of ale. While under the in¬ fluence of this liquor, and immediately before taking the arsenic, he had eaten five or six cold potatoes. The exact quantity of arsenic swallow ed could not be ascertained, but it must have been a very large dose *. The vehicle in which he took it was one very likely to pro¬ duce its peculiar effects upon the sto¬ mach ; it w as also evident that the sick¬ ness previous to the use of the pump had left the contents untouched, or * A quarter of au ounce of arsenic sold in the shops equals two drachms and two scruples Apo¬ thecaries’ weight. N 178 MR. ROBSON ON THE HYDRATED TRITOXIDE OF IRON nearly so. The injection of the warm water would still further dilute the fluids already in the stomach ; and allowing- that a portion of the arsenic was dissolved and vomited *, would not the very dilution facilitate the deposi¬ tion of the remainder on the mucous membrane P It was now two hours since the poi¬ son had been taken. About six drachms of the carbonate of iron were mixed in water and given to him at twice, one draug-ht immediately following the other. He said his stomach felt cooler ; and his pulse, which had been upwards of 130 just before, sank to 112. The pain ceased, or nearly so. He was ordered to bed, and to take half an ounce more of the carbonate in half an hour. At half-past five I found him asleep, and in a copious perspiration. When he awoke he had no pain ; there were oc¬ casional sensations of burning ki the epigastrium, and strong palpitations ; ulse 108 ; his eyes were still red, and is look anxious. A quantity of the newly-prepared oxide of iron was now administered. In the course of the evening he made a large quantity of clear and healthy urine. The pain con¬ tinuing under the ensiform cartilage, he had ten leeches applied. He did not sleep. About two in the morning he was seized with violent pain and twist¬ ing in the belly, which was followed by vomiting; his bowels acted two hours after, and the urine was abundant. The matter vomited seemed to consist prin¬ cipally of the oxide, but at the bottom of the pot were some pieces of stringy mucus, which might be drawn up the sides amongst the urine ; the stool could not be examined. He said he felt sick and worse after taking the physic; occasional heartburn ; pulse 90. On Thursday morning we had more of the prepared oxide, which was more carefully washed than the first. He said it was not so good to take ; but he had no more sickness ; pulse 75; slight headache. He slept soundly in the night, and early on Friday morning feit an inclination to go to stool, but passed nothing. The oxide was dis¬ continued, and he had an ounce and a * A part of the fluid with potatoes rejected at this period, after having been boiled and filtered, was subjected to the action of sulphuretted hy¬ drogen gas, and assumed the characteristic lemon tint, but remained, perfectly clear. half of castor oil, which operated twice. The first stool was of a formed con¬ sistence, of a dark green colour mixed with brown, and with several pieces of undigested potatoe in it, exactly like those vomited on Wednesday ; the second stool was preceded by some griping, but was not seen. He had some twitching in his head on Saturday, so that, as he said, he was not able to hold it still. Had another stool, of a natural consistence, of a peculiar brown colour, and partially covered with a black shining mucus. His diet during the whole time consisted of gruel, tea, and dry toast. The best commentary upon this case will be a detail of such experiments and trials as have been made with the oxide of iron since its discovery as an anti¬ dote to arsenic. The history of the discovery is given in a letter from Dr. Bunsen to M. Poggendorf, dated May 1, 1834, which is published in the Journal de Pharmacie for October, 1834. “ Having found, first, that pure hydrate of iron precipi¬ tates arsenious acid in solution so com¬ pletely as not to leave a trace of it in the supernatant liquor, — and, secondly, that if a few drops of ammonia be added to the hydrate, and arsenious acid in fine powder be digested with it at a gentle heat, the latter immediately be¬ comes an insoluble arsenite of the tri- toxide of iron,” — the Doctor requested Dr. Berthold to experiment on some dogs, and the result was, that in their opinion it is a better antidote to arsenic than albumen is to corrosive sublimate. Some months after this an accident occurred at Paris which led to much discussion and several series of experi¬ ments. Seven horses got some arseniate of potash in their corn ; four died before any thing was done ; to the other three M. Boulet, a veterinary surgeon, ad¬ ministered the hydrated tritoxide twenty- eight hours after the arseniate : one horse lived three hours, another thirty- six, and the other some days *. These untoward circumstances gave rise to new investigations, and MM. Miquel and Soubeiran instituted a set of laborious experiments on dogs. After some preliminary trials, from which no * TSulletin de Therapeutique, Oct. 1834. It is remarkable that in the first horse that died (of the seven) no arsenic was found either in the stomach or intestines. AS AN ANTIDOTE TO ARSENIC. 179 positive conclusion could be drawn, they tied the oesophagus of a dog’ to ascertain how long* he would live in such a state : the animal died in seventy-two hours. They next gave a dog twelve grains of arsenic, and then tied the oesophag'us : he lived two hours. Another dog had nine grains of arsenic, and, with the same operation, lived two hours and a half. They now g*ave a small dog twelve grains of arsenic, and im¬ mediately after twelve times as much hydrated oxide of iron. The oesopha¬ gus was tied, and the animal left to itself; it tried to vomit. In two or three hours the effects of the poison went off. Twenty-four hours after the liga¬ ture was removed, and as the dog could not swallow solid food, some broth and milk was g*iven to it. It died on the sixth day after the operation. Tn cases where the ligature was not removed, one dog lived seventy-eight, another eighty-four hours. It had the power of retarding* death when given two hours after the operation ; but when joined with fatty substances it was less effica¬ cious. After examining the chemical action of the two substances on each other, MM. Miquel and Soubeiran came to the following conclusions: — 1. That M. Bunsen’s opinion, that the hydrated oxide of iron is a good antidote to arse¬ nic, is correct. 2. The oxide must be used in excess with regard to the arsenic. 3. It instantaneously neutra¬ lizes and precipitates arsenious acid in solution. 4. When the powdered arse¬ nious acid is added to the hydrated oxide diffused in water, its effects are completely neutralized by the oxide ; but it recommences its action the mo¬ ment the oxide is deficient. 5. The oxide will not prevent death when the poison has been long in the stomach. (5. While the oxide prevents any further action of the poison, it is not likely that it will do away the effects already produced*. Early in March, 1835, M. Boulet, who has been already mentioned, read a paper to the Royal Academy of Me¬ dicine (of which he is a member), con¬ taining an account of additional trials. The subjects of his experiments were horses. The first got two ounces of ar- * Bulletin g6n6ral de Therapeutique, Dec. seniate of potash, and immediately af¬ terwards a pound and a half of the protoxide* of iron : the animal lived 57 hours. He now learned that similar experiments, with the same result, had been made at the Veterinary School at Alfort ; and M. Lassaigne, one of the experimenters, accounted for their fail¬ ure by the greater affinity between ar¬ senic acid and potash, than between it and iron. In order to meet this, he tried the sulphate of iron. He gave tw o ounces of the arseniate, and directly afterwards a pound of the sulphate : the horse lived 63 hours. When M. Boulet mentioned these circumstances to Pro¬ fessor Orfila, the professor thought he had not g*iven a sufficient quantity of the antidote ; and in the next experi¬ ment he exhibited two ounces of the arseniate, and four pounds of the hy¬ drated peroxide : death took place in 54 hours. A fourth horse had two ounces of the arseniate, and eight ounces of the sulphate of iron, and died in 52 hours. In all these cases the usual effects of arsenic w ere found in the intestinal ca¬ nal ; and, moreover, in the two instances where sulphate of iron was administered, there was a serous infiltration between the mucous and muscular coats of the stomach. M. Boulet now gave up the arseniate of potash ; and from six dif¬ ferent trials found that it required two ounces of the white oxide of arsenic to kill a horse. On the 16th December he gave one, two ounces of arsenic, and immediately after it four pounds of* the hydrated peroxide. The horse ap¬ peared quite well till the 25th, when he w as killed : two ulcers were found in the stomach, one the size of a crown- piece, the other much less. In two other experiments the lesions were even lighter than these ; in a fourth, the in¬ testinal canal wras found inflamed and swollen in different parts, and an ero¬ sion six inches long, and three broad, in the colon, penetrating through the mu¬ cous, and having disorganized the mus¬ cular coat. To ascertain how long a time might intervene between the administration of the poison and the antidote, one horse had the former two hours, another four hours, before the latter. Both recovered. * It may be stated, that any difference of ter¬ minology in this article belongs to the original writers of the memoirs quoted. ISO hydrated tritoxide of iron an antidote for arsenic. In another case, the oxide given twenty- five hours after, at the time when the first symptoms of the poison appeared, produced no effect, and the animal died in twenty-four hours. M. Lassaigne analysed separately the contents of the stomach, the small intestines, the caecum, and the colon, of a horse, which had been killed seventy-two hours after having taken the poison and the anti¬ dote, having shewn no symptom of being poisoned, and did not find a trace of arsenious acid any where. As a summary, says M. Boulet, it seems to follow from these facts — 1. That the hydrated peroxide of iron will not counteract the effects of the arseniate of potash. 2. That the sulphate is equally useless. 3. That it requires about two ounces of the arsenious acid to poison a horse, and death constantly follow's on the second or third day. 4. That the hydrated peroxide of iron is an anti¬ dote to arsenic, and must be exhibited in a much larger dose than the poison. 5. That when it is given with the poi¬ son, it generally annuls the effects of the latter. 6. That it does so if given four hours after the poison. 7, and lastly, That it does not prevent death if given a long time after it*. Drs. G. Borelli and C. Demaria, at Turin, were, about the same time, in¬ vestigating the powers of the same sub¬ stance, and published the results in the Hepertorio Medico-Chirurgico del Pie¬ monte. , for March 1835 : an abstract of their article is given in the Bulletin de Ther apeutique for May, to which § am indebted. Their first experiments were made on rabbits, and were unsatisfac¬ tory enough, till they ascertained that fifty grains of the peroxide alone was sufficient to cause the death of one of these animals in six hours. When they experimented on dog-s, the consequences were different: in most of the cases the effects were as apparent as in those of Miquel and Soubeiran, and it would be a mere repetition to detail them. In one, six drachms of the tritoxide were given half an hour after fourteen grains of arsenic, and the dog got well ; in another, after twelve grains of arsenic, five drachms of the tritoxide, which had been prepared fifteen days before, did not prevent the animal’s death in twelve hours. Starch mixed with the tritoxide * Bullet, de Tlierap. Mar. 1835. retarded, but did not prevent its action. In no case was there any free arsenic discovered in the intestines. These experiments, if not conclusive, W'ere sufficiently satisfactory to induce any observer to try the peroxide in a case of poisoning by arsenic ; and ac¬ cordingly, M. Geoffroy, officier de saute in a provincial town in France, gave it to a man named Fouquet, a barber, who, in a fit of delirium tremens, had taken a drachm and a half of arsenic tw'enty minutes before. In the course of a quarter of an hour he drank five or six pints of hot or cold water, charged with the peroxide : this was followed by co¬ pious vomiting, and a large stool. Be¬ tween six o’clock and two be was conti¬ nually swallow ing the same liquid, vo¬ mited thrice, and had as many stools. No symptom of the poison shewed it¬ self, but he was still delirious. After eight hours the quantity of the antidote was gradually diminished, and the fol¬ lowing morning (his senses returned gradually) he was convalescent, and asked for breakfast. This man took the oxide prepared from six ounces five drachms of the sulphate of the peroxide of iron, in from twenty to twenty-five pints of water, sometimes hot, sometimes cold*. On the 13th of August, 1835, five little girls, on their w'ay from school, picked up some pieces of a dry, brown, brittle cake, which had been thrown on a dunghill, and each partook of it, about two o’clock in the afternoon. In half an hour there wms more or less vomiting, and the usual symptoms of arsenical poison, inflammatory and spasmodic. At five o’clock they got the tritoxide ; the vomiting gradually ceased, the other symptoms subsided, and the next day the patients were all convalescent. The cake had been made two years before, for rat poison ; and it w as calculated that each had taken about thirty grains of the oxide of arsenic. These cases are detailed by M. Bineau, a physician, and M. Majeste, an apothecary, at Saum urf. Two other cases belong to Dr. Bu- zorini, and are extracted from the Me- dicinisches Correspondenz-Blatt , in the Gazette Medicale de Paris , November * Journal de Med. et Chirurg. Pratiques, Sept. 1835. t Journal des Connaissances Medico-Chirur- gicalea, Nov. 1835. MR. SKEY ON TIC DOULOUREUX. 18! 1835. The poison was given in coffee, about nine o’clock in the morning, May 26th. Dr. Buzorini did not see the pa¬ tients till six the following* morning* ; one had suffered severely from ineffec¬ tual efforts to vomit; the other had been very sick. These and the other symp¬ toms gradually gave way, and both pa¬ tients recovered by the end of the month. The quantity of arsenic taken was, in one instance, not ascertained, but eigh¬ teen or twenty grains were found at the bottom of the cup ; and, in the other, it is stated at thirty-five grains ; but no data are given for this assertion. Such are all the facts which I have been able to ascertain respecting* this important discovery. It remains for me to describe the plan of administering the tritoxide in our case. The man, as has been stated, had six drachms of the common carbonate as soon as the sto¬ mach-pump was removed, and four drachms in half an hour more ; this was done for the purpose of getting time to prepare the new oxide, after the formula used by M. Majeste, in one of the cases already mentioned. Half an ounce of iron filings was put into an earthenware pipkin, and two ounces each of the muriatic and nitric acids poured upon them. This was put near the fire till the iron was dissolved ; half a pint of dis¬ tilled water was added, and in a few minutes the pipkin was removed from the fire, and an ounce and a half of liquid ammonia poured into it. A fresh addition of water was made, the whole stirred up, and allowed to settle for ten or fifteen minutes. The upper portion was poured off, and more water added, which, when the precipitate had pretty much fallen, was again decanted. The whole of this remainder was put into a bottle, and when we saw the man at half-past five, it was decanted into a basin to within three or four ounces, which formed the dose ; and in this way he took half a tea-cupful of the dreg’s of the liquid every half hour. During Thursday he had it every hour. M. Majeste made use of twice the quantity of iron, &c., and states that from it he obtained twelve ounces of the hydrated tritoxide. M. Lassaigne prepared his tritoxide in the same way, but without the muriatic acid. MM. Miquel and Soubeiran make it with the sulphate of iron, a quantity of which is put into a capsule of platinum, or porcelain, with five or six times its weight of water ; when it boils, nitric acid is gradually added till the red fumes cease to appear. The liquor is then diluted, and the oxide precipitated by adding ammonia in ex¬ cess: it requires washing like the other precipitates. It may be well to observe, that the precipitation takes place sooner in a large quantity of liquid than in a small one. — I am, sir, Your obedient servant, John Robson, House-Surgeon to the Warrington Dispensary.. Warrington, Oct. 11, 1836. ON THE NATURE AND TREAT¬ MENT OF ACUTE NEURALGIA, OR TIC DOULOUREUX. To the Editor of the Medical Gazette . Sir, If you think The inclosed cases, with the accompanying remarks, of sufficient interest to warrant publication, you will obi ige me by transferring them to your pages. They relate to a disease interesting rather from its intensity, than either from its frequency or its danger, in the treatment of which, the medicine em¬ ployed exhibited its remedial influence in so unequivocal a manner, that I make no apology for intruding them on the attention of your readers. In the majority of cases of acute neu¬ ralgia, or tic douloureux, the pain has been referred to that part of the face in¬ volving the distribution of the 2d divi¬ sion of the 5th pair. Emerging as it were from the infra orbit, foram., the pain darts with electric rapidity towards its terminal ramifications, involving many, but limited in its greatest intensity to a few of its branches. When it has existed with severity during a long pe¬ riod, its frequent recurrence appears to involve the ramifications of the nerve which extend in the direction of the mastoid process, This may possibly have led to the belief that the portio dura itself might be the actual and pri- ~ mary seat of the disease — an occurrence which, if 1 may, without prejudice, de¬ termine from my own reasoning*, and comparatively limited experience, ap¬ pears to me, to say the least, highly im¬ probable. My own experience has never furnished me with a case in which MR. SKEY ON THE NATURE AND 182 the pain of acute neuralgia, arising’ in the neighbourhood of the stylo-mastoid foramen, extended itself along the track of the portio dura with the rapidity or the intensity with which it attacks the 5th pair. Doubtless, a certain amount of pain attends that frequent morbid condition of the portio dura which is the precursor and attendant on paralysis of the face : at least I have seen no ex¬ ample of the latter affection in which pain in that region has not been both a precursor and an attendant symptom. But in the latter description of case may not the nerve be secondarily affect¬ ed, and is not the temporary suspension of its function referrible to the pressure of the surrounding parts, inasmuch as it invariably yields under the influ¬ ence of local depletives and counter- irritants ? If acute neuralgia consist in an inflammatory condition of an affected nerve, is it reasonable to expect that the ordinary signs of inflammation should be absent ? Is it reasonable to attribute to the effects of inflammation, or to in¬ flammation itself, a condition of nerve which admits of almost instantaneous mitigation from the use of remedies, highly aggravative of inflammation in other parts ? Do we possess any experience with which we can determine the amount of pain arising from actual inflammation of the portio dura, or even whether pain, nnusual in kind or degree, would be an attendant symptom at all ? The opera¬ tion for the removal of a portion of nerve affected with acute neuralgia has de¬ tected no morbid, or at least no inflam¬ matory condition of the nerve. Again, it is notorious that a paroxysm of neuralgic pain is frequently induced by the most gentle application of the hand, by a current of cold air, or the slightest effort of the affected part ; yet it will not only bear forcible pressure, but is actually relieved by it. If the pain be referrible to the distension of the neurilema, and their pressure on the nerve by the dilated vessels, of course the external pressure predominating*, ought to increase the pain. In severe cases of neuralgic pain of the sciatic nerve, the same fact, 1 be¬ lieve, generally holds — pressure on the nerve for the most part mitigating ra¬ th er than aggravating* the pain. I have myself submitted cases of sciatica to the severest treatment, by cupping, blister¬ ing, and embrocating, from none of which remedies have I ever obtained the smallest remission of pain. In one severe case tbirty-six ounces of blood were taken at one time, by cupping over the track of the nerve. This was succeeded by a succession of blis¬ ters, liniments, and embrocations, with¬ out affording relief. Had the benefit been partial or temporary, a sceptical pathologist might have found material for an opinion favourable to inflamma¬ tion ; but the pain was literally unmiti¬ gated : and I speak with confidence on this head, for I was myself the subject of it. Is there any difference, except in in¬ tensity, between the diseases known under the terms tic douloureux, neural¬ gia, and sciatica? They all affect sen¬ sitive nerves, the motor functions in the case of sciatica remaining unaffected ; nor is this more remarkable than that the sensitive branches of the face can be paralysed, without the smallest in¬ fluence being conveyed to the motor nerves of the same part. Neuralgia, either acute or chronic, is considered an excess of the natural function of the nerve, a “ morbid sensibility and are not twitchings, chorea, or convulsions, a “ morbid activity” of the spinal motor nerv.es in which sensibility is unaffected ? Yet we do not treat these as inflamma¬ tion of the nerves themselves, although they may possess a remote origin in altered structure. What are the most effi¬ cient remedies in neuralgia? Certainly not those which experience teaches us as most influential in the treatment ofin- flammation — ammonia, guaiacum, iron, colchicum, bark. A form of neuralgic pain which frequently attacks pregnant women, and occasionally referred to the presence of a carious tooth, I have re¬ peatedly seen relieved in the course of a few hours by half-drachm doses of the muriate of ammonia, taken in solution. I cannot comprehend the nature of such influence on any theory of an inflam¬ matory condition. Again : the treat¬ ment by depletion and counter-irritants, as far as I have seen, is invariably un¬ successful ; nor do I believe that the digestive system exerts any beyond the most remote influence over the disease. To the above may be added, as unfa¬ vourable to the inflammatory condition, the fact of the periodical nature of the attacks in some individuals, with their pertinacious adherence to a few of the branches of the affected nerve ; and this TREATMENT OF TIC DOULOUREUX. 183 is the more remarkable when we consi¬ der the propensity which the various forms of inflammation possess to extend along- the textures primarily affected by them. Surely there is no resemblance between the influence possessed by the remedies employed in acute neuralg-ia and that exercised by bark, steel, and other tonics, in cases of chronic inflam¬ mation of the asthenic form, which, as it were, overwhelm the disease by the force and vigour they give to the circula¬ tion ; for here the effect, though most imperfectly understood, is direct and al¬ most immediate. My friend and neighbour, Mr. Spry, a well-known member of our profession, has suffered from repeated attacks of acute neuralgia since the year 1827, which occupied the region of the lower jaw on the right side. The pain, which was occasionally intense, originated from the mental foramen of thatside,and thence extended in various directions along the track of the mental nerve. When the attack was somewhat more than usually severe, the pain shot outwards towards the mastoid process, but never originated in that region. It was at any time ex¬ cited by gentle friction of the hand, or by a current of cold air. Previous to the year 1835, he had employed most ac¬ tively the remedies usually resorted to by professional men, with occasional, but only temporary, mitigation. During the early part of the year 1835, he con¬ sulted a medical gentleman of considera¬ ble experience in the treatment of simi¬ lar affections, who recommended him that of counter-irritation. In conse¬ quence, he commenced the application of leeches, about a dozen at a time, which were repeated at intervals of two or three days. In this manner he applied, in succession, about six or seven dozen. This plan was prosecuted by the use of blisters, of which he applied many, and these were succeeded by an ointment composed of deuto-ioduret of mercury. The effect of these remedies, as regards the face, was great tenderness and exco¬ riation, and a remitting pain was con¬ verted into an unremitting one ; as re- ards the disease, it was undiminished, saw him after this plan was relin¬ quished, in a paroxysm of pain, and at my recommendation he took two scruple doses of the muriate of ammonia. The first dose relieved his pain in a very consi¬ derable degree ; to use his own expres¬ sion, “ in a greater degree than any medicine he had ever taken.” The second dose produced a trifling diminu¬ tion, while the third was inoperative. About the month of August in that year he was recommended to try the effectof theaconitine,fivegrains ofwhich, obtained at Morson’s, in Southampton- Row, were rubbed down into an oint¬ ment with five drachms of cerate. The first application subdued the pain in a partial degree. It was applied in a small quantity by the forefinger over the track of the painful nerve, and was gently rubbed, or rather smeared, over the surface, for half a minute or longer. Th ese applications were made according to the degree of pain — either once or twice in the day. They were applied during six days only, when the pain ceased entirely : nor has he suffered from relapse to the present hour — a period of fourteen months. He describes the medicine as very powerful, pro¬ ducing a sense of numbness over the jawr, which continued for about twelve or eighteen hours, and during- w'hich the functions of the motor nerve w’ere perfectly unaffected — so that the effects were rapid and conclusive. He can now face any w'ind or temperature with impunity. He informed me that in consequence of the manifest advan¬ tages which he had derived from the aconitine, he recommended its use to a lady who, like himself, had been a very severe sufferer from this disease, — that she made the same applications, and with the same result, although she has, I am informed, suffered a slight relapse, from w hich the same remedy once more relieved her. Richard Hodge, aged 40, a fisher¬ man, of dark swarthy complexion, and apparently of healthy constitution, was admitted into St. Bartholomew’s Hos¬ pital on September 10. During the last eight years he has been suffering from acute neuralgia of the right side of the face, for the relief ofwhich three molar teeth had been at various times extracted. On the extrac¬ tion of the first tooth, a portion of alveo- lary process was fractured, by which the pain, instead of being relieved, was greatly aggravated. His medical ad¬ viser ordered him to be cupped, embro¬ cated, and blistered, from which he derived no benefit. Among a large variety of other medicines which he had taken were dark powders (probably earb. ferri), which produced but little 184 MR. SKEY ON TIC DOULOUREUX. relief, and, indeed, the whole treatment was inefficient. A surgeon at Scar¬ borough, whither I presume he resorted for his health, extracted two sound teeth, and applied leeches and electri¬ city during four months without benefit. From Scarborough he visited Exeter, where a repetition of the same treat¬ ment was threatened, but not carried into execution. During the whole of this period he had had no longer cessa¬ tion of pain than three or four days in succession; and though he continued to follow his occupation of a fisherman, he was frequently driven on shore by the severity of the pain, for the occasional relief of which he resorted to laudanum. His present symptoms are, severe darting and sometimes fixed aching pain, after long continuance, oil the right side of the lower jaw, extending as high as about the middle of the face, and including half the nose ; pain un¬ der the tongue; flashing of light before the right eye when the paroxysms are intense, causing- depraved vision. He is rarely free from pain for more than two or three days, and describes a con¬ stant gnawing sensation over the affect¬ ed side of the face ; pain exasperated by movement in eating, drinking, or speaking, or by the application of either extreme of temperature : it often wakes him from sleep. Temperature of each side of the face the same. His constitution is apparently healthy, and he has not been addicted to drink. On the 14th I ordered him the oint¬ ment employed in the former cases — Aconitin. gr. v. ; Cerat, 3vj. Up to the 28th the ointment had been used most sedulously, without pro¬ ducing any perceptible effect either on the skin or upon the nerve. On the 28th some aconitine, obtained from Morson, w-as used as above, the application of which was followed by the same benefit which attended its use in the former cases. When asked to describe the effect produced by the ointment, lie said, “ It appeared to search out the pain.” He could not bear its use more than once a day, as his face swelled after its application. He likewise said it produced a numb¬ ness of his face for some time after. He applied the ointment about eight days, and from this period to the 11th of October he has had no recurrence of actual pain : on this day he left the hospital in good health and spirits, suf¬ fering only occasional twitchings, which he declares “ are not worth mention¬ ing.” He used ten grains of the drug. These two cases are not introduced to your notice with the intent to claim the merit of originality of treatment ; — I obtained the hint from others, and have but verified their recommendation. The interest of the cases may be found in the fact that an acro-narcotic poisou will cure a local pain, where every de¬ scription of depletive and counter- irritant has failed. What reasonable practitioner, however fond of trying new methods, would dream of rub¬ bing in aconite ointment over a local inflammation ? — yet why not, if tic douloureux be an inflammatory disease ; for it will undoubtedly cure that. It ap¬ pears to me just as reasonable to at¬ tempt the cure of local phlegmonous inflammation by aconite ointment, as to hope to mitigate acute neuralgia by leeches and blisters. Pain may be a concomitant of inflammation, but singly can never constitute it. When an at¬ tendant symptom, it never greatly pre¬ ponderates, but always holds a certain ratio to the rest. And does not the very fact of excessive pain lead the practi¬ tioner towards the opinion, should in¬ flammation really exist, that there is something’ more — some nervous derange¬ ment, either physical or vital, giving an eccentric character to the case ? Probably sciatica differs but in in¬ tensity from tic douloureux : there is the same irregularity of pain, darting along a sensitive nerve, and excited by the same causes. It will in some in¬ stances pursue with great exactness the distribution of the posterior crural nerve, dividing above the ham, and following the two branches of posterior and ante¬ rior tibial to the foot. Neither do these cases yield to counter-irritants or deple¬ tives, although sciatica runs its ordi¬ nary career more rapidly than the acute form of the disease. Its cure may be referred to means which really possess no influence over it. Sciatica, except in old persons and in confirmed cases, generally, I believe, yields to the in¬ fluence of time without treatment, or at least is greatly mitig’ated by it. During the last autumn, while I was on duty at St. Bartholomew’s Hospital, I happened to have three cases of scia¬ tica in the hospital at one time: one MR. BUSK'S CASE OF POPLITEAL ANEURISM. 185 case was complicated with other dis¬ ease ; in the other two, antiphlogistic treatment, as it is termed, had been freely but inefficiently applied by their respective medical attendants, — in one during six weeks, and in the other dur¬ ing three. Both recovered with com¬ parative rapidity under the use of col- chicum given in large doses, with guaiacum and opium. The aconite, if a very expensive me¬ dicine, is at least a very powerful one. The drug first employed in the case of Richard Hodge was, I presume, ob¬ tained from a French house in London, by which it is imported from M. Pelle¬ tier in Paris. However, it was per¬ fectly useless; while that which was obtained from Morson was as strikingly efficient. — I am, sir, Your obedient servant, F. C. Skey. Charter-house Square, Oct. 26, 1836. CASE OF POPLITEAL ANEURISM. RAPID AND PERFECT CURE. To the Editor of the Medical Gazette. Sir, Some apology probably may be thought necessary for troubling your readers with an account of a case of popliteal aneurism ; but I send the following as an instance of the shortness of time in which the circulation in the limb, and through an aneuHsmal tumor, may re¬ cur, after ligature of the femoral artery, in a subject, moreover, whose arterial system generally w as in a morbid con¬ dition, and yet without impeding the perfect cure of the aneurism. The number and size of the anasto¬ mosing vessels in the head and neck render the phenomenon of quickly- restored circulation less remarkable in cases where the carotid has been tied, of which fact numerous instances are on record ; as one of which I may cite a case of orbital aneurism, of which a short report was given by me, and pub¬ lished in your journal for February 27th, where full pulsation returned in the tumor four hours after the opera¬ tion, but yet without interruption to the entire removal of the aneurismal disease. The cause, however, of the quick restoration of circulation in the present case is not so obvious, as the disease can hardly be supposed to have existed long enough, or to have at¬ tained sufficient size so far to inter¬ rupt the course of the blood through the main channel, as to give rise to much enlargement of the collateral vessels ; and, on the other hand, the event proves there was no unusual divi¬ sion of the femoral artery, as occurred in a case operated on by Sir Charles Bell ; and in one, a preparation of which is in the museum, I believe, of St. Bar¬ tholomew’s Hospital : and these circum¬ stances, of long-continued pressure from a large tumor, and unusual distribution of vessels, are the only causes commonly assigned as accounting for a rapid re¬ storation of the circulation, as indicated by pulsation in the tumor, and continua¬ tion of the vessel below it. Both the case above alluded to and the one I have now forwarded, show also the marked and the immediate good effects of blood-lettinsf on the occasion of any considerable increase in the pul¬ sation of an aneurism after ligature of the artery supplying it. At the conclusion of the relation of the case of orbital aneurism, I stated that 1 should report any further chang’e that might occur in the subject of it while under my charge. When he left the hospital his eye had quite returned into the orbit, and no vestige of the tumor remained, but with the paraly¬ sis of the left side of the face, including the eye-lids, unaltered; his vision, how¬ ever, as far as the optic nerve w as con¬ cerned, unimpaired. In alluding to this case, I take the opportunity of recalling attention to two cases of aneurismal orbital tumors which were, I imagine, of a very similar nature to the one related by me, reported, the one by Mr. Travers, in the second volume of the Medico- Chi rurgical Transactions, and the other by Mr. Dairy mple, in the sixth volume of the same publication. These two cases are given as, and I believe gene¬ rally considered as, instances of Mr. John Bell’s aneurism by anastomosis. The propriety, however, of this diagno¬ sis may probably admit of question ; but it would entail too long a disquisi¬ tion to enter on the question here. I am not aw are of other cases of similar nature being on record, nor, conse¬ quently, of any post-mortem examina- 186 MR. BUSK’S CASE OF POPLITEAL ANEURISM. tion which might throw positive light on the subject. I have the honour to be, sir, Your obedient servant, John Busk. Seamen’s Hospital, Dreadnought, Oct. 23, 1836. P. R. Welshman, aged 37, admitted July 22d, 1836 ; short and muscular in appearance, but pale. He has a large pulsating tumor in the left ham, which protrudes also slightly on the inner side of the thigh, in front of the inner ham¬ string; painful on pressure, not dis¬ coloured, and compressible. A loud very distinct aneurismal whiz is heard on applying the stethoscope ; pulsation in the tumor ceases on compressing the artery in the groin. It is stated to have commenced about five weeks ago, and no cause for it can he assigned, nor can he remember any sudden snap or attack of pain. The considerable size of the tumor prevents extension of the limb. Its greatest length is about five inches, and breadth about four. He states that he has long been subject to dyspnoea on exertion, and to sudden attacks of pain in the region of the heart. The heart’s impulse is powerful, and can be felt over an extended surface ; and with the stethoscope a strong bellows sound can be heard accompanying its action : this sound, is loudest under the middle of the sternum, and on the left side, between the cartilages of the third and fourth ribs. The course of the abdominal aorta can readily be traced by the eye when he lies on his back, but is unac¬ companied with any sound. The fe¬ moral arteries on both sides can also be seen to pulsate to their passage through the adductors, and they seem to the touch to be of larger calibre than usual. The continuation of the right anterior tibial on the dorsum of the foot can also be readily seen, but is not so distinct on the left. All the arteries which can be felt pulsate powerfully, and appear of large size, and the pulsation in most of them is accompanied with a peculiar sort of thrill. In the evening he was seized with acute pain in the cardiac region, for which a sinapism was applied. July 23d. — Fiee from pain. Y.S. to xx. oz. 24th. — Blood buffed and cupped. He feels lighter; tumor unaltered, and very painful when touched. I then pro¬ ceeded to secure the femoral artery in the upper third of the thigh, with a sin¬ gle fine ligature. The vessel was of larger size than I ever observed it be¬ fore : the passage of the needle caused so much pain, that I examined the part with great care for any nerve which might be in danger of being included, but could observe none. On the knot being tightened, he felt very acute pain ex¬ tending down the whole limb, and which lasted several minutes. The wound was united with numerous fine sutures. The pulsation of the tumor immediately ceased, but its size was not immediately much altered. No other change took place in the limb, and assiduous friction was kept up for several hours. 25th. — Has passed a tolerable night, with occasional pain, from which he is now quite free. The tumor, which is greatly diminished, is still very tender; limb’s appearance and temperature na¬ tural; pulse 96, hard; tongue white. R Tinct. Digitalis IT[v.; Magnes. Sulph. 3j.; every 6 hours. 26th. — Has had some pain extending down the leg during the night, and complains of a constant numb, yet pain¬ ful sensation, in the upper two-thirds of the tibia. The wound is entirely united, excepting the exit of the ligature, and without least inflammatory blush. Pulse 84; skin cool. Pergat, and an opiate, at night. 27th. — Very little pain, but does not sleep. Pulsation is distinct in the tu¬ mor, and in the dorsal artery of the foot. Pulse 90, firm. V. S. to x. oz. Pergat. 28th. — Pain lessened ; pulsation not at all increased ; pulse 86, soft. A co¬ pious deposit of lithic acid sand in his urine; blood buffed and cupped. 29th. — Pulsation in the tumor not in¬ creased, but he has considerable pain and tenderness in it; pulse 86, much softer than it has been. The force of the circulation generally appears to be diminished. 30th. — Tumor not so tender; pulse 84, soft; tongue clean. He does not sleep, notwithstanding a strong’ opiate, and has startling dreams. In the even¬ ing, the pulsation of the tumor having become more evident, pounded ice in a bladder was applied to it, and 12 oz. of MR. BUSKOS CASE OF POPLITEAL ANEURISM. 187 blood taken from the arm ; and at night he took a grain of muriate of morphia. 31st. — Has passed a good night, and is free from pain. Blood taken last night buffed and cupped, with a small coagulum. Pulsation very indistinct in the tumor, and hardly to be distin¬ guished in the foot. No pain or tender¬ ness in the tumor. His urine still de¬ posits a copious lithic sand. R Magnes. Sulph. 3b Calcinat. 3ss. T. Digitalis vij., 6tis horis. August 1st. — Pulsation and size of tumor very much diminished, and he complains of very acute pain in the ex¬ tremity of the left thumb, which is a little swelled. Hirudines xij. Poultice. 2d. — No clear pulsation to be detected in the tumor ; thumb and middle finger very painful — apparently from some gouty affection. Hirudines xxx., which in the evening had not afforded much relief. Adde Vin. Sena. Colch. 3ss. Sing, haus- tibus. 4th. — Hand easier; leg free from pain. 5th. — Hand well ; no pulsation in the tumor, and very indistinct in the foot ; urine loaded with lithic acid. (5th . — Has rheumatic pain in the knee, which prevents sleep. Pergat. 7th. — Rather more pulsation in the tumor ; the passage of the gravel causes much pain in the urethra. Y.S. ad Jxij. 8th. — Blood buffed and cupped ; knee less painful ; sand very copious. Adde Liquoris Potassa?, 3ss. haustui. Omitt. Magnes. Sulphas. 9th. — Pulsation can be felt only on the inner side of the tumor; urine with less gravel, and smells strongly. 11th. — Free from pain. The ligature remaining firm, was tied round a piece of bougie, in order to keep up extension, and on the next morning was found detached. 15th. — Has occasionally darting pain about the wound, where there is some hardness; it has been long healed, ex¬ cepting at the exit of the ligature. The popliteal tumor has been stationary the last few days, and still obscurely pul¬ sates; it is free from pain, but prevents full extension of the limb. A bandage was applied from the toes upwards, with a compress over the tumor, but the pres¬ sure could not be long borne. 22d.— Has no complaint but of slight pains in the knee ; tumor much the same, and still pulsating ; the bandage and compress have been applied when¬ ever they could be borne. 23d. — Has great pain about the heart, and more than he had in the knee. The heart’s action is violent, and the bellows sound loud in the situation of the left ventricle. V.S. ad Ijxij. F. C. regioni cordis. Hirudines xij. genu. I11 the evening the pain about the heart was much relieved ; knee much the same. Blood buffed, and slightly cupped. Yin. Colchiei, 3j.; Muriat. Morphiaa, gr. j. h. s. 24th. — The pain in the knee conti¬ nues, but he has none about the heart. R Ext. Colchiei Acetat. gr. ss. ; Ext. Hyosciam. gr. iij. ; Morphias Muriatis, gr. Ter die. Sept. 4th. — The tumor very small, and quite free from pain or pulsation. He still feels, occasionally, pain in the inner side of the knee and tibia, where there is also some degree of numbness. A small fistulous opening still remains in the wound. 10th. — A few drachms of pus escaped suddenly through the small opening in the wound, since the discharge of which all pain has left him, and on the 12th — He was discharged quite well, having perfect power of flexion and extension. The femoral artery can be felt pulsating to within an inch and a half of the spot at which the ligature was applied, and pulsation is very dis¬ tinct on the dorsum of the foot. Scarcely any remains of the tumor are to be found, more than a little fulness in the ham, and slight induration ; no pulsa¬ tion whatever. He feels well in all re¬ spects, but the bellows sound still ac¬ companies his heart’s action. I had prepared to send this account for insertion in your journal some time ago; but as the man, about the time I had it ready, returned to the hospital labouring under an attack of acute rheu- 188 MR. ROBERTS ON THE EFFECTS AND USES OF SMOKING. matism in the arms, and also affected with severe rheumatic pericarditis, I delayed the sending- of the history of the case until he should have recovered from the attack, which at one time ap¬ peared doubtful. He is still labouring- under considerable affection of the heart, and rheumatic pains in the hands and arms ; his leg- remains well. A NEW METHOD OF PREPARING IODIC ACID. To the Editor of the Medical Gazette. Sir, I send for insertion in your valuable periodical a new method of obtaining iodic acid ; it will he found to be cheaper and safer than the mode used by Sir Humphry Davy, and afford a purer acid than the plan proposed by Gay Lussac. I say purer, since, from some late experiments, which I intend to repeat, I am led to conclude withJSir H. Davy, that the acid of Gay Lussac is sulpho-iodic acid. Put one atom, or 124 grains, of iodine into a bottle containing 24 ounces of water, and pass chlorine, previously washed, through the mixture, until this having undergone various changes of colour, from orange-red to yellow, shall have become as colourless and transpa¬ rent as water. The solution is then to be carefully heated to 212° Fabr. to ex¬ pel the excess of chlorine, and five atoms, or 690 grains, of pure oxide of silver being added, the mixture is to be boiled for ten minutes, filtered, and cau¬ tiously evaporated to dryness. The pro¬ duct is pure iodic acid, and must be kept in a well-stoppered phial. Since the liquid obtained in the first part of the preceding process not only possesses the taste and smell of muriatic acid, but will also afford that acid by distillation, it is but reasonable to con¬ clude that the liquid itself is a mixture of muriatic and iodic acids w ith water, and consequently that the chloriodic acicl of Sir Humphry Davy is merely chlo¬ ride of iodine, with a variable quantity of iodine in excess. I have not, how¬ ever, been able to combine chlorine and iodine directly in the proportions neces¬ sary to produce these acids (muriatic and iodic) on being dissolved in water, but I have no doubt that this may he done in a sufficiently reduced tempera¬ ture. In the most considerable experi¬ ment which I made on this subject, 50 grains of iodine absorbed 41 5 cubic inches, or about 31 grains of chlorine. The orange-coloured product thus ob¬ tained, on being dissolved in water and exposed to the light for a few days, deposited nearly 8 grains of iodine, and became of a pale yellow colour ; in which state it still remains, and gives, w ith nitrate of silver, a white precipitate, soluble in ammonia. As the iodate of ammonia is not de¬ scribed in any work on chemistry with which I am acquainted, I think it right to state here that it is a highly crystal¬ line granular powder, and possesses but little solubility. The iodic acid is open to so many objec¬ tions as a test for the presence of morphia, that no reliance ought to he placed on it, since it affords a precipitate not in any way to be distinguished from that by morphia with the following sub¬ stances — viz. sulphocyanic acid; the sulphocyanates of potash and soda; saliva, doubtless from the presence of the above ; urine, perhaps from the same cause ; albumen ; arsenite of potash ; tartarized antimony ; and the proto-salts of iron, tin, and manganese. The importance of these facts, in a me¬ dico-legal point of view, is considerable. The solution of muriatic and iodic acids will answer equally well as iodic acid alone, for the purpose of test¬ ing- morphia. — I am, sir, Your obedient servant, Lewis Thompson, Member of the Royal College of Surgeons. Roe-Buck Place, Great Dover Road, Nov. 2, 1836. EFFECTS AND USES or SMOKING. To the Editor of the Medical Gazette. Sir, If you think the following observations upon the effects of smoking worth pub¬ lication, their insertion in your journal will oblige, sir, Your obedient servant, Frederic Roberts, m.r.c.s. Galt-y-Beren, Carnarvonshire, October 23, 1836. MR. ROBERTS ON THE EFFECTS AND USES OF SMOKING. 189 The properties of the tobacco plant are well known to be those of acting upon the heart, producing- an irregu¬ larity in its action, which is at first in¬ creased, and afterwards becomes dimi¬ nished, or altogether suspended, whereby the circulation is stopped, and syncope produced. Nausea, vomiting, vertigo, tremors, dilated pupil, cold perspira¬ tions, a very feeble pulse, with great anxiety and dejection, are the symp¬ toms of an over-dose of the infusion , which Sir B. Brodie has proved to dif¬ fer in its action from the distilled oil , by reason of the latter containing no nicotin ; and “ whether applied to the tongue or injected into the intestines, does not stop the action of the heart and induce syncope, like the infusion of tobacco, but that it occasions death by destroying the functions of the brain, without directly acting on the circula¬ tion. In other* words, its effects are similar to those of alcohol, the juice of aconite, and the essential oil of almonds.” Upon these principles, it is exhibited as an antispasmodic and diu¬ retic in dropsy and dysuria. Its good effects in asthma, colic, ileus, and stran¬ gulated hernia, prove its antispasmodic properties in an eminent degree. It has a powerfully sedative influence upon the nervous system, as is familiarly ex¬ emplified by its relieving appetite when chewed. Upon the same principles also, I shall endeavour to show the effects of smoking, which greatly vary in different constitutions. Smoking, when moderately indulged in, relieves tension and constrictions, by gently relaxing muscular fibre ; and by its action on the heart it moderates the circulation, and determines to the cen¬ tre, thereby rendering the circulation in the capillaries less active ; which, I sup¬ pose, w'as the reason that led to its em¬ ployment lately on the continent in scarlatina. A very frequent effect of smoking is to excite the action of the intestines; indeed, “ suppositories of the leaf are used in India, to provoke the action of the bowels in children.” Its operation in this manner is effected by increasing the secretion of the mucous membrane of the intestines , as the exha¬ lation by the shin is diminished. The constriction of the skin, from disorder of its function, is succeeded by a relaxa¬ tion, if the smoking is continued or in¬ dulged in, by one of a relaxed habit, or of an irritable stomach. However ob¬ noxious and worthless this plant may be considered, there is no doubt that the Creator intended it, like every thing else, for some purpose, and has in like manner placed it where it would be most required. Upon the principles, then, on which wre have shewn this plant to operate, it must be considered as a natural provision for man against the evils which the nature of his climate subjects him to: where¬ upon we find tobacco growing in a country w'here man, from excessive heat, becomes exhausted by profuse perspira¬ tion, from which this leaf so agreeably relieves him. The evil of a slight de¬ termination to the centre, which might occur, would be counterbalanced by the good effects of checking the profuse sweating, and the action on the bowels. The custom of smoking by Europeans in hot climates must, in this manner, be frequently beneficial ; as in moderating the perspiration, the excessive secretion of bile, from the sympathy which exists between the liver and skin*, is ob¬ viated, thus preventing fevers (especially bilious) and other diseases in which the liver is implicated. It must also dimi¬ nish the liability to those cutaneous dis¬ eases which occur in hot climates, from excessive action in the vessels of the skin. Its ill effects, especially in a cold moist country like our own, are evi¬ dently frequent and numerous ; it checks the perspiration, produces nervousness, a flabby constitution, congestion in the larger viscera, and its consequences ; predisposes to cutaneous diseases, which arise from want of action in the skin ; and aggravates those already existing, besides others, in which the functions of the skin are imperfect, particularly chro¬ nic inflammatory dyspepsia, which is accompanied by a dry skin. It impairs digestion, by expending the saliva, the increased secretion of which, dis¬ charged by spitting, diminishes the cuticular exhalation — a circumstance which may give rise to a foetor of the breath, by morbidly increasing the ex¬ halation by the lungs. * In immoderate exhalation by the skin, the secretion from the liver differs from that of other organs, by being increased, and not diminished. — Johnson on Tropical Diseases. 190 TENANCY BY THE COURTESY. HOMOEOPATHIC IMBECILITY. DISEASES OF THE METROPOLIS. To the Editor of the Medical Gazette. Sir, The almost total absence of inflamma¬ tory disease from the metropolis, during’ the last five or six years, has enabled the converts to homoeopathy to revel in its mysteries with perfect impunity. Had these individuals been men of no standing in the profession, they might have been allowed to use their atoms without interference ; but when we find gentlemen of professional attainments, and of literary acquirements too *, ad¬ vocating this empirical study, it is high time the public should be informed, through their professional friends, of the false security of such treatment, and to pause before they confide in the forty-eighth part of a grain of blue pill, or the twelfth part of a grain of camomile flowers, removing an attack of inflam¬ mation. To show how completely free the metropolis has been from all active disease during the last year, I would mention, that in the two large public establishments (not hospitals) of which I have the care, there have been ad¬ mitted 14,000 persons. I have only had occasion to use the lancet three times : twice in cases of phrenitis from exces¬ sive drinking, and once in a case of fractured skull ; the deaths in the 14,000 amounting, in the year, to twenty-six ; which, taking into consideration the dissolute and abandoned characters of the majority, is unusually small. I hope, sir, you will consider it your duty to assist in dispelling the delusion under which the public are suffering, and that the profession will not cease to heap ridicule upon the homceopathist, till he exclaims in despair, “ No?l tali auxilio — miseris succurrere disco” — I am, sir, Your obedient servant, Henry Wakefield. Lansdowne Place, Nov. 2, 1836. TENANCY BY THE COURTESY. To the Editor of the Medical Gazette. Sir, I have with pleasure witnessed the in¬ terest which you take in every subject * Our correspondent means to be complimen¬ tary — Ed. Gaz. relating to medical jurisprudence, and I am sure, therefore, you will not deny me the opportunity of obtaining, through the medium of your excellent journal, an answer to the following question : — Is tenancy by the courtesy still a part of the law of this country ? In a respectable Quarterly Review, it is stated that the law of “ tenant by the courtesy has been recently annulled It is possible that the reviewer may be right ; but it would have been more satisfactory had he, instead of content¬ ing himself with a bare assertion, given the authority upon which he rested it. I am induced to think he is wrong', for the following reasons : 1. Mr. Chitty, in his wrork, published in 1834, speaks of it as then in exist¬ ence f . 2. No mention is made of any altera¬ tion in the law in the statutes of 1834 and 1835. Not having yet seen the statutes for 1836, the act annulling it, if it be annulled, as the reviewer states, may be among them. One of your correspondents, in a letter addressed to you in August, 1833J , re¬ marks, that “ the law with regard to tenancy by courtesy has been com¬ pletely changed, in consequence of the first report of the Law Commissioners on real property; so that it will no longer be necessary to prove that a child has lived for a second or tivo in order that the father should enjoy the tenancy by courtesy.” He also speaks of Acts (Bills?) being brought into parliament by the then Solicitor General (Sir J. Campbell) on the subject; but whether the Bills were brought in or not, there is no evidence of their having passed, as your correspondent intimates. It is, indeed, hardly likely, that, had such an alteration been made, Mr. Chitty would have failed to notice it in a work published the year following your cor¬ respondent’s communication. So far from this, Mr. Chitty refers to the old law as still in existence ; and the sta¬ tutes of 1834 and 1835 contain, as far as I can perceive, no enactments to the contrary. The question is of material import¬ ance in regard to the survivorship of * British and Foreign Medical Review, Oct. 1836, p. 408. t Chitty’s Medical Jurisprudence, p. 435. t Medical Gazette, vol. xii. p. 677. ANALYSES AND NOTICES OF BOOKS. 191 children, either during or immediately following birth. Perhaps either your¬ self or some of your numerous corre¬ spondents will be able to remove the doubt which seems to me to hang* 1 over the subject. — I am, sir, Your obedient servant, M. J. London, Oct. 24, 1836. [We can give our correspondent a categorical answer : there has been no alteration of the law of tenancy by the courtesy. Neither the statute 3 and 4 Will. IV. c. 106, affecting’ inheritances, nor the preceding chapter, 105, amend¬ ing the law of dower, disturb in any way the courtesy as previously esta¬ blished ; and the bill which was pre¬ pared in 1833,' to amend the law of tenancy by the courtesy, was never carried. — Ed. Gaz.] MUSCLES OF THE EYE-BALL AND THEIR NERVES. To the Editor of the Medical Gazette. Sir, Mr. Walker’s statement and mine are now before the readers of the Gazette ; I do not, therefore, feel it at all incum¬ bent upon me to enter into any further explanation of the subject until the publication of my paper in the next volume of the Transactions of the Pro¬ vincial Medical and Surgical Associa¬ tion. I trust the perusal of that paper will render any such further discussion as could be founded on the views given by Mr. Walker in bis letter of Sept. 20th, totally unnecessary. I shall for the present be contented with briefly mentioning the discoveries to which I have presumed to lay claim. These are different explanations of the functions of the third, fourth, and sixth pairs of nerves from any previously given, founded on a careful examination of the muscles which these nerves supply in reference to their separate and combined action. I would ask, then, if this statement be correct, am I not right in requiring more acknowledgment from one who has made use of these views than is con¬ tained in Mr. Walker’s remark, nearly at the end of his letter — that “Mr. Hunt first suggested the probahilitg that the complexity of the nerves of the orbit was connected with the varied motions of the two eyes which I have pointed out” ? — I am, sir, Yours respectfully, E/. T. Hunt. Manchester, October 22, 1836. ANALYSES and NOTICESof BOOKS* “ L’Auteur se tue a allonger ce que le lecteur se tue a abr^ger.”— D’Alembert. leones Plantarum; or Figures , with brief descriptive Characters and Remarks , of New or Rare Plants , selected from the Author's Herbarium. By Sir W. J. Hooker. 8vo. Part I. London, 1836. Few persons, during the last quarter of a century, have laboured more assidu¬ ously, with pen and pencil, in the cause of botany, than Sir W. J. Hooker; none more successfully. The state, by be¬ stowing its honours upon him, has borne testimony to the extent and value of his exertions, and the es¬ teem in which they are held by all sci¬ entific persons is a farther confirmation of their worth. Eager, apparently, to justify yet further his claim to such general homage, he now comes forward with a new work, which, if not so ele¬ gant and ornamental as some of its pre¬ decessors, is calculated to be equally useful. Indeed, we regard the idea of this work as a singularly happy one. “ It has often occurred to the author of the work now announced, that by means of lithographic draw ings, executed on moderately-sized paper, an important series of plates of new and little-known plants might be. offered to the scientific world, at a price so moderate as to bring them within the reach of almost every one interested in the subject.” Nor is it the zeal alone of the author that we are called upon to notice with com¬ mendation, but likewise the liberality of the publishers. “ Even should the publication meet with the success that bis fondest wishes might anticipate, yet the price set upon it is so low as to forbid any hope of profit; and he is anxious to express bis acknowledg¬ ments to the publishers, for kindly guaranteeing him against any pecuniary risk in the undertaking.” In con- 192 ANALYSES AND NOTICES OF BOOKS. sequence of this, we have here 58 well- executed lithographic representations of a considerable number, nearly 100, rare plants, for the plates devoted to the mosses contain sometimes six species, at a price incredibly low. Yet a prudent caution, rising out of sad experience of the slender encouragement given to illustrated scientific works in this country, has occasioned the impression to be limited to 300 copies. We trust, however, that the increasing zeal for natural history, diffusing itself over the country under the influence of the British, and many local Associations, will lead to such extended patronage of this work, as will justify ere long a second edition. Meanwhile, those who feel desirous of possessing these beautiful representations of plants, of very diversified form and structure, from trees down to Ferns and Mosses, will do well to make application while they are yet to be had. By the plan adopted in the letter-press, when the work shall have been completed, the plates, and the descriptions of them, may be arranged and bound up in what¬ ever way the possessor may prefer. This is a great advantage, but" we trust the series may be so extended that some hundreds of plates shall be published before any one is required to decide how he would wish them arranged. On Disease of the Hip Joint , with plain and coloured Plates. By Wm. Coulson, Consulting Surgeon to the London Lying-in Hospital, late Sur- g’eon to the General Dispensary, &c. Mr. Coulson has devoted considerable attention to the diseases of the hip joint, and two clinical lectures on the subject, which he delivered about five years ago, will be found in one of our early volumes. Since that time, we learn from the preface, that his opportu¬ nities of investigation have been in¬ creased by his appointment to the Board of the Sea-Bathing Infirmary — the result of all which is the monograph before us. The anatomy and physiology of the hip joint are fully described in the open¬ ing- chapter; but of this, the only por¬ tion to which we shall allude, is the ac¬ count of some experiments of Weber’s, in reference to the means by which the head of the femur is retained in the acetabulum, and which would seem to shew that atmospheric pressure ha* & considerable influence. The German authority says, that a body was placed in such position as to suffer the thigh to hang freely over the table ; the muscles and ligaments were then cut through, and yet the thigh did not fall ; on the contrary, the articular surfaces remained in close apposition. A small hole was made in the acetabulum, so as to allow the air to enter, and straightway the limb dropt as far as the capsules w'ould suffer it, and this, although the muscles and ligaments were not divided. The head of the bone was then re-adjusted in the socket, and the aperture in the acetabulum stopped with the finger ; the bone was now retained in situ , but once more fell out on the finger being removed. These experiments have been repeated by Mr. Coulson, and with similar results “as regards the most essential point.” He adds, that the ex¬ tent to which the head of the bone can be removed from the acetabulum by the admission of air, the effusion of fluid, or by force, somewhat exceeds an inch. By the latter, it is difficult or impossible to effect so great a lengthening, unless the limb be rotated inwards at the time. Disease of the hip joint is regarded by Mr. Coulson as the mere external demonstration of a pathological condi¬ tion, involving the general system, and consequently any views limited to the part itself are too confined. The vital or nutritive functions are those which he believes to be primarily affect¬ ed ; while the secretions are remarkably implicated in almost every instance. This view leads him to distrust the efficacy of topical remedies so generally used, which, indeed, he speaks of as having produced an exacerbation in almost every case in which they have been employed. Where the secreting organs are large, and the locomotive proportionally small, then it is that, according- to some au¬ thors, disease of the joints, especially the hip, are most readily developed ; and he instances the Saxon population of England and Holland in illustration, having large trunks and feeble extre¬ mities. Camper states that in his time as many as one in twenty-eight of the Hollanders became lame. This princi¬ ple is adopted by Mr. Coulson, and worked out by numerous, and some of them ingenious, remarks, the sum of the TREATMENT OF A MEDICAL OFFICER. 193 argument being, that the affection of the joint is “ not a consequence, but a mere, external symptom, of constitu¬ tional disease.” It is proper to add, that while treat¬ ing of the pathology, Mr. Coulson brings successively before the reader the opinions of all the best authorities, both at home and abroad. The morbid anatomy of the hip-joint is interesting-, and a very good account is given of it. The changed appear¬ ances vary more in degree than in kind, marking the extent of the mischief rather than difference in its nature. The chief changes are inflammation of the syno¬ vial membrane, its thickening, ulcera¬ tion, and perforation ; preternatural secretions into it of synovia, lymph, or pus ; its entire destruction. The liga- mentum teres becoming ulcerated or absorbed. The articular cartilages abraded, ulcerated, or entirely removed. Destruction of the cartilages being replaced by an ivory deposit ; portions of them being found loose and floating. Widening- and shallowing of the socket ; the bone becoming denuded and carious, or ulcerated. Lessening of the head of the femur, and contraction of its neck ; softening of the bone, and deposition in its cancelli of yellow caseous matter, or of transparent fluid. The most strik¬ ing feature in this form of disease is the absence of the secretion or deposition of bone ; being, in this respect, very dif¬ ferent from common inflammation, in which (especially when chronic) the ossified deposit is increased. A clear account is given of the symp¬ toms of hip-joint disease, but it does not contain such novelty as to warrant our dwelling upon it. In the treatment, it is held by Mr. Coulson to be of great importance to distinguish between those cases which occur in strong and those in scrofulous patients; an observation in keeping with what has been made by other writers on the subject. The subjects are illustrated by six well-executed lithographic engravings. Physiologie des Menschen [ Human Phy¬ siology .] Von Friedrich Tiedemann, Lehrer der Anatomie und Physiologie an der Univ. zu Heidelberg. Dritter Band. Darmstadt, 1836. Schloss. The excellence of the two former vo¬ lumes stamped a character on this work, and created a strong desire for its con- 460. — XIX. tinuation. The third volume has just issued from the press, and will, we think, be found as replete with interest as its predecessors. It treats exclusively of the function of digestion and of aliment, giving an account of all that has been ascertained on the subject, both through the experiments of the author, and of bis contemporaries. MEDICAL GAZETTE. Saturday , November 5, 1836. ** Licet omnibus, licet etiam mihi, dignitatem Artis Medicos tueri ; potestas modo veniendi iu publicum sit, dicendi periculum nonrecuso.” Cicero. THE POOR LAW COMMISSIONERS’ TREATMENT OF A MEDICAL OFFICER. Our remarks on the Harpeuden affair— an affair to the last degree damnatory of the amended poor-law system — were founded on a document issued from So¬ merset House. On their own shewing we proved that nothing could be more vile than the conduct of the Commis¬ sioners, in attempting to throw the heavy blame attaching to their proceed¬ ings in that case off their ow n shoulders on those of their medical officer. They made him, or endeavoured to make him, their scape- goat, fastening the iniqui¬ ties of their system on his back, and then turning him adrift. But we find we were only half- informed when we made those observations : our informa¬ tion was ex parte , being altogether de¬ rived from the honourable Commis¬ sioners’ statements. We were not aware to what an extent official papers may be made to lie, when it serves the pur¬ pose of the party in office to give them a certain colouring. A letter from Mr. Kingston, of St. Alban’s, has since appeared in the news¬ papers, throwing quite a new light on some of the circumstances connected with the affair. This gentleman, it will perhaps be recollected, was the medical officer so unceremoniously dealt with by O 194 TREATMENT OF A MEDICAL OFFICER, the Somerset House authorities ; anil certainly his version of the story, which appears to have all the impress of truth upon it, forms a remarkable comment on the statement of the commissioners. We freely confess that we were prema¬ ture in our censures of some part of Mr. Kingston’s conduct ; but we were be¬ trayed into severity by adopting too unhesitatingly the official report, never once thinking that it could be so grossly unworthy of credit. The lesson may be useful : we shall know in fu¬ ture bow to appreciate productions com¬ ing from the same quarter. The letter, in the first place, confirms all the chief facts relative to the Com¬ missioners’ trickery ; and a more insi¬ dious, disgraceful trick, never was at¬ tempted to be practised upon the public. The main circumstances of the case cannot be too fully exposed. The public indignation was gathering into a storm : in addition to the mani¬ fold instances of heartless cruelty exer¬ cised towards the poor under the “amend¬ ed” system, the case of a wretched wo¬ man absolutely left destitute of all medical assistance, and whose death was clearly owing to the mischiefs of the new law, wras about to lead to a crisis, when the conscientious function¬ aries resolved to allay the ferment, at whatever risk. They could hit on nothing better than to sacrifice one of their officials. After due parade and preparation, they proceed. They throw their unfortunate hireling’ overboard— a sort of tub to the whale : but the whale is not so easily deceived ; and the tub itself turns up eventually to their utter discomfiture and confusion. Mr. Kingston has well exposed the whole train of machinations employed by the wily utilitarians. They took every advantage of him. He was en¬ trapped into a conference at Somerset House with the secretary of the Commis¬ sioners, and while he thought he was offering an explanation simply of his conduct, every word that dropt from his lips was taken down by a short-hand writer, and given to the public as bis defence. This, as Mr. K. very properly says, is what would not be done with the greatest criminal in England: if Mr. K. were regularly on his trial, he w'ould be apprised that his confessions or statements were to be preserved, and he would be warned to be cautious to say nothing that might tend to crimi¬ nate himself. But no : neither was any such warning given, nor were his depo¬ sitions read to him, nor was he allowed to read them over, so as to guarantee their correctness: the first notification of the proceeding wras, seeing his pri¬ vate conference with the secretary in Somerset House committed to the wrorld through the newspapers ! There might still be some excuse, if the thing were correctly done: but Mr. Kingston has pointed out some egregious misrepre¬ sentations : things were put into his mouth which he never uttered. Such at least was the haste of the zealous secre¬ tary to make a case for the public. Among* other points, they represent Mr. Kingston as saying*, that he would conceive himself justified in attending more promptly to the call of the Squire, or any rich patient, than to the order of an overseer. Mr. K.’s obvious meaning was that he would consider the Scjuire’s the more pressing* case of the two, unless the order w'ere duly backed by a request to be prompt, the case being really serious ; for the Squire w'ould not send unless there were some actual urgency, whereas the pau¬ per’s order has been often found vexa- tiously deceptive ; the patient being probably at work, and no way ill, when the medical man, in obedience to the order, has arrived. Ao-ain : Mr. Kingston is misstated as describing himself thirty years connected with parish practice; thirteen years were his words. Can there be a more con¬ vincing proof of the eagerness of the NORTH LONDON HOSPITAL. 195 party to make out a case ? In their haste to come before the public with something' in the form of an excuse, they have not the common decency to see that their officer is correctly reported. But if Mr. Kingston were taken by surprise, not so was Mr. Secretary Chadwick : all the interrogatories were duly arranged for the occasion; the matter as well as the tone and temper. The object is manifest to all who read the published account of the confer¬ ence. It w'as attempted to wring’ from Mr. Kingston an admission that parish medical duties were more strictly enforced under the new system than the old; and it was conceived that such an admission, coming* from an offi¬ cer of thirty years’ experience, would be much stronger than coming- from one of only thirteen. The letter of Mr. Kingston, however, is clear upon the point of relative me¬ rits : he speaks positively on the sub¬ ject, and, from his experience of both states of things, he is perfectly com¬ petent to give an opinion. All the strictness and severity of the present system he admits ; but he distinctly denies its superiority. The poor were better attended to under the old sys¬ tem ; there were more medical officers, and greater liberality in granting or¬ ders for relief. Under the new reyime the amount of medical aid is greatly limited : the hands arc fewer, and much worse paid, while the duties imposed on those few and ill-paid officers are beyond the powers of men of ordinary physique. The consequence is, that when an order is granted, as it g*cnerally is, with a most niggard disregard of the pressing wants of the unhappy pau¬ pers, there are many chances against its being effective ; the means being utterly inadequate to the end proposed. But on this head we beg to refer our readers to the excellent letter of an “ OM Navy Surgeon,” at page 204, MADAME MALI BRAN. Mystery still hangs over the decease of this ill-fated child of genius. It was asked in the Times a few days ago, whether M. de Beriot had not abruptly left Manchester with all her apparel and property ere she had ceased to breathe ; and to those interrogatories we take leave to add a few others which relate to the medical proceedings. Is it true, or rather is it not true, that when Dr. Bardsley was so unceremo¬ niously discharged, his patient was going on favourably,-— in fact, that she was then nearly or altogether conva¬ lescent ? Is it true that it was afterwards thought desirable by some coup de pratique to enable her to complete her engagement ? Is it true that manual interference was had recourse to for the purpose of effecting premature delivery, and that this failed to produce any other effect than that of overwhelming exhaustion ? And, Is it true that when the body of the unfortunate deceased was receiving* the last offices from the strangers to whom she W'as left, the relaxing hand of death completed what art had been unable to accomplish ? These are questions of interest to science, to which we trust either M. Bel- luomini or Mr. Lewis will reply. They will perceive that a great practical lesson is involved, and although they have doubtless, fully learnt it, the medi¬ cal world is still kept in suspense. OPERATION AT THE NORTH LONDON HOSPITAL, IN PRESENCE OF THE PATRON. On the 21st ult.-Mr. Liston performed one of those operations on the face, for his boldness and dexterity in accom¬ plishing which, that gentleman has be¬ come remarkable. The patient was a female, named Mary Griffiths, aged 20. The tumor, 196 A WELCH MEDICAL SOLON. which was of fibrous character, origi¬ nally appeared seven or eight years ago upon the upper gum, above one of the incisors, and progressively increased, notwithstanding various efforts made to extirpate it at different times. On her admission into the North London Hos¬ pital the tumor and ulcerated surface occupied the site of the upper lip, nose, and great part of both cheeks, particu¬ larly the left. The whole was dissected out, and large portions of the upper maxillary and cheek hones were also removed, apparently with great ease, by means of the bone nippers. Astonish¬ ingly little disfiguration of the face re¬ mained after the flaps had been brought together; and the patient has since con¬ tinued to do well. A considerable sensation (to use the language of the newspapers) was caused by another production, of still more anomalous character, and which like¬ wise was brought into the operation- room for the inspection of the pupils. On closer examination this proved to be neither more nor less than the person of Thomas Wakley, Esq. M.P. Patron and Puffer of the establishment, and Slan¬ derer-General of all the other schools in the metropolis, who had kindly con¬ sented to appear on this occasion in propria persona , in order to oblige the Professors, and to prove to the world that there is one hospital in London into which he is admitted! We understand that it is in contem¬ plation to perpetuate the event, by erect¬ ing in the theatre a bust of the honoura¬ ble Patron. The inscription has not yet been finally decided upon ; but the learned printer to the “ University” has suggested, as being at once neat and appropriate, his own motto — “Alere fi. a m mam .” A WELCH MEDICAL SOLON. “ Late Infanticide at the Bishop of Worcester’s Palace. — Mr. C. Lle¬ wellyn, surgeon, of Llanymyneich, says, in reference to the woman accused of this crime — ‘ 1 am sorry to observe that Charlotte Grounsel, an inmate of the Bishop’s palace, has, in my humble opi¬ nion, been a sufferer from the statement of her case before the Coroner’s jury. I do not pretend to account how, or in which way, the wound on the child’s neck was inflicted ; but looking at it correctly, and in an anatomical sense, it could not have caused the child’s death; neither do I tbiuk that the mere floating of the lungs in water is a proof of its having been born alive; therefore, in my opinion, the post-mortem examina¬ tion was not calculated to throw any light on the matter. The floating of the lungs in water has been long exploded as a medical test.’ ” — Berrows' Worces¬ ter Journal. This is a sample of the sort of medico¬ legal information which that “ best pos¬ sible public instructor” — the newspaper press — is in the habit of diffusing. The circumstance of having the name of a professional man attached to it, no doubt gives the paragraph an air of authority. But who, we should like to know, is this Mr. Llewellyn, who plays “ will- o’-the wisp” on the occasion ? If he be not a mere nominis umbra , perhaps he would favour us with a reason for the opinion which he volunteers so benevolently. To put the best construction on his conduct, he ap¬ pears strongly disposed to save the accused at all hazards : but he is a very wrong-headed man if he thinks his bare assertion is to have any weight against the strong presumptions de¬ rivable from observation and experience. He is certainly a very ignorant or very dishonest person to state that the hydro¬ static lung-test has been exploded *. every well-informed medical man knows to the contrary. The phenomenon of the floating or sinking of the lungs, when observed with proper caution, is capable i of affording a high degree of presump- • tive evidence as to the fact of live or still-birth ; and when taken in conjunc- • tion with other appearances, of which I Mr. Llewellyn seems to have not an idea, may constitute proof of the most convincing character. We pretend not to pronounce any opinion respecting the i particular case of Charlotte Grounsel, i for whom Mr. Llewellyn’s sympathy is engaged : we should have facts before us, to warrant such a proceeding. Our i 197 SIR B. C. BRODIE ON LOCAL only object in noticing the above para¬ graph is to show what silly stuff some¬ times conies before the public, under the sanction of a medical name. As to Mr. Llewellyn, if their really be such a iicrson, we recommend him to look into his books, or ask some respectable brother practitioner what may the hy¬ drostatic lung test mean. Till then, he had better throw a veil over his igno¬ rance, and remain quiet. THE NEW PHARMACOPOEIA. The Order in Council which recently appeared in the London Gazette was a necessary preliminary before the new Pharmacopoeia could be published. We understand that it will now appear almost immediately. THE UNIVERSITY OF LONDON. The Charter of the new University re¬ ceived the sign manual a few days ago. It requires, however, to be confirmed by Parliament before the parties in whose favour it is granted can enforce its pro¬ visions in the courts of law. LECTURES ON LOCAL HYSTERICAL AFFEC¬ TIONS, Delivered in the Medical Theatre of St. George's Hospital , By Sir B. C. Brodie, Bart. F.R.S. Lecture I. Hysterical Affections of the Joints, particularly the Knee and Hip — their Characters — not confned to the Female Sex. Hysterical Disease oj the Spine — Illustrations. Gentlemen, — In commencing my course of lectures for the present season, it is not my intention to occupy your time by of¬ fering you any introductory observations. It seems to me that you hear a sufficient number of introductory lectures alreadv, and, if 1 were to add to the list, I must inevitably trouble you with the repetition of what has been already said to you by your other teachers. For this reason, I think it advisable to enter at once on tUe consideration of some subject connected with practical surgery ; and I am the more inclined to do so, as my course of lectures being of limited extent, I cannot well afford to devote any of them to other purposes. I call tliese clinical lectures, because they are intended to illustrate the history and treatment of particular cases in the ''ards of the hospital. I do not intend, however, to confine myself absolutely HYSTERICAL AFFECTIONS. to lectures of this description, and I may sometimes call your attention to a particular disease, or order of diseases, without reference to any of the patients who may be under my care at the time. My general rule will be to deliver lec¬ tures that are truly clinical ; but the rule will have some exceptions, and one of these will occur in the begin¬ ning of the course. Those gentlemen who attended the hospital during the last spring, will remember that 1 promised to give some lectures illustrative of those lo¬ cal hysterical affections of winch I have occasionally spoken to you in the wards. I fully intended at that time to redeem my promise during the summer months, but various circumstances having prevented my doing so, I propose to redeem it now. When I was formerly engaged in the study of the diseases of the joints, having, at the period, to which I refer, few oppor¬ tunities of investigating the subject except in my hospital practice, I occasionally met with cases in which a particular joint was affected with pain, and a great degree of morbid sensibility, attended occasionally with some degree of tumefaction of the soft parts, although the characteristic symptoms of the ordinary diseases to which these organs are liable were wanting, and the usual consequences of abscess and destruction of the joint did not ensue. For a long time these cases occasioned me great perplexity, and it was not until after I had published the first edition of my Treatise on the Diseases of the Joints that the occurrence of the case, w hich I am about to describe, first led me to suspect the real origin of the symptoms, which I had not comprehended formerly. I was consulted concerning a young lady who complained of severe pain and a morbid tenderness of the knee, in the first instance attended with no perceptible en¬ largement of the joint. The remedies which, with such knowledge as I then possessed, I w?as led to recommend, gave her no relief; and after some time a slight degree of tumefaction took place, depend¬ ing, as it seemed, either, on a fulness of the small vessels, or on an effusion of lymph or serum into the subcutaneous cellular texture. She had been in this state for a considerable time, when she was seized with a succession of violent paroxysms of hysteria, which terminated in an hyste¬ rical affection of the brain ; so that she lay in a state approaching to that of coma, with dilatation of the pupils of the eyes. She was now' attended by the late Dr. Babington and myself. I do not under¬ take to say whether the disease yielded to the remedies employed, or reached its na¬ tural termination but, from one or other 198 SIR B. C. BRODIE’S LECTURES ON of these causes, the patient recovered of the last mentioned symptoms, and from that time she never complained of her knee. Not Hong afterwards another young lady was brought to me, labouring under what had been supposed to be a scrofulous disease of the wrist. The resemblance of this case to that of the last-mentioned pa¬ tient led me to doubt the correctness of this opinion, and the results proved my doubts to be not without foundation. She also was seized w ith a succession of vio¬ lent paroxysms of hysteria ; and when, after the lapse of many days, she had re¬ covered from them, the disease of the wrist had vanished. It seemed impossible to doubt that in each of these eases there was some con¬ nexion between the local symptoms and the constitutional disease under which the patient laboured ; and a great number of other cases, which fell under my observa¬ tion afterwards, confirmed me in the opinion ; that w here there is that state of the general system, whatever it may be, which produces the phenomena of hysteria, it is not uncommon for a particular joint to be affected with pain and morbid sensi¬ bility, such as may lead a superficial ob¬ server to believe that it is the seat of some serious local disease, although no such disease in reality exists. In the second and subsequent editions of my Treatise on the Diseases of Joints, I have given some account of these local hysterical affections. I trust that what I have there stated may have been not wholly unacceptable to those, who are engaged in the practice of our art ; but the subject is one of great interest both to the scientific pathologist and to the practical surgeon, and believing that I can furnish you writh some information respecting it, beyond that which is to be found in my former jDublications, I am led to call your atten¬ tion to it on the present occasion. I have already mentioned, that when my opportunities of studying these diseases were limited to what I saw in the wards of the hospital, these affections of the joints fell occasionally under my observa¬ tion. Since I have been engaged in a large private practice, they have pre¬ sented themselves, I may say, without ex¬ aggeration, almost daily. This is easily explained. “ Fceminarum enim paucissimce” says the sagacious and observing Syden¬ ham, speaking of hysteria, “ ab omni horum adfectuum specie prorsus liberce sunt , si istas excipius quce laboribus udsuetce duram vitarn trahunt .” The liability to hysteria is, in fact, among females, one of the severest penalties of high civilization. It is among those who enjoy what are supposed to be the advantages of affluence and an easy life that wre are to look for cases of this description, not among those who, ful¬ filling the edict of the Deity, “ eat their bread in the swreat of their face.” I do not hesitate to declare that among^ the higher classes of society, at least four-fifths of the female patients, who are commonly supposed to labour diseases of the joints, labour under hysteria, and nothing else. Frequently the hip joint is the seat of the disease. The symptoms then have a considerable resemblance to those of dis¬ eases in the bones or cartilages, yet a minute examination of the case will rarely leave you in doubt as to your diagnosis. There is pain in the hip and knee, which is aggravated by pressure and the motion of the limb, and the pa¬ tient often lies fixed in one position on the bed or sofa. You will say,. “are not these indications of a diseased hip joint?” But observe further. The pain is notin general fixed in any one part : it belongs to the whole limb/ The patient winces, and sometimes screams, wrhen you make pressure on the hip, but she does the samet if you make pressure on the ileum, or on the side as high as the false ribs, or on the thigh, or even on the leg, as low as the ankle : and every where the morbid sensi¬ bility is chiefly in the integuments. If you pinch the skin, lifting it at the same time off the subjacent parts, the patient complains more than when you forcibly squeeze the head of the thigh-bone into the socket of the acetabulum. As her at¬ tention is more directed to the examina¬ tion, so the pain, which she suffers from it, is aggravated ; and if her mind be occu¬ pied in conversation, she will scarcely complain of that, which wrould have occa¬ sioned torture otherwise. Then, there is no wasting of the glutcei muscles, and no flat¬ tened appearance of the nates; and the aspect of the patient is different from that w'hich you would expect to find if tlie bones and cartilages of a joint were in a state of ulceration. Neither are there those peculiar and painful startings of the limb at night, attended often with fright¬ ful dreams, which mark the existence of this last disease. The pain will sometimes prevent the patient falling asleep, but if once asleep, she sleeps soundly for many successive hours; and this state of things may continue for weeks, or months, or even for years, wuthout leading to abscess, or any further ill consequences. There may be a suspicion of abscess, (I have known this in a great number of instances) but the suspicion is never realised. Some¬ times there is a general tumefaction of the thigh and nates, the consequence either of a turgid state of the small vessels, or of an effusion into the cellular texture ; (I sup¬ pose of the former, as the parts do not pih i or remain indented after pressure) but this i LOCAL HYSTERICAL AFFECTIONS, 190 is entil'd)' different front the swelling of an abscess. In a few rare instances there is a more defined and circumscribed swell¬ ing, but still it is altogether different from that of abscess. There is no perceptible fluctuation, and I can compare it to no¬ thing better than a wheal of urticaria of unusual magnitude. A careful examina¬ tion will always enable you to distinguish these swellings from abscess. For the satisfaction of others, I have sometimes made a puncture with a grooved needle, or some other convenient instrument, the in¬ troduction of which would have detected matter, if matter had existed. I have said that, in these cases, there is no wasting of the glutaei muscles, and no flattened appearance of the nates. It is, however, not uncommon to find much al¬ teration in the figure of the parts, of ano¬ ther kind ; namely, a bulging of the pelvis posteriorly, at the same time that it is elevated on the side of the disease, so as to make an acute, instead of a right angle, with the column of the vertebras. Of course, under these circumstances, the limb is apparently shortened, and when the patient stands erect, the heel does not come in contact with the ground. A super¬ ficial observer may be led to believe that there is an actual dislocation of the hip ; and, indeed, it requires a careful examina¬ tion to enable the surgeon to understand that all tliis strange distortion is but the result of the predominant action of certain muscles, and of a long-continued indul¬ gence in an unnatural position. When the symptoms are referred to the knee, they bear a near resemblance to those which have been just described. There is great tenderness of the joint; but the patient suffers more from pinching the skin than from pressure, and the morbid sensibility extends for some distance up tbe thigh, and down the leg, perhaps as low as the foot and ankle. The patient suffers less from an examination when the attention is fixed on other matters, than when it is directed to the affected parts; and she does not usually complain when pressure is made on the heel, so as to press the articulating surface of the tibia against that of the femur, provided that care be taken at thesame time to produconomotion of the joint. In most instances the leg is kept extended on the thigh, whereas, in cases of real disease in the knee joint*, it is usually a little bent. These symptoms may continue without any material alteration for an indefinite time; for weeks, or months, even for years, the joint retaining its natural size and figure: but occasion¬ ally a slight degree of tumefaction is ob- sci i able, especially on the anterior part, over, and on each side of, the ligament of the patella. This tumefaction is not to be confounded with a general enlargement of the joint, by which surgeons are frequently misled, the result not of the disease, but of the remedies employed. I refer to cases which have been misunderstood, and mis¬ managed by the application of blisters, issues, and a succession of various eoun tor- irritants. What I have now stated may be suffi¬ cient to enable you to understand the na¬ ture of the symptoms which you may ex¬ pect to find where these hysterical affec¬ tions occur in the other joints of the extre¬ mities. The following observations are equally applicable to all these cases, and while they are necessary to complete the history, will be found of use in enabling you to form a correct diagnosis. The patients thus affected are, for the most part, not much above the age of puberty. In many instances they labour under some irregularity with respect to men¬ struation ; while in others this function is in no respect different from what it is un¬ der circumstances of perfect health. Those w ho labour under habitual cold¬ ness of the hands, have a weak small pulse, and afford other indications of a feeble circulation, are more liable than others to suffer in this manner; yet it is not very unusual to find these symptoms existing in combination with a florid countenance and a sufficient development of animal heat. In some instances the joint to which the symptoms are referred, and even the whole limb, is affected with a remarkable alterna¬ tion of heat aim cold. Thus in the morning the limb may be cold, and of a pale or pur¬ ple colour, as if there were scarcely any circulation of blood in it; while towards the afternoon it becomes warm, and in the evening is actually hot to the touch, with the vessels turgid and the skin shining. This state of things is often a source of serious alarm to the patient, and even to the medical attendant, but 1 never knew it to be followed by ill consequences, j The majority of the patients thus af¬ fected exhibit other proofs of their liabi¬ lity to hysteria. Sometimes they have been subject to the usual paroxysms of hysteria, which have ceased on the local symptoms showing themselves; and a re¬ currence of the former has been followed by an abatement of the latter, or by com¬ plete recovery from them. Not unlrequently the origin of these symptoms may be traced to a severe ill¬ ness, which has left the patient in a state of great physical exhaustion ; at other 200 SIR B. C. BRODIE’S LECTURES ON times they are as clearly to be attributed to some moral cause having a depressing influence on the constitution. In like manner the agency of moral causes, espe¬ cially of those which compel the patient to make much physical exertion, often leads to her recovery. But we must not be led by this last-mentioned circum¬ stance to adopt the harsh conclusion, that these symptoms exist only in those who are of a fanciful and wayward disposition. Young women of the highest moral quali¬ ties, and of the strongest understanding, are not exempt from these maladies ; but it must at the same time be acknowledged that a cure is more easily attained in them than it is in others. Although there are none of those pain¬ ful and involuntary startings of the limbs which occur in combination with caries of the joints, spasmodic actions of the mus¬ cles of the limbs are not uncommon in the cases of which I am now speaking. In some cases convulsive motions of the limbs are produced by pinching, or more lightly touching the integuments. These bear no very distant resemblance to the move¬ ments of chorea ; and it is worthy of notice, that they do not occur if it can be managed, at the same time, that the atten¬ tion of the patient should be otherwise directed. I have also known them to take place independently of any manifest ex¬ citing cause. In the case to which I now more particularly refer, the limb wras at irregular periods evidently agitated, so as almost to throw the patient off her couch. In these cases there is always a sense of ' weakness in the limb, which for obvious reasons becomes aggravated in proportion as the muscles have been for a longer time in a state of inaction. While the pain and morbid sensibility of the jointare gradually subsiding, this sense of weakness increases, until at last it is the predominant symp¬ tom. Under these circumstances the pa¬ tient often says, “ I have no pain, but I cannot walk, because the limb is so w'eak.” Weakness of the muscles, how¬ ever, is not the only circumstance which interferes with the speedy recovery of the use of the limb in these cases. The tunics of the small blood-vessels, when the limb has been long kept in the horizontal pos¬ ture, seem to partake of the condition of the muscles; and when the foot is first put to the ground, the skin assumes in conse¬ quence a red colour, sometimes amounting to a purple hue, as dark as that which, when limited to a particular spot, is often the precursor of a vesication. The symptoms which have been de¬ scribed for the most part come on gra¬ dually. In the majority of cases they subside gradually also ; but sometimes it is otherwise, — they may vanish without any evident cause. For example : in the year 1834 I was consulted respecting a young lady labouring under a wrell marked hysterical affection, simulating disease of the hip joint. As she was not a resident in London, I had no opportunity of watch¬ ing the progress of the case, but I have lately received the following account of it from Dr. Mortimer, the surgeon of Has- lar Hospital : — Her symptoms had con¬ tinued nearly unaltered for nearly two years, when one night, on turning herself in bed, she said that she had a feeling as if something had given way in her hip, and from that moment she was quite well. Another young lady was brought to London for my opinion in October, 1833. She also was supposed to labour under a disease of the hip-joint. After a careful examination of her case, I was satisfied that it was one of hysterical affection, and that there wras no actual disease of the joint. I recommended her to leave her couch, to which she had been confined, and to take exercise, especially on horse¬ back. Being a sensible and well-disposed person, she followed this advice, in spite, I doubt not, of a good deal of in¬ convenience in the first instance. After the lapse of a year, I received from her father the following statement respecting her : — “ In pursuance of your advice, she began to use the limb more freely, but with little alteration as to pain and lame¬ ness until about six weeks ago, when, by a fall of the donkey on which she was riding, she was thrown over the animal’s head, standing on the foot of the lame limb, writh her wreight upon it. She felt immediately what she describes as a sud¬ den snap, as if something near the joint had given wrav. This wras attended with a violent acute pain, winch, however, lasted only a short time. She was re¬ placed on the donkey, and rode home, a distance of four miles. To her great sur¬ prise the former habitual pain of the limb had entirely discontinued, and there has been no return of it since. She wras able to walk up and down stairs without diffi¬ culty or pain, and now w’alks a considera¬ ble distance, using the one leg as freely and as well as the other. Her general health is improving rapidly, although she is still weak. There has been no hysteri¬ cal fit since the accident ; in short, the cure has been complete.” However, in this case the cure was not permanent. Three months afterwards the complaint recurred, having the same character as for¬ merly, except that it w^as not nowr com- LOCAL HYSTERICAL AFFECTIONS. 20 J bined, as it had been in the previous at¬ tack, with other hysterical symptoms. She was at this time on the continent, and I have not heard the result of the case. I have hitherto described these cases as if the symptoms wrere peculiar to the fe¬ male sex ; but it is not so in reality ; and I have known several (though by compa¬ rison certainly rare) instances of males being affected in the same manner. I em¬ ploy the term hysteria because it is in com¬ mon use, and because it would be incon¬ venient to change it for another; but the etymology of it is undoubtedly calculated to lead to a great misapprehension with respect to the pathology of that disease. It belongs not to the uterus, but to the nervous system ; and there is no one who is much engaged either in medical or in surgical practice, who will not be able to bear testimony to the accuracy of Syden¬ ham’s observation on this subject : — “ Quinimmo non pauci ex iis viris qui vitam degentes solitariam , chartes solent impallescere eodem morbo tentantur.,) Hysterical affections, in which the symp¬ toms are referred to the spine, are of very frequent occurrence. Such cases are, in many instances, mistaken for those of ul¬ ceration of the intervertebral cartilages and bodies of the vertebrae ; and in conse¬ quence of this unfortunate impression on the minds of the medical attendants, I have known not a few, but very numerous, instances of young ladies being condemned to the horizontal posture, and even to the torture of caustic issues and setons, for several successive years, in whom air and exercise, and cheerful occupations, would probably have produced a cure in the course of a few months. In these cases the patient complains of pain and tenderness of the back, to which one or more of the following symptoms may be superadded as those which chiefly tend to mislead the medical or surgical attendant : — Pains in the limbs, espe¬ cially in the lower limbs; a sense of con¬ striction of the chest ; involuntary spasms of the muscles, sometimes induced by change of position, at other times recur¬ ring without any very evident cause; a sense of weakness in the lower limbs, so that they are scarcely capable of support¬ ing the weight of the body; and even ac¬ tual paralysis; difficulty of voiding the urine. When the patient first complains ofpaininthe back, it must be acknow¬ ledged that there is some difficulty in forming a positive diagnosis; but the dif¬ ficulty vanishes afterwards, so that none but a superficial observer can have any doubt as to the real nature of the disease. The pain in the back is not confined to a single spot, but it extends to different re¬ gions of the spine, and it not unfrequently shifts its place from one part to another. The tenderness of the spine is peculiar. The morbid sensibility is chiefly in the skin, and the patient, for the most part, flinches more when the skin is even slightly pinched, than when pressure is made on the vertebrae themselves. The pain is, in the majority of cases, more se¬ vere than in those of real vertebral dis¬ ease ; and the spasms of the muscles have a near resemblance to those of chorea. Where there is paralysis, or a tendency to paralysis, it is quite different from what is observed in cases of pressure on the spi¬ nal cord or brain; and I may take this opportunity of observing, with respect to hysterical paralysis generally, that it has this peculiarity — it is not that the muscles are incapable of obeying the act of volition, but that the function of volition is not exercised. The accuracy of this observation will, if I am not much mistaken, be acknowledged by all those who are at the pains of studying these cases with the attention which they so well deserve; and the importance of it in medical and surgical practice is suffi¬ ciently obvious. There are still other cir¬ cumstances which may assist us in form¬ ing our judgment ; such as the general aspect of the patient, and her condition in other respects; her time of life; the state of the menstruation ; and especially the liability to the more common hysterical affection. Patients with a weak pulse, and cold hands and feet, are, on the whole, more liable to suffer in this manner than other persons. But this is almost a need¬ less repetition. It would be sufficient for me to refer to what I have already stated in speaking of hysterical affections simu¬ lating diseases of the joints of the extre¬ mities. I have frequently known surgeons to apply a hot sponge to the spine, believing that if the patient complained of pain on the application, this was a proof of the existence of caries. My own experience leads me to believe that a patient who la¬ bours under a nervous pain of the back will complain of the hot sponge even more than one in whom real disease exists. I mention this trifling matter, that you may avoid being misled by it in your diaguosis. 202 NEW-FANGLED DOCTRINES. NEW-FANGLED DOCTRINES RESPECTING THE TREATMENT OF INFLAM¬ MATION. To the Editor ' of the Medical Gazette. Sir, At a time like the present, when every thing around us appears to be undergoing a change — when long cherished medical theories and modes of practice are aban¬ doned by some, and looked upon with scorn — it becomes, I think, the duty of pro¬ fessional men to make such strictures upon the new-fangled principles and opi¬ nions of the age, as they may think likely to be productive of benefit to the profession, and to their fellow-creatures. I shall, therefore, without further preamble, pro¬ ceed to make a few remarks upon a paper which was published a short time ago, in a contemporary journal, by Mr. Searle, of Kennington, in which he endeavours to show that the practice usually followed in the treatment of acute inflammatory dis¬ eases, being founded upon erroneous prin¬ ciples, is absurd, and therefore ought to be abandoned. Mr. Searle sets out by pronouncing a terrible condemnation upon the antiphlo¬ gistic plan of treatment. He then lays down certain rules for the treatment of in¬ flammatory diseases, which, he says, are confounded “ in science, in reason, and in nature,” and in doing so, he divides the treatment into what he calls the treatment of the constitution, and the treatment of the local disease. Under the head of the treatment of the constitution, we are told that the predisposing cause of inflamma¬ tory fever being either a reduced or a low grade of muscular power, in order to pre¬ vent its accession, depletory means, which considerably diminish that power, should be carefully avoided; that the diet should be nutritious, without being unnecessarily stimulating; and that exercise, which is a salutary mode of preventing pyrexia, may be had recourse to in many cases during the first, and after the latter stages of, in¬ ternal inflammation. When inflammatory fever has com¬ menced, measures for the removal of its predisposing cause, similar to the above, w hich are recommended for the prevention of the fever, Mr. Searle says ought to be adopted, limited only by the disability of the patient to pursue them so fully. Ani¬ mal food in a solid form, he states, cannot, in general, he taken, if the fever be acute, but “ milk, wdiey, beer, wine and water, eggs, or good broth, can be taken in small quantities, and frequently;” and he adds, that if nourishment be judiciously and fearlessly administered, the strength will gradually increase, while the irritability and consequent fever will be proportionally diminished. The medicinal treatment, wre are told, depends much upon the character of the inflammatory fever. When the general circulation is inordinately increased, and when considerable pyrexia attends sub¬ acute inflammation, sedative medicines, such as tartarized antimony and digitalis, are recommended, though upon what principle it is difficult to imagine ; for every one must, I think, perceive, if it be right, in the dietetic treatment of the con¬ stitution, to increase the general circula¬ tion, by the fearless administration of milk, beer, wine and water, eggs, and good broth, that it cannot at the same time be proper, in the medicinal treatment, to lower the vascular action by means of tartarized antimony and digitalis. But it happens that this treatment can seldom be put into execution ; for when emetic tartar is given in doses sufficiently large to produce a sedative effect, it never fails, at the same time, to cause severe nausea; so that when a patient is under the influence of that medicine, his stomach, w hich must he in a very unfit state to receive eggs and broth, will necessarily rebel against those good things, and either refuse them admit¬ tance, or eject them soon after their en¬ trance. As far, therefore, as regards the constitution, it must, I think, be plain that the treatment recommended for it by Mr. Searle is inconsistent, and often im¬ practicable. Under the head of the treatment of the local disease, we are told that it is some¬ times necessary to depress and sometimes to raise the circulation. The vascular ac¬ tion is to be depressed by means of tar¬ tarized antimony, when inflammation has been caused by excitement of the general circulation ; but this is nothing more than the practice which is recommended for the treatment of the constitution. The vascular action is to be raised when in¬ flammation of an internal organ has been brought on by any considerable depression of the circulation, as when the surface and extremities of the body have been ex¬ posed for several hours to wret and cold. In a case of this kind, sudorifics, warm baths, flannel clothing, and whatever excites the general circulation, are re¬ commended ; and when the feet remain cold, and the circulation continues lan¬ guid, blisters or sinapisms to the patient’s insteps, and diffusible stimulants, become, Mr. Searle states, indispensable, in order to raise the general circulation “to the level of that in the inflamed organ,” NEW FANGLED DOCTRINES. 203 whereby he thinks that the superabund¬ ant quantity of blood which exists in the diseased part will be reduced. But let us suppose the internal organ which is affected to be the'intestinal tube. What, in a case of this kind, would be the effect of Mr. Searle’s stimulating plan of treatment, provided it could be followed, which will seldom be the case, because, in acute enteritis, the stomach is frequently so irritable that it ejects every thing ? But admitting that diffusible stimulants could in such a case be taken by the patient, and kept in the stomach, what, I ask, would be their immediate effect ? In con¬ sequence of the general circulation being raised, the vascular action in the extre¬ mities and outer surface of the body would be increased, and, at the same time, and in the same ratio, the action of the larger vessels in the diseased part ; for I do not agree with Mr, Searle in opinion, that, by increasing the general circulation, we draw the blood, as it were, from the dis¬ eased over- loaded organ into the extre¬ mities and outer surface of the body. No; when the general circulation is increased, the blood is propelled, with increased force, throughout the whole of the body, and, therefore, as diffusible stimulants are general stimulants, and exert no specific local influence, to whatever extent the cir¬ culation may in any one part of the body be raised through their agency, it will to the same extent be raised in the larger vessels of the diseased organ, above the state in which it was before these medicines were administered ; so that if this view be correct, it clearly follows, that to give dif¬ fusible stimulants in a case like the one now under consideration, would only be to add fuel to a raging flame. But if we were to adopt a different practice : if, instead of giving diffusible stimulants, we were to open a vein, and to take away a large quantity of blood, and if the pulse, soon after this, were to rise and become fuller, as it generally does after bleeding in enteritis, we should in this way not only increase the vascular ac¬ tion in the extremities and outer surface of the body, but, at the same time, lessen the determination to the bowels, by re¬ moving from the body a considerable quantity of that very fluid, the presence of which, in the diseased part, is the imme¬ diate cause of the inflammation. This, which is the practice of the present day, is a practice founded upon reason ; it is a practice which experience has led us to adopt; and it is a practice which, not¬ withstanding Mr. Searle’s objections, will continue to be followed by all judicious physicians so long as the nature of inflam¬ mation remains unchanged. But Mr. Searle strenuously opposes the antiphlogistic plan of treatment, on the ground that it consists of lowering mea¬ sures ; and yet he says that the circula¬ tion ought sometimes to be lowered, ac¬ cording to the primary cause which has given rise to the inflammation. What is this but antiphlogistic treatment ? Surely, when we lower the circulation, we do so by antiphlogistic means, — by means which, we are told, are opposed to Mr. Searle’s views, and which, lie says* often destroy life when the disease would not. But, if inflammation ought always to be treated according to its primary cause, when that cause can be discovered, and if the pri¬ mary causes of inflammation be numerous, and some even of opposite nature, as Mr. Searle admits, it follows that the treat¬ ment must vary according to the primary cause, and, therefore, that antiphlogistic measures cannot always be improper. For instance, when an inflammatory disease has been brought on by a cause the very opposite to one which would excite an in¬ flammation, for the removal of which sti¬ mulants are requisite, the antiphlogistic or lowering treatment, in such a case, must, for obvious reasons, be the only treatment which could be had recourse to with any thing like a rational prospect of success. But Mr. Searle will not admit this. He seems to have a strange antipathy to the words antiphlogistic treatment, and only to the words; for he admits, as has been shown, the principle upon which that plan of treatment is founded, and yet, when it is called antiphlogistic, his lan¬ guage respecting it, from the beginning to the end of his paper, is the language of condemnation ; indeed he goes so far as to say, that “ inflammation, like fever, is a bugbear ;” that the strict antiphlogistic system of treatment is always injurious, and always of fatal tendency ; and that its measures are tenfold more terrific than the disease itself. Will it be believed that this is the lan¬ guage of a British surgeon in the year 1836 ? Surely some sort of a professional mania has broken out in the land. One man tells us that fractured thigh-bones may be cured, in an amazingly short space of time, by merely placing the patients in an easy position on a bed, and leaving them to nature and a pillow ; another, that a few infinitessimal doses of common sulphur, each dose not being larger than a billionth part of a grain, will work wonders in removing some diseases over which no other kind of medicine would have any power; and a third soberly and seriously states, that the antiphlogistic plan of treatment, in acute inflammatory diseases, 204 PARISH SURGEONS AND POOR-LAW UNIONS. ought to be carefully avoided — that if it were, for the first time, proposed for the consideration of the jirofesion, in this en¬ lightened age, it would be treated with deserved contempt — and that if Hippo¬ crates were to rise up from his grave, and to hear of nothing hut the antiphlogistic treatment, he would offer a woful lament for mankind, because twenty-two centuries have produced, in the chief department of medical practice, nothing better than a rule without a reason. Surely, after this, no one will doubt that some such malady as the above-mentioned is spreading amongst us, and that if it continue, it may be attended with direful consequences. I should not, however, have taken any notice of Mr. Searle’s opinion respecting the treatment of inflammatory diseases, had his paper not been published in a journal which is pretty extensively circu¬ lated, particularly among the junior mem¬ bers of the profession ; but, seeing that it holds a conspicuous place in the Lancet, and fearing, on that account, that some may suppose the stimulating part of Mr. Searle’s practice to be approved of by the conductors of that work, which perhaps is the case, I consider it to be my duty to lift up my voice against it. If the above observations should act as a caveat, and be instrumental in causing any of my young professional brethren to pause and think before they adopt a practice which every man of experience must know to be fraught with danger, the object which I have in view, in forwarding this letter for publication in your truly excellent journal, will be accomplished. — 1 have the the honour to be, sir, Your constant reader, And most obedient servant, Investigator. London, Oct. 37, 1836. PARISH SURGEONS AND POOR LAW UNIONS. To the Editor of the Medical Gazette . Sir, Will you permit me, through the medium of your Gazette, to make a few observa¬ tions on the following advertisement, which has lately appeared in the Northamp¬ ton Mercury ? “Leighton Buzzard Union. “ To Medical Gentlemen. “ The Board of Guardians are desirous of receiving applications from medical gen¬ tlemen, duly qualified, who may wish to fill the situation of medical officer of this Union. “ The Union consists of the following parishes: — Leighton Buzzard, Billington, Egginton, Heath and Reach, and Stan, bridge, in Beds, — and Edlesborough, Ivinghoe, Slapton, Grove, Wing, Lin- slade, Soulbury, Cheddington, Martmore, and Stoke Hammond, in Bucks ; and comprises a population of 1 1,800 persons. “ The gentleman appointed will be re¬ quired to devote his whole time and at¬ tention to the duties of his situation, which will comprise, amongst other things, due and punctual attendance in all medical, surgical, and midwifery cases, and vaccination for all paupers ; and he will provide, at his own cost, all medicine, drugs, and medical and surgical requisites, &c., trusses excepted. He will be required to enter on his duties on the 1st of Decern- ber next, and to reside in the workhouse at Leighton Buzzard, where apartments (unfurnished) and stable-room w'ill be pro¬ vided for his accommodation. “ The salary will be 200/. a year. “ Testimonials of qualification, charac¬ ter, &c., accompanied by a letter, stating the age of the applicant, and whether he be married or single, to be sent, free of postage, addressed to the Clerk to the Board of Guardians, Leighton Buzzard, on or before the 20th October, instant. “ The Guardians, at the meeting of the Board, on the following day, projjose to select from the gentlemen sending in testi¬ monials, three applicants, who, on receiv¬ ing an intimation to that effect, will be ex¬ pected to attend in person at the next meeting, when it is intended that the ap¬ pointment shall take place. “ The Board, howrever, do not pledge themselves to elect any applicant, unless fully satisfied of his eligibility. “Leighton Buzzard, Beds. Oct. 1, 1836.” In the first place, I cannot but observe howr firmly resolved these gentlemen of the Board of Guardians are, to appoint no one as their surgeon who is not duly qualified for the office — will devote his whole time to its numerous duties — and can produce testimonials favourable to his character. Now all this is exceedingly proper— no one can dispute it; but supposing any surgeon, possessing the requisite qualifica¬ tions, w:ere capable of fulfilling the duties of the situation (which I am confident the physical powers of no one man in existence are equal to), howr is he to be remunerated ? “ The salary will be 200/. a year.” How very inadequate a sum for providing medi¬ cal and surgical attendance — medicines of all descriptions, aiid attendance on mid- PARISH SURGEONS AND POOR-LAW UNIONS. 205 wifery cases, for a population of 11,800 persons, extended through fifteen country parishes ! I am not acquainted with Leigh¬ ton Buzzard, or its neighbourhood ; but I know well what a country practice is, having been engaged in one for the last five-and-twenty years. Why, sir, the mid¬ wifery alone, extended over so wide a dis¬ trict, would be far more than any one per¬ son could accomplish : the number of cases occurring annually would probably be from twenty-seven to thirty for every thou¬ sand of the population. Can any person, having the slightest knowledge of the fre¬ quent, vexatious, though unavoidable, de¬ lays incident to midwifery practice, ima¬ gine it possible for any one individual to attend annually between 300 and 400 ac- couchements, scattered through fifteen country parishes? — an average of nearly one case every day ! I can picture to my¬ self the poor fellow, after riding hard through a dreary winter’s day, returning, not to a quiet comfortable home and a happy domestic circle, but to his solitary apartment in a parish workhouse : there he sits in solitude, but not in quiet ; for constantly is he assailed by the ceaseless din of its clamorous inmates ; — in despair he retires to his couch, but scarcely has he stretched his weary limbs, and closed his eyes in slumber, ere a loud knocking at the outer gate, accompanied by an impa¬ tient shout, rouses him from a momentary oblivion : again must he mount his already jaded steed — again must he brave the in¬ clemencies of a winter’s night, and plunge through the mud of numerous intricate lanes, the only path to some wretched cot¬ tage four or five miles distant. Here he is compelled to wait the event of a tedious case, not unattended with hazard ; seated by the side of a smoky fire, he rests his head against a pillow fastened to the wall by a fork to prevent its falling, and endea¬ vours to procure a little sleep. Morning at length arrives, but his patient must not be left : anxiously he considers how he shall get through the various du¬ ties of the coming day. In the midst of his deliberations a hasty messenger, mounted on a panting cart-horse, demands his immediate attendance in an opposite part of the Union. What can he do ? — how is he to proceed ? His misery is complete ; — no, far otherwise : before he has time to reply to the last messenger, another arrives with the intelligence that a man has been run over by a waggon, that his thigh is broken, and that he lies bleeding at a public-house about three miles distant. Where shall he look for assistance ? The neighbouring practi¬ tioners will not afford it; if they do, the Board of Guardians will not pay them for their exertions, however urgent the case may be : he has taken the union, and must abide the consequences. Of this I have myself very lately had proof. But do not mistake me ; I have not taken an union, nor will I take one. The case I allude to is briefly as follows : — A neighbouring sur¬ geon, having a pauper patient in a very dangerous state, sent for me to consult with him on the propriety of an operation. I attended, at a distance of about five miles from my own home; the operation was decided on, and immediately per¬ formed. The Board of Gurdians referred the case to the Poor-Law Commissioners in London, who immediately refused to sanction any payment whatever. But supposing it possible for any one man to accomplish the duties required, how very paltry the remuneration ! Two hundred pounds per annum, for a man who has gone through the whole routine of his medical education, and, by passing his examinations, proved himself qualified for practice ! I hope the various lecturers in London, when they give the farewell address to their pupils at the close of their several courses of lectures, will not fail to set forth, in proper colours, the various benefits arising from a Poor-Law Union. I hope the President of the Royal College of Surgeons, when the oath in which they swear to promote the dignity and welfare of the College is administered to the can¬ didates for the diploma, will not fail to in¬ form him, that, if they conduct themselves fairly and honourably in the practice of their profession, they may, in due time, ex¬ pect to be promoted to the enviable situa¬ tion of an Union surgeon; that should they be fortunate enough to obtain the Leighton Buzzard appointment, after they are completely worn out with its ar¬ duous duties, they may probably be per¬ mitted an asylum in the workhouse; and, after a life of ceaseless toil, finally close their eyes to this world, stretched on a miserable pallet in a ward crowded with paupers. But to resume: the poor ought to be attended, during any illness with which they may be afflicted, by properly educat¬ ed and duly authorized practitioners, members of the Royal College of Sur¬ geons, at a good and sufficient salary, wrho should not be compelled to undertake an immense district, and forego all the advan¬ tages of private practice. The districts should in all cases be small, and manage¬ able ; if to the exclusion of private busi¬ ness, the salary should be much larger than wrhere private practice is permitted. But, in each instance, the surgeon should be allowed, in urgent eases, to call in the as¬ sistance of a neighbouring practitioner, wffio should be properly remunerated for his services. 206 PATHOLOGY OF EPILEPSY ACCORDING TO THE WENZELS. I have often wished that parish surgeons were appointed and paid by the govern¬ ment. Why not have government sur¬ geons to parishes, as well as to ships and to regiments ? How very differently, and how very easily, would the business be managed. Take the Leighton Buzzard Union, with its population of 11,800 per¬ sons, for instance. The Guardians pro¬ pose to elect one surgeon, with a salary of 200/. a year, and apartments in the Work- house. Now, sir, let us look to the navy, and see how the affair is managed in that ser¬ vice. The crew of a first- rate ship of war, including officers, is 900 persons ; there¬ fore, the crews of thirteen first-rate ships wrould be 11,700 persons, 100 less than the Leighton Buzzard Union. All medicines are provided by government. Every ship is allowed one surgeon and three assistant- surgeons, all of whom are duly qualified for naval practice ; — -and how are these gentlemen paid ? The ship is their home, and they have the ship’s allowance of pro¬ visions: if they think proper to keep a more luxurious table, they are at liberty so to do. The net annual pay of a surgeon is 159/. 9s. 4 d. in all rates: any increase of pay depends upon length of service, and not on the size of the ship. The net an¬ nual pay of an assistant surgeon is 1 19/. 12s. in all rates ; consequently— £ s. d. The annual pay of 13 surgeons will be . 2073 1 4 The annual pay of 39 assis¬ tant-surgeons (three to each ship) . . . * 4664 8 0 Total annual pay of the medi¬ cal officers of 13 first rate ships of war, containing 100 individuals less than the Leighton Buzzard Union, for which 200/. per annum - - is offered ••••«*» . . • 6737 9 4 I am not so well acquainted with the pay and allowances of the army surgeons and assistants; but I have reason to be¬ lieve that the difference is not great : I know there is an allowance for the keep of a horse. — I am, sir, Your obedient servant, An Old Navy Surgeon. Oct. 29, 1836. TETANUS. - NOTE FROM MR. CURLING. To the Editor of the Medical Gazette. Sir, In the notice of my work on Tetanus in your lust number, you refer to a case men¬ tioned on the authority of Wepfer, in which it is stated, both in my Essay and in the Gazette, the disease proved fatal in three minutes. This is a misprint. It should have been thirty minutes, and stands corrected thus in the “ Corrigenda.” As the error makes a considerable difference in the ease, you will oblige me by noticing it. — I am, sir, Your obedient servant. T. B. Curling. Mount Place, London Hospital, OctoberSl, 1836. PATHOLOGY OF EPILEPSY. DR. SEYMOUR’S LECTURE. To the Editor of the Medical Gazette . Sir, Your Gazette of Saturday last contains a report of a clinical lecture by Dr. Sey¬ mour, in which it is stated that the Wen¬ zels published a work some years ago, in which 30 cases of that disease are men¬ tioned, and “ in every one of these there was more or less disease of the cerebellum .” Dr. John Sims* pointed out an error in this statement, and ascribed the mistake to the circumstance of the word “ hirnan- hang” (pituitary gland), having been in¬ correctly translated “ cervelet,’’ in a French version of Wenzel’s work, with which English writers were better acquainted than with the original. If Dr. Sims’ remarks were correct (and I am not aware that they have been con¬ tradicted), it is desirable that the error should not be propagated by so respectable an authority as Dr. Seymour’s. I am, sir, Your obedient servant, W. II. Bernard. [Cheltenham, Nov. 1, 1S36.] CASE OF EXTENSIVE AND DEEP-SEATED INJURY OF THE BRAIN, Unattended by any disturbance of the intellect, and terminating favourably . By James Couper, Jun. M. D. Of New Castle, Delaware. On the 13th of September, 1835, at 10 o’clock in the morning, a son of Mr. Allen of this neighbourhood, three and a half years old, of full size and perfect health, climbed to the top of a fence four feet * See Medical Gazette, Dec. 18, 1830. CASE OP EXTENSIVE INJURY OF THE BRAIN. 207 eight inches in height, and when there lost his balance, and fell headlong on the op¬ posite side. On that side of the fence there happened to be a pile of weather¬ boards, which had been taken from an old building. One of them rested on the ground, and extended to the spot upon which lie fell. It was so firmly fixed by the weight of boards above it, as to be incapa¬ ble of yielding to the impulse of a body falling on it, and through the end of it the sharp extremity of a wrought nail pro¬ jected. Tn falling, the head of the child struck upon this nail. Its point entered the right parietal bone, just behind the central point of the right half of the coro¬ nal suture, and at the distance of half an inch from it. Its direction was, from the point of entrance, towards the centre of the base of the brain, and the part of it which entered the skull measured two inches and a quarter. After the head had been driven close up to the surface of the board by the perpendicular force of the fall, the child fell over on his right side, thus causing the point of the nail to de¬ scribe a segment of a circle within the substance of the brain. The accident was first observed by a girl belonging to the family, who ran to the assistance of the child, and made several ineffectual efforts to relieve him by lifting up his body. Having failed in her attempts, she called to her aid a young man, who at first made like trials to release him, by raising his body from the ground. Defeated in these, he at last succeeded in extricating the boy from his distressed situation, by interlock¬ ing the fingers of both his hands beneath the head, and forcibly raising it off from the board. Upon the extraction of the nail, small portions of brain were found adhering to it, and other pieces afterwards came away from the wound. But little blood was lost; it amounted, perhaps, to two fluid ounces, and came principally from a minute arterial twig belonging to the scalp. When 1 first saw' the patient, which was within an hour from the time of the accident, he had fallen asleep, but was readily aroused by my efforts to clear away the blood from the wound, and struggled resolutely to escape from them. During the afternoon of that day, he vo¬ mited freely several times. At ten o’clock at night, he was suddenly seized with total loss of power over the left side, but without any corresponding loss of sensation, or any paralytic affection of the tongue. His speech, both then and afterwards, was perfectly natural, as were also his eyes and the general expression of his countenance. Distinct attempts were made by the system to set up inflammatory action within the cranium on the second, fourth, fifth, and seventh days after the injury, but these were readily defeated by prompt and effi¬ cient depletory measures. A slight dis¬ charge continued to flow7 from the wound for about a week, and then ceased entirely. The paralysis has passed off regularly, but slowly. At this time (five months from the date of the accident), although the child runs about as usual, and exercises constantly and very freely without diffi¬ culty, there remains a slight general weak¬ ness of the arm, with a degree of defect in the power of the flexor and adductor mus¬ cles of the thigh of the affected side. The treatment of this case, in which I w7as aided in consultation by Dr. Baker, of Wilmington, consisted in the diligent use of free general and local depletion, toge¬ ther with those other measures by which inflammation of the brain may be pre¬ vented or removed. The preceding case appears to me to be interesting — 1. On account of the depth and extent to which the brain must have been broken up by the nail in its entrance, and its sub¬ sequent movements within the cranium, produced by the various ill-directed efforts to release the child. 2. From the fact that paralysis of the opposite side did not come on as an im~ mediate , but remote effect of such serious injury to the brain, occurring at the end of twelve hours from the time of the acci¬ dent, and that suddenly. 3. As exhibiting an instance of recovery after extensive deep-seated damage to the brain, and especially as proving that such important mischief within the skull docs not necessarily impair the intellectual powers. No aberration of mind whatever was observed during the whole course of the case, although it wras carefully watched with particular reference to this point*. MR. W ALFORD. If the Editor of the Lancet is to be be¬ lieved, a person named Walford has inti¬ mated to him, that he (the said Mr. Wal¬ ford) was not privy to certain editorial articles which have recently appeared in this journal. For the information of all whom it may concern, we beg to state that no person of that name ever wras, in any way, directly or indirectly, connected with the Medical Gazette, and that the circumstance alluded to, if it ever oc¬ curred, must either have been intended as a hoax upon Mr. Wakley, or be the result ot some incomprehensible impertinence on the part of his correspondent. * American Journal of Medical Sciences, for August 1836. 208 BILLS OF MORTALITY.— METEOROLOGICAL JOURNAL COLLEGE OF SURGEONS. LIST OF GENTLEMEN WIIO RECEIVED DIPLOMAS IN NOVEMBER. T. Ridout Tuck, Montague St., Russell Square. J. R. Cole, Odiham, Hants. W. T. Wilson, Armagh. Janies Godfrey, London, Thos. Talbot, Roscrea, Tipperary. A. C^wie, St. Fergus, Aberdeenshire. George Bury, Dublin. Thos* Erskine, Cavan. Mark A. B. Corbin, Guernsey. G. E. Blinkins, Half-Moon-Street. Frederick C. Lukis, Guernsey. Wm. Jones, Bristol. Richard J. Kilburne, Liverpool. James T. Smith, Much Hadham. John Henning, London. H. F. Edwards, Brislington. Henry Goodwin, Westmoreland, Jamaica. W. Honeywood, Batavia. J. Selkirk, Bury, Lancashire. W. Hay, High Wycombe. J. R. Gibson, London. R. D. Harris, Torrington Park, Hornsey. James Haines, Cheltenham. Benjamin Collinette, Guernsey. James Fletcher, Oldham. Thomas Dwyer, Thurles, Tipperary. Francis Hird, Richmond, Yorkshire. Thomas Young, Nelson Sqnare. William Holmes, Madras. C. T. Thomson, Brightwell, near Wallingford. Caleb Basan, London. W. G. Everett, Devizes. Jas, Brideoake, Leigh, Lancashire. Wm. Cooke, Boston. Joseph Williams, Clapliam. APOTHECARIES’ HALL LIST OF GENTLEMEN WHO HAVE RECEIVED certificates, Oct. 27 and Nov. 3, 1836. Thomas Adolphus Boyrenson, 13, Leman Street. James William llott, Bromley, Kent. John Herbert Patterson, Portsmouth. Samuel Osborn, London. Joseph John Lay, Peasenhall, Suffolk. Augustus Slight, Portsmouth. Joseph Lay Faulkner, Leeds, Yorkshire. Arthur Paul, Winchester. Thomas Richard Jackson, Congleton. Richard Allatt, Brelton. Thomas Cowdry, Batherston. Chanes Knevitt, Isleworth. Thomas Stocks, Hattoft, Lincolnshire. Richard Kinneir, Cricklade. James Fletcher, Arundel, Sussex. Manwaring Shurlock, Guildford. John Hullock, Stockport. James Richard Quick, St. Mawe’s, Cornwall. Robert Morley Lasalles, Stillington, Yorkshire. Ebenezer Vorley, Carlton, Bedfordshire. William James Best, Thetford, Norfolk. Wm. Hodgson Peacock, Simmington, Yorkshire. Thomas Hanley Barker, York. William Atkinson, Leeds. John Hare Gibson, Hull. John Roberts Hogg, Brighton. Samuel Maberly, Farnham. John Dymock Scale, Cardiff. Thomas Jones, Cwm Neath, Glamorganshire. William Hibbit Moore, Woodbridge. Richard Vicary Gorham, Wollesly, Suffolk. Daniel Antrobus, Betley, Staffordshire. John Morley, Barton-upon- Humber. James Drew, Cambridge. John Dungate Watt. Augustine Valentine Dennis, Wells, Norfolk. Edward Smith Walters, Cheadle. Samuel Farrow, Loughborough. William Deakins, Leicester. William Gifford Everett, Devizes. PORTRAIT OF IIUFELAND. A striking likeness of the late Professor Hufeland, after Kruger, has just been published by Mr. Schloss. It is a very fine specimen of the lithographic art, and will form a companion portrait for the Tiedemann, lately brought out by the same publisher. LITERARY INTELLIGENCE. Sketch of the Comparative Anatomy of the Nervous System ; with Remarks on its Development in the Human Embryo. Illustrated by plates. By John Anderson, M.E.S., Hon. Fellow of the Physical So¬ ciety of Guy’s Hospital. In the press. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Nov. 1, 1836. Age and Debility . 17 Heart, diseased • 2 Apoplexy 1 Hooping Cough • I Asthma 7 Inllammation • 8 Cancer . 1 Bowels3z Stomach 3 Consumption 29 Lungs and Pleura 2 Convulsions 17 Insanity • 2 C r o u i) « • • 1 , Liver, diseased Measles 1 Dentition or Teething 3 • 10 Dropsy 8 Mortification « 2 Dropsy on the Brain 7 Paralysis • 3 Dysentery 1 Rheumatism • 1 Erysipelas . . 3 Sore Throat and Fever . . . 3 Quinsey . • r Fever, Scarlet . 4 Thrush . . 1 Haemorrhage . 1 ! Unknown Causes 10 Decrease of Burials, as compared with > the preceding week . . i ' METEOROLOGICAL JOURNAL. Kept at Edmonton, Latitude 51° 37' 32" N . Longitude 0° 3' 51" W. of Greenwich. Oct • 1836. Thermometer. Barometer. Thursday . 27 from 37 to 52 29-62 to 29 86 Friday . . 28 31 42 29 87 29 73 Saturday . 29 24 43 29 42 29-72 Sunday . . 30 26 37 29-93 29-97 Monday . . 31 Nov. 22 39 29 97 30-03 Tuesday . . 1 23 43 30-03 29 94 Wednesday 2 39 53 29-89 29 86 Prevailing winds, N.W. and W. by S. Generally cloudy, with frequent rain. A heavy fall of snow on the morning of the 29th, averag¬ ing in depth about four inches. Rain fallen, *2 1 25 of an inch. Charles Henry Adams. NOTICES. il F.” had better send us a sample of his facts and arguments : our pages are al¬ ways impartially open for a fair trial ; but facts must be authenticated with a real signature. We have been obliged to postpone tem¬ porarily the letters of Mr. Flower and Mr. Hulbert, for want of room. Wilson & Son, Printers, 57>Skinner-St, London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOUMAL OF iHfUtctne anti tf)f Collateral £>rtcnre£>. SATURDAY, NOVEMBER 12, 1836. LECTURES ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine, By William Cummin, M.D. Lecture VII. Further Remarks on the Identity of Living Persons — Extraordinary case of alleged Ab¬ duction and contested Identity — Some recent Cases. Identity of Persons found Dead — Supposed remains of Hampden and Milton The head of Charles I. identified, — Identity of the victim essential in prosecutions for Murder — Remarkable instances of identifica¬ tion which have occurred in England and France — Inquiries relative to changing the co¬ lour of the Hair for the purpose of confound¬ ing identity — Hints for detection — Practical rules for the investigation of cases of doubtful identity. I have given some instances of identity being mistaken in criminal prosecutions; eye-witnesses swearing positively to the identity of a wrong party. I shall add one example more, from the extraordinary case of Mary Squires, which occupied so much of public attention about the middle of the last century, and which to this hour has not been satisfactorily cleared up. Extraordinary case of contested identity. — j Mary Squires was an old gipsy-woman, who might have lived unnoticed, and died ! without remembrance, had not a prosecu- i tion for robbery, followed by sentence of ' jE&th, fixed the public eye upon her. i 1 lie circumstances of the case excited in¬ quiry, and, according as prejudice or party i opeiated, the convict became alternately 1 an object of detestation, pity, or contempt. It appeared by the declaration on oath of Elizabeth Canning, a girl about eighteen years of age, that on the night of new- year’s day, 1753, she was returning to her 407. — xix. master’s house, in Aldermanbury, from the neighbourhood of Rosemary-lane, when she was stopped, near Bethlem wall, Moorfields, by two men, who robbed her of her gown, apron, hat, and half a guinea, tied her hands behind her, and, on her struggling, gave her a violent blow on the temple, accompanied with oaths and exe¬ crations. She was then dragged to the house of one Mother Wells, at Enfield- Wash, where she saw Mary Squires. Squires made her overtures, as Canning understood her, to become a prostitute; and, upon her refusal, ripped up her stays, which she took from her, and, after manv threats, thrust her into a back room, or hay-loft, where she was confined for twenty-eight days, without fire, or any kind of sustenance, except some pieces of bread, amounting to about a quartern loaf alto¬ gether, about a gallon of water in a pitcher, and a small minced pie which she accidentally had in her pocket. During the whole of this time, Canning further declared that no human creature visited her. The bread and water being exhausted, she broke down a window- shutter, which was nailed, got out of the window on a sort of pent-house, and thence jumped to the ground, nine or ten feet below, according to her description. She reached home, by walking, as fast as her weak condition permitted. The case became known, and immedi¬ ately excited the sympathy and indigna¬ tion of the public. A subscription was got up for the young woman. Squires and Wells were taken into custody, tried at the Old Bailey, and sentence of death passed on the former. But Sir Crisp Gascoyne, the Lord Mayor, perceived that there were many contradictory points in Canning’s evidence. Her description of the loft in which she was confined did not exactly tally with the room in Wells’s house. A girl, too, one Vertue Hall, who had been a principal witness for the prosecution, retracted her P 210 DR. CUMMIN ON FORENSIC MEDICINE. evidence, “ having been threatened and frightened into what she had sworn.” This girl had, in the first instance, corro¬ borated the statement of Canning relative to the conversation at Enfield with Squires, and the ripping of the stays. A memorial was presented to the King, and the convict was respited for a few weeks. She ulti¬ mately received a free pardon, upon the law officers of the crown declaring that the weight of evidence was in her favour. A re-action now took place ; for if Squires was not guilty, Canning could not be innocent : the latter was accord¬ ingly indicted for perjury. Her trial, which did not come on for nearly twelve months after that of Squires, occupied five days: the witnesses were numerous, and their testimony of a very intricate and con¬ tradictory nature. The question of Identity was the one on which the proceedings chiefly turned. Could Canning, and could a host of other persons, be mistaken in the appearance of Squires ? The old woman had features of the most remarkable description. When the constable went with the warrant to apprehend her, she said to Canning, on being charged with robbing her of her stays, — “ Do you say I robbed you ? Look at me : if you have once seen my face, you must remember it, for God Almighty never made such another!” It is said that when this part of the evidence was given in court, every eye was fixed on the old woman, whose countenance exhibited an assemblage of the most uncommon, and diabolically hideous fea¬ tures. Yet thirty-six witnesses swore one way, and twenty- six another, as to seeing her at certain places about the same time. It appeared, according to one train of evi¬ dence, that the old gipsy was at Abbots- bury in Dorsetshire, from the 1st of Janu¬ ary to the 9th ; that she was in various places in Dorsetshire, Wiltshire, Hamp¬ shire, &c., from that time to the 18th ; and that she did not arrive at the house of Mother Wells till the 23d. On the other hand, it was proved, or attempted to be proved, that she was, during this very time, seen nearly every day in the neigh¬ bourhood of Enfield. The only medical evidence produced was that of a physician and an apothe¬ cary, who deposed to the languid and re¬ duced state of Elizabeth Canning on her return to her mother’s, and that she ap¬ peared like one who had suffered extreme hunger, thirst, and cold ; but they ac¬ knowledged that a person might be as she W'as from other causes. There were, however, several circum¬ stances in the case that would have ad¬ mitted of mcdico-legal elucidation. In a physical or physiological point of view, it is highly improbable that the girl could have subsisted for eight-and-twenty days on a quartern loaf and a gallon of water ; or, at all events, if life re¬ mained, the sufferer should have been nearly exhausted from famine ; her person should have exhibited striking proofs of starvation from cold and hunger : yet there is no reason to believe that such ap¬ pearances were remarkable in the alleged sufferer. Other minor but not less important points might have engaged the attention of the medical jurist. If Canning had been confined so closely in a hay-loft for so long a time, the natural excretions might have been referred to in proof ; and the catamenia, also, would probably have left their traces. No notice, however, seems to have been bestowed on these things. It has been already mentioned that Canning’s account of the place of her in¬ carceration was incorrect in certain parti¬ culars: it was, in fact, such an account as might have been trumped up from the description of somebody who had seen the place ; but this was not all : some damn¬ ing facts against this part of her evi¬ dence came out on the trial. A poor man, named Fortune Natus, proved that he and his wife slept in the room in which Canning swore she was confined, during the whole of that month, and for five or six weeks before. This testimony was also corroborated by Ezra Whiffin, a neighbour of Mother Wells, who being in w ant of a sign-board, and hearing that she had one to dispose of, called to see it, and accompanied Wells into the very room in question to seek for it. They there found it under some hay, which made part of the bed on which the wrife of Natus was actu¬ ally lying at the time— namely, on the 18th of January. It wras not possible that Canning could have been in the room, or she must have been seen, and would proba¬ bly have called for help. She had swrorn, besides, that no person of any description had entered the room during the wrhole of her confinement. I omit a great many other discrepancies and contradictions which came out in evi¬ dence. There were not less, it is said, than 120 witnesses examined altogether. The jury brought in a verdict of “wilful and corrupt perjury;” and the sentence was “ transportation for seven years.” Yet, strange to say, many people still insisted on the innocence of Elizabeth Canning : the newspapers and periodicals of the time were filled with discussions on the subject. Fielding, the novelist, who was also a magistrate, w rote a pamphlet in Canning’s favour ; but lie was replied IDENTITY OF THE DEAD. 211 to with critical severity by Dr. (Sir John) Hill. To conclude the story, Canning was transported to New England, accord¬ ing to her sentence: there she married ad¬ vantageously, and one of her original sup¬ porters left her a legacy of 500/. I may add, that before her departure, wishing doubtless to have the last word, she pub¬ lished a declaration in these terms: — “ I declare in the most serious manner, that I am fully persuaded, and well assured, that Mary Squires was the person wdio robbed me, and that the house of Susannah Wells was the place in which I was confined for twenty-eight days!” It certainly has never been explained where she was during the twenty-eight days, if not in Mother Wells’s hay-loft. Such were the leading facts of a trans¬ action which excited as much interest at the period as the affaire La RoncRre has latterly done in France. In both, the tes¬ timony of a young female formed the chief ground of accusation against a pri¬ soner; in both there has been room for medico-legal research; but the main fea¬ tures of the charge have been very dif¬ ferent in each, as l may hereafter, in al¬ luding more particularly to the La Ron- cRre cause, have occasion to show. Identity of a child. — The question of a child’s identity was raised in a recent trial at Cambridge, for an assault. The parties were Wagstaff v. Bruyere, The prosecutrix (Miss Wagstaff) swore that she was the mother of a child which was carried away from her forcibly by Mr. Bruyere, and some police officers. Mr. Bruyere (brother-in-law of prose¬ cutrix) proved that it was his wife’s child which he took away, and that it was seven months younger than Miss Wagstaff ’s. A medical witness gave some important testimony. He had at¬ tended Mrs. Bruyere professionally in all her confinements, and he swmre to the identity of the disputed child, “ bringing forward some of the most convincing reasons .” What these reasons were I have not been able to learn ; but it is probable they wrere certain personal marks and peculiarities. Much stress was laid upon the colour of the hair, the colour of the eyes, and the grow th of the child. I need not more fully allude to this remarkable trial, of which you will find a good report in the Times, July 29, 1836 ; but I have no doubt that, had it occurred in France, it would have obtained a place among the Causes celcbres. Tn another trial, for murder and robbery, which took place lately at the Exeter Summer Assizes, the identity of one of the prisoners was questioned: and the fact of his wanting one or two of the front teeth w as particularly dwelt on by some of the wit nesses. But it may probably be said, that in most cases of this kind, the evidence of ordinary witnesses is as much to the pur¬ pose as that of medical men. There may be some force in the observation, though in most of the examples which I have quoted, medical evidence either was, or might have been, given with much ad¬ vantage; but at all events, supposing that professional testimony may not greatly avail in identifying living persons, the case is different when we have to examine the dead : and this brings me to the second division of my subject — Identity of the Dead , Essentially medico-legal. — In investi¬ gations respecting the identity of indi¬ viduals found dead, especially where the remains may be much decomposed, or reduced to a mere skeleton, medical men are obviously the fittest persons to be en¬ trusted with such a task. Their fami¬ liarity with the appearances of the human subject, acquired during their anatomi¬ cal and pathological studies, and their habit of observing the features and ge¬ neral aspect of the dying and the dead, render them the most capable of appre¬ ciating the alterations which dissolution and external influences usually produce. Of the changes wrought in the human body during the progress of putrefaction under various circumstances, I shall here¬ after have to treat with all the requisite detail. At present wre shall confine our¬ selves to examples of the mode in which identity has been ascertained in doubtful cases, and conclude with some practical rules which may be beneficially employed by the medical jurist. Remains of Hampden. — A curious inquiry was instituted in the year 1828, at Hamp¬ den Church, Buckinghamshire, by which, indeed, not exactly a medico-legal, but a medico-historical, point was to be deter¬ mined. Hampden, the patriot, wrns know n to be there buried : he had received a death- wound in the battle of Chalgrave Field, in 1643 ; but the nature of that wound, and the circumstances of his death, are vari¬ ously related by historians. Lord Claren¬ don says he was shot in the shoulder w ith a brace of bullets, which broke the bone, and caused his death in three weeks ; while another authority informs us that he died in the course of a few days, in consequence of the bursting of his pistol, which shattered his hand in a shocking manner. It w'as thought that a view of the body would settle the question ; and a formal visit was made to the vaults in Hampden Church, for the purpose; but the result was not as favourable as might have been expected. As there has been some controversy con¬ cerning the trustworthiness of the pub¬ lished reports of the examination, I 212 DR. CUMMIN ON FORENSIC MEDICINE. shall not enter into the details, referring you for the satisfaction of your curiosity on the subject to the Gentleman’s Ma¬ gazine for 1828. Thus much, however, relative to the disinterment, has been ascertained through the inquiries of Mr. Southey (I quote from his Letter touching Lord Nugent) : — “ that search was made, in the place mentioned, for the body of Hampden, and, as the persons present understood, at the instance of Lord Nu¬ gent [his Lordship was at the time en¬ gaged on his Memorials of Hampden] ; that several coffins were inspected, but not opened, because either the date did not agree with that of Hampden’s death, or the inscription bore a different name ; that one coffin was at length found, which had neither date nor inscription, and this was opened, although, from its form, it appears to have been older than his time. Mr. Norris, a surgeon of Risborough, examined the body, which was that of a very lusty man, the head covered with rich auburn hair, reaching beneath the shoulders : it was in high preservation, except that one arm crumbled off, owing to the action of the air, which had made its way to that part through a crack in the coffin; but there had been no amputation, nor opera¬ tion of any kind.” Remains of Charles the First. — The search for the remains of King Charles the First, at St. George’s Chapel, Windsor, in the year 1813, was more successful. It was conducted by Sir Henry Halford, in pre¬ sence of the Prince Regent, and some mem¬ bers of the court. The particular vault in which the coffin wras deposited had long remained unknown, though it was un¬ derstood to be the one in which Henry the Eighth and one of his wives were laid. Accident led to its detection. A scroll, with name and date, served in some measure to authenticate the outer covering ; but the examination of the head left not a doubt of the identity of the royal remains. Upon disengaging the face from the cere-cloth, which had been lined writh an unctuous and resinous substance, apparently with a view to exclude the external air, the complexion of the skin was observed to be dark and discoloured. The forehead and temples had lost little or nothing of their muscular substance : the cartilage of the nose was gone; but the left eye, in the first moment of expo¬ sure, was open and full, though it va¬ nished almost immediately ; and the pointed beard, so characteristic of the pe¬ riod of the reign of King Charles, was perfect. The shape of the face was a long oval; many of the teeth remained; and the left ear, in consequence of the interpo¬ sition of the unctuous matter between it and the cere-cloth, was found entire. The countenance, in short, notwithstanding its disfigurement, bore a strong resemblance to the coins, the busts, and especially to Fig. 15. the pictures of Charles the First by Van¬ dyke. Finally, the fourth cervical vertebra was found divided transversely — the cor¬ responding-surfaces being smooth, betoken¬ ing that they had been separated by a heavy sharp instrument. I quote these particulars from the interesting narrative lately published by Sir Henry Halford. Supposed remains of Milton. — When re¬ searches of this kind are attempted by in¬ competent persons, the most gross blunders are often committed. As an instance, I may mention a disinterment which took place some forty years ago, in this very neighbourhood. Milton was known to have been buried next his father, in the chancel of St. Giles’s, Cripplegate. In August 1790, the spot where his body had been deposited was opened, and a corpse has¬ tily supposed to be his was exposed to public view. But it was suspected by some, nay, asserted — nor has the assertion ever been disproved — that the disinterred corpse was that of a female. One gentle¬ man (Mr. Capel Loff't), in censuring the “ sordid mischief” committed on the occasion, and “ the market made of the eagerness with which curiosity or admiration prompted persons to possess themselves of the supposed re¬ mains,” tells us there was reason to be¬ lieve that the said remains, so far from being Milton’s, were “ the bones of a per¬ son not of the same age or sex /” Regal distinction. — When it is remem¬ bered that, consistently with our law, no man can be condemned for murder IDENTITY OF TIIE DEAD. 213 unless the body or remains of his sup¬ posed victim be produced and identified, we must admit the deep importance of attending to this subject. Eugene Aram made it a part of his ingenious defence, that the skeleton which was foimdfourteen years after the supposed mur¬ der, was not proved to be Clarke’s; so far from it, that it was not even shown to be a male skeleton ; and he argued, that the bones produced might have been those of some hermit who had, in former times, in¬ habited the cave where they were disco¬ vered. More satisfactory evidence of identity is required in modern trials. Several me¬ dico legal disinterments might be referred to in proof of the fact. In the case of Maria Martin, who was murdered by Corder, evidence of the identity of the vic¬ tim was obtained by exhuming her body after it had lain buried in a barn for eleven months. Mr. Lawton, the surgeon, gave evidence at the trial. He described the appearances, by which the nature of her death was ascertained. The head of Maria Martin was identified chiefly by the absence of one or two teeth from the upper and lower jaw. Certain observations also, which wrere made on the state of the lungs, were important: there were adhesions of the pleura, and other marks, by which it ap¬ peared that the deceased had had cough and pain of the chest not long before death — which was precisely the case with this unfortunate young woman. I have already mentioned the case of the late Marchioness of Salisbury, whose remains were identified by the jaw-bone having certain appendages for artificial teeth. Another instance of a similar kind may be worth quoting. Four medical students were prosecuted at Edinburgh some years since, for exhuming the body of a lady. It was necessary to identify the remains, and much difficulty in this respect arose from the very contradictory evidence of the medical witnesses as to certain appearances connected with the ovaries: the point, however, was even¬ tually determined by a dentist, who pro¬ duced a cast of the gums which he had taken before derth. In the year 1814, Dupuytren identified the person of a murdered man, chiefly by observing a coxo-femoral malformation under which the deceased must have laboured. The description of the parts, as given in the official report, ( Annates d' Hygiene, vol. i.) is beautifully clear; but the following is perhaps all that properly belongs to our present subject ; it consti¬ tutes the first part of the summing up, or resumt of the report : — “ 1. The body submitted to us was that of a man between 36 and 40 years of age. 2. He must have had, in infancy, disease of the two articulations of the thighs with the pelvis. And 3. This disease, though of old standing, and cured, must have left a remarkable defor¬ mity about* the lower part of the trunk ; and the individual, in his move¬ ments of progression, must have experi¬ enced difficulties — probably lameness — certainly an unpleasant balancing of the body on the lower limbs.” M. Dupuytren then proceeds to shew that there was a difference in the length of the limbs, and that the deceased must have walked chiefly on the toes of his right foot. In another remarkable case investigated by MM. Laurent, Noble, and Vitry, at Ver¬ sailles, in the year 1828, the remains of a man who had been murdered, and had lain buried in a cellar for about three years, were identified by noting an analogous mal¬ formation, which must have produced a certain degree of lameness. After stat¬ ing the sex, age, stature, and other parti¬ culars relating to the skeleton, the reporters say in their conclusions : — “From the structure of the bones of the pelvis, the depression of the fifth lumbar vertebra, the curvature of the bones of the legs, and more particularly of those of the left side, which is six lines shorter than the right, the individual must have had rachitis in his infancy; and if he did not actually halt, he must at least have leaned considerably in his gait towards the left side.” A very singular case was investigated at Paris two or three years ago, one in which proof of identity was successfully deduced from the relics of a female eleven years buried. I have already alluded to some o f t h e c i rcu m s tan ces ; bu 1 1 h ey ar e al toge t h e r so striking, and so illustrative of the sub¬ ject under consideration, that I shall read for you an abstract of the official re¬ port drawn up by Orfila, Chevallier, Bar- ruel, and Boys de Loury, the medico-legal examiners engaged in the investigation : — In the year 1821, a widow lady, of the name of Houet, residing in the city of Paris, disappeared ; and certain persons, Bastien, Robert, and Robert’s wife, who had taken the house, No. 81, Rue de Vau- girard, were suspected of having made away with her. A judicial inquiry waspend¬ ing for some time, in the Court of Assize ; but the accused, for want of evidence, had been set at liberty. Not long ago, how¬ ever, some information was obtained touching a body said to have been buried for about eleven years in a particular gar¬ den. An investigation was accordingly set on foot; and by dint of patient and ably-directed research, such satisfactory evidence was procured of the identity of the remains, and of the manner of the death, that the prisoners were convicted, and punished. 214 DR. CUMMIN ON FORENSIC MEDICINE- The first part of the inuiry — thebjori- dical exhumation —was conducted by M. Bovs de Loury. After excavating different parts of the garden for about five hours, one of the workmen hit upon a hollowed spot, in which there were bones. The greatest care was taken to uncover them with the least possible disturbance ; they w ere evidently those of a human body, re¬ duced almost to a perfect skeleton. A drawing was made of the parts in situ. The figure reposed on the left side ; the head was bent forward on the neck ; the vertebral column was curved; the right fore- arm was raised, so that the bones of the hand nearly touched those of the face. The pelvis was turned obliquely upwards, resting on the left haunch. The thigh¬ bones were raised considerably, and the legs were crossed beneath them. The co¬ lour of the remains generally was between an ochre and a brown ; and when the earthy matter was removed from some of the long bones, the uncovered parts were found to be of a deep red colour. The grave was four feet deep, funnel- shaped, measuring five feet and a half in length at its upper part, but at the bottom only two and a half : its greatest breadth was about two feet. Some lime- stone had been placed over the body, so as to form a sort of vault. Having made these general observations, the particular parts were next examined. The skull was small and lengthy in its shape: it seemed, by the way, from the position of the head, that the body had been thrown into the grave head foremost. The parietal bones were very yielding: the sutures were well knit ; the teeth white, and had been used with care : three molars were wanting, and one of the incisors was carious. A small quantity of light-coloured or ruddy hair was found, having some grey mixed with it. The state of the neck was particularly striking. The third, fourth, fifth, and sixth cervical vertebrae, as well as the right clavicle, were held together by a blackish mass, in the composition of which there could not be recognized any tissue. This mass was surrounded at its lower part by several twists of a cord two lines in diameter; the cord was in a very decayed condition, and no knot could be found upon it. Minute attention was subsequently given to this piece de conviction, and the obvious inference that the deceased had been strangled , was fully borne out by all the direct and colla teral circumstances. Among the bones of the left hand was found a gold ring, of small diameter, carved in facettes ; and several small well- formed finger-nails were also discovered. The pelvis, from its shape and propor¬ tions, could only be that of a woman. Some portion of cloth, probably part of a stocking, was found near the legs; but upon exposure to the air, it rapidly crcm- bled to dust. I need not enter into a more minute detail of the several parts found. Other reporters, MM. Orfila, Marc, Barruel, and Chevallier, were afterwards added to- M. Boys de Loury ; and three or four ela¬ borate documents were drawn up, of the first of which I shall read the resume : — “ From the preceding facts, we feel our¬ selves justified in concluding, “ 1. That these bones are those of a hu¬ man skeleton. “ 2. That the skeleton is that of & fe¬ male. “■ 3. That this female had attained the age of from 60 to 70. “ 4. That her stature was about 4 feet 8 or 9 inches (nearly 5 feet Eng,) u 5. That the hair of the female, which was of a bright blond colour in youth, was mixed with grey at the time of her death. “ 6 That the hands were small. “ 7. That during life, the bones had never suffered any injury. “ 8. That this woman died of strangula¬ tion, and that the act was, to all appear¬ ance, homicidal ; and “ 9. That the body must have lain for several years in the earth.” A very ample report follows, stating the processes which were adopted for ana¬ lyzing chemically the various debris about the body. Thus the earth at the bottom of the grave was examined, as were also certain concretions which were taken to be biliary calculi, and the softened masses in the neighbourhood of the pelvis : but no¬ thing very important was detected in this search. Justice was satisfied. The prisoners, who had been long suspected, were brought to trial and condemned. They were sentenced to forced labour for the remainder of their lives. Inquiries respecting the Hair. — I am re¬ minded by the remark in the report just quoted, respecting the colour of the hair, that there have been some special inquiries made by Orfila and others on this sub¬ ject, which are exceedingly interesting, - in a medico legal point of view. Cir¬ cumstances occurred in Paris, a few years since, which rendered it necessary to in¬ quire whether a man who was suspected of having committed a murder, could have changed the colour of his hair in a very extraordinary manner, in a short time. Certain witnesses deposed to having seen him in Paris, at two in the afternoon, with black hair; Avhile others declared that they saw him at Versailles, with fair hair, at five or six o’clock the same evening. The man’s hair was naturally jet black, and it does not appear that he wore a wig. The question, in consequence, proposed by the IDENTITY OF THE DEAD 215 * law authorities to M. Orfila was, whether black hair could be dyed fair? Michalon, one of the first hair-dressers in the French metropolis, who was also consulted, gave his opinion that it was impossible; but M. Orfila stated that it was not only pos¬ sible, but had been effected twenty-six years before, by Yauquelin, by means of chlorine. The question, however, as M. Devergie observes, was not sufficiently definite. It should not have been simply whether the thing was possible, but whether, within a given time — say a few hours— hair could be changed from black to fair?— for no small part of the difficulty consisted in the journey to Versailles, in addition to the process employed, and all within three or four hours. Repeated trials made since by experienced hands seem to indicate it as an impossibility. Means of darkening ihe hair.' — It is well known that there are various methods in use for altering the colour of the hair: in general the object is to change red or sandy hair to a darker hue, to brown or black. Preparations of lead, silver, and bismuth, are employed for the purpose, lime or ammonia being first used to remove the fatty matter of the the hair; and a very common agent is a mixture or compound of lime and oxide of lead, called plombite of lime, of the mode of using which Mr. Pereira gives an interesting account in his lectures*. Tests. — But in these cases, as it is not difficult to attain the desired end, so neither is it to detect what has been done, by close inspection, or by re¬ agents. The blackening depends on the formation of metallic sulphurets by the union of the lead, silver, or bismuth, with the sulphur either of the hair or of a solu¬ tion of sulphuretted hydrogen applied for the purpose. Now, muriatic acid will extract the bismuth, and nitric acid the lead, from hair thus dyed ; and by the proper tests, these metals may be readily detected in the resulting solutions. When nitrate of silver has been used, the process of detection will be a little different. Treat the hair with a solution of chlorine, by which chloride of silver is formed, which is soluble in ammonia, and again precipi- table on the addition of nitric acid; in which state it may be readily detected by the usual means. Means of making the hair of a lighter colour . ■ — V hen the object is to render dark hair of a lighter colour, it is obtained by the employment of chlorine; first washing the hair with water of ammonia, in order to remove all greasiness. One part of strong liquid chlorine, diluted with four parts of water, will change, in the course of two hours, according to Orfila, black hair to dark chesnut. By successive im- * Medical Gazette, vol. xviii. p. 312. mersionsin a solution of the same strength, it will be brought to a bright chesnut. If the same hair be brought to a deep blond colour, it may ultimately be rendered a bright yellow, or white, with a yellowish tinge. Another effect of these successive and prolonged immersions, is to render the hair very stiff' and brittle. M. Devergie, in his experiments on this subject, has found, that when the chlorine is strong, it does not destroy the colour very uniformly; there may be seen in the hair experimented upon a variety of tints; nor is the full effect of whitening produced in less than twelve, fifteen, or twenty hours. In regard to the effect of combing out the hair in solution of chlorine, MM. Devergie and Orfila are at variance. Orfila says, that by this treatment he has brought black hair to a deep brown in a short time, and that probably, if the pro¬ cess were continued for several hours, and the solution employed were stronger, the result would be the same as that from maceration. But Devergie has tried the method in repeated instances at the Morgue, and has never produced more than very slight, if any, effects. As medical jurists, I fancy we shall not often have to deal with circumstances like those described. Whoever wishes to dye his hair for the purpose of confounding his identity, will have to encounter difficulties which will probably lead to his detection. The altered colour is not permanent, since, as the hair grows, the new hair, or the new ])ortion, has its usual colour ; while in all cases the proceeding is troublesome, and must occupy considerable time. The requisite chemical knowledge, besides, for performing the process adroitly, is not common ; and the probability, after all, is, that it cannot be done bv any hands, how¬ ever expert, uniformly, and so as not to display various tints on a nearer inspection. We shall now proceed to sum up the principal points to be attended to in in¬ vestigating cases of doubtful identity. Practical rules. — M. Orfila has suggested a good set of practical rules, which we may adopt with some slight modifica¬ tion : 1. The determination of the sex and age of the individual should be effected, though the latter be only pos¬ sible to be ascertained in a rude way. 2 The stature should be determined. 3. The form of the head and its size ought to be noticed ; the hair, whether it be thin or thickly grown ; whether the fore¬ head is prominent or retreating ; the eyes, whether large or small, sunken or projecting ; the form of the nose, whether short, flat, broad, long, aquiline, or point¬ ed ; whether the lips are large or small — with or without scars; the teeth, as to number and regularity of arrangement ; whether the mouth is big or little; the chin single or double, with a dimple — 216 DR. CUMMIN ON FORENSIC MEDICINE. pointed or round; the beard, whether thin or tufted ; the size and shape of the coun¬ tenance. 4. The neck, whether short and thick, or thin and remarkably long. 5. The chest, whether well or ill formed ; the shape of the shoulders, with reference to the spinal column ; whether there be traces of gib¬ bosity, and in what way — whether ante¬ riorly, posteriorly, or laterally ; whether the individual have a flat sternum, or be what is called hen-breasted; whether the ensiform cartilage be remarkable for any deviation from the ordinary shape; the breadth between the two bases of the scapula. 6. The size or breadth of the pelvis. 7. The extremities : the feet and hands — whether bulky, clumsy, or otherwise ; the fingers particularly, whe¬ ther long or short, as compared with the hand or with one another; whether the knees are turned in, or bowed ; the ankles projecting more than usual ; the feet long or short, well proportioned, or broad and flat; whether there be any difference in the length of the legs, or any deformity. 8. Whether the genital organs, or other parts, have any peculiar malformation. 9. Congenital spots on the skin ; for these are indelible, while warts or tumors of any kind may be re¬ moved by caustic. 10. Cicatrices from burns are good proofs of identity, or where they result from wounds or the spontane¬ ous opening of tumors ; for marks of this kind are never effaced, and may often, by reason of their situation, their form, their direction, or extent, furnish ns with valu¬ able indications. And, 11. Whether there he any traces of fractures or luxations. These are all the marks and tokens of identity on which wre as medical jurists can rely. As for a number of other points mentioned by authors — such as the beauty or ugliness of the individual, his leanness or plumpness, the colour of the eyes and hair — all these are capable of alterations in the course of time, and the latter, as we have seen, by art, which render them not to he depended on. The age of the person — the passions— the diseases to which he is subject— the climate in which he lives — - the kind of life he leads— the nature of his diet, and a thousand other things, in¬ fluence the body in respect to the tran¬ sitory signs just mentioned. The well- known lines of Sir Walter Scott may perhaps be not inappropriately quoted: — Danger , long travel, want , or woe, Soon change the form that best we know; For deadly fear can time outgo. And blanch at once the hair. Hard toil can roughen form and face. And want can quench the eye’s bright grace; Nor does old age a wrinkle trace More deeply than despair. As for placing any reliance on mere resemblance, the testimony of ordinary ob¬ servers, the recognition of parents, friends, and relations, or even very often on docu¬ mentary evidence, which there are so many ways of forging, enough has been said to inculcate a proper degree of caution. Ere I conclude I should wish to bring to your notice one case more, which, if not very instructive, may be at least amus¬ ing. A bout three years ago, a dead woman was taken out of the river at Black- friars’ bridge, and an inquest was held on her. She was identified as Eliza Baker, aged 17. A Mr. Wood first came for¬ ward and identified her : she had lived with him as a servant, but his wife growing jealous of her, she (Eliza Baker) was turned off*. The master was evidently very much attached to the deceased, for he cut off a lock of her hair before the jury, and betrayed the utmost grief. He also fetched the deceased’s parents : and they too, upon seeing the body, wrere loud in their lamentations. There were a number of witnesses examined, mostly relatives, and they all swmre positively to the body. When Mr. Wood, the alleged seducer and destroyer of the girl’s peace, was called upon to give his evidence, he wras so over¬ come by his feelings at the melancholy occurrence, that nothing could be made of him ; in fact, he was like a man in a state of stupefaction. (I extract the remaining details from the Times report.) “ Mrs. Wood, the wife, was called in ; she is twenty-eight years older than her husband, and shook her head at him, but nothing was elicited from her, her passion completely overcoming her reason. A juryman. — The more we dive into this affair the more mysterious it appears against Mr. Wood. This remark was occasioned on account of some marks of violence on the body; there had been a blow on the nose, a black mark on the forehead, and a severe wound on the thigh. The jury were commencing to deliberate on their verdict, wrhen a drayman in the employ of Messrs. Whitbread and Co., brewers, walked into the jury -room, and said that he wished to speak to the coroner and jury. Mr. Carter. — What is it you want? Drayman. — I comes to say, gentlemen, that Mrs. Baker’s daughter, you are now holding an inquest on, is now alive and in good health. The coroner and jury (in astonishment). — What do you say ? Drayman. — I’ll swear that I met her to-day in the streets, and spoke to her. The coroner, witnesses, and jury, were all struck with amazement, and asked the drayman if he could bring Eliza Baker forward, which he undertook to do in a short time. In the interim the jury and witnesses went again to viewr the body of the de¬ ceased. Mr. Wood shed tears over the MR. COLLIER ON DRACUNCULUS. 217 corpse, and was greatly affected, as were all her relations. The drayman’s story was treated as nonsense, but the jury, al¬ though of the same opinion, were deter¬ mined to await his return. In about a quarter of an hour the dray¬ man returned, and introduced the real Eliza Baker, a fine looking young woman, and in full health ! Several of the jurors remarked that they never saw such a strong likeness in their lives as there was between Eliza Baker and the deceased, w'hich fully ac¬ counted for the mistake that the witnesses bad made. The whole scene was most extraordinary, and the countenances of witnesses and jurymen it is impossible to describe. There was no evidence to prove who the deceased was; and the jury, after about eleven hours’ investigation, returned a verdict of ‘ Found drowned.’ ” ON DRACUNCULUS. (circular.) Bombay, May 9, 1836. To the Medical Officers in Charge of H. M.’s Regiments . Sir, I beg to transmit to you the following1 extract from a communication from the Director-General, upon the subject of the Inspection Report upon the Hospi¬ tals of this presidency : — “ You will, I hope, encourage by every means in your power the use of the stethoscope, an instrument the value of which is every day becoming more evident. “ The subject of Dracunculus is one, too, which is well worth the attention of the scientific inquirer; and I have to request a special report may be required from each medical officer under vour t •/ superintendence, who may have had opportunities of investigating the sub¬ ject. It may be sent with the next annual sick returns, but disjoined from them so as to admit of being bound up separately. It may facilitate the in¬ quiry, if you will circulate a few que¬ ries to each medical officer, and transmit to me a copy of the same, as well as your own review of the answers.” With respect to this last subject of dracunculus, I beg to propose the que¬ ries which follow, as seeming' to em¬ brace the more important points of the inquiry; but still with the wish (as my own opportunities have been but desul¬ tory and infrequent) that officers would, if they see fit, modify or add to them, so as to comprehend, in the way most con¬ sonant with their own opinions, the whole subject which is thus submitted for our investigation. It may be convenient to assume, as a consequence from very general assent, that the dracunculus is an animal within the tissue of the human body, and that it produces a disordered state of the part, w hich (disorder), although it may resem¬ ble other irregular actions, has the spe¬ cific appellation of its cause; and hav¬ ing assumed so far, it remains to deter¬ mine, if possible, its own nature — its times of appearance — its characters as disease — and the rationale of cure. 1. What is the organization of the dracunculus; and, as corollaries, what its mode of movement, of nutrition, and of reproduction ? 2. Has climate (in the widest sense of the term), and has season, influence over its appearance in the human body ? Does sex, age, or temperament, dispose or indispose to its appearance in the subject? 3. What the symptoms which mark the existence of dracunculus in a part ? 4. Rationale of cure? I have the honour to be, sir, Your most obedient servant, (Signed) Charles Collier, Deputy Inspector- General. This circular was addressed, in the month of May last, to each medical of¬ ficer in charge of corps ; and the several acknowledg’ments of it are herewith submitted. By these it appears that nothing has been added to their former knowledge of dracunculus, either upon the nature of the animal, its immediate influence upon the human body, or the principles of cure. Indeed, the whole of our knowledge concerning* dracun¬ culus may be comprised in the follow¬ ing theorems : — That it is an animal ; that it appears in the cellular tissue of the body, and most frequently, but not universally, in the lower extremities; that, sooner or later, apparently while making its way to the surface, it causes disturbance of the part ; and that this, like other local disturbances, affects the constitution variously, according to ag*e, temperament, and state of health at the 218 MR. COLLI HR ON DRACUNCULUS. time. Although nothing’ beyond mere conjecture has yet been offered respect¬ ing1 its production, its habitat, and mode of admission into the body, all are agreed that its presence is confined nei¬ ther to person, to sex, nor to age — facts which make still more mysterious its nature, and still more difficult the appli¬ cation of prophylactics. It is almost trivial to note, that the dracunculus is the Filaria medinensis, both of Cuvier and Lamarck; that the former has ranged it in his first Order, “ Nematoidea,” of Entozoa. The lat¬ ter is a section of his second order of Vermes; and that both hold it to be essentially a zoophyte. The organiza¬ tion of Dracunculus has not been made out, it would appear, by any member of our service, and only one opportunity of examining a recent specimen ever offered itself to me ; but from that exa¬ mination I could satisfy myself upon little beyond the broad facts that it was an animal ; that its body was tubular, and composed of two tunics; that these were fibrous ; that there were nervous cords, or traces of cords like such, and that the contents of the tube were fluid. This is the extent of my knowledge of its structure, and although very scanty, yet but little more is given by either of the eminent naturalists who have been alluded to. The characteristic features of the class laid down by M. Cuvier seem to involve a contradiction or else an anomaly ; and it is scarcely pos¬ sible, after an attentive perusal of the description, to avoid the inference, that the author himself was hardly satisfied upon the subject, and, therefore, that his language became obscure and con¬ tradictory. The difficulty, says M. Latreille (who compiled this part of the work) of con¬ ceiving how they (the Filarise) attain the part where found, joined with the fact of their not having been observed out of the body, has given rise to the belief of spontaneous generation. It is now certain, not only that the greater part produce ova, or living prototypes, but many have sexual distinction, and copulate like ordinary animals ( animaux ordinaires). We may, then, believe that they are propagated by germs, small enough to be transmitted through the narrowest ways, or that often the animals in which they live bring with them, at their birth, the germs ; in other terms, that the Entozoa may be connate. This general description of the class, alike vag’ue and contradictory, is not made clearer by either of these able naturalists in their account of the g-enus of Filaria; so that even after their la¬ bours, all the more interesting facts per¬ taining* to Dracunculus are yet deside¬ rata in science. “ There can be per¬ ceived,” it is further said by M. Latreille, in his account of the ‘Class,’ “ neither tracheae nor other organs of respiration, and, therefore, that the in¬ fluence of the oxygen can be communi¬ cated only by the medium of the ani¬ mals in which they live : they have no trace of a circulation, and traces only of nerves, but those so obscure, as to have justified doubts upon their existence at all.” The description of the Dracuncu¬ lus itself is well given both by M. Latreille and M. Lamarck, and it an¬ swers to that which is the subject of this paper — a body, long* and filiform, having at its extremity the round open¬ ing of the mouth, resembling closely the Gordii ; and again, “ Corpus teres, filiforme, subaequale, Isevigatum, soepe longissimum, rigidiusculum. Os termi- nale, orbiculare, minimum.” The generic history of Filaria, by M. L., is not satisfactory, because it as¬ sumes wffiat has never been proved, and also what would seem to be hardly com¬ patible with the facts. After stating* that it is very common in warm climates, it is said to insinuate itself ( s’insinue ) un¬ der the skin, especially of the legs, and there to develop itself to a length often feet and upwards ; that it may remain there many years (plusieurs annees) without exciting very evident sensations, but yet that sometimes it may produce, according to the part attacked, acute sufferings and violent convulsions : and w hen it does show itself, to be seen from without, then it is laid hold of, and drawn out very slowly from the dread of breaking* it. Its size is that of a crow'-quill. Its distinguishing feature is, the end of the tail being both hook¬ like and pointed. It can scarcely be necessary to show the vagueness and the contradiction of much of this. After confessing the dif¬ ficulty of conceiving how the Filarise gain admission into the parenchyma, and acknowledging their never having been met with apart from the body, yet they are said to insinuate themselves be¬ neath the skin, without one fact having been adduced to prove the entrance, or MR. COLLIER ON DRACUNCULUS. 2It> one argument advanced to show its pos¬ sibility. The Filarise, like Entozoa, be¬ long' to zoophytes; and of them all our knowledge may be said to be negative, and therefore obscure : we know neither their origin, their mode of nutrition, nor how they attain the place where they are found. It is observed by M. Lamarck, that, “ for ages, during which observations have been going* on, intestinal worms of acknowledged species have been met with no where but in the bodies of ani¬ mals; no where, neither in the earth, the water, nor in the interior of plants, are their analogues to be met with.” With re gard to its appearance in the body, the same author says it inhabits the subcutaneous cellular tissue, espe¬ cially of the legs and feet of men, and only in the warm climates of Asia, Africa, and America. Is, he asks, the filaria developed there where it is found, or is it introduced from without ? This (mode of introduction) is yet doubtful, and therefore its genus has been un¬ settled. Some individuals have been found more than two feet in length ; there are species in other animal bodies (of the Simia genus), gracilis — of birds and fishes, — “ attenuata,” — “ ovata,” — - cum aliis. 2. This branch of the subject has been discussed in great part already- — climate has to do with the appearance of dracuncle, since it is found only in warm climates ; but then as it is not found in all, (it is not found, for in¬ stance, at the Mauritius, which is ba¬ saltic, like Bombay (excepting in sub¬ jects sent there). Its topography tracked out is yet a desideratum; and as the greatest number of cases of it have occurred in the hottest months, season may seem to have something to do with its production ; and yet, as if to baffle all such generalization, while common at Kirkee, not an instance of it has occurred in the contiguous cantonment of Poonah. The observation of Dr. Perston, which has been extensive, sup¬ ports the inference that the male is more subject to it than the female, and the adult than the child ; but relatively so only, for “ all (he observes) are obnoxi¬ ous to its invasion.” Dracunculus is very widely known; in fact, over India it exists under varying conditions of sub¬ jects, soil, water, and even temperature; but whether it be found on ground so high as to cause a lower mean average temperature than the plains, there is no facts to show. 3. The pathog-noinonic signs of the preseuce of dracunculus in a part, is the appearance of a bleb (bulla), or large vesicle, with, as it may be sup¬ posed, inflammation, greater or less in extent and in intensity, according* to circumstances : at the bursting of the vesicle, a small circular aperture is per¬ ceived, and soon the end of the worm is found, either projecting through, or else beneath it. As this is the com¬ mencement of the worm’s passage out¬ ward in most instances, so a bulla be¬ comes a proof, although not universally good, of the animal’s existence beneath. Exceptions to this law are noted by M. Latreiile, and, indeed, both by Dr. Perston and by Dr. Wilkins. Some¬ times the worm may be felt beneath the skin, without the party having been conscious of its presence ; sometimes, on the contrary, the part may be tumid and red, and painful, without any trace at the moment of the animal ; and again, a sudden sense of pain, as from a thorn, and then, as Mr. Wilkins has ob¬ served, the dracuncle to be manifested. But the pathognomonic sign, subject, as it has been said, to some exception, is, a bleb, with slight surrounding inflam¬ mation, and at the rupture of the cuti¬ cle a small circular aperture : beneath which lies the worm ; constitutional sympathy depends upon appreciable causes, of course, but this, w hen all con¬ ditions are estimated, may be affirmed to be strangely low. There is a tact in detecting dracunculus, which, like all experimental know ledge, may be gotten only by practice. Experience is re¬ quired, that is, for the diagnosis, as it is, for the surer removal of the cause ; but this leads me to the last of the con¬ siderations. The rationale of cure consists in the removal of the worm whole, (for, if broken in the attempt, the fluid exuded from it excites higher inflammation) if possible ; but if that may not be, by g’radual extraction, day by day, taking care to retain the part already drawn, by a simple yet easy apparatus. This is the method followed by the native medical men as well; and, indeed, as it is not possible to follow, in many instances, the windings of the worm, and as further mischief results from it if ruptured, it seems to be the the only one practicable ; there is some 220 MR. COLLIER ON DRACUNCULUS. tact, of course, required for the prac¬ tice, but, then, it is a tact which is easily gotten. Warm, or rather hot, fomen¬ tations are preferred, while the worm is yet in its nidus, and so they are, indeed, through all the subsequent processes. It has appeared to me, and the sugges¬ tion has been offered, that evaporation by cold lotions would act better; but my clinical opportunities have been too few to give terms for comparison. The method of extraction is, no doubt, tedi¬ ous (the average period of cure being not less than a month), and it acts pre¬ judicially, by the confinement and the suffering, upon the health ; sometimes, also, especially when in the neighbour¬ hood of a large joint, the local inflam¬ mation is so vehement and extensive as to be a source of sinuses and other and further mischief than had first been done. As such consequences, when they do happen, come within the gene¬ ral domain of surgery, they need not be dwelt upon here. The constitution is to be attended to, and the actions of the part quieted by position, by free openings for the discharge of fluids, and by suitable applications. It has sometimes occurred to me, I confess, that it would be better, when dracunculus had made its appearance in a part, if the whole matter were taken into the hands of the surgeon ; the worm extracted by incisions, if pos¬ sible, and if not, extracted entire, be¬ lieving that such would, by their own operation, be preferable to the process resorted to ; but more opportunity, and the consideration of others’ opinions, have altered, or modified at least, that impression. To sum up, then, what is known at this presidency, upon dracunculus and its treatment, in order that our know¬ ledge may be compared with, and elu¬ cidated by, inquiries at other places, the following generalization is submitted : — I. Dracunculus is a round thread¬ like worm, attaining a length of * two feet and upwards ; and it is found in the parenchyma of the human body, exten¬ sively over India, without much respect for age, or sex, or condition. Its ap¬ pearance, though not confined to, is * This, which is the length of the animal, as given by M. Lamarck, is confirmed by the expe¬ rience of medical officers here. Dr. Perston has never seen one which exceeded three feet, but Latreille affirms, upon others’ authority, that it does sometimes exceed even ten feet. most common in, the hot dry months ? but then capriciously appearing, in many instances, at one place, and not at all at another in its neighbourhood. The worm consists of two tunics, w hich are evidently fibrous; it is furnished with an orbicular mouth at one end, at the other (which is pointed and curved) is the anus, and a tube or alimentary canal is extended, probably, betw'een them. There are traces to be perceived of what appear like nervous cords, but here is closed our knowledge upon its structure. Nothing is known about its circulation, if any, its mode of nutrition, reproduction, or existence in the part where found ; all these general facts belong', indeed, to that vast family of Being' at its source, where objects, by their minuteness, and by, so to say, their peculiarities of existence, baffle observation and elude inquiry. Specu¬ lation may be hazarded, but speculation can form no base for therapeutics. IT. Climate has to do, no doubt, with dracunculus, since it does not exist, so far as it has been hitherto learnt, ex¬ cepting in warm latitudes, but then not continuously ; preferring, whatever the cause may be, one spot to another, and the hottest dryest months are those most suited for its development; but, under suitable circumstances, there is no ex¬ emption to be found in age, or sex, or condition of life. III. The symptoms are a bleb, or else a large vesicle, with slight sur¬ rounding inflammation, and, at the bursting of the cuticle, a circular aper¬ ture to the worm beneath ; occasionally erythematous appearance, without bleb or vesicle ; sometimes the w orm itself to be felt under the cuticle, without lo¬ cal action or disturbance of any kind. IV. The removal of the worm whole, if possible, at once; if not possible, whether from local attachment or from depth of situation, then by the process of extraction, which is well described by the officers who have seen much of the affection. This method, or process, is soon ac¬ quired, as it is easily practised (indeed the patient mostly ministers to himself), and it involves very little pain. The objections to it are its tediousness, and the injury w hich may be sustained by the health during the period of cure. Now it was to avoid both these results that a bolder surgery offered itself to me as preferable ; assuming that, at the DISLOCATION OF THE ASTRAGALUS AND OS NAYICULARE. 221 worst, failing to remove the worm at once, it would still place parts in a bet¬ ter state for supporting* the secondary actions, and to expedite recovery. But this impression has been much modified, both by my own and hy others’ experi¬ ence, and I am now content to witness the slow process of extraction, as being, on the whole, the safer mode of cure. The matter is altogether peculiar, and so must be, apparently, the management of it. Charles Collier. Dep. Insp. Gen. Hosp. CASE OF COMPOUND DISLOCATIONofthe ASTRAGALUS AND OS NAYICULARE. To the Editor of the Medical Gazette . Sir, I beg to inclose you a very rare case of compound dislocation of the astra¬ galus and- os naviculare, if you have room to place it in your valuable jour¬ nal. — I am, sir, Your obedient servant, C. M. Burnett. Alton, Hants, July 10, 1836*. Colonel G - is an active man, of a spare habit of body, upwards of 60 years of age. On the 23d of February lasthe was fox-hunting, and had made a leap, when suddenly he found himself unable to follow, in consequence of his right foot being displaced. His usual habit was to ride in his stirrup, the foot rest¬ ing on its outer side. YVhen I first saw him the hoot had been removed, which, from the force of the injury, had given way, the bones protruding through it. The foot was dislocated inwards, at right angles with the leg*; and two hones were plainly to be seen projecting out of a wound, which was about three inches in length, extending* across the outer ankle. I carefully examined the situation and shape of these bones : the upper one, the os naviculare, bad projected its cuneiform surface outwards and for¬ wards, in an oblique direction ; and the other bone was the astragalus, which had forsaken its natural cavity, was * The paper only reached us last week,— Ed. Gaz. driven forwards and outwards, and pre¬ senting that surface which in its natural position would be in contact with the os calcis. I steadily kept pressure as firmly as I could, for nearly a quarter of an hour, upon the prominent os navi¬ culare, in the direction of the joint, to which I was directed by the ends of the tibia, which was plainly to be seen be¬ neath the astragalus. At the expira¬ tion of this time I had the satisfaction to see the bones slip into their proper places, and the foot resume its natural character. The end of the fibula was not fractured. Having placed the limb in proper splints, I conducted him home, where he was met hy his family sur- g*eon, Mr. Wickham, of Winchester, in whose able hands I had every satisfac¬ tion in knowing it would be watched with an active and intelligent eye. The case has done remarkably well ; and by a letter which I have received from Mr. Wickham, he tells me — “ I am able now to inform you that Colonel G - ’s case has been brought to the most sa¬ tisfactory termination. The wound is healed, the motion of the joint is per¬ fect, and the swelling* of the part is nearly reduced. Weakness, which time only can remove, and the occasional puffiness from use, are the only remain¬ ing effects of the injury. You are aware that the progress of the case has scarcely been interrupted, and that in¬ flammatory symptoms only once occur¬ red during the period of bis confine¬ ment; these were ushered in by a rigor and succeeding heat; they occurred about three weeks after the accident, and only lasted a few hours. At pre¬ sent he is able to walk with crutches, without the least inconvenience, and the limb bears occasionally its share of the weight of the body. As to the motion of the joint, it cannot only be per¬ formed by myself, but he can freely bend and extend the foot.” Upon this very interesting case allow me to make a few observations. As I have not been able to hear or read of a similar case to this, it may be doubted whether the os naviculare was really displaced; but of the existence of the fact I cannot be deceived, for I saw and felt both this bone and the astragalus before they were reduced. And as I was enabled, by keeping* up a long-continued pressure in the most fa¬ vourable direction, to reduce the joint 222 DR. HUGHES CASES OF PERICARDITIS * WITH to its natural state, it is reasonable to infer, in all cases where the astragalus alone has been dislocated, that it may by perseverance be replaced ; although we admit, where dislocation of the foot has not taken place, this operation is ren¬ dered more difficult. The consequences of this bone not being' replaced involve its death and subsequent extraction, if amputation be not resorted to previously, to shorten the process of mortification which would otherwise take place. Delpech mentions three ways in which the astragalus can be dislocated*, one of which, where “ the bone is com¬ pletely thrust out of its natural position, and thrown upon the dorsal surface of the tarsus,” is the nearest approach to the present case ; for here it would have taken its place on the dorsal surface, accompanied by the os naviculare, had not the tarsus been dislocated inwards. He says, “ in a case of lateral luxation of the foot, we have seen the astragalus completely thrown out of its natural position, and carried on the dorsal sur¬ face of the cuboid bone ; and what is still more singular, notwithstanding the great displacement, which supposes a complete isolation of the bone, on mak¬ ing use of the necessary extensions on the leg and foot, while making at the same time compressions upon the astra¬ galus, in a direction from before back- wards, it was brought back into its na¬ tural situation, the luxation of the foot was reduced, and an easy and rapid cure was obtained ; and the bone thus displaced preserved from necrosisf.” It seems, if the astragalus is to be pre¬ served, and the joint completely re¬ stored, it must be reduced. In those cases recorded, where this bone has not been reduced^, necrosis has taken place, followed by its discharge or extraction ; and though the foot has been spared, it has been at the expense of shortening*, and almost anchylosis. There is every probability, if the dis¬ location in the present case had not been reduced, that the displacement of the tw o bones would have occasioned the loss of the entire foot. * Delpech, Maladies Chirurgicales, vol. iii. p. 139. t lb. p- 140. y See Medical Gazette, vol. i. p.624; vol. xi. p. 527. TWO CASES OF PERICARDITIS ; WITH AUSCULTATORY DIAGNOSIS AND REMARKS. To the Editor of the Medical Gazette. Sir, About twelve months since I read be¬ fore the Physical Society of Guy’s Hos¬ pital “ Some Observations on the Diag¬ nosis of Pericarditis,” which, consi¬ derably contracted, were afterwards published in the first number of the 46 Guy’s Hospital Reports.” In that paper I made no mention of Dr. Wat¬ son as one of the contributors to the pa¬ thology of this disease. I think it, therefore, due both to that gentleman and myself, to state, that the cause of this omission was my ignorance of the fact of his having written upon the complaint, and that, till 22d instant, when lookingover the sixteenth volume of the Medical Gazette for another purpose, I had never enjoyed the ad¬ vantage of reading his clinical lectures upon the subject. This, sir, to myself is a misfortune, as, agreeing with Dr. Watson in many important particulars, in some of which we both differ from some recent writers upon pericarditis; and having both arrived at our conclu¬ sions after strict observation of the dis¬ ease, and without any communication on the subject, I should have been highly gratified to have been enabled to advance so distinguished a name as that of Dr. Watson, as a supporter of the opinions I then advocated. In some minor particulars I differ from that gentleman, as w ill be seen by the observations appended to the two cases 1 herewith send, should you con¬ sider them suitable for the pages of your journal. The former occurred many months since, and I regret that but few notes were taken ; it is there¬ fore brief and general : the latter has taken place very recently, and is there¬ fore more copiously and particularly detailed. —I am, sir, Your obedient servant, H. M. Hughes, M.D. 13, Wellington- street, Southwark, Oct. 29, 1836. Case I. — II. W., ag-ecl 18, a thin de¬ licate youth, of pale face and light com¬ plexion, after exposure to wet and cold, became affected with rheumatism of a AUSCULTATORY DIAGNOSIS AND REMARKS, subacute character, for which he came under medical treatment on the 15th of April. He was bled, and took the com¬ mon medicines for rheumatism wiih very great relief. Oil the 18th, it was discovered that he had pain, and some tenderness on pressure, at the scrobicu- lus cordis, and at the intercostal spaces over the preecordial region. He con¬ stantly maintained the recumbent posi¬ tion without inconvenience, and turned to either side without much distress; though his pain was slightly increased by lying on the left, and his easiest posture was with the body partially turned towards the right side. He had no cough; his respiration was but very slightly hurried; his tongue was white and moist; and his pulse rather fre¬ quent, thrilling, and regular. Thechest was resonant on percussion, and there was no unusual dulness in the prsecor- dial region ; the respiratory murmur was natural. The impulse of the heart was sharp, but not heaving; and its rhythm, as far as it could be ascertained, appeared normal. The first sound was replaced, or masked, by a bruit cle souf¬ flet , which was heard over the whole heart, but most clearly in the situation of the aortic valves ; the second sound was scarcely audible. On the outer side of the left nipple was distinctly heard a double rubbing sound, the frottement of the French authors and Dr. Stokes, the “ to-and fro sound” of Dr. Watson. It had no similitude to the creaking of new leather, but exactly resembled the noise produced by the friction of two rough and rather soft surfaces. It was confined to a small circumscribed space, was very superfi¬ cial, and perfectly distinct from the bruit de soufflet ; which, moreover, ap¬ peared to be produced only during the systole, whereas the frottement evidently accompanied both the systole and dias¬ tole of the ventricles. He was ordered to be cupped over the region of the heart, and to take Calo¬ mel, gr. j. ; James’s Powder, gr. iv. ; Ext of Henbane, gr. iij. everv four hours, in a simple saline draught. On the 20th the gums were slightly affected; the pain was rather less; the rubbing sound less distinct, and heard over a still smaller space ; but the bel¬ lows sound remained as before. I he pills, & c. to be continued three times a day only. OO'l On the 23d the frottement had nearly, or quite disappeared. The soufflet was still distinct ; and some pain and ten¬ derness remaining, fifteen leeches were applied with temporary relief. On the 27th, some pain still existing, twenty more leeches were applied. The frottement had entirely ceased, but the bruit de soufflet was yet very distinct ; the respiration remained but very little affected. He was now ordered Antim. Tart. gr. H Opium, gr. §, and Calomel, gr. ij. every night ; and a mixture with Tr. Digitalis, )Rx. ; Nitr. Potass, gr. xv. ; and Sp. tE ther. Nitr. njxv. three times a day. About ten days after this he bad some slig'ht return of pain, for which, on May 7th, a blister was applied with benefit. On the 11th he was ordered decoct, cinchon. and sulphuric acid, and in a week or two returned to his employ¬ ment, previously to which I ascertained that though the impulse of the heart was rather feeble, its rhythm and sounds were natural, and that no bruit de soufflet, even after walking briskly for a short distance, could now be discovered. Case II. — Samuel Barney, aged 31, a thin delicate-looking man, of light complexion and lymphatic tempera¬ ment, became a patient of the Surrey Dispensary, under my care, 27th Sept, last. He is by occupation a dancing and music master, and has been very regular in his habits. He has been married six years, but has had no chil¬ dren. He has on two occasions pre¬ viously been the subject of rheumatism ; and though he does not recollect to have been affected at such times with dysp- ucea, palpitation, or any symptoms of thoracic obstruction, he has been very liable to catarrh, and has more than once been confined in consequence of pain of the left side ; and for the last year, when exerting himself more labo¬ riously than ordinarily, has been trou¬ bled with dyspnoea, pleurodynia, and palpitation. Two weeks previously to my seeing- him, after exposure to cold and wet, he was attacked with rheumatic pains of the limbs, the increase of which had, for the last six or seven days, confined him to bed. I found him at my first visit labouring under subacute rheumatism. The wrists and ankles were swollen, rather red, painful, and very tender; the 224 DR. HUGHES’ CASES OF PERICARDITIS; WITH tongue was clean and moist, with the exception of two broad lateral furred lines ; the margins of the gums were ulcerated ; the countenance appeared natural ; the pulse 116, small, fluid, and regular; the respirations 22, and unem¬ barrassed. He had no cough, nor any thoracic uneasiness, when perfectly quiet, but on deep inspiration felt some pain under the left breast, which I as¬ certained had first appeared on the pre¬ vious day ; he lay flat in his bed, and felt no inconvenience (except from pain of the extremities in the act of moving) by turning to the right side, though some uneasiness was produced by in¬ clining to the left. There was some tenderness on pressure below the ensi- form cartilage, but none at the inter¬ costal spaces over the heart. The chest was generally fairly resonant on per¬ cussion, but considerable dulness and some contraction existed over the lower ribs on the left side, near the heart ; the remainder of the prsecordial region was not more dull than natural. The im¬ pulse of the heart was weak ; the rhythm could not be ascertained, as, excepting over the ensiform cartilage, where it was indistinctly audible, the double flap of the healthy heart was replaced by an extensively diffused superficial rubbing noise, most distinct about one inch on the inner side of the left nipple, but more harsh and grating on the outer side of the same point ; the former resembling the friction of two pieces of cloth, the latter that of rough horny surfaces. This souud did not accompany merely the first or second sound of the organ, but obscured both, and, though varying in intensity, appeared to be without intermission. The respiratory murmur was audible over the chest, excepting at the base of the left lunsf. Ordered Hirudines, x. parti dolent. Antim. Tart. gr. £. Opii, gr. Hyd. Submur. gr. j. 4tis. horis ; et Magnes. Sulph. 3ss. Yin. Colch. 3ss. Mist. jCamph. 31SS. ter die. The next day I found the symptoms little changed ; the pain as before ; the bowels only once relieved, and then not from medicine. V. S. yx. vel prim. sign, deliquii. Rep. Pil. cont. Mist, ad plm. alv. solutio- nem. 29th. — The bowels had been freely acted upon by medicine, the wrists and ankles were quite free from pain and tenderness; he had passed a restless night. The dulness of the chest, sounds of the heart, tenderness at the scrobicu- lus cordis, and pain on deep respiration, remained as before. Respiration easy ; tongue clean and moist ; pulse 120, small, soft, and irregular, excepting that about every 60th beat, a little de¬ lay, not amounting to an intermission, was observable. C. C. part, dolent. ad. ^x. Rep. Pil. c. Hydr. Submur. gr. ij. Omitt. Mist. On the 30th he could turn to either side without inconvenience, having found much more decided relief from the cupping than from the venesection; pulse 104, soft and fluid ; skin natural; no mercurial action was evident on the gums ; tongue slightly furred ; impulse of heat, and dulness as formerly; no bruit is now heard at the scrobiculus cordis, but the natural sounds appear weak ; below the left nipple was heard a harsh bruit de soufflet, or rape, syn¬ chronous with, and following the systole of, the ventricles, and concealing the souud attending the disastole ; above, and to the outer side of the left nipple, in addition to, and perfectly distant from, but still partially concealing this bruit, W’as a superficial rough rub¬ bing, or grating noise, which was almost continuous, or at least had no regular and perfect intermissions. Rep. Pil. 6tis horis, et Capiat Mist, si opus erit. Oct. 1st. — Bruit softer, but more dis¬ tinctly heard over a large space ; pulse 96. Rep. Pil. ter die Empl. Cantharid. re- gioni cordis; Capt. Haust. Efferv. 6tis horis. 3d. — The blister removed all remains of pain, but he now complained of some tenderness in the vicinityof the caecum; no action of mercury upon the gums; sounds of the heart unaltered. Pergat. 4th. — Fomentations had removed the abdominal tenderness ; below the nipple was still heard a harsh bruit de soufflet, and above this point, and at its exterior the frottement still existed, but now consisted of three regularly successive sounds which may be thus represented— tee te ie—tee te te — tee te te ; tongue rather morbidly clean and smooth, not red; pulse 88, with the slight delay be- AUSCULTATORY DIAGNOSIS AND REMARKS. 2*25 fore observed occurring1 less frequently ; there was still no mercurial action, as evinced by the salivary glans or gums. Pergat. 5th. — The rubbing* noise had entirely disappeared, but both above and below the nipple was now distinctly heard the bruit-de-soufflet synchronous with the systole, and running1 into and obscuring1 the second sound of the heart ; pulse 96, slightly thrilling*. 6th. — Alvine evacuations green from mercury for the first time, but still no appearance of salivation ; complains of some pain and tenderness in the right hypocnondrium on turning or lying on the left side. Pil. Hydrarg. gr. iv. ; Opii, gr. f ter die. Omitt. Mist. Appl. Hirudines vj. et Fotus, parti dolent. 8th. — I this day heard for the first time that he was not only troubled with piles, but had passed some blood after each evacuation for the last two or three days ; bruit less harsh ; he now again complained of some pain and slight swelling of the wrists. Decoct. Cinchonas 3ix.;Mucilag. Acacias, 3ij.; Syr. Papaver. 3j. ter die. Pulv. Ipecac, c. Opio. gr. x. om. nocte. 15th. — Pains removed entirely from wrists, but complains of some wander¬ ing uneasiness about the shoulders ; bowels relaxed, and evacuations still followed by a little blood occasionally. Bruit-de-soufflet much softer, and the second sound of the heart was now in¬ distinctly heard over the cartilages of the third and fourth ribs. Inf. Cusparias, Jiss. Pulv. Cretas c. 3j. Liq. Opii Sed. tRiij. ter die. Rep. Pulv. 17th. — Bowels regular, and little or no trace of blood existed in the excre¬ tions. He slept well ; pulse 96, soft, and feeble. He had no pain ; respira¬ tion was easy; the dulness of the left side had of late much decreased ; and over the portion of lung which afforded no indication of the ingress of air, was now heard a muco-crepitating rattle, which either did not formerly1 exist, or was concealed by the abnormal sounds of the heart. A soft bruit-de-soufflet was now observable over the greater portion of the praecordial region, but below the left nipple it was still harsh and loud, approaching to the bruit-de- rape ; and at the base of the sternum 467.— xix. the natural double-flapping sounds of the heart w ere distinguished, still feeble, but pure. Over the cartilages of the third and fourth ribs it is now clearly audible, the second sound in its natural state. — Pergat. 19th. — Some uneasiness in shoulders ; tongue and bowels in a healthy condi¬ tion. Ordered again — Decoct. Cinehon. c. Conf. Aromat. 9j. ter die. Rep. Pulv. gr. v. om. nocte. 24th.— He continued free from pain ; the shoulders were now quite easy; his appetite w as good ; his sleep natural ; the dulness of the chest had almost disappeared ; the pulse was 96, and feeble ; and the sounds of the heart remained as at last report : believing them to arise from chronic affection of the valves, and probably to be beyond the reach of medicine, after giving many directions as to exercise, food, and clothing, I ceased reg ularly to visit him. Remarks. — There are few, I imagine, who, after an attentive perusal of the preceding cases, will have any doubt as to the presence of pericarditis; though fortunately we had no opportunity of absolutely proving its existence. Yet none of the many distressing symptoms usually stated as characteristic of this disease, were here observable. The sense of burning and weight at the heart, and flushing of the left cheek, mentioned by Corvisart — the evident dis¬ parity between the forcible but irregular impulse of the, heart and the pulse at the wrist, spoken of by Laennec — the increased dulness and projection of the praecordial region, considered of so much importance by Louis— w'ere all absent; for the dulness observed in the second case was clearly referrible to the lung or pleura, and was probably the result of some former attack. There was here none of the anxiety and violent oppression ; no dyspnoea, orthopncea, or lividity of countenance ; no inability of motion from impending suffocation ; no disposition to fainting, or actual syn¬ cope; no tumultuous action of the heart, or extreme feebleness, irregula¬ rity, or inequality of the pulse, often (and sometimes, indeed, truly) noted among the symptoms of pericarditis. But I am disposed to believe, that did the physician wait for the appearance of such indications previously to sus¬ pecting the presence of pericarditis, or Q 226 dr. hughes’ cases of pericarditis ; WITH acting’ on his suspicions by the adoption of a vigorous antiphlogistic treatment, his patient would, in a majority of cases, be beyond the reach of remedies, when, at length, tardily applied. The conclu¬ sions of Laennec upon this disease, ap¬ pear amply confirmed by cases such as the above, and those less frequent but more distressing examples referred to. 44 Ces faits,” says he, “ et plusieurs au- tres me paraissent prouver que, dans quelques cas, la pericardite meme aigue est une affection locale tres-peu grave, et dont l’influence, non seulement sur 3e systeme general, mais meme sur celui de la circulation, est presque nolle ; tandisque, dans d’autres cas, la meme affection, an meme degre on a mi degre inferieur est accompagnee de fievre aigue, et d’un trouble de presque routes les fonctions, assez grave pour compromettre la vie du malade.” This striking difference of symptoms and of termination, 1 am induced, from obser¬ vation and reflection, to believe depends (as I have already stated in the essay mentioned above) upon the different character of the inflammatory effusion, which in the one case is for the most part solid and in comparatively small quan¬ tity, and in the other fluid and abun¬ dant. Experience clearly shows that rheumatic pericarditis is, and must be, generally of the former character, as daily observation proves that it has been and is continually overlooked ; which would be impossible if attended with the grave symptoms which accompany serous or sero-purulent effusion into the pericardium. The existence of such affection has, indeed, often been not even suspected either by the medical attendant or the patient, till the heart being irre¬ coverably and permanently deranged, and the symptoms of chronic disease of the organ being too decided to be mis¬ taken, the observant practitioner in¬ quires the previous history of the suf¬ ferer, and finds that formerly (perhaps some years since) he has been affected w ith rheumatism ; since which he has been more or less troubled with pain of the side or shoulder, dyspnoea, and pal¬ pitation ; and to which, therefore, the disease is clearly to be referred. 1 am fully convinced that a great majority of the chronic diseases of the heart are originally produced by a rheumatic affec¬ tion of the organ, or at least an inflam¬ matory attack of the pericardium, while rheumatism is at the same time present in other parts of the body : and as tho¬ roughly convinced am I, that few, very few, children and youths affected with rheumatism, escape this or some other inflammatory affection of the. heart. Any one who chooses to inquire into the history and origin of the cases of heart disease presented to his notice, or to ex¬ amine, by auscultation, the prsecordial region of children suffering from rheu¬ matism, submitted to his care, may speedily convince himself of the truth of these observations. Yet it is. a la¬ mentable fact that many practitioners, even of the present day, remain either ignorant or regardless of the frequency of such attacks, and that numbers of lives are perhaps, if not lost, at least considerably shortened by want of at¬ tention to their slightly obtrusive symp¬ toms. I may here observe, that neither of these patients complained either of pain or tenderness, till after inquiry wras made and pressure was used. Even then, they were so comparatively trifling that they might be not unnaturally attributed to rheumatism of the inter- costals, or acidity of the stomach. Sus¬ picions, however, of pericardiac mis¬ chief were excited by the nature of the cases, and the application of the stetho¬ scope immediately changed suspicion into certainty ; a characteristic rubbing noise was distinctly heard, which dis¬ pelled any remaining' doubt, and at once clearly established the true nature of the disease, and proved the inesti¬ mable value of auscultation. I have already stated it as my opinion, in opposition to that expressed by Dr. Stokes, that the bruit- de-soufflet, and frottement or to-and-fro sound, arise from different causes, and are produced in different parts of the heart. The circumstances observed in the cases, and particularly the second, related above, some of which were observed by other stethoscopists, as well as myself, are strongly confirmatory of this opinion. Thus in the progress of the case, the soufflet appeared deep-seated, the frotte¬ ment comparatively superficial; the for¬ mer was generally diffused over the heart, the latter confined to a small space; the former was evidently syn¬ chronous with the contraction of the ventricles, and regularly intermitted ; the latter accompanied both contraction and dilatation, and though variable, AUSCULTATORY DIAGNOSIS AND REMARKS. 227 was continued ; the one became more dis- tantastheothergradually decreased ; the one still remains, the other has entirely ceased. Dr. Watson, in his valuable clinical lectures on this subject, has stated his belief that the bruit de soufflet in these cases is dependent upon the inflammatory thickening of, or deposit upon, the valvular apparatus ; that this bruit is seldom absent, and is often one of the first indications of mischief about the heart, and that it probably sometimes exists in rheumatic affections, without inflammation of the pericardium. With these opinions, my observation leads me perfectly to coincide ; and in one parti¬ cular alone do ! differ from that g*entle- man. He appears to suppose that it is the smooth surface of the membrane co¬ vering the valves which is usually affect¬ ed, and that the inflammatory deposit upon them, by diminishing the apertures through which the blood passes, is the cause of the sound ; and he brings for¬ ward the granulation, or excrescences, occasionally met with upon the valves after death, as a proof of the correctness of his opinion. Now (in England at least) it fortu¬ nately happens, I believe, that rheuma¬ tic pericarditis is rarely immediately fatal, however frequently it may shorten the period of life ; and we, therefore, seldom have an opportunity of proving* the coexistence of endocarditis in the first attack of the disease. We must therefore refer, for confirmation or refu¬ tation of this opinion, to the more chro¬ nic affections of the heart: we cannot have demonstrative proof, and must therefore, in a great measure, depend upon circumstantial evidence and ana¬ logy. These induce me to suppose that it is the tissue beneath the lining mem¬ brane, or the attached surface of that membrane itself, which is usually the seat of inflammation and effusion. This tissue is most constantly affected in dis¬ eases of the general vascular system ; depositions in the coats of arteries al¬ most always occur behind, and not upon the internal lining membrane; athero¬ matous, cartilaginous, and ossific depo¬ sits, are exceedingly common beneath the membrane covering the valves, the unattached surface of that membrane remaining smooth and polished, and are very frequent in chronic diseases of the heart, a very larg’e number of which appear distinctly referrible to rheuma¬ tism, whereas the granulations or ex¬ crescences are, according to my experi¬ ence, comparatively rare. Seeing, then, that the bruit de souf¬ flet usually appears early in the disease, continues throughout its progress, and often remains during life, at least upon slight exertion ; that this bruit is now, I imagine, generally acknowledged to be dependent upon disease of the valves in chronic affections of the organ ; that in these the deposit is beneath the mem¬ brane, and that they are frequently, perhaps generally, the result of inflam¬ mation accompanying rheumatism, it does appear to me natural to conclude, that the original inflammatory effusion or thickening occurs below*, or on the attached surface of the membrane. It is true that, the granulations, or excres¬ cences, as they are called (I say called, for I believe they are not a morbid growth ), may possibly become absorbed, and disease going on, and the bruit re¬ maining unaltered, other matter may at the same time be deposited in a different portion of the affected valves : this is possible, but it appears not probable. On the treatment of the former case I make no observations, as it was not under my own direction. On that of the second I have to state, that mer¬ cury, which I regard as our sheet- anchor in these cases, was given quite to the extent that I thought justifiable, particularly as, though' the ordinary constitutional effects' w'ere not produced, after it had been regularly administered for many days, all the symptoms gra¬ dually decreased, and finally altogether disappeared, with the single exception of the bruit de soufllet, wdiich I have every reason to believe was the result of some former attack. I was led to adopt this opinion not only by the pre¬ vious history of the man, by his having before suffered from rheumatism, and, though he supposes on different occa¬ sions, from pain of the side, and from dyspnoea, and palpitation upon exer¬ tion, but by the decided dulness and slight contraction of the part said to have been before affected. It is, how¬ ever, interesting to notice the decrease both of the harshness of the bruit, and of the dulness on percussion, over the diseased portion of lung into which the air now evidently passes, though with considerable difficulty. The heart disease appeared so en- 22& DR. BURKE ON OPIUM IN INCIPIENT INFLAMMATION. tirely a local affection, that I did not, on the first day, think it necessary to abstract blood generally, especially as it has been observed by some, and I think also by myself, that topical often affords more decided relief than general bleeding. The lancet was, however, used on the second day, but simply as a precautionary measure ; and the expres¬ sions of the patient certainly indicated that the benefit obtained by cupping was considerably greater than that af¬ forded by the previous venesection. The above remarks on the relative ad¬ vantage of local bleeding are, of course, intended to apply solely to the disease under consideration. OPIUM IN INCIPIENT INFLAM¬ MATION. To the Editor of the Medical Gazette. Sir, I fear the crowded state of your journal can hardly afford space for the accom¬ panying observations on opium ; but should you find room for them, it may fix general attention on a subject which we have all too much neglected. Your obedient servant, Richard Burke, M.D. 3, Sackville Street, Nov. 7, 1836. For some time back my attention has been directed to the employment of opium and its preparations, as preven¬ tive remedies, in the early stages of ir¬ ritation, with a hope of checking in¬ flammation ; but the few opportunities which private practice affords, of work¬ ing out any theory, however simple, induce me to call the notice of the pro¬ fession to it, through the medium of the Gazette. If I could succeed in fixing upon it the attention of our hos¬ pitals, where alone medicine can hope to make any advances to the nature of a fixed science, I shall, in some degree, have attained my object. The question is of paramount importance, and cannot rest where it is. In the range of the materia medica, there is not a drug w'hich has been so extensively used, under every form, and in almost every disease ; one to which the system so readily accommodates itself ; and yet scarcely one upon which there are so many contradictory opinions. As the views which I here propose have reference to the employment of opium in irritation, so as to check the second stage, which is inflammation, it is of the last importance to have correct ideas of irritation. It has been variously defined by men of eminence, but differ¬ ing little in substance. It is the exal¬ tation of the organic action of a part, which is attended by inflammation when the irritation extends to the capil¬ laries, and has been considered the pri¬ mitive and principal form of the greatest number of diseases. In some it enters only as a secondary form, whilst there is another class, characterized by a sink¬ ing of all the powers of the system, into which it is supposed never to enter. The three elements which enter into the composition of irritation are, an exaltation of sensibility ; an afflux of fluids to the capillaries of the part; a sojourn of those fluids there. In con¬ sidering this question, our attention cannot be too closely directed to the following facts : — That without previous irritation there can be no inflammation, nor irritation without excitation, nor this last w here sensibility does not exist. Irritation, when unaccompanied by in¬ flammation, cannot be fairly called a morbid phenomenon. Broussais defines irritation “ that state of an organ w here excitation is carried to such a degree of intensity, that the equilibrium resulting from a balance of all the functions is broken.” John Hunter says it is “ a disposition to act without the power to act.” But all these leave us still as much as ever in the dark as to the es¬ sence of irritation. We can have but a confused idea of the influence which irritation exercises over the production of disease, without an accurate knowledge of the nervous system, to which at first it is limited, but which, when inflammation appears, extends to the vascular system. The loose w ay in which medical men, until very lately, viewed the question of irritation, has most certainly led to serious errors. The simple, but com¬ prehensive axiom, of uhi stimulus , ihi fiuxus , was quoted only to be forgotten ; and yet there are few to which we should more carefully attend. The first material character of inflammation is an. Dft. BUBK.E ON OPIUM IN INCIPIENT INFLAMMATION. afflux of fluids to the interstices of the irritable fibre, but until this deposit take place disease is hardly imagined. It would, then, appear, that if this deposit were prevented, disease could not occur. It is generally laid down in books, that narcotics have the property of allaying irritation, if applied at a very early period, aud that thus inflammation is checked. For the theory of combating irrita¬ tion, in its early stages, by exhibiting narcotics, we have the authority of Sir Everard Home, in the view which he takes of the influence of the nerves upon the action of the arteries, where he thinks inflammation depends upon the afflux of blood caused by the irritation of the nerves, and then concludes, that allaying the nerves is the best antiphlo¬ gistic. There are two points which demand our serious consideration before we pre¬ scribe narcotics ; if possible, to ascertain whether it be the ganglionic or cerebral system that is engaged. This is a point I fear not much attended to. If positive and manifest inflammation do not exist, then only do the majority of us prescribe narcotics. It is needless to say that this is not the only stage in which they may with safety be applied. In that restless agitation which sometimes succeeds fever, there is nothing to be compared with opium. Frank, no mean autho¬ rity, tells us, “ that when an intense pain, an excess of sensibility, a vivid affection of the mind, threatens an in¬ flammation, a large dose of opium im¬ mediately after bleeding very often wards off the disease”. Bleeding alone w ill not do, for we know that though we leave but one drop of blood in the body, that drop will, despite our bleed¬ ings, obey the summons of the irritating cause*. At a meeting of the Royal Medical and Chirurgical Society, Dr. Yelloly, last year, made some very curious and interesting observations which bear di¬ rectly on this subject. He does not think that vascular appearance from disease always necessarily denotes the existence of inflammation, and sup¬ ported bis views by producing a portion of the spinal marrow, which was highly vascular, but which was dependent, not on inflammation, but venous turges- cence. From this we see that the mere fact of increased redness should not ne¬ cessarily direct us to the lancet. Upon the precise operation of opium we have much to learn : whether it act directly, by diminishing the secretions, or by rendering the membranes upon which the fluids are poured out, as in diarrhoea, insensible to their stimulating qualities, is still a question. One thing clear is, that it is with one or the other intent it is generally exhibited. If we find it useful in the case of inflamed membranes, w here by checking the se¬ cretion it stops the first process of in¬ flammation, it is not going too far to extend the same reasoning to muscular inflammation in its incipient .state. Is it too much to say, that opium may act in another way than on the attributes of the solids — excitability, sensibility, contractility ? Sir Gilbert Blane hints that it may act on fluids, from the pro¬ perty of life which the blood is supposed to possess, and illustrates his view by the w'ell-known fact, that the healing process of many ulcers is retarded by the existence of morbid irritability and sensibility, and which being allayed by opium, the cure is completed by nature. We look in vain to the works of the earlier writers on medicine for informa¬ tion on this head ; the limited know¬ ledge which they had of anatomy, and which led them to confound, under one common denomination, nerves, liga¬ ments, aponeuroses, and blood-vessels, is at least some excuse. Until we come down to Sydenham, there is little of in¬ terest on this subject. That great man viewed it under three heads, to which he reduced the pathological phenomena which yield to its influence — severe pain, vomiting, and copious dejections. To allay pain is of itself of paramount importance, for it alone will often de¬ stroy life. The late Dr. Pemberton spoke from sad experience, when he said that pain was the greatest sedative in nature. Looking at the various diseases in which opium is given, in one form or another, we must admit that there is something in the operation of this drug which we are as yet not thoroughly ac¬ quainted with. The ordinary diseases in which w e see it given are inflamma¬ tions, or injuries of such a nature, either Andral’s Pathology. •230 DR. BURKE ON OPIUM IN INCIPIENT INFLAMMATION. from accident or design — as amputa¬ tions, or sprain, which induce inflam¬ mation so rapidly as to leave no time for its exhibition as a preventive remedy. In such cases its exhibition is based upon empiricism, solely with a view to procure a temporary respite from pain. J am strongly disposed to believe that opium does a great deal more even in those cases; and if we could but shake off our little prejudices, which cramp our better judgment, opium, instead of being’ given as a placebo, which is un¬ fortunately too often the case, would become a leading feature in the subju¬ gation of positive disease. Our attention has not been sufficiently directed to the consideration of abstract pain ; it is, unhappily, too often viewed as a symptom, when it is really the dis¬ ease itself. I am led to this conclusion by the operation of corrosive poisons, which, when taken into the stomach, often destroy life by their action on the nervous system, and which is marked by extreme pain, when, after death, we are unable often to discover any change of structure in any organ or tissue. May not the custom of the Arabian phy¬ sicians, and which has its followers even amongst ourselves, of giviug' opium largely and successfully in intermittent, be accounted for in this way — that by rendering' the system insensible to the stimulus of disease, it thus cures it ?. oi¬ ls it that the nervous system, which opium is supposed by some to select for its operation, is the seat of intermittent fever? In this there is some probabi¬ lity, for we find it given by men of re¬ putation, both in the hot and cold fit. I have experienced in my own person the good effects of opium, if taken in the incipient stage, when catarrh threa¬ tened. Half an ounce of laudanum, in an ounce and a half of liquor ammonise acetatis, taken at bed-time, has fre¬ quently allayed incipient catarrhs ; but danger is to be apprehended if we allow the first ten hours to elapse before vve ap¬ ply it, for the catarrh is then inflamma¬ tion, which is sure to be aggravated by it. The part which opium plays in that very distressing' disease, colica pictonum, is, I am inclined to think, to be ascribed to the power which it exercises in subdu¬ ing- irritation. A patient suffering from this complaint, took, in three days, 9(3 grains of opium and <3 oz. of the syrup of poppies, without feeling the slightest disagreeable sensation.s At the expira¬ tion of three days, all pain ceased, and the bowels were easily moved by mild aperients. A very curious and ingeni¬ ous theory has been offered, I forget by whom, to account for the part which opium plays in some thoracic diseases. It is supposed, that by shortening the respirations, less blood is admitted into the lungs, and consequently a diminish¬ ed quantity of stimulating’ fluid reaches them : that under its employment the blood becomes less vivifying, no longer excites the arteries and tissues, whose life it was intended to maintain. This is not altogether visionary. Opium, we know, has some- direct effect on the blood, though we are not yet pre¬ pared to say what that is. In cases of poisoning by it, the blood in the left ventricles of the heart is generally found black. There are two remarkable cases in the Dictionary of Practical Medicine and Surgery,in the article “ Apoplexy,” by Cruveilhier, of the effects of opium in cerebritis. One, a woman with he¬ miplegia, 78 years of age, wh oexperi- enced in the upper paralyzed extremity, violent shocks, during which the hand struck the breast with great violence, producing the most painful contrac¬ tions, and accompanied with loud screams. He tried opium internally, having found every other remedy use¬ less, and the pains were instantly calmed. The other case is when the pain in the paralyzed limb was so severe that nothing- but opium afforded the slight¬ est relief. There is another interesting case recorded by Valisnieri. A jealous man administered to his concubine a larg'e dose of cantharides, with the in¬ tent of destroying- life. The stomach and intestines instantly became the seat of excruciating pain, accompanied by the most heart-rending cries, when, with the intent of giving her a quietus , the mon¬ ster gave her two drachms of solid opium. The woman slept soundly for three days, at the expiration of which she woke, free from all pain. Some of our standard works abound with illustrations of the value of this drug, even in acute diseases. Cullen and Lieutaud both assert that no medi¬ cine is to be compared with it in check¬ ing the paroxysm of pyrosis. Sydenham, mr. Thomson’s case of feigned parturition. 23 1 too, in his own aphoristic way, tells us that, sine iilo , manca et claudicet me¬ dic in a. Huxham and Sarcone g-ave it in pneumonia. Barras states that nine out ten of Broussais’ gastro- ententes are best combated by it, as irritation, not inflammation, is the disease. Much of the obscurity which shrouds the operation of this medicine, and the class of narcotics in general, is owing to the opposite and contradictory opi¬ nions advanced by writers on this sub¬ ject, few, if any, of which, are the result of inductive reasoning. When allaying pain, we find them described as ano¬ dyne ; sedative when checking- the ra¬ pid flow of humours; and hypnotic when producing sleep. One class ob¬ jects to opium in incipient inflamma¬ tion, from a belief that it quickens the action of the heart and arteries ; others as stoutly assert that it produces the op¬ posite effect. Some, again, account for its effects by dividing its properties into two classes — stimulant, which acts first; and then sedative : whilst some of the French school assert that its action is neither sedative nor stimulant, but what they denominate- — perturbatrice . Opinions like these are sufficient to shew that we have yet much to learn on this subject. The dread of its poisonous properties has excluded its administration in many cases, where a free use of it would in all probability be attended with marked success. We have cases where 1500 grains were taken in seventeen days ; and where twenty ounces of laudanum bad been taken in twenty-four hours, without destroying life. The opium- eater took daily 8000 drops. In the case of children I confess my¬ self unable to offer a satisfactory expla¬ nation of its operation. We know that its exhibition has been attended with fatal results, in the case of infants, even in the small dose of three drops; so that in our present state of knowledge as regards the different preparations of opium, we must, in the case of infants and children, use it with the caution which their tender age and helpless condition demand. CASE OF FE IGNED PARTURIT LON ; WITH REMARKS ON THE PROOFS OF DELI¬ VERY" AND INFANTICIDE. To the Editor of the Medical Gazette. Sir, If the following cases, with remarks, seem to you sufficiently interesting, be pleased to give them a place in your excellent journal, and favour Your obedient servant, J. B. Thomson. Alva, Oct. 28, 1830. Aug. 9th, 1836. — This day I was con¬ sulted by - , to ascertain whether or not his wife, from whom he had lived apart for the last eight months, had given birth to a child, as was reported. The husband stated, that about fifteen months ago he married rather against his better judgment, but was driven to do so in consequence of his wife, the object of the present investigation, set¬ ting forth that she was with child by him. This proved to be an imposition. In about three months after marriage she again gave out that she was in the family w ay, took to her bed, shewed all the signs of a miscarriage, and actually imposed upon the surgeon who was then called to attend her. In conse¬ quence of these instances of duplicity, and divers malpractices, - - says he left his wife about eight months ago. This morning he is informed, on her own authority, that she bore a child at one o’clock a.m., which died in two hours after ; and upon this feet he re¬ quires medical testimony. He not only doubts his wife’s word, but says another reason for not believing in her having’ borne a child is, that he never knew her to be as other women are — i. e. having’ menstruation. Without delay I called on Mrs. — . I found her a good-looking person, turned of 30 years of age, who, with clean cap, white bed-gown, and white sheet covering the bed-clothes, appeared as women are accustomed to do en ac¬ couchement. Her face had the ruddy hue of high entonic health, perhaps co¬ loured with a degree of shame and con¬ i’ • fusion. 232 mr. Thomson’s case of feigned parturition. With some difficulty I persuaded her to submit to my inquiries, and answer a few plain questions, and insisted that, for the sake of allaying- public clamour, it was quite necessary medical evidence should be had in her case. I remon¬ strated with her, shewing- that if there was any truth in the report of her hav¬ ing- borne a child, that she had exposed herself to judicial inquiry, since she had not called adequate assistance ; and, moreover, I could satisfy myself by a short investig-ation whether her story was true or not. In fine, 1 recommend¬ ed her at once to tell the truth, for her own sake and that of all concerned. By this time she allowed me to lay my hand upon her breasts and belly, &c. She now became alarmed, and confessed that there was no child born. She said that she had not any menstrual discharge for twelve months before ; that she gra¬ dually enlarged in consequence, until she and all the neighbours believed her pregnant, and through the night she had a fearful discharge of blood, &c., with something substantial, which was thrown out by an attendant. I then pointed to a coffin for an infant lying on the table, and asked what was the use of this if her story was correct. The husband was now brought into the room, who said that a child, or some¬ thing like one, had been laid out upon the table some time ago, but that his wife had taken it into bed with her, and concealed it among the clothes. He put his hand among the bed-clothes, and brought out a miserable imitation of a child, being a bundle of rags, with a stick or two to give the shape con¬ sistence ! The object of all this ruse was to procure money from the hus¬ band. The most important part of the fore¬ going case is the plausible story of the woman, that she had not any menstrual discharge for twelve months before ; that she gradually enlarged in consequence , and through the night she had a fearful discharge of blood , § c., with something substantial , which was thrown out by an attendant. The confession after¬ wards, and the subsequent disappear¬ ance of the woman, hindered me from satisfying myself as to the truth of the foregoing story ; but had she not con¬ fessed, and the statement proved true, there would surely have been very con¬ siderable difficulty in this investigation. Had it been true that the accumulation of menses for twelve months that morn¬ ing appeared, and brought away some¬ thing substantial, almost all the valid signs of delivery might have been pre¬ sent, and led astray the medical in¬ quirer. It is well known that the state of the abdomen after delivery may be simu¬ lated after it has been recently distend¬ ed, by many causes, as hydatids, dropsy, atrophy, and, as was possible in the present case, accumulated menses. Af¬ ter such diseases we should find a loose and flaccid belly, a soft and full and tumid state of the vulva and external organs of generation, enlarged uterus, patulous os uteri, laceration of the four- cbette or perineum, and even a dis¬ charge not easily distinguished from the lochia, independent altogether of delivery of a child. As to the mammae and other appearances, they are often of a very delusive and unsatisfactory na¬ ture as proofs in a case of much mo¬ ment. From these observations we learn that few subjects demanding medical testi¬ mony are more involved in doubt and difficulty than inquiries into the proofs of delivery. Happily for the honour of the times in which we live, the spirit of attention and philosophic investigation has been especially directed to this im¬ portant branch of judicial medicine. The ingenuity of our own profession, which has never been proverbial, and that of the law, which has alwavs been so, have shed much additional light on such topics. The result has been, that what a few years ago was accounted most unequivocal evidence on some medico-legal cases, has of late been scouted at as matter of great uncer¬ tainty ; and where not a grain of doubt was cast into the opposing scale, a weight of new facts has equipoised, or completely turned, the balance of jus¬ tice on the side of the accused. Not less uncertain are the proofs of infanti¬ cide, with a remark or two on which subject I shall close this communica¬ tion. The following cases lately came within my own knowledge. Mrs. B. was suddenly taken with la¬ bour when sitting* at the breakfast- table with the other members of the MR* THURNAM ON THE MUSCLES AND NERVES OF THE EYE-BALL. 233 family. She speedily arose from the table, and made for her bed : but before she could reach it, and before medical assistance arrived, a fine child was born. She was yet upon her feet, and the child being1 unattended to, fell upon the floor, and was taken up by the surgeon, when he arrived, quite dead. Mrs. H., a worker in the Devon Col¬ liery, while in the pit, and at a distance from help, was suddenly taken in labour, and bore a child alive; but it died be¬ fore any one arrived to assist her. Cases like these are by no means un¬ common, and certainly ought to be kept in mind bv medical men, when called on to give evidence in a case of suspected infanticide. With respect to appearances of violence , it behoves the examiner to exercise the strictest caution, both as to the facts detailed, and the inferences deduced therefrom. Injuries to the body, and crushing of the cranial bones, it is clear, could not be accounted satis¬ factory evidence that a child had been voluntarily destroyed, unless borne out by more important and collateral proof. Swellings of the soft parts, bruises, crushing of the bones, and even fracture, may occur in circumstances where the mother perhaps denies herself the assis¬ tance which would be desirable, or is suddenly taken in labour, and no aid can be rendered. Strangulation has ever been held as a process most likely to be resorted to, and well suited to accomplish the de¬ struction of an infant. But a suspi¬ cious case, attended by an unskilful person, lately came under my notice, where the child was strangled by the umbilical cord about the neck. Chil¬ dren are very often born with the umbi¬ lical cord about their neck, and there¬ fore any evidence drawn from appear¬ ances of strangulation must be preca¬ rious and uncertain. Perhaps the publication of these remarks may be useful, in shewing the uncertainty attending the proofs of de¬ livery and infanticide. [We should be glad to be favoured with the particulars of the case to which our correspondent alludes — “ where the child was strangled by the umbilical cord about its neck.” Instances of death produced in that way have been considered rare. — Ed. Gaz.] OBSERVATIONS ON THE COMPARATIVE AN.ATOMY OF THE MUSCLES AND NERVES OF THE EYE-BALL, AND ON THE THEORY OFTHEIR FUNCTIONS, PROPOSED BY MESSRS. HUNT AND WALKER. By John Thurnam, M.R.C.S. In making a few observations upon the subjects embraced in the title of this paper, I would wish to observe, that it is to the explanation of the functions of the nerves and muscles of the eye-ball, given by Mr. Walker in a paper pub¬ lished by him in the Medical Gazette, for September the 24th, that I refer throughout. I think it, however, only fitting to place the name of Mr. Hunt, in conjunction with that of Mr. WTilker, as, according to the admission of the latter gentleman, his theory is based upon an original suggestion of Mr. Hunt’s. The theory of the functions of the nerves and muscles of the eye given by Mr. Walker must, I think, be gene¬ rally admitted by physiologists as, at the least, much nearer approximating to the truth, than any hitherto proposed. I have the greater pleasure in making this avowal, in consequence of having on a former occasion been opposed, and on that subject I still am, to the views of Mr. Walker*. In order, however, to the full establishment of any physio- gical theory, it is not, I think 'it will be admitted, sufficient merely to prove that it is consonant with the anatomy of, and with the result of experiments upon, the organs concerned, in the healthy adult human subject. The physiologist ought in all cases to be prepared also to shew that his theories are all, at the least, re¬ pugnant neither to any facts observed in the gradual development and growth of such organs, from their earliest appear¬ ance in the embryo, to their attaining their full maturity in the adult form ; nor yet to a consideration of the human organism in either an original or an accidental abnormal condition. Lastly, the theory should, mutatis mutandis , be likewise applicable to the explanation of the functions of the corresponding * Medical Gazette, vol, xiii. p.p.8'54, 971. 234 MR. Til URN AM ON THE COMPARATIVE ANATOMY OF THE organs in tlie lower animals. It may, I believe, be safely affirmed, that physio¬ logy has been too long studied in refer¬ ence to but one object of its domain — man; and that from this one-sided pur¬ suit of the science, numerous false doc¬ trines have been, and still continue to be, promulgated, which, under a more extensive view of the matter, would never have been propounded. In phy¬ siology, too long* have we neglected the celebrated axiom of Bacon,— “ Omnium eravissimus error in deviatione ab ulti- c5 o . mo doctrinarum fine consistit.” It is in a portion of that spirit of in¬ vestigation that I thus venture to recom¬ mend to others, that I am desirous of making the ensuing remarks upon the functions of the nerves and muscles of the eye-ball. It is well known to comparative ana¬ tomists, that in addition to the six mus¬ cles of the eye-ball met with in man, there exists, in all mammiferous ani¬ mals, with the exception of the quadru- mana, another muscle, which arising* from the bottom of the orbit around the optic foramen, passes forwards, surrounding the optic nerve, and is in¬ serted into the sclerotic coat of the eye, a little behind the attachment of the tendons of the four straight muscles. This muscle varies in form and arrange- merit in different animals. In the ox, as in other of the Ruminantia, it forms a kind of muscular tube or funnel around the optic nerve, and after a short course, partially separates into two fasciculi, one of which, double the size of the other, is situated internally and superiorly ; the other externally and inferiorly. These two fasciculi are inserted into a circular line on the sclerotic coat, about three lines behind the attachment of the recti. In the dog, ag'ain, as in tlie other Carnivora, the muscle has the same origin, but divides at an early part of its course into four fasciculi of equal size, which are connected with each other laterally, by a delicate apo¬ neurosis, and are inserted into the scle¬ rotic coat, at four equi-distant points, intermediate to, and a line or two be¬ hind the insertion of the four proper straight muscles of the eye. This mus¬ cle is met with in the turtle, and in most, if not in all, the Rep til i a and Amphibia ; it is absent in fishes, and in birds its place is occupied bv the mus- culus quadratus of the nictitating* mem¬ brane. It was familiarly known to the earlier anatomists, some of whom, as Vesalius, erroneously attributed it to man ; and it is generally known under the name of the suspensorius or retractor oculi. It constitutes the “ musculus Septimus brutorum ” of the English anatomist, Willis, and is the “ muscle choano'ide” of Cuvier. Willis, in his work “ De Anima Brutorum*,” gives the following explanation of its func¬ tion : — “ Observare est quod quadrupe- des, qui oculos in terrain pronos, ac pen- dulos g*erunt, musculum peculiarem ha- bent, quo oculi globus suspenditur, et, lie pondere suo extra ossis orbitam dilabi aptus sit, sustentetur.” This explana¬ tion of the function of the muscle is also adopted by other anatomists ; but on the other hand, there are some who attribute to it, not so much of a general suspensory action as an occasional re¬ tracting one, and by the latter it is generally spoken of as the retractor muscle of tlie eye. I incline myself to believe that it is seldom called into ac¬ tive voluntary contraction in such a way as to produce a powerful retraction of the ball of the eye; an action in which I should suppose it to be only subsidiary to tlie four straight muscles of the eye. I shall hereafter assign a rea¬ son for this conclusion, viz. that the eye in quadrupeds is suspended by tlie ordi¬ nary and uniform degree of contraction of the seventh muscle. Although the muscles of the eye ap¬ pear to have been well examined by our modern comparative anatomists, yet it is to be regretted that the nerves supplying* them should have been comparatively neglected ; for I do not find that any modern author states the nerve which the suspensory muscle receives. It is, at the least, not named in the works of Cuvier, Blumenbach, Cams, Fyfe, or Grant. A priori , probably, it would have been expected that its nervous supply would have been derived from the common motor nerve of the eye, of the third pair. It is, however, supplied by a division of the abductor nerve of the sixth pair; and this would appear to be a universal fact, for I have found it to be thus in the Ruminantia (ox and sheep), the Solipeda (horse), Pachyder- niata (swine), and Carnivora (dog), amongst Mammalia. Tlie distribution * Cap. xv. p. 78. MUSCLES AND NERVE OF THE EYE-BALL. 235 of the sixth nerve to the suspensory muscle is, so far as I know, mentioned only by one modern author, and that is in relation to the Chelonian reptiles, by Bojanus, in his splendid monograph, “Aiiatome Testudinis Europoem. ” What is a singular circumstance in the anatomy of the sixth nerve in the Mammalia is, that although of the two muscles to which it is distributed, the suspensory is double the size of the ab¬ ductor, yet that it gives a much larger proportion of its filaments to the latter. In the various eyes that I have dissect¬ ed, I have uniformly noted that two- thirds, or even three-fourths of the fila¬ ments composing the sixth nerve, are given to the abductor, and only the re¬ maining third or fourth to the suspen¬ sory muscle. This circumstance, I think, is sufficient strongly to support the view of the function of the latter muscle, which I have taken above. Wh en T first noticed this fact in com¬ parative anatomy, I was not aware that there was any published account of it ; and two years since, when I had the pleasure of attending Mr. Mayo’s lec¬ tures on the anatomy and physiology of the nervous system, I took an oppor¬ tunity of pointing it out to that gentle¬ man as a fact apparently opposed to his explanation of the functions of the nerves and muscles of the orbit*. I have since found, however, that the comparative anatomy of the sixth nerve was well known 150 years ago to Wil¬ lis, from whom I quote the following : — “ Nervus iste (conjugationis sextae) an- trorsum ten dens, prope oculi orbitam in duos ramos diviclitur ; quorum alter in musculum oculi abducentem, in exte- riore ejus anguli situm, inseritur ; atque alter in varias fibras diremptus, muscu¬ lo septimo, brutis proprio, impenditur, adeo ut hie etiam nervus oculi motibus, fere tantum pathcticis, aut ab instinctu naturali excitatis, inseivire videaturf.” Willis likewise concludes, that the fourth pair of cerebral nerves, to which he gave the name of pathetici , as well as the sixth, are involuntary nerves; and that the voluntary motions of the eye are all performed by the muscles supplied from the third pair. He thus anticipated the views of Sir Charles Bell upon this question— views, how¬ * Vide Mayo’s Physiology, second edition, p. 394. t Nervorum Dcscriptlo et Usus, cap. 22. p. 73. ever, which, like the theory of a respira¬ tory system of nerves, of which they form a part, cannot, I think, be regarded as satisfactory, and to which there appear to be insuperable objections. 1 would here submit, that before we ought to regard the theory of the func¬ tions of the nerves and muscles of the eye proposed by Mr. Walker as esta¬ blished, we ought to be able to show that it can be reconciled with the fact of the suspensory muscle in the lower animals being supplied by the sixth nerye. Mr. Walker will, I am sure, agree with me in considering it highly desirable to subject his theory to every test capable of being applied to it; and more especially when we recollect that with its adoption is necessarily connect¬ ed the rejection of two theories on the same subject, propounded by such dis¬ tinguished physiologists as Sir Charles Bell and Mr. Mayo — theories, however, which, it must be observed, cannot be regarded as having' the same claim to attention that the one proposed by Mr. Walker has, inasmuch as they neither of them attempt to give a complete ex¬ planation of the nerves and muscles of the eye; the one of them, that of Sir Charles Bell, offering no explanation of the abductor muscle having a distinct nerve ; and the other, that of Mr. Mayo, leaving* the question of the superior oblique muscle, and the fourth nerve, equally in the dark. In relation to one of the disputed points involved in this discussion, I may observe that in two dissections of the muscles of the eye of the ox and dog', made since the publication of Mr. Walker’s paper, I have noticed that the insertion of the two oblique muscles is decidedly anterior to the vertical axis of the ball, — a fact confirming, I think satisfactorily, the view which Mr. Walker takes, in common with Meckel, Cloquet, and Knox, of the action of these muscles, in opposition to the re¬ verse doctrine of Albinos, Bell, Mayo, Dalrymple, and others. Although I have bestowed upon this subject considerable attention, and some reflection, yet I have not been able to perceive the necessity for any peculiar consent or sympathy between the sus¬ pensory and abductor muscles of the eye of quadrupeds. Mr. Walker, how¬ ever, or some other physiologist, may perhaps be able to point out such a con- 236 MR. MIDDLEMORE ON THE REMOVAL OF THE CRYSTALLINE LENS. wexicm ; and will probably be kind enough to answer the query with which I shall conclude these very cursory ob¬ servations — Is the fact of the suspensory muscle of the eye in the lower animals , being supplied by the sixth nerve , recon¬ cilable or not with the explanation of the functions of the muscles and nerves of the eye ball , given by Mr. Walker P Westminster Hospital, Nov. 2, 1836. ON THE OPERATIVE PROCEEDINGS RK QU I RED FOR THE REMOVAL OF THE DISLO¬ CATED LENS. By Richard Middlemore, Surgeon to the Birmingham Eye Infirmary. In addressing ta you some further ob¬ servations on the operative measures required in certain varieties of disloca¬ tion of the crystalline lens, I shall offer no hackneyed apology for what may he considered the limited and very sec¬ tional character of my remarks, inas¬ much as it appears to me that the elabo¬ ration of the details of medical and surgical subjects is one of the most legi¬ timate and important objects contem¬ plated by the establishment of medical journals ; for in what other vehicle of information can the various objects of me¬ dical inquiry be investigated with equal minuteness? If the author of an ordi¬ nary octavo volume attempt this elabo- boration of detail , it is not difficult to predict bow large a part of the project¬ ed matter of his work will remain unac¬ complished. Regarding, therefore, me¬ dical journals as depositories of informa¬ tion the most ample and exact, and of inquiry the most elaborate and extended, I have, in my various communications to the Gazette, frequently selected, for investigation, a part of the section of a subject (if I may be permitted so to speak) which, if it has not instructed, has at least fatigued somewhat less than if a prolonged investigation of a large and comprehensive subject had been entered upon in the same manner in re¬ spect to all its parts. It appears to me that every practitioner should be en¬ couraged to come forward, and deposit his stock of useful knowledge as he gradually acquires it (and who is there who can practise our profession without acquiring some portion of information worth communicating to others ?) in a place which we have endeavoured to represent as being peculiarly adapted to its reception, so as to supply to the ac¬ tively intelligent and devotedly indus¬ trious, an opportunity of aggregating the information comprised in the scat¬ tered labours of many writers, in a con¬ densed and readily accessible form. In short, every man should feel it to be his duty to furnish some part of the mate¬ rials, at least, of that rising fabric which the more diligent and enlightened will eventually fashion into a storehouse of professional knowledge — a temple of medical science, of a construction so perfect and beautiful that the finite fa¬ culties of man can scarcely further im¬ prove or adorn it. To approach even this typified perfection of knowledge, the active and constant exertions of all are required. The practice of removing the lens, when displaced into the anterior cham¬ ber by accidental violence, or from other causes, has been long known, but not, until lately, so much acted upon as, I think, it ought to have been. Daniel mentions, that “ M. Petit a pratique, en 1708, la section de la cornee pour extraire le crystallin qui etait passe dans lachambre anterieure* and Dr. Warren has furnished an elaborate and able article upon the subject f, in which be appears to consider that it is not only necessary to remove the displaced lens by an operation, when it has already produced acute inflammation of the eye, but that it is also justifiable to extract the lens immediately after it has become displaced, as a means of preventing the occurrence of severe inflammation. I do not, however, intend to point out the forms of dislocation which more espe¬ cially require the performance of the operation, nor the period, after the oc¬ currence of the displacement, at which it would be desirable to operate ; for these things have been already fully discussed J. My chief object is to di- * M<±moires de l’Academie Royale de Chirurgie, tom. ii. t Loudon Med. and Physical Jour. vol. xxxvi. t London Medical Gazette, vols. v. and ix. The North of England Medical and Surgical Journal, No, 4. Midland Reporter, vols. ii. and iii. Transactions of the Provincial Medical and Surgical Association, vols. ii. and iii. PECULIARITY IN THE STRUCTURE OF THE DECIDUA VERA. 237 reet attention to the mode in which the displaced crystalline should be removed, in those cases where from its constant or occasional residence in the anterior cham¬ ber, or in whatever situation it may be placed, such operation may be deemed requisite. If, then, it be necessary to extract the displaced crystalline through an incision of the cornea, should that incision be made at its upper or lower part? Before replying- to this question, it is proper to inquire into the usual state of an eye in which a dislocation of the lens into the anterior chamber (for it is to this form of accident, or disease, that my remarks are more especially in¬ tended to refer) has recently occurred. We find that the eye is more or less in¬ flamed — that its muscles, and those of the eye-lids, are irritable and spasmodic in their action — and that there is g-reat intolerance of light. If an attempt be made to raise the upper eye- lid, the or¬ bicularis muscle acts with g-reat power ; the surface of the eye is exposed with considerable difficulty, and the patient suffers extreme pain. Having', how¬ ever, made a section of the upper part of the cornea, varying- in size in corre¬ spondence with the magnitude and den¬ sity of the lens, it is found to be amaz¬ ingly difficult to introduce a hook for the purpose of removing- the displaced crystalline : to introduce a hook through an opening- at the upper part of the cornea, for the purpose of extracting- a lens situated at the lower part of the anterior chamber, in an eye already much inflamed, is, I repeat, a matter very difficult of performance, and ha¬ zardous of execution. Skill and tact may accomplish it, but I entreat my professional brethren to witness the com¬ parative ease with which a different mode of operating- may be practised, before they resolve on making- such ex¬ traordinary demands on their operative dexterity. If the incision be made at the lower part of the cornea, and the knife be carried, as it ought to be, behind the solid (if soft, it will not require ex¬ tracting) lens, it is then prevented from retiring behind the iris, and no efforts at removal are necessary ; for the crystal¬ line generally passes through the cor¬ neal opening without any trouble what¬ ever. The preceding method of operating- has been recommended in my work *, and I should not so soon have referred to the subject again if I had not had a recent opportunity of observing' the dif¬ ficulties encountered by an excellent surgeon, in consequence of pursuing a different practice, and of ascertaining, by conversing with various professional friends, that they are prepared to give the influence of their recommendation to this, as I conceive, very mischievous and erroneous surgical practice : for it Cannot escape observation, that the evils to he apprehended arise not so much from the mere section of the cornea as from the manipulations required, and the injury inflicted by the attempts to remove the lens. NOTICE OF A NEWLY-DISCOVERED PECULIARITY in the STRUCTURE of the UTERINE DECIDUA, or DECIDUA VERA. By W. F. Montgomery, M.D. Professor of Midwifery to the King and Queen’s College of Physicians in Ireland*. It would be an unprofitable occupation of the time of the Association to enter into any thing of a general or detailed account of the structure and relations of the decidua, which are so familiar to the profession. I shall, therefore, take for granted that my hearers are in full possession of the different points already well known on this subject, and confine myself exclusively to a brief notice of a peculiarity in the structure of this pro¬ duct, which, as far as I am aware, has never been described, although perhaps one of its most important and interest¬ ing features. About four years ago, while preparing the component parts of a human ovum, in the third month, for lecture, I observed that when the deci¬ dua vera was immersed in w ater, with its uterine surface uppermost, there ap¬ peared amongst the floating and shred¬ like processes which covered it, certain small circular openings, which at first I took to be merely foramina in the membrane ; but on attempting to pass the point of a fine glass rod through one of them, I found it to be a cul-de- * Read before the Medical Section of the Bri¬ tish Association, at Bristol, Aug. 2.r», 1836. • Vol. ii, p. 47, 238 DR. SKILLMAn’s CASS OF POISONING BY ARSENIC. sac. Being' thus incited to ascertain how the matter really was, and examin¬ ing- carefully then, and having- repeated the examination frequently since, I have fully satisfied myself and others who have examined the part with me, or to whom I have exhibited it in my lectures on embryology, both of the existence and peculiar character of the structure about to be described. There are on the external or uterine surface of the decidua vera a great number of small cup-like elevations, which project from it like little hags, the bottoms of which are attached to, or embedded in the substance of, the decidua: they then expand or belly out a little, and again grow smaller towards their outer or uterine end, which is, in ]yy far the greater number of them, an open mouth, when separated from the uterus : howr it may be while they arc adherent, I can¬ not say. Their form is circular, or very nearly so ; they vary in diameter from one -twelfth to one- sixth of an inch, and are elevated to about one-twelfth of an inch above the surface to whith they adhere* : in the way of comparison, I would say that they were miniature re¬ presentations of the suckers of the cut- tie fish. They are not confined to any one part of the decidua, but are usually most numerous and most distinct in those parts of it which are not connect¬ ed with the capillary rudiments of the placenta, and at the period of gestation which precedes the formation of the latter (the placenta) as a distinct organ : hence the best time for examining them is up to the third month. In the ad¬ vanced periods of gestation they are not to be found ; at least I have not seen them then. I am ready to confess at once, that I am not prepared to offer any decided opinion as to the precise nature or use of these decidual cotyle¬ dons, for to that name their form, as well as their situation, appear strictly to en¬ title them ; but from having on more than one occasion observed within their cavity a milky or chylous fluid, I am disposed to consider them reservoirs for nutrient fluids, separated from the ma¬ ternal blood, to be thence absorbed for the support and development of the ovum. This view appears strengthened when we consider, that at the early pe¬ * An accurate engraving of these decidual co-' tyledons will appear in a work on Pregnancy, now on the eve of publication. riods of gestation the ovum derives all its support by imbibition, through the connexion existing between the decidua and the villous processes covering the surface of the chorion. CASE OF POISONING WITH ARSENIC; RECOVERY, AFTER HALF AN OUNCE HAD BEEN SWALLOWED. Bv Dr. Jacob T. B. Skillman, Of New Brunswick, N. J. I was called to see Jane B., a native of this place, aged 22 years, at eight o’clock in the morning of the 27th of April, 1836. On my arrival, I was in¬ formed by her mother that she had taken sixpence w’orth of arsenic, or half an ounce, as I afterwards learned from the apothecary who sold it to the patient. Her mother handed me the papers*in which it had been put up, and which showed very evident marks of having contained the poison, from the colour left upon the inside paper. She informed me her daughter had taken the whole dose the preceding evening, about twilight; that it soon produced emesis and catharsis, which continued frequent through the night. On exa¬ mination, I found her pulse 140 in a minute, and irregular ; she complained of much pain in her head, throat, and stomach ; fauces appeared much swol¬ len and red ; eyes considerably in¬ flamed; frequent sighing-. Although somewhat reduced and exhausted by the action of the poison upon the sto¬ mach, I immediately took from her arm about twenty ounces of blood, which I thought had some effect in producing- more regularity in her pulse, and would perhaps reduce the inflammation of the alimentary canal. I was also informed that her dejections appeared to contain a considerable quantity of the poison, in an undissolved state. I directed, after bleeding, an ounce of castor oil every third hour, and a wine glassful of a solution of Epsom salts in a quart of soapsuds, every intervening' hour, until it should act freely upon the bowels ; this last solution to be given lukewarm. At six o’clock p.m. I found that she had rejected the most that she had ANALYSES AND NOTICES OF BOOKS. 239 taken, and that the operation upon the bowels was very scanty ; pulse more frequent ; complained of more pain in the stomach. Ordered the medicine in smaller doses, and to be continued through the night until it should pro¬ duce the desired action upon the bowels. At eight a.m. on the 28th, her bowels had been freely acted upon by the me¬ dicine stomach appeared less irritable ; complained of more pain in the fauces, throat, and stomach. I prescribed leeches to the throat and stomach. At six p.m., pulse more frequent, and an ash-coloured appearance of the centre of the tongue ; edges much reddened by inflammation; complained of much pain throughout the system, with great and incessant itching* of the skin ; some tenesmus and strangury. Directed her to take a solution of tart, antim. and sp. nit., a tea-spoonful every hour, until the excitement abated ; toast water and barley water for drink. At 8 a.m., 29th, appeared somewhat relieved of all the unpleasant symptoms, and had eaten half a cracker. Directed a dose of salts, and a continuation of the solution of antimony. At 6 p.m. salts had not operated : symptoms more aggravated. Directed a repetition of the salts, and a continua¬ tion of the antimony. At 8 a.m., on the 30th, all the symp¬ toms much more favourable ; had eaten a cracker. Toast water and barley water continued for drink, and continu¬ ation of the antimony. May 1st, at 8 a.m., symptoms the .same as the previous day: had had a very restless night: drops began to act freely upon the bowels. 2d. At 8 a.m., has had a comfortable night compared with the former: tongue appears cleaning : has eaten some oyster soup. 3d. At S a.m., appears still more com¬ fortable: sits up part of the day, and appears convalescent. She now com¬ plains only of debility and soreness of the tongue: her lower extremities ap¬ pear somewhat cedematous, and her pulse is still frequent, but soft and elastic. health* ^ ** C^°yin^ ber usual usuSs? J°Urnal °f Medical Sciences, for ANAL YSE S and NOTIC E S or BO O K S . “ L’Autenr se tue a allonger ce que le lecteur se tue a abreger.”— D’Alembert. Darstellungen und Ansichten zur Ver- gleichung der Medicin in Franhreich, England , und Deutschland. [A Com¬ parative Sketch of Medicine in France, England, and Germany.] Von Dr.’ Adolph Muehry. Hannover, 1836. Schloss. Dr. Muehry’s tour took place in 1835, and the notes made on the occasion have formed a very respectable pocket volume, which strangers from Germany will find useful as a guide. Correct maps of London and Paris are subjoined, having the chief localities interesting to the medical visitor conspicuously mark¬ ed upon each. I he account given of our hospitals is, generally speaking*, coirect, or at least there are no material errors in it, which, perhaps is as much as can be expected from a tourist making one or two flying* visits. Historisch - kritische Darstellung der Theorien uher das Wesen und den Sitz der psgchischen Kranhheiten. [Account of the several Theories which Prevail, respecting the Nature and Seat of Mental Diseases.] Yon Dr. J. B. Friedreich. Leipzig, 1836. Schloss. This . is an extremely interesting' work, displaying all that erudition and practical experience through which Pro¬ fessor Friedreich has long since attained so distinguished a name. The subject is lucidly treated under the respective heads of the material, immaterial, and the mixed theories, with critical remarks on the principal supporters of each, ihe views of Jacobi and Combe are dis¬ cussed ; also those of Heiurotb, Harper Groos, and other authors of reputation : and on the whole, we have such an ac¬ count presented to us of the actual state of medico-psycholog*ical literature, as we should be glad to see transferred into our own language. It would serve, we think, materially to promote in this country the study of a branch of medi¬ cal science which has been but too much neglected — we mean that of mental diseases. 240 ANALYSES AND NOTICES OF BOOKS. Dr. Gustav Blumroder ub°.r das Irre- seyn, oder anthropologisch-psychia- trische Grunds'dtze [Dr. Blumroder on Insanity]. Leipzig’, 1836. Scliloss. In this brochure, Dr. Blomroeder has attempted to treat the subject of insanity in a popular manner, or at least as well for the non-professional as the profes¬ sional reader. He gives an account of the unity ( einheit ) of man, of the blood, the brain, and spinal marrow — of the two great faculties of the understanding' and the will — of the various kinds of mental unsoundness, imbecility, melan¬ choly, eccentricity, delirium, insanity ; with views of the etiology, diagnosis, prognosis, the treatment and pathologi¬ cal anatomy of mania. The author’s great resources of learned experience shine throughout ; but how far bis book would be popular here, even if it were translated into English, is questionable. It is dedicated to Professor Friedreich. Analehten uber Kinder kranheiten. Heft. i. — viii. Stuttgart, 1834-6. Schloss. This is a collection of papers on the diseases of children, which appears pe¬ riodically, and is designed for the use of German practitioners. The contri¬ butors are of all countries ; many of them French, American, and English. Encyklopadie der gesammten Medici- nischen und Chirurgischen Praxis. [Cyclopedia of Practical Medicine and Surgery]. Yon Dr. G. F. Most, &c. Heft, i.— v. Leipzig, 1836. Schloss. It is intended to complete this Ency¬ clopedia in twelve hejfte, forming two octavo volumes; and a valuable work it will be, if we may judge from the portion (nearly the half) which is before us. It abounds with information on the several topics which are treated, and the literature is rich to profusion. The ar¬ rangement is alphabetical. Der Mensch nach den verschiedenen Seiten seiner Natur , oder Anthropo¬ logies fyc. [Man variously contem¬ plated, &c.] Von Dr. K. F. Buu- dach. Stutgart, 1836. Schloss. Professor Burdach here offers to the “ educated portion of the community,” a popular physiology, executed in a manner worthy of his distinguished abilities. It is to be completed in five parts, two of which have appeared — the first treating of organic, and the second of animal life. Die Leistungen und Fortschritte der Medicin in Deutschland im Jahre 1834. [Progress of Medicine in Germany during the year 1834.] Yon Dr. M. J. Bluff. Berlin. We last year gave an account of the first tw o volumes of this work, and have been anxiously expecting the appear¬ ance of the continuation. The volume nowr published only brings us to the close of the year 1834 ; but every al¬ lowance must be made for the author of such an undertaking, when we consider that he not only gives us an account of all the new works, and new editions of works, brought out in Germany during the year, but a notice of all the articles published in the periodicals, arranged under their respective heads ! The two indexes of names and subjects, which are added, render the work perfectly accessible in the way of reference. Medical Study; an Introductory Ad¬ dress delivered at the Bristol Medical School. By J. A. Symonds, M.D. We have perused this Address with much pleasure; it contains a great deal of valuable advice within a moderate com¬ pass, and displays the author’s taste and good sense throughout. Some extracts w?e should be glad to transfer to our pages did our space permit ; for only one can wre find a corner. The author eloquently advocates the claim of our profession to be considered, as in this country it has long been, a learned one. He discou¬ rages, however, the mass of students from discursive literary pursuits, recom¬ mending in preference a concentration of their talents upon some w ell-defined object. “ To the many” says Dr. Sy¬ monds, “ I address myself ; to those w ho with good average understandings wish to fit themselves for their future duties ; and to such I would say : Be • ware of frittering upon a multitude of objects, talents which, prudently econo¬ mized, may make you w’ise in your ge¬ neration, and useful to many generations to come. Medical science is not what HOMOEOPATHY SKETCHED IN ITS OWN COLOURS. 241 it was in former times, nor is, indeed, any science. Look to any one of the physical sciences, and observe the divi¬ sion of labour. Take natural history : for one Cuvier, who commanded all its departments, what numbers you discern, distinguished indeed, but distinguished only in particular branches. How well, then, might we expect, a priori , that medicine must demand, from ordinary minds, an attention all but undivided. How much stronger also must this view become, by reflecting on the practical duties, cares, and distractions, which the application of medical science in¬ volves !” MEDICAL GAZETTE. Saturday , November 12, 1836. ** Licet omnibus, licet etiam mihi, dignitatem Artis Medicos tueri; potestas modo veniendi in publicum sit, dicendi periculum nonrecuso.” Cicero. HOMOEOPATHY SKETCHED IN ITS OWN COLOURS. The homoeopaths say that they are not rightly understood, — that their doctrines are misrepresented, — and that they have not had a fair hearing. Poor innocents ! We shall try w hether we cannot aid them in becoming* better known to the public. But lest we too should be subjected to the charge of mis-stating, we think it right to premise that we shall simply read a leaf out of their own book — make, in fact, a few selections from a prime production of the great Master himself — and offer a few plain comments, to im¬ press their importance the more strongly on the minds of our readers. Every body knows, or ought to know, that homoeopathy abhors unpleasant doses of physic : that is to say, the ho¬ moeopathic doctors never administer so much as a grain, for instance, of any medicine; they go to work with the millionth, or fraction of a millionth, of that quantity, — which no doubt is a potent recommendation of them to many 447. — xix. people who hate the taste of drugs. But we apprehend that the world is not sufficiently aw are of the miraculous effects of these invisible doses ; which, indeed, seem to be the more wonder¬ working the more infinitessimal and spi¬ ritual they are rendered. Let us take an example. The vulgar medical world — styled by the disciples of Hahnemann, allopaths — have long- thought that there were many substances which, though still retained in our phar¬ macopoeias, were inert, especially when exhibited internally. This the homoeo¬ paths have discovered to be a mistake. Charcoal, for example, which had often been tried medicinally, and given even to the extent of a pound in the day, without other effect than that of passing out of the body unaltered as it went in, has proved in the hands of the “revivers” of medicine to be a substance of most thaumaturgic qualities: the millionth of a grain of charcoal has given rise to astonishing- symptoms. I11 the Materia Medica of Hahnemann — even in the condensed French trans¬ lation by Jourdan — no less than forty-six octavo pages are devoted to the detail of the symptoms produced by charcoal in doses not exceeding the millionth of a grain. Seven hundred and twenty is the number of symptoms ascribed to this dose of vegetable charcoal (carbo ligni), while one hundred and ninety are attri¬ buted to the same quantity of carbo animalis. In other words, the - — l- - - ’ 5,760,000,000 of a close which has been found per¬ fectly inert, is described as producing 720 symptoms ! But let us see what are those symptoms. Here are some specimens almost taken at random : and we pray the reader to keep steadily in his mind that the person or persons who have experienced these symptoms have taken the maximum dose of the millionth of a grain of char¬ coal — charcoal made of any kind of R 242 HOMOEOPATHY SKETCHED IN ITS OWN COLOURS. wood ; for Hahnemann says it is not material from what kind of wood it is made. 84. The face itches, particularly about the eyelids. 85. The inner angle of the left eye itches. ( Gersdorff. ) 86. A sensation of smarting itchiness, particularly in the external angle of the right eye. (Idem.) 87. Itching in the left eye ; the part smarts after being rubbed, particularly at the inner angle. 88. A smarting in the inner angle of the left eye. And so on for upwards of twenty more symptoms — all about the eye ; or as some vulg’ar jesting* allopath would say, “ all my eye” : but this specimen may serve. The eye, however, it appears, is not the only part that itches when we take the millionth of a grain of charcoal. 324. Itching of the anus ; the part gets hot after it is rubbed. ( Gersdorff. ) 325. In the morning, while in bed, the anus itches, and gets worse for scratching: heat of the part follows. ( Caspari.) 326. Smarting of the anus.f Gersdorff. ) Oh, wonderful sympathy of MM. Cas¬ pari and Gersdorff! immortal pupils of the great Hahnemann ! how will pos¬ terity admire the acuteness of your sen¬ sations, and the extreme profundity of your remarks ! Now for another set of symptoms. Enter Messrs. Gersdorff and Caspari again, having taken their millionth dose. 299. Windy colic : flatus circulating* irregularly in the bowels, more particu¬ larly towards the left side and the back. ( Gersdorff.) 300. Rumbling in the bowels, imme¬ diately. (Idem.) 307. After the rumbling, emission de vents nombreux. (Idem). 308. Rumbling in the lower bowels perceptible to the ear, avec emission sourde de vents presque inodores , hu- mides, et chaudes. ( Idem.) 309. Flatus rolling in the bowels, et il en sort quelques unes qui sont sans odeur , (in the course of half an hour.) ( Caspari.) But Gersdorff finds that in an hour and a half the case is altered : the nose begins to perceive as well as the ear. 312. Vents, ayant un odeur putride. Yet once again- — 310. On awaking in the morning, enorme emission de vents sans odeur. For this last observation we are no doubt indebted to Hahnemann himself : there is a boldness in the enorme which gives it all the air of a master. With due deference, therefore, for so high an authority, presuming that we have to deal with the Doctor himself, we shall very humbly submit whether he and his pupils are quite sure that these formida¬ ble emissions de vents are altogether owing to the charcoal. Our hesitation to believe it simply arises from this, that the experimenters while on duty are allowed to eat French beans, g*reen peas, and carrots. (Vide Organon, 1 18.) Now to us it appears something like an infraction of the just laws of in¬ ference, to conclude, because a man is affected with flatus after a vegetable repast, that the said flatus is due, not to the peas and beans he has devoured, but to the millionth of a grain of char¬ coal w’hich has been taken some hours before. Such, however, is the ingenious reasoning of the homoeopaths. Admi¬ rable logicians ! The reader perhaps thinks that there is nothing else remarkable about char¬ coal : but this is not the case. W e have still a few other symptoms to notice. 226. Repugnance to butter. This wonderful property belongs to wood charcoal ; but the animal sort is not less remarkable. 69. The appetite becomes destroyed ( se perd ) by eating ! Here is another symptom produced by animal charcoal — HOMOEOPATHY SKETCHED IN ITS OWN COLOURS. 243 114. Upon riding’ on horseback, the seat gets heated, and the part blisters. In other words, the millionth of a grain of charcoal will cause a horseman speedily to “ lose leather.” But to proceed : 146. The right axilla itches. 159. A wart on the finger itches. 177. Lively dreams of scientific ob¬ jects : dreaming of the discussion of literary works : talking aloud in sleep. Innocent and happy homceopathists, if these were your only dreams ! Take charcoal, ye Uwinses and ye Everests, and be happy! But stay; what do we see in another part, among the effects produced by this potent drug? Really our readers must translate for themselves. 374. Pollution qui ebranle fortement et douloureusement les nerfs : apres quoi ardeur extremement violente a la partie anterieure de l’uretre, et en uri- nant une vive douleur secante avec ardeur, &c. ( Gersdorff. ) 375. Erection continuelle pendant la nuit, sans sensations ou idees voluptu- euses. ( Idem.) 376. Absence totale de l’appetit ve- nerien, le matin ; il ne peut meme etre excite par des idees lascives (au bout de vingt-quatre heurs). — Idem. Again ; hear another worthy dis¬ ciple : — 123. Pollution nocturne, pour la pre¬ miere fois depuis tres long-temps, avec reves voluptueux, sans erection; apres le reveil, douleur spasmodique le long de l’uretre, surlout a sa partie poste- rieure. — (Adam.) Now only conceive all this arising “ pulveris exigui jactu “ exigui” did we say ? — the millionth of a grain, and that grain of charcoal! What wonder that sedate men, like the Gil¬ christs, the Everests, and the Uwinses, men such as Hahnemann himself would have chosen for conducting his experi¬ ments, should be captivated with ho¬ moeopathy. The candour, the gravity, and the decency of the revelations above given are inimitable ! Be it always remembered, that these experiments for ascertaining the virtues of invisible doses are ordered to be con¬ ducted by such persons as we have de¬ scribed — men of sedate mind. Such is the precept of the great Founder. Hear the Organon : — “ The person who makes the experi¬ ment ought to avoid all fatiguing' la¬ bour of mind and body, all excesses, debauches, or mental excitement, dur¬ ing the whole of the time that it conti¬ nues. [Hear that, Master Gersdorff, you with the idees lascives /] No ur¬ gent business must prevent him making the necessary observations, and he must of his own accord be scrupulously at¬ tentive to every thing’ that passes in the interior of the body, without permitting anything to interrupt his care; and finally, he should unite with a healthy body (in its kind) a necessary degree of judgment, that he may be able to ex¬ press and describe clearly all the sensa¬ tions he experiences.” Granting that the experimenters are in this high and serene state of mind and body, who can fail to be struck with the effects produced by an atom of char¬ coal ? Our difficulty, however, consists not only in conceding the postulate, but in allowing a particle of credit to the flatulent dreamers. A word or two more concerning these experiments. It appears that the ladies are not allowed to be inactive disciples : we must have their experience too. But how this is gathered, we are not informed : whether the wives and sisters of the Gersdorffs, the Casparis, and the Adams, have been employed to ob¬ serve the effects of invisible doses on their own persons, and have communi¬ cated their sensations to the father of the sect-— or whether their husbands or brothers have interpreted for them, ap- peareth not : this only doth appear, that many odd symptoms are set down to the female experimenters. For exam¬ ple, dose tucdmj gr. of charcoal : 244 BRITISH MEDICAL ASSOCIATION. 377. Forte excoriation aux parties genitales de la femme, en avant, le soir. 378. Ardeur dans les parties geni- tales de la femme. 379. Douleur cuisante aux parties genitales de la femme, aver flux leucor- rhoique abondant, pendant deux jours, See. 386. Flux de mucus blanc par le va- gin (au bout de quatre jours). 124. From a similar dose of animal charcoal, whites at the end of a fort¬ night ; and 125. Leucorrheal discharge, staining the linen yellow, at the end of three weeks. Why have we not the names of the illustrious ladies who made these reve¬ lations ? why should they be cheated of their fair proportion of fame, having laboured so zealously to verify the old adage “ ex carbone thesaurus ?” But enough, perhaps, of charcoal for the present. We doubt not we shall be “ carbone notandi” by the Hahneman- nians, for our pains. They cannot say, however, that we have misrepresented them. We have quoted their beastly descriptions given in the ipsissima verba , in which they express their pruriency, their flatulence, and their filth ; and we have risked the displeasure of our read¬ ers by transferring so much egregious nonsense into our columns. With reference to this last point, we can only urge in excuse, that our duty as public journalists seemed to demand that we should thoroughly expose the me¬ dical imposture of the day. We should have been spared the nauseousoffice, were it not for the late public circumstances which bestowed a certain degree of no¬ toriety on the Hahnemannian delusion. It had fallen to its lowest ebb — that is to say, it was already in the embrace of certain pitiful pamphleteers, who were fast smothering it with their protection. Accident, however, or rather the mis¬ chievous bungling’ of one of the sect, brought the imposture again, for a mo¬ ment, into notice : some of the sectaries attempted to profit by the occasion ; so that they have only themselves to thank, if they now become better understood than ever. Their own foolish hands have served to tear off the veil of mys¬ tery, or obscurity, which gave them hitherto their only claim on the credu¬ lous. They pretend to want publicity and fair trial. They shall have both, if we can promise any thing within our powers of performance. And as we have shown up their impudent humbug in charcoal now, perhaps we may try them in chalks , or some other matter of that sort, on the next occasion. COLLEGE OF SURGEONS. By a recent regulation the Council of the College of Surgeons have determin¬ ed not to receive in future the certificates of any lecturers in anatomy or surgery, who do not appear before them for examination with reference to their qualificationsfor teachingthose branches. BRITISH MEDICAL ASSOCIATION. In our notice of the meeting which was recently held by the members of the British Medical Association, we expressed our regret that the card which they had the politeness to send us was not received in time for us to make use of it, so that we were compelled to take our report of the proceedings from the Times. The Editor of the Lancet, in the fulfilment of his dishonest calling, last week gave inser¬ tion to the letter of an anonymous slan¬ derer, whose object was to produce the be¬ lief that our statement was false, and that the members of the Association regarded us with very different sentiments from those feelings of courtesy and fellowship which we had expressed towards them. Nothing, it seems, raises Mr. Wakley’s bile so effectually as the idea of the General Prac¬ titioners presuming to think for them¬ selves, and to judge of us by what appears in the pages of the Medical Ga- BRITISH MEDICAL ASSOCIATION. 245 zette, rather than by his jealous and in¬ terested calumnies. Besides the commu¬ nication which we subjoin, we have also to acknowledge the receipt of another, from an official quarter, in which anxiety is expressed to do away the impression which, it is feared, “ the intemperate and unjust ’’ letter alluded to, must have pro¬ duced. We beg to assure the members of the Association that there is no risk of our connecting them with the maligners of the Lancet; and that this journal shall always be open to the furtherance of all measures calculated to advance the common honour and interests of our profession, from what¬ ever quarter they may emanate. To the Editor of the Medical Gazette. Sir, At a meeting of the stewards held last night, I was directed to express to you •their regret that the ticket, for the late Ge neral Practitioners’ Dinner did not reach you until too late to be used. This arose from the resolution desiring the attend¬ ance of reporters having only been made at so late a period as the Monday night preceding the dinner. On the whole of Tuesday I was very busy, and found it impossible to send to you, and to the Edi¬ tor of the Times , the tickets placed at your disposal, until the evening of that day. As the report of what occurred at the dinner, as copied by you from the Times, (although not incorrect), by no means does justice to our intentions, I forward to you, by the direction of the committee, a state¬ ment of the ends and objects of the British Medical Association, contained in a sketch of the plan upon which it is founded, and as read at the dinner by the chairman. Requesting that you will do us the favour to publish it in an early number of your valuable periodical, — I am, sir, Your humble servant, W. Eales, Hon. Sec. Southwark, Nov. 2, 1836. OBJECTS OF THE ASSOCIATION. The following is a general sketch of the nature and objects of the British Medical Association : — It is proposed, 1st, that the medical general practitioners of England and Males shall form themselves into an Asso¬ ciation, for the purposes of exciting and cherishing kindly and honourable feelings towards each other, and of guarding, watching over, and protecting the rights, privileges, interests, and respectability of the profession. 2dly. That the society shall be called “ The British Medical Association.” 3dly. That those gentlemen willing to become members, shall, at an early meet¬ ing, appoint proper officers: such as a President, Vice-Presidents, Secretaries, Councillors, Committees, &c., and shall form a code of laws for the government of the Association, to be submitted to the consideration of a subsequent general meeting. 4thly. That the Association shall hold frequent meetings for the transaction of business. 5thly. That it shall oppose all encroach¬ ments from without, and all dishonourable or unprofessional conduct among its mem¬ bers. Gthly. That it shall, by all legal means, or by application to parliament, if consi¬ dered necessary, endeavour to remove all professional grievances, evils, and hard¬ ships. 7thly. That it shall protect its members from all illegal or unjust prosecutions. Stilly. That it shall endeavour to form a benevolent fund for the assistance of de¬ cayed members of the profession, and for the benefit of their widows and orphans. 9thly. That, to effect these important purposes, subscriptions shall be paid by the members, in such manner as shall be hereafter agreed upon, and donations re¬ quested from their friends and the profes¬ sion at large. lOthly. That the Association shall en¬ deavour to extend its expected advantages over the kingdom, by corresponding with, and inviting the co-operation of, their medical brethren in cities, towns, or local districts; and by recommending them to form themselves into societies, having the same or similar important ends and ob¬ jects in view. llthvThat the members and their friends shall dine together at least once a year, in the metropolis; and that the As¬ sociation shall, by all means in its power, endeavour to promote the welfare, prospe¬ rity, and union of its own body in particu¬ lar, and uphold the dignity, respectability, and usefulness of the whole medical pro¬ fession. P.S. — Since writing the foregoing, it has occurred to me that it would be as well to send you an extract which was read at the dinner by the chairman, from the Address prefixed to the laws of the South¬ wark General Medical Practitioners’ So¬ ciety. As the members of that society have been principally instrumental in es¬ tablishing the present Association, the following extract will tend further to elu¬ cidate their views, and to show that these 246 SIR B. C. BRODIe’s LECTURES ON are not opinions arising out of any impro¬ per motives, or taken up to serve a pur¬ pose at the present moment merely', but that they are the deliberate opinions of honourable men : — “ It is not the object of this Society to institute or encourage a monopoly. It is intended to promote fair and honourable conduct among the practitioners at large towards each other — to encourage among them the exercise of harmony and good will — to diffuse useful medical informa¬ tion — to insist upon the rights and privi¬ leges vested in the members by the law of the land — to suppress illegal practitioners, and thereby protect the real interests of the public — to require the due observance of medical etiquette between the physician and consulting surgeon, and the general practitioner — in few words, to render the profession within the sphere prescribed honourable, useful, and respectable.” These were the only objects of the gen¬ tlemen forming the before- mentioned so¬ ciety; and although, from the apathy of general practitioners, it was never sup¬ ported as it should have been, it has gone on until the present time; henceforward it will be lost in the British Medical Asso¬ ciation : and if this be supported, as pre¬ sent appearances warrant us in assuming it will be, and, I may be permitted to add, as it deserves to be, by the profession, it will confer upon all its members incalcu¬ lable advantages, and prove ultimately of essential benefit to the public. LECTURES ON LOCAL HYSTERICAL AFFEC¬ TIONS, Delivered in the Medical Theatre of St. George’s Hospital, By Sir B. C. Brodie, Bart. F.R.S. Lecture II. Hysterical Retention of Urine — ■ Aphonia — Affections of the Breast — Tetanus — Singular Affection of Hand — Sneezing, fyc. Those which I described in the last lec¬ ture are only a part of the local hysterical affections which fall under the observa¬ tion of the surgeon, and an acquaintance with which is necessary, to enable him to practise his art with credit to himself, and advantage to the public. Hysterical retention of urine is of such frequent occurrence, that any parti¬ cular description of it would seem to be superfluous. An observation, which has been already made, is equally applicable to this as to other forms of hysterical para¬ lysis. The muscles are not incapable of obeying the act of volition, but the voli¬ tion itself is not exercised. So it is, at least, in the first instance : but if the patient has allowed the bladder to remain for a great length of time in a state of extreme distention, actual paralysis may ensue, and she may then strive in vain to empty the bladder, without the aid of the catheter. In these, and in other cases in which the bladder has been long ex¬ tremely distended, the mucous membrane becomes affected with chronic inflamma¬ tion, secreting the usual adhesive mucus ; and even worse consequences may ensue than these. In a case, to which I have had occasion to refer in my lectures on the diseases of the Urinary Organs, hysterical retention of urine having been for a long time neglected, at last forty ounces of urine were drawn off by the catheter. In the post-mortem examination, the bladder was found of a very large size, of a dark and almost black colour : there were only slight vestiges of its natural structure left, the muscular fibres being very much wast¬ ed, and the internal membrane presenting the appearance of a very thin film, which was readily separated from the parts be¬ low, The dark colour of the bladder did not seem to arise from mortification, there being no foetor, nor, with the exception of the black colour, any indication of it. Females who labour under hysterical re¬ tention of urine, if left to themselves, usually recover in the course of a short space of time; sometimes almost suddenly ; but if the catheter be employed, their recovery may be protracted for an indefinite period. We may lay it down as a general rule, that in these cases the catheter should not be had recourse to : and the only ex¬ ceptions to it are in those extreme cases in which actual paralysis has taken place, and the bladder is likely to become dis¬ eased, if not artificially relieved. Hysterical aphonia , or loss of voice, al¬ lowance being made for the different functions of the affected parts, corresponds very nearly to the hysterical retention of urine. It takes place suddenly, continues often for many months, even for one or two years; and then disappears as sudden¬ ly as it began. A patient thus affected may, when under the influence of strong moral excitement, find herself speaking in her natural voice,- when, for some time before, she had spoken only in a whisper. Her recovery may be permanent, or she may relapse into her former condition. LOCAL HYSTERICAL AFFECTIONS. 247 This symptom is not unfrequently met with in the male sex, especially in those of the clerical profession, probably because they often lead very sedentary lives, and also because in their profession they are called upon to speak in public in a tone raised above the ordinary standard. A tympanitic distention of the intestines is not an uncommon symptom in young women who are affected with hysteria ; and, when existing to a great extent, is frequently mistaken for ovarian dropsy. The majority of cases in which the patient has been supposed to be cured of ovarian dropsy, by the agency of iodine and other remedies, have been, I doubt not, of this description. Yet the diagnosis is not diffi¬ cult. The absence of fluid is distinguished by the absence of fluctuation ; and the sound produced by percussion sufficiently indicates the cause of the distention. When the tumor is of a large size, there is pain in the abdomen, and the respiration is rendered difficult in consequence of the impediment which exists to the descent of the diaphragm. If the uneasiness be such as to induce the practitioner to direct the use of the warm bath, and the tympanitic distention be great, the effect is remarka¬ ble. Instead of sinking in the bath, as under ordinary circumstances, the patient floats on the surface. If an elastic gum tube be cautiously introduced, so as to reach the upper part of the rectum, and pressure be made on the surface of the abdomen, the air may, in some instances, be made to escape through the tube, until the abdomen is reduced almost to its natural dimensions: but it becomes re¬ accumulated in the course of a few hours. A stimulating injection, made with the confectio rutce, will sometimes produce the same result. Young women are subject to an affec¬ tion of the breast, corresponding to the hys¬ terical affections of the joints, and indicated by very similar symptoms. These cases have been noticed by Sir A. Cooper, in his observations on the Diseases of the Breast. The patient complains of pain in the breast, and shrinks on pressure being made with the fingers, or even on the skin being slightly pinched. Not unfrequently the examination of the part produces twitches and motions of the body, bearing no small resemblance to those of chorea ; yet if it can be dexterously managed, while the examination is being made, that the patient’s attention should be otherwise engaged, not only these motions do not occur, but she may seem scarcely sensible of pain. The morbid sensibility is not confined to the breast, but extends to the axilla, and down the arm. No distinct tumor is perceptible in the breast, but nlien the disease has been of long continu¬ ance, the whole organ becomes slightly en¬ larged, probably in consequence of an in¬ creased determination of blood to the small vessels; yet there is no redness of the skin, and indeed the skin is even paler than natural, with a somewhat glossy appear¬ ance of its surface. These cases are to be distinguished from those of a rare kind of irritable tumor of the breast, of which a representation is to be found among the plates annexed to Sir Astley Cooper’s wrork. I con¬ ceive that they ought also to be distin¬ guished from those which may occur at any time of life, and in women who have no particular disposition to hysteria. In the cases to which I now allude, the pain and tenderness are much less than in the true hysterical affection of the breast, and it will be almost invariably found that the patient has witnessed the miseries of some friend or acquaintance who has suffered from carcinoma. No part of the body will bear that rigid scrutiny to which the breast is subjected under these circum¬ stances. Close attention will discover in any, even in the most healthy organ, sensations which had been previously overlooked; and constant anxiety on the subject may magnify such sensations into pain. In these last-mentioned cases a strong assurance that no disease exists will make the patient happy, and remove the pain ; but no such assurance will be adequate to the cure of a genuine hysterical affection. Hysterical tympanitis is always attended with a more or less constipated state of the bowels. But obstinate constipation of the bowels is a frequent occurrence in hysteri¬ cal patients, independently of any consi¬ derable degree of tympanitis ; and I have know n many instances in which a case of this kind has been mistaken for one of stricture in the upper part of the rectum. The surgeon here sometimes misleads him¬ self by taking it for granted that a very long bougie may be introduced into the rectum, if there be no actual contraction ; not recollecting that the naturally tortuous course of the bowrel is often sufficient to pre¬ vent a bougie being passed more than a few inches, even in a healthy rectum. But the statement of the patient tends to mis¬ lead him also; for she describes herself as going to the water-closet, and yet being unable to eject the contents of the bow'els. I wrill not say that it is so in all cases, but I am satisfied that, in some instances, if you cross-examine the patient, you will find reason to believe that the hysterical constipation of the bowels is of (he same nature with the hysterical retention of urine. The effort of volition is not exer¬ cised except when the accumulation of faeces has become excessive. Hysterical 248 SIR B. C. BRODIE’S LECTURES ON difficulty of deglutition, which is some¬ times mistaken for stricture of the oeso¬ phagus, is probably an affection of the same kind ; there being no actual spasm, but a defective action of the voluntary muscles, by means of which deglutition is performed. Symptoms resembling those of tetanus occasionally occur in patients who are under the influence of hysteria ; sometimes assuming the form of trismus, at other times that of opisthotonos. A case of locked jaw, cured by the injection of oil of tur¬ pentine into the rectum, and published by Dr. Phillips (then residing at Andover), in the sixth volume of the Medico-Chi- rurgical Transactions, is manifestly one of this description. In a great number of instances, local hysterical symptoms appear to be connect¬ ed with some accidental injury — generally a very slight one; and they are then espe¬ cially liable to be misunderstood, and mis¬ taken for something very different from what they really are. For example : a woman is bled in the arm. She complains, perhaps, of severe pain at the time; but this subsides, and the wound heals, as under ordinary cir¬ cumstances. Then she complains of pain again, extending down the forearm to the hand, up the arm to the axilla and shoul¬ der, and even to the side of the neck, and sometimes down the side of the chest also : the extent and degree of pain varying in different cases. You examine the cicatrix, but can discover nothing unusual in it; but the patient flinches when it is touched. She very commonly complains of the sur¬ geon, saying that she was badly bled, or bled with a blunt lancet, or a foul lancet, or that a nerve was pricked which ought not to have been touched; while the real ori¬ gin of her symptoms may be traced to the peculiar state of her own nervous system. If you investigate the case further, you will always find that she has been liable to various nervous symptoms previous to those which are attributed to her being bled; and when these last disappear, ner¬ vous symptoms of some other kind show themselves. In anothel* case, the patient has received a blow on the head. In order to avert the consequences which such an injury may be expected to produce, she is bled repeat¬ edly, takes aperient medicines, and is kept on a low diet. When her physical powers are thus reduced, she complains of pain in the head even more than she did in the first instance : but the pain is of a different character, and is usually attended with other symptoms, such as do not belong to inflammation. Thus she has a sense of diz¬ ziness, or feeling as if water was trickling over her head. Then the countenance is blanched, the skin is cool, and the pulse is probably small and quick, and wreak. If, under these circumstances, the surgeon, mistaking the nature of the case, conti¬ nues to abstract blood, and to keep the patient on a low diet, all these symptoms become aggravated ; other symptoms of a more decidedly hysterical character show themselves, and no improvement takes place until a more judicious treatment is adopted. In another case, which is of no unfrequent occurrence,, a young woman pricks her finger, or perhaps the finger is merely pinched. Soon afterwards, she complains of pain extending from the fin¬ ger upwards, along the hand and fore arm. This probably is followed by a convulsive action of the muscles of the arm, or by a continued contraction of the flexor mus¬ cles on the anterior part of the arm, so that the forearm is kept permanently bent ; at least wdiile the patient is awake, for the spasm is generally relaxed during sleep. But the symptoms which, in hysterical patients, are attributed to a local injury, often proceed much further than what I have hitherto described. For example: — A young lady, eleven or twelve years of age, pricked the fore-finger of her left hand with the point of a pair of scis- sars. This was immediately followed by pain in the course of the median nerve, and on the following day the fore-arm w’as fixed by muscular contraction, at a right angle with the arm. After a few days, all the muscles of the hand and fore arm were affected with violent spasms, producing strange convulsive movements of the hand and fore- arm. These were attended with sickness and vomiting, so that for two days, whatever wras received into the stomach w;as imme¬ diately rejected from it. By degrees the other limbs became affected in the same manner, and it was impossible for the patient to walk, or even to stand. Some¬ times the diaphragm was affected so as almost to threaten suffocation. At other times the jaw wras closed by a con¬ traction of the masse ter muscle, or she lay in a state of opisthotonos. Occasion¬ ally there was a violent pain in the head, which wras described as having the same character as that of the finger which had been pricked ; and these symptoms con¬ tinued (sometimes one order of them, sometimes another, being predominant) until recovery took place under the cir¬ cumstances which I shall have occasion to notice hereafter. With a view to the further illustration of this part of the subject, I shall mention another case. A female about 30 years of age was admitted into St George’s Hos¬ pital, on account of a simple fracture of both bones of the fore-arm. There was LOCAL HYSTERICAL AFFECTIONS. 249 nothing unusual in the fracture, but she complained of an extreme degree of pain in the injured part. By degrees the pain extended up the arm to the axilla ; then to the same side of the neck and head. The smallest motion of the limb, even the lifting the fore arm off the pillow on which it lay, occasioned violent pain, and convulsive agitation of the limb, which were soon followed by what might be termed a state of hysterical syncope, in which the patient lay apparently insensi¬ ble to external impressions for several mi¬ nutes. The fracture united as under ordi¬ nary circumstances ; but the nervous symptoms continued for many weeks, then subsiding gradually. It is worthy of no¬ tice (and this circumstance confirms the opinion, that symptoms of this kind be¬ long more to the constitution than to the actual injury), that about two years before the occurrence of this last accident, this individual had met with a slight injury of the ankle, for which she w'as attended by Mr. Fuller, of Piccadilly; and that a train of nervous symptoms at that time super¬ vened, nearly similar to those with which she wras afterwards affected in the hospital. It is also worthy of notice, that on both occasions she had occasionally a spitting of blood, probably furnished by the mu¬ cous membrane of the pharynx or trachea, as there was no reason either at the time, or afterwards, to suspect the existence of disease in the lungs. I have seen several cases of a singular affection of the hand and waist, which ma¬ nifestly belongs to the class of cases of which wre are now treating. It occurs in females who have a disposition to hysteria, especially in those who have suffered from mental anxiety and over-exertion, and is usually, but not constantly, referred to a sprain, or some other slight accident. The patient complains of pain in the back of the hand and wrist, trifling at first, but gradually becoming more severe. In many instances, after some time has elapsed, there is a diffused swelling of the soft parts, extending a short distance up the lower extremity of the fore-ann; and dowmw'ards as low as the fingers. This swelling is not attended wTith redness of the skin ; and having lasted for a few weeks, it subsides, wdiile the pain remains, constant in its character, aggravated by every motion of the limb, and always more severe in proportion as the patient’s atten¬ tion is in a greater degree directed to it. To prevent the motion, which she so much dreads, the patient keeps her hand in one position, and the consequence is that the joints become comparatively stiff, the hand at the same time having a very cha¬ racteristic appearance, the skin being smooth and shining, and appearing to ad¬ here more closely than is usual to the parts beneath. This state of things may conti¬ nue for three months, for six months, or even for one or two years; the symptoms then gradually subsiding, without leading to any further ill consequences. The re¬ sult, however, is not always so fortunate. I attended a lady who laboured under the symptoms which I have just described, with the late Dr. Luke. She left London on a visit to the continent, without any amendment having taken place. I saw her again after the lapse of four or five years : the muscles of the fore arm were at this time wasted and paralytic; the whole hand W'as shrivelled and useless ; the fingers permanently contracted towards the palm of the hand ; the nails thin and scabrous. I shall conclude the present lecture by a brief notice of some cases, which will serve to illustrate further the variety of singular local symptoms which may arise as a consequence of hysteria, and which may fall under your observation as prac¬ titioners in surgery. I was consulted concerning a young lady, 18 years of age, under the following circumstances. She wras liable to fits of incessant sneezing, attended with a most abundant flow of watery fluid from the nostrils. This sometimes alternated with a nervous cough ; wrhile at other times she suffered from that sensation in the throat which is usually described under the name of globus hystericus. Not unfre- quently she wras affected with ordinary paroxysms of hysteria. She had a feeble circulation, and cold hands and fee t, and her menstruation was irregular and defi¬ cient ; in other respects she wras in good health. There was no evident disease in the nostrils. A married lady, 37 years of age, was affected with similar fits of sneezing, at¬ tended also with a copious watery dis¬ charge from the nostrils. These symptoms attacked her once in a week, and in each of these attacks she sneezed not less than one hundred times; the watery fluid drop- ing from the nostrils so as to wet a pocket- handkerchief completely through. About the same time she began to experience a disagreeable sensation in the face and pa¬ late, not amounting to pain, but which she described to be such as might be pro¬ duced by a worm creeping in her flesh. These latter symptoms gradually became more distressing, w'hile the fits of sneez¬ ing became less frequent. At the time of my being consulted, three years after the 250 ROYAL MEDICAL AND CHIRURGICAL SOCIETY. commencement of the disease, the fits of sneezing did not occur oftener than once in a month, but she complained of an aching pain, with a sense of pulsation, in the roof of the mouth, the teeth, and tongue, occurring chiefly during the night, and being then very severe. There were no perceptible marks either of inflamma¬ tion, or of other disease, in the parts to W'hich the pain was referred. An unmarried lady, 32 years of age, consulted me on account of her being lia¬ ble to some very distressing paroxysms, in which she experienced a difficulty of re¬ spiration, attended with a sense of con¬ striction of the chest, and great general excitement * and agitation. These pa¬ roxysms often continued for ten or fifteen minutes, recurring at irregular intervals ; sometimes without any evident cause ; while at other times they might be traced to some sudden emotion of the mind. So far the case did not differ from many other cases of hysteria ; but the peculiarity of it, and the circumstance which led to my be¬ ing consulted, was as follows : — There was a particular spot, near the ensiform carti¬ lage, which she believed to be in some way or another connected with her com¬ plaint. Nothing could be discovered in this part different from what is usual, by the most strict examination ; but the pressure of the finger on it never failed to induce one of the paroxysms which I have just described. When these paroxysms wrere most severe, they were always at¬ tended with an abundant flow of limpid urine. These symptoms had existed in a greater or less degree for ten or twelve years, and had supervened on a state of exhaustion occasioned by an attack of typhus fever. A young married lady, who was liable to ordinary attacks of hysteria, complained of a tender spot on the anterior part of the abdomen, a little below the ensiform car¬ tilage. The slightest pressure of the finger on it caused excessive pain, and was fol¬ lowed by violent agitation of the whole person, bearing a more near resemblance to the convulsive motions of chorea than to any thing else, and continuing for several minutes. AN ILLYRIAN DWARF. There is at present in Paris a dwarf aged 22 years, and not three feet high. His name is Matthias Gulia. He was born in Illyria, not far from Trieste, of parents of good size and shape. Gulia exhibited nothing anomalous in his forma¬ tion till he was five years of age, when he ceased to grow. He is distinguished from individuals of his own height by his culti¬ vated mind, and his excellent proportions. He speaks five languages — the Croatian, Illyrian, German, French, and Italian. He is, moreover, accomplished : plays the violin very well, is fond of being on horse¬ back, and is a good sportsman. — Journal Hehdctfnadaire. ROYAL MEDICAL AND CHIRUR¬ GICAL SOCIETY. Mr. Earle, the President of the Society, in the Chair. The first meeting of the society this sea¬ son was held on the 8th of November, at half-past eight o’clock p.m., in the So¬ ciety’s house, 53, Berners -street. Oxford- street. A considerable number of the Fellows, as well as many visitors, attended, and numerous presents of books were an¬ nounced to the meeting. The first part of a paper was read, en¬ titled, “ Necros’s ; being an Experimental Inquiry into the Agency ascribed to the Absorbents in the removal of the Sequestrum ,” by George Gulliver, Esq., Assistant-Surgeon to the Forces. It was communicated by Sir James Macgrigor, Bart. The object of this paper was to deter¬ mine what becomes of the dead bone in necrosis, and by what means it is re¬ placed. The first part of the paper only was communicated to the society, and this wras confined to the question — “ whether dead bone admits of removal by absorp¬ tion;” — the consideration of the other means by which it may be discharged was reserved for a future communication. The opinions of the author, derived from preparations contained in the mu¬ seums of anatomy and pathology, from cases, and from experiments, went to show that the absorbents have no power in re¬ moving dead bone; and that the facts which have been brought forward in sup¬ port of a contrary opinion may be other¬ wise accounted for. These facts were shortly enumerated in the paper as — 1st, the gradual disappearance of the se¬ questrum in many cases of alleged necrosis; 2d, the irregular and eroded state of the dead portion ; 3d, the contact of granulations with the indentations on its surface; 4th, the absorption of the fang of a transplanted tooth ; and, 5th, PROCEEDINGS IN CAMBERWELL. 251 that portions of dead bone have dimi- ninished in weight after having been kept in contact with the granulations of an ulcer. The author, in taking a review of these facts, asserts, with respect to the alleged disappearance of the sequestrum, that some cases have been described as necrosis which in reality have been thickened bones, the result of long-continued in¬ flammation, in some of which small frag¬ ments of dead bone have been detached from their interior; that the deposition of new bone around the old is not an ab¬ solute proof of the death of the latter ; and that he has observed several cases in which pieces of dead bone have remain¬ ed for months in contact with living parts, unaltered in form, size, and weight. The worm-eaten appearance on the sur¬ face of many sequestra, he refers to the death and separation of the bone, and rather attributes to the effect of the ulce¬ rative process while the part retained its vitality, than to the action of the ab¬ sorbents after its death. The aspect and situation of the granula¬ tions with respect to the sequestrum he believes to depend in some cases upon the extension of the ossific process into them, and in others upon the work of ex¬ foliation. The disappearance of the fang of a transplanted tooth seems, in the au¬ thor’s opinion, to indicate that it preserved its vitality, and that accordingly it became subject to the laws of the living body of which it formed a part. Mr. Gulliver relates, in his communica¬ tion, five cases and no less than sixteen experiments to show that dead bone, when laid in contact with ulcers — when buried in the soft parts of the body — or when placed either on the surface or in the inte¬ rior of living bone — undergoes no change in size, weight, or appearance. In con¬ clusion, the author repeats his belief that the absorbents are not the means by which a portion of dead bone, or the sequestrum in cases of necrosis, is removed. Ligature of the External Iliac Artery. The next communication read to the society was the sequel of a case, related at page 95, in the 10th volume of the Med. and Chir. Trans., in which the external iliac artery was tied by George Norman, Esq. of Bath. The subject of this history died twenty years after the operation, having continued free from aneurismal disease up to the period of his death. The limb was injected from the lower part of the aorta, and the wax ran freely even into the minute vessels of the foot. It was found on dissection that the external iliac artery was obliterated from its origin to a little above the point where the epigastric and circumflexa ilii arteries are given off. A mass of fibro-cellular substance occupied the situation of the common origin of the profunda and external circumflex arteries, which, though obliterated, could be dis¬ tinctly traced to the femoral, which was pervious in its whole extent. The colla¬ teral circulation had obviously been car¬ ried on by the ramifications of the internal iliac, as follows : — 1. The ilio-lumbar anastomosing with the circumflexa ilii and the external circumflex. 2. The obturator with the epigastric and internal circumflex. 3. The gluteal with the external cir¬ cumflex. 4. The ischiatic with the perforating branches of the profunda. 5. The internal pudendal with branches of the internal circumflex. All these arteries were larger than na¬ tural. At the close of the meeting, the Presi¬ dent announced that in future no papers could be published in the volumes of the Transactions, unless they had been pre¬ viously read before a meeting of the society. At the next meeting, a paper will be read on “ Atrophy of Bone,” by Mr. B. Curling. PROCEEDINGS in CAMBERWELL. POOR LAW MEDICAL CLUB. To the Editor of the Medical Gazette. “ And shall we own such judgment ? no; as soon Seek roses in December, ice in June, Hope constancy in wind, or corn in chaff. Believe a woman, or an epitaph, Or any other thing that’s false, before You trust in critics, who themselves are sore.” Sir, Passing over any attempt to convince your constant correspondent, Mr. Crisp, that Messrs. Flower and Young are neither of them Dutchmen, I shall make a few observations on the conduct of those gen¬ tlemen who came, some like the wise men from the east, others from the west, the north, and the south, to bestow upon the practitioners of Camberwell terms of the most “enlightening character;” and so delighted were they with the success of their mission, that I believe it has since been celebrated “ where sit, involved and lost in curling clouds of Indian fume, all loud alike, all learned, and all wise,” some of those persons whose sweet voices made the room at Camberwell echo with the melodious notes of black sheep, &c. &.c. 252 PROCEEDINGS IN CAMBERWELL. Being present at this first meeting, and witnessing what I am not singular in call¬ ing “ din and confusion,” and which Mr. Crisp, although not present, did not on that account refrain from giving his ac¬ count of it, I do not see why I should not give an account of the second, seeing all those with whom I have conversed upon the subject, holding different opinions on the formation of a Medical Club, and who were present upon the occasion, were una¬ nimous in describing it as the most dis¬ graceful scene they had ever witnessed. One gentleman told me that if I com¬ plained of such terms as “ black sheep, not upholding the honour and dignity of the profession,” it was positive politeness compared with some of the terms made use of at the last most triumphant meet¬ ing. Another, who was not favourable to the Club, declared he was so disgusted with the proceedings as to leave the room with a full determination never to attend another medical meeting. A third gentle¬ man stated that ‘‘thieves, traitors, robbers,” and other such like terms, were used; and at length, fearing that the parties w7ho talked of shedding the last drop of blood in the cause would suit the action to the word, thought it better not to wait the “ tug of war,” but act on FalstafPs maxim — deeming discretion the better part of valour: and he also left. I could give their names, but as they said they were heartily “ sick of physic,” they begged to be excused. Had there been nothing more than the parties on each side stating their opinions on the question, without imputing motives and offering personal insults by wholesale, I should never have put my pen to paper on this subject; and it is to such conduct as this I apply the term “gross abuse:” I think it quite un¬ necessary to waste words about posting the names, after seeing them published in the following week’s Gazette. I am aware that verbal statements are not considered so authentic as written ; I therefore quote the imputation of “ concerting measures to take the bread out of the mouths of the poorer class of surgeons,” as applied to “Forbes, Bean, Brown, and Flower:” and as defiance seems to be the order of the day, I defy either Mr. Crisp, or Mr. Bowen, or those other gentlemen who have not yet thrown off the mask — who have not yet come out from their hiding places— and who have taken far more pains than Mr. Crisp to ascertain whether Messrs. Flower and Young pay a rate for a Camberwell gas-light, or are one foot removed out of Camberwell parish ! and I doubt not but as the masks fall from their faces, and they come out from the Holland Street Dutch¬ man, we shall recognize faces darker and longer than any that yet figure on the scene; and as we gaze in mute astonish¬ ment upon the mottley group, we may well exclaim, “ Pity that all these should be defied to prove the charge of “ concert¬ ing” ! Yes ; but methinks I already hear some one assert , — It is easy for us to get through all our difficulties; try first the scheme that has silenced all who have yet ventured to oppose us: you have only to put on the “ assertion and misstatement extinguisher; and in case that fail, try the Dutch mode of recapitulating the argu¬ ments”! I put it to any candid mind to say, whether Mr. Crisp, in what he calls the recapitulation of my arguments, has not “ mapped them out in such a way as to suit his own purpose.” Mr. C. states that the very basis of the system is unsta¬ ble and rotten; for it is founded in an untruth — that the members are told they will become independent, when, in fact, they are in a state of dependence; and that the great evil of the scheme is — that it holds up a bait for the upright man to leave the path of honesty, &c.; and yet with wonderful sagacity admits— that the plan may be practicable in a coal mine ! I think it requires but little argument to show that, according to this doctrine of independence, we are all living in a state of dependence, from the king down to the lowest subject. I stated, as he will see, if he will take the trouble to read my letter over, that there were a numerous class of profes¬ sional men who considered it no degrada¬ tion — no dishonour — to the professional character, to lend their assistance in raising the moral condition of the poor, by che¬ rishing that feeling of independence, &c. This is widely different from stating this system will raise the moral condition of the poor, and make them independent in Mr. Crisp’s sense of the word. I again assert, that we cherish a spirit of indepen¬ dence when we place the poor in such a position as enables them (by our accepting a small sum suited to their circumstances) to obtain our assistance without being de- ing deterred by a fear of incurring to them embarrassing pecuniary liabilities ; and small, indeed, must be his experience of the feeling of which I speak, who supposes I mean by independence “ riding in an elegant chariot, receiving his guineas,” &c. I envy not the feelings of any man who can come to this question wresting words from their legitimate meaning, or arraying himself in the flimsy mantle of the wran¬ gling logician. The independence, sir, of which I speak is that of the spirit which those who harbour in their own breasts would gladly see diffused around them : it is a spirit which, retaining a rational de¬ sire to perform the relative duties of life, would yet scorn to receive that as a de- PROCEEDINGS IN CAMBERWELL. 253 graded pauper which is placed within his reach as a positive right. Yes; I would cherish this feeling even at the risk of being occasionally overreached by the cunning and dishonest; and as to not being able to com¬ pel the latter class to pay towards the Club, I am not sure that the club is not better without than with them; at all events, if it be an evil, it is one that if left to itself will wrork its own cure: it will at any rate prevent the dishonest man wearing the mask of the honest; and if without his mask he cheats the profession, it will be their own faults: and as to the objec¬ tion of the higher grades adopting it, “ I said under judicious limitations,” by which I meant to be understood, the exclusion of abuses. It is not a fair mode of argument to bring against the usefulness of this or any other measure, the abuses to which it may be liable in common wTith everything else that is good and beneficial to man¬ kind : if such a mode of argument be per¬ mitted, will any of the noble institutions w hich have for ages been the praise and admiration of the wisest and the best of men, bear the test of this method of attack ? Independent, indeed, as they are called, they are still, according to the doctrine of Mr. Crisp, based on a rotten and unstable system, founded on the “ untruth” that while they are independent, they are yet in a state of dependence. Equally absurd is it to suppose that a system founded for the express purpose of preventing the poor man sinking into absolute pauperism, should be held up as a bait for the upright man to leave the path of honesty and “ independence,” to walk in that of pau¬ perism. I need not argue this point, as there are none independent, according to Mr. Crisp’s doctrine, and therefore the path is of no use; so that the bait is quite superfluous, as no wise man thinks of fishing in a pond where he knows there are no fish. I did not state that the me¬ dical practitioners in his neighbourhood were in the habit of sending in ruinous bills to the poor; so that the tone of de¬ fiance, like the bait, is quite superfluous : I did not offer to bring forward any invi¬ dious distinctions of those ruined by pay¬ ing a long bill; and when I stated that the advantages of medical clubs offered the poor the option of selecting their own medical attendant, I wras not such a Dutch¬ man as to think I spoke of a shadow : I took for granted their formation. And now, sir, a few words on the de¬ gradation implied in the swinish simile of physicking a pig, which has no legitimate bearing on the subject; the contested principle not applying to individual six¬ pences or shillings, but mainly to the ag¬ gregate; the many constantly making up a purse to defray the exigencies of the few; probably by such means insuring an amount equal to that which many practi¬ tioners are now receiving for attendance on the various metropolitan institutions. I am accused of placing the highest grounds in the foreground, and suspecting t h e g r a n d s e e r e t o f n o n - r e m u n e r a t i o n wo u 1 d be found concealed under the mask of the zeal for the honour and dignity of the profession. I placed before them in the prominent part of the picture the gist of the question on their side of the argument, and then, as if touched by the magician’s wand, the mask suddenly fell off, and pre¬ sented in large and flaming characters this motto: — “ A less sum than the village far¬ rier would expect for physicking his pig.” Not having instituted any comparison be¬ tween young gentlemen (who either have or have not attended lectures) with the parish midwife, I feel it unnecessary to enter on that subject. “ O wad some power the giftie gie us To see oursels as others see us ! It wad frae monie a blunder free us An’ foolish notion.” That each individual has a right to form and enjoy his own opinion I readily ad¬ mit; but to impute unworthy motives to others — to descend to low and vulgar terms of abuse — or to palm individual opinions on the public as the sense of the profession, this I utterly deny: it was dis¬ gust with such conduct that drew forth my first letter. Attached as I feel to the pro¬ fession of my choice, and jealous of all its properly defined rights and immunities, and desirous of cultivating a good under¬ standing with all my professional brethren, I should have reviewed even more nar¬ rowly than I did the steps by which I ar¬ rived at mv determination, had the sub¬ ject been fully, fairly, and rationally dis¬ cussed. It, however, affords me satisfac¬ tion to find so many of my professiona. neighbours have come to the same conclut sion as myself. I presume not to say tha I am right in the estimate I have formed of the worth of this system ; but inasmuch as the advantages of theoretical data are far outweighed by the possession of prac¬ tical realities, and garnered experience availeth more for useful purposes than the thick darkness of gainless uncertainty, I trust, with so many in its favour, it will not be condemned, or rather I should say abandoned, without being put upon its trial. Were this, indeed, a question involving any “ professional rights,” — something be¬ yond the mere breaking a fly upon the wheel, or impaling a beetle, — 1 trust I feel I should be found in the vanguard of the onslaught; but to wage a puny warfare with “ emaciated want,” — to gnarl over a fleshless skeleton, — or to make keen a 254 CAMBERWELL PROJECTED CLUB. weapon against a keener misery, is to achieve such honour as my humble ambi¬ tion descrieth not even from afar, and for which I have neither aim nor hope to imitate; and although this system comes recommended by the Poor Law subordi¬ nates, why are we to be frighted from our propriety to espy the mountain in the mole hill, or with the distemptered ima¬ gination of the monomaniac, to conjure up more devils than vast hell can hold, even in the fleshy form of Poor-Law Com¬ missioners ? - - “ Tigris agit rabidi cum tigride pacem Perpetuam, ssevis inter se convenit ursis.” But whilst possessed of the mens sana, and enjoying the blessing of sober conscious¬ ness, I hope to see things as they really are, and not through the medium of an affrighted or distorted imagination. I have to crave your indulgence for so soon after taking my leave, again intruding on the columns of your journal; but not liking to be silenced, either by the misstatement extinguisher, or the Dutch mode of reca¬ pitulation, I am induced to appear again before you to offer thus much in explana¬ tion. “ What right, what true, what fit, we justly call, Let this be all my care— for this is all.” J. S. Flower. Camberwell Green, Nov. 1, 1836. CAMBERWELL PROJECTED CLUB. MR, HULBERT’S REJOINDER. To the Editor of the Medical Gazette. Sir, When I last addressed you, T had not in¬ tended continuing a controversy relative to the late occurrences at the Camberwell meeting, at which the honour of the medical professiori was so opportunely and spiritedly re¬ deemed ; butthe/dcfs mentioned in my first letter having given rise to many fallacies, and to none more obvious than that of their being represented as mis-statements, with the incorrect account given by Mr. Crisp in the Gazette of October 22d, in justification of those personalities to which he candidly acknowleges he descended, has in¬ clined me to a different course. The correctness of the account I gave of the conduct displayed towards me at that meeting being known to all who were present, I should have considered the attempt to represent it as a false¬ hood as too contemptible to notice, had it not been for the extensive circula¬ tion of your journal amongst the most respectable classes of the profession, with many of whom, in different parts of the country, as well as in the metropolis, I have the honour of being personally ac¬ quainted. To several who were at the Camberwell meeting it must have appeared exceed¬ ingly strange to have witnessed the recep¬ tion given me by Mr. Crisp and a few others who are non-residents in Camber¬ well ; and stranger still to have read the veritable account transmitted to the Lancet, that the “ honour of the profession had been so opportunely and spiritedly redeemed ” on that occasion. If it is a “ redemption of honour ” to have recourse to “ invectives, personalities, and misrepresentations,’5 we are certainly ar¬ rived at a new era of the profession, and must henceforward consider those prin¬ ciples advocated by Percival, Gregory, and other writers on medical ethics, as the vague theories of bewildered imaginations, glittering, like igv.es fatui, with delusive light, to lead their followers into the gulphs of error and confusion, and not as the result of experience, reason, and strict propriety of moral conduct. In his letter of the 22d ult., Mr. Crisp has commenced in so emboldened a strain, that, with the determination of carrying every thing before him, “he trusts you will give insertion to all h's statements, as he is prepared to prove their correctness .” Had all his statements been correct, they would unquestionably reflect a vast deal of professional honour upon him in giving them publicity. But wffth the view of un¬ deceiving those who may have read his statements, more than with the intention of justifying myself, I now address you, in order to give an explanation of the very correct accounts which he has brought for¬ ward. In the first place, Mr. Crisp observes, that at the Camberwell meeting I had made the following statement : — “ I am sure I do not wish to act in opposition to my professional brethren.” This is partly, but not wholly, correct; for when speak¬ ing of my having advocated the cause of Self supporting Dispensaries, I very well recollect saying, that “ had I ever con¬ sidered they would have a tendency to injure or degrade the medical profession, I would not have taken the steps I had done, as I had no wish to act in opposi¬ tion to the welfare or respectability of the profession; but that I was firmly con¬ vinced, as regarded such institutions, that they would not be prejudicial to the real interests of my professional brethren, or to the welfare of the public.” How far the “ whole tenor of my proceedings has not been actuated by this feeling,5’ it remains for those of my professional brethren to CAMBERWELL PROJECTED CLUB. 255 decide who are better acquainted yith me than the author of such a statement, and who can look upon my conduct with an unprejudiced eye and unperverted ima¬ gination. The circumstance of my coming into this neighbourhood a stranger, ought to have entitled me to the courtesy generally shown to strangers; how far this was shown to me at the meetings at Camber¬ well, Newington, and Southwark, let those who were present at those meetings deter¬ mine. In the circular to which an allu¬ sion has been made, it was mentioned, that “ for several years past a considerable portion of my time had been devoted to the medical attendance of the poor; and that having witnessed the good effects of Self supporting Dispensaries, I had in¬ vited my esteemed friend, Mr. Smith, the projector of those institutions, to explain their principles and advantages to the clerical and medical professions, and any others who feel an interest in the welfare of the poor.” This statement I made chiefly on account of my being, compara¬ tively speaking, a stranger. Above 400 copies were printed, and a man accus¬ tomed to distribute circulars employed, on the 5th of August last, to deliver them ac¬ cording to their directions. Unacquainted with the names and residences of my pro¬ fessional brethren in this neighbourhood, including Newington, Walworth, Camber¬ well, &c. &c., 1 requested a few friends to assist me, and by one medical gentleman I was favoured with upwards of fifty names, exclusive of those given me by others, to each of whom a letter was ad¬ dressed. To gentlemen of the clerical profession very few were sent; and I am not aware of there having been one at the first, and I believe not more than three or four at either of the subsequent meetings. It has been stated by Mr. C. that a very small number of these circulars reached the medical profession ; and that “ my excuse for the omission was, that my boy was unable to find the residences of the medical men, and therefore returned the circulars.” This account is incorrect, as I mentioned that the man whom I had em¬ ployed, and paid for his trouble, had only performed part of his duty, and that I had endeavoured to remedy this deficiency as much as was in my power and the short¬ ness of the intervening time would allow'. A%sufficient number of the circulars were, however, distributed, to ensure the attend¬ ance of at least three to one of any other class of persons wTho were invited. In the next place, Mr. Crisp asserts that at the adjourned meeting (September 7th), he “found me sitting with men who characterized the members of our profes¬ sion as gross mercenary conspiritors,” &e. This is so glaringly incorrect, and such a perversion of the truth, as to require a more particular explanation. So far from his finding me siding with the gentlemen alluded to, w'hen I entered the room him¬ self and others were assembled, the chair had been taken for several minutes, and the business of the evening had com¬ menced ; and during the remainder of its continuance I was in a different part of the room, for the convenience of being near the chairman, and had not ever seen either of those gentlemen before. The hostility displayed to a measure acknowr- ledged, by many who opposed themselves to it, to have an excellent tendency in re¬ spect to the industrious though poorer classes of society, and that their opposition arose from the apprehension of its inter¬ fering w'ith their professional interests, and that they w'ere determined if possible to crush it, together with the hissings and clamour displayed against the promoters of such a measure, excited the indignation of some wrho wished to inquire into the merits of the cause, and led to a warmth of expression which they doubtless (at the time) considered themselves justified in employing. The sneering and contemp¬ tuous manner in which the allusion to the parable of the good Samaritan, and the precepts contained in the sacred volume, were received, also excited a feeling of in¬ dignation, that men, who in the exercise of their profession, especially among the lower orders, are witnesses of much human suffering and misery, should consider the doctrines of Him, “ who went about doing good, and healing all manner of diseases,” as deserving of their contempt and ridi¬ cule. I will not enlarge upon this point, which, however it may raise another sneer at my expense, I do not hesitate to declare, exerts considerable influence on my mind, being aware that theological polemics should as much as possible be refrained from on occasions like the present. I w ill therefore pass on to the next statement of Mr. Crisp, wherein he asserts that, in waiting to the Editor of the Surrey Stan¬ dard, I had called his account impartial, “ w'hen I knew that the reporter only gave the arguments of those who were favoura¬ ble to the plan.’’ This also partakes of incorrectness, and facts can here speak for themselves. The report published in the Surrey Standard of Sept. 10th was the least incorrect of any which has appeared relative to the Newington meeting of Sept. 7 ; notwithstanding the assertion of a correspondent signing himself “ Chirur- gus,” in the following number of the same journal, that “ a more partial, one-sided statement was never penned.” Upon re¬ ferring to it I see no cause for altering my opinion. Let the report be compared with that in the Lancet (so celebrated for correctness and impart’ nitty) and then let 258 BILLS OF MORTALITY.- — METEOROLOGICAL JOURNAL. anv unprejudiced person be asked which account presents the character of one¬ sidedness, and which the contrary. I am, sir, Your obedient servant, J. F. Hulbert. 6, Trinity Square, Southwark, November 2, 1836. [Want of space obliges us to omit that part of our correspondent’s letter which relates to Mr. Crisp’s remarks on the com¬ munication from Mr. Hawes, M.P., which was read at a subsequent meeting. — E. G.] PARISH UNIONS. QUERY FOR AN OLD NAVY SURGEON. To the Editor of the Medical Gazette. Sir, May I, through the medium of your valu¬ able periodical, ask your correspondent, the Old Navy Surgeon, if he wishes your readers to understand 11,800 to be the pauper population of those sixteen parishes comprising the union, one of which. Grove, in Bucks, has twenty-one inhabit¬ ants. I rather suspect he has been calcu¬ lating the gross population ; if so, all his computations and comparisons are wrong. He feelingly describes the discomforts of the union officers, forgetful all country practitioners are exposed to the same. I do not intend to discuss point by point, but I consider the whole account to be exaggerated; and being a constant reader of your work, I feel regret it should be made the channel of such communica¬ tions. If you consider this worthy of a niche in your columns, you will oblige, Your obedient servant, E. C. T. Nov. 9, 1836. [We have no doubt the “ Old Navy Surgeon” will readily explain. — Ed. Gaz.] ANECDOTE OF DUPUYTREN. The late M. Dupuytren in his last illness had effusion into the chest consequent on a pleurisy. He was at first disposed to have himself tapped for it; but three of his medical attendants being against, while two were for, paracentesis, he changed his mind, and observed, “ I would rather die by the hand of God than of man!” — M. Husson in the Acad, de Med. HINT TO PHRENOLOGISTS. A Dr. Gaubert, who has been holding forth at the Phrenological Society in Paris, on the skull o a lady who died lately, has got himself into a scrape with her relations. They have brought an ac¬ tion against him for defaming tire family, in the remarks which he made on the cha¬ racter of the deceased ; and a newspaper which reported the defamatory trash has been included in the action. The trial was to have taken place on the 9th instant. APOTHECARIES’ HALL LIST OF GENTLEMEN WHO HAVE RECEIVED CERTIFICATES. November 10, 1836. John Senior Turner, Gleadthorpe Grange, Notts. James William Jeans, Grantham, Lincolnshire. John Henry Bell, New Cut, Bristol. George Tweddell, Bishop Auckland, Durham. John Hatton, Manchester. Edward Hodge Eykyn, Ackleton, Shropshire. William Blakely, Kington, Herefordshire. William Elliston, Ipswich. George Anthony. Joseph William Field, London. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Nov. 8, 1836. Age and Debility . 22 Apoplexy . . 4 Asthma . . 14 Cancer . . 1 Childbirth . . 3 Consumption . 55 Convulsions . 22 Croup ... 4 Dentition orTeethiug 4 Dropsy . . 5 Dropsy on the Brain 8 Dropsy on the Chest 1 Epilepsy . . 1 Erysipelas . . 1 Fever ... 4 Fever, Scarlet . 9 Fever, Typhus . 3 Heart., diseased . 1 Increase of Burials, ; the preceding wet Hooping Cough . 5 Inflammation . 37 Bowels& Stomach 2 Brain . . 1 Lungs and Pleura 1 Insanity . . 1 Liver, diseased . 2 Measles . . 7 Mortification . 4 Rheumatism . 1 Small-pox . . Sore Throat and Qufnsey . • Thrush Unknown Causes 10 Casualties • 8 3 compared with > .a. METEOROLOGICAL JOURNAL. Nov. 1836. Thermometer. Barometer, Thursday . 3 from 34 to 50 29-70 to 29-59 Friday . . 4 36 46 29-53 29 39 Saturday . 5 36 45 29 14 ' 29-34 Sunday . . 6 26 45 29-38 Stat. Monday. . 7 27 41 29-52 29 72 Tuesday . . 8 22 39 29-87 30-01 Wednesday 9 25 50 29-94 29-77 Prevailing winds, W. by S. and S. W. Generally clear, except the 3d, 4th, and 9th. A heavy shower of rain and hail, accompanied by thunder and lightning, on the evening of the 3d. Rain on the 4tli, and mornings of the 5th and 9th. Lightning very vivid on the evening of the 6th. Rain fallen, *35 of an inch. NOTICES. Ciiirurgus. — The subject of the Letter requires consideration : next week, per¬ haps, we shall be able to give our corre¬ spondent an answer. We regret we have not space this week for Mr. R. Ceeley’s communication rela¬ tive to the Bucks Association. W i i.s on & Son, Printers, 57, Skinner- St. London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOUMML OF iHeti trine anti rite Collateral Primers. SATURDAY, NOVEMBER 19, 1836. LECTURES ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine, By William Cummin, M.D. Lecture VIIL Medho-Legal relations of the Reproductive Function — Inability, or Impotence, a ground of Divorce — Legal distinctions respecting the Marriage Contract — Suits of Nullity of Marriage. — Impotence in the Male: 1. Physical Causes — Inadequate or imperfect Development — Some curious Cases — Castra¬ tion — Extraordinary Case of Count Sorlisi. — 2. Moral Cause — Fascination, or Witch¬ craft — Fear — Desire — Habits of intempe¬ rance — Partial impotence — Errors of the ■ ecclesiastical or canonical authorities — Spe¬ culations of theologians. We now enter upon a large class of rela¬ tions, embracing subjects of much interest ahd importance in Forensic medicine. I allude to those connected with the gene¬ rative or reproductive function. When I lately treated of Sex, I did so merely with reference to structure, whether nor¬ mal or abnormal, and without any special regard to the uses of the parts. I shall, however, now have to notice those uses, — and the abuses also. Questions arising out of the considera¬ tion of the sexual functions are usually divided under the several heads of Impo¬ tence and Sterility, Violation, Pregnancy, Abortion, and the Births of children. Legal distinctions. — Certain legal conse¬ quences are attached to the imperfect ex¬ ercise of the sexual functions, and it de¬ volves occasionally on the medical jurist to determine how far the power of minis¬ tering to reproduction exists in the indi- 4G8. — xix. vidual. In respect to marriage, some of the most valid grounds of divorce rest on the proofs of inability; and in charges of violation, abortion, &e., evidence of the fact is almost equivalent to exculpation. As I shall hereafter treat distinctly of the subjects involved in the latter charges, I shall confine myself on the present occa¬ sion principally to the question of inabi¬ lity in reference to marriage. I must premise, that I intend not at present to consider all the medico¬ legal circumstances connected with mar¬ riage, but only those which have relation, to the chief object of the married state, as contemplated by the laws, — the procrea¬ tion of children. Other considerations which may also form grounds of divorce, may more properly be introduced hereafter. Marriage, how contemplated by the law. — Marriage, in the eye of the law, the common law of England, is simply a civil contract. The holiness of the wedded state is an attribute which it possesses in the estimation of the ecclesiastical or canon law; and in countries where this law prevails more than it does among us, it will be readily understood that there is ample room for casuistry, and for much me¬ dico-legal, as well as juridical interfe¬ rence. The business of the medical jurist, in this country, *'■ considerably limited, in relation to the question of marriage, in consequence of the plain view taken of the contract by the law of the land : still, however, the difficulties which occasionally occur, and which it xs the province of the professional witness to renu "eyare by no means of a very simple or superficial na¬ ture; on the contrary, they require our best and gravest attention. Conditions of the contract. — The condi¬ tions which render a marriage legally valid, are briefly those which constitute the validity of any other contract, — namely, that the contracting parties be willing, that they be able, and that they S ’ 258 DR. CUMMIN ON FORENSIC MEDICINE. shall have complied with certain requisite formalities. Now it is on questions con¬ nected with the two first conditions that the medical jurist is sometimes required to lend his assistance. He may have to con¬ sider whether the parties, or either of them, be capable of exercising a will or a discretion, in respect to entering on a ma¬ trimonial contract : one or other, or both the parties, may be disqualified, for ex¬ ample, by reason of too tender or too ad¬ vanced an age, or there may be some im¬ becility or unsoundness of mind, not ad¬ mitting the exercise of a will. Of such a state of things, I shall enter on the consi¬ deration in a future lecture. On the other hand, as to the condition of being able, it will probably be the duty of the medical jurist to examineliow far either party is qualified in respect to bodily cir¬ cumstances, He may have to show whether either party does or does not labour under certain disabilities which would invalidate the contract; under certain corporeal in¬ firmities, in fact, existing at the time the marriage is celebrated. Non-age. — I have already mentioned the ages recognized for legally forming a mar¬ riage-contract at the earliest— fourteen for the male, and twelve for the female. But the ecclesiastical courts look rather to the habit, strength, and constitution of the parties; they only inquire whether they be habiles ad matrimonium , and not how many years they may have numbered: and,' indeed, the common law will hold even infantile marriages, solemnized with due formality, valid, when the parties, on reaching the ages just stated, do not demur to the contract. Sexual inability. — The corporeal imperfec¬ tions are chiefly those constituting impo¬ tence,- or an inability to have sexual inter¬ course ; and this may belong either to the male or the female. Neither party should be impotent at the time of the marriage; and should it afterwards appear that either was —that, in fact, the marriage was not consu m- mated, and that the inability continued — it is a ground for annulling the marriage in the ecclesiastical courts, although the party so disqualified was ignorant that the defect existed at the time. Grounds of divorce. — It is to be ob¬ served, that there are two kinds of di¬ vorce ; the one, which may be consi¬ dered complete, a vinculo matrimonii ; the other incomplete, a mensa et thoro. Now impotence is a principal ground for obtaining the former; and in suits for that object, the party complaining must prove that the incapacity existed at the time of the marriage, and continued to be of a nature incurable : if the impediment was not natural, but supervened after the marriage, there is no sufficient ground of divorce. “ In a suit of nullity,’’ says Mr. Chitty, “ by reason of the alleged impotency of the husband, a certificate twelve years after the marriage, that the wife still was virgo Intacta , although apta viro, coupled with twro several confessions of the hus¬ band of his incapacity, and with proof that the woman’s health had suffered, though the husband had not given in his answers, and chat he had removed into France, and had refused to undergo surgi¬ cal examination, wras holden sufficient in the ecclesiastical court. On the con¬ tinent, suits for a divorce on this ground are frequent ; but for the ho¬ nour of English ladies, their delicacy in general deters them from thus publicly complaining; and such suits are compara¬ tively rare, unless there be other strong ground for seeking a dissolution of the contract — as intolerable ill temper, which, although of itself not a sufficient ground for a divorce, may yet constitute an in- ducement to make the disagreeable dis¬ closure, and proceed for a divorce on the legal ground of the incapacity of the hus¬ band.” Distinction between sterility and impotence. — Impotence, as I have said, may belong to man or woman ; and so may sterility, — understanding by this term, an inability to be prolific. Sterility implies, that not¬ withstanding the existence of an aptitude for sexual intercourse, there is no power of procreation. This species of inability, however, is more commonly imputed to the female than the male ; for wffiere no charge of impotence can be established against a man, it is difficult to make out his steri¬ lity, though there may be strong presump¬ tion that he is bond fide unprolific. The question of sterility in either sex is in great measure inferential, and the fact is generally dependent on internal organiza¬ tion, of which the medico-legal examiner cannot in general have sufficient cognizance in the living body. For this reason, and because in suits of divorce it is the question of impotence which is principally enter¬ tained, we may, perhaps, more usefully di¬ rect our attention to this infirmity than the other, although both are so closely con¬ nected, that it were not possible, even if desirable, to wholly separate the considera¬ tion of sterility from that of impotence. We may divide the subject as it relates to males and females : and first let us in¬ quire what are the causes and signs of IMPOTENCE IN THE MALE. Inability to have sexual intercourse may in man arise either from physical or moral causes. IMPOTENCE IN THE MALE. 259 1. Physical Causes. (a.) Insufficient development. — The age of the party may be such as naturally to ex¬ clude the idea ofpotency. Previous to puber¬ ty the individual must be presumed, and is presumed by the criminal law, to be incapa¬ ble of the generative act : the seminal se¬ cretion has not yet begun, and the stimu¬ lus derived from that source is conse¬ quently absent. On the other hand, old age may have extended its withering influence over the sexual parts, and the man who was prolific may cease to be so any longer. But the limits of either period cannot be precisely fixed. Puberty is in many in¬ stances retarded, in many accelerated, ow¬ ing to various causes : the climate, habits of life and education, and constitutional peculiarities, have material influence; and accordingly we have on record many ex¬ amples of precocious puberty, and not a few of its late development. With respect to the aged, it is still more difficult to say when, even on an average, the powers of procreation cease. Aristotle, long ago, fixed on the seventieth year; but numerous instances might be adduced to show that the generative power has often continued to a period much more advanced. Boerhaave says he has known examples of men who were still prolific at ninety. In the celebrated Banbury Peerage case, it was urged among other arguments against the claimant of the title, that the ancestor under whom he claimed could not have been the son of Lord Banbury, because that nobleman was 80 years old when the child was born. The remarks of Lord Erskine on this point are worth quoting: — “ But what evidence is there of Lord Banbury having been impotent ? There is no statute of limitations on the powers and faculties of man. Instances of robust longevity might be cited still more extraordinary. Sir Stephen Fox married at the age of 77, and had four children ; the first child was born when the father was 78, the second and third were twins in the following year, and the fourth was born when the father was 81. Parr became a father when even his son was of a more advanced age than Lord Banbury.” Sir Samuel Romilly, in his observations on the same head, thus expresses himself: “ The objection to the age of Lord Ban¬ bury may at once be dismissed. The law of England admits of no age at which a man may not become a father ; and many medical authorities may be cited to show that this rule is founded on reason. Dr. Gregory, of Edinburgh, whose name must be familiar to all admirers of science, says upon this subject: — ‘ Magna autem de his rebus differentia; decantantur enim ex- empla senum in castris Veneris strenue merentium, postquam centum annos com- pleverant; neque sane dubium, aut adeo rarum octogenarium patrem fieri.’ Haller likewise pronounces a man of 90 to be capable of procreating. Parr became a father in his 140th year. In short, the li¬ berality of the law on this subject is ex¬ cessive, for there is no age, from seven up¬ wards, at which a man is denied the pri¬ vilege of having children.” I take both these extracts from Mr. Le Marchant’s book on the Gardner Peerage. (6.) Imperfect structure. — A more obvious cause of impotence is found in an imper¬ fect structure of the genital organs. Ei¬ ther owing to congenital malformation, or some factitious alteration of the parts, they may be rendered incapable of exer¬ cising their proper functions. (a.) Affections of the penis — Deficiency. — It may happen that the penis is wholly or in part deficient. There have been in¬ stances of this part being totally absent from birth, and numerous examples of its removal by wounds, disease, or surgical operation. When the organ is completely absent, there can be no intromission, and, to all intents and purposes, the individual must be accounted impotent; unless, in¬ deed, we understand that term in some other acceptation than that in which it is usually employed, I have been made acquainted, through the kindness of Mr. Whitmore, of Cold- bath-square, with the particulars of a cu¬ rious case w hich came under his observa¬ tion. In the year 1823, a man, of the name of Staunton, lost his penis: it was amputated by his wife, one night, while he lay asleep by her side in bed; — the part was cut clean off at the root. Yet this very man wras brought up, about three years ago, before the magistrates at Union Hall, on a charge of bigamy and filiation. He w7as presumed to have become the father of a child after his mutilation. This, at least, w as the impression of many who knew the individual. But Mr. Whitmore thinks it doubtful that the child was begotten, how¬ ever it might have been born, after the out¬ rage. If the child’s age could be ascer¬ tained, it would settle the question. But where any portion of the organ is present, we must be cautious how we pro¬ nounce against its efficiency. It is an as¬ certained fact that impregnation may be effected if the semen be only deposited with¬ in the very orifice of the vagina. Hence it would be rather precipitate to assume the impotence of a person well formed in other respects, who should appear, on examina¬ tion, to have merely a portion of the corpora cavernosa and urethra, yet capa¬ ble of being introduced within the external parts of the female. The glans penis is known, in frequent instances, to have been 260 DR. CUMMIN ON FORENSIC MEDICINE. lost from accident or disease, yet the indi¬ viduals so affected have had sexual inter¬ course as usual. “ Piazzoni relates a case,” says Dr. Paris, “ where both the corpora cavernosa were destroyed, but, as the canal of the urethra was preserved, the person could perform the act of coition without difficulty. Frank also states an instance in which so considerable a portion of the penis had been carried away by a musket- shot, that, when the wound healed, the organ remained curved, and yet it re¬ mained adequate to the performance of its functions.” I am indebted to Mr. Whitmore, who so obligingly communicated the case already quoted, for the two following also, which are, perhaps, not less curious: — “I have had two other cases where the loss of the penis had been sustained. One occurred in one of my parish patients, who died a few weeks ago : he left a tine family of children ; his penis had been amputated many years since. The other case occurred in a boy about fifteen, from the bite of a stone- horse. I remember, while under treat¬ ment, he sent word to his sweetheart, “not to fret, for that he should be able to stump her yet!” These were his words ; doubt¬ lessly a faithful indication of his feelings and intentions. Hypospadia and epispadia. — Another im¬ perfection of the penis, which might seem likely to interfere with the generative act is, that irregular opening of the urethra constituting hypospadia, or epispadia*. But persons of such a conformation have not only not been impotent, but unquestion¬ ably prolific. Belloc gives a curious in¬ stance of a hypospadian who had four children ; two of them having precisely the same malformation as their parent. Even where the orifice of the urethra has been as low down as the root of the penis, im¬ pregnation has been effected, with the aid of an artificial contrivance. At least we have it, on the authority of Sir Everard Home, that John Hunter gave certain directions to a person so affected, which were attend¬ ed with complete success. An hypospadian assisted by Mr. Hunter. — This celebrated case is so often referred to, that it may be as well to state it to you in the words of Sir Everard Home himself, who originally published it in the Philosophical Transactions for the year 1799. The paper in which Sir Everard (then Mr.) Home relates the case, is one on the subject of hermaphrodism in a dog ; and he introduces into it several very cu¬ rious observations on reputed hermaphro¬ dites of various species ; and, among the rest, he notices those malformations in which inexpert observers have found rea¬ sons of their own for supposing the pre¬ sence of hermaphrodism. Sir Everard tells us that the gentleman in question had an aperture in perinteo, which it was found impossible to stop; for as the canal of the urethra was continued to the exter¬ nal orifice of the glans penis, the attempt to close the anomalous passage was made, but in vain. “ Under the circumstances,” says Sir Everard, “ the person married. When he had connexion, the emission was complete ; which proved that the testicles were perfect, but the semen always passed out at the perinasum. The late Mr. Hunter was consulted to remedy, if possible, this inconvenience, and to enable the person to beget children. After the failure of several modes of treat¬ ment which were adopted, Mr. Hunter suggested the following experiment. He advised that the husband should be pre¬ pared with a syringe fitted for the purpose, previously warmed ; and that immediately after the emission had taken place, it should be taken up by the syringe, and in¬ jected into the vagina, while the female organs were still under the influence of the coitus, and in the proper state for receiving the semen. This experiment was actually made, and the wife proved with child. Upon a subject of this kind, it is proper to speak with caution; but from all the attending circumstances, no doubt was entertained by Mr. Hunter or the husband, that the impregnation was entirely the effect of the experiment. Spallanzani’s experi¬ ments “ upon animals,” adds the writer, “ were made several years after this propo¬ sal of Mr. Hunter was attended with success*.” Phymosis and other affections. — But to return to the imperfections of the male organ. The part may be affected with congenital phymosis, and this, unless an operation be performed, will certainly prevent the generative act. It was a cus¬ tom, in ancient times, to produce an arti¬ ficial phymosis by injibu'ating the prepuce of young slaves. The method was effec¬ tual in precluding sexual intercourse, and was adopted in order to keep them in high health and beauty : perhaps also to restrain them from vicious indulgences. The muscles of the penis have some¬ times been affected with paralysis; and while such an affection lasts, it must be considered as inevitably entailing impo¬ tence. The cause of such a condition may generally be traced to some disturbance of the nervous system, through which channel alone the remedy must be supplied. Priapism frequently occurring, severe strictures, and certain diseases of the * See Lecture V., p. 132, ante. * Phil. Trans., 1799, p. 161—2. IMPOTENCE IN THE MALE. 261 prostate gland, may also be considered as occasional causes of impotence: but as they are all more or less remediable by art we must take care not to form too hasty a medico legal diagnosis. (jS.) Affections of the testes.— The imper¬ fections hitherto noticed have all belonged to the penis. We have now to notice another cause of impotence, arising more or less from deficiency or disease of the testes. Where the testes are wholly absent — re¬ moved by an operation, or carried away by some injury — the impotence of the party is obviously to be inferred ; but in such case, the marks of castration, or the cica¬ trices from the injury or wound, ought to be discernible. Where the testes are simply not found in the scrotum, and there is no appearance of their removal, we must in¬ quire further before we hazard an opinion. These organs may not have descended into their usual place, nor have passed the ab¬ dominal rings: they may still be in the abdomen (persons so affected are called Cmpsor chides), where their anomalous situ¬ ation during adult life, is, in the opinion of some, so far from being an impediment to the reproductive function, that it is rather conducive to their efficiency. This, how¬ ever, is very doubtful. If the testes have wasted away, as they sometimes do from disease — elephantiasis, for example — proofs of that fact will not be wanting in the individual: the charac¬ ters of manhood will be more or less ab¬ sent; the sexual appetite will be lost ; and, in short, it will be a case of incurable im¬ potence. The same result must have befallen those individuals whom it was the custom to emasculate in childhood by bruising the testicle, as is still done with deer and other animals. The injury deprives the parts of their organic life, they become atrophied, and unsuited to perform their natural functions. As to castration, it is well known that it does not immediately or necessarily entail impotence. Much will depend on the ex¬ tent to which the operation is carried, and the time of life at which it is performed. If both testes be removed in infancy, or boyhood, the individual never acquires a masculine character — he cannot but be impotent; but where castration has been effected in an adult, the sem¬ blance of virility will still be retained ; though it is said that the beard will be¬ come more thin and scanty. Persons of this description are known to retain a cer¬ tain imperfect power of sexual intercourse, attended with the discharge of a mucous fluid from the vesicuhn seminales, and pro¬ bably from the prostate. But it is out of the question that they should ever be pro¬ lific, unless the generative act should be accomplished some short time after emas¬ culation ; for there may still be some semen in the vesicles. Otto, indeed, mentions one case in which he found plenty of ap¬ parently good semen in the vesiculae semi¬ nales of a man who had castrated himself a year before, in a fit of melancholy. In cases where one testicle is left (per¬ sons so affected are termed Monorchides ), no matter how the other have been lost, we must cautiously abstain from pronouncing against the generative faculty of the indi¬ vidual. In fact it has been proved, in nu¬ merous instances, that two testes are by no means essential to potency, notwithstand¬ ing that the parliament of Paris, in 1665, decreed that the marriage contract should not be held valid unless two testes were producible ! Remarkable case of Count Sorlisi. — It was about this very date that the circum¬ stances of a celebrated case were much dis- cussedjin Germany : I allude to the marriage of the Count de Sorlisi. Valentin, in his Novella; Medico -Legates, gives a full account of the case, under the title of Conjugium Eunuchi ; and Dr. Ferriar has presented us with a very interesting abstract of it, in his Illustrations of Sterne. I shall take leave to give you a brief summary of the princi¬ pal facts. Bartholomew de Sorlisi, a young noble¬ man, held a commission in the army of Charles XII. of Sweden ; but his military career was brought to a close by a catas¬ trophe which befel him at the battle of Fiihnen : he received a musket-shot, by which he was deprived of the testes — bombardcB icta eviratus est. The wound was healed; but disgusted with the chances of wrar, he retired to an estate in Pomerania, wffiere he endeavoured to forget his misfor¬ tune in the occupations of a country life. Here he became acquainted with a family in w hich there w7as an only daughter, Doro¬ thea Elizabeth Lichtwer, a beautiful girl of sixteen. Of her he became deeply ena¬ moured, and the attachment being mutual, he w7as induced, forgetful of his situation, to make proposals of marriage. These wrnre readily accepted, and the time fixed. But unfortunately some of the lady’s re¬ lations were opposed to the match, chiefly on account of a difference of religion be¬ tween the parties, the Count being a Roman catholic; this, however, might have been got over, had not an unexpected piece of treachery thrown Sorlisi into the hands of his enemies. It appears that in unsus¬ pecting confidence he consulted the physi¬ cian of the Lichtwer family, and disclosed to him the secret which preyed upon his mind. The doctor, forgetful ot his inaugu¬ ral oath, shamefully betrayed his patient, and furnished the discontented party with 262 DR. CUMMIN ON FORENSIC MEDICINE. facts which seemed sufficient to overwhelm the object of their dislike. Sorlisi faced the storm gallantly, and bv exposing his life in some duels, soon procured an ex¬ emption from further private insults. It should be mentioned that circum¬ stances had by this time gone so far, that it was necessary for the Count to explain his situation to his intended bride, and her only surviving parent. How this delicate task was accomplished, we are left to imagine : but the result is known ; Madame de Lichtwer was inclined to give up the match, but Dorothea declared that no misfortune could affect her attachment, and that she was determined to pass her life with Sorlisi under every disadvantage. The parties were now betrothed with the mother’s consent. How to complete the marriage was the question ; for al¬ ready the theological faculties had taken alarm, and murmured so loudly against the proposed scandal, that it was evident no clergyman would venture to solemnize their nuptials. Sorlisi was obliged to draw' up his case, and submit it to the ecclesiastical consis¬ tory of Leipsic ; the answer of the consis¬ tory was favourable and very fair, though founded on a curious casuistical distinction. It was stated that the Count’s impotence was not of such a nature as to prevent, the generative act , but only the effect: non quidem talem impotentiam et inhabilitatem quee generationis actum , ut scholastici loquuntur , sed generationis effectum tantum impedit. After considerable delay, the marriage was at length permitted to be privately performed. But the matter was by no means suffered here to rest. The supreme ecclesiastical consistory, which had hither¬ to taken no cognizance of the case, inter¬ posed, and demanded that the parties should be separated. Madame de Sorlisi, too, who protested that she w'ould rather die than forsake her husband, was inter¬ dicted the sacrament. The various theological faculties of Ger¬ many were now consulted; and nothing could exceed the zeal of those learned bodies in dissecting and discussing all the various distinctions that could be made out respecting the case. It would seem, in¬ deed, that to counteract the practice of vice, they had thought it necessary to be com¬ pletely masters of every vice in specula¬ tion. The faculty of Hasse- Giessen were for dissolving the union immediately, for the lady’s sake: for they thought that she must be tormented excessively by her hus¬ band, whom they compared, in the language of St. Basil, to a bull with his horns cut off, instar bovis cui cornua sunt abscissa, imagi- nem impetus facere, incrcdibilem vesaniam spirando. The faculty of Strasburg held that so damnable a connexion could not be tole¬ rated, approved, or defended : they said that the lady, in desiring to live with her hus¬ band, committed a mortal sin ; and finally exclaimed, that if the young couple did not consent to separate, they ought to be banished from a land of piety. In the faculty of Jena the matter was discussed with more mildness. They thought, however, that Sorlisi should rather have married some old w'oman, as it was only society he could have wanted; and they, therefore, were of opinion, that a separation should take place. The Konigsberg faculty thoughtthatsome regard should be paid to the contentment of the lady, and that the parties should be allowed to remain together. On the same principle, the faculty of Greifswald opined that, as the lady had got into the scrape with her eyes open, she should abide by the consequences, though it did not seem to them toamountto amortal transgression. There were, besides these thundering bodies, several individual skirmishers in the field. A Dr. Bulaeus took part with Sorlisi, and showed that there was nothing so very scandalous and alarming in the marriage. He censured the scandal that arose out of the discussions which had taken place, and proved on the whole, that excepting the certain prospect of sterility, there was nothing to be complained of, while many other matches, equally ob¬ jectionable in that respect, were often formed between persons of very unequal ages. But others maintained in round terms, that it was a match brought about by the Devil himself; that it was absurd to give more credit to the fancies of a raw girl than to the grave opinions of a host of bearded divines; and one advised that the lovers, instead of being allowed to marry, should have been cudgelled out of their mu¬ tual affection. This last polemic literally called out for clubs; “ ad baculum, ad bacu- lum, quo pruritum extinguite /” To conclude this chequered history, the Consistory of Leipsic, in May 1668, two years after the commencement of the pro¬ ceedings just detailed, formally declared that the marriage ought to be tolerated, and the parties freed from further annoy¬ ance. The Elector, however, appended a clause to this decision, that the case was not to be made a precedent, and that no future indulgence of the same kind should be permitted. I shall only add that this narrative was the one on which Sterne so wittily found¬ ed Uncle Toby’s wound in the groin, and the consequent doubts of Widow Wadman. But independently of this, the distresses of the Abelard and Ileloise of Germany IMPOTENCE IN THE MALE 263 seemed deserving of being better known, especially as they constitute a decidedly medico-legal case. 2. Moral Causes. It happens not un frequently that al¬ though there be no external defect of struc¬ ture, still the individual is really impotent. In such circumstances, however, the inabi¬ lity is generally functional and temporary. The case has often been quoted, which John Hunter relates in his treatise on the Venereal. A gentleman consulted him, complaining of absolute inability to have sexual intercourse; upon which the saga¬ cious surgeon, suspecting the cause, as there was no apparent physical reason for impotence, made him promise upon his honour to pass six nights with a young woman, without attempting to have any connexion with her, however strong might be his desire. The spell was broken, the current of the pa¬ tient’s thoughts being changed: instead of anxiety about his supposed impotence, he soon began to apprehend that he could not restrain himself so as to keep his word of honour passed to Mr. Hunter; and such proved to be the case. Fascination, fear, and other affections. — In times of superstition, such a state of impotence was always sure to be attributed to the influence of magic ; and you will see in Montaigne what a remarkable cure that acute essayist effected on a friend of his, by supplying him with a pretended counter- charm. Cases also have often been met with, in which the doubt of impotence has led to the fact, and the unfortunate dupes of their own suspi¬ cions have sought a termination of their distresses in suicide. On the other hand, excessive desire is a frequent cause of ina¬ bility; but it seldom lasts long, and can prove but a temporary impediment. Habits and modes of living. — Certain ha¬ bits, such as frequent intoxication, and vicious indulgences of various kinds, often produce such a want of ner¬ vous energy, and so debilitating an effect on both mind and body, as to render the individual incapable of exercising the ge¬ nerative function. Strong narcotics, also, such as opium and tobacco, and according to some — Metzger among the number — cof¬ fee, when taken immoderately, are said to have the same effect. An odd story is told by Murray, in his Apparatus Medicaminum , of one of the wives of the Sultan Mahmud, who, on looking out of her window one day, saw some grooms proceeding to cas¬ trate a fine horse : she called aloud to them to forbear, and to give the animal coffee, for she had observed the effects of that beverage upon her husband ! Cam¬ phor also was long believed to possess anaphrodisiae qualities, or, as the verse has it, — " Camphora per mires castrat odore mares.” Sir Thomas Browne combats this notion as a vulgar error. Partial impotence. — It is a well-known fact that men may become impotent with regard to particularfemales, w hile with others they possess their full powrers. The law recog¬ nises such a form of inability, which it terms impotentia quoad hanc, and a divorce was granted in the Earl of Essex’s case on tins ground, Lady Essex charging his Lordship with impotence, and he confessing him¬ self so with regard to her. Some other curious particulars connected w'ith this case I shall hereafter have to notice. The impotence quoad hanc, can, in gene¬ ral, be accounted for; and will probably be found in most cases to arise from one or more of the bad qualities summed up by Baumer as the extinguishers of affec¬ tion-- Morositas, contemptus, ircp, tristitia, corporis irnmundicies aefostor, venerem primario supprimunt. A very singular case wras published at Venice, in the year 1815, and w as much discussed in the German journals soon after. It w?as a marriage w hich was dis¬ solved the day after it wrns celebrated. The bride, a lady of 27, much admired for her beauty, was most unexpectedly found to have her person covered from the breast to the knees with a profusion of black, thick, and bristly hair: she was, in fact, compared to a black poodle in those parts: and it was held to be a sufficient ground of divorce. A remarkable blunder, which had well nigh been attended with serious conse¬ quences, was once committed in our eccle¬ siastical courts, by the authorities there pronouncing too absolutely in a question of impotence. This was in the case of one Bury, who wras divorced a vinculo matri¬ monii for frigidity or “ perpetual impotency of generation.” He afterw'ards married another wufe, and had children by her; upon which it was urged that the church having been evidently deceived, the di¬ vorce thereupon wras null; and if so, that the second marriage was unlawful, and the issue illegitimate. But the courts of common law decided, that since there had been a divorce for impotence, it was clear that each party might law¬ fully marry again ; and though it should be allowed that by reason of the error of the church, the second marriage was voidable, yet till it wrere actually made void, it remained a marriage, and the issue wrere to be deemed unlawful. Similar cases have occurred on the con¬ tinent, and have led to much casuistical discussion, — perhaps also to some scandal. 264 MR. BULLOCK’S CASES OF POISONING A grand controversy was, whether a man, who had been divorced for impotence through sorcery, and had married again and had children, might, on the death of the second wife, be claimed by the first ? The canonists thundered against each other, as they took different sides of the question. In truth, ever since Sanchez wrote his great work, de Matrimonio , the discussion of all possible cases in which capability may exist at one time and im¬ potence at another, has been a favourite occupation of the casuists; and it is said that some of their refined hypotheses never entered into the imagination of any other people in the world, than themselves. CASES OF POISONING BY OPIUM, AND BY BELLADONNA. To the Editor of the Medical Gazette . Sir, Two cases of poisoning- by laudanum having- recently been brought to St. Thomas’s Hospital within twenty-four hours of each other, and as the parties were nearly equal in age, and similar in physical power, while the quantity of the opiate they had taken, and also the time that elapsed before they were sub¬ mitted to medical treatment, was almost precisely the same, it was thought that so fair an opportunity for determining the effects of bleeding- in these cases ought not to be neglected. The cases, therefore, were treated alike in every respect, with the exception that one was bled, while in the other that operation was omitted. From the narration of the cases, it will be seen that the latter re¬ covered in a much shorter time, and with fewer distressing symptoms, than the former; a fact which, although it might have been predicated from the known laws of poisons, remained still to be proved by experiment; and as the cases in this point of view are import¬ ant, I shall feel obliged by your giv¬ ing them insertion in your valuable journal. I inclose also a case of poisoning by belladonna, in which the little patient was bled ; but it will be seen that after the bleeding' her recovery was very doubtful, and that the symptoms were so imminent, that I should hesitate in having recourse to that operation in any similar case. — I am, sir, Your obedient servant, Henry Bullock. St. Thomas’s Hospital, Nov. 14, 1836. Case I. — Poisoning by Opium. Sarah Todd, 21 years of age, and of robust health, was brought into St. Thomas’s Hospital at four o’clock in the afternoon of Wednesday, Oct. 5, 1836, having taken an ounce of laudanum tw'o hours previously. It was stated, that half an hour after she had drunk it she complained of sick¬ ness and of excessive thirst; that at length she became drowsy, and ulti¬ mately insensible. On being taken to the ward she lay comatose, with her Impils contracted and insensible to light, ier countenance livid, her respiration slow, almost imperceptible ; the surface of her body cold, and her pulse slow and feeble; and what was remarkable, was the great relaxation of the muscu¬ lar system. Her stomach w'as immediately emp¬ tied by means of the stomach-pump, and then washed out by the repeated injection of large quantities of warm water. An emetic dose of the sulphate of zinc was next given, which excited vomiting se¬ veral times. She was then made to walk round the squares of the hospital, supported by two men, resting at inter¬ vals. At seven o’clock we wTere grati¬ fied by her becoming sensible, when she complained of headache, of lassitude, and of drowsiness. Twelve o’clock ar¬ rived, and as the symptoms remained much the same, she w-as bled to twelve ounces, and a mustard cataplasm ap¬ plied to the stomach, which had no sooner drawn, than the same forced acti¬ vity was directed to be continued, while lemon-juice and strong coffee were ad¬ ministered at short intervals. The pa¬ tient was in this manner kept moving for twelve hours, when all the symp¬ toms of poisoning having subsided, I allowed her to g’o to bed, with mustard cataplasms placed on her feet as a pre¬ cautionary measure. On Thursday she had some refresh¬ ing sleep, but as late as Friday she com¬ plained of headache, was feverish, and her tongue w as dry, while the pupil was but slightly acted upon by light. On Saturday, however, the symptoms con- BY OPIUM AND BY BELLADONNA. 265 siderably abated, so that on Monday she left the hospital quite well. Case II. — Poisoning by Opium. Jane Morgan, 20 years of age, a strong and equally healthy person with Sarah Todd, in a fit of jealousy, took an ounce of laudanum at 11 o’clock on Thursday morning, October 6th, 1836. About an hour and three quarters after¬ wards she was brought to the hospital, when it was stated that almost immedi¬ ately after having taken the opium, she complained of headache, but subse¬ quently she fell into a stupor, and at the time I saw her, she was completely in¬ sensible and comatose, with her eyes fixed, the pupils contracted, and alto¬ gether unaffected by light; h er breath¬ ing was also slow and stertorous, her pulse feeble, scarcely to be felt, the surface of the body cold , her countenance bloated, and no stimulus I could em¬ ploy had any effect in arousing her. Without loss of time, T introduced the stomach-pump, evacuated the contents of the stomach, and cleansed it by means of repeated injections of warm water ; copious vomiting was next produced by a solution of the sulphate of zinc, and this having subsided, she was, as in the former case, kept constantly moving, by the assistance of two men. At 8 o’clock she had become so far sensible as to re¬ cognize her friends, and to be able to speak, thoug'h still overpowered by sleep, and suffering intense headache : a mustard cataplasm was then applied to the epigastrium, and immediately afterwards directions were given to make her drink freely of strong coffee and acids, and to persevere with the same forced exercise. At 12 o’clock these means had been so far successful, that she was perfectly sensible ; and as all the urgent symptoms, except severe headache, bad disappeared, she was put to bed, and mustard poultices ordered to the feet. During the night she slept but little, and on Friday morning she expressed herself as being quite reco¬ vered. Certainly not a single distress¬ ing symptom remained, for even tbe iris acted well ; she left the hospital, quite well, on Tuesday. Many physicians have advocated the treatment by bleeding, and speak of its universal success. Formerly, within my own recollection, bleeding was tbe practice of this hospital ; and l am in¬ formed, on good authority, that some years since, it was received as a general principle, and constantly acted upon. This doctrine, however, having been lately considered untenable, and at vari- ance with all the known laws of the ac¬ tion of remedies upon the system, and bleeding consequently suspended, the results have been infinitely more success¬ ful, and the convalescence completed within a much shorter time. I would not be understood to intimate that bleeding in all cases in which opium has been taken is prejudicial, or inadmissible, but as these cases singu¬ larly illustrate the great principle, that bleeding is not the rule of treatment when tbe system is under the influence of poison, I have thought that the pub¬ lication of these might induce others to abandon, in similar instances, the use of the lancet, and to report the results. Poisoning by Belladonna. September 23, 1836. — Ann Forth, a girl nine years of age, was brought to St. Thomas’s Hospital at night, by her parents, who stated that she had been poisoned by belladonna, having, in the evening, ate portions of the bark, and masticated the root of that plant. Two hours after, she w as taken w ith a feeling of sickness, a loathing of food, a dis¬ tressing sense of lassitude, and dryness of the throat. At nine o’clock, or four hours after the accident, delirium came on, which lasted about an hour, and was succeeded by an irregular convulsive ac¬ tion of the whole muscular system. About this period I saw her, when she wras in a state of complete insensibility, approaching to coma ; her face was dis¬ torted and pallid ; her eyes protruded and suffused, the lids separated, the pu¬ pils fully dilated, and scarcely affected by the action of light ; whilst there were frequent convulsions of the mus¬ cles of the face, as well as of the extre¬ mities, for tbe angles of the mouth were retracted and agitated ; the lower jaw was alternately fixed and trembling. In addition to these striking phenomena, tbe surface of the body was cold and clammy, the pulse small, rapid, and in¬ termittent, and she had sunk into a state of lethargy so absolute that it wTas im¬ possible to rouse her. Assisted by my friend, Mr. Stone, of Christ’s Hospital, the stomach-pump w as immediately em¬ ployed, warm water plentifully injected, and the contents of the stomach in this manner removed. This was no sooner 266 MR. SHAW ON THE NERVES WITHIN THE ORBIT. effected than an emetic dose of sulphate of zinc was injected into the stomach, and the treatment was so successful that the convulsions subsided previous to withdrawing1 the tube. Enemata of warm water were now administered, a mustard plaster applied to the nape of the neck, and I directed that she should be sharply shaken and be kept in con¬ stant motion about the squares of the hospital; lemon-juice and water being freely supplied her. By one o’clock, a.m., the child having- frequently vomit¬ ed, had decidedly less stupor; and althoug-h almost overpowered by the tendency to sleep, yet the iris acts per¬ ceptibly on the impression of light. The unfavourable symptoms were, her pulse continuing- intermittent, though of more volume than before ; the alvine evacuations and urine passing- involun¬ tarily. %/ 4 a.m. — Has continued to improve, and attempts to answer questions ; com¬ plains of headache, and of total blind¬ ness ; pulse 112, regular, and stronger. The power of recognition having re¬ turned, she was now bled to six ounces, mustard cataplasms applied to the legs, and the same forced activity to be con¬ tinued ; for so imperative was the dis¬ position to sleep, that, if allowed to re¬ main quiet only for a minute she fell down in a profound sleep. At 8 a.m. she was quite sensible, able to walk alone, and her eye being- less prominent, and the pupil sufficiently obedient to the action of light, the power of vision was restored, though she saw but dimly. As she had now been in a state of con¬ stant motion for fourteen hours, she was permitted to go to bed, with mustard plasters applied to the feet, and an ape¬ rient medicine. From this period to the time of her leaving the hospital, on the 8th of October, she gradually recovered ; making occasional complaints of head¬ ache, soreness of the eyes, and intole¬ rance of light; which, however, at length ceased. ON THE NERVES WITHIN THE ORBIT. To the Editor of the Medical Gazette. Sir, In the communication by Mr. Thurnam of last w eek, he admonishes physiolo¬ gists not to neglect the study of compa¬ rative anatomy ; and after this salutary advice, proceeds, with much compla¬ cency, to state that a peculiar distribu¬ tion of the nerves in the orbit of certain of our domestic animals, has been en¬ tirely overlooked by the modern writers w ho have treated of these nerves. Upon this ground he makes sundry reflections on the inconvenience of proposing theo¬ ries which do not admit of general ap¬ plication, and even calls upon us to re¬ ject every explanation of the uses of the nerves in the orbit that has hitherto been started. One would naturally conceive, that before coming- forward with such sweep¬ ing denunciations of neglect and error, Mr. Thurnam would have taken some pains to become acquainted with the works of the authors whose opinions he criticises. The fact in comparative ana¬ tomy w hich he announces in this osten¬ tatious manner, is the distribution of the sixth pair of nerves in quadrupeds to the conoid or retractor muscle—that muscle w hich, arising- at the back of the orbit, embraces the optic nerve, and is attached to the posterior part of the eye¬ ball. Mr. Thurnam informs us that one great authority on the nervous system, Willis (from whom we continue to take our nomenclature of the nerves), w;as familiarly acquainted with this distri¬ bution ; but he asserts that the fact was completely lost sight of by subsequent anatomists and physiolog-ists ; and he claims some credit, it would appear, for having revived our knowledge on this point. One of the gentlemen whom he sing-les out in particular, as having been guilty of the negligence imputed to physiologists generally, is Sir Charles Bell ; and from the short and positive manner in which he dismisses this au¬ thor’s reasonings on the nerves within the orbit, w'e should be led to conjecture that Mr. Thurnam had perused his works with the greatest attention. Now it may astonish your readers to learn, that although Sir Charles Bell’s writ¬ ings are thus held up to view as based on imperfect observations, they contain, nevertheless, an accurate statement of the fact toiwhich so great importance is attached ; and not only is the distribu¬ tion in question conspicuously brought forward by the author, as harmonizing with his other views, in no less than two of his best-known works, viz. the “ System of Anatomy” (vol, ii. p. 504), MR. TAYLOR ON THE REMUNERATION OF MEDICAL WITNESSES. 267 and tbe “ Nervous System” (p. 215), but to shew bow be estimated the fact, it is made tbe foundation of an original theory, of which Mr. Thurnam proves himself entirely ignorant, to explain why the sixth nerve in man should supply the abducens muscle of the eye exclusively. I may remark, in addition, that it is acknowledged by Sir Charles Bell that the observation was obtained by him from Willis, whose character as an accu¬ rate anatomist he takes the opportunity of praising in the highest terms. It is not, I presume, expected that I should here enter into an explanation of the theory alluded to, as proposed by Sir Charles Bell, in connexion with this piece of anatomy. I have done enough in shewing that, contrary to Mr. Thurnam’s representations, he has not altogether neglected the comparative anatomy of the eye. I might, indeed, prove, that so far from such being the case, he has gone further into the in¬ quiries bearing upon this subject than was contemplated by this ingenious comparative anatomist himself. Let me ask, why has Mr. Thurnam never once alluded to the mechanism for protruding the third eye-lid, or how, in those animals that possess the retractor muscle, and to which the sixth pair is distrubuted ? Does he know that quad¬ rupeds have a third eye-lid ? By ne¬ glecting this apparatus, nothing can be conceived more fanciful or absurd than the use which he has attributed to the retractor muscle ; following, I ought to say, the authority of Willis. It may, perhaps, be quite just to recommend this old English anatomist for the accu¬ racy of his anatomy ; but it was scarcely to be expected that, in the present day, he would he readily accepted as an authority in physiology. What, then, is the opinion that Willis entertained of the proper function of the retractor muscle, and to which Mr. Thurnam gives his especial approbation ? He considered that as this muscle is found in animals which feed with their heads hanging low, it was added for the sake of retaining the eye-hall securely in the socket — for preventing the globe of the eye slipping bolt out, when these ani¬ mals were grazing ; an accident which he supposed was likely to occur, even although this organ is held in its place, as we know, not only by means of the optic nerve, and the four strong recti muscles, hut by the two eye-lids also, which could close upon the eye, and hold it in, if ever the necessity arose for preventing its dropping out* ! In token of his admiration of this notable theory, Mr. Thurnam speaks always of this muscle as the “ suspensory” muscle. I have the honour to be, Your obedient servant, Alexander Shaw. Middlesex Hospital Medical School, Nov. 14, 1836. REMUNERATION OF MEDICAL WITNESSES. To the Editor of the Medical Gazette. Sir, The particulars of the accompanying medico-legal case were furnished to me by a friend, who acted as witness on the occasion. I have appended to it a few remarks on the remuneration of wit¬ nesses, which may possibly interest th ose of your readers who are engaged in the practice of medical jurisprudence. I am, sir, Your obedient servant, Alfred S. Taylor, Lecturer on Med. Jur. and Chemistry in Guy’s Hospital. Nov. 14, 1836. A coroner’s inquest was held, a few months since, upon the body of a child, which was found under such circum¬ stances as to lead to the suspicion that it had been murdered at its birth. There was no evidence to support the charge of infanticide against the mother; but there were reasons to believe that she had concealed the birth, and had thereby rendered herself indictable for a misde¬ meanor. The jury returned a verdict of “ found dead.” The question of concealment being out of the jurisdic¬ tion of the Coroner, that functionary transmitted a copy of the depositions, taken before him, to a police magistrate. The different witnesses, including the gentleman who had ably conducted the medico-legal investigation, were subse¬ quently examined by the magistrate, *■ Observare est quod quadrupedes, qui oculos in terrain pronos ac pendulos gerunt, musculum peculiarem habent, quo oculi globus suspenditur, et ne pondere suo extra ossis orbitum dilabi aptus sit, sustentatur,— WUHs% 2C8 MR. TAYLOR ON THE REMUNERATION OF MEDICAL WITNESSES. and were by him bound in the usual re¬ cognizances to prefer a bill of indict¬ ment against the prisoner at the sessions. The case was soon afterwards tried, and the prisoner was acquitted, some circumstantial points having been ad¬ duced in her favour. On the medical witness applying to the court for remuneration for his trouble and loss of time, he was informed that it had no power to order payment of expenses in that particular misdemeanor. He was then referred to the act, 7 Geo. IV. c. 64. s. 23, which allows the pay¬ ment of expenses to prosecutors and witnesses only in certain misdemeanors there enumerated : “ concealment of birth” is not among* them. The injustice to which the witness was subjected in this case will appear more striking, when it is considered- — that he had already conducted a trouble¬ some investigation before the coroner, having inspected the body of the child, and performed the usual experiments to determine whether it had respired or not, for which, by 6 and 7 Will. IY. c. 89, s. 5, he being connected with a parochial infirmary, and the case being* a parish case, could receive no remu- ration ; — that he had afterwards to ap¬ pear and confirm his evidence before the police magistrate, for which, even had the misdemeanor been one of those named in the statute 7 Geo. IV. c. 64, he could have received no fee, since sec. 23 positively forbids the payment of expenses and compensation to wit¬ nesses, for attendance before the exa¬ mining magistrate ; — and that subse¬ quently, at a great sacrifice of time and personal convenience, he was compelled to attend and give evidence on the trial of the prisoner at the sessions, where he had to learn the existence of this casus omissus in the statute. It appears to me that we have here an instance of defective legislation which must often press particularly hard upon members of the profession, and a grievance which ought, as a matter of common justice, to be speedily removed. For the information of those practi¬ tioners who may not have the statute by them, it may be stated that the fol¬ lowing* are the misdemeanors for which alone the expenses of witnesses are al¬ lowed : — Assaults with intent to commit felony; attempts to commit felony ; riots ; misdemeanors for receiving* stolen property, knowing* the same to have been stolen ; assaults upon peace officers in the execution of their duty, &c. ; as¬ saults committed in pursuance of any conspiracy to raise the rate of wages ; knowingly and designedly obtaining property by false pretences ; wilful and indecent exposure of the person ; wil¬ ful and corrupt perjury ; subornation of perjury. The only two cases in the above list which are likely to require professional testimony, are — assaults with intent to commit felony, and at¬ tempts to commit felony ; and in these, it must be remembered, a witness is not entitled to any remuneration for the evidence which he may give before a magistrate. Besides, whatever trouble and inconvenience he may be exposed to, should the prosecutor remove the in¬ dictment by certiorari into the King’s Bench, and the case be tried at Nisi Prius, he is not entitled under this sta¬ tute to any fee even for his evidence at the trial of the prisoner*. The refusal of his expenses to a me¬ dical witness attending before an exa¬ mining magistrate to give evidence in a case of misdemeanor, is as much a mat¬ ter of specific injustice, as it was for¬ merly, in the case of his attendance before a coroner. The wilfully throw¬ ing of sulphuric acid or other corrosive substances, on the person, is, for exam¬ ple, a misdemeanor (in England) which might require as careful a chemical analysis, on the part of a practitioner, before a prisoner could be committed by a magistrate, as any case of fatal poi¬ soning falling* under the jurisdiction of a coroner. On what principle, there¬ fore, does this statute prohibit the pay¬ ment of expenses to witnesses, without any reservation in favour of those whose time is so often, in other ways, gratui¬ tously sacrificed to the public good? There are other misdemeanors, altoge¬ ther omitted by this statute, in which, as in the case of “ concealment of birth,” a practitioner must give his pro¬ fessional testimony before a magistrate, and at the sessions, without, in either case, receiving any fee or remuneration whatever. In charges of felony before a magis¬ trate, a medical witness is, by sec. 22, entitled to his expenses for attendance at the examination, provided he obtains a certificate from the magistrate before * Rex v. Johnson, R, and M. 173: Archbold’s Crim. Pleading, 140. DR. GREENHGW ON THE USES OF ALOES. 269 the trial ; but the granting of this certi¬ ficate is left optional with the magis¬ trate. Here is a very singular legal distinction. To the medical practitioner it can matter but little whether the crime of which the prisoner, ag'ainst whom he appears, is accused, be a fe¬ lony or a misdemeanor: the sacrifice of time on his part, and the knowledge required for conducting the medico¬ legal investigation, will be much the same in the two cases. Indeed, the at¬ tendance before a magistrate in a mis- demeanor, may often give rise to more trouble than in felony ; and yet the law decrees remuneration to the witness, not according’ to the trouble incurred, but according to the degree of crime of which a prisoner may have been guilty ! It would be occupying too much of your valuable space to pursue this sub¬ ject further; but I think these observa¬ tions will suffice to show that some ad¬ ditional legal provisions ought to be made, to remove w hat must be regarded as an oppressive evil. ON THE USES AND ABUSES OF ALOES. To the Editor of the Medical Gazette. Sir, When you can afford space in your ex¬ cellent journal, I shall feel obliged by your admitting the following* observa¬ tions on the use and abuse of aloes. I remain, sir, Your obedient servant, Edward Greenhow, M.D. North Shields, Nov. 8, 1836. There is no substance which enters so largely into the composition of aperient medicines, as aloes, and none, perhaps, for which we should find it so difficult to procure a substitute, the dose required being so minute, that it is readily admi¬ nistered in a small bulk; and its action being confined to the large intestines, little or no derangement of the alimen¬ tary canal is occasioned by its opera¬ tion : such at least is the case when used with discretion ; but I am prepared to shew that great and serious mischief often results from the inordinate, or too long-continued use of aloes, more parti¬ cularly when taken habitually, as has become too commonly the case, without the knowledge or supervision of a medi¬ cal man, the non-medical part of the community being* little aware that any ill effects can attend the use of a remedy so universally employed. Medical writers describe aloes to be a stimulating cathartic bitter, which is said to act by increasing the muscular or peristaltic action of the intestines; but it evidently acts also by irritating the mucous membrane of the intestines, and producing a larger secretion ; this is manifest from the large quantity of mucus often passed with the evacuations when aloetic aperients have been exhi¬ bited. Authors differ considerably as to the doses which ought to be given ; Lewis mentions 3ss., or 3 ij . , when we wish to purge effectually : “ at the same time,” he says, “ it occasions commonly great irritation about the anus, and sometimes a discharge of blood;” he then goes on to say, “ in smaller doses, as ten or twelve grains repeated once or twice a day, it not only unloads the first passages, but attenuates and dis¬ solves viscid humours in the remote parts, warms the habit, quickens the circulation, and promotes the menstrual and hsemorrhoidal fluxes: its continued use renders the blood sensibly more fluid, as appearson venesection. Cullen says, it empties the great intestines, and it is remarkable it does this in a very small dose. I have known innumera¬ ble instances of persons who very con¬ stantly obtained this effect from one or two grains of aloes. Paris states the dose to be from five to fifteen grains, and says, no greater effect is produced by a large dose, than by one compara¬ tively moderate. Braude states tbe dose to be from tw o to ten or fifteen grains. Pereira says, “ taken internally in small doses, aloes acts as a tonic to the ali¬ mentary canal, assisting the digestive process, strengthening the muscular fibres, and promoting the secretions, es¬ pecially that of the liver, which organ it is thought specifically to influence: in large doses it acts as a purgative.” I will now detail the result of my own observations during several years, in a great number of cases, in which aloes wras given in every variety of dose ; and I have almost uniformly found that very small doses have answered all the purposes to be obtained by its use, viz. substantial feculent evacuations, attend¬ ed by little or no irritation ; and for this 270 ANALYSES AND NOTICES OF BOOKS. purpose from two to five grains will be found sufficient : when administered in larger doses, it is apt to occasion grip¬ ing, heat about the anus, and, if long continued, haemorrhoids ; it also loses its effect of properly emptying the large intestines, producing’ frequent small evacuations, consisting principally of mucus, and attended with tenesmus, the abdomen being- at the same time distended and tender, the patient com¬ plaining that “ his bowels feel as if scraped the pulse is sensibly quicken¬ ed, and a sense of constriction is felt about the head. The long-continued use of aloetic aperients has a tendency to produce emaciation, and their action upon the bowels becomes capricious and uncer¬ tain, sometimes failing to produce any effect, and at others producing frequent small evacuations, as before described ; the mucus being occasionally passed in long membranous bands, and sometimes in substances resembling pieces of flesh. I have also seen two cases, in which the mucus passed along' with the evacua¬ tions had all the appearance of fat. It is not difficult to conceive that such a state of irritation, kept up for any length of time, or frequently recurring, must ultimately tend to some organic change of structure ; and I think it highly pro¬ bable that stricture in the rectum may sometimes have its origin in this source ; and I have seen cases of enteritis which I believed to be traceable to the inordi¬ nate use of aloes. It appears probable that aloes does not undergo any change or solution in passing through the alimentary canal, but that it becomes intimately blended with the dejecta; and when these are detained in the colon and rectum, that its stimulating effects are felt, causing these viscera to expel their contents, the unloading of which may give rise to a freer flow of bile. Aloes is undoubtedly useful as an emmenagogue ; and, in combination with iron, is perhaps more to be relied upon than any other re¬ medy. It is more difficult to account for its possessing any power over the action of the kidneys, yet such, I am convinced, is the case. I have many times found that when squill, along with other diuretics, failed to act, the addi¬ tion of aloes has speedily produced a copious diuresis. When aloes is given simply as an aperient, the best vehicle is some vege¬ table extract, as gentian, or chamomile. Soap is objectionable, as impairing its purg’ative powers ; so also do the aro¬ matic oils to a certain extent ; and al¬ kalies are said to have a similar ten¬ dency. One or two grains of ipecacu¬ anha combined with each dose of aloes, has the effect of diminishing, or often of altogether removing, its irritating effect upon the anus; and many persons la¬ bouring- under piles are not only able to take it in this way with impunity, but with advantage. When aloes produces griping’, it may generally be remedied by the addition of a few grains of henbane extract, or ex¬ tract of hops : the latter will be found preferable in most cases of dyspepsia. The effect of aloes is increased by com¬ minution ; therefore g’reat pains should be taken in its preparation. Masticb is sometimes ordered in combination with it ; I believe principally with a view to a more minute division of its particles. When aloes is combined with opium, its purgative properties are not generally lost, but only delayed, which makes it a valuable medicine to give in conjunc¬ tion with that druo'. ANALYSES and NOTICESof BOOKS. “ L’Auteur se tue a allonger ce que le lecteur $e tue a abreger.” — D’Alembert. Facts and Cases in Obstetric Medicine ; with Observations on some of the more important Diseases incidental to Fe¬ males . By J. T.‘Ingleby, M.R.C.S L. Senior Surgeon to the General Dis¬ pensary, Surgeon to the Magdalen Asylum, and Lecturer on Midwifery at the Royal School of Medicine, Birmingham. 8vo. pp. 206. Long¬ man and Co. We hail with pleasure the publication of practical works like this, for they denote a degree of intelligence and ac¬ tivity among our provincial brethren which deserves every encouragement. Mr. Ingleby is a gentleman who has read, seen, and thought much, and who, to unwearied industry, has added the g’reatest ardour in the pursuit of profes¬ sional knowledg’e. The present work consists of seven sections, a portion of which has already appeared in an es- MR. INGLEBY's OBSTETRIC MEDICINE. 271 teemed periodical. They are all oil practical subjects of much interest. Section 1. On Puerperal Convul¬ sions. — This is full of valuable matter: the only point about it which we regret, is the great want of clear and simple arrangement. The materials are excel¬ lent ; they could scarcely be better ; but they are spread out before us with so little attempt at classification as to render the subject much more obscure than it otherwise would be. The au¬ thor mentions the arrangement made by Dr. Dewees, into three classes, — viz. the epileptic, the apoplectic, and the hysterica] convulsions; and very properly adds the anaemic, as also the tetanic forms of puerperal convulsions. This latter form was described by Pro¬ fessor Naegele, many years before M. Velpeau had noticed it; also by Wi- gand. We could have wished to have seen these different forms discussed un¬ der separate heads; the distinctions would then have been more marked, and much more available to the student. The cases at the end of the section, in¬ dividually, are excellent ; they are de¬ scribed with clearness and precision, the practice is judicious and good ; but col¬ lectively they are liable to the same objection of want of good arrangement. They are classed according to when they occurred — viz. firstly, those cases which took place during pregnancy and previous to labour ; secondly, those pre¬ vious to labour and terminating in de¬ livery ; thirdly, during the dilatation of the os uteri; fourthly, after the full di¬ latation of the os uteri; fifthly, after the birth of the child, and before the expulsion of the placenta; sixthly, after delivery. We cannot approve of this arrangement, because the treatment can¬ not be guided by the period at which the convulsions occur, but by the cha¬ racter of the attack. Sect. 2. — On Malposition of the Ute¬ rus. , Ovaria , bladder , and Urethra , both in the impregnated and unim¬ pregnated state , in connexion with retention of Urine. The observations on retroversion of the uterus, and prolapsus vesicae, are especially valuable and practical, and are illustrated by well-reported cases of much interest ; those on prolapsus vesicee during the latter months are well worthy the attention of practitioners. Sect. 3. — On Obstructions in the Soft Parts to Progress of Labour. Some instructive cases are given of tumefied labia, from varicose veins or extravasation of blood into the labial tissues. In a case of the latter kind, which the author describes, the tumor burst, and nearly a pint of coagula was removed by a pair of dressing forceps, th rough a laceration at the edge of the vagina. This affection does not occur frequently, and its extent is seldom so great as to become serious, as it rarely passes beyond the margin of the labium ; even this, however, may become enor¬ mously tumefied, and where it bursts before the head has approached the os externum, may give rise to profuse haemorrhage. This will cease, or at least be in great measure diminished, during the passage of the child ; and if it returns afterwards to any extent, must be controlled by cold astringents, and other appropriate remedies, in some rare cases, the extravasation of blood into the cellular tissue has proceeded to an enormous extent, implicating the nates, and even the hips, in the swell¬ ing. The plan of puncturing the tumor, which Mr. Ingleby has found unsuc¬ cessful, is not adapted to all cases; and we are rather inclined to think that the opening which he made was not of sufficient depth and extent. Extravasa¬ tions of this kind do not merely retard labour by the obstruction which they produce at the external opening, but also by the effect which they appear to have upon the pains: these not unfre¬ quent] y cease as soon as the extravasa¬ tion takes place, leaving the patient in a state of serious exhaustion. (Edematous labia, especially where accompanied with anasarcous tendency, may retard labour when the swelling is very large: the danger will chiefly depend upon the patient’s general health. The author has recommended puncturing them with a fine curved needle, by which a load of serum is drained off, and much relief obtained. Tf labour be already commenced, we have scarcely any other means of relief in our power ; but when the patient has still some days to g-o, warm stimulant fomentations will prove of great service. The species aromaticce of the Prussian and other pharmacopoeias soaked in some hot wine, will, in many cases, speedily remove the tumor. A simple imitation of this is a hot poultice of chamomile- 272 ANALYSES AND NOTICES OF BOOKS. flowers, sprinkled over with a little red wine. Mr. Ingleby’s observations on the great value of active blood-letting in cases of contracted vagina from cica¬ trices, the results of former injuries, are practical and good ; but why is the name of Dewees omitted ? an author whose remarks on this subject are of the first-rate merit. Our limits will not permit us to go into the details of this section ; we will merely make a short quotation from the author’s observations under the head of vaginal tumors; the rest we strongly recommend to the at¬ tentive perusal of our readers, especially those who are in actual practice. “ There are two forms of ovarian tumors which obstruct the passage of the child. In the one, a small cyst, in connexion with a very bulky cyst, or else a portion of a large cyst, passes in¬ to the recto- vaginal septum, and bulg’es through the posterior part of the vagina. In the other, and that which occurs by far the most frequently, the whole ovary moderately enlarged prolapses within the septum. The descent is peculiarly liable to happen at two periods ; the first near the end of gestation, the second during labour, the prolapsus being pro¬ moted by the relaxation of the soft parts.” (p. 119). An admirable case, among others, is given by Mr. William Birch, of Barton, where the tumor was punctured. The question of puncturing th ese tumors is ably discussed by Mr. Ingleby, and well worthy of attention. We pass on to Sect. 5. — On the Laceration of the TJterus and Vagina. Among other interesting points, the author notices the fact, that rupture oc¬ curs more frequently in multiparse than in primiparse — a circumstance which would at the first view be scarcely ex- ected, had it not been fully established y long experience. His observations on the situation and course of the lacera¬ tion deserve attention. “ With a single exception, the cervix uteri has been more or less lacerated in every instance which I have seen, the rent being oblique in its direction, rather than lon¬ gitudinal, extending to the body and side of the organ. The transverse di¬ rection has been erroneously represented as occurring most frequently, but of this I have only seen a single case, the rent being confined to the fundus, and the result accidental.” (p. 185). In case of rupture of the uterus, where the foetus has escaped into the abdominal cavity, and where delivery per vaginam be¬ comes impossible, either from the con¬ tracted state of the wound, or the firm closure of the os uteri, the author proposes the important question, whether gastrotomy be justifiable. We agree with the author in consi- dering gastrotomy less dangerous than the Caesarean operation ; and the suc¬ cess which has lately attended this latter operation would strongly tend to sup¬ port Mr. Ingleby’s views. Ten cases of rupture are recorded, four of which are peculiarly interesting — viz. Nos. 6 and 7 terminated successfully. In No. 9, the uterus wras ruptured at the eighth month, by the patient falling upon a step ; the child escaped into the ab¬ domen, and she died undelivered. We feel strongly inclined to agree with his opinion, that gastrotomy was indicated. No. 10 is one of those rare cases where merely the peritoneal covering of the uterus was lacerated. “ A great number of lacerations were discovered on the posterior surface of the uterus, the largest being upwards of four inches in leng’th and nearly three in breadth ; the flap hanging’ down, and exposing the fibrous structure.” The 6th Section, “ On Inversion of the Uterus ,” is short, but one of much interest. Inversion is a displacement of very rare occurrence, but Mr. Ingleby has nevertheless had the opportunity of observing several cases. We agree with the author in considering that “ the case of this displacement implies the existence of softening and enlargement,” but we do not understand him when he considers that a portion of the placenta left attached to the uterus will cause its inversion. The four degrees of inversion which are described by the French authors, are very properly discarded, as useless and unpractical : we regret, however, that he has not mentioned the division com¬ monly followed— viz. into partial and complete. Dewees’s excellent observa¬ tions we could have wished to have seen noticed — White’s also. In a note to page 224, Mr. Ingleby says, “ Candour induces me to confess having once excised a polypus for the inverted uterus.” We do not make this quotation to show where an error in practice has been made, but to express MR. LEE ON THE CONTINENTAL WATERING PLACES. 273 our high respect for an author who has had the manliness and honesty to avow openly where he has erred. The care¬ ful record of an unsuccessful case, in the hands of an experienced and talented practitioner, is worth a dozen success¬ ful ones: it points out the difficulties and dangers which we have to encounter, and, by its instructive example, warns us to avoid them. It is candour of this sort which distinguished the celebrated La Motte, more than a hundred years ago — that “ homo sine err imusf as Haller called him ; it is the same honourable feeling which has chraete- rized the inestimable records of our own admirable Smellie. Mr. Ingleby has followed an excellent precedent — would that others did the same ! It is of the greatest importance to reduce an inversion as quickly as possi¬ ble after its occurrence. When done immediately, the reduction is generally effected with the greatest ease ; in proof of which we may mention a case where an intelligent midwife recognized inver¬ sion to have taken place, and instantly returned it: after a short time, whether from coughing or some other cause, the fundus was again forced down, and she again succeeded in replacing it. It has, however, been too generally supposed, that, if not seen within two or three hours after the accident, the chances of reposition would be very small. Mr. Ingleby has given an excellent case, where he succeeded in replacing the uterus on the eighth day after labour, at which time the inversion took place, and where the patient appeared mori¬ bund. Boyer has recorded two extra¬ ordinary cases of inversion, which had resisted all the ordinary means of re¬ duction, and which were accidentally but permanently cured by a s ,dden and violent fall on the nates. The one oc¬ curred to a practitioner named Barre, after lasting fourteen days ; the other to Baudelocque, after a period of eight years. Of the seventh and last Section we niust say but little; not from want of interest, but want of room. It is en¬ titled, “ On the Signs and Symptoms of Pregnancy ; their obscure and deceptive Characters , their Complication with Disease , and the Signs which denote the Extinction of Life in the Foetus ” Sixty pages of valuable matter are here collected, on one of the most important subjects of diagnosis. We cannot agree 408.— xix. with the author, in his note to page 240, in considering the plan of bringing down one foot of the child, in turning, as due to Mr. Radford, of Manchester: this was pointed out more than a century ago, but has not, we think, received the sanction of high obstetric authorities. We ourselves advocated this plan at one time, thinking that as the presentation now bore a greater resemblance to that of the nates, the chances of the child being bom alive would be so much greater. Our experience has not con¬ firmed this view : by bringing down only one foot, the hips of the child do not enter the brim of the pelvis so equally and readily; and our practice has been more successful since we have made a point of bringing down both feet: compelling the body of the child to move slowly and gradually through the os externum, has generally ensured a sufficient dilatation of the soft parts for the safe and speedy expulsion of the head. This last Section teems with practical matter, as indeed the whole work does. We take leave of Mr. Ingleby with feelings of high respect for his industry, talents, and great ex¬ perience : we look upon the work as one of great merit, and cordially recommend it to the attention of the profession. An Account of the most frequented Watering Places on the Continent , and of the Medicinal Application of their Mineral Springs ; with Tables of Analyses , and an Appendix on English Mineral Waters. By Edwin Lee, Esq., M.R.C.S., &c. &c. This constitutes by far the best account to which the English invalid or physi¬ cian can turn for information regarding the continental watering places. Sir Francis Head’s amusing “ Bubbles from ffie Briinnen” has tended to make this kind of narrative more anxiously sought after, although even now the efficacy of mineral springs is much less estimated in this country than it is abroad. Mr. Lee has visited most of the watering places on the Continent, and viewed their several peculiarities with an in¬ quiring and intelligent eye. He remarks upon the vagueness of the general di¬ rection so often given to invalids, to try a course of “ some of the continental waters,” and the impossibility of rectify¬ ing this when abroad, as the practi¬ tioners at all and each of the places T 274 MEDICAL WITNESSES’ BILL, which may be visited fail not to laud their own waters as of sovereign effi¬ cacy in the particular complaint, be it what it may, under which the applicant happens to labour. Some good illus¬ trations are given, to prove that the be¬ nefit so frequently derived from a visit to some favourite spring or bath, is not to be attributed so entirely as many imagine, to the change of scene and re¬ creation attending the employment. And among other arguments used by Mr. Lee, is the occasional instinctive preference for the particular waters dis¬ played by the lower animals. Thus, Alibert says, “ It is a known fact that at Vichy, in the month of April, the pe¬ riod when the snow melts on the moun¬ tains, when the wind has passed over the springs from the direction of Puy de Dome, and has carried the vapour to distances more or less considerable, the ruminating animals on the left bank of the Allier swim across the river to come and drink with avidity at the springs of the establishment: the waters are then fit for use, and the people of the country are in the habit of saying the season has commenced, the beasts have passed across — les betes out passes The above anecdote will probably bring to the minds of our readers the legend of Bladud, who was led by his swine to the discovery of the springs at Bath. Mineral spring's owe their impregna¬ tion either to fixed or volatile ingre¬ dients, and some of the most celebrated yield but a very small portion of solid matter on being' subjected to analyses. Thus Wildbad yields only 1 gr. in six¬ teen ounces of water, Gastein 1|- gr., and Pfeffers 2| grs., while on the other hand Pullna yields as much as 182 grs., Saydscbutz 160 grs., and Seidlitz 126 grs. In some the gaseous parts are merely suspended in the water, and consequently escape very rapidly after it is drawn. This occurs at Hartfell, Cheltenham, and Tunbridge, where, as at Seltzer, Pyrmont, Spa, and some others, the gaseous constituents are inti¬ mately blended with the fluid. This accounts for the great difference in the degree to which various waters are affected by exportation. It is obvious that mineral waters are sometimes of the alterative class. Their action is chiefly evinced by increase of the secretionary functions, and it is asserted that more benefit is often deriv¬ ed from them when their effects are insen¬ sible at the time. Nay, Dr. Kreyrig in¬ forms us that a cure is not unfrequently preceded by augmented indisposition, the excretions being diminished, the face becoming' flushed, the pulse strong, and the sleep disturbed. After a fort- nigbtor three weeks, a crisis supervenes, generally in the shape of purging, which is followed by immediate relief. For the history of particular Springs, we must refer to the work itself, which, embracing' an account of the chief wa¬ tering places, both at home and abroad, will be found a useful manual, either by the physician, or the invalid travelling for his health. MEDICAL GAZETTE. Saturday , November 19, 1836. •• Licet omnibus, licet etiam mihl, dignitatem Artis Medicce tueri; potestas modo venieudi in publicum sit, dicendi periculum nonrecuso.” Cicero. MEDICAL WITNESSES’ BILL. LEGISLATION EXTRAORDINARY. The representative of Finsbury has, ere this, we fancy, found out that it is one thing to push a short bill through its stag'es so as to have it made a law, and another to make that law work. It may happen that the object of the law is ridiculous and absurd — as when some one got a bill passed to prevent the cry of 6. Describe the structure of the exoge¬ nous and endogenous stem. 278 ANNUAL PRIZES OF THE SOCIETY OF APOTHECARIES. 7. Explain Du Petit Thouars’ theory on the formation of wood, and shew that it is equally applicable to endogens and exogens. 8. Where are the secretions of exogens chiefly deposited ? 9. At what period are the secretions of herbaceous plants in the greatest perfec¬ tion ? 10. What is the nature of stipules } 1 1. Are there any orders which are dis¬ tinguished by the form, presence, or ab¬ sence of them ? 12. What are bracts ? State their va¬ rious kinds. 13. Explain the following terms: — Spike, rac&me, amentum, spadix, corymb, umbel, fascicle, capitulum, panicle, cyme. 14. Give examples of the following kinds of leaves: — The veinless, straight- veined, curve- veined, netted, ribbed, hid¬ den-veined. 15. Are there any orders which are dis¬ tinguished by the venation of their leaves? 16. State the use of leaves. 17. What functions are performed by the cuticle and stomata, and why are these organs wanting in submerged leaves ? 18. Name any closely allied orders which are distinguished by the number of cells in the anther. 19. Describe the structure of the pistil. 20. Give examples in proof of floral or¬ gans being derived from modifications of leaves. 21. What are the conditions necessary for the germination of a seed, and the che¬ mical and physical phenomena accompa¬ nying that process ? 22. Are there any closely allied orders which are distinguished by the milkiness of the sap ? 23. Explain Dutrochet’s theory of the motions of fluids in plants, and by this theory account for the dispersion of the seeds of Momordica Elaterium. 24. The fruit of Convolvulus, and C. major, has a descending direction, that of C. sepium an ascending. How do phy¬ siologists account for this ? 25. Define the following terms: conicus, conoideus, cylindricus, tubulosus, ovoi- deus, ovalis, ovatus, filiformis, capillaris, ringens, labiatus, subulatus, acerosus, truncatus, prsemorsus. 26. State briefly the artificial system of Linnaeus. 27. Give the essential characters of the primary divisions of plants, according to natural affinities. 28. Translate the following passage, and name the author. “Classes, quo magis naturales, eo, caeteris paribus, praestantiores sunt. Affines convenient habitu, nascendi modo, proprietatibus, vi- ribus, usu. Summorum Botanicorum ho- diernus labor in his sudat, et desudare de- cet. Methodus Naturalis hinc ultimus finis Botanices est, et erit.” 29. It is said that plants exhibit a cor¬ responding agreement in structure, and medical or chemical properties. Are there any orders which offer no exceptions to this rule ? 30. What is the character of Ranuncu- laceaa, and how are they distinguished from Dilleniace®, Magnoliacete, Papave- raceae, and Nympheaceae ? 31. How are Proteaceae distinguished from the orders to which they are most nearly allied ? 32. How are Lobeliacem distinguished from Campanulaceae, and Urtieaceae from Artocarpeaa ? Refer to their proper places in the natu¬ ral system, the following plants. 33. Raphiolepis Indica. 34. Cluytia pulchella. 35. Aralia sambucifolia. 36. Olea capensis. 37. A species of Muralta. 38. Trachymene lanceolata. 39. Escallonia rubra. 40. Iberis Gibraltaica *. Each of these questions was valued by a certain number of marks, the total value of the whole series of questions being estimated at 1 1 10 marks. The gentleman (Mr. Jenner) to whom the gold medal was adjudged, obtained 965 marks, while the gainer of the silver medal (Mr. Teggemeir) had 925. The answers of three other cam di dates were so excellent, that Mr. Ward considered they were entitled to some mark of approbation, but as the meeting on Tuesday was not competent to give this, the motto papers were not then opened, and consequently the names of these three gentlemen are at present un¬ known. The number of marks gained by the first of the unsuccessful competitors was 885. Mr. Ward read over to the meeting the answers of several of the candidates to three or four of his questions; and it is hut justice to the competitors to say, that they were excellent : and judging from these specimens, we have no hesitation in saying the successful candidates well de served the prizes they gained. * These plants were, of course, given to the candidates unnamed. SIR B, C. BRODIE ON LOCAL HYSTERICAL AFFECTIONS. 279 LECTURES ON LOCAL HYSTERICAL AFFEC¬ TIONS, Delivered in the Medical Theatre of St. George' $ Hospital , By Sir B. C. Brodie, Bart. F.R.S. Lecture III. Pathology of Hysteria— Result of Dissections — Treatment of Local Hysteria — Prevention of the Disease — I'f 'ect oj Tonics — Local appli¬ cations — Division of Nei'ves— Other opera¬ tions — Concluding caution. Although the examples of local hysterical affections which I have adduced in the two preceding lectures, form only a part of those which you will meet with in prac- tice, they are probably sufficient to answer the purpose of rendering you less liable than you would have been otherwise, to fall into the very common error of con¬ founding cases of this description with those of real local disease. This is the principal object which I have had in view', in directing your attention to this subject : but it is one of much interest, and I am unwilling that you should leave it without proceeding somewhat further in the in¬ quiries to which it leads. In the present lecture, then, I propose to offer some ob¬ servations on the pathology of these cases, and on the treatment which should be em¬ ployed for their relief. Pathology of Hysteria. Probably the following question has al¬ ready presented itself to your minds. Is there any sufficient evidence that symp¬ toms so various and dissimilar as s one of those which have been described, depend on one and the same cause? Are there good grounds for the hypothesis that a pain in the knee in one case, retention of urine in a second, tympanitis in a third, are only different manifestations of one and the same disease, and that they are connected with the same state of system as that which gives rise to the common fits of hysteria? The same question may arise if you refer to Sydenham’s observa¬ tions on hysteria, in which he has endea¬ voured to point out the symptoms which may mislead the medical, as I (following him baud passibus crquis) have now endea¬ voured to point out those which may mis¬ lead the surgical, practitioner. To this it may be answered, that there is scarcely a single case, such as I have endeavoured to describe, in which, if you have the op¬ portunity of studying its history and pro¬ gress, you will not find abundant proof of the patient having suflered, in a greater or less degree, from the ordinary and acknow¬ ledged symptoms of hysteria : the two or¬ ders of symptoms sometimes existing si¬ multaneously — at other times, and more frequently, alternating with each other ; and thus even a limited experience will enable you to satisfy your minds on the subject. But when you have attained an enlarged experience in your profession, you will find that it affords you evidence of another kind, though of such a nature that one individual cannot well communi¬ cate it to another, either in a lecture or writing. You will then find, that while no two of these cases are precisely and in all respects alike, it is by no means difficult to trace a series of cases leading from one to the other by an almost imperceptible gradation, and con¬ necting with each other symptoms which, in the first instance, might be regarded as the most distant and heterogeneous. Another question cannot fail to arise in the progress of these investigations. What is the real nature of the disease on which these various and anomalous symptoms depend ? We cannot doubt that ‘its loca¬ lity is in the nervous system. This is suf¬ ficiently demonstrated by the characters of the symptoms themselves. Dissection, which illuminates so many of the darkest regions of pathology, affords us little as¬ sistance here: at least we derive from it only negative information. I have, in several instances, examined the parts to which hysterical pains had been referred ; and in one very aggravated case of the kind, I made a careful dissection of all the nerves by which they were supplied, but T have never been able to discover in them any thing different from what be¬ longed to their natural condition. But every part of the body has its correspond¬ ing point in the brain, and the greater number of them have their corresponding points in the spinal cord also. Does the examination of these organs lead to any more satisfactory result ? The best proof that it does not do so is furnished by the following circumstance : although so many die of other diseases, who have suflered from hysteria also, and the opportunities ot examining the bodies of hysterical pa¬ tients after death are therefore sufficiently numerous, yet the works of the best mor¬ bid anatomists contain no observations whatever on the subject. I have had the opportunity of instituting post-mortem ex¬ aminations in three cases, in which the hysterical affections were of so aggravated a kind as to be, directly or indirectly, the cause of death ; and you shall know the result. In one of them, the patient la¬ boured under a very severe hysterical pain in the side, and w as liable, among various other hysterical symptoms, to fits, in which 280 SIR B. C. BRODIE’s LECTURES ON she was scarcely conscious of her own ac¬ tions. It must have been in one of these attacks that a great number of needles were introduced into one of her legs, which afterwards occasioned much inflammation and effusion of serum into the cellular texture. The patient died, and the body was most carefully examined, but no mor¬ bid appearances of any kind could be dis¬ covered in it, except what belonged to the cedematous state of the leg. Another case is one to which T have referred already, in which, the patient having long laboured under an hysterical retention of urine, the bladder was found enormously distended, of a black colour, the mucous membrane and muscular tunic being at the same time much attenuated. This patient was an unmarried female, twenty nine years of age. Having been previously indisposed for a considerable time, she was supposed to have sprained her wrist in lifting a heavy saucepan. From this time she was never free from pain, referred to the outer part of the lower extremity of the radius. The pain extended up the fore arm, and downwards on the side. In November, 1814, about a month after the occurrence of the accident, she was admitted into the hospital. At this time the most careful examination could detect no alteration in the appearance of the limb, but she com¬ plained of a constant and intense pain, which extended from the supposed seat of the injury downwards to the fingers, up¬ wards to the shoulder, and again down¬ wards to the spine and sternum. She had great oppression and difficulty of respiration, occasional twitches of the muscles of the face, and any sudden mo¬ tion of the hand aggravated all these symp¬ toms, and then threw her into a state ap¬ proaching to that of syncope ; in which she was almost unconscious of all that happened, lying with her eyes wide open, and at last recovering with an hysterical sobbing. Her pulse was feeble, beating 120 times in a minute. Forty ounces of urine were drawn off from the bladder, but without any relief as to the other symptoms. The tongue became black and dry ; the pulse more feeble ; the belly tympanitic ; the alvine evacuations being of a dark colour. Then there was hic¬ cough and vomiting; she became weaker and weaker, and died after the lapse of 14 days from the time of her admission into the hospital. After death, the brain and the thoracic and abdominal viscera were very carefully examined, but no mor¬ bid appearances were discovered in any one of them, with the exception of the pe¬ culiar condition of the bladder which wots described formerly, and two ulcers of the mucous membrane of the ileum , each not more than half an inch in length, but oc¬ cupying almost the entire circumference of the intestine. The female, who was the subject of the third ease had laboured under a paralytic affection of the lower limbs ( paraplegia ), which Dr. Seymour believed, with good reason, to be connected with, and the con¬ sequence of, hysteria. A practitioner whom she consulted, however, thought it advisable to have recourse to repeated blood-letting and other methods of deple¬ tion- The result was, the formation of ex¬ tensive sloughs of the nates and of the soft parts covering the ankles. The patient was now admitted into the hospital, in a state of great exhaustion, and soon after¬ wards died. The brain and spinal cord were most carefully examined, in the pre¬ sence of many of you who are now' pre¬ sent, but it could not be discovered that they differed, in the smallest degree, from their natural condition; nor were there any signs of disease in the thoracic or ab¬ dominal viscera. In adducing these facts, how'ever, I by no means intend to assert that the organi¬ zation of the nervous system, in a person who is liable to aggravated hysterical af¬ fections, differs in no respect from that of another. The intimate structure of the brain, spinal cord, and nerves, is on too mi¬ nute a scale for our senses to be able to per¬ ceive and comprehend it, and of course there may be differences in the organization of these organs which our senses are incapable of detecting also. Thereis, it is true, nothing in the history of hysteria to justify the opinion that it is connected with any mor¬ bid growth, or morbid change of structure, such as wTe find to exist in what are usually termed organic diseases : but it is easy to suppose, without reference to organic dis¬ ease, that the construction of the nervous system, at the period when growth is con¬ cluded, may not be the same in all indivi¬ duals, and that an imperfect development of it may lay the foundation of all the ag¬ gravated hysterical affections. It seems to me that this hypothesis affords a reasonable explanation of all the phenomena w hich those strange diseases present to our ob¬ servation, and that it is not easy to ex¬ plain them in any other manner. This being admitted, the connexion of hysteria with the habits of early life, while growth is going on, becomes no mystery. We can understand, also, wherefore it is tha.t the disposition is often, to a certain degree, hereditary — that it prevails in particular families, and that having been onee esta¬ blished in the system, it is never totally eradicated. Nor is this opinion in any way contradicted by the circumstance of hysterical symptoms alternating with longer or shorter intervals of perfect health. It is the same with many other LOCAL HYSTERICAL AFFECTIONS. 281 nervous diseases, some of which are much more formidable than these. The lunatic has intervals in which his delusions vanish. A tumor pressing on the brain may occa¬ sion epilepsy : the cause exists always, but after the patient has had one fit, weeks or months may elapse before he has ano¬ ther. In like manner a patient may have a nervous system so constructed as to ren¬ der her liable to attacks of hysteria. While she is strong and healthy in other respects, no hysterical symptoms arise ; but if she be weakened by an attack of fever, by loss of blood, by too great exer¬ tion of mind and body, or depressed by anxiety, grief, or disappointment, the disease is rendered manifest, and it as¬ sumes one form or another, accordingly as accident directs its influence to one or another part of the system. This view of the origin and nature of hysterical affections derives some confir¬ mation from a circumstance which I have had frequent occasion to observe; al¬ though it has not, as far as I know, been noticed by pathological writers. In those who are much disposed to them, there is an evident weakness and laxity of the tissues, independently of what may be supposed to belong to the tissues of the nervous sys¬ tem. Thus there is a peculiar looseness of the joints; sometimes existing to such an extent that they are liable to a kind of subluxation (a slipping in and out, as the patient terms it), without any laceration of the synovial membrane or ligaments. I have known several cases in which a pa¬ tient, on making some sudden exertion, has experienced a sensation as if some muscular or ligamentous fibres had given way; and, in some instances, a severe ner¬ vous pain, referred to this and the neigh¬ bouring parts, has remained for a long time afterwards. It is not unusual for the smaller blood-vessels to burst, so as to oc¬ casion slight haemorrhage; although there is no actual disease in the bleeding part. This occurs most frequently with respect to the vessels of the mucous membranes. The disposition to haemorrhage, how¬ ever, is not peculiar to these textures. In a patient concerning whom I was con¬ sulted with Mr. Mawdslev, there had been repeated haemorrhages from the ears. These things must be regarded as indi¬ cations of want of physical power in the system, and such is the prevailing charac¬ ter of hysterical disease — most distinctly marked, of course, in the most aggravated cases of the kind. A large proportion of hysterical patients suffer from cold hands and feet, have a feeble contracted pulse, a small appetite lor food, and are wearied by very small exertions; they are more liable than other persons to lateral cur¬ vature of the spine. In some instances, and more especially in the parts which are most exposed to the external tem¬ perature, or at the greatest distance from the vital organs, the point of the nose, for example, and the ankles, the circulation is so weak that they assume at times a purple appearance, followed by vesications, and even by a thin slough. These last-mentioned symptoms are, in themselves, a proof of an insufficient gene¬ ration of nervous energy; they correspond to what is observed after severe injuries of the spinal cord, as well as to what occurred in the following cases, as the consequence of an injury of a nerve. A young man met with an accident, in which the ulnar nerve was divided behind the inner con¬ dyle of the arm. The wound healed rea¬ dily ; but when I was consulted, about three months afterwards, the little finger was cold, and deprived of sensation, with purple spots on it, similar to those which precede the formation of vesications. A girl wms admitted some years ago into the hospital after a similar accident. The little finger was cold and benumbed, and occasionally the whole of the integuments covering it assumed a dark purple colour : this wras always followed by a broad vesi¬ cation ; then by a superficial sore, which, however, healed by the formation of a new cuticle ; and this process was repeated se¬ veral times w'hile the girl remained in the hospital. Treatment of Local Hysterical Affections. In some instances the disposition to hysteria manifestly depends on an original mal-construction of the nervous system, which probably has been transmitted from the parent to the child: in others it is equally manifest that it is the result of injudicious management in the early part of life. In the latter order of cases, the ill consequences, w'hieh would otherwise en sue, may be altogether averted by the timely adoption of a better system of edu¬ cation; and in the former, much may be done in the interval between the period of infancy and that of growth being com¬ pleted, to improve the condition of the individual, and to render her situation in after-life less distressing than it would be otherwise. You can render no more essential ser¬ vice to the more affluent classes of so¬ ciety, than by availing yourselves of every opportunity of explaining to those among them wrho are parents, how much the ordi¬ nary system of education tends to engender the disposition to these diseases among their female children. If you would go further, so as to make them understand in what their error consists — what they ought 282 SIR B. C. BRODIE’s LECTURES ON to do, and what they ought to leave un¬ done, you need only point out the dif¬ ference between the plans usually pursued in the bringing up of the two sexes. The boys are sent at an early age to school, where a large portion of their time is passed in taking exercise in the open air; while their sisters are confined to heated rooms, taking little exercise out of doors, and often none at all, except in a carriage. Then, for the most part, the latter spend much more of their time in actual study than the former. The mind is over-edu¬ cated at the expense of the physical struc¬ ture, and, after all, with little advantage to the mind itself; for who can doubt that the principal object of this part of educa¬ tion ought to be, not so much to fill the mind with knowledge, as to train it to a right exercise of its intellectual and moral faculties, or that, other things being the same, this is more easily accomplished in those, whose animal functions are pre¬ served in a healthy state, than it is in others ? But these observations relate only to measures of prevention ; whereas, in prac¬ tice, you will have to deal with cases in which the hysterical construction of the nervous system already exists. The medical treatment of hysteria is in the department of the physician ; and as this subject is treated of at length in the lectures on the practice of medicine, I shall only offer a few observations as to the principles in which it should be con¬ ducted. In those in whom the liability to hyste¬ rical diseases exists, as I have already had occasion to observe, the symptoms of hys¬ teria are not always present, and much may be done by art towards rendering their occurrence less frequent, and their charac¬ ter less severe, than would be the ease other¬ wise. These symptoms are especially called into existence whenever, from any cause, the bodily powers are reduced below the ordinary standard ; and it is reasonable to suppose that an opposite effect will be pro¬ duced by whatever tends to elevate these powers, and maintain the general health. The whole class of tonic remedies, espe¬ cially steel, quinine, sulphate of zinc, and ammonia, may, under certain circum¬ stances, be employed with advantage. So also, it is of importance that the patient should live on a generous diet — that she should take exercise out of doors — that she should live in the pure air of the country rather than in that of a crowded city — and that her mind should be agreeably occu¬ pied, without being exhausted by great exertions. Nothing tends more to aggra¬ vate the disposition to hysteria than the tedium and ennui of a life without occu¬ pation ; when the mind is, as it were, thrown back upon itself, brooding over imaginary misfortunes, ,and creating for itself objects of anxiety. The use of what are usually called anti spasmodic remedies, especially valerian and assafoetida, is indicated, not where there is merely a liability to hysterical symptoms, butVhere these symptoms are actually present. Those tonics which are useful in preventing these symptoms, are useful in the removal of them also, espe¬ cially where the disease assumes a chronic form, as it generally does in the cases which fall under the observation of the surgeon. Here, also, I have in several in¬ stances known much advantage to arise from a long-continued course of the sul¬ phate of copper administered in pills, in small doses. Nor must we overlook ano¬ ther important rule of practice. There is often some particular circumstance in the state of the system at the time, which operates as the immediate exciting cause of the hysterical symptoms, and which medicine may remove. For example, in one individual there may be a furred tongue, and a costive state of the bowels ; in another deficient menstruation ; and purgatives and emmenagogues may be ad¬ ministered with advantage, either sepa¬ rately or in combination. Again, it is not unusual in aggravated cases of hysteria to find the urine depositing a large quantity of litliie acid, in the form of sand ; or the urine may be voided high-coloured, depo¬ siting a pink amorphous sediment., abound¬ ing in the lithate of ammonia; and in either of these cases the exhibition of al¬ kalies, combined with alterative doses of mercury, and a regulated diet, will contri¬ bute to produce a cure, the unhealthy qua¬ lity of the urine seeming to be the cause rather than the effect of the hysterical affection. On all these points I refer you to the instructions which you will receive from some of your other teachers; but there are some questions connected with the surgi¬ cal treatment of local hysterical affections, into the consideration of which I shall feel it my duty to enter more fully; al¬ though, in so doing, the advice which I shall have to give you will be for the most part of a negative kind, relating not so much to what you ought to do, as to what you ought to leave undone. Hysterical pains are sometimes relieved by friction with a stimulating liniment — such, for example, as the compound cam¬ phor liniment, which may also he used in combination with the tincture of opium. The application of the belladonna plaster is occasionally useful, although it certainly LOCAL HYSTERICAL AFFECTIONS. 283 does not produce those remarkable effects which not unfrequently follow its use in other cases of neuralgia. Hysterical pains are sometimes palliated by bathing the affected part with the following lotion, applied tepid : — R Misturae Camphora?, ^iss. ; Spiritus Rosmarini, Jiss. M. fiat lotio. In some instances the patients derive advantage from the exposure of the part to the vapour of hot water. This is espe¬ cially useful in the cases of that peculiar affection of the wrist and hand which I described in the last lecture. In those cases in which the limb to which the symptoms are referred is affect¬ ed alternately with heat and cold, I have known the following plan of treatment to be attended with excellent effects. Dur¬ ing what may be termed the hot fit, let a compress be applied wet with a cold spi¬ rituous lotion ; and when the heat has subsided, and the limb has become cold, let a thick woollen stocking be drawn over it, and then an oiled silk covering over the worsted stocking, so as to confine the heat and perspiration. When the cold fit. has subsided, the oiled silk covering may be removed. This local treatment, however, should be combined with the exhibition of the sulphate of quinine, the use of which seems to be especially indicated by the in¬ termitting character of the symptoms. In some cases of hysterical neuralgia the patient is supposed to derive benefit from the abstraction of blood by leeches, or cupping, or even by venesection. In¬ deed, I have no doubt that the loss of blood is occasionally followed by a real alleviation of pain. But the relief is never otherwise than temporary; and wherever I have known this kind of treatment to be frequently resorted to, the ultimate result has been, certainly, not only not beneficial, but absolutely injurious to the patient. In fact, we may lay it down as a general rule, that whatever lessens the physical powers tends to prolong the duration of hysterical diseases of all kinds ; and no¬ thing produces this effect in a more mark¬ ed manner than repeated blood-letting. Those who are subjected to this treat¬ ment, according to my experience, become almost invariably invalids for life ; and I have no doubt that not unfrequently their lives are materially shortened by it. Blisters, issues, and the whole class of counter-irritants, in the majority of cases increase the patient’s sufferings; and there is one objection that may be urged against all local remedies, which applies especially to these, namely, that they prevent the attention being abstracted from the local symptoms. I may take this opportunity of observing, that nothing is more essen¬ tial to the patient’s recovery than that her mind should not be constantly occupied with the subject of her ailments. The treatment employed should be such as will involve as little as possible deviation from the ordinary habits of life. Thus in a ease of hysterical neuralgia of the knee or hip, it seldom happens that any real amendment takes place while the patient remains confined as an invalid to her sofa. The pain may abate, but a sense of weakness follows, which disables her from walking, more than the pain itself, and which, for obvious reasons, goes on in¬ creasing in proportion as the confinement is of longer duration. The first step to¬ wards a cure is, that the patient should have sufficient strength of mind to begin to use the limb in spite of present suf¬ fering. Another question connected with surgi¬ cal practice remains to be considered. In hysterical diseases affecting the extre¬ mities, will any advantage arise from the division of the nerves which supply the affected part, so as to destroy the commu¬ nication between it and the sensorium > or from the entire removal of the part itself, by excision or amputation ? If the view which I have been led to take of these affections, namely, that they belong to the nervous system generally, and not to the part to which the symptoms are re¬ ferred, has any foundation in reality, it cannot be expected that such operations will lead to any good result: and the no¬ torious failure of similar operations, when performed in cases of tic douloureux of the face, and tetanus, undoubtedly tends to confirm this opinion as to their utter inu¬ tility. Pathological science, however, is not so far advanced as to authorize us in any instance to disregard the lessons of experience; and it is well, before we arrive at a positive conclusion on the sub¬ ject, that we should refer to this higher source of instruction. In a case which I have already men¬ tioned, of a young lady who had a train of most severe hysterical symptoms follow¬ ing the accidental prick of her finger, I was induced (many years ago) to divide the digital nerves. This was effected by a circular incision, carefully performed, ex¬ tending through the whole of the nerves, in . teguments, vessels, and cellular texture, to the bones laterally, and to the aponeu¬ roses of the tendons, anteriorly and poste¬ riorly. The result was, that the patient’s sufferings were aggravated rather than relieved. As long ago as the [year 1818, I was requested to visit a lady in the country on account of a disease of the knee. I 284 SIR B. C, BRODIE’s LECTURES ON was led to believe that she had laboured under an inflammation of the syno¬ vial membrane, which had in a great degree subsided, but that the harder textures had suffered in consequence, and that the cartilages were in danger of being ulcerated, and I recommended a plan of treatment accordingly. Whether, with mv present experience on the subject, I should have taken the same view of her case, 1 will not undertake to say, but the result was, that a material improvement took place in the first instance. After some time, how¬ ever, there was a manifest aggravation of all her symptoms. She suffered more than ever ; so that she became anxious to undergo the amputation of the limb. I was now again consulted respecting her, but from the written accounts which I re¬ ceived, I concluded that the pain did not indicate the existence of any serious dis¬ ease, and that the circumstances of the case did not justify so violent a mea¬ sure as had been proposed. However, her wishes remained unaltered, and two sur¬ geons of eminence in the country yielding to her entreaties, performed the opera¬ tion. On dissection of the amputated joint, they were surprised to find that there was no collection of matter in its cavity — that the cartilages had disap¬ peared in one spot, of very limited extent . — and that there was no other mischief. The stump healed readily enough, but she obtained no relief I had the opportunity of seeing her some months after the opera¬ tion, suffering more than ever, with in¬ tense pain in the stump, and violent con-. vulsive action of the muscles which move the thigh bone on the pelvis. • Mr. Soclen, of Bath, informed me of another of these cases, which fell under his observation, in which also the limb was amputated above the knee, but with no better result than in the case last men¬ tioned. The symptoms attacked the stump, and the patient suffered as much after the operation as she had done before. The history of a third case of the same kind has been published by Mr. Mayo, in his Outlines of Pathology. The knee was amputated, and the stump healed. Soon after, the stump was accidentally struck, and this slight accident was followed by pain in the part, exactly similar to that which had been referred formerly to the knee. Amputation was then performed a second time; but as the wound healed, the pain recurred, being now referred to the stump. Mr. Mayo then divided the sciatic nerve, below the edge of the glut a. us maximus muscle. At first the pain was supposed to have been relieved, as after the former operations; but it return¬ ed on the wound being healed. At tin's period I had the opportunity of seeing the patient, the pain which she endured being as severe as ever. In short, she had under¬ gone these various operations, without having derived the smallest advantage from any one of them. It must be acknowledged that these, and other similar cases which might be enume¬ rated, seem to be quite conclusive against all attempts to relieve these hysterical affections by operation. Some evidence, however, may, and has been, adduejd, on the other side of the question. A young woman was bled in the arm, in July, 1820. The wound healed as usual, but on the 7th of August she was admitted into St. George’s hospital labouring under hysterical pain, referred chiefly to the cicatrix, but extending also downwards to the hand, upwards to the axilla, and again downwards on the side to the leg and foot, the latter being at the same time in a great degree benumbed. The whole of the arm was cold, and of a purple colour, and the skin was exquisitely sensible when pinched. On the 25th of August I ex¬ cised the cicatrix. She was supposed to be immediately relieved, and when the wound made in the operation was healed, she left the hospital as cured. So far, then, it appeared as if the operation had been successful. But observe what hap¬ pened afterwards. At the expiration of two months, she was re admitted, not on account of a recurrence of the pain in the arm, but with other symptoms depending on the same state of the general system. The nose was cold, and of a purple colour, and there Mas a similar condition of the integuments of the ankle. On the latter there was a broad vesication ; and both of these parts seemed as if on the point of becoming gangrenous. This result, how¬ ever, did not take place, and I lost sight of the patient some time afterwards. In Mr. Mayo’s patient*, whose case I have already mentioned, we are informed that he afterwards was induced to perform a further operation — removing the head of the thigh bone from the acetabulum : and I have a letter from Mr. Mayo, in which he states that this last measure has been followed by a relief from pain up to the present time. We are also informed that Sir Astley Cooperf amputated the arm at the shoulder joint, on account of a neuralgic affection of a stump, and that the patient was permanently cured; and that similar operations were performed successfully by Mr. Bransby Cooper and Mr. Langstaff. However, until w e know more of these cases than is * Medical Gazette, May 7, 1836. t Op. cit. LOCAL HYSTERICAL AFFECTIONS. 285 now recorded, it is impossible for ns to de¬ termine whether they did or did not belong to tbe class of hysterical affections. Even if they did, the question still remains — how long did the patients remain under the observation of the surgeons afterwards; and was a cure really obtained, or was there simply a commutation of one hys¬ terical affection for another? In estimating the value, not only of such operations, but of various other inodes of treatment which have been supposed at one time or another to be useful in cases of aggravated hysteria, we are never to lose sight of the following circumstances. 1. Hysterical symptoms frequently disappear at once , without any manifest cause for their dis- appearance. Examples of this fact may be found among the cases to which 1 have had occasion to refer in the preceding lec¬ tures. A young lady, who had been for more than two years confined to her bed on account of an hysterical affection simu¬ lating disease of the hip joint, recovered suddenly one night while in the act of turning in bed. Another young lady, in whom a long train of most severe hysteri¬ cal symptoms followed an accidental prick of one of her fingers, after the disease had existed for a great length of time (if I am not much mistaken, for more than two years), recovered suddenly, also. 2. It still more frequently happens that recovery from hystei'lcal symptoms immediately follows a forci¬ ble impression of any kind made on the nervous sustem. A young lady, who had long laboured under an hysterical neuralgia of the hip and thigh, and had been unable to walk, or even to stand, in consequence, lost all her symptoms on being thrown from a donkey which she was riding. This case also has been already noticed; and the following are only a few, among many bthers, which might be adduced, if it were necessary, to illustrate the same principle, shewing that moral and physical impressions are in this respect alike, and capable of producing exactly the same effect. Many years ago, I attended a young lady on account of a painful affection of the instep, which I certainly did not un¬ derstand at the time, but of which, with mv present experience on these subjects, I am satisfied that it was hysterical neu¬ ralgia, and nothing else. She was at¬ tended by other surgeons afterwards, who, 1 believe, were as much perplexed as I was as to the nature of the disease, and who, at all events, gave her no relief. At last, while suffering as much as ever, she ■was informed of some remarkable cures obtained bv the use of the vapour- bath, and champooing, and she immediately went to Brighton, that she might make a trial of these remedies. The first champoo¬ ing gave her great relief ; the second com¬ pleted the cure. I was consulted respect¬ ing her afterwards, labouring under a nervous affection of the arm and forearm. I have been informed, on good authority, of the case of a young lady, who had long laboured under a severe hysterical affection, attended with spasmodic contraction of the muscles of one of the lower limbs, and whose symptoms left her suddenly on the extraction of a molar tooth. In the Christian Observer for November, 1830, we find recorded the history of Miss Fancourt, who had long been confined to her couch, in consequence of what was evidently an hysterical affection simulating disease of the hip joint, and was supposed to have been miraculously cured under the influence of the prayers of her spiritual adviser, leaving her couch at once, and walking down to supper, to the astonish¬ ment of her family. We need not pursue this part of our in¬ quiries further. To you who will soon be engaged in the practice of your profession, what I have now stated will be sufficient to impress your minds with a proper de¬ gree of scepticism, and to prevent you being misled by the caprices of these strange disorders. With respect to the great majority of society, who do not know by experience how great is the difficulty of obtaining exact evidenceas to the operation even of the remedies in common use, and whose minds are not trained to these in¬ vestigations, I feel that it would be almost a waste of time to endeavour to enlighten them on the subject. “ So ardently,” says a distinguished moral philosopher*, “ do we desire to find every thing that happens within our observation thus con¬ nected with something eke, as its cau^e or occasion, that wre are apt to fancy con¬ nexions upon the slightest grounds ;^and this weakness is most remarkable in the ignorant, who know least of the several connexions established in nature. * * * * Many years ago a white ox was brought into the country, of so enormous a size that people came many miles to see him. There happened afterwards an uncommon fatality among women in child-bearing. Two such uncommon events following one another gave a suspicion of their con¬ nexion, and occasioned a common opi¬ nion among the country people that the white ox was the cause of the fatality.” Many of the notions which the public en¬ tertain on subjects connected with the healing art, may be traced to the operation of the principle which has been thus ex- * Reid’s Inquiry into the Human Mind ; on the Principles of Common Sense. Chap. ii. sect. 9. 286 BUCKS MEDICAL ASSOCIATION. posed bv Dr. Reid. Conjurors of all kinds, from Prince Hohenlohe and the professors of animal magnetism, down to the most vulgar impostors, will never fail to share the reputation of curing diseases with those who have studied their profession as a science ; and it is especially in that class of cases to which I have called your atten¬ tion in this and the preceding lectures, that their success will be greatest. We must submit to this mortification. But let us at the same time be careful that there is nothing in our own conduct to en¬ courage such delusions. If we would lead the public to more correct views on those subjects, we must first endeavour to make them understand, in some degree, what our art is worth, and what it is not; and, in particular, we must divest ourselves of that morbid anxiety for reputation, which would |lead its to claim for ourselves the credit of our patient’s recovery, in those instances in which it must be manifest to a disinterested observer that it belongs to the ordinary course of events, to the efforts of the patient’s constitution, or to accidental circumstances, and not to our own skill and attention. Before I quit this subject, I shall trouble you with one further piece of advice. I have told you that it is important that you should not mistake cases of nervous affection for those of real local disease. It is equally important that you should not mistake the latter for the former. When¬ ever you are in doubt, be careful that you do not employ any kind of treatment which would be injurious if local disease existed. A short delay will always enable you to understand the exact nature of the case, so that you can no longer hesitate as to the remedies which are required for its relief. BUCKS MEDICAL ASSOCIATION, * DECLARATORY RESOLUTIONS, AND PETI¬ TION TO PARLIAMENT. To the Editor of the Medical Gazette. Sir, I have the honour to transmit to you an abstract of the minutes of a late meeting of the Bucks Medical Association, and a copy of a petition to both Houses of Par¬ liament, to be presented early next session, and am, sir, Your very obedient servant, Robt. Ceely, Hon. Sec . Aylesbury, Nov. 9, 1836. At a meeting* * of the Bucks Medical Association, held at the Infirmary in Ayles¬ bury, November 3, 1836, Henry Luplon, Esq. in the chair, it was resolved — That this meeting views, with the deep¬ est concern, the increased oppression and injustice inflicted on the medical profes¬ sion by the Poor-Law authorities; which, it is to be feared, if passively submitted to, will have a serious influence on its character and station. That the attempts of the Poor-Law Commissioners to induce the medical offi¬ cers of parochial unions to fill the subordi¬ nate office of district registrars of births, deaths, and marriages, is considered by this meeting to be another device for in¬ juring, insulting, and degrading the gene¬ ral practitioner. That the recent conduct of the Poor- Law Commissioners and their Secretary, towards Mr. Kingston, of St. Alban’s, abundantly manifests their readiness to visit on an individual, when convenient, that ob¬ loquy and reproach so eminently due to their scheme of medical relief, which, in spite of every remonstrance, they so perti¬ naciously maintain. That their professions of humane consi¬ deration for the necessities of the suffering poor, and of retributive justice towards those who neglect them, are proved to be insincere, by their allowing the treatment of the sick poor to be let by tender to the lowest bidder ; by their forcing medical practitioners, under severe penalties, to un¬ dertake duties which, from their nature and extent, are clearly impracticable; by their augmenting the difficulties and increasing the causes of delay in procuring medical aid ; and by their utter disregard of the many lamentable and even fatal conse¬ quences that have already ensued, and must inevitably recur, from the notorious insufficiency of their own arrangements. That, to secure a judicious distribution, and the proper performance, of medical duties, as well rs to furnish a competent tribunal for investigating the conduct of medical officers, it is essential that a me¬ dical board, as in the army and navy, should be appointed, to Superintend and control the medical department of the poor-law administration. That a petition, embodying the above sentiments, and praying for inquiry, be presented to both Houses of Parliament, early in the ensuing session. That this meeting recommends to the notice of the members of the Bucks Medi¬ cal Association, the circular lately issued by the Provincial Medical Association, for the purpose of collecting opinions as to the mode and amount of medico-parochial re¬ muneration. That it is highly desirable that medical practitioners should collect and arrange authentic facts relative to their complaints WOUND OF THE BRACHIAL ARTERY. 287 against the present system of medical re¬ lief, preparatory to the proceedings of the expected Parliamentary Committee of In¬ quiry. [Then follow two or three resolutions of thanks to individuals, &c.] The Petition of the undersigned Medical Prac¬ titioners , residing in the County of Bucks, humbly sheweth, That your petitioners deprecate the sys¬ tem of providing medical relief for the sick poor adopted by the Poor-Law Com¬ missioners. That the prevalence of contract by “ tender,” — the general inadequacy of the remuneration — the increased extent of districts, with a diminished and insuffi¬ cient supply of medical officers — the nu¬ merous impediments to an efficient per¬ formance of medical duties — and the in¬ dignities offered by the new authorities to medical practitioners— are productive of effects equally pernicious to the sick paupers, the medical profession, and the whole community. That a remuneration calculated to se¬ cure proper attendance ; a mode of ap¬ pointment not derogatory to the profes¬ sion ; regulations for the prompt supply of medical relief to the destitute sick ; and a general supervision and control of the me¬ dical department of the poor-law admi¬ nistration, by a Medical Board, are essen¬ tial to the interests and welfare of all par¬ ties concerned. Your petitioners, therefore, humbly but earnestly pray, that your Honourable House will speedily take this import¬ ant matter into serious consideration, by appointing a Committee of Inquiry, and enact such remedies as to your wisdom may seem fit. And your petitioners, as in duty bound, &c. &c. WOUND OF THE BRACHIAL ARTERY, Cured by Compression. By J. W. Heustis, M.D., of Mobile. On the night of the 27th of March, I was called to see a man that had been stabbed in the humerus : as I was not at home, my student, Mr. Carter, attended him, in company with Dr. Lynch H. Deas. We met in consultation a short time after¬ wards. The haemorrhage had ceased from syncope and loss of blood, and I found the patient perfectly blanched, and almost lifeless ; he was cold and nearly inanimate, with no perceptible pulse. The wound had been inflicted with a dirk, upon the inner side of the biceps, about six inches below the upper extremity of the humerus. I had previously experienced the efficacy of compression in wounds and aneurisms of the artery at the bend of the arm, of which an account may be found in a pre¬ ceding number of this journal. It was, therefore, adopted on the present occasion. A graduated compress was employed ; and some five or six pieces of money, from the size of a dime to that of twenty-five cents, were wrapped in a rag, and placed accu¬ rately on the wound : over this a larger compress was applied, extending five or six inches along the course of the artery, and the whole secured by a roller bandage. A bandage of the same description was next applied, with moderate tightness, from the hand upwards, and the patient left, for the present, to time and repose. The next morning he was better ; re¬ action had taken place, and the pulse in the opposite arm from the one wound- ed was quite perceptible, although no pulsation could be perceived in the other. On the third day, as he com¬ plained of pain from the tightness of the bandage, and as there was some tume¬ faction of the hand, the compression was slackened, and the pieces of money re¬ moved. The arm was still considerably swollen above the bandage, as it had been at first, where the bandage wras ap¬ plied, from the injection of blood between the muscles, and into the subcutaneous cellular substance. The compression, however, had caused this to be principally absorbed, so that w'here the compress had been applied, there was quite an indenta¬ tion. The wThole of the interior of the arm and forearm were much discoloured with ecchymosis, and tender to the touch. There was no subsequent disposition to haemorrhage from the wTounded artery, which healed up, together with the exter¬ nal orifice, by the first intention, and with¬ out the formation of any aneurismal tu¬ mor. The pulse, however, in the radial artery of the injured limb, is still scarcely perceptible, and has probably been ren¬ dered impervious at the wounded part. His arm retains its sensibility and motion; the man, howrever, still remains rather feeble and pallid, from his excessive loss of blood. From this and other instances which 1 have witnessed, I am inclined to think that ligatures are seldom necessary in wounds of the arteries of the extremities*. * American Journal of Medical Sciences, for August 1836. 288 BILLS OF MORTALITY. - METEOROLOGICAL JOURNAL. * SIR WILLIAM KNIGHTON. [We know neither whence, nor from whom, the following has been sent to us; but as it bears internal evidence of fidelity, we give it to our readers just as it has been given to us. — Ed. Gaz.J The Editor of the Medical Gazette should be informed that the late Sir Wil¬ liam Knighton left Tavistock to be with Dr. Geach, who was the surgeon of the Royal Naval Hospital. He was a physi¬ cian and accoucheur; and as this was be¬ fore the period of reform, so called, he had a great deal of country practice ; and to all his friends he introduced Mr. Knighton, saying, “ that he might be trusted ashim- seif, and that he had two advantages of which he wras deprived, youth and memo¬ ry.” Dr. Geach died suddenly; and al¬ though Mr. Knighton’s juvenile appear¬ ance made some of his patients at first demur, his manner was so prepossessing, that he soon became a general favourite. It was known how assiduously he studied ; he was never heard of at a ball or public dinner. In two or three particular cases he met with great success. He attended the daughter of a naval officer, in a dan¬ gerous fever, with unwearied assiduity : night after night, for nearly three weeks, he remained by the bed-side. The Admi¬ ral’s country residence was eight miles from Plymouth. During the day he was spared to see other patients; but at night he returned, when he was anxiously ex¬ pected. The child’s perfect recovery — the parents’ gratitude being first due to the blessing of God — was gratefully, and in every respect satisfactorily, acknowledged by them. The mother particularly, to a numerous acquaintance, spoke in raptures of Mr. Knighton : in short, the ladies made him the fashion, and it may be said the lords also ; for it was in the time of war, and there were many persons of con¬ sequence at Plymouth, in the militia re¬ giments, who had power to patronize him in London. He was exhorted to quit the West of England. He had many friends, who grieved to part with him, but all of judgment felt, that, had it been in their power, they would not have detained him. The difficulty that first attended his prac¬ tising in London has been detailed; I only trouble you because you passed over in silence the great era which, as I have said, had certainly much influence on the destiny of Sir William Knighton. I do not put any signature, for you know me not, nor do I know to whom I am writing. Nov. 4, 1836. PORTRAIT OF SIR B. BRODIE. To the Editor of the Medical Gazette . Sir, Portraits of Sir A. Cooper, Mr. Aber- nethy, and other individuals of distin¬ guished talents and superior merit, are in the hands of many of us; but, as far as I can learn, a likeness of Sir Benjamin Brodie has never yet appeared. It would give me great pleasure to add my mite to any subscription which might be set on foot to obtain one; and I am only sur¬ prised that, considering Sir Benjamin Brodie’s exalted station in the profession, and his truly estimable character, this compliment has not yet been paid him. With many apologies for trespassing on your valuable time, I am, sir, Your obedient servant, w. c. w. London, Nov. 16, 1836. [Our correspondent is evidently not aware that there is a print of Sir Benjamin, — • though certainly not a good one. — E. G.] NEW MEDICAL BOOKS. A Treatise on the Structure of the Ear, and on Deafness, by A. W. Webster. 8vo. Elementary System of Physiology, by J. Bostoek, M.D. 3d edit. 1 vol. 8vo. 20s. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Nov. 15, 1836. Abscess 1 Fever, Typhus 5 Age and Debility . 44 Gout . . . 2 Apoplexy . 9 Heart, diseased . 4 Asthma 12 Hooping Cough . .4 Cancer 1 Inflammation 31 Childbirth 1 Bowels & Stomach 5 Consumption . 52 Brain 2 Convulsions 29 Lungs and Pleura 7 Croup . 1 Liver, diseased , 13 Dentition or Teething- 7 Measles 6 Dropsy 18 Paralysis . . 4 Dropsy on the Brain 5 Small-pox . . 10 Epilepsy 1 Thrush 1 Erysipelas . 1 Unknown Causes 8 Fever 3 Fever, Scarlet 2 Casualties 6 Increase of Burials, as compared with the preceding week NOTICES. Mr. Crisp’s strictures have been re¬ ceived ; but we really must decline allow¬ ing the controversy to proceed any farther. Our correspondent from the London Hospital will see that his suggestion has been adopted. N. D. — We reply in the affirmative. “Hibernicus” has been received. Also “An Old Navy Surgeon.” Erratum. — In Dr. Burke’s paper, last number, p. 230, line 45, for half an ounce of laudanum, read half a drachm. Wilson & Son, Printers, 57, Skinner-St. London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOTOI1ML OF iWfiurme anU tfte Collateral ^firmest. SATURDAY, NOVEMBER 26, 1836. LECTURES ON FORENSIC MEDICINE; Delivered at the Aldevsgate School of Medicine , By William Cummin, M.D. Lecture IX. Medico-legal consideration of Impotence in the Female — Imperfect or anomalous structure — - Occlusion, constriction, or total absence of essential parts — Sterility , from deficiency of the Uterus— the Ovaries — Modes of ascertain¬ ing the fact of Impotence in France, Eng¬ land, Germany — Remarkable cases — Practi¬ cal suggestions. Having treated, in last lecture, on those conditions, physical and moral, which constitute impotence in the male — and having noticed (always, you will observe, with reference to the requirements of Forensic Medicine) those modifications which are recognized as belonging to sexual inability — we shall now proceed to consider the subject of IMPOTENCE IN THE FEMALE. The grounds of any alleged inability in the female to have sexual intercourse must be sought wholly in physical causes. (a.) Imperfect Development. Age. — As in the male, the effect of either immature or advanced age is such as to prevent the reproductive act in the female. The constriction of the vagina previous to the approach of puberty is usually such as to preclude the intro¬ duction ot the male organ; and so far there is decided impotence : while, with respect to very aged women, the rigidity of the parts may lead to the same result. 469. — xix. The time at which this incapacity ceases in the young, and begins in the old, is by no means fixed; but we can give a nearer guess at that epoch in the girl than in the old woman. Puberty commences in this country, with females, about the thirteenth or fourteenth year; but it depends greatly on constitutional habit, and modes of education : in other climates it is a good deal earlier, or a good deal later, ac¬ cording to the temperature. On the other hand, it is very uncertain when females cease to have an ability for sexual inter¬ course : they have continued to be prolific in some cases even to their fiftieth or fifty- fifth year. (b.) Anotnalous Structure. Occlusion. — The most obvious physical cause of impotence in the grown female would be occlusion of the vagina, from whatever cause. There was an ancient practice (and, indeed, travellers inform us it is still observed in some parts of Afri¬ ca) of preventing young women — slaves, for instance— from having connexion, by artificially producing this impediment. Inflammation, generally by the cautery, was excited in the labia, and the oppo¬ site surfaces were thus made to adhere: an operation afterwards being necessary before the generative act could be effected. There is a curious passage in the Menagiana on the subject, where it is said that this practice, familiarly termed boucler le f emmes — is what was really meant by some old authors, who treated de castrandis mulieribus. It resembled the infibulation of boys, and perhaps was more properly of that nature, when performed, as it sometimes was, by sutures, or by rings drawn through the parts, still further secured by a lock. I may refer to an erudite note in Beckmann (In¬ ventions and Discoveries, vol. iv.) where he treats on this point with his accustomed research, and traces the origin of the lock — the cadenat des jaloux, which some consi¬ der rather as an Italian than a French in- U 290 DR. CUMMIN ON FORENSIC MEDICINE. vention. Brantome says that they were not mueh employed in France, because the ladies soon found out how to muke false keys. And Bonneval tells us that, while in Italy, he once met with a lock of this kind, which he had long wished to see. One remark more may be made on infi - bulation : it was practised in this country at one time, to prevent cattle from copula¬ tion. In Harvey, De Generatione Animalium, we have an account of a beautiful mare which was presented to the Queen, and which was infibulated— “ ejus genitalia (ne ah equis admissariis inita, corporis gratiam atque equitandi usum amitteret) equisones, ut fieri solet, annulis ferreis infibulave- rant but she was impregnated, and brought forth young notwithstanding. But adhesion of the labia, causing at least temporary impotence, may occur in females from accidental inflammation; and such accidents are not uncommon in children. The hymen, also, may be of so tough a consistence as to defy any ordi¬ nary means of rupture. In all such cases, however, the assistance of surgery will re¬ move the impediment to sexual intercourse. Absence af a vagina. — The vagina is some¬ times altogether wanting, or in so ques¬ tionable a state as to preclude sexual in¬ tercourse. A remarkable example of this is to be found in a case quoted by Fodere, from the Causes cilebres. A female, aged 25, married ; but six years passed away, and there was no consummation. It was now deemed necessary that her person should be examined by a midwife, who declared, that instead of external sexual organs, there was nothing to be seen but a solid body pierced by a small hole. It further was ascertained that the woman had never menstruated : but she had always enjoyed good health, notwithstanding. M.Dejours, a surgeon, who was called in, supposing the case to be one of simple occlusion of the va¬ gina, proposed to divide the barrier, in hopes of reaching and laying open the cavity. He accordingly carried a scalpel to the depth of two fingers’ breadth, but instead of reaching a vagina, lie was still opposed by solid resisting parts. Finding this, he judged that he had nothing to hope for in going further, and that he should run great risk of wounding the bladder or rectum. He therefore contented himself with keeping open the wound by the introduction of tents, and this opening remained during life. Matters remained quiet for eight years, when the husband in disgust demanded a divorce : it was not granted — probably through the reporters holding out hopes of another operation being successful. The woman died at Lyons ten years afterwards, and on exami¬ nation it was found that the place of the vagina and uterus was occupied by a hard compact substance, in which no cavity could be traced. Dr. Beck cites, from the New York Medical and Physical Journal, a recent, and perhaps not less striking, instance of deficiency of the vagina. A woman, aged twenty- three, has been married upwards of two years : she has had excellent health, yet never menstruated. There is, how¬ ever, about every twenty-eight days, a feeling of uneasiness about the pelvis, fol¬ lowed, for a day or two, by an active diar¬ rhoea ; and this she has experienced since the age of seventeen or eighteen. As no sexual intercourse could be effected, she consented to be examined; when it was found, that although the external parts were well formed, there wras no vagina. About the usual situation of the hymen, there was found a complete septum. Imagining that this might be an imperfo¬ rate hymen, Dr. Mott made an incision into it about an inch deep, but without success. He afterwards tried it to the depth of two or three inches; but still no trace of a vagina could be discovered. Dr. Mott suspects that the uterus, as well as the vagina, is wanting. The woman has never had the least sexual desire. Excessive constriction. — As to extreme nar¬ rowness of the vagina, it can in general be scarcely considered as a cause of im¬ potence. Besides that all conditions of largeness and smallness are merely rela¬ tive, it is certain that art can do a great deal in remedying the inconvenience. Benevoli was called upon to treat a married woman whose vagina had no larger calibre than that of a goose quill. Every effort to dilate the part seemed fruitless. The parietes of the passage were of a scirrhous hardness. A divorce was about to be sued for ; but the surgeon, by the employment of emollient fomentations, and the successive introduction of pessaries of gentian root (gradually enlarged), suc¬ ceeded in ultimately rendering the part of the usual size. There are, however, certain cases, it is said, in which, owing to excessive con striction and thickening of the parts, coi¬ tion is totally precluded. Yet it would appear, that even in the most unpromising cases of this kind, the natural powers, unassisted by art, may sometimes prove effectual in re¬ storing the proper conformation. In the Memoirs of the Academy of Sci¬ ences of Paris, there is a case which confirms this view. A young woman, who married at sixteen, had the vagina so narrow as scarcely to admit the introduction of a common quill. At every successive menstrual period she expe¬ rienced a painful tension of the womb; the catamenia flowed with difficulty; and IMPOTENCE IN THE FEMALE. 291 it was supposed that the upper part of the canal was still more constricted than the lower. Sexual intercourse seemed per¬ fectly impracticable: yet, after being mar¬ ried eleven years, she proved with child, although the vagina still preserved its strait condition. That she could ever he delivered seemed now scarcely possible. To¬ wards the fifth month of pregnancy, how¬ ever, the passage began to dilate, and by the ninth it was of dimensions sufficient to allow the safe birth of the infant. Irritability. — Excessive irritability of the sexual organs, attended with in¬ tolerable pain when coition is attempted, must be considered as in some measure a source of impotence, which it may be very difficult to remedy. Dr. Cock- burn traced a case of this kind to internal haemorrhoids, and removed the effect together with the cause. Mr. White is quoted by Dr. Paris, as hav¬ ing published three very interesting cases, in which the pain which accompanied the attempt • at coitus was so acute, that the women rarely escaped faint¬ ing. Upon examination, the surgeon discovered in each of them a small fistu¬ lous opening, leading into a sinus of at least two inches and a half in length. The disease was attributed in each instance to a local injury having some years pre¬ viously occasioned an abscess in those parts. This painful state of the vagina was entirely and permanently cured by dividing the sinus. Total absence of external organs. — But where the external organs and the vagina are wholly wanting, there can be no hesi¬ tation in pronouncing for both impotence and sterility ; unless, indeed, the latter passage have an opening somewhere else, as on the abdomen — at the navel, for ex¬ ample; or unless it communicate with tbe rectum. In either case it is pos¬ sible — indeed it has happened — that women have conceived : and the ques¬ tion has even been proposed to the casuists, “ whether, if a wife be so formed, it be lawful to have connexion with her ?” Much heat and contrariety of opinion were displayed on this point, and a judicial decision in the negative was pro¬ nounced by a royal court of justice, at Treves. However, I shall quote for you a remarkable case or two. M. Barbaut, in his Midwifery, relates that in two cases of communication of the vagina with the rectum, delivery was ef¬ fected— once by a laceration which ex¬ tended to the meatus urinarius; and in the other instance by an incision, which was requisite for the removal of the foetus. A young woman of Piedmont, who had no external genital organs, got married; but as her malformation was known, it was not suspected that pregnancy could possibly take place; and, consequently, some labour pains of which she com¬ plained were imputed to colic. Upon ex¬ amination it was ascertained that there was no trace of the external organs of gene¬ ration. It was thought that the pains were from retention of the menses. Professor Rossi (who relates the case) examined the rectum, and determined to make an inci¬ sion in the natural direction of the vagina. He was much astonished on feeling with his finger, which he introduced into the wound, the membranous sac containing the waters lying over the opening of the neck of the uterus. The membranes at length gave >vav, the head of the child presented, and the labour was completed by the natural efforts. The new passage was kept open by means of a tube, dis¬ tended with air after its introduction, so that the artificial vagina might be of the natural dimensions. Two years after¬ wards this female proved pregnant again, and wras delivered bv the newr opening. The information gained from her husband led to a more careful examination of the rectum, and an orifice w7as found within the anus, which would only admit a small probe. This orifice communicated with the artificial canal made by the surgeon ; and there could be no doubt that it wras through it that the first impregnation had been effected. It is further worth observ¬ ing, that the orifice did not pass in the direction of the opening of the cervix uteri, but formed an angle with the part*. Absence of the Uterus. — The uterus may be absent: this is one of the physical causes of sterility, and perhaps the only one, which can be ascer¬ tained by actual examination ; the vagina in such cases being a mere cut de sac . There is a case related in Hufeland’s journal, where Professor Stein, in pro¬ ceeding to remedy what was supposed to be merely a constriction of the vagina, ascertained to a high degree of probability that there was no uterus present : the va¬ gina terminated in a mass of cellular tis¬ sue. Dr. Stein quotes several instances of the same anomaly, which he found already on record. In a female operated upon by Dr. Mac- farlane, of Glasgow, .for what appeared to be imperforate vagina, the thick muscular substance which formed the occlusion was divided, but without effect. The patient died, and it was ascertained that she had no uterus; but the ovaries wrere large and well formed, and the breasts fully deve¬ loped. It was Van Ilelmont’s opinion that wmmanhood essentially depended on the womb — propter u ter am solum mulier est id * Medical Gazette, vol. i. p. 133. 292 DR. CUMMIN ON FORENSIC MEDICINE. quod est ; but the last case, as well as seve¬ ral others which might be quoted, shews that the external appearance and attri¬ butes of the sex cannot depend on that organ, but on some other, which is inva¬ riably present when a woman exhibits the sexual characteristics of voice, shape, ha¬ bits, propensities, &c. Such an organ is the ovary, which bears an exact analogy in this respect with the testicle in the male. Deficiency of the Ovaries. — Some remarka¬ ble instances are on record of one or both ovaries being wanting in females exa¬ mined after death ; but perhaps the most curious example of their absence is that related in the Philosophical Transactions for 1805, by Mr. Charles Pears. The wo¬ man in question lived to be 29 years of age, but had not grown after ten. She was only four feet ten inches in height, and had a very narrow pelvis as compared with the breadth of the shoulders. Her breasts and nipples never enlarged; nor did she ever menstruate, or shewr any other sign of puberty, physical or moral. She died of chest disease. On examination after death, the uterus was found to be in every respect natural, save that_ its size shewed it had not enlarged beyond the in¬ fant condition. The fallopian tubes were pervious throughout; but the ovaries were so indistinct, that they “ shewed ra¬ ther the rudiments which ought to have formed them, than any part of their natu¬ ral structure.” When the ovaries are deficient, we can very well conceive that they may entail impotence as well as sterility. In fact, persons in this condition are similarly cir¬ cumstanced with eunuchs; for while the latter lose their sexual character and appe¬ tite, as well as power for intercourse, the former also are unsexed, and destitute of all reciprocal feeling. The woman just described by Mr. Pears “ always expressed aversion to the familiarities of young men.” The difficulty respecting the ovaries in a medico-legal point of view is in making the diagnosis; for however we may ascertain in the living person the presence or absence of an uterus, wre can scarcely hope to demonstrate the fact with regard to the ovaries, and can be guided by circumstances alone. It may happen that, in addition to the un¬ feminine characteristics of the indivi¬ dual, we may obtain cognizance of some disease of the abdomen under which she may have laboured, or of some accident which might have destroyed the vitality of one or other of the ovaries. Zacchia thinks that the loss of one ovary is enough to render a woman sterile, and that a fe¬ male in such a condition is even worse off in respect to reproduction than a spado, who has only one testis. In the passage where he expresses this opinion, Zacchia, by the way, speaks familiarly of the castration of females. He had mentioned just before, that it was an ancient practice in use among the people of Asia Minor, and, as he understood, prevailed in his day in some part of Germany. It is probable that, with respect to the latter cir¬ cumstance, the shrewd old jurist was mis¬ informed, and that the Asiatic practice was no other than that already alluded to, as consisting in producing occlusion of the vagina. But there can be little doubt, indeed it is certain in some cases, that the ovaries have been actually removed. Mr. Pott re¬ moved them in operating for inguinal her¬ nia, and a complete change came over the female so deprived. Before this period she was stout, large-breasted, and men¬ struated regularly; afterwards, although she enjoyed good health, she became thin¬ ner, her breasts were gone, and she never menstruated. Her age at the time of the operation was 23. De Graaf, referred to by Mahon (though I have not been able to find the passage in the treatise, De Muli- ruurn Organis ), mentions a German who cut both the ovaries out of his daugh¬ ter, being provoked at her misconduct, and wishing to render her more chaste: and Boerhaave (quoted by Dr. Paris) relates the story of a sow-gelder in Spain, who, in a fit of passion, treated his daughter in the same cruel manner. In both instances the women seem to have escaped with life, but their sexual characters, it is said, were completely destroyed. Other supposed causes. — Other reputed causes of impotence and sterility in wo¬ men — such as prolapsus of the uterus, or of the vagina — need not delay us; they are so reputed without any sufficiently good reason : conception has been known to take place in such conditions of the fe¬ male, as well as when fluor albus, im¬ moderate menstruation, or even a carcino¬ matous state of the womb is present. I have omitted for obvious reasons many of those organic causes of impo¬ tence and sterility,, in both male and female, which are wholly internal, for they afford no indications to the medico-legal practitioner. They are in general not as- scertainable until after the death of the individual, and mere suspicions in a case of this nature can be attended with but little practical utility. Means of determining the question of Impotence. The earliest provision met with for dissolving a marriage by reason of im¬ potence, is in Justinian’s code; where it is stated, that if the parties have lived MEANS OF DETERMINING THE QUESTION OF IMPOTENCE. 293 two years together without consummation, — si maritus co’re minim e propter naturalem im- becilitatem valeat — a divorce is to be granted. In a subsequent law, the time is extended to three years. But in what manner the old civilians satisfied themselves of the husband’s incapacity appeareth not. It was the Canon law which introduced the mode of proof by personal inspection. The husband was inspected first, and if he appeared capable, the examination went no further: the woman (the complainant) was obliged to be silent. But if, upon inspection of the husband, there were doubts raised as to his ability, the wife was then inspected, provided she had not been married before. This method of in¬ spection, too, was adopted by the Canonists as a sort of dernier ressort ; for, in ordinary cases, the affirmation of the parties, with that of seven of their relations, was held sufficient. The Congres. — It remained for France to introduce the most disgusting and absurd mode of proof ever devised. This was the ac¬ tual congress, which was commonly had re¬ course to for about a century and a half, but was at last abolished by a special law, in the year 1677. It is said that the num¬ ber of divorces sued for and granted with¬ in this period, was greater than was ever before known. Women who wished to be divorced, and were aware of some appa¬ rent deficiency or diffidence in their part¬ ners, had only to challenge to the con¬ gress, and all the chances of victory were in their favour. There was one remark¬ able case, however, in which the lady was defeated. The circumstances of this case are illustrative of some points in the present lecture, and therefore may be, per¬ haps, not inappropriately introduced. The Baron d’Argenton was accused of im¬ potence by his wife, in the year 1600: she had actually gained her cause be¬ fore the Official of Sens, and afterwards before the delegates of the Primacy of Lyons. The Baron appealed from the sentence; he maintained that he had consumated the marriage, demanded that his wife might be inspected, and finally offered to accept the congress. Rouillard, his counsel, one of the most learned advocates of the parliament of Paris, published a capitulary on the occa¬ sion, proving “ that a man born without any visible testicles, but having all the other marks of virility, is capable of the conjugal duties.” This was the Baron’s case. The tables were turned on the lady, who now declined either a congress or an inspection, as being equally repugnant to her modesty. It is scarcely necessary to add that she lost her cause. The able ad¬ vocacy of Sebastian Rouillard, upon this occasion, was rendered memorable by the strong arguments adduced in favour of the congress; they were full of ingenuity, and deservedly admired for their wit and learning. But a greater advocate arose a few years after, in the person of Vincent Tagereau, who demonstratd in a very eloquent tract, (On the Impotence of Men and Women) that the method of proof by congress was both immodest and uncertain. Pare also wrote against the practice, and called loudly for its sup¬ pression. Nor was there, perhaps, a more efficient champion on the side of modesty than Nicholas Venette, a learned physi¬ cian of Rochelle, whose work, entitled Tableau de L’ Amour Conjugal, went through several editions. He denounced the congres as “ a pretence for a divorce, and the effect of the lasciviousness and impudence of women. They induce the judges to grant a trial, which is as precarious as it is indecent: for not one man in a thousand can come off successful from so public an ordeal.” The proceedings of the congress are variously described ; some say that they were conducted with circumstances of disgusting indecency, under the immediate eye of the inspectors, (namely, the physi¬ cians, surgeons, and midwives, three of each, besides a magistrate) ; while others assert that the midwives alone were in immediate attendance, the professional men not being summoned until the moment sufficient proof was producible. Voltaire distinctly denies that there was any very indecent ceremony ob¬ served. “ This proof,” says he, “ about which so much noise has been made, was not conducted exactly as people have imagined. It has been supposed that a conjugal consummation took place under the inspection of witnesses; but such was not the fact. The parties simply retired to bed, and at a proper time the inspectors, who were assembled in the next room, were called on to pronounce upon the case.” However this be, the congres continued for half a century after the remonstrances of Pare, Tagereau, and others, and would probably have been retained longer by the law authorities, had they not been made ashamed of their conduct in a memorable case. The Marquis de Langeais, in 1659, was accused by his wife of impotence, and having accepted the congress, failed, as it is said, through the management of the lady. He demanded a second trial, but the judges refused, pronounced the Mar¬ quis impotent, his marriage void, forbade him to marry again, and allowed his wife to take another husband. The Marquis, however, disregarded one part of the sen- 294 DR. CUMMIN ON' FORENSIC MEDICINE. tence; be married a Mdlle. de Navailles, and had by her seven children. His first wife having died, he appealed to the Grand Chamberlain against the sentence of impotency; whereupon this great offi¬ cer, sensible of the ridicule of the whole affair, confirmed the second marriage, ad¬ mitted the appellant’s ability, and pro¬ cured a law whereby the ceremony of the congress was ever after abolished. The French law at present seems to have run into the other extreme : it is totally silent on the subject of impotence, obvi¬ ously with a view to discountenance such a charge as a ground of divorce. Mode of investigation in England. — Not so, as we have seen, in England; here impotency and sterility have long been admitted as sufficient grounds in nul¬ lity of marriage; and impotence, as we have further seen, is recognized by our ec¬ clesiastical authorities, according as it is absolute or relative. The case of Lord and Lady Essex has been already alluded to; but the steps which were taken for the dissolution of their marriage are further deserving of notice. It was notoriously the wish of the lady to be divorced, in order to be married to her paramour, Vis¬ count Rochester, the King’s favourite. For this purpose she trumped up a charge of impotence against her husband, and so managed matters that he was effectually so in respect to her, and had no hesitation in confessing it, as he was anxious to get rid of a woman so worthless. It was resolved, therefore, to proceed in accordance with the established practice. The parties had been married above three years, and the wife pleaded, that although she was apt a viro, she was notwithstanding a virgo intacta ; in proof whereof, she of¬ fered to submit to the requisite personal inspection. How the remainder of the proceedings were conducted I shall relate in the words of a writer of the period, merely observing, that there is no reason to believe that there is any exaggera¬ tion in what is asserted of the device adopted by the Countess. The partiality of the King was notorious throughout the wdiole affair; and the eagerness which he displayed in bringing about this adulte¬ rous union, which afterwards led to the murder of Sir Thomas Overbury, has left an indelible spot on his reign. “ The King commanded the bishops to sue out a divorce between the Earl and his lady, in order that the Viscount might marry her; for he had been practised for¬ merly in Scotland, in his minority, with the like experiment. Elizabeth, daughter to the Earl of Athol, being married to the Earl of March, under the pretence of impo¬ tency, but merely for lust (as the author reports), was divorced from her husband, anti married to the Earl of Arran, the King’s favourite, who had been before a partner in her adultery. “ The bishops and others, having a com¬ mission under the great seal to convene the Earl of Essex and his Countess before them, sent out their summons, and they made their appearance accordingly. But before they proceeded, they caused a jury of twelve discreet matrons to be irapan- nelled, to search the Countess, whether she were (as she pretended to be, and was re¬ puted) a maid still; for if she were a maid, they would fasten upon a nullity, and so separate them for the more honour of her virginity. The Countess being ashamed [or afraid] to come to such a trial, would not expose her face to the light; but being to appear before the ma¬ trons, under a veil, another young gentle¬ woman, who had less offended, was fobbed into her place ; and she passed in the opi¬ nion both of jury and judges to be a vir¬ gin. Then the articles were drawn up, where she 'accused her husband of impo¬ tency, whereby, &e. The good Earl, will¬ ing to be rid of so horrid a mischief, made an acknowledgment, upon which the judges proceeded to a divorce.” The custom in this country, in trying the incapacity of women, as well as of as¬ certaining whether they be, as they state, intacta;, still is, to submit them to the scru¬ tiny of a jury of matrons. The reputed impotence of men is ge¬ nerally referred to the ‘ investigation of inspectors chosen by the court, and duly sworn : these inspectors are ge¬ nerally two surgeons and two phy¬ sicians; and such a jury has in several instances latterly been substituted for the absurd and ignorant jury of matrons. German proceedings. — In Germany the usual method is to comm it the investigation of the proofs to the recognized medical inspectors, generally an Amt-Physikus and Amt Chirur- gus, who draw up their report, and present it for adoption to the higher authorities. I have before me two of these reports, re¬ cently published by Professor Bernt, in his Gerichtlich-Medicinische Gutachten ; but the extreme indelicacy of both forbids me to give more than the briefest sketch of their details. In the first case, a man aged 48, being charged with impotence by his wife, a young woman of 18, the parties appear in person to be examined. The man has been already divorced from a former wife for inability ; and his general appearance is unfavourable: short stunted growth; thin beard ; high-toned voice ; meagre shapeless limbs, &c. The sexual parts without being malformed, are excessively DR. ALCOCK. ON THE NERVES OF TASTE. 295 diminutive — not larger, in fact, than those of a boy of twelve: the measurements I omit. This person states that he has strong impulses occasionally, and can per¬ form his conjugal duties well enough ; that his wife is only prompted to proceed against him by some malicious people, but he hopes to please and to satisfy her yet, &c. On examining the wife the next day, she proves to be a bouncing vigorous young woman, well formed in every re¬ spect, and exhibiting no marked appear¬ ance of having cohabited : no hymen, how¬ ever, nor carunculae. The moral circum¬ stances I forbear to enter upon. In fine, the examiners conclude that the parties are wholly unsuited to each other ; that the young woman seems well adapted for having a family, but it is physically im¬ possible (which, by the way, appears to be a little too strong) that the man can ever prove prolific. The second case is one in which impo¬ tence was falsely imputed. The parties wrere married but a few days wffien the wife chose to decamp. The husband was thirty-one years of age, underwent the most minute examination of the inspec¬ tors, and was pronounced to be perfectly potent. Some of the interrogatories put to the husband by the Consistory Court of Weimar, in consequence of the deposi¬ tions of the wife, are curious ; nor are the replies less so. But I cannot venture to notice them further. Practical rules. — In proceeding to examine alleged cases of impotence, it may be as wrell to observe a few plain rules, which may be useful to us, and expedite our researches. 1. We should note the age of the parties, and particularly of the individual com¬ plained of. The general appearance, the habit of body, and state of health, should be observed. And we should ascertain what diseases the person may have previ¬ ously laboured under. 2. The sexual parts must be carefully examined with regard to mal-formed, deficient, or redundant structure. The urethra of the male should be sounded, and the condition of the prostate explored. 3. All manipulations of a gross or inde¬ licate kind should be carefully avoided: they are wholly unnecessary, when there is sufficient opportunity for other examina¬ tion. It can scarcely be mentioned with¬ out disgust, that it is the custom in some of the German states — Wittemberg, for example — to require the professional in¬ spector to lie for some nights in the same chamber with the suspected party, in or¬ der to ascertain, by immediate and ocular evidence, whether there be occasional erections! Yet Henke thinks well of this practice. 4. No artificial stimulus should be em¬ ployed. It is a strange proceeding, and surely very reprehensible, for certain me¬ dical jurists to recommend the use of pro¬ vocatives, by way of giving the accused a full and sufficient trial. Even Haller himself suggested that tincture of cantha- rides should be administered ; and others have prescribed the cold bath, warm va¬ pour, electricity, and nettles. Lastly, Physical causes are those which wTe should chiefly endeavour to ascertain ; and those of an enduring character more particularly deserve our best attention. The main question, be it constantly kept in mind, is, whether the party be actu¬ ally impotent, and how long ? For, as I men¬ tioned before, if it be sought to procure a divorce, the bodily infirmity complained of must have existed previous to the marriage contract : if it originated after marriage, it is no ground of divorce or separation, for the end of the contract may have been answered — namely, the procreation of children. Erratum. — In last lecture, p. 263, last line but three, for “ unlawful,” read “ lawful.” DETERMINATION OF THE QUESTION, WHICH ARE THE NERVES OF TASTE ? By B. Alcock, M.B*. My attention having been particularly directed to the physiology of the fifth nerve, the uncertainty in which the rela¬ tions of the sense of taste have remained, even to the present time, has led me into a series of investigations, the results of which, I hope, will be considered worthy of being submitted to the profession. The first question relating to the sense which engaged my attention, was the de¬ termination of the doctrine of Panizza, that the glosso-pharyngeal nerves are the special nerves of taste. The name of Panizza is so eminent, and his statement so circumstantial, and stamped with candour, that one must hesitate to call his opinion into question : however, it is so opposed to received doc¬ trines that I determined to repeat the ex¬ periments upon which it has been founded. The following are the results which I have obtained from the division of the lingual branches of the fifth, and of the glosso-pharyngeals ; 1st, after the section * From a paper read at the Bristol Meeting of ti e British Association, August, 1836 ; here con¬ densed from the Dublin Journal of Medical Sci¬ ence, for November. 296 DR. ALCOCK ON THE NERVES OF TASTE. of the former, the animal lost the tactile sensibility of the tongue, and retained the sense of taste ; but, though it tasted, it appeared evidently to be by other parts of the mouth, and it seemed equally plain that it had lost the sense in the anterior part of the tongue, at least; for after it had been trained to suffer its mouth to be opened, quietly, and to have something laid upon its tongue, it allowed the pure coloquintida, moistened, to remain so long upon that part of it, care being taken to confine it to it, that no doubt could re¬ main that the animal did not taste by the organ at its anterior part; but as soon as it was let go and closed its mouth, it dis¬ played at once its sense of the taste by the ordinary indications. The inference there¬ fore of Panizza, that taste continues un¬ impaired in the tongue after the section of the lingual branches of the fifth, is in my opinion incorrect; so far at least as it is understood in an unqualified sense, and its application extended to all parts of the organ. 2nd. I have divided both glosso-pharyngeals in several dogs, with the following results : in two of them, each time that either nerve was taken upon a hook, preparatory to its division, a most violent action of the pharyngeal muscles was excited, resembling precisely the pharyngeal effort to reject the matter, which most persons must have experienced, when something nauseous or revolting has got beyond the power of the tongue, and entered the pharynx; and it was so im¬ perative, that the animal struggled to get upon its feet, and was with difficulty re¬ strained. In a third, a similar effect, only less marked in degree, was produced, by pulling upon the nerve with a ligature passed underneath it ; and in one of the three the root of the tongue was at the same time depressed, and rendered con¬ cave from side to side. In three of the animals, muscular startings occurred in the throat, while the nerve was held upon the hook ; but the phenomenon just de¬ scribed did not, at that time, take place. In one of those the startings wTere strong and repeated ; in the others, though ob¬ vious, they were less remarkable ; and in one also, as lias been mentioned, the first effect described was caused by pulling upon the nerve. In all but one, the animal displayed much suffering from stretching, pinching, and division of the nerve. In every instance deglutition was more or less impaired ; I say more or less, because in my first attempts I did not succeed perfectly in dividing the nerve, but only its pharyngeal division ; and this occurred in the animal which I presented to the Surgical Society of Ireland, during the past session ; as I afterward learned from dissection : in that instance the animal required at times repeated efforts in order to get a morsel down ; though at others it appeared to swallow with tolerable freedom. But in those instances in which the nerves were perfectly divided, degluti¬ tion was so very much interfered with, as in some cases to be impossible: the animal took, and masticated the morsel as usual, and swallowed it from the mouth into the pharynx freely ; but then, after repeated and unavailing efforts to get it further, it made equal efforts to get it back again, in which it often experienced so much diffi¬ culty, as to become much exhausted, or to seem even in danger of suffocation, before it succeeded. Yet even here the animals, under certain circumstances, were able to get food dowm — meat in small bits and moist — but if either in large bits or dry, it would not pass. Panizza’s conclusion, therefore, with regard to the influence of the nerve upon deglutition, as also that with regard to its sensibility, appears to me as incorrect as the former. The power of the animal still to swallow, may be readily explained by reference to the mechanism of deglutition ; which pro¬ cess consists not of a single act, but is accomplished by a succession of actions in the several successive portions of the part of the intestinal tract engaged in it : hence, where no difficulty exists, the loss of action in one part, the pharynx, may be com¬ pensated by the action of the part imme¬ diately behind it — the mouth — which may suffice to propel a morsel through the former into the (Esophagus, and this effect will be favoured by the natural tendency of the matter to descend; but where, from any cause, the pharynx is called on itself to act, then difficulty arises. Lastly, the animal’s taste did not ap¬ pear, to say the least, much affected : even immediately after the operation, when exhaustion renders it in general very in¬ different, it unquestionably tasted the coloquintida introduced into its mouth, — in one to such a degree, that efforts to vomit were excited by it, — and when food embittered with it was offered to the animal, it rejected it, though it appeared to me to manifest less aversion than pre¬ viously. In those experiments, as much as could be of the nerve was in each re¬ moved, to provide against reunion. The inference from them, as regards taste, is obvious; that the glosso pharyngeal nerves, if connected at all with the sense, are not the sole or special media of its per¬ ception. How, then, are the results of Panizza’s experiments to be explained ? This task belongs properly to another; but justice to my own induces me to suggest two sources of fallacy, by which he may have been misled. I cannot, in the first place, DR. AICOCK ON THE NERVES OF TASTE. ‘297 believe that he operated on the glosso¬ pharyngeal nerve; and failed to find it sensitive, or to influence muscular action; yet he asserts that it is devoid of both properties ; or that he divided the nerve completely, and that afterwards deglutition was perfect. Indeed, from my own ex¬ perience of the operation, I should say that no one, who makes the experiment once only, or for the first time, is likely to succeed in his purpose, inasmuch as the lingual division of the nerve is so close to the base of the cranium, is so short, and runs so directly inward away from the pharyngeal, that it is almost certain to be overlooked, until, after having, as he thought, cut the nerve at its exit, the operator finds on dissection post mortem that he has left the lingual portion untouched; and from a comparison of my experience with the history of the opera¬ tion given by Panizza, I can hardly hesitate to assert that he did not reach that portion ; else he would not have omitted to mention a source of failure the most remarkable in the case : again, he makes no reference to the external carotid artery, which is situate between the surface and the track of the nerve, and which it is, in my opinion, necessary to tie with a double ligature, divide and displace, in order to allow sufficient room, and to guard against haemorrhage. 7 If not the glosso-pharyngeal, then, what other nerve could it have been? It might be the superior laryngeal : indeed, this nerve is situate so near to the other, that it has very frequently presented in the course of my operations; and I have been for some time uncertain which of the two it was: it is doubtless somewhat lower and somewhat more superficial than the glosso-pharyngeal ; but it will be readily understood, that with a deep wound, and a trying operation, the difference in both respects might be easily overlooked. Again, I have not found, in the trials I have made, the superior laryngeal display either of the disputed properties; and, if this conjecture be correct, we can explain how he may have divided, as he thought, the former nerve; and found it devoid both of sensibility and of muscular in¬ fluence. In the second, beside the ac¬ knowledged power of hunger, I have found that some dogs are naturally so devoid of taste, that a conclusion could not be safely drawn with regard to that sense, from the result of any experiment upon them ; and I have actually rejected a dog as an unfit subject on that account : the animal ate, uninjured, with avidity, food, which others, naturally voracious, rejected with disgust: and taste might have easily seemed obliterated in it after the division of the glosso-pharyngcals. It being then, as it appears to me, satis¬ factorily proved by the preceding details, that the glosso-pharyngeal nerves are not the special media of taste, we are thrown back again upon the fifth nerves, to which it has been generally attributed. But if they be the media, with which of their branches is it associated ? or, is it re¬ stricted to particular branches ? The linguals are those which have been gene¬ rally considered the nerves of the sense ; whence they have obtained the name of “ gustatory.” Several considerations, however, cast a doubt upon that opinion : first, if they be nerves of taste, they cer¬ tainly are not the sole; since it continues after their division; and secondly, if taste be a faculty derived from them, it might be expected that all parts of the mouth supplied by them should possess it ; but they give filaments to parts which are not seats of taste, and thus, while they are proved by the first not to be the sole, the second throws a doubt upon their being nerves of taste at all. Again, in the sec¬ tion of the lingual branch of the fifth, that of the chorda tympani is necessarily involved, and the effect consequent on the division of the former may be due to that of the latter ; while it is one of a set, and the only set, of nerves distributed from a common source to the seats of taste in the human subject, viz. the branches of the spheno-palatine ganglion. Those con¬ siderations — to which is to be added that suggested by Mr. Noble, that no other function has been w ith any degree of cer¬ tainty assigned to the cord — appeared to me so forcible as to induce me to adopt the opinion, that the ganglion and its branches are the source and media of taste to the tongue and fauces, the seats of the sense in the human subject at least. The same opinion has been already suggested by Mr. Noble of Manchester, and advocated by him on rational grounds. Bellingeri also maintains the doctrine that the chorda tympani is the source of taste; and it ap¬ pears further to have been adopted by Magendie ; inasmuch as wre have been lately informed of his removing a defect of taste by passing a galvanic current through the course of the cord. To the doctrine two objections, however, present them¬ selves : viz. that the branches of the spheno-palatine ganglion are distributed to other parts beside the seats of taste — the nose — and that even its palatine branches cannot all be considered nerves of the sense, since we do not taste with the hard palate ; and hence either taste is not a special sensation, or those are not its special nerves. On the other hand, those objections might be removed by the principle, too much disregarded in our reasonings upon the source of sense, that 298 DR. ALCOCR ON THE NERVES OF TASTE. peculiarity of sense may be equally, or even more, the result of peculiarity of organization in the organ, as of peculiar nerves ; and experiment alone offered a prospect of solving the difficulty. But how experiment upon the spheno¬ palatine ganglion and its branches ? Not¬ withstanding the apparent impracticability of it, it occurred to me to attempt the removal of the ganglion from the dog, and thus directly decide the question. In this design I was encountered at the outset by the authority of Magendie and Desmoulins, according to whom neither ganglion nor chorda tympani exist in that animal. On dissection, however, I ascertained with great facility that both do exist, and not only in the dog, but also in every one of the individual mammalia from which thev expressly state that the parts are absent. Further, I learned that the dog presents a most felicitous opportunity for determining not only the influence of the ganglion upon taste, but also its relation to the fifth nerve. In the human subject, the ganglion exists upon a branch of the nerve; and hence it has been, for the most part, assumed and described to be a part of the fifth; but in the dog it does not engage the nerve; it is separate, and is only attached by its anterior extremity to the naso-palatine branch of the seconddivision; while its posterior gives off, or receives, as it may be, the chorda tympani : its cha¬ racters, too, are altogether different from those of the branches of the fifth. It is thence manifest that it cannot be regarded as an essential, original, or necessary part of the fifth, but only an adjunct, and pretty certainly a part of the sympathetic system ; with the main portion of which it is connected by one of its posterior filaments. After several attempts I succeeded — and for the accomplishment of the experi¬ ments which I am about to relate, I take this opportunity to make my acknowledg¬ ments to the two friends who assisted me; Mr. Williams, Lecturer on Chemistry, and Mr. Thomas Hart, Conservator of the Museum in the Medical School, Park- street; without whose patient, cordial, and judicious co-operation, as well in them as in my other experiments my attempts must have failed — I succeeded in the removal of the ganglion from both sides. In order to do so it is necessary to open the zygo¬ matic fossa, by displacing the zygomatic arch, and the coronoid process of the lower jaw, with the insertion of the temporal muscle; that done, the superior maxillary nerve may be exposed, lying upon the pterygoid muscle ; and on drawing aside or raising the nerve, the ganglion will be found beneath it upon the muscle: the deficiency of the wall of the orbit, and the consequent size of the fossa, afford abun¬ dant room for accomplishing satisfactorily the several steps of the operation. I have thus twice extirpated the gan¬ glion from both sides; and in both in¬ stances the animals tasted acutely after¬ wards. We must then abandon, as ground¬ less, the idea that taste depends, whether for its existence or perception, upon the presence of the ganglion or the chorda tympani, and seek another office for those parts. The conclusion that taste is independ¬ ent of them, is confirmed by the existence of the sense, to a very high degree, in ani¬ mals in which neither ganglion nor cord has been discovered, — for instance, birds ; and if those parts have any connexion with the sense, it must be by some other relation than that of the media of percep¬ tion. That they have a connexion I am strongly disposed to think, because in the animals in wiiich they exist, they are con¬ nected especially with those nerves, which will presently appear to be at all events the chief media of perception to the sense; and because, where they are absent, the seats of the sense are probably less nume¬ rous, and the apparatus more simple. It is necessary to suppose the existence of some superadded provision, else howr is the sympathetic action of the several parts of the apparatus — for instance, the rapid flow of saliva from the impression of a sapid agent, to be explained ? but at present this is but speculation, and premature. It next occurred to me that taste, w hat¬ ever be its real nature, may be a sensation perceived through the ordinary nerves of the parts where it resides, viz. the palatine and lingual branches of the fifth; and that the question might probably be de¬ cided by the section of those branches. For this purpose, the dog also offered a favourable subject, inasmuch as an inter¬ val of some lines exists between the origin of the naso-palatine nerve, and the attach¬ ment to it of the extremity of the gan¬ glion ; and thus an opportunity wTas af¬ forded of cutting the nerve between those points, without interfering w ith the gan¬ glion or its connexion. I performed the experiment in twTo modes : in two dogs I simply cut the lingual branches below the jaw, and the palatines at the interval de¬ scribed, by w'hich proceeding the influence of the ganglion over the latter w'as not in¬ terrupted ; and in two others, at the same time that I cut the palatines, I also re¬ moved the ganglion ; and in both cases the result was quam. proxime the same, viz. that taste wras very nearly obliterated, though sufficient evidence of its presence wras still manifested to compel me to ad¬ mit its existence. The effect produced wras, that the animals, which had pre- DR, ADCOCK ON THE NERVES OF TASTE. 299 viously displayed the usual disgust at the coloquintida, no longer manifested any, hut only ceased to eat food embittered with it : they would eat several bits in succes¬ sion, and then refuse to take more, or drop the bit, taken, from the mouth, and take presently a clean bit if offered to them. I examined two of those animals — one of each — after death ; and I found the nerves so fairly divided, that the experi¬ ments appear to me unexceptionable. I must also add, that they were accom¬ plished without injury to any other nerve than those mentioned, with the exception of the masseteric branch of the fifth, and part of the superficial temporal, which were of necessity divided ; but neither the buccal branch, the infra orbital nerve, nor the portio dura, was injured. All positive conclusion from them must therefore apply to the palatine and lingual branches of the fifth. They confirm, in the first place, the conclusion already drawn with regard to the ganglion and the cord. In the se¬ cond, they prove positively that the pala¬ tine and lingual branches are, in the mam¬ malia, media, and probably the principal media, of taste; so much so, indeed, that in the first instance, in which the experi¬ ment was made after the first method, and in which the palatines were divided on both sides within the same day, the dog seemed absolutely indifferent to a strong solution of the coloquintida poured in quantity into the mouth and fauces; but the animal had received a severe shock, and that the absolute indifference to the bit¬ ter was due to the shock, appears to me satisfactorily shewn by the result of the experiment when differently conducted, i. e. when an interval of several days was allowed to intervene between the two ope¬ rations; in which case the effect was such as has been detailed. It should be known, in order to complete the latter inference, that as, on the one hand, when the lingual branches alone are cut, taste seems im¬ paired; so, on the other, the same result is obtained, when the palatines are the nerves divided ; a fact which I have had an opportunity of witnessing in the course of the preceding experiments. In the third place, they shew, that it is as branches of the fifth nerve itself, and not in virtue of their connexion with the spheno-palatine ganglion, that the pala¬ tines act as media of taste. And, lastly, they indicate, in the subjects of experi¬ ment at least, another medium. For the performance of this office, two sets of nerves offer: either the other branches of the fifth, distributed to the mouth, or the glosso-pharyngeals. There does not appear reason to suppose that the former take part in the function; because, first, in the human subject, in which alone we can hope to be able to decide the point, taste is certainly not enjoyed by other parts of the mouth than those already mentioned; and therefore other branches of the fifth than the palatine and lingual are not likely to be connected with it ; and secondly, because in some of the experi¬ ments upon those, the buccal branches also have been divided, and the result was the same. There remain, then, only the maxillary branches, and the filaments of the lingual not distributed to the tongue, and, they being likewise consumed in parts devoid of taste, it is to be inferred that they also are not associated with it. On the other hand, the manner in which the glosso- pharyngeal nerves are distribut¬ ed in all animals, but more particularly in birds, and especially in parrots, can leave no doubt that they fulfil in all a function of sensation ; and as well the manner of distribution, as the dispropor¬ tion between them and the lingual branches of the fifth in the parrot, which manifestly tastes by the tongue, would lead to the inference, that in that bird the glosso-pharyngeals are the chief, perhaps the sole, nerves of taste to that organ; and here again experiment alone can decide. This might probably be accomplished upon the parrot ; but I have not had an opportunity of attempting it. I have, however, succeeded, I think, in determin¬ ing the point upon the dog. In one, upon which I had before divided the palatine and lingual branches of the fifth, on both sides, with the effect already described, I afterward cut the glosso-pharyngeals also ; and I believe, so far as a single experi¬ ment can decide the question, that the animal was then absolutely tasteless. On the fourth day after the operation, I tested him with the coloquintida twice within a few hours, and each time he ate, without hesitation, a meal of meat containing so much of the bitter, that I fear it caused his death : at all events he sickened, an hour or two after the second meal, and did not recover. My experiments, therefore, justify the inference, on the one hand, that the sensa¬ tion oftasteis perceived through morenerves than one, and, on the other, that the glosso- pharyngeals, though not the sole or special media of its perception, have yet a part in the function, and that they are nerves of taste as well as the lingual and palatine branches of the fifth; and if this conclu¬ sion be confirmed, the difficulty furnished by the disposition of the fifth nerve in in¬ ferior animals, as an objection to its gus¬ tatory functions, is still further removed; and we may feel at liberty to estimate the 300 DR. KEMP ON THE EMPLOYMENT OF relative gustatory properties of the two nerves according to their relative develop¬ ment and distribution. The result just stated, further, furnishes a possible solu¬ tion of those obtained by Panizza, sup¬ posing him to have operated on the glosso¬ pharyngeal nerves ; inasmuch as were the faculty, as exerted through the fifth, weaker, and that through the other nerves more active in the subjects of experiment, the result might be easily explained ; but I must repeat, that I incline to the opi¬ nion, that he either did not operate on those nerves, or that, if he did, he divided only their pharyngeal portions. In conclusion, I feel justified in draw¬ ing the following inferences from the ex¬ periments and reasonings which have been detailed: 1st, that taste is a special sensa¬ tion ; 2d, that it enjoys two media of per¬ ception ; 3d, that its media of perception are the glosso pharyngeal nerves, and the lingual and palatine branches of the fifth nerves; 4th, that the glosso-pharyngeal nerves are not its special media; 5th, that the latter nerves both are sentient, and in¬ fluence muscular action; and 6th, that the spheno palatine ganglion and chorda tympani have no influence upon either the existence or perception of the sense. ON THE EMPLOYMENT OF TAR- TARIZED ANTIMONY IN INFLAMMATION OF THE MUCOUS MEMBRANE OF THE LUNGS. To the Editor of the Medical Gazette. Sir, I have inclosed the following" case as an instance of the decided effect of tar- tarizecl antimony in allaying inflamma¬ tion of the mucous membrane of the lungs. Hitherto the use of this medi¬ cine has been, in a great measure, re¬ stricted to cases of inflammation of the cellular texture of the lungs ; and even in these cases its use has not been so general as the statistical report contained in the Gazette, vol. ii. p. 191, with other unimpeachable documents, would justify. In fact, there is but one soli¬ tary circumstance which contra-indicates its use — viz. an irritable state of the mucous membrane of the alimentary canal ; and the symptoms of this affec¬ tion are so palpable that the slightest observation will detect it. Without entering upon the question whether bronchial inflammation be an exciting cause of tubercular phthisis, (an opinion, however, which has been decidedly negatived by M. Louis,) it will not be disputed, that in this coun¬ try, particularly in our large towms, a considerable proportion of the cases of acute and chronic bronchitis occurs in persons who give every indication of a prevalent tubercular diathesis, so far as we can judge from a general want of tone, with absent or distant respiratory murmur under one or both clavicles ; and in these cases, the removal of in¬ flammation by active depletion, or mer¬ curial action, is frequently followed im¬ mediately by the rapid development of tubercles. The tartar emetic treatment, under such circumstances, will, I am sure, be prized by those who have an opportunity of witnessing its marked results. Another object in sending the case, is to introduce to the notice of the profes¬ sion a preparation which has not, so far as I am able to learn, been yet used in this country; but which will, I am con¬ vinced, be numbered amongst our valu¬ able therapeutical agents, so soon as its beneficial results are more extensively known. On a future occasion, I hope to have the honour of submitting to your notice some cases illustrative of the action of the bromide of iron on the processes of absorption and nutrition. These cases, however, contain nothing more than an account of results. Our knowledge of the physiology of nutrition is at present so limited, that any reasoning’ on the pathology of that function must be purely hypothetical, and therefore un¬ safe. — I beg leave to subscribe myself, Sir, Yours very respectfully, Geo. Kemp, M.B. Clieshunt, Herts., Nov. 12, 1836. October 26, 1836. — E. Huntley, ret. 27, cook, has been suffering for the last week from a severe cough, with which she has for some years been frequently harassed. On account of the great dis¬ tress occasioned by speaking, I am un¬ able to obtain a connected history of her case, but learn from her sister that she has been under the care of a medical man in the neighbourhood for the last few days, who applied a blister to the chest, which is still open, and that yes¬ terday she was attacked with shivering ; TARTAR1ZED ANTIMONY IN INFLAMMATION. 301 since which time the cough and dysp¬ noea have much increased. At present (3 p.m.) the ^difficulty of breathing* is very considerable, the countenance anxious and flushed, the lips livid, and the cough incessant. Pulse 120, irritable ; expectoration ex¬ cessively viscid. She does not complain of pain in the chest, and can bear firm pressure in the intercostal spaces. Percussion elicits a dull sound over the whole chest, and the stethoscope discovers every modification of mucous rale, both anteriorly and posteriorly, with crepitant rale over a small space in the left infra-clavian region. From the history of the case, so far as I could obtain it, the general appear¬ ance of the patient, and the situation of the crepitant rale, I presumed that a tubercular diathesis existed, and pre¬ ferred the tartar emetic treatment to blood-letting^ or exciting mercurial action. Half a grain of tartar emetic was ac- cording'ly ordered to be taken imme¬ diately, out of camphorated water, and to be repeated every four hours. 27tli. — Unable to see her till 8 p.m., when I found her much better in every respect. She complained of nausea, but had not vomited ; pulse 80, soft and compressible; cough less frequent ; ex¬ pectoration less viscid, and beginning to assume a detached rounded form. Mucous rale still considerable, but the crepitant rale has disappeared. She was directed to continue the tartar emetic. 28th, 11 a.m. — The cough has not troubled her much during the night. The last dose of the tartar emetic occa¬ sioned vomiting. Mucous rale much diminished. The tartar emetic to be discontinued ; and as the bowels are rather constipated, one ounce of castor oil is directed to be taken immediately. Four grains of James’s powder are di¬ rected every four hours. 29th. — Much better; has only cough¬ ed two or three times within the last twenty-four hours. 30th, 9 a.m. — A remission of inflam¬ matory symptoms occurred this morn¬ ing about 4 o’clock ; the cough has been very frequent since that time. At present the dyspnoea is considerable ; the mucous rale is prevalent over the whole chest, but no crepitation can be discovered. The expectoration has ag*ain become extremely viscid and transparent ; pulse 90, irritable, but yielding to pressure ; tongue furred, but red at the margin. She does not com¬ plain of any pain in the chest, but the mucous membrane is so irritable, that every effort to speak occasions cough. One grain of tartar emetic is ordered immediately, to be repeated every four hours. A blister is also directed to be applied over the sternum. 5 p.m. — Having just taken the tartar emetic, complains much of nausea, but there has been no actual vomiting ; cough less troublesome. Pulse 80. 31st, 10 a.m. — Has slept well the cough is considerably less troublesome, and the expectoration having again as¬ sumed an opaque appearance, is rejected in distinct pellets, with little effort. Pulse 80, soft and compressible. The mucous rale is not extensive, and con¬ stantly shifting ; the tongue is slightly red at the margin, and the last dose of the tartar emetic occasioned vomiting*; it is therefore discontinued. Nov. 1st. — All inflammatory action has apparently subsided ; the respiration is in many parts of the chest quite healthy ; it is, however, indistinct under both clavicles, particularly the left. 2d. — The patient now complains of nothing but debility, and having pre¬ viously seen great advantage derived from the use of the bromuret of iron, in cases where a tubercular diathesis ap¬ peared to exist, she is ordered to take a grain and a half three times a day, dis¬ solved in distilled water. This preparation is analogous in its effects to the ioduret of iron, which is certainly one of the most valuable tonics we possess. One great objection to the administration of the ioduret exists in the circumstance of its undergoing rapid decomposition immediately on its being exposed to the atmospheric air. The bromuret may be kept in a state of so¬ lution witli distilled water for many weeks, without the occurrence of any appreciable decomposition. The solu¬ tion is the only form in which this salt can be given, on account of its great deliquescence. T have generally order¬ ed it in a solution of the same strength as Dr. Thompson’s solution of the iodu¬ ret, viz. three grains of the bromide to a drachm of distilled water, of which thirty minims are taken at first twice, and subsequently three or four times a 302 DR. HAKE ON THE PHYSIOLOGY OF SALIVATION. day, the patient being- careful to keep the bowels regulated by means of cas¬ tor oil. As I have bad great difficulty in ob¬ taining the preparation in London, I may just mention that it has been very carefully prepared for me by Mr. John¬ son, chemist and druggist in this place. THE PHYSIOLOGY OF. SALIVATION. By T. G. Hake, M.D. Physician to the Brighton Dispensary, &c. There has been no greater impediment to science than the mind itself, which, instead of calmly awaiting the results of its researches, glides anxiously for¬ ward in anticipation, and, in so doing, passes over the truth, which was too simple, too similar to the things amid which it lived, to be observed. So vast is the range of thought, that if it stray beyond the boundaries of its sub¬ ject, as liable to do, it unconsciously betrays itself into remote analogies, which perform their functions apart, and are too beautiful, perhaps, to be refused in illustration of an inquiry which the intellect may have proposed to elucidate. In the sciences connected with phy¬ sic, as in all other things, the many are influenced by the few ; and the creeds of the medical world may be traced to sources which are limited in comparison with the numbers who adopt them. It is the province of some to collect the most perfect facts, concentrating all their reason in vision — these are the working classes of philosophy ; and of others, to mentally resolve facts into their elements, and at one glance to compare them with all knowledge, in order to detect a way through those labyrinths, which afterwards they have to traverse. In physiology, this influence of the few is yet more strongly felt than in physic, for he who carefully practises the latter art arrives so nearly at general principles, by the experience of a constant return of like facts, that truth may be said to have taken a hold on the instinct before reflection has confirmed it, and only awaits the ap¬ proval of authority or reason, to be changed from a sentiment to a percep¬ tion of its reality. But in physiology, because men do not perpetually reflect, the inexperienced mind is very apt to be seduced. The details of this science are hidden from us, so that facts the most uninteresting are received, and theories the most inappropriate adopted, to swell its annals. The writer of this paper has before defended the absorbent system against those who would render it accountable for the mischief produced by many poisons, whose action is transmitted by the nerves; he will now, therefore, preface his theory of salivation with a view only of the manner in which the venereal virus acts, and mercury, the cause of ptyalism. The great functions of a nervous system are produced in the extremities of nerves ; they may be impeded by interruptions in the trunk, but the per¬ formance of the grand duty resides in the terminal branches, where they ex¬ pand into the membranous form, and mingle inseparably with the tissues which they govern. By means of a nervous system , the disorders of one organ may he trans¬ lated to another , similar in structure , their sources of nervous power being related.— On this principle becomes ex¬ plicable the venereal progress : it com¬ mences in mucous membranes, and, through its nerves, attacking the glandu¬ lar structure of the part, excites derange¬ ments in adjacent glands, or confining itself to mucous structure, affects distant mucous tissues. But mercury, similar in its mode of action as regards the system which it affects, has a directly opposite effect to the. venereal virus ; the one being permanently sedative, the other stimu¬ lant in its powers. Mercury pursues the same track in supporting-, as the virus does in undermining the nervous system ; and so far does this analogy extend, that the depression consequent on mercurial action disorganizes, when pushed too far, the same tissues as those which suffer from the virus, and causes the like affections; such, for example, as glandular enlargements, ulcerations, and cutaneous eruptions. When mercury is internally adminis¬ tered, in quantities proportionate to the final causation of ptyalism, the following mu. walker’s case of fistula lacrymalis. 303 processes occur. A stimulant acts by contact with the expansion of sympa¬ thetic nerves on the stomach and intes¬ tines. As it is propelled along- that diversified line of organization, it acts on all its functions in a similar manner, but with different results. In the duo¬ denum it urges the nervous battery with which it is in contact to increased power, stimulating- the very glands themselves, whose ducts open into the upper bowel, and so causing* an in¬ creased secretion and outpouring of pancreatic juice and bile ; the same being produced through the medium of nerves extended between the mucous surface and the glandular bodies whose function is to secrete these fluids. In the meantime, the mercury being pursued, its impulse reaches the remoter parts of the sympathetic system, and on its terminal branches, the expanded seats of func¬ tion, acts. The secretions are now more plenteous, and the solids are ab¬ sorbed, but the principal change which is taking place in the system at this stage, is the provision instituted in the the blood to meet the great demand for bile and pancreatic juice, the general harmony of the secretions having been compromised by the specific action of the stimulant on the hepatic and pan¬ creatic glands. The bile being exerementitious, the system can meet its increased secretion to only a limited extent. The quantity of this fluid existing in the blood in an elementary state may for a time answer the demand made in the duodenum, and the solids yielding to the absorbents may prove a further resource ; but this can continue only so long as the sources of bile are not dried up. But, fortu¬ nately, organized matter not only be¬ comes insensible to every stimulant after a certain duration, but even de¬ pressed below its standard tone. In accordance with this principle, the liver refuses to overact its part before the scarcity of its secretion is appreciated in the system. The pancreas, on the other hand, secreting a fluid easily yielded by the arteries, and daily replenishable from that inexhaustible source, the food, bears the mercurial impulse longer, and when at length it becomes insensible to the stimulant, the habit of elaborating pancreatic juice, or rather its compo¬ nents, in the blood, is established, and maintained by the tonic action which the mercury still supports in the ab¬ sorbent vessels. It now appears, that the action of mercury, primarily on the pancreas, and secondarily on the absorbents and lacteals, causes the circulation to be overloaded with an excess of pancreatic fluid, which does not find egress at the pancreas any longer, that organ being unable in its depressed state, the conse¬ quence of over-excitement, to secrete even its usual quantity of fluid. It is essential, however, to the equalization of the secretions, that this excess of abdominal saliva should be evacuated, as long as its production continues. It therefore becomes a question, through what channel it may be expelled ; and as the salivary glands, that is, the parotid, submaxillary, and lingual, are similar to the pancreas in structure, and the fluids which all secrete are nearly alike — moreover, these former organs having received the mercurial impulse subsequently to the pancreas, and being consequently under its influence, while the pancreas has sunk into its atonic state — they are in every way adapted to relieve the blood of its excess. It is not thus maintained that pan¬ creatic juice, but that saliva, is evacuated by this system of glands, for the former contains ingredients which probably the latter does not. For these there are uses in the system, they being animal matter ; they may be deposited for use, or evacuated through other channels : while the salts, in a state of solution, are plenteously excreted at the salivary- glands. This is the physiological history of salivation. CASE OF FISTULA LACRYMALIS, TREATED AFTER DUPUYTREN’S METHOD. To the Editor of the Medical Gazette. Sir, The question has often been asked, what becomes of the tube, (that so extensively used by Dupuytren) after it has been passed into the nasal duct, in cases of fistula lacrymalis ? The difficulty of tracing these cases to a termination has, doubtless, stood in the way of a satis- 304 ANALYSES AND NOTICES OF BOOKS. factory answer. The following- case will, at least, answer for itself, and will prove that the termination of such cases cannot always be so favourable as is sometimes stated; although, for aught I know to the contrary, it may still be considered as efficient a mode of treat- tiient as any other with which I am acquainted. Mrs. S. consulted me in July, 1833, complaining of considerable irritation in her right eye, tumefaction over the situation of the lacrymal sac, and a continual flow of tears and mucus down the face. She had been annoyed in this manner for some months, the integu¬ ments over the sac becoming swollen, inflamed, snppurating, and then gra¬ dually subsiding. The disease returned periodically, and always about the time of menstruation. The simple antiphlo¬ gistic treatment w?as at first recom¬ mended, with temporary relief. The affection continuing, it was thought advisable to introduce the style into the nasal duct, which I did wdthout difficulty. This she wore for about six months, at the expiration of which time she express¬ ed a strong desire that something more might be done, as the tears continued to run over the cheek, so as to torment her considerably, although her sufferings had, on the whole, been much lessened. To gratify this desire, I thought it proper to remove the style, and to insert instead of it one of the silver tubes. This was accomplished w ith great faci¬ lity, so slight was the obstruction. On the next day the aperture had healed over, there was nothing visible, and she expressed herself very comfortable. She continued to go on well, and soon ceased to complain. The tears now passed off through the duct, and she expressed herself highly delighted with the result of the treatment, considering- herself as cured. From this period 1 saw her occasionally, and she continued to re¬ gard herself as quite well, until about six or eight months since, when she again began to complain of uneasiness in the corner of the eye, and said, that on blowing- her nose she thought she perceived the motion of the tube. There was a degree of tenderness and watery state of the eye, and a small capillary aperture was visible, just over the sac, through which the lacrymal fluid ap- * peared to ooze. Not perceiving that any thing more could be done, I advised her to wait patiently, until some further change was observable. About two months since, she was startled one morning, while lying in bed, at experiencing a sudden sense of choking, as if from some foreign body in the throat, and which, when ejected, proved to be the remains of the tube which had been intro¬ duced into the lacrymal sac three years before. I found that a considerable portion had been corroded — more than one-half — the broad upper portion being entirely gone, or else separated from the lower, and remaining behind. She expresses her¬ self easier since it came away, and has not much to complain of, except the discharge of the tears through the little © . . © fistulous opening in the sac, w'hich, how¬ ever, is not very distinct. I am, sir, Your obedient servant, John Walker. Manchester, Nov. 17, 1836. ANALYSES and NOTICES of BOOK S. “ L’Auteur se tue a allonger ce que le lecteur se tue a abreger.” — D’Al’kmbeiit. Hygiene Publique ; ou Wle moires sur les questions les plus importantes tie V Hygiene appliquee aux Professions et aux travaux d'utilite publique. Par A. J. B. Parent-Duchatelet, Membre de Conseil de Salubrite, &c. Deux Tomes. Paris, 1836. Bailliere. The name of Parent-Duchatelet will long be remembered in connexion with the extraordinary work which we lately noticed — his Statistical and Physiolo¬ gical Account of Prostitution in the City of Paris ; but the volumes now published are, perhaps, not less extra¬ ordinary, from the variety and extent of their subjects: they form altogether the; richest mine of information, on every j thing relating to the public health, that has ever been offered to the professional world. There are not less than about thirty papers here, which have, for the> most part, been drawn up at the request; of the French government : they are the result of indefatigable labour bestowed on matters of research, many of which would deter most inquirers, not by their HOMOEOPATHY ; FURTHER ILLUSTRATIONS OF ITS NATURE. 305 difficulty alone, but by the disgust which they could not fail to excite; for instance, the elaborate Essai sur les Cloaques on E gouts de la Ville de Pa vis , and the Rapport sur le Curage et V Assainissement cles E gouts , fyc. But on the other hand, how many of the subjects are there not as attractive as they are important? We may cite, for example, the articles, on the Methods of respiring deleterious Gases with impu¬ nity ; on Artesian Wells; on the Purifi¬ cation of Dissecting-rooms ; on Inhuma¬ tions and Exhumations; on Knackeries and the methods in use for drying dead horses ; on feeding pigs with horseflesh ; and several essays on the influence of certain trades on the health of the work¬ men. To do justice to the contents of these volumes would require more ample space for analysis than we could well afford ; some, however, of the topics we have touched on before, in certain no¬ tices of the A nnales d' Hygiene ; and it may be possible, certainly it vvould be desirable, to take up some of the others on future occasions. Most, if not all, the essays and re¬ ports in this collection, have been ga¬ thered from the periodical just men¬ tioned. But the reader will readily appreciate the amount of his obligation to the spirited publishers, who have so liberally collected into a moderate com¬ pass, and rendered procurable at a very reasonable expense, what has hitherto been diffused through numerous vo¬ lumes, accessible, in general, only in our larger libraries. MEDICAL GAZETTE. Saturday , November 26, 1836. “ Licet omnibus, licet etiam nribi, dignitatem Artis Medices tueri; potestas modo veniendi in publicum sit, dicendi periculum non recuso.” Cicero. HOMCEOPATHY ; further illustrations of its nature. Our last specimen of Homoeopathy was confined to the effects produced by that potent drug charcoal — a drug which, though taken only in the millionth of a grain, excites so very extraordinary an 46n>nce0* SATURDAY, DECEMBER 3, 1836. LE CTURE S ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine, By William Cummin, M.D. Lecture X. Ihe subject of Rape medico -legally considered — R hat is meant by ihe term in legal accepta¬ tion— -Opinions of ihe Judges — Case of the convict Williams — Physical proofs of Rape — The sexual organs in the Virgin — Ambi- guity of the signs of Def oration — Too little or too much proof — Evidence of emission ought to be sought for — Seminal spots ; their physi¬ cal and chemical characters — Spermatic ani¬ malcules described. We shall next proceed to consider those abuses of the sexual functions which are connected with the commission. of certain heinous crimes. Violation. — ■“ In all civilized countries,” says I>r. Percival, “ the honour and chasti¬ ty of the female sex are guarded from vio¬ lence by the severest sanctions of law. And this protection is at once humane, just, and necessary to social morality. It is conso¬ nant to humanity that weakness should be secured against the attacks of brutal strength : it is just that the most sacred of all personal property should be preserved from invasion: and it is essential to mo¬ rality that licentious passion should be restrained, that modesty should not be wounded, nor the mind contaminated — in some instances, before it is capable of forming adequate conceptions of right and wrong.” The medico legal consideration of out¬ rages on chastity comprehends the cog¬ nizance of a variety of circumstances 469. — xix. more or less indicative of violence of¬ fered to individuals of the other sex. The inquiry submitted to the profes¬ sional examiner may either relate to the proofs of a capital crime, or those of a high misdemeanor; and it generally happens that the indictment is preferred, either for the completion of the offence — actual rape — or for an assault with intent to commit that crime, — and this according to the amount of evidence which the medico¬ legal inspector may be able to adduce. Legal distinctions us to what is meant by Rape. — But let us determine, in the first place, what is meant by the law authorities, when they speak of the crime of rape. The ordinary definition seems clear; yet it is far from being so explicit as not to require further explanation. Blackstone says it is “ the carnal knowledge of a woman forci¬ bly and against her will ;” but then, what are we to understand by “ carnal know¬ ledge ?” for there are discrepancies on the point in the records of our jurisprudence. In common law, and in accordance with the decisions of many able and learned judges, emission has been held essential to "the completion of the crime; and in order to conviction, there should always be either positive proof of that fact, or it should be inferential with a high degree of pro¬ bability. The statute law, however, as enacted a few years since, seems to make carnal knowledge consist in penetration merely. These are the words of the act [9 Geo. IV. c. 31. s. 18.] — “ And whereas upon trials for the crimes of buggery and of rape, and of carnally abusing girls under the respective ages hereinbefore mentioned (viz. ten and twelve), offenders frequently escape by reason of the difficulty of the proof which has been required of the completion of those several crimes ; for remedy thereof, be it enacted, that it shall not be necessary, in any of those cases, to prove the actual emission of seed, in order to constitute a carnal knowledge, but that the carnal Y 322 DR. CUMMIN ON FORENSIC MEDICINE. knowledge shall be deemed complete upon proof of penetration only.” Question of penetration . — Here you will probably say that the matter is perfectly clear; there can be no more difficul¬ ty; the law is well defined ; and nobody can mistake the meaning of the statute. But not exactly so : the interpretation of acts of parliament is not so very simple as many people suppose. A point was made by some of the judges, not long after the promulgation of the statute just quoted, involving rather an intricate question. It was assumed that the statute could not be at variance with the common law, and that however the evidence requisite in proof of carnal knowledge might be al¬ tered, the nature of the crime remained the same. It was further argued, that the very wording of the statute confirmed this opinion; for it spoke of the difficulty of obtaining proof of emission, and pro¬ vided that it should therefore be dispens¬ ed with, as not absolutely essential. Hence it was held that if emission could be negatived, or, in other words, if it could be proved on the part of the accused that there was no emission, the capital in¬ dictment could not stand. But perhaps I had better read for you an abstract of a judge’s charge, in which this view of the meaning of the statute is laid down. The case was a trial for rape (Carlisle Spring Assizes, 1832), where the prosecutrix proved penetration. and that her clothes were wet. Mr. Justice Alderson thus addressed the jury : “You must be satisfied that the prisoner pene¬ trated her private parts with his : if you are satisfied of that, I shall submit to your consideration another question, viz. ac¬ cording to law it is established beyond all doubt, that on proof of penetration, a jury may infer completion of the offence — the offence still consisting of penetration and emis¬ sion. But a doubt has arisen upon a late act of parliament, whether where no emis¬ sion has taken place, the offence is com¬ plete by penetration only. I have no doubt, however, that it is for you, if you are of opinion that there has been penetra¬ tion, to presume emission, unless the con¬ trary is proved ; and it lies on the prisoner to show that emission did not take place. If you are satisfied of penetration, but that no emission did take place, I shall reserve the question for the judges; but if you are convinced of the penetration, and in doubt or ignorance whether emission took place, I am clear you ought to find the prisoner guilty.” The jury did not trouble his Lordship to refer to the judges on this occasion : they acquitted the prisoner. But at the same as¬ sizes ( Spring, 1 832) for W orcester, a case was tried, which brought the question to an issue. John Cox was convicted of rape, upon the following finding of the jury*; — “ We are of opinion that penetration took place, and we are of opinion that no emission took place.” Whereupon the judge passed sen¬ tence on the prisoner, but granted a re¬ spite, in order that the opinion of the judges might in the meantime be taken. In the next (Easter) term, the judges were accordingly consulted, when they gave it as their unanimous opinion that the convic¬ tion was right. Sir Gregory Lewin, how¬ ever (from w hose excellent “ Report of Crown Cases on the Northern Circuit” the foregoing particulars have been borrowed), adds, that “ the case was not argued before the judges by counsel:’’ so that wre must not be too sure that .the point is defini¬ tively settled yet. But let us suppose —as we certainly have a right to do — that the meaning of “carnal knowledge” has been defined — that it signifies “penetration;” is there nothing further to be explained? — are the authorities all agreed as to wdiat is meant by the latter term ? It would appear not. Some modern cases — among them, that of Cox, just now quoted — would lead us to believe that sufficient proof of penetra¬ tion might be obtained, “ although the hymen were not broken, and the vagina wrere found so small that even a finger could not be introduced in fact, the sta¬ tute has been interpreted in its obvious sense, as implying that any introduction of the male parts within the labia externa constituted penetration. But a remarka¬ ble case, which attracted much public at¬ tention about two years ago — that of the convict Williams, wrho was sentenced to death for a rape committed on a child of eight or nine years of age — seems to have shaken the commonly received sense of the term, if not to have in a great measure stultified the law. It was urged by a medical man, who took a very active part in inquiring into the circumstances of the case, and who may be said to have saved the prisoner’s life, that legal grounds for the conviction were want¬ ing — that penetration was not proved; and, indeed, that from the relative con¬ dition of the parties— a grown man and a child under puberty — the fact was physi¬ cally impossible. He maintained that there wms no proof (as, indeed, there was not) that the hymen had been ruptured, and tbence argued that there wras no evi¬ dence of penetration : in support of which view, he adduced the authority of certain anatomists, who held that all exterior to the hymen is exterior to the body — that membrane forming tbe natural barrier through which alone admission could be obtained into the sexual parts. He fur¬ ther offered to prove that the male organ PHYSICAL PROOFS OF RAPE. 323 of the adult could not be introduced into the undeveloped vagina of the impuberous female. The Secretary of State, to whom these representations were made, was stag¬ gered by their force, or at least satisfied that sufficient care had not been taken to procure evidence of penetration; a respite was accordingly granted, and ultimately, it being found that however unquestion¬ able was the moral guilt, of the prisoner (the crime, in fact, was committed with circumstances of gross atrocity), the legal proof required by the statute w'as not had, — a commutation of the sentence was ac¬ corded. Now if this case were allowed to form a precedent, it is evident that the pre¬ sent law of rape would, in a large propor¬ tion of cases, become a dead letter. It would be frequently impossible to convict a criminal who had committed the grossest outrage on a female child, and the proof of rape effected on adults would be rendered in the highest degree difficult: the ends of justice would be defeated. But some late convictions for rape on infants, show that no such precedent has been established : and notwithstanding the dissentient opi¬ nions of one or two of the judges — Baron Gurney, for example, and Mr. Justice Taunton — the law is likely to be hence¬ forth interpreted in its proper and obvious signification. It must be admitted that the point made by the gentleman referred to was ingeni¬ ous; but I apprehend that the great body of anatomists would refuse their assent to the doctrine which he maintained — that the external sexual organs of the female, from the hymen outwards, were only the exterior of the body: for, independently of the difference of integument observed on the outer and inner portions of the ex¬ ternal labia, it is contrary to all usage to assert that the labia interna, prepuce, clito¬ ris, &c. are external parts. Besides, in the natural condition of the female organs, the opposite portions of the pudenda lie in contact ; and, in short, it were perhaps as rational to say that a catheter introduced into the bladder was not really within the body, as that penetration would not be effected unless the actual vagina were in¬ vaded. Physical proofs of Pape. Evidence of penetration. — We have next to consider what are the proofs of penetration. These may vary, from the most slight to the most palpable. If we have no opportunity of observing them early, they may be greatly modi¬ fied, if not entirely obliterated. But in general, in cases of actual rape, there will be found sufficient indicia of vio¬ lence: the brutality of the offender will leave its traces; and the probability is, that, in the actual state of the law, mere penetration being as punishable as the most perfect completion of the carnal knowr- ledge, the guilty party, who may be aware of that fact, will not be careful in attempting to save appearances. We may, therefore, when called to examine the person of a complainant a few hours after the alleged commission of the offence, expect to find such marks and tokens as may warrant our judgment respecting the true state of the case. Defloration. — It mostly happens that the females who suffer sexual violence, consti¬ tuting rape, are young, unmarried, or persons who have not had sexual intercourse before. The signs, therefore, resolve themselves into those of forcible defloration. Now, in or¬ der to be able to appreciate the indicia of defloration, or deprivation of virginity, it is necessary that we should be acquaint¬ ed with the natural uninjured state of the sexual parts in the young female. The female organs in their uninjured state. — The vulva is described, by Maygrier, as comprising the mons veneris, the labia majora and minora, the vestibule, the cli¬ toris, the urethra, the hymen, the carun- culas myrtiformes, the fourchette, the peri¬ neum, and the entrance of the vagina. Some of these parts will need to be spe¬ cially noticed. The mons veneris is the prominence in front of the os pubis, composed chiefly of a quantity of fatty cellular substance. It begins, at puberty, to be furnished w ith hair, which is more or less abundant, ac¬ cording to the age, constitution, and habits of the party. The labia majora , or externa, extend from the mons veneris to the perinseum. They are large in women of full habit. Ex¬ ternally, they are covered with integu¬ ment, which is the continuation of that of the thighs, and contains a large supply of sebaceous follicles. Their internal sur¬ face is of a reddish colour, smooth, and consisting of mucous membrane ; and the opposite sides are in contact, in their un¬ disturbed condition. The labia minora, or nymphee, are two membranous folds, erectile, and of a bright red colour, commencing from the prepuce of the clitoris, and broader in the middle than at the extremities. They are very large in female children at birth, but of a moderate size in the adult. It is to be ob¬ served, however, that the size of the nymph® varies very considerably, according to the age of the individual, the country she be¬ longs to, and the maladies that may have affected the part. It has been sometimes necessary to remove them with the knife; nor is the operation usually attended with any unpleasant consequences. Between the clitoris and the orifice of the urethra, and bounded laterally by the nymph®, is a triangular space, somewhat 324 DR. CUMMIN ON FORENSIC MEDICINE. depressed, and, in uncleanly persons, con¬ taining a quantity of sebaceous matter. This is the vestibule. The clitoris is. an elongated tubercular body, lying within the upper commissure of the nymphas, and commonly concealed by the labia externa. It is of different size in different individuals. In the well- formed virgin it is small. But we have seen, in a former lecture, that the part is sometimes so large, in certain females, as to assume the appearance of a penis. It is composed of an imperforate glans, en¬ circled with a membranous fold, which forms for it a kind of prepuce, — of a ca¬ vernous body, fixed by two roots to the descending branches of the pubis, and connected with the symphysis by a sort of suspensory ligament. A little papular prominence containing an aperture is observed at the base of the vestibule. This is the urethral orifice. The urethra itself is capacious, but not much above an inch long. The hymen is a membranous fold, differ¬ ing in size and shape in different females, and formed of the mucous membrane of the vulva, just as it dips into the vagina. It is situated at the posterior and lateral parts of the orifice of the vagina, so as to close the passage more or less completely. In general, the thickness of the mem¬ brane is inconsiderable; but occasionally it is both considerably thick and tough. With regard to form, it is most frequently semilunar, sometimes elliptical transversely, or nearly circular, with a central aperture. In some rare cases it is without any aper¬ ture: it is imperforate; when it prevents the menstrual discharge, and must affect the health. An operation is, under such cir¬ cumstances, requisite. Some eminent accoucheurs inform us of a remarkable fact, that they have some¬ times found the hymen so strong and un¬ yielding as to interfere with the progress of a labour; in which case they have been obliged to free the passage by an incision. The fact is well worthy our attention, as medical j urists, since it shows that not only sexual intercourse, but impregnation, may be effected without any rupture of the hymen. On the other hand, the absence of this membrane, in the opinion of many, warrants the supposition that it was destroyed by some mechanical means ; but it is considered that some very slight accident may lead to it : it may have occurred in childhood, for nurses some¬ times, in rubbing dry the sexual parts, may break the hymen ; or inflamma¬ tion with ulceration may supervene, and obliterate that emblem of virginity — which may thus be too hastily presumed to have been lost, when it happens simply not to be present. CaruncuUe myrtiformes is the name given to certain little reddish tubercles, of differ¬ ent shapes, round or flat, which are formed, as most authors believe, of the debris of the hymen, but, as Beclard has endeavoured to show, of the mucous mem¬ brane which is puckered or gathered in those parts. If this latter opinion were correct, carunculm ought sometimes to be found contemporaneous with and pre¬ vious to rupture of the hymen ; they are, however, rarely, if ever, found, save in the absence of that membrane. Their number varies from two to five or six, and their colour and consistence de¬ pend on the constitution of the female : they may be of a bright scarlet hue, or they may be pale and livid ; they may be firm, or soft and yielding. The fossa navicular is is a little depressed space, lying between the lower part of the orifice of the vagina, and the posterior commissure of the labia externa, which latter part is often denominated the four- chette. And lastly, the perineum is the space lying between the fourchette and the anus ; it has a raphe, and is shorter and narrower in woman than in man. The vagina itself requires to be partially noticed. In the virgin state (and fre¬ quently after repeated acts of intercourse), it has the appearance of a passage, the opposite sides of which are in contact. The mucous membrane with which it is lined exhibits numerous ruga, running transversely along the floor of the cavity, and lost on the walls. These rugse are principally found in the anterior and lower portion of the vagina ; and they are said to become obliterated sometimes by forcible connexion. Signs of Virginity. — Such is a brief sketch of the natural condition of the sexual parts in the young unmarried female; and I may now add that physical virginity (as it is called) is usually considered as consisting in such a combination as the following : — the fresh colour, firmness and elasticity of the labia, the integrity of the fourchette, the presence of the hymen, or at least of the earunculse myrtiformes, the nar¬ rowness and rugose condition of the vagina, aud finally, a plump elastic condi¬ tion of the breasts, which remain firm without support. Some add as further signs, the difficulty experienced in a first intercourse, the pain felt by the female on that occasion, together with a show of blood, in consequence of the laceration of the hymen. Should all the preceding signs be met with in one and the same person, the fact of virginity is rendered highly probable. But the truth is, that perhaps not one in a hun¬ dred would be found intact in this strict sense, while the absence or modification of several of the said signs by no means rebuts the PHYSICAL PROOFS OF RAPE. 325 claim of purity. For instance, there are many natural causes which would affect the state of the labia, such as disease, dis¬ charges, &c., without necessarily inferring that there had been sexual intercourse: while on the other hand those parts have been found to possess all their elasticity and apparent integrity, in young women who unquestionably had connexion. Even the hymen itself, as we have seen, may be absent without necessarily compro¬ mising the virgin character of the fe¬ male. This membrane does not appear to be an essential attribute of the sex. Most virgins may have it, but many are without it. Again, instances have oc¬ curred in which virginity has certainly been infringed, without loss of the hymen. It may be very relaxed at the menstrual period, and may yield without laceration under such circumstances : and we have already mentioned that impregnation has been frequently known to have taken place without rupture of the membrane. Capu- ron relates an instance of his having attended a woman in labour, where the expulsion was powerfully impeded by the resistance of the hymen. He incised the membrane, which had naturally in it only a very small aperture, and shortly after, a pair of large and lively children were born. And finally, the membrane may have been lacerated otherwise than by copulation. As to the carunculas myrtiformes, they are not universally found, even where there is naturally no hymen ; and they are gene¬ rally considered as the relics of this mem¬ brane; so that their presence would rather be an indication of unchastity than other¬ wise. Narrowness, or constriction of the orifice of the vagina, is not peculiar to virgins, and it may be artificially imitated ; while the contrary state, which may possi¬ bly be owing to leucorrhceal discharge, profuse menstruation, &c., does not neces¬ sarily imply that there has been a loss of virginity. The firmness of the breasts, and muscu¬ lar system generally, is but a vague sign of chastity: many widows and mothers might compare with undoubted virgins in this respect ; while the opposite condition might be traced to physical and moral causes wholly unconnected with any in¬ fraction of sexual purity. As to the other supposed signs of virgi¬ nity, namely, the difficulty of a first con¬ nexion, the alleged pain experienced by the female, and the show of blood, they are of too fallacious and uncertain a descrip¬ tion to merit the attention of the medical jurist. The first may certainly arise from relative disproportion, but may also be effected by the use of astringents, while the others may be feigned. Ambiguity of the signs of defloration. — Thus we observe that the signs of de¬ floration may be very ambiguous, and the more so, where little or no violence has been used, and perhaps only a single act of sexual intercourse has occurred. That there may be difficulty in pronounc¬ ing a decided opinion, even under circum¬ stances where the reverse might be ex¬ pected, is well exemplified by the fol¬ lowing case, related by M. Parent Ducha- telet, in his valuable work Be la Prostitu¬ tion dans la ville de Paris: — “Several years ago, two young women of genteel appear¬ ance were attacked in the public streets by some young men, who called them gross and opprobrious names, and told the passers by that they were nothing better than common prostitutes. Some good-na¬ tured personsresentedthisconduct,and took the girls’ part. A complaint was lodged on their behalf against their defamers, and the latter were summoned to appear before a magistrate. The defendants pleaded a justification, while the females, on the contrary, stoutly insisted on their purity: they even offered to submit to a personal inspection by a medical examiner, — which the opposite party dared them to do. A sworn inspector, a clever and conscientious man, was appointed by the magistrate, and the result of his investigation was this — that it was totally out of his power to say any thing certain in regard to one of the females; she might, or she might not, be a virgin ; but for the other, she probably had had some intercourse with men, but he could not assert the fact posi¬ tively. The issue of the dispute, 1 know not; but this is certain, that it sub¬ sequently came out that these same young women had actually been for some time entered on the registers of the police, and one proof of their being any thing but virgins, was, that they had both been, on several occasions, affected with venereal disease.” Forcible defloration. — We should not, how¬ ever, be discouraged from investigation by such cases as these : we should re¬ member that they are not instances of recent injury; and that it is generally known the sexual parts have an amazing facility in throwing off, after a time, the semblance of lesions. But the cases which- we are now more immediately considering are those of forcible defloration, to the exa¬ mination of which we are called soon after the alleged injury has been committed. The examples just alluded to may serve to warn us that we should lose no time: we should not defer our inquiry for a moment : the signs are evanescent, and if not speedily appreciated, are lost for ever. Solomon himself has compared the traces of lost virginity to the path of an eagle through 326 DR. CUMMIN ON FORENSIC MEDICINE. the air, a ship through the sea, or of a serpent upon a rock ! In recent cases of forcible defloration we -should certainly expect to find some proofs of penetration ; and those proofs would, of course, be the more convincing, the greater number of circumstances indi¬ cative of a disturbed state of the sexual parts that might appear. On the other hand, the probabilities would be the fainter the fewer the indicia. Laceration of the hymen, with marks of lesion, corre¬ sponding in their appearance with such as might have been inflicted at the time of the inj ury complained of, would afford a high degree of presumption of the fact ; while an uninjured state of the parts would be a prima facie testimony against it. Where penetration alone is alleged, as hav¬ ing been forcible, though without rup¬ ture or laceration, we should expect to find bruises at least, or other indicia of violence about the external organs, as well as on other parts of the person. It may happen that, in consequence of a re¬ laxed state of the sexual organs, from menstrual or other discharges, the marks of injury may not be very palpable; but even in the most relaxed condition, it would not be too much to expect evidence of injury, provided we are called in suffi¬ ciently early. Suspicious cases. — Rut does it not oc¬ cur to you, that light may be thrown on some cases by the complainant en¬ deavouring to prove too much? The proofs may be redundant, or incon¬ sistent ; and when this is the case they will generally be found to be, not lacera¬ tions nor incised wounds, but, contusions superfluously produced, and without much regard to the appearances which ought to correspond with the alleged time of injury. The question may even be raised, under such circumstances, whether defloration, if it have really taken place, has been ef¬ fected by the male organ? It is known that strange things have sometimes hap¬ pened, when females have accidentally let slip foreign bodies, introduced for lasci¬ vious purposes, into the sexual parts. “ The records of surgery,” says Capuron, “ supply us with many instances of sur¬ geons being called in to extract from the vagina pessaries, glass phials, pomatum pots, and tweezer cases. And of what is not a woman capable, who is determined to be revenged on some faithless lover, or to get rid of one whom she detests ?” M. Capuron then proceeds to shew how easy it would be fora female to inflict on herself such injuries as would ground a charge of violation. A timely and judicious examination will generally expose fraudulent attempts of this kind. Fodere supplies us with an il¬ lustrative case, A female child, between nine and ten years old, was said to have been violated by several persons. The mother brought the charge against them and was rather suspected to be acting with a view to extort money from the ac¬ cused. M. Fodere was commissioned tc investigate the affair. He found the sexual organs of the child to be perfectly uninjured: the hymen was entire, and the little finger could hardly be inserted into the orifice of the vagina. There were, how'ever, some marks of violence about the pubes and the external labia: a red circle, about the size of a crown piece, was observed to be impressed on the pudenda, and it had all the appearance of having been recently made. This was, indeed, the fact; for by waiting a little it gradu¬ ally disappeared, having evidently been produced by the indentation of a piece of money just before the visit of the me¬ dical examiner. If the mark had been the effect of great violence, such as was stated by the mother, it would have in¬ creased in intensity, with the usual effects of inflammation. It was thus discovered to be a gross fraud, and the complainant was driven out of court with disgrace. Evidence of emission. — To return, how¬ ever, to the question already started, — how are we to know, in any given case, that penetration, or defloration, was ef¬ fected bv the male organ ? For it does not follow that the sexual violence might not have been perpetrated by some foreign body of a different nature. Here we are driven to moral or circumstantial evi¬ dence, unless wre can devise some means of procuring physical indicia ; and this obliges us to consider the question of emission as well as of penetration. I mentioned to you, that as our sta¬ tute-law now stands, it is no longer ne¬ cessary to seek for proof that emission has been effected. In the former state of our jurisprudence it was of great import¬ ance to detect semen in the vagina (as was sometimes supposed to be done), or to discover marks or spots of it about the woman’s garments. Now we cannot say that it is not so still ; for in almost every case where the medical man finds that there has been defloration, or violent pe¬ netration of the vagina of a female, he can go no further — he may presume, it is true, but, he cannot prove, more than that some¬ thing, some substance or “ voluminous body” (as the French reporters call it), had been introduced forcibly into the pudenda. The case is greatly altered, however, when semen is found about the parts, for it i leaves little doubt but that a man has been there. The discovery of semen, then, is; clearly of much importance to the Eng-i lish medical jurist; and pains ought to i PHYSICAL PROOFS OF RAPE. 327 be taken in every case of alleged rape, Where a personal examination is allowed soon after the injury has been received, to inspect narrowly the sexual organs, with a view to the detection of semen, and to be sure to see the very clothes worn by the complainant on the occasion. Seminal spots. — I know not how the pre¬ sence of semen has been satisfactorily ascertained hitherto in this country ; but I suspect that in cases where it was said to have been detected, the medical wit¬ ness formed his judgment simply from the colour, and perhaps the smell, of the stains. Such evidence, however, would not at present satisfy a court of justice ; for an assertion so weighty, and fraught with such serious conse¬ quences if made good, would be, at least, expected to be corroborated by the aid of chemical science. You will do well, there¬ fore, to note the following observations, gathered from Orfila, for they seem calcu¬ lated to render your evidence on this sub¬ ject in a high degree satisfactory and valu¬ able. When seminal fluid, or what is supposed to be such, is found on a garment— a linen chemise, for example — it forms spots of greater or less extent, round or irregular, thin, greyish, or sometimes sliglitly yellow, which is best discerned by placing it be¬ tween the eye and the light. Pressing the spots between the finger and thumb, we find them stiff, as if they were starched : they have no smell unless we mois¬ ten them with a little water, when they immediately emit the well-known semi¬ nal odour. Holding them before the fire, taking care not to scorch the linen, the spots become of a ruddy yellow ; and very often other spots, not till then per¬ ceived, are brought out by the pro¬ cess. And what shews that the desic¬ cation, or drying, is alone the cause of the appearance thus produced, is, that upon moistening the stains once more they become colourless, or lose that yellowness which they had just presented. This ef¬ fect of heat on the stains of semen is cha¬ racteristic; it does not take place with common mucus, or with morbid dis¬ charges, such as that of gonorrhoea, fiuor albus, or the lochia. If the seminal spot be dipped in water, it is moistened all through and evenly, not as if there were any fatty matter in its composition. Whitish filaments detach themselves, flaky ; and if the fluid be eva¬ porated, it assumes the appearance and consistency of a solution of gum. When still further concentrated, it exhibits an alkaline character, as is sufficiently attest¬ ed by its effects on litmus paper. “ If the evaporation be carried to dryness, the re¬ sidue is semitransparent, like dried muci¬ lage, glistening, of a ruddy or slightly red¬ dish hue,: and this, on being agitated for two or three minutes in cold distilled water, separates into two parts, the one glu¬ tinous, yellowish grey, sticking to the finger like glue, insoluble in water, but soluble in potash ; the other per¬ fectly soluble in water. The watery solution is yellowish, transparent, and gives a white flaky precipitate when treated with chlorine, alcohol, acetate or subacetate of lead, and corrosive sublimate. Pure nitric acid, concentrated, communi¬ cates to it a slightly yellowish tinge , though it be colourless before: nor does the acid cause any cloudiness in the solution — which is a characteristic test — for nitric acid added to a similar watery solu¬ tion of other discharges, such as the go¬ norrhoeal, the lochial, &c. throws down a precipitate, or whitens the fluid invari¬ ably.” But you should know, that satisfactory as is this mode of testing the presence of semen, we can sometimes even go further. When we are called in very soon after the alleged violation, and find some fluid which we suspect to be semen in a free state — that is to say, not that which is found smeared on the linen of the com¬ plainant, but perhaps lying in the va¬ gina — we shall probably be able to apply another test, which, if it succeed, can¬ not fail to be in the highest degree satis¬ factory; — I mean the detection of sperma¬ tic animalcules. Spermatic animulcules. — By the appli¬ cation of the microscope we may be able to discover those animalcules pecu¬ liar to semen, which were first described by Leeuwenhoek, afterwards admirably ex¬ amined by Spallanzani, and the existence of which Prevost and Dumas have proved in the semen of all male animals which have reached the age of puberty. It was about the year 1770 that the Abbe Spallanzani made his valuable ob¬ servations on this subject; and nothing that has since been ascertained impugns in any manner the correctness of his views. Here is the representation which he gives Fig. 16. 328 MR. URE’S OBSERVATIONS ON THE of the animalcules, as seen with a power¬ ful glass, soon after they were taken from the human body. Their figure, while in motion, is that in the space («), spherical, with filamentous tails: when at rest, or dead, (for while alive they seem perfectly restless) the fluid about them being dried up, they exhibit the shape seen in the space (b), somewhat oval or elongated, with a tapering tail. “ The bodies,” says Spallanzani, “ bad two distinct mo¬ tions ; one oscillating laterally, curv¬ ing the tail from side to side; the other progressive, advancing by means of the oscillation. During this, one would suppose them blind; they strike against every obstacle; and when amidst a num¬ ber, make agitations and contortions, tak¬ ing at last that way where there is least resistance. They are restless and conti¬ nually moving.’’ The representation given of them by Buffo n, is this ; (fig. 17.) and it is the appearance wThich they generally present when viewed with a microscope of no very extraordinary powers. Fig. 17. As to the actual size of these creatures, Leeuwenhoeck says he saw 10,000 of them moving freely in a space not larger than a grain of sand. They are smaller than the globules of the blood : Raspail thinks that they are less than the T^tli of a millimetre (about ^ inch Eng.), while the sanguine¬ ous globules are fully as large as the ^th. They are, as nearly as possible, of the same size and shape in the semen of man, of the dog, ram, and rabbit. Spallanzani, in his loose fashion of no¬ menclature, called these animalcules vermi - culi ; but the scientific naturalists of the present day classify them with Cercarice: and “ Cercaria seminis” is the appella¬ tion given by Mr. Owen to this human entozoon — “ cui locus semen virile.” But I must not enter further into gene¬ ral considerations respecting spermatic animalcules, although so many temp¬ tations offer themselves in the odd theo¬ ries which have prevailed respecting their \in the animal economy. There are curious speculations on the subject in Spallanzani ; but Prevost and Dumas have broached some of the most singular. Perhaps I may add, that the opinion which seems at present to be deemed most worthy of acceptation, is, that the Cer¬ caria seminis supplies the nervous system, the vascular and other substance of the foetus being pre-existent in the ovum. These animalcules, however, cannot be observed in such a solution as that which I have just now mentioned as obtained from the spots on linen; for no doubt, by the process of drying, moistening, and trans¬ ferring them from the cloth to the stage of the instrument, the creatures are de¬ stroyed, or at least so dismembered as to become unappreeiable to our senses. If, however, we can obtain the semen, as I have said, in a free state, and cautiously submit it to inspection, the case will be dif¬ ferent, even though the substance become dry. Orfilasayshesawanimalculesin semen which had been dry for eighteen years ! But it is within the first half-hour, hour, or say two hours, after the emission, that the ani¬ malcules are most likely to be fully re¬ cognized: they are then seen in their pe¬ culiar shape — with their tails and their oscillations, performing those remarkable movements which are so characteristic of them, as to enable us to say, from simple inspection, that the liquor under exami¬ nation, and in which they are found, can be no other than semen. OBSERVATIONS ON THE NATURE AND TREATMENT OF LUPUS. By Alexander Ure, M.D. M.R.C.S. Formerly House-Surgeon to the Royal Infirmary of Glasgow. In the following’ observations, which I have the honour to submit to the profes¬ sion, upon the nature and treatment of lupus, it is my intention to confine the application of that term, often vaguely and indiscriminately used in nosology, to two varieties of erosive ulcer. One seated in the proper structure of the skin, the dartre rongeante scrofuleuse of M. Alibert; the other in an accessory part of the cutaneous organ, the dartre rongeante idiopathique of the same author. Proceeding in this manner, I hope farther to show, that those two, although resembling each other in many respects, yet differ in others, and conse¬ quently require certain modifications of treatment, which have not heretofore met with due attention. Neither variety can be regarded in NATURE AND TREATMENT OF LUPUS. 329 the light of a malignant affection, for the reason that adjacent parts and organs are influenced, not by absorp¬ tion, but simply by contact. An affection, designated by some pathologists lupoid tubercle , developed at an advanced period of life, I am dis¬ posed to consider as one of a malignant type, yet bearing the impress of malig¬ nancy in an inferior degree, because implanted in a substance endowed with a low grade of vitality. It is, in fact, what 1 have elsewhere described as the primary cancer of the skin — the cancer of the cutaneous glandular texture, ad¬ verted to by M. Breschet, in his admira¬ ble Memoir*. On this account I deci¬ dedly protest against such misappropria¬ tion of the word lupus. Lupus exedens, or eating tetter, has been defined a tubercular disease, in¬ ducing ragged ulceration of the skin. Dr. Bateman, in his Synopsis, has touched very lightly upon it, and assigns as a reason, that he can mention no remedy which has been of any es¬ sential service in the cure of it. To portray the amount and intensity of its depredations, analogous to the gnawing of some voracious animal, or the ravages of some insect, the epithets lupus vorax , formica corrosive } were bestowed upon it by the ancient medi¬ cal writers. By the Greek translators of the works of the Arabian physicians, it is described as the 'egTrys es&ioyzvos, corresponding to the Latin herpes ex¬ edens. In France, it is called dartre rongeante ; in Germany, die fressende Flechte. The common locality of lupus is some portion of the face. I have, however, seen it attack the nates ; and M. Alibert mentions an instance of its occurring on the breast. A remarkable circum¬ stance connected with it is, that of its being usually solitary, confined to a single point of the integument. There all its virulence seems concentrated. I. Erosive ulcer of the derma. — This form is by no means infrequent. It attacks both sexes indiscriminately dur¬ ing childhood and adolescence ; at the period of life when there exists the greatest predisposition to affections of the cutaneous and glandular systems. The individuals most liable to suffer from this particular ulceration are those of a fair, occasionally rosy complexion, * Nouvelles Recherches sur la Structure de la Peau. Paris, 1835. with light auburn hair, grey or blue irides, and a tender skin. To a super¬ ficial observer, the general health seems unaffected ; but on minutely investigat¬ ing* the state of the different functions, more or less derangement will, in the majority of cases, be detected in those of the chylopoietic viscera. The tongue is redder than natural, especially along the margins, and towards the extremity ; its central portion presents a cream- coloured fur, through which the red papillae project. The breath is more or less offensive ; the evacuations from the bowels irregular and unhealthy. To these we may find superadded other signs indicative of strumous dyspepsia — an affection well described by Dr. Clark in his Treatise on Consumption. From the survey of a considerable number of cases of this variety of erosive ulcer, I am led to coincide with those authors who look upon it as a sympto¬ matic affection. It is generally de¬ pendent on some disordered condition in the functions connected with assimila¬ tion and nutrition. If, indeed, ever truly localized, it has either been pre¬ ceded or accompanied, during some period of its course, by unequivocal marks of those errors of function to which allusion has just been made. Dr. Macfarlane, in his valuable Cli¬ nical Reports, mentions that, in Glas¬ gow, during the years 1818 and 1819, when the working classes were exceed¬ ingly ill fed, he had occasion to see a greater number of cases of lupus among the district poor under his charge, than at any former or subsequent period. According to M. Rayer, it has been at times extremely prevalent among’ the indigent in some parts of France, particularly the sterile mountainous re¬ gions of the Flaute Auvergne, from scanty and unwholesome nourishment. The affection is seated in the dermoid texture ; and judging from the nature of the secretion emitted after ulceration is established, in the glandular body se¬ cerning that mucus, which, according to M. Breschet, becomes at a later period the horny matter*. On attentively ex¬ amining the process set up prior to the ulcerative absorption of the epidermic layers, the following phenomena will be remarked. In some point of the attenu¬ ated and delicate integument investing* the nose, cheek, or lip, a minute yellow* - * Op. cit. 330 MR. URe's OBSERVATIONS ON THE ish speck appears, surrounded by a reddish halo. The point of the skin corresponding- to this tiny abscess, be¬ lieved to exist in the muciparous appa¬ ratus is removed by absorption. A mode of ulceration is at length esta¬ blished, which is generally superficial, not extending beyond the derma ; and though accompanied with preternatural redness, yet rarely with any swelling of surrounding parts. It is characterized by its ragged edges, on a level with the base; by its pale mammillary surface, whence issues that peculiar secretion which rapidly concretes on exposure to the air, into greyish yellow crusts ; and lastly, by its being the seat of hot smarting pain, and occasional pruritus. The furfuraceous crusts are soon de¬ tached, and fresh ones re-produced to supply their place ; the affection creep¬ ing on meanwhile with insidious cer¬ tainty. After having subsisted for some time, the original type of the disease is modi¬ fied, and in some measure obscured ; the surface acquires a pink glassy aspect, and loses the papillary appearance it originally presented. When situate in a part where there is much loose cellular substance, the immediately ad¬ jacent textures become indurated, con¬ densed, and assume a dusky red or purplish hue. Ulcers of this kind differ extremely one from another in their degree of virulence. If the nose is primarily in¬ vaded, and particularly the inferior ortion of the septum, as frequently appens, the ulceration advances by imperceptible steps, corroding and con¬ suming- every tissue, muscle, and carti¬ lage, down to the very bone, which at times participates in the devastation. The mutilation thus produced is often hideous and irreparable. That this is not purely a local disease seems further ascertained from the ob¬ stinacy with which it resists topical agents. I have seen nearly every de¬ scription of stimulant tried, and myself employed the most powerful caustics, but never have known any permanent benefit accrue, unless measures have been conjointly taken to modify the state of the system at large. I adduce the two following cases, to demonstrate the comparative inefficacy of severe escharotics, even where an extensively varied treatment had been pursued. St. George’s Hospital, May, 1836. — Anne Paisley, aged 15, auburn hair, greyish blue i rides, tolerably healthy complexion, gives the following- history of her case : — Between five and six years ago, she discovered a small hole in the lower part of the partition of the nostrils, which was constantly covered hy a little dry scab. It occasioned no uneasi¬ ness. For twelve months previously, she had suffered pain in the back part of the head. At that period she was living with her parents in the country. Desirous to be rid of this crust within the nose, she consulted a physician, who prescribed tonic medicines, which were accordingly persevered in for a considerable time, without any good effect. After remaining in this compa¬ ratively indolent state for a couple of years, the affection at length extended to the exterior surface of the nose, in consequence of caustic having been applied by a surgeon in town. Since then the ulceration has slowly advanced, w ithout intermission. The greater part of the nose, including the cartilaginous septum, is gone. The ulcerated surface, irregularly disposed, corresponds in character with the description above assigned, and is the seat of heat and smarting. Has been for several months past a patient here of Mr. Coesar Hawkins, who has left hardly any plan untried which science could sug-gest. As the clisefle seemed to baffle every sort of treatment, Mr. Hawkins determined to prove the effect of my preparation of the chloride of zinc*. It was accordingly applied from time to time during the * The preparation of the chloride which I pro¬ posed and introduced into practice in this coun¬ try, differs in a most important feature from that originally employed by M, Canquoin. The wheaten flour prescribed in the French formula is apt to envelop the chloride in a glutinous dough, which blunts its power, or at any rate tends to confine its action to the particles on the surface of the paste; but the anhydrous gypsum of my formula, while it can exercise no chemical action upon the chloride, forms a porous medium, through which the whole particles of the deli¬ quescent chloride may transude upon the morbid albuminous tissue, with the effect of decomposing or destroying it with certainty to any definite depth. This preparation of mine has been adopt¬ ed in several of the London hospitals, and has been found to be unfailing in its escharotic powers. It was probably owing to the counter¬ action of the vegetable farina that M. Sanson, the distinguished surgeon of the HStel Dieu at Paris, failed last year in the application of the paste — a fact communicated to me by M. le Doct. Nonat, in a letter dated Paris, Aug. 3d, 1835, of which the following is an extract. “ Je sais que M. Sanson en a fait usage dans les cas du NATURE AND TREATMENT OF LUPUS. 331 months of February, March, and April, to the nasal ulceration, and likewise to two ulcerated spots which had formed near the centre of each cheek. Water dressing- was applied to the eschar, and to the subsequent surface, in order to give the caustic a fair trial. Each ap¬ plication was attended with the most lively pain, and some inflammatory in¬ filtration of the adjacent cellular tex¬ ture. But the nature of the sore had undergone a change : it put on a sound appearance, and speedily healed. The cicatrization, however, was only partial, and in some places temporary. The disease still pursues its eroding- course. A little boy was sent to me in the spring, by Mr. Duffin, of Foley Place, for a similar affection to the above, oc¬ cupying about one-half of the outer sur¬ face of nose, and extending to the cheek of same side. Beyond were traces of the membranous cicatrix , denoting the previous existence of the same kind of ulcer; and which 1 was informed had been healed by a skilful employment of strong nitric acid. There was a degree of ectropion referrible to the puckered contracted condition of the adjoining integument : the tongue presented the red dots on the grey fur. The boy had, in addition, a porriginous eruption of the scalp. Tn compliance with that gentleman’s request I applied a thin stratum of the gypsum paste, the same as in the preceding case. Here the result w’as equally unsatisfactory, for the amendment was but of brief du¬ ration. It is thus demonstrably evident, that the more powerful escharotics are ina¬ dequate to effectuate a radical cure of the affection in question, so long as the constitution is at fault ; for no sooner has the effect of the escharotic subsided, than by a reflex action the sympathetic disease of the skin is again called into activity. In the above cases the action of the remedy was to suspend for an interval that morbid equilibrium subsisting be¬ tween internal and external surfaces. But no sooner had that ceased to in- Cancer du sein, et que jusqu’ici il n’en est pas satisfait. Adkuc sub judice lis e.s t.” The new, and I believe, important fact in ani¬ mal chemistry, of the action of chloride of zinc upon albumen, to which I now add that of the nitrate of zinc, first observed and stated by me j and the consequences deducible relating to the morbid albumen of cancer, are peculiarities also to which I lay claim. fluence, than the still existing, though latent, general cause resumed its ascen¬ dancy. An opinion is entertained by some medical men that this species of lupus must run a certain course, or exhaust itself, ere its career can be put a stop to by any method of art. This is based, however, rather on imperfect truth than on fundamental error. When the dis¬ ease is long left uncontrolled, a morbid habit is superinduced, which ordinary means fail to eradicate. But if mea¬ sures be taken at an early stage to alter that peculiar condition of the system upon which the ulcerative process seems to depend, or with which it is associat¬ ed, we have every reason to expect that that course will be materially abridged, and much disfigurement and mutilation prevented. Now the chief indication is to correct the state of the digestive organs, and invigorate the system, by a proper re¬ gulation of diet, residence in a pure air, free out-door exercise ; duly attending to the state of the cutaneous exhalation and alvine evacuations. Much benefit will be obtained, in most cases, by sub¬ stituting for a too stimulating* animal diet, one composed of farinaceous arti¬ cles and milk. The patient must strictly abstain from fermented liquors, and have occasional recourse to bathing and gentle laxatives. Various alterative and tonic medicines, such as arsenic, mercury, iodine, sarsaparilla, with al¬ kalis, steel, and sulphate of quina, will each in its turn, according- to circum¬ stances, constitute valuable auxiliaries. When a visible melioration is per¬ ceptible in the general condition of the patient, when the different functions are all properly performed, then is the most favourable time for resorting to those topical remedies which act, not as caus¬ tics, but as pow-erful alteratives of the organic relations of the part. Among these arsenic claims the preference. Sir E. Home was in the practice of em¬ ploying an aqueous solution of the white oxide of arsenic — arsenious acid. Dr. Macfarlane likewise advocates the use of the arsenical solution, because he has never known it produce local mis¬ chief or constitutional disturbance. His formula prescribes six grains to the ounce of distilled water. I can from experience attest its efficacy. The fa¬ vourite application of Dupuytren was a pow der consisting- of one part of arse- 332 MR. URE’s OBSERVATIONS ON THE nious acid in ninety-nine parts of ca¬ lomel. A topical stimulant of acknowledged utility in interrupting the progress of lupus, is the red-hot iron : it often exerts a most salutary effect in modifying the nature of the sore, producing healthy granulation and prompt cicatrization. Among other metallic stimulants the solution of nitrate of silver is found to do good in slight cases. M. Canquoin, in his work on Cancer, speaks of the chloride of antimony as a veritable spe¬ cific for the dartre rongeante. He ad¬ vises it to be used in the following wray. Let the whole extent of the affected part he touched with a pencil imbued with the chloride. About a couple of minutes after, the pain thus produced is to be allayed by laying on compresses dipped in cold water. In this way the . energetic chloride is at once transformed into an inert subchloride. This opera¬ tion is to be repeated once every ten days, until the sore heal. Some of the German surgeons recommend the imme- diate application of the corrosive subli¬ mate. The inconvenience, however, with which its absorption into the sys¬ tem is fraught, must restrict its use to cases of very limited extent. I already noticed the nitric acid. Before resort¬ ing to topical measures, it is always ex¬ pedient to remove the crusts by means of emollient poultices. If there be much pain and heat about the sore, cold poultices ought to be employed till these subside. It is sometimes advantageous to add a narcotic solution to the cata¬ plasm. The stability of the cure may be in¬ ferred from the character of the cicatrix. When the new skin is soft, free from tenderness, and nearly of the natural colour, it may be considered sound ; but when it remains preternaturally red and indurated, or, on the other hand, pre¬ sents a delicate membranous aspect, like an arachnoid web traversed by mi¬ nute tortuous blood-vessels, there is every likelihood of relapse. Under such circumstances it is incumbent on the patient to persevere in the therapeutic means above proposed ; for it is only by repeated applications and unremitting attention that a cure can be accom¬ plished. This disease sometimes yields to the administration of internal remedies alone; sometimes, again, it spontane¬ ously cicatrizes. Dr. Triistedt, of Ber¬ lin, mentions his having cured lupus by means of the decoctum Zitmanni (a com¬ pound, slightly purgative, preparation of sarsaparilla), spare diet, w arm baths, and the subsequent exhibition of sarsa¬ parilla by itself*. This practice is si¬ milar to that recommended by Rust, one of the principal surgical authorities of Germanyf. II. Et •osive ulcer of the follicles . — This frequently originates like a catar¬ rhal affection of the Schneiderian mem¬ brane. By and by the inflammation, being, as it were, concentrated in one particular point, leads to erosive ulcera¬ tion, which almost invariably terminates in perforation of the cartilaginous sep¬ tum. The only circumstances whereby the patient’s attention is directed to the mischief going on, are a degree of ten¬ derness and fulness in the membrane, felt more especially on exposure to cold air; and the constant reproduction of crusts on the point of lesion. After a time, from cold or other determining cause, some portion of the external sur¬ face of the nose becomes inflamed, and ulcerates. One or other ala, by conti¬ nuity of tissue, is commonly attacked. Small red angry-looking tubercles make their appearance, and are speedily con¬ verted into a spreading ulceration. The ulcer all along preserves the tubercular character : the apices of the tubercles are more or less concealed by dry, hard, tenacious crusts;};. As the disease pro¬ ceeds, fresh tubercles are developed, and encroach more and more upon the healthy integument. The confines of the sore have a dusky red hue. This ulce¬ ration is alw ays attended by loss of sub¬ stance, and the havoc committed by it when unrestrained is often very great. The parts ordinarily destroyed are the cartilaginous septum and ala. Accord¬ ing to M. Rayer, it may begin exter¬ nally, and spread to the lining mem¬ brane of the nostrils secondarily. The disease, as stated by Sir A. Cooper, con¬ sists in ulceration of the sebaceous folli¬ cles. Hence, whenever the pre-existing irritation passes along from the internal mucous cryptae to the external ducts, the ensuing inflammation induces oc- * Med. Zeit. f. Heilkunde in Preussen, No. 11. 1833. t Aufsalze u. Abhandlungen. Berlin, 1834, p. 377. t According to Vauquelin, who subjected them to chemical analysis, the crusts consist of albu¬ men, some animal mucus, and salts. NATURE AND TREATMENT OF LUPUS. 333 elusion of the orifices, succeeded by ulcerative absorption of the follicles. The papillae, endowed with a higher degree of sensibility, and a greater ca¬ pacity for resisting the process of disor¬ ganization, may now and then be re¬ cognized forming little vascular emi¬ nences, the adjacent textures having previously disappeared. Are we to ascribe to this circumstance the extreme sensibility of the morbid surface to the impression of any stimulus P The present variety of corroding ul¬ cer is seldom met with before puberty. It begins most frequently between the ages of fourteen and thirty; rarely after the fortieth year, although M. Alibert has adduced cases where it occurred at a later period in life. As with the former, so also with the present form of lupus, the subjects chiefly predisposed are those of a blond complexion, with light hair and irides, and undue deve¬ lopment of the sebaceous follicles of the nose. The latter feature may be said to characterize and accompany this sort of ulcer. Although the phenomena of strumous dyspepsia are absent here, yet the patient is seldom of a robust con¬ stitution ; he feels languid ; most usu¬ ally labours under symptoms of indi¬ gestion; has what is commonly termed “ a weak stomach.” Nor does he dis¬ play the clear and blooming complexion indicative of health and vig'our. As respects the intensity of its pro¬ gress, we observe great variation. In one individual its course is so slow as to seem almost stationary, while, in ano¬ ther, it runs on with rapid strides. In combating this form of ulcer, so obstinate and intractable in its nature, it is indispensable, towards restoring a healthy action, that we should not only destroy the morbid habit of the part, but at the same time modify the organic relations of subjacent textures. This done, the lesion will spontaneouslv heal. Now this twofold object can be at once accomplished by employing the chlo¬ ride of zinc paste above-mentioned. In very superficial cases, a solution of the nitrate of zinc in strong nitric acid, answers the same end*. This combi¬ * Procured by dissolving one to two drachms of the fused nitrate of zinc in an ounce of aquafor¬ tis. The fused nitrate is, like the chloride of zinc, a powerful escharotic. I have pro¬ duced, with a thin layer of a paste composed of it and gypsum, in the space of seven hours, an es¬ char about three lines thick : considerable pain and swelling accompanied its action. It is less deliquescent than the chloride. nation resembles, in therapeutic action, the chloride, but is less energetic. I prefer it to the nitrate acide demercure , recommended by MM. Recamier, Jules Cloquet, and Velpeau. One or two ap¬ plications of the paste will at most suf¬ fice. So soon as the eschar is detached, the healthy sore is to be treated wflth water dressing ; or if there be much un¬ evenness of surface, witli narrow strips of adhesive plaster. These ought to be symmetrically disposed, and not inter¬ fered with until they drop off. Great circumspection must be observed in using' this powerful remedial agent; for injudiciously employed, it may on one hand produce a dangerous degree of erethism, on the other only irritate the sore, and exasperate the disease. Although internal remedies are here of minor importance, still the perma¬ nence of cure will be confirmed by a judicious application of the hygienic and therapeutic precepts formerly laid down. A milk and vegetable diet, by rendering the blood less stimulating, exerts a remarkable influence upon the state of the cutaneous capillaries. This is exemplified by the fact, that nothing tends more than such a diet to subdue that capillary congestion, that turges- cence of the follicles, and also to dimi¬ nish that morbid oily secretion of the skin, which may accompany or follow this affection. There is one symptom we are gene¬ rally called upon to treat, as a concomi¬ tant or sequela to the ulcer — namely, a sense of tenderness or rawness of the pituitary membrane, depending on chro¬ nic inflammation. It is allayed by pro¬ tecting the part against external im¬ pressions, and especially that of cold, by plugging the nostrils with charpie, or the fleecy dowrn of finely- carded cotton wool. Where the irritation has persist¬ ed for a period of years, and is attended with superficial ulceration of the mu¬ cous membrane, some astringent lotion ought to be thrown up once or twice every day. I have prescribed, with ad¬ vantage, the following liniment, used by M. Canquoin for cancerous sores : — R: 01. Oliv. ^j. ; Zinci Chlor. gr.xv. M. fiat linimentum. The affected* part is to be pencilled over with the liniment once a-day : in the course of a few weeks, by pursuing this plan, the membrane will be restored to a sound condition. I subjoin the following cases, in 334 MR. URE'S OBSERVATIONS ON LUPUS. order to illustrate the practice above detailed : — Case I. — E. C. Deedy, cet. 21, of a fair complexion, light hair, greyish blue irides. I saw her on the 18th February last, by the request of, and along with, Dr. Roe, under whose professional care she then was. Right ala nasi was the seat of erosive tubercular ulceration of the follicles. There was an inflammatory blush round about the sore, which was covered with furfuraceous crusts, and the source of smarting, pricking, and occasionally shooting* pain. The septum was perfo¬ rated by a large aperture. The affection commenced some years previously, inside of the cavity of the nostrils, and had progressively spread to the ala. She had consulted many medical men, and tried a vast number of remedies, with the view of gettingthesorehealed, but in vain. It having been agreed to apply the chloride of zinc, a thin layer of the gypsum paste was accordingly laid over the sore. No sooner had the eschar se¬ parated than the ulcer beg'an to heal, and within fifteen days was completely cicatrized. For some time subsequent she took the decoction of sarsaparilla, by the advice of Dr. Roe. She now enjoys the most excellent health ; the cicatrix is firm, white, and solid, and the redness of the apex has long since vanished. Case II. — William Blake, set. 22, clerk, light hair, and blue irides. The sebaceous follicles strongly developed on the surface of the nose. I was asked to see him last spring*, by Mr. Pettigrew, under whose care he was, on account of an erosive tubercular ul¬ ceration of the left ala nasi, which was in part eaten away. He gave the fol- lowing history of his case : — About seven years since lie was attacked with a dis¬ tressing tenderness of the nostrils; soon after, the partition ulcerated. The ulce¬ rative process continued for five years ; it has destroyed the greater portion of the septum. Four years ago, a crop of pimples came out upon the side of the nose, in which originated the present ulcer. There is a deep redness all round the sore. Has tried numberless remedies, internal as well as external, but without benefit. Among others, iodine and sarsaparilla; which, without meliorating the local disease, have dete¬ riorated bis general health. Complains of increased sensibility of the lining membrane of the nostrils, aggravated on exposure to draughts of cold air. The chloride of zinc was applied to this most refractory sore, and the result of that application has been a permanent cica¬ trix. 1 saw this patient within the last few days. The exterior of the nose remains perfectly sound, and the morbid irrita¬ bility of the pituitary membrane is sub¬ siding under the use of a milk diet, conjoined with the topical means de¬ scribed while treating of this particular symptom. Case III. — Mrs. M***, residing at Westbourn Green, Bayswater, came to consult me for a corroding ulcer on the nose, by the recommendation of Dr. Roe. She is 32 years of age, the mo¬ ther of a family : has cbesnut-coloured hair, and grey irides, She informed me that the ulceration, which has the marked tubercular character, was re¬ ferable to an affection of the inside of the nose, attended with formation of scabs ; that it began like a cold, up¬ wards of two years ago : for in less than a year from that date, a little scab made its appearance on the left ala, accompa¬ nied with some inflammation. Leeches and poultices were applied, and a variety of internal remedies exhibited ; and to the irritation caused by a single leech- bite she ascribes the formation of the present sore. The ulcer consists of a group of irritable-looking tubercles, covered with crusts, and accompanied with a dark -red hue of the adjacent integument. The cartilaginous septum is perforated, and a portion of the ala destroyed. Beneath the crusts she feels a constant itching, which changes to a sense of heat and smarting on their de¬ tachment. Her general health is indif¬ ferent. The sebaceous puncta are un¬ duly prominent on the nose, which pre¬ sents those minute varicose veins near the apex, termed by German patholo¬ gists hemorrhoidal vessels. On the 25th June I applied a thin layer of the gypsum paste ; in a few weeks after, a healthy cicatrix occupied the site of the ulcer. She called upon me very recently. Thecicatrixremainsfirm and unchanged. An amendment has taken place in her general health, she tells me, since the removal of the irritation maintained by the sore. INSTRUMENT FOR CLOSING RECTO-VAGINAL FISTUL7E. 335 In each of the above cases the loss of substance is inconsiderable, and may be ascribed, not to the action of the remedy, but to the previous process of ulcerative absorption. 13, Charlotte-street, Bedford-Square, Nov. 25, i 836. INSTRUMENT FOR CLOSING RECTO-VAGINAL OR VESICO-VAGINAL FISTULA. To the Editor of the Medical Gazette. Sir, I beg to transmit to you a description and outline of an instrument which I have invented, for the purpose of sew- ing1 together the edges of vesico-vaginal and recto-vaginal fistulie ; in the for¬ mer of which cases I assisted a friend to operate with this instrument a few days ago. _ The long diameter of the aper¬ ture in the bladder was situated trans¬ versely to the mesial plane, and large enough to allow the fore-finger to pass easily into it. The formation of the suture was not attended with the least difficulty, and occupied but a few mi¬ nutes. X think, also, that the suture was of the best possible kind for the purpose ; that is, the ligature could not cut itself out from the edges of the fis¬ tulous opening ; for being passed double through opposite points of the aperture, a piece of bougie was placed within the loop of the ligature on one side, and another piece of houg'ie between the ends of the ligature on the other, so that the silk, when drawn tight and tied, cut only on the pieces of bougie, and the latter pressed together the edges of the aperture, forming the com¬ pound or quilled suture of the old surgeons. The instrument, it is seen, is in the form of forceps, one blade of which is a needle, curved towards its point, close to which is its eye. The other blade is broader on its opposing surface, less curved, and at its extremity has a hole (seen in fig. 2), through which the needle point, and just the loop of the ligature, are carried, when the blades are closed. On the back of the broad blade is a spring, which, when pushed forwaids, the blades being previously closed, catches the ligature on its point, and holds it. < Fig. 2. — Back of the broad blade. Fig. 1. In using this instrument the operator has only to seize in its points, in the same manner as he would with a pair ot forceps, the border of the fistulous opening: the blades should then be closed, and the ligature will be carried through one lip of the aperture. The opposite border is then to be seized, and the blades to be closed and held so. The spring on the back of the broad blade is now to be pushed for¬ wards, by which the ligature is caught and held at its point. The blades are then to be opened and gently with¬ drawn, leaving a double ligature passed through opposite points of the fistulous aperture, so that a common or quilled suture may afterwards be formed. I have the honour to be, sir, Your obedient servant, Wm. Beaumont. 47, Berners-street, Nov. 22, 1836. 336 dr. macrobin’s MEDICAL REPORT OF MEDICAL REPORT OF THE LUNA¬ TIC ASYLUM, ABERDEEN. To the Editor of the Medical Gazette. Number of Patients in the Asylum, 1st May, 1835 (date of last Re¬ port) . 120 Admitted between 1st May, 1835, and 1st May, 1836 . 37 157 Whereof were considered curable (of former number) . - • • 23 Ditto (of the latter number) .... 26 Total number of supposed cura- ? ^ ble cases during the year * • • • $ RESULTS. Dismissed between 1st May, 1835, and 1st May, 1836, recovered. ... 20 Ditto diito, convalescent, or much improved . 4 Ditto ditto, somewhat improved • • 5 Ditto ditto, by desire of friends, un¬ improved . . • 2 Ditto ditto, of incurable and inof¬ fensive, or otherwise improper patients . 8 Dead, ditto, (of recent cases) . 4 Ditto, ditto, (of old and confirmed cases) . . 7 Total number dismissed during the year . 50 Total number remaining in the Asy¬ lum, 1st May, 1836 . 107 From the foregoing- table, it will be seen that thirty-seven patients have been admitted during- the year; twenty- six of whom were considered, at the time of admission, to be curable, and the remainder incurable. The admission of so large a proportion of incurable pa¬ tients is always much to be regretted, seeing they tend to injure the character of the Asylum, as an institution for the cure of insanity- ; and for this, as well as for other reasons, it does appear to be inadvisable for the managers to sanc¬ tion the admission of so many patients of this description, unless where they are distinctly proved to he furious , and dan¬ gerous to the public , and altogether un¬ manageable at home. I am happy to observe, however, that the gentlemen of the visiting Committee, for the last two quarters, have shewn a desire to act on this principle ; having refused to sanc¬ tion the admission of idiots and other harmless incurables , who, it is very evi¬ dent, cannot be benefited either in their mental or corporeal condition, by being shut up for life within the walls of an asylum, in a state of idleness, occupying the room that might be appropriated to others, with an infinitely greater pros¬ pect of benefit, as well to individuals as to the public at large, and to the cha¬ racter and general prosperity of the in¬ stitution. The table also exhibits the number of those who, in the course of the by-gone year, were considered to be fit subjects for the medical and moral treatment of the institution, and who, accordingly, have been duly subjected thereto. The total number of this class of patients was forty-nine. Twenty of them have been already discharged fully reco¬ vered : whilst four more have been sent home in a greatly improved condition, along with five others less improved. It thus appears that twenty-nine, out of the forty-nine curable patients, have been more or less benefited by their re¬ sidence in the Asylum, and already dis¬ charged ; and that the number of cures is in the proportion of rather more than two-fifths of the number of those who have been placed under treatment, which is considerably above the average proportion of recoveries in most of the large public hospitals for the insane, as laid down in the statistical table, drawn up by Esquirol and others. And I may here also be permitted to observe, that a like proportion of recoveries has been obtained on an average of the last six years; for out of 279 patients who have been subjected to the curative treatment of this institution, within the period just mentioned, 115 have been reco¬ vered, exclusive of thirty-three who have been dismissed, partially recovered. Of the four principal modifications, or species of insanity — viz. mania, monomania, dementia, or acquired fa¬ tuity, and congenital fatuity, or idiot- ism — the two first only are considered to be fit subjects for medical treatment; the two latter being generally believed to be hopeless, or nearly so. No less, however, than ten of these incurable in¬ dividuals have been admitted during the year, and, in some of these instances, palsy or epilepsy was combined with the insanity. The cases of mania wherein there is general disturbance of THE LUNATIC ASYLUM, ABERDEEN. 337 the intellectual functions, with violent excitement, are unquestionably by far the most favourable for cure ; and it is surprising1 how soon a change for the better takes place in the condi¬ tion of such persons, when removed from their friends and put under an early and judicious course of treatment. In several instances of this kind, a most striking1 improvement has been ob¬ served within a week or two after ad¬ mission ; and this has even occasionally happened when, for some weeks pre¬ viously, the complaint had been pursu¬ ing its course with much violence, and without intermission : although it must be confessed, that in other instances, where the treatment has been so long deferred, hopeless fatuity has been the consequence. These are facts which, I think, cannot be too often or too strongly urged on the attention of the friends of insane patients, in order that they may learn, by a well-timed removal from home, to secure for them, as far as pos¬ sible, the chances of a recovery ; and thus to save them from the risk of that complete and permanentoverthrowof the mental powers, which is so apt to ensue whenever the violent mental and bodily excitement, so characteristic of mania, is left to pursue its course uncontrolled. The remedial means which have been adopted throughout the year, in the treatment of the different cases, have of course been varied, according to the na¬ ture and urgency of the predominating symptoms — insanity being a varied and complex disease, both as regards its causes and its phenomena. In regard to what is usually styled the moral treatment, I may just observe, that, in accordance with the established Tact — that occupations of a kind fitted to en¬ gage the attention and encourage exer¬ cise in the open air, are highly condu¬ cive to the cure of insanity — 'every pos¬ sible opportunity has been seized of giving effect to this important principle, so soon as the patient was brought into a state capable of being benefitted by it. I still, however, regret to say that the field of occupation is altogether ina¬ dequate to the exigencies of the esta¬ blishment, so far, at least, as relates to the male side of the house ; and con¬ sequently, that in this very essential particular, the institution is defective. I trust, therefore, that the managers 470. — xix. will again take this matter into their earliest consideration ; and I feel pretty confident, that when we are furnished with more suitable and constant em¬ ployment than we at present possess, not only a greater number of patients will be recovered, but several others not susceptible of a complete recovery will be gradually trained to habits of regu¬ larity, and at length brought into such a condition as to render them in some degree useful members of society, and safe to be at large. It is hardly requi¬ site to adduce any arguments in addi¬ tion to those formerly embodied in a special report, which I presented to the managers in reference to this sub¬ ject in 1834; it will be sufficient, I think, to quote the opinion of the cele¬ brated Pinel. The following1 are the words which he employs, in speaking of an establishment in Holland, where the number of recoveries was very great, compared with other establishments in which employment formed no part of the curative treatment. “The patients are divided early in the morning into parties, some of whom are required to assist in various household offices, while others are conducted to the work rooms, furnished with the implements of their respective trades. But the majority are distributed, under the superintendence of the keepers, through a large iuclosure, where they are occupied in gardening and agriculture. Uniform experience has proved the efficacy of these labours ; and it is particularly to be observed that those of the higher ranks of life who live in the same Asylum, but in a state of idleness and sloth, retain their lunacy and privileges together, while their inferiors are restored to themselves and to society.” With reference to the causes which gave rise to insanity, in the different individuals who have been admitted during the year, we find that twelve of them were traced to hereditary predis¬ position ; two to congenital imbecility ; five to a highly scrofulous constitution of body ; five to domestic afflictions — pecuniary embarrassments — grief, aud other depressing passions; six to ine¬ briety, and other demoralizing habits ; two to an hysterical constitution, and previous attacks ; two to an interruption of the uterine functions; one to injury of the bead from a blow ; one to child- Z 338 MEDICAL REPORT OF THE LUNATIC ASYLUM, ABERDEEN. birth ; one to epilepsy ; and one to a severe febrile attack ; whilst two arose from occult causes ; in other words from causes which could not be traced, or had nearly escaped detection. Notwithstanding-, however, that such appear to have been the more prominent of the remote causes, there was unques¬ tionably in a g-ood many instances a combination of these in operation, all tending- to the same end, some of them of a predisposing, and others of a more immediate or exciting nature. The causes of insanity are, indeed, often obscure ; but in general it will be found that several have been acting’ simulta¬ neously towards its production, and also, that, in a majority of instances, there is an hereditary predisposition to it. I have only further to observe on this head, that four of the female patients, who have within these last six years been discharged convalescent, have been re-admitted after the lapse of some months, or it may be one or more years, labouring- under fresh attacks ; but that these secondary attacks have been comparatively rare amongst the males. Females would seem, from their peculiar habits of life and situation in society, to be at all times more under the influences of the moral than the physical causes of disease. And as it is very difficult, if pot in most instances impossible, to withdraw an individual entirely from the operation of those of the former class, we are, I imagine, from this cir¬ cumstance, enabled to account, in some measure at least, for the fact that they are more subject to relapses or recur¬ rences of their complaint than males. Eleven patients have died during the year. Seven of these were aged and confirmed lunatics. A post-mortem examination was in¬ stituted in every one of those fatal cases (with consent of the friends), and the appearances carefully noted. Lesions of the brain or its membranes, and some¬ times of both together, w'ere found in all of them; and although the morbid ap¬ pearances in this region of the body were not in every instance precisely si¬ milar, yet were they substantially alike. Other organs of the body were also oc¬ casionally found in a state of disease. Thus five of the male patients died with symptoms of palsy and fatuity, and in all of them w ere discovered unequivocal traces of disease of the investing mem¬ branes of the brain, along with copious depositions of a serous fluid beneath the same, and into the ventricles. Anothei male patient who had long been subject to epilepsy, and who died of ileus, exhi¬ bited disease of the brain, as well as of the intestines. The last of the male patients who died, and who was in a state of fatuity when admitted, also ex¬ hibited traces of cerebral disease. The first female who died had been long subject to insanity : she exhibited marked disease of the cerebral mem¬ branes. The second was a young- girl, who laboured under congenital idiotism, and whose mother has been long an inmate of the institution : she died of pulmonary consumption, and exhibited a tubercular formation in the right he¬ misphere of the brain, besides extensive tubercular disorganization of the lungs, peritoneum, spleen, and other abdomi¬ nal viscera. The third person who died among- the females had been for some time subject to violent paroxysms of mania: she also exhibited traces of ce¬ rebral disease, and two tumors were found in the cavity of the abdomen, be¬ sides intense injection of the inner coat of the stomach and bowels ; the one tu¬ mor was attached to the stomach, and the other to the liver, and the irritation which they had excited in the organs with which they were in contact, ap¬ peared to have operated as the imme¬ diate cause of the maniacal paroxysms. The last was a young woman, who had been long subject to epilepsy, and w'as fatuous at the time of admission, and who died from exhaustion, consequent on the violent struggles which she had long sustained: the brain and its mem¬ branes were in this case much injected. In reference to this brief statement of the morbid appearances in the fatal cases, it is worthy of remark, that while five of the deaths among’st the males were preceded by a state of palsy, not one of the women exhibited this condi¬ tion ; and, moreover, that the morbid appearances were precisely similar in all those five cases. This circumstance I have also noticed in the fatal cases of former years. I can recollect, indeed, of onl y one instance of a female patient having- exhibited symptoms of palsy during the last six years, whereas not ; less than a third of all the male patients < ANALYSES AND NOTICES OF BOOKS. 339 who have died within the same period, had, previously to this event, fallen into the state referred to. It appears to me, that we oug'ht to look to the differences in the nature and mode of operation of the exciting’ and predisposing- causes, to which the two sexes respectively are most apt to be exposed, in order to ob¬ tain an explanation of this remarkable difference in the termination of insanity, in male and female lunatics. The males, for example, are more exposed to power¬ ful causes of a physical kind, especially the abuse of spirituous liquors, tending greatly to the production of inflamma¬ tion of the brain, and its consequences ; palsy being, together with derangement of the mental faculties, one of these consequences: while, on the other hand, the females are exposed to those moral causes which rather beget a state of nervous irritation than of inflammation. Such of the patients as are in a quiet and composed state of mind, and are not impressed with delusions likely to be aggravated by religious exercises, are permitted to join regularly in public worship. The attendance of the pa¬ tients on devotional duties, when con¬ ducted in public, and under the limita¬ tion to which I have just referred, has, I think, been equally productive of the good effects (particularly in calming the passions) that are reported to have ac¬ crued from it in other establishments of a like kind. In conclusion, I have to observe, that amongst other arrangements for secur¬ ing the welfare of the inmates, and a due regard to their feelings, and the feelings of their relations, it has been the prac¬ tice for a considerable time past to deny strangers access to those departments of the house that are occupied by the pa¬ tients during their w aking hours, unless under particular circumstances; such, for instance, as in the case of a medical visitor, or one really in quest of useful information. The Aberdeen Asylum has, therefore, been rendered in this point of view as much a private esta¬ blishment as any other which goes un¬ der that name ; and as much so as is consistent with a just measure of public ! surveillance, always highly proper as ! tending to keep up its respectability, and to correct any abuses which might I otherwise be apt to creep into such in¬ s' itutions. Thus no one can gratify idle curiosity at the expense of w ound¬ ing- the patients’ feelings, whilst every thing that is fitted to meet the eye of casual visitors is still open for in¬ spection. John Macrobin, M.D. Aberdeen, Nov. 11, 183f> . [We are happy to be able to add, that Dr. Macrobin has received the thanks of the Managers for the manner in which he has discharged his duties, and that the suggestions made by him in the above report have been acted upon. — Ed. Gaz.] BROMIDE AND IODIDE OF IRON. To the Editor of the Medical Gazette. Sir, In consequence of a paper which ap¬ peared in the last Gazette, respecting* bromide of iron, by Dr. Kemp, of Ches- hunt, I am induced to trouble you with a few remarks. It is more than two years since I first prepared it for the medical profession in town, during which time several have prescribed it ; and from my own experience I venture to assert, that it has no advantage over the iodide of iron, as to its keeping when dissolved ; one undergoes decom¬ position quite as soon as the other; but both are easily kept in a perfectly neutral state, by inserting a bunch of iron wire, or a coil of the same, long enough to traverse the whole column of the solution — I am, sir, Your most obedient servant, P. Squire. 277, Oxford-Street, Nov. 28, 1836. ANALYSES and NOTICESof BOOKS. “ L’Auteur se tue a allonger ee que le leeteur se tue a abreger.” — D’Alembert. The British Medical Almanack , 1837. Edited by W. Farr. Sherwood. British Annual and Epitome of the Progress of Science, for 1837. Edited by Dr. R. D. Thomson. Bailliere. The Medical Almanack , for 1837. 340 ANALYSES AND NOTICES OF BOOKS. Published by the Company of Sta¬ tioners. The Medical Pocket-Book , for 1837. By John Foote, M.R.C.S. The first on the list is decidedly the business almanack for the profession : it is superior to any thing1 of the kind that has yet been produced ; there are, however, several points in it which shew that the editor has not profited as much as he might have done by his three years’ experience. We have met with some mistakes, and not a few omis¬ sions : nor are these of a trifling' nature. It is both a great mistake and an omis¬ sion, to set down all belonging' to the College of Physicians in alphabetical order, putting the Fellows, Licentiates, and even the Candidates, in one com¬ mon list ; and the late statutes, so important to the medical public, are wholly unnoticed, as if they had no ex¬ istence. The recent ordinance of the College of Surgeons respecting teachers of anatomy is omitted, although pub¬ lished in this journal nearly a month ago. “AVakley’s Act” is left out — query , does the editor intend by this to express his opinion of its true value ? The title of Doctor is unceremoniously taken; from the hospital physicians and teachers, in London, by way of econo¬ mising space (?) ; while it is partially given to those in the provinces. The school of anatomy belonging to St. George’s Hospital is stated to be in Grosvenor Place, instead of Kinnerton- street. Mr. Bage is mentioned as as¬ sistant - apothecary to that hospital, instead of M. Depasquier. . Creosote is talked of precisely as it was in last almanack (much of the pharmaeo- poeial part being merely reprinted), as if nothing had been ascertained since re¬ garding the real value of the medicine; and no antidote is given for arsenic ex¬ cept “ hydrated tritox. iron in thirty times the quantity of the poison.” We are sorry, too, that we can¬ not give unqualified praise to the author of the paper on National Sta¬ tistics; for he adopts a tone of censure and dogmatism, throughout which we think is neither warranted nor be¬ coming. A De Moivre or a Laplace could not, and we are sure would not, assume so magisterial an air. Perhaps the more modesty a writer evinces in lay¬ ing down principles in statistical science the better: statistics are only in their infancy ; and it is worthy of the phrenolo¬ gists alone to plunge confidently be¬ yond their depth into a sea of assump¬ tions, where there is nothing certainly known beyond the first few footsteps. The price of the almanack, we must add, is very unreasonably increased : last year we had 160 pages for 2s.; this year only 216 for 3s. ; while the supple¬ mental matter contains so much that is really objectionable — unsuited, we should say, to the pages of an alma¬ nack. The editor of the British Annual has aimed at the production of a yearly periodical suited to a much larger class of the community than that composed merely of the members of the medical profession. To the latter, as well as to scientific readers generally, he here offers a year-book on the plan of the well-known French Annuaire , only modelled so as to be more particularly useful to the British public. Besides containing all that is really valuable in the French production — minus M. Arago’s essay, whatever it is to be for next year — the Annual before us is en¬ riched with some excellent scientific articles. The editor himself supplies a paper on the Progress of Vegetable Chemistry, and the Rev. Baden Powell a comprehensive and able report on the recent progress of Optical Science. Mr. Woolhouse gives a sketch of the pro¬ gress of Astronomy, and Mr. Davies a curious and learned history of Magnetic discovery. The whole forms a hand¬ some little volume, w ith w'hich we are very much pleased, and hope that the experiment may be as successful as it is commendable. The Almanack of the Stationers’ Company is a very poor affair. No pains seem to have been taken to pro¬ cure correct lists of any establishments save those of the Metropolis: the re¬ turns, for example, of the Irish and Scotch Colleges are not sufficiently re¬ cent, and even the Metropolitan an¬ nouncements seem scarcely to be relied on. If the Company cannot find some active intelligent medical man to edit their production in future, they had better not trouble themselves with pro¬ viding an almanack for the profession. Mr. Foote’s “ Medical Pocket-Book” contains much less than any of the others — yet has some of the things in OPERATION OF "WAKLEy’s ACT.” 341 which the most bulky of the others is deficient ; such as the new statutes of the Corporate Bodies, and the Medical Witnesses’ Act. There is, however, in every way a littleness about it — half the bulk is blank paper, too scanty for memoranda or for any other useful purpose. MEDICAL GAZETTE. Saturday , December 3, 1836. " Licet omnibus, licet etiam mihi, dignitatem *4rtis Medicos tueri; potestas modo veniendi in publicum sit, dicendi periculum non reeuso.” Cicuro. OPERATION OF “ WAKLEY’S ACT.’’ When the Medical Witnesses’ Bill had received the sanction of Parliament, and thus became a law, we ceased to dwell on the distrust which we had previously ex¬ pressed of it ; and, uninfluenced by any of those personal feelings which the parent of this defective act, judging* of others by himself, has never failed to attribute to us, we gave to the measure our hearty and active support. Several editorial notices regarding it are to be found in our pages, aud one entire article was devoted to its exposition. In reviewing our efforts in its favour, the only cir¬ cumstance with which we can reproach ourselves is, that we were over-liberal, and in our anxiety to prop what was evidently so weak as to require assist¬ ance, suffered ourselves to be led into expressions more favourable than the result has proved it to deserve. • The Medical Witnesses’ Act — notwith¬ standing that it was drawn up, we are informed, by his friend Mr. Theobald, the special pleader, and lecturer on Medi¬ cal Jurisprudence — has proved a failure. — The labour and responsibility to which it exposes all our professional brethren, hut especially the general practitioner, are most inadequately re¬ munerated by its provisions ; and the recompense which the law allows is clogged by so many impediments to its acquisition, as to have in many in¬ stances rendered it altogether unattain¬ able. To the fact of the fee being, un¬ der particular circumstances, wholly disproportionate to the sacrifice of time and talent, we have already in a former article alluded ; but as this is a point which does not at first sight seem very apparent, we shall now more particu¬ larly illustrate it. If the medical man were merely called upon to attend the Coroner’s Court, and having given his evidence, at once to receive his fee and retire, the sum awarded to him would doubt¬ less be sufficient ; this, however, is very far from being the case, as the subse¬ quent details will shew. But besides the trouble and loss of time which, ac¬ cording to the present system, attends the attempt to obtain remuneration, there is this great defect in the act — that however often an inquest may be ad¬ journed, and however often the witness may be compelled to be present, his col¬ lective attendances are nevertheless reck¬ oned but as one, and entitle him but to a solitary fee. Now one effect of the bill has been to induce coroners to dispense with medical witnesses as much as possible, so that they are chiefly had recourse to in cases of obscurity, and in such, one sitting is often insufficient to lead to a decision. The witness, however, has to be in attendance; and instances have occurred in which the Coroner has sat four or five times upon the same body ; while we have the ex cathedra assurance of the member for Finsbury him¬ self, that however often the witness may have attended under such circum¬ stances, he is entitled to no more than one guinea. It is quite obvious that the estimate here formed of the value of a me¬ dical man’s time is preposterously low, and that one tithe of the real interest for the profession to which the father of this 342 OPERATION OF ‘ act lays claim, would have induced him to make the fee a guinea at least for every separate day on which the wit¬ ness was compelled to be present. But again; if a post-mortem exami¬ nation be required, another guinea is awarded — no more, certainly, than the service merits. Well ; having earned his additional guinea by a laborious autopsy, it may be that the evi¬ dence is not yet sufficient, or the worthy Coroner or the jury may be fond of scientific pursuits, and choose to have the contents of the stomach analysed. The witness is instructed to enter upon the required manipulations. Here begins by far the most difficult, the most tedious, and the most delicate portion of his task — one requiring apparatus, reagents, skill, and time. All these, however, we shall suppose have been at his command, and he appears once more before the Coroner, to communicate the result of his researches. What remuneration, most courteous rea¬ der, should you deem sufficient for all this time and scientific labour? At what do you conceive the framer of the Act estimates this part of the services of the general practitioner, on whom he pro¬ fesses to have bestowed so great an obligation ? — why simply and abso¬ lutely at nothing. It may appear incredible, but such is the plain unper¬ verted truth. Not one sous is awarded for the analysis. The contents of the stomach cannot be examined w'ithout opening the body ; if the body be opened, the party is entitled to a guinea for having' done it ; and if he be “ or¬ dered ” to institute the laborious chemi¬ cal process alluded to, he gets not one farthing more. True it is, that the honourable framer of the act is pleased to say, that if the witness analysed the contents of the stomach, the Coroner would be “justified” in giving an order for another guinea. Ob, most provident legislator ! — most wakley’s act/' wise and uprightexpounder of the law ! — already do Coroners hesitate in giving one guinea for such examination, not¬ withstanding that the law allows it; yet would they be “justified” in giving an order for more, although such pro¬ ceeding would be in direct violation of this learned commentator’s own “ act.” Overseers, already indisposed to pay, would delight in this as an infringe¬ ment of the statute — which would assuredly “justify” them in refusing' the whole. A rare expounder of his own wise act, say we again — yea, a second Daniel ! But however monstrous and absurd the above declaration of our contempo¬ rary may be in other respects, it is at least of value in this — it is an admis¬ sion that his Bill has provided for the witness less than his services fairly merit; — a defect which we pointed out some months a«ro. We have hitherto assumed that what the act professes to bestow, the party entitled to it can readily obtain, but we regret to say that the statements which have appeared in the daily papers, and the repeated applications which have been made to us on the subject, clearly prove that obstacles of the most vexatious kind present them¬ selves : medical men are called upon as witnesses, and then on seeking for their fee, frequently do so in vain: some instances there may possibly be in which the fee has been obtained, — but there are already numerous examples in which it has been refused altogether. It is quite clear that, as the law stands, the medical witness is entitled to a fee ; and seeking an explanation of the difficulty he experiences, we find two circumstances which mainly lead to this result; the first is, the disreputable parentage of the Act, which has taken from it all the moral influence which is calculated to assist the operation of a new law. Parish authorities have in OPERATION OF “ their wisdom conceived a notion that, as it is only “ Wakley’s Act,” they are “justified” in resisting- it. This is the doctrine maintained in a public letter addressed some time ag-o to the honourable member for Finsbury, by “ an Overseer of St. Pancras,” — of which letter, by the way, that worthy has had the prudence to take no notice*. But another and more important im¬ pediment to the operation of the act is, the facilities which its defective con¬ struction affords to evade the demand. In order to become entitled to his fee, the witness lias numerous steps to go through ; and first, he must be certain that he has got a proper “ order” to at¬ tend. His actually attending, — the re¬ quiring and obtaining of his evidence by the coroner’s court, — avail nothing, it the slightest imperfection or irregu¬ larity exist in making out his summons ; and in this manner, from accident or design, many have already been cheated of their money. Secondly, having- at¬ tended, he must procure another “order” from the coroner for the sum to which he is entitled. It might, indeed, be supposed that no risk could be incurred here, if the preliminary step had been attended to ; but not so, — the coroner may demur; and in various instances has done so. True there is redress — most satisfactory redress; for we are told by the honourable authority above alluded to, that the party ag’grieved has only to bring an action in the Court of King’s Bench against the recusant coroner. Oh, most happy device ! — ■ — most profitable pastime ! — bring an action to recover an “order” for the sum of one pound sterling; which order, when procured, if procured , may or may not be honoured ! And * A Letter from an Overseer of Saint Pancras to T. W&kiey, Ksq. M.P., Editor of lhe Latlceti repelling the unjustifiable Attack made upon the Overseers ot Saint Pancras, for exposing his in- efficient attempt “ In provide for t lie attendance ui.d remuneration oi Medical Witnesses at Coro¬ ners Inquests.” London, 1836. wakley’s ACT.” 343 this brings us to the third stage of this eventful history — that, namely, at which the witness, having seen to the correctness of his first order — and hav¬ ing attended — and having* given his evi¬ dence — and having made a formal ap¬ plication to the coroner for an order for his fee, more lucky than many, has obtained it. Thus armed, he now pro¬ ceeds to the overseer; but this function¬ ary probably cannot venture, upon his own responsibility, to make so great an outlay, and desires him to call again: perhaps he requires a consultation with his colleague in office, or with the other parish authorities ; and after laying- their wise heads tog-ether, they resolve to refuse the fee, and let the “ Doctor” do his worst. This is bad enoug-h : but still, as we are assured, there is re¬ dress : he may go to law a second time — aided, too, by all the experience which his former suit lias afforded him. These are no imaginary evils — no merely supposititious cases — the several obstacles to payment above enumerated having- actually occurred, and having been brought within our cognizance by the complaints of correspondents. There are numerous instances in which medi¬ cal men have been fain to go with- out their fee, after having been put to a g’reat deal of trouble. But however harassing and vexatious this may be, no one has hitherto been provoked into the imprudence of going- to law for so small a sum. Now these considerations have cer¬ tainly altered our opinion of the practi¬ cal benefits to our profession likely to result from “ The Medical Witnesses’ Act ;” and we have freely given ex¬ pression to those misgivings. But we were not prepared for the indirect admission of its failure which our re¬ marks (in the Gazette of this day fort¬ night) have drawn from the profound and upright legislator, with whom it ori¬ ginated. Conscious of what has occurred 344 OPERATION OF u WAKLEy’s ACT.’’ to many of those who have attempted to recover under his act, and anticipat¬ ing’ what is to follow, he puts forth the cool and deliberate falsehood that we have instigated overseers not to pay the fee ; and follows this up with another assertion, equally mendacious — namely, the fifty-times repeated tale that it is our hatred of g-eneral practitioners which has made us do so. The latter assertion is an old trick of Wakley’s, which does not require exposure ; as to the former, we have merely to refer, in proof of its falsehood, to the articles upon the sub¬ ject which have appeared in our pages. But further: the honourable member knows well, that even if disposed to in¬ jure his Bill in the estimation of over¬ seers, such proceeding1 on our part would have been entirely one of supere¬ rogation ; the letter above alluded to, from an overseer of St. Pancras, in which he is set at defiance, and his Act held up to “ ridicule and derision,” having been printed and circulated nearly three months ago ! That Mr. Wakley had chiefly in view his own glorification when he penned the Act, his sickening and merciless iteration of “ our parliamentary la¬ bours” clearly proves ; but that he also intended to confer a boon upon general practitioners, who must be principally called upon as witnesses, we nothing doubt. It was on the latter account that we encouraged the measure, and exerted ourselves in its favour. The importance attached to our co-operation by the honourable member for Fins¬ bury, is proved by this —that he sent us the Act in slips from the Lancet Office before it was published, so as to secure its appearance in the Medi¬ cal Gazette a week earlier than could otherwise have been the case (viz. August 20, 1836). Again : unin¬ fluenced as we ever have been by personal hostility, and preferring to forget for a moment the habitual prosti¬ tution of his pages to the vilest pur¬ poses, we farther besought the favoura¬ ble opinion of the profession towards him, as one who, in this instance at least, had done his best to lay them under obligation. And so highly was this poor compliment of ours appreciated by our contemporary, that it was straight¬ way transferred to his pages through the medium of an anonymous letter — evidently written by himself. We cannot close this article without alluding, in terms of indignation, to the scandal of seeing an adventurer, to whom accidental circumstances, at a moment of political excitement, gave a seat in the legislature, endeavouring to convert this event, by indirect means, to the purposes of private gain. Not content with childish and eternal references to his own parliamentary career — heedless of its notorious failure and insignificance — he attempts to pro¬ cure purchasers for his journal by hold¬ ing out his own “ act,” in terrorem, over the medical profession. He pub¬ lishes lectures on Medical Jurisprudence, and then appends as a standing notifi¬ cation, that the enactments of the Medi¬ cal Witnesses’ Bill render it impossible for practitioners to neglect the subject, “ without exposing themselves to the risk of irretrievable ruin and professional degradation .” Thus, then, it stands : — if the practi¬ tioner does not obey the summons of the coroner, he has the certainty of be¬ ing fined 51. ; if he does obey it, he has a chance of getting an order for a guinea, which he is at liberty to recover — if he can; but if he has not purchased Lan¬ cets enough to enable him to make a good figure in the court, then is he ex¬ posed to “ irretrievable ruin.” Such are the obligations conferred on the medical profession by the legislation of Thomas Wakley, M.P. for the district of Fins¬ bury ! ! dr. Seymour’s clinical lecture. 345 CLINICAL LECTURE, Delivered at St. George's Hospital , November 25, 1836, By Dr. Seymour, fever. I spoke at our last meeting of those cases of fever which had been taken in a few days before, and which were under my care. All these cases are convalescent. SCARLATINA. There was one case of fever, however, which differed from the others, and of which I will endeavour to speak to-day — more especially, because it is a disease at present very rife in London, and the treatment of which is of very great im¬ portance. I allude to scarlatina, or scarlet fever , as it is called. A case of this disease was taken in on Wednesday wreek, and is in York ward. It <#ccurred in a youth named Charles Turner, set. about 20. It is a very mode¬ rate case of the complaint, so far as the urgent symptoms are concerned ; at the same time, it is better to take one of these ordinary cases, and explain the accidental circumstances which arise dur¬ ing its progress, than to take a very severe case, such as you may not see again for a great length of time. This man’s case is called scarlatina avginosa. Nosologists have divided scarlatina into S. simplex, S. angi- nosa, and S. maligna. The latter is the same disease as the ulcerated sore throat of Huxham and Plenciz, and one of the most fatal diseases with which I am acquainted. This, however, is an unusual form of the disease; whereas, the other species is very common. The circum¬ stances which accompany the disease make it of great importance, in a practical point of view, to attend to the eruption with which it ordinarily begins. I should tell you that people have got an odd notion into their heads ; they imagine that scarlatina means some¬ thing else than scarlet fever. This, it is said, is to be attributed to the late Sir Walter Farquhar, who, to calm the fears of people, when it prevailed to a great extent, said that it was only scarlatina, and by using this diminutive, they thought it was another disease, whereas scarlatina is only the Latin name for all the varieties of the complaint. The eruption almost always comes out on the second day of the disease, but sometimes not until the third. In the present case, two full days elapsed before the eruption appeared. This contra¬ distinguishes it from measles, in which the eruption never comes out before the fourth day — a difference of time which enables us to form a correct diagnosis. The diagnosis between measles and scarlet fever, al¬ though sufficiently plain in general, is sometimes very obscure. The eruption is generally efflorescent, and not raised in the semi-circular form in which it occurs in measles, in addition to which it is almost always attended w ith a sore throat. In the early stages of the complaint, the danger of the patient is exactly in pro¬ portion to the degree of severity of the sore throat. In general the tonsils are swollen, and of a bright scarlet colour. About the second day there begin to appear slight eminences, which sometimes coalesce, forming sloughs. If they coalesce early, and the sloughs are ash-coloured, the disease is extremely dangerous; the impression made on the nervous system is so great, that the patient dies on the 2d, 3d, or 4th day of the eruption. Indeed, it w as the death of patients under this com¬ plaint having been of a more than usually appalling character, which gave rise to the great efforts made by the profession generally to treat it. It was not, how¬ ever, knowrn to the ancient physicians, but described bv Huxham, and great attention called to the severe epidemic w’hieb occurred in 1747. In that epi¬ demic, two sons of the Right Honourable — Pelham, then Chancellor of the Exche¬ quer, died within an hour on the same day. Of course such an event, particularly in the higher classes of society, was a subject of great excitement. I suppose that similar accidents happened frequently in the course of that epidemic. In conse¬ quence of this, physicians began to investi¬ gate the subject, and Dr. Fothergill pro¬ duced a w'ork on Ulcerated Sore Throat. In the case which we are considering, the throat early became violently affected. There appears to be a sympathetic effect on the nervous system, and patients are destroyed very rapidly. A boy, to my knowledge, may be perfectly well on Thursday, and dead on the following Saturday morning. This patient was attacked on Sunday night with vomiting, rigors, and pain in the back — commonly preceding symp¬ toms; and on the Wednesday morning, leaving Monday and Tuesday clear, he ffrst observed red efflorescences on the skin ; probably they came out a little earlier, but were not perceived. He had a blister applied to the exterior of the fauces, which I beg you to observe is, for reasons I will presently explain, very bad practice. The blister, however, relieved the swelling, and in this instance did no harm. The whole of the membrane of the mouth and throat became of a scarlet-rcd colour, and there I 34G - dr. Seymour’s clinical lecture. was some pain on inspiration referred to the scrobiculis cordis. The skin, when I saw him, was moist, an unusual circum¬ stance ; the pulse was 110, and not weak; and the bowels had been opened by medi¬ cine. I mentioned that the application of a blister is always bad practice, and for this reason, that there is a great degree of irritation about the mouth and throat, and sometimes a blister acts as a direct stimulant, unless other remedies be used, and constant fomentation. In hospital practice this is doubly unjustifiable, because erysipelas is apt to come on. There was a nurse in the hospital not long ago, in whom this accident occurred, and she was in a very dangerous state. After the scarlet fever was over, she nearly died from the irritation of a blister inducing erysipelas. Where you think counter¬ irritation useful, a mustard poultice ap¬ plied just long enough to excite redness, will be sufficient, and is often very benefi¬ cial. But in general, where the fauces are much inflamed and swollen, the appli¬ cation of leeches to the throat is the most effectual practice. In fact, your attention is directed, in the early stage of the com¬ plaint, to diminish the heat of the skin, which is excessive, and to reduce the swelling and inflammation of the fauces. If the heat of the skin be steadily above the natural temperature — and I should observe that in this disease it is more commonly above the natural standard than in any other febrile affection known in this country, being frequently 104p Fah. ; and if the eruption be full and red — the best thing that can be done is to put the patient into a shower bath, or into a tub of cold water — cold affusion. But in private life people will not submit to this; they are greatly alarmed by it, and there¬ fore the next best thing is to wash the body over with vinegar and water. This may be done several times a day, and the effect is, to diminish the heat of the skin. The next point is to get the bowels freely onened, and to diminish the inflammation. It is seldom that blood-letting is neces¬ sary; but if the symptoms are very violent in the early part of the case — if the skin be hot, and the eruption has already come out— there can be no objection to taking blood from the arm, though it is not often necessary. With regard to getting the bowels open, swallowing is always a matter of great difficulty, but the object may be effected by putting a couple of grains of calomel on the tongue every four or six hours, and exhibiting, as soon as possible, two drachms of sulph. magnesia in an infusion of roses. In most cases this is sufficient. I should say something respecting gar¬ gles. In the first place, it is seldom that a patient can gargle the throat at all, and then the simple inhalation of the steam of hot water is the only thing to which you can have recourse. If the patient can swallow w'arm bread and milk, it acts as a fomentation : the best gargle you can employ is hot barley-water. Do not begin in scarlatina with an astringent gargle, for I have seen very serious effects arise from it; the throat has become more inflamed, the patient a great deal more distressed, and the practitioner, I remember, in one instance was turned out. Commence with applying warmth as much as you can to the throat, which relieves the swelling of the tonsils, and in the course of time the disease will go away. You must keep the bowels open by a saline powder, and place on the patient’s tongue, at first every night, and in a short time every other night, two grains of calomel with sugar. This, with simple gargles, is almost all that is re¬ quired in ordinary cases. But the disease sometimes does not stop here ; and you must bear in mind, that the most dangerous sequelae in scarlatina oc¬ cur after a mild rather than a severe erup¬ tion. These sequel® are of various kinds. Sometimes inflammation of a serous mem¬ brane takes place, more especially of the pleura and pericardium. I have seen a patient come into the hospital with the secondary affection, and I have seen two quarts of matter taken from the pleura after death, in consequence of inflamma¬ tory action having been set up there subse¬ quently to the decline of the original dis¬ ease. I have knowm two cases in private life, where children died from inflamma¬ tion of the pericardium, after they ap¬ peared to be safe. Inflammatory symp¬ toms will sometimes take place in the se¬ rous membrane of the bowels ; but this is not very common. Another case which occurs after the sub¬ sidence of scarlatina is the swelling of the parotid and submaxillary glands. This frequently occurs, likewise, towards the end of continued fever, and has been looked upon as critical, asending the com¬ plaint. If the parts slough, which they rarely do, it ends the case very de¬ cidedly; but if this symptom disappears, it is generally considered as not disadvan¬ tageous. I do not know whether this can be said to be the case in scarlatina. The patient whose case is before us was admitted on the 9th, and I ordered two grains of calomel, and two grains of sugar, to be placed on the tongue every six hours, and two drachms of sulphate of magnesia to be given in an infusion of roses twice a day. On the 11th the eruption declined SCARLATINA. 347 rapidly, and the pulse was only 80. On the 14th the disease entirely disappeared. Nothing could be more easy than this. But though the scarlatina had disappear¬ ed, the ease was by no means satisfactory as to the state of the patient. He wras getting up his appetite, and so far things were favourable; but the time had not yet elapsed at the end of which he might be considered safe. From the 18th to the 23d day of the disease dropsy frequently supervenes, or an effusion into one of the internal cavities of the body: this is said to occur most frequently — I do not know how truly — where the desquamation of the cuticle is slow. The ordinary form of the disease terminates by the cuticle more or less separating; and it is said that dropsy occurs most frequently before it separates : I am not sure, however, that this is a just observation. On the 16th there was heat of skin, the face was very red, the pulse 100, and he complained of much pain in the back, particularly in the region of the kidneys. The urine which he made was exceedingly small in quantity, and very much loaded. I was exceedingly alarmed lest dropsy should supervene, and I had him immediately bled to twelve ounces, and gave him a sufficient quantity of su¬ pertartrate of potass to open his bowels freely. Instead, however, of this occurring, as I was afraid it would, the parotid glands on the left side swelled considera¬ bly, and likewise the submaxillary glands. Antiphlogistic treatment was used to get rid of this condition : leeches were applied, then an evaporating lotion, and the bowels were kept steadily open. Under these means this has disappeared the patient still made little water, however, and I was afraid lest dropsy might supervene ; I therefore kept him upon diuretic medi¬ cines, and ordered him a nitre draught, consisting of fifteen grains of nitrate of potassa in an ounce and a half of mint water, with a drachm of spirits of nitric aether, and twenty drops of tincture of squills. His urine was still loaded, and depositing a sediment. To-day his tongue is clear, and getting better. This is a good and instructive case as to what may occur in what was originally a very mild form of the disease. I am rather inclined to think that there is in the present epidemic a mixture of disease of the parotid glands with scarla¬ tina. I was called to see a gentleman last week at a large school, who had scar¬ latina ; and since he has had this com¬ plaint, a number of the boys have had mumps — a swelling of the parotid glands. I have seen another case, where two chil¬ dren were ill, one with scarlatina, and the other with a swelling of the parotid glands, immediately succeeding the fever. As this occurrence is not very common, I am in¬ clined to think that there is, as I have said, a mixture of the diseases, so that scarlatina is more likely to be followed by a swelling of the glands than in an ordi¬ nary epidemic. Our patient has got quite well of this, but I still fear lest dropsy should come on. This leads me to say a few words upon the effusion which takes place in this af¬ fection. It is remarkable that in Dr. Fo- thergill’s work on Angina Maligna, the dis¬ ease which attracted so much attention in 1717, no one case is stated to have termi¬ nated in dropsy. In every case which I have seen of dropsy after scarlatina, the latter has been mild. A case occurred in this hospital some years ago, of a woman who had a still milder case than the pre¬ sent. She had been well of the complaint more than a week, and was merely kept in as a matter of precaution. Sudden effu¬ sion took place into the brain ; she was bled ; a blister was put on the top of the head, and kept open bv mercurial oint¬ ment, calomel and diuretics being given at the same time. She was treated briskly antiphlogistically, and recovered. The effusions which succeed scarlatina are ge¬ nerally more troublesome than those which occur in ordinary diseases, or are the re¬ sult of other affections. I saw some years ago, the case of a child in Regent’s Park with scarlatina. The case was mild, and the child recovered. There were two other children, and they were sent into the country, and the house painted from top to bottom. At the expiration of two months they returned, and ten days after¬ wards, which is about the period of the dis¬ ease lying dormant, they both took the com¬ plaint. One of them was five years old. The case was mild, and the eruption passed off. Suddenly, on the eighteenth day, dropsy came on, and there was anasarca, to a greater extent than I ever saw it in any other individual. The eyes were per¬ fectly closed, and I should compare it to a blowm-up pillow-case : there was no ap¬ pearance of a child. This shews that it is no trifle where it does occur ; but happily, from the treatment pursued, dropsy does not very frequently appear. Writers have laid too little stress on this subject. The best description of dropsy supervening on scarlet fever was in a work published by Plenciz, a German physician ; and this was aftenvards improved by Dr. Wells, in a paper published in the Trans¬ actions of a society for the Improvement of Medical and Surgical Knowledge. I recommend you to read that paper. It not unfrequently happens that effu¬ sion takes place into the brain, sometimes 348 DR. SEYMOUR S CLINICAL LECTURE. into the belly, but most frequently into the cellular membrane, and thus causes anasarca. A great many questions have arisen as to how this particular complaint is to be treated when it succeeds an eruptive dis¬ ease. It is supposed that it is the result of debility, and some assert that more die of this than of the original complaint. Some think that it has become less fatal in consequence of less stimulants being em¬ ployed ; and most modern writers agree on this point. Purging has been frequently employed in the course of the complaint, and even venesection under some circumstances. I am of the same opinion. I have never seen a case in which stimulation has succeeded. Where the inflammatory symptoms run high, and there is great heat of skin, the best plan is, if the child be not broken down, to take blood from the arm, and subsequently to use those diuretic medi¬ cines which act strongly on the bowels — saline medicines, with mercury. If the disease has actually become established, and the child is weakly, recourse may be had to some of those medicines which act on the kidneys : pyrola umbellata, joined with saline medicines, appears to be the most beneficial. I have seen the exhi¬ bition of liquor potass® followed with great success in cases w'here the urine was much loaded : a tea-spoonful may be given three or four times a day, in milk ; in ge¬ neral it has produced diuresis. The admi¬ nistration of bitters, with diuretics — such as an infusion of gentian and of digitalis — is a favourable mode of proceeding in some cases The Germans are of opinion that an infusion of broom-tops is better adapt¬ ed to this form of disease. I believe, however, that dropsy rarely takes place where the patient has been properly purged. In Dr. Hamilton’s work on Pur¬ gative Medicines, you will find an account of an epidemic scarlet fever which raged at Edinburgh in his time; and in that epidemic, after the boys had appeared to recover for two or three days, effusion took place into the different cavities of the body. This led him to be careful in examining the reason, and he found that by purging freely as soon as the patients became convalescent, no other cases oc¬ curred during the w hole progress of the epidemic. Foreigners, particularly the French and Italians, never think of em¬ ploying cold affusion. When a patient has" scarlet fever, he is shut up in a room, and ordered to be kept in that state forty days : not an atom of air is allowed to enter ; and if the patient then has no ana¬ sarca, he is considered to be safe. It is almost like treating a person after the plague. Many years ago, I attended two children in Italy labouring under scarlet fever. I ordered the windows to be left open, and cold water applied, in the month of November. The effect was astonishing to some medical men. The patients recovered perfectly, and no un¬ favourable symptoms took place. In fact, dropsy, I believe, will not occur where the inflammatory symptoms of the disease have been treated during the com¬ plaint. Besides, there is another con¬ sideration. Almost all eruptive diseases, if left to themselves, terminate by diar¬ rhoea ; and if this is kept up by medicine towards the end of the complaint, all goes wrell. But if patients are not purged, and diarrhoea does not come on, then it is reasonable to imagine that the vessels will pour out fluid into the different cavities of the body. You are therefore to attend throughout the whole course of scarlatina to keeping the bowels freely open; and where the inflammation runs high, it is to be treated like any other inflammatory disease. The severe .form of the disease, although not common, is an inflammatory disease, and is not followed by those sequel® wdiicli occur in the milder form of the complaint. But there are cases of scarlatina in wdiich it becomes necessary to stimulate the pa¬ tient from the very beginning of the dis¬ ease, and in which absolutely there ap¬ pears to be no inflammatory condition, The patient is taken very ill, and an ulcer forms on one or both tonsils, wrhich is ash-coloured, and the breath is so offen¬ sive that you cannot bear to approach him. The inflammation creeps down the wundpipe, and the patient dies. At other times the inflammation is of so fatal a character, that the nervous system becomes affected sympathetically, and in that way the patient dies, — just as a malignant dis¬ ease at a distance produces death under other circumstances. You are to bear in mind, that the mild form of the disease in one patient may produce a severe kind in another. Some years ago, I was called to see a child, over Westminster Bridge : it was then at the breast, and laboured under scarlet fever. Nothing could be more mild than the complaint. There was a little efflorescence, and a little difficulty in sucking, but it soon passed off. Eight or ten days afterwards, the mother was attacked with rigors; voimting and head¬ ache came on ; and this was followed by great prostration of strength. A purple eruption came out on the legs, and she was much depressed. The throat was dreadfully ulcerated, so that the mouth could scarcely be opened, and the smell w as hardly supportable. The patient was ordered three or four grains of sulph. st. george’s hospital. 349 quinine, dissolved in as little water as pos¬ sible, on account of the difficulty of swal¬ lowing, to be taken every three or four hours, and as much wine as could be got down: indeed she could not have swal¬ lowed a great quantity. The woman was by this means raised up from her state of depression, and eventually recovered. I have no doubt that such cases may occa¬ sionally occur. Ammonia has been re¬ commended under these circumstances, but the difficulty is to administer it. There is no question but that though scarlatina is an inflammatory disease, yet cases do occur where there is no inflammation, and the impression on the nervous, system is so violent, that, if stimulants be not applied, the patient will die during the progress of the complaint. Cases, however, some¬ times recover very rapidly. The nurse to whom I alluded presented one of the worst cases I ever saw. A considerable quan¬ tity of quinine and wine was given, which cured the complaint ; erysipelas then came on ; the same remedy was used for the second disease, and the patient recovered. With regard to the contagious nature of scarlatina, I apprehend there can be no sort of doubt on that question. You will frequently be consulted on this subject, and it is a matter of great importance to know how to reply. It is believed in the profession (and I entertain the same opi¬ nion), that a patient labouring under scar¬ latina, however modified, may spread the disease to another person at any time with¬ in a month from the period of attack. Consequently a boy should not be returned to school, or placed with other children, till that period has elapsed. You will re¬ member the cases which I mentioned at Regent’s Park, where the children were sent away, and the house painted through¬ out, and yet, upon their return, in ten days both the children had the disease. In the great majority of instances this will not take place :"the children might be returned, and no one would imbibe the disease ; but in some instances they would, and you are called upon to guard against such a circumstance in every possible way. You should not advise the child to be re¬ turned to the society of other children un¬ til a month has elapsed from the com¬ mencement of the complaint. PURPURA. There is a case in the house of what is termed purpura. The patient was with us before; he was relieved, and went out, but has returned. The case is in progress, but the patient is very ill. I shall speak of it at our next meeting, and state the reasons which induced me to employ the practice I adopted. GOUT. One of the gouty patients has had a slight return of the affection, but, upon the whole, the case is doing well. The two other patients are ready to go out whenever I think proper. I have no doubt that the slight return will be removed by the same means as before. / EPILEPSY. 1 spoke, in a former lecture, of two cases of epilepsy : one case was attributed to a fall, and a seton was placed in the neck. Since that, time the patient has had one fit, but it is now several weeks since, and he is going to be dismissed. The other is the case of the boy who has epilepsy once a month. We have verified this by the case ; because I kept him in, that we might see he was not deceiving us. I put him on arsenic, and increased the dose to six drops of the arsenical mixture three times a day, as he approached the period when he expected to have a fit. Whether it will come on, I cannot say; but the charm is destroyed, for the period has passed by two or three days, and con¬ sequently we may hope that the chain of action is broken which constituted the disease. I mentioned that the best way would be to put him on arsenic, and so far as the case has gone it appears to be suc¬ cessful. ST. GEORGE’S HOSPITAL. Case of Poisoning with Hydrochloric Acid. Joseph Goodman, aet. 25, cabman at Chelsea, admitted, under the care of Dr. Chambers, October 31st. Pulse 58, small ; skin warm ; tongue much excoriated, dry. He was reported to have taken about ^ij. of hydrochloric acid nearly two hours before he was admitted into the hospital. He had vomited some dark greenish matter, which effervesced with carbonate of soda. About §iij. of this 'were then administered to him, with mucilaginous drinks and linseed tea. He did not him¬ self think that he had actually swallowed much of the acid. R Magn. Ustae, gr. xv. ; Mucil. Acacias, 3iss. ; Aq. Distill. 3x. 4tis horis. Enema emolliens, 6tis horis. Hirud. xviij. gutturi et postea. Cata- plasma Lini. Fotus abomini. Fever diet. He vomited once or twice in the courseof the night some dark matter. November 1st. — Pulse 180, rather sharp ; bowels not open ; tongue dry ; complains 350 ASSIST AKT-SURG EONS IN THE NAVY. of much soreness about the throat and fauces. V. S. ad 3xviij. Enema 01. Ricini. Vespere repetantur Hirud. xx. gutturi. 01. Ricini, ^ss- cras niane. 2d. — Symptoms somewhat relieved; throat less sore; no sickness; no pain in abdomen. Pt. 3d. — Pulse 85, rather sharp. Tongue healing, not so dry. Throat very sore. R Decoct. Cydoniae, ^iss. Mell. Bo- racis, ^j- M. ft. Garg. ssepe utend. Hirudines xij. gutturi. 4th. — The sickness has returned, and he has vomited some dark-green matter. There is this morning some slight pain in epigastrium on pressure. Hydr. Submur. gr. ij. ter die. 5th. — Sickness has rather abated, and there is scarcely any pain in the epigas¬ trium. Throat less sore. Pt. 6th. — His tongue is much swollen, so that he can hardly protrude it. He com¬ plains of his throat being very sore, with pain extending downwards to the left side of his chest. There is a slight erysipela¬ tous appearance on the nose. V. S. adjxij. II. Salinus c. V. Ant. Tart. 3ss. c. singulis Pilulis sumend. 7th. — Pulse full, soft, frequent, regular. Tongue much swollen and dry ; has great difficulty in swallowing. There is much pain in the left side of the chest, with some palpitation and giddiness. There is strong action of the heart, but without bruit. He had some shivering this morning. The patch of pale erysipelas on the nose had nearly disappeared, but has now returned. Blood drawn yesterday much inflamed. C. C. reg. cordis ad Jx. Decoct. Cydon. Aq. Rosas aa. jpij. Mell. Boracis, Jss. Ft. Garg. Rep. Pil. et H. Salinus. Milk diet. He fainted after the cupping, but soon afterwards rallied. In the evening he was seized with great difficulty of breathing, but without much pain either in the chest or epigastrium, and till the last complained only of his throat. He died on the 8th, about a.m. Post-mortem. — On opening the chest there was found in the right cavity of the pleura about Oss. of serous fluid, mixed with blood; and in the left about Oj. of the fluid, with shreds of lymph floating in it. There was some inflammation of the la¬ rynx, and this increased as it descended into the bronchial tubes. The left lung was much inflamed and condensed, and purulent matter exuded from the cut edges of the small branches of the bron¬ chial tubes. In the pericardium there were about 5ij. of fluid. The tongue was much inflamed and enlarged. The oeso¬ phagus was highly inflamed; and in some parts the mucous coat had sloughed, and in others it was rather thickened. The coats of the stomach were very highly in¬ flamed, and in most parts had sloughed ; and large dark shreds of the slough were hanging from its sides, especially about the pylorus. The inflammation had extended into the duodenum, but no sloughing had taken place there. The liver, pancreas, kidneys, and heart, were healthy. ASSISTANT-SURGEONS IN THE NAVY. MANNER IN WHICH THEY ARE TREATED. To the Editor of the Medical Gazette. Sir, I think you cannot be aware of the man¬ ner in which medical affairs are conducted in the navy, or your attention would long ago have been directed to the subject. I am inclined to think so from the temperate and straightforward course you have al¬ ways pursued — giving praise where praise is clue, and never shrinking from the duty of exposing abuses where real abuses exist. It is with this sense of your impartiality that I am induced to bring before your notice, and that of the medical profession, facts which I fear have hitherto been kept too secret, and not proclaimed with that truth and publicity which their importance demands. Whether this supineness results from the aggrieved party being absolutely so ashamed of their condition as to prefer privacy, or from other causes, I know not; but this is certain, that no proper means have yet been adopted to remove the griev¬ ance, either by the actual sufferers, or by any other parties. The surgeons and assistant-surgeons of the navy both labour under great disad¬ vantages, and are even now far behind their brethren of the army; but it is to the condition of the assistant- surgeon that I particularly wish to draw your attention, because it is the most glaring and most degraded. The state of the surgeons is tolerable, nay respectable, but that of their assistants is altogether degrading. Those who enter the navy are for the most part young Scotch physicians, who, having finished their education, enter the ASSISTANT-SURGEONS IN THE NAVY. 351 service with a false idea of its being- a con¬ venient place for study, and prosecuting practically their favourite sciences on fo¬ reign shores. But, alas ! how many un¬ fortunate young men, when too late, have discovered that these notions were precon¬ ceived and erroneous — that their hopes were merely the fictions of their own ar¬ dency, and that they have, heedlessly and unadvised, taken a step totally inconsist¬ ent with their previous habits and educa¬ tion. Such a one, perhaps, has “ interest” in the navy; he is young, and full of hope (not to mention dazzled by a fine uniform, which is very natural) ; he has a laudable desire of visiting distant shores, his pre¬ vious education having taught him to be¬ hold them with a scientific eye; he is anxious to witness and to investigate the causes of natural phenomena, the produc¬ tions of remote climates, both geological, zoological, and botanical : all these glow¬ ing inducements decide his doubting mind. He is consequently appointed to a ship; he is no sooner embarked than his troubles commence; he is conducted to the mid¬ shipman’s berth, and learns that these boys are to be his future messmates and com¬ panions, together with a few petty officers, — as the coxsw'ain, carpenter, &c. ; he has to sleep in public !— it is a fact ; he has no private cabin, though the carpenter and others have this convenience. To read is out of the question ; if he attempt it, his books are torn and otherwise ill treated : indeed he seems to be singled out as an object of degradation and contempt. Now what is the consequence of all this ? Why look to the poor suffering officers themselves, and read the melancholy an¬ swer ; see how necessity triumphs over education and all moral restraint — how they acquire the habits of their associates, and daily lose more and more of their previous acquirements, till at length they become unfit for promotion. The truth must be spoken, sir, however painful the intelligence may be ; for the surest wray of curing a malady is to ascertain its extent. I need scarcely observe how the evil extends beyond the actual sufferer — how it impli¬ cates the whole medical profession; for surely no insult can be offered, or degra¬ dation heaped upon any portion of a pro¬ fession, without its being felt, in some shape or other, by the whole brotherhood. But it is not so much to the personal in¬ conveniences that I allude(which, in truth, are bad enough), as to the impolicy, the cruelty, of placing these officers in a situ¬ ation to which they are totally unsuited, both from the nature of their professions and the studious habits which they have, or ought to have. It is all very well for boys who are learning navigation and the duties of a naval officer; indeed, in such a case it is indispensable, for they must of necessity be separated from their supe¬ rior officers, to keep up that distinction which a more intimate intercourse would destroy; for, as boys, they could not ap¬ preciate such intimacy without losing that awe which must exist between the twro ; — but with the assistant-surgeon it is quite otherwise; he has already gone through the drudgery of his own profes¬ sion, and his sole object now should be to retain w hat lie has acquired, and direct it in proper channels; and until suita¬ ble opportunities are afforded him to fur¬ ther these objects, the naval service will ever wrant that degree of medical skill which her peculiar circumstances demand. After duly considering this subject, I am convinced there is only one remedy for the evil, and until that be adopted there can be no hopes of improvement among this class of officers. He should be admitted into the gun-room, and to the society of its inmates; a claim to which he is en¬ titled by all the rights of humanity and justice — a claim which the respectability of his own profession demands — a claim which science calls aloud to be satisfied ; and I cannot but think that those who stand in the wray of its adoption, are ac¬ cumulating a heavy load of responsibility- on their own heads; and, oh! could they but see, in one concentrated view', the dark train of evil consequences resulting from their apathy, I am sure they w ould relent, and give every aid to promote, ra¬ ther than oppose, this measure. I might advance many arguments in support of this claim, and particularly dw'ell on that which relates to the obsta¬ cles of scientific pursuit, and its conse¬ quences; but I know that your time is much occupied at this crisis of medical science, in turning aside the revolutionary flood which is setting in, and swelled too, by the efforts of her own members. We must acknowdedge that you have a task which requires undivided attention ; ne¬ vertheless, I entreat, in behalf of the unfor¬ tunate sons of that profession, who are nowr rolling on the sea under a tropical sun, that in the midst of your exertions you will not be unmindful of their suffer¬ ings; they are scattered far and wide on the bosom of the ocean, and therefore cannot come before you with clamorous complaint: their silence may be mistaken for contentment or resignation, but I fear it is the sullenness of wounded pride. I remain, sir, Your obedient servant, W. M. B * * *. November 24, 1835. 352 BILLS OF MORTALITY. - METEOROLOGICAL JOURNAL NERVES OF THE ORBIT. NOTE FROM MR. SHAW. To the Editor of the Medical Gazette. Sir, I am unwilling your readers should think that, in noticing the error committed by Mr. Thurnam, I expressed myself in a man¬ ner calculated to warrant the belief that I was “ wanting in good feeling.” I should be very sorry if it were considered that I took advantage of this gentleman’s hav¬ ing fallen into a mistake (of which, indeed, there could be no question), in order to make my observations more severe than his negligence really warranted, or that I was actuated by any improper feeling. Permit me to remark, that in deprecating my supposed want of good feeling, Mr. Thurnam forgets that, by his own careless¬ ness, he had laid himself open to a worse charge than I brought against him, that of wilfully committing an act of injustice towards another. His last letter shewrs how his mistake originated ; and I take this opportunity of saying, that if I had been aware that the early paper to which he referred did not contain the view's rela¬ tive to the sixth nerve, which have been the subject of our discussion, I should have given him the advantage of this cir¬ cumstance, and have explained his error in such manner as not to have caused him the least pain. I have the honour to be, sir, Your obedient servant, Alexander Shaw. Middlesex Hospital School, Nov. 28, 1836. APOTHECARIES’ HALL. Thomas Partin Atkinson, Kilham. Cornelius Waddell, Colchester. Charles Robert English, Bath. John Challice, London. Robert Nathaniel Slone, Bath. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Dec. 3, 1836. Abscess . • 2 Age and Debility . 22 Apoplexy . . 7 Asthma . . 13 Cancer . . 3 Childbirth . . 4 Consumption . 48 Constipation of the Bowels . . 2 Convulsions . 22 Croup ... 3 Dentition or Teething' 5 Dropsy . . 13 Dropsy on the Brain 10 Dropsy on the Chest 1 Epilepsy . . 2 Erysipelas . . 1 Fever ... 5 Fever, Scarlet . 5 Fever, Typhus . 2 Gout . . . 1 Haemorrhage . 1 Heart, diseased . 1 Hernia . . . 1 Hooping Cough . 3 Inflammation . 30 Bowels & Stomach 1 Lungs and Pleura 4 Insanity . . 1 Liver, diseased , 3 Measles . .12 Mortification . 3 Paralysis . . 3 Small-pox . . 7 Sore Throat and Quinsey . . 1 Spasms . . 1 Thrush . . 3 Unknown Causes 3 Casualties • 10 Decrease of Burials, as compared witli > ^ the preceding week . . 1 METEOROLOGICAL JOURNAL. Kept at Edmonton, Latitude 51° 37' 32" N. Longitude 0° 3' 51” W. of Greenwich . Nov. 1836. Thermometer. Ba romkte a. Thursday . 24 from 32 to 43 29-42 to 2949 Friday . . 25 25 38 29 65 29 61 Saturday . 26 30 43 29 37 29 '28 Sunday . . 27 33 55 2954 29 44 Monday . . 28 51 57 29' 25 29 33 Tuesday . . 29 49 57 29-04 29-42 Wednesday30 42 48 29 '42 2y-62 Prevailing wind, S.W. Generally cloudy, except the 24th, with fre¬ quent and heavy showers of rain. On the 28th and 29th wind very boisterous, perhaps never more so than on the 29th, doing much damage to buildings and trees. Rain fallen, 1 inch and ‘05 of an inch. Charles Henry Adams. LIST OF GENTLEMEN WHO HAVE RECEIVED CERTIFICATES. November 17, 1836. John Kimnell, Leamington Spa. George Carpenter, Chippenham, Wilts. Nicholas Rundell, Callington, Cornwall. George Augustus Harrison Capes, Castle Heding. ham. Maurice Searle Barton, Market Rosen, Lincoln¬ shire. Isaac Barnes Murcott. Thomas Davies, Hookwood, Surrey. Edward Hodges Cree, Bridport. November 24th, 1836. Samuel Hill, Southwark. Charles Jones. John Morris, Shucknall, Herefordshire. Benjamin Ward, Leeds. Jesse Henry Newington, Trieliurst, Sussex. Thomas Cooley, Alfriston. Thomas Bayley Mercer, Deal, Kent. December 1st, 1836. Gurney Turner, Yarmouth. John James Ibbotson, Nafferton. NOTICES. We cannot make our pages a vehicle for Mr. Guthrie’s circular lecture: such com¬ munications we consider as mere adver¬ tisements. “A Pupil” is unreasonable in expect¬ ing us to publish his statement unauthen¬ ticated: we little doubt the facts — yet what warrant have we of their accuracy ? Errata. — In Dr. Ogston’s paper, page 172, col. 1, line 21, for “ 1830,” read “ 1831 ;” p. 175, col. I, line 9 , for “wi¬ dowers,” read “ widows col. I, line 11, for “ widowers,” read “ widower;” col. 1, Table l, opposite 1827, for “ 2,” read “ 3;” col. 1, Table 2, opposite 1827, for “ 3,” read “ 2 col. 2, line 2, for “ average,” read “increase;” p. 176, col. 2, line 45, fur “ hard,” read “ soft.” Wilson & Son, Printers, 57,Skinner-St. London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY OF iHrti trine anti tfie Collateral ^eteitceef. SATURDAY, DECEMBER 10, 1836. LECTURES ON FORENSIC MEDICINE; Delivered, at the Aldersgate School of Medicine , By William Cummin, M.D. Lecture XI. Further remarks on the Evidence of Rape — Violation without defloration — Appearances in prostitutes — Possibility of the proofs in mar¬ ried women — Miscellaneous considerations — Ages of the parties — Violation of infant children — Evidence jrom certain discharges — Distinctive characters of menstrual fluid — Pregnancy in reference to rape — Question of consent — Sham cases — Practical rules for investigating cases of rape — Report in illus¬ tration. In the last lecture I treated of some of the chief circumstances connected with rape — a subject of high importance in Forensic medicine; as will readily be admit¬ ted, when wre take into consideration the frequency of the charge, the difficulty of the proofs, and the doom that awaits the con¬ vict. General evidence in cases of rape. — “ The accusation,” says Lord Hale, “is easy to be made, and harder to be proved ; but it is harder to be defended by the party accused, though innocent.” And in another part of the “ Pleas of the Crown,” this learned Judge notices parti¬ cularly the precariousness of the evidence of the crime: it presents, he says, “the greatest difficulty; wherein many times persons are really guilty, yet such an evidence as is satisfactory to prove it can hardly be found ; and on the other side, persons really innocent may be entangled under such presumptions, that many times carry great probabilities of guilt.” 471. — xix. In cases of this kind the primary evi¬ dence is generally given by the complainant herself ; her single testimony is adduced in proof of the fact, and she is held to be a competent witness, (even the wife against the husband — as in Lady Castle- haven’s case, 3. State trials, 41 1) provided certain moral circumstances concur to attest her credibility. She must be a person of good character, must have de¬ nounced the offender without loss of time, and be able to show that she made all pos¬ sible resistance. But, on the other hand, it deserves to be noticed, that even though she be of bad character, and have con¬ cealed the injury for some time after she had an opportunity of revealing it, and although it does not appear that she made any outcry at the commission of the offence, still her testimony is not to be wholly rejected. Medical evidence. — Among the colla¬ teral facts, proof of which is requisite to support the general accusation, marks of violence on the person, and especially about the sexual organs, must be clearly made out. The circumstances should be very peculiar, indeed, to justify a convic¬ tion for this crime, without any appear¬ ances indicative of violence being detected about the complainant’s person. Hence the necessity of medico-legal interference. I have already observed that the crime of rape is usually distinguished by the medico-legal authorities, (the legal make no such distinction) according as it is com¬ mitted on those who have had, and those whohavenot had, sexual intercourse before. Consistently with this arrangement, I no¬ ticed in last lecture the signs of forcible deprivation of virginity ; and it remains to offer some remarks' on the proofs of rape that may be looked for in other females than those who have been recently virgins. Violation without defloration. — The com¬ mon impression is, that if it be difficult to detect the fact of violated chastity in the 2 A 354 DR. CUMMIN ON FORENSIC MEDICINE. young and unmarried, it is infinitely more so — more truly like exploring “ the way of a serpent on a rock,” when the person to be examined is differently situated. We should recollect, however, that by far the greater number of alleged rapes are attended with brutal violence; and if we may credit some excellent authorities, the difference between the used and the unused is not generally so great as to make a material alteration in the indicia of sexual injury, especially if it have been excessive. Even in the case of prostitutes it does not appear that the difference is very obser¬ vable. I shall here make an extract or two from Parent-Duchatelet’s volumes, ( De la Prostitution dans la ville de Paris ) already quoted, a work which abounds with facts the most extraordinary — at the same time, I believe, the most authentic. “If there be one opinion more gene¬ rally received than another, it is that the genital parts of prostitutes must present appearances and alterations in¬ separably connected with their occupa¬ tion : it is the common talk of liber¬ tines, high and low, young and old, and a standing joke when any of the associates of the latter happen to marry women who had formerly been on the town. I have even found medical men themselves more tinctured with the popular notion on this head, than the common orders of society, * * * * In order to obtain exact informa¬ tion, I applied to all the most likely sources— to the dispensary physicians and surgeons, to those attached to the hospital of the police, to the prison infirmaries, and, in fact, I allowed no opportunity to escape me. The results are precious, and shall be concisely stated. “There is no special or peculiar change observable in the sexual parts of prosti¬ tutes ; no difference, indeed, between them and the most respectable married females. The frequent use of the speculum, and the other methods employed in examining wo¬ men of the town who apply at the dispensa¬ ries, as well as those leaving thehospitals and prisons, have convinced the medical in¬ spectors that largeness and smallness of the vagina are merely natural and conge¬ nital conditions, no more remarkable than the disproportion which is commonly met with in individuals as to the size of other parts of the body. Young prostitutes are frequently met with just commencing their trade, and who have never been with child, yet having the vagina more dilated than is found in married women who have had five or six accouchments ; while on the other hand, we may observe women who have been on the town for twelve or four¬ teen years, nay, who have decrepitude stamped upon them, yet whose sexual parts, and particularly the vagina, exhibit no trace of alteration. There was a wo¬ man pointed out to me one day in the pri¬ son of the Madelonnettes; she was 51 years of age, and had been for fifteen years a prostitute in the metropolis; notwith¬ standing this, her sexual parts might have been confounded with those of a virgin at puberty.” Appearances in married women. — The statement of these facts is most import¬ ant as regards the possible proofs of rape in married women, or those who have avowedly had previous sexual intercourse. With the exception of absence of the hy¬ men, it is possible that such women may have had, anterior to the violence offered them, all the appearances of uninjured chas¬ tity, and consequently whatever marks of violence of a recent nature are present, may reasonably be attributed to the alleged out¬ rage. It is an unreasonable as well as an uncharitable doctrine to hold, as some do, that appearances of this kind in married complainants must be looked on with sus¬ picion, as indicating that methods had been taken to produce aggravated lesions, by way of having a stronger corpus delicti. Why may not the marks of brutality be observable in such women, as wrell as in others — especially if we admit the correctness of the remarks of Parent- Duchatelet and his informants? And is not the contrary persuasion founded in that very vulgar errorwliich these autho¬ rities have exposed ? Great caution undoubtedly ought to be observed in gathering the proofs in such cases ; but so ought it in every case, whe¬ ther relative to the unmarried or the mar¬ ried. Some have suggested that more evi¬ dence of proof should be required in respect to the married than the other ; and it has been even proposed that, however the fact of penetration may be deemed sufficient in the latter case, proof of emission should al¬ ways be insisted on when a woman who liasavowedly had previous connexion is the complainant. I cannot help thinking that this suggestion is founded in bad physio¬ logy; for it assumes a position for Which there is not sufficient warrant, that wo¬ men are always sensible of the occur¬ rence when emission during the generative act takes place. And if this be so when there is no mental disturbance, how un¬ reasonable to expect that a female should attend to such an event when she is made the victim of outrageous and brutal as¬ sault ! To demand proof of emission from the married, is as unjust and as absurd as to require rupture of the hymen in proof of penetration in the unmarried; for in both instances what is this else than to “ contend that more is necessary to con¬ stitute rape in law than generation in na¬ ture?” For without either perception of MISCELLANEOUS CONSIDERATIONS. emission, or penetration into the vagina, impregnation may be effected ; as in fact the same learned authority I have just quoted says, “ the utmost wrong to one party, and the malignant intent of the other, may have been complete ; while in¬ jury on the one hand, and malice on the other, are truer criteria for administering justice than the dicta of lawyers, and the etymologies of schoolmen.” I have dwelt upon these points chiefly with a view to remove those impressions which are prevalent, more particularly if you should happen to entertain them, that there is little or no use in examining the persons of females complaining of rape who have had previous intercourse. With ordinary caution, it may be done, I think, with more confidence than is usually sup¬ posed; and although we shall find no la¬ ceration of the hymen, yet the other signs may in great measure be expected to be present: wre may find bruises, red spots, and excoriations of the sexual parts, such as would be produced by the introduction of a foreign body ; a sort of mucus may be detected about the parts, which may prove to be seminal fluid; and, lastly, ecchymoses or other marks of injury may be observed on different parts of the body. When such appearances are seen, the pro¬ bability of the alleged violence must be considered strong; and the presumption will be admitted to be greatly strength¬ ened when it is borne out by moral and collateral circumstances, such as have been already alluded to — namely, the timeliness of the complaint, the solitariness of the locus in quo, with the impossibility of ob¬ taining assistance there, — and, lastly, the general demeanour and conduct of the woman. Miscellaneous Considerations . Age of the parlies. — The present law of rape seems to be of dubious application in other respects beside those already noticed. I mentioned in the lecture on Age, that boys under fourteen are presumed, in law, to be incapable of the crime of rape, evi¬ dently with the idea that emission is essential to the act. But by the late sta¬ tute making the essence of rape consist in penetration merely, the commission of the crime, wholly independent of the hypothesis of precocious puberty, is ob¬ viously within the powers of very youth¬ ful delinquents. Mr. Chitty notices this circumstance, and seems to think that some alteration of the law wrould be ex¬ pedient : “ perhaps a different rule might without impropriety be adopted, so as to include offenders of an earlier age than fourteen (who are between that age and seven, legally capable of committing other crimes). Yet,” he adds, “ as the law has once fixed that age as the earliest time when the ability to commit a sexual crime is to be considered as established, it is most probable that the rule would be still adhered to, although one of the reasons for its adoption has ceased.” WTith respect to female infants, the law is strict in yielding them protection under certain ages; they are presumed to be in¬ capable of giving consent under twelve , and it is a capital felony, under any cir¬ cumstances, to have carnal knowledge of a child under ten. The act formerly re¬ ferred to (9 Geo. IV. c. 31) says in the 17th section, — “ that if any person shall unlawfully and carnally know and abuse any girl under the age of ten years, every such offender shall be guilty of felony, and being convicted thereof, shall suffer death as a felon ; and if any person shall unlawr- fully and carnally knowr and abuse any girl, being above the age of ten years andl under the age of twelve years, every such offender shall be guilty of a misdemeanor, and being convicted thereof, shall be liable to be imprisoned, with or without hard labour, in the common gaol or house of correction, for such time as the court shall award.” Yet cases of this criminal nature are not infrequent. Scoundrels, particularly in low life, entertain an idea that the re¬ mains of a venereal affection, such as go¬ norrhoeal discharge or gleet, may be got rid of by a sexual intercourse with a healthy female ; and an infant under the age mentioned in the act is preferred, as not likely to offer much resistance. The following are instances of this infatu¬ ated guilt, and they may serve to shew how the law deals with such malefactors. At the Norwich Spring Assizes this year (1836), Robert Bunting was indicted for a rape committed on Phoebe Tafts, a child only four years and a half old. The case, it appears, was fully proved, but the evidence was deemed unfit for publication. The child died of the injuries received from the violence of the prisoner. The prisoner was sentenced to death, without hope of respite. In June last, a man of the name of Kinsey was tried at the Old Bailey, for violating the person of a girl under nine years of age. He was found guilty, and sentenced to death ; but has since been transported for life. According to the brief report of this case which I have seen, the child did not complain until six weeks or two months after the “ outrageous” act (as the Recorder termed it) ; yet the sur¬ geon who gave evidence wras able, from inspection of the infant’s person, to speak positively as to the commission of the 356 DR. CUMMIN ON FORENSIC MEDICINE. crime. This would seem to warrant the supposition that gonorrhoea or venereal disease was communicated to the child, which led to the detection of the prisoner’s guilt; and probably the injury done to the sexual parts might have been suffi¬ ciently serious to leave its traces even after that lapse of time. Discharges. ('*.) Supposed venereal. — When violation is effected with the notion of get¬ ting rid of some venereal complaint, it is very probable the malady may be commu¬ nicated to the victim. But great caution must be observed in judging of this fact : the nature of the discharge, if there be one present in the complainant, must be carefully ascertained, the appearances of violence on the surrounding parts must be noted, and the time should form a mate¬ rial element in our estimation of the pro¬ bability that the disease originated in the manner alleged. Some well authenticated eases are on record, which should serve to warn us of the mischief that may be done, if the true state of the complainant be not deliberately and wisely investigated. Dr. Percival mentions a remarkable case of a little girl, only four years old, who was attacked with mortification of the sexual parts, attended with great soreness and general depression of strength. She had slept with a boy of fourteen, and it was suspected that he had taken criminal li¬ berties with her. The mortification in¬ creased, and the child died. The boy was presently apprehended, and tried at the Lancaster Assizes; but wTas acquitted on evidence being given that several instances of a similar disease had appeared in other children, about the same time, in which there was no possibility of injury or guilt. In one of these cases the body was opened after death. The disorder had been a ty¬ phus fever, accompanied with mortifica¬ tion of the pudenda. There was no evi¬ dent cause of this extraordinary symptom discoverable on inspection : the lumbar glands were dark-coloured, but all the viscera were sound. Capuron relates a case almost identical, in which he had the utmost difficulty in convincing the parents of a little girl, only four years old, that they were in error. The child had great swelling of the sexual parts, with pain and purulent discharge; and it was attributed by the father and mother to some impure venereal contact or violation. But the medical examiner shewed them that a similar catarrhal affection of the sexual organs prevailed epidemically about this time; and by the use of some simple remedies the child was cured. The same authority mentions his having met with a case in the year 1809, where the presence of a most acute leucorrhoea, in a child of six, would certainly have per¬ suaded the parents that it originated from a venereal commerce, had they not been more reasonable than in the preceding in¬ stance. It was nothing more than a ca¬ tarrhal disorder of the uterine system, pro¬ ceeding from the cold and moisture of the weather, and owdng in great measure to the want of sufficiently warm clothing on the little patient. Venereal in reference to rape. — It has happened in some instances that, after an alleged violation, the complainant describes herself as infected with gonor¬ rhoeal discharge, or chancre ; and this has been found to be the case. But how does the fact of communicated venereal bear on the charge of rape? We must recollect what time usually elapses after an impure connexion, before chancre or gonorrhoea is perceived. Three days may be about the average period ; and it will be for the me¬ dical examiner to form an opinion, from the appearances, how7 long the complain¬ ant may be actually labouring under the disease. Above all, he must be perfectly satisfied that it really is venereal. Mow suppose a woman with incipient gonor¬ rhoea or chancre to bring a charge of rape against a particular person; it will readily be seen that the case cannot be very re¬ cent, nor should the marks of violence about the sexual organs be expected to be very striking, if, indeed, they should be at all visible. On the whole, the presence of venereal in the complainant can scarcely be considered as an accessory proof of rape, unless it coincide in every respect with the other lesions observable on the sexual parts; and unless the accused party labour under similar venei’eal disease. (b.) Supposed semen. — A gross error com¬ mitted by a medico-legal examiner has been pointed out w ith strong censure by M. Orfila. The examiner in question was called to inspect the person of a girl, under the age of fourteen, wffio was said to have been violated nine days pre¬ viously he considered the appearances conclusive that copulation had been ef¬ fected, and one of his proofs was, that he found a quantity of semen in the vagina! Orfila, who was consulted subsequently on the correctness of the report, shewed that this statement of the discovery of seminal fluid was most improbable. The girl, it appears, had a mucous discharge from the part, wffiieh must have carried away any sperm that might possibly have been de¬ posited in the vagina nine days before. At all events, the broad assertion that the fluid found was semen, was w'holly unwar¬ rantable ; for it does not appear that any attempt was made to shew that it was not QUESTION OF CONSENT. 357 mucus : no chemical, no microscopical ex¬ periment was tried; and on the whole, did it not appear that the examiner was not aware of the serious nature of his statement, so rash an opinion would have justly cost him his professional repu¬ tation. (c.) Menstrual discharge. — Great stress is sometimes laid on the discharge of blood said to take place in consequence of forci¬ ble defloration. But there is nothing in this positively indicative of the deflora¬ tion being forcible; it may occur in a first or other intercourse, even with con¬ sent. Besides, we should distinguish, if possible, between an alleged hemorrhage and the menses. In the former case there should be evidence of laceration of the hymen or nymphae, or rupture of some of the vessels belonging to the genital organs. In the latter we may be guid¬ ed by circumstances, as well as by the physical characters of the menstrual dis¬ charge. If there be no apparent rup¬ ture of parts, and the fluid be traced high up into the vagina, there is a probability that it is the menstrual flux proceeding from the uterine vessels — a pre¬ sumption which will be corroborated by the distinctive appearances of that fluid. The menstrual flux, though it has been traced to the vessels of the uterus, has hardly any common property with blood, except that of being a liquid of a red co¬ lour. It is chiefly distinguished by its not being coagulable; and hence, when coa- gula are found in it, as in laborious or profuse menstruation, blood is certainly intermixed. “ It is,” according to John Hunter, “ neither similar to blood taken from the vein of the same person, nor to that which is extravasated by accident in any other part of the body ; but is a spe¬ cies of blood changed, separated, or thrown off from the common mass, by an action of the vessels of the uterus similar to that of secretion ; by which action the blood loses the principle of coagulation, and, I sup¬ pose, life.” Other observers have since confirmed these views, by finding that the menstruous fluid differs from blood chiefly in containing little or no fibrine. And another character, in addition to its non-coagulability, has been attributed to it — namely, that it is not acted on by exposure to the air, as venous blood is, which it chiefly resembles. “ If a cloth be steeped in blood as it flows from a vein, the colour will be observed to become brighter by degrees : but this is not the case with the menstruous fluid; it retains its dark colour however long exposed*.” * Ilamsbotbam : p. 271. Medical Gazette, vol. xiii. But it must be confessed that we are still in want of a good analysis of the menstrual fluid. The only account of its chemical qualities which I have been able to meet with is that given by Gmelin, in his Handhuch dev Chemie, consisting of two cases which he takes from other journals. In a woman who had prolapsus uteri, the menses were examined : they contained no globules, were green by transmitted light, and resembled a strong solution of the co¬ louring matter of the blood in serum. In the other case, where the fluid had been retained for some time by an occlu¬ sion of the vagina, it appeared as a thick, glutinous, brown-red syrup, without any smell ; three days’ exposure to the air pro¬ duced no change in it; there was no depo¬ sit (or coagulum), nor any approach to putrefaction ; it was liquified by potash, and thickened by sulphuric acid and alco¬ hol ; water, in which it was immersed, took very little of its colour, but subse¬ quently became clouded in evaporation, and as if coagulated on the addition of alcohol. Pregnancy in reference to rape. — It was at one time a matter of great importance to ascertain whether a woman who com¬ plained of rape would prove with child : if she did, it was assumed that she must have given consent, and her charge of vio¬ lation fell to the ground. It was even customary to stay the execution of the convicted ravisher until the question of pregnancy was determined. But a more sound physiology has dissipated this error; and it has long since been ascertained, that, so far from consent being essential to conception, complete insensibility — nay, agony, hatred, and the most violent strug¬ gles of resistance — are not inconsistent with a fecundating act of copulation. Of this, however, more hereafter. Question of Consent. — The point just touched upon, respecting the consent of the female, is one that requires further notice. The legal definition of rape — carnal knowledge forcibly and against the will — sufficiently indicates that this cir¬ cumstance in the crime must be clearly made out, and, in ninety-nine cases out of a hundred, the question of consent consti¬ tutes the chief difficulty. There is, indeed, one case in which a rape may obviously be committed without resistance, and appa¬ rently with consent: that is, where a vio¬ lator takes the husband’s place, and thus accomplishes his purpose. The crime, however, is not altered in its nature by the deception; for it is inferred that the wo¬ man, had she known the vile fraud, would have resisted with all her powers. Again, there may be no resistance, yet a rape, — where the female is under the in¬ fluence of some narcotic or intoxicating DR. CUMMIN ON FORENSIC MEDICINE. beverage. Forcible defloration might be, and has been, effected under such circum¬ stances, and a case of the kind excited much public disgust about three years ago, — a Mr. Luke Dillon having seduced from her home and violated a young lady, whom he first brought under the influence of intoxication. But when it is alleged that the crime has been committed in deep sleep , the fact is scarcely credible except the female be one who has been accus¬ tomed to sexual intercourse. Of the possi¬ bility of defloration in profound sleep, we must be permitted to entertain doubts, notwithstanding the decision of the learn¬ ed Faculty of Leipzig, which held — “ dor- mientem in sella virginem inseiam deflo- rari posse nor can one help suspecting, with Valentin, that it must be a fox’s sleep: he shrewdly observes, in his Intro¬ duction, in reference to the case, that it reminds him of an old German proverb (Es schlaffen nicht alle, so die augen zu baben) — •“ all are not asleep who have their eyes closed.” The term forcible defloration is com¬ monly employed in the sense of rape, but that is not its exact import: a defloration may be forcible (and it is said that every defloration is more or less so), yet it may not amount to criminal violation. That an extraordinary degree of force may not be inconsistent with consent, we learn from a very shocking fact mentioned by Dr. Evory Kennedy, in the Dublin Journal, of the whole vesico-vaginal septum being broken down, in a first connubial inter¬ course ! Sham, cases. — Much may be ascertained by the medical jurist, in regard to the question of consent or non- consent. It is in this that the detection of sham cases consists; of which, according to Mr. Amos, there are probably a dozen or more met with on circuit, for every genuine case that comes to be investigated. By noting the physical powers and mo¬ ral nature of the complainant, much light may be thrown on the facts. At the Derby spring assizes this year, a lad of the name of Dolman, aged 17, was capitally indict¬ ed for a rape on Sarah Baxter, aged 21. The complainant proved to be a coarse woman of loose character, who, as ap¬ peared from the evidence, seduced the pri¬ soner to the act of sexual intercourse, on a public bridle road. The prisoner was acquitted. On his cross-examination, the surgeon who had inspected the person of the female, and appeared as a witness, deposed, that “ he was of opinion, as a medical man, that the woman’s statement, that she had not been intimate with more than one man before, was untrue.” Some authorities go so far as to hold that no violation can ever take place with¬ out some consent on the part of the fe¬ male ; she having it generally in her power to foil her assailant. “It is beyond a doubt,” says Orfila, “ that it has been found impos¬ sible to violate certain girls, though their arms, their legs, and their heads, were held by three or four persons ; and it is well known,” he adds, “ how difficult is a first act of intercourse, if the female de¬ murs.” Then comes the old story of the Queen of Navarre and the unsheathed sword. But surely the inference is too positive ; a woman with strength of body and presence of mind, has a great deal in her power, no doubt; but if, overpowered with terror and violence, she sink into syncope— if she be labouring under the effect of narcotics, or be made senseless by intoxication, the case is altered ; and certainly, jas the annals of crime but too well testify, a female may be beset by such a number of savage ruffians as would ren¬ der all her efforts at resistance fruitless. Where there is an obvious contrast in the physical powers of the complain¬ ant and the accused — the former being a robust strong young woman, and the lat¬ ter, suppose, an elderly and perhaps a de¬ bilitated person — the charge should be ad¬ mitted with great caution. There is an old epigram, in Bayle, on the subject, which I should quote, but that it is in such antique doggrel rhyme. It supposes the question put to a vigorous young com¬ plainant, as to how she could swear that her alleged violator — a feeble old man — had effected his purpose in spite of her efforts. Her reply is, that on any other occasion she could sufficiently protect her¬ self, but that she could not on this, for it was really impossible, — she laughed so much ! An anecdote told by an old French au¬ thor, in a Treatise on Crimes — the same, in fact, on which Cervantes founded his celebrated judgment given by Sancho in the Island — serves very well to shew the extreme difficulty of violation, when the parties are pretty fairly matched. A young man who was condemned for rape was sentenced to forfeit a purse of money ; and he wras ordered to hand it over to the com¬ plainant in open court. On leaving the dock, however, he was permitted to follow the woman, and recover his purse if he could : he soon found that this was im¬ possible, so violent wras her resistance. The woman returned, and complained to the judges; but they, being of opinion that one wrho could so well guard her money might have as easily protected her virtue in the alleged rape, ordered her to give up the purse. An attention to the moral circumstances will often settle the question of consent. Mr. Amos cites a case which was tried at Leicester, in which a bailiff was charged PRACTICAL SUGGESTIONS. a59 with the capital ofTence of violating a young woman, in a house where he was stationed as a keeper. The girl was the daughter of the owner of the house, and it came out that the alleged rape was com¬ mitted early in the night, in the very next room to that in which her father and mo¬ ther slept. Upon being asked if she screamed, she answered, “ No.” — “ Why not?” “Forfear of waking my mother!” In another case which was tried at Derby, the woman was quite positive as to the length of time during which the occurrence was happening. It was ten minutes. — “ Are you sure?” “ Positive.” — “ How do you know?” Witness hesitated ; question re¬ peated. “ I counted.” — “ How did you count?” “One, two, three, four, &c.” — “ Did you count sixty, ten times over?” ‘‘ Yes !” Even when there has been evidence of screams and resistance, doubts fatal to the issue of the case have been raised, as to the sufficiency of such resistance. “ In one in¬ stance, in particular,” says Mr. Amos, “I re¬ collect the screams of the girl being proved by several witnesses. But she had, in some measure, brought the mischief on herself, by walking with the accused in a solitary place late in the evening; and what had considerable weight with the jury, was, that as soon as the man had accomplished his purpose, the girl said to him, ‘ Oh, George, there is nothing like a good con¬ science and a pious life !’ ” Practical Suggestions. I shall conclude this part of my subject by laying before you some rules of con¬ duct which may be serviceable in the in¬ vestigation of rape cases. 1. Take a note of the time when you are called in to make a personal inspection ; for this may be of great importance in de¬ termining the nature of the charge— espe¬ cially if it should appear that there had been any suspicious delay. And lose not a moment in proceeding to the inspection ; for the evidence founded on the appear¬ ances will greatly depend on the timeliness of the visit. Furthermore, one of the first memoranda to be taken in investigating the case, is the time at which the alleged violation occurred. 2. Observe the age and general habit of body of the complainant. Examine the person cursorily, with reference to alleged bruises, wounds, or lesions, of whatever kind. These are afterwards to be more particularly considered with regard to the mode in which they are stated to have been inflicted. 3. Proceed to examine the sexual parts, with special regard to the question of pe¬ netration Notice the general form and disposition of the parts; observe any swelling, inflammation, or discharge about them ; laceration of the hymen, if there be appearances of it: state of the carun- culae myrtiformes; and any contusions or marks of violence about the labia, or in their vicinity. 4. Compare the general and particular lesions with reference to the probable date and cause of their origin. We must make allowance for the period elapsed since the occurrence of the injury, and take into consideration the constitutional peculiarities of the complainant. Was it during the menstrual period that viola¬ tion took place ? or did she labour under any debilitating or relaxing discharge ? In such cases there should be less sign of penetration expected to be present than in others; and consequently it may be more difficult to affirm the fact. On the other hand, mark well whether there may not be too much proof forthcoming : whether some of the appearances do not seem exaggerated, or different from what might be produced by the male organ. Recol¬ lect that other foreign bodies may have been introduced into the parts, and that pains may have* been taken to aggravate what w*as probably at first only a very in¬ considerable, if any, injury. 5. Let such discharges as may be pre¬ sent be well observed, — whether they be the result of recent inflammation — of leucorrhoea — of gonorrhoea, &c. : and above all, if called in speedily after the alleged violation, seek for seminal fluid in the vagina, as well as for seminal spots and stains on the woman’s garments. These are to be tested by their physical, chemi¬ cal, and possibly also by their microscopic characters : should such tests be success¬ ful, they afford a high degree of proba¬ bility in corroboration of the fact of pene¬ tration by the male organ. G. Should the individual have died in consequence of sexual violence, her body should be examined most scrupulously : lesions may possibly be detected on the sur¬ face ; there may be fractures, luxations, substances found in the mouth (introduced perhaps to prevent the deceased from calling for assistance)— all sorts of indi¬ cations, in short, of recent and violent rape. It is possible, on the other hand, that the post-mortem may lead to an opposite conclusion — that death has rather resulted from some other cause : that the deceased had not been recently deflowered — perhaps that she had been a mother. 7. Lastly, examine, if possible, the per¬ son of the accused ; for though we may not be enabled to affirm that the indi¬ vidual whom we inspect has committed the crime, it may be in our power from such inspection to say that he has not. We may find him destitute of the means of effecting penetration, or his structure of parts may be such as to render ithighly im. 360 REPORT OF THE LONDON COMMITTEE ON THE probable he should have perpetrated the amount of injury alleged. Besides, the inspection of the accused party may throw light on the circumstances in another way : in the case of alleged rapes on in- fants, it will be important to ascertain whether the accused be not infected with gonorrhoea or syphilis, which would cer¬ tainly in some degree strengthen the pre¬ sumption of his guilt. And further : there may be bruises and scratches on his per¬ son, denoting the resistance of the woman; there may be spots and stains on his linen also corresponding with those observed about the female. All these points, and many more which will in practice be sug¬ gested by the circumstances of each case, deserve your best attention : for though it may not be possible to obtain proof of actual penetration, those minor matters, relating to bruises, scratches, stains, &c., may have the effect of establishing the prisoner’s guilt on a charge of assault with intent to commit a rape. It is by no means unusual, when the capital charge fails, for the judge to direct another in¬ dictment to be preferred, charging the prisoner with the misdemeanor. A report, taken from Sedillot (Manuel complet de Med. L6g.) may serve as an illus¬ tration of some of these rules. “ We, the undersigned, went this day, at eight o’clock in the forenoon, to visit the daughter of M. G., aged 16, who was said to have been violated yesterday even¬ ing at ten o’clock. “ Upon entering the chamber, we found the girl in bed, concealing her face. We were told that on the preceding night she allowed herself to be prevailed on, under false pretences, to enter the room ofM. D., aged - , who, after making her certain proposals, accomplished his purpose, having previously used violence, and ill- treated her, and threatened her with death. Upon examination, we observed that the girl was sufficiently grown and well formed for her age, but delicate and very timid : she seemed to have pre¬ viously enjoyed a state of perfect health. We saw on her arms, her chest, and lower limbs, several recent eceliymoses, — some of them were close together, and on the arms indicated the pressure of fingers: on the thighs, they were larger and more apart, where it seemed they were occa¬ sioned by the closed fist and the bruises of the knees. The whole pudenda were swollen, and there was a discharge from them of a mucous fluid of a yellowish white colour : the external labia were red, and, as it were, slightly glued together; the nymph® were tumefied, very red, and presented the appearance of laceration, still bloody, and covered with mucus. “ The hymen was ruptured— its remains were distinct and bloody : the mucous coat of the vagina, which was strongly marked with rug®, was inflamed and contused ; all the parts were painful ; and various red spots diffused over the pubes and the thighs, particularly their upper and inner part, gave evidence of recent vio¬ lence. “ Having requested to see the dress which Mdlle. G. wore at the time of the alleged violation, it was brought to us. The chemise was stained with blood in several places ; and we also noticed cer¬ tain greyish spots, not very thick, but suf¬ ficiently tough, making the cloth stiff, as if it was starched in those places. We moistened them, upon which they gave out a very well-marked spermatic odour ; and on putting them to the fire, they assumed a distinct reddish-yellow hue. As we were desirous of leaving no doubt about the matter, we collected a small quantity of it in a watch-glass. It formed flakes and cloudiness in the dis¬ tilled water which held it in suspension, and which had become alkaline. We then evaporated the liquor, and the residue was of a light brown colour, which, when treated with some drops of distilled water, was dissolved but in part, leaving a yel¬ lowish-grey glutinous substance, which disappeared in a solution of caustic potash, — facts which leave not the least doubt in our minds of the presence of semen. “ We therefore hold ourselves justified in concluding — from the existence of the contusions and ecchymoses wdiich we ob¬ served, from the above-mentioned state of the genital organs, and from the spots of blood, and of semen, detected on the clothes — that the person of Mdlle. G. has been violated. In which persuasion wre affix our signatures to this report. — Dated Paris, 17 July, 1823.” REPORT OF THE LONDON COMMITTEE OF THE BRITISH ASSOCIATION, ON THE MOTIONS AND SOUNDS OF THE HEART*. August, 1836. The Committee of members of the Bri¬ tish Association resident in London, charged with the investigation of the motions and sounds of the heart, have had numerous meetings, and performed a con- * Read at the Bristol meeting of the Associa¬ tion, and communicated to the Meuical Ga¬ zette. MOTIONS AND SOUNDS OF THE HEART. 361 siderable variety of experiments on living' and on dead subjects, with a view to the endsoftheirappointment. They have also taken pains to inform themselves of the facts and reasonings published by recent inquirers, and have now the honour to submit to the Section the results at which they have hitherto arrived, toge¬ ther with such particulars of their expe¬ riments as they consider necessary to substantiate their conclusions. Before entering, however, upon the statement of their experiments, or of the conclusions to which they lead, they beg leave to say a few words with regard to the scope and plan of their inquiries, and the spirit in which they have entered on them. The Committee would first remark that, though in their inquiries they did not neglect to take note of any phenomena which might il¬ lustrate the action of the diseased heart, yet they have felt it their especial duty to investigate the physiological branch of the subject, and have principally oc¬ cupied themselves with that part which includes the normal sounds of the heart. With regard to the general views by which they have been guided, they wish to observe that, in entering upon the investigation, it seemed to them possible, a priori , that each sound of the heart might have a single pecu¬ liar cause, or several co-operating causes; and, if several co-operating’ causes should be found more probable, that then some of such causes might be only contingent or occasional, and others constant and invariably present ; also upon the sup¬ position of a plurality of causes of one or both sounds, that some causes might be common to both sounds, or that each sound might have its own set of causes exclusively. Keeping in view these several possible a priori positions, the Committee made an enumeration of the circumstances attending the heart’s ac¬ tion that had been, or might be, supposed capable of producing sound, and endea¬ voured so to vary their experiments, as to exclude in turn each of those circum¬ stances, with a view to isolate, or at least to bring sufficiently into relief, the essential cause or causes of each sound. To the execution of the plan of experi¬ mental inquiry thus glanced at, the Committee have devoted some time during the summer, in the course of which they have had to encounter nu¬ merous difficulties, especially from the want of sure means of destroying the sensibility of the animal, without sus¬ pending or greatly impairing the action of the heart. And in this respect they have been much less fortunate than several preceding experimentalists, having in no one of the numerous subjects on which they have operated, been able to con¬ tinue their observations for a longer period than forty-five minutes, notwith¬ standing the utmost care to avoid unne¬ cessary loss of blood, and to maintain artificial respiration. It is proper to add, that the subjects of their observations were in most in¬ stances young asses from three to six months old, in apparently good health; and that the mode of preparation was in a few instances poisoning with woorara, in others, stunning by a blow on the head ; but in a majority of the experi¬ ments the animal was pithed. Other animals were tried as well as young asses, viz. the horse, the dog, and the domestic fowl : but, for various reasons, th ese trials were not attended with results recommending their repetition. The Committee consider the most con¬ venient order in which to state the facts in their possession, and their inferences from those facts, to be, to describe first succinctly, and from the notes taken on the spot, such of their experiments as gave available results ; then briefly to notice under the head of each sup¬ posed or possible cause, such points in the experiments as may seem to the Committee to make decidedly in favour of, or against the claims of each of such possible causes ; and lastly, to give a summary of the conclusions w hich the Committee have adopted from the whole of their inquiries. Memoranda of Experiments , fyc. To satisfy themselves fully as to how far the sounds might be modified by circumstances, such as the state of the lungs, whether distended or collapsed; the state of the circulation, whether ex¬ cited or tranquil ; and the position of the body ; the Committee examined the heart on their own persons under all those varie¬ ties of circumstance, and found that when the subject of observation is supine, or lean¬ ing a little backwards and towards the right side, the first sound is uniform, dull, and without any considerable impulse; butw hen leaning forwards, and especially if inclining much to the left side, the first sound is louder and fuller-toned, and accompanied 362 REPORT OF THE LONDON COMMITTEE ON THE by strong impulse ; they found also that full respiration operated like leaning to the right, or the supine position — by diminish¬ ing sound and impulse ; while full expira¬ tion , like leaning forwards and to the left side, rendered the sounds and impulse more dis¬ tinct ; the former louder, the latter stronger and more diffused. When the heart’s ac¬ tion is excited by exertion, they found, as might be anticipated, the systolic sound and impulse at their maximum of tone and force. Moderate exertion they ob¬ served to increase the intensity of both sounds, -—whereas sudden exertion, suffi¬ ciently violent greatly to accelerate the action of the heart, they found impaired the distinctness of the second sound, the first continuing loud, short, and with strong impulse. The indistinctness of the second sound in rapid pulsation of the heart seemed to depend in part on its following so closely on the loud first sound as to be masked by it. Exp. 2.— The Committee made similar experiments on voluntary muscular contrac¬ tion, with a view to ascertain how far that act is accompanied by sound. The muscles operated on with best eff ect wrere the bucci¬ nator, masseter, muscles of the neck and forearm, and of the parietes of the abdo¬ men. And in all those the flexible ear-tube carefully applied so as to prevent friction, yielded sounds more or less striking ; but the most remarkable results were obtained from the last mentioned parts. From the abdominal muscular contractions, sounds of a “ systolic ” character, if the expres¬ sion is admissible, in all respects, and as loud as, or louder than those of the heart, were with facility obtained. The sounds were produced by sudden expira¬ tory efforts, made with force and with the mouth closed, and wrere obtained with the flexible ear-tube from various parts of the parietes. The sound of muscular contraction seems in the case of the abdo¬ minal muscles to be exaggerated by the hollowness of the subjacent parts. At the time the sound was heard, the muscle under observation always felt to the finger tense and hard, but the sound ceased at the moment that the fibres had attained their maximum of tightness and hardness, and was not renewed except by a repetition of the contractile effort after previous relaxation. Exp. 3. — Subject a young ass, poisoned with woorara introduced into an incision in the flank. The animal died sixteen minutes after the introduction of the woorara; much blood was lost in opening the chest ; the heart was acting at the moment of expo¬ sure, but not strongly; its action became more regular after inflation was made more steadily. Both sounds were heard with the instru¬ ment applied to the great arteries, but the sound with impulse, or first sound, alone was heard on the ventricles. The heart, when yielding these sounds, could not, the Committee were satisfied, strike against the chest’s walls, or any other hard object. After opening the pericardium the sounds were wreaker, but both sounds were heard with the stethoscope applied to the roots of the great arteries. Both sounds were heard also on the great arteries, when a portion of lung was interposed between the instrument and the great vessels. The heart continued to act for forty minutes. Exp. 4.— Subject a young ass, prepared as the last. Death twenty-six minutes after poisoning. At the roots of the great arteries the two sounds were distinctly heard, but after the introduction of two curved awls into the arteries, for the purpose of hooking up one lamina of each sigmoid valve, the second sound was wanting, the first being indistinct. On withdrawing the awls, two sounds were heard, and soon after the heart ceased to act, twenty minutes after the death of the animal. At each systole, while the heart acted vigorously, the ven¬ tricles felt to the finger as hard as carti¬ lage. The heart being cut out and plunged in wrarm salt and water, a slight undulatory contractile motion pervaded the substance of the ventricles and column® carnese, and continued for some time. In this and every other observation, this vermicular or undulatory motion supervened upon the cessation of the normal action of the organ, and never before the organ had ceased to act as a whole. Exp. 5. — Subject a donkey, 7 months old, which expired 43 minutes after being poisoned with woorara. The heart just before death was heard with short loud pulsations. When the chest was opened it ceased to beat, and was very much distended with blood. When part of the blood was let out by cutting the pulmonary artery, the ventricles began again to pulsate feebly, but without sound. When the heart was cut out, it presented the undulatory motion, which was in¬ creased by immersion in cold water. The two ventricles being opened by cuts at the apex, at right angles to the septum, and the heart being drawn with the apex up¬ wards through water, the lamin® of the mitral and tricuspid valves were seen to close together each time the heart was so drawn upwards through the water. MOTIONS AND SOUNDS OF THE HEART. 363 Exp. 6.— Subject a young ass, destroyed by pithing. On opening the chest the heart acted regularly, producing both sounds dis¬ tinctly. Curved awls were then intro¬ duced into the aorta and pulmonary ar¬ tery, to hook back the valves, when the second sound was replaced by a sucking or bellows sound. The awls being with¬ drawn, both sounds were again heard; the heart acting feebly. Exp. 7. — Subject a young ass. A small quantity of woorara was introduced into the flank, but without destroying life, and the animal was dispatched by a blow on the head. Heart acting very quickly and strongly when the chest was opened ; first sound only audible. The auricles being pushed in by the fingers into the ventricles, so as to keep the auriculo-ventricular valves open, the first, or impulse sound, only heard ; the second sound w anting. On withdrawing the fingers from the auricles both sounds were audible, the heart act¬ ing more slowly, but yet strongly. The roots of the arteries being compressed be¬ tween the fingers and stethoscope, the first or impulse sound only heard, accompanied by a loud bellows or rasp sound. On re¬ moving the pressure (from the arteries), both sounds again became audible. An incision being then made into the left auricle, a finger was passed through the auriculo-ventricular orifice to the bottom of the left ventricle, and the fingers of the other hand being placed under the right ventricle, the heart was compressed be¬ tween the hands, so as to obliterate the cavity ; the first'or impulse sound w as still distinctly heard by all, but weak. Exp. 8. — Animal a young ass, destroyed by a blow on the head. •> The heart at first acted convulsively, as from great exertion, but afterwards nearly normally slow for a short time. While the heart’s action was quick, no second sound was heard ; but after it became slow, both sounds were heard : shortly afterwards its action became too feeble and irregular for observation. Exp. 9. — Subject a young ass. Poison¬ ing by introduction of 24 drops of an in¬ efficient preparation of coneia into the peritoneum proving unsuccessful, the ani¬ mal was ultimately pithed. On opening the chest the heart dis¬ tinctly audible as to both sounds, and in vigorous action. The fingers wrere pushed into the auricles, and through the auriculo- ventricular orifices, when a first sound was heard, prolonged by a whizzing sound. On withdrawing the fingers both normal sounds were heard. Needles were then introduced to hook up a lamina of the sigmoid valves of aorta, when the second sound was heard by two observers. The pulmonary sigmoids were also attempted to be so treated (the aortic valves being continued under the needle), when two observers heard the two sounds, but not the third observer*. Exp. 10.— Subject a young ass; pithed. Chest immediately opened, when the heart wras acting slowly but forcibly. At first no second sound wTas heard, but a bellows sound (instead) ; then a violent action was attended writh a single sound, accompa¬ nied by a bellows sound, which (latter) ceased as the heart became more slowr in action, after which both sounds became distinct; then the arteries being pressed with the finger at their origins, a first sound was heard, with a blowing murmur accompanying, and another murmur fol¬ lowing, but no flapping (or second) sound* On removing the pressure (from the ar¬ teries), the second sound was heard, and the murmur ceased. Immediately after the systole a flapping or jerking sensation was sensible to the finger applied to the arteries at their roots. The inversion of the auricles was accompanied by a sensation of thrilling in the finger of the operator. The auriculo-ventricular valves were found to act in water after the removal of the heart from the body, closing on its being drawn, apex upwards, through water. Exp. 11. — Subject a young ass; poi¬ soned with essential oil of bitter almonds. A small opening was made in the carti¬ lages opposite the heart, when the stroke was perceived and felt by the fingers inside and outside the sternum at the same time, with sound and with considerable pressure upwards against the finger placed between the heart and cartilages. The chest and pericardium were then opened, which lat¬ ter had a little serum in it. After turning over the animal on its left side, so as to make the heart hang vertically out of the chest, a first sound was heard through the tube applied to the ventricles, but no second sound. The same sound was heard on the right auricle posteriorly, without the second sound : the heart acted in both cases weakly. The tube being applied to the roots of the arteries, gave the same result to one observer — i.e. a first without a second sound. The animal be- * The Committee were uncertain how far the hooking up of the valves was really effected, owing to want of strength in the needles; they were not afterwards able, as in other cases where curved awls were used, to find the marks of the needles, so as to ascertain the direction in which they had passed. 364 REPORT OF THE LONDON COMMITTEE ON THE ing again laid on his right side, the first sound was heard by two observers. Cir¬ cumstances prevented the third member of the Committee from auscultating during this experiment, which was not repeated. Exp. 12. — Subject as above, and pithed. Heart acted 33 minutes. On opening the chest the two sounds were heard, the heart acting slowly and with tolerable force. The auricles were then inverted by the fingers, and the first sound, continued into a bellows murmur, was heard. The mur¬ mur was accompanied by a thrilling mo¬ tion, sensible to the finger of the operator, and synchronous with the impulse. A lamina of each sigmoid valve was then hooked up (with dissecting hooks), when a sound was heard not followed by a second sound; but on removing the hooks, the second sound was again heard. On in¬ verting the auricles again, the chordae ten- din eae of the mitral valve alone were felt to become tense in systoie, and lax in dias¬ tole. A finger being introduced into the left ventricle, through the auricle, the first sound was heard with a murmur. Exp. 13. — Subject a young ass; pithed. On opening the chest and the pericardium both sounds were distinctly heard, but feeble. On touching the arteries in the vicinity of the valves, a sensation of flapping (or jerking) was observed by all, commencing immediately after the systole, and accom¬ panying the second sound. The awls being introduced into the ar¬ teries (so as to hook up the valves), the second sound was wanting. After remov¬ ing the awls, at first only the systolic sound was heard, but after a short time both were heard by all. On opening the heart (at the close of the experiment), the valves were found to have been sufficiently hooked up in both arteries. Exp. 14. — Subject a young ass; pithed. After opening the chest the pericardium was opened, and a thick layer of tow was interposed between the heart and sur¬ rounding parts, the heart continuing to act. At first the systolic sound was heard, followed by a bellows murmur; but after¬ wards the flapping sensation, and second sound, were very distinct also. The finger being introduced into the left ventricle by inversion of the auricle, was felt to be gently embraced and pushed, as if by a membrane distended with blood. On the right side nothing similar was un¬ equivocally observed. On pressing the aorta or pulmonary artery between the finger and thumb gently, a to and fro thrill was felt accompanying the systole and diastole of the ventricles, and terminated by a flap. The sensation of flapping (or jerking) was felt to be synchronous in the two arteries. The tension and hardness of the ven¬ tricles, during their systole, were very re¬ markable. The pulmonary artery being cut across, the first sound was still loud : and the aorta being then cut across likewise, the same result was obtained — viz. a first without a second sound. The heart was then severed from its other attachments, and the systolic sound was still heard dis¬ tinctly. The heart was then grasped strongly under blood : it continued to contract vigorously, and the first sound was heard (but not loud) with the flexible tube as well as the common stethoscope. The heart was then taken out, and held in the hand of one of the Committee; when the first sound was distinct, but feeble. On opening the right ventricle, the co- lumnese carneas were distinctly seen con¬ tracting simultaneously with the ventricle. Such are the particulars of all the more successful experiments of the Committee. With regard to those pos¬ sible causes of the normal sounds of the heart, which have been investigated by the Committee, the principal of them are as follows : — The first sound has been attributed to, 1 . Impulse , or the beating of the heart against the parietes of the chest. 2. Muscular sound, or the resonance attending muscular contraction. 3. Collisions of the particles of the blood against each other, or against the parietes, valves, &c. of the heart’s ca¬ vities. 4. The action of the auriculo -ventri¬ cular valves during systole. 5. And the collision of the opposite interior surfaces of the ventricles in the same state. The normal or second sound has been attributed to, 1. Impulse of the heart against the thoracic parietes, owing to the rapid expansion during diastole. 2. An intrinsic sound attending the diastole, analogous to that which the observations of the Committee prove to attend the systolic action of the ven¬ tricles. 3. Flapping of the auricolo-ventricu- lar valves, during- diastole, against the sides of the ventricles. 4. The rushing of fluids into the great arteries, after the systole. 5. The mshing of the fluids from the MOTIONS AND SOUNDS OF THE HEART. 365 auricles into the ventricles during1 dias¬ tole. 6. Sudden tension and flapping of the sigmoid valves after the systole. 01 the causes to which the first sound has been attributed, the Committee feel it necessary to notice each separatel y, ex¬ cept the last. With regard to the alleged causes, however, of the second sound, they will feel themselves justified in being less minute ; partly to avoid tiresome repetitions, but principally on account of the obvious preponderance of evi¬ dence, as the Committee conceive, in favour of the theory last-mentioned. First Sound. — Valvular Tension. It is well known that several eminent writers have attributed the first sound to the sudden closure of the auricolo- ventricular valves during the systole. With reference to that question, the Committee have made the following observations : — 1. Inverting the auricles, and pass¬ ing the finger into the auriculo-ventri- cular orifices, does not prevent the first sound, though it must prevent the ac¬ tion of the valves. (Exp. 58.) 2. In the experiments just referred to, the action of the mitral valve, as felt by the finger, was of too gradual and feeble a kind to be capable of pro¬ ducing sound ; while, on the right side, the tightening of the tricuspid was not strong enough to be sensible to the fin¬ ger at all. 3. Various instances where the ven¬ tricles were treated so as to obliterate their cavities by pressure, and render valvular action impossible, gave, never¬ theless, the first sound. (Exp. 6, 7, &c.) From those facts, the Committee con¬ clude that valvular action is not a cause of the first sound. First Sound. — Collision in the Fluids , Sfc. The following are the facts observed by the Committee, with regard to the alleged sonorous* collisions of the parti¬ cles of blood amongst themselves, or against the parietes, valves, &c. of the ventricles. 1. The obstruction of the auriculo- ventricular orifices, by the fingers intro¬ duced by inverting the auricles, does not materially modify the first sound. (Exp. 7, 8, &c.) 2. The heart being pressed between a finger introduced through the auricle to the bottom of the left ventricle, and the other hand placed outside the right ventricle, continued still to emit the first sound. (Exp. 7 and 12.) 3. The heart being grasped firmly in the hand, after separation from its attach¬ ments, and while immersed in blood, gave the first sound distinctly. (Exp. 14.) The pressure in this case must, in the opinion of the Committee, have prevented friction between the opposite interior surfaces of the organ. 4. The division of the aorta and pul¬ monary artery, and even the extraction of the heart, does not prevent the first sound. (Exp. 14.) 5. The Committee made also various experiments in order to ascertain the power of fluids to produce sound when in contact with solids. On compressing, by the stethoscope, the gum elastic bottle, filled with wa¬ ter and under water, they could not suc¬ ceed in producing any other sound than occasionally a bel'lows-sound. The power of obstructed currents of liquid to produce the various modifications of the bellows sound, was further illus¬ trated to the Committee in several ex¬ periments on animals, in which pres¬ sure of the arteries, partial obstruction of the auriculo-ventricular orifices, and the suspension of the action of the sig¬ moid valves, were repeatedly accompa¬ nied by this phenomenon : the thrill ac¬ companying this sonorous passage of liquids was, in every case, sensible to the finger. 6. To this we may add, that the ex¬ periments of MM. Pigeaux and Piorry (Archiv. gen. de MeJ., &c.) have been repeated by the reporter, in the presence and with the assistance of Dr. Edwin Harrison, and other gentlemen, not of the Committee, but in no instance of several trials was any thing like the first sound produced. Irorn the preceding facts, the Com¬ mittee conclude that the normal first sound of the heart is in no degree re¬ ferable to any collisions of the particles of the fluids amongst themselves, or against the parietes, &c. of the ventricles. First Sound. — Impulse. The facts relating to the connexion of impulse with the first sound, that are contained in the preceding experiments, are the following : — In a variety of circumstances, in which it is difficult to see how impulse could occur to cause sound, the systolic sound was distinctly audible — viz. 1. When the heart lay exposed, de- IiEPORT OF THE LONDON COMMITTEE ON THE 3 6(> prived of its pericardium, and supported by the mediastinum alone, as in Exp. 1. 2. When the heart was held between the fingers, with some force of pressure, the left side cavities being empty, or nearly so, as in Exp. 12. 3. When the heart was imbedded in tow. (Exp. 14.) 4. When the heart hung out of the thorax by its vessels, removed from all contact to which sound might be re¬ ferred, as in Exp. 11.* 5. When the heart was severed from all its attachments, and grasped strongly in the hand, as in Exp. 14. On the other hand, several facts show that the impulse against the ribs may produce sound. 1. In Exp. 11, and in others, in the memoranda of which the fact has been omitted, the heart, during systole, was felt, both outside and inside the chest, to press with force ag'ainst the sternum and cartilages. 2. In our observations on the effects of posture, we remarked, that leaning to the left or forwards, gave additional force to the impulse and loudness to the the sound ; while inclination of the body, such as to cause the heart to gra¬ vitate away from the ribs, diminished at once the sound and impulse. 3. To those we may add the facts pointed out by Dr. Spittal, (Edinburgh Medicaland Surgical Journal) whichhave been repeated and verified by the re¬ porter , assisted by Dr. E. Harrison and other gentlemen not of the Commit¬ tee, and which seem to prove that if the living heart impinge with any force upon the walls of the thorax, sound must result. From the whole of these facts the Committee conclude that impulse is not the principal cause of the first sound, but that it is an auxiliary and occa¬ sional cause, nearly null in quietude, and in the supine posture, but increasing very considerably the sound of the sys¬ tole in opposite circumstances. First Sound — Muscular Tension. The facts ascertained by the Com¬ mittee relating directly to muscular ten¬ sion as a possible cause of the first sound, are few but striking-, and in their judgment decisive. 1 . The heart in svstole becomes sud- %> denly, from a comparatively soft and * In the four experiments just referred to, the instrument was applied to the arteries near their roots. flaccid body, extremely tense, and to the touch hard as cartilage. (Expts. 4 and 14, and many others in which the fact was not recorded). 2. The unvarying and uniform cha¬ racter of the systolic sound, however diversified the circumstances in which the heart was placed (Expts. 3, 7, 11, 14), furnishes a strong argument in favour of its intrinsic nature. 3. The voluntary muscles, when sud¬ denly contracted, become tense and hard, and emit sounds resembling strikingly the first sound of the heart. This is especially observable in the action of the abdominal muscles. (Expt. 2.) 4. From these experimental facts, taken along with the self-evident fact, that the muscular tension thus experi¬ mentally proved to be sonorous is an essential part of muscular contrac¬ tion, the Committee conclude that the first sound of the heart is a physical re¬ sult of the sudden transition of the ven¬ tricles from a flaccid condition to a state of extreme tension; — that, in a word, the first sound is essentially a muscular sound. Second Normal Sound of the Heart . We now proceed to the consideration of the normal second sound, and of the hypotheses that have been, or might be, advanced respecting it, and the facts we possess that throw light on its causes and mechanism. The Committee had proceeded but a short way in their experimental in¬ quiries, when they found the conclusion forced on them, that the majority of the hypotheses (above enumerated) regard¬ ing the second sound, were wholly un¬ tenable. In some of their first experi¬ ments they found that the second sound might be absent, although the first sound was present and the systolic and diastolic actions were quite normal. The second sound, for example, was suppressed by — 1, pressure on the roots of the arteries ; 2, by hooking up a valve of each set of sigmoids ; 3, by suspending the heart out of the chest; 4, by inverting* the arteries, &c. (see Expt. passim) : the first sound and i alternate ventricular actions continuing; unaffected in any material degree ini each case. Such facts, of which there : are many in the accounts of the experi¬ ments, seemed to the Committee quite i incompatible with any other hypothesis: respecting the second sound than the' MOTIONS AND SOUNDS OF THE HEAbT. 3G7 last, viz. that which refers it to the action of the semilunar valves. Be¬ sides, several of those hypotheses ap¬ peared liable to the weighty pre¬ liminary objection, that they are wholly arbitrary, and without any foundation, so far as the Committee have been able to ascertain, in accurate observations or experiments. Under those impressions the Committee think it best to proceed at once to state the facts which, in their opinion, tend to establish the action of the sigmoid valves to be the cause of the normal second sound. For this some repetition perhaps may be neces¬ sary, but will, it is hoped, be excused. The following experiments were made with especial reference to the mechanism of the second sound. 1. Pressure with the fingers and thumb was exerted on the arteries close to the sigmoid valves, so as to flatten the tubes a little, and the second sound, previously clear, and in every respect normal, was immediately suppressed, and a bellows murmur was heard in¬ stead : this murmur ceased, and the normal sound returned instantly on the removal of the fingers. (Expts. 7 and 10). 2. A degree of pressure sufficient, it was conceived, to change but veryslight- ly, if at all, the shape of the vessels, gave to the finger sensations of currents moving in opposite directions, — the one current, from the heart, more strik¬ ing and coinciding with the systole, — the other, towards the heart, less forcible, and synchronous with the diastole, and ending suddenly by a sensation of flapping or jerking. (Exp. 14). 3. The fingers being* applied gently to the regions of the sigmoid valves, and the ear-tube applied to the heart, the flapping sound was heard, and a sensation as of a gentle tap was felt by the finger in coincidence with the dias¬ tole and second sound. (Exps. 10 and 14). 4. One valve of each set of sigmoids was hooked up in each artery suc¬ cessively, and the jerking motion in¬ variably ceased, with one apparent ex¬ ception only, and continued suppressed in the artery in which a valve had been so hooked up. If a valve in one artery only was so engaged, the second sound was weakened ; but if a valve of each set of sigmoids was fixed, then the second sound wholly disappeared. In ) some instances there was a murmur of the sucking* or o blowing kind following the systole during the suspension of the valve ; in other instances there was absence of sound simply. (Exps. 4, 6, 12, 13). 5. The arteries were cut across close to the sigmoid valves, the veins being left entire, and the heart beating with considerable force ; the ear-tube was then applied, but gave only one sound, and that one coincident with the sys¬ tole. (Exp. 14). 6. In the separated heart the first sound was repeatedly observed, but the second sound never. Summary and Conclusions. 1. The first sound of the heart, as heard in the chest, is generally com¬ plex in its nature, consisting of one constant or essential sound, and one perceptible only under certain circum¬ stances. This constant element of the first sound may be considered as in¬ trinsic, appearing to depend on the sud¬ den transition of the ventricles from a state of flaecidity in diastole to one of extreme tension in systole ; while the extrinsic, or subsidiary sound, which in a variety of circumstances contributes largely to the first sound, arises from the impulse of the heart against the parietes chiefly of the thorax. 2. The collisions of the particles of the blood amongst each other, or against the interior parietes, valves, &c. of the heart, do not appear to have any share in the normal first sound of the heart; neither do the motions of the auriculo- ventricular valves ; and the attrition of the opposite interior surfaces of the heart’s cavities seems purely hypo¬ thetical. 3. The principal and apparently only cause of the second normal sound of the heart is the sudden closure of the sigmoid valves, by the columns of blood that recoil back on them during the diastole, impelled by the elastic con¬ traction of the arteries. 4. The columnce carneoe appear to act simultaneously with the parietes of the ventricles, and in such a manner as to make it apparently impossible that the auriculo-ventricular valves should close with a flap in the same manner as the sigmoid valves*. * An opinion which is further confirmed by the anatomy of the heart of the domestic cock, in which M. Bonillaud (Du Cceur, tom. i.) ap¬ pears to have heard both sounds with the naked ear. In that animal there is no tricus¬ pid valve resernblng that of man, but the valvular office is discharged by laminar ex- 368 MR. WALKER ON THE NERVES AND MUSCLES OF THE ORBIT. To conclude : the Committee feel strongly that the subject of the heart’s motions and sounds requires further in¬ vestigation, especially in their patho¬ logical relations, and a wider range, and greater variety of experiments, than have hitherto been performed. (Signed) C. J. B. Williams, M.D. F.R.S. &c. R. B. Todd, M.D., Profes¬ sor of Physiology and General and Morbid Ana¬ tomy in King’s College, London. J. Clendinning, M.D. , Fel¬ low of the Royl. Coll, of Physicians ; Hon. Sec. Royl. Med.-Chir. Soc. of Loudon ; Physician to the Marylebone Infirmary. Reporter. NERVES AND MUSCLES OF THE ORBIT. To the Editor of the Medical Gazette. Sir, I could not help regarding Mr. Thur- nam’s communication, on the compara¬ tive anatomy of the muscles and nerves of the eye-ball, as one of considerable interest. The spirit of research, as well as the correct feeling it displays, appear to me worthy of commendation ; and I think the question put by that gentleman is capable of a satisfactory answer. The notion that the retractor muscle of the eye of quadrupeds is intended simply for the suspension of that organ, cannot now, I think, be maintained. The fact that this muscle is found only in those creatures who possess the hav;, — that it neither exists in the quadrumana, or in man, — and that in birds there is a direct communication between the third eye-lid and the quadratus and pyrami- dalis muscles, which are absent in qua¬ drupeds, all seem to imply that there is a relation between the two. This is now, I presume, very generally ad¬ mitted. In experiments on the eyes of qua¬ drupeds, I have always found that on pushing the ball backwards and from tensions of the substance of the parietes of the ventricle, which meet in the middle, so as dur¬ ing the systole to cover the auriculo-ventricular orifice. J the temporal side, the haw has been made to start forward over the front of the eye. The question that I would offer tor consideration, then, is this — does the action of the retractor muscle, conjointly with that of the abductor, pull the eye backwards and outwards in a similar manner to that in the experi¬ ment above noticed, and thus cause a protrusion of the haw ? If so, we see at once, why these two muscles should be so intimately connected as they are made to be, by being supplied with branches of the same nerve. Undoubt¬ edly, the arrangement of the nerves of the eye generally would lead to the conclusion, that where there is a com¬ mon distinction of nervous filaments, there must likewise be a relation, more or less, between the offices of the differ¬ ent parts to which they go. Me see this principle displayed here in the most striking manner ; as, for example, in the case of the levator palpebree and levator oculi, so that we cannot but regard it as one of first-rate importance. Sir C. Bell seems to have entertained some idea of there being a relation be¬ tween the action of the two muscles in question, — “ that there is something common to the retractor oculi and the rectus externus*.” Elsewhere, however, Sir C. Bell says,— “ In quadrupeds I have ascertained that the oblique mus¬ cles act when the haw is protruded, but I have also found that the retractor oculi alone is capable of forcing forward the bawf.” On the whole, I see no reason for concluding’ that the fact of the retractor muscle being supplied by the sixth nerve, at all militates against the ex¬ planation of the functions of the muscles and nerves of the eye-ball, as given in my paper of the 24th September. As Mr. Thurnam has himself remarked, the view suggested by Mr. Hunt, and since carried out and perfected by him¬ self, refers to the primary and more important functions — functions which are common to all creatures in which the eye is fully developed; whereas, the fact of the branches of the sixth nerve supplying the retractor muscle has reference to secondary arrangements, and such as are but partial in their ap¬ plication. — I have the honor to be, sir, Your very obedient servant, John Walker. Manchester, Nov. 28, 1836. * The Nervous System, 4to. p. 215. t Ibid. p. 191. DR. EDWIN HARRISON ON PHYSICAL SIGNS. 369 TREATMENT OF LUNG DISEASE. To the Editor of the Medical Gazette . Sir, If it be not a generally-known fact that the tartar emetic is such an excellent remedy for inflammation of the mucous membrane of the lungs, I take the li¬ berty of sending you the following case, in addition to that of Dr. Kemp, which, if you consider worthy a place in a corner of your valuable journal, is quite at your disposal. A short time since I was suddenly called to a Mrs. B., cet. 28, married, but without children, of consumptive aspect, and whose father died of phthisis. She had been suffering from an affection of the lungs previously to this, for which she had had the advice of a medical man, and was much better, some days before I saw her. When 1 saw her she was labouring under the greatest de¬ gree of dyspnoea it has ever been my lot to witness; a most distressing cough, so that she could not speak ; and a pulse of 130. My impression at the time cer¬ tainly was, that she could not live : however, I determined to try the effect of tartarized antimony, and ordered the following : — Antim. Tart. gr. ij. ; Trae Digit, irjxxx. ; Oxym. Simp. 5vj.; Aq. Distil. Jviij. Cap. coch. ampl. ii. quaq. h.; and a blister to the chest. This treatment, sir, acted like a charm, and in two or three days I had the satisfaction of seeing my patient in a comfortable condition (comparatively.) I was soon after obliged to discontinue the medicine, as it occasioned so much sickness. The after-treatment was such as would suggestitself to every enlmht- ened mind. I should say though, that after the violence of the attack had subsided, my patient laboured under the most marked symptoms of tubercular disease, and I scarcely dared to hope she would be re¬ stored to health ; but they gradually gave way, and in six weeks she wras as well as she had been for the last two years. In the latter part of my treatment I gave her the troe. ferri mur. in rtpx. doses, and think it did some good ; but I certainly cannot lay claim to much credit for any thing 1 did towards the 471. — xix, removal of the phthisical symptoms, and am disposed to think that nature effected the cure. — I am, sir, Very respectfully yours, Edwin Ellis. Tulse Hill, Brixton, Nov. 30, 1836. DR. EDWIN HARRISON ON PHYSICAL SIGNS. [Dr. Edwin Harrison, in continuation of the investigations connected with the physical signs of disease, in which he has been for a considerable time en¬ gaged, and some account of which has been communicated to our readers by his friends Dr. Williams* and Dr. Clendinningf, has transmitted to us the following propositions. — Ed. Gaz.] One or more of the follow ing circum¬ stances present themselves in a suffi¬ cient number of instances to deserve, I think, the attention of those who take an interest in physical signs : — 1. A depression about the height of the lower dorsal, or first lumbar verte¬ bra, from which the finger, in mount¬ ing along’ the spine, will come to ano¬ ther depression, corresponding’ with to¬ lerable accuracy to the height of the diaphragm at that part. 2. On moving the hand along either side of the chest vertically, on what may be considered as the median line, it will sink into a depression correspond¬ ing to the height of the diaphragm on that side. 3. A depression, or depressions, be¬ tween the ribs, can be felt, or seen, or both felt and seen, at each abdominal inspiration, indicating (at least in the physiological state) the presence of the diaphragm in that part of the chest. By this means the height of the dia¬ phragm on the left side can be judged, of, to a certain extent, even through the heart. Query — What relation do these last- named depressions bear to the tilting up of the chest, which occurs not merely at its lower parts, but as high up at least as the lateral depressions previously mentioned ? * Med. Gaz October 3, 1835. t Ibid. July 23, 1836. 2 B 370 ANALYSES AND NOTICES OF BOOKS. It is scarcely necessary to add, that these remarks are offered as mere gene¬ ralities, and, as such, are open to excep¬ tions, limitations, &c. some of which I hope to be able to speak of hereafter with more precision than I can at present. If it should turn out that my opinions are not so original as 1 believe them to be, I trust that I shall always be found ready to make the avowal. ANALYSES and NOTICESor BOOKS. L’Auteur se tue a allonger ce que le lecteur se tue a abrdger.” — IVAlembert. Elements of the Practice of Physic ; presenting a View of the present state of special Pathology and Therapeu¬ tics. By David Craigie, M. D. F.R.S.E., See. &c. Edinburgh, 1836. There exists not, in medical literature, a greater desideratum than a good elemen¬ tary work on the practice of physic. The voluminous “ Study” of Mason Good, and the elaborate essays in the “ Cyclopaedia,” and in the “ Dictionary” of Dr. Copland, form great stores, from which the student may draw, when seeking for all that is known on any particular subject; butrthey are scarcely adapted for the student, who requires to have his knowledge in a more condensed form, and, as it were, already digested for him. We never expect to meet with any work which shall equal the “ First Lines” of Cullen; so admirably suited to its purpose, that it kept possession of the schools long after the theory which pervaded it had become obsolete. Long was it attempted, by notes and additions of various kinds, to accommodate it to the progress of science, but the effort has become utterly hopeless, and the work may now be regarded as the pro¬ duction of a by-gone period, no longer qualified to constitute the hand-book which is to initiate the student into the mysteries of physic. Such has been the dearth of efficient successors to Cullen in this department, that we apprehend lecturers on medicine must often be at a loss what elementary work to recommend to their pupils : for there are several which profess to have sup¬ plied the deficiency, yet they are all either superficial and defective, or marred by some peculiar crotchets of the author’s own, to the exclusion of sounder doctrines; and thus they be¬ come unsuited lor their ostensible pur¬ pose. The work before us seems to be calculated to hold an intermediate place between the more superficial books manufactured professedly for students, and the elaborate volumes above alluded to. The first volume only has appeared, and it seems intended that there shall be but two altogether. This would make about 2000 pages of a pretty close type, and therefore affords ample space for the intended purpose. It is quite folly, or affectation, in any man to suppose that he can construct a system calculated to convey any thing like a complete view of the present state of medical science, from his own individual observation and experience. Dr. Craigie has wisely avoided attempting* this, and has en¬ deavoured, in its place, to present us with a work embodying the “ united result of the observations and researches of all the ablest pathologists and physi¬ cians by whom the science of medicine lias been cultivated, and by whom it has been simplified, improved, and rendered energetic.” Each chapter is preceded by a list, chronologically arranged, of those works upon the subject to which it relates, which Dr. Craigie deems, most worthy of being- consulted, and a condensed view is given of the leading doctrines and facts, followed by the inferences of the author himself. Established modes of treatment, whether old or of recent introduction, are throughout preferred to those which, if possessed of more novelty, are still under probation, and the pathological characters of the disease are always referred to in con¬ nexion w ith the therapeutic indications. Of the fulness of the articles some idea may be formed from this — that the chapter on Ague occupies 114 pages; within which space is comprised a longer or shorter notice, we really be¬ lieve, of every important point connected with the history of the disease, as well as of numerous remedies which have at various times been recommended. Upon the whole, we are inclined to regfard Dr. Craig-ie’s Elements as the best we at present possess ; and we trust that the second volume will not be delayed in the manner which has of ANALYSES AND NOTICES OF BOOKS. 371 late become the fashion , rendering- so many of those works which are brought out in parts comparatively useless. Coup D'CEH sur Les Hopitaux de L on- dr es, et sur Vetat actuel de la Mede- cine et de la Chirurgie en Angleterre. Par Edwin Lee, Membre du College Royal des Chirurgiens, Londres. It can scarcely be expected that the work bearing the above title should afford much information to the English reader, nor is this the author’s object. Mr. Lee has visited the principal medi¬ cal institutions of the Continent, ' and has thus had an opportunity of observ¬ ing the general ignorance which pre¬ vails with respect to the state of the hospitals in this country ; and with a view of contributing to remove this, has given a short sketch of the metro¬ politan institutions of England, which he has very properly written in the French language, and published abroad* It is, we believe, the only effort to enlighten our neighbours on the subject which has been made since the work of M. Roux ; which has been rendered obsolete by the numerous changes that have subsequently occurred. NEW GERMAN PUBLICATIONS*. Denkwurdigkeiten in der arzlichen Praxis. (Memoirs and Papers re¬ lating to Practical Medicine.) Von Dr. J. H. Kopp. Drei Bande. Frank¬ furt, a. M. 1836. The name of Dr. Kopp, of Uanau, is somewhat familiar to our readers, through his able article on thymic asthma, which we lately published. That arti¬ cle is contained in the third volume of this collection, along with a variety of other contributions to medical practice. The second volume is wholly devoted to an estimate of the homoeopathic quackery. Die Erhenntniss und Heilung der Ohrenkranltheiten. (On the Nature and Treatment of Diseases of the Ear.) Von Dr. Wilhelm Kramer. Berlin, 1836. Sammlung auserlesener Ahhandlungen und Beohachtungen aus dem Gehiete der O/irenheilkunde. (A Selection * Imported by Mr. Schlpss, of Great Russell- street, Bloomsbury. of Papers on the Treatment of Ear Diseases.) Herausg. Von Dr. C. G. Lincke. 1 — 3. Leipzig, 1836. The first of these works is a systema¬ tic treatise, in which the diseases of the ear, and their appropriate remedies, are regularly noticed. The second is a pro¬ duction which appears periodically (not, however, at reg'ular intervals), on the same subject: among the selected pa¬ pers are some by the first names in Ger¬ many. Versuch einer pragmatischen Ge- schichte der Anatomie und Physiolo- gie , vom Jahr 1800 — 1825. (His¬ torical Account of Anatomy and Physiology.) Von Dr. Burkard Eble. Wien, 1836. A work of great research ; containing- a mass of information relative to the strides which anatomy, general and particular, human and comparative, has made during' the first quarter of the pre¬ sent century. The bibliography alone would render the volume one of great value to anatomical teachers. Das Blut in mehrfacher Beziehung phgsiologisch und pathologisch un- tersucht. (Physiological and Patho¬ logical Investigations concerning the Blood.) Von Dr. Hermann Nasse. Bonn, 1836. Enter sucliungen zur Physiologie und Pathologie. (Physiological and Pa¬ thological Researches.) Von Dr. F. Nasse und Dr. H. Nasse. Hefte 1 — 3. Bonn, 1836, The volume on the Blood is an ela¬ borate treatise, full of the fruits of expe¬ rimental inquiry. The otljer work, by father and son, is on miscellaneous sub¬ jects, appearing in successive fasciculi. Sammlung auserlesener Ahhandlungen liber Kinder Krankheiten. (Select Essays on the Diseases of Children.) Von F. J. v. Mezler. Bande 1—5. Prag. 1833-6. A very superior work to the Analehten , lately noticed. Paris und die JRheingegenden. Tage- huch einer JReise im Jahre 1835. (Paris and the Rhine country ; being Notes of a Tour, &c.) Von Dr. C. G. Carus. Zwei Bande. Leip¬ zig-, 1836. We have here a very interesting ac- 372 PARENT-DUCHATELET ON PROSTITUTION. count of a tour by the celebrated Carus, the comparative anatomist. His notes of his visit to Paris, where he had every advantage of mixing with all the savans , and of seeing every thing worthy of be¬ ing seen, are, as might be expected, shrewd, intelligent, and valuable. We wish the distinguished author had crossed the Channel, and reported pro¬ gress respecting medical affairs in this country : his observations, we doubt not, would have created a sensation in the professional world similar to what Yon Raumer’s have in society generally : no disparagement, however, to M. Cams, in comparing him with the Berlin pro¬ fessor of history, whom we do not esti¬ mate at any high rate. De Retina Observations Anatomico- pathologices . (Anat. Phys. Observa¬ tions on the Retina.) Auctore B. C. R. Langenbeck, M.D. Got- tingte, 1836. An elaborate quarto, containing a very complete account of the structure and functions of the retina. It is illustrated with plates representing various objects of comparative anatomy. Das System cler Circulation in seiner Enwicklung durch die Thierreihe und im Menschen. (The Circulation in Animals and in Man.) Yon Dr. C. H. Schultz. Stuttgart und Tiibingen, 1836. Supplemente zur Lehre vom Kreislaufe. (Additions to the Doctrine of the Circulation ) Yon Dr. A. F. Mayer. Hefte 1 und 2. Bonn, 1827-1836. Further contributions on the subject of the circulation. The first is a syste¬ matic work.* The others contain some further elucidations of Professor Mayer’s views. Einieitung in die technische Chemie fur J edermann. (Introduction to Practical and Popular Chemistry.) Yon Dr. F. F. Runge, Professor an der Universitat zu Breslau. Berlin, 1836. Well calculated to fix the students’ at¬ tention ; it abounds with coloured repre¬ sentations of the various substances, as they are met with either in their native state, in solution, or as precipitates. The idea of presenting these to the eye by means of slips of coloured cloth pasted on the pag'e, has, we believe, been borrowed from Dr. Thomson of Glas¬ gow. Handworterbuch der prahtischen Arz- neimittellehre. (Dictionary of Prac¬ tical Materia Medica.) Yon Dr. L. W. Sachs und Dr. F. P. Dijlk. Theil. 1 — 3. Konigsberg. This promises to be a very useful work of reference : the third and last volume is not yet completed. MEDICAL GAZETTE. Saturday , December 10, 1836. «* Licet omnibus, licet etiam mihi, dignitatem Artis Medicae tueri ; potestas modo veniendi in publicum sit, dicendi periculum non reenso.,f CieiiRO. PARENT-DUCHATELET ON PROSTITUTION. This extraordinary work is full of in¬ terest, both for the medical and general public : its details are of a nature calcu¬ lated to explode many errors, as wrell as to establish many valuable facts. We shall endeavour to give something like a summary view of it to the reader, who may not have leisure to peruse it for himself. What is to be done with prostitution in a state P This is a question which has often puzzled legislators. To sup¬ press it as an evil may have been a well-intentioned project in the infancy of society; but the time has long gone by since the possibility of such a scheme was dreamt of. Under the most ancient governments, public women were permitted ; and, in Rome, all such persons were obliged, on pain of ba¬ nishment, to have themselves registered by the ediles. Modern Rome has long followed the example of its venerable mother, and the system of inscription has been practised there with much re¬ gularity from an early date. Even in this country, when Rome had so much influence over our religion and PARENT-DUCHA.TELLT ON PROSTITUTION, 373 morals, licenses used to be granted sys¬ tematically to the keepers of brothels, and the higher ecclesiastics derived no inconsiderable portion of their revenues from that polluted source. At present it is well known how lax are our regu¬ lations in this respect — no cognizance whatever beinof taken of those who pu rsue prostitution as a trade, unless they happen to attract attention by some infraction of social order; while our French neighbours possess the most regular system in the world respecting these matters, and, in fact, have be¬ come the envy and the model of several European states. Which policy is the better, the relaxed or the strict — that which prevails amongst us, or that amongst the French — may be made a question : but we believe there can be little doubt that, with all their strictness and discipline, there is far more liber¬ tinism and profligacy in the French me¬ tropolis than in the British. Startling assertions have been some¬ times made relative to the prodigious number of prostitutes in London : it is not long since a demi-official report in the newspapers stated forty thousand to be somewhat about the mark. But a hint or two from Parent-Ducbatelet will show us the vagueness which usually attends those round-number calculations. In Paris itself, it appears that until recently it has been the common prac¬ tice to make similar exaggerations. Twenty, thirty, nay sixty thousand, has been stated as about the number of files publiques in that metropolis. Wri¬ ters in the political journals, whether for or against the administration, assumed ad libitum whatever estimate seemed to them most probable, or perhaps suitable to their purpose ; and even persons who, from their con¬ nexion with the government, had means of access to more exact information, have commonly talked of eighteen or twenty thousand. Now what thinks the reader is the actual number ? Du- chatelet states it precisely. He tran¬ scribed into his volumes the entries in the registries of the police, made regu¬ larly month by month for twenty- one years (from 1812 to 1832), and not until the year 1829 does the number of pros¬ titutes in Paris reach 3000; and the greatest number is that entered in 1832, namely, 3817 ! So much for the value of approximations — such as wre very much suspect those to be, which assert that there are tw7enty, thirty, or forty thousand public women in London. Figures, like facts, are stubborn things. The. system of registering prostitutes can scarcely be said to be of long1 standing in France : it is only, indeed, of late years that it has been practised in such a manner as to attract general approbation. The first suggestion rela¬ tive to inscribing1 the names in the po¬ lice registers was made not earlier than 1765, and it was some years later (1771) that an individual presented a memorial to government, on the propriety of tak¬ ing cognizance of the health of those inscribed. The commission which was charged with the consideration of this project, reported — “ that the suggestion regarding a surveillance sanitaire was the dream of a benevolent man, but that it was wholly impracticable.” A mode of registering of some sort w as adopted previous to the revolution, but it was clogged with gross abuses. The women were inscribed, and taxed, and visited ; but the official people — nay, the medical men — whose duty it was to make the requisite inspections, derived a vile pecuniary profit from the opportunities which their situation afforded them. Since 1804 the administration of po¬ lice has taken under its own charge both the sanitary visits and the inscrip¬ tions; and much order and regularity 374 PARENT-DUCI1ATELET ON PROSTITUTION. have prevailed in consequence. Regis¬ ters kept with extreme care, now exhi¬ bit at one view both the numbers and state of health of the women inscribed. Nor is this all : in 1828 another import¬ ant arrangement was made : the certifi¬ cate of birth has been rendered neces¬ sary, — so that the exact age of every female on the books is known. This latter regulation is attended with much <5 advantage ; for very few of the appli¬ cants being provided with their actes de naissance , a communication with the local authorities is requisite, whereby overtures are occasionally made for re¬ storing some of the unfortunate females to their friends. It may probably be said that there are more prostitutes in Paris than those on the books of the police. That we shall not gainsay ; but the number can¬ not be very considerable. The police have their eye on all whom they suspect as insoumises , and the moment they catch them in any overt proeeedingcon- nected with prostitution, they put them immediately under arrest, and enter them in the registers as a matter of course. On the causes leading to this degrad¬ ed condition of life the author makes several sound reflections. He notices all the more ordinary inducements that operate on wreak minds — the love of variety, of finery, of gourmandise , &c. ; he comments on the neglect of education -—the selfishness and cruelty of parents among’ the lower ranks of society: but he goes deeper towards the root of the evil — he points to the deplorable disar¬ rangement which prevails in society, whereby females are left a prey to idle¬ ness — most of those occupations which would suit them being engrossed by men. “ Is it not disgusting,” says Pa¬ rent- Duel) atclet, “to see, in our shops and coffee-houses, so many men in the vigour of their age leading such effemi¬ nate lives, with scarcely any other em¬ ployment than that of wiping vessels, or handling rags ?” Rousseau long since pointed out this anomaly, and some of our ablest English writers have also denounced it. Fashion, however, which is omnipotent in these matters, must have its way; and mew-milliners must be forthcoming, at whatever cost. Some most singular facts are men¬ tioned with regard to the motives which occasionally lead to prostitution. Any other authority would be scarcely cre¬ dible; but full credit cannot but be accorded to Duchatelet, — martyr as he proved himself in the cause of truth. He assures us of several in¬ stances having come to his knowledge of women being led to prostitution through a virtuous or moral motive, urged, howrever, by distress. “ II n’est pas rare,” says he, “ de voir des femmes mariees, abandonees ou privees de leur mari, et par consequent de tout sou- tien, devenir prostituees dans l’unique dessein de ne pas laisser mourir de faim une famille nombreuse ; il est plus commun encore de trouver de jeunes filles, qui ne pouvant trouver dans le travail les moyens de pourvoir aux besoins de leur parens vieux et infirmes, font le soil’ le metier de pros¬ tituees, pour completer ce qui leur manque ; j’ai trouve trop souvent des notes particulieres sur ces deux classes de prostituees, pour n’etrepas convaincu qu’elle est a Paris plus nombreuse qu’on ne pourrait le croire.” These persons belong to that class called filles isoUes , and could never endure the sort of life which is led by those belonging to the maisons pub- liques. Of the manners and habits of the latter class, as well as of the dames de maison , and of all those employed about them, we have such a picture as could not well be imagined, without being surveyed. Only fancy a separate WAKLEY AND HIS ACT.’" world of people, with an aristocracy, a middle class, and a populace : the peo¬ ple, too, governed by rulers whose au¬ thority knows no bounds — who, in the pursuit of a traffic a hundred times worse than the slave-trade, reduce their unhappy subjects to the most degrading* occupations, to a condition comparable only with that of brutes, did not the hideous immorality accompanying* it ren¬ der such a comparison but too flattering. Such is the tyranny of those (so called) dames de maison. Under the sway of these despots, the lives led by their victims is, as may be imagined, wretched beyond descrip¬ tion. Obliged to prowl about the streets, or wander in the fields for hours, exposed to all kinds of weather, they are thrust, towards the end of the night, into some miserable corner, where the only resource for many of them is to forsret their wretchedness in the most disgusting* intoxication. o What, it may be asked, is the end of all this ? What becomes of those un¬ fortunates in their latter days ? The common opinion is, that once they have plunged into their headlong career, re¬ treat is impossible — that they soon reach the bottom of the abyss : that they all die in the hospitals, eaten up with disease. This, however — and there is some relief in the knowledge of the fact— happens to be a mistake. Prostitution, to use the language of Duchatelet, is but an episode in the life of the majority of those women ; they, in general, only pursue the trade for a certain number of years, after which they contrive to live as other people do. Some return to their parents or relatives ; others form connexions with old celiba- taires — sometimes with artisans of the lowest classes. A great many of them obtain situations as servants ; some marry, occasionally even with men of rank ; others, in fine, but they are com¬ paratively few, retire with a competency, 375 which they have saved up by strict economy — a thing which certainly can never happen to those under the direc¬ tion of the dames de maison. Here we shall close this summary sketch. We have only touched on some of the more general topics treated in the volumes : we have said nothing of the punishments, the prisons, the houses of correction and refuge, nor of the valua¬ ble suggestions offered by the author on these and a multitude of other points. When next we notice the work, as we hope to do ere long, we shall be more strictly professional ; for there are a number of interesting subjects scattered through the volumes in connexion with the statistics of disease, with which we should like to make our readers ac¬ quainted. WAKLEY AND HIS “ ACT.” The Lancet of last week presented a laughable exhibition — Wakley’s at¬ tempt to write fine and be genteel ! It reminded us for all the world of Jack Falstaff’s determination, in future to “ purge and live cleanly,” as a gentle¬ man ought to do. But the explanation of the pheno¬ menon is easy. Wakley is desperately sore about that unfortunate bantling of his: he sees all its faults well enough ; yet, fathered as he is with it, what can he do but endeavour to back it up ? In his quandary he sends a parcel of fishing letters to his correspondents — those especially that he can depend upon — just to ask them “ How does my Act work ?” Of course they answer by return of post that it works beautifully . Any one that was not blinded by a parent’s foolish fondness, would see, however, that among the replies he received, and which he publishes as an answer to us, there was scarcely one which offered even the shadow of a fact. We said there were many medical men 376 LEGAL MEDICINE. who had been unable to obtain their fees under the Act ; and we believe so still. No fishing letters have been written V us to our correspondents : yet we have g'ot facts as many as we want. “ Chirurgus” was a difficult nut for Mr. Wakley to crack: yet perhaps the gentleman whom we have now the honour to introduce to him will not * prove a less stubborn witness against the mischiefs of his bungling legislation. We shall not blunt the force of our cor¬ respondent’s letter by any comment of our own— at least for the present. To the Editor of the Medical Gazette. Sir, The following facts, T think, will shew the total inefficacy of the act for remu¬ nerating medical witnesses, and that where it ought, if possible, to have w orked well, a medical man being the coroner. I was sent for to see a person, who when I arrived was dead. I found, upon inquiry, that she had miscarried the previous day. A half-pint bottle, in which there had been turpentine, was in the room. From this and other cir¬ cumstances I thought it w as a case in which some legal steps ought to be taken to inquire as to the cause of death. Upon acquainting* the magistrates, they were of my opinion, and ordered the coroner (Mr. Ferrier, a surgeon) to hold an inquest. This gentleman accord¬ ingly requested a surgeon, a friend of his, to make a post-mortem exa¬ mination of the body, and summoned me to attend the inquest, at which he held forth very learnedly, favour¬ ed the jury with a long harangue about the treatment of tape-worm by turpentine, and stated that a large dose of turpentine had the same effect upon the system as small and repeated doses had. After the inquest he refused to give me an order for payment, stating as his reason that I had not a special summons ! I then appealed to the ma¬ gistrates, who told me that they had no power to make him do it. If Mr. Wakley really intends to amend the act, he had better insert a clause preventing medical men being coroners, as it gives them an opportu¬ nity of forwarding the interest of their friends, and gratifying private pique in their public capacity, which in this case most decidedly has been done. I am, sir, Your obedient servant, Chas. C. Aldred. Yarmouth, Norfolk, Dec. 3, 1836. TRIBUTE TO SIR CHARLES BELL. A very handsome, richly ornamented, silver urn has been presented to Sir Charles Bell by some (a hundred and thirty) of his professional brethren, on the occasion of his leaving London to take up his abode in the northern me¬ tropolis. We are requested to state, that any of the subscribers may view it at the makers, Messrs. Storr and Morti¬ mer, Bond-street, where it will remain till the 20th instant. LEGAL MEDICINE. [We have thought the following trial and inquest worth preserving : the first on a subject, not certainly of rare occurrence, but requiring the most careful attention on the part of medical witnesses; the second curious, and exemplifying the mis¬ chief that may arise from the use of un¬ sound food. The poison was probably generated in the bacon, by a sort of de¬ composition similar to ivhat has been sometimes observed to take place in Ger¬ man sausages. — Ed. Gaz.] INFANTICIDE — CONCEALMENT OF THE BIRTH. At the Old Bailey, on Friday last week, Jane Hale, spinster, aged 18, was indicted for the wilful murder of her male infant child, by suffocation ; and in another count in the indictment the prisoner wras charged with inflicting certain wounds with a sharp instrument on the neck of the infant, by which its death was occa¬ sioned. Mr. Bodkin stated the case to the jury. Elizabeth Seymour deposed, that she was nurse in the family of a lady named Jeffrey, who resided at Stoke Newington. The prisoner wras servant of all work in the same family, and had lived there for about six months prior to the present charge. In consequence of her altered ap¬ pearance, witness had several times taxed her with being pregnant, but she denied it. On the morning of the J 9th of No¬ vember she complained of illness, and LEGAL MEDICINE. 377 went up stairs to her bed- room. Witness informed Mrs. Jeffrey of the circumstance, and subsequently went to the prisoner’s bed-room, and found her packing up her clothes, her mistress having given her warning to leave her service that day. Witness went to her bed-room again after some interval, and found the prisoner in the same position as before, and she then observed some stains upon the floor. She told the prisoner that her mistress had gone to fetch Mr. Drayton, the surgeon, when she replied that she did not want him. Mrs. Sarah Jeffrey corroborated the chief part of this testimony. Cross-examined. — The prisoner, while in her service, bore a good character for humanity and kindness of disposition. Mr. G. B. Drayton, a surgeon, residing at Stoke Newington, proved that on the morning of the 19th of November last he was called upon to attend the prisoner, and found her in her room quite dressed, packing up some things in her box. She said she was preparing to go away, and that she was then quite well. After some conversation with her he proceeded to ex¬ amine her, and found that she had lately been delivered of a child. She denied it ; upon which witness said he w'as convinced of the fact, and if she C id not tell him where the child was he should call the police. She hesitated a few minutes, and then said, “ It is under the bed.” Wit¬ ness lifted up the bed-clothes, and found a bundle tied up in a woollen covering. On removing the wrapper, he found a second covering of linen ; and having also removed that, he discovered the head and face of a child. On examining the neck he observed a cut, and asked the prisoner howr she could have been guilty of such a disgraceful act. She made no re¬ ply. Witness then sent for the police, and they took possession of the child’s body; upon examining which, they found it still warm, and the limbs flexible ; — and, from the appearances which the body presented, it appeared to have been dead about half an hour. Witness then told the prisoner that she would save the police much trou¬ ble if she would point out the instrument with which she had inflicted the wound on the neck of the child. She then pointed to a knife, and w itness observed some spots l of blood upon the blade. On the fol- i lowing Monday, witness and Mr. Robin- i son, another surgeon, examined the body. I he witness then proceeded at considera¬ ble length to describe the appearances it presented ; and the substance of his evi- ; dence with regard to the cut on the throat i w as) that it would not have been sufficient to cause death. The lungs were remarka¬ bly small, and of a purple colour, and from their appearance he was of opi¬ nion that the child had not breathed at¬ mospheric air ; but upon testing the lungs, by placing them in w^ater, he found that they floated, and upon cutting them a slight oozing of air took place, which caused him to alter his opinion ; and, from all the circumstances in the present case, he should say that the child was born alive, and that the marks of violence wrhich he found, with the exception of the bruise on the head, were not sufficient to produce death. The contusion on the head might have taken place by a fall on the floor at the moment of birth. The wrnund on the throat was quite superficial. When an infant at its birth breathed freely, the lungs entirely filled out the cavity of the chest, and they were of a bright red co¬ lour, wrhich was not the case in the present instance. The case being closed for the prose¬ cution, Lord Denman said that the two great questions in the case were, first, as to whe¬ ther the child wras born alive ; and se¬ condly, if so, whether the prisoner had wilfully caused its death. He deemed it right, in this stage of the inquiry, to tell the jury that both questions appeared to be involved in so much doubt, that the bench were of opinion that the evidence wrasnot sufficient to support the charge of murder; and unless the jury entertained a different opinion, and wrere desirous to hear a further discussion upon the points in question, it would be useless to proceed further as regarded the more serious of¬ fence. There could be no doubt, however, but that the prisoner had been guilty of concealing the birth of the child. The jury intimated to his Lordship that in their opinion the charge of murder could not be sustained. Mr. Carrington said, that he was much indebted to his Lordship for relieving him from a most anxious and painful duty — that of addressing the jury on behalf of the unfortunate prisoner, on a charge af¬ fecting her life, and he was willing at once to admit that the evidence had fully esta¬ blished the minor offence, that of conceal¬ ing the birth. A witness w'as then called, with whom the prisoner lived for three years, and wdio gave her an excellent character. The jury, under his Lordship’s direc¬ tion, returned a verdict of Not Guilty of the murder, but Guilty of concealing the birth of the child. The prisoner wras then called up for judgment, and, 378 LEGAL MEDICINE. The Recorder proceeded to pass sen¬ tence upon her, observing that the learned persons who had tried the case had in¬ structed him to inflict the fullest punish¬ ment the law attached to the offence of which she had been found guilty ; and of the justice of the verdict every person who heard the case must be perfectly satisfied. As the organ and instrument of the Court, he was therefore called upon to sentence her to a confinement of two years, with hard labour, in the House of Correction ; but the hard labour would not be added to the sentence until her state of health al¬ lowed it. It was needless for him to recal to her mind the suspicions and alarming facts disclosed upon the trial ; but he must observe, that the circumstances which came out in evidence furnished at least probable grounds for believing that she had medi¬ tated, if not actually perpetrated, the mur¬ der of her helpless child. POISONING WITH UNSOUND BACON. An inquest was held at Westminster Hos¬ pital on Monday last upon the body of Caroline Jones, who came by her death under the following circumstances: — Con¬ siderable interest was excited in conse¬ quence of a prevalent rumour that the deceased had been poisoned by some of the bacon which became impregnated with arsenic on the occasion of the late fire at Fenning’s wharf, London-bridge. Richard Jones, of No. 8, Franklin’s-row, Lower Chelsea, messenger to His Majesty’s commissioners of Tithe- inquiry, deposed that the deceased was his daughter, and nearly 15 years of age. Her health had been always good from her infancy up to Sunday seven weeks ago. On the preced¬ ing evening, Saturday, 15th October, wit¬ ness and his wife bought a piece of bacon at a shop opposite the Chelsea bun-house. The bacon was labelled 4d. per lb. It looked very good, and the shopman per¬ suaded witness to buy 8^1b. at a reduced price, warranting it to be good. It was cooked the next day, with greens. The whole family dined together, the deceased eating very heartily of the lean part of the bacon. During dinner, witness remarked a peculiar flavour in the bacon. It disa¬ greed with him, and he ate very little of the fat, and none of the lean. Soon after dinner, he felt a burning sensation in his throat, and a disposition to vomit. About an hour after dinner, his son, who was afflicted with the St. Vitus’s dance, was taken ill, and seized with pains and vomiting. The servant had gone out with a younger child, and returned about five o’clock, complaining of dreadful head¬ ache, and burning at her stomach. W it- ness gave her some tea, when she went to bed, and was attacked violently with spasms and retching, but nothing came off her stomach. Whilst witness was attending the deceased, another child, aged 8 years, was attacked in precisely a similar way. There were two other children, who had not partaken of the bacon, and they were not affected with any illness. Witness went to a druggist’s shop, and procured calomel pills, of which he gave three grains to each of the sick children and their mother, and took five grains himself. The deceased continued ill for several days, and in a fortnight a medical gentleman was brought in, but as she grew wrorse, in the course of a week she was removed to the hospital, where she died on Friday last. Every one of the family who had tasted of the bacon wras affected in the same way as the deceased, but not so seriously. Wit¬ ness did not show the bacon to the doctor: he threw it down the water-closet. He had observed black spots upon it before he threw it away. Immediately upon finding the ill effects of it after dinner, he cut it open, and, besides the black spots, he particularly observed that it had a nau¬ seous heavy smell, but very unlike that of putrid meat. He could liken the taste to nothing but that of sugar of lead. Witness acknowledged that he was wrong in not calling in medical advice sooner, but he hoped that the purging pro¬ duced by the calomel would have cured them all. Fie had heard of other families in Chelsea being made ill by eating bad bacon. Mr. John Thomas, surgeon to the hos¬ pital (?), stated that the deceased was ad¬ mitted on the 8th November, suffering very severe pains in the abdomen, and ex¬ cessive purging. For about three weeks she seemed to be recovering; but after that she became worse, and died on Fri¬ day last. Upon the post-mortem exami¬ nation, great ulceration of the stomach was observed, which was the immediate cause of death. The friends of the de¬ ceased had said nothing about the sup¬ posed cause of her illness until about three days before her death. The symp¬ toms might have been produced by other causes than the taking of deleterious matter into the stomach ; but witness was inclined to believe, from the evidence wdiich he had heard given by the deceased’s parents, that the bacon was the cause of the illness, and consequently of the death. Tainted or diseased meat would produce symptoms similar to those which the de¬ ceased exhibited. They might also have been produced by some mineral poison. Mr. Keen, cheesemonger, of Grosvenor- ROYAL MEDICAL AND CHIRURGICAL SOCIETY. 379 Row stated that the bacon, sold to Mr. Jones was bought of Messrs. Parry and Beazley, Holborn-hill, and he had never heard of any complaint about it until this day. The bacon had certainly not come from Fenning’s wharf. He had sold all the better parts at lOd.and lid per pound, and he was glad to dispose of the inferior parts at a low price. John Brown, clerk to Messrs. Parry and Beazley, produced the invoice of the ba¬ con soicl by them to Mr. Keen. There was no part of the bacon diseased or taint¬ ed. It had not come from Fenning’s wharf. He attributed the black spots spoken of by Jones to bruises. The jury, after consulting for about twenty minutes, came to a unanimous verdict, that the “ Death of the deceased was caused by eating unwholesome bacon, but that no blame was attached to the vendor *.” ROYAL MEDICAL AND CHIRUR¬ GICAL SOCIETY. Abstract of a Paper in the forthcoming Trans¬ actions, entitled “Researches on some Points of the Pathology of Pulmo¬ nary Tubercle. By Peter Nugent Kingston, M.D., Physician to the St. George’s and St. James’s Dispensary.” The object of this paper is to shew, 1st, that the common pulmonary tubercle is a vascular texture ; 2dly, that it sometimes originates in an alteration of the air-cells and their secretions ; and 3dly, that now and then the disease is entirely healed, when it has even extended over a very large portion of the lungs. I. — The opinion that pulmonary tuber¬ cles are destitute of nutrient vessels, and consequently of all the properties of or¬ ganization, has prevailed since the time of Stark. The principal ground on which it rests is, that they cannot be injected from the vessels of the lungs. But here it is assumed that no vessels can be so mi¬ nute, even in the most delicately organized parts, as not to admit and be brought into view by the fluids employed for anatomical injection, which is contrary to the opinions of many of our best anatomists and patho¬ logists, and is irreconcileable with the fact, that the articular cartilages, when in¬ flamed, exhibit red vessels, which, in the healthy state, are impermeable by injec¬ * Both cases slightly condensed from the Times' report. tions. The injection of pulmonary tuber¬ cles has not, however, been fairly tried, for the fluid has been thrown only into the pulmonary arteries and veins; where¬ as, those parts of the pulmonary structure which are imperviousto air being nourished exclusively by the bronchial arteries and veins, it may be inferred that with these alone are the nutrient vessels of the tuber¬ cles connected, and that by the bronchial arteries alone can their injection be at¬ tempted with any reasonable hope of success. The author then gives an analysis of seven cases of pulmonary tubercles pos¬ sessing the ordinary appearance, and hav¬ ing during life given rise to the ordinary symptoms. On careful section, the inte¬ rior, both of those which were yellow and opaque, and of those which were greyish and translucent, was distinctly seen to be traversed by red vessels, often of conside¬ rable length, making frequent ramifica¬ tions and anastomoses, sometimes extend¬ ing from the centre of the tubercle to its circumference, where they communicated with the vessels of the lungs. If the vascularity of the common pul¬ monary tubercle be admitted, there is no longer any difficulty in explaining the changes of colour and consistence which take place in its interior during the several stages of its progress, and the frequent commencement of these changes in the centre; whereas, under the supposition that it is destitute of organization, these phenomena are inexplicable, or at least have received no explanation generally satisfactory to the profession. II. — It 'was held by certain authors, nearly a century ago, that pulmonaiy tubercles sometimes consist of air-cells distended with morbid secretion, which has gradually solidified and acquired the various appearances presented by tuber¬ cles in their several forms and stages. During the last twenty years, observations in support of this opinion have been brought forward, first by Magendie and Cruveilhier, and since by Andral and Dr, Carswell. But the evidence is still consi¬ dered by many as incomplete, and as needing addition and support from further investigations. Dr. Kingston then relates cases in which the following series of appearances were observed in portions of the same lung. 1. Excavations at the apices of the lobes. 2. Bodies having the ordinary charac¬ ters of miliary, crude, and softened tuber¬ cles. 3. Bodies which, to the eye and touch, scarcely differed from the preceding, but upon close examination were found to be 380 MR. ASTON KEY ON THE membranes filled with viscid mucus, to be continuous with the bronchi, and hence to be portions of the air-passages. 4. Bodies forming a transition between the third and fourth groups. There appears no room for doubt that these w ere but different stages of the same disease ; and hence it may be inferred that the tubercles originated in a thicken¬ ing and distension of the air-cells ; that the parietes of the latter continued to thicken, and their contents gradually soli¬ dified, till at last a total obliteration of their cavity was effected, and there result¬ ed a number of solid, white or grey, more or less opaque bodies, frequently of round¬ ed form, such as have received the appella¬ tions of miliary tubercles and miliary granulations. This conclusion throw's light upon seve¬ ral practical questions ; in particular, it confirms the opinion of those wrho, w hile they allow the necessity of a predispo¬ sition, think that a lingering inflamma¬ tion, or long continued irritation of the air-cells, and minute bronchi, excite the disease in many wdio, though the diathesis existed, w'ould otherwise have escaped. III. — A fewr cases have lately been brought forward by Laennec and Andral to shew7 that, where a very small number of pulmonary tubercles exist, they are occasionally healed. Dr. Kingston relates a case in which a tuberculous affection had been entirely healed, after having disorganized the wThole of one lung, and a fourth part of the other. One lung consisted of little more than a congeries of excavations, ail lined with healthy membrane, free from tuber¬ culous and purulent matter, and inclosed by a thin lamina of condensed pulmonary structure. A fourth part of the other wras taken up with hard carbonaceous masses, some of wdiich w7ere encysted, and a few contained in the centre a little yellow, opaque, dry, friable tuberculous matter. In each lung there were besides a very few encysted, withered tubercles, suffici¬ ently indicating the nature of the lesion which had produced the excavations. The man first came into St. George’s Hospital for a severe wound on the leg, from the kick of a horse. Of this he was perfectly cured in about four months. He came in a second time w ith inflammation of both kidneys, from getting wet. By this, and a supervening affection of the head, he was carried off in twrelve days. During the periods of his stay in the hospital, an occasional fit of coughing, with expectora¬ tion, occurred in foggy weather, but there were no habitual chest complaints of any kind. The healing of a tuberculous affection of the lungs, so extensive as this, has no parallel on recm-d, and had not, even by Laennec, been contemplated as possible. OBSERVATIONS ON THE NATURE AND TREATMENT OF GANGLION. Br Mu. Aston Kev. The pow7er which tendons have of form¬ ing bursal cysts, w'hen they are exposed to extraordinary pressure or friction, is one among the many resources possessed by organized structures, to prevent the occur¬ rence, as w7ell as the consequences, of in¬ flammation. It would seem that ganglia are not merely diseased bursae mucosae ; for the former are found in parts wrhere, in a state of health, bursae do not exist. I look upon them as new structures, formed upon tendons, as pressure or friction, or undue exercise of a part, may call them forth. On the patella the presence of a bursa is accidental ; it is not ahvays met with in dissection ; and probably its for¬ mation may depend on the exertion which the ligamentum patellae has to undergo, or on the jmessure which it may have to sus¬ tain, in the frequent act of kneeling. The contents of a ganglionic tumor differ from those of a common bursa mucosa. The latter secretes a fluid like ordinary syno¬ via, for the purpose of lubricating the tendon : the ganglion most usually con¬ tains a substance like the outer layers of the crystalline lens, soft, viscid, and nearly solid. These crystalline ganglia, as they might not improperly be called, are fre¬ quently formed about the hand, especially on the extensor tendons, as they pass over the carpal bones ; less frequently on the lowrer part of the theca containing the flexor tendons of the fingers, forming small but sensitive swellings near the metacar¬ pus. They also are occasionally seen on the extensor tendons of the fingers where they pass over the joints, giving pain, and accompanied by a great sense of weakness in the part. These crystalline ganglia are formed, as I have said, on the tendinous structure, and appear to consist of a double bag : the outer one tendinous and firm ; the inner, like a synovial membrane, thin and se¬ creting. In one that I examined on the tendon of the external gastrocnemius mus¬ cle, this double bag wras distinctly seen. In most instances, the outer cyst cannot be separated from the inner; the whole seem- NATURE AND TREATMENT OF GANGLION. 381 iug to be made up of one fibrous bag, secreting on its inner surface. The treatment usually adopted for those situated on the back of the wrist-joint, is, to burst the cyst by a sharp blow with a book or any other hard body. If well aimed and sharply struck, it often effects the object of breaking it down ; but it as frequently fails, either from the firmness of the cyst or from the unskilfulness of the blow, or from want of sufficient resistance afforded by the wrist. It is also a painful remedy, and is occasionally productive of more subsequent inconvenience than the ganglion had occasioned. The more sim¬ ple plan is, that of making a small punc¬ ture with the point of a lancet ; or a cata¬ ract needle, when the tumor is small. There is no fear to be entertained of in¬ flammation taking place; as the cyst is little disposed to inflame, and the closure of the opening, after the contents have escaped, by means of a band or piece of plaster, is a sufficient guard against its oc¬ currence. I have never seen or known any mischief to arise from the operation of puncturing these ganglia ; and their return is equally prevented as by any other inode of treatment. For the small tumors that occupy the base of the palmar side of the fingers, the puncture is the only remedy. Blisters or blows are ineffectual : the former are very slow in operating, and rarely succeed in removing them ; and blows cannot be struck with sufficient accuracy to ensure a rupture of the cyst. The cataract needle is the most convenient remedy: the tumor being sensitive, the patient experiences some pain in its introduction ; but it is momentary, and the relief afforded is com¬ plete. When the swelling is situated over the back of a joint on the extensor tendon, pressure should be kept up for some weeks after the evacuation of the cyst. A gentle¬ man, who was much in the habit of writ¬ ing, applied to me for a swelling of this kind on the first phalangeal joint of the right index: he complained of pain and weakness in the use of it, and was unable to employ the finger steadily in writing. A small puncture was made in it, and about a drachm of crystalline fluid escaped: a piece of ribband was bound over the joint, and firm pressure was thus made on the cyst. The fluid did not collect again; and by wearing the ribband for a few weeks, in order to secure and steady the finger when employed in writing, he regained the perfect use and strength of it. I once punctured a similar swelling over the tendon of the trochlearis superior muscle of the eye; and it never shewed any disposition to return. Occasionally, the part that has been the seat of the ganglio¬ nic enlargement becomes thickened after its contents have been allowed to escape; and a slight hardness remains, but does not interfere with the use of the part. The ganglion patellae is a cyst formed upon the expanded tendon that invests the surface of the patella. Its structure re¬ sembles that of the other ganglion, having a dense fibrous covering lined by a secret¬ ing membrane. The secretion differs from that of the crystalline ganglia, in being fluid ; probably in consequence of having less albumen in its composition. I need not enter particularly into the ordinary modes of managing such ganglia, when they become large or painful. Blisters, stimulating plasters, and pressure with a bandage, are often resorted to with advantage. The more effectual plan for dispersing them altogether, is, to puncture them with a lancet, to let out the contain¬ ed fluid, and to employ firm pressure with a bandage and plaster. If this does not prove permanently successful, the seton becomes the most ready, the most mild, and the most effective remedy that we have at command. I have frequently had occasion to em¬ ploy this remedy for this affection of the knee; and can aver it to be milder in its effects, and in the annoyance it causes the patient, than the common blister. If a few threads be passed through a ganglion patellae of one knee, and a blister applied to another on the opposite limb, the pa¬ tient invariably, I have noticed, complains of more suffering from the blistered sur¬ face than from the suppuration caused by the seton : and this is in accordance with what we know of the sensitiveness of the skin, compared with the sensibility of a bursa, even in a state of inflammation. The pain complained of during the stage of acute inflammation is inconsiderable; and the moving the threads, during the process of suppuration, occasions but little uneasiness. Sometimes a little feverish excitement is produced by the pus not es¬ caping freely from the apertures, which, being retained, becomes decomposed : this inconvenience is remedied by keeping the openings, where the silk enters, free and clear. The seton should be kept in for several days after suppuration is esta¬ blished, in order to promote granulations, and to facilitate the escape of the pus. Even where the ganglion suppurates it¬ self, the seton may be used with advan¬ tage, towards accomplishing these two ob¬ jects. The detail of cases in which the seton was employed is unnecessary, as they re¬ semble each other in all points of practi¬ cal import. The length of time required for the complete action of the silks, and the extent of the inflammation induced 382 EMPLOYMENT OF THE SUCKING PUMP IN STRANGULATED HERNIA* by them, may vary in different individuals. Many cases have occurred in the hospital, during the last three years, in which the seton has been effectually employed; and, on the whole, I prefer it, as being more certainly effective, and combining with such efficiency the advantage of not being severe or painful. It is not to the ordinary ganglion pa¬ tellae alone that its use is confined. The operation of the seton is more especially adapted to the indurated ganglion. By this kind of swelling, I mean one in which, from the continued existence of in¬ flammation, the cyst of the tumor has be¬ come exceedingly thickened by successive deposits or layers of adhesive matter or fi brine, converting the tumor into an al¬ most solid mass. These hardened ganglia cause great un¬ easiness to the subject of them; and inca¬ pacitate the person from bearing on the part in kneeling, as well as weaken the limb in the act of extension. The ap¬ pearance of these tumors, when they are laid open, sufficiently indicates their man¬ ner of growth, and also the mode in which the loose bodies, resembling melon-seeds, that are often found mixed with their fluid contents, are produced. The operation usually employed for the cure of such indurated cysts on the pa¬ tella and its ligament, is excision of the entire mass. The operation is easily per¬ formed, does not involve the joint in dan¬ ger, and is effective in removing the dis¬ ease. When the tumor is small, the ope¬ ration is quickly performed; but if it be large, and overlap the synovial membrane, a surgeon cannot divest his mind of all risk of wounding the capsular ligament, especially if the base of the cyst be adhe¬ rent to the subjacent fascia; and the ope¬ ration requires some cautious dissection. Fortunately, the seton is equally success¬ ful in promoting suppuration of the cyst, as it is in the smaller and soft ganglia. But the most gratifying result is the entire disappearance of the hardened coats of the cyst by absorption. The indurated parietes appear to be produced, and to be kept up, by the irritation of the bag; which being filled up by the inflammation and suppuration established by the seton, ceases to act as a cause of irritation, and the absorbents set to work for the removal of the walls of the tumor. — Guy’s Hospital Kepovts, No. 3. ON THE EMPLOYMENT OF THE SUCKING PUMP IN STRANGU¬ LATED HERNIA. M. Koehler, in 1821, effected the reduc¬ tion of a scrotal hernia, by applying a cupping-glass above it. Not having heard of the use of the pump in such cases, he did not attribute the effect produced to its true cause ; but on seeing the paper of M. Busch, in Hufeland’s Journal for 1832, he was induced to try this new method. The first trial was upon a patient sixty years of age, who had laboured during nine years under scrotal hernia of the left side, which had become suddenly strangulated. He was affected with the most violent pains, and all the efforts of the surgeon to effect reduction proved abortive. Such was the state of matters on the 3d, when M. Koehler saw the patient for the first time. The hernial sac had now attained the size of an ostrich’s egg; the countenance was shrunk, and expressive of great suffering; the skin covered with cold sweats; the abdomen tympanitic and hard; the pulse almost imperceptible; constipation of three’ days standing; hic¬ cough, and stercoraceous vomiting. One more, and that an ineffectual attempt, Was made at effecting reduction by the taxis, when recourse was had to the exhausting pump. On the first application over the in¬ guinal ring, borborygmus was heard with¬ in the hernial sac; and to the surprise of all, the reduction was straightway accom¬ plished : the vomiting immediately ceased, and some hours afterwards the patient had an evacuation from the bowels. In the course of a few days the recovery was complete. M. Koehler gives the details of six other cases of strangulated hernia, both ingui¬ nal and crural, in which the strangula¬ tion yielded to this means, after having re¬ sisted every other — an operation alone excepted. One of these, however, re¬ quired considerable perseverance. A Jew mendicant, aged 62, had laboured under a scrotal hernia for twelve years, which had become strangulated in consequence of the mal-application of a bandage. When he came to the hospital the sac was as large as a child’s head, and was tense, without being very sensible. He had vomited twice, and, notwithstanding the administration of clysters before his ad¬ mission, he had been constipated during four days. The first application of the pump not having been attended with suc¬ cess, he was bled, and had large doses of calomel administered internally, while an anodyne ointment was applied to the part. No improvement being thereby effected, the pump was tried again ; but it was not till its third application that some peristaltic movement became perceptible within the sac. The exhaustion was per¬ formed once more, when the reduction was immediately accomplished. Thebowels acted soon after, and in a few days the patient was quite well. COLLEGE OF SURGEONS - DIPLOMAS GRANTED IN NOVEMBER. 383 Some of M. Koehler’s colleagues have also used the pump, in a case of strangu¬ lated umbilical hernia, also with most satisfactory result. A woman, fifty years of age, and very corpulent, had an um¬ bilical hernia of two years’ standing, which was partially irreducible : it be¬ came strangulated, with stercoraceous vo¬ miting and constipation of three days’ duration. The tumor was as large as an orange, hard, and very sensible. All other remedies having failed, the air-pump was next tried: its application gave pain, and chafed the integuments by the trac¬ tion they experienced; nevertheless the re¬ duction was complete. In conclusion, this method succeeded completely in twenty-three very severe cases. — Koehler’s Annalen. DESTRUCTION OF THE LEFT HE¬ MISPHERE, WITHOUT AFFECT¬ ING THE INTELLECT. M. Nobell has communicated to the Bulletin de la Societe de Medecine of Ghent, a case which presents considerable interest in reference to the functions of the brain. A young man of 16, habitually grave, uncommunicative, and of obtuse intellect, thought that he had been deceived by a girl to whom he was attached, and de¬ termined, in consequence, to destroy him¬ self. He discharged a pistol into his head, two balls from which penetrated by the same aperture at the anterior part. About two ordinary cupsful of cerebral sub¬ stance were evacuated by the opening, and a catheter was introduced to the depth of four inches, without meeting with the slightest impediment. The patient, who had been at first insensible, recovered within twenty-four hours, presenting no disturbance of sensibility or power of mo¬ tion : his sight, however, was gone. The wound healed favourably : a considerable quantity of cerebral matter was lost each day during the dressing, and at the end of the twenty- seventh day the wound was completely healed — neither ball having been extracted. A remarkable change had been effected in the character of the youth. He became gay, intelligent, and talkative. His vision wras never restored, but his sense of smell was quite unimpaired. About six months after the accident he became subject to convulsions, which were removed by one bleeding. At the end of two years he died. The great loss of cerebral substance which this individual had suffered had occasioned no derange¬ ment of the intellectual powers, notwith¬ standing that the balls had penetrated very far back into the brain ; and as the wound was situated at the middle of the os frontis, and beneath the left frontal protuberance — as besides, the course of the balls departed from the median line at an angle of about 15° — it is more than proba¬ ble that the left lobe was destroyed. COLLEGE OF SURGEONS. LIST OF GENTLEMEN WHO RECEIVED DIPLOMAS IN NOVEMBER. William Innes, Tain, Rosshire. John B. Samuel, New Bridge-street, Vauxliall. J. L. Eland, King’s Cliff, Northampton. J. Barker, Coleshill. TEmiliaus Holbeche, Sutton Coldfield. Joseph Glover, York. S. Tilley, Bermondsey. T. Barrow, Co. Cavan. W. Bell, Newry. R. Riggs, Castle Pollard. W. Birtwhistle, Skipton-in-Craven. S. D. Fereday, Sedgley. H. R. Banks, Uevenport. Richard T. Morris, Uphollam. John Thompson, Thornton Stewart, Yorkshire. W. Parkinson, Burnley, Lancashire. W. H. Oliver, Rotherhithe. M. J. M-Cormack, Dublin. W. F. Sealy, Bombay. Robert F. M. Low, Mallow. J. A. Reynolds, Ballyshannon. Thomas B. Salter, Poole, Dorset. W. Ellis, Abergavenny. R. Kinneir, Cricklade, Wilts. John D.Watt, Calthorpe Place, Gray’s Inn Road. R. W. Tamplin, Billiter-street. James Drew, Cambridge. R. M. Rendall, Maiden Newton. J. A. Wood, Uttoxeter. P. Reiliey, Plymouth. J. J. Lay, Peasanhall. S. Garrard, Blyford, Suffolk. W. Isaacson, Mildenhall. J. Laughnan, Tralee, Co. Kerry. Edward Davies, Merthyr, Tydvil. APOTHECARIES’ HALL. LIST OF GENTLEMEN WHO HAVE RECEIVED CERTIFICATES. December 8, 1836. James Troutbeck, Congleton. John Pearse, Tavistock. James Bratton, Shrewsbury. William Eliis, Rawmarsh, Rotherham. John Joseph Pitts, Southwark. John Marston, London. NEW MEDICAL ROOKS. The Fallacy of the Art of Physic, as taught in the Schools. By S. Dickson, M.D., 8vo. 7s. The Principles of Surgery. By James Syme, F.R.S.E. Second edit. 8vo. 14s. Cowan’s Bed-side Manual, 18:no. 2s. 64. Lectures on the Morbid Anatomy of the Serous and Mucous Membranes. By I . Hodgkin, M.D. Vol. 1, 8vo. 10s. 64. Pathological Researches on Phthisis. By Louis. Translated by Cowan. 8vo. 12s. 384 BILLS OF MORTALITY. METEOROLOGICAL JOURNAL. UNIVERSITY OF DUBLIN. LECTURES ON ANATOMY. To the Editor of the Medical Gazette. Sir, Allow me to request that you will have inserted in the Medical Gazette the annexed order of the Board of Trinity College, Dublin, for the purpose of coun¬ teracting any erroneous impression that might exist as to the delivery of the ana¬ tomical course in the University of this place. — I remain, sir, Your very obedient servant, Francis Barker, Registrar to the Professors. 22, Bagot-street, Dec. 'I, 1836. (copy.) Trinity College, Dublin, Nov. 26, 1836. Ordered by the Board, that the Profes¬ sor of Anatomy and Surgery shall deliver Jive lectures a week in anatomy, at the hour of one o’clock, in their Anatomical Theatre, during the medical session, from the first Monday of November to the end of April in every year; and that this order be esteemed a “ bye-law,” agreeably to the 26th section of the 40th Geo. III. By order of the Board, (Signed) Robt. Phipps, Registrar. NORTHERN DISPENSARY. We are glad to learn that, at a special general meeting of the Governors of this dispensary, held on Tuesday last, the fol¬ lowing resolution was carried by a large majority ; so that there is reason to hope the evils recently complained of will be corrected, and that the prosperity of the institution will ultimately be advanced. Resolved — “ That this meeting, in con¬ sidering the causes which led to the resig¬ nation of the late medical officers of this charity, is bound to acknowledge that those gentlemen resorted to the most be¬ coming expedient to vindicate their own honour, and to arouse the attention of the governors to the danger which threatened the existence of the institution. “ That this meeting has heard with re¬ gret, that the representations made to the Committee of the causes which led to their resignations, did not induce the Com¬ mittee to adopt decisive measures for the protection of the charity ; and this meet¬ ing considers it due to the medical officers making these representations, to thank them for their praiseworthy efforts to maintain the usefulness of the charity, and request that they will resume their several offices.” WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Dec. 10, 1836. Abscess 4 Brain • 12 Age and Debility . 145 Lungs and Pleura 22 Apoplexy . . 22 Insanity 19 Asthma 45 Jaundice 8 Cancer . . 7 Liver, diseased 8 Childbirth . 13 Locked Jaw 3 Cholera . . 2 Measles . 39 Consumption 221 Miscarriage . 2 Convulsions 87 Mortification 9 Croup . 2 Paralysis 17 Dentition orTeethine26 Rheumatism 3 Dropsy 50 Scrofula 3 Dropsy on the Brain 26 Small-pox 37 Dropsy on the Chest 3 Sore Throat and Dysentery 4 Quinsey . 2 Epilepsy 2 Spasms 4 Erysipelas . 5 Stone & Gravel 1 Fever 31 Stricture • 2 Fever, Scarlet 25 Thrush 2 Fever, Typhus 5 Tumor 3 Gout . . . 4 Venereal 2 Heart, diseased . 9 Worms 4 Hernia . . . 2 Unknown Cause s 43 Hooping Cough . 24 Inflammation 127 Casualties 33 Bowels & Stomach 56 Increase of Burials, as compared with } 971 the preceding week . . ) *** The increase in this week’s bill has arisen from several clerks of large parishes, who had neglected to make their reports in due order, hav¬ ing now made reports previous to the close of the year, for insertion in the General Bill. METEOROLOGICAL JOURNAL. J)ec. 1836. Thermometer. Barometer. Thursday . 1 from 29 to 43 29-84 to 30 03 Friday . . 2 35 52 29-97 29 75 Saturday . 3 45 53 29 64 29 80 Sunday . . 4 48 56 29-73 29 78 Monday. . 5 46 56 29-77 29 77 Tuesday . . 6 41 55 29-77 29-85 Wednesday 7 46 51 29-51 29-49 Wind S.W., and occasionally boisterous. Generally overcast, with daily rain. Rain fallen, -575 of an inch. NOTICES. “ S a Hahnemannite, who calls upon us “ to confirm or refute” the statements of one Simon, had better tell us, in the first place, who the said Simon is: he may be a lineal descendant of Simon Magus for aught we know. Then we should wish to be informed w-ho are Bakody, Stutter, Seider, &c. whom Simon quotes. It is a question of evidence; and “ S.’s” is of the worst hearsay description wre have lately met with. We quote none but Hahne¬ mann himself, and the disciples whom he vouches for in his books. “ R.” shall be attended to. “ E. C. P.” should give his name, as the “ Old Navy Surgeon” has, long since. Communications have been received from Dr. Ashwell, Mr. Noble, Dr. Kemp, Mr. H. L. Smith, Mr. Pritchard, Mr. Hul- bert, “ Z.,” “ Hibernicus.” W i tsoN & Son, Printers, 57,Skinner-St. London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOURNAL OF iflctunitr anti the Collateral Jbriemesi. SATURDAY, DECEMBER 17, 1836. LECTURES ON FORENSIC MEDICINE; Delivered at the Aldei'sgate School of Medicine , By William Cummin, M.D. Lecture XII. Medico-legal illustrations of Rape ■ — German and Italian cases — Analysis of the celebrated Thornton and Ashford trial — The prosecu¬ tor’s statement and prisoner’s defence , how far borne out by the circumstances — The me¬ dical evidence, with remarks — General evi¬ dence The alibi — Probable cause of Mary Ashford’s death — Margaret Patterson’s case — Violation with horrible cruelty — Stupra contra naturam — A few remarks on un¬ natural crimes, and the" extent of proof of which they admit. The medico-legal report with which I closed the last lecture, seemed wrell adapt¬ ed for an illustration. It served to show the systematic careful method usually pursued by French medical jurists, inves¬ tigating a case of alleged rape; and so well does every point seem to have been attended to in that instance, that there appears, indeed, to be nothing left to de¬ sire. The Germans, also, have their re¬ gular forms for reporting in rape and other cases, and I could have wished to present you with a specimen of their mode of proceeding ; but I find that the examples supplied us, even by some of the most recent authorities (Dr. Bernt, for instance, who brought out a new edition of his Visa Reperta only a few months ago), are somewhat musty — dated as far back as 1783 and 1791. Italian case of alleged rape and infection. — We are indebted to Dr. Beck' for the particulars of an interesting Italian case which involved more than the mere ques- 472. — xix. tion of violation. Signor Crespi, a young man of good family, at Rome, was charged with a rape committed on a girl under the age of puberty : he was arrested, and the girl examined by three physicians and two surgeons. The report was, “ that the sexual parts were altered and tumid ; that the hymen was entirely wanting, and the whole of the vagina was irritated, in¬ flamed, and of a deep red colour — parti¬ cularly so at the point of the fra^nulum.,, The vagina was dilated so as to admit a finger with perfect facility; and, finally, they observed a copious discharge of pu¬ rulent and sanguinolent matters. The medical examiners were of opinion that the complainant had been defloAvered re¬ cently, and that the discharge arose either from mechanical injury or actually from a communicated gonorrhoea. The girl her¬ self stated that the discharge began imme¬ diately after the rape: it did not yield to the ordinary antiphlogistic treatment ; and subsequent examinations by the same phy¬ sicians induced them to lean more strongly to the idea that it w'asof venereal origin. The accused wtis convicted. ButProfessor Metaxa took up the case, and argued two points — that there w as not sufficient evi¬ dence of the rape, and that the girl la¬ boured under leucorrhcea. Respecting the first, his position wras general, — the diffi¬ culty of the proof derived from apparent ab¬ sence of virginity ; and it was urged that a rape committed on a female under pu¬ berty would have left more positive marks than were observed in the present case. His observations on the second point wrere more conclusive: he maintained that the nature of the discharge ought to have been better ascertained ; gonorrhoea only affects the inferior and more external parts of the genitals, while leucorrhcea proceeds from a higher source : if the parts, there¬ fore, had been washed carefully, and then again inspected, no mistake could have occurred. He argued further, that gonor¬ rhoea has its regular period of high in- 2 0 386 DR. CUMMIN ON FORENSIC MEDICINE. flammation and decline, while leucorrhcea is often ehfonic, and increases and dimi¬ nishes at irregular intervals. The state¬ ment that the discharge began immediately after the alleged violence, he insisted was opposed to the idea of its being venereal. Some other circumstances mentioned in the report were also criticised by the Pro¬ fessor ; such as the assertion that the parts were acutely inflamed, while it appears they could be handled without giving pain ; and it seems there was no haemorrhage of any kind, nor was there any account even of carunculae myrtiformes in the ab¬ sence of the hymen. Testimony was also produced that the girl did actually labour under leucorrhcea. So strong a representation of all these facts and inferences was presented to the authorities, signed by twenty-eight other professors and physicians of Rome, that it led to a reversal of the sentence. Dr. Beck concludes his notice of the case by assenting to the shrewd observation made by a reviewer, in an American journal, that the Professor, while he certainly showed that the physicians were wrong in supposing gonorrhoea, weakened his ar¬ guments not a little by insisting so strongly on leucorrhcea ; for, admitting that leucor- rhoea was present, there seems to have been quite enough of indicia of violence observed about the sexual organs to war¬ rant the probability of rape. Signor Crespi must, therefore, be considered as having escaped through the remissness of the examiners in ascertaining a collateral point of testimony. The celebrated Warwickshire trial — Thorn¬ ton and Ashford case. — I shall now beg to call your attention to a very celebrated English case, which created an intense interest in the public mind about nineteen years ago, and some of the circumstances connected with which have not to this hour been explained. A joung woman was found drowned, with recent marks of defloration on her body. Suspicion of rape and murder alighted on a man who had been seen in her company only a few hours before her death, and who acknow¬ ledged afterwards that he had had con¬ nexion with her : he was indicted and tried for both crimes, but acquitted — the evi¬ dence not satisfying the minds of either judge or jury. The popular voice, however, pronounced Thornton, the accused, guilty, and his escape from condign punishment was attributed to the mere technicalities of the law. A second trial was loudly called for; and it appears that, accord¬ ing to certain ancient statutes, the nearest of kin of the deceased had a right to appeal. The brother of the deceased was, in this instance, induced to appeal ; whereupon the appellee claimed a trial by battel. It was gravely argued in the Court of King’s Bench, whether this sort ol trial should be permitted. The proceedings occupied several months. Battel was ulti¬ mately granted, but declined by the ap¬ pellant; whereupon the prisoner was per¬ mitted to go at large. Let us review the principal circum¬ stances of this case, for they are worthy of our best attention. I shall take, in the first place, the statement of the prosecutor’s counsel, as it will serve to represent the popular side of the story. We shall then compare with it the prisoner’s statement, and see how far each was borne out by the evidence. Prosecutor’s statement. — After the usual preliminaries about the heinousness of the crimes with which the prisoner, Abraham Thornton, was charged, connsel proceeded. The deceased, Mary Ashford, was a young woman of engaging manners, hand¬ some in her person, and of unblemished character. She was well known in that part of the country — that is, atErdington, and in the neighbourhood; her parents were poor, and she lived with her uncle, a farmer at Langley. On the evening of the 26th May," 1817, the deceased went with her friend, a young woman of the name of Hannah Cox, to a dance at a public-house in the vicinity of Castle Bromwich, called Tyburn-house. Thorn¬ ton was there, and was much struck with her appearance : he inquired who she was, and on being told it was old Ashford’s daughter, he said, “ I have been connect¬ ed with her sister, and 1 will with her, or I’ll die by it.” He danced with her in the course of the evening, and about twelve o’clock, when she left the house for the purpose of returning home, he accompa¬ nied her. Hannah Cox also went part of the way with them ; but after she parted, there is no account of prisoner and deceased till three o’clock in the morn¬ ing. At that hour a man saw them sitting together on a stile, when Mary Ashford appeared anxious not to be recognized. At four o’clock she called at Mrs. Butler’s, where Hannah Cox slept. There she changed her white dancing dress for the red spencer, pink frock, and black stockings, which she had worn the day before, put her other things in a bundle, and left for home at about a quarter past four. She was in good spirits, and cheerful in talking to her friend Hannah on this occasion : said that Thornton had stopped with her a good bit ; and that she had slept at her grand¬ father’s. [This last assertion was wholly untrue.] Soon after leaving Mrs. But¬ ler’s, deceased was seen goingup Bell-lane on her way home. It was at this time at least a quarter past four. At half-past six, MEDICO-LEGAL ILLUSTRATIONS OF RAPE. 387 her bundle, her straw bonnet, and her shoes, six, the murder with which the prisoner were found beside the pit from which her was charged must have been perpetrated, body was soon after dragged; so that be- In the harrowed field, adjoining the one tween a quarter past four and half past in which the fatal pit is situated, were ob¬ served the footsteps (d, e, a) of a man and woman. They wrere off the foot¬ path (c) which led through these fields to Langley. These footmarks were those of two persons now running, now dodg¬ ing, and again walking, and were found to lead to a spot (v) where there was an impression of a human figure ex¬ tended on the ground. In the middle of this impression wras a quantity of blood ; at the bottom of the figure there was a still larger quantity ; and from this to the pit traces of blood could be plainly de¬ tected. Now the footsteps in the har¬ rowed field were evidently those of Thorn¬ ton and Mary Ashford, for the shoes they wore were compared with the impressions. There was the mark, also, of a man’s foot at the edge of the pit — the left foot, slant¬ ing, the outside pressing deeper than the other, as if made by a person who had leaned forward to tlirow something into the water. [This footmark, however, was not shown to be Thornton’s.] When the body was examined by two surgeons, the proofs of defloration were clearly made out ; and it was said that there were marks of violence on each arm, as if caused by the grasp of a man’s hands while hold¬ ing the deceased down on the ground. The prisoner confessed that he had been with the deceased till four o’clock in the morning, and that he had been connected with her, but with her own consent. His clothes confirmed the fact of the con¬ nexion ; and hers, found on the body, were stained with blood and dirt. Such were the leading facts in the case for the prosecution : the obvious inference from which would be, that the violation had been effected after the deceased had been seen alive for the last time, and that she was then murdered. The crimes were laid to Thornton’s charge, as he had ex¬ pressed his intention to have carnal know¬ ledge of the deceased, and had been seen in her company so late as three o’clock : he acknowledged, indeed, himself, that he had been with her till four. Account of Thornton. — It will now be proper to state what account the pri¬ soner was able to give of himself ; and perhaps it may be as well to premise a few wrords relative to Thornton’s person¬ nel. To such a height did the public in¬ dignation carry all those who had not seen the man, that they believed him to be “ a bloated disgusting-looking person,” at least twice as old as Mary Ashford (who was twenty), and likenesses of the parties were sold in all the print-shops, shewing, of course, as much contrast in their re¬ spective physiognomies as possible; — he all ugliness, she a Venus j in fact, it was 388 DR. CUMMIN ON FORENSIC MEDICINE. a sort of “ beauty and the beast” af¬ fair. Those, however, who were ena¬ bled to satisfy their curiosity by a sight of the monster (as thousands did when he was brought up on successive oc¬ casions at Westminster), found that he had been unfairly -jiealt with ; and he is described by eye- witnesses as “ a stout, wrell-looking young man, about live feet seven in height, with a fresh complexion, and appearing to be not more than twrenty- five or twenty- six years of age.” He was the son of a respectable builder at Castle Bromwich, and worked at the business as an assistant to his father. When, on the morning the body was found, the circumstances were canvassed on all sides, it was suspected immediately that Thornton was implicated, and steps were taken to have him apprehended. Daniel Clarke, the publican wrho kept Tyburn-house, went over to Castle Brom¬ wich, where he met the person he wras in quest of, riding on a pony along the turn¬ pike-road. I shall quote the evidence of Clarke. “ I asked him wiiat became of the young woman who went with him from my house last night ? He made no answer, and I told him she wras murdered and thrown into a pit. Prisoner said, Murdered ! I said, yes, murdered. Pri¬ soner said immediately, I was with her till four o’clock this morning. I asked him to come along writh me to clear himself ; he went with me to my house, better than a mile ; he said be could soon clear him¬ self ; he said nothing more about this ; we were talking about farming and the like. He put up his pony; he said he should walk afoot to Sutton. He went into the room and had something to eat and drink; he might remain there half an hour; he staid in the house till the constable came. I did not offer to discourse about the mur¬ der afterwards, although I was very much shocked. I did not know that the pri¬ soner had been with her till four in the morning, till he told me. I thought he appeared a little confused when I first put the question to him.’’ Prisoner's statement. — On being taken before a magistrate, Thornton made a voluntary deposition to this effect, — that he had been at the dance the evening before, and stayed till twelve o’clock ; that he then wrent away with Mary Ashford and two others; that after the latter had left them, he and Mary Ash¬ ford went on as far as Mr. Freeman’s [marked in the map as Grandfather’s] ; they then turned to the right, and wrent along a lane [Bell lane] till they came to a gate and stile on the right hand side of the road; they wrent over the stile, and along the foot-path across four or five fields— -could not say how many. [Here the fact of the connexion seems to be implied in the prisoner’s examination — nothing is stated; he then continues — ] Examinant and Mary Ashford then re¬ turned the same road ; when they came to the gate and stile they first got over, they stood there ten minutes or a quar¬ ter of an hour talking; it might be about three o’clock. While there a man came by, to whom examinant said “ good morning !” and the man said the same ; he (Thornton) and Mary Ashford stayed at the stile a quarter of an hour afterwards; they then wrent on together towards Er- dington, (within a short distance of Mrs. Butler’s), where he parted with the girl, and never saw her after. He waited for her about five minutes, expecting her re¬ turn; it was then four o’clock, or ten mi¬ nutes after four. Examinant then went by the foot-road home; passed Shipley’s; afterwards went by Holden’s, where he saw some people busy about cows; then came to the flood-gates, on the way to Twramley’s mill, where he saw the keeper, whom he knew, and of w'hom he inquired the hour; it wras near five o’clock; and so on, he described his journey home. Now every part of this statement or de¬ position capable of being verified by colla¬ teral testimony, was found correct: the other part rested on the same sort of pre¬ sumption on which the alleged circum- stances of the murder rested. The ques¬ tion was, which presumption was the stronger. Cit cumstantial evidence . — There cannot be a doubt but that Mary Ashford wras in Thornton’s company, alone, from shortly after twelve till three in the morning. This included the dark part of the night: it was clear day-light by three o’clock, and people were up and stir¬ ring, going to their work by four, or soon after. Was the defloration effected within those three hours, or not till half¬ past four or later ? In other wrords, did Thornton exercise all his arts of seduction in vain during the period which was in every way most opportune for him, — or did he wray-lay her on her road home, violate her, and then murder her by drown¬ ing, all in open day-light, and beside a frequented foot road ? Mary Ashford changed her dress when she called at Mrs. Butler’s. If the sexual in¬ tercourse took place before this, would she have been in good spirits and cheerful, as her friend described her, — would she not have complained, — and wrould not her dancing clothes betray the treatment she had met with ? As to the first, it is clear that she dissembled with her friend : she also told her what was not the fact — that she had slept at her grandfather’s, and concealed the circumstance of her having MEDICO-LEGAL ILLUSTRATIONS OF RAPE. 389 parted with Thornton only shortly before. But the evidence connected with the clothes is worth observing. The gown, petticoat, and white silk stockings (her dancing dress), which she took off at her friend’s, and there w’rapped up in her bundle, were exhibited to, and examined by, the jury at the trial. They were all bloody : the stockings particularly were stained all the way up. It is true that the frock she then put on was found very bloody also in the seat part behind ; but the black worsted stockings worn at her death were not bloody, but quite clean and un¬ stained, except one little round spot of dirt on one of them. That she had the menses on her, and that, too, profusely and unexpectedly, that morn¬ ing, is certain : she also lost a great quantity of blood in consequence of the defloration. Now it is very remarkable that she never told Hannah Cox the state she wras in, if it were only in respect to the menstrual dis¬ charge: nor is it easy to conceive any mo¬ tive for concealing it, unless in connexion wdth other points to be concealed also. The medical evidence. — I shall read for you the medical evidence given bv Mr. Freer — taking occasion to observe, that it is per¬ fectly authentic in the form in which it is here reported, being, in fact, the judge’s notes of what fell from the lips of the witness. “ Mr. George Freer, examined : — ' “ Is a surgeon at Birmingham ; wrenton Tuesday [27th] to the coroner at Penn’s Mills. Examined the body at night, at half-past seven o’clock. Had a cursory view of the body. Being night, 1 reserved the examination for another day. I observed the body was placed in a very dark and small room : it wras removed into a larger room. During the time of its being re¬ moved, I went to examine the pit. When I returned, they had undressed it, and just washed off the upper surface. Between the thighs and the lower part of the legs was a great deal of blood ; the parts of genera¬ tion were lacerated, and a quantity of coagulated blood was about those parts. It was getting dark, and I deferred the opening of thebody till Thursday morning. On Thurs¬ day morning I proceeded to open the body, and found the parts of generation lace¬ rated; some coagulated blood about them; and she had the menses upon her. I then opened the stomach, and found in it a portion of duck weed, and about half a pint of thin fluid, apparently chiefly water. In my judgment she died from drowning. Two lacerations quite fresh. I was per¬ fectly convinced (that) till these lacerations she was a virgin. Some coagulated blood adhered to them. Saw the coagulated blood on the ground. The menses do not produce such blood as that. The coagu¬ lated blood proceeded from the lacerations. The laceiations were from the sexual in¬ tercourse. “Cross-examined. — Observed nomarksof violence at all but wdiat I have mentioned. Nothing in the coagulated blood or the laceration that would produce death. There was no laceration but what might or might not arise from sexual intercourse with a virgin, with consent and without violence. It is very evident that the menses came on at a very unexpected moment by her. It may increase a little for a day or twro : may be less at first, and increase in an hour or two. It might be¬ come extremely copious and troublesome. “ Re-examined. — Dancing likely to in¬ crease it. About five feet four inches high : robust, fine young person. An unusual quantity of blood, independently of the menses.” I cannot help here remarking, consistent¬ ly with the principles and rules laid dowm in the preceding lecture, that there are some striking faults in the medico legal conduct of Mr. Freer. Upon his ow n showing, he did some things wdiich, I should say, he ought not to have done. Why did he re¬ serve the examination for another day ? The alleged rape was committed early in the morning of Tuesday; he had an op. portunity of making a personal inspection on the Tuesday evening : yet he put it off till Thursday ! Surely this was not the way to go to work in order to detect sexual lesions. He also allowed the body to be undressed, apparently without direct¬ ing any attention to the state of the clothes ; and what is worse, he permitted the body to be w ashed, — “ they just washed off the upper surface,” — without noticing the many appearances which possibly might have been observed in an early exa¬ mination of the parts. But to return to the general evidence. General evidence resumed . — The foot-marks in the harrowed field, and in the clover field, seemed to give damning proofs against the prisoner. But at what time were they made, — before or after the par¬ ties were seen at the stile ? Thornton is said to have admitted at the trial that the evidence was correct respecting the foot¬ prints of the running, dodging, See. (a.) to¬ wards the clover field; but he denied that the track (b) from that quarter towrards the lower gate was his ; and it is worth noticing, that the print beside the pit was not in any manner shown to be his : his left shoe was not compared with it, evi¬ dently because there was some obvious dissimilarity. And, by the way, concern¬ ing the foot-marks on which so much stress has been laid, long ere the requisite comparisons were completed, they were so confounded with the foot prints made by 390 DR. CUMMIN ON FORENSIC MEDICINE. numerous visitors who came upon the ground, together with some rain which fell, that it became necessary to secure the identity of a few of the impressions, by boarding them over. I shall not go through the details of the alibi set up by the prisoner. Two points in it, however, are so strong as to be almost conclusive. The last time Mary Ashford was seen by any of the witnesses was about twenty minutes past four, when going up Bell-lane alone ; but Thornton was seen at Holden’s, walking home lei¬ surely, and by no means heated or hurried, at about half-past four. Now the distance from Mrs. Butler’s (which Mary Ashford left at ten minutes or a quarter past four) to the pit, is one mile, two furlongs, and thirty eight yards; and the distance thence to Holden’s, by the shortest possible route, is two miles and two furlongs: so that the whole distance gone first by her, and after¬ wards by him (after the supposed murder) was upwards of three miles and a half. Is it at all possible that these three miles and a half could be traversed — all the run¬ ning and dodging have taken place — the violation, the murder by drowning, and all inclusive — within ten, or at the very ut¬ most twenty minutes, making every allow¬ ance for inexactness of clocks — which clocks, however, were, in the course of Tuesday, carefully compared? , Now this is the difficulty in regard to the alibi, which must be got over by those who are not shaken by the other evidence. But is it not an extraordinary question to ask, after all this, and asked it may cer¬ tainly be without impropriety, whether there was any proof of murder in the case ? There was none of rape : what was there of murder? It does not seem to have been proved that there was any killing even : there was, therefore, no corpus delicti. Yet, though there was no evidence of either murder or rape having been com¬ mitted by any one, Thornton was tried for having committed both ! Probable cause of death. — It will always remain a curious speculation, how, if she were not murdered, did the unfor¬ tunate Mary Ashford perish? Was it by suicide, or by accident. Her shoes were very bloody : they must have been so when she put them on again after changing her stockings at Mrs. Butler’s; for her black stockings were wholly free from blood. Those shoes were placed together at the brink of the pit with her bonnet and bundle, in such a man¬ ner as no murderer would leave them, even if he wished it to be considered a suicide, for their bloody appearance must necessarily lead to further inquiry. There is a bare possibility, of the very slightest description, that she committed self-destruction. Yet, supposing this to be the case, in consequence of some sudden fit of despondency seizing her on her way home, what could have induced her to take off' her bonnet and shoes, and to pjace them so carefully as she did ? On this fact it is, that a third, and, as I think, the most plausible conjecture as to the manner of her death, is grounded. 1 shall quote the words of an intelligent and learned gentleman (Mr. Holroyd,son of the presiding judge) who wrote the most clever pamphlet which appeared on the subject, and who seems to have first suggested this mode of accounting for the death of the de¬ ceased. “ In her bundle wrere her half boots, the only part of her daily dress which she had not resumed. One of her dancing shoes, with which she was returning home upon her feet, being all blood, and the other bloody, who can say whether, startled with observing as she walked, that blood upon it which would be visible to persons meeting her upon the road, and to her un¬ cle upon her return home, she might not have put down her bundle, and taken oft' her shoes and bonnet, in order to take out and put on her half boots instead of her bloody shoes? And what was more probable than that she should do so ? If that was the fact, when the exhaustion and fatigue she had gone through in her walk to Birmingham and back again (12 or 13 miles) the day before, her dancing at night, her want of sleep and rest after¬ wards, the circumstances attending the connexion that had taken place between her and Thornton, her loss of blood, and want of nourishment, for none was on her stomach when her body was opened, what is more probable than that in stooping and turning to take out her half boots in order to put them on, on the top of a bank of a very sloping pit side, where the surface of the water was as much as four yards below the pit bank, she should, by an in¬ advertent step backward or otherwise, slip in, or turn faint and giddy, and so tumble in ?” In concluding this somewhat detailed account of so remarkable and mysterious a case, I cannot refrain from saying, that, in my opinion, the acquittal of Thornton was right. There was no evidence save of the defloration and death of the girl ; of rape and murder there was none, ex¬ cept what was of the most loosely cir¬ cumstantial nature. Thornton, however, had the guilt of the seduction and de¬ floration, and no doubt, by implication, the death of the unfortunate girl to answer for ; and if there be weight in the indignation of an insulted public, he has long ere this expiated his heavy of¬ fence. He was hooted from the society of his fellow men in this country, and STUPRA CONTRA NATURAM. 391 was obliged at last, I understand, to take refuge in America. Margaret Patterson’s case. — I mentioned, in the last lecture, the importance of ex¬ amining the persons of individuals said to have been violated, with a view to finding indicia of violence and cruelty; which are sometimes found by searching the cavities — the mouth, for instance — where sub¬ stances may have been introduced in order to prevent the victim from calling for help. But who could have imagined what was discovered in the body of an unfortu- nate woman who was brutally ravished some years since in Scotland ? I allude to the affair of the Gilmerton carriers, who violated and murdered Margaret Patterson, in the year 1830. The details of the crime were too horrible for exposure to the public eye. At the trial, the proceed¬ ings were conducted with closed doors, and no report of the evidence has ever been published, or perhaps preserved. What we know of the nature of the crime committed is sufficiently shocking. The victim, an unprotected female, making her way on foot from Edinburgh to Dalkeith, was taken into their cart, by those villains, under the pretence of assisting her on her journey. There they violated her person repeatedly, and became so infuriated with their wick¬ edness that they took stones from the road, coal, straw, prickly plants, and every thing they could immediately find, and forced them into the vagina. When she fainted and sunk under her tortures, they threw her out of the cart into a ditch by the road-side, where she was found next morning, with only life enough re¬ maining to linger out three days of agony ; luckily, however, with the power to dis¬ close the names of her murderers. On examining the body after death, the sub¬ stances just mentioned were found in the vagina and rectum — for both passages were broken down into one — the perinasum being dreadfully lacerated. All the abdo¬ minal viscera were in a high state of in¬ flammation. 1 subjoin the Latin account of the horrid transaction, as it was given in the North Briton newspaper, by the learned editor, Dr. Browne: — “ Quum ii scelestissirai vehicularii, om- nis nequitiae et immanitatis capaces, Dia- bolo suadente, foeminam, semel atque iterum, in vehiculo suo constupraverant, atque ita crimen raptus poena capitali pu- niendum admiserant, procul dubio est, ut in vaginam miserrimae lapides tres, iis similes quibus via publica strata est, car- bonem, stramentum, grarnen cum spinis quibusdam, injecerunt, osse thoracis nexi- lis, ut fistuca, utentes : quo fact©, raptores, saevitia gaudentes, miserrimam e vehiculo dejeoerunt et postea corpus exanime in fossam juxta viam publieam abripuerunt. Et plus triduo, id est dum Gilmertoni commorata est, ac etiam usquedum mors finem fecit miseriis, foemina haecce intra abdomen suum liabuit lapides, earbonem, stramentum, grarnen, cum spinis quibus¬ dam, scelestissimis vehiculariis inferta, more nefando, per os thoracis nexilis, ut jam superius dictum est. Post mortem, dissectione corporis facta, omnia haec in- venta’aut in recto aut in vagina ; perineum ita dilaeeratum ut ex vagina et recto una tantum canalis facta, quod rarius accidit, etiam in parturitione diffieilima; haemor- rliagia fere continua, qua multus sanguis effusus et indusium penitus totum cruore tinctum ; signa violentiae ernribus im- pressa; atque omnia intra abdomen in- flammata.” The two wretches were executed, of course; but it is only the punishment which some of the old feudal governments, most skilful in torture, would have inflict¬ ed, which could have been adequate to the enormity of their guilt. STUPRA CONTRA NATURAM. Multum mihi animo volventi utrum, cum de stupro violento dissererem, pauca quoque de vitio isto abominando contra naturam adjicere auderem, ita facere tan¬ dem visum est. Nam siomnem mentionem stupri istiusomitterem,sic mecum reputavi, hiatus certe insignis in hisce sermonibus foret ; et dein censendum, si apud auctores Germanos, Italos, et. Gallicos, quorum in patria crimen violatas naturae leviter tantum vel non omnino punitur, attamen notatu dignum liabeatur, quam multo for¬ tiori argumento apud nos, quorum legi-* bus hujus criminis damnatus capitali poena percutitur, de hac re nefanda verba facere necesse est. Idcirco salvo pudore, sub umbra doctioris linguae, irap/iTjertafecrflat liceat. Casta severitas majorum vix nomen cri- minibus hujusce generis imposuit. Cum Langobardus quidam sceleris istius so- domitici accusatus esset (an. 50, Edw. ITT.), crimen ejus “ peccatum illud horribile inter Christianos non nominandum” vo- cabatur. Hodierni tamen hand tam deli- catis auribus vel lingua praediti sunt. In praelectione penultima* locus statuto- rum recentium [9 Geo. IV. c. 31] laudatus est, in quo, crimen de quo agitur, proprio et nudo nomine appellatur. Et in sectione xv. ejusdem statuti flagitium abominabile cum sua poena apertissime denunciator. Quisquis porro post annum suum deci- mum quartum scelus hoc commiserit capite damnatus erit, et suspendio * Vide Lecture X. p. 321, ante. 392 DR. CUMMIN ON FORENSIC MEDICINE- punietur; et lioc, quanquam socius in araplexu abominabili, sine vi illata con- sensum dederit. Non obstante terrore legum, baud perraro casus istiusmodi in foro audiuntur: falso vel vere crimina in- dividuis objiciuntur,et luminis quod medi- cina prasbere nonnunquam potest magis¬ tral bus opus est. Stuprorum nefandorum plurima genera recensentur: stuprum videlicet masculi- num, inter marem et marem patratum, nomine ira^epacma antiquis bene notum ; stuprum fceminarum inter se, quod Div. Paulus in Ep. ad Rom. verbis igneis denunciat — antiquioribus pernotum ut TpifiafiiKr) a(Te\.yeta, recentioribus autem, quam familiariter, Nuptise Romans, vel Facetiae Florentine, nuncupatum ; dein stuprum cum cadaveribus, sicut inter Egyptios haud inusitatum fuit, nec, si quibusdam credatur,temporibus longe pras- teritis intentatum in aliis locis; et denuo, hominum (proh pudor !) cum bestiis. De uno alterove horum vitiorum, quanquam durum atque molestum de vitiis verbura facere quag hominem infra animantia ce¬ tera deprim unt, pauca in medium afferre oportebit. 1. Quaenam sunt signa quibus mascu- linum stuprum testatur? In judicando caute procedendum est ; namque facts penetrationis indicia haud facile pro certo attineri queant. Yel recens est stuprum vel vetustum ; vel semel, aut saltern pan¬ els vicibus, flagitiuin admissum est, vel in consuetudinem venit. Recentis dagitii documenta, ad judicium probabile acce- dere possunt. Vetusti sceleris, et raro pa- trati, nulla signa supererunt. Si vetustum et consuetum, possibile est, inspectione par- tium, fidem circumstantiis aliter cognitis addere. Audiamus quid dicit celeb. Orfila, satis audacter, ut opinor, hac de re ex cathredra loquens : — “ L’ouverture du rectum pre¬ sente chez les personnes entachees de ce vice la forme d’un entonnoir, remarque due a feu M. Cullerier, qui, en sa qualite de medecin de l’hospice des veneriens, n’a que trop souvent eu l’occasion de la verifier. Le bourrelet de l’anus estgros, boursouffle et lache; le sphincter secontracte difficile- ment, et le doigt entre sans effort. II est vrai que cette disposition de Pan us suppose en general un certain nombre d’introduc- tions ; mais la disproportion entre le m em¬ ir re viril et l’orifice peut etre telle que la forme de Pouverturedu rectum soitchangee, meme par suite d’une premiere tentative. Des hemorrhoides considerables, des fis- tulesprofondes,lerenversement,lesquirrhe, et meme le cancer du rectum; telles sont les maladies qui peuvent accabler les per¬ sonnes qui se livrent habituellement a la sodomie.” Consilium idem auctor tunc addit, caute distingendum esse, ne pro stupri nefarioris indiciis morbi venerii effectus sumantur. Namque rhagades, verrucas, cristse, ma- riscas, ficus, in errorem facile inexpertum perducere possint. Illustris ille Parent-Duchatelet nuper et minis cito morte prmreptus, in opere suo De la Prostitution, fidem nimiam signo isti a Culleriero monstrato reponere vetat; proptereaquod nemo medicorum dispensa- torii a se consultorum, neque DD. Jac- quemin et Collineau, ne uno quidem ex- emplo in pluribus casibus ubi stuprum contra naturam in fasminis admissum fuit, istam intestini recti conditionem infundi- buliformem compertam habuerant. 2. De vitio foeminarum quas Tribadum nomine appellant, vix quasstio in curiis oriri potest, nisi cum crimine alio seel us istud conjunctum sit. M. B. Valentinus insignem narrat historiam qua “ furens quid feemina possit” exemplo memora- bili docemur: — “Fcemina sexum virilem diu mentita tandem aliam sibi conjugio maritari,et,horrendumdictu ! copula sacer- dotali jungi curavit ; cui ut se virum prasstaret, membrum virile artificiale, fe- moribus et inguini alligando, et cum amasia sua consuescendo muliebria hujus tantopere exercuit, ut tandem miserrime violata nefandum faeinus consanguineis primum, et abhinc magistratui publico cletegere necessum habuerit.” Faeinus de quo loquitur Valentinus Facultati juri¬ dical Giessenias relatum est anno circiter 1721 ut de poena consultum esset; nam rea convicta crimen confessa est et pcenam tun temporis quo Valentinus scripsit, ex- pectabat. 3. Quandoque consortii carnalis cum bestiis, nempe equabus, vaccis, canibus, suibus, gravis suspicio oritur. In talibus casibus nefandis, vix fides adhibenda est, nisi complures testes asseverent se flagi- tium vidisse. Attamen si ex inspectione animalis probamina criminis magistratus colligere velint, quaerant veterinarios. Ca- sum brevem, in quo per indicia super cor¬ pus animale visa crimen detegebatur, ad- jungere liceat. Albertus Meckel in suo Lehrbuch rem hisce verbis narrat : — “ Ein j linger Hirt missbrauchte kiirzlich eine Kuh ; die That wurde entdeckt, weil die Geschleehtstheile der letztern in Entziin- dung geriethen, und das Thier erkrankte. Der Grund dieser Erscheinungen lag jedoch keineswegs in der mentula des Kna- ben, vielmehr darin, dass letzterer, weil er Schwangerwerden des Thiers befiirchtete, dies zu verhiiten, einen Stock in die Geshlechtstheile geschoben hatte !” De stupro cujuscunque generis, hactenus : tantum. 393 dr, Seymour’s clinical lecture. CLINICAL LECTURE, Delivered at St. George’s Hospital, December 2, 1836, By Dr. Seymour. PURPURA HEMORRHAGICA. I promised to speak to you to-day re¬ specting a case which is one of considera¬ ble interest, from the great obscurity which exists regarding the cause of the disease. It is that of a man named Ward, who came into the house some time back, la¬ bouring under purpura haemorrhagica. He went out apparently well, but subsequently returned, and has since died. Now what is purpura haemorrhagica ? The name is applied to an ecchvmosis, or an effusion of fluid under the cuticle. This occurs sometimes in very large spots to¬ wards the end of malignant fever, and it occurs likewise without any fever being present. Sometimes there is not only ef¬ fusion under the cuticle, but it extends over the whole surface, and to a number of the mucous membranes. There is bleeding from the nose, bleeding from the mouth— a sort of exudation of blood into the mouth, the stomach, and the in¬ testines: this sometimes occurs without an eff usion under the skin, and sometimes with it. Sometimes, under these circum¬ stances, very large quantities of blood are passed from the kidneys, sometimes from the conjunctiva of the eye, and from the membrane lining the ears. It is observed under very different cir¬ cumstances. The most frequent form of purpura is accompanied by a languid pulse, and there is a great tendency all over the body, on the occurrence of any acci¬ dent, to the extravasation of fluid from the vessels : this would appear to be particu¬ larly the case in the last stages of fever. These petechias, vibices, or whatever name you choose to give them, arise from a weakened condition of the circulation in the capillary vessels, and, as we may well suppose, a dissolved state of the blood. The blood drawn in this disease does not coagulate in the same manner as under ordinary circumstances ; it does not sepa¬ rate. When persons die from these has- morrhages, they often expire from a great quantity of blood being extravasated upon a vital organ — the lungs, the liver, or the surface of the brain. A case occurred not long since to Dr. Macleod of this disease, in which after death a clot of blood was found in the brain. Dr. Elliotson men¬ tions one or two cases in his lectures, which proved fatal by an effusion in the brain. But there is another form of the disease, where, instead of the circulation being di¬ minished, it is greatly increased. This man, Ward, was admitted on the 14th September, with an eruption of pur¬ pura about the arms and lower extremi¬ ties, coalescing over the feet. At the time he was admitted his mouth was affected bv mercury. It was clear that he had laboured under some degree of dropsy from enlargement of the heart, and he had been put upon mercury with a view of dimi¬ nishing some inflammatory action which was supposed, and which undoubtedly did exist. When he was admitted the first thing was to cure his mouth, and he was then put on mineral acids. Three drops of carbonic acid, and two drops of nitric acid, were given in an infusion of orange peel, two or three times a day. In all ex¬ travasations of blood, the acids have been considered particularly useful. Some persons perceive an analogy be¬ tween this disease and sea scurvy. Sea scurvy is attended with this extravasation of blood ; but there is extraordinary weak¬ ness of the constitution, the gums are spongy, the teeth fall out, the bones soften, the muscles also become soft, and under the skin are effused these purpura spots upon which we are speaking. Some per¬ sons have consequently thought that the purpura seen on shore must arise from a similar state of constitution ; but this is quite a mistake. There is in the majority of cases, so far as I can see, no sort of analogy. The fact is quite notorious, that since "the taking of vegetable acids by the fleets and armies abroad, scurvy has been almost entirely unknown. The disease used to carry off and destroy the crews of whole navies, but it has now become most rare where the sailors are provided with fresh lemon juice — and which is taken out for the purpose — or where they can procure fresh vegetables of any sort. The vegeta¬ ble acids have been likewise prescribed with the same view in this disease ; but inasmuch as these affections differ, we cannot expect they will produce the same effects. The mineral acids have been thought useful, as giving tone to the circulating system, while at the same time they puri¬ fied the blood. That was the idea, but of late we have heard that this is all wrong ; that so far from its being the case, it is the neutral salts which are to act on the blood, and restore it from a black to a florid co¬ lour. Till the experiments on scurvy have been proved to be fallacious, we shall hardly fall in with this hypothetical idea. When I was physician to the Hospital Ship, I saw many cases of scurvy, and I never met with one which resisted the in- 394 dr. Seymour’s clinical lecture. fluence of vegetable acids. It is true that taking fresh meat, or taking fresh vegeta¬ bles of any kind, will cure the disease, and free the patient from the state of body in¬ duced by being kept on salt provision ; but it is quite clear, that if the acids act by turning the blood black, and the neu¬ tral salts by returning it to its florid con¬ dition, the quantity of acids given would not cure the disease — the disease would not get well under them ; on the contrary, the introduction of acids into the system would make it worse. This, however, is not the case. If it is a problem at all, it must remain so, till we are enabled to prove that sea scurvy is cured in some ex¬ traordinary manner by alkaline remedies just as well as by acids — an experiment which, I think, is not likely to be tried. Ward took this medicine some days, and the eruption decreased remarkably, and his mouth was now well ; and argu¬ ing from the opinions which exist on the nature of the disease, from his face having been swelled, from the white appearance of the whole body, and the spots disap¬ pearing, instead of putting the acids into an infusion of orange peel, I ordered them to be put into a decoction of bark, with a little tincture of bark. This disagreed with him ; he could not bear this quantity of stimulation, and I was obliged, of course, to discontinue the bark; but he went on with the acid; and finding that the action of the heart and arteries in¬ creased, I bled him, and the blood was buffed and cupped. I bled him a second and a third time, and the blood still pre¬ sented the same appearances, separating into the ordinary coagulum which occurs in inflamed blood, with a considerable quantity of buff’ on the surface. This is a very different condition to that of the state of purpura, in which the vessels pour out, as it were, a fluid perfectly altered in its composition. On the 22d, a very slight portion indeed of the eruption remained; he had gained very great strength, and was dismissed. He was re admitted on the 21st Novem¬ ber, and therefore he had been out just a month, during which time, I should mention, it appeared he had been taking bark. It would appear that he return¬ ed with the eruption more conspicuous than ever all over the thigh and leg; he had a good deal of difficulty of breath¬ ing ; there was pain of the head ; and the pulse was hard and 120. There was now a considerable diminution of urine; so that, instead of putting him on the acid as before, I ordered him a diuretic draught of nitre, and kept his bowels open. He was bled again to twelve ounces, and the blood drawn was buffed and cupped, but not to such an extent as would induce you to repeat the operation. The coagulum was very firm, there was a large proportion of serum, and the buff surface was very much lessened; neverthe¬ less, away went the eruption; it was hardly possible to discover it. This was on the 23d ; the purpura was scarcely visible, and some difficulty of breathing began to take place ; and on the evening of the 24th he had a shivering fit, which was followed by great dyspnoea, and some degree of indistinctness. The breathing was somewhat of a stertorous character, but at the same time not such that people are generally subject to when there is any indication of increased action. I believed that effusion was taking place to the brain ; but not thinking from the last appearances that he would be relieved by more bleeding, I ordered a blister to be ap¬ plied between his shoulders, and a turpen¬ tine injection to be given. The blister rose indifferently, but on the following day he was better. He seemed to be greatly re¬ lieved by the injection, and it was repeated at night, though without avail ; and he died on the 28th. He was examined the next day, and many of you were present. All the symp¬ toms were those of a person labouring under effusion in the brain ; but there was no effusion of blood, nor was there extra¬ vasation of blood in any part of the body, neither had the muscles or the brain more bloody points than natural, nor was deter¬ mination of blood apparent to any viscus. The brain was firm and white, and the fluid poured out perfectly clear and pellu¬ cid ; not at all stained with blood, as is sometimes the case under these circum¬ stances. The heart w'as enlarged, dilated, and flabby; and the valves, particularly the tricuspid valve — which is very uncom¬ mon — were thickened by that kind of de¬ posit which, when it exists to a great extent, renders the arteries inelastic, and presents some obstruction to the flow of blood from one cavity of the heart to ano¬ ther. This is all that can be said of this disease as to the particular appearances. There are certain circumstances con¬ nected with purpura which I shall men¬ tion, because they occur in other com¬ plaints, such as the subsidence of the eruption, and in some cases internal in¬ flammation. I was much struck with a case which occurred some years ago. A man applied to me who had a large spot of purpura in the face — not a nrevus ma- ternus, but a regular spot of purpura. He was put on mineral acids, as usual, and I think he was occasionally bled. By this treatment the spot disappeared in a few days, but a violent attack of inflammation PURPURA HAEMORRHAGIC A . 395 of the pleura came on. He was bled re¬ peatedly, put on mercury, and eventually got well of the pleuritic attack. Soon af¬ terwards the purpura in the face re-ap¬ peared; he was again put on mineral acids as before ; the purpura disappeared, and inflammation of the peritoneal cover¬ ing of the bowels came on, from which he died. As soon as the purpura disappeared, these symptoms of internal affection began to take place. In the present case the effusion of blood upon the extremities, and into the cavities, took place in both in¬ stances connected with an enlargement of the heart; so that as soon as the extremi¬ ties of the capillary vessels ceased to pour out this quantity of blood, they began to pour out water. The same thing occurs frequently in dropsy from enlargement of the heart. Where the dropsy has ceased, where the effusion of fluid which relieves the circulation no longer goes on, a vessel ruptures. These cases are of constant oc¬ currence. There is a woman in the house at this instant, who has laboured under dropsy : there was no longer any effusion ; the heart was beating over a considerable surface, and in three or four days she had a fit from effusion into the brain. She was largely bled; and after the second bleed¬ ing she came out of the fit. The lower extremities then became swollen ; the cel¬ lular membrane filled with fluid ; that was followed by relief, and she has since been better. But when the vital pow'ers cease to make the dropsy, which is the relief of the symptoms, then great fear is to be ap¬ prehended of the rupture of a vessel. I have seen similar cases to the one be¬ fore us in young persons, and I have known them recover. A boy of 13 years of age came under my care : he w'as taken with what is called cramp in bathing. Some time after he wras covered with spots of purpura, some of which wrere very large, and the heart w'as beating violently. I treated him as I should a case of inflam¬ matory action of the heart; the inflamma¬ tion was removed, and he got perfectly well. There are two reasons for giving the turpentine injection. One is, that it is exceedingly useful in cases of serous apo¬ plexy in making a determination to a distance. Stimulating injections are some¬ times peculiarly useful under such cir¬ cumstances ; but in reference to this par¬ ticular instance, turpentine is considered more especially useful where there is a transudation of blood from the vessels, — where it escapes in small quantities, as wre see here; or in large haemorrhages, par¬ ticularly from the intestinal canal, there is no remedy so useful as the oil of tur¬ pentine. In the case of haematemesis, vomiting of blood from the stomach, it exercises apparently almost a specific in¬ fluence. I have seen cases w here two or three doses cured the complaint. A man W'as brought on board the Hospital Ship, w'ho had lost a large quantity of blood in this way. He was ordered two drachms of oil of turpentine and two drachms of castor oil mixed up in a mucilage, and twro table-spoonsful were given three or four times a day. In two or three days no blood made its appearance. No blood was ever brought up again from the sto¬ mach, and none made its appearance ex¬ cept that which had been sw'allowed and digested. In bleeding from the intestinal canal, a portion passes downwards ; it un¬ dergoes a certain degree of the process of digestion, and is exactly like soot. Some people call this melcma, because they w'ant to give it a name. It is a blood which has been swallowed, and wrhich has been ope¬ rated upon by the digestive process. This will go on for several days after haemor¬ rhage to any extent has occurred from the intestinal canal. I saw, in conjunction with Dr. Lee, an artist who had brought up blood, and who had been treated bv calomel and other medicines, from a suspicion that it arose from an undue secretion of the liver. I wras shewn half a wrash hand basin of blood. He took turpentine, and for several years I heard no more of the case. Last year he had another attack of vomit¬ ing of blood; he again took turpentine, and the complaint disappeared. There is a case which I have seen within two or three streets of the hospital, where twice within six months the patient has vomited blood, and in both instances, upon taking oil of turpentine, it immediately disappeared. It w'ould seem that in intes¬ tinal hemorrhage, wiiether it arises from a breach of the surface or an exudation from the vessels, the oil of turpentine has a considerable influence in stopping it. I do not know that here wre have an evi¬ dence of its stopping purpura because that disappeared, but I made choice of a sti¬ mulating glyster from its being so useful, rather than any other under the effusion into the brain which had taken place. It is quite certain that this man laboured un¬ der organic disease of the heart. So long as the dropsy occurred in the first instance he was relieved by it; when the dropsy disappeared, this purpura came out; and when the purpura was cured by remedies, serous effusion took place into the cavities of the body. This is the only explanation I can give of this case, though it does not explain all the phenomena which occurred. There are cases in which the capillary vessels pour out fluid instead of blood, de¬ pendent upon a diseased condition of the 396 Dll. SEYMOUR S CLINICAL LECTURE. heart, and which are much relieved by the secretion. The effusion from the capillary vessels induces what is called dropsy, and most generally in the cellular membrane. But with regard to purpura, the circum¬ stances are much more difficult to be ex¬ plained. Where purpura accompanies the last stages of fever, stimulants are applied, and opium and camphor are the best combination with which I am acquaint¬ ed for such purpose, together with wine. I remember seeing a case of petectual fever in a whole family. Two out of three of the patients owed their lives to the stimulus of opium, camphor, and wine. It is rare that you will see such cases, but it is scarcely possible to keep the patient from sinking. The same thing no doubt occurs in ordinary cases. The state is one of a great diminution of the powers throughout the system, and the vessels not only pour out this fluid from the mucous membranes of the body, but likewise into the vital organs of the body ; and it would appear that most frequently this viscus is the brain. There is a predisposition which we know nothing about, which is termed the hemorrhagic diathesis. Certain people are constitutionally more disposed to bleed than others. Sir Benjamin Brodie relates a case of father and son, both of whom died from the extraction of a tooth. Some persons are very liable to a bleeding from the nose in a most alarming degree. In some cases purpura is present ; and in some, haemorrhage exists without purpura, either from the nose, the mouth, or the urinary organs; and sometimes purpura precedes the attack. It must be looked upon as the same disease. Where fluid is effused under the cuticle, and haemorrhage takes place in great abun¬ dance from some of the mucous mem¬ branes, some authors have attributed this form of the disease to the spleen. Many years ago, I saw a boy, twelve years of age, who laboured under epistaxis, accompa¬ nied with purple spots : the bleeding from the nose occurred to a great degree. He was bled, purged, and saline aperients were exhibited ; and he got better, and remained so for some time. The epistaxis then returned, and nothing stopped it — neither bleeding, ice, nor plugging the nos¬ trils. The patient bled to death, and even in his last moments blood squeezed out of the nostrils. On opening the body, no membrane was found to have given way ; the Schneiderian membrane was more vascular than usual, as if the pa¬ tient had had a severe cold, but that was all. The spleen, however, was three- fourths decomposed; it could not be col¬ lected. You will find several cases on re¬ cord, of this disease connected with pur¬ pura, where it was found that the mass of vessels constituting the spleen were in a stale of decomposition. Some persons suppose that the two facts may be con¬ nected, but the intermediate chain of rea¬ soning no one can supply. When the dis¬ ease is attended with a low condition of the system, it is supposed by some to arise from a weakness of the arteries, and others believe it to arise from an alte¬ ration in the composition of the blood itself. One does not exactly see how this should cause the exudation of blood on the surface. A third idea is, that it is connected, somehow or other, with dis¬ ease of the spleen. No one knows what is the use of the spleen. It is a congeries of blood-vessels, largely supplied from trunks of arteries, and may be removed with impunity from the bodies of animals. It has been the fruitful source of a great number of theories, even down to our own times. Sir Everard Home suggested that the spleen was the organ through wrhich substances passed into the circulation without going through the digestive organs, lymphatics, and thoracic duct; and thus accounted for diuretic substances being found in the urine so soon after they were swallowed ; but he did not make out his case. Descartes, I think (at any rate, some philosopher), thought that its object wqs to keep the rest of the organs of body safely packed. Of late years, we have been told that it is the means by which warmth is preserved in the body in hybernating animals ; that it is a sort of human warming-pan. The fact is, that no philosophical explanation has yet been given of its object. That it is a congeries of blood-vessels there can be no doubt, which, during the period of digestion, are more turgid than at other times ; and some sup¬ pose that it is provided with super abun¬ dant blood, as a reservoir during the period of digestion. It is quite certain, that in some of the cases of which we have been speaking, the spleen has been found in a re¬ markably unhealthy condition, and even allowing that it is of no use in the ordi¬ nary state of the body, in a diseased state it must be a very disagreeable addition to it. I should state that I have seen persons recover, in a condition very similar to that which existed here, in which the blood has been inflamed, and the action of the heart and arteries has been very great. So I have seen persons recover who have been treated, in an opposite condition of the system, by stimulating remedies. I went, some years ago, with Dr. Locock, to see a woman, advanced in pregnancy, who had met with a fright, and soon afterwards PERICARDITIS SUPERVENING ON RHEUMATISM. 397 the appearance of purpura took place over the body. She was in a very low state. Her bowels were freely opened, and a feel¬ ing still exists, among some physicians, that repeated purging will cure the com¬ plaint. I have seen it tried in two or three instances, but never with success. I do not see how repeated purging can operate in curing such a disease. In the first instance, where there is some inflam¬ matory action going on, it might be use¬ ful ; but how it is to operate upon this con¬ dition in which blood is exuding from every mucous surface, I am at a loss to deter¬ mine. We saw the woman again the next day, and she appeared to be dying. The pulse was hardly to be felt, and it became necessary that she should be stimulated. We were then of opinion that she should take bark; however, bark was not to be got immediately, it requires some time to make a decoction, and we therefore went to a chemist’s; and the draught which was given I remember was this Six grains of subcarbonate of ammonia, one drachm of spirits of sulphuric aether, and two drachms of compound tincture of bark, (this brings back to my remembrance that we used the tincture because there was not time to procure the decoction of bark) ; and this was given, in camphor mixture, every two or three hours. I went away with little hope of seeing her again, but the next day she was better. She ultimately got well, and carried the child (which is very remarka¬ ble) the full time. This is one of the cases in which stimulation is not only neces¬ sary, but no doubt saved the patient’s life. In general, when I am called to a case of this sort, and find the patient low, I am in the habit of giving the turpentine mixture three or four times; and if there be great depression of spirits, ammonia at the same time. If the case is of a more chronic kind, the treatment then is by mineral acids, fresh vegetables, and supporting the strength: in ordinary cases this wifi ge¬ nerally succeed. The case which we have just considered was remarkable, and therefore ought to be taken out of the ordinary occurrences. It was attended with considerable action of the heart and arteries, and got worse under the influence of bark, or any permanent stimulus. If, under other circumstances, fluid had been poured out instead of blood, the circulation would have been re¬ lieved for some time from this state, which would have constituted dropsy ; and, in fact, he did labour under this for some time. gout. Several cases were admitted on Wednes¬ day last, but unfortunately not any of them are of very great importance. I will, however, state what they are. There is one which is something similar to those of which we have been recently speaking — a case of gout. It is in a man named Graves, in King’s ward, who complains of pain in the knees, attacking him sometimes with so much violence as to cause him to fall dowm. In addition to this, he had pain at the scrobiculis cordis, and the region of the stomach. His urine was scanty and high coloured, and there was pain in passing it. The bowels were confined. It would appear that this dis¬ ease had sometimes come on very severely, and lasted some time, and then there was a perfect return to ease. Not knowing much better what to do with him, I open¬ ed his bowels, and put him upon small doses of colchicum, the same as the other cases. RHEUMATISM. A case of rheumatism was also admitted affecting the hands, and which wras re¬ lieved by warmth. One of those very bad cases, in which the patient was so frequently ordered to be bled, and according to the treatment w'hieh I laid down at the commencement of the course, was put upon guaiacum mixture and a grain of opium at bed time, I am happy to tell you, is going on as well as possible. The man Allen, where the secretion of acid was so great, has entirely recovered. He appeared to me, after the blood-letting, to derive more benefit from guaiacum than any other remedy. SCARLATINA. In the case of scarlatina there is a little puffiness about the ankles, showing what would have been the case if wre had not bled him, so as to prevent the coming on of anasarca. PERICARDITIS SUPERVENING ON RHEUMA¬ TISM - LARYNGITIS TRACHITIS. There is a specimen on the table, which has been kindly sent to me by Dr. Macleod, that those gentlemen may have an oppor¬ tunity of examining it who were not at the autopsy. This man laboured for some period of his life under rheumatic pericarditis. You may see the old layers of lymph thrown out on the pericardium. He did not die of this disease, but of inflammation of the larynx and trachea. There is extensive inflammation going into the state of ulce¬ ration at the upper part of the windpipe. It extends throughout the whole of the bronchial tubes. You may see the notes in Dr. Macleod’s book, and compare the symptoms with the present appearances. 398 DR. ASHWELL ON THE INDUCTION OF PREMATURE LABOUR ON THE INDUCTION OF PREMATURE LA¬ BOUR IN PREGNANCY COMPLICATED WITH TUMOR. To the Editor of the Medical Gazette. Sir, I shall be obliged by the insertion, in the next number of the Gazette, of the accompanying observations. I am, sir, Your obedient servant, Samuel Ashwell, M.D. Obstetric Lecturer and Physician to Guy’s Hospital. Nov. 30, 1836. Mr. Ingleby, the experienced teacher of midwifery in the Birmingham School, has recently published an able and in¬ teresting work on Obstetric Medicine. In one part of it there are strictures on a paper of mine, in the second number of the Guy’s Hospital Reports, urging the “ induction of premature labour in certain cases of pregnancy complicated with tumor;” and against the new prin¬ ciples and practice there recommended, Mr. Ingleby takes large exceptions. The views contained in that paper are few and simple, and the treatment rests on facts, and is entirely safe. If I did not regard the induction of prema¬ ture labour as a most valuable addition to our remedial management of these unfortunate complications, I would not occupy your valuable pages by a sin¬ gle word in its defence. While, however, 1 thank Mr. Ingleby for the interest he has displayed in the subject, as I am convinced he is in error .about it I am bound by my estimation of the importance of the practice to cor¬ rect misconception, and to shew the ge¬ neral accuracy of the paper. Pregnancy, whatever may be said to the contrary by Mr. Ingleby, is not un- frequently complicated with malignant tumors of the uterus itself, of the ovary, and with those of a purely adventitious character, growing either from the ab¬ dominal or pelvic cavities, and giving- rise in labour to difficulties of the worst kind. It can scarcely be necessary to con¬ firm these statements by extended re¬ ference ; but I may mention the eigh¬ teen cases of Dr. Merriman, numerous others, and my own, as clearly proving the not uncommon coincidence of con¬ ception with tumors dangerously ob¬ structing labour. A perusal of Mr. Hew'lett’s case, in the seventeenth vo¬ lume of the Medico-Chirurgical Trans¬ actions, of several of Dr. Merriman, and of my own (Nos. 1 , 2, and 5), will satis¬ factorily establish the malignancy of the growths themselves. I might en¬ large here ; but sufficient testimony has been perhaps adduced, to neutralize an opinion of Mr. Ingleby, “ that the coin¬ cidence of conception with a disease of the uterus, already malignant, is ex¬ ceedingly rare.” If by the term “ already malignant,” it be meant that the growths in the un¬ impregnated state are fibrous, indolent, and harmless, and that their subse¬ quently developed malignancy is the result of the vascular and nervous ex¬ citement of pregnancy, then a stronger confirmation of the correctness of my pathology of these enlargements could not be obtained ; and if such be Mr. Ingleby’s opinion, he must acquiesce in the propriety and advantage of an early termination of the g'ravid state, as its continuance must induce increased and almost permanent morbid activity of the diseased growths. Again, Mr. Ingleby “ having doubted the accuracy of my views,” (a point, I trust, which my present communication may solve,) “ thinks it questionable whe¬ ther the instances already adduced, viz. th ose of Dr. Merriman, Mr. Hewlett, numerous others, and my own, afford sufficient data to establish, as a g'eneral principle, the adoption of the new mea¬ sure in similar cases.” Now it must be remembered, that I propose to evade the dangers of inflam¬ mation of the pelvic tissues and perito¬ neum, and of the still more hazardous evils of unhealthy softening, suppura¬ tion, and ulceration, of the tumors them¬ selves, by the simple and safe expedient of premature labour, — a practice acci¬ dentally suggested to me, and enforced on reflection, by the fact that death had frequently occurred where pregnancy wras so complicated, under the best known treatment, exclusively of prema¬ ture labour artificially induced. Nine out of the eighteen cases which fell under the notice of Dr. Merriman, ter¬ minated fatally ; Mr. Hewlett’s case was equally unsuccessful ; and three of my own patients fell victims to gan¬ grenous inflammation of the tumors, IN PREGNANCY COMPLICATED WITH TUMOR. 399 produced by their contusion during the parturient process. Worse results could not have followed premature labour ; and I feel confident that, had it been induced, several lives would have been saved. Mr. Ingleby would inquire, whether there was not sufficient mischief done to the uterus in these cases to in¬ sure a fatal event? Certainly not : in most of the cases mentioned by Dr. Mer- riman there is no allusion to the condi¬ tion of this viscus; and when there is, it is stated, with one exception only, to have been healthy. In Mr. Hewlett’s and my own examples, the womb was free from inflammation. I believe these patients to have been destroyed, as others will be, where premature labour is not practised, by morbid and malignant changes in the tumors themselves : collapse and final sinking having been induced, much in the same way as after pressure and strangulation of an intes¬ tine, or after contusion of the soft parts in difficult labour, where an inspection after death commonly brings into view intense inflammation, and sometimes gangrene and disintegration. A valuable corroboration of the pa¬ thology of the practice, is furnished by the marked success attendant on punc¬ turing the tumors, especially where their contents were fluid, or considerably viscid ; and in one or two instances, where blood only escaped. By this operation the bulk and tension of the tumor is diminished, and the double purpose is accomplished of a partial re¬ moval of the obstacle hindering partu¬ rition, as well as a preservation of the growth from that severe pressure and contusion which may lead to rupture of its parietes, inflammation or gan¬ grene of its substance. The six cases published by Mr. Park, of Liverpool, in the second volume of the Medico-Chirurgical Transactions, are equally in point. Puncturing the tumors was the most successful of all the measures adopted, and it is worthy of observation, that the only fatal ter¬ mination occurred in a case where the tumor, occupying the recto-vaginal septum, was subjected to the pressure and contusion of the foetal cranium for three days. Delivery was eventually accomplished by the natural efforts, and the patient died in twenty-four hours, from vomiting and constipation. A perusal of all that has hitherto been written on the subject, will satisfy any one that the proceedure to be adopted in these unfortunate complications, at the time of labour, is by no means clearly de¬ fined. If the opposing g*rowth can be pushed above the brim, the parturient difficulty is at an end ; but if it cannot be so raised, although puncture of the morbid structure is the best remedy for tumors with fluid contents, it will avail little in the management of solid and very hard growths. Extirpation by the knife may be thought of, but the connexions of the tumor, the shock of the operation, the probable haemorrhage, and the subse¬ quent inflammation, are events too cer¬ tain and too hazardous to allow of a favourable prognosis. These remarks are strictly applicable to morbid enlargements opposing the descent of the child ; but they are equally pertinent to hard and malignant tumors of the uterus itself, and to ovarian and other growths, of such magnitude and firmness of attachment as to pre¬ clude the possibility (vide Mr. Hewlett’s and my own cases) of their being lodged in the abdominal and pelvic cavities, together with the gravid womb, without excitement, pressure, and contusion. This observation is especially true where pregnancy is complicated with one or more hard tumors imbedded in the uterine parietes. If the induction of premature labour were dangerous to the mother — if it increased her risk at the time, or if afterwards it placed her in a worse position than she had previously occupied — Mr. Ingleby’s sentiments would carry g-reat weight. It is, how¬ ever, satisfactory to know that none of these evils are the effect of premature labour artificially induced. Dr. Hamil¬ ton, of Edinburgh, my friend Dr. E. IT. Ramsbotbam, and many others, have frequently resorted to the practice, with¬ out the slightest bad consequence. My own testimony, from a rather large number of cases, is equally favourable. T think, therefore, I may regard as proved, that great advantage will accrue from this method, where the tumor can¬ not be raised above the brim — where it is situated in the abdomen, and is of such size as to restrain the development of the uterus without painful pressure and contusion, or when the growths are in the uterus itself. Mr. Ii igleby, at the end of his candid and intelligent critique, admits “ that an emergency may arise, justifying the measure; but, again, he doubts whether 400 mr. lonsdale’s observations on the Dr. Ashwell has sufficiently restricted and defined the principle which he ad¬ vocates.” I am pleased that Mr. Ingleby, in his five divisions of appended cautions and conditions, has included all and nothing more than what my own paper contains. To this part of my essay I beg the attention of your readers, as this paper is too long to permit their being annexed to it. OBSERVATIONS ON THE FUNCTIONS OF THE MUSCLES AND NERVES of the EYE-BALL. By Edward F. Lonsdale, Demonstrator of Anatomy at the Middlesex Hospital School. In the number of the Medical Gazette for September the 24th, will be found a paper from Mr. Walker, of Manchester, on the Functions of the Muscles of the Eye- Ball, in which he offers a very in¬ genious explanation of the action of the superior oblique, by making it act in combination with the external rectus of the opposite eye, by which the parallel motion between the two eyes is pro¬ duced, when we view any object late¬ rally. It is for this reason, he says, that these two muscles have two dis¬ tinct nerves distributed to them, while the other muscles have one common to them all. As soon as I had read Mr. Walker’s paper, I was anxious to know how far his theory was probable, and to what extent it w^as borne out by the anatomy and physiology of the muscles to whicli he refers the above action, and upon which he founds his theory. I have since considered the reasons he has ad¬ vanced, and have thought a good deal upon the subject, without being able to come to the same conclusion that he has ; for it appears to me, that so far from the superior oblique muscle acting with the external rectus of the opposite eye, that it never acts at all with it, but that its function is quite distinct and opposed to that of the external rectus. I shall give my reasons for supposing this to be the case, presently, after I have stated some of the objections that occur to me with regard to the view' he has advanced ; I shall then make a few remarks upon these muscles and nerves generally, and offer what appears to me a likely explanation of the complexity that exists in their mode of distribution and in their function. Mr. Walker’s explanation does not appear satisfactory to me, for, in the first place, I do not consider that the action of tbe superior oblique of the one eye can be in accordance with the ex¬ ternal rectus of the other (even allowing the former muscle to turn the eye in¬ wards) ; for the external rectus, acting alone, can pull the eye in one direction only, which is horizontally outwards, while the superior oblique rotates the eye upon its axis; and supposing it to turn it inwards, must at the same time turn it dowuiwards : so that the axes of the two eves cannot correspond if these two muscles act together, for the one will be turned on its vertical axis, and the other on its horizontal. At first sight, then, this view of their action must appear incorrect. Mr. Walker also states, that it is on account of this lateral motion of the two eyes in one direction, that we find this complexity of the muscles and nerves distributed to them ; and that if it had not existed, there would have been no necessity for any muscles except those that are used in looking- straight for¬ ward. In making this statement, he appears to have quite overlooked the action of the eye-ball in connexion with the motions of the eye-lids, and the many involuntary motions the eyes per¬ form totally independent of this lateral direction, and which renders the ex¬ istence of many of these muscles neces¬ sary, even if this lateral motion had not to be performed. Again : if the use of the superior oblique be only to bring the eye of one side inwards, while the external rectus of the opposite side turns the other eye outwards, how- is it that we find this muscle existing in those animals whose eyes are placed laterally, and in whom the parallel motion similar to that in man can never be produced. Take the horse or the sheep, for instance, and suppose that the superior oblique, according to Mr. Walker’s theory, were to act w ith the external rectus of the opposite eye, one eye would be turned directly inwards towards the nose, while the other would be turned outwards towards the ear; so that the animal would be looking for- FUNCTIONS OF THE MUSCLES AND NERVES OF THE EYE-BALL. 401 wards with one eye, and backwards with the other, producing* any thing but a parallel motion between the two. This muscle in these animals, then, and in all others with the eyes similarly placed, must have some other office than that Mr. Walker ascribes to it. There is another point also in which I cannot ag*ree with him, namely, as to the anatomy and individual action of the superior oblique muscle ; for he says that it is “not inserted behind, but directly over, the centre of the eye-ball, or perhaps rather anterior to it, just over the tendinous expansion of the superior rectus, and passing down a little towards the tendon of the external rectus.” This statement certainly made me anxious to examine this point again, and I procured a human eye at the earliest opportunity, and have since exa¬ mined three others, and was much sur¬ prised to find the description he gives so different from what appears to me to be the true insertion of the muscle, for I could distinctly trace the tendon of the muscle going quite to the posterior and outer part of the sclerotic, to within about three lines of the entrance of the optic nerve : so distinctly can these fibres be traced, and also seen, when the tendon is pulled upon, that it appears to me difficult to mistake them. They are also made more evident by macerating the eye for a short time, when the ten¬ don can easily be raised up from the sclerotic as far back as its point of in¬ sertion. Such being the insertion of the mus¬ cle, its action must be that of rotating the ball of the eye downwards and out¬ wards ; for as the point of insertion is brought nearer to the pulley through which the muscle plays, it is drawn in a line upwards, forwards, and inwards, and so must turn the eye in the opposite direction, which is downwards and out¬ wards. That such is the action of the muscle, I have repeatedly satisfied my¬ self on the dead body; and the best way to get the action of it is by first turning the eye upwards as far as it will go, and then pulling upon the su¬ perior oblique, when it will be distinctly seen to move in the direction I have stated. This direction outwards, how¬ ever, is not to that extent to make it an important action of the muscle, but is quite enough to show that the eye is turned contrary to the direction in¬ wards. I believe that the chief action 472. — xix. of this muscle is that of turning the eye downwards and drawing it forwards. With regard to the nerves distributed to these muscles, Mr. Walker accounts for the fourth and sixth nerves each going to separate muscles, by supposing the superior oblique and external rectus to act together in the lateral motion of the two eyes. Allowing this theory of his to be correct as to the action of these muscles, this explanation of the nerves might appear satisfactory ; but if it is found that they cannot act together in the manner stated (and the reasons for supposing they cannot I have given), some other explanation of their peculiar distribution must be sought for. I11 speaking of the third nerve, Mr. Walker says, u Now, with regard to the muscles of the third pair, we perceive that they are brought into action in all those motions in which the two eyes correspond, such as straight forwards, with its modifications upwards, down¬ wards, and inwards.” Is it meant by this statement that the muscles supplied by this third nerve have the power of acting without the superior oblique and external rectus because if so, I con¬ ceive that many of them will produce any thing but corresponding* motions between the two eyes, namely, the two in¬ ternal recti and the two inferior oblique ; their action together cannot do other¬ wise than turn the axes of the eyes in opposite directions. From Mr. Walker’s statement, I should suppose him to think that the superior oblique and ex¬ ternal rectus only act in accordance with one another, and with no other muscles, so givingthem a distinct func¬ tion, having the office only of producing the parallel lateral motion between the two eyes ; for he says in the passage I have already referred to, “ Doubtless, had it not been for this lateral motion of the eyes, there would have been no necessity for any muscles except those which are used in looking* straight for¬ wards.” Another important point which he appears to have overlooked is, that by allowing the superior oblique to turn the eye inwards, and to be the muscle that acts with the external rectus of the opposite eye, the internal rectus is ren¬ dered useless ; for if this latter muscle is not called into action when the external one of the opposite eye acts, when is it called into action ? — for it certainly is not with the internal rectus of the oppo- 2 D 402 mr. lonsdale’s observations on the site eye, otherwise we should be con¬ tinually squinting*, by having* both eyes drawn inwards towards the nose. Where is the difficulty in supposing that, while the external rectus of one eye acts, the internal rectus of the other eye should be brought into action with it, and that the other internal and external rectus should remain relaxed until the eyes are wanted to be turned in the opposite direction ? That this action can take place, I shall endeavour to show, and that it is dependent upon a peculiar sympathy between the two eyes, which is essential for the preservation of the parallel motion that must exist, in order to give us distinct and single vision of objects. Having made these objections to Mr. Walker’s theory, I shall now offer what appears to me a more probable explana¬ tion of the function of these nerves and muscles, and shall endeavour to show that they admit of being classified ac¬ cording* to the peculiar motions the two eyes have to perform, and that their complexity may be much diminished by attending more to the sympathetic action that exists between them than hitherto has been done. I shall first make a few remarks upon tbemany different directions in which the eyes can be turned, and mention certain laws that appear to be constant with re¬ gard to the action of the muscles con¬ nected with them; for it is upon the different motions they are capable of producing, and by attending to those that are voluntary, and those that are involuntary, that their true classifica¬ tion depends. There appears to be a peculiar sym¬ pathy between the two eyes that causes one to follow the other in whatever direction we turn them, and over which we have no command, for we cannot prevent it, however much we try ; when we turn one eye, the other must turn too. It is upon this law that our distinct and single vision depends ; for, had the motion of both eyes at once been volun¬ tary, wre should then have been obliged to be constantly thinking of keeping* them parallel to one another while look¬ ing at any object; and the least devia¬ tion of the axis of one eye from the other would produce indistinctness of vision, and so become an evil of frequent occurrence, by abstracting our thoughts from the object we are looking* at. There is also a sympathy between the motions of the eye-ball and the eye-lids, for we cannot move the one without moving the other also : thus if we raise the upper eye-lid, the eye-ball follows with it; if we close the eye-lid, the eye rolls upwards, and when we open them again it rolls downwards, so that certain muscles are brought into action quite independent of the w ill ; for we cannot prevent the eye taking these directions, with the above motions of the eye-lids, however much we try. With regard to the particular action of each muscle, I think it will be found that the following statement is a correct one. When one rectus of either eye acts, the eye-ball w ill be drawn in the direc¬ tion of the side on which the muscle is inserted ; thus if the superior rectus acts, the eye will be turned upwards; if the inferior, it will be turned downwards, and so on with the other two. If the four recti act together, the eye-ball will of course become fixed, as one will then antagonize the other, and this, no doubt, is one great use of these muscles — namely, to steady the eyes in any parti¬ cular direction wre may require, while looking at an object. It is said that when two of the recti act together, the eye is turned in a direction midway be¬ tween the two muscles : thus if the ex¬ ternal rectus act with the inferior, the eye will be drawn downwards and out- W'ards at once by their combined action. I am not at all certain, however, that two of the recti muscles ever do act in this manner, so as to pull the. eye in an oblique direction ; and this is an import¬ ant point to ascertain, as upon it depends the possibility of the eye-ball being capable of rolling upon its antero-pos- terior axis, which motion I am inclined to think it never performs ; for I believe it w ill be found that the only action the recti muscles have, is that of turning the eye directly upw ards or downwards, inwards or outwards, and that they never act two together simultaneously in the same eye. The following expe¬ riment may be made to prove this : — Watch carefully the eye of another per¬ son when looking straight forwards, and then tell him to turn the eye up¬ wards and outwards, and to try and carry it in a line midway between the two directions, without either turning it directly upwards or outwards. It will be found that if he perform this motion slowly, he has not the power of doing so ; but that the eye is first of all I FUNCTIONS OF THE MUSCLES AND NERVES OF THE EYE-BALL. 403 turned upwards by the superior rectus, and then turned outwards by the exter¬ nal rectus, and so brought to the object wished to be looked at. When the mo¬ tion is performed quickly, the eye ap¬ pears to move in the direction at once, for the action of the one muscle follows the other so rapidly, that it seems to take place simultaneously. If two of the recti, then, cannot act together, so as to bring’ the eye in a line midway between the two muscles, we should not expect it to have the power of rotating-, for, of course, if the eye cannot be brought into the interme¬ diate position, it cannot be brought round from one muscle to another, which motion must take place before rotation can he produced. An experi¬ ment may be made to prove this also. If we watch the eyes of another person, and tell him to try and rotate them as much as he can, it will be found that no rotation takes place, but that the eyes are turned rapidly upwards and downwards, inwards and outwards, and that they are never brought into the in¬ termediate position between any two of these directions. Lastly, when we look at the position of the four recti muscles, and at their mode of insertion into the sclerotic, they appear to be more fitted for acting all at once, and so to steady the eye, or else that one alone should act, and pull the eye in the direction of the side to which it is attached. The fact is, that no rotatory motion of the eyes is required; for when we want to look at any object obliquely, upwards or downwards, we turn the head at an angle that enables us still to move the eyes horizontally ; for we can place the head in any direction we | like, and so bring the eyes in a position I that allows them to turn upon their axis, the same as when looking at an object | straight before us. This lateral motion of the eyes, then, y from side to side, being one of the two >1 motions that is most frequently required, t and there being also that peculiar sym- i pathy between the two eyes that we si cannot move one without the other one |l following in the same direction, are cir- j(l cumstances that render it necessary that r we should have the power over one 11 muscle oidy ; for we only want a mus- r cle to move the eye of the side on which H ^e object we wish to look at is placed ; li and the other eye must follow by a ifi sympathetic or involuntary power placed in it, and this one muscle is the ex¬ ternal rectus; and now we see the rea¬ son why it should have a separate nerve, for in it is the only muscle over which it is necessary that we should have a voluntary power, when looking at ob¬ jects placed laterally. Thus if we want to look at an object placed to the right, we will to turn the right eye, and the other follow's immediately with it (for we cannot prevent it) so that we only want the power over one muscle, which is the right external rectus, and we will to move this muscle, and so turn the eye to the right, and the left eye follows sympathetically. If we wish to look at an object to the left, we relax the right external rectus, and will to move the left, and so turn the eye to the left side, and the right eye follows involuntarily. We have also the poweroverboth external recti at once, which power we employ when looking- at objects straight before us; for we then neither wish to move the eye to the right or left, and so make one external rectus act against the other, and the eye becomes fixed directly forwards. If the above be the true explanation of this lateral motion of the two eyes, there can be no doubt about the exter¬ nal rectus being a voluntary muscle. It now remains to be seen what is the ac¬ tion of the other muscles, and in what manner they are influenced by the nerves going to them. The remaining muscles are the levator palpebrae, the superior, inferior, and internal recti, and the supe¬ rior and inferior oblique ; one of these, namely, the superior oblique, is supplied by the fourth nerve, while the other five are supplied by the third nerve. With regard to the third nerve, it is found to divide into two branches just before it enters the orbit, which two branches remain quite distinct ever after. The superior branch crosses the optic nerve, and supplies two muscles only, namely, the levator palpebrae and superior rec¬ tus, while the inferior branch goes be¬ low the optic nerve, and supplies the internal and inferior recti, and the infe¬ rior oblique. This inferior branch is also further distinguished from the supe¬ rior, by going to form the lenticular ganglion with the nasal branch of the fifth pair. It is upon this division of the third nerve into its two branches that I mean to explain the action of the remaining- muscles, and wish to show that the 404 MR. lonsdale’s observations on the inferior or ganglionic portion governs the involuntary or sympathetic motions of the eye-ball, while the superior or ganglionless portion governs the volun¬ tary motions. In order to support this theory that I have advanced, we must see if these two sets of muscles are so employed, and ascertain if the inferior rectus, internal rectus, and inferior oblique, are used involuntarily or sympa¬ thetically, and if the levator palpebrae and superior rectus are used as voluntary muscles. The muscles the superior division of the third nerve supplies, as already stated, are the superior rectus and leva¬ tor palpebrae; and there can be no doubt that their action is quite volun¬ tary, for we can will to turn the eye-ball and eye-lid upwards whenever we like ; and these two motions are done toge¬ ther, as both muscles are supplied by the same branch of the nerve ; and they are required to be moved always in the same relation to one another, otherwise, if we turned the eye-ball upwards with¬ out the eye-lid going with it, this mo¬ tion of the eye would be of no service to ns, for we should move the cornea behind the lid, and consequently obstruct our vision by this movement. St was neces¬ sary, then, to combine the action of these two muscles together, and to g’ive the voluntary stimulus to both at once, in order to preserve their relation one to another. And this is done by the supe¬ rior or ganglionless division of the third pair of nerves, which I therefore call the voluntary portion. It now remains to be seen if the muscles supplied by the inferior or ganglionic branch of the third nerve possess the power of acting' sympathetically or involuntarily. The internal rectus, one of the muscles supplied by it, I have already shewn to be completely involuntary ; for it is brought into action with the external rectus of the opposite eye, and turns the eye inwards, quite independent of the will, for no effort on our part can pre¬ vent it following; for while we have a voluntary power over the external rec¬ tus, we have none over the internal ; it is, therefore, an involuntary muscle. With regard to the inferior rectus, I think it will be also found to act sym¬ pathetically ; for it is brought into ac¬ tion only when the upper eye-lid is relaxed, and it appears to have a sym¬ pathy with the levator palpebrae ; for so long as this muscle acts and keeps the eye-lid raised, so long are we prevented looking downwards, which we should not expect to be the case were the infe¬ rior rectus a purely voluntary muscle. When we want to look downwards, we must first of all relax the upper eye-lid, when the inferior rectus then acts in combination with a portion of the orbi¬ cularis palpebrarum, so causing it to be purely sympathetic in its action, for it cannot act independently by itself. The other muscle supplied by this in¬ ferior portion of the third nerve is the inferior oblique ; and there can be no doubt about it being purely involun¬ tary or sympathetic in its action, for it turns the eye upwards when the eyelids are closed during sleep, or winking, which motion is quite independent of the will, for we cannot prevent it tak¬ ing place, any more than we can pre¬ vent the eye rolling downwards when we open the eyelids. It is also sympa¬ thetic in its action ; for we cannot bring the orbicularis palpebrarum into action without the inferior oblique acting' at the same time, and producing the in¬ voluntary rolling’ of the eye upwards; in which position it remains as long as the eyelids are closed. So soon as the orbicularis muscle becomes relaxed, the inferior oblique does, but not till then. The only muscle remaining to be ac¬ counted for is the superior oblique ; and it, no doubt, is also quite involun¬ tary in its action, for it is the antago¬ nist to the inferior oblique, and not the inferior oblique that is the antagonist to it, as is generally described ; for when the eyelids are closed, as during sleep or winking, the eye-ball, as stated above, is rolled upwards, which motion must take place before the superior ob¬ lique muscle can be called into action. When the eyelids are closed, the eye¬ ball not only is turned upwards, but re¬ cedes to a certain extent into the orbit, by the pressure of the eyelids upon its anterior surface ; so that it not only has to be rolled downwards, but also has to be brought forwards, when the lids are opened again ; and this I conceive to lie the office of the superior oblique mus¬ cle, for its position and peculiar course fit it for both these motions ; its tendon going so far back, will bring’ the whole, globe of the eye forwards at the same time that it rolls it downwards. It cannot be the inferior rectus that rolls the eye downwards during this motion of opening the eyelids, for I have FUNCTIONS OF THE MUSCLES AND NERVES OF THE EYE-BALL. 405 shewn that it cannot act except when the levator palpebra is relaxed, which of course it is not while the lids are being* opened, for then that muscle is in strong* action. The only muscle that can do it, then, is the superior oblique, and there can be no doubt about itsaction being* involuntary, tor, as before stated, we cannot prevent the eye-ball rolling* downwards when the eyelids are opened, any more than we can prevent it rolling* upwards when they are closed. Thus it is seen that there are three voluntary muscles — namely, the leva¬ tor palpebrae, superior rectus, and ex¬ ternal rectus; and two voluntary nerves — namely, the superior division of the third and the sixth ; while there are five involuntary muscles, none of which act except in sympathy with the volun¬ tary muscles, and are supplied by two nerves — namely, the inferior division of the third and the fourth nerve. It may be asked, if the superior ob¬ lique be an involuntary muscle, why should it not also be supplied by the same portion of the third nerve as the other muscles that I have called invo¬ luntary ? The reason I should offer is, that its situation renders it necessary for it to have a separate nerve, as it is far distant from the inferior portion of the third nerve. Also the peculiarity of the course and action of the muscle would lead us to expect a separate nerve to be distributed to it ; at the same time that it is also an antagonist to one of the muscles supplied by this portion, the third — namely, the inferior oblique; which is an additional reason why it should not be supplied by the same nerve, but rather have a separate one to itself. There is a motion of the eyes that I have not yet considered, and one that I think further illustrates the theory I have advanced ; I mean where both eyes are turned inwards towards the nose, when we look at any object placed very near. It will be found that if we place the finger, or any object, midway between both eyes, and look stedfastly at it, and then gradually approach it nearer and nearer, both eyes turn directly inwards, and an involuntary squint is produced. The reason of this, no doubt, is, that both external recti be¬ coming relaxed, which they must before the axes of the eyes can suit themselves to an object placed so near, causes the involuntary muscles to come into play, which are the two internal recti, and they then draw both the eyes inwards, and produce the squint that is found to take place. That the external recti are relaxed in this case, is proved by our being able suddenly to bring them into action, when immediately the near object vve were looking* at becomes in¬ distinct, and the axis of the eyes is accommodated to an object more re¬ motely placed. We have only again to relax the external recti, and the invo¬ luntary squint is immediately repro¬ duced ; and we see the object placed near the nose as distinctly as before. It may be said, that if the above mo¬ tion of the eyes is dependent upon the involuntary action of the internal recti, how is it that some people have the power of voluntarily squinting inwards ? To this 1 should answer, that it is not found that every body can produce this voluntary squinting ; which we should expect they could, were these muscles under the influence of the will ; for it is found that some people can only squint in a very slight degree, while others cannot at all. This circumstance I should explain by supposing that some have the power of relaxing both external recti at once, either naturally or from habit, while others have not this power; and as the external recti cannot act until these muscles are relaxed, is the reason why some can voluntarily squint while others cannot. Squinting downwards and inwards is produced by the voluntary portion of the third also being* relaxed, for so long* as the stimulus of the will is given to the levator palpebrae and superior rec¬ tus (supplied by this upper portion of the third), so long is squinting inwards only produced; but immediately on re¬ laxing these muscles, the eyelid falls, and the inferior rectus then pulls the eye dow nwards ; which it cannot do so long as the levator palpebrae and superior rectus are in action. This motion, then, suits the theory that I have advanced, of the levator palpebrae, superior and external recti muscles, being purely voluntary; for while they are kept in action the eyes are neither turned in¬ wards nor downwards, but immediately on relaxing them they are rolled in both these directions, and an involuntary squint is produced. This, then, is the explanation I should offer of the action of these mus¬ cles, and of the function of the nerves 406 MR. HULBERT’S CASES OF LOCAL HYSTERICAL AFFECTIONS. distributed to them ; which I fear, how¬ ever, may seem complicated, and that many may have objections to advance against them. I merely offer it as one that appears to me plausible, from the fact of its classifying the different muscles in a manner that agrees with their peculiar action, and with the pe¬ culiar distribution of the nerves that supply them. The view that I have taken of the superior division of the third nerve being the voluntary por¬ tion, and the inferior the portion that governs the sympathetic movements of the eyes, I am not aware to have been advanced before ; and it appears to me to be probable, since what I have called the voluntary portion certainly supplies two muscles, over which we have per¬ fect command — namely, the levator palpebroe and superior rectus ; while the inferior portion supplies muscles that chiefly sympathize with those muscles that I have called voluntary, and never act by themselves until these latter muscles are relaxed ; and this sympa¬ thetic action is gained by the peculiar connexion of the inferior division of the third nerve with the lenticular gan¬ glion and the fifth nerve, which is known to give sensation to the eye, and to be the nerve that excites many of the involuntary motions that exist be¬ tween the eyeball and eyelids*; which motions are produced by this lower division of the third, and by the fourth nerve. There is another action, also, which goes to prove this lower portion of the third nerve to be involuntary — namely, the action of the iris ; which is found to be influenced by it, from experiments that have been made f, and which mo¬ tion we know to be sympathetic only, and to be dependent on the impressions made upon the retina, and not upon any voluntary stimulus that we can give the iris itself. I have not mentioned any of the theories that have already been ad¬ vanced with regard to the action of these muscles, as it would extend my paper to a length that I am not desirous of do¬ ing ; and they none of them affect the resent views that I have put forth, ly only wish is to endeavour to do away with some of the difficulties that exist with regard to the physiology of * Vide Sir Charles Bell’s papers on the Nerves. Y Mayo’s Physiology. til ese parts, by offering what appears to me a simple explanation of the distri¬ bution of these nerves, by classifying the muscles according to their peculiar actions, and distinguishing between those which are sympathetic and those which are purely voluntary. 2, South Crescent, Bedford-Square, Dec. 6, 1836. CASES OF LOCAL HYSTERICAL AFFECTIONS. To the Editor of the Medical Gazette. Sir, In perusing the excellent lectures of Sir B. Brodie, on Local Hysterical Affec- tions, published recently in your valua¬ ble journal, my mind was forcibly impressed with tbe importance and correctness of that part wherein he al¬ ludes to the mistaken practice of refer¬ ring the symptoms of hysteria to disease of the spine, and observes, that “ in con¬ sequence of this unfortunate impression, numerous instances have occurred of young ladies being condemned to the horizontal posture, and even to the tor¬ ture of caustic issues and setons, for several successive years, in whom air and exercise, and cheerful occupations, would probably have produced a cure in the course of a few months.” From among several cases which have come under my observation, which fully corroborate the justness of this remark, I will select two which occurred a few years ago, premising, that at the time of their occurrence I was engaged in an extensive practice in the country, where I had frequently seen the treat¬ ment of condemning young persons to confinement in the horizontal pos¬ ture , made, as it were, a hobby , or a fashionable practice ; being had recourse to without due discrimination, or deli¬ berate investigation into the origin and progress of the more prominent symp¬ toms of disorder, to the benefit of few, but to the serious inconvenience and injury of many. I shall not relate these cases accord¬ ing to the order of time in which they took place, the second having occurred about two years prior to the first, my object being* to exhibit the dangerous tendency and absurdity of the practice MR. HULBERT’S CASES OF LOCAL HYSTERICAL AFFECTIONS. 407 in question, and then to display the advantage of an opposite plan of treat¬ ment. Case I. — M. B., a healthy looking young woman, who had previously en¬ joyed an almost uninterrupted exemp¬ tion from illness, and w as employed as a dairy-maid at a large farm, where she had been frequently exposed to the vi¬ cissitudes of the weather, applied to me in consequence of suffering severely in her back, with inability to move from one place to another. Whilst motion¬ less in bed she was comparatively free from pain, but she felt acutely when en¬ deavouring to sit up, or to turn herself on either side. She referred the com¬ plaint to her getting wet through when milking, and continuing afterwards in her damp clothes, at a period when more -than ordinary care was required. Con¬ sidering the case to be an inflammatory affection of the sacro-ischiatic ligaments, partaking of the character of lumbago rheumatica, I had recourse to venesec¬ tion, and directed her to have leeches applied to the part, and also gave her a saline aperient mixture, with colchicum. She was much improved by this treat¬ ment ; but her employers, dreading the expense and inconvenience of her con¬ tinuing with them, especially as she had no relations residing in the neigh¬ bourhood, had her removed to the paro¬ chial poor-house. The removal brought on a renewal and increase of the symp¬ toms, for w hich I adopted a similar plan of treatment to that just mentioned, and subsequently employed cupping and blistering as topical remedies, and gave her a mixture composed of the liq. am- mon. acetat., misturee camphor®, and pulv. ipecac, co. (in the proportion of six grains of the latter to a dose) three times a day. Considerable amendment ensued, and there appeared a probability of her being soon enabled to leave the house, and return ag*ain to service. She was, indeed, so far recovered, that I dis¬ continued seeing her oftener than once in two or three days. Calling one morning with the expectation of finding her below, engaged in some light occu¬ pation, 1 was desired to walk up stairs, where I found her in a horizontal pos¬ ture on a mattress ; and was informed that some ladies had been to see her, who had sent another medical man, and he had given directions for her continu¬ ing in that position for twelve months. As my term for attending at the house was nearly expired, and the practitioner who had given these orders would in a few days become the parochial surgeon for the ensuing year, according to pre¬ vious arrangement, I made no comment upon the affair in the presence of the patient, but in conversation with the Master of the house, who expressed his regret that I had been treated, as he Expressed it, “ so unhandsomely.” I requested him to inform the parties that they had acted incorrectly , in placing the patient under another surgeon, and having the treatment altered, without making me acquainted therew ith ; and I also added, that the treatment he had adopted would, if continued, prove inju¬ rious to the welfare of the patient. In alluding to the ladies, whom I re¬ presented as acting “ incorrectly,” I had 110 intention of reflecting upon their conduct in a general way ; it was solely concerning what has frequently proved a source of great annoyance to the sur¬ geon, as many of your readers have with¬ out doubt experienced— -namely, the in¬ judicious interference of recommending a favourite practitioner, or a peculiar or fashionable theory, to which some prac¬ titioners, from motives of self-interest (and contrary to their better judgment, if they acted honourably and consist¬ ently), are not unwilling to accede. As regards the ladies in question, I had many opportunities of witnessing their benevolence and humanity, which me¬ rited the highest commendation ; but could not consider their knowdedge of pathology sufficient to justify the re¬ presentation of any who disapproved of a plan of treatment they recommended, as guilty of folly or ignorance. At different times subsequently I in¬ quired respecting the progress of the case, and was informed that the patient did not improve, but appeared to be gra¬ dually declining in health. At length, about nine or ten months from her being condemned to the horizontal posture , a surg'eon from a neighbouring town was requested by the same ladies to see her, who at once declared the plan of treat¬ ment which had been adopted was in every respect w rong, observing, that she ought not in the first instance to have been submitted to it, as she did not ap¬ pear to have had any spinal disease whatever; and that the only remaining 408 MR, HULRERt’s CASES OF LOCAL HYSTERICAL AFFECTIONS. chance for her recovery was an imme¬ diate removal to a more airy and cheer¬ ful situation, where she could have the advantage of easy or gentle exercise, if able to bear it, with other means for in¬ vigorating her debilitated system, which appeared to be sinking under the effects of consumption. This far more correct and rational plan was adopted ; but too late. I called upon her after her re¬ moval, at her request, and found her hectical, emaciated, and gradually yield¬ ing' to that fatal disease, phthisis, to which she fell a victim in a few weeks. Case II. — It was, as above stated, about two years before the occurrence of the preceding case, that, in correspond¬ ing with a young surgeon who had been my pupil, in one of his letters he mentioned several particulars relating to a young lady, whose parents resided in the town in which he was then living as an assistant, in whose welfare he felt a lively interest. She had been labour¬ ing’ for some time under considerable debility, with occasionally severe pain in the inferior dorsal and lumbar verte¬ brae. Several practitioners had been consulted, and amongst others a cele¬ brated physician in a neighbouring city, and also a surgeon to a county hospital, a man of considerable experience, and of acknowledged and well-merited re¬ putation. By these she had been di¬ rected to be confined to the horizontal posture for a period of not less than nine or twelve months. “ Knowing your views concerning similar cases,” observed my correspondent, “ I have to request your giving me your sentiments upon this.” In my reply, I advanced my reasons for concluding the opinion was erroneous respecting the local affec¬ tion, and the treatment recommended. My letter was read to the parents of the young lady, and as they entertained great dread of her being' confined for so long- a period, I was solicited to take the earliest opportunity of seeing her. In accordance with their request I visited her (at the distance of thirty miles), and, after a deliberate investigation into the general symptoms and local affection, gave, as my decided conviction, the opinion, that there was not any disease existing in the spine, and that the pain and tenderness experienced in that part did not result from any disorganization of the vertebra*, or of the intervertebral cartilages, but was merely sympathetic, or dependent upon general or constitu¬ tional disorder. The plan of treatment I advised was that of endeavouring to improve the system by tonic medicines, diet of a nutritious or invigorating quality, and gentle exercise in the open air, with the occasional use of the shower-bath and flesh -brush. The season of the year was favourable to recovery, it being- early in the summer ; and I was gratified by the result ; for in the space of two months she was so far recovered as to be able to visit a relation above a mile from the town, walking all the way; and was soon after perfectly restored to health. The subsequent history of this case has been truly satisfactory. My patient has since that period enjoyed good health, with an exemption from the local disorder. She afterwards mar¬ ried the young surgeon, who is now in excellent practice in one of the principal cities in the west of England ; and she has become the mother of five fine and healthy children. I shall forbear an extended comment on these cases, as it is probable similar ones have come before the observation of many of your readers. The first I consider as an exemplification of the evil effect of pertinaciously adhering to mistaken theory, and the second as a happy illustration of the good resulting from a departure from theoretical opi¬ nions (as reg'ards any peculiar method or plan of treatment), notwithstanding they may have obtained sufficient pub¬ lic approbation to render them w hat has been denominated popular or fashiona¬ ble, or to have been recommended by some of the most eminent members of the profession. Had the first been al¬ lowed the use of her limbs, and occa¬ sional exercise without fatigue, in all probability she would soon have ob¬ tained a restoration to the enjoyment of health ; and had the second undergone her nine or tw elve months’ confinement to the horizontal posture, it is not un¬ reasonable to conjecture that she would not, as she is at present, have become the healthy parent of a fine and healthy progeny. — I am, sir, Yours very respectfully, J. F. Hulbert. 6, Trinity Square, Southwark, Dec. 8, 1836. DR. BUCHANAN ON THE CASE OF AN OPEN CANCER. 409 CURE OF AN OPEN CANCER OF THE BREAST. To the Editor of the Medical Gazette. Sir, In the number of jour journal published on the 15th Oct. a very brief account is given of a case of cancer of the mamma, treated last spring’ in the Glasgow In¬ firmary with bydriodic acid. Through the kindness of Dr. Craig’, Hig'h-Street, under whose care the patient now is, I have procured the following history of her case, subsequently to the time of her being dismissed as iucurable from the Infirmary. I consider myself in some degree bound to publish this his¬ tory, in consequence of its being in direct opposition to the very unfavour¬ able prognosis recorded in your jour¬ nal ; and Dr. Craig and myself concur in thinking that it will probably not be read without interest by your profes¬ sional brethren. I extract the original case from the Infirmary Journal (see Journal for 1836, Ward No. 8, pp. 131, 132, and 139), and shall add the subse¬ quent history and an account of the pre¬ sent state of the disease. Janet Herriot, set. 40, married. Cal- ton, Jan. 21, 1836. — About three years ago first observed a small tumor, about the size of a common pea, situated at base of nipple of left mamma. It gra¬ dually increased in size, its growth be¬ ing accompanied by occasional attacks of lancinating pain. It now occupies about one-half of the gland, being about two inches and a half in dia¬ meter. It is hard, and pretty regular in its form, and moves freely on the pectoral muscle. Three weeks ago the skin surrounding the nipple became chapped and ulcerated. Ulceration has spread considerably, sore now measur- ing about an inch and a half in diameter. The nipple has been absorbed, and sur¬ rounding integuments are of a livid hue. Eight days since had a rigor, fol¬ lowed by pain, swelling, and redness along the lower border of the pectoral muscle, and slight enlargement of axillary glands. Since this attack, pain and uneasiness have much increased, and have been accompanied by a de¬ gree of feverishness. Health previousl y good ; tongue whitish, somewhat florid at tip ; bowels costive ; catamenia re¬ gular, and always preceded by increase of pain of breast. Loco dolenti admoveantur Hirud. x. et postea Cataplasma. Cras m. s. 01. Ricin. Ji. February 13th. — Inflammation of lymphatic glands having been subdued by leeching, and a consultation having’ sanctioned the removal of tumor, should patient desire it, the day for operation was fixed, but it was not performed, in consequence of a slight attack of erysi¬ pelas: redness of surface now gone, but there remained under skin covering pectoral muscle several hard lines, size of whip-cord, and a gland above cla¬ vicle is now felt hardened and enlarged. Sum. ter indies Acid. Hjdriodie. Liquid, ^ss. March 26th. — Has used hydriodic acid since last report. No change in glands of axilla and above clavicle ; tumor of mamma larger, and ulceration deeper, more extensive, and very foul. Little change in pain, though for the last two days it has been aggravated ; pulse 84; general health pretty good. Dismissed, with advice to use hem¬ lock poultice, &c. &c. November llth. — The patient now resides in New Vennal, and is better known by the name of Mrs. Williamson. According to the account she gave yesterday to Dr. Craig* and myself, for about three months after she left the Infirmary the sore of breast continued to increase in size, and her general health to decline. When the sore was at the largest, it was as broad as the mouth of a tea-cup, and very deep : it had the same foul appearance as when she left the hospital, and yielded a thin dark-coloured discharge, which she compared to moss-water, and which was so profuse as to soak through the dress¬ ings, and keep her clothes constantly wet: the foetor was loathsome to herself and all around her. At this period she had an attack of dysentery, which re¬ duced her strength to a very low ebb, and dried up the sore ; hut on the dy¬ sentery subsiding, the discharge return¬ ed. About ten weeks ago she was recommended by a friend to apply citrine ointment, and after various unsuccess¬ ful attempts to procure what she con¬ sidered the genuine ointment (for she was particularly warned against a bastard kind of it), she succeeded in 410 MR. NOBLE ON THE NERVES OF TASTE. procuring1 from Dr. Craig1 an ointment with w hich she w as satisfied, and which was the unguent, citrin. dilut. of the Edinburgh Pharmacopoeia. On the application of this ointment, the sore began to improve ; it was a good deal better when Dr. Craig first saw it, and from that time the filling up and cica¬ trization of the sore have gone on with¬ out interruption. The patient ascribes her cure partly to the ointment and partly to her good nature , which she says she was always confident would carry her through. On examining the breast, the cicatrix left by the sore was found to be about two inches in diameter, indurated, and quite flat. No ulceration could be per¬ ceived upon it, but in the centre there was a thin crust, which, according to the patient, consisted of the ointment applied, but which seemed, in part at least, to be formed by an exudation from beneath. The surrounding parts seemed quite healthy. Several of the axillary glands were enlarged ; one of them, in parti¬ cular, was as large as a chesnut, and very hard. No trace of the enlarged lymphatic vessels, or of the gland above the clavicle, could be discovered. No pain or any other uneasiness is felt, ei¬ ther in the breast or the axilla. Her general health is perfectly g’ood ; strength quite restored ; tongue clean, and pulse natural. The preceding case is interesting, as establishing that a genuine cancer of the mamma does admit of being cured, to whatever circumstances the cure is to be ascribed. That the disease w as really cancer no doubt can be entertained. The period of life at which the tumor occurred, its progress, and, above all, its characters cognizable by sight and touch, were such as could leave no doubt in the mind of any person in the habit of examining such cases, as to the true nature of the disease. At a full consultation held upon the case, no difference of opinion was ex¬ pressed as to the nature of the disease ; but, as very often happens in the ad¬ vanced stage of cancer, while one- half of the gentlemen present recommended that the woman should be allowed to die in peace, without being subjected to the pain of an operation, which they thought would only accelerate her fate, the other half considered it right to give to her whatever chance of life excision might hold out. If any further evidence of the truly cancerous nature of the disease were re¬ quired, it is unfortunately still to be found in the state of the glands of the axilla, which, I regret to say, have too much of the characters of cancer. That these glands will not hereafter give trouble, and that the woman can be considered as free from all risk of a re¬ currence of the disease, it would be rash to predict. All that can be said, in the meantime, is, that a cancerous sore of the breast, instead of going on from bad to worse till the destruction of life, after spreading to a certain size began to improve, and ultimately healed, the pa¬ tient at the same time recovering her health and strength. With respect to the remedies which were used, the patient took the hy- driodic acid internally, and had poul¬ tices and citrine ointment applied to the sore. The hydriodic acid was begun soon after the ulceration commenced, arid w as continued for forty-two days ; the quantity of iodine taken being 2460 grains. The iodine appeared as usual in the urine, but never could be detected in the discharge from the breast. The poultices were applied during the early stage of the ulceration, and the citrine ointment was not re¬ sorted to till after the sore had spread to its utmost extent. What share these remedies had in the cure which was ef¬ fected, or whether they had any share in it, cannot be determined by the re¬ sult of a single case. Farther experi¬ ence of their effects is therefore re¬ quired ; and while the acknowledged inutility of all other remedies will ope¬ rate as an inducement to make fresh trials, it cannot fail likewise to cast doubt in the meantime on the probabi¬ lity of their success. — I remain, sir, Your very obedient servant, Andrew Buchanan. Glasgow, 1 10, St. Vincent-street, Nov. 12, 1836. “ WHICH ARE THE NERVES OF TASTE ?” — NOT VET DETERMINED. To the Editor of the Medical Gazette. Sir, In a late number of the Medical Gazette* you have given insertion to a * Present vol. p. 225. MR. NOBLE ON THE NERVES OF TASTE. paper by Dr. Alcock, of Dublin, where¬ in the author assumes to have deter¬ mined the question relative to the ner¬ vous connexions of the sense of taste. I propose to oiler a few remarks upon the inferences which have been deduced from the experiments narrated in this paper, inasmuch as it appears to me that they are by no means warranted by the premises, and that, as some of them are totally at variance with recognised principles in physiology, we must look for evidence of a much more decisive character, before Dr. Alcock can be allowed to have determined the question “ which are the nerves of taste?” Dr. Alcock, at the conclusion of his paper, observes — “ I feel justified in drawing the following inferences from the experiments and reasonings which have been detailed : 1st, that taste is a special sensation ; 2d, that it enjoys tw o media of perception ; 3d, that its media of perception are the glosso-pha- ryngeal nerves, and the lingual and pa¬ latine branches of the fifth nerves; 4th, that the glosso-pharyngeal nerves are not its special media ; 5th, that the lat¬ ter nerves both are sentient, and influ¬ ence muscular action; and 6th, that the spheno-palatine ganglion and chor¬ da tympani, have no influence upon either the existence or perception of the sense.” With the first of these propositions I shall certainly not find fault; but I deny that it is proved by the experi¬ ments of Dr. Alcock. It appears to me that, if we may rely upon the accuracy of his data, “taste” is not a special sensation, inasmuch as it is dependent upon no special nerve, but associated with two nerves whose main functions, according to Dr. Alcock, are, the one for “ muscular action,” and the other for “common sensation;” just as if these nerves disposed of a little superflu¬ ous endowment to produce the sense of taste. However, that taste is a specific sensation, and not a modification of the common tactile sensibility of the tongue, T consider to be fairly established ; I believe the conclusion to be fully war¬ ranted by certain cases, with experimen¬ tal investigations, observed by the pre¬ sent writer, first published in the Medi¬ cal Gazette, and afterwards appearing in some of the Continental and Ameri¬ can journals. I assume no originality in having long doubted the accuracy of 411 the popular doctrine that taste was only a modification of common sensation ; but, until it shall appear that I have been anticipated in my observations, I must claim priority in having de¬ monstrated , by the best kind of evi¬ dence, that “ taste is a special sensa¬ tion.” If reference be made to the Medical Gazette of Oct. 25th, 1834, a paper of mine will be found, wherein the follow¬ ing conclusions are assumed to he war¬ ranted, from previously recorded experi¬ ments upon a patient labouring under one of the forms of facial paralysis, “ that whilst the common sensation of one half of the tongue was annihilated, the sense of taste was unimpaired. Does not the above case decide that taste is something more than a modification of common sensation ? And if so, must it not, as in the case of smell, be depen¬ dent upon a specific nervous supply?” In the Gazette of Nov. 21, 1835, another case of facial paralysis, which I had investigated, was published, and the following- remarks occur towards the conclusion of the paper. — “ These experiments were considered to render it clear that, in this case, whilst the common sensibility of the left half of the tongue w as but little impaired, its specific feeling w'as lost.” These cases, then, manifesting, in one instance, loss of feeling with mainte¬ nance of taste, and, in the other, loss of taste with maintenance of feeling, it w'ill, I think, be generally allowed that the inference which I have always drawn from them is warranted ; and I regret that in assuming to have deter¬ mined, amongst other things, that “ taste is a special sensation,” Dr. Alcock has not had the candour to refer to what had been previously offered to the pro¬ fession by myself. He may certainly have been unacquainted with the full share which I have had in the discussion of this question, though it is somewhat singular that he should have shewn himself to be well acquainted with some of my suggestions , and yet be in igno¬ rance of the facts with which those mere suggestions have been accom¬ panied. I remarked at the outset of the pre¬ sent communication, that some of Dr. Alcock’s inferences were at variance with principles generally recognized in physiology. The proofs of this may be 412 DR. KEMP ON BROMIDE OF IRON. demanded. Is it not, then, a recog¬ nized principle in the physiology of the nervous system, that a simple and spe¬ cial function must have but one simple nerve for its manifestation ? and, reci¬ procally, that a nerve whose origin is simple, can subserve one function only ? Let Sir C. Bell, and other leading au¬ thorities, decide this point ; a reference may readily be made to their works. Well, but Dr. Alcock infers, in the se¬ cond place, that taste, which he allows to be a special nerve, has two media of perception ; and, thirdly, that these me¬ dia are the glosso-pharyngeal nerves and certain branches of the fifth pair ; and, fourthly, that the glosso-pharyn. geal nerves are not its special media, though nerves of a special sense ; and, fifthly, that the latter nerves (whose simplicity of origin is not questioned) perform two functions — the functions of both motion and specific sensation. Without proceeding farther, has not enough been said to shew the inconsist¬ ency of Dr. Alcock’s inferences with some of the best established principles in physiology ? But it will be contend¬ ed, that if facts disprove the correctness of such principles, these latter must be modified so as to accord with the facts. Most assuredly; such reasoning is un¬ exceptionable. But the accuracy of the facts themselves must first be esta¬ blished ; and that Dr. Alcock’s paper furnishes the proofs of such accuracy, most, I conceive, will be inclined to dis¬ allow. I do not, however, propose to examine seriatim, and in the detail, the ■various proceedings which were adopted in this gentleman’s experiments ; but I protest altogether, and in the wholesale, against the possibility of coming* to certain conclusions, upon such a subject, by mutilation of living animals. So far as such experiments could be considered to have proved any thing, those of Pa- nizza demonstrated that the glosso¬ pharyngeal was the nerve of taste, to which conclusion no argument from analogy could be opposed ; but shortly after the publication of their perform¬ ance they were repeated by Mayo, and with contrary results. And again, Dr. Alcock’s experiments would prove Pa- nizza and Mayo alike to be both right and both wrong*. I must reiterate, the whole procedure, as a means of “ deter¬ mining” the question, is, in my own humble judgment, unsound and falla¬ cious. It is to pathology, and to morbid ana¬ tomy, that I look for the ultimate settle¬ ment of this matter. Pathology, I con¬ sider, has proved that taste is a special sense, and I expect that morbid anatomy will hereafter reveal its special nerve. I am, sir, Your obedient servant, Daniel Noble. Manchester, Nov. 29, 1836. PREPARATION OF BROMIDE OF IRON. To the Editor of the Medical Gazette. Sir, I hardly know whether I am correct in troubling you with the following re¬ ply to Mr. Squire’s note, in the Gazette for last week; indeed, the relative me¬ rits of the bromide and iodide of iron are not of sufficient interest to justify any lengthened consideration of the matter in a periodical which has always subjects of vastly higher importance to introduce to its readers. The decomposition of the bromide of iron will be exactly proportionate to the purity of the preparation, and this will depend mainly on two circumstances — the state of the iron which is made use of, and the accuracy of the manipula¬ tion. With reference to the first, I beg to remark that the use of iron filings is extremely objectionable, even when se¬ parated by the magnet; not that I can suppose that a wholesale drug-vender would even make use of this simple ar¬ tifice to produce a pure article. To ob¬ viate any chance of impurity from the iron, I have directed fine iron wire, in the form of a coil, to be used. There is also an important point to be observed in the manipulation. In eva¬ porating the solution, a very gentle heat must be used, or the bromine will be separated in the form of gas. It is to a preparation made with these precautions that I alluded when I stated that it could be kept in a state of solu¬ tion for weeks, without any appreciable decomposition taking place. I had made a series of careful experiments be¬ fore I presumed to send you my paper, ACCUMULATION OF FAECES IN THE LOWER PART OF RECTUM. 413 some of them verified by repetition, un¬ der very unfavourable circumstances; and as to any attempt on the credulity of your readers, no man, with any claim to sanity, would, with such an object, have communicated his name and ad¬ dress. A coil of wire will certainly render the solution of the iodide less liable to de¬ composition, but a coil of wire cannot be sent in a mixture to a patient. The so¬ lution of the bromide needs no such pre¬ caution, if originally well prepared. I must again apologize for even giv- iug you the trouble of reading this ; in fact it is a matter of perfect indifference to me, whether the iodide or bromide be preferred. I had observed certain advantages occur during the adminis¬ tration of a therapeutical agent, and having good reason to suppose that the benefit and medicinal preparation stood in the relation of cause and effect, I felt justified in recording the same, with the hope that publicity would elicit truth. — I have the honour of subscribing myself, sir, Yours very respectfully, George Kemp. Cheshunt, December 6, 1836. P.S. — Mr. S. speaks of the coil of wire keeping the solution in a neutral state ; the fact is, that what, for brevity, I have called a bromide of iron, is a per -bromide. EXTRAORDINARY ACCUMULATION OF FAUCES IN THE LOWER PART OF THE RECTUM. By James Heygate, M.D. M.R.C.S. London, and Physician to the Derby¬ shire General Infirmary. An occurrence of the following nature, at least to the extent mentioned, .does not frequently happen, and when it does it must be attributed to neglect. The only practical advantage to be gleaned from its recital, is to put physicians on their guard should a like occurrence befall them. Much distress is often ex¬ perienced by elderly bedridden patients from a similar, though lesser evil, of this sort; many of whom are not able to describe their own feelings. Whenever, therefore, they suffer from obstinate constipation, and where the administra¬ tion of active aperients only increases the distress, it is most important to ascertain the state of the rectum, and see whether some insuperable barrier, in the shape of hardened faeces, do not present itself. The ineffectual at¬ tempt of the nurse to introduce an enema pipe has frequently been the first indica¬ tion of such a cause. Mrs. S. between 60 and 70 years of age, (who had been for some time pre¬ viously bedridden) told me that for some days she had suffered most excruciating pains in the lower part of the rectum, which came on at tolerably regular in¬ tervals, assuming precisely the cha¬ racter of the pains of parturition. I questioned her as to the state of her bowels, and she told me that they were quite open, and that frequently some loose evacuation came away; this led me to suppose that the pains might be produced by some peculiar irritation, or ulceration, &c. As she was very reluc¬ tant to be examined, I prescribed some medicine calculated to relieve pain. I was however summoned early the next morning, and told by the daughter that her mother had had a most dreadful night, with “ the forcing down pains.” Having now acceded to an examination, I immediately found that an immense hard, dry ball of fseces, was making fruitless though strong attempts to pass the anus, which was greatly dilated ; so much so, as to be compared to nothing better than the os uteri, when pressed upon by the caput of the descending foetus, and dilated to the size of a crown piece or more. Mrs. S. being very thin, and the sur¬ rounding- parts greatly attenuated by pressure, I could with my fingers dis¬ tinctly trace the size of this hard ball, the form and circumference of which, was, without exaggeration, similar to the head of a full-grown foetus. Notwithstanding her exhausted state, nature had made most extraordinary efforts to dilate the anus sufficiently to pass this hard ball of clay, which it resembled both in colour and consistency. After ascertaining* as nearly as possible the extent of the accumulation, I with the handle of a tea-spoon (having* no better instrument at hand) with some difficulty broke down the mass and brought it away piece-meal, and then ordered an enema to be administered, 414 method of observing the structure of the brain. which effectually removed the remainder. Strict injunctions were enforced, calcu¬ lated to prevent a recurrence of this evil. I ought to have said, that on exami¬ nation, some loose feculent matter was found to pass with the pains — it escaped round the sides of the ball. This ap¬ parent action of the bowels prevented, in the first instance, all suspicion of the cause of the ailment, and deceived both the patient and myself. Derby, Nov. 10, 1836. THE METHOD OF OBSERVING THE TUBULO-FIBROUS structure OF THE BRAIN. To the Editor of the Medical Gazette. Sir, The admirable discovery of Ehrenberg, of the fibrous structure of the brain, not having been observed in this coun¬ try, it may be interesting to many of your readers to learn in what manner it may be seen ; for even as a microscopic object, a more beautiful and delicate one I have not examined, while, in a physiological point of view, its high im¬ portance is evident to all. The brain which I examined was that of a sheep, which had only been killed about half an hour ; it had been immersed in weak spirit, which corru¬ gates it, and should not be used ; it must, however, not be allowed to dry. Exp. 1. — I cut a thin transverse section of the tr actus opticus *, and placed it, with a little water, between two slips of glass, using a slight pres¬ sure. When this was placed under the microscope, charged with a power equal to a single lens of one-twentieth of an inch focus, the whole appeared as com¬ posed of a granular amorphous mass, surrounded by a thin transparent mem¬ brane. On more attentive examination, the particles appeared to me to consist of short broken fibre, but the evidence was not sufficient to come to any posi¬ tive conclusion; though I felt convinced they were not globular. * Mr. Lomas kindly furnished me with the brain. Exp. 2. — I now carefully cut out a small longitudinal piece from the same part of the brain, laid it on a slip of glass with a little water, and covered with a very thin plate of mica ; avoid- iny even the slightest pressure. Under the same amplification the edges ap¬ peared irregular, but no fibrous charac¬ ters could be discovered. I now charged the instrument with a power equal to a single lens of one-fiftieth of an inch focus; using a fine achromatic object glass, with an aperture of 55°. 1 could now distinctly see fibre (indeed the whole mass appeared composed of it), but I could not decide whether it was tubular ; nor was the evidence sufficient to say whether they were of uniform diameter throughout their length. On placing a diaphragm, with a condenser, behind the stage of the engiscope, to direct the light properly through them (an arrangement always advisable for the examination of cylindrical bodies*), I was enabled, without altering- the power, to see the enlargements at cer¬ tain intervals, and also to determine that the fibre was tubular, as shewn in the fiofure. The tubes near the ed«-es having separated, their structure was quite evident. The diameter of the constricted parts, I find, varies from I-1500th to l-18O0th of an inch. Hoping the above will be useful in enabling others to verify this valuable discovery, I remain, sir, Your obedient servant, Andrew Pritchard. 263, Strand, Dec. 7, 1836. * See Microscopic Cabinet, p. 155. POISONING WITH UNSOUND BACON. 415 ACCOUNT OF THE LATE CASE OF POISONING WITH UNSOUND BACON. To the Editor of the Medical Gazette. Sir, I beg leave to correct two mistakes into which the reporter for the Times has fallen, in his account of the inquest on the body of Caroline Jones, whose death, the jury were of opinion, was occasion¬ ed by eating1 diseased or unwholesome bacon, and which report has been trans¬ ferred to your columns. The medical witness on the occasion was myself, whilst in the report be is described as “ Mr. John Thomas, surgeon to the hospital.” Again, in the evidence of Richard Jones, the father of the de¬ ceased, a mistake occurs. Instead of “the servant had gone out with a younger child,” &c., it ought to have been, “ the deceased had gone out,” &c. As the case is one of some interest and importance in a medico-legal point of view, and as the medical history, as given in evidence, was necessarily brief and defective, I take this opportunity of furnishing you with a more detailed ac¬ count of the symptoms and post-mortem appearances. I was gratified to find that the view which you have expressed of the case in your editorial capacity, is the one that seemed most satisfactory to my own mind, although I must observe that, at the dissection, there were some gentle¬ men, including one of the physicians to the hospital, who regarded the appear¬ ances as the result simply of continued fever, w'ith severe abdominal complica¬ tion. These gentlemen, however, had not, I believe, watched the progress of the case. On the other hand, it has been, and I think not without reason, suggested, that the severity of the symp¬ toms was such as to lead to the idea of a mineral, rather than an animal poison ; and allusion was particularly made to the possibility of the bacon having been cooked in a dirty copper vessel. At my suggestion, therefore, {)articular inquiry was directed to this lead at the inquest, but there did not appear to he the least ground for sup- Eosing that any mineral poison had een introduced into the meat, either by carelessness, accident, or design. — I am, sir, Yours very respectfully, John Thurnam. Westminster Hospital, Dec. 1 1, 1836. Caroline Jones, aged 14, was ad¬ mitted into St. Margaret’s Ward, West¬ minster Hospital, November 8th, as a patient of Dr. Bright. She complained of extreme pain in the epigastric and right hypochondriac regions, which was greatly aggravated by pressure, with almost constant and profuse diar¬ rhoea; some tenesmus; evacuations fluid, watery, and deficient in biliary matter. There was considerable ema¬ ciation; countenance generally pale; centre of each cheek flushed ; features expressive of intense suffering, being drawn into a sardonic grin. She lay in bed on the right side, with the knees drawn up to the abdomen. Skin rather hot and dry; tongue very dry, covered with a thin brown coating ; lips parched, and rough ; pulse very frequent, small, and wiry ; thirst excessive. App. Hirud. xx. regioni Hypocliond. dext. R Hydrarg. c. Creta, gr. v. Pulv. Ipe¬ cac. Comp. gr. vij. M. ft. pulvis sta¬ ff m sumend. 9th.— R Pulv. Creta? Co. 3j. Hydrarg. c. Creta, Dj. Pulv. Ipec. Co. 3ss. M. ft. pulveres, viij. Capt. j. ter quo- tidie. This treatment wras persisted in, with but very temporary relief ; the leeches, in diminished number, being repeated at intervals of from tw o to seven days. One of the most prominent symptoms at this period was the extreme thirst ; the quantity of milk and water, of bar¬ ley and toast-water, that she consumed, being excessive. 19th. — Rep. Hirud. viij. R Hydrarg. Submuriat. gr. j. Opii, gr.£. M. ft. Pilul. ter quotidie sumend. 22d. — App. Emp. Canth. Epigast. A day or two after this a little im¬ provement appeared to be taking place ; the pain became less severe, and, indeed, gradually left her, but she still suffered from extreme tenderness. The counte¬ nance became less expressive of suffer¬ ing, and the cheeks less flushed ; the tongue wascleaner, and the appetite im¬ proved so much that she asked for ani¬ mal food, and was allowed a mutton- chop. The pulse became fuller, softer, 416 INCISION OF THE PERINEUM IN LABOUR. and less frequent. The diarrhoea still continued, but in a less severe degree. About the 29th or 30th of November she was rather suddenly taken worse ; the pain and tenderness upon pressure returned with increased severity ; every symptom wras greatly aggravated ; slight delirium came on ; the countenance was anxious and sunken, the features being occasionally distorted ; some strabismus was noticed occasionally. Emaciation made great progress, the powers of life gradually sank, and she died Dec. 2d. Inspection of the body , 16 hours after death. — Brain healthy. Thoracic vis¬ cera free from disease, with the excep¬ tion of a few crude tubercles dispersed through the lungs, which organs were also rather congested. Abdomen. — The stomach contained from one to two pints of a rather thick glairy fluid, consisting* of coagulated milk, bile, and mucus ; its tunics were rather attenuated ; the mucous lining soft and grey, having a layer of viscid mucus adherent to it. There was ob¬ viously increased vascularity of this organ, chiefly affecting the capillaries and smaller arterial branches of the cul de sac, and greater curvature. The duodenum was considerably dilated, with decided thinning of its parietes ; its mucous surface had a regularly mam- millated appearance, dependent appa¬ rently upon hypertrophy of its mucous follicles; there was also a diffused blush of redness in this membrane. No farther morbid appearances were de¬ tected in the small intestine, until approaching within about twelve inches of the coecum, when irregularly-shaped patches of ulceration were met with in the mucous membrane ; these were seated chiefly in the side of the gut, opposite to the attachment of the me¬ sentery, and became larger, and deeper, and more numerous, as the coecum wras approached. Ulcers were also met with in the ascending and transverse portions of the colon, but the remainder of the large intestine, including the rectum, was healthy. One of the ulcers in the ileum, situated in the angle formed by that gut with the coecum, had produced a perforation of the canal, and this had led to a peritonitis, affecting the serous covering of the lower half of the abdo¬ minal viscera, these being* covered in many places with flakes of recently- formed false membranes, and about half a pint of sero-albuminous fluid being* present in the pelvic cavity. The me¬ senteric glands were enlarged, and pre¬ sented an increased vascularity ; upon being cut into, they reminded one most of the character of a fine erectile tissue. The other abdominal viscera did not present any abnormal appearances. THE LANCET WISEACRES ON INCISION OF THE PERINEUM IN LABOUR. To the Editor of the Medical Gazette . Sir, That the Editor of the Lancet is blessed with a due number of dull correspond¬ ents the columns of that publication leave us no room to doubt ; but we w'ere charitably enough inclined to consider the insertion of Mr. Holland’s letter as a mere oversight, and laughed at the blunder accordingly ; for we considered the letter itself a sufficient indication of the state of the writer’s mind, nor for a moment imagined that a production in which there is neither a connected sen¬ tence nor a sane idea, could have called forth a reply. It appears we were wrong. The serious refutation of poor Hol¬ land’s proposition by two separate cor¬ respondents in the Lancet, is too absurd an affair to be altogether passed over in silence. The sombre gravity of the former of these obstetric Quixotes is ir¬ resistibly comic; nor is the triumphant self-gratulation of the second less ridi¬ culous. This latter hero informs us, in a note, that in the Army the opportunities of obstetric observation are necessarily rare. What can the man mean ? We recommend the Editor of the Lancet to suppress the names of his fu¬ ture contributors from Fort Clarence . We remain, sir, Your obedient servants, Two or Three. Fort Pitt, Chatham, Dec. 12, 1836. [This letter has been duly authenti¬ cated. It may be necessary for the infor¬ mation of our readers to add, that Mr. Rolland’s, of Fort Clarence , suggestion w'as to divide the perineum at once whenever it offered any obstacle in parturition ! Fort Clarence, it is well know*n, is the place where officers of the Army, who are “ under observation,” are confined.— Ed. Gaz.] PHYSIOLOGY OF SALIVATION. 417 PHYSIOLOGY OF SALIVATION. To the Editor of the Medical Gazette. Sir, Permit me to offer a few remarks on an article entitled the “ Physiology of Sa¬ livation,” which appeared in your num¬ ber for Nov. 26, 1836. The author, in explanation of this phenomenon, proposes a theory which is novel, and somewhat ingenious. It may be briefly stated thus : — The pan¬ creas stimulated to increased action by the internal administration of mercury, pours forth in profusion its peculiar secretion. After a time it falls into a state of atony, and is unable to secrete even its usual quantity. But the full amount of pancreatic fluid is elaborated in the blood. To prevent the ill effects which would arise from its accumula¬ tion, the salivary glands, already un- usally excited by mercurial stimulation, take on increased action, and pour forth the pancreatic, or some analogous fluid. This is the physiology of salivation. Of the many objections which might be urged against this theory, it is suffi¬ cient to mention two. 1. Salivation may be excited by mercury applied ex¬ ternally, long before the chain of sequences supposed above can be esta¬ blished. 2. The pancreas is regarded by physiologists as analogous in struc¬ ture and functions with the salivary glands. Admitting, then, that exalta¬ tion of the action of an organ is followed by depression, the salivary glands hav¬ ing suffered during salivation from con¬ tinued excitement, will, after a time, become atonized, and probably the quantity of their secretion will be dimi¬ nished. But, according to the above theory, the full amount of salivary fluid will be elaborated in the blood. Inju¬ rious effects would ensue from its accu¬ mulation ; it must have egress through some channel. The pancreas, which now will have recovered its tone, seems well adapted for the purpose ; it is roused again to increased action ; but depression will follow, and the pheno¬ mena described above will be repeated. Thus there will be alternate discharges of salivary and pancreatic fluids for ever. This is absurd. It may be objected to the case I have just proposed— that the pancreas 472. — xix. had suffered no mercurial stimulation antecedent to its increased action. In the above theory it is not stated that such stimulation is the sole or necessary cause of exaltation of function. It is easy to demolish theories — it is easy, even in the absence of facts, to substitute others in their room. Far be it from me to attempt the solution of a question so difficult as the physiology of salivation — a question which involves the inquiry as to the modus operandi of mercury on the human body. I venture, however, to throw out a conjecture as to its immediate cause — -a conjecture which appears to me to de¬ rive support from the order of superven¬ tion of the pathological conditions, and from analogical reasoning’, which is just, and apparently conclusive. The symptoms attendant on a case of salivation may be arranged in three divisions. They are developed in the following order: — 1. “ Slight tenderness and tumefaction of the gums, which acquire a pale rose colour, except at the edges surrounding the teeth, where they are deep red. The mouth becomes sore ; the tongue sw'ol- len. 2. The salivary glands become tender and sw ollen ; the saliva and mucus of the mouth flow abundantly. 3. If the use of mercury be continued, aggravation of the 1st division of the symptoms; the gums slough, the teeth drop out, and there is necrosis of the alveolar processes*.” Distinct conditions are marked out by the first and second division of these symptoms. The 1st division indicates in¬ flammation of the mucous membrane of the mouth ; the 2d, inflammation of the salivary glands. Tt is evident, then, that salivation occurs subsequently to the inflammation of the buccal mucous membrane. Analogy favours the con¬ jecture that this inflammation is its im¬ mediate cause. A\ hat doctrine of pathology is more firmly established than this — that in¬ flammation of glandular structures is often excited by irritation of the surface of relation w ith which they are in con¬ tact; for example, the lesion in duode¬ nitis, the mesenteric glands in enteritis, &c. Can we refuse to apply this doc- * Pereira’s Lectures, Medical Gazette, vol. xviii., p. 388. 2 E 418 OBSERVATIONS ON PARENT-DUCHATELET’s WORK. trine to the case in question? The analogy is too powerful to be rejected. Again; stimulants taken into the mouth induce temporary salivation ; and finally, Bichat has shewn that stimula¬ tion exerted on the surface of relation with which glands communicate, is the natural mode of excitement of these organs. The conjecture, then, that salivation is a consequence of inflammation of the mucous membrane of the mouth is not unfounded. This, however, advances us but a little way in our inquiry. The question meets us as to the cause of the development of this inflammation. To treat on this subject at length would require more space than I could presume to occupy in your journal. I remain, sir, Your obedient servant, Z. December 6, 1836. ANALYSES and NOTICESof BOOKS. “ L’Auteur se tue k allonger ce que le lecteur se tue a abr6ger.” — D’Alembert. Annales eV Hygiene publique et de Me- decine legale. No. XXXII. The new number of the Annales con¬ tains several excellent articles, of some of which we can at present do little more than mention the names. On Suicide , as it prevails at the pre¬ sent period , by M. Brouc, is an ela¬ borate paper, in the composition of which the author has availed himself of extended and varied resources. The next article is M. Ratier’s prize essay on the Best means of arresting the spread of Venereal Disease. After which we have Memoirs by MM. Rengi, Santi, and Kuhlmann, on dif¬ ferent subjects of hygiene. In the department of legal medicine, we have two able papers by M. Ollivier d’Angers and Professor Froriep, of Ber¬ lin, on the determination of the ques¬ tion — What is properly to be considered a new born Child P — an inquiry ex¬ tremely necessary to be made in refe¬ rence to the French and German crimi¬ nal codes. In this country a similar question might not improperly be pro¬ posed — What, strictly speaking, is In¬ fanticide ? — for, in accordance with legal phraseology, it might imply the murder of any person under the age of one-and-twenty. An interesting medico¬ legal report on a Case of supposed In¬ fanticide is given by M. Schneider, of Fulda, communicated by M. Marc: after which comes a short case of Sup¬ posed Poisoning — but actual suicide, re¬ lated by M. Boutigny. We are glad also to find that the Editor begins to look to our English books for material in this department: he has extracted from Mr. Alfred Taylor’s “ Elements” that gentleman’s remarks on the cause of death by hanging. These, together with the Varieties and Bibliography, make up a number of considerable value. We shall give a more satisfactory account of some of the contents hereafter. A Medical Vocabulary ; or , Expla¬ nation of all names , synonymes , terms and phrases , used in Medicine and Surgery , and the relative branches of Medical Science. By a Medical Practitioner. Edinburgh, 1836. This is a very neat little manual, of which the junior student or general reader may avail himself with ad¬ vantage. There is a deficiency of good word-books in our language, the two or three hitherto published being larger than need be, and not so complete after all as their goodly bulk would lead one to expect. The Vocabulary does not make great pretensions, but what it professes to be, it is— a useful book of reference for the student. MEDICAL GAZETTE. Saturday , December 17, 1836. ** Licet omnibus, licet etiam niihi, dignitatem Artis Medicos tueri ; potestas modo veniendi in publicum sit, dicendi periculum non recuso.” Cicero. PARE NT-DUCHATE LET’S WORK. FURTHER OBSERVATIONS. It is the merit, or the demerit, of this singular work to have matter in it to at¬ tract every class of readers. The statesman (occupied only with serious OBSERVATIONS ON PARENT-BUCHATELEt’s WORK. 419 subjects), the careless lounger in tbe joffee-house, tbe grave physician, the idle profligate, the kind-hearted lover )f his species, and the hardened in pice — all may find something in it to wrest their attention. This variety of information it is, together with the un¬ reserved and candid manner of the au¬ thor, which has given the last leg’acy }f Duchatelet such vogue in the Pa- risian salons, and must confer on it notoriety, at least, wherever it circulates. We gave a brief general view of the production in our last: in our present notice we shall confine ourselves to cer¬ tain parts of it which are more imme¬ diately professional. The third and fourth chapters, for instance, are of this nature ; treating expressly of physiolo¬ gical and pathological considerations respecting the prostitutes of Paris ; also the sixteenth and seventeenth chapters, on the sanitary measures adopted by the French government in carrying into effect their extraordinary scheme of organizing vice, as it has been called. Some of the questions discussed by tbe author, relative to certain bodily pe¬ culiarities of these public women, are curious, but their interest does not rest there : they involve some very intricate physiological considerations, and in that point of view are deserving of more particular notice. Of this description is the account which is here given us of the plumpness — the embonpoint — of the personyiel of prostitutes. Excessive fatness even is observed in a great number of these females, and many reasons have been assigned for that condition of body. The most common opinion has been, that it is occasioned by the repeated use of mercury ; and several circumstances seem to have contributed to the notion. It has been seen, for example, how iquickly women who have been reduced to extreme leanness by syphilis, have recovered their vigour and health after a mercurial course : it is observed also, that the fattest are among the oldest women of the town, and consequently of the number of those who have been most frequently under treatment; and the conclusion accordingly appears to be rigorously drawn. Nor have physiolo¬ gists been wanting to countenance the supposition. Some have attributed it to the effect of mercury on the lymphatic system ; and one wiseacre even went so far as to recommend that animals intend¬ ed for the market should be fattened by a course of mercury ! Parent-Duchatelet inquired into the phenomenon without begging the ques¬ tion. He first endeavoured to ascertain whether it was a fact that those who took most mercury were most stout : and he soon found that there was no relation whatever between mercury and fatness as cause and effect. He even met with several instances of women who never had contracted syphilis, or who had not had the disorder for many years, yet were of extraordinary obesity. The true cause, as the author suggests, is to be found in the idle inactive life led by prostitutes, together w ith the abundance of aliment which they consume. Another peculiarity is the change of voice noticed in certain prostitutes. A hoarse masculine tone is contracted, and it has been attributed by some to cir¬ cumstances connected with their sexual habits — tbeir loose profligate debauchery causing them to lose that delicacy of intonation properly belonging to the female. Our author is not satisfied w ith this explanation ; though we con¬ fess we should require stronger reasons than he gives us before we would yield the impression we entertain that there is some connexion between the abuse of the sexual character, and the alteration of the vocal organs : his idea is, that it is owing to repeated drunkenness, and 420 OBSERVATIONS ON PARENT-DUCHATELET’s WORK. the chills to which these unhappy wretches are exposed. Here, however, we doubt whether his conclusions have been slathered in his usual cautious manner. We are obliged to pass over several curious subjects of inquiry — relative to the colour of the hair and eyes more or less frequent with prostitutes (considered of course as indicative of their tempera¬ ment) — their stature and general ap¬ pearance : these we must leave undis¬ turbed in the volumes, to be explored by readers who take a special interest in such researches. Nor can we dwell on the remarks made by the author respect¬ ing- the state of the sexual organs in the prostitutes ; the subject is one of much importance in a medico-legal point of view, but cannot well become a topic in our present summary of Duchatelet’s labours. There are few opinions more gene- rally received in the medical world, than that of the sterility of prostitutes ; but it does not stand the test of fact,— it proves to be an exaggeration. It is true that the number of accouchments which take place amongst them is much less than what might be expected from so many women of between 18 and 25 years of age; but when we find, on re¬ ferring- to the register of the Bureau des Moeurs, from 1817 to 1822, an ave¬ rage of about 51 accouchments annually, while at the Hopital des Veneriens, at the prison, and the Maternite, the average is above 63, to which we should add the seven or eight deliveries which occur yearly at the private residences of some of the women, — who shall say that prostitutes are sterile? Nay, we ought to take into account a certain number of abortions likewise, not inconsidera¬ ble neither, but regarding which the statistical returns are not exact. In treating of the diseases of prosti¬ tutes, the author notices— 1, those mala¬ dies which are immediately connected with their mode of life ; and, 2, those which are common to them with other women. Of the first description are, uterine haemorrhages, tumors of the ex¬ ternal organs, recto-vaginal fistuloe, can¬ cer of the womb, convulsive diseases, and mental alienation. In the second category he places syphilis ; and pro¬ bably to many readers the details given respecting the latter disease will seem the most valuable in the whole work. We gave some account last week of the police arrangements which exist in Paris relative to the registering and vi¬ siting’ the flies puhliques. It may be proper to add some further particulars regarding the mode in which the visits are managed. They are conducted by the physicians of the dispensary in three different ways : — 1. The most general practice is for the women to come to the dispensary to be inspected ; this they are obliged to do twice a month. The act of inspec¬ tion is performed with great adroitness : the person examined is placed sur un fauteuil el eve a dos reinverse. Each me¬ dical attendant may thus visit 25 women in an hour, entering the results of his observation at the same time in the re¬ gisters. 2. At the establishments of the dames de maison , visits take place once a week, or four times a month. Each medical man belonging to the dispensary Has his particular district. The hour of vi¬ siting being' fixed, all the women, are obliged to be present. The results of the inspection are recorded as in the former case. 3. Another system of visiting takes place at the depot of the prefecture of police. This depot is a sort of prison, perhaps somewhat resembling our sta¬ tion-houses. It is a temporary place of detention for persons taken up during the night for robbery, breaches of the OBSERVATIONS ON PARENT-DUCHAT E L ET ’ S WORK. 421 peace, &c. ; and among* the prisoners are generally found a number of jiUes puhliques. These are lodged in a sepa¬ rate room ; and it is customary not to suffer them to leave the place till their state of health is ascertained. The practice is the more necessary, as these prostitutes are often found to belong to the class denominated insoumises, and who have thus escaped regular in¬ spection previously. A surgeon from the dispensary, therefore, makes his vi¬ sit to the depot every morning, and en- ters the particulars in his journal. Such were the sources from which M. Parent-Duchatclet drew his statis¬ tics of syphilitic disease. From the dispensary registers in particular he was enabled to g’ather facts demonstra¬ tive of the frequency of venereal, as well as of those conditions of the wo¬ men most apt to contract it. The fol¬ io wins* table will show some of the results. Suppose we desire to know the frequency of venereal maladies occur¬ ring* in the whole prostitute population of Paris, comprising those in the pri¬ sons and hospitals, we have the follow- ing proportions # Infected. In 1812 average 1 in 28 1813 c • • ... 21 1814 ... 19 1816 ... 25 1817 c • • ... 32 1818 ... 38 1819 ... 44 1820 • • • ... 44 1821 ... 52 1823 ... 39 1824 ... 33 1825 • • • ... 32 1827 ... 27 1828 • ■ • ... 2.j 1829 • « • ... 29 1830 ... 33 1831 • • • ... 29 1832 • • • ... 47 It will, however, he desirable, in or¬ der the better to comprehend the re¬ sults of the sanitary surveillance, to observe separately the returns made for those women who live in the maisons puhliques , as well as for those wbo though living* isolees , have always been under observation. In Maips. ubl. Isoldes 1812 1 in 20 1 in 39 1813 ... 13 ... 32 1814 ... 9 ... 28 1825 ... 8 .. 25 1826 ... 9 ... 23 1828 ... 11 ... 42 1829 ... 22 ... 57 1830 .. 33 ... 57 1831 ... 28 ... 43 1832 ... 26 ... 60 How very different these results ap¬ pear! At first sight it would seem as if the women in the maisons puhliques were by far the more infected set, and the more dangerous, as tending to spread the disorder. Blit, as Parent- Huchatelet observes, there are a consi¬ derable number of the isolees to be de¬ ducted from the account— those, for ex¬ ample, who are more properly thieves ( vo - lenses ), who use the veil of prostitution only for the purpose of carrying on their trade more successful!}" — also another class “ ces vielles filles laides decrepites et degoutantes, qui se designent sous le nom de manuelles , et qui, par la nature de leur actes, sont tres raremeut ex- posees a contracter la maladie veneri- enne.” Such are many of the isolees . We should also add, that the girls of this class are visited at longer intervals than the others : they may not be in¬ spected for 20 or 25 days together — while the jilles of establishments, as we have already stated, are examined re¬ gularly once a week. Among* the insoumises the population of the infected is enormous, varying from 1 to 5 or G, to 1 in 3, and even 1 in every 2, annually ! How strongly does this at all events justify the expe¬ diency of a surveillance ! We have only room for one or two more facts regarding the syphilitic infection. During the month of April, 422 METROPOLITAN UNIVERSITY. 1832, while the cholera raged in Paris, there appears to have been an extraor- nary diminution in the numbers of the infected. As compared with the months immediately before and alter, the con¬ trast was striking. In April the return was 1 in 87, while in March it was 1 in 35, and in May 1 in 36: so that the terror of the epidemic may be presumed to have operated very remarkably as an extinguisher of debauchery. Another circumstance worth observ¬ ing is the large proportion of prostitutes who escape syphilis altogether. The fact is one which has long been sus¬ pected ; but every day’s experience seems to confirm its truth. Some wo¬ men are rarely, if ever, diseased ; while others are so in rapidly successive at¬ tacks, seldom quitting the hospital but to return in the course of a week. The dispensary physicians think that about half the Jilles publiques resist the infec¬ tion ; but Parent-Duchatelet, with rea¬ son, doubts the accuracy of this conclu¬ sion : he considers it as rather exagge¬ rated . Other remarkable observations re¬ specting syphilis, its frequency, and its ultimate tendency, we must wholly omit in these our circumscribed limits — tak¬ ing occasion once more to recommend the perusal of the work itself to those interested more particularly in such in¬ quiries. We could have wished, also, to have made a few more extracts from Ducbatelet ; but we find it impossible to gratify ourselves in this respect, with¬ out neglecting other topics of more im¬ mediate concern. METROPOLITAN UNIVERSITY. We announced in our number for Nov. 5 that the King had appended the sign manual to the Charter of this establish¬ ment; and wTe published the draught of the Charter itself, in September last. The newspapers this week give the documentinitscompleted form; differing from what has already appeared in this journal, only in two sentences, and in the addition of the names. We give the sentences to which we allude : — “ And for the purpose of granting the degrees of Bachelor of Medicine, and Doctor of Medicine, and for the improve¬ ment of medical education in all its branches, as well in medicine as in surgery, midwifery, and pharmacy, We do further hereby will and ordain that the said Chancellor, Vice-Chancellor, and Fellows, shall from time to time report to one of our principal Secretaries of State, what appear to them to be the medical institutions and schools, whe¬ ther corporate or unincorporated, in this our metropolis, or in other parts of our United Kingdom, from which either singly or jointly with other medical institutions and schools in the country or in foreign parts, it may be fit and expedient in the judgment of the said Chancellor, Vice-Chancellor, and Fel¬ lows, to admit candidates for medical degrees, and on approval of such report by our said Secretary of State, shall admit all persons as candidates for the respective degrees of Bachelor of Medi¬ cine and Doctor of Medicine,” &c. “ That the said Chancellor, Vice- Chancellor, and Fellows, shall have power, after examination, to confer the several degrees of Bachelor of Arts, Master of Arts, Bachelor of Laws, Doc¬ tor of Laws, Bachelor of Medicine, Doctor of Medicine, and to examine for medical degrees in the four branches of medicine, surgery, midwifery, and phar¬ macy, and that such reasonable fees shall be charged for the degrees so con¬ ferred as the said Chancellor, Vice- Chancellor, and Fellows, with the ap¬ probation of the Commissioners of our Treasury, shall from time to time direct.” The following list of the names of the corps d’elite we give exactly as it has been published. There are peculiarities about it worth preserving in their origi¬ nal state: it is a curious specimen alto¬ gether, in more respects than one, of the “talent of this enlightened age:” but we shall have more to say about it in our next. MATERIA MEDIC A LECTURES 423 Our right trusty and well beloved cousin, William Cavendish, Earl of Burlington (Chancellor.) The Right. Rev. Father in God Edward Lord Bishop of Durham, The Right Rev. Father in God William Lord Bishop of Chichester. Our right trusty and well beloved Coun¬ cillor Henry Baron Brougham and Vaux, and Our trusty and well beloved George Biddel Airy, Esq. our Astronomer Royal, and Fel¬ low of the Royal Society. Andrew Amos, Esq, Barrister-at-Law. Thomas Arnold, Doctor in Divinity, John Austin, Esq. Barrister-at-Law, Neil Arnott, Esq. Doctor in Medicine. John Bacot, Esq. Francis Beaufort, Esq. Captain in our Royal Navy, Hydrographer of the Ad¬ miralty, and Fellow of the Royal Society. Archibald Billing, Esq. Doctor in Medi¬ cine, and Fellow of the Royal College of Physicians. William Thomas Brande, Esq. Vice- President of the Royal Society. James Clarke, Esq. Doctor in Medicine, Fellow of the College of Physicians, and of the Royal Society. Philip Cecil Crampton, Esq. Doctor of Civil Law, Fellow of the Royal Society, and our Surgeon-General in Ireland. John Dalton, Esq. Doctor of Civil Law, and Fellow of the Royal Society. William Empson, Esq. Barrister-at-Law, Professor of General Polity and the Laws of England at the East India College. Michael Faraday, Esq. Doctor of Civil Law, Fellow of the Royal Society. Sir Stephen Love Hammick, Bart. Doctor in Medicine, Fellow of the Royal College of Physicians, and Fellow of the Royal Society. John Stephens Henslow, Clerk, Master of Arts, Professor of Botany in the Univer¬ sity of Cambridge. Cornelius Hewett, Esq. Doctor in Medi¬ cine, and Downing Professor of Medicine in the University of Cambridge. Thomas Hodgkin, Esq. Doctor in Medi¬ cine. Francis Kiernnn, Esq. John George Shaw Lefevre, Esq. Fellow of the Royal Societ}-. John William Lubbock, Vice-President and Treasurer of the Royal Society, (first Vice-Chancellor.) Sir James M‘Grigor, Baronet, Doctor in Medicine, Doctor of Civil Law, Fellow of the Royal Society, Fellow of the College of Physicians, one of our Physicians Extraor¬ dinary, and Director-General of the Army Medical Board. Richard Rainy Pennington, Esq. Jones Quain, Esq. Doctor in Medicine. John Rideout, Esq. Peter Mark Roget, Esq. Doctor in Medi¬ cine, Secretary of the Royal Society. Nassau William Senior, Esq. one of the Masters of our High Court of Chancery, and Fellow of the Royal Society. Joseph Henry Gerrard, Doctor of Laws, Principal of the Bristol College. Richard Sheepshanks, Clerk, Fellow of the Royal Society. John Sims, Esq. Doctor in Medicine. Connop Thirlwall, Clerk, Fellow of Trinity College, Cambridge. James Walker, Esq. Fellow of the Royal Society, and Henry Warburton, Esq. member of the Commons House of Parliament, and Fel¬ low of the Royal Society. NEW BRANCH OF THE PROVIN¬ CIAL ASSOCIATION. We have much pleasure in devoting- a portion of our space this week to an ac¬ count of the meeting- at Southampton. The object of establishing- a Southern branch of the great Provincial Medical Association is wholly praiseworthy. When it was attempted some time ago to institute an Eastern Association, we expressed our dissent, because we saw that it was likely to weaken the Asso¬ ciation, by converting it into a sort of merely Western union: we considered it as a needless, if not a mischievous division of power — a squandering* of resources which might be better applied. The projected Eastern establishment has since, we believe, become whatitshould have been from the first — a branch of the originaltrunk. To both the Southern and the Eastern branches, in this relation to the parent institution, we heartily wish every success. The grand central Association has had our best wishes from the very commencement. MATERIA MEDICA LECTURES. Mr. Pereira has kindly consented to let us have a new series of his valuable lectures on Materia Medica, supple¬ mentary to those already published in our last two volumes, and which are required to render the course complete. We make this announcement in conse¬ quence of applications from many cor- 424 MEETING AT SOUTHAMPTON respondents who were desirous of know¬ ing- what we intended to do oil the sub¬ ject. Next week a lecture on Nux Vomica will be given, with illustrative engravings. ROYAL MEDICAL AND CHIRUR- GICAL SOCIETY. Mr. Earle, President, in the Chair. Dec. 13, 1836. A Cuse of Lithotomy was read, by Mr. W. Hill, of Wotton-under-Edge ; the paper was communicated by Mr. Stanley. The patient was a boy six years of age, who had all the usual symptoms (rather severely manifested) of stone in the bladder. Mr. Hill performed the lateral operation with the gorget, and removed the stone, which proved to be of the mulberry kind, with a very rough surface. Considerable bleeding took place from the wound soon after the operation, but it yielded to cold applications ; and though it returned on the following night it stopped again. The wound healed in about a fortnight, but the boy was troubled for some time afterwards with various pains and complaints. He felt pain in the glans penis, while making water; the elbow- joint became inflamed; and subsequently the scrotum of one of the testicles. For several months the pain in making water continued, and sometimes was very severe, and attended with calcareous and mucous deposits in the urine. The boy however at length recovered. The author of the communication seemed inclined to suppose that when irritation produced by the stone in the bladder was withdrawn, the nervous func¬ tions became deranged, and gave rise to all the above-described symptoms. Infrequency of Calculus among Seamen. A note was afterwards read, from Mr. Copland Hutchison, in continuation and eonlirmation of some former observations advanced by him in the 9th and 16th volumes of the Society’s Transactions. They went to show' the great infrequency of calculous disorders in seafaring people of all ages ; and the author quoted a curious passage from Aretaeus in support of his opinion. Mr. Hutchison likewise observes, that he has found, contrary to what has been advanced on this subject, that the inha¬ bitants of Scotland are as subject to cal¬ culous disorders as their southern neigh¬ bours. We are enabled to give the following more ample account of Mr. Hutchison’s note, — - the chief points to be established by which were — first, the infrequency of calculous diseases among sailors; and secondly, their prevalence among the natives of Scotland. On the present occasion he confined himself to the former; merely stating in reference to the latter, that his opinion had been confirmed by further evidence, during a recent visit to the North. To the idea that the complaints alluded to are infrequent among sailors, it has been objected — that this comparative immunity arises not from any influence of the mode of life among sea faring people, but from the parties not entering it until after the period at which the calculous diathesis becomes developed. This objection Mr. Hutchison met, by stating that many boys are admitted into the navy between the ages of nine and ten (2000 boys are expressly mentioned in the Parliamentary Estimates for the Navy), while the number of operations for stone on persons above fourteen is more than double that on boys of younger age. He also further fortified his position by adducing the authority of Aretaeus, who distinctly enumerates a sea¬ faring life (— • k(x\ t rAovs Ka\ 7/ &v OaXacrcry fiioTTi)* as among the remedies for calculous affections. Mr. Hutchison recently applied to Sir William Burnet, Physician-General of the Navy, by whose directions the records of the Naval Hospitals were searched ; and it was thus ascertained that only one case of calculus had occurred since 1830, the date of the author’s former paper. Mr. Hutchison concluded by recom¬ mending pure air, open bowels, active exercise, swinging, warm clothing, a spare use of vegetables, and iodine given inter¬ nally, and rubbed over the region of the kidneys, as the best preventive and remedial measures. MEETING AT SOUTHAMPTON, FOR THE FORMATION OF A SOUTHERN BRANCH OF THE PROVINCIAL MEDICAL AND SURGICAL ASSOCIATION. Pursuant to a requisition signed by nearly one hundred physicians and sur- * Medico. Graeco. Opera, accurante Kuhn, vd. xxiv. p. 333. Lepsiee, 1828. MEETING AT SOUTHAMPTON. 425 geons practising medicine in the Southern Counties, a meeting was held at the Audit House, Southampton, on Tuesday, No¬ vember 29th, for the purpose of organizing a district branch of the Provincial Medical and Surgical Association. Notwithstanding it was the day on which the high gale of wind occurred, the attendance was most nume¬ rous, there being above seventy medical men present from all parts of the district, many coming twenty, thirty, and even forty miles. Amongst the medical gentle¬ men from a distance were — Dr. Forbes, of Chichester; Dr. Crawford, Mr. Wickham, Sen., Mr. Mayo, Mr. W. J. Wickham, Mr. Smith, of Winchester; Dr. Groves, Mr. Henry Coates, Mr. Sampson, Mr. J. Winza, of Salisbury; Dr. Towsey, and Mr. Finder, of Lymington; Mr. Burnett, and Mr. Curtis, of Alton ; Dr. Engledue, Mr. Hillard, Mr. Davey, of Portsmouth; Mr. Beddome, and Mr. Sainsbury, of Romsey ; Mr. J. Blatherwick, of Fareham ; Mr. T. Blatherwick, and Mr. Andrews, of Titchfield; Mr. Caldwell, and Mr. War¬ wick, of Millbrook; Mr. Bury, of Farnham ; Mr. Eager, of Guildford; Mr. J. P. Gruggen, and Mr. Elliot, of Chichester; Mr. E. O. Spooner, of Blandford ; Mr. Smart, of Cranbourne; Mr. Smith, of Bishop’s Waltham; Dr. Twynham, and Mr. Peskett, of Petersfield ; Mr. Lee, of Hythe; Mr. J. Welch, of Christchurch; Mr. Goodwin, of Totton: and of those residing in Southampton, there were — Dr. APRoberts, Dr. Steed, Dr. Down, Dr. Oke, Dr. Hennen, Dr. Wheeler, Mr. Maul, Mr. Reele, Mr. Judd, Mr. Stace, Mr. Corfe, Mr. Colebrook, Mr. Fowler, Mr. Simpson, Mr. Bullar, Air. Clarke, Air. Ware. On the motion of Dr. APRoberts, of Southampton, seconded by J. R. Beddome, Esq. of Romsey, Dr. Forbes, of Chichester, was called to the chair. Dr. Forbes returned thanks for the honour done him in placing him in the chair, and whilst he disclaimed his peculiar fitness for the office, yet, wishing well to the society, he was anxious to do anything which others might deem calculated to promote its interests. He felt proud to see so numerous and respectable an as¬ sembly met on such an inclement day, and many of them at so great a distance from their homes. It was a proof that those present were anxious to emulate their brethren in other parts of England, who had originated and kept up the Provincial Aledical and Surgical Associ¬ ation ; and a good augury that the medical practitioners of the South were both able and willing to assert the honour and dignity, and to protect the interests of the profession. He had been a member of the Provincial Association from its origin ; and having attended nearly all its meetings, he was deeply convinced of its importance, and was therefore resolved that anything tending to extend its influence should obtain his zealous support. We were met, he said, to-day, to bring this Associ¬ ation home to our own doors, by establish¬ ing a branch of it, of which all of us might become members, and at the meetings of which we might all, without journeying far from our own fire-sides, share at least in part in the pleasures and advantages which all who attended the meetings of the parent society must have experienced. He concluded by saying, that as Mr. Wickham, who had the honour of suggest¬ ing the establishment of the branch, and who, together with Mr. Bullar, had taken upon himself all the labour of realizing it, was prepared to state the objects for which we were met, and the means w hich wrere deemed most proper for accomplishing them, he would not detain the meeting longer, but would take the liberty of requesting Mr. Wickham to bring forward the propositions he was prepared to make. W. J. Wickham, Esq., (of Winchester) delivered the following address. Gentlemen, — The requisition which has assembled us here to day will have suffi¬ ciently explained to you the objects of this meeting, viz. the extension of the Provin¬ cial Aledical and Surgical Association through the southern counties — not, in¬ deed, to increase its numerical strength alone, for that is already great — but to form a branch of the parent trunk, which shall impart strength and vigour to its operations, and render that Society, at least in these parts, more effective, and more useful. In the name of those with whom I have been associated in the attempt to procure this meeting, and for myself, I beg to thank you for the readiness with which you have responded to our call. It is, I trust, no unworthy cause in which wre w ould engage you : and I hope it may not suffer from the poor ability of the indivi¬ dual who is now called upon to address you. Association , gentlemen, is the great feature of this Institution, a power which, whether exerted for evil or for good, multiplies and combines individual strength and talent, in a ratio proportionate to its extent. It is a power now resorted to in our political conflicts , and is found to be mighty. It is exerted to diffuse and extend the blessings of religion, and is found to prosper. It is adopted on an extensive scale to promote the cultivation of general science, and is found to give an impetus of no ordinary strength to the progress of its pursuits. I feel satisfied that I have good reason 426 MEETING AT SOUTHAMPTON. to congratulate you, and the medical profes¬ sion at large, on the employment of this great power in the service of our depart¬ ment of science. Societies have existed for many years in our profession — they have been formed in the metropolis and in the provinces— but they have been mostly wanting in that vital property, association; their in¬ terests, too, have been local, and therefore their energies have been cramped. It has been reserved, however, for the Society under whose influence we are met here, to incorporate ourselves — to wield this great power with a gigantic strength. It has brought Northumberland into close alli¬ ance with Cornwall; it has identified the interests of the eastern with the western counties; it has brought men into commu¬ nion who by their acquirements and la¬ bours only have been known to each other; it has created friendships in some; it has renewed them in others ; it has cemented them in all. It has roused the slumbering energies of many; it has encouraged ardent cultivators of our science ; it has moreover given a tone to the character of provin¬ cial men, which their high and honoura¬ ble calling demands. It has been my good fortune only to meet the Association once, at Oxford, last year; I there became acquainted with men of whom I had heard all my life — great men, whose attainments I had long respected, but whose generous and bene¬ volent minds, until then, I knew nothing of. It was there I saw the interchange of opinions between men of high and those of humbler stations, each willing to impart — each eager to receive. It was there I saw a Kidd, a Pritchard, a Hastings, a Car rick, a Johnson, a Forbes, and others with intellects of like capacity, receive the homage of above three hundred of their brethren. I saw two of our distinguished members receive the honorary degree of the Uni versi ty of Oxford ; I saw all participate in the most marked attention and respect which the highest characters in Oxford could offer. Surely, Gentlemen, it is a matter of congratulation to us all, that the provincial members of our profession have thus associated to advance the science of medi¬ cine, and to assure for it the position amongst its kindred sciences to which it is justly entitled. It was at Oxford too that inquiries were set on foot upon the subject of medical attendance on the poor, the result of which is now before the public, in the shape of a report from the Provincial Association. To that report, which has just appeared, I beg your earnest attention ; it is drawn up at considerable labour, and is grounded on the most authentic information. Its recommendations have been enforced with considerable temper; and the subject treated with the utmost impartiality, “ great care having been taken to separate the bare facts of each case submitted to the committee, from expressions of indignation, which a keen sense of oppression and injury had wrung from the correspon¬ dents.” The report has forcibly shewTn that by the existing system the burthen of main¬ taining the poor during sickness is imposed on the medical profession, and imposed too in the most arbitrary and oppressive manner, — not indeed for the benefit of the poor, but for the imaginary benefit of the “ rate payers.” It further shews that the profession is by the new authorities submitted to insult and degradation ; and that the Commis¬ sioners have put forth charges which are entirely unfounded, in order, “ by impugn¬ ing the character of the medical body, to reconcile the public to the unjust treatment which they have put upon it, and in many instances successfully.” The report sets forth the errors of the system of “ tenders and competition ; which, independently of the professional degradation associated with it, exhibits a narrow-sighted policy on the part of the Commissioners, producing great injustice and cruelty to the poor, by exposing them to the calamities which must result from incompetency and neglect from their medical attendants.” The report recommends that redress be sought, by petition to the legislature, and application to the Colleges of Physicians and Surgeons and the Society of Apothe¬ caries. “ Should the Association and the medical body fail in obtaining redress from the legislature, after well-considered and well-directed efforts, the alternative is open to us — either to take a lower station in society, or firmly to decline any participation in the medical appointments of the neio poor- law. The report expresses a regret that there is a want of some “ presiding influence over the members of our profession,” to check the wretched spirit of rivalry and speculation, the under-bidding and job¬ bing, which too frequently is to be found. In this Association can hope alone rest: this institution seems well suited to raise the moral and professional feeling among medical men in the provinces; and by means of it, more exalted principles, supe¬ rior aims, and a firmer unity of purpose, will be engendered in the great body of practitioners throughout the country. It was there also that a benevolent fund MEETING AT SOUTHAMPTON. 427 was instituted, for tlie aid of our poorer brethren : surely it is a matter for our rejoicing that our interests are thus watched, protected, and supported. It is to a society which seems to me to embrace so much that is excellent, and to involve so little that is objectionable, that I wish to invite your attention : I ask you to join its ranks ; and whether you may be disposed to do so in immediate con¬ nexion with the Association itself, or whether through this proposed branch, still your services will be acceptable, and your support of value. The first point which we have to con¬ sider, is, how we can best contribute our aid to the Provincial Medical and Surgi¬ cal Association ? In order to carry its ob¬ jects fully into effect, and to extend its usefulness, I submit that associating and forming ourselves into a Southern District Branch Society , is the most effectual mode we can adopt to answer these purposes. The next point for me to show, is what title we may have to engraft ourselves on the Provincial Association, and how far we are fulfilling its objects in so doing. In 1834, at the meeting of the Associa¬ tion at Birmingham, the following resolu¬ tion was agreed on, on which the present extension to district branches is founded : — “ The Council would recommend, where many members of the Association reside, that occasional meetings of such members take place, for the promotion of the gene¬ ral objects of the Association — namely, the free communication of professional knowledge, and the cultivation of good feeling among the members ; the rules for such sectional meetings being left to the consideration of the respective parties.” Again: at the late meeting at Man¬ chester, it was considered by the Council, and expressed in the proposals for a union of the Eastern Association with the Provin¬ cial, that district branch associations would render the operation of the society more effective; and, indeed, if the magnitude and extent of the Provincial Association be taken into consideration, it will, I think, be conceded that its strength will be much increased by the meetings of practitioners from time to time within a smaller sphere. Moreover, Dr. Hastings, the founder and present secretary to the Association, has sent me the terms on which we shall be permitted to unite with the Association, and the privileges which we may expect to derive from it. This letter shall by-and-by be read. Thus, then, gentlemen, we have as much sanction and encouragement as we can obtain in this stage of our proceedings, for the formation of this Branch Associa¬ tion. It must remain for us to receive the official admission to it at the next general meeting at Cheltenham. Propositions for the conduct and regula¬ tion of the Society will, in due order, be submitted to you. The Association being thus constituted, and the seal placed upon it by this day’s meeting, let us, gentlemen, go on to carry out its objects to their full accomplish¬ ment ; let each of us feel pledged to con¬ tribute something (and who is there amongst us that has not some original in¬ formation to impart?); let this associa¬ tion, then, be the treasury in which each may deposit his contributions to medical science. The opportunities of extensive inquiry, or very deep research, are open to but few, but the means afforded in the most limited sphere should be embraced. Facts, as they present themselves, should be recorded by us all, and truths, wherever they may be discovered, should be trea¬ sured up. To accumulate them, and to diffuse them as their value becomes esta¬ blished, is the province of this Association. I feel a difficulty and a hesitation in requesting your attention to any particular course of inquiry; but I will state a few points to which the parent Society has especially directed its members. In anatomy, the recent discoveries which have been made have laid open a field of investigation in which there ap¬ pear before us treasures of inestimable value. In displaying the course of the nerves with the minuteness and fidelity which are the characteristics of Sir Charles Bell’s labours, he has greatly ex¬ tended our knowledge of their functions and their pathology; but still he has taught us that objects of great interest yet remain to be attained, and which it should be our desire to search after. Anatomy, too, has of late years unfolded to us the intimate structures of the elementary tissues, which has furnished the pathologist with abundant materials, from which much has already been gained, but of the fruits of which there yet remains much to be gathered. Medical topography and sta¬ tistical inquiries have received great en¬ couragement from the Association. The labour necessary to collect accurate and useful information on this subject is very great, and the materials do not at first sight appear to afford much of interest. To the reader they are heavy and dis¬ couraging ; but they remain as records which wall hereafter prove valuable to the patient inquirer after truth ; and as works of reference, will give an accuracy of in¬ formation which will silence the specula¬ tive theorist, and furnish means from which alone just conclusions can be drawn. 428 A student’s REMARKS ON MR. WAKLEY, Impressed with the importance of the subject, the Council of the General Asso¬ ciation has recommended to its members the investigation of epidemic diseases. The record of cases in medicine and surgery, from private sources and from public hospitals and dispensaries, are per¬ haps the principal means we have of con¬ tributing to the advancement of science; and if each case be faithfully narrated, having so much of matter only in the tale as is applicable to a practical deduction, this source of information is highly in¬ structive. It has appeared to me that too much encouragement has been given to the simple narration of cases as they occur in public institutions ; our periodicals have teemed with cases merely transcribed from the hospital note-books, without being selected for the value, and without being- convertible, in the form in which they have been published, to any practical pur¬ pose. This mode cannot, in my opinion, be too much reprehended : it encumbers the literature of medicine and surgery, and takes the space which should be allotted to more useful matter. Much benefit might accrue from the communication of the nature and results of severe injuries from accident which have occurred and may occur in practice. No emergencies in surgery are more perplexing than fractured bones, with their various complications. There are no cases to which the surgeon has to bring a ma¬ tured judgment and a prompt decision into more immediate exercise ; and how are these qualifications to be attained? — they can alone be built on facts accumu¬ lated by well-attested results, — not, in¬ deed, from the personal experience of any one man, but from the combined experience of the many. The question of amputation is often in¬ volved in the treatment of these accidents ; it is this — are we to sacrifice the limb to save life ? — or is the life to be jeopardized by the attempt to save the limb ? The principles which guide the decision are for the most part well founded ; but I would ask, how have they been formed ? — • certainly not on the experience, not, I say, . on the experience of any one man, — not on the result of any one case. The experience of any one man is too limited to establish a principle on a point so momentous. You will perceive readily, then, how the communication of cases of this description which may have occurred in your indi¬ vidual practice, would tend to establish present principles or to overthrow them. I would ask you not for cases which shall astound and astonish by their extra¬ ordinary character, — these are seldom practically important, — but. I would ask you for cases on which you have your¬ selves formed particular opinions, and from which we may all participate in the result of your reflections. As your facts abound, — as your deduc¬ tions are closely and philosophically formed, — so will your records be in pro¬ portion valuable, and your service to science great. A series of resolutions were then passed in accordance with the principles advo¬ cated in the opening speech and address. We regret we have not room to give them insertion, but presume they will be adver¬ tised and extensively circulated. Dr. Oke, Dr. Hennen, and other gentle¬ men, delivered their opinions at considera¬ ble length in supporting certain of the re¬ solutions. Dr. Forbes was elected President, and Messrs. Wickham and Bullar have been appointed Secretaries. In the evening about fifty gentlemen dined together at the Star Inn, confirming by a banquet, libation, and all the honours, the very satisfactory proceedings of the day. A STUDENT’S REMARKS ON MR. WAKLEY— THE SOCIETY OF APOTHECARIES, &e. &c. To the Editor of the Medical Gazette . Sir, Although there is no unseemly boasting- in your excellent periodical, nor unmean¬ ing professions for the welfare of medical students — as in the Lancet, yet I have al¬ ways observed, where there is any thing to be effected for them, you take that path which time proves to be the best. Now I have been waiting in anxious expectation to see the working of the Crown and An¬ chor meeting of last season, and the threat¬ ened destruction of the “ Blaekfriars drug¬ gists” put in execution ; but as nothing comes of it, I hope you wall allow- me, through the medium of your journal, to summon your recreant opponent to do bat¬ tle wdth the “ Flags of Rhubarb Hall,” as he calls them, or ingenuously confess that he has not power to keep his promise. When I heard him boast that he thanked the examiners wrho rejected Mr. S - , as giving him additional power over them, I doubted not but that the days of the Apothecaries were numbered. But as we get older v,re get w iser, at least I have in SOCIETY OF APOTHECARIES,, &c. &c. 429 this instance, for I now find out that Wak- ley’s power lies more in the coffee-house than with the influential members of a certain other “ House/’ or with those of the medical profession ; for to my sur¬ prise, when, about two months back, I went on the same day into two medical libraries in London (neither of them Guy’s), and asked the librarians to favour me with the Lancet, they both answered, in nearly the same words — Here is the Medical Gazette, sir; but if you want the Lancet, you must go to the coffee-shop, for we do not take it here. Knowing that I was an intruder in the library where I first went, I concluded that this circum¬ stance led to my getting this answer ; but I was soon convinced of the contrary by the man coming up to me, and saying — “ Any book in the collection you like to see, sir, I shall be happy to get out for you; but we do not take the Lancet on account of its scurrilous and useless politics, which dis¬ tract the students’ minds from study, and set them imagining a state of things which will never exist.” I now see the truth of this last statement ; for had the students, instead of rebelling with such a leader as Wakley at their head, manfully signed a paper in disapprobation of Mr. S.’s rejec¬ tion, they could not have got less by it than they did by the “ Crown and An¬ chor” meeting: and they would have had the consolation of having acted openly and boldly, while the Worshipful Company would have seen that they might not abuse the students with impunity. I must say it was a positive injustice on the part of the Hall the rejection of Mr. S., whom I had the pleasure of seeing exa¬ mined twice, with from thirty to forty other students, who all went up to the Hall, some before and some after Mr. S, without one being rejected ; and yet, from the number of questions which he answer¬ ed with elegance and accuracy, and from the manner in which the other students looked up to him, I at once saw he w’as the most talented pupil present. In the Lancet for the 29th of October, we see such a silly criticism on the regu¬ lations of the Hall respecting apprentice¬ ships, that, did I not believe the gentle¬ men at the Hall infinitely above transact¬ ing any business with Wakley, I certainly should think they had paid him to contra¬ dict all his former statements, and that the abusive and useless paragraph which pre¬ ludes the paper was a blind ; for so tho¬ roughly is it at variance with all he has previously given to the world in the Lancet, on the subject of the Hall, that it reminds me of “ Satan divided against himself,” and convinces me that Wakley has no settled principle of action. In former numbers of the Lancet may be read (if any one likes so to waste their time), accounts of oppressive regulations, which pick the pockets of students, by their long stay in London, and by lec¬ tures; the necessity of lawrs to authorize medical men to prepare their own sons and apprentices for examination during their apprenticeship, &c. ; and when the Apothecaries make a lenient and very pro¬ per regulation, enabling students to ap¬ pear for examination at the expiration of their apprenticeships, he finds fault with that also. And yet, I have no doubt, if the Hall is done away with (which I trust it wall be if they do not reform), and the University substituted to give licenses in pharmacy, we shall see him, like Oliver Proudfoot (in Scott’s Chronicles of the Canongate), boasting of victories he has never wron, and of which he has only retard¬ ed the achievement, by appearing in the field. I must now call the attention of your readers to the abuses existing at Apothe¬ caries’ Hall, which I am sure you will in¬ sert in your valuable journal; for although I know from experience that you are infi¬ nitely above giving students improper ad¬ vice, which is likely to make them rebel against the powers that our government, in its wisdom, has set over them, yet I am wrell persuaded that if these powers be¬ come abused by the persons to whom they have descended, to the injury of students, their friends, and the country at large, you will not allow7 it to go on without en¬ deavouring to prevent the mischief likely to ensue. 1st, The lower classes of this country will, in time, become considerably injured by the expenses attendant on a medical education, if allowred to exist as at present, by lessening the number of medical men, and by keeping out those wdio, from their previous position in society, wTould be content to attend the poor properly, and be satisfied with such remuneration as they could afford. We all know that most me¬ dical men, afterfour or five years’ practice, are no longer solicitous as to who attends the poor in their vicinity (though, to the credit of the profession be it spoken, few cases of neglect can be adduced), and thus, as is natural, the poor fall into the hands of ignorant quacks, who are always endeavour¬ ing to ingratiate themselves with them; or into the out-patient department of hospi¬ tals, where they fall into the hands of sci¬ entific and humane physicians and sur¬ geons; therefore they could not do better, were it not for the necessary exposure to the vicissitudes of the atmosphere, and the disquiet the patient is often put to in be¬ ing obliged to come from a distance. Yet 430 A STUDENT S REWARKS ON MR. WAKLEYj &c. &c. at the present time any person, however humble, may procure the attendance of a well-educated medical man at his own re- sidence ; but if this three-winter and two- summer regulation of the Hall last long, it will be different this time six years, for it has frightened no less than three youths of my limited acquaintance out of the profession, who were well educated, and likely to become honourable and useful members of the profession ; but the waste of so much time was more than they or their friends would submit to. Now it is this three years’ course of education I find fault with, as being so great an evil, and not to the expense of lectures ; for I consider the lecturers are not sufficiently W'ell paid, where they have small classes, considering the extent of information re¬ quired of a lecturer. When I passed the Hall, which was about nine years back, we were only re¬ quired to attend for six months; but then we studied all the while with diligence, knowing that our time was only just sufficient to become well acquainted with our profession. But now, by what I saw of the state of medical education when last in London, about two months back, young men seem to know that they are compelled to study so much longer than a man of ordinary abilities requires, to learn to be an apothecary, that they procrasti¬ nate studying until within a short time of examination, when they go and grind. And from conversations 1 had with several who have lately passed, I am convinced they are not nearly so wrell informed in medicine and pharmacy as most of the six months’ men who studied in 1826 wrnre. Now, as a remedy for this first abuse, I would suggest that the fees for lectures be very considerably increased, so that lec¬ turers may receive from each student in a much shorter time that remuneration which, from their scientific attainments acquired for the use of the students, they have a right to expect. This w7ould give the public interested in medical education a much better opinion of lec¬ turers than they have now ; for the general opinion now is — whether true or not, I know not, that the Hall requires this long course of study, that the lecturers may have time to fill their pockets at the expense of the students ; the Apothecaries’ Society knowing wrell that they must blend the interest of the medical schools with their own, to keep their power much longer. 2dly. Students complain that they are not treated by the beadle as gentlemen, when they go to register, &e. This is a great evil; and I am told by students, that the manner the Company behave to¬ wards them now, if at anytime they make inquiry at the Hall during their studies, is such as to put them forcibly in mind of an unopposed country shop-keeper, who, knowing the articles he sells cannot be procured elsewhere, is not over civil to his customers. A little wholesome opposi¬ tion on the part of the New University will reform this abuse. 3dly. Rejections at the Hall are much more numerous than at any other place of examining students in this country. This is easily accounted for, when we consider that the names of the Examiners are not known to the world by any scientific works, and by their not being among the heads of the profession ; hence public confidence would be soon wanting, were it not for fre¬ quent rejections ; but as it is, the public think having the license implies know- ledge, although signed by men quite un¬ known to science. 4thly. The Latin arrangements at the Hall are very bad ; students are allowred to go up and be examined in Celsus and Gregory, before they go up for general ex- amination. This is very much done now, and generally w'ith success : having got through this, they think, and very justly, that they cannot be in danger of rejection in prescriptions, and certainly no one can, if he is able to translate Celsus or Gregory properly; rbut it is the fact, that many who have successfully got through Celsus and Gregory, have been sent back for six months in prescriptions ; therefore the better way for students to prevent such a wranton injury, would be to undergo the examination in Celsus and Gregory when they go up for general examination, when, if rejected in classical Latin, they cannot keep a student back six months ; and they w'ould not be silly enough to reject him in the easy Latin of an ordinary prescrip¬ tion, after having immediately before passed him in Celsus. Such are a few' of the abuses wffiich have reached me. I hope these, and others w hich exist, will be reformed by the Wor¬ shipful Company, especially those W'hich keep young men in London so long, wast¬ ing their time, in most cases, in vice and idleness. Should they reform, there is no one wishes the Worshipful Company less evil than myself ; but should they continue their oppressive regulations, I shall re¬ joice most heartily if the University puts an end to their pretensions. I dare say you will think I am en¬ deavouring to make you a radical: no¬ thing is farther from my w'ish, for I admire your politics, and my opinions always coincide with those of the Ga¬ zette. But there are two things which annoy me in the profession. First, Wak- EXPERIMENTS ON THE VOICE. 431 ley’s scurrility and wrong views of things, which sometimes mislead me; and 2dly, the oppressive regulations of the Apothe¬ caries, — a general complaint, which, it so happens, affects relations of mine conside¬ rably, — who very justly say, if we are to be apothecaries, why give us a physi¬ cian’s education ? and after our labours and expenses are finished, are we to be satisfied with an apothecary’s license? These are the causes of this budget; and as I have not much time for writing, I wanted, as the vulgar say, to “ kill two birds with one stone,” (Wakley and the Apothecaries.) Hoping that my friends will not forget to put this in your letter-box, and that you will insert this in the Gazette of "Saturday next, I subscribe myself Your Constant Reader. Liverpool, December 6, 1836. I have not put my name to this paper, because it might injure several relations; and I am sure what Wakley says about anonymous letters in his last Lancet, will have no more weight with you, than his endeavour to injure you will have with the profession. He proves by para¬ graphs from the Gazette, that when his “ Act” was first made you spoke favourably of it, but when it was brought into use, and found not to answer, you were obliged to discountenance it, as any other theory which sounds well when read, but which is totally useless in practice. [We have given insertion to the above (slightly condensed) because it appears to be written by a student who makes some sensible remarks with amusing quaintness, At the same time we beg not to be sup¬ posed to concur in all the sentiments ex¬ pressed by our correspondent. — Ed. Gaz. j EXPERIMENTS ON THE VOICE. Having laid bare the vocal organs of an adult male, I raised the larynx to the position it wrould occupy by the elevation of the voice an octave, being about half an inch, and at the same time minutely observed the position of the lowest ring of the trachea in reference to the sternum. By this operation I found the trachea was raised out of the chest, nearly to the same extent as the larynx had been elevated towards the base of the skull. My next step was to examine whether any change I had taken place in the diameter of the tube. Having for this purpose examined i the diameter of the trachea in its natural position, I again elevated the larynx to i the same extent as before, and found the I diameter diminished one third. These experiments prove that, contrary to the general preconception, the elevation of the larynx shortens the tube independent¬ ly of the contraction between the thyroid cartilage and os hyoides, and at the same time lessens its diameter. The same effects may easily be detected during life by placing the finger on the trachea imme¬ diately above the sternum during the elevation of the larynx, w hen the trachea is found to ascend out of the chest, and afterwards to return to its former position, a movement in which the lungs and bron¬ chia participate. The alteration of the tube in diameter may also be perceived by gfasping the trachea with the finger and thumb during the elevation and depression of the larynx. Such are the principal means provided for adjusting the vibrations of the vocal tube to those of the glottis ; but as the variation of length is not sufficient to render the tube capable of adjusting itself to the whole range of tones, the relative tension of its surface supplies the defici¬ ency. The influence of the tension of elastic membranes in modulating the tones produced by them has been very satisfac¬ torily demonstrated by the interesting ex¬ periments of Savart, and it is no doubt materially concerned in the analogous phenomena of the voice. The diameter of a tube does not influence the pitch of its sound, but there is an obvious appro¬ priateness in the diminution of the diame¬ ter of the trachea as the sound becomes sharper ; for experience has taught the makers of wind instruments that the best qualities of tone for the lowrer notes are obtained when the bore of the instrument is large, and for the higher notes when it is small. The influence of the vocal tube as far as relates to its effects on the key of the voice, is terminated at the velum palati by the several perforations of the nostrils, the Eustachian tubes and the mouth. The opinionof Savart, that the mouth modifies thekey ofthe tone, is consequently erroneous. We find analogous acoustic effects in mu¬ sical instruments; for instance, the lowest joint of the flute, which is six inches in length, having three perforations, when its keys are open lowers the tone of the in¬ strument only half a note. The important distinction between the effects of air pass¬ ing through the tubes of musical instru¬ ments, according as their sides are rigid or membranous, is, that in the former case, as exemplified in flutes, hautboys, &c., the air vibrates independently of the sides of the tube, whilst in the latter, the tube enters into compound vibrations with the column of air. — Mr. Bishop on the Voice. 432 BILLS OF MORTALITY. METEOROLOGICAL JOURNAL WORKING OF “ WAK LEY’S ACT.” To the Editor of the Medical Gazette. Sir, Allow me to thank you for your able'and complete exposure of the inefficiency of the Honourable (!) Finsburian’s measure. I feel it is due to you to acknowledge that in a few days after the insertion of my note and your powerful remarks, the over¬ seer of the parish of — — called, without any solicitation from me, and discharged the amount of the coroner’s order. The affair speaks for itself, and requires no comment from — Your obedient servant, Chirurgus. Dec. 14, 1836, NOTE FROM MR. WALKER. To the Editor of the Medical Gazette. Sir, I shall be much obliged by your noticing the following errata, which appeared in my paper of Saturday last, December 10th. In the paragraph commencing “Un¬ doubtedly the arrangement of the nerves of the eye, &c.,” for “ distinction,” read “ distribution of the nervous filaments.” In the last paragraph, for “carried out and perfected by himself,” read “ myself, &c.” As these errors materially affect the whole, I think it important that they should be pointed out. — I am, sir, Your obedient servant, John Walker. Manchester, Dec. 12, 1836. NEW MEDICAL ROOKS. Practical Observations on various sub¬ jects relating to Midwifery. Bv Dr. James Hamilton. Part II. 8vo. 7s. 6d. Elements of the Practice of Physic. By D. Craigie, M.D. Vol. 1, 8vo. 18s. Outlines of a Course of Lectures on Medical Jurisprudence. By T. S. Traill, M.D. 2s. 6d. Elements of Medicine. By R. Williams, M.D. Vol. 1, 8vo. 10s. 6d. Quain’s Anatomical Plates of the Mus¬ cles. Coloured edition, royal folio, 51. 5s. APOTHECARIES’ HALL. LIST of gentle men who have received CERTIFICATES. December 15, 1836. William Henry Swallow, Halifax, Yorkshire. John Macartney, Nolan. Mervin George Walker Coates, Salisbury. Joseph Welsby, Prescot, Lancashire. Charles Stevens, Oxford. Charles Maynard Frost. Thomas Pooley Smyth, Ramsey, Huntingdonshire. William Henry Cullen. John Bond, Warwickshire. John Thompson, Middleham. John Roberts. WEEKLY ACCOUNT of BURTALS, From Bills of Mortality, Dec. 13, 1836. Abscess . . 22 Age and Debility . 233 Apoplexy . . 65 Asthma . . 86 Cancer . . 17 Childbirth . . 21 Consumption . 333 Constipation of the Bowels . . 6 Convulsions . 214 Croup . . .53 Dentition or Teething 75 Diarrhoea . . 4 Dropsy . .102 Dropsy on the Brain 41 Dropsy on the Chest 14 Dysentery . . 1 Epilepsy . . 3 Erysipelas . . 13 Fever . . .61 Fever, Scarlet . 42 Fever, Typhus . 7 Gout . . .30 Haemorrhage . 2 Heart, diseased . 28 Hooping Cough . 70 Indigestion . . 1 Inflammation . 232 Eowels& Stomach 20 Brain . . 21 Lungs and Pleura 25 Influenza 1 Insanity . 55 Jaundice 4 Liver, diseased , 36 Locked Jaw 1 Measles . . 84 Miscarriage . . 8 Mortification 21 Paralysis . . 32 Rheumatism » 5 Scrofula 3 Small-pox Sore Throat and 69 Quinsey . 4 Spasms 15 Stone & Gravel . 3 Stricture 1 Thrush 48 Tumor . . 5 Unknown Causes 591 Casualties . 43 Increase of Burials, as compared with > the preceding week . . j *** This being the 52d Weekly Bill, and the last which will be included in the General Bill of the present year, several of the Parish Clerks who had neglected to make their returns in due order, have now reported their deficiencies ; from which cause appears the great increase in the Burials. METEOROLOGICAL JOURNAL. Dec. 1836. Thermometer. Barometer. Thursday . 8 from 38 to 45 29-23 to 2910 Friday . . 9 32 41 29-06 28 92 Saturday . 10 28 42 2911 29-35 Sunday ..11 27 41 29-45 29-55 Monday. . 12 22 50 29-55 29 31 Tuesday . . 13 45 48 29-22 Stat. Wednesday 14 32 44 29-23 29-49 Wind S.W. Except the 9th and two following days, generally cloudy, with frequent rain. A heavy shower of hail on the evening of the 8th. Rain fallen, ‘85 of an inch. Charles Henry Adams. ERRATA. In the report of the London Committee of the British Association, on the Motions and Sounds of the Heart, p. 365, col. 1, for “ Exp. 58,” read “ Exp. 7, 9, 10, 12, 14,” Again, lower down, same col., for “Exp. 6,7, 9,” read “Exp. 7, 12, 14.” And again, still lower down, for “Exp. 7, 8,” read “ Exp. 7, 12, 14.” Wilson & Son, Printers, 57,Skinner-St. London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOURNAL OF jHetu'ct'ne ana tfie Collateral Primers. SATURDAY, DECEMBER 24, 1836. LECTURES ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine, . By William Cummin, M.D. Lecture XIII. Medico-legal consideration of Pregnancy — Cases in which the ascertainment of preg¬ nancy is required by law — The old writ “ De ventre inspiciendo” — Jury of matrons — Signs of Pregnancy — Of conception — Popular signs of pregnancy from suppressed menses, constitutional peculiarities, and en¬ largement of the person — Important diagnosis from the state of the areola — Discoloration of the vagina — Movement of the foetus — Quick¬ ening — State of the cervix uteri — Ballotte- ment — The auscultatory signs — Conclusions respecting the signs derivable from auscul¬ tation. The subject which next presents itself to us, in the simple and natural order adopted in these lectures, is pregnancy ; and I have only to premise, that in treating it, I am not to be expected to take in that wide range which more properly belongs to the teach¬ ers of physiology and midwifery. A view of the subject on so extensive a scale, would embrace a complete history of the changes which occur in the female system from the moment of conception to that of parturition, with an account of the vari¬ ous theories which have been suggested relative to the causes of those changes. But our purpose will be fully answered, if, in our medico legal capacity, we be enabled to satisfy the demands occasionally made on us in courts of justice, to determine whether, in particular instances, pregnancy I exists, — how long, — and whether the foetus be alive or not. I 473. — xix. Legal distinctions relative to Pregnancy. — • Questions may arise, both in civil and cri¬ minal cases, as to the existence of preg¬ nancy. The pregnant state may be feigned, or it may be concealed ; and though there are old arrangements still in force, osten¬ sibly for procuring the necessary informa¬ tion on this head, through the agency of females, — “discreet matrons,” — still the inefficiency of such method has often been, recognized, and the more usual practice now is to depute professional men to make the requisite inquiries. It is therefore in¬ cumbent on us to be prepared for such investigations. Alleged pregnancy. — The cases in which the medical practitioner may be called upon for his medico-legal assistance, are commonly these : — • 1. Where a plea of pregnancy is ad¬ vanced by a widow, who, soon after her husband’s death, in her own name and that of the infant of which she declares herself enceinte, lays claim to a portion of an inheritance. In order to provide against any imposition in a matter of so much im¬ portance, the old Roman lawq de ventre in¬ spiciendo, wras long ago adopted in this country ; a rude and barbarous arrange¬ ment for ascertaining the fact of preg¬ nancy. It consisted in a personal inspec¬ tion, made in presence of a number of “ discreet men,” by a number of “ discreet women,” who handl d the breasts and belly of the examinant, until the whole party were satisfied whether she wras really pregnant or not. The writ authorizing this sort of proceeding has been at dif¬ ferent times issued : in the reign of Elizabeth there was the celebrated case of Lady Willoughby ; and in the last century occurred the case of Sir John Chaplyn’s lady, whose three sisters-in-law wrere to inherit, provided Lady Chaplyn’s alleged pregnancy did not prove real. Even so recently as a year ago, in the case of Mrs. Ann Fox, who. pleaded preg¬ nancy, and the probability of a son and 2 F 434 DR. CUMMIN ON FORENSIC MEDICINE* heir to her deceased husband, the question was argued at large in Chancery, whether the old writ should be issued, as applied for by the heir presumptive; and it would probably have been granted in that case, but that, during the tediousness of the Chancery suit, the lady’s pregnancy be¬ came so far advanced as to leave little doubt of its reality ; a slight surveillance, in the shape of an occasional visit from two matrons and two medical men, was all that was then deemed necessary *. 2. In criminal cases, pregnancy is some¬ times pleaded in bar of execution : it forms the ground of a reprieve — infavorem prolis — that the innocent may not suffer with the guilty. This law also has come down to us from ancient Home, where it was held “ quod prsegnantis mulieris damnatEe psena differatur, quoad pariat.” But be¬ fore the plea is admitted, it must be made good by the verdict of a jury of “ twelve matrons, or discreet women,” impanelled from among those who may happen to be y>resent in court: and it must be found, not only that the prisoner is pregnant, but that she bears a quick or living child. Jury of Matrons. — The absurdity of committing so difficult an inquiry to such referees, must be obvious to every one: but there is reason to believe that the practice is worse than absurd — that it is mischievous, and fraught with dan¬ ger. This had nearly been the case in an instance which occurred at Nor¬ wich about three years ago. A female was condemned to death : she pleaded pregnancy, for a respite of her sentence, and a jury of matrons, such as the court¬ house afforded, was impanelled to try her plea. The jury and the prisoner retired for an hour ; but what methods were taken for ascertaining the fact of pregnancy dur¬ ing that time, we know not : we only know that the verdict of the twelve dis¬ creet women was, that the convict was not pregnant. The crime for which the un¬ fortunate woman was tried was murder ; her execution, therefore, as the law then required, was to take place on the next day but one after her trial. It fortunately happened that the atten¬ tion of two or three intelligent surgeons was attracted to the case. They procured an opportunity of examining the prison¬ er’s person, and came to a very different conclusion from that of the discreet jury of matrons : they found that she was in the sixth month of pregnancy, and that the child was alive. By much exertion, deserving of the highest praise, they were enabled to make a timely representation of the true state of the case to the judge, and the con¬ sequence was that a reprieve was granted. I may add, that, in due time, the correct¬ ness of the professional diagnosis was veri¬ fied ; a living infant was brought forth in less than four months.* Ought not this to put an end to the jury of matrons’ system for ever? So gross, so almost fatal a blunder, ought surely to stand in perpetual judgment against such a prac¬ tice. Yet the old law remains, nor is there any likelihood of its being soon re¬ pealed. The only chance, therefore, of a rational proceeding, is to be looked for from the discretion of the judges. As they have, in some civil cases, committed the examination of the person to two physi¬ cians and two surgeons, selected for the purpose, so it is to be hoped that the custom will be generally followed, and that the female jury may be only known by the next generation, as one of the absurd things which their fathers had so long and so strangely countenanced. 3. It may be necessary, in other cases beside those in which a prisoner is capi¬ tally condemned, to inquire into the fact of pregnancy. The magistrate may be induced to grant a mitigation of pu¬ nishment — the severities of imprisonment or hard labour may be relaxed, should the convict prove to be pregnant. 4. And lastly, the question may be of vital importance in regard to charges of attempted abortion. If pregnancy were denied by the accused, and not shown to exist upon sufficient medico-legal evidence, it is clear that there would be no corpus delicti : while, on the other hand, compe¬ tent professional testimony that the pri¬ soner is positively not pregnant, must put an end to any charge of the sort preferred against her. Concealed pregnancy. — The detection of pregnancy is in general a difficult task ; but especially so when the female is gift¬ ed with powers of deceit, and has strong motives for concealing her condition. When the attention of the medical man is not immediately directed to that point, and no circumstances occur to awake his suspicion, as when his ser¬ vices are required for other complaints, nothing is more common than that he should find himself astonished at last by the operations of nature. Ridicule and blame have often been the meed of the practitioner for his supposed simplicity, in thus letting himself be duped, even in cases where no moral presumption could well have been entertained respecting the conduct of his patient. But whether blame justly attaches or not in such cases, 1 shall not stay to inquire : it is the affair of the practitioner, in the discharge of his ordinary routine duties. We, in our * Medical Gazette, xvi. 697, and xvii, 191. * Medical Gazette, vol. xii. p. 22, and 585. SIGNS OF PREGNANCY. 435 medico-legal capacity, must never be with¬ out our suspicions; we are called in, in fact, only when suspicion already exists, and it is our business to determine whether it be well founded or not. SIGNS OF PREGNANCY. What are the signs on which the medi¬ cal jurist may depend as indicative of pregnancy ? It is plain that, for medico¬ legal purposes, those vague indications on which the vulgar place reliance, and which have been unreasonably called the rational signs, can be of little or no use. At the very utmost they may warrant a presump¬ tion; but, collected as they must be from extraneous circumstances, or the allega¬ tions of the females themselves, they can only be received with the utmost caution. In legal medicine w'e must have visible, tangible, and audible proofs, and more or less of these in combination, before we attain what would deserve to be considered as conclusive evidence. Let us first suppose the pregnancy to be uterine, and that the changes consequent on the development of the embryo proceed in their ordinary or normal course. Ex¬ tra-uterine pregnancy, and the irregulari¬ ties attendant upon that and other condi¬ tions, may afterwards be more conveni¬ ently noticed. Question of conception. — It has been thought that soon after conception some appearances indicative of the occurrence of that state might be observed. But it would be idle to mention the falla¬ cious and ridiculous signs which were once depended on by medical authorities, and still are by gossiping people of either sex. They were almost all grounded on certain sensations supposed to have been expe¬ rienced by the female— a sudden chill, ex¬ cessive languor, &c. — after increased sexual enjoyment. The question, however, is sel¬ dom or never proposed to the medical jurist, to determine the fact of recent con¬ ception in the living female. Where a woman has died presently after an alleged connexion — from poisoning or other in¬ jury — it may be possible to gather from the state of the organs of generation some strong presumptions, which may greatly corroborate the circumstantial and moral evidence. A deciduous membrane may be found lining the cavity of the uterus; a mucous-looking fluid resembling semen may be found in that cavity, as well as perhaps in the fallopian tubes; and pro¬ bably a corpus luteum may be detected in one or other of the ovaries. I have here [exhibiting it] a very beau¬ tiful drawing made from nature by my accomplished colleague, Dr. Hope. It re¬ presents the state of the vagina, uterus, and its appendages, in a young female wrho poisoned herself. From the history of the case, and an evidently recent lacera¬ tion of the hymen, it was probable that impregnation had taken place within a very short period. In the uterus, which is somewhat larger and redder than in the virgin state, was found a quantity of gela¬ tinous matter, with that dark coagulated blood in small flakes which John Hunter describes as belonging to incipient infceta- tion. Both the ovaries appear turgid with very dark blood; the section of the left displays a corpus luteum, with a T-shaped scar in the corresponding surface, through which the ovum had probably escaped. In the right ovary may be seen an ovum apparently mature for impregnation. Both the fallopian tubes were filled with a fluid, whiter and more opaque than mucus; and in the uterus was a similar fluid, but more gelatinous and transparent. It would have been interesting had this fluid been more particularly examined as to its phy¬ sical and chemical characters, I shall have occasion to refer to this drawing again *. Enumeration of the signs of pregnancy. — In enumerating the ordinary symptoms of the pregnant state, we cannot wholly over¬ look those w’liieh are properly esteemed vulgar, although they be so little worthy of notice for the purposes of forensic me¬ dicine. The first three among the fol¬ lowing are of this kind — -viz. suppression of the menses, morning sickness, and en¬ largement of the breasts and belly. 1. Suppression of the menses. — The fact of the non-appearance of the catamenia at the usual period can be of little value in a medico-legal point of view ; yet, as a symptom of pregnancy, it is the one which commonly makes the strongest impression on females themselves, and from which they usually calculate the date of their gestation. But it is obvious that suppres¬ sion of the menstrual discharge may be owing to a variety of circumstances beside pregnancy. At a certain time of life it indicates a total cessation of the functions of child-bearing; and, on the other hand, women have been pregnant without ever having had the menses. Women again may menstruate more or less during the period of pregnancy. Heberden mentions a lady who had borne several children, yet had never ceased, either during her preg¬ nancy or nursing, to menstruate regularly. Denman, on the contrary, insists strongly on the sign, and considers it as a sine qua non of the pregnant state. 2. Nausea., fyc. — The concomitant cir¬ cumstances of morning sickness, depraved appetite, irregular aches and pains, sharp¬ ness of the features, See., may be classed * See an engraving from it in next lecture. 430 DR. CUMMIN ON FORENSIC MEDICINE. together as a set of vague signs, which ac¬ quire any value only when strongly corro¬ borated by collateral facts. It is true that most pregnant women do experience many of these symptoms during pregnancy ; but we must recollect that they may all origi¬ nate in totally different causes, and are sometimes not observable during the whole period of gestation. As to sharpness of the features, it is certainly peculiar, but is chiefly observable only in the later months, when the abdomen is very large — the integuments of the face being then affected, even drawn down by the disten¬ sion and weight of the part: it is that condition which the gossips call being “ all mouth and eyes.” Dr. Dewees lays great stress upon a sign which he holds to be infallible, and that is, a peculiar kind of salivation which sometimes takes place: the pregnant wo¬ man spits frequently, and in such a way as to justify the remark that she is “ spit¬ ting cotton.” In this country, or at least in Ireland, as we shall see by a trial to which I shall probably refer in the sequel, the term is not very different, and evi¬ dently applies to the same thing: the wo¬ man is said to be spitting “ long spits.” But these are matters obviously of little.or no practical importance to the medidal jurist. 3. Enlargement of the breasts and abdomen. — The breasts sometimes become unusu¬ ally large, and are popularly noticed as symptoms of pregnancy. Should this en¬ largement be contemporaneous with other well-marked signs, it may have some va¬ lue ; but the breasts so frequently sympa¬ thize with the uterine system, and, indeed, are so invariably affected in their size and consistency by accumulation or suppres¬ sion of the menstrual fluid, to whatever cause that circumstance may be owing, that it can clearly be only accounted as a collateral and very vague sign. Even though there be miik in the breasts, it is far from being a certain sign per se ; for virgins are known to have had a secretion of that fluid ; and old women, too, long after the cessation of child¬ bearing; nay, men have had an abun¬ dant flow of milk in their breasts, suf- cient at least, according to some re¬ markable narratives given us on the au¬ thority of the celebrated Humboldt, and Captain Franklin, in his Overland Jour¬ ney, to suckle their own children. The abdomen. — With respect to enlarge¬ ment of the abdomen, that most po¬ pular of the visible signs of pregnancy, we must take care not to be deceived. In the first place, are we sure when we observe this increase of size that it is owing to an enlargement of the ute¬ rus? and secondly, are we quite sure that such enlargement is owing to the pre¬ sence and the development of a foetus ? These are points on which we must have some assurance before we can infer the fact of pregnancy. The phenomenon may result from drop¬ sy — simple, or encysted, or ovarian — from tympanitis, or other affections, with the diagnostic signs of which we ought to be sufficiently well acquainted not to con¬ found them with the effects of pregnancy. Enlargement of the abdomen in uterine pregnancy is generally uniform and sym¬ metrical— an appearance which serves to distinguish it from that which is conse¬ quent on extra-uterine pregnancy, or dropsy of the ovaries. The degree of aug¬ mentation which is observed to charac¬ terise the several stages of pregnancy is worth attending to. No very obvious enlargement of the ab¬ domen can probably be observed until after the completion of the fourth month. About this time, say between the fourth and fifth months, the belly begins to be globular, the skin appears distended, and the fundus uteri is found to correspond to the middle point between the umbili¬ cus and the pubes. On the completion of the sixth month the fundus has reached about the height of the umbilicus. The augmentation of volume is now very strik¬ ing. About the seventh or eighth month the fundus is perceived to be higher, consi¬ derably so in many cases, than the navel. Towards the early part of the ninth month the fundus even reaches the sero- biculus cordis, though, shortly before par¬ turition, there is a manifest sinking of the parts to about the volume they occupied in the course of the eighth month. The state of the navel ought not to be overlooked. It undergoes changes in its figure during the regular enlargement of the abdomen ; it is ultimately thrown out¬ wards, first becoming gradually oblite¬ rated, or at least levelled with the surface of the belly; and during the latter months assuming the form of a prominent boss. 4. Areola. — The preceding signs are, as I have said, more or less fallacious : those, however, which I have now to notice are deserving of a higher degree of attention ; and the first of these is the peculiar state of the nipple, and of the integument around it, constituting the areola. The appearance of the areola as indi¬ cative of pregnancy, has long been observ¬ ed by medical men, and some have been known to place great reliance upon it. Dr. William Hunter is said to have considered it as a master-sign; and a story is told of his having pronounced a woman pregnant, whose body he merely happened to see in the dissecting-room; and he persisted in his assertion, though it was objected to SIGNS OF PREGNANCY. 437 lira that the hymen was unruptured : his iiagnosis, however, was formed from the appearance of the areola, and his opinion proved to be fully justified by the subse¬ quent inspection of the internal parts. But little notice seems to have been be¬ stowed on this diagnostic sign of late years, and, in fact it had fallen into almost total discredit, when Dr. Montgomery, of Dub¬ lin, took it up, and by his excellent de¬ scription of its characteristic appearance, brought it into much higher estimation than it has ever before enjoyed. I shall read for you some part of his observa- tions on the subject; they are taken from his very able and elaborate article in the Cyclopcedia of Practical Medicine, on the “ Signs of Pregnancy.” After remarking that this is one of the changes consequent on pregnancy which is of the “ utmost va¬ lue” in evidence of the fact, and having noticed Roederer’s account of the areola, he proceeds: — “ One other we shall add, as equally constant, which is a soft and moist state of the integument, which, to¬ gether with its altered colour, gives us the idea of a part in which there is going for¬ ward a greater degree of vital action than is in operation around it ; and we not im- frequently find that the little glandular follicles are bedewed with a secretion suf¬ ficient to damp and colour the woman’s inner dress. We mast recollect, also, that these changes do not take place imme¬ diately after conception, but occur in dif¬ ferent persons after uncertain intervals; we must therefore consider, in the first place, the period of pregnancy at which we may expect to gain any useful informa¬ tion from the condition of the areola.” “ We cannot speak very positively as to what may be the earliest period at which this change can be observed, but we have certainly been satisfied of its existence at the end of the second month; at which pe¬ riod the change of colour is by no means the most distinct character to be observed ; but the turgescence of the nipple, and the development of the little glandular folli¬ cles, are the objects which should princi¬ pally engage our attention, — the colour at this period being, in general, little more than a deeper shade of rose or flesh colour, slightly tinged with a yellowish or brown¬ ish hue. During the progress of the next two months, the changes in the areola are, in general, perfected, or nearly so ; and it then presents the following character : — A circle around the nipple, whose colour varies in intensity according to the pecu- i liar complexion of the individual, being generally much darker in persons with iblack hair, dark eyes, and sallow skins, than in those of fair hair, light- coloured eyes, and delicate complexions. The ex¬ tent of the circle varies from a diameter of an inch to an inch and a half, and in¬ creases in some as pregnancy advances, as does also the depth of colour. In the cen¬ tre of this circle the nipple is observed partaking of the altered colour of the part, and appearing turgid and prominent; and the part of the areola more immediately around the base of the nipple has its sur¬ face rendered unequal by the prominence of the glandular follicles, which, varying in number from twelve to twenty, project from the sixteenth to the eighth of an inch ; and, lastly, the integument cover¬ ing the part is observed to be softer and more moist than that which surrounds it; and the breasts themselves are, at the same time, observed to be full and firm, at least more so than was natural to the person previously. Such,” adds Dr. Montgomery, “ such we believe to be the essential cha¬ racter of the true areola, the result of preg¬ nancy; and that when found possessing these distinctive marks, it ought to be looked on as the result of that condition alone, no other cause being capable of pro¬ ducing it.” Placing the fullest reliance on the accu¬ racy of this description, I should recom¬ mend to you the importance of comparing it with actual examples, as they may happen to fall in your way. In order to judge satisfactorily from appearances like these, it were advisable to combine yourowm experience with the observations of others ; and I need scarcely add, that no pains can be superfluous when bestowed for the purpose of putting us in posses¬ sion of so capital a sign. Only con¬ ceive the importance of our being able to obtain evidence of a highly probable, if not a conclusive, character, from simply viewing the female mamma ! I dare not, from any experience of my own, venture to assert that so high an amount of evidence can be procured from even the most careful inspection : but the authority of Dr. Mont¬ gomery, Dr. Hamilton of Edinburgh, and others who have recently devoted their at¬ tention to this subject, is suflicient to warrant me in pointing out to you the change of appearance in the areola as a sign of pregnancy worthy of your most especial notice. Discoloration of the vagina. — As somewhat related to the alteration of colour just no¬ ticed, I may here introduce a few words respecting a curious diagnostic sign of pregnancy lately announced in Parent- Duchatelet’s volumes. It appears that the extensive opportunities which M. Jacque- min has had, in examining the public women at the Dispensatory in Paris, have enabled that gentleman to discover a pe¬ culiarity belonging to the pregnant state — • namely, a change of colour in the lining membrane of the vagina. It becomes of a 438 DR. CUMMIN ON FORENSIC MEDICINE. violet hue, or purplish, like the lees of wine. M. Jacquemin says he is never deceived in this appearance, and that he can de¬ pend upon it even without taking into ac¬ count any of the other symptoms com¬ monly observed. He has had, it seems, no less than 4,500 cases passing through his hands, and upon which he was enabled to prove the correctness of his diagnosis. Should this be found eventually a good test of pregnancy, it will be of great im¬ portance in forensic medicine. In ordi¬ nary practice there would be strong ob¬ jections to the employment of it, — while every facility would be afforded for ob¬ serving the areola : but in medico-legal practice the awkwardness of applying the speculum vaginae would, perhaps, be readily overlooked. 5. Motions of the foetus. — The remaining signs are of what has been called a sensible nature, perceptible by the touch or hear¬ ing : they are derived more immediately from the presence of the foetus, and are to he appreciated when the child is alive and healthy. We may perceive the move¬ ment of the foetus by having recourse to a little management. Towards the conclu¬ sion of the fifth month, or even somewhat earlier (for some quicken, as it is called, that is, feel the first symptoms of the vita¬ lity of a being within them, earlier than others), the organs of locomotion in the foetus are in such a state of activity as to become sensible to the hand applied on the exterior of the abdomen, and are even sometimes distinctly visible through the clothes of the female. It must, however, be recollected, that in some wo¬ men, spasmodic contractions of the uterus and of the intestines may present very similar phenomena ; and even experienced accoucheurs are said to have been deceived by relying upon this sign. What Dr. Gooch says on the subject — and he attaches very high importance to it — deserves to be quoted: — “If the hand is laid on the naked abdomen, between the pubes and the umbilicus, the foetus will sometimes be felt to stir. As, however, it moves only occasionally, this may not happen during the examination. It is said that by dip¬ ping the hand in cold water, and laying it suddenly on the naked abdomen, the foetus may be made to move. As I have long had the cold hand of a dyspeptic sufferer, I have no occasion to dip my hand in cold water; it is always cold enough to make the patient shrink, and by laying it sud¬ denly on the naked abdomen, I have sometimes felt the child move, but this has been only an occasional occurrence. If distinctly felt, it is of course the most con¬ clusive symptom.” Quickening. — Connected in some measure with this subject is the question of the fact of quickening. The phenomenon of quickening was supposed by the older physiologists to arise from the accession of life (as the term implies) to the foetus at that period. But when we know that what is understood in general by quickening does not take place till between the fourth or fifth month after conception, we are pre¬ pared to reject that hypothesis, for we know that the communication of life is the immediate consequence, if not the very essence, of the act of conception. It is more probable that quickening, so called, is the first impression made by the foetus on the mother, the foetus being then sufficiently developed, and sufficiently lively, to make a sensible impression on the mother by its movement. Another hypothesis, of more recent date than the foregoing, is, that it arises from the sudden ascent of the uterus out of the pelvis, that viscus now requiring more room for its development. But whatever be the true cause, the sensation to the mother is decisive. She generally compares it to something tap¬ ping within the uterus, or to the flutter¬ ing of a bird ; and syncope often accom¬ panies the first impression. The time of quickening is not the same in different women, for it depends, 1st, on the acuteness of the mother’s sensations; 2dly, on the strength of the foetus; andBdlv, on the quantity of the liquor amnii present. These remarks are not to be considered as made on a point merely curious: for the medical jurist may be particularly ex¬ amined as to the fact of quickening, whe¬ ther it has taken place or not : the crime of wilful abortion, for example, is either a capital felony, or one of a lower degree of guilt, according as the fact of quickening may have been ascertained or not. But the medical wdtness has no other means of solving the question, than by ascertaining the movement of the foetus. 6. State of the cervix uteri. — The next sign to which I would direct your at¬ tention, is that which must be ascer¬ tained by the touch — le toucher of the French accoucheurs. In the unimpreg¬ nated state, it will be remembered that the cervix uteri forms a nipple like promi¬ nence, which projects into the vagina about two-thirds of an inch. Shortly be¬ fore delivery, it is found almost wholly obliterated, or nearly flat, to the finger. Now the obliteration is effected gradually, during the state of pregnancy, but a change does not begin to be perceived un¬ til about the fifth month. By the seventh, it has become much altered, very soft, broad, and short, and so on to the close of gestation. In making the examination requisite for ascertaining the state of the part, and thus judging of the stage of SIGNS OF PREGNANCY. 439 pregnancy, the forefinger of the right hand is to be applied against the projec¬ tion in the vagina, while the left hand is to be laid on the abdomen. By then pressing gently with the left hand downward, the finger in the vagina has full liberty to explore the shape and size of the cervix, at the same time that ano¬ ther observation may be made. By alter¬ nately forcing upward with the right fore¬ finger, and downward with the left hand, we may assure ourselves that the tumor felt through the walls of the abdomen is the same as that felt through the vagina — the most satisfactory proof that it is an en¬ larged uterus. This method may be prac¬ tised with effect as early as the fourth or fifth month: but it should be added, that the examination as to the form of the cervix cannot in general be successfully made until about the sixth. Both this examination and the former, relative to the movement of the foetus, may be perhaps best effected, the female being recumbent. Dr. Gooch says, “ the bladder should be empty, the woman in bed, in her night¬ dress, on her back, in a posture between sitting and lying, with the knees slightly drawn up.” Ballottement.' — Another important point to be ascertained by the touch is the ballottement. It will be recollected that in the pregnant uterus the foetus floats in the liquor amnii, and when the female who is to be examin¬ ed is in the erect posture, the head of the foetus, if there be one present, must rest over the top of the vagina. “ Now, if the examiner,” says Dr. Gooch, “ applies his finger to the uterus, just in front of the neck, and gives it a push, the foetus will float for an instant, and the next instant fall with perceptible weight on the point of the finger ; this sensation, if once felt, can never be mistaken ; it is scarcely infe¬ rior in conelusiveness to the muscular movements of the child, and has this ad¬ vantage over the latter, that it can be felt, whether the foetus is alive or dead.” The best time for detecting this rebound, or ballottement , as the French call it, is from the fifth to the seventh month : the reason is obvious, when we consider the relative proportion of the liquor amnii to the bulk of the foetus; “earlier than the fifth month the foetus is too light to be felt; and later, it is often too closely pack¬ ed to be moved.” 7. Auscultatory signs. — I have reserved for the last, an account of the latest and best, method of ascertaining the existence of preg¬ nancy — a method which, when successfully cm ployed, not only assures us of the presence of the foetus, but of its vitality. It is not applicable where the child is dead, or pecu¬ liarly placed in the uterus. But with these exceptions, the use of auscultation is at¬ tended with advantages to the medical jurist which cannot be too highly prized. We are indebted to M. Kergaradec for the first hint of applying auscultation, with the naked ear, or the stethoscope, to the abdomen of the pregnant female. M. Mayor, of Geneva, preceded him, indeed, by a few years, in observing the pulsations of the foetal heart through the abdominal parietes; but not having made any practical application of the fact, he has scarcely any claim as a discoverer. Through the stethoscope, M. Kergaradec detected two distinct systems of pulsation in the abdo- men of the pregnant female — the one be¬ longing to the foetal heart, the other to the placenta. Let us suppose the woman five or six months gone with child : on ap¬ plying the stethoscope or the naked ear to the middle space between the umbilicus and the crural arch on the left side, we shall probably hear a ticking sound like that of a watch ; this is the beating of the foetal heart, and the pulsations, which are double, are generally from about 120 to 160 in the minute, wrhile perhaps the mo¬ ther’s pulse, reckoned by holding the wrist at the same time, does not exceed 70. I may mention here, in passing, that there appears some contrariety in the state¬ ments of different observers respecting the rate of the foetal pulse. Dr. Jeff'ray, of Glasgow, Dr. Hamilton, of Edinburgh, and others, maintain that the pulsation in the umbilical cord, and, of course, that of the foetal heart, does not exceed sixty in the minute — nay, is rather less. So many able auscultators, besides Kergaradec, have sa¬ tisfied themselves that the foetal pulsation is at least double as quick as the Scotch pro¬ fessors allowr it to be, that one cannot help suspecting that there is some mistake, and that probably both parties are really not so much at variance, after all. Dr. Hamil¬ ton, and those who are with him, allude particularly to the beating of the cord, and that about the period of labour; when, in fact, the first stage is over; or any stage, as it would seem, pre¬ vious to respiration. The others trust to their ears, while yet there may be no symptom of labour commencing. Now may there not be an essential difference in the circumstances ? — may not some change, hitherto not wfell observed, have taken place in the foetal circulation, preparatory to the commencement of the respiratory process ? — may not some new arrangement have occurred, the effect of which is to reduce the circulation of the foetus in the number of beats ? I feel so satisfied of the trustworthiness of both sets of observers, that I can only endeavour to reconcile them by thus imagining that each has been describing a different state of things. But to return to the phenomena. 440 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS. Having observed the double pulsations, the stethoscope is next to be applied to another part of the abdomen ; and here we shall probably find the beating of the other system, single pulsations, per¬ fectly isochronous with the pulse of the mother. These are, moreover, attended with a peculiarity which distinguishes them from the beats of a common ar¬ tery ; they are characterized by a bel- lows-sound, or bruit- de-soufjlet. This phe¬ nomenon, which is observed to be connect¬ ed with the placental circulation, is said to be appreciable much earlier duringgestation than the double beating already described : it may be perceived, according to some, even as early as the end of the third month, upon applying the stethoscope just above the pubes. But it is more probable that in general it cannot be detected till the fourth month. It sometimes requires considerable pa¬ tience before we can place the stethoscope so as to be able to hear what we are in quest of : the state of the woman’s intes¬ tines, which may be distended with flatus, may deceive us ; the position of the pla¬ centa in the uterus, its various attachments, sometimes even over the os tincse, and the various positions of the foetus itself, are all calculated occasionally to try our in¬ genuity as well as our good temper. Conclusions respecting auscultation . — Three conclusions may be borne in mind, with respect to the use of the stethoscope, in attempting to ascertain pregnancy : — (a.) That though we may be unable, after repeated trials, to hear any sound with the instrument applied to the abdo¬ men, we are not to infer that pregnancy does not exist ; for the foetus may be dead, or very feeble, or so situated that we can¬ not hear either the beating of its heart or the circulation in the placenta. (b.) That where we can hear nothing more than the placental pulsation, we are not justified in asserting that pregnancy exists; for perhaps the uterus may con¬ tain some other substance than a foetus, or there may probably be some j^eculiar condition of the uterine vessels. (c.) But that whenever we distinctly hear the double pulsations, with or without the placental souffle, we may affirm posi¬ tively that the woman is pregnant. Nay, should we detect simultaneously another set of double pulsations, as sometimes happens, we may announce the fact of twin pregnancy. Nor are these all the advantages to be derived from the use of the stethoscope in connexion with medico-legal inquiries. The auscultatory method will further in¬ form us whether the pregnancy be extra- uterine or not : also, by its indications respecting the placenta, where may be the safest place of the abdomen on which to perform the Caesarean section. It would, I think, be superfluous to say more on the great importance of auscul¬ tation as a diagnostic aid to the medical jurist in determining the pregnant state; but I cannot refrain from suggesting one short piece of advice in conclusion, and that is, that you should avail yourselves of every opportunity of acquiring dexterity in this application of the stethoscope, — for it is by diligent practice alone that you can attain that degree of tact which will give satisfaction to yourselves, as wrell as to those who may require your opinion. LECTURES ON MATERIA MEDICA, OR PHARMA¬ COLOGY, AND GENERAL THERAPEUTICS, Delivered at the Aldersgate School of Medicine , By Jon. Pereira, Esq., F.L.S. Lecture LIII. Gentlemen, — In this lecture I propose to examine those pharmacological agents yielded us by the order APOC YNACEjE. The first and most important substance in this family is the Nux vomica. Stryctyios Nux vomica. History. — We became acquainted with Nux vomica through the Arabian authors. In the Latin translation of one of the wrorks of Serapion (w'ho is supposed to have lived early in the eleventh century), we find the wrord nux vomica, but it ap¬ pears to have been applied to some other substance (probably to St. Ignatius’s bean). “ Est nux,” says he, “ cujus color est inter glaucedinem et albedinem, major avellana parum et sunt in ea nodi.’’ To which he afterwards adds, “ movet vomitum from which I presume the name of vomic, or vomiting nut, was originally derived. It is probable that the nux mechil of Sera¬ pion is the substance which we denomi¬ nate nux vomica. Botanical history. — Tliefollowdngisashort abstract of the characters of this plant, taken from Roxburgh’s “ Flora Indica ,” to which I must refer for further informa¬ tion : — The Nux vomica tree is of middling size, and is common in almost every part of the coast of Coromandel ; flowering dur¬ ing the cold season. It belongs to class NUX YOMICA. 44 I Pentandria , order Monogynia, of the Lin- nean classification. The trunk is short, often crooked, and pretty thick ; the branches irregular ; the wood white, hard, and bitter. The leaves are opposite, oval, shining, entire, and from three to live nerved. The flowers are in small terminal corymbs, and are composed of a five¬ toothed calyx, a funnel-shaped, greenish white corolla, five stamina inserted over the bottom of the divisions of the corolla, a two-celled ovarium, a style the length of the tube of the corolla, and a capitate stigma. The fruit is a round smooth berry, of the size of a pretty large apple, covered with a smooth, somewhat hard, shell, of a rich beautiful orange-colour when ripe • filled with a white, soft, gelatinous pulp, which is greedily eaten by many sorts of birds, and, therefore, seems perfectly inno¬ cent. The seeds ( nuces vomicJf are several, im¬ mersed in the pulp of the berry and at¬ tached to a central placenta. As they occur in commerce they are round, peltate, scarce¬ ly an inch in diameter, nearly flat, or very slightly convex on one side, and concave on the other, and are surrounded by a filiform, annular stria. From their fan¬ cied resemblance to grey eyes, as well as from their being poisonous to crows, the Germans term them Krahenaugen , or croivs ’- eyes. In the centre of the ventral surface of the seed is the orbicular hilum or um¬ bilicus. Fig. 143. — Nux vomica. a , The convex surface. b, The concave surface. These seeds have two coats ; the outer one, or testa, is simple, fibrous, and gives origin to short silky hairs, of an ash-grey or yellow¬ ish colour, and which are directed from the centre towards the circumference : within this is the inner coat, or endopleura, which is simple, and very thin, and envelops the nucleus of the seed. a, Testa, with the hairs attached to it. b, Endopleura. c, Albumen. This nucleus is composed of two parts — namely, albumen and embryo. The albu¬ men is bipartite, cartilaginous or horny, of a dirty- white colour, of an intensely bitter taste, and has in its interior a cavity ( loculamentum verum ). Unlike that of most seeds, the albumen nux of vomica is of a poisonous nature. The embryo, which is milk-white, is seated in the circumference of the seed, its locality being frequently indicated by a point somewhat more pro¬ jecting than the surrounding parts. It consists of two large cordi form, acuminated, triple-ribbed, very thin cotyledons, a dis¬ tinct cauliculus, and a centripetal radicle (i. e. a radicle directed towards the centre of the fruit). c, Transverse section of the seed. d, The cavity laid open to shew the natural situation and figure of the embryo. Chemical composition. — Several analyses of this seed have been published : but I shall pass over those made by Desportes, Bra- connot, and Chevreul, and principally confine myself to that of Pelletier and Caventou, made in 1818. These celebrat¬ ed chemists found the following sub¬ stances : — 1. Strychnic or igasurie acid. 2. Strychnia ? in combination with 3. Brucia $ strychnic acid. 4. A little wax. 5. A concrete oil. 6. A yellow colouring matter. 7. Gum (a considerable quantity). 442 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS. 8. Starch (a little). 9. Bassorine. 1 1. Vegetable fibre. 12. In the ashes were found carbonate of lime and chloruretof potassium. The strychnic or igasuiic acid, mentioned in this analysis, in many of its properties agrees with malic acid, but is distin¬ guished by the solubility of its alkaline salts in alcohol, and by its action on the salts of copper. Thus, when a solution of the ammoniacal sulphate of copper is added to the infusion of mix vomica, the liquid immediately becomes of an emerald green colour, and gradually deposits a greenish -white precipitate of the strych- nate of copper; the ammoniacal sulphate of strychnia remaining in solution. In this action on the cupreous salts, strychnic agrees with meconic acid ; from which we distinguish it by the red colour which meconic acid produces when added to the persalts of iron, and which is not deve¬ loped by strychnic acid. If nitric acid be mixed with the infusion or decoction of nux vomica, an orange- red colour is produced, by the action of the acid on the brucia and yellow colour¬ ing matter. A solution of iodine at first communicates a yellowish-brown tint to the decoction, but after a few minutes the .colour disappears, the iodine being con¬ verted into hydriodate (and probably into iodate also) of strychnia and brucia, and is then no longer detectable by starch, unless nitric acid or chlorine be also added. The salts of iron communicate an emerald green colour to the infusion of nux vomica, which disappears on the addition of hy¬ drochloric acid : this coloration does not depend, according to Pelletier and Caven- tou, on the strychnic acid ; nor can it arise from tannic acid, since gelatine gives no indication of the presence of this acid. By boiling infusion of nux vomica with animal charcoal, it is deprived of this power of becoming green on the addition of ferruginous salts. Tannic acid, or in¬ fusion of galls, produces a copious preci¬ pitate with the infusion or decoction of nux vomica; but by heating the liquid the precipitate is dissolved. This precipi¬ tate consists of tannic acid, strychnia, brucia, and some other vegetable matter. Alcohol added to the infusion of nux vo¬ mica precipitates the gum. Acetate and subacetate of lead produce cojuous preci¬ pitates, composed of oxide of lead com¬ bined with strychnic acid, gum, and some fatty and colouring matter. The wax mentioned in the above ana¬ lysis seems to be derived from the hairs co¬ vering the seeds : it enables them to resist moisture. Some authors mention resin as a constituent of these seeds : its ex¬ istence is very probable, since an alcoholic tincture of nux vomica becomes milky when mixed with water. By distillation with waiter, an odorous, non-acid , innocu¬ ous principle is procured. As the decoc¬ tion of nux vomica undergoes the vinous fermentation, the presence of sugar has been presumed. Meissner says he found copper in the ashes of nux vomica, but I have never been able to detect it. Physiological effects: 1. On vegetables. — - Marcet states, that a quarter of an hour after immersing the root of a haricot plant (Phaseolus vulgaris) in a solution of five grains of the extract of nux vomica in an ounce of water, the petals became curved downwards, and in twelve hours the plant died. Fifteen grains of the same extract wrere inserted in the stem of a lilac tree, on the 15th of July, and the wound closed. In thirteen days the neigh¬ bouring leaves began to wither. 2. On animals generally . — Nux vomica ap¬ pears to be poisonous, in a greater or less degree, to all classes of animals. On the vertebrata its effects are very uniform, though larger quantities are required to kill herbivorous than carnivorous animals. Thus a few grains will kill a dog, but some ounces are required to destroy a horse. It occasions in all, tetanic convul¬ sions, increased sensibility to external im¬ pressions, asphyxia, and death. 3. On man . — We shall establish three degrees of the operation of nux vomica on man. (a.) First degree : tonic and diuretic effects. — In very small and repeated doses, nux vomica usually promotes the appetite, as¬ sists the digestive process, increases the secretion of urine, and renders the excre¬ tion of this fluid more frequent. In some cases it acts slightly on the bow els, and oc¬ casionally produces a sudorific effect. The pulse is usually unaffected. In somewhat larger doses, the stomach not unfrequently becomes disordered, and the appetite im¬ paired. (b.) Second degree : rigidity and convulsive contraction of the muscles. — In larger doses, the effects of nux vomica manifest them¬ selves by a disordered state of the muscu¬ lar system. A feeling of weight and weakness in the limbs, and increased sensi¬ bility to external impressions, (of light, sound, touch, and variations of tempera¬ ture), with depression of spirits and anx¬ iety, are usually the precursory symptoms. The limbs tremble, and a slight rigidity or stiffness is experienced when an at¬ tempt is made to put the muscles into action. The patient experiences a diffi¬ culty in keeping the erect posture, and, in walking, frequently staggers. If, when this effect is beginning to be observed, you tap him suddenly in the ham while stand¬ ing, you may frequently bring on a slight NUX VOMICA. 443 convulsive paroxysm, so that he will have some difficulty to prevent himself from falling. I have often in this way been able to recognize the effect of nux vomica on the muscular system, before the patient had experienced any particular symptoms. If the use of the medicine be still per¬ severed in, these effects increase in inten¬ sity, and the voluntary muscles are thrown into a convulsed state by very slight causes. Thus, when the patient inspires more deeply than usual, or attempts to walk, or even to turn in bed, a convulsive pa¬ roxysm is brought on. The sudden con¬ tact of external bodies also acts like an electric shock on him. The further em¬ ployment of nux vomica increases the severity of the symptoms; the paroxysms now occur without the agency of any evident exciting cause, and affect him even when lying perfectly quiet and still in bed. The muscular fibres of the pharynx, larynx, oesophagus, and bladder, also become affected, and Trousseau says those of the penis are likewise influenced, and the nocturnal and diurnal erections be¬ come inconvenient even in those who, for some time before, had lost somewhat of their virility. Females also, he says, ex¬ perience more energetic venereal desires ; and “ we have,” he adds, with great naivete, “ received confidential information on this point, which cannot be doubted.” The pulse does not appear to be uni¬ formly affected; for the most part it is slightly increased in frequency between the convulsive attacks, but Trousseau says he has found it calm even when the dose of the medicine was sufficient to cause general muscular rigidity. Previous to the production of the affection of the muscles, various painful sensations are oftentimes experienced in the skin, which patients have compared to the creeping of insects (formication), or to the passage of an electric shock; and occasionally an eruption makes its appearance. It is remarkable that in paralysis, the effects of nux vomica are principally ob¬ served in the paralysed parts. The formi¬ cation and the convulsions here first manifest themselves ; and Magendie states he has observed sweating confined to these parts. “ I have seen,” says this physiolo¬ gist, “ the affected side covered with an anomalous eruption, while the opposite side was free from it. One side of the tongue is sometimes sensible of a very bitter taste, which is not perceptible to the other side.” 3. Third degree : Tetanus and Asphyxia. — I think I cannot do better than relate a case of poisoning by nux vomica reported by Mr. Ollier, in order to illustrate the third and most violent degree of operation of this drug. A young woman swallowed between three and four drachms of this substance in powder, and in half an hour was seen by Mr. Ollier. She was sitting by the fire, quite collected and tranquil; her pulse about 80, and regular. He left her for about ten minutes to procure an emetic, and on his return found that she had thrown herself back in her chair, and that her legs were extended, and conside¬ rably separated. She was perfectly sensi¬ ble, and without pain, but seemed in alarm, laid hold of her husband’s coat, and entreated him not to leave her. A perspiration had broken out on her skin, her pulse had become faint, and much quicker, and she called frequently for drink. She then had a slight and tran¬ sient convulsion. Recovering from it, she was in great trepidation, kept fast her hold of her husband, and refused to let him go, even for the alleged purpose of getting her drink. In a few minutes after, she had another, and a more violent attack, and shortly afterwards, a third: the duration of these was from a minute and a half to two minutes. In them she retained her grasp ; her whole body was straightened and stiffened, the legs pushed out and forced apart. I could not, says Mr. Ollier, perceive either pulse or respiration ; the face and hands were livid, the muscles of the former, especially of the lips, violently agitated, and she made constantly a moan¬ ing, chattering noise. She was not unlike one in an epileptic fit, but did not strug- glejthough, as she was forced straight out, it became difficult to keep her from falling- on the floor. In the short interval of these attacks she was quite sensible; was tormented with incessant thirst; perspired; had a very quick and faint pulse; complained of being sick, and made many attempts to vomit. (I should state she had swallowed some ipecacuhana powder to evacuate the poison). She continued to refuse to let her husband move, and to the question whether she was in pain, replied, no — no — no 1 A fourth and most vehement attack soon followed, in which the whole body was extended to the utmost, and she was rigidly stiff' from head to foot, insomuch that, with all the force of the surgeon, he could not bend her thighs on the pelvis to replace her in her seat. From this she never recovered; she fell into a state of asphyxia, and never breathed again. She now relaxed her grasp ; her discolour¬ ed hands dropped upon her knees ; her face, too, was livid ; the brows contracted ; the lips wide apart, shewing the whole of the closed teeth, and a salivary foam issued plentifully from the corners of her mouth. The expression of the whole countenance was at this moment very 444 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS. frightful. On removal of the body, it was discovered that the urine had been dis¬ charged. She died in about an hour after taking the poison. Five hours afterwards she was still as straight and stiff as a statue ; if you lifted one of her hands, the whole body moved with it, but the face had become pale in comparison, and its ex¬ pression more placid. Post-mortem appearances. — In the case just related, the body was observed to be rigid after death, but in animals the reverse is generally noticed. As in other cases where death takes place from obstructed respiration, venous congestion is observed. Occasionally there is redness or inflamma¬ tion of the alimentary canal, and now and then softening of the brain or spinal cord. Modus operandi. — There are several points connected with the modus operandi of nux vomica, which require examination. In the first place, is this seed a local irritant ? — In medicinal doses it does not usually disorder the stomach, nor is it invariably irritant in its operation, even when swal¬ lowed as a poison. In some instances, however, the pain and heat in the stomach, the burning in the gullet, and the nausea and vomiting, are evidences of its local action ; and in several cases marks of in¬ flammation have been observed in the stomach on examination of the body after death. Secondly, on what part of the body does mix vomica exercise a specific effect ? — The symp¬ toms clearly indicate the nervous system to be specifically affected. But what por¬ tion of it — the cerebro-spinal or the gan¬ glionic system ? As the voluntary muscles are supplied with nervous influence from the cerebro-spinal portion of the nervous system, it is presumed that it is on this portion that nux vomica exerts its princi¬ pal or sole influence. Physiologists, how¬ ever, have endeavoured to ascertain what part of the cerebro-spinal system was principally affected. Now the tetanic symptoms, and the absence of narcotism, have led to the conclusion that the spinal cord was the seat of the disease — a conclu¬ sion suppported by the fact that the divi¬ sion of this cord — nay, even complete de¬ collation, will not prevent the poisonous effects of nux vomica, whereas the destruc¬ tion of the cord by the introduction of a piece of whalebone into the spinal canal causes the immediate cessation of the convulsions; and if only part of the cord be destroyed, the convulsions cease in that part of the body only which is supplied with nerves from the portion of medulla destroyed. These facts, then, originally observed by Magendie, and which I have myself verified, lead to the conclusion that the abnormal influence, whatever it may be, which causes the convulsions to take place, is not derived from the contents of the cranium, but from the medulla spinalis itself. Moreover, as the motor nerves seem principally affected, it has been pre¬ sumed that the disorder is seated in the anterior columns of the cord. But the increased susceptibility to the influence of external agents clearly proves that the sensitive nerves, and, therefore, the pos¬ terior columns of the cord, are also in an abnormal state. M. Flourens, a distinguished French physiologist, asserted that the part of the nervous system on which nux vomica more particularly acted, was the medulla oblon¬ gata. But MM. Orfila, Ollivier, and Drogartz, in their report on a case of poi¬ soning by this substance, particularly men¬ tion that they observed no traces of altera¬ tion in the condition of the medulla ob¬ longata, the tuber annulare, or the crura cerebri, which is in opposition to Flourens’ opinion, for he asserted that the specific or exclusive action of each substance on each organ always left after death traces of its action, sufficient to distinguish the affected from other organs. But it may be asked, is the cerebrum unaffected by nux vomica ? I think we are hardly justified in replying to this in the affirmative. It is, indeed, true that the in¬ tellectual functions are not usually much disordered by this drug, but the mental anxiety commonly experienced by persons under its use, the occasional appearance of stupor, and the observations of Andral and Lallemand on the injurious effects of it in some apoplexies, leave no doubt that oc¬ casionally at least the cerebrum is af¬ fected. The cerebellum is said by some to be acted on by nux vomica, but for the most part on hypothetical grounds, though it must be mentioned that MM. Orfila, Olli¬ vier, and Drogartz, observed the cerebel¬ lum presented more evidences of lesions than the other parts of the nervous system. Another argument which probably w ould be advanced by phrenologists in favour of the affection of the cerebellum of this drug is the observation of Trousseau, that the sexual feelings are usually excited by it. Serullas found, in his experiments on animals, that in some cases life could not be prolonged by artificial respiration, and that after death the heart could not be stimulated to contract. These and other reasons seem to show that nux vomica ex¬ hausts the irritability of the heart. But in all probability this viscus is affected only secondarily, the essential and primary ac¬ tion being on the nervous system. Thirdly, what kind of action does nux vomica set up in those parts of the nervous system on ichich it ads ? — As the muscles receive from the nervous system a preternatural stimu- NUX VOMICA. 445 lus to action, it is presumed that this sys¬ tem (or at least certain parts of it) is in a state of excitement or irritation. In one case mentioned by Mr. Watt, there was observed softening of the lumbar portion of the spinal cord ; and in the case report¬ ed by MM. Orfila, Ollivier, and Dro- gartz, the whole cortical substance of the brain, especially of the cerebellum, was softened. Andral and Lallemand have both observed that this remedy in some forms of apoplexy produced symptoms indicating ramollissement. Fourthly, does nux vomica or its active prin¬ ciples become absorbed ? — Several reasons, some of which have been before alluded to, may be adduced in favour of the affir¬ mative of this question. Thus the blood of animals under the influence of this poi¬ son has been found to be poisonous (though Messrs. Morgan and Addison deny that this was the case in their before-men¬ tioned experiments). Moreover, the acti¬ vity of this drug seems to be in the ratio of the absorbing power of the part. Fifthly, in what manner is death produced by nux vomica l — Frequently by the stoppage of respiration, in consequence of the spas¬ modic condition of the respiratory mus¬ cles. In other cases, death seems to arise from excessive exhaustion of the nervous power. Uses. — I now proceed to notice some of the uses of nux vomica. 1. In paralysis. — Of all the diseases for which nux vomica has been employed, in none has it been so successful as paralysis ; and it is deserving of notice, that this is one of the few remedies whose discovery is not the effect of mere chance, since Fou- quier was led to its use by legitimate in¬ duction from observation of its physiolo¬ gical effects. That a remedy which stimu¬ lates so remarkably the muscular system to action should be serviceable when that system no longer receives its accustomed natural stimulus is, d priori , not astonish¬ ing. Paralysis, however, is the common effect of various lesions of the nervous centres, in some of which nux vomica may be injurious, in others useless, and in some beneficial. It is, therefore, neces¬ sary that I should point out to you under w hat circumstance this remedy is likely to be advantageous or hurtful. A very frequent, and, indeed, the most common cause of paralysis, is haemorrhage of the nervous centres. Blood may be effused on the external surface of these centres, into their cavities, or in their sub¬ stance, the latter being by far the most common case, in the proportion, according to Andral, of 386 out of 392 instances of cerebral haemorrhage. It is superfluous for me to say that the radical cure of these cases can be effected only by the removal (that is, absorption) of the effused blood. Now the process by which this is effected is almost entirely a natural one: art can offer no assistance of a positive kind, though by the removal of impeding causes she may be at times negatively useful. Nux vomica can, in such cases, be of no avail ; on the contrary, it may be injurious. The part immediately surrounding the sanguineous clot is usually much softened, a condition formerly regarded as the effect of the effusion. But Lallemand has satis¬ factorily shewn that it often, though not invariably, precedes the haemorrhage. This softening, or ramollissement, as the French term it, is, according to the same autho¬ rity, a constant and necessary result of an acute or chronic irritation ; but the facts at present known do not warrant this ge¬ neralization, since cases occur which ap¬ parently are unconnected with irritation. For this softening art can do but little; we have, in fact, no particular or uniform treatment. If we can connect with it any increased vascular action, of course blood¬ letting and the other antiphlogistic means are to be resorted to ; whereas if the reverse condition of system exist — marked by great languor and debility, tonics and stimulants may be administered. Nux vomica in these cases offers no proba¬ bility of benefit; on the contrary, we might suspect, that as it irritates the spinal cord, it might probably have the same effect on the brain, and hasten the pro¬ duction of softening. Now experience seems to confirm our theoretical anticipa¬ tions. Andral relates the case of a man wdio was hemiplegic, in consequence of an old apoplectic attack. A pill containing only one-twelfth of a grain of strychnia (the active principle of nux vomica), "was given him, and it produced a strong teta¬ nic stiffness of the paralysed members. The following day he complained of pain in the head, on the side opposite to that paralysed; his intellectual functions were weaker, and his hemiplegia was increased; in fact, he had all the symptoms charac¬ terising softening of the brain. It is, therefore, probable that the strychnia set up an inflammatory condition of the ner¬ vous substance around the apoplectic de¬ deposit, and that this condition wras the precursor of ramollissement. When, there¬ fore, nux vomica is employed in those cases of paralysis which are connected with in¬ flammation of the brain or spinal marrow, it is very likely to increase the evils it is intended to mitigate. Lallemand, in his Researches anatomieo-pathologiques sur VEnce- phale, reports two cases in which this drug, administered against cerebral maladies, occasioned convulsive movements, which continued until death. On opening the 446 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS, bodies, the cerebral substance surround¬ ing the sanguineous clot was found disor¬ ganised and exceedingly softened. These remarks therefore, will, I trust, suggest some useful reflections as to the use of this powerful drug in paralysis, and prevent its indiscriminate use in all cases of this dis¬ ease. But there are cases in which paralysis, arising from cerebral haemorrhage, may be advantageously treated by nux vomica. The blood which is poured out in the apo¬ plectic cell has at first a gelatinous con¬ sistence, some of it still remaining fluid. “ Somewhat later.” says Andral, “ twelve or fifteen days after the attack, for in¬ stance, the coagulum is found to be firmer and more circumscribed ; later still, it be¬ comes white or yellow, and is surrounded by a brownish-red fluid. The walls of the containing cavity are smooth, and lined with a delicate membrane. The surround¬ ing cerebral substance in some eases re¬ tains its natural appearance, and in others is altered both in colour and consistence. As the interval between the effusion and the examination increases, the coagula gradually disappear.” The cyst is now found to contain a serous fluid, occasion¬ ally having a few cellular bridles running from one side to the other; and nature subsequently attempts to get rid of the cyst by producing adhesion of its sides, leaving only a linear cicatrix. Now it is well knowm, that by long disuse of some of the voluntary muscles, the power over them becomes gradually diminished ; and it ap¬ pears that occasionally in cerebral haemor¬ rhage, after the absorption of the effused blood, the paralysis remains, as it were by habit. In these cases the cautious em¬ ployment of nux vomica, or of its active principle, may be attended with beneficial results, by favouring the return both of motion and sensation. But paralysis, like some other diseases of the nervous system, may exist w ithout our being able to discover after death any lesion of the nervous centres ; and it is then denominated a functional disorder, as if there were actually no organic lesion. To me, however, the fact of the lesion of action is a convincing proof that there must have been an organic lesion of some kind, though we see nothing. “ It is highly probable,” says Andral, “ that some orga¬ nic lesions do exist in such cases, though they escape our notice.” Be this as it may, experience has fully established the fact, that nux vomica is more beneficial in those forms of paralysis usually unac¬ companied w'ith lesions of structure, such, for example, as paralysis resulting from exposure to the influence of lead and its various compounds. Thus, of ten cases of saturnine hemiplegia, treated by nux vomica or its active principles, and which are mentioned by Bayle in his Travaux Therapeutiques, three were cured, and three ameliorated. As hemiplegia more frequently depends on cerebral haemorrhage than some other forms of paralysis, so it is, for the most part, less amenable to remedial means. Thus, while out of twenty-six cases of pa¬ raplegia, nineteen were cured by nux vo¬ mica or its active constituents, yet in thirty instances of hemiplegia only thirteen were cured. In six cases of general paralysis (that is, paralysis of both sides at once), four were cured by this remedy. In the paralysis which sometimes affects the mus¬ cles of certain organs, nux vomica (or strychnia) has been employed with advan¬ tage. Thus a case of amaurosis, accom¬ panied with paralysis of the eye-lid, is said to have been cured by it ; and several cases of incontinence of urine, depending on pa¬ ralysis, or diminished power of the mus¬ cular fibres of the bladder, have also been benefited by the same means. 2. Lesions of sensibility. — The good effects obtained from the use of nux vomica in paralysis have led to its employment in certain functional lesions of the organs of sensation. Hitherto, how'ever, the trials have not been numerous, nor remarkably successful. In amaurosis benefit has been obtained in some few instances ; and where no organic lesion is appreciable this re¬ medy deserves a trial. The endermic me¬ thod of using it has been preferred. Small blisters covered with powdered strychnia have been applied to the temples and eye¬ brow's. The remedy causes sparks to be perceived in both eyes, especially the af¬ fected one ; and it is said the more of these, the better should be the prognosis : moreover, the red-coloured sparks are thought more favourable than sparks of other colours. 3. In other affections of the nervous system. — Nux vomica has been used in chorea, hysteria, epilepsy, and hypochondriasis, with occasional benefit. Of course it is only applicable in the absence of irrita¬ tion or inflammation of any of the nervous centres. I have seen it very serviceable in that shaking or trembling action of the muscles produced by habitual intoxi¬ cation. 4. In affections of the alimentary canal. — On account of its bitterness nux vomica has sometimes been resorted to as a tonic and stomachic in dyspeptic cases, more espe¬ cially when the symptoms are supposed to arise from, or be connected with, a dimi¬ nished pow'er in the muscular fibres of the stomach. In dysentery, particularly when of an epidemic nature, nux vomica has gained some reputation. Thus Hagstroin says he has proved its value in some lnm- NUX VOMICA. 447 dreds of cases of this disease. Hufeland employed it in one hundred and forty eases of epidemic dysentery with great benefit, most of the patients being cured on the second or third day. In prolapsus of the rec¬ tum Dr. Schwartz has recommended the use of this remedy, which he has employed for ten years, both in adults and children, with great benefit. One or two grains of the alcoholic extract are to be dissolved in two drachms of water ; and of this solution he gives to suckling infants two or three drops ; older children, from six to ten or fifteen drops, according to their age. 5. In impotence. — The excitement of the sexual feelings which Trousseau has seen produced by nux vomica, led him to em¬ ploy this remedy against impotence ; and he has found it successful both in males and females. In some cases, however, its good effects were observed only while the patients were taking the medicine. A young man, 25 years of age, of an athletic constitution, who had been married for eighteen months without having any other than almost fraternal communications with his wife, acquired his virility under the use of nux vomica, though he again lost it soon afterleaving off'its employment. 6. Other uses. — Besides the cases now mentioned, nux vomica has been employed in intermittents, intestinal worms, nervous colies, asthma, &c. Modes of exhibition. — Nux vomica may be exhibited in the form of powder, tincture, or alcoholic extract. The dose of paved' red nux vomica is two or three grains, gradually increased. Fouquier has sometimes increased the dose to fifty grains. The tincture of nux vomica is ordered, by the Dublin College, to be made by digest¬ ing two ounces of scraped nux vomica in eight ounces of rectified spirit of wine, — from five to ten drops being given at a dose. This preparation is sometimes used as an embrocation to paralysed parts, and its good effects in this way seem increased by combining it with ammonia. The alcoholic extract may be pre¬ pared by the evaporation of the tincture ; but in the Dublin Pharmacopoeia proof spirit is employed in its preparation. It is given in the form of pill, beginning with one grain for a dose, and gradually in¬ creasing the quantity. It is somewhat surprising to find no pre¬ paration of nux vomica (strychnia ex¬ cepted) in the new edition of the London Pharmacopoeia just published. Antidotes. — In the event of poisoning by nux vomica, the best method of treatment is the following. Evacuate the stomach as speedily as possible,— by the stomach- pump if at hand, and in the absence of this by emetics (of sulphate of zinc or sul¬ phate of copper.) As yet we know no certain chemical an¬ tidote for this poison ; for several reasons lead me to doubt the value of iodine, bro¬ mine, and chlorine, recommended by Donne. On theoretical grounds I should expect infusion of astringent substances (as of galls) would be serviceable — an opi¬ nion in which Buchner coincides. Ac¬ cording to Emmert’s experience, vinegar and coffee increased the effects of the false angustura bark, and, therefore, it is advis¬ able to abstain from using them in poison¬ ing by nux vomica. To relieve the spasms narcotics may be employed. Sachs and others have recom¬ mended opium for this purpose. Accord¬ ing to Dr. Christison coneia is the coun¬ terpart to strychnia, and, hence, probably might be employed with advantage in poisoning by the latter, or by substances containing it. As the action of coneia and hemlock is, according to the same au¬ thority, identical, the latter will be a con¬ venient substitute when the former cannot be procured. Detection of nux vomica. — Nux vomica, un¬ like opium and some other vegetable poi¬ sons, may often be recognised in the sto¬ machs of persons poisoned by it ; and, therefore, it is of some importance to esta¬ blish its characters. In a case of poison¬ ing by this substance which occurred in France, MM. Orfila and Barruel were re¬ quested by M. le Procureur du Hoi, to ex¬ amine a parcel marked mort-aux-rats (rats¬ bane), containing a fallow grey powder, and which was found on the deceased’s bed; and also to examine the contents of the stomach. The following extract from their report shews their mode of proceed¬ ings, and by which they were able to re¬ cognise the powder as that of nux vo¬ mica : — 1 . Characters of the powder of nux vomica. — It has a fallow grey colour, a bitter taste, and a peculiar odour analogous to that of liquorice. Thrown on burning coals it inflames when the temperature is very high ; but when lower, is decomposed, evolves a thick white smoke of a peculiar odour, and leaves a carbonaceous residuum. Concentrated sulphuric acid blackens it. Nitric acid communicates to it a deep orange-yellow colour. By boiling it for a few minutes in distilled water, there is obtained a yellowish, opaline, bitter liquid, whose colour is deepened by ammonia, and becomes reddish-yellow by nitric acid. Tincture as well as infusion of nut-galls causes a whitish precipitate. If the powder be digested with boiling water acidulated with sulphuric acid, the filtered liquor is turbid and slightly yellow. Nitric acid, after some minutes, reddens it ; ammonia makes it brown, and precipitates blackish flocks. 2. Characters of pondered nux vomica found 448 PROFESSOR GRAVES’ CLINIC AL LECTURES. in the stomach. — In the stomach and duo¬ denum was found a greyish liquid. It was mixed with very dilute sulphuric acid, and boiled for ten minutes : by this means a yellowish liquid was obtained, which be¬ came of a deep orange-yellow colour by the addition of nitric acid. Its taste was acid, and sensibly bitter. After having- satu¬ rated the excess of acid by carbonate of lime, the liquid was evaporated to dryness, and the residuum treated by successive portions of alcohol; the different portions of which being mixed, were found to pos¬ sess a hot acrid taste, very similar to that of very concentrated alcohol, without at first evincing any bitterness ; but subse¬ quently this was developed. Evaporated to the consistence of syrup, the residuum had a bitter taste, similar to that of bru- cia and strychnia, and became deep orange- yellow coloured by nitric acid, and formed a flocculent precipitate by ammonia. At the end of two days the bottom of the cap¬ sule was covered with very visible crystals of strychnia. In addition to this account, taken from the report before alluded to, I may add, that the green colour produced by the salts of iron, as well as by the cupreous salts, with an infusion or decoction of nux vo¬ mica, are important characters. CLINICAL LECTURES, DELIVERED AT THE MEATH HOSPITAL AND COUNTY OF DUBLIN INFIRMARY, During the Session 1836-7. By Professor Graves. Lecture I. Introduction — Connexion between Diseases of different Organs; between Arthritis, Jaun¬ dice, and Urticaria ; between Periostitis pro¬ duced. by abuse of Mercury, and Hypertrophy of the Liver — Details of cases illustrating this connexion — Its explanation — Hypertrophy of the Liver produced by Scrofula — Enlarge¬ ment and Inflammation of the Liver after Scarlatina — Importance of recognising this disease. Although it is customary to state, at the commencement of a course of clinical lec¬ tures, the mode of instruction the teacher intends to pursue, it is not my intention to dwell on the plan of communicating me¬ dical information adopted in this hospital, or the facilities, advantages, and induce¬ ments which it affords. I have spoken so often on the subject, and my opinions have been so long before the public, that I do not feel it necessary to enter into details on the present occasion. It is extremely satisfactory to me to find that the mode of clinical instruction which I introduced at this hospital in 1822, has been adopted in most of the Dublin hospitals, and in many of the medical institutions of Great Bri¬ tain. It is now several years since 1 de¬ livered an introductory lecture at the old Meath Hospital on the Coombe, setting forth the insufficiency of the clinical in¬ struction imparted to the students in Dub¬ lin at that period, and proved, to the satis¬ faction of my auditors, that the German mode was infinitely superior. The lecture I then delivered was subsequently pub¬ lished in the London Medical Gazette*. This mode I soon afterwards introduced at this hospital, and it is a source of ex¬ treme gratification to me to find it adopt¬ ed and approved of by so many medical teachers of established reputation. It is recommended at once by its simplicity, and by its admirable fitness for fulfilling the purposes which it is intended to ac¬ complish. A card is suspended over each patient’s bed, on which is recorded the date of his admission, the history of his case, and the daily treatment, dietetic as well as medical. These cards remain in the wards until the patient leaves the hos¬ pital, and in this way any gentleman who wishes to observe the progress and ter¬ mination of any particular case, can easily make himself master of its principal fea¬ tures, and the different remedial agents employed for its alleviation or removal. I shall not dwell any longer on this sub¬ ject, as my object at present is to excite 3rou to a diligent cultivation of the many and valuable opportunities which this in¬ stitution affords. Go round the wards, and observe the numerous and varied form 3 of disease they present. You will find in them many examples of mor¬ bid affections interesting alike to the student and the practitioner, and ca¬ llable of affording practical lessons of inestimable value. Lie must be sadly deficient in zeal, attention, and every other quality necessary to constitute the accom¬ plished and successful physician, who does not feel himself excited to study by what is there presented to his observation. Did time permit, I should be glad to furnish you with an outline of the most interesting cases which have been under treatment in our wards for the last three months, in order to give you some idea of the prevailing forms of disease, and their most remarkable modifications; and in this way to prepare you for studying with more advantage the cases that may come under your notice during the ensuing ses¬ sion. We have had some cases of extreme interest during the months of August, * See Medical Gazette, vol. x. p. 401. CONNEXION BETWEEN DISEASES OF DIFFERENT ORGANS. 449 September, and October; but I fear even a brief review of these would occupy more time than I could conveniently devote to the subject, and would interfere with mat¬ ters of paramount importance. I have, however, kept records of these cases, and shall feel most happy to show them to any gentleman who may be anxious to peruse them. Before I proceed to make any observations on the cases at present in our wards, I shall give a statement of the most remarkable results obtained in the chronic wards, and the most im¬ portant pathological observations made in the fever wards, during the last three months. This will occupy but two or three lectures, and in the interim I shall each day direct your attention to any thing of importance which occurs in the wards. It is my intention at present to limit myself to the illustration of some points connected with pathology, and to dwell merely on those prominent features of disease which bear a special reference to practical medicine ; I shall afterwards give some lectures on fever. I shall not enter into any disquisition as to the origin and cause of fever; for these matters you must consultyour books: all you can expect from me is to endeavour to impart to you some useful hints on the treatment of fever. In order to acquire a correct and avail¬ able knowledge of human pathology, and to extend the range and confirm the accu¬ racy of diagnosis, it is of the utmost im¬ portance to observe attentively the con¬ nexion between the diseases of certain organs or systems of the body. You are aware that some organs, when labouring under disease, are apt, after the disease has continued some time, to implicate other organs, giving rise to various de¬ ranged conditions, which are developed, sometimes simultaneously, but in general consecutively, and in sequence. I have already pointed out several diseased ac¬ tions thus associated together, each form¬ ing a link in the morbid chain. Now it is of the greatest importance to study each link, and ascertain the nature of its connexion, so as to have a distinct concep¬ tion of the whole. Last session I directed the attention of my class to a train of morbid phenomena sometimes observed co-existing with arthritic inflammation. A person labouring under inflammation of the joints gets an attack of hepatitis, ac¬ companied by jaundice, and this is fol¬ lowed by urticaria. I have observed this sequence of disease in eight or nine cases. The first was in a gentleman residing in Low'er Mount- Street, whom I attended with Dr. Cheyne. This gentleman, in 1 consequence of exposure to cold, was at¬ tacked with arthritic inflammation and 1 fever. After he had been about ten days 473. — xix. ill, he became suddenly jaundiced, and in a day or two afterwards a copious erup¬ tion of urticaria appeared over his body and limbs. Exactly the same train of phenomena, and in a similar order of suc¬ cession, were observed in a man treated in the Meath Hospital in 1832. A short time before this, I had been attending a medical friend in Baggot- Street, who had been affected in the same way ; and I mentioned to the class, as soon as I per¬ ceived the man was jaundiced, that he would most probably get urticaria. I made a similar prediction in a case which occurred recently in our wards, and it was verified by the event. Now this is not a mere fortuitous occurrence; the various symptoms must be connected in the rela¬ tion of cause and effect. It is interesting to bear this in mind, and it is besides of considerable importance to the practising physician ; it enables him to predict the appearance and form of disease, and in¬ spires his patient with confidence in his opinions and judgment. There is another sequence of disease, not unfrequently observed, but of which the connexion has not been hitherto noticed by any writer, as far as I can ascertain. About two years since, Mr. Crampton and I were consulted by an English gentleman, who had been ill for a considerable time. The his¬ tory of his case from the commence¬ ment was this: — Three years previously he had venereal, — used and abused mer¬ cury, — was exposed to cold, and got periostitis. He now got into a bad state of health, used mercury a second time, ob¬ tained some relief, and then relapsed again ; finally, after having used mercury three or four times, he was attacked with mercurial cachexy, became weak and ema¬ ciated ; the periostitis degenerated into ostitis, producing superficial caries and nodes of a bad character; he had exfolia¬ tion of the bones of the cranium, and rupia, and was reduced to a most misera¬ ble state. Under our care the symptoms gradually disappeared ; he recovered to all appearance, and even got fat. He then caught cold and relapsed again. At last his liver became engaged ; he was attacked with hypertrophy of the liver, ascites, and jaundice, and died soon afterwards. Here, then, we have venereal, abuse of mercury, periostitic inflammation, abuse of mercury followed by exacerbation of the periostitis, and the establishment of mercurial ca¬ chexy, and the history of the case is wound up with hypertrophy of the iiver. This was the first case in which I had observed this concatenation of diseases ; since that period I have seen a similar train of mor¬ bid phenomena, twice in private practice and once in hospital. First we have 2 G 450 PROFESSOR GRAVES’ CLINICAL LECTURES. abuse of mercury, then periostic inflam¬ mation and mercurial cachexy, and the scene is closed by morbid enlargement of the liver. Now I do not look upon this sequence as merely fortuitous. The dis¬ eased actions are, I think, related as cause and effect, and each successive condition is consequent on the previous one. It may not be amiss to mention here some curious circumstances observed in the case to which I have just alluded. While this gentleman’s liver was enlarging, there wTas no tenderness of the right hypochondrium on pressure. I have observed the same absence of tenderness in all the cases of this description which I have witnessed. The gentleman could bear pressure over the hepatic region without any incon¬ venience, and yet the liver was so enor¬ mously increased in size, that its inferior margin extended almost down to the pel¬ vis. What is equally remarkable, he had no fever, and the tongue w'as perfectly clean and moist during the whole course of the hepatic affection. In my observa¬ tions on a case in the fever wrard, I re¬ marked a fewr days since that some persons wrere too hasty in drawing inferences from the state of the tongue as to the existence of affections of the digestive organs. I shall not touch on this point, how’ever, at present, and shall merely observe that this gentleman’s tongue was perfectly clean and moist, notwithstanding the mor¬ bid condition and rapid growth of the liver. Another curious circumstance w as, that during the hepatic affection, diges¬ tion appeared to go on very well, at least so far as the formation and due expulsion of feces are concerned. The alvine eva¬ cuations were regular, and the matter discharged presented the form and con¬ sistence of that which is passed by a per¬ son in good health. But there was a peculiarity in it to which my attention was first directed by the patient, who w'as an intelligent and observant per¬ son. The cylinder of fsecal matter wras composed of parts differing in colour and appearance : two or three inches consisted of pale clay-coloured substance ; and im¬ mediately after this another portion, of about the same length, was observed, pre¬ senting the ordinary bilious or brown co¬ lour of natural excrement ; and then again another mass of clay-coloured matter, without any obvious trace of bile. This appearance I have now frequently wit¬ nessed ; and the inference to be drawn from it is this, — that in such forms of he¬ patic disease the functions of the liver are performed, as it were, intermittently ; it secretes bile during a certain period of the digestive process, then stops, and then se¬ cretes again. This peculiarity is noticed in many dis¬ eases of the liver; and it is important to remark, in attempting to explain the ra¬ tionale of these hepatic affections, that in no disease of the liver is this symptom more frequently observed than in the scro¬ fulous. Scrofulous disease of the liver is that state in w'hich there is an increase of size in the organ, with induration and imperfect secretion, but without any re¬ markable tenderness. This condition in children is accompanied with irritability of the digestive organs, fretfulness, ema¬ ciation, loss of sleep, and impaired nutri¬ tion. The little patient becomes what is termed “ pot-bellied,” and labours under thirst, debility, and febrile excitement. This has been frequently called remittent fever, and disease of the mesenteric glands, but in my opinion unjustly. It is only a form of general cachexy connected with the scrofulous diathesis, affecting secretion and nutrition in general, and the digestive and biliary systems in particular. It W'ould be quite wrong to imagine that, in this form of disease, the liver is the cause of the whole train of morbid phenomena ; it is merely affected in common with other organs, and forms only an individual fea¬ ture in the group of symptoms. Now' in this form of scrofulous cachexy, where you have diarrhoea, emaciation, fever, thirst, and restlessness, the liver is frequently affected in the manner already described ; and in the loose stools of such a child, you will find one part bilious, ano¬ ther part clay-coloured ; they w'ill be yel¬ low to-day, and pale the next, accordingly as the liver secretes bile or suspends its functions. But in this instance, I repeat that the liver is only one of many organs affected by the same general cachexy. Could we ascertain the derangements of other secreting organs wfith the same faci¬ lity, it is very probable we should find si¬ milar evidences of the morbid influence w'hich pervades the whole system. This view of the question shews that you are not to expect to succeed in remov¬ ing the disease by the use of calomel or any other mercurial preparation. Many of those persons whose practice is little better than routine, when called to treat a case of this description, first examine or inquire as to the nature of the alvine eva¬ cuations, and fixing on the single symp¬ tom of deficiency of bile, immediately pre¬ scribe calomel, to be repeated or conti¬ nued until the secretion of the liver is established; but they forget that this state of the biliary system depends on the gene¬ ral state of health, and that the absence of bile is the consequence, and not the cause, of the disease. Almost all the organs of the body are affected; and though calomel may restore the secretion of the liver for a time, it cannot bring back the organ to its CONNEXION BETWEEN DISEASES OF DIFFERENT ORGANS. 451 natural state, or cure the disease. The malady is to be remedied in a different way : the secretions (and that of the liver among the rest) are to be improved by change of air, by an appropriate diet, by exercise, tepid or cold bathing, and the use of those remedies which are adapted to modify or correct that state of the sys¬ tem on which the general derangement depends. An observation of such cases has led me to a train of reflection respecting the oc¬ currence of the same order of symptoms in persons who have been injured by the abuse of mercury. Many persons who get venereal employ mercury injudiciously, and fall into what has been termed the mercurial cachexy, in which there is a ge¬ neral unhealthy state of the organs. A patient who has fallen into this state very closely resembles a scrofulous person, and is apt to labour under the same emacia¬ tion, impaired nutrition, irritability, fever¬ ishness, and the same sort of cutaneous, glandular, and periostitic affections. The chronic mercurial cachexy is very like the scrofulous, and attacks very nearly the same organs and tissues. Hence the diffi¬ culty of curing affections of the liver, and other organs, when they are the result of this depraved habit. This is the key to the explanation of those horrible ravages which we frequently witness in cases of venereal disease complicated with mercu¬ rial cachexy — a state of constitution which is closely allied to the scrofulous. You will frequently meet with this consecutive affection of the liver in cases of morbus coxae, where the patient has been labour¬ ing for years under ulceration of the joint. The growth of the rest of the body appears checked, the patient is stunted and ema¬ ciated, while the liver increases rapidly in size. It was from observing the occur¬ rence of liver disease in persons labouring under the scrofulous cachexy, that my at¬ tention was first turned to its occurrence in persons broken down by long or injudi¬ cious courses of mercury. One word, gentlemen, as to the curabi¬ lity of hepatic affections of this kind. I believe that it is always an unpromising form of disease; but persons of originally good constitution, and under the age of thirty, will generally escape, if treated ju¬ diciously, and with proper care and atten¬ tion. Some months ago I attended, with Dr. Marsh, a young gentleman labouring under this affection, as a consequence of the abuse of mercury. We found him greatly emaciated, and labouring under considerable enlargement of the liver, with commencing ascites. He had also great determination of blood to the abdomen, diarrhoea, and hemorrhoids. By strict attention to his bowels, a well-regulated diet, change of air, and the use of taraxa¬ cum, coni urn, and hydriodate of potash, he was ultimately cured, after an illness of nearly two years, during which the liver had grown to an enormous size. I may state that he is at present in good health, and that the liver is nearly reduced to its natural dimensions. It may be proper to add, that this gentleman’s age is about fo u r- an d - 1 we n ty . I observed one circumstance in the pro¬ gress of this case which is worth noting. He was suddenly attacked with a papular form of purpura, accompanied by much tingling and itchiness, and answering to the description given of Purpura urticans. This peculiar eruption was very trouble¬ some at night, and formed several succes¬ sive crops, which altogether lasted a month. It occupied the extremities, up¬ per and lower, and was very abundant on the latter. This gentleman wore a ban¬ dage, to relieve a varicose state of the veins of the left leg. Now the eruption never appeared in the parts subjected to the pressure of the bandage, although it was very thick immediately below and above those parts. In persons below' thirty the liver may become enlarged to a very considerable extent, and yet return again to its natural size under proper treatment. I could point out several persons in Dublin in whom the liver had been so much en¬ larged that I thought their cases hopeless, and yet they have recovered, and are at present in the enjoyment of good health. The process by wdiich the organ returns to its natural state and dimensions is gene¬ rally slow'; in twm or three cases it occu¬ pied a space of time varying from one to two years. I attended a gentleman some time ago with Mr. Carmichael ; and from the history of the case, as well as the symptoms present, we were induced to look upon it as incurable ; and yet the pa¬ tient has completely recovered. Mr. Mac- namara and I attended a lady who had a very remarkable enlargement of the liver, but in the course of a year the viscus di¬ minished so much in size, as to be very little above the normal dimensions. This is a matter of no common interest, for cases of this description have been gene¬ rally looked upon as beyond the reach of medical aid. You should therefore be very careful in your prognosis of such cases, and not give them up at once as in¬ curable. I may observe in conclusion, that it is entirely as the result of the cachectic habit that this enlargement of the liver is ob¬ served. I have assumed this principle as the basis of ray argument, and I think it is founded in fact and truth. It is also curious to observe, that the same cachectic 452 PROFESSOR GRAVES’ CLINICAL LECTURES. state which gives rise to emaciation and decay of the body, generally occasions hypertrophy of some particular organs. What we most commonly observe in such conditions is, general wasting of the sys¬ tem, accompanied by increased morbid nutrition in certain organs. This appears to be the general law. You perceive that in the explanation I have given, I have supposed that enlarged liver is the result of a general cachectic state of the system, and it is of importance to recollect that this state may be brought on by the injudicious exhibition of mercury, or by carrying mercurialization further than the con¬ stitution will bear. In this instance we are compelled to allow that our prac¬ tice may furnish weapons to be turned against us by the disciples of homoeopathy. It cannot, however, be denied, that the immoderate use of mercury has been pro¬ ductive of liver disease. The late Mr. Hewson pointed out this to the attention of those who visited the Lock Hospital while under his care. At this period it was the custom to salivate every patient, and keep him under the full mercurial in¬ fluence for a month or two ; and it fre¬ quently happened that, just as the mercu¬ rial course was finished, the patient got disease and enlargement of the liyer. Were I inclined to theorize, I might perhaps offer some fanciful hypothesis in explana¬ tion of this occurrence, and might trace some connexion between the stimulant effects of mercury on the liver, and the subsequent hypertrophy. I shall, how¬ ever, content myself at present with no¬ ticing the fact, and leave the explanation to my juniors, who always explain mat¬ ters, according to my observation, much more readily than their seniors. There are also other diseased states of the system, in which we have enlarge¬ ment and morbid alteration of the liver. I can point out to you four different states of the system in which hypertrophy and disease of the liver forms one of the results of the general affection of the system. The next of those to which I shall direct your attention is scarlatina. Those who have attended the wards during the past month have seen examples of this. We have observed during the same week two patients labouring under scarlatina, who got disease of the liver and jaundice. One of the patients, a little boy, was attacked with the disease in an extremely violent form, accompanied with high fever, and a very remarkable eruption. In a few hours after the exanthema appeared, the entire cutaneous surface was dyed of a brilliant red; in fact, the skin looked as if it had been painted over, and there was not a single spot free. In cases of this kind the violence of the cutaneous inflammation is sufficient to kill, without any other un¬ favourable complication; and the patient seldom lives more than three or four days. You observed in this case, that the whole epidermis peeled off. Rut what I wish to direct your attention to is, that this boy after two days had evident symptoms of disease and enlargement of the liver. A young man, in the same ward, had also an attack of scarlatina, but in a milder form. On the third day he likewise got inflammation of the liver, but was cured by general and local antiphlo¬ gistic treatment. You are aware that scarlatina is one of those diseases in which a train of unfavourable sequelae are apt to remain after the removal of the original complaint. Persons, after recovering from the exanthematous fever, will sometimes get into a bad state of health, and instead of convalescing, become restless and fever¬ ish towards evening — have an irritable jerking pulse, hot skin, derangement of the digestive organs, diminished urinary secretion, and finally become dropsical. Now, from observing the supervention of hepatic disease in such cases, both in hos¬ pital and private practice, my attention has been directed to the liver ; and I never omit making an examination of that organ when called to treat those symp¬ toms which are looked upon as the sequel® of scarlatina. In many of these patients I have found the liver in a state of inflam¬ mation of rather a chronic character, and without any of that remarkable pain or tenderness which characterizes acute he¬ patitis. But still it w'as inflamed, as proved by the benefit derived from local antiphlogistic means ; and, moreover, its condition appeared to retard and prevent convalescence. Not long since, a friend of mine, a very intelligent practitioner, who was attending a case of this descrip¬ tion, and had tried a variety of remedies without any benefit, w7as very much sur¬ prised when I drew down the bed-clothes and showed him that the liver was diseased. He had not thought of the existence of any thing like an hepatic affection, and was very much surprised that his treatment had proved so ineffectual. By the use of leeches to the right hypochondrium, the employment of mercury, and a proper regulation of diet, the patient was soon relieved, and the fever, thirst, and ana¬ sarca, quickly disappeared. In cases of this kind the hepatic affection is the re¬ sult of the general inflammatory diathesis superinduced by scarlatina. You are all aware that nothing is more common, after scarlatina, than inflammation of various organs. Thus some persons are attacked with pleuritis, some with pneumonia, others with inflammation of the liver. Many persons continue in a valetudinary MR. SEARLE ON THE TREATMENT OF INFLAMMATION. 453 state after the eruption has declined ; they do not convalesce according' to our expec¬ tations ; the pulse remains rather quicker than natural; the bowels are deranged; the appetite bad ; thirst urgent, and urine scanty. In many of these cases you will find that there is a species of chronic he¬ patitis going on, which keeps up the fever¬ ishness and retards convalescence. This is a point of great importance, to which I am the more anxious to draw your at¬ tention, because even the latest writers on scarlatina have either entirely omitted or very insufficiently noticed it. OPPOSITE MODES OF PRACTICE IN THE TREATMENT of INFLAMMATION. To the Editor of the Medical Gazette. Sir, I beg to be allowed to reply to Inves¬ tigator’s remarks upon what he is pleased to denominate “ the new-fang-led doc¬ trines It should first be observed that your correspondent assumes a name which does not belong- to him ; it is evident that his proper name is “ Conservative,” for he complains that “ long-cherished medical theories and modes of practice are (being) abandoned.” While charg¬ ing me w ith inconsistency , he does not perceive his own : he denominates him¬ self an Investigator, and pretends to be a matter-of-fact man, by denouncing any new principles of practice as “ new¬ fangled,” and proofs of a “ professional mania.” In what manner should a person prepare himself in order consist¬ ently to pronounce his dictum against either new or old doctrines in medicine? Certainly by patient inquiry, and by the test of facts. But the soi-disant Investigator opposes his mere ivords of the moment to facts , which have re¬ quired many years to collect and inves¬ tigate. To use no harsher expression, it is neither philosophical nor fair in an individual who is acquainted with only one side of the question, to condemn the conclusions of those who have ex¬ amined both : for my own part, I should be very reluctant to raise prejudices against Mr. Radley’s method of treat¬ ing fractured bones, merely because it was new to me : nay, further, since he has practised according to the old “ che- * Med. Gaz. present vol. p. 202, ante. rished” system as well as the new, and asserts that the latter is attended with decided advantages over the former, and confirms them by the relation of cases. I certainly should, if I became the sub¬ ject of fracture, request that his plan of treatment might be adopted. Then in allusion to Investigator’s de¬ nouncement of homoeopathy as another “mania;” how much more like a true Investigator would he have been if he had first made trial of it. And now with regard to my own “ mania” of treating inflammatory diseases upon a system opposed to the current practice of the clay, I beg to state that during the first ten years I was engaged in the medical profession, I pursued the strict antiphlogistic sys¬ tem in the treatment of inflammatory diseases, having been taught so to do, and that w hen I met with fatal cases I in general ascribed the want of suc¬ cess to not being bold enough in the abstraction of blood ; and this notion became so strong in my mind, that during two years previous to my relin¬ quishing this mode of practice altogether, I phlebotomised copiously, and at very short intervals, in order to anticipate and prevent the reaction which so fre¬ quently ensued ; this practice, however, was attended with still more fatality and vexation. I was then advised by the late Dr. Armstrong to administer one or tw o doses of calomel and opium, after each abstraction of blood, which certainly did considerably allay the in¬ ordinate vascular action. In the spring of 1822, I had an interview' with Dr. Darwin, of Sh rewsbury, relative to a patient : in conversation, he stated that he considered all pulsations above 90 or 100 in a minute were indications of debility, and not of the degree of in¬ flammation, to which I fully assented, and mentioned Dr. Armstrong’s method of controlling this irritable action, when Dr. Darwin replied that if I could thoroughly examine the effects of bleed¬ ing, I should not long remain so strong aii advocate for the practice. Although these were the only remarks which occurred between Dr. Darwin and myself upon the subject, yet, having already had the greatest reason to doubt the efficacy of general bleeding as a remedy, I immediately turned my atten¬ tion to the other side of the question, and w'as soon convinced by the happy results of this new system of practice, 454 MR. SEARLE ON THE TREATMENT OF INFLAMMATION. that the old “cherished” system was founded in error. I have ever since — during' fourteen years — been observant of their respective merits ; and having- well considered them, I felt justified in recently presenting in the Lancet this “ new-fangled doctrine” to the con¬ sideration of the profession, and think that no one can with propriety condemn it until he has proved it to he fallacious: hut since Investigator has not regarded this just order of proceeding, he is hound in justice to make a fair trial of the practice he so prematurely con¬ demns, and to report the results. There is but one point among- Inves¬ tigator’s remarks deserving serious no¬ tice, and that not on account of its arising out of an impartial inquiry, hut on account of its being a misrepre¬ sentation, as the following quotations will prove. First his quotation blended with his remarks. “ The medicinal treatment, we are told, depends much upon the character of the inflammatory fever. When the general circulation is inordinately increased, and when con¬ siderable pyrexia attends subacute in¬ flammation, sedative medicines, such as tartarized antimony and digitalis, are recommended, though upon what princi¬ ple it is difficult to imagine; for everyone must, I think, perceive that ifit be right, in the dietetic treatment of the constitu¬ tion, to increase the general circulation, by the fearless administration of milk, beer, wine and water, eggs, and good broth, that it cannot at the same time be proper in the medical treatment, to lower the vascular action by means of tartarized antimony and digitalis. But it happens that this treatment can seldom be put into execution ; for when emetic tartar is given in doses sufficiently large to produce a sedative effect, it never fails at the same time, to cause severe nausea : so that when a patient is under the influence of that medicine, his sto¬ mach, which must be in a very unfit state to receive eggs and broth, will necessarily rebel ag*ainst those good th in gs, and eith er refuse th em ad mi ttan ce, or eject them soon after their entrance. As far, therefore, as regards the con¬ stitution, it must, I think, be plain that the treatment recommended for it by Mr. Searle is inconsistent and often impracticable.” According- to the above remarks of Investigator, it is made to appear that it is my practice, in the treatment of inflammatory diseases, to give food freely with one hand, and tartarized antimony with the other. Why did he not give a full quotation? Because he could not then have indulged in his disingenuous observations; for they are anticipated and answered, as the following full quotation will shew : — “ The medicinal treatment depends much upon the character of the inflam¬ matory fever. If considerable pyrexia attend subacute inflammation, it is evident that the predisposing cause, excitability, is greater than the exciting- cause, inflammation. Under these cir¬ cumstances, febrifuge medicines, espe¬ cially those of a sedative nature, as tar¬ tarized antimony, digitalis, &c. will, in general, produce a beneficial effect. But if, as in acute inflammation, the exciting cause play the greater part, then febri¬ fuge medicines will avail but little. Sedative medicines would appear, a priori , to be indicated whenever the general circulation is inordinately in¬ creased ; but very high and strong ar¬ terial action cannot be controlled by sedative medicines, as tartarized anti¬ mony and digitalis ; for small doses of these medicines have no effect, while large doses occasion vomitings, which are often distressing and injurious to inflamed organs ; and unless they pro¬ duce a uniform sedative effect, they are pernicious, as temporary depression of the circulation induces reaction, and thus defeats the object to be attained ; and to nauseate the stomach without subduing the disease is worse than use¬ less, as it renders the patient incapable of taking that nutriment which, of itself alone, would, according to the views which have been already given of the nature of inflammatory fever, tend to diminish the pyrexia. “ The sedative agency of cold may be often employed advantageously, by placing the patient, who should at the same time be thinly clothed, in a current of cool air. No kind of danger need be apprehended from this exposure, unless the phlegmasia have originated from revulsion of blood, occasioned by expo¬ sure to cold ; then, indeed, to renew the original cause of the disease would be committing the folly of addingfuel to fire. In such cases calomel and opium in com¬ bination form an exceedingly useful seda¬ tive, producing a general and uniform effect. While they allay inordinate action, they maintain an equal distribu- DR. BARR ON THE RECENT CASE OF POISONING WITH BACON. 455 tion of blood ; if they fail to induce sleep they compose both mind and body ; they alleviate delirium when it exists, and in other cases prevent its occurrence.” It is clear that I mean by tartarized antimony, digitalis, &c., the whole ca¬ talogue of sedative medicines. I placed tartarized antimony at the head because it is most frequently employed by the profession, and because I wished to make considerable strictures upon its use. So far from its being a favourite remedy of mine, I prefer calomel and opium, or any other medicine which will not nau¬ seate the stomach ; in short, I do not believe that ten prescriptions could be produced, in which I had recommended, within the last six years, tartarized antimony as an internal remedy, whilst hundreds might be brought forward of my having prescribed calomel and opium. But let it be supposed that the “ &c.” had been really omitted, and that I intended to recommend tartarized antimony only, to what eases have I restricted its administration ? To those in which considerable pyrexia attends subacute inflammation. Under what circumstances does this form of pyrexia occur? The patients are either very young children, or of very delicate constitutions. Under the former, tar¬ tarized antimony is never given, nor even thought of, and under the latter the patients are such as habitually take but little food, and when ill, manifest, in general, an insuperable aversion to it. In such cases there can be no in¬ consistency in administering tartarized antimony. So that if I had made no more comments upon this medicine than those which were convenient for Inves¬ tigator partially to quote, his charge of inconsistency would, even then, have been perfectly groundless. Investigator has yet to learn that if nutriment be fearlessly and judiciously administered at the commencement of an attack of intestinal inflammation — when it can, in general, be taken — the inflam¬ matory fever, if it exist at all, will scarcely ever become so high as to merit any special attention, and that the in¬ flammation itself will not often assume a very acute character. If he were a real investigator, he would soon discover that the acute and dangerous characters which sometimes accompany inflamma¬ tion arc almost always owing to the large abstractions of blood, and the pri¬ vation of nutriment which the strict an¬ tiphlogistic system of treatment enjoins. Although Investigator is pleased to denominate the system of practice I am advocating “ a mania,” he will, most probably, on some future day look back with horror, as I now do, on his present favourite and “ long-cherished” system, as one which has converted a number of cases of mild into acute and alarming forms of inflammation, which has im¬ paired numbers of good constitutions, and which has destroyed many lives. I am, sir, Your obedient servant, Henry Searle. Kennington, Dec. 6, 1S36. ON THE RECENT CASE of SUPPOSED POI¬ SONING with UNSOUND BACON. To the Editor of the Medical Gazette , Sir, In consequence of a report of the in¬ quest held at the Westminster Hospital, on the body of Caroline Jones, appear¬ ing in your journal of the 10th hist.., in which a verdict was brought in that “ the death of the deceased was caused by eating unwholesome bacon,” 1 beg to offer a few observations on the case ; which, previous to admission into the hospital, was under my care. Caroline Jones, act. 14, was admitted a patient at the Chelsea Dispensary, on 25th October. As she was too ill to come to the institution, and was con¬ fined to bed, I visited her at her own home. She complained much of pain in the back and limbs, and general uneasiness and restlessness. There was considerable headache, a dry and foul tongue, mucous sordes about the mouth, thirst, no appetite, hot skin, quick pulse, cough, with pain in the chest ; over the fore part of which, slight sono¬ rous rattle was general. She had been ill about ten days, and the only cause which the mother then assigned as the origin of her illness, was her having been exposed to fatig’ue and cold during her journey up from Gloucestershire by the waggon, in which she had slept two nights on the road : two or three weeks had since elapsed. Leeches were ordered to be applied to the chest and 456 DR. BARR ON THE RECENT CASE OF POISONING WITH BACON. head, and the hair to be cut close. A purgative and diaphoretics were admi¬ nistered. The pain in the chest and cough shortly disappeared, and the headache was relieved. A few days afterwards, she complained of pain in the bowels, with much purging, and there was considerable tenderness of the abdomen on pressure. She had leeches, followed by poultices, applied twice. Small doses of hyd. c. creta, with pulv. ipecac, comp, were given , and subseq uent- ly the mist, cretse, with a few drops of tinct. opii; under which treatment the pain of abdomen and diarrhoea ceased, and she was evidently getting better. On my next visit, after an interval of two days, I found she had been up in the meantime, and had felt tolerably free from complaint, and that her appetite having returned, she had probably in¬ dulged it too freely, as the fever had in¬ creased, and the pain in abdomen and diar¬ rhoea had returned. I have since learned that on both days, besides meat at din¬ ner, she had taken pickled cabbage, with half a pint of porter and wine. At the solicitation of the mother, who, in consequence of having so young a family, and of the sickness of another daughter, said she was unable to pay proper attention to her, I gave her a letter to the Westminster Hospital, with strict injunctions to guard against cold ; but either from being too early at the hospital, or some other cause, she tells me her daughter was kept in the wait¬ ing-room for three hours, which, to¬ gether with exposure to cold in the coach on her way there, no doubt caused an aggravation of the symptoms. Such is the case, so far as I attended it ; and independent of the history, as since given by the father on the inquest, we should have no hesitation in con¬ sidering it simply as an instance of continued fever, complicated with abdo¬ minal affection. The question is, whe¬ ther that evidence can be so relied on as that we can have no doubt that the fever and subsequent death were solely the result of eating unwholesome meat. At the time when it is stated that all who partook of the bacon were so seriously affected, the eldest son, a boy of about twelve years of age, was under my care for chorea, and was attending the dispensary twice a week with his mother; and although he is said to have suffered from pain and vomiting, no notice was taken of it to me at the time. During my whole attendance on the girl it was never mentioned ; nor in a letter which the father wrote to me during her stay in the hospital, request¬ ing my advice, as she was getting worse, if she might be removed home; nor on my being asked to prescribe for a younger sister a few days after the elder had become a patient of the dis¬ pensary ; nor was the slightest account given of such an occurrence after her admission into the hospital, till within three days of her death. I can hardly think that on all these occasions, had the symptoms occasioned by eating the bacon been as serious and violent as since stated, it could have escaped re¬ collection to have named it as the pro¬ bable origin of the disease. That sick- ness was caused, I do not doubt ; but I fully believe, on inquiry, that the effects produced have been much exaggerated, — perhaps unintentionally, — for we know how prone people are to attribute their complaints to any unusual cause. I know not if there be any case on re¬ cord in which the symptoms produced by eating unwholesome meat so exactly resemble those of continued fever. Dr. Christison, in his excellent work on Poisons, thus details the symptoms, on the authority of Kerner and others, occasioned by sausages which had be¬ come poisonous; and perhaps I shall be excused for quoting the passage entire. “ The symptoms of poisoning seldom begin till twenty-four, or even forty- eight, hours after the noxious meal, and rather later than earlier. The tardiness of their approach seems owing to the great indigestibility of the fatty matter with which the active principle is mix¬ ed. The first symptoms are, pain in the stomach, vomiting, purging, and dryness of the mouth and nose. The eyes, eyelid, and pupils, then become fixed and motionless; the voice is ren¬ dered hoarse, or is lost altogether ; the power of swallowing is much impaired ; the pulse gradually fails, frequent swoonings ensue, and the skin becomes cold and insensible. The secretions and excretions, with the exception of the urine, are then commonly suspend¬ ed ; but sometimes profuse diarrhoea continues throughout. The appetite is not impaired; fe^er is rarely present; and the mind continues to the last unclouded. Fatal cases end with con- 457 dr. harrison’s remarks on pectoriloquy. vulsions and oppressed breathing', be¬ tween the third and eig'hth day. In cases of recovery, the period of conva¬ lescence may be protracted to several years. The chief appearances on the dead body are, the signs of inflamma¬ tion in the mucous membrane of the alimentary canal, whiteness and dryness of the throat, thickening of the gullet, redness of the stomach and intestines ; also croupy disposition in the windpipe; great flaccidity of the heart ; and a tendency in the whole body to resist putrefaction Similar effects have been produced by bacon. In an account of an accident of the kind given by M. Ollivier, three members of a family at Paris, after eat¬ ing ham-pie, were seized with shiver¬ ing, cold sweats, violent pain in the stomach, frequent vomiting, burning thirst, excessive tenderness of the belly, profuse purging, and colic ; but the symptoms did not come on till the day after partaking of the pie ; and other customers of the pastry-cook who sup¬ plied it had been similarly affected. They all recovered. In the above case it is stated by the father that he himself found it disagree with him while eat¬ ing ; the son vomited during dinner ; the daughter was taken ill about three hours after; and the mother in the course of the night. We know not how far the purging was the result of eating the bacon, as the father immediately dosed them all with calomel. The post-mortem appearances were those which are found after fatal cases of pro¬ tracted fever ; there was no ulceration of the stomach, as stated in the report of the inquest ; but numerous ulcerations were found in the ileum, near the ileo- coecal valve, one of which had pene¬ trated all the coats of the bowel. On reviewing the whole of the circum¬ stances, I think we ought to pause be¬ fore placing this on record as an un¬ doubted instance of death proceeding from poison generated in unsound ba¬ con. — 1 am, sir, Your most obedient servant, John Barr, M.D. Physician to the Chelsea Dispensary. 18, Sloane-Street, Dec. 16, 1836. SOME REMARKS ON PECTORI¬ LOQUY. To the Editor of the Medical Gazette. Sir, In speaking of pectoriloquy, Laennec recommended the application of the stethoscope to the larynx and trachea of a healthy individual, as a means of acquiring a good idea of this sign. At this stage of his proceedings pectoriloquy was for him “ la transmission evidente de la voix a travers le cylindre” ; and having first noticed it in ulcerated cavi¬ ties from the softening down of tuber¬ cles, he appears at that time to have considered such transmission, and such cavities, as essentially connected, al¬ though the examples of the larynx and trachea were calculated to excite doubts on this point. If we constantly bear in mind this first strong impression of Laennec as to the connexion between “ ulcerated tubercles”,* and the passage of the voice up the tube, we shall find in it an explanation of some of the con¬ fusion to be met with in his work, on the subject of pectoriloquy, and which seems not to be altogether banished from the minds of several of his followers. Subsequent researches, however, proved on the one hand, that “ ulcerated tuber¬ cles” do not always give transmission of the voice up the tube, and on the other, that this transmission might be produced without any such ulcer ; so that he came afterwards to give the name of pectoriloquy to some cases in which there wras no transmission of the voice, although he refused it to others in which such transmission was produced by consolidation of the lung surround¬ ing a bronchial tube. Still, however, the passage of the voice up the tube ap¬ pears to have maintained a high place in the mind of Laennec ; and the undue importance attached to it as a sign has, I think, been a source of much mischief. The attention of the student has in this way been withdrawn from what is, in my opinion, the most valuable auscultatory sign of a cavern (so far as the voice is concerned — namely, a sensation that the space in which the voice plays is “circumscribed;” such space not existing naturally in the * Christison on Poisons, 3d edit. p. 585. * “ Tubercules ulcer6s,” an expression of Laennec which is sufficiently intelligible. 458 ANALYSES AND NOTICES OF BOOKS. part of the lung- from which the sensa¬ tion is communicated. To this sign. Laennec has not, I think, given a sufficiently prominent situation ; he has not sufficiently in¬ sisted upon its perception as the “ sine qua non” of a generally correct diag¬ nosis (by the voice) of a “ circumscribed space.” The extension which he gave to the term pectoriloquy, in applying it to some cases where the “ transmission de la voix n’est pas evidente,” as well as to some in which “ la resonnance est tres faible,” was calculated to create in¬ extricable confusion; and such has been the result. Even in cases of ulcerated cavity in the lungs, where there is a strong resonance under the stethoscope, with or without some transmission* of the voice, these circumstances are perhaps as often connected with the bronchi as with the cavity itself; and not only so, but the modification of sound pro¬ ceeding from the cavity, maybe little or not at all attended to, on account of the stronger resonance in the bronchi. In such cases the auscultator is confirmed in his error, by finding after death the cavity which he had predicted, and the existence of which w'as in his opinion indicated by what he calls pectoriloquy. The next case which he meets with presents, perhaps, the same sounds as the last ; he confidently predicts the existence of a cavern, but finds to his astonishment, if the patient dies, that there is nothing’ of the kind. Now I think such mistakes would be less frequent, if, from the commence¬ ment of his auscultatory career, the student’s attention were strongly fix¬ ed upon the advantage of being able to appreciate the circumstance above mentioned, viz. “ the resonance of the voice in a circumscribed space.” The practice so generally adopted of representing auscultation, by implica¬ tion at least, as one of the most easy studies on which a medical pupil can enter (it being in reality one of the most difficult) is attended with serious disadvantages. The pupil who has thus been encou¬ raged to commence the study of it with ardour and zeal, is the more mortified * Cases of decided transmission through the wholelength of the stethoscope are perhaps rather exceptions, independent of those where there is only a resonance under it. and discouraged when, after having pursued it for years, he finds himself frequently in doubts and difficulties on those very points concerning which auscultation had appeared to hold out the fairest promises. What is pectoriloquy*? What is it a sign of? The chances are that the twro first auscultators (not beginners) you meet with, will differ on one or both these points ; nor can you be sure that even the most recent authors will be free from variations or contradictions on this subject. Those writers and lecturers, however, who try to allure on our inge¬ nuous youths in the way above men¬ tioned, may prove that they are acting on a principle which has the sanction of antiquity, “ut pueris olim dant crustula blandi Doctores, eiementa velint ut discere prima.” I remain, sir, Your obedient servant, Edwin Harrison. Grove Terrace, Lisson Grove, Dec. 19, 1836. ANALYSES and NOTICESof BOOKS, “ L’Auteur se tue a allonger ce que le lecteur se tue a abreger.” — D’Alembert. Elements of Medicine. Yol. I. On Morbid Poisons. By Robert Wil¬ liams, M D., Trinity College, Cam¬ bridge ; Fellow of the Royal College of Physicians ; and Senior Physician of St. Thomas’s Hospital. Many will refuse their assent to the leading* propositions adduced by Dr. Williams, but no candid person will deny that the volume exhibits very con¬ siderable talent and originality. Though professing to consist of “ Elements,” we cannot recommend it to the student, for it requires some previous reading, and some practical familiarity with the dis¬ eases treated of, to enable any one to judge of its merits and to detectits faults. After an introductory essay upon the action of poisons, (in which he adopts the opinion of the best authorities — that they are usually absorbed, and act through the medium of the blood,) the author pro- * If I recur again to pectoriloquy, it is certainly not from lack of subjects calculated to illustrate the difficulties — the extreme difficulties — which are met with in the study of auscultation. DR. ROBERT WILLIAMSES ELEMENTS OF MEDICINE. 459 cecds to the consideration of those dis¬ eases which lie holds to be both conta¬ gious and infectious; namely, typhus, scarlatina, morbilli, variolse, varicella, erysipelas, pertussis. In this list, how¬ ever, there are more than one with regard to which it is by no means an acknow¬ ledged truth that they possess the cha¬ racters in question. First in the catalogue stands “ Ty¬ phus,” which, we are told, “ is a conti¬ nued febrile disorder having no inter¬ missions : it runs a course of very varied length, and is both infectious and conta¬ gious.” On reading this proposition, we supposed that Dr. Williams limited his application of the term typhus to certain forms of the continued fever of this country, which he regarded as un¬ equivocally communicable from one per¬ son to another, and had this been the case we should not probably have made any remark upon it ; but on turning the page, we find (p. 27) that “ there is but one simple continued fever known in this country, and that is caused by the agency of the typhoid poison.” Now these two positions taken together amount to this -.—typhus is contagious, and there is no other fever in this coun¬ try,— therefore all our fevers are conta¬ gious. This, we apprehend, is giving a universality to the principle, in which he will find very few- disposed to agree with him : in fact, the doctrine seems to be assumed as an axiom, and all the il¬ lustrations adduced are intended to shew the manner and circumstances attending a pre-established fact, rather than to de¬ monstrate the accuracy of the principle itself. So confident, indeed, is Dr. Wil¬ liams in the existence of contagion as the only source of the disease, that he attributes it to this even after the in¬ terval of months from the date of expo¬ sure, rather than have recourse to any other origin. Thus, “ a man slept with his father, nursed him, and lost him in typhus early in the spring of 18*28. In the September following this person sickened with a most violent form of fever, and was only recovered with great difficulty. Now supposing this man to have imbibed the contagion from the only source to which he could trace it, five or six months must have elapsed from the time of his exposure to the cause till the appearance of the dis¬ ease. The extreme periods, then, which the poison of typhus may lie latent, vary from a few hours to a few weeks, or perhaps a few months,” Although we have thought it proper to give the reader an idea of the extent to which Dr. Williams carries his no¬ tions on this head, as essential to a just view of his opinions, we are nevertheless far from having any intention of going into the discussion on contagion. We now proceed to the practical views of our author. Having once affected the human body, the poison of typhus is described as “ falling” sometimes upon one tissue, sometimes upon another, but more espe¬ cially implicating the alimentary canal, the brain, and the lungs, — of the changes produced in which a very clear and sa¬ tisfactory account is given. But even here there are some positions the accu¬ racy of which we cannot admit: thus we are told that “ it is a law that the typhoid fever does not wear itself out or die ; that the patient does not become insensible to its action until it has pro¬ duced the lowest state of depression consistent with human existence.” Now the only idea we can attach to this is, that before a patient can recover from typhus fever, he must previously be re¬ duced to a condition in which he is all but dead, so that the slightest imagina¬ ble increase of his depression would be fatal. But some patients pass through the fever with comparatively little debi¬ lity, being scarcely confined to bed at all; while another is laid on his back for weeks, with a black tong*ue and a thready pulse. Are we, then, to admit that both these are equally brought to the lowest state of depression? this can scarcely be Dr. Williams’ meaning, and yet if it be not, we really do not under¬ stand the expression. The treatment is divided into cura¬ tive, dietetic, and preventive. It has been attempted to arrest fever at once by cold affusion, and by the exhibition of emetics ; but of neither expedient does our author entertain a favoura¬ ble opinion. The assertion that “ a poison circulating with the blood can¬ not be removed from the system hy ablution of its (?) surface,” conveys his estimate of the one ; and with respect to the other, we are told that there seems but little ground for believing that emetics can, “under any circumstances,” have the effect of stopping the disease. Have we, then, any antidote to the poison ? Bark is first discussed, and summarily dismissed, nor without suffi¬ cient reason, the mass of evidence against it being quite conclusive. Next comes 460 ANALYSES AND NOTICES OF BOOKS mercury, concerning- which Dr. Wil¬ liams expresses no more favourable opi¬ nion than this, that the evidence ag-ainst it “ is not so great as that against the use of bark ;” but the argument on this part of the question is very infe¬ rior to that in which bark is discussed. We shall admit, however, that mercury is not a “ specific ” in continued fever, in order that we may arrive at the last and most novel part of the subject, namely, that in which the idea of cut¬ ting short the disease, or of finding any direct antidote, being abandoned, the author proceeds to inquire what is the best mode of treating this formidable disease ? The different authorities who have written for or against bleeding are ad¬ duced; and after a fair estimate of their statements, the conclusion is, that the evidence against bleeding outweighs that in its favour, so that, although this depletion may be occasionally use¬ ful, yet such cases constitute the excep¬ tions, and not the rule. This brings us to the chief peculiarities in the views of our author, and which we subjoin in his own words. “ The positive rules of treatment are not to anticipate any thing in fever, but to await the occurrence of each particu¬ lar symptom; and inflammation being set up, to remember that it bears a spe¬ cific character, and that we might as well attempt to stop the small-pox eruption as to impede its course. All, therefore, we can effect prior to the in¬ flammation, is to remove all those causes which may irritate, and conse¬ quently predispose any organ liable to be affected; or supposing the inflamma¬ tion exists, to remain satisfied with so moderating its intensity, that the life of the patient may not de endangered by this particular affection ; and beyond tbis, medicine has at present no power, except to stimulate those secretions which are in defect, and to restrain those which are in excess. “ The attempt to cure fever by anti¬ mony, ipecacuanha, or any of the many other of the large class of diaphoretics or purgatives, and where there is no particular indication to be met, is now considered to be a useless practice, or only calculated to amuse the mind of the patient. Let us therefore, looking to the rules that have* been mentioned, suppose the fever to be established, and that the poison has, or is about to set up its great specific action on the mucous membrane of the intestinal canal ; what is the mode of treatment to be adopted ? “ As a general principle, there is no known symptom that marks the point at which disordered function of the mu¬ cous membrane of the intestinal canal ends, and alteration of its structure be¬ gins. It is necessary, therefore, in all cases in which the disease has existed but a few hours, to assume that inflam¬ mation of some portion of the alimentary canal does exist: an assumption which, though it may not actually be the fact, is true in forty-nine cases out of fifty. In this state of the disease, a large number of experiments has been made in St. Thomas’s Hospital, to determine the most beneficial modes of treatment, and the following are the results of my experience. “ In a very large majority of cases diarrhoea is the only, or the principal symptom, when the alimentary canal is inflamed. The number of stools varies from three or four to eight or ten, or even to twenty, in the twenty- four hours. They are always loose, and may be indifferently green or yellow, ochre-coloured or black, and frequently contain large flakes of mucus, tinged with bile, and resembling moss-like vegetations. These stools do not fur¬ nish us with any accurate data, either as to the nature, the gravity, or the par¬ ticular seat of the inflammation : for no difference has been observed in them, whether the inflammation be diffuse or follicular, or whether its seat be the colon, the caecum, the small intestines, or the stomach. It will be evident, in such a state of things, that the exhibi¬ tion of a series of doses of purgative medicines can only tend to keep up an irritation, which must greatly tend to aggravate the existing inflammation ; so much so, that out of ten patients treated by purgatives by Andral, nine died. It is also certain, that even so mild a remedy as the hydragyrusc.creta has little power over the diarrhoea to assuage it, and perhaps none to change the character of the stools, and to ren¬ der them more healthy, until the vio¬ lence of the disease be past. The whole class of astringents seldom proves effi¬ cacious ; opium affecting’ the brain, while kino, hcematoxylum, and catechu, increase rather than soothe the inflam¬ mation. Neutral salts, which are not DR. ROBERT WILLIAMs’s ELEMENTS OF MEDICINE. 401 purgative, as the acetate of potash, ei¬ ther in the state of effervescence or otherwise, are grateful to the patient, and, by tranquillizing the stomach, al¬ ways give relief, and are so far bene¬ ficial ; but in other respects they exer¬ cise a very trifling influence over the disease. “ Medicines, then, have little effect, either in controlling or subduing’ the in¬ flammation of the intestinal canal in fever, or even in controlling the diar¬ rhoea. It remained, therefore to try what effects an almost purely local treatment would produce, and whether, by means of soothing the intestine, we might not moderate the inflammation, and in this manner produce, both di¬ rectly and indirectly, more sanatory effects. Many different plans have been tried to effect this object, but that which has been found the most success¬ ful is that of enemata, consisting of barley-water and of syrup of poppies. This plan has been tried during the last seven years in a large number of pa¬ tients at St. Thomas’s Hospital, and with, comparatively speaking, very favourable results. The mode of treat¬ ment is as follows : — “ Immediately on the admission of the patient, whatever may be the stage of the disease, ten grains or a scruple of rhubarb are exhibited. The object of this preliminary dose is thoroughly to empty the intestines ; for notwith¬ standing the patient has been suffering greatly from diarrhoea, it has frequently been found, on posthumous examina¬ tion, that the inflamed portion of the in¬ testinal canal has so strongly contracted on some hard scybala, as to have re¬ tained them, and thus, contrary to all expectation, an irritating cause has ex¬ isted in the intestines, which has mainly contributed to the fatal result. The bowels having been satisfactorily emp¬ tied, an enema, consisting of a pint of barley-water, together with half an ounce of syrup of poppies, has been di¬ rected to be given night and morning. This simple treatment has been con¬ tinued till the patient is convalescent, and has been rarely complicated by the exhibition of any medicine whatever. Its success has been remarkable, com¬ pared with other modes of treatment, when the fever has been of any mode¬ rate degree of intensity ; so much so, that in the years immediately before the cholera, out of sixty-three cases treated in this manner, only one died. The cholera was preceded and accompanied, and followed, by a fever of great seve¬ rity, and of unusual fatality, and the treatment by enemata in those years has been by no means so successful, only one being saved out of four or five. But still it has been considered, on a comparison of the deaths and recoveries under other modes of treatment, that this by enemata was on the whole the most successful.” From gr. x. to Dj. of rhubarb in the first place, and afterwards a clyster, consisting of barley-water, with Jss. of syrup of poppies, night and morning, — such, with “rare” excep¬ tions, is the whole treatment of fever adopted by Dr. Williams. And here the thought is almost forced upon our minds, that the students at St. Thomas’s, who a few years ago attended the joint lectures of Dr. Williams and Dr. Elliot- ton, must have been very singularly situated, and very thoroughly puzzled ; for it is impossible to imagine any thing, even in the proverbial uncer¬ tainty of physic, more at variance than the heroic remedies of the one, and the expectant treatment of the other. But to return: the passage we have quoted above is a very remarkable one. We are told that, of 63 patients treated for typhus fever, in the manner above-described, only one died! This is a success almost or altogether unprecedented. Louis, Andral, and Chomel, gave 1 in 3 as the average number of deaths, and 1 in 4^ is about the least mortality described by any of them. In London, 1 in 12 has been the least mortality at the Fever Hospital, and on the great scale, it is more than 1 in 8. Seeing these results were so different from that obtained by Dr. Williams, we at first supposed that he had included in his list numerous slight febrile attacks, which scarcely run into fever, properly so called ; but we found (page 79) that he makes an express distinction “ be¬ tween fever and those ephemeral febri- culse which simulate the first symptoms of typhus.” But again, while the usual mortality was so very small as to give only one death in 63 cases, yet in the epidemic fever which prevailed some years ago, when cholera visited this country, the 462 ANALYSES AND NOTICES OF BOORS. change was so great that three out of four, or four out of five, died ! while it is implied, that where the practice above recommended w'as not adopted, the number of deaths was even greater. There is surely some typographical er¬ ror in the passages we have quoted ; for while we believe no other practitioner can boast so small a mortality in his cases of “ typhus” as one in 63, so, few we believe, in the epidemic to which Dr. Williams refers, lost any thing like so many as he admits having done. But our author, though employing ene- mata, as described, in the great majority of cases, points out, nevertheless, various circumstances which render them less useful, or even hurtful. Among the former is the seat of the inflammation being in the stomach or small intestines, instead of the caecum or colon, or where the bowels are so irritable that the clys¬ ters are immediately rejected. Among* the latter are those cases in which a con¬ siderable degree of meteorism is present, and also where there is haemorrhage from the bowels. A few leeches, if much blood has not always been lost, are re¬ commended ; but, otherwise, the mineral acids, or supertartrate of potass, are to be preferred. Indeed, we may observe that the author is very chary in applying leeches : he says, “ in applying leeches to the abdomen, much is at all times put to hazard.” When the head is affected, the follow¬ ing directions are given : — If the deli¬ rium be moderate, and unaccompanied by pain, it may be disregarded ; but if the pain of the head be severe, and the conjunctiva injected, ten or twenty leeches are to be applied to the forehead and temples : if the pain be relieved, they are not to be repeated. In one form of head affection, though unaccom¬ panied by pain, leeches are of use — namely, where the pulse is preternatu- rally slow, not exceeding 60, or it may be even 40, in the minute. Blisters are very “ capricious,” and not to be relied on. In cold applications Dr. Williams has so little faith, that he has nearly abandoned their use for several years. When the lungs become implicated, the poison is regarded as having* nearly exhausted itself. Local bleeding, by means of a few leeches or cupping*, is generally sufficient to control the in¬ flammation ; but if not, a small vene¬ section may be practised. Here mercury is admitted to be a useful adjuvant. A blister is also frequently of service, and it is recommended to dress it with a common linseed poultice. “ In the cho¬ lera years,” we are told that the affec¬ tion of the lungs was among the earliest symptoms, and that depletion was ex¬ ceedingly prejudicial, the most success¬ ful treatment having* consisted in the exhibition of tonics from the commence¬ ment of the attack. Among the reme¬ dies of this class Dr. Williams particu- cularly mentions salicine, as possessing* many “ singular and valuable proper¬ ties ;” but he does not inform us what those are, farther than that it is pleasant and easily digested. Under the head of preventive treat¬ ment, Dr. Williams remarks, that “ after taking* care of the patient, it is neces¬ sary to take care of ourselves,” — an ob¬ servation, we need scarcely say, founded on the engrossing idea of the danger of infection, and which leads him to in¬ quire into the different modes of avert¬ ing this. The chlorides, he believes, possess no power beyond that of destroy¬ ing smells. He places more confidence in an elevated temperature, and quotes the experiments of Dr. Henry, — expe¬ riments, however, we venture to say, which require to be repeated on a much larger scale, before any satisfactory in¬ ference can be drawn from them. But were it otherwise, the degree of heat required is inapplicable during the con¬ tinuance of the treatment, and therefore we are left to the simple expedient of cleanliness, separation, and ventilation. Such is a faithful and, we trust, sufficiently distinct, though necessarily very condensed, account of the views entertained by our author on the subject of fever. If his opinions should ever become generally adopted, they will constitute a new era in the treatment of that disease ; but even without this, they will probably tend to render the in¬ terference of the practitioner Jess con¬ stant, and probably, therefore, less ha¬ rassing than it usually is. There are, however, two sets of remedies frequently adopted in our hospitals in the treat¬ ment of fever, to which Dr. Williams does not, in our opinion, do justice : one is that of simple salines, and the other that of mild alterative mercurials. Of the former he says, they exercise “ a very THE RADICAL UNIVERSITY. 4(33 trifling- influence over the disease ;” and of the latter remedy, that its entire abandonment “ would in no case lessen the chances of the patient’s recovery,” — an assertion which we do not find to be borne out by any evidence adduced. Again, with respect to the enemata, there are one or two passages which appear to us to amount to contradic¬ tions in terms. Thus, speaking of the fever of the “ cholera years,” we are told at pag-e 85, “ But still it has been con¬ sidered, on a comparison of the deaths and recoveries under other modes of treatment, that this, by enemata, was on the whole most successful.” And again, at page 91 , speaking of the same epidemic, it is remarked, “ Some few of these cases recovered under the treat¬ ment of enemata ; but the more suc¬ cessful mode was, in despite of the symptoms, a tonic treatment from the commencement of the disease.” Now it is just jiossible that Dr. Williams may allude to different classes of cases; but if so, it is not sufficiently expressed in the context ; and this leads us to ob¬ serve, that there is frequently a loose¬ ness, not to say inaccuracy, of lan¬ guage, which much diminishes the force of h is composition. But farther: it is said of enemata at page 94, “ it is a mode of treatment that is applicable to every form of the disease , and should be adopted in every case, only omitting* the syrup of poppies when the bowels become constipated.” But we had previously been told, at page 89, that it was not applicable “ in every case : thus the cases in which enemata are of no service are those in which a considerable degree of meteo- rism is present.” Nay, further: “when considerable haemorrhage takes place from the bowels, the tepid warmth of the enemata must of necessity he in¬ jurious , and they ought consequently to be omitted.” These passage cannot, we apprehend, be reconciled. We shall probably take another op¬ portunity of examining Dr. Williams’s opinions on the other subjects of which he treats ; meantime we recommend the volume to the perusal of those who, having seen some practice, are able to form a rational estimate of its merits, without being misled by its peculiarities. MEDICAL GAZETTE. Saturday , December 24, 1836. *' Licet omnibus, licet etiam mihi, dignitatem Artie Medicos tueri ; potestas modo veniendi in publicum sit, dicendi periculum non recuso.” Cicero. THE RADICAL UNIVERSITY. There is, we believe, but one opinion among those not immediately connected with it, touching the merits of the new Board of Government Commissioners for the manufacture of Degrees, — namely, that it displays a most edify¬ ing- illustration of the progress which has been made in the art and mystery of jobbing. This is the second “ Uni¬ versity” for which we have had to thank the same parties; and they have at least displayed some ingenuity in contriving another institution as unlike as was the first to those seminaries which have hitherto borne that respected name. We object to the principles on which the new establishment is founded, and to the persons by whose instrumentality it is to be attempted to carry those prin¬ ciples into operation. Universities, like most other pub¬ lic bodies, may ere now have had more or less of a political character, derived from the opinions of their mem¬ bers, and from the circumstances of the times; and no doubt statesmen have heretofore endeavoured, by various in¬ direct means, to win their support or to neutralize their opposition. Oxford and Cambridge have thus had the reputa¬ tion of being the one a Tory and the other a Whig establishment ; but to whichever party they inclined, their bias was the result of opinion, and their’s were the politics of free men. But, as Lord John Russell has in¬ formed us, the intellectual darkness of former times has given place to the bolder and more enlightened policy of 464 THE RADICAL UNIVERSITY. the present era. It was reserved lor the nineteenth century to dash aside all ancient prejudices, and in the founda¬ tion of a Radical University, openly to subjugate literature and science to the minister of the day. Every rule and regulation regarding courses of edu¬ cation, the examinations for degrees, the mode of granting the same, the selec¬ tion of the schools to be attended, and, in fact, “ touching all other matters whatsoever,” must be submitted to, and receive the assent of, the Secretary for the Home Department, before they can be acted upon. The so-called “ Sena¬ tors” are mere tools in the hands of their masters in Downing-street ; they have power to do nothing whatever of themselves, — no, not so much as to pur¬ chase red tape enough to tie up the orders transmitted to them. An extraneous jurisdiction of this nature cannot but be highly injurious to the cause of learning : even the capa¬ cious mind of “ one of our principal Secretaries of State” cannot grasp all the intricacies of science ; and by the new duties imposed upon him by this charter, he must be exposed (a rare oc¬ currence, doubtless, in the present day), tolegislate on matters of which be is pro¬ foundly ignorant. But, worse than this, the introduction of a discretionary power is always liable to favoritism and abuse ; and the prospectus of the new Univer¬ sity is very far from removing the appre¬ hension of its being converted into an engine of oppression. The whole ma¬ chinery is so dependent on the will of the administration, that politics cannot fail to become blended with every de¬ tail : new motives are thus called forth, and the streams of science become polluted by the agitations of party. No jurisdiction or control over the studies of persons destined for learned professions should be conceded to any but those deeply versed in such sub¬ jects; and the ulterior reference to the Home Office we regard as the most arbitrary and tyrannical principle which in these days of political freedom it has been attempted to establish. Smith, in his Wealth of Nations, alluding to what had then only been witnessed in a fo¬ reign country, and referring in terms of prophetic indignation to the pos¬ sibility of “ some minister of state” at home being presumptuous enough to hazard a similar interference, ob¬ serves, “ the person subject to such jurisdiction is necessarily degraded by it, and instead of being' one of the most respectable, is rendered one of the meanest and most contemptible persons in society. It is by powerful protection alone that he can effectually guard himself against the bad usage to which he is at all times exposed ; and this protection he is most likely to gain, not by ability or diligence in bis pro¬ fession, but by obsequiousness to the will of his superior, and by being ready at all times to sacrifice to that will the rights, the interest, and the honour of the body of which he is a member.” The consideration which more imme¬ diately led to the construction of a new University by the present government, was obviously the desire to establish a power to counterbalance the influence of Oxford and Cambridge ; the former of which was by far too conservative, and the latter not nearly radical enough to suit its purpose. The complaints made by the Dissenters of the disabilities they laboured under, gave a plausible pretext for interference, and the advantages of conciliating so large a body of men were sufficiently obvious in a political point of view. Let us therefore consi¬ der what those disabilities are of which the Dissenters complain, and from which they demand to be relieved. The English universities deny them access to academic honours, and thus, THE RADICAL UNIVERSITY. 465 it is said, obstruct their advancement in professional life : not that the de¬ grees which they are refused would necessarily afford them access to any of the learned professions, hut that they are pre-requisites, without which the doors are at once closed against them. But the extent to which this ever was the case, has been greatly, and, we fear, designedly over-rated : at all events, as we shall presently show the extent to which it now exists is so slight as to constitute little more than an imaginary grievance ; and certainly is such as to render the elaborate machinery which has been constructed for the ostensible purpose of removing it perfectly ridi¬ culous. The first degree is that in Arts ; and it is one which, per se , is of no value, in reference to any profession which a a Dissenter can follow. Now, as we have said, in all the remonstrances on the part of the Dissenters, and in all the govern¬ ment measures connected with the subject, it is assumed that the preli¬ minary distinction being denied, a bar¬ rier to th eir professional progress is placed at the very threshold. But the fact is, that, practically, the barrier is con¬ stantly overlept, and that without the slightest difficulty; after which the path is equally open to all. The only exception to this is in the Church, where, indeed, a degree in Arts from an English university is of value, as it affords a ground for the bishop on which to ordain the holder of it ; but here it is obvious that even if he had the required diploma, no profes¬ sional benefit could accrue from it to the Dissenter. In the Law, no insuperable obstacle ever existed ; and the only impediment wras, that students from Oxford or Cambridge were called to the bar at the end of three years, while others, whether Dissenters or not, were only 473. — xix. admitted at the end of five. Even this, however, has recently been discon¬ tinued, and no impediment whatever now exists, in the Inns of Court, to the Dissenter’s free and undisputed pas¬ sage, without any reference to his reli¬ gious opinions. In Medicine it was different; and those who have attended to the subject are aware, that here by far the strongest case existed ; as was proved both by the evidence given before Mr. Warburton’s Committee, and as was set forth in vari¬ ous petitions presented to both houses of Parliament. In fact, it is our delibe¬ rate opinion, that the only real griev¬ ance which could be established, was with reference to the medical profes¬ sion. No one w'as admitted to be a Fellow of the College of Physicians save by special grace, and consequent¬ ly no one could calculate on attain¬ ing the highest rank in his profession unless he had an English degree ; and this, Dissenters, of course, could not obtain. It is not true that the Col¬ lege of Physicians ever refused to admit them as Licentiates, or threw any obstacle in the w^ay of their prac¬ tice; but we admit, and have often formerly complained, that the disability was, notwithstanding, of a very formi¬ dable and oppressive nature. We have said that we complained of the Eng¬ lish graduate receiving of right what others only obtained by favour ; but we do not continue to complain of that which does not continue to exist — we do not, like his Majesty’s Ministers, em¬ ploy our artillery to break down bar¬ riers which have already been freely thrown open. The English gradu¬ ate no longer has any advantage in this respect over his dissenting neigh¬ bour all are equally required to have passed through a prescribed course of study, but without any restriction as to where this may have been carried on, 2 II THE RADICAL UNIVERSITY. 4 (56 — and all are equally admissible to ex¬ amination for the diploma, with or with¬ out any previous University degree. By the new statutes of the College of Physicians, all are placed on precisely the same footing-, without prejudice and without favour. Now this important measure of medi¬ cal reform had been for a considerable time in agitation, and its earlier enact¬ ment was only delayed by the opposition of some physicians of the old school, since deceased. The fact of it having been finally accomplished early in the present year, was made known to Mr. Spring Rice long before he had orga¬ nized the new institution which had been intrusted to his parentage ; and we have no doubt that, if any communication had been made to the College of Physicians, the whole affair might have been ar¬ ranged to the satisfaction of all parties. But this docs not appear to have been the object; that gentleman talked with individuals, but never communicated with the Body. Nothing- would have been simpler than either to have con¬ ferred on the Colleg-e of Physicians the privilege of giving the degree of M.D., under certain restrictions, or to have appointed a Board to act in conjunction with them ; by which all the rivalry and scandal which must now ensue would have been avoided. But there was a political purpose to be served, and a coup d'etat put in exe¬ cution, that the learned professions might, if possible, be brought under the control of the Minister, and that the Dissenters might receive at his hands the boon — though an inferior one — of degrees in physic which confer no right to practice ! We beg leave to ask Lord John Russell what he is to do for his phy¬ sicians when he has made them. Will he candidly tell them that they may not practice on the strength of his diploma ; or will the Secretary for the Home De¬ partment connive at the violation of the law? Here is the dilemma; without an act of Parliament, annulling that which already exists, the graduates of the new University must still come be¬ fore the College of Physicians — or prac¬ tise illegally. Now although indivi¬ duals occasionally do this, it remains to be seen whether a Government will be bold enough openly and professedly to countenance and protect an infringe¬ ment of the statute. But if their gra¬ duates are obliged to appear before the College in Pall Mall, then what be¬ comes of the University ? — for besides this admission of its inferior authority, the degree is no passport to a license without the prescribed education having- been gone through ; and if this has been done, then no degree is required. In either case the diploma of the Radical University, so far as regards medicine will be useless : nor can this difficultv be got over in any other way than by procuring an act of Parliament, — which, as the House of Peers is not yet extin¬ guished, my Lord John knows, by ex¬ perience, is more easily said than done. When from the principles of* the new institution we turn to the men by whom they are to be carried into effect, we find some names highly distinguished in general science, which have most pal¬ pably been introduced to float the dead weight of the medical department. When we say of the physicians, that, with some exceptions, they are respectable * men, we use the most complimentary epithet which, without being ironical, it is pos¬ sible for any one to bestow upon them ; but our limits will not allow us to enter at present on their individual and pro- * As the same expression has been applied to them by a correspondent in the Times, we beg to say that we did not borrow the epithet of him, not having seen his letter till this was jtassing the press The coincidence tends to show the ap¬ plicability of tije term ; but as to the rest, there is much in which we differ from M.D. — Ed. Gaz. THE NEW PHARMACOPOEIA. 467 per merits. There is one point, how¬ ever, to which we would briefly allude, because it has been brought before the public through the medium of two letters in the Times. It is implied, if not asserted, by the writers in question, that the government were fain to take what physicians and surgeons they did — be¬ cause better men refused. This is true, but it is not the whole truth. Cooper, Brodie, Chambers, Holland, and others, were applied to, not, however, to con¬ struct, — but to concur; not to organize the medical portion of the new institu¬ tion, (which, being all Whigs, it might be supposed they would have done on sufficiently . liberal principles,) but by their rank and weight in the profession, to give influence and authority to plans previously laid down by others. They were asked to countenance principles of which they disapproved, and to become the colleagues of men already appoint¬ ed, and with whom they thought it no honour to be associated. Therefore — and not from “ being already connected with other Colleges,” as has been as¬ serted — did they, after repeated attempts at conciliation, decline the overtures which were made to them. As it is, we trust that when the sub¬ ject of this same charter comes before the House, and the proposal of placing all professional education under the control of the Minister is discussed, there will not be wanting some to repeat the words of Milton, addressed to the government on a somewhat similar oc¬ casion — “ Truth and understanding are not such wares as to be monopolized and traded in by tickets, and statutes, and standards: we must not think to make a staple commodity of all the knowledge in the land, and to mark and license it like our broadcloth and our woolpacks * Milton’s Areopagitica. CROWDING AT OPERATIONS. We insert, in another part of the pre¬ sent number, some communications re¬ specting the late disturbance at the operating' theatre of St. Thomas’s Hos¬ pital. As the case is to be tried at the Sessions, we abstain from making any remarks applicable to it in particular ; but we take this opportunity of insist¬ ing upon the very great inconvenience which results from the admission of too many persons into the area of the operating theatres at our hospitals. It is quite obvious that half a dozen heads close to the patient, prevent ten times that number of persons, placed at a proper distance, from seeing at all ; and it has long been a complaint among students generally, from whom we have often received letters upon the subject, that they are thus frequently prevented from getting- even a glimpse of what is going’ on. At some of the hospitals, efforts have recently been made to abate this nuisance, and we earnestly hope that the present unfortunate occurrence will at least have the advantage of leading to a complete reformation. It is impossible to do justice to the great body of the students, to the patient, or the operating surgeon, unless the rule be rigidly adopted of excluding from the area every individual except the operator and the patient, and those immediately required for their assistance. THE NEW PHARMACOPCEIA. This long -looked -for volume has at length made its appearance. It is very different from its predecessor, being no mere reprint, but a complete remo¬ delling; presenting a great number of new articles of materia medica, various new pharmaceutical processes, and a very extensive change of nomenclature. So much at the first glance ; but it re¬ quires to be looked through carefully, and when we have done so, we shall say more about it : mean time wre insert, at page 478, a list of the names which have been changed. 4G8 ROYAL MEDICAL AND CHIRURGICAL SOCIETY. ROYAL MEDICAL AND CHIRUR¬ GICAL SOCIETY. MR. C. HUTCHISON versus DR. JAMES JOHNSON. To the Editor of the Medical Gazette. Sir, I was informed by a friend, that last Saturday’s Lancet contained the report of a speech made by Dr. James John¬ son at the Royal Medical and Cbirur- gical Society, on the previous Tuesday evening, upon the occasion of a note of mine being read *. The journal in question is now be¬ fore me, and- the speech, as reported, consists of five sentences, as follows : — “ Dr. Johnson said he had passed a long time at sea, and doubted the fact broad¬ ly stated by Mr. Hutchison. He had seen many cases of calculus in seamen. Sailors were not operated on in the ships or naval hospitals during the wars, because seamen, when known to have calculus, were invalided, and sent to our civil hospitals, and there cut. He knew a naval surgeon who was twice cut for stone, and several naval officers who were affected with calculus. He did not consider seafaring men to be more exempt than others.” With regard to the first sentence. Dr. Johnson has a right to doubt what any man says ; and though my opinions are supported by the most convincing official documents from all the civil sea-port hospitals in the United Kingdom, as well as those of the Royal Naval Hos¬ pitals, yet still, I say, he has a right to doubt. I shall be extremely obliged to Dr. Johnson if he will have the kindness to point out the names of the hospitals and ships in which he has seen so many cases of calculus in seamen, for with such information I can test the correct¬ ness of his observations by a reference to the hospital and ships’ books at the Admi ralty . The next sentence is so severe a libel on the naval hospital surgeons since the year 1800, — from which period my ob¬ servations and calculations on the sub¬ ject of calculous disorders commenced, and only about a year and a half after * On the Infrequency of Calculus among Sea¬ men. See our preceding number, page 424.— Ed. Gaz. Dr. Johnson entered the naval service, — that I hardly know in what terms to designate the assertion. Will Dr. John¬ son say that any man was ever in¬ valided * from Deal Naval Hospital during the period of war, (when I was for several years surgeon to the institu¬ tion), for the purpose of being sent to the Civil Hospital to undergo any operation whatever ? There are now living, Dr. James Veitch, Mr. George Yance, Dr. Jait, Sir Stephen Hammick, and some others, I believe, who were surgeons of naval hospitals in war time, and whose very names I should think are sufficient warranty to disprove the assertion. The naval hospital surg’eon alluded to by Dr. Johnson as having been cut twice for stone, was Dr. Duke, whose case, and that of every other officer or man so operated upon which I could in any instance trace, are all mentioned and honestly recorded in my previous papers. With regard to the Doctor’s fifth and last sentence, the answer is, that as it is a mere unsupported assertion, opposed to the most authentic documents, it does not require any further refutation. If I be not very much mistaken, naval hospital surgeons, and their brethren afloat, have been among the very first to lead the way in operative surgery, and to advance the science generally, instead of sending their patients to civil hospitals. But I rather suspect that my friend Dr. Johnson, when he went to the Society on the evening in question, had but just risen from perusing Smollett’s Roderick Random, and so had gone back in his thoug’hts nearly a century. The subjoined documents will speak for themselves; but I must add, that as truth has ever been my main object in this, as in every other professional in¬ quiry and statement, I am sure that the profession and the public will not be satisfied without some explanation from Dr. Johnson, after so groundless an as¬ sertion. — Yours, &c. A. Copland Hutchison. 10, Queen-Street, May-Fair, Dec. 20, 1836. * No officer or man can be permitted to leave the service on account of ill health, until he have been surveyed by the medical officers of one of the Home Naval Hospitals, two captains, and two surgeons afloat : this is what is called invaliding* MR. H L. SMITH ON SELF-SUPPORTING DISPENSARIES. 4(39 LETTER FROM DR. BAIRD. Clarges- Street, Dec. 20, 1836. Sir,— I have received your note of yes¬ terday’s date, desiring to know if, during the period of my service in the navy, whe¬ ther as physician of a fleet, a member of the Sick and Wounded Board, and subse¬ quently Inspector of Naval Hospitals, I ever knew an instance of an hospital sur¬ geon in our service invaliding a patient for the purpose of being sent to a Civil Hospital to undergo an operation for the stone. In reply, I have to inform you that no instance of the kind occurred from the date of my appointment, in 1803, up to the period of my ceasing to perform public duty ; and I have further to state, that if any instance had occurred betraying such incompetency, I would have felt it an im¬ perative duty to represent the case to the Board of Admiralty. — I am, dear sir, Very truly yours, A. Baird. Alex. Copland Hutchison, Esq. LETTER FROM SIR WILLIAM BURNETT. Admiralty, Dec. 19, 1836. Sir, — In reply to your note of this date, requesting to be informed whether I have ever known or heard of any naval hospital surgeon who invalided patients requiring operations of any kind, for the purpose of their being operated upon in civil hospi¬ tals, — I can have no hesitation in saying, that I never heard of, or was acquainted with, any such occurrence. With respect to your second question, I naturally conclude that if such a thing had happened, the surgeon doing so would have been considered unfit for his situa¬ tion ; and I can only add, as respects the present time, that I should feel no hesita¬ tion in immediately recommending the removal of such a person from the office of surgeon of any of our hospitals. I am, sir, Your humble servant, W. Burnett, Physician- General. Mr. Alex. Copland Hutchison, Surgeon, R.N. CASE OF LITHOTOMY. NOTE FROM MR. HILL. To the Editor of the Medical Gazette . Sir, In your last Gazette you mention a case of lithotomy sent by me to the Royal Me¬ dical and Chirurgical Society, in which you have omitted the only circumstance which appeared to justify me in occupying the time of the Society, — I mean the total insensibility of the nervous system, with the entire loss of power of the sphincters of the rectum and bladder, produced by moving the calculus from its situation at the entrance of the bladder, some time be¬ fore the operation was performed. The symptoms after the operation were, indeed, very severe and unusual, but not suffi¬ ciently so in themselves to be related to the Royal Medical and Chirurgical So¬ ciety. — I am, sir, Your obedient servant, Wm. Hill. Wotton-under-Edge, Dec. 20, 1836. [We regret that there should have been any omission, but are not accountable for the abstract of his paper referred to by Mr. Hill. It was furnished to us officially from the Royal Medical and Chirurgical Society .“-Ed. Gaz.] AN ADDRESS FROM THE FOUNDER OF THE SELF- SUPPORTING DISPENSARIES. To the Members of the British Medical Association. Gentlemen, Every medical man in the kingdom will sincerely rejoice, who has heard that an Association is formed in the metropolis for the laudable purpose of increasing the usefulness, and upholding the respectabi¬ lity, of the profession. And although, as I am informed, at your first meeting, the plan I have for nearly twenty years been endeavouring to carry into effect was reprobated as detri¬ mental and pernicious to your interests, I have no doubt, even if my informant is correct, that when the Association is disa¬ bused of the prejudices that have been ab¬ surdly created against Self-supporting Dis¬ pensaries, many amongst you will bring honest minds to the investigation (which is all that the scheme requires), and will be able to appreciate the difficulties that have been surmounted, the interests recon¬ ciled, the untiring spirit shewn, and the practical good effected by the projector. During the whole of my professional life I have sacrificed my own interests to my proposed scheme of improving the medi¬ cal profession, bv effecting a “ radical re¬ form in its position towards the working 470 MU. H. L SMITH ON SELF-SUPPORTING DISPENSARIES. people of the country.” Through good report and evil report I have persevered; and I can but smile at, although I regret, the misrepresentations which have already been current amongst you. I have grate¬ fully discovered that there are a few in your great town that may be made useful allies in resisting the unjust warfare that has been carried on against the medical profession. These acts of insult and oppression are of the same character, whether under the new Poor-law Amendment Act, or the darker doings of overseers in irresponsible vestries. It is the dealing in human life on the principle of contract, that is the evil; and no amount or mode of fixed salary can make it endurable to Christians. The lovers of their neighbours will not be satisfied till every poor person, and every pauper, can choose for; himself his own medieal attendant. But the authorities — whether commis¬ sioners, guardians, or overseers — whether the abettors of, or even dealers in quackery — are only external causes of injury and degradation to medicine as a science. The internal are the most injurious, — that host of illegitimates, who, paid for exercising one-part skill and three-parts trade, find it difficult to take up a higher station. The craft is their status, and they are naturally prone to mystify and misrepresent every attempt to liberate their dens of drugs, dregs, and darkness, from the thick clay with which they are covered. We have, indeed, another internal ene¬ my — to which I will not at present parti¬ cularly allude, as I am unwilling to open a wider field for discussion in my first let¬ ter than necessary — but which the “ Bri¬ tish” and Provincial” will unite in abat¬ ing as a common nuisance, as soon as they are sufficiently organized to give weight to their growing powers, and improving influences. Our noble art, by means of its united brethren, of which the “ Prov incial” is the first-born, is destined to establish, through the best affections of mankind, lessons of the truest wisdom. The science which in practical useful¬ ness excels all others, must no longer be separated from that benevolence in the body politic, which can best make it va¬ luable. Schools and mechanics’ institutions have extended the dominion of know¬ ledge ; “ self-supporting dispensaries,” “ medical associations,” and an elective “ medical board,” are now required to ex¬ tend the dominion of real charity. Beggar making, like pauper making, is an offspring of mammon, and not of cha¬ rity. Let us, who know more of the na¬ ture of man than guardians, masters, or legislators, teach the world a useful lesson. I am thankful, (as Dr. Webster, your chairman, stated,) that I have been so in¬ strumental in bringing you together; rest assured, gentlemen, that no future efforts on my part shall be wmnting to keep you at your posts, and stimulate you to in¬ creased exertions. It is a noble cause ; and if we pursue a straight-forward and favourable course, all the wmrld will be with us; do not despair. The same fore¬ seeing and quiet faculty of combination that has so moulded events as to cause your assemblage, can direct your move¬ ments as may best suit its own purposes; travel with me, and the good is accom¬ plished ; resist me, and the glory of suc¬ cess will be altogether my own. I find by the published Report, that on the cloth being withdrawn, Dr. Webster, in a speech which appears to me full of good humour and good sense, drank the toast of the evening, “ Prosperity and unanimity to the general practitioners of medicine throughout the universe.” Amen, and amen, is responded from land’s end to land’s end. When I admit that your chairman’s speech w7as full of good sense, you must permit me to change one word of it only, for without that change, as you yourselves shall decide, it was a sort of kaleidoscope of sentiments without object or meaning. The chairman is reported to have said, “ I wish now to mention what I consider in medical language to be the proximate causes of the meeting. I will not conceal from view the recent and still continued attempts to inflict on the profession a host of evils in the shape of ‘ Self-supporting Dispensaries.’” I am convinced that the Doctor must have meant to say cure , instead of inflict. Every paragraph he utters afterwards confirms this amended reading. “ It is not the object of these societies (or institutions) to institute a monopoly ; they are intended to promote fair and honourable (competition be¬ tween institutions) conduct among the the practitioners at large towards each other; to encourage among them (in each concentrated locality) the exercise of harmony and good will; to diffuse medical information ; to insist upon the rights vested in its members by the law of the land ; to suppress illegal practitioners, and thereby protect the real interests of the public, &c. ; in few words, to render the profession within the sphere pre¬ scribed, honourable, useful, and respecta¬ ble.” MR. II. L. SMITH ON SELF-SUPPORTING DISPENSARIES . 471 These, gentlemen, are the sentiments I have so often for eighteen years reiterated as the probable fruit of Self-supporting Dispensaries, when comparatively disre¬ garded and unknown, that I cannot but hear them quoted in the manifesto of the British Association, with feelings of com¬ placency and good will, that is undis¬ turbed, though my health, and success to my views, was not the distinguishing toast of the evening. I must copy a few more observations from the chairman’s address: he is very wrathful with the Commissioners, and the Penny Clubs. Before I repeat his remarks on this head, I should like to be told what have “ Poor-law Commis¬ sioners” to do with affairs that do not belong to them. The Foreign Office would be as much in place, giving directions on the parish constabulary, as the Poor-law Commissioners have been in their inter¬ fering in this matter at all. Dr. Webster says, “ I shall not shrink from declaring what I feel to be the truth, that nothing has occurred for a century past which has so much tended to degrade and lower general practitioners, not only in the eyes of the public, but our own eyes also, as the introduction of these Penny Clubs.” I must here silence the “cheering and immense applause ” that followed, by ob¬ serving, that there have been other causes much worse than Penny Clubs — “ farming the sick poor of parishes,” and submitting to have (Oh, for the moral cowardice of London practitioners!) reports of medi¬ cal proceedings inserted in the Lancet. These are standing libels on the profes¬ sion, which have vilified and degraded it beyond all others combined. But to return. “ We are to be put up to Dutch auction — not to the highest, but the lowest bidder; we are to be pitted, the man of little experience against him of the most extensive observation, and to be forced to perform the anxious and laborious duties of our profession for an utterly contemptible pittance.” This is perfectly true. I have enlarged on the same facts for the last twenty years, and Lord John Russell presented a petition for me to the House of Commons, on the same subject, in 1826. I have also endeavoured to remedy the evil by suggesting a judicious system of “ co-operation” amongst medical men themselves, and not the “ competition” which the Penny Clubs establish and per¬ petuate. I hope, for the sake of consis¬ tency, that none of the gentlemen who cheered the chairman’s observations on the Penny Clubs, or four shillings and four- pence annual payment, were surgeons to clubs allowing them considerably less per annum for each person ? I am not friendly to Penny Clubs— but that I foresee they must merge in Dispen¬ saries. But to return to the chairman. He says, “ Need I mention another griev¬ ance — that of quackery ? This is an evil which truly preys upon the vitals of the public, and weighs down our profession, spreading over the land and assuming in¬ numerable shapes. “ Another, and one of the greatest evils from which our body suffers, is the existence of what may be called prescrib¬ ing or dispensing chemists; men who, without a particle of medical or scientific knowledge, are becoming the general practitioners in all minor ailments,” &e. They are decreasing, Dr. Webster, in all those places where there is a “ Self- supporting Dispensary” established. “ I know of no country where our sys¬ tem of unlicensed practice exists, and I am satisfied, that, if we act with unani¬ mity, it cannot continue in this country. Let the duties of chemists be properly re¬ gulated, and not be allowed to interfere with those of the regular practitioners.” “ Another evil,” — 1 entreat attention to this last extract, because Self - support¬ ing Dispensaries progressively secure the only remedy — that is, a payment for time andskili, instead of drugs: — “ Another evil is the mode of payjng general practitioners; a mode which un¬ fortunately leads to unjust suspicions of his integrity, and is often very galling to an honourable-minded man.” The following letter from a gentleman who is a stranger to me, so admirably il¬ lustrates the practical good sense of the chairman’s speech, that I must trespass on your patience for its insertion. It proves that Penny Clubs, or “ Self sup¬ porting Dispensaries,” are the only cure for the host of evils of which he complains. It is so satisfactory, that I expect to have, on some early occasion, your countenance, favour, and even personal protection, when I shall next visit town, in the hope of es¬ tablishing “ Self-supporting Dispensa¬ ries” through the length and breadth of the land. A scheme for this purpose I intend shortly to submit, through the pages of the Medical Gazette, to the members of the “ British” and “ Provincial Medi¬ cal Association ;” as I learn there are not a few who are sufficiently philanthropic and patriotic to take up the matter in good earnest. Tn the course of time, from them a “ Medical Board” must be elected, for re¬ gulating and bringing into order and sys- 472 PRESENT STATE OF THE IRISH MEDICAL CHARITIES. tem our present chaos of medical economy. The outline of that scheme shall be the subject of my next communication. I have the honour to remain, gentlemen, Your obedient servant, Henry Lillet Smith. Southam, Dec. 4, 1836. P.S. There is a letter in the Lancet, to your Association, signed H. S. : be pleased to observe, I am not the author. The following letter is from a gentleman, who is personally unknown to me, and of whom I made some inquiries, which will be perfectly understood by the answers. Dear Sir,— I have much pleasure in re¬ plying to your letter respecting our medi¬ cal institution, and have given it my best attention, in hopes of being able to answer your several queries satisfactorily : at the same time allow me to say, it was based upon the principles you have so fully laid down. With respect to your first query, I really think that not more than one in ten of the free members have been accustomed to seek medical advice on their own respon¬ sibility ; and of that number, perhaps one- fourth made no payment whatever; the others after an indefinite period of from six months to four or five years. That the sale of quack medicines is less¬ ened, I have not the least doubt, since the establishment of our institution ; but this must, of course, depend in a great measure on the attention which the medical men are disposed to pay to such complaints as those medicines are generally sought for. The opportunity the members have, also, of changing their medical attendant after a given time, should they not experience the relief which they had anticipated, wrill, I think, do much to lessen that evil. An institution of this description neces¬ sarily brings medical men into each others’ society, to suggest ideas for the good of all, as wrell as for the well-working of the institution itself. This naturally tends to engender a better feeling; and I am con¬ vinced that the little jealousies which arise, and which are perhaps increased to ill will, more frequently takes place from a want of knowing each other than from any other cause; and I have no hesitation in saying, that a much better feeling does exist in this town among the medical men than before the formation of the insti¬ tution. I have just seen the rate of payments proposed to be adopted by the institution at Stratford. I very much fear they are too high, particularly for an agricultural district. I think they should not be much, if anything, higher than ours are, other¬ wise many of the most deserving of the labourers will not be able to avail them¬ selves of it, particularly those with large families ; but if the payments are kept to our limits, the numbers wrill make up for the smallness of the sum. I am sure ours would never have reached half the number it does at present, with such a scale. That medical men, in general, will not expect that an institution of this kind is to re¬ munerate in the manner they ought to be remunerated, I am wrell convinced ; but it will do more than they will be at first dis¬ posed to admit; and w'here is the man in practice who is not alwrays wrorking with¬ out even the shadow of remuneration. This should not be forgotten, nor the plea¬ sure of doing so much good on such a sure foundation, independent of what ought to be our first motive — that of having the approbation of the Supreme Being for such good intentions. It is also desirable to keep within a certain distance of the town, if possible five miles, otherwise the labour is too great, particularly if the ge¬ neral confidence is not very equally ba¬ lanced between the parties. Should you think these observations can be of any service, you are at perfect liberty to make use of them in any way you may think best. Allow me to subscribe myself, Yours, &c. &c. Thomas Taylor. Oncblade, Aug. 30, 1836. REMARKS ON THE PRESENT STATE OF THE IRISH MEDICAL CHARITIES; particularly in the southern PROVINCES. To the Editor of the Medical Gazette. Sir, In my former letter I presented to the readers of your excellent journal an ac¬ count of the position which the profes¬ sional men who preside over our medical charities occupy, with respect to the appli¬ cants for relief. I dealt (but mercifully) with their varied pursuits, and gave a brief sketch of the insufficiency and inefficacy of that professional assistance which the poor must avail themselves of, and at so considerable an expense. Well and truly might I exclaim (to which exclama- PRESENT STATE OF THE IRISH MEDICAL CHARITIES. 473 tion I am confident every rational and thinking member of society will respond), “ Charity, O charity ! many, gross, and glaring, are the abuses which exist, and publicly injurious are the delinquencies which are perpetrated, under thy hallowed name !” Paradoxical as it may appear, I could, without fear of contradiction, de¬ clare the Irish Dispensaries, under existing regulations, a disgrace to any civilized community, and a convincing proof that, by artful and designing persons, who have the unblushing hardihood to advance cha¬ rity as their watchword, the design of those institutions may be so metamor¬ phosed as to become a burlesque on com¬ mon sense. However, it would not dis¬ play much profundity of wisdom to soli¬ loquize over the degraded state of esta¬ blishments which never enjoyed an exalt¬ ed position, or to regret the mean and lowly estimate of professional character of gentlemen who appear so perfectly in¬ different about their reputation : would it not be more philosophical to endeavour if possible to effect the rescue of the Irish medical charities from their original and present chaotic state, and remodel the mode of getting up such institutions, by establishing a system that would abolish many abuses in their very formation, and disarm them of those powrers which in their subsequent vicious government are pregnant with so great a mass of misery? Much of the manoeuvring and finesse practised in the getting up of dispensaries, is already known to your numerous read¬ ers ; even so, I cannot permit this oppor¬ tunity to pass without recording as an exemplification a case from real life. A son, a son-in-law, or a brother, after a pre¬ paratory medical education, incapable of securing an independence by an honoura¬ ble competition with his professional brethren, beneath the scrutiny of a dis¬ cerning public, becomes an incumbrance, each individual to his respective family; the aggrieved party, smarting under so great an annoyance, or the aggrieving feeling his situation rather irksome, mutu¬ ally coalesce in endeavouring to secure some provision which will place the de¬ pendant beyond the reach of public patron¬ age; the necessity for a local Dispensary in some district is immediately suggested ■ — a necessity which never had an existence but in the inventive imaginations of the parties reciprocally anxious to get rid of what each conceives an evil, the interests of the poor being set forth as a mere sub¬ terfuge to justify so outrageous, so bare¬ faced, a proceeding before a few gentlemen, who never deign to cast away a thought on the subject, being already fully con¬ vinced from repeated examples, that bene¬ volent intentions towards the afflicted form the least item in the proceeding, being viewed as a matter of no considera¬ tion whatever, when brought in competi¬ tion with the interests of the medical practitioner. If direct interest cannot be commanded, which is seldom the case, it is solicited indirectly ; in either instance, the support and patronage of a few influ¬ ential persons (be they of high or low degree) in the locality are procured : under this sanction, a business previously decided on is easily arranged, a few subscribers enrolled, many of them nominally, and just enough to vindicate their soliciting a presentment from the grand jury. Having so far prosperously progressed, the day for the nomination and appointment of a medical attendant to the charity is adver¬ tised ; a something farcical, in common parlance called an election, is gone through, and the zealous candidate for dispensary honours is, in accordance with precon¬ certed measures, duly elected. Should an anxious desire to anticipate the pos¬ session of the proffered prize induce a meritorious candidate to endeavour to divide the interest, and advance his claim to the eleemosynary sinecure established by a party ; under such circumstances, to provide against the event of success being doubtful, a ruse is practised; a number of frieze-coated electors, levied for the occa¬ sion, are brought to the poll, previously supplied with a guinea each by the friends of the opponent ; furnished with money, and armed with their shillelahs — the usual emblems of their prowess — they are quite indifferent as to whether they are to annihilate the pretensions or the existence of the rival aspirant ; and if a choice were afforded, my unbiassed opinion is, the pre¬ dilection for the latter would decidedly predominate. After so meritorious and successful a manoeuvre, a separation of the frieze-clad reserve could not take place without the celebration with more than ordinary hilarity of so great an achieve¬ ment, and a scene that at this stage of the proceeding ended in violation of their taste and ideas, without a general ren¬ contre, could not be allowed to pass away without an adjournment to some neigh¬ bouring pot-house, where they regale them¬ selves with a long and deep drink to his honour or his reverence (being both used as synonymous appellatives) to commemo¬ rate the important triumph ; and before the spirit should evaporate they consider the present a most convenient opportunity to arrange some ancient and hereditary disputes between the members of rival clans, when after numerous hostile demon¬ strations and consequent parlies, a general action eventually ensues, ending as usual, 474 PRESENT STATE OF THE IRISH MEDICAL CHARITIES. in the extensive laceration of scalps, a wanton demolition of teeth, and after sun. dry other injuries are inflicted, a truce is agreed on, and they withdraw from the field of action; thus speedily affording a convenient opportunity for a practical display of the skill of the newly installed dispensary tyro; a demoralizing exhibition on the first establishing a medical charity, and an ominous introduction to so impor¬ tant a functionary. Many memorable instances of the success of this manoeuvre have occurred: on a late occasion, when a dispensary was being established for the especial provision of a young friend, another candidate started, was verv un- successful in his canvas, a sweeping ma¬ jority being against him : the case was an extreme one in the most literal acceptation ; a friend stepped forward, supplied the necessary funds, and a number of electors created for the occasion, who never sub¬ scribed afterwards, presented themselves unexpectedly, and voted in the opposition candidate, much to the annoyance and discomfiture of the gentleman for whose accommodation the medical charity was being founded. Such subscriptions cease after the first year. Many of the sub¬ scribers, disgusted with the operations of the charity, withdraw; some continue, fancying it the cheaper way to have their domestics, horses, and dogs, physicked : others, through a more charitable motive, labouring under the delusion of rendering through the institution some relief and comfort to invalided paupers, but negligent unconcernedness being the estate of all, the professional gourmand is allowed to devour both subscriptions and grand jury grant, giving the hapless poor out of the capture, under the semblance of doing something, a little treacle or vinegar, a solution of Glauber salt, or some rancid castor oil ; it being a matter of no con¬ sequence to the suffering community, if in addition he devoured those also as condiments to the mammon. However, these good things have had their day; abuses, gross abuses, may grow and flourish luxuriantly for a season, until they savour too powerfully of the rankness of that soil in which they vegetate: establishments may be so metamorphosed into engines of destruction, that their very existence becomes a harlequinade on public decency. Could, I would ask, such a state of medical institutions or medical science be credited, were it not ad¬ vanced on indisputable authority? — could it be conceived that the lives of the appli¬ cants in extensive districts are trifled with by the administration of a little treacle as a universal panacea, and that large sums are advanced by subscribers, and from the county treasury, to support so outrageous a humbug and imposition > But the mor¬ tifying truth is too apparent, that such abuses at present exist. St. John Long was held up to public censure, prosecuted, and punished ; Morison’s disciples are undergoing similar odium, are criminally sued, and forced to suffer penal retribu¬ tion, each and all most deservedly; and in some corner of neglected Ireland, with her many advantages — as it were, under the rose — we daily witness treatment less founded in reason, and much more pre¬ posterous, than that practised by those re¬ doubted charlatans — treatment pursued by gentlemen who are in some measure pro¬ vided for by the law of the land, and who are bold enough to declare, that the whole of medical and surgical literature may be comprised in a volume equal in size to a diamond edition of Lord Byron’s Childe Harold. Prospects in the dim vista are at last commencing to brighten, if we are justi¬ fied in indulging so pleasing an anticipa¬ tion from a ray of reform which has just beamed upon us in the shape of a clause in a late legislative enactment; at least the spirit which it has evinced clearly proves that the Irish medical charities are not altogether overlooked or forgotten, but that some of their malpractices are known in higher quarters, and duly esti¬ mated. It is not to be expected that the readers of your able journal can be ac¬ quainted with acts of Parliament directed to advance the interests of Ireland. I take the liberty, then, of directing their atten¬ tion to the Irish Grand Jury Act, which was passed into a law during the last ses¬ sion, and which, in its 81st clause, pro¬ vides, “ That no presentment can be made for any dispensary, in case it shall appear that the salary of the medical attendant during the last year amounted to one-half of the sum which the subscriptions, dona¬ tions, and the sums presented for, would amount to.” If every measure that is in¬ troduced savouring of novelty, and .every innovation on accustomed usages, how¬ ever salutary, will meet with opposition as a necessary consequence, how much more strenuous must the resistance be, when the pockets of those defaulters against whom this shaft is aimed are trespassed on. As might be expected, this very wholesome measure, on its introduction to this country, created a great sensation amongst the physicians and surgeons of dispensaries. The legislators and the go¬ vernment were denounced, and appear¬ ances are wearing a formidable aspect. Trifling incidents have often given rise to serious results, which the British govern¬ ment, from dearly-purchased experience, PRESENT STATE OF THE IRISH MEDICAL CHARITIES. 475 must be fully convinced of ; and the abet¬ tors of disorder have laid it down as an established rule, to raise an outcry against every enactment that interferes with their views. The grievance, as they have been pleased to call it, has been long and warmly dwelt on. The tocsin of alarm was immediately sounded, by a body whom I fear I must bring under observation, as being the originators of the hue and cry, however willing to permit them to repose in their accustomed obscurity. A medical club, under the specious appel¬ lation of the Western Medical Society, was brought into existence, — I cannot be par¬ ticular as to the exact day, not being at its accouchment; and as an application to its venerable sire might awaken unhap¬ py reminiscences, as the offspring is occa¬ sionally looked on rather unworthily by the parent, more especially when expecta¬ tions are grievously disappointed, and no credit whatever can attach itself to the progeny ; and as an application to its god¬ father, the jovial secretary, to learn the exact day of the month, or week, or hour, might be attended with tedious delay, as he may not be very communicative under existing circumstances, and would view the inquiry with suspicion, — it is suffi¬ cient for my present purpose that such a club has been established these seven years lor the purpose of indulging in and enjoy¬ ing the festivities of the season, and ban¬ queting together on appointed days. But a most unprecedented and unaccountable transmigration has taken place ; it has actually bounced from its infancy to its dotage, without going through the usual developmental processes or gradations in¬ cident to life, or even deigning to pass through the climacterics between these two extremes of animal existence. Extraor¬ dinary as it may appear, I can positively vouch for the authenticity of the fact, leaving the explanation of this (to me) un¬ paralleled violation of the laws of nature, to the sagacity of some more profound physiologist. I can only throw out, as mere speculative suggestions, the effects the late dampness of our climate is said to produce on the constitutions of many, and the influence the planetary system is said to exercise over sublunary mortals, however loaded with hoary honours. And in this unenvied state of premature decay and mental imbecility have those anti- Apollonists set up Bacchus as their tute¬ lary deity; and during one of their sa¬ crificial orgies to this" divinity, drivelled forth a requisition, announcing the neces¬ sity for convening a public meeting, in ac¬ cordance with a requisition published in the daily papers. A number of the medi¬ cal attendants of dispensaries, alive to their own pecuniary interests, assembled, each individual vieing with his brother practitioner in ardent desire to inflict sum¬ mary vengeance on the presumptuous in¬ truders on their vested rights. After the usual preliminaries were gone through, an endeavour was made to depict the extremity of their distress; but their spouting was of that order that the re¬ porter, through compassionate feeling for the members of a learned profession, from whom something chaste, if not very elo¬ quent, should be expected, refrained from publishing their ridiculous rhodomontades. Four resolutions were proposed, and for¬ mally seconded. The first expressive of the injustice of the concluding proviso of the 8 1st clause of the New Grand Jury Bill for Ireland, which proviso I have be¬ fore alluded to. The second embodies the vague and defective state of the laws hi¬ therto passed for the regulation of the me¬ dical charities in Ireland; that the claims of the objects of charity have not been sufficiently protected ; and that the adop¬ tion of such measures as may tend to the establishment of a system more adequate to the alleviation of the wants and mi¬ series of the destitute poor, is most impe¬ ratively called for. The third maintains that a fair and competent remuneration is a simple, just, and natural right, and as such it is claimed in common with the other liberal professions in this country. The fourth demands the attention of the profession at large, in the strongest man¬ ner possible, to the absolute necessity of union, firmness, and active co-operation. The term injustice, in the first resolution, flows with an unbecoming grace from the lips of gentlemen, for a history of whose injustice in the discharge of the most momentous duties, I have only to refer to the reports of the assistant medical com¬ missioners, and delinquency actually cou¬ pled with injustice; when we call to mind that the performance of those duties was left to their honour, and the dictates of their consciences, commodities so ex¬ ceedingly elastic on this occasion, as in some other cases, that the}' can be stretched with the most placid composure and self- satisfaction, to any desired extent. As to the second resolution, fortunate would it have been for the public at large, and more especially for the distressed appli¬ cants at the Irish Medical Charities, had laws long since existed sufficiently strict to have enforced the observance of obliga¬ tions which were never sincerely entered - upon, and have been so grossly violated in most instances ; laws which would have rendered imperative the protection of the objects of charity, whose interests from the first foundation of these institutions, have been considered of a mere secondary nature. It is sufficiently evident that no 476 PHE ENT STATE OF THE IRISH MEDICAL CHARITIES. system, however valuable, can tend to the alleviation of the wants and miseries of the poor, whose direction and chief go¬ vernment are left to the option and caprice of persons who view their dispensary duties as a mere formal routine to save appearances, and as drawbacks on their ordinary amusements. The third resolu¬ tion clearly evinces the spirit and feelings which dictated the whole procedure, a dread, in fact, of the privation of emolu¬ ments which they are enjoying at the ex¬ pense of the destitute and afflicted, with¬ out discharging a single obligation, and displays the resistance to any measure, however salutary, which will be offered, should it interfere with their depositing the whole proceeds of the institution in their own exchequer. In the fourth we have an appeal to the feelings of the pro¬ fession ; an endeavour to enlist in their cause, union, firmness, and active co-opera¬ tion ; these are expressions very familiarly used, and well understood in this country to mean firm, active, and co-operative combination — an evil, misguided spirit, which too freely opposes itself to all legal¬ ised measures, and has introduced some of its most devoted partizans to very exalted, but not very honourable, elevations. A committee was formed of dispensary super¬ intendents, and from this troubled estuary will flow the muddy inundations which threaten to deluge {he Lords and Com¬ mons. On the whole, we have in this de¬ lightful morceau from the physicians and surgeons of dispensaries, an acknowledg¬ ment of error, imperfection, want of legal measures to enforce obedience, and avari¬ cious acquisitiveness, which could not pro¬ ceed from the united wisdom of any similar meeting in the universe. A letter was read from Lord Morpeth, in reply to some communication stating that the clause was introduced at the instance of Irish mem¬ bers of all parties. But, as if consistency was doomed never to be a virtue inherent in the bosom of an Irish senator, dis¬ claimers to this accusation were sent by three absent members of parliament, who threw the whole onus on the House of Lords. One member condescended to at¬ tend the meeting, who, in the enjoyment of his ambitious elevation, was complaisant enough to plume himself on belonging to the medical profession, and promised, as a pacificator, to introduce a bill immediately on the meeting of parliament, to get this clause repealed, to which they (indulging in a witticism) have applied the soubriquet “ obnoxious.” To be inducted a member of parliament in this distracted country, the political adventurer, in order to lay claim to public patronage and indivi¬ dual suffrage, has only to embark as a public brawler, make speeches about com¬ munity of rights, agrarian division, and the propriety of an equal distribution of property, proving that as we are all born alike, no one had a right to have more property than his neighbour. Such being his laxity of principle, it is only equalled by his inattention to the duties imposed on him, and his faithlessness to the inte¬ rests of his constituents. That such a member can have the effrontery to demand the abolition of a clause likely to introduce a salutary improvement, I feel satisfied, and even advocate the welfare and utility of the Irish medical charities under their present professional and fiscal arrange¬ ments, in the face of the adverse reports published by the assistant medical com¬ missioners. It can scarcely appear credi¬ ble that any government will, after enact¬ ing a measure, and with sufficient reason, render itself a puppet in the hands, and repeal their edict at the suggestion of, a partial body, without affording time to witness its operation. Nothing could, in my opinion, tend more powerfully to esta¬ blish against themselves the charge of hasty legislation, incapacity, and incon¬ sistency. What reasonable allegation can they advance in justification of the de¬ mand? From all the information which has been acquired at so great a labour and expense, and from written documents, it appears irrevocably established, that the Irish dispensaries do not, neither are they calculated, to advance scientific research. They are of no public utility ; they are not meritorious appendages to any official functionaries; and as at present consti¬ tuted, can in justice claim nothing from the government but a most sweeping and intrinsic reform : in reality, every party anxious to disown a collusion with abuses, must feel desirous to have such incum¬ brances erased. Even in the department of forensic medicine they seem totally in¬ operative. It has been my desire to avoid en¬ croaching unnecessarily on the pages of your very valuable journal. I shall, as briefly as possible, communicate a case, selected from numerous instances, to sup¬ port the position of their inutility in the province of forensic medicine, which I have just advanced. A person received some injuries from the brutal usage of another individual, for the alleviation of which, after the customary preliminary visit of the medical superintendant of the charity to the applicant’s house, he was admitted as an intern hospital patient, and treated according to the routine of the establishment. The matter afterwards became the subject of legal proceedings, and on the trial the surgeon of the hos¬ pital was called to give evidence as to the nature of the inj uries, the effects that re- 477 DISTURBANCE AT ST. THOMASES HOSPITAL, suited from them, with other information likely to throw light on the case : the nature of the injuries could not be elicited, nor could the results be ascertained from his examination : all appeared wrapped in the most profound mystery : he prevari¬ cated, and the assistant barrister who pre¬ sided, animadverted sharply and indig¬ nantly on the professional evidence, and expressed considerable surprise at its utter inability to assist in forwarding the inves¬ tigation of what to all appeared a very plain and simple case. Some other strange medical features which presented them¬ selves during the examination, induced an inquiry into the treatment adopted, when after the detail of some exceedingly frivolous measures, it appeared the remedy on which chief reliance was placed, and that remedy considered of most vital im¬ portance, was the suspension of a blistering plaster at the head of the patient’s bed, as a scare-devil to frighten away disease which could not be comprehended. The w'hole scene drew forth the censure of court and jury ; so shameful an exposure of practice, which never had a precedent, powerfully impressed the hearers with a painful conviction that the practice of medical men was a tissue of perfect hum¬ bug ; and thus was odium drawn not only on the gentleman who flourished so despicably before a court and jury, but on the profession at large. We have heard of charms and amulets, spells or incantations, in short, of every description of humbug and quackery, likely to please the fancies, and operate on the credulity of the public, but this treatment in an hospital in the nineteenth century, with ample funds to advance its interests in every department, surpasses all. ' Hibernus. Nov. 14, 1836. DISTURBANCE AT ST. THOMAS’S HOSPITAL. MEETING OF GUY’S STUDENTS. (From a Correspondent*.') On Monday evening last a meeting of the students of Guy’s Hospital was held, at the Three Tuus Tavern, Borough, for the purpose of taking into consideration the circumstances connected with the distur¬ bance that took place at the operating theatre of St. Thomas’s Hospital, on Fri¬ day the 16th, and of adopting such mea¬ sures as should seem necessary to vindicate themselves and friends from the charges * We have taken leave to condense considera¬ bly the report of our correspondent. — Ed. Gaz. brought against their conduct on that oc¬ casion. About 150 students were present. Mr. Blackburn was called to the chair. The Chairman explained the object of the meeting, and urged the importance of proceeding steadily, and with good tem¬ per, to business. He recommended, also, that time should not be lost; and in order to set an example of needful dispatch, called on Mr. Tweedie to bring forward the first resolution. Mr. Tweedie complained in severe terms of the conduct of the door-keepers and others at St. Thomas’s. On Friday last two operations for lithotomy were to have been performed at that hospital, and a large concourse of students were collect¬ ing to witness them. Several gentlemen from Guy’s, in accordance with their usual custom, presented themselves for admis¬ sion : and having upon former occasions sustained inconvenience from the incivility of the porters, took care to be provided with their cards of admission. Two of the dressers from Guy’s were proceeding to their proper seats, having shewn their tickets, when they were rudely assaulted by two menials stationed within the the¬ atre. This sort of treatment being resisted, a disturbance took place. The students at the outer door, imagining that personal violence was being inflicted on their friends within, burst open the door, and rushed to their rescue. Such was the ground for an unjust charge of assault which had been brought against the twro gentlemen already mentioned ; and a third, who was not in the hospital at the time, was summoned for breaking dowrn the door. No difficulty, how’ever, would be found in rebutting the charge, and demonstrating that the whole disturbance originated in the conduct of those who had now the audacity to add false accusations to their gross violence. Mr. Tweedie concluded by moving — “ That the students of Guy’s Hospital having understood that certain charges, arising out of the recent disturbance in the operating theatre of St. Thomas’s Hospital, are brought against Messrs. Mosgrove, Lingwood, and Carrington, three of their fellow students, and be¬ lieving these charges to be without foun¬ dation, resolve to combine for the purpose of investigating the evidence and laying it before a proper tribunal.” Seconded by Mr. Tamplin, and carried unanimously. Mr. Gaselee, in submitting to the meet¬ ing the next resolution, considered this as a question not affecting one or two pu¬ pils, but the school at large; upon which a stigma of misconduct had been levelled by some of the officers of St. Thomas’s Hospital ; for from the moment that the pupils of St. Thomas’s had been desired, 478 LIST OF MLDIC1SES, THE NAMES OF WHICH ARE by Mr. South, to separate themselves from the pupils of Guy’s, it was clear that the imputation was cast upon the whole, and the odium of misbehaviour (if any) was attempted to be removed from the shoul¬ ders of the few to be affixed to the body of the school at large. He could not help expressing his surprise also at the uncere¬ monious rejection which one of the ac¬ cused gentlemen experienced, when he afterwards went oyer to the steward of St. Thomas’s, with an anxious desire to afford such explanation on his part as should effect an amicable and satisfactory adjustment of what had occurred. He would add, that no three gentlemen could probably have been selected from the school of Guy’s Hospital, upon whom the imputation intended to be conveyed could have been framed with greater primd facie evidence of its untruth ; for they were each distinguished in the school for his general propriety and demeanour. Mr. Gaselee concluded by proposing the following resolution, which was also car¬ ried unanimously : — “ That, for the purpose mentioned in the first resolution, a Committee, consist¬ ing of Messrs. King, Tweedie, and Black¬ burn, be appointed, to collect the evidence and prepare the defence; and that all those who can furnish any information be urgently requested to place themselves immediately in connexion writh this Com¬ mittee.’’ The meeting then resolved itself into a Committee, at the chairman’s suggestion. Those wdio had evidence to offer were to remain in the room, the rest retiring in good order and harmony; and the Com¬ mittee, aided by their Solicitor (Mr. Peile), wrere engaged up to a late hour in examining the evidence. PROTEST OF THE ST. THOMAS’S STUDENTS. To the Editor of the Medical Gazette. Sir, The particulars of a disturbance which occurred in the operating theatre of St. Thomas’s Hospital, on Friday last, have been circulated in the daily papers. The surgical pupils of that institution have expressed to their medical teachers their indignation at the gross misconduct exhibited to strangers then present. We are nowr desirous, through the me¬ dium of your journal, to give publicity to that declaration of our feelings, and con¬ vey to you, thus briefly, the expression of our abhorrence of such proceedings, and our conviction that they are alike discredi¬ table to the character of the individuals concerned, and derogatory to that of a liberal profession. — We are, sir, Your obedient servants. [Between fifty and sixty signatures.] PROCEEDINGS AT UNION HALL. On Wednesday, the circumstances of the disturbance w’ere brought under the cognizance of the magistrates of Union Hall Police-Office, when, charge and counter charge being heard, the affair ter¬ minated for the present by the three students of Guy’s, Messrs. Lingwood, Carrington, and Mosgrove, being held to bail to answer a prosecution by indict¬ ment at the ensuing Quarter Sessions. Mr. Jeremy considered some points in¬ volved in the case to be of too intricate a nature to allow him to dispose of the mat¬ ter summarily. LIST OF MEDICINES, THE NAMES OF WHICH ARE CHANGED IN THE NEW PHARMACOPCE'A. NOMINA PRIORA. NOMINA NOVA. Aeidum aceticum dilution. - muriatieum. Ammonias murias. • - subcarbonas. Antimonii sulphureturo. • — - sulphuretum praecipitatum. Antimoniumtartarizatum. Arsenicum album. Bismuthi subnitras. Calcis murias. Ceratum simplex. Confectio amygdalarum. Confectio aurantiorum. - - scammoneae. Cuprum ammoniatum. Aceturn destillatum. Aeidum hydrochloricum. Ammonise hydrochloras. - sesquicarbonas. Antimonii sesquisulphuretun'. — - oxysulphureturn. • - potassio-tartras. Aeidum arseniosum. Bismuthi trisnitras. Calcii chloridum. Ceratum. Confectio amygdalae. Confectio aurantii. - scammonii. Cupri ammonio-sulphas. CHANGED IN THE NEW PHARMACOPOEIA. 471) NOMINA PRIORA. Decoctum cinchona?. - lichenis. - - sarsaparilla?. — - sarsaparilla? compositum. Emplastrum pieis compositum. Extractum cinchona?. - opii. Ferri subcarbonas. Ferrum ammoniatum. - - tartarizatum. Hydrargyri oxydum cinereum. • - oxydum rubrum. — — - oxymurias. - submurias. - sulphuretum nigrum. - sulphuretum rubrum. - - praecipitatum album. Infusum caryophyllorum. Linimentum ammonia? fortius. - - ammonia? subcarbonatis - hydrargyri. - - saponis compositum. Liquor ammonia? subcarbonatis. - arsenicalis. - calcis muriatis. ■ - cupri ammoniati. - hydrargyri oxymuriatis. • - plumbi subacetatis. - potass® subcarbonatis. Magnesia? subcarbonas. Mistura amygdalarum. Mucilago acacia?. - amyli. Oleum pulegii. • - terebinthina? rectificatum. Oxymel simplex. Pilul® hydrargyri submuriatis composit®. ■ - saponis cum opio. Plumbi oxydum semivitreum. - subcarbonas. Potassa fusa. Potass® carbonas. - subcarbonas. • - supertartras. - sulphuretum. Pul vis antimonialis. Sod® carbonas. - murias. — — subboras. - subcarbonas. Soda tartarizata. Spiritus camphor®. - - - lavandul® compositus. - pulegii. Syrupus aurantiorum. - - sarsaparill®. - - simplex. Tinctura ferri ammoniati. • - ferri muriatis. ■ - Rhei composita. - - senn® composita. Vinum antimonii tartarizati. Unguentum elemi compositum. • - hydrargyri pr®eipitati albi. NOMINA NOVA. Decoctum cinchon® cordifoli®. ■ - cetrari®. • - sarz®. - sarz® compositum. Emplastrum picis. Extractum cinchon® cordifoli®. - opii purification. Ferri sesquioxydum. - ammonio-chloridum. - potassio-tartras. Hydrargyri oxydum. - - binoxydum. - bichloridum. - chloridum. • - sulphuretum cum sulphure. - bisulphuretum. - ammonio chloridum. Infusum caryophylli. Linimentum ammoni®. • - ammoni® sesquicarbonatis. - hydrargyri compositum. - saponis. Liquor ammoni® sesquicarbonatis. - potass® arsenitis. - calcii chloridi. - cupri ammonio-sulphatis. - hydrargyri bichloridi. - plumbi diacetatis. - potass® carbonatis. Magnesi® carbonas. BJistura amygdal®. - acaci®. Decoctum amyli. Oleum menth® pulegii. ■ - terebinthin® purificatum. Oxymel. Pilul® hydrargyri chloridi composit®. - saponis composit®. Plumbi oxydum. - carbonas. Potass® hydras. — . — bicarbonas. — - carbonas. - bitartras. Potassii sulphuretum. Pulvis antimonii compositus. Sod® sesquicarbonas. Sodii chloridum. Sod® biboras. - carbonas. - potassio-tartras. Tinctura camphor®. - - lavandul® composita. Spiritus menth® pulegii. Syrupus aurantii. - sarz®. Syrupus. Tinctura ferri ammonio-ehloridi. • - ferri sesquiehloridi. — - rhei. - - senn®. \rinum antimonii potassio tartratis. Unguentum elemi. - - hydrargyri ammonio-ehloridi. 480 BILLS OF MORTALITY. - METEOROLOGICAL JOURNAL OUTRAGE AT APOTHECARIES’ HALL. We regret very much to state, that an outrage of the most violent and disgrace- ful nature took place on Thursday even¬ ing, at Apothecaries’ Hall. A gentleman had been examined; and having answered the questions put to him in a manner which induced the Court to decline giving him a license, he took from his pocket one of those instruments loaded with lead which are called “ life-preservers,” and attacked those present in the most violent manner. Mr. Hardy was knocked down and dangerously wounded, by a blow on the head; Mr. Este and Mr. Merriman severely wounded on the face and temple. Mr. Taggart also received a slight blow on the head. The assailant was then mas¬ tered, and given in charge to the police. He was yesterday examined, and com¬ mitted to stand his trial. It does not ap¬ pear that either insanity or intoxication can be pleaded in excuse of this most out¬ rageous proceeding. There were above twenty students wait¬ ing to be examined : they conducted them¬ selves in the most becoming manner, and the examinations were postponed till last night. A writer, only in our last number, asked for the fruits of the “ Crown and Anchor Meeting” of last season : let him behold a specimen of the consequences of that and the other systematic attempts of our con- temporary to incense the students against the Worshipful Society. INJURIOUS EFFECTS OF “ WAK LEY’S ACT.” To the Editor of the Medical Gazette. Sir, I beg leave to send you the following case, as another illustration of the defective working of the act lately passed for the remuneration of medical men called to at¬ tend at coroners’ inquests. On Tuesday morning last, at about two o’clock a.m., a man was found apparently dead on a wharf near the City Road. I was called to attend between four and five o’clock, and on my arrival ascertained that life was extinct. No opinion could be formed as to the cause of death ; but he was known to have been intoxicated on the previous night. The body was re¬ moved to the Islington Workhouse, where a post-mortem examination was performed, and it appeared that the man had died of apoplexy, without rupture as it appeared of any considerable vessel, and probably induced by excessive drinking, as the sto¬ mach contained a quantity of gin. I, of course, expected to be summoned to the inquest; but it took place without any medical evidence being required, and the jury brought in a verdict of — “ Died of excessive drinking,” on the evidence of two or three bargemen. The objection to the production of me¬ dical evidence was founded on the neces¬ sity of paying the medical witness, accord¬ ing to the provisions of the new act. Now I need not argue for one moment on the necessity of medical evidence in cases of suspicious death; and can only declare that I am ready, gratuitously, at all times, to investigate such cases for the further¬ ance of the ends of justice, science, and humanity, and heartily desire to see a speedy repeal of an act which, though good in itself, thus enables the coroner to defeat these admirable purposes. I remain, sir, Your constant reader, Robert H. Semple. Islington, Dec. 22, 1836. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Dec. 20, 1S36. Abscess . . 5 Age and Debility . 30 Apoplexy . . 1 Asthma . . 10 Childbirth . . 3 Consumption . 42 Convulsions . 19 Croup . . . 1 Dentition orTeething 5 Dropsy . . 18 Dropsy in the Brain 7 Dysentery . , 1 Epilepsy . . 1 Fever ... 6 Fever, Scarlet „ 6 Gout ... 2 Hernia . . . 1 Hooping Cough . 6 Inflammation . 24 Bowels& Stomach Brain . . Lungs and Pleura Insanity . Liver, diseased Measles . Mortification Paralysis . Rheumatism Small-pox . Sore Throat at Quinsey . Stricture . Thrush Tumor Unknown Causes 1 2 5 1 2 3 2 5 O sJ 4 1 I 1 1 17 Casualties METEOROLOGICAL JOURNAL. Dec. 1836. Thursday . 15 Friday . . 16 Saturday . 17 Sunday . . 18 Monday. . 19 Tuesday . . 20 Wednesday 21 Thk rm o meter. from 32 to 40 29 43 28 47 41 52 41 50 38 45 34 45 Baromf.ter. 29-80 to 29-75 2959 29-94 29 99 29-98 29- 98 30 05 30- 06 30 04 30-09 30-17 30-15 30-19 Prevailing winds, S.W. Generally cloudy, except the 15th and 16th; with rain at times. Rain fallen, -2125 of an inch. Charles Henry Adams. Erratum. — In Mr. Lonsdale’s paper, last week, page 405, second column, near the middle, for “ external recti,” read “in¬ ternal recti.” Wilson & Son, Printers, 57, Skinner-St. London* THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JO'TOIMAL OF itttirintte an tr tfte Collateral SATURDAY, DECEMBER 31, 1836. LE CTURE S ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine, By William Cummin, M.D. Lecture XIV. Signs of Pregnancy further considered— Com¬ plications of Pregnancy — Dropsy — Ovarian tumors — Moles and hydatids — Extra uterine Pregnancy — Cases of fallopian and inter¬ stitial pregnancy — Postmortem signs of preg¬ nancy and conception — Corpora lutea — Medico-legal questions — Grounds on which the gravidstate may be negatived — Pregnancy without consciousness, how far admissible — Prussian law — Responsibility of women in the pregnant state. In my last lecture, I gave a summary ac¬ count of the signs of uterine pregnancy, and confined myself chiefly to a notice of those which seemed more or less worthy of confidence, and most likely to serve the pur¬ pose of the medical jurist. It may be useful to recapitulate those signs : not, however, in the order in which they have already been stated, but in one suggested by a view to the requisites of practice; for it should be kept in mind, that a prin¬ cipal point expected to be determined by the medico-legal referee, is not only whe¬ ther pregnancy exists, but how long it may have existed. What, then, are the signs which may be observed during the suc¬ cessive stages of utero-gestation ? Fiist three months. — To say that we can have even equivocal signs of pregnancy in i the living female, during the first two or I three months, were almost too strong an i assertion in forensic medicine. It is possi- I ble, indeed, that, in midwifery practice, an 474. — xix. accoucheur may assure himself, partly rely¬ ing on thestatementof his patient, andpart- ly on certain doubtful appearances which acquire some value in connexion with colla¬ teral testimony, that there is reason to be¬ lieve a woman pregnant, within the first few months after avowed intercourse ; but no such ground of belief can be assumed by the medical jurist : he can only rely on ocular, tangible, or audible signs; and of these, perhaps, there is only one that can be available at so early a period ; I allude to the marked appearance of the areola — that is, when it is marked. The sign is by no means invariably met with in pregnancy; but when it does present itself, it affords a high degree of probable evidence. Towards the end of the second month, the turgescence of the nipple, and the development of the little glandu¬ lar follicles, are principally to be observed, although the characteristic change of colour is not yet very distinct. “ The colour, at this period,” says Dr. Mont¬ gomery, “ is in general little more than a deeper shade of rose or flesh colour, slightly tinged with a yellowish or brownish hue.” The examination of the breasts, even at this early period, may exhibit more signs than might immediately be expected. The gentleman just quoted relates the case of a girl who had incurred the risk of preg¬ nancy, but contrived to lull suspicion, for a time, by staining her linen at the usual menstrual periods. Dr. Montgomery vi¬ sited her during the third month, and found the areolm so distinct, and exhibit¬ ing their proper characters so perfectly, that he was persuaded of her pregnancy. But perceiving, moreover, that the breasts were marked with those silvery lines ob¬ servable on parts previously much dis¬ tended, he told her his opinion, that she was then with child, and, further, that she had certainly been so before. She was so completely taken by surprise that she confessed the fact, and added that she had suffered much from distonsion of the 2 1 482 DR. CUMMIN ON FORENSIC MEDICINE. breasts, during the pregnant state, two years previously. Fourth and fifth months. — There is a pos¬ sibility of the movement of the foetus be¬ ing perceived towards the end of the fourth month. But when we recollect how many circumstances may tend to deceive us, no great expectations can be entertained on that head. If the female has a motive to feign pregnancy, she can readily puzzle her examiner by spasmodic contractions or twitches of the muscles under his hand. This sign, in fact, can only be properly ob¬ served when the woman is perfectly qui¬ escent, or at least indifferent as to the re¬ sult of the inquiry ; and sueh is not a very likely case to occur in medico-legal prac¬ tice. The stethoscope may, about this time, distinguish the placental bruit , and, according to some observers, the pulsa¬ tions of the foetal heart also can be heard. If these latter indications are observable, and that satisfactorily, the point is settled. But, for reasons already stated, we must not be too sanguine in expecting, so soon, so high a degree of evidence. The areola by this time has undergone a further degree of development, rendering those characters just now described in every way more distinct. The dark- coloured disk or circle, having a diameter of above an inch, around the nipple, and varying in the intensity of its hue, accord¬ ing to the complexion of the party, has nearly attained perfection ; and the nipple itself, together with the integument im¬ mediately around its base, are pullulent with turgid glandular follicles. The mois¬ ture, too, of the parts is to be noticed. Sixth month. — As the duration of preg¬ nancy advances, the proofsaccumulate. The areola, if such sign have made its appearance at all, is by this time perfect. The en¬ largement of the abdomen, provided it be found symmetrical, with an alteration in the navel, becomes a sign presumptive to¬ wards the fifth or sixth month. The aus¬ cultatory method of observation may now be applied with more chance of success. By the sixth month, the double pulsations of the foetus will very probably be heard, provided the child be alive, and not in¬ opportunely located. The touch will now most likely indicate the change of form of the cervix uteri ; and the ballottement , or passive motion of the child, may be dis¬ tinctly felt. Possibly the active movement of the foetus may also be satisfactorily per¬ ceived by the application of the hand to the abdomen. Should we be fortunate enough to gather all these proofs, we may, without hesitation, pronounce positively for the pregnancy. But falling short of such an amount, or even though they be almost all absent, we had need to be guarded : we must still take care not to negative the possibility of the pregnant state. Last three months. — Unless there be some remarkable complications in the case, the proofs during the seventh, eighth, and ninth months, are comparatively easy. All those already mentioned, except the ballottement , ought to be more or less ascertainable. I shall illustrate these remarks by nar¬ rating to you some particulars of a French report, which I find in a recent medico¬ legal work. These official reports, by the way, which are prepared for the tribunals in France, are, many of them, as I have already observed, well calculated to in¬ struct. They show the order in which the several circumstances deemed most im¬ portant are usually observed in practice. The person examined in this instance wras a young widow, eighteen years of age. Her husband had been dead for two months, and it was said she was enceinte. The medical jurists, to whom the personal inspection was committed, made their external observations, of course, first, and they particularly noted the enlarge¬ ment of the breasts, and the appearance of milk in them; also, the enlargement of the abdomen, and the projection of the na¬ vel. They then proceed to sav, — “ Having requested Madame G. to stand up, leaning against a piece of furniture, with her legs a little apart, the forefinger of the right hand was introduced into the vagina, whilst the left pressed externally on the abdomen. We found that the uterus was much augmented in volume, and that it reached as high as the navel ; its neck was turned upwards and backwards; and the ballottement left no doubt of the presence of a moveable body in the womb. The ste¬ thoscope being applied in the space be¬ tween the umbilicus and the crural arch on the left side, enabled us to hear pulsa¬ tions double as quick as those which were perceptible in other parts of the abdomen. From these observations, we conclude that Madame G. is in the sixth month of preg¬ nancy, or thereabouts.” Other supposed signs. — In closing this ac¬ count of the signs of uterine pregnancy, I ought to mention that I have omitted a multitude of others, purely because they were not suited to the purposes of the medical jurist. The state of the pulse during pregnancy, though it has the prestige of antiquity about it, being as old, indeed, as the time of Galen, need not delay us: nor should I occupy your time very profitably with an account of the blood in pregnant females. A word or two, however, may be devoted to the subject of the wrine in pregnancy. Sa¬ vonarola, towards the latter part of the fifteenth century, described a certain cloudiness which he said he noticed in the COMPLICATIONS OF PREGNANCY. 483 urine of pregnant women; and Fodere thought the observation worthy of note, as he said he had verified its accuracy. But M. Nauche still more recently informs us, that if the urine of a pregnant wo¬ man be allowed to stand for thirty or forty hours, it deposits a white, flaky, pulverulent, grumous matter, which proves to be caseum, or the same kind of substance which is formed in the breasts during pregnancy. My able colleague, Mr. Pereira, has investigated the subject, so as in a great measure to set the question at rest. He has found “ caseum or coagulated al¬ bumen” in the urine of women far ad¬ vanced in pregnancy, but not invariably in that voided during the early months. He refers a-lso to Gmelin’s Handbuch, where it is mentioned, on the authority of Caballe, that caseum has been found in the urine of a healthy young widow ; and on the authority of Wurzer, that it has been detected in the urine of a man whose breasts were previously swollen. Complications of Pregnancy. I have said that there may be complica¬ tions of pregnancy, such as to interfere materially with our diagnosis. Some of these must be specially noticed. Death of the foetus. — The foetus may be dead: how may this operate in obscuring our indications ? In the first place, sup¬ pose the child to die in the second or third month, it is obvious that enlargement of the abdomen cannot be expected to be present. Nor can we, of course, appre¬ ciate several of those signs by which we should otherwise be enabled to say how far the pregnancy had advanced. It happens not unfrequently that the em¬ bryo dies, and yet is not expelled as an abor¬ tion, but retained till the ordinary time of deli very. There is an interesting case in Dr. Gooch’s book, which will at once serve to illustrate the difficulty, and to point out the conduct which it is most fitting to adopt under the circumstances. “ A lady, after the usual symptoms of pregnancy for four months, had a slow hemorrhage for many days. No ovum came away; the hemorrhage stopped; but though her abdomen was enlarged, from that time forth it did not continue to in¬ crease. In this state, and without men¬ struating, she continued five months longer, when, at the end of the ninth month from her first calculation, labour pains came on and expelled a shrivelled foetus, of the size of the third month. There can be little doubt that it had died before the haemorrhage. The fact that her labour occurred just at the end of the ninth month, is one of the best proofs that labour commences at that time, not from idistension of the uterus, but as a law of nature. It is curious that the same pro¬ cess took place in her next pregnancy : the foetus whs blighted about the same period, and yet was retained during the natural length of pregnancy. In such doubtful cases the most prudent plan is to avoid giving a decisive opinion, and, if pushed hard, to state the impossibility of doing so.” Suppose we have reason to believe the female pregnant, but have our doubts as to the life of the foetus, how may those doubts be removed ? The signs by which it is commonly judged that the foetus has died during gestation are those expe¬ rienced by the mother herself. She is said to have the sensation of a weight, or of a foreign body lying loosely in the ab¬ domen. When she rises from her chair, when she turns in bed, stoops, or in any way changes her posture, she feels the rolling about of this weight. These sensations, however, are of no great importance to the medical jurist, and scarcely so even to the obstetrician. A nervous sensitive mother is very apt to be mistaken. She feels great uneasiness, loss of appetite, has a bad tjaste in the mouth, is pale, and has a livid ring round the eyes; her breasts are flaccid, the cervix uteri is relaxed, foetid mucus tinged with blood is discharged from the vagina, and there is a distinct feeling of cold in the lower part of the vagina. Even these signs are extremely falla¬ cious, — the last particularly so ; it cannot but be the pure effect of fancy, for the putridity affecting the foetus should rather increase the heat above that of the sur¬ rounding parts. Is there, then, no sign on which the medical jurist can place reliance ? Fortu¬ nately the method of auscultation here comes to his aid, which enables him either to say distinctly that the child is alive, or, upon a comparison of observations, that there is a strong presumption that it is dead. Dr. Evory Kennedy gives a case in point — peculiarly applicable to our present pur¬ pose. “ It may to the medical jurist become a matter of much importance, to arrive at accurate information on the subject of the child’s life or death during the pro¬ gress of pregnancy. A case illustrative of this fact occurred to the author about three years since, when assistant to the Lying-in Hospital. A woman, in the seventh month of pregnancy, was sent to that institution from the police office, to be examined whether her child was, as she asserted, killed in her womb by certain blows and other injuries inflicted upon her by a female with whom she had a scuffle. She described very accurately all the reputed proofs of the child’s death as being pre- 484 DE. CUMMIN ON FORENSIC MEDICINE. sent. When, however, the stethoscope was applied, the foetal heart’s action was distinctly audible, and our announcement of the child’s being alive dissipated all her hopes of legal vengeance, as she appeared to calculate upon hanging her antagonist at least. The prisoner, who was imme¬ diately dismissed, might, in the absence of this test, have been subject to a vexatious prosecution or imprisonment; and if the child had died subsequently, its death having no connexion whatever with the assault, she might possibly have been un¬ justly punished.” Recollect, however, that absence of the foetal pulsation is no proof that the foetus is dead, nor is absence of the souffle, for the placenta may be placed so as to be dif¬ ficultly heard ; and even though the pla¬ cental souffle be detected, there may still be no living foetus. So that under all the circumstances you will see how much cau¬ tion is necessary. Ovarian tumors. - — There are diseases, such as enlargement of the ovary, which have sometimes led to mistakes. A care¬ ful and competent examiner, however, will not fail to detect the real state of the case : the touch is generally adequate to the purpose. If the enlargement of the abdo¬ men be from an ovarian tumor, simply, the neck of the uterus is prominent and firm, unaltered, and its body unenlarged. But it may be a complicated case; there may be both ovarian tumor and pregnancy. The possibility of such a conjuncture must put us on our guard lest we hastily report on the presence of one state, omitting, per¬ haps, the more important. We shall need, in such circumstances, to put our best diagnostic tests of pregnancy in requisition. Dropsy. — I have already alluded to the fact that pregnancy may be confounded with dropsy, and vice versd. Drelincourt confesses that he mistook dropsy for preg¬ nancy in the case of an unmarried woman ; Salzmann tells us that he pronounced a pregnant woman to be merely dropsical ; and Zimmermann relates that he was deceived in a case of pregnancy, considering it as tympanites. Dangerous errors are also on record of pregnant women having been tapped, the operators not knowing the risk they ran of wounding the uterus, and destroying both mother and child. In distinguishing dropsy from preg¬ nancy, a careful examiner will observe the superficial fluctuation — the diffused swelling of the abdomen, while the en¬ largement from a gravid uterus is gene¬ rally circumscribed — and, above all, the absence of the characteristic signs of the pregnant state. When the disease, how¬ ever, is complicated with dropsy, as it fre¬ quently is, we must be doubly cautious. Perhaps it would be a good rule, as well in ordinary as in medico legal practice, al¬ ways to suspect pregnancy where ascites may be present in the married woman ; and it might have prevented some serious mistakes, if the possibility of such a com¬ bination, in all females of a child-bearing age, had been, in certain instances, called to mind. Encysted dropsy is still more likely to simulate pregnancy, especially when attended with amenorrhcea, and the cyst occupies the lower fore-part of the abdomen. But should there really be no pregnancy, the uterus will be found empty, and all the chief signs of the gravid state will be absent. Distensions of the uterus. — But sometimes the complication is within the womb, while there may or may not be a foetus present : there may be air, water, moles, or hyda¬ tids. Tympanites of the uterus — Physo - metra — a malady in which the womb ge¬ nerates gases, which distend its cavity, and after a time are expelled, — is rather rare ; and perhaps when air is formed in the organ, it is generally only contained in it for a very short time, when it de¬ serves rather to be called flatus of the ute¬ rus. Dr. Gooch knew a lady who had this affection : air was expelled from the uterus with a noise many times a day. It was doubted whether it really came from the uterus ; but the fact of her not being sub¬ ject to the infirmity any longer the moment she became pregnant, seemed to put the matter beyond a question. Cases of this kind are said not to be rare. Dropsy of the uterus — Hydrometra — is not a common complaint, yet it may occur either sim¬ ply or as a complication of pregnancy. J. P. Frank, in his excellent work l)e Morhis curandis, tells us of a German Princess, of a certain age, who was pro¬ nounced pregnant by her medical atten¬ dants: she, however, discharged a large quantity of water, and the uterus resumed its natural state. Not long after, the same symptoms appeared, and the same result was expected, when, to the confu¬ sion of her medical men, she gave birth to a living infant. Moles and hydatids. — Moles and hydatids are another source of difficulty ; and much caution is required for that reason, when we merely know that the uterus is enlarged; for it may contain something which, with or without a foetus, may prove to be a solid sanguineous mass, or the product of a false conception. The term Mole is applied to a great variety of substances which are found in the uterus, — some say even of women who have never known man : nuns have had moles, and their chastity has not been sus¬ pected ; or rather they have found advo¬ cates who maintain that such an occur¬ rence may take place, and yet the woman EXTRA-UTERINE PREGNANCY. 485 have never conceived. These are called false moles, and are said to consist chiefly of sanguineous concretions. The menstrual fluid probably is retained, distends the womb, the form of which it assumes, and it is thus composed of successive layers : the colour and consistence of these masses vary much in different cases. But what are called ti ue moles always contain the relics of a conception in some shape or other. It results from the death of the embryo, or the degeneration of the pla¬ centa, and of course its appearance will greatly depend on the period at which this death or degeneration takes place, and the length of time the organic remains lie deposited in the body of the organ : teeth and hair are frequently found in these amorphous masses. Moles are classsfied by authors as chaotic, aqueous, fleshy, hairy, stony, bony, Sec. (the product of conception), and again as sanguineous, windy, polypous, vesicular, Sec. (not produced by stccual intercourse); but it may be sufficient for our purpose here to observe that they are often found of a very nondescript character. In a case related by Dr. Gooch, which strongly resembled pregnancy, but was attended with profuse discharges of water and blood, the patient died, and on dissection there was found in the cavity of the uterus (which was about big enough to hold two fists) neither fetus nor hydatids (as some predicted), but a mass, about the size of a goose-egg, of stringy matter, like very soft placenta, and unattached to the inner surface of the uterus : this surface wras red and irregular, like a granulating sore ; its walls were thickened, as in pregnancy, of a dark red hue, and flaccid texture. As to hydatids of the uterus, or those cysts resembling hydatids, as some prefer to consider them, they are a frequent cause of fallacy in obstetrical practice, and of course might happen to prove a serious cause of mistake in medico- legal inspec¬ tion. There is considerable contrariety of opinion as to the origin of these cysts — some holding them to be independent of sexual intercourse — others the reverse. “ The development of hydatid masses in the uterus,” says M. Desormeaux, “is most frequently, if not always, a conse¬ quence of conception and the generality of observers are agreed as to this fact, that they are owing to morbid alterations of the ovum and placenta. Velpeau even thinks that the hydatiform granulations which are commonly found on the external surface of the chorion, are the normal con¬ dition, or the natural state, of the part during the first twro mon ths after conception. But be this as it may, the medical jurist had need be prepared" for their occasional occurrence in the course of his practice. This affection of the uterus is attend¬ ed with remarkable enlargement of the abdomen; but it is also remarkable that the enlargement is generally dispropor¬ tionate to the period of pregnancy, and that it becomes stationary after having ad¬ vanced rapidly. A discharge of blood is also a common symptom of the gestation of hy¬ datids; and it frequently gives alarm, from the apprehension of approaching abortion. Polypus. — The only kind of polypus which can create difficulty is the intersti¬ tial — formed in the tissue of the uterus itself : the other kinds are in general easily recognized. But though we detect the presence of a polypus, we m ust not con¬ clude hastily and at once that there is no fetus; for polypus may occur as a com¬ plication of pregnancy. The late Dr. Beatty, of Dublin, gives an account of a case in which a lady, a patient of his, who had a uterine polypus weighing nearly four pounds, miscarried ; the fetus wTas one of about three months : the ovum was entire, the membranes not having been ruptured. The polypus itself was ex¬ pelled in six days after, with pains re sembling those of labour; the uterus was inverted by its descent, but on separation of the slight attachment between it and the tumor, it wras easily restored to its place. Such cases, howmver, are consi¬ dered to be very rare. Extra- uterine pregnancy. — We sometimes meet with pregnancy of another sort, which, from some of its symptoms, might induce an inexpert examiner to suppose that there was rather an ovarian tumor, or some other abdominal disease pre¬ sent, than actual pregnancy. The preg¬ nancy may be extra-uterine. The ovum, from causes which are imperfectly under¬ stood, sometimes fails of being carried into the womb; it may not quit the ovary ; it may stop on its way while yet in the fallo¬ pian tube ; it may even reach the tissue of the uterus, and then become developed: nay, it may fall into the abdomen, it is said; and according to these several cir¬ cumstances the pregnancy is termed ova¬ rian, fallopian, interstitial, abdominal, & c. — mere special appellations, which are all included in the general name of extra- uterine. But wffierever the ovum is depo¬ sited, a peculiar development takes place : a cyst is formed about it, which serves it for a uterus. And what is remarkable, and might, if not duly attended to, lead us into error, is, the peculiar development of the uterus itself : w hether the ovum reach that organ or not, it enlarges and acquires at least two or three times its ordinary vo¬ lume; and its inner surface is lined with a deciduous membrane. In a case ob¬ served by Chaussier, the neck of the ute¬ rus was sufficiently dilated to admit the introduction of the finger. The results of extra- uterine pregnancy 486 DR. CUMMIN ON FORENSIC MEDICINE. are often very curious. They are frequently fatal, but have sometimes proved no im¬ pediment to the fecundity of the mother. I saw a case some time ago, in which a woman survived a fallopian pregnancy, and bore three children before the extra- uterine foetus was extracted. It was not till eight years after the conception that this event occurred : a spontaneous process of ulceration taking place near the umbi¬ licus, the opening was enlarged, when the foetus was removed, and found to be in excel¬ lent preservation - it measured 22 inches in length, and was well formed. The mother was still alive when I saw her, about a week after the operation ; she was then a patient in a fever hospital, and not specially under treatment for the circum¬ stances just mentioned. Albert Meckel quotes a case which oc¬ curred in tho year 1820, and has been re¬ corded in some of the German journals. The wife of a rope maker remained preg¬ nant for six years, during which time she gave birth to two living children. At length she was delivered per naturales vias of her weary burden, which proved to be a perfectly well-formed and mature foetus, dead of course, but the mother recovered. The pregnancy, in this instance, is sup¬ posed to have been of the interstitial kind. The signs of extra-uterine pregnancy are generally too obscure and complicated to enable us readily to recognise it : in some cases it is not till after death, or at least till the period of natural labour has passed without delivery, that the fact is ascertained : previous to this we can at best only suspect the true state of things. Some particulars from a report on extra- uterine pregnancy, by Orfila, are deserving attention : — Upon reaching her chamber we found Madame N. in bed. She said she was six months gone with child, and told us that during that period the catamenia had been suppressed, and she had a constant feeling of weight and obstruction in the pelvis. We were further informed that the belly had increased in volume only on one side, and that its elevation had frequently occa¬ sioned the sharpest pains ; that she had felt the infant move about the end of the fifth month, but since then had perceived no sort of movement. We proceeded to an ex¬ amination, and recognised towards the right iliac fossa a tumor of a round move- able character, the corresponding region on the other side of the abdomen being much less swollen. The uterus wras pushed to the left ; it seemed to be about double the size of what it is in women w ho are not pregnant; the orifice of the uterus, elastic and elongated, was not closed ; the hand was introduced into the womb, but no foetus was there. While moving the sides of the vagina laterally and from below up¬ wards, very unequivocal motions of bal- lottement were distinguished. The stetho¬ scope applied to various parts of the ab¬ domen detected no contractions or pulsa¬ tions. Furthermore, the patient suffered much from sharp pains in the whole of the lower part of the abdomen, and com¬ plained of excessive thirst. Her skin was hot, and she had much fever, sleepless¬ ness, loss of appetite, and sometimes diar¬ rhoea. We hence infer that Madame N. is pregnant, and that her pregnancy is extra- uterine.” Post-mortem signs of pregnancy . — Where the female has died, and the question of pregnancy is raised, we have ample opportunity of deciding it on inspection of the internal parts. If we find the ovum with its normal appendages in the uterus, the case is clear; but even though the ovum be not detected, in consequence of the very early period of pregnancy — say in the first week or fortnight — we may still have evidence in the state of the womb, and particularly in the state of one or other of the ovaries. If there have been a recent conception, there must be a corpus luteum found : the presence of this body gives us the strongest possible assurance — indeed, 1 should say, the certainty of the fact. I have already noticed this very striking drawing from nature by Dr. Hope, and I beg once more to call your attention to it. In the left ovary you see a regular cor¬ pus luteum, with the cicatrix belonging to it, marked by a bristle. There was a re¬ cent laceration of the hymen, gelatinous fluid was found in the cavity of the uterus and fallopian tubes, and such other changes were observed as, taken together, could not leave a doubt of the fact of re¬ cent conception. The characters of the corpus luteum ought to be well under¬ stood by the medical jurist, for mistakes have been made on the subject by many whose names have weight in the medical world. Such mistakes, however, are likely to be prevented in future by the complete account of corpora lutea given by Dr. Montgomery, in the masterly article al¬ ready so frequently referred to. I must sav, I never read a more convincing piece of medical criticism than that in which the Dublin professor exposes the miscon¬ ceptions of several who treated on this point before him ; and though he cannot be said to introduce any innovation in physiology by the viewrs which he advo¬ cates — they being, in fact, those of Haller and Meckel — yet his details are so full and accurate, that he may be said to have made the subject entirely his own. On the present occasion I must be content with referring you to the article in question : in MEDICO-LEGAL QUESTIONS. 487 Fig. 19. the next lecture I shall perhaps have to notice it more particularly. Medicable gal Questions. A variety of questions suggest them¬ selves in relation to the pregnant state; but it will not be possible to notice more than a few. For instance: can we, as medical jurists, in any case pronounce a woman not pregnant ? — Decidedly ; when she labours under a physical disability, such as absence of a uterus and ovaries ; and most probably when her age is such as to disqualify her. In the case of Johanna Southcote, who was sixty, some of her medical examiners were deceived by her fat and flatulence; but Johanna would never allow them to try test of the touch ; “ her warning spirit,” she said, “forbade her to submit to that.” Again : can we determine, in the case of an abnormal pregnancy, whether a woman bears a mole ? A set of symptoms are given by some authors ; but, without en¬ tering into particulars, we may say that there is probably no difference between the gestation of a mole and a dead foetus. We must take time, and abide the issue. There are one or two other ques¬ tions upon which the medical jurist ought to have clear and collected opinions. He may be asked, with reference to the moral character of a female who is preg¬ nant, and who has no right to be so, whe¬ ther, contrary to what she may assert, she must necessarily have been conscious of the act of coition ? for women have again and again denied, in certain circumstances, that they have ever had to their know¬ ledge carnal intercourse with a man. They have in some instances gone on even to the moment of delivery, apparently not knowing themselves pregnant, or insisting upon the impossibility that they should be so, since they had no connexion with any one. Pregnancy, of course, never happens without connexion (though it has been sometimes contended that it might!) so that when the presence of that state is established, the question is simply this— - might a person have taken advantage of her, and got her with child without her knowing any thing about it? There are a number of cases on record, which would seem to determine the reply in the affir¬ mative. Not to go back to the well-known story of the girl who was laid out for dead, and who was impregnated in this condition by an ecclesiastic, who watched by her bier, — in a compendium of mid¬ wifery not long since published* there is the following case : — “ A maid at an inn, who was always thought to be virtuous, and bore a good character, be¬ gan to enlarge in a way which excited suspicions of pregnancy. She solemnly declared that she never had connexion with any man. At length she was de¬ livered, and wras afterwards brought be¬ fore a magistrate to swear to the father; but she repeated her former declaration. Not long afterwards a postboy related the following circumstances : that one night he came late to this inn, put his horses into the stable, and went into the house ; he found all gone to bed except this girl, who was lying asleep on the hearth-rug, and without waking her he contrived to gratify his desires. This shews,” adds the author, “ that impregnation may take place without the knowledge of the fe¬ male.” A . case, the complete counterpart of this, is given by Dr. Montgomery, in his essay on the Signs of Pregnancy. Capuron says “ It is a fact, which experience has more than once confirm¬ ed, that a woman may become preg¬ nant w hile in a state of hysteria — under the influence of narcotics — during as¬ phyxia, drunkenness, or deep sleep ; and consequently without being conscious of it, or sharing the enjoyment of the man wTho dishonours her ;” and, in proof, he mentions having attended a young woman who was got with child while totally un- * Compendium of Gooch’s Lectures on Mid wiferv, p. 81 . 408 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS. conscious, being buried in a deep sleep, produced by punch given her by her para¬ mour. Such cases as these ought to render us careful in pronouncing a severe opinion, when we are consulted in charges of concealment of the birth ; for if a woman may become pregnant without knowing it, there is some chance, if she be not very quick-witted or have experience, that she shall go on to the time of her delivery un¬ consciously, and without having made any preparation for that event, whereby the life of the infant is compromised. Women have often been really ignorant of their condition, though they have confess¬ edly incurred the risk. There is a well- authenticated story of a simple-minded girl, who yielded to her lover in a bath, be¬ cause he told her that no consequence would ensue from a connexion under such circum¬ stances : she believed him, and could not be persuaded that his word was untrue till the moment of her delivery. Klein also, as quoted in Henke’s Abhundlungen, gives two cases which came under his cogni¬ zance; one, that of a married woman, who, even in the pains of labour, believed herself ailing otherwise than with preg¬ nancy ; and the other that of a young gir), who was confident, even in the ninth month, that she was not pregnant, because she had had only one connexion ; and her seducer told her that in such a case there could not possibly be any consequences. Thus there may evidently be three states to account for the ignorance of the female : 1. Some disease resembling pregnancy; 2. Menstruation (as it sometimes does) occurring after a fruitful intercourse ; and 3. An erroneous impression deeply rooted. The practitioner had need to be care¬ fully on his guard when he has to deal with women who make these assertions; for wrhile he bears in mind the ■possibility of the truth of what they say, he must also recollect the obstinacy wuth which they often maintain that they are not pregnant, when they know they are, and yet dare scarcely confess it to them¬ selves. “ It appears difficult to ex¬ plain,” says Dr. Gooch, “ the obsti¬ nacy of assurances which those who make them know to be false, but I suspect they deny to the last that they can be pregnant, because they hope to the last that they are not so. Another circumstance likely to bias the medical man, is the respectability of the patient; but this, too, must be dis¬ regarded. Single women sometimes be¬ come pregnant in all ranks of life, not only among the low but among the high, and not only among these, but in the mid¬ dle ranks; and the practitioner, in his in¬ tercourse with the world, will often be placed in puzzling situations, and have t® listen to very curious disclosures.” I may here mention, that the Prussian law refuses to believe that a woman can arrive at an advanced stage of pregnancy without knowing it : “ after the 30th week,” it expressly states, “ no plea of ignorance can be admitted.” Another medico-legal question connect¬ ed with pregnancy is, whether a woman in the pregnant state is always to be accounted. a responsible agent — whether, in fact, those longings, and peculiar states of mind which we know to be common in pregnancy, should form any excuse for a female who would be otherwise criminally judged? Medical men have sometimes been consulted on this head, and the in¬ quiry has generally been limited to this — whether a pregnant woman may so be got the better of by her imagination, and may have her will so depraved, as to be im¬ pelled to commit certain crimes — more especially theft? I believe the truth to be, that such an admission is in many cases unavoidable ; but it would be a dangerous precedent to admit it generally : social or¬ der might suffer severely from such an in¬ dulgence : a^woman with a propensity to thieving in all states of her system would have a dangerous latitude allowed her, if she were protected by her pregnancy. If, however, the disturbance of the mind be extraordinary, the medical jurist who is consulted will not have much reason to hesitate in excusing the woman : but if otherwise, it will be his duty to refer the magistrate to some other quarter for the elucidation of the question — for it does not properly belong to medicine. The legal functionaries will in general be the best judges how to act, by comparing the character of the accused in her ordinary unimpregnated state wuth her conduct while pregnant : by considering her cir¬ cumstances, whether she is in no want — or whether she is distressed : considera¬ tions such as these will throw more light on the question, than any medical evidence to prove that the woman is of an irritable temperament, or of a melancholy or hypo¬ chondriacal state of mind. LECTURES ON MATERIA MEDICA, OR PHARMA¬ COLOGY, AND GENERAL THERAPEUTICS, Delivered, at the Aldersgate School of Medicine, By Jon. Pereira, Esq., F.L.S. Lecture LIV. Strychnia. History. — On the 1 1th December, 1818, Pelletier and Caventou announced to the STRYCHNIA. 489 French Institute the discovery of a new vegetable alkali, to which they proposed to apply the term vauqueline, because the cele¬ brated Vauquelin was the first to signalise the existence of an organic alkali. Ma- gendie proposed to denominate it tetanine , to express its effects, as this term would then be in harmony with morphine and emetine. The term strychnia , however, was considered most appropriate, and, therefore, has been usually adopted. Native state. — Hitherto it has been found only in certain species of the genus Strych- nos, namely, S. nux vomica, S. Ignatia, S. Colubrina, and S. Tieute. Probably, also, it is contained in S. Guianensis, which yields the American poison Urari. It is frequently associated with another alkali (brucia), and is always combined with an acid. Preparation. — There are several methods by which strychnia may be procured; one of them is the following : — Boil nux vo¬ mica in water, evaporate the strained decoction to the consistence of syrup, and then precipitate by slacked lime. The precipitate is to be collected on a filter, washed first with water, and then with weak spirit, and afterwards dried and pulverised. It is then digested in rectified spirit, and the alcoholic solu¬ tion distilled : the residuum is impure strychnia. To purify this add dilute sul¬ phuric acid, boil with animal charcoal, and precipitate by ammonia: the product is termed precipitated strychnia. To separate the brucia which this usually contains, it is to be digested in weak spirit, which dis¬ solves the brucia and leaves the strychnia. Or convert the two alkalies into nitrates; the nitrate of strychnia may be separated by crystallization. Theory of the process. — By boiling nux vomica in water, we obtain a solution of the strychnates (or igasurates) of strychnia and brucia, along with gum and some co¬ louring matter. The lime which is added unites with the stryclmic (or igasuric) acid, and sets free the strychnia and brucia. By washing with water and weak spirit, part of the impurities (the gum and co¬ louring matter) is removed. By digestion in rectified spirit we obtain a solution of strychnia, brucia, and colouring matter, which constitute the impure strychnia. By the addition of sulphuric acid two sul¬ phates of the alkalies are formed ; and by boiling with charcoal the colouring matter is got rid of. By the addition of ammonia, strychnia and brucia are precipitated. Brucia being soluble in weak spirit, is readily separated from the strychnia. The process given in the new London Pharmacopoeia is the following : — Boil for an hour two pounds of bruised nux vomica with a gallon of rectified spirit, in a retort with which a receiver is connected. Pour off the liquid, and boil the residuum with another gallon of spirit and the recently distilled spirit. Having poured off this liquor, treat the residuum a third time in the same manner. Express the nux vo¬ mica, and distil the spirit from the strained and mixed liquors, and evaporate the re¬ siduum to the consistence of an extract, which is to be dissolved in cold water and filtered. Evaporate by a gentle heat to the consistence of syrup, and to the liquor, while warm, add gradually a sufficient quantity of magnesia to saturate it, shak¬ ing them together. Set aside for two days, then pour off the supernatant liquor. Express what remains wrapped in linen ; boil it in spirit, strain, and distil the spi¬ rit. Add a very little dilute sulphuric acid mixed with water, and macerate with a gentle heat. Set aside for twenty-four hours, that crystals may form. Express and dissolve these. Lastly, add ammonia to these, dissolved in water, shaking now and then, that the strychnia may be pre¬ cipitated. Lastly, dissolve this in boiling spirit, and set aside, that pure crystals may be formed. Theory. — The theory of the pharmaco¬ poeia! process is readily comprehended. The watery solution of the alcoholic ex¬ tract contains the strychnates of strychnia and brucia: the magnesia decomposes these, abstracts the strychnic acid, and precipitates the strychnia and brucia. The sulphuric acid which is added converts them into sulphates, which are decom¬ posed by the ammonia, strychnia being precipitated along with some brucia. Properties. — Pure strychnia is a white, odourless, intensely bitter, crystalline sub¬ stance, the form of the crystal being the octahedron, or four-sided prism. When rapidly crystallized, it assumes a granular form. It is fusible, but not volatile; de¬ composing at a lower temperature than most vegetable bodies. Though so in¬ tensely bitter, it is almost insoluble in water, one part of strychnia requiring 6067 parts of water, at 50°, to dissolve it; that is, one grain needs nearly fourteen ounces of water to hold it in solution. It requires 2500 parts of boiling water to dissolve it. It acts on vegetable colours as an alkali, saturates acids forming salts, and separates most of the metallic oxides (the alkaline substances excepted) from their combina¬ tions with acids. In some cases part only of the metallic oxide is precipitated, a triple salt being formed. This is the case with the sulphate of copper : strychnia boiled with this salt throws down part of 490 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS. the oxide of copper, while a green solution of sulphate of copper and strychnia re- mains. Composition. — This base is anhydrous. According to Liebig it consists of — 30 atoms carbon, 30 X 6 • • 180 16 atoms hydrogen . 16 1 atom nitrogen . 14 3 atoms oxygen, 3 X 8 * • • • 24 1 atom strychnia . 234 Characteristic tests. — Pure gallic acid does not precipitate it. Tannic acid, or infu¬ sion of galls, precipitates the tannate of strychnia. The strychnia of the shops is coloured red by nitric acid, though pure strychnia is not. The substances present in ordinary strychnia, which thus become coloured by nitric acid, are brucia and a yellow incrystallizable matter, which is with difficulty separated. This red colour is destroyed by the addi¬ tion of some deoxidizing agents, as sul¬ phurous acid, and sulphuretted hydrogen. Hence the phenomena of coloration appear to depend on oxidizement. This colour produced by nitric acid passes successively from red to yellow. By a prolonged ac¬ tion of the nitric acid, oxalic acid is formed. When the solution has become yellow by nitric acid, deoxidizing agents no longer decolorize it. if potash be added to a very concentrated solution of a strych¬ nia salt, which has been reddened by nitric acid, an orange precipitate is formed. An excess of water redissolves this precipitate. The salts of iron are not coloured by the addition of strychnia. Another character of strychnia is its action on the salts of copper before mentioned. Salts of Strychnia. — When pure, they are for the most part crystalline, white, and very bitter. They possess the following chemical characters : — 1. They are precipitated by the alkalies and their carbonates. 2. As usually met w'ith in the shops, they are reddened by nitric acid. 3. They are precipitated by tannic, but not by gallic acid. 4. They are unchanged by the action of the persalts of iron. 1. Sulphates: (a.) Neutral. — -Exists in the form of small cubes, soluble in ten parts of water at 59° Fahr., and of course in a less quantity at a higher temperature. When heated, it fuses and loses three per cent, of its weight, probably water of crystallization : but Liebig detected no water in sulphate dried at 212°; so that if it had contained water, this temperature must have expelled it. It consists of 1 atom strychnia . 234 1 atom sulphuric acid t . . . . 40 274 (b.) Bisulphate. — It has an acid and bit¬ ter taste, and crystallizes in slender needles. 2. Nitrates: (a.) Neutral. — It crystallizes in pearly needles, grouped in stars. It is much more soluble in hot than cold water; is slightly soluble in alcohol, but does not dissolve in tether. When heated to a little above 212°, it decomposes and be¬ comes yellow, swells up, detonates slightly (but without the disengagement of light), and leaves a carbonaceous mass behind. If the strychnia contain brucia, the nitrate has a reddish tint. (■ h .) Binitrate. — Crystallizes in very fine needles. When heated, decomposes, be¬ comes red, and detonates with the disen¬ gagement of light. 3. Hydrochlorate or Muriate. — This salt crystallizes in four- sided needles, which lose their transparency in the air. It is much more soluble in water than the sulphate. When heated, it is decomposed with the evolution of hydrochloric acid. Physiological effects. — The effects of strychnia are of the same kind as those of nux vomica, but more violent in degree. As ordinarily met with in the shops, it may be regarded as about six times as active as the alcoholic extract of nux vomica. The following are a few examples of its poisonous operation : — (a.) On animals. — Dr. Christison says, “ I have killed a dog in two minutes with a sixth part of a grain, injected, in the form of alcoholic solution, into the chest; I have seen a wild boar killed in the same manner with a third of a grain, in ten minutes.” Pelletier says, “ half a grain blown into the mouth of a dog produced death in five minutes.” Half a grain ap¬ plied to a wound in the back of a dog caused death in three minutes and a half. In all these and other instances death was preceded and accompanied by tetanus. The salts of strychnia act in a similar manner. (h.) On man. — Some individuals are more susceptible of the action of strychnia than others. Andral has seen a single pill, containing one-twelfth of a grain, cause slight trismus, and the commencement of tetanic stiffness of the muscles ; while in other cases, the dose may be gradually in¬ creased beyond a grain with comparative little effect. The largest dose I have given is a grain and a half, and this was re¬ peated several times before the usual symptoms indicative of the affection of the system came on. STRYCHNOS IGNATIA. 491 Uses. — The uses of strychnia are pre¬ cisely those of nux vomica already men¬ tioned. Mode of exhibition. — Strychnia is usually given in doses of one sixth of a grain, gradually increased until its effects on the muscular system are observed. It is com¬ monly made into pills, by means of conserve of roses ; or it may be dissolved in alcohol, or in acetic acid. The salts of strychnia, as the sulphate, nitrate, or hydrochlorate, may be given in doses of one-twelfth of a grain. In amaurosis strychnia is employed after the endermic method, as already noticed. Antidotes , and mode of detection in the con¬ tents of the stomach. — These are the same as for nux vomica, before mentioned. Brucia, History. — This alkali was discovered in 1819, by Pelletier and Caventou, in the bark called false angustura, which was at one time supposed to be the product of the Bnicia antidysenterica. As, however, this is now known not to be the origin of the bark, the term brucia is of course objec¬ tionable, and some have proposed to term it pseudo- an gustine. Native state. — It exists not only in this false angustura bark, but also in nux vomica and St. Ignatius’s bean ; in the two latter cases it is associated writh strychnia, and is in combination with igasuric or strychnic acid, but in the false angustura bark it is combined with gallic acid. Preparation. — It is prepared by the same process as already described for making strychnia. Purification. — To purify this alkali, con¬ vert it into an oxalate, which is insoluble, or nearly so, in alcohol. Wash with cold alcohol, to remove the colouring matter. Afterwards, decompose the oxalate by magnesia, and separate the brucia by boiling alcohol. Properties. — Brucia in the anhydrous form, as obtained by fusing it, has a waxy appearance ; but when combined with water, it is capable of crystallizing, the form of the crystals being oblique four¬ sided prisms j or sometimes the crystalshave a pearly laminated appearance, something like boracic acid. Its taste is very bitter, though less so than strychnia. When the crystallized brucia is heated, it gives out 17 per cent of water, and fuses. Solubility. — It is soluble in 850 parts of cold, or 500 parts of boiling water ; but the presence of colouring matter, of which it is difficult to deprive it, promotes its solubility. It is very soluble in alcohol, but is insoluble in aether and the fixed oils, and is very slightly soluble only in the volatile oils. Composition, — 'According to Liebig it consists of 32 atoms carbon . 192 18 atoms hydrogen . 18 1 atom nitrogen . 14 b atoms oxygen . 48 1 atom anhydrous brucia ♦ • 272 6 atoms water . 54 l atom crystallized or an- ? hydrous brucia . $ Characteristics. — Nitric acid assumes a fine red colour when added to brucia : de¬ oxidizing agents, as sulphuretted hydrogen and sulphurous acid, decolourize this solution. Iodic and chloric acids produce the same phenomena as nitric acid. Salts of brucia. — These are readily formed by saturating dilute acids with brucia. They possess the following properties : — for the most part they are soluble and crystallizable, and have a bitter taste. They are decomposed by potash, soda, ammonia, the alkaline earths, morphia, and strychnia, which precipitate the brucia. They are precipitated by tannic acid. Nitric acid colours them as it does free brucia. Physiological effects.- — The effects of brucia on man and animals appear to be precisely similar to those of strychnia, though larger doses are required to produce them. Uses. — The uses of brucia are those of strychnia and nux vomica before related. Mode of administration. — The dose of brucia is from half a grain gradually in¬ creased to about five grains. It may be given in the same way as strychnia. Antidote. — Poisoning by brucia is to be treated like that for nux vomica. Strychnos Ignatia. St. Ignatius’s bean, says Alston, came into the Dutch shops about the latter end of the 17th century. But there is some reason to suspect they wTere known long before this, and are probably the sub¬ stances which in the Latin translation of Serapion was denominated nuces vomicae. Dale gives, as one of their synonymes, “ Igasur, seu Nux vomica legitima Serapi- onis.” They are obtained from the Strychnos Ignatia (called by some Ignatia amara), a tree indigenous to the Philippine Islands, whose fruit is smooth and pyriform, and contains about twenty seeds. These seeds, the St. Ignatius’s* beans of the shops, are about the size of olives, rounded and con¬ vex on one side, and somewhat angular on the other. Externally they are brownish, with a bluish grey tint. Within the envelopes of the seed is a very hard horny or cartilaginous albumen, in w hose cavity 492 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS. is contained the embryo. These seeds have been analysed by MM. Pelletier and Caventou, who found their constituents to be the same as those of nux vomica, though in somewhat different proportions. Their effects, therefore, are similar. False Angustura Bark — Bark of Strych- nos - ( ?) History.— In 1804, Dr. Rambaeh a phy¬ sician at Hamburgh, observed that some specimens of angustura bark, said to be from the East Indies, acted as a powerful poison ; and as repeated cases of poisoning occurred with the same substance, an order was issued forbidding the use of angustura bark. On the 15th October, 1815, the Commission of Health of the grand duchy of Baden ordered all the angustura bark in the possession of the apothecaries to be seized and jdaeed under a seal ; the phy¬ sicians at the same time receiving an inti¬ mation that they were not, in future, to prescribe this bark. Similar ordinances were issued in Austria, Bavaria, and Wirtemberg. The origin of the bark is said, by Batka, to be as follows: a quantity of it was imported from the East into England, and not being saleable was sent to" Holland; and as no better means of getting rid of it offered, it was mixed with, and sold as, genuine angustura or cusparia bark. Botanical history. — Great obscurity has long existed as to the tree which yields it. At first it was attributed to the Brucea ferruginea , or an tidy sent eric a, a na¬ tive of Abyssinia, belonging to the family Xanthoxyiacese ; but in 1831 Geiger had occasion to examine the bark of the B. ferruginea, and found that it had no resemblance to false angustura. Now the composition and effects of this bark render it in the highest degree probable that it is the product of some tree of the family Strychnaeem, most probably of the genus Strychnos; Batka says of the S. nux vomica, or some neighbouring species. I have carefully examined the specimens of this genus in the herbarium of the Linnsean Society, and found on one of the native specimens of the nux vomica plant, in Dr. Wallich’s collection, a slight fungous-kind of excrescence, somewhat analogous to that found on the false angustura bark. Description of the hark. — It occurs in quills or flat pieces (angustura falsa convoluta seu plana), or in pieces arched backwards, having the twisted appearance of dried horn. It is more compact and heavy than real angustura bark. The epidermis varies: sometimes it consists of a dark fungoid or spongy rust-coloured layer (hence the term angustura ferruginea), which is only the altered epidermis; at other times it is not thick, not fungous, but covered with numerous whitish promi¬ nences, formerly supposed to be some species of lichen, but now known to be only an epidermoid alteration, the more advanced stage of which constitutes the rust-coloured layer already mentioned. The powder is intensely bitter, and of a yellowish white colour. Composition. — The following are the constituents of this bark, according to the analvsis of MM. Pelletier and Caven- * tou : — 1. Gallate of brucia. 2. Fatty matter (not deleterious). 3. Gum (a large quantity). 4. A yellow colouring matter ( Strychno - chromin) soluble in water and al¬ cohol. 5. Sugar (traces). C. Lignin. Chemical tests. — By reference to the con¬ stituents of this bark, the action of the tests for it may be readily understood. An infusion of this bark reddens litmus, in consequence of the excess of acid pre¬ sent. Strong nitric acid added to this solution produces a red colour; and by dropping the acid on the inner surface of the bark, a blood-red spot is produced: in both these cases the effect arises from the action of the acid on the brucia. If nitric acid be applied to the external sur¬ face of the bark, it produces a deep green colour, in consequence of the action of the acid on the yellow colouring matter. In¬ fusion of galls added to the infusion of this bark occasions a white precipitate of the tannate of brucia. Sulphate of iron colours the infusion green, from its action on the yellow colouring matter. Physiological effects. — (a) On Animals. — The experiments of Pfaff, the Vienna Faculty, Emmert, Meyer, Orfila, Magen- die, and J tiger, have shown that it is a powerful poison to dogs, rabbits, wolves, and other animals. Thus eight, twrnlve, or eighteen grains of it kill dogs, the symptoms being precisely the same as those of nux vomica already detailed. ( h .) On Man it also acts as a powerful poison. Emmert mentions that a boy who had taken by mistake the decoction of this bark died therefrom. His intellectual powers were unaffected; he entreated his physician not to touch him, as violent convulsions were immediately brought on; he wras powerfully sweated, but did not vomit. Professor Marc wTas nearly poi¬ soned by swallowing through mistake three quarters of a liqueur glassful of a strong vinous infusion. Uses.— It is sometimes employed for the UPAS OR JAVA POISON. 493 extraction of brueia, in consequence of this alkali existing in this bark unmixed with strychnia. Antidote. — The treatment of cases of poisoning will be precisely the same as for nux vomica. Upas or Java Poison. The poison tree of Java has been ren¬ dered notorious principally in consequence of certain gross fabrications and mis-state¬ ments made concerning it about the year 1780, by a person of the name of Foersch, said to have been a surgeon in the service of the Dutch East India Company. Male¬ factors, says this author, when they receive sentence of death, are offered the chance of life, if they choose to collect this poi¬ son ; and although every precaution is taken to prevent its action on the system, out of seven hundred persons who went to collect it, only two returned alive; and from their reports, no living being (vege¬ table or animal) is to be seen for a wide tract of country around it. Foersch says he himself found this to be tire case for eighteen miles in every direction from the tree ! ! ! Darwin, believing this report, has made it the subject of his muse in the third canto of his “ Loves of the Plant$.‘,> 1. Upas Antiar. — The account given by Foersch has long been known to be a gross falsehood and imposition, principally by the researches of Dr. Horsefield and M. Lesehinault. From their accounts, it appears that the true poison tree of Java (the Arbor toxicaria of Rumphius), is called Antshar or Antiar ( Antiaris toxicaria of bo¬ tanists), and belongs to the family Urti- cacem. It is one of the largest forest trees of Java, being from 60 to 100 feet high. Here is a drawing of it, taken from a recent publication of a German botanist. Fig. 146. — Abor toxicaria. lpo. Rumph. Antiaris toxicaria. Lesehinault. You will observe he has strikingly repre- parasitic plants, and birds depicted on the sented the non- poisonous qualities of its tree, as well as by the natives in its imme- emanations, by his picture of the richness diate neighbourhood. of the surrounding vegetation, by the Preparation. — The juice contained in the 494 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS. bark of this tree is viscid, milky, and bitter. It is extracted bv incision, and when boiled to the consistence of an extract with the juice of arum, galanga, onions, garlic, pepper, and capsicum, forms the Oopas or Upas poison, and which is employ¬ ed for the purpose of poisoning arrows. Composition. — Pelletier and Caventou analysed this poison, and found it com¬ posed of — 1. A peculiar elastic resin. 2. Slightly soluble gummy matter, ana¬ logous to bassorine. 3. A bitter matter, soluble in alcohol and water, and composed of three substances : (a) . A colouring matter, absorbable by charcoal. ( b ) . An undetermined acid. (c) . A substance precipitable by the tincture of galls, and which is the active principle of the poi¬ son. As it is probably alkaline, it has been termed Antiarine. Effects. — The symptoms which result from its action on the system indicate a double influence exercised on the nervous system and stomach. According to Andral, its action is not absolutely identical with the UpasTieute,to be mentioned presently : the first produces clonic convulsions, or con¬ vulsions with alternations of relaxation; the second causes tonic convulsions, or tetanus properly so called. Moreover, the Upas antiar, after becoming absorbed, irritates the stomach. According to Sir B. Brodie, death results from the heart being rendered insensible to the stimulus of the blood. 2. Upas Tieute. — But besides the Upas antiar just described, there is another poison yet more violent, produced in Java from a large winding shrub called th e Tieute or Tshittik (the Strychnos Tieute of bo¬ tanists), belonging to the family Apocy- nacem. Its roots extend themselves horizon¬ tally sometimes to a considerable length ; and its stem occasionally ascends to the top of the largest forest trees. Preparation. — To obtain the poison, the bark of the tree is boiled in water, and the decoction filtered and evaporated to the consistence of an extract : onions, garlic, pepper, galanga, ginger, and capsicums’ being added to render the supposed charm good. Composition. — This poison also has been analysed by MM. Pelletier and Caventou. It contains — 1. Strychnia, combined with an acid (igasuric ?) 2. Reddish brown colouring matter ( strychno-chromine ), which becomes green when mixed with nitric acid. 3. Yellow soluble colouring matter, which is coloured red by nitric acid. These celebrated chemists detected no brucia in this poison. Effects. — The active principle of this poison being strychnia, its effects are pre¬ cisely similar to those produced by nux vomica and strychnia. Thus, when ap¬ plied to wounds, injected into the serous sacs or blood vessels, or applied to the mucous membrane, it produces tetanus, asphyxia, and death. Forty drops of upas dissolved in water, and injected into the pleura of an old bay horse, gave rise almost immediately to tetanus and as¬ phyxia, and the animal died after the second attack. Lignum Colubrinum , or Snake-Wood. (Strychnos Colubrina. ) In countries infested with poisonous ser¬ pents, the natives have usually some sub- tance which is fancied to possess the power of preserving them from the bites of these poisonous animals ; and thus we have va¬ rious articles, seeds, roots, and woods, which have the word snake prefixed to them. In Asia there has long been known a wood which has been supposed to possess the above-mentioned property, and it has, therefore, been denominated snake wood, or lignum colubrinum. The specimens, how¬ ever, met with in commerce, show that there are various substances to which this term is applied, some being the wood of the root, others the wood of the stem. This wood is probably the produce of Strychnos Colubrina, though occasionally it is procured from other species of Strych¬ nos — especially S. Nux vomica. According to the analysis of Pelletier and Caventou, this wood has the same contituents as the bean of St. Ignatius, though in different proportions. Thus it contains more fatty and colouring mat¬ ters, much less strychnia, and, in the place of bassorine and starch, a larger quantity of woody fibre. Its action, therefore, is precisely similar to the before-mentioned poisons. Tanghin Poison. From the kernel of the Tanghinia veneniflua or Cerbera Tanghin, a plant belonging to the family Apocynacese, is obtained the celebrated Tanghin poison. A single seed (which is not larger than an almond) is said to be sufficient to destroy twenty persons ! ! It is (or was) used in Madagascar to determine the guilt of suspected persons. Those who are able to withstand the ordeal (that is, those un¬ affected by the poison) are considered in¬ nocent, and vice versa. CEREBRAL AFFECTIONS FROM DEFICIENCY OF CRANIUM. 495 CEREBRAL AFFECTIONS FROM DEFICIENCY OF CRANIUM. To the Editor of the Medical Gazette. Sir, In the Medical and Physical Journal, published in London, for October, 1821, a paper has been written by Sir Gilbert Blane, on the efficacy of mechanical compression in certain cases of hydroce¬ phalus. He says, “ In reflecting on the circumstances which characterize the history and description of hydrocepha¬ lus, some of the chief of which are — that it is very seldom met with but in very early life, and most commonly in in¬ fancy, before the bregma is closed ; that there is in most cases a preternatural size of the head ; and that it is usually attended with a rachitic state of the bones, and a general scrofulous flacci- dity of the soft parts, and runs in parti¬ cular families — it occurred to me that the distension of the head and bregma is owing to a want of firmness and due resistance in the bony compages of the skull, which consequently yields to that effort of pressure with which the brain, in its growth, acts on its parietes. In reasoning further on the subject, it ap¬ peared to me conformable to some of the most approved principles of physiology, that, as there is a certain degree of ten¬ sion and pressure necessary to the sound condition and action of parts, the with¬ drawing of this, by inviting afflux and congestion, produces serous effusion ; and for the like reason there may be a deficiency of that interstitial absorption upon which the healthy state of this and all other parts of the living frame de¬ pends.” Sir G. Blane relates one well- marked case, shewing its advantages. Probably the following surgical case, in which a large portion of the bony scalp was deficient, may tend to support the above doctrine, as I could assign no other cause of death but the want of the bony support to the encephalon. George Patterson, aged five years and three months, received a fracture of the upper and posterior part of the left side of the os frontis, and anterior edge of the parietales adjoining, which exfo¬ liated, leaving an aperture in the bony structure three inches by two inches in size. The wound healed ; he remained well till the age of thirteen, after which he became subject to epileptic fits, which returned at times, increasing in severity till the age of sixteen, when they would put on every symptom of compression of the brain, till at last he would lie in a state of complete insen¬ sibility, with stertorous breathing, for seventy hours at a time. Treatment consisting of general and local bleed¬ ing, mercurials, arsenic, antispasmodics, quinine, counter-irritation through the skin and stomach, by means of ant. tart., all proved unavailing, till death termi¬ nated Iris sufferings Oct 17, 1831, at the age of seventeen years. Autopsy , ten hours after death. — On viewingthe body, the only external de¬ fect was in the integuments of the back part of the scalp and ears, which were of a livid colour. On dissecting the in¬ teguments off the head there was extra¬ vasation of blood, with the appearance of contusion on the back part of the skull, opposite the ridge of the occipital bone. On removing the calvarium the dura mater adhered closely throughout, but was perfectly healthy; it was want¬ ing’ over the original wound, the cover¬ ings of which were as follows — integu¬ ment, tunica arachnoides, and pia mater. The sinuses were gorged with venous blood, also the veins leading to them presenting’ an unusual size. The tunica arachnoides healthy ; the convolutions of the hemispheres of the brain were flattened ; in the ventricles was found a small quantity of a sero-sanguineous fluid ; the cortical and medullary sub¬ stances of the cerebrum and cerebellum firm, without any infiltration. The tho¬ racic and abdominal viscera presented every appearance of health. The mind, or intellectual constitution, was rather of a superior order than otherwise; me¬ mory strong. He was amiable in his disposition ; fond of horse exercise and shooting ; very lively between the pa¬ roxysms, which interval sometimes last¬ ed three months. It might be asked, why was he not subject to epilepsy between the time of the accident and the commencement of them, at thirteen years of age P On in¬ quiry I learned, from the time the wound healed over till he was thirteen, he wore a metallic plate, secured on 496 HOMOEOPATHIC DOSES. with a tight bandage, artificial pressure. Should you consider the above worthy of insertion in the Medical Gazette, 1 shall feel obliged by your giving it publicity; and remain, sir, Yours most respectfully, John Grantham. Crayford, Kent, Dec. 21, 1836. thereby making HOMOEOPATHIC DOSES. DO THE HOMCEOPATHS COMPREHEND THEM ? To the Editor of the Medical Gazette. Sir, The annexed extracts from a letter re¬ ceived from a clerical friend, to whom I had lent Hahnemann’s and Quin’s books on Homoeopathy, amused, and at first certainly somewhat startled me, until I had gone through one or two of the cal¬ culations and verified their accuracy. I have never before seen the extreme absurdity of homoeopathic doses so clearly demonstrated ; and could you find room for their insertion in your valued periodical, you will oblige, sir, Your obedient servant, Thos. H. Smith. St. Mary Cray, Kent, Dec. 22, 1836. “ Many thanks for the books on Ho¬ moeopathy. I have read them atten¬ tively : the result has amused me, as it may amuse you also. The point to which I will first allude is the exces¬ sively minute quantities in which the homoeopath ists profess to administer their medicines. A physician of our acquaintance, as he was laughing at these small doses a few days ago, ob¬ served that it was like throwing a grain of an active medicine into the Thames. He meant to exaggerate, but he in fact, as I shall presently shew, enormously underrated the deyree of attenuation : Two decillionth parts of a grain is a favourite homoeopathic dose. Now tril¬ lions and decillions are very pretty words, to which, however, we can affix no definite or even approximate idea ; we are not aware how the powers of numbers mount up, unless we have oc¬ casion to apply our minds to a close and accurate investigation of them. When we talk of a deciliion, we know' we are naming’ a number which consists of an unit with sixty cyphers in its train ; but if we would form any sort of notion of its magnitude, we can only reach it by taking some enormous intermediate in¬ teger. The diameter of the earth is about 8000 miles ; the solid contents of spheres vary as the cube of their respective dia¬ meters. The population of the world has been calculated at about eight hun¬ dred millions; and a homoeopathic dose of opium amounts to two decillionth parts of a grain. Upon these data we proceed. From one grain of opium abrade an atomic particle which shall bear the same proportion to the whole grain, that a spherule one-thousandth part of an inch in diameter bears to the globe upon which we stand : divide this particle into homoeopathic doses, and cause each individual on the face of the earth to swallow a dose every second, it will require twenty millions of years to take the particle described. It will, I apprehend, be of little mo¬ ment whether you administer opium in these ideal quantities, or distilled water, or — moonshine. If the Lord Mayor’s orders respecting the provisions spoiled at the fire in Tooley-street were really carried into effect, there can be no por¬ ter brewer using Thames water who has not administered to every half-pint cus¬ tomer very alarming doses, hotnceopa- thically speaking, of the arseniate of ham. This should certainly be look¬ ed to. But to our illustration above — Opium : it may be objected that it is really a powerful medicine : let us glance at some drug of milder properties. Capsi¬ cum I use to my boiled beef in formi¬ dable allopathic doses ; let us see how Hahnemann administers it. This he attenuates to the ninth degree; that is, he would give a globule of sugar or spirit, which are his only vehicles, con¬ taining' one-trillion tli part of capsicum ; that is , one part of capsicum to one- trillion of the same parts of sugar. Now suppose we wished to attenuate one grain of capsicum in this proportion, we should, of course, require one tril¬ lion grains of sugar. Will you tell me off-hand in what space, within a ship- DR. HAKE ON HYDRIODATE OF POTASS. 497 load or so, you might stow away a tril¬ lion grains of sugar? A West India- man of GOO tons is a very large West Indiaman indeed ; if we freight ten thousand such ships, and let them each perform ten thousand voyages, there would still remain above hall' a million of such ships loads at Jamaica, out of the trillion grains. The calculation is simple enough, and my accuracy, there¬ fore, is easily tested. You seemed to fancy an illustration from the pyramids. The area of the great pyramid is 480,250 square feet, and its height 499 feet, call it 500 ; consequently its solid contents are 480,000 x 500 — or 80,041,666 cubic feet. I have not at this moment the specific gravity of sugar, but that of pure spirit (the only other vehicle) I have. The weight of a cubic foot of spirit is 866 ounces : multiply this by 437^, you get 378,875 minims in the cubic foot ; di¬ vide the trillion by this number, and the result is, that you have above two and a half billions of cubic feet in a trillion of minims ; extract the cube root, the result is 13,750 in feet, which will be the length of each side of a cubi¬ cal vessel which will hold a trillion of grains of pure spirit, — that must be above two miles and a half long, two miles and a half wide, and two miles and a half high; or, comparing it with the pyramids, it would require above thirty-two thousand, six hundred pyra¬ mids to contain spirit enough to dilute one grain of capsicum. You will thus see that our friend would certainly poi¬ son the Thames with his drop of lau¬ danum.” ON THE VIRTUES op HYDRIODATE OF POTASS, AS A REMEDIAL AGENT IN DISEASE. By T. C. Hake, M.D. Physician to the Brighton Dispensary. Having selected the bydriodate of po¬ tass for internal administration in many diseases, I have been induced to embody my experience of its properties, without 474. — xix. comparing it with the views of others, and to present it in the form of an essay. I am in possession of at least one hun¬ dred notices of its internal use, during the last twelve months, at the dispensary. Although one-half of these has been dismissed without comment, there is not one but has either confirmed my gene¬ ral knowledge of this substance, or caused it to be directed into new chan¬ nels of research. The diseases in which I have seen its efficacy proved are principally those of tegumentary membranes, whether af¬ fected in their functions or org-aniza- tion ; and of the fibrous tissues; and its virtues depend on a tonic and stimulant power. As a remedy acts through fixed laws, and is unable to adapt itself to the cir¬ cumstances of its administration, it is the latter which we are constantly con¬ sidering- after our ideas of the former are made perfect ; and through these that we are to extend our knowledge. A stimulant, for example, increases ac¬ tion ; but it is whatever kind of action may exist at the time of its application, whether an inflammatory, irritable, or merely debilitated action ; therefore our first object is to ascertain which of these states is present, and to convert one into another, according to the end we would accomplish, and the peculiar state of system on which we are desirous to practice. In many disorders in which final ad¬ vantage may be anticipated from the bydriodate of potass, there are states of the system which forbid its use. It cannot be given in the acute stages of rheumatism, because of the febrile symp¬ toms; but directed with skill to certain varieties of the chronic, it is a specific. This distinction arises also in acute and chronic diseases of the skin ; and in disorders where there may be no excite¬ ment of the system, although there exist local irritation of the stomach or intesti¬ nal canal, this abnormal state will suffer aggravation instead of tone being di¬ rected to tli e system, or relief to the disease. The hydriodate of potass, when inter¬ nally exhibited, may perform the office of a tonic, the circumstances attendant on its exhibition being adapted to this kind of action. If, for instance, the mucous tissues be in a debilitated state, 2 K 498 PR. HAKE ON THE VIRTUES OF HYDRIODATE OF POTASS it will elevate them to their natural tone, and will afterwards, if pursued, assert its influence as a stimulant over distant organs, or the one to which its action may have been directed by supe¬ rior art. If the tegumentary membrane of the stomach suffer irritation through inevi¬ table sympathy with disease, so as to be irreducible beyond a limited extent so long as the cause exists, it should be antagonized by counter-irritants, such as henbane, hemlock, lettuce, and the like, according to their degrees of appli¬ cability, at the same time that the hy- driodate of potass is given. Then the prime remedy will often act as if there were no irritation. The hydriodate of potass has a power over the liver similar to that of mercury and colchicum, but milder; and this power is based on a stimulation which it sets up in the duodenum. By what law is this effected? The question might be responded to by an analogy the most perfect, and with undeviating confidence, but that there are invisible lovers of science*, who, interfering in what they are intended by nature not to understand, the limits of their reason being assigned, are doomed in their nar¬ row' sphere to consider hypothesis as inimical to philosophy. Still it may be stated why the stimulation of hydrio¬ date of potass in the duodenum, like that of mercury, colchicum, and other agents, is productive of a flow of bile. It is by an admirable deception of na¬ ture ! When the chyme escapes from the stomach into the duodenum, it performs its part as the only natural stimulant of the intestine, and successfully solicits bile. But when, in the absence of chyme, artificial stimulants are resorted to, the biliary apparatus, unintelligent, still obeys the call, and there is an eva¬ cuation of gall greater or less in pro¬ portion to the degree of stimulation above or below that of nature, and ac¬ cording as the stimulus of chyme is similated by the artificial agent em¬ ployed. The hydriodate of potass mildly simi- lates the power exerted over the liver by chyme. And in what manner does this a^ent n * Vide the letter, " Z.,” in the Medical Ga- sett it for Deo. J 7. affect the intestines as it passes througl their channel ? The hydriodate of potass stimulates the lacteals, and thus similates the ac¬ tion of chyle. Unendowed with intel¬ ligence, acting only through fixed laws to them the stimulant is sufficient, and they are prepared to absorb. But though excited, they find no chyle, — it is the hydriodate of potass; and this they re¬ fuse to imbibe. Thus a very important result is obtained — the effort of absorp¬ tion without the act; important, in¬ deed, in mesenteric disease, where the functions are deeply compromised, but where exercise of organization may thus be incited. Here it may be well to propose a question — one of a somewhat subtle nature — whether this exercise of the lacteals, w ithout a flow of chyle throug'h their tubes, or, if the expression be adapted, this action on vacuity , has the same effect on the secretions as if actual absorption had occurred ? Secretion is kept in a ratio with absorption by nervous sympathy ; the increase or diminution of the one influences the other in like manner; therefore, since it is less the presence of absorbed fluids than the organic action which consti¬ tutes absorption, will not this artificial action of the cliyleless lacteals produce an increased natural action of the secre¬ tions on the mucous surface? The view which has been now sug*- gested of a similating power exercised by medicinal bodies, is worthy of being further developed, and considered in re¬ lation to the degrees of deviation from the natural standard ofstimulation — that exercised by chyme and chyle, accord¬ ing to the agents employed. By the observation of our daily habits, we are informed of the stimulating power of almost all foreign bodies on the salivary glands ; and although the intestinal structure and its dependencies are be¬ yond our view, the analogy is perfectly extensible to them, and enables us, by a correct process of ratiocination, to as¬ sume that as the action of chyme is, so is that of mercury, on the liver; that those bodies whose action is on the lac¬ teals have the same effect as chyle on those organs; and that these various i actions on tbe same apparatus differ j only in degree. An instance which I witnessed may be here adduced to demonstrate the I AS A REMEDIAL AGENT IN DISEASE. 499 similarity of action possessed by bydrio- date ot potass and mercury on the living1 body. A female had taken half a grain ot calomel night and morning, in the form ot Plummer’s pill, and discontinued the medicine after a short period, with¬ out constitutional disorder having* super¬ vened. The hydriodate of potass suc¬ ceeded its use, and in a few days in¬ duced salivation. But in another in¬ stance, swelling of the glands having been too suddenly attributed to hydrio¬ date of potass, inasmuch as the tume¬ faction subsided under its continued ad¬ ministration, it was thought proper, in the former case, to continue the medi¬ cine ; hut salivation rapidly increased, and was alleviated only when the hydriodate was withheld. A metastasis of the tonic and stimu¬ lant action of hydriodate of potass to various organs may result from its con¬ tinued administration. The stomach, probably the oesophagus, as w'ell as the intestines, may he made subservient to the transmission of its effects. In these jarts the local action must be stimulant before new power can be imparted through them to tissues which are re¬ mote, and connected less, if at all, by continuity, than by a medium of ner¬ vous fibres. In thickening of structure, such as is found in the mucous tegu¬ ment of bronchial tubes, there is a cer¬ tain degree of atony ; that is, the cir¬ culation in the part is retarded by the condensed state of the tissue, and’tbere is little advance made by its absorbent and excretory vessels. in this di¬ lemma the stimulus of hydriodate of potass, urged from the stomach to the bronchial membrane, is not at first stimulant at its final destina¬ tion, but tonic ; nor until a higher vitality becomes established, is a sti¬ mulation induced in the thickened structure. This, however, being* once accomplished, that is, the action of natural tonicity being exceeded, the ab¬ sorbents will begin their task of carry¬ ing off the superabundant particles which constitute thickening; secretion follows ; the blood is freely oxygen¬ ized, and the function of animal temperature restored. And by what means are the absorbents thus induced to act? Before, unable to restore the condensed tissue to a normal state, they became insensible to the sti¬ mulus of particles which it should have been their first duty to release from organic relations ; an artificial stimulus renews their tone, — they experience ex¬ traordinary power. Organic particles, bordering on the transition state from solid to fluid, are the stimuli of ab¬ sorbents attached to tissues for their gradual removal ; the hydriodate of potass similates through nervous media those stimuli; the exercise of the ab¬ sorbents gives these vessels strength, w hich, if at first ineffectual, is finally sufficient to break down the organiza¬ tion, and convey the detritus into the circulation. Thus is established a new confirma¬ tion of the truth, that medicine in its successful action is an imitator of nature, the stimulus of the substance in ques¬ tion on the absorbents being similar in kind, although not in degree, to that of solid particles about to be removed by them from a healthy tissue. In the same way as it acts on the duodenum with a power like that of chyme, and deceives the intestines with a chyle-like action, it similates the natural stimuli of absorbent vessels. But what is to be brought forward hereafter as a principal means of curing certain diseases with the hydriodate of potass, may be here alluded to as ac¬ cessory to its constitutional effects, — the power of carrying off bile from the system, and by opening the duct, of causing a free passage for the elements of diseased structure which the ab¬ sorbents may have added to the blood. By tracing the symptoms which hy¬ driodate of potass produces on a living body, we are only tracing the direction and distribution of nervous fibres, and determining1, by the simplest process of discovery, the manner in which it acts. For instance, in hysterical subjects, in¬ stead of fulfilling, as intended, any par¬ ticular indication, it will act as soon as swallowed on the stomachic, and pro¬ bably the oesophageal branches of the pneumo-gastrie nerve ; and spending its power on the superior laryngeal and the adjacent nerves, produce globus hystericus, which will continue some¬ times for several hours. Moreover, in tracing these symptoms in comparison with the disease existing, we obtain a still higher confirmation of the truth. A person with enlarged prostate, having taken hydriodate of potass, felt, after a reasonable time, a constant and plunging pain in the sacrum. An occasional pain then ex- 500 ANALYSES AND NOTICES OF BOOKS. tended along’ the line of the perineum, striking the prostate, and the extremity of the penis and rectum. Again, the bearing-down pains and others connected with the uterus which are attended by pain in the sacrum, may be removed by hydriodate of potass. These two instances show' that the branches of the hypogastric plexus and sacral nerves which are distributed at the colon and rectum may equally be attached in those parts by an hydrio¬ date, with a view to the relief of dis¬ eases which are under the control of its final distribution. And the manner in which the indica¬ tion is fulfilled is this : — A pain in the spinal cord is expressive of increased action, which art or nature may produce. In either case the new energy is given to nerves proceeding from the seat of excitation to its disordered viscus, to establish in the latter a process of cure. The hydriodate of potass, stimulating the spine through the nerves which ac¬ knowledge its source, and at the same time acting in like manner on the hypo¬ gastric plexus, the two-fold effect is conveyed to the terminations of the united nerves. In the first of these cases, that of dis¬ eased prostate, the action is set up ; in the second it is made complete. It is the desire of the author to illus¬ trate these theories by the cases on which they are founded, in a succeeding paper. CORRECTION OF AN ERROR IN THE NEW PHARMACOPOEIA. To the Editor of the Medical Gazette. Sir, May I beg that you will insert, in the next number of your journal, the follow¬ ing correction of a very palpable error in the formula for the extemporaneous preparation of hydrocyanic acid, intro¬ duced into the new edition of the Phar¬ macopoeia Londinensis ? I am indebted for its detection to Mr. Thomas Henry, operative chemist, of Great Ormond- st.reet. — I am, sir, Your obedient servant, C. H. Dec. 24, J83G. Tn 8vo. p. 50, 1. 21, — in 32mo. p. 61, 1.9: — pro granis novem cum sennsse, lege gr. 48*5. In 8vo. p. 50, 11. 22, 3,— in 32mo. p. 61, 1. 11 : — pro Acidi Hydrochlorici di- luti minimis novem, lege Acidi Hydro¬ chlorici gr. 39’5. ANAL YSES and NOTICESof BOOKS. “ L’ Auteur se tue a allonger ce que lelecteur se tue a abreger.” — D’Alembert, A 'Practical Treatise on the Manage¬ ment and Diseases of Children. By R. T. Evanson, M.D., and H. Maunsell, M.D., Professors in the Royal College of Surgeons, Dublin. The lack of good scientific books on children’s diseases in this country, has long been felt by practitioners, young and old, and might well have formed a ground of reproach to British medicine, if there were not other topics fully as strong’, and probably more obvious, to be urged by our continental brethren. Both in France and Germany, great at¬ tention has been paid to the subject, and in the latter country there are pe¬ riodical wrorks regularly established for the publication of papers on the diseases of infants, and their proper modes of treatment. Two of these wre announced not long since, among our notices of re¬ cent German works. But we hope, nay, we think there are symptoms of it, that this unseemly defect in our medical literature w'ill be gradually supplied. The volume before us is more than an earnest of a better order of things. The authors have had ample opportu¬ nity of acquiring experience on the subject about w hich they have written, and, as it seems to us, they have pro¬ fited by the occasion. Their book bears intrinsic evidence of the fruits of careful observation ; it is judiciously and skil¬ fully drawn up, and exhibits the joint production of the fellow-labourers in a very attractive light. Dr. Evanson treats of the peculiari¬ ties of the infant structure and consti¬ tution, of infant pathology and thera¬ peutics, of the diseases of the digestive org’ans and the brain, &c. ; while Dr. Maunsell considers the physical educa¬ tion of infants, the accidents and dis¬ eases peculiar to new-born children, dis¬ eases of the respiratory organs, vacci- THE CORPS D’ ELITE OF THE NEW UNIVERSITY. 510 nation, eruptive fevers, and constitu¬ tional diseases occurring1 during the infantile period. It will be seen that the range of to¬ pics is extensive : we can safely add, that it is wrought out diligently in every part. The volume is compendi¬ ous, hut it must not be confounded with those Mothers’ Guides and Nur¬ sery Treasures which make their mis¬ chievous, or at least good-for-nothing, appearance from time to time. It as¬ pires to a scientific character, and we doubt not will be found useful by all who have to grapple with the difficul¬ ties of practice. A Description of the Bones , for Stu¬ dents in Anatomy. By J. F. South, Assistant-Surgeon to St. Thomas’s Hospital. Third edition. This new edition is rendered far supe¬ rior to its predecessors, by being richly illustrated with wood engravings inter¬ mixed with the letter-press. We think it must be one of the best manuals of osteology for the student. MEDICAL GAZETTE. Saturday , December 31, 1836. “ Licet omnibus, licet etiam mihi, dignitatem Artis Medicce tueri ; potestas modo veniendi in publicum sit, dicendi periculum nonrecuso.” ClCKRO. THE CORPS D' ELITE OF THE NEW UNIVERSITY. W e last week pointed out our objec¬ tions to one of the most conspicuous principles of the new University — namely, that which places all educa¬ tion under the control of the Minister,-— an arrangement the more extraordinary coming from an administration who found their claims to public favour on the ultra-liberality of their politics. Next to this most un-Eu«dish resrula- lion, the worst feature is the spirit of monopoly already evinced, and we may add, the injustice displayed, towards many existing schools, — two only being named in the charter, al¬ though the right of others to a like dis¬ tinction was admitted in certain speeches, which, though possibly forgotten by the orators, are — thanks to Hansard — not lost to the world. True, we are told that other establish¬ ments may be added hereafter; but why was this not done at once ? Why is an equality in this respect not given to all who equally deserve it ? Why are others to sue, cap in hand, for that w hich is conceded without question to two in¬ stitutions ? The answer is quite obvious : to favour that establishment, w hich en¬ joys the patronag-e of the government. But it may, perhaps, be said, the mi¬ nisters did not know of any other schools worthy to be so honoured. Now our business is with medicine; and we say in reply, that, with regard to our profession, they did know of others ; that they v:ere aware of the existence of numerous medical schools as good as those selected; and that this knowledge resulted from theirhaving* put the teachers in those schools to an immense deal of trouble, and to the expense of 450/., to make good their rights before the Privy Council. In words and speeches the ministers at length acknowledged those rights, — and acknow ledged only to disregard them. When Mr. Tooke made a motion, praying* his Majesty to bestow a charter on University College, Lord John Russell, in his place in the House of Commons, observed, that “ he (Lord John Russell) had been present at that Council. * * * The great objec¬ tion appeared to him, and he believed all the Council thought so, to be not so much on the part of the two Universi¬ ties, as on the part of the medical schools of London, and he thought that the other schools of London would be en¬ titled to confer medical degrees, if that power was given to the University of London*.” Such w'ere the words then * Hansard, Vol. xvii. p. 299. 602 THE CORPS D ELITE OF THE NEW UNIVERSITY. used by the Secretary of State for the Home Department ; and we leave it for our readers to judge how far they are consistent with the omission from the charter of every one of the medical schools whose merits he thus acknow¬ ledged. It is necessary to Jay down certain regulations as to the period and man¬ ner of study suited to the average capa¬ bilities of human intellect; and it is proper to take care that the means re¬ quisite for acquiring knowledge shall have been enjoyed ; but beyond this all should be free and uncontrolled. Certain of the larger and more influential schools of medicine, as a matter of course, will be admitted, were it only for the sake of decency; but with some not less deserving it will probably be otherwise; and thus a most objectiona¬ ble system of preference and patronage take the place of free and open compe¬ tition. Again: of the men chosen to carry this compound of radicalism and oppression into the walks of science, we remarked last week, that all we could say of them (with a few exceptions) was, that they were respectable ; and we cannot, on re¬ flection, find any epithet more applicable to their general standard of scientific or professional acquirement. With regard to some of the appointments, we are not aware that any rational explanation can be offered : the parties may thank their stars, and say with Malvolio, “ Well, ’tis Jove’s doing ;” or they may perhaps remark, on the same authority, that “ some are born to greatness.” Several of the nominations, how'ever, are very easily accounted for. We have four or five physicians who entailed a debt of gratitude on the Chairman of the Medical Parliamentary Committee, by the unmitigated bitterness of the evidence they gave against their own College ; at least if this be not the cause of their selection, we confess ourselves at a loss to offer any feasible conjec¬ ture on the subject. Here there is all obvious connexion between the cause and the effect; and this illustrates the second mode of advancement — for “some achieve greatness.” One respected phy¬ sician, holding a high professional office under government, we are assured became a “ senator” upon compulsion, and another, the best known of all in the paths of science, had his name in¬ serted w ithout the preliminary courtesy of asking his permission ! Nor is this a solitary case ; and here w'e have il¬ lustrations of Malvolio’s third mode of advancement — for “some have greatness thrust upon them.” We do not wish to say any thing w an¬ tonly to hurt the feelings of the gentle¬ men in this department, but the plain truth is, that there is not one pre-eminent man among them, and of the two or three who enjoy any distinction, this has been acquired in some other branch (as natural history, or natural philoso¬ phy), and not in the teaching or in the practice of their ow n profession. But if the new University be weak in physic, what are we to say of the other departments? What names re¬ nowned in surgery are to grace the embryo diplomas? Who are the illus¬ trious men who have been selected to counterbalance the fame of the College in Liiicoln’s-Inn ? Let the profession hear, and mark it with admiration. They are Sir S. L. Hammick and Mr. Kiernan. The name of the former may possibly be known to our readers, as we announced his elevation to the baronetage a few’ years ago. An inju¬ dicious friend of this gentleman, who has written in defence of his appoint¬ ment, tells us that he has performed the operation of amputation two hun¬ dred and eig’hty times ! Without dis¬ puting the accuracy of an informant so intimately acquainted with the details, we take leave to ask him whether, il THE CORPS D ELITE OF THE NEW UNIVERSITY. 503 Mr. Hammick had not happened to at¬ tend Lord Grey’s family during their residence at Plymouth, it is probable that he would now have been either a baronet or a “ senator,” even if he had cut off the arms, as well as the legs, of the 280 persons whose limbs he ampu¬ tated ? The name of the latter gentleman (Mr. Kiernan) cannot, we are sure, be forgotten,' as that of an ingeni¬ ous young anatomist, whose papers on the liver have deserved and received our warm commendation ; but whose name is yet wholly unknown in surgery. And could no other surgeon be found, to give something like respectability to this department of the University — none to save it from mere mockerv ? * %/ In London there was none ; no Eng¬ lish surgeon, who had a name or repu¬ tation to lose, would hazard either; hut Ireland had “ our well-beloved Surgeon- General ! Philip Crampton, Doctor in Laws.” Did Mr. Crampton know that he was applied to as a dernier ressort , because all of bis own rank here declined ? Are his prospects in Dublin so reduced that he will come to London, on the strength of an appointment which none of his compeers here could be prevailed upon to accept ; or is it the plan that he shall not be required to visit the metropolis, but have the di¬ plomas sent to him like bills of ex¬ change, for the benefit of his signature ? We would strongly recommend this last arrangement, as the safest to be adopted ; for though we readily ad¬ mit that he is a distinguished sur¬ geon, yet he may rest assured, never¬ theless, that the “ General of the Lan¬ cers*” is much better known in the Irish metropolis than here. * The Surgeon-Ge??er«n is, or was, in the habit of going to the Lord Lieutenant’s levees in a splen¬ did military uniform. On one of these occasions. Lord Norbury, observing him pushing- his way, with some difficulty, through the crowd, cried out, “ Make way, there ; make way for the General of the Lancers .” When a young man has been edu¬ cated as a surgeon in London, and has passed the ordeal at Lincoln’s- Inn Fields, he carries with him a document which commands respect, in whatever part of the civilized world his destinies may carry him. What is this owing' to ? Simply to the names attached to his diploma — to the signatures of Cooper and Brodie, of Lawrence and Travers, of Green, of Keate, of Guthrie, and others of scarcely inferior note. No proof of this is necessary, but we give the following anecdote, because it is a striking illustration of our ar¬ gument. — In the early part of the present civil war in Spain, a young English surgeon presented himself in the Carlist army, then pent up among the mountains of Navarre. He was wholly unknown, and had no voucher of any kind but his surgical diploma. Zumalacarreguy saw the name “ Astley Paston Cooper” attached to it, and ap¬ pointed him without further inquiry to be a surgeon on his staff. We should like to know if the whole list of Senators of the new University, from Lord Bur¬ lington downwards, would have done as much for him P But there is yet another branch in the medical department of the Univer¬ sity : Messrs. Bacot and Ridout, two of the examiners at Apothecaries’ Hall, are Fellow s and fellow “ Senators.” We attribute their nomination to a piece of skilful generalship on the part of Mr. Warburton. The Colleges of Physicians and Surgeons would not be seduced ; but we understand that he flattered the Apothecaries into acquiescence. The gentlemen above named are wise, too, in their treneration ; for if the University succeed, their former occupation will be gone ; and if it fail, they have only to retreat ag'ain to their brethren at Blackfriars. But for the other mem¬ bers of the Worshipful Society, what are they about? — are they drugged 504 THE CORPS D ELITE OF THE NEW UNIVERSITY. ■with their own opium, not to perceive that the success of the University must be their destruction ? The College of Physicians has some prestige — the Col¬ lege of Surgeons some reputation ; both have the magic of a name to support them ; but what have they of the “ Hall” to trust to ? If their chairman and most redoubted examiner concur in conferring diplomas at another Board, which carry with them the Doctorate, who, think they, will apply to them for an entitled license ? As three surgeons were appointed, so also were there three general practi¬ tioners ; the third being no less a per¬ son than the fashionable apothecary who attends the present Premier and several of his colleagues. Mr. Penning¬ ton - - ; but he has had the good sense to direct that his name may be withdrawn. We have neither heard of, nor can discover, in the selection of the “ Se¬ nators,” any one avowed or ostensi¬ ble principle which is not violated. Th us the absence of the names of those best fitted for the task of Exa¬ miners is attributed to a determina¬ tion to admit no one actually en¬ gaged in teaching; and this with a view of securing’ impartiality. Yet Mr. Faraday teaches at one school, and Mr. Braude at two ! Again, the same motive is assigmed for the exclusion of those connected with hospitals ; but to this an exception is made in favour of Dr. Billing', — for what reason, does not appear on the record. In fact, the only principle consistently followed out is that of placing- on the senate the greatest possible number of persons connected with University College, Gower-Street, — and this also, doubtless, with the view of securing impartiality. Neither are the blunders which have been made in the names and designa¬ tions of the members of the Senate less remarkable. Several of them are wrong spelt ; two Fellows of the Colleg'e of Physicians are robbed of that distinc¬ tion, while it is bestowed on two others to whom it does not belong; nay, in one instance a surgeon is mistaken for a physician, and assigned to the wrong College ; although it is now' in evidence that he has amputated more limbs than the Body in question has members. In fact, it is difficult, in reading over the names, to say which is most calculated to excite admiration — the excellence of* the selection, the correctness of the de¬ signations, or the felicity of the or¬ thography. Here, then, we enter our protest. Nothing would have given us more gra¬ tification than to have seen a medical institution on really liberal principles, by which the summi honores should have been open to all, without the ne¬ cessity of leaving the metropolis. But the new University is only calculated to remove the distinctions in the pro¬ fession, by “ levelling downwards.” It is an embodying of the “ One Fa¬ culty” chimera, by which all grades are to be done away, and consequently the chief motive to exertion destroyed. It is a blind and stupid confounding of the aristocracy of intellect with aristocracy of birth ; as if the same reasoning applied to each ; — and so far as its influence may extend, it is to secure to mediocrity the same rank as to the highest attainments. It is to throw down the torch of discord be¬ tween the existing corporate bodies and the new — between the alumni of the one and the graduates of the other. And while in principle it combines democratic professions with an arbitrary subjection of science to political power, it establishes a system calculated to ruin many of those now engaged in teach¬ ing, and to give a shock to the whole fabric of education in this country, the effects of which years may not be sufficient to undo. 505 dr. Seymour’s clinical lecture. TREATMENT OF MEDICAL WIT¬ NESSES UNDER “ WAR LEY’S ACT.” We have not room this week for any remarks on the subject to which the following- letter relates, but shall take an early opportunity of placing’ in its true light the conduct both ofWakley and his “ very obedient servant,” the coroner of Yarmouth. Meantime Mr Aldred must not be prevented from expressing his opinion of the worthy pair. To the Editor of the Medical Gazette. Sir, A letter appeared in the Lancet of last week, from Mr. Ferrier, the Coroner of Yarmouth, attempting to explain bis conduct. I shall take no notice of any of his insinuations, but will pledge my¬ self to prove the correctness of my state¬ ments, and the falsehood of his, pro¬ vided mine are denied by any person upon whose word I can piace the slightest reliance ; but it would be like fighting* with a shadow to reply to any thing said or written by such a person. As to his malignant observations unon my lithotomy case, I have merely to ob¬ serve, that I acted by the advice of much better and more experienced surg-eons than Mr. Ferrier (who, by the by, has only been in practice seven years long’er than the person he designates the very young practitioner). Before conclud¬ ing, I beg to assure Mr.Wakley that he may vent his low abuse and slang upon me as long as he likes, as I con¬ sider his character as much upon a par with that of his correspondent Mr. Ferrier. — T remain, sir, Your obedient servant, Chas. C. Aldred. Yarmouth, Norfolk, Dec. 26, 1836. CLINICAL LECTURE, Delivered at St. George’s Hospital, December 16, 1836, Bv Dr. Seymour. ORGANIC DISEASE OF THE STOMACH. There are not many cases in the hospital at present respecting which I w ish to ad¬ dress you ; I will, howrever, notice one or two— one in particular, because I spoke of it in the second of this course of lectures, and it has issued precisely in the manner which I expected it would do when we first considered it. It is the case of a man named Wilson, and you may remember that I spoke of him as labouring under organic disease of the stomach*. I told you that there was a tumor situated midway betw-een the um¬ bilicus and the superior anterior spine of the ilium, on the left side. I mentioned that we not unfrequently found the sto¬ mach pushed down in this direction, and the pylorus being thickened externally, it gave the appearance of a tumor. After a little time the pain which this man suffer¬ ed in the tumor wras greatly relieved by the application of leeches, and subse¬ quently it disappeared altogether. This led some gentlemen to doubt how far the diagnosis was a just one; but the man’s appearance, the w ater-brash, and the cer¬ tainty of the tumor in the first instance, always made me feel satisfied that the complaint still remained. The fact is, he lay in or on the bed for some successive wreeks, and the tumor not adhering to the parietes of the abdomen, the stomach changed its position, and the tumor dis¬ appeared. For a short time he was so well, that I thought it very likely that he would not remain much longer in the hospital. All the symptoms were quiet until the 28th of last month, when he began to be attacked with a very remarkable kind of fever, a fever evidently denoting that suppuration was going on in some internal organ. There was a violent accession of heat; shi¬ vering followed by heat, and sweating to a very great degree; and as this diminish¬ ed, there were all the symptoms of that great disturbance of function which is termed typhus fever — low fever. There was a dry dark tongue, subsultus tendinum, especially in the muscles of the face, and occasional vomiting. It was quite obvious that this was a token of a very considera¬ ble degree of disturbance going on in the system, and of the internal disease having- taken on some accession. When this had continued about a wreek he died ; and, upon opening the body, we found that about one inch above the py¬ lorus was a tumor about the size of a pi¬ geon’s egg, and which was attached to the coats of the stomach. The coats of the stomach around that part wrere greatly thickened, and in one portion were so ac¬ cumulated as to contain, in a depression * Vide Medical Gazette, No. 465, p. 151. 506 DR. SEYMOUR S CLINICAL LECTURE. formed by the thickened coats, a space about sufficient to enable you to place in it a walnut. In addition to this, a tumor of the same kind was seen attached to the cellular membrane of the pancreas, w hich, upon being cut into, was soft, as if it were undergoing an operation similar to suppuration. A part of this which was still hard presented a melanotic appear¬ ance, shewing evidently the malignant and cancerous nature of the disease. I have no doubt, from the changes which took place in the large tumor, that during life it wras the size of a hen’s egg. This cause gave rise to a set of symptoms which would have been called, if no internal dis¬ ease had been visible, a ease of typhus fever. You are to remember that the same symp¬ toms would have been set up from inflam¬ mation of the brain, from inflammation and ulceration of the bledder, from inflam¬ mation and rapid ulceration of the small intestines, or any other rapid lesion of an internal structure, the due performance of the functions of which is necessary to life. HYSTERIA. The next case respecting which I mean to speak, and which I shall take an oppor¬ tunity of doing in this lecture, is that of Vaughan, who came in labouring under rheumatism*. Subsequently to her get¬ ting well of that complaint she had a vio¬ lent attack of that form of disease termed hysteria. Even w'hen she was cured of the rheumatism the nervous system was in a state so easily admitting of being disturb¬ ed, that it was quite impossible to send the poor woman back to her labour; at the same time there was no great disease — cer¬ tainly no disease of structure ; nothing but a general derangement of function re¬ maining. This case will lead me to speak of hysteria in general. It is of great importance in a practical point of view7, to know' the real disease from that which may be called, under particular circumstances, the simulated disease. Everybody knows what an hys¬ terical fit is. The patient complains of something rising up into the throat like a ball, w hich cannot be swallowed ; this is usually followed by a convulsive motion of the muscles, often of the trunk and of the face, accompanied with laughing, cry¬ ing, screaming, and violent efforts to swal¬ low at the same time, but always an alter¬ nation of crying and laughing. This is termed an hysterical paroxysm. Nothing can be more common than this; but you are not to suppose that hysteria stops here. One of the great masters of our art, Sy¬ denham, who once enjoyed considerable practice, and wrho still possesses great re¬ putation in the medical world, says that the changes of this particular disease are more variable than the hues of the chameleon. But it sometimes takes on, or simulates, all the appearances of in¬ flammatory disease in different viscera of the body. It not only does this, but it gives rise to a train of symptoms, or men¬ tal disorder as it may be called, which leads the patient to practise imposition. I know nothing more difficult, or more necessary, than to endeavour to distin¬ guish between these two diseases, because in the one case you may do a great deal of good, and in the other you may really kill the patient — by overlooking a real inflam¬ matory state, on the one hand, or taking an hysterical state for inflammation, on the other. I stated that every one knows wrhat an hysterical fit is ; but there is another set of symptoms which accompanies this con¬ dition of the body. There may be pain over one eye, and you can cover the part affected with your finger; this is termed claims hystericus. Sometimes there is pain in the hypochondriac, but it most fre¬ quently occurs on the left side ; and hence it has been supposed to arise from the va¬ pours of the spleen, especially if in such circumstances the patient is low-spirited and fantastical. You will find it spoken of in books, and you will hear persons talk, as if the patient were labouring un¬ der vapours of the spleen— a sort of hys¬ terical condition. But although the pain is a most remarkable symptom, it may be doubted whether it arises from that source. Patients are often troubled with flatq- lence ; and some persons believe that where the left hypochondrium is affected, it arises from wind in the stomach ; and where the right hypochondrium suffers, that the wind is collected in the upper part of the abdomen. In either case, how¬ ever, it is simply a symptom, and is to be taken together with the other symptoms of the complaint. I do assure you, that scarcely a week elapses in which I do not see cases where these symptoms have been treated as symptoms of acute disease. Be¬ cause acute inflammation of the liver, or the spleen, is laid down in books as pro¬ ductive of pain in the right or left hypo¬ chondrium, increased on pressure, and be¬ cause the patient in hysteria complains of pain increased on pressure, it is therefore concluded that she labours under one of the former complaints. But in hysteria * Vide Medical Gazette, No. 464, p. 1 17. HYSTERIA. 507 the pain is so increased, that no inflamma¬ tion except the acutest form could give rise to so much suffering when she is touched. The patient’s health is some¬ times not affected, or if affected, it is in a dilapidated condition. In general, though not always, the menstrual discharge is ir¬ regular^ it is too much, or, which occurs more frequently, too little 5 or it does not take place at the natural periods. You have, then, this second form of the dis¬ ease. But hysterical paroxysms will come on in such a condition of the body as this, of the most alarming kind. The patient will be for hours together with the back bent, as in opisthotonos, with the teeth clenched, and the hands and fingers drawn in. At other times there will be great difficulty of swallowing, and at others great difficulty in passing water; and this is very commonly the case in hysterical women. The next form of the disease is where the mind seems to be still more affected than the body, with this general derange¬ ment and nervous sensation. The patient will try to persuade the practitioner that she has real disease. Hence the cases which occur of sand and gravel being pre¬ sented as having been passed from the bladder, such sand and gravel as you know could not originate in an animal body; very different secretions from what take place there. At other times stones, and even Jiint stones, are shewn, and are said to have been passed from the bladder. Such cases, although 1 do not mean to say that they are the most common things in the world, are by no means uncommon. There is scarcely a physician of any prac¬ tice in this town who has not seen cases of this kind. At other times the patient will cat nothing. I saw a young lady who for several months had taken nothing but half a cupful of tea two or three times a day, and in this condition there were hysterical fits almost amounting to epilepsy. You have, therefore, in the treatment of this disease a great deal to which to at¬ tend. In the first place, knowing as you do that a great number of the^e cases are simulated, you are to be firm in your treat¬ ment, not to be biassed on one side or the other by persons coming and giving you their adv ice. You have at the same time to be very firm with the patient; but take care that you do not disgust her by laugh¬ ing at her, or ridiculing her, for she will in that case imagine that you cannot cure the disease, and she will send for some one else who is more credulous or patient. You must bold a tight vein, insisting upon that being done which is necessary, and stating to the family that in the end the patient will recover if such means be put in practice. But it often requires a very great deal of care and attention in order to effect this. Sometimes there is even vo¬ miting of blood: this occurs in this very patient. 1 here is sometimes hysterical palsy in the lower extremities. I saw a case of hysterical palsy which occurred in a servant. She had been very laboriously exercised, her health had given way, and she had palsy of the lower extremities. She had been bled four times, and had had on eleven blisters. When I saw her there was a want of due circulation, blisters arose on her extremities, her back slough¬ ed, and she died in consequence of it. Now this was not an imaginary ease. I will tell you one instance which occurred lately, and where the treatment was suc¬ cessful, and therefore it is a much more important case. A very young lady, and of uncommonly active appearance, had three or four years ago a fall from a horse. It was said that she sustained concussion of the brain. I mention this to show that the ease was complicated. She had been well for three years, and the blow might have been forgotten, as if it had not hap¬ pened. Latterly, however, she had be¬ come exceedingly ill : there was pain in the head, pain in the back, globus hysteri¬ cus, and towards the evening there came on a violent fit, resembling very much something between epilepsy and hysteria. She was abroad at the time. She was cupped, bled, put on a course of mercury, and had moxae applied all dow n the spine. She was then brought to England that a physician might attend her here, and she came to town. 1 have seen her for three hours bent like an arch, with her feet be¬ hind, her hands clenched, her teeth shut, exhibiting the strongest instance of what is called tonic spasm which I ever saw in my life, as bad as you see repre¬ sented in pictures of tetanus. Yet all this went off with the hysterical fit: it was neither more nor less than hysteria. On one occasion 1 w as sent for to see her, and I did w'hat I cannot recommend you to do : disregarding inconvenience altoge¬ ther, 1 poured pail after pail of water upon her as she lay on the bed, and then forced her to drink a large quantity of sal vola¬ tile. Then came the trial of getting her to take food ; for the patient always sets herself against it : it is not that she cannot take it, but she will not. She was then ordered a dr; chm of asafoetida, an ounce of lime w ater, and half an ounce of pi¬ mento water, to he given two or three times a day. It is exceedingly nasty, no doubt, hut it has an effect of which you 508 dr. seymouh’s clinical lecture. really have no idea. This patient was given a combination of conium and galba- num as well as asafoetida. By degrees she got better, the paroxysm which used to come on at six o’clock in the afternoon went off, and then came a spasmodic shut¬ ting of the eyelids. That likewise left her, and then she was able to stand. But I should tell you that when the case was first brought to England the whole of the lower extremities had entirely lost their motion, and very nearly their sensation. This, combined with the fact of the blow, the cupping, and the application to the spine of such an abundance of blisters and moxa?, would render the case very com¬ plex. Still, from the circumstance of the patient’s general appearance and good health, with her quietness when hot in a paroxysm, her age, and the irregularity of the uterine discharge, I entertained no doubt of her condition, and the young lady is now perfectly well. Before she went out of town I requested that Sir B. Brodie might see her, because, if there should be any return, persons might persuade her friends — and they might be themselves mistaken — that she was suffering from disease of the spine. He accordingly exa¬ mined the spine, and it was in a perfectly good condition ; but at the same time the appearance of the scars on this part of the body, which had been produced by the severe treatment she suffered abroad, was quite extraordinary. I have not the least hesitation in saying that every one of the measures adopted was unnecessary, — that every one aggravated the disease, so that she nearly fell a victim to them. Hence you see the great necessity of understand¬ ing well what may be called apparent dis¬ ease, in contradistinction from that which arises from a real affection. Unfortunately the patient often has pain in the right or left hypochondrium ; and when it occurs on the right side, it has been called hypo- chondrialgia. This pain, if it were really arising from an inflammatory condition of the structures, would be attended with a febrile pulse, with a foul tongue, with great disturbance, and great depression of strength ; but it is not attended with any one of these symptoms ; and though the tongue may be more or less white, and the pulse weak, yet the patient bears the application of pressure, and has her usual appearance. Sometimes the disease affects the breast in such a way as to cause it to be tumid. I saw myself a young married woman, who had no family, who, at every period of the menstrual discharge, had such vio¬ lent pain in the breast, and such violent hysterical fits, that it was sometimes thought that she would not survive the night. This was entirely cured by asa- fcetida. There was a casein the hospital, some years ago, of a woman named Osmond, who made a great deal of noise in the world. She had been in love, and was in a disposition of mind disposing her to an hysterical diathesis. It was said that she had taken laudanum, but I could not make that out. When she was brought into the house she was paralytic in the lower extremities, and remained so for some months. None of the ordinary remedies were of any use in removing the palsy, — neither bleeding nor blistering, nor any kind of counter-irritation. They were tried, but in vain, because I did not then know that the disease went to such an extent as to simulate so severe a com¬ plaint as actual palsy of the lower extre¬ mities. At length I put her on asafoetida, and asafoetida alone ; I gave it her at night in pills, and in mixture by day, and kept her quiet. By degrees she began to recover the use of her limbs, and I then ordered the shower-bath, which is an ex¬ ceedingly useful adjunct in this complaint, and she recovered. She went out of the hospital ; she has since married and borne two children, and has never had any re¬ turn of the disease. There was another case which made a great noise some years ago, of a young lady who could not swal¬ low any thing in consequence of a sort of spasmodic action. A number of observa¬ tions were published on the case. She recovered by the constant use of cold affu¬ sion, pouring cold water upon her— (and such cases, in point of fact, you frequently meet with) — followed by rubbing in a drachm of belladonna every two hours, and lin. camphorae compositum. You will remember a woman in Roseberry Ward, with an hysterical affection, which caused her to walk on one side, to whom we applied this remedy, and who got manifestly better. She had not been long in the hospital when she went out, having been in one hospital before. 1 believe she went out because she was getting better, and we were controling the disease. It was not quite her cue to get well, and I have no doubt she would go to another hospital. The most extraordinary part of this business is the imposition which females w ill practise in such circumstances. There was a woman in the hospital wdio had constant vomiting, but there were none of the symptoms usually accompanying it — no real disease of the stomach, no real disease of the brain, and no real disease of the lungs ; and yet she vomited every thing she took. 1 had her very narrowly HYSTERIA. 509 watched, and it was found that her friends brought her opium, which she took in order to produce this vomiting, and to excite my surprise. This was a case purely of imposition. In private life you will meet with persons who under other cir¬ cumstances would disdain a falsehood or imposition, who will practise similar de¬ ceptions. I attended a hoy, who took opium mixed with something else, to pro¬ duce apparent violent spasmodic vomiting during the day. What are we to call the state of mind under which the patient labours when it goes to this extent ? It would be called maniacal ; and yet it certainly depends upon that irregular condition of the ner¬ vous system of which I liavs been speak¬ ing. This great peculiarity of mind — this hysterical diathesis — will be cured by lirmness on your part; by checking if too abundant, or by restoring if deficient, the catamenial discharge, and the use of those foetid gums to which I have adverted — asafoetida, galbanum, castor, and prepa¬ rations of ammonia, such as spirits and tincture of ammonia. Ten or twrelve years ago I w7as very much struck with a case of this kind, which occurred in a young lady about 18 years of age. I had attended her for the measles some months before, from which she recovered. She complained of constant pain in the right side, and it was very severe indeed ; her tongue was load¬ ed, and she was a person apparently of full habit of body, and the pulse was quick. There were all the symptoms laid dowrn in books as indicative of derange¬ ment of the liver — such as pain in the side shooting up to the shoulder, and aversion to food. I had her bled, gave her calomel and saline medicines, — treated her as though she laboured under hepatitis, and under which that disease wrill ordi¬ narily get well. She became no better, and the larger the doses of medicine which I gave, the more constipated her bowels appeared to become. This is a very com¬ mon symptom in young ladies labouring under hysteria ; they bear such large doses of medicine, that you are astonished how a person, otherwise so delicate, can require so much purgative medicine before a mo¬ tion is produced. When this occurs to your mind, be assured that there is no oc¬ casion for such violent means — more mode¬ rate doses, repeated at proper intervals, will succeed when the disordered con¬ dition of the nervous system throughout the body has been removed. Her bowrels were constipated, and at length she began to have great difficulty in making water. I then had a suspicion that it was one of those diseases which we see every day of our lives in a hospital. The course was altered : l gave her some aloetic pills with myrrh, and ordered the shower-bath. The pain in the hypochondrium disappeared, and she got well. I have mentioned the case because it is instructive to you, as pointing out, that wherever you see a young person with this particular form of complaint, unless there be other symptoms, such as disturbance of the natural and vital functions, tallying, as it were, with the great severity of the pain, whether in the side, the head, or the chest, you should doubt whether it is not one of those irre¬ gular cases in which, in order to cure the state, you should strengthen the nervous system, rather than resort to those ordi¬ nary methods of treatment adapted to in¬ flammation situated in the viscera. When a patient has gone so far, it is astonishing how she will sometimes re¬ cover. 1 assure you that I do not exag¬ gerate when I tell you that I have seen case after case of this sort. I saw a young- lady recover who had been pronounced by one of the most competent authorities to be labouring under abscess of the brain. She recovered by means of tonic medicine, by nutritious food, beginning by degrees, and then riding on horseback. She is now quite well. Suppose she had been treated by the urgent symptoms only, by lowering that state of the system which appeared to be set up by structural disease, undoubted¬ ly the patient wrould have died. In the presen t case — that of Vaughan — she was put on asafoetida on the 5th November. She had some slight return of the rheumatism, which was obliged to be cured ; but in this instance the rheuma¬ tism w7as so masked by the hysteria that I gave her opium, and opium alone; of which she took a grain every two hours. The rheumatism being removed, she then returned to the asafoetida, and I have no doubt that she will ultimately recover. It is very uncommon for us not to have two or three such cases in the house. The best treatment, where a patient has a difficulty in walking up stairs, is a drachm of ammonia and tincture of vale¬ rian, placing in the shower-bath, and giving her good diet and rest. The cases which w-e see in the hospital are generally those of young women w7ho have been overworked — servants of all-work, or milliners’ apprentices, or ladies’ maids, who sit up at night for their mistress, and then lie in bed till she gets up, which is generally twelve or one in the day, and who get no sort of exercise. They labour under all those diseases which affect the higher classes of life, and 510 dr. Seymour’s clinical lecture. this is one of the number. Soothe the patient well, and she will speedily get cured. Supposing, however, that the disease is more severe — supposing there is some loss of power in the lower extremities, or severe pain in the hypochondria m — then you must have recourse to foetid drugs, and asafoetida is the best. The most remarkable part of the complaint is, that although patients at first are very naturally disgusted at the nauseousness of the fcetor, yet it is astonishing how soon they get rid of it: after a short time, all the nauseousness of the remedy is taken away, and the patient clings to it — asks for it. The extraordinary me of foetid gums in this disease, has been asserted from the time of the great physicians, who attempted to explain their modus ope¬ rands by supposing that the uterus became swollen and rose from the pelvis, and that the odour of these gums caused it to re¬ turn to its proper situation. This proves, however, the very imperfect knowledge of anatomy and physiology which the ancients possessed. They were in the habit of using odoriferous drugs in fumigation, to entice, and gave the foetid gums to drive the uterus back again. These complaints of a spasmodic nature, and disorders of function of the nervous system, were relieved, 2000 years ago, by those very remedies which are now em ployed ; so that they have the test of experience, whether their mode of operation be well or ill explained. But it is a matter of great importance to remember that their use is confirmed by so many years’ experience. You should carefully consider these par¬ ticular cases at the bedside af the patient. I know an instance at this moment, of a young lady who was thought to be labour¬ ing under spinal disease, and who was kept lying on her back for nine months. It suddenly went away, and then it was suspected that it might be nothing more than hysteria. Such cases, I am sorry to say, are not uncommon. When the patient is young, and there is any debilitating cause, or any irregularity in the catamenia, then you must be especially cautious on this subject, and not believe that inflam¬ mation is set up in one or more parts merely because it seems to be so — because you have the symptom of pain. Great evil was done in our profession by that universal system which went to prove that the liver was the cause of all diseases. Every thing painful in the right hypo- chondrium was referred either to acute or sub-aeute disease of that organ, and that, by the way, in a class of the popula¬ tion — viz. young females— the least ad¬ dicted to those very circumstances which bring on disease of the liver; such as gross feeding and habits of intemperance. Every thing was put on the liver, and blue pill was the universal remedy. The mo¬ ment a patient complained of pain in the right side, it was set down that she was bilious, and that it must be purged oft' with mercury; whereas, in nine cases out of ten, there was only a collection of flatulence, arising from the want of proper exercise and pure air, which are at all times so necessary to the health of the body, When you find the symptoms very dif¬ ficult to manage, and you are quite satis¬ fied of the nature of the case, from the time and attention you have bestowed on it, then the proper way is to speak to the patient aside; state that you are satisfied that it is an imposition, hut at the same time the feeling must arise from ill health, and you will not say any thing about it if she will not repeat it. This often has a very good effect. Dr. Pemberton has mentioned several cases in which such a practice has been attended with great advantage. GO NO RRHCEAL RHEUMATISM. There are hut few eases now remaining in the hospital, and in going round to-day I have scarcely written any prescription. Unhappily, the case of disorganization of the joints, from gonorrhoeal rheuma¬ tism, makes but little progress, though some degree of improvement takes place in the hand. I have been trying counter- irritation in the knees — such as a large blister — and I have subsequently tried tartar emetic ointment, but both produced so much pain that they were obliged to be given up. Fomentations have since been applied, and the patient has been put un¬ der the specific use of colehicum, which in some cases does relieve the pain very materially. Still the great length of time during which the patient has laboured un¬ der the disease, makes me fear that little will he done. Though he has gained more benefit than could be expected, still his knees are so disorganized that it seems im- possible to effect a cure, or at least many years would he required for that purpose. Ho wever, I shall not desist from trying all that the art of physic can do. OVARIAN DROPSY. The very fewT cases which were last taken in are all convalescent, and the patients are about to leave us. There is, however, a case of an ovarian tumor on the left side, in Queen’s Wrard, but the poor wo¬ man is unfortunately labouring under de¬ rangement of intellect, and therefore I do not expect that much good will he done. THE LATE DISTURBANCE AT ST. THOMAs’s HOSPITAL. 511 She was principally taken in because the pressure of the tumor is such that the wa¬ ter is obliged to be drawn oil' twice a-day. She has been put under iodine, which she takes twice a day. It may produce a de¬ cided effect, which it sometimes does, or the tumor may so grow that it will rise out of the pelvis, and thereby the pressure will be removed from the bladder. It often happens that this is the case. I re¬ member, some years ago, seeing a curious case in private practice. One ovary slipped down between the uterus and the colon, and by its weight dragged the ute¬ rus, so as to tilt up the os uteri between the pubes ; and in this way it prevented the proper excretion both of the faeces and urine. A sort of retroversion of the ute¬ rus took place. 1 had the patient brought to the hospital, and applied an opiate sup¬ pository. By keeping her quiet, and hav¬ ing the urine drawn off, the tumor by de¬ grees became larger, arose out of the place where it was nitched behind the uterus, and the latter organ got right again, so that she was enabled, although labouring under the disease, to go out of the house. The case upstairs is of the same kind. Nothing shall be omitted to try to get rid of the tumor by means that produce ab¬ sorption ; but the growing of the tumor will remedy the pressure, and this is the only view with which I keep her in the house. THE LATE DISTURBANCE AT ST. THOMAS’S HOSPITAL. To the Editor of the Medical Gazette. Sir, A singular error has crept into a letter forwarded to you from the St. Thomas’s Hospital pupils, by which the whole tenor of its meaning is altered. May I beg you to correct it, by altering .the monosyllable “ to,” in the eighth line, to “ by,” so that the sentence will stand — “ exhibited by strangers then present.*” I feel satisfied, sir, that your impartiality will not allow you to be influenced by any biassed statement you have receiveJd, or may in future receive, from the gentlemen of Guy’s. Let me ask if those gentlemen mentioned in the communication of your * The error was purely typographical ; but the context and heading of the letter surely ought to have sufficiently explained. — Eu. Gaz. correspondent were present at the dis¬ turbance, — I mean Messrs. Tweedie, Gase- lee, King, &c. Can they be fit judges of that which they did not witness ? You evidently have not been informed that the very first breach of order resulted from that “ crowding at operations” which you so justly complain of in the pre¬ sent number of your journal. The gentle¬ men, I believe, did produce their tickets, but they forced themselves into the space around the table, which the porter had been expressly ordered to keep clear. You have not heard, sir, of the impertinent manner in which both Mr. Travers and Mr. Tyrrell were here addressed, and how the latter gentleman was hooted and hissed, because he gave out that it was im¬ possible to operate under the existing state of excitement. Does it not amount to something more than a misdemeanor, that a multitude of students overpowered a menial, whose most aggravated fault was a strict per¬ formance of his duty; and with cries of “ throw him over,” forced him to the ban¬ nisters of a staircase two storeys high, and were on the eve of casting him over? Was it nothing that this same multitude turn¬ ed the current of their fury upon a gentle¬ man whose noble conduct alone saved them from committing an act of violence rendered shocking bv its premeditation, and the result of which might have been too frightful to bear a thought ? Were the feelings of the patients considered when this outrage actually invaded the wards ? When the proceedings (both pro ate and public) are made known — when the result of the evidence at the Sessions is pub¬ lished, then may you form a candid opi¬ nion respecting which was the aggrieved party, and who were the aggressors: then* and not till then, will the public, and the profession in particular, appreciate the motives of the medical authorities at St. Thomas’s in prosecuting their charge. I may add, sir, that so far from impli¬ cating the character of the Guy’s students generally, considerable regret was, I be¬ lieve, expressed by the officers of St. Tho¬ mas’s that they were unable to detect and separate all, or even the worst, offenders. If the Guy’s gentlemen have chosen to make the cause their own, surely it is not justice to complain of the course pursued by the insulted to obtain restitution for offended dignity.— I am, sir, Your obliged correspondent, A Voice from St. Thomas’s. December 26, 1836. 512 BILLS OF MORTALITY.— — METEOROLOGICAL JOURNAL. LETTER FROM THE PUPILS OF ST. THOMAS’S. To the Editor of the Medical Gazette. Sir, The statement which appeared in your Gazette of last week, relative to the late proceedings at St. Thomas’s Hospital, is verbally incorrect ; it being therein said that gross misconduct was exhibited “ to strangers j” the original expression being “ by strangers.” In justice to the pupils of St. Thomas’s Hospital, you are requested to insert in your next Gazette the inclosed copy of the letter addressed by the pupils to their teachers; of which it may be observed that it does not assume the form of a protest. “ St. Thomas’s Hospital, Dec. 17, 1836. “ The undersigned apprentices, dressers, and pupils of St. Thomas’s Hospital, beg to express to the medical and surgical offi¬ cers and teachers in general, their indig¬ nation at the wanton outrage and miscon¬ duct on the part of strangers, which oc¬ curred yesterday in the surgical theatre. They respectfully solicit the interference of the officers and lecturers, and desire that such measures may be adopted as shall prevent the like proceedings for the future, and ensure to the undersigned the undis- turbed enjoyment of their rights. In fur¬ therance of the above object, the under¬ signed are willing to forego any and all advantages which may be supposed to be¬ long to their privilege of attending the sur¬ gical practice of Guy’s Hospital ; and, taking into consideration the malevolence evinced on the late occasion, they respect¬ fully submit that ajl strangers whatsoever should in future be excluded from the right of attending the practice of St. Thomas’s Hospital.” Here follow fifty-two signatures. St. Thomas’s Hospital, Dec. 28, 1836. MICROSCOPIC DISSECTION UNDER FLUIDS. The late M. Cuvier appears to have been the inventor of the little trough in which microscopic subjects are most conveniently dissected. It is a sort of shallow tray about two inches long, by about an inch and half broad. The mode of preparing it is this: — Take a compound of bees’-wax and Venice turpentine, or Canada balsam, and line the trough with it while warm ; then lay in the subject to be dissected, first having dried the parts intended to be fixed to the compound; and when the whole is cold, the dissection may be commenced, the trough being first filled with water — or very dilute spirit. By using this con¬ trivance, the parts of the subject are more readily separated, and being covered with a fluid, the adventitious portions are easily washed away with a carael’s-hair pencil. The knives used for dissecting microscopic subjects are similar to those employed by oculists for operating on cataract. — For some curious information on this and other practical points connected with the use of the microscope, w7e must refer the reader to Dr. Goring and Mr. Pritchard’s new work— the “ Micrographia.” NEW MEDICAL BOOKS. A Practical Treatise on the Manage¬ ment and Diseases of Children. By R. T. Evanson, M.D., and H. Maunsell, M.D. 12mo. 7s. 6d. Andral’s Clinique Medieale. By Dr. Spillan. 8vo. 25s. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Bee. 27, 1836. Abscess . • 1 Age and Debility . 23 Apoplexy . . 5 Asthma . . 10 Childbirth . . 1 Consumption . 36 Convulsions . 13 Croup ... 2 Dentition or Teething- 3 Dropsy . . 7 Dropsy in the Brain 5 Dropsy on the Chest 2 Erysipelas . . ! Fever ... 2 Fever, Scarlet . 3 Fever, Typhus • 1 Gout . . . 1 Heart, diseased . 1 Hooping Cough . 10 Decrease of Burials, ; the preceding wet Inflammation . 24 Bowels & Stomach 1 Brain . . 3 Lungs and Pleura 3 Insanity . . 6 Liver, diseased . I Measles . . 7 Miscarriage . . 1 Mortification . 1 Paralysis • . 5 Scrofula . . 1 Small-pox . . 1 Sore Throat and Quinsey . . 1 Stone & Gravel . 2 Unknown Causes 3 Casualties • 4 5 compared with > NOTICES. “ A Young Practitioner” may charge both for attendance and medicine ; but he had better specify the latter, and be mo¬ derate. It has been so decided from the Bench. How are wre to know whether the state¬ ments of “ Veritas” are true or false ? Why not give his name? anies the second movement of the leart, and which consists of a rushing , or blowing noise. Yet it may further the object of the present paper, if I state that in every instance of this kind, where I have had the opportunity of examining the heart after death, I have found some change which must have rendered the closure of the aorta by the sigmoid valves imperfect. And 1 had concluded that the same valves were affected in the two cases in which I had heard that different and much louder booming sound, approaching in its tone and quality to the human voice. This conclusion was at length strength¬ ened by the occurrence of a third and fatal case. Case II. — Thomas Bunin, a butler, aged 36, became my patient in the hos¬ pital, on the 27th of last May. His feet and legs were anasarcous, and his belly contained some fluid. He complained of difficult breathing, which prevented him from lying down — of “fluttering” at the heart — and of a slight dry cough. He had been ailing for nine months, with uneasy sensations in his chest, and i palpitation much increased by moderate exercise. Four days before his admis¬ sion his legs began to swell. The orthopnoea had existed for a week. Sixteen years previously, for the only time in his life, he had had “rheumatic fever.” His chest was then blistered, on account of pain which he felt there. Large crepitation could be heard at the lower part of each lung. The first sound of the heart was not unnatural. The second consisted in a long drawn and very loud vocal note, audible to the patient himself, who (unprompted) compared it to the cooing of a pigeon. It was noisier on the right than on the left side of the sternum. He remained in the hospital till his death, which took place on the 2d of July. His dropsical symptoms had gradually increased, and the dyspnoea, which was permanent, became aggra¬ vated in occasional paroxysms of ex¬ treme severity. They were more re¬ lieved by mustard poultices than by any thing else. The loud cooing sound scarcely varied, and was never absent. The recollection of the two former cases made the inspection of the body a matter of peculiar interest to myself. Much curiosity respecting it was shewn also by the students and others, it having been conjectured by some that the cause of the sound would be found in a diseased state of the mitral valve. The heart was very large. The peri¬ cardium adhered to it at all points, by cellular tissue, which was dry, and evi¬ dently not of recent formation ; but neither was it dense or tough. The right side of the heart offered no unusual appearance. The left ventricle was much dilated, and considerably thickened. The mitral valve perfect and healthy. The aorta was narrowed at its commencement by abundant depo¬ sition beneath its lining membrane, which was projected into bosses or little tumors, immediately behind the valves. There was a small ulcerated spot on the summit of one of these projecting no¬ dules. The sigmoid valves of the aorta were curiously altered. They were all irre¬ gularly thickened by opaque matter de¬ posited between the layers of membrane of which they are chiefly formed. Two of them were folded, or rather bung* back, a little way. Their free margins, to the depth of two or three lines, were quite loose and flapping, so that the 528 MR. EVERITt’s REVIEW OF slightest force, even their own weight, was sufficient to incline them to either side, to produce either inversion or re¬ troversion of the loose portion. The edge of the third valve was straight and tight, as usual ; hut the others could not be pulled tight, so as not to flap. They were all capable of perfect appo¬ sition with the sides of the aorta, but the two were evidently not capable of sustaining the backward pressure of the blood in that vessel during the diastole. Th e stream of regurgitating fluid must have occasioned their loose margins to vibrate ; and the vibration doubtless gave rise to the peculiar sound. The physical conditions necessary on acous¬ tic principles, for its production, appear to have been complete. It can scarcely be questioned that the cardiac disease commenced during the attack of acute rheumatism. I have the honour to remain, sir, Your obedient servant, Thomas Watson. Henrietta- Street, Cavendish-Square, Dec. 28, 1836. The present gallon and pint are there¬ fore about one-fifth larger than the old ones ; and the present ounce, drachm, and minim, about l-25th smaller. I shall not attempt to argue for or against the necessity of this change, nor dilate on the possible results. The dif¬ ference in the value of the ounce and drachm is so small, that it may in most cases be neglected, and the old measures used for the new. One of the principal objects of the editors of a Pharmacopoeia ought cer¬ tainly to be, to relieve the medical man from as much as possible of the mental REVIEW OF SOME OF THE PROMINENT NOVELTIES OF THE NEW EDITION OF THE LONDON PHARMACOPCEIA ; AND A Fevj Specimens of the “ great Care, Pains, and Industry ,” with which the Old Edition has been “ Revised, Corrected, fy Reformed.” By Thos. Everitt, Esq. Lecturer on Chemistry at the Middlesex Hospital School of Medicine. In the first place, the measures have all new values; for in the old edition the wine gallon of 231 cubic inches of pure water was taken as a standard ; this was divided into eight pints, the pint into sixteen fluid ounces, the ounce into eight drachms, and the drachm into sixty minims. In the present edition the imperial gallon of 70,000 grains of distilled water, at 62°, is assumed as a standard ; this is divided into eight pints, but the pint is now divided into twenty ounces ; the further division as drudgery of recollecting and calculat¬ ing proportions : might it not, therefore, have been well, when they felt com¬ pelled to alter the value of their mea¬ sures, in order to make them agree with the imperial gallon, to have thrown overboard all arbitrary divisions of pint, ounce, drachm, &c., and have taken the grain, 10-grain, 100-grain, 1000-grain measures of distilled water at 62° ; these st^ill would have been aliquot parts of the imperial gallon. Then, by making all the fluid solutions contain a certain round per centage (a great number m i h t have contained exactly the same) before. Hence — Value in Grs. of pure Water, at 62®. Old. New . Gallon (231 X 252*45) . 58316 70000 Pint . 7289*5 8750 Ounce . 4556 437-5 Drachm . 5695 54-7 Minim . 56 95 54-7 60 60 THE NEW PHARMACOPOEIA. 529 of the active principle, no calculation on the part of the medical man would be necessary. But by the present re¬ gulations we have no unity of design; for some solutions are defined as con¬ taining so much for the fluid ounce or drachm — as, for instance, the arsenical solution, half a grain to the drachm ; some as containing so much per cent., as the dilute hydrocyanic acid, which is to contain 2 per ICO of real acid ; and the same of the other dilute acids, &c. Thus when a medical man has to pre¬ scribe hydrocyanic acid, and wishes to come at the quantity of real acid he is exhibiting by measure, he must call to mind — 1st. That the dilute acid contains 2 per 100. 2dly. That the fluid drachm contains 54 7 grains. Lastly, make the mental calculation, as TOO : 2 : : 54 7 : X. Had they defined the fluid drachm to contain one grain of real acid, all this drudgery would be spared. The next novelty is the “ Notee breves, ad res chemicas praecipue spec- tantes, quibus quidque, sincerum sit, necne quantum fieri potest, deprehen- datur.” These we conceive to be highly valuable ; and had they been more ex¬ tended and precise, and the formulae in the body of the work entirely omitted, this part would have assumed a form which the present state of things de¬ mands. At a period when every druggist was presumed to make his ounce and pound of these chemicals, such formulae were useful ; but now that they are manufac¬ tured by cwts. and tons, it is quite use¬ less giving processes which few will find either economical or convenient to follow. Here again wre observe a want of unity of design ; for why have we not a formula i for preparing sulphuric acid ? “ Be¬ cause,” I suppose they would answer, ; “ any arrangement for making a small [ quantity, would furnish it at a price ten or twenty-fold dearer than as at present made.” This sort of reasoning applies to all the formulae in kind, to many even in degree. Now as all these mat- iters (it is, of course, not intended to in¬ clude mixtures, such as tinctures, plas¬ ters, &c., but only definite chemical products) can be so precisely defined 1 475. — xix. chemically and physically, as to enable any one to distinguish the body named from every other, and to detect the mi¬ nutest trace of adventitious matter, and as by being manufactured on the large scale they are furnished at a minimum cost, why take the trouble of giving a formula, when perhaps half a dozen others may be equally good, and it will depend entirely on the other objects of the manufacturer which is the most economical. Thus A is a maker of car¬ bonate of soda from salt ; he gets hydro¬ chloric acid at the same time. B is a maker of sulphate of magnesia from bittern ; he also gets hydrochloric acid at the same time ; and this acid, pro¬ cured from distilling sulphuric acid with muriate of magnesia, is just as good as that obtained from salt by sulphuric acid, provided care be taken to have it pure. The third novelty is the change of names. Although this may be a source of slight annoyance to old practitioners, every teacher of chemistry and phar¬ macy will hail with joy this alteration, as he was constantly confusing his pu¬ pils by a confounding of the scientific chemical names with those used in pharmacy. This, therefore, will scarcely be a change to all those who have been educated within the last ten years, but will be relieving them from the ne¬ cessity of recollecting the distinction between the two nomenclatures. We will now give a few instances illustrative of the great care with which this work has been executed. Amongst the Notee breves we have the strength of the ammoniae liquor defined 0'960, and of the ammoniae liquor for- tior, 0882; “ liquor hie ad normam liquoris ammoniae redigi potest, cuique fluid-unciae adjestis fluid-unciis tribus aquae destillatae.” In the body of the work we have no formulae for making the fortior, but for the liquor am¬ moniae — “ R Ammonite Hydrochloratis, uncias decern; Calcis, uncias octo ; Aqua?, octarios duos. Calcem aqua resolu- tam in retortam mitte, dein Ammo¬ nia? Hydrocldoratem in frustula con- tritam et reliquam Aquam adjice. Destillent Liquoris Ammoniae fluid- uncia? quindecim.” Now liquor ammoniae of ’960 con¬ tains about 10 per 100 of ammonia ; and 2 M 530 MR. EVERITT’S REVIEW OF THE NEW PHARMACOPOEIA. liquor ammonite of *882 contains about 30 per 100 of ammonia. Hence a fluid ounce at -882 weighs (437-5 x ’882) 386 grains ? and 100 : 30 : : 386 ; 1 15*8 ammonia, 270-2 water. Hence, to re¬ duce this to 10 per 100, or to -960, it will require 774 grains of water, or, in round numbers, 1 f. oz. 6 f. drs. ; at any rate, only 2 f. oz. of water to 1 f. oz. of the stronger to reduce it to the weaker, and not three, as prescribed. Touching the formula, perhaps the worst of those in the old edition was that for preparing liquor ammonise, and in the present the alterations are merely to suit the new measures. Every 54 grains of hydrochlorate of ammonia con¬ tain ! 7 grains of ammonia. Hence as 54 : 17 : : (10 oz. X 489) 4800 grs. : 1511 ammonia in ten ounces; and 15 fluid ounces at "980 weigh (15 X 437-5 X *98) 6300 grains, which, at 10 per cent.9 gives 630 grains of ammonia obtained, and consequently wasted 881, by the badness of the process. What manufacturer will follow a pro¬ cess where the loss is more than one- half? I always consider my operation bungled if the loss amounts to five per cent.; and I proceed thus: — Hydro- chlorate of ammonia, 10 parts ; lime, 8 parts. Put 4 parts of water on the lime, cover it over, and allow it to slake and cool. Put both into a flask having a long neck ; pour in 6 parts of water ; through a cork which fits the mouth of the flask tightly, put a safety tube, and a eras conducting- tube bent twice at right angles; the joint to be secured by lime and white of egg lute. Place the flask in a sand bath ; insert the free end of the bent tube to the bottom of a narrow-mouthed bottle, surrounded by cold water, or ice if at hand. Put into the bottle water, according to the strength of the liquor ammoniae re¬ quired ; for that of -960 about 30 parts ; gradually increase the heat of the sand hath, so as to drive over the ammonia and some water. By the time that the 30 parts of water in the receiver bottle have increased to 35 parts, nearly all the ammonia will have passed over. By operating in this way the liquid has no empyreumatic odour; and I have frequently, on noting the quantity and exact strength of the product, not lost, more than two per cent. ; which has happened to me in two careful repeti¬ tions of this process, made since the new Pharmacopoeia came into my hands. If the liquid be required much stronger, it is better to have two receiving bottles arranged, so that what escapes absorp¬ tion in the first goes on to the second. By having the flask of such capacity that it could contain about three times the quantity operated on, and by its having' a long neck kept vertical, all risk of any of the lime salt spirting over is avoided (much of the commercial liquor ammonise contains chloride of calcium from this cause), and the pro¬ duct is quite pure. For very delicate chemical purposes an intermediate small receiver is useful, but for pharmaceuti¬ cal use quite unnecessary. Hence the ten ounces of hydrochlo¬ rate of ammonia could at any rate make 30 fluid ounces at *960, in the room of 15. The great loss is occasioned, first, by not putting part of the water into the receiver at the commencement, as sufficient does not pass over when the mixture is first heated to condense the g’as ; and, secondly , by leaving so much water in the retort at the end. 1 must confess that this is the worst specimen which a hasty glance has dis¬ covered, and that I have experienced great satisfaction at seeing- many ol the improvements; for having had to lec¬ ture for the last six years expressly on the Pharmacopoeia at Mr. Grainger’s School, it has always been a disagreea¬ ble task to comment on many of the old formulse, which were below all criticism ; whereas, in its present form, it will be comparatively a pleasure to go over the same course. I cannot refrain from stating-, that it is a source of some disappointment to me the not being allowed by the Col¬ lege to make a translation, with com¬ ments, for my pupils ; as four months of last summer, independently of previous investigations, have been closely devoted to experiments on these subjects. I have, however, the consolation to know that the announced work of Mr. Phillips will , as far as my pupils are concerned, render this circumstance unimportant. There is a misprint in the second for¬ mula for dilute hydrocyanic acid, which s not among* the errata of the duodecimo dition ; and as it is from a suggestion I’ my own, I wish to point it out hem. fhe proportion of cyanide of silver , 9-% DR. CLEND1NNING ON THE RESONANCE IN PERCUSSION. 531 grains , and dilute hydrochloric acid , 9 minims , for one ounce of water, ought to be 48-5 grains of the cyanide , and 395 grains of the strong hydrochloric , to produce an acid of the defined strength, 2 per 100. Laboratory, Middlesex Hosoital, Dec. 27, 1836. ON THE CAUSES OF THE RESONANCE IN PERCUSSION. To the Editor of the Medical Gazette. Sir, In a report of a discussion at the West¬ minster Medical Society, contained in the Lancet of last Saturday, it is stated that my friend, Dr. C. J. B. Williams, contended, in a communication to the meeting “ Upon the Theory and Prac¬ tice of Percussion as a Means of Diag¬ nosis” — “ that the sound heard in per¬ cussing the chest is not seated in the air contained within the chest, but that it is dependent upon the vibrations of the walls of that cavity, those vibrations being modified by the quantity of air contained within” — “ that the chest be¬ longs to that class of musical instru¬ ments in which the sound depends 011 the vibrations of a solid, as in the drum, the string of a harp, &c., as distin¬ guished from instruments in which the notes are the results of the vibrations of the air itself, as instanced in the flute,” See. See. ; the author then proceeding, with his usual ability, to illustrate his position experimentally and otherwise. Those observations of Dr. Williams re¬ mind me of the accompanying observa¬ tions and experiments, which I had in¬ tended many weeks since to forward, as I hoped in a more complete state, to the Medical Gazette, and which you will oblige me by inserting in an early number. Some portion of them has been made to clear up a difficulty in which I found myself, upon the occasion of a paper on Percussion, read by me some weeks since at the Harveian Society, and con¬ taining a view of the causation of pec¬ toral resonance, from which my friend Dr. Will iams dissented : I allude to the comparative trials of lung and liver in various media, &c. But the greater part originated in the phenomena of a case that occurred about six months since, in the Marylebone Infirmary, and respecting the interpretation of which there w-as some difference of opinion. The former part appears to me difficultly reconcileable w ith Dr. Williams’s theory of percussion, as expressed in the ex¬ tract above given from the Lancet,and as understood by myself from his oral ob¬ servations at the Harveian Society ; and if verified by others, will, as l‘ think, call for some modification of the theo¬ retical views entertained by Dr. Wil¬ liams on the subject. The latter illus¬ trates a point in semeiolog’y not gene¬ rally w ell understood, as I imagine, and yet worth knowing- — a point respecting which, at all events, I was myself much in the dark, until I had made the expe¬ riments about to be detailed— viz. the ready transmissibility of sounds, such as those occasioned by tapping the chest, and by breathing, through considerable masses of morbid effusion. — l am, sir, Your obedient servant, John Clendinning, A.M. M.D. Sec. Wimpol e-Street, Jan. 1, 1837. George Priest, aged 45, servant of a gentleman in Brook-Street, was ad¬ mitted under Dr. Sims on the evening of June 20, 1836, labouring under symptoms obviously referable to a pleu¬ ritic attack. He had been in his ordi¬ nary health, which he described as g-ood, until within a month of his admission. He was then affected with pain in his right side, and other pleuritic symptoms. An eminent physician in the neighbour¬ hood prescribed for him, and amongst other things introduced Davis’s needle on the side affected, but without obtain¬ ing any decisive result. On his admis¬ sion he complained still of pain in his right side, and had cough and fever, and considerable anasarca ; there was little respiratory sound, little resonance 011 percussion on the side affected, and the motions of the ribs w-ere very slight. O11 the left side respiration was loud, and resonance and mobility normal ; he had the appearance of a person much broken by disease. The pleuritic symp¬ toms were first attended to ; afterwards the dropsical symptoms became urgent, and d iuretics w'ere ordered. The chest had become round, tense, and distended on the right side, which measured more than an inch more than the left ; the 532 DR. C LEND INNING ON THE RESONANCE IN PERCUSSION. distension was especially observable about the hypochondrium, which be¬ came quite tumid. Before this time the edge of the liver had been perceptible far below the level of the edges of the ribs on the right side, and had after¬ wards become imperceptible to the finger, owing to the tenseness of the hypo¬ chondrium. Over the whole of the side affected there remained to the last mo¬ ment, and even on the dead body, above the summit level of the diaphragm, or from about the nipple upwards, a very easily appreciable degree of pulmonary resonance ; far below the normal stan¬ dard, of course, but still clearly superior to that of the region of the liver, or of any solid organ. In the Infirmary, likewise, the needle was tried, but, owing to what cause I cannot say, with no better success than out of doors. Nothing escaped from the puncture but a little bloody serum. This might seem to render doubtful the diagnosis; but whatever may have caus¬ ed the failure of the needle, the real state of the chest could not be ques¬ tioned. Three or four physicians that saw it agreed without hesitation as to its being a case of hydro-pleurisy ; but there appeared still room lor doubt as to the precise condition of the lung', as to the extent of the effusion, and the de¬ gree of compression and shrinking of the lung. On this point there was some difference, more especially between my¬ self and my friend Dr. Harrison. The remnant of resonance obtainable every where above the level of the nipple, and not affected by change of posture, led me to think that the lung must have escaped total compression, owing, pro¬ bably, to some attachment to the ribs preventing its complete shrinking back upon the mediastinum; while Dr. Har¬ rison, from experiments on mediate per¬ cussion, &c. by M. Piorry, W'hicb he had witnessed, and other facts that had fallen under his observation, conceived that the resonance was not less than, or different from, what might be expected in a case of extreme compression and shrinking. The patient lingered a month, and sank the 19th of July last. Permission was obtained to inspect the body, and the following was the result, i shall notice only the appearances bearing' on the subject of the diagnosis. The body was much wasted, and the rounded and enlarged right side ap¬ peared on that account the more strik¬ ingly abnormal in size. The chest gave the same resonance in every part as dur¬ ing life ; the whole right thorax was filled with dark serum, amounting to about 14 pints ; the lung lay solid and concentrated against the mediastinum, and more forwards than the spine, and was of firm spleen-like consistence ; the diaphragm on the side affected wras everted, so as to be concave above and convex below; the right half of the liver was thrust down into the umbilical region, and the left half tilted up, so as to encroach upon the regions of the sto¬ mach and heart; the stomach was thrust down into the iliac and hypogastric re¬ gions ; the lungs were on both sides sound, the compressed lung not less so than the normally distended lung. Such are the memoranda taken on the spot. Now assuming that the serum and compressed lung constituted the whole contents, it is obvious the rem¬ nant of pulmonary resonance observed during life and after death, on the dis¬ eased side, must be attributed to one or both lungs. But I could not conceive that the re¬ sonance of air could be heard through such a dense medium as the effusion from a distance of several inches ; or more properly, I could not believe that, a g'entle tap, such as used in percussion, would cause audible sound in air at five or six inches distance, and protected from the impulse by a thick layer of dense fluid interposed. I accordingly had recourse to experiment, to satisfy myself of the correctness of Dr. Harri¬ son’s view of the matter, and with that intention made repeated trials, with that gentleman’s assistance, with sound and unsound lungs, and with the following results, as recorded in my memorandum- book : — July 29th. — After having removed all the pectoral viscera from the thorax of a female dead of apoplexy, that cavity was filled with water, and a piece of lung was immersed in the water, and percussion practised. The lung was field down under water at various dis¬ tances from the side, and the tap was always given to a part of the walls of the chest below the level of the surface of the water. When the lung wrns held within half an inch or an inch of the rib, the resonance was clear and une- DR. CLEN DINNING ON THE RESONANCE IN PERCUSSION. 533 quivocal, though of course not equal to that obtained when the lung1 was brought into contact with the ribs. At greater distances it was less soft, and much duller, and about four inches from the ribs became obscure. Now the lung used in that experiment w’as much charged wTith blood, and less resonant, probably because more dense than normal. On the 1st of August, therefore, I repeated the experiment, with a lungin all respects normal, but collapsed, of course, and containing but the minimum of air. The chest was tilled and percussion used, as before, and various distances tried ; and in this case the resonance of the immersed piece of lung could be heard at any distance from the spine to the rib per¬ cussed. Indeed my note states that the piece of lung told, on percussion through the water, from the opposite side of the spine — i. e. across one half of th e chest and the spine. Every body present wras satisfied that the resonance was distinctly audible when the lung was immersed in the water close to, but beyond, the spine.” October 4th. — Lastly, we had an op¬ portunity of trying the experiment with a highly emphysematous lung. In this case, the objection that the reso¬ nance in each experiment might be ow¬ ing to vibrations of the portion of the thoracic parietes projecting above the water, as it w as impracticable to fill the chest quite full, was obviated by the use of a screen. The chest was filled as far as it would hold water, and the em¬ physematous portion of lung w as im¬ mersed ; but instead of modifying the resonance merely by varying the dis¬ tance between the part struck and the lung, we used a pasteboard screen also, by inserting which, wholly or partially, between them, without change of in¬ terval, we produced numerous shades from distinct resonance to dulness, and satisfied ourselves that the emerging portion of the parietes was not the cause of the softer or clearer sound elicited by percussion, when unimpeded by a screen or by distance. October 14th. — I again repeated the (experiment with a screen, with perfectly sound lungs, and w ith considerable care, land with the same results, for the most mart, as before ; except that we agreed that the screen did not so completely 'intercept the impulse of the percussion as to prevent the presence of a piece of lung being sensible to the ear across half the chest, provided the percussion was pretty strong and the impulse was given in the direction of the lung. I mean vertically to the lung; for any con¬ siderable degree ofobliquity in the direc¬ tion of the stroke, we found to diminish, or even to extinguish, resonance in the portion of lung operated on. In this experiment, a split kidney was likewise used as a screen, owing to some doubt respecting the acoustic properties of the pasteboard; and with that fleshy and rather thick screen, the pulmonary re¬ sonance was still, though less easily, obtainable. From the preceding facts, T felt war¬ ranted to conclude, that, in cases of hydrothorax, if either lung be nearly sound, there will be no fleshy dulness of resonance in any of the lateral parts of the chest; because, even in cases such as Priest’s, in which one lung w as consolidated, the opposite lung would yield a certain resonance of a pulmonary character to even moderate percussion on the middle-third of the ribs. Since, however, it might still be doubted whe¬ ther the interposition of the contents of the cavity of the mediastinum — the trachea, oesophagus, great vessels, bronchial glands, and lower down the pericardium and heart — would not in¬ tercept the impulse of a stroke practised on the middle parts of the diseased side in a pleuritic subject, and extinguish resonance of the sounder lung, I made, some days after, the following experi¬ ment : — ■ A chest was filled with wrnter, and a sound piece of lung was immersed, or rather left immersed in situ , with the heart, great vessels, trachea, and other contents of the posterior mediastinum entire. Percussion was then practised on the opposite side, and an unequivo¬ cal pulmonary resonance was obtained through the water filling the side of the chest percussed and the contents of the posterior mediastinum remaining in situ, from the sound portion of lung lodged beyond the spine in the other cavity. This experiment w as repeated sufficiently often, and with results suffi¬ ciently uniform, to satisfy every observer, when taken in connexion with the pre¬ ceding ones, that, in the living subject, the destruction of one lung and occupa¬ tion of the space by water, would not, if the other lung were pretty sound, ne¬ cessarily prevent the evolution of pulmo- 534 DR. CLEND INNING ON THE RESONANCE IN PERCUSSION. nary resonance on percussion of the dis¬ eased side, notwithstanding' the interven¬ tion of the contents of the posterior me¬ diastinum, and of a quantity of water sufficient to fill one pleural cavity. From the preceding- case, in con¬ nexion with these experiments, then, it appears that, in simple pleurisy, we must not expect to find the pulmonary resonance wholly wanting-, even in cases of extreme effusion and compres¬ sion ; and that considerable effusion and compression, and consequently con¬ siderable functional lesion of the lung-, may co-exist with a degree of resonance of percussion that might readily deceive an experienced observer. Respiratory sounds. — In the case of Priest, the respiration was audible, dis¬ tant, and feeble, rather within ten days of his death, when there was already a very copious effusion in his chest. The fact I distinctly remember of a sensation as of a respiratory sound, but at the time (forgetful of certain cursory notices by Andral, Clin. Med. t. iii. ; Piorry, Frocede Oper.), I was disposed to think myself mistaken or deceived by some of the numerous sources of fallacy sur¬ rounding- all observations on living bo¬ dies. Since then I made some experi¬ ments that show that it really was the bronchial respiration that I heard. On the 25th of November last I procured the lungs of a child seven months old, and immersed them in the chest of an adult, previously filled with water, and then had them inflated through the trachea, and while under water. The lung was first held on the spine under water, and then inflated, and the ear- tube was meanwhile applied to the outside of the chest, and the reso¬ nance of the inflation, resembling the normal respiratory murmur, was distinctly heard by my friend Dr. E. Harrison, who assisted me in the experiment, and by other gentlemen, i think, as well as myself. The lungs were then removed to the corner formed by the spine, ribs, and diaphagm, on the floor of the chest, and then inflated, and the ear-tube was applied above the clavicle of the opposite side, or at a dis¬ tance of more than six inches from the inflated lung’, and the respiratory mur¬ mur or resonance of artificial respira¬ tion was distinctly heard. The lungs were then removed to an open vessel of water, and while immersed were in¬ flated ; and at the same time the end of the ear-tube was immersed in the water at two or three inches distance from the swelling lung, and then the resonance of inflation was distinctly heard. The lung was then inflated while floating on the water, and the ear-tube was applied to the bottom of the vessel, so as that several inches — as many as three or four —of water were interposed between the ear-tube and the source of sound, and then also the resonance of inflation was distinctly heard. Experiments similar in essential nature and in result were made with a flexible tube, to imitate the bronchus, through which air was forced by means of an elastic bottle fastened on one end of the tube, and alternately compressed and suffered to expand ; but the results were as above, and the experiments with the lungs seem to admit of but one interpretation, viz. that in cases of effusion in the thorax respiratory sounds maybe expected to be heard at the usual places, so long as the effusion is not so great as to compress the lung to an ex¬ treme degree, — probably so long as any considerable portion of the lung conti¬ nues permeable by air of the bronchus. Theory of Percussion. — The preced¬ ing experiments relate to the use of the mechanical signs in the diagnosis of dropsical affections of the chest; the following refer entirely to the theory of some of the principal of those signs, especially percussion. I have, in the note accompanying this statement, given extracts from the Lancet report of Dr. Williams’s views as to the causation of pectoral resonance, and stated that they differ from my own in that my friend Dr. W. attributes much, or even the principal share, of the sound to vibration of the walls of the chest; whereas I incline to the opinion that those walls are, for all medical purposes, to be considered as but con¬ ductors of, and often embarrassing im¬ pediments to, sounds elicited by per¬ cussion, breathing-, speaking, &c. from the viscera they enclose. Of the facts upon which that opinion is founded, the following appear to me sufficient ex¬ amples. With respect to the sounds of respiration, &c., suffice it to say that I have repeatedly auscultated the lungs during inflation both in and out of the body, i. e. mediately and immediately, and with this only difference, that I heard better immediately than me- DR. ALCOCK ON THE SENSATION OF TASTE. 535 diately : the flexible ear-tube, applied alternately to the chest and to the sub¬ stance of the swelling- lung*, g*ave in the former a feebler, in the latter a louder sound. But to pass from what I am not sure that Dr. W. and I differ about, to what I know we disagree upon, I sub¬ join experiments, tending* to establish, as I conceive, my views as to the share ol the walls of the chest in the reso¬ nance of percussion. Taking* a piece of sufficiently healthy lung* and a piece of liver, as extreme examples, I subjected them to percus¬ sion in a variety of circumstances. I had both of them held side by side in¬ side and against the same wall of the thorax, and percussion practised out¬ side the thorax, alternately over one and the other, — and the one gave purely a pulmonary, and the other a fleshy re¬ sonance. On repeating* the experiment in water, I obtained the like results, the presence of the denser fluid making* no material difference. The lung and liver were then removed to a wooden shelf, and percussed mediately with the pexi meter and the finger, and imme¬ diately with the finger or a scalpel, and with like results in all cases : the lung* gave true pulmonary resonance, and the liver that of fleshy parts, hepa- tized lung*, See. The same experiment was repeated on a marble table, and with the parts successively suspended in air, and supported on water, without any material difference of result. Now these experiments having* been repeated sufficiently often, and being quite simple, admit of but one interpretation, as I con¬ ceive, viz. that the wall of the chest is not the source of the soft pulmonary or dull hepatic resonance, which are owing mainly, and, practically speaking, we may say wholly, to the lungs, liver, &c.; respectively seated underneath the parietes; and that the walls are but conductors, and often at the same time dampers, of the resonance of the organs beneath them. “TS TASTE A SPECIAL SEN¬ SATION ?” To the Editor of the Medical Gazette. Sir, I have perused, in your number for Dec. 17, a letter from Mr. Noble, of Manchester, reflecting upon the paper lately published by me in the Dublin Journal, upon the relations of the sense of taste, and to which you have paid the compliment of republishing it in your journal. The temper and purport of the letter alluded to have surprised me beyond measure; and being as un¬ conscious of having given to Mr. Noble any just cause for dissatisfaction or complaint, as I am desirous to stand ac¬ quitted of the charges which he has endeavoured to father upon me, I solicit your insertion of my reply. 1 beg, in limine , to remind you that the first paragraph of my paper states, that my design was to communicate the results of a series of investigations into which I had been myself led by the un¬ certainty which prevailed with regard to the sense ; and having thus pre¬ mised, and in terms tolerably express, that my purpose was to submit my own views and inquiries, I was not pre¬ pared for being taken to task for not paving* introduced those of others fur¬ ther than the course of my own investi¬ gations rendered necessary. The letter of Mr. Noble contains three distinct imputations — l, that i have not been candid toward him ; 2, that my in¬ ferences are, some of them, totally at variance with recognized principles of physiology ; and, 3, that the accuracy of my facts is doubtful. He says, “ I regret that in assuming to have deter¬ mined, amongst other things, that taste is a special sensation, Dr. Aleock has not had the candour to refer to what had been previously offered to the pro¬ fession by myself.” Now, sir, were it even so,— were it true that I had not referred to what had been previously offered to the profession by Mr. Noble, still the want of candour is to be proved. Have I either detracted, or attempted to detract, from the originality, the pri- ority, the validity, the propriety, of Mr. Noble’s experiments and views? As¬ suredly not. On this his own showing* they remain, so far as I am concerned, untouched in all those respects. How, then, can the charge of want of candour apply to me? Would Mr. Noble im¬ ply that the doctrine, “ that taste is a special sensation,” has originated with him? He disclaims it himself: I have not, then, wronged him there. Would he imply that it was first suggested to me by his papers ? Here, were such the case, and I did not avow it, f should certainly have been uncandid ; but I can 536 DR. ALCOCK ON THE SENSATION OF TASTE. assure the gentleman that if he thinks so he is mistaken : every tyro in physio¬ logy knows that, according to the popu¬ lar opinion, taste is as real and distinct a sense as any other ; and I do not ask too much in claiming credit for the same amount of knowledge. Or would he imply that I have made use of his labours without acknowledging the debt ? I request that he will show where I have done so, and I will make amends ; but if he can not, T expect that he will admit the injustice of his charge. Again, I ask, though I had not referred at all to Mr. Noble or his opinions, where yet was the breach of candour ? What was it to me w hat he or any other man had offered to the profession, if it did not suit my purpose, or if T did not make use of it ? And if not, why should I, in the pursuit of my own investiga¬ tions, refer to it? Am I not at liberty to investigate for myself, and to use my judgment and choose what course 1 will pursue ? And shall I not pursue it unmolested so long as I do not trespass upon that of others ? I choose one way, and shall Mr. Noble dictate to me ano¬ ther ? Or, cannot one write his own views without violation of candour, un¬ less he bring forward at the same time all the arguments which may have been from time to time advanced upon the subject, whether good, bad, or indif¬ ferent ? Each man thinks his own the best ; and why Mr. Noble should be conceded a compliment above his fel¬ lows, I know not. Were I writing a systematic account or history of the question, I should feel myself bound to bring together every thing* worthy of preservation, or which I could reach, and I should certainly not omit Mr. Noble’s cases and his inferences ; but not being in the present case either the chronicler or the trumpeter of any man’s opinions, but only seeking after satis¬ factory knowledge, I did not feel, nor do I acknowledge, any obligation to have occupied my pages, already, per¬ haps, too much extended, with views with which I was no further concerned than that they tended in the same direc¬ tion with my own to the establishment of an opinion, to the origin of which neither party had any claim. But, sir, it is not the case that I have “ not re¬ ferred to what Mr. Noble had offered to the profession,” for I did refer, when it fell within the limits of my design ; and further, when I did so, I acknow¬ ledged it ; and I have yet to learn what obligation I was under to go out of my way to do so, and to introduce what was not appropriate, inasmuch as the data from which I reasoned were purely anatomical and physiological, while Mr. Noble’s data were pathological, — what was already known, since, according to himself, it has been circulated through several vehicles, — and what, it might be, I did not regard in exactly the same light with its author, — what, at least in my judgment, requires to be confirmed, and put beyond doubt, before, to use Mr. Noble’s own phrase, he “can be allowed to have determined the ques¬ tion.” But Mr. Noble “ claims priority in having demonstrated, by the best kind of evidence, that taste is a special sen¬ sation.” Well, be it so : assuredly I have not questioned it; and l call upon him to produce, from my paper, any assertion of priority in the matter at all. When i assert such a claim, it will be time to task me with it; but I am not so puerile as to put forward such pretensions with regard to a doctrine which was received of physiologists be¬ fore I was born; — I only claim to have investigated the question according to my ability : 1 found two opinions at hand, and I sought to determine, if I could, which was better founded ; and if I have succeeded in throwing any additional light upon the subject, I am entitled to Mr. Noble’s thanks for having’ given confirmation to the view entertained by himself, and not to his censure for want of candour. Secondly, sir, my inferences are at variance with recognized principles of physiology ; and why? Because, says Mr. Noble, it is “ a recognized principle in the physiology of the nervous system, that a simple and special function must have but one simple nerve for its mani¬ festation.” What doth he mean here ? One simple nerve ? Doubtless a dis¬ tinct nerve ; else his principle is devoid of force as an objection to my inferences. And further, be it observed that the strict interpretation of his principle is, that the manifestation of a simple and special function can have but one sim¬ ple nerve ; else, again, there is no in¬ consistency in my opinion, that taste has two media of perception. Now, where, among our senses, do we find the con- DR. ALCOCR ON THE SENSATION OF TASTE. 537 firmation of this? There is not one of them which is not provided with more nerves than one ; nay, there is not one, with the exception, at the most, of touch, in which the co-operation of two nerves, apparently dissimilar, is not re¬ quired, at least for its perfect manifesta¬ tion. Smell is not perfect without the fifth nerve. Injure the fifth nerve, and amaurosis is the consequence; and in Mr. Noble’s own case of facial paralysis of the fifth nerve, the hearing- was im¬ perfect. The inference, therefore, thus far, is not inconsistent. Again : will Mr. Noble please to reconcile with his recognized principle, the fact that, ac¬ cording* to the highest anatomical autho- ritieS, the auditory nerve is in many fish only a branch of the fifth? Will he reconcile with it his own conclusion — perhaps, to avoid imputation of want of candour, T had better say, though he appears to dislike the word, the sugges¬ tion— that the chorda tympani and the other branches of Meckel’s ganglion are the nerves of taste ? They, too, are branches of the fifth nerve; and their special character he has not proved. Or, again, his own reasoning with re¬ gard to the glosso-pharyngeal nerve. According- to him, “ the simplicity of origin” of that nerve “ is not questioned ;” and “ a nerve whose origin is sim¬ ple, can subserve one function only.” Yet, if he take the trouble to examine the distribution of the nerve in question, he will find abundant reason to doubt its singleness of function. But Sir Charles Bell and other leading authorities de¬ cide in favour of Mr. Noble. Be it so ; but are there none of a different opinion entitled to consideration ? I would suggest to Mr. Noble, even for curio¬ sity sake, to consult the writings of Magendie, and he will find that that physiologist almost goes the length of maintaining that the fifth nerve sub¬ serves the three senses of smell, sight, and hearing; also those of Dumeril and Serres, from which he will learn that those authorities are of opinion that, though the dolphin has not got an ol¬ factory nerve, yet that it enjoys the sense of smell through the fifth ; and that several animals which are devoid of optic nerves, can yet see by means of the fifth. And further, that Cuvier, who is entitled to some respect in those mat¬ ters, held “ that the difference of the functions of the nerves depends rather upon the different organization of the parts to which they are distributed, than upon their proper essence.” Therefore, if the battle is to be fought with autho¬ rities, it would seem that they are to be had on both sides, and that Dr. Alcock’s inferences might contradict all Mr. Noble’s leading authorities, and yet find others to countenance and support them ; nay, that they might find autho¬ rities in nature — “the best kind of evi¬ dence” — to justify them. Lastly, sir, facts are stubborn things ; “ but the accuracy of the facts them¬ selves must first be established ; and that Dr. Alcock’s paper furnishes the proofs of such accuracy, most, I con¬ ceive, will be inclined to disallow.” This charge I know not how to treat, because it is equivocal and offensive, leaving an imputation upon my vera¬ city, to be understood according- to the reader’s pleasure ; and further, because he adds, “ I do not, however, propose to examine seriatim and in detail the vari¬ ous proceedings which were adopted in this gentleman’s experiments.” And if not, sir, how can their accuracy be decided ? or who, withoutsuch examina¬ tion, can pronounce judgment upon them ? Mr. Noble, it appears, has ven¬ tured to do so. But why not examine, and rigorously too ? It is what I de¬ sire, and what I have endeavoured to do myself: I do not pretend to infalli¬ bility, and I promise, when convicted of error, to acknowledge it. This question I leave to Mr. Noble to answer : I can¬ not suppose that he would pronounce a judgment which he was unable to main¬ tain. One obligation, however, I owe to Mr. Noble, and I hasten to acknowledge it. His letter has led me to discover a misconception into which I have fallen with regard to Mayo’s repetition of the experiments of Panizza In my peru¬ sal of his paper upon the subject, in a former number of the Gazette, I un¬ derstood him to say that he had divided the glosso-pharyngeal nerve on one side, and the lingual branch of the fifth on the other; whereas, on refe¬ rence, 1 find that it is “ lingual branch of the same nerve on the other.” The experiment, as I understood it, appeared to me inconclusive, and I have said so ; but I take thus the earliest occasion to correct my mistake, which I can ex¬ plain only by the use of the terms “ lingual branch,” inasmuch as the lin¬ gual portion of the nerve is not in the 538 Dll. ROBERT WILLIAMS ON FEVER. dog' a single branch, but a leash of branches, among which it is not pos¬ sible to distinguish, in the living ani¬ mal, those especially intended for the tongue from the rest, and by the habit, which I have for some time adopted, of calling the “ gustatory ” nerve (so called) simply “ the lingual branch of the fifth.” — I remain, sir, Your obedient servant, B. Alcock. Dublin, Dec. 26, 1836. DR. 11. WILLIAMS ON FEVER, AND THE “ ELEMENTS OF MEDICINE.” To the Editor of the Medical Gazette. Sir, I feel much obliged to the reviewer of the Elements of Medicine for pointing out a typographical error which had escaped me, and in which the word saved has been substituted for lost. The passage should have been thus: — “ The cholera was preceded and accom¬ panied, and followed by, a fever of great severity, and the treatment by enemata in those years has been by no means so successful, one being lost out of four or five.” As the value of the work depends al¬ together on the soundness of the prin¬ ciples on which it is based, it may not be unimportant for me to state, that we have had this season, in St. Thomas’s Hospital, the strongest confirmations of the contag-ious nature of typhus fever. Early in the autumn, two cases were admitted into Edward’s ward, ill of a severe fever, and, in a short time after¬ wards, four other patients in the same ward were seized with the disease, w hile the sister and nurse also caught it. The sister suffered very severely, so that many thought it impossible she could recover, and her symptoms wTere remarkable, for her pulse, which beat the other day at 84, was counted for several days during the fever as low as 32 and 33 in a minute. She* recovered by the use of the enemata, a few leeches to the abdomen, and mustard poultices ; but the nurse, an aged woman, died. The pathological phenomena in two * Soda-water, the best of saline medicines, was allowed ad ^libitum, but she could not, after a bottle or two had been taken, be persuaded to persevere, and its exhibition was abandoned. cases that have fallen within the last few weeks, have been strikingly dif¬ ferent; for in the nurse just mentioned there was no trace of disease in the ali¬ mentary canal, neither was there any injection of the membranes of the brain ; and the only morbid appearance found w as effusion of serum into the arach¬ noid cavity ; while, in a boy that died in King’s ward, the follicles of the colon were generally enlarged and strongly marked, the appearances of the head being also trifling'. I should have anticipated the best results from the use of enemata in this latter case, but the patient obstinately opposed their use ; and it is singular, he was more affected with delirium than the nurse. The liberal adversary with whom I have to contend, and who evidently has left the university much later than my¬ self, will, 1 am sure, not be offended w hen I state I do not understand his logic. This art has never been made plain to ordinary understandings, and I am quite sure, had Mrs. Glass affirmed “ there is but one famous Christmas- pudding known in this country, and that is made of plums,” that no power could have persuaded her she had as¬ serted, “ therefore, all our puddings are made of plums.” The disjunction of the substantive from its adjective, is, I apprehend, unprecedented in reasoning. I certainly am astonished, when every medical authority admits nine-tenths, at least, of the patients labouring under typhus, pass into a brown tongue stage of greater or less intensity, any doubt can exist that it is a law of the disease, the typhoid poison does not wear itself out, or else the patient does not become insensible to the action of the poison until it has produced the greatest state of depression consistent with human existence ; for surely every law is de¬ duced from the great majority of facts, and though rendered less universal, is not superseded by the exceptions. I am also surprised that the “ Elements of Medicine” should have been considered as an improper title, and as synonymous with what is usually termed an elemen¬ tary work. Cullen adopted “ First Lines” as the title of his book, although it was the profoundest treatise on medi¬ cine then extant. But this great man compared, in his own mind, the little that was known of our vast science, w ith what remained to be accomplished, and clearly sawr his sketch was only des- MR. SKEY’S CASES IN OPERATIVE SURGERY. 539 tilled to lead the way to greater disco¬ veries; and the proportions of a child are not more dissimilar to those of the man than is the system of Cullen to the present state of medical science. I be¬ lieve there is no error, therefore, in the title I have adopted. I reasoned as Cullen had reasoned before me, and had certainly no intention of misleading the public. It is not, however, my inten¬ tion to prove the truth of the line of Pope — “ Ten censure wrong, for one who writes amiss but to thank him for his courtesy in at¬ tributing the error he has pointed out to its right cause; to assure him the leaf that contained it is already cancelled in the unsold copies ; and to add that your kind insertion of this admission of the mistake in your valuable journal, may, perhaps, enable some of those w'ho pos¬ sess the work to correct it. I remain, sir, Your obedient servant, Robert Williams. 39, Bedford Place, Russell Square, Dec. 29, 183(5. CASES IN OPERATIVE SURGERY; WITH REMARKS. To the Editor of the Medical Gazette. Sir, If you consider the following- cases deserving of publication in your journal, they are at your service. Believe me, sir, Your obedient servant, F. C. Skey, Assistant-Surgeon to St. Bar¬ tholomew’s Hospital, &c. Charterhouse-Square, Jan. 3, 1637. Removal of a portion of the Lov;er Jaw. Mrs. M., aged 56, residing at Wim- I bledon, accompanied by Mr. Tapley, : her medical attendant, consulted me in i the latter end of September last, rela¬ tive to a diseased condition of the lower jaw. On examination, I found the walls of the bone on the right side con- I siderably separated by a morbid growth of a somewhat remarkable character, 1 occupying the situation of the molar and bicuspid teeth. The extreme breadth to which those walls were separated was about an inch, which rendered her cheek prominent. Both the inner and outer gum were more than usually vascular and tumid, and pressure on either occasioned pain. The teeth had been either removed or had come away spontaneously, at a date of many years antecedent to the first ap¬ pearance of the disease. The alveoli were occupied by the diseased growth, which, apparently arising from their base, extended upwards to the level of the swollen gum, in the form of thread¬ like processes, terminating either in rounded or acuminated extremities ; the whole possessing a sort of verrucous or caulifhwer character. The disease ex¬ tended beyond the original situation of the last molar tooth posterior^, and reached, in the direction of the sym¬ physis, the first bicuspid. No other structure appeared to be in¬ volved, and the basis of the bone, as likewise the cervical glands, were to all appearance healthy. The disease had existed about six months, and was attended by consider¬ able darting pain, recurring at irre¬ gular intervals, which increased- to a degree sufficient to occasion sleepless nights and generally impaired health. The slightest violence produced bleed¬ ing from the tumor, not always readily controlable ; and this symptom was likewise on the increase at the date of her visit to me. I had no doubt, on inquiry and ex¬ amination, of the necessity of its re¬ moval ; and being unwilling to under¬ take a large operation without the concurrence of some professional per¬ son, I requested the opinion on the case of mv friend Mr. Kiernan, who coincided with me in the necessity of an early operation, although, like my¬ self, he was uncertain of the precise nature of the disease. I performed the operation on the 29th of September last. I had previously seen several similar operations for the removal of the half of the lower jaw, but in each an incision was made, which appeared to me in some degree objec¬ tionable, viz. that of the cheek, com¬ mencing at the angle of the mouth, and extending outwards to the masseter muscle. This, for reasons I shall here¬ after state, appeared to me unnecessary 540 Ml?. SKEY’S CASES IN OPERATIVE SURGERY. in this case. Having’ placed the pa¬ tient in a convenient position, I made an incision from the symphysis to the angle of the jaw down to the bone, and divided the facial artery, which 1 im¬ mediately tied. Introducing the fore¬ finger of my left hand into the mouth, I passed the knife from the wound up¬ wards between the cheek and the gum, which were separated from each other to the extent of the external wound. Without waiting to tie many smaller vessels that were bleeding* profusely, I pressed the tongue to the opposite side, and divided the mucous membrane which forms the floor of the mouth and the attachment of the mylo-hyoideus muscle to the bone, with a curved knife, the point of which was supported on my finger below, the inner surface of the bone being the guide for the in¬ cision. I had then the whole bone in¬ sulated. With a large pair of Liston’s forceps, I divided the jaw near the sym¬ physis, which split through without difficulty, and I again introduced them into the mouth, passing them back¬ wards to the angle of the bone, which was in like manner easily divided, and I had the whole diseased growth re¬ moved. I then observed the sublingual gland, which was exposed, and as it appeared somewhat indurated, I re¬ moved it with one or two strokes of the knife. Many vessels were divided, and the haemorrhage w7as considerable. I tied some arteries from the internal pterygoid and masseter muscles, and a branch of the submental. Wet lint was applied to the wound, and the pa¬ tient w as carried to bed. The operation occupied 11 minutes. In an hour afterwards I removed the lint, and as all tendency to bleed had apparently ceased, 1 united the sides of the w'ound by means of two sutures, and requested that wet lint might be reapplied over them. in six hours after the operation, in consequence of an attempt to speak, such considerable haemorrhage recurred as to induce Mr. Tapley to divide the sutures and expose the wound. The bleeding ceased, and on the following day our patient was free from pain, and suffering merely from symptoms at¬ tendant on loss of blood. There arose no other drawback to her recovery, and she was convalescent in a month after the operation. A section of the bone exhibited the full extent of the disease, which had apparently commenced in the alveoli, and extended in the direction upwards by the formation of the thread-like processes I have above alluded to. It had likewise extended backwards towards the angle of the jaw, in the form of a whitish, somewhat schirrous- looking grow th, which having imbedded itself in the substance of the bone, was gradually producing absorption of its more cancellated texture in this di¬ rection. In reference to its malignant cha¬ racter or otherwise, great uncertainty existed ; and it wTas exhibited to many men eminent in the profession. Hitherto there has been no recur¬ rence of the disease, and her health is perfectly reinstated. I conceive the operation performed in this case to possess advantages over those which I had previously witnessed, both immediate and prospective. The operation is more simple. There can be no error as regards the first incision, either as to direction or depth. There is no danger of wounding the parotid duct, nor of making a second division of the facial artery, w hich is almost inevi¬ table to the other operation. The bone is more immediately under the incision, and consequently more readily exposed, whereas, in the operation commencing by a transverse incision through the cheek, from the angle of the mouth, the diseased bone always lies more or less concealed, unless the incision indeed be very extensive. Should secondary haemorrhage occur, as in the above case, it is always prefer¬ able to have a direct rather than an oblique wound in the bottom ; if not, the blood may accumulate. If the external w ound be immediately over the bleeding vessels, the trickling from the wound would admonish the attendants of the impending evil. I am aware that much may depend on the extent of the disease, which may involve not only the base of the bone as far as the angle, but even the ramus as high as the condyle or coracoid process ; and again, this extent may not be de¬ terminable till the operation is advanced. But notwithstanding the possibility of these difficulties, I should prefer the division along the basis, because, under all circumstances, a considerable part of the ramus, probably its inferior half, might be commanded from the lower MR SKEY’S CAkES IN OPERATIVE SURGERY. 541 wound ; and should the disease he found to extend beyond the part exposed, I conceive it would be perfectly unob¬ jectionable to make a division across the masseter, which would avoid the otherwise necessary injury to the portio dura nerve, effected by a vertical one. The prospective advantage is that which arises from avoiding the deformity reduced by the division of the face, n the case above detailed, the deformity is so slight as to be almost impercepti¬ ble. There remains a slig’ht hollowness of the cheek on that side, but nothing to indicate that so severe an operation had been performed. T aliacotian or Rhinoplastic Operation. W. Detheridge, aged 52, called on me about the latter end of August last, with a letter from a medical friend, con¬ taining a request that I would examine his face, with a view to the performance of the Taliacotian operation. The man stated that he had been at various times under the advice of ex¬ perienced and eminent surgeons, but that all had declined his most urgent request that some attempt might be made to amend his unhappy condition of features attendant on the partial loss of his nose. There was an earnestness in the man’s appeal, almost imploring my assistance, accompanied by the assurance that he could not live to be the object of scorn and derision of all his acquaintance, that induced me to believe that there were some grounds for the suspicion that he was the subject of insanity. On investigating the circumstances at¬ tending the case, I ascertained that he had been endeavouring for twenty years to obtain the consent of some surgeon to undertake the operation, but all had prudently declined. He seemed to con¬ sider me in the light of a last hope, and employed all his eloquence, of which he possessed a more than ordinary share, to induce me to do that which the elite of the profession had declined, and in this he certainly succeeded, but not till I had convinced myself that his eccentricities were referable to too obvious causes to render my refusal inevitable on that score. I considered the man to possess a large share of personal vanity, and to be ex¬ ceedingly and morbidly sensitive to any defect which involved his personal ap¬ pearance. From the days of his boyhood he had suffered considerable annoyance from the discoloration of his nose on exposure to cold. He complained that he could never keep it at the right tint of colour — warmth reddened, and cold blanched it. With a view to meet the effects occa¬ sioned by the variation of temperature, he carried in his waistcoat pocket a quantity of chalk, with which he was accustomed to rub his nose as occasion required. After a time, however, this expedient failed him, and he made a serious re¬ quest to a medical gentleman to cut off his nose, and make him another of bet¬ ter materials. On the refusal of this gentleman to accede to his wish, he re¬ turned home, and with his own hand cut off the extremity of the offending organ, by an incision which com¬ menced about one-eighth of an inch be¬ low the nasal bones, and passed down obliquely to the middle of the lateral cartilages. He then renewed his appli¬ cation to the surgeon, in the hope that all objections were removed. On the assurance of the man’s mental sanity, by two medical gentlemen of the highest professional respectability, who had known him for many years, and in¬ fluenced by his own urgent entreaty, repeated in defiance of my assurances that the operation would be both a tedi¬ ous and a painful one, and possibly at last unsuccessful, I consented to under¬ take it. The operation was commenced by paring off the skin covering the re¬ maining’ part of the nose, leaving well defined margins all around. This the man bore with the most stoical indiffer¬ ence, as indeed he did every stage of the operation. Fie felt himself the hero of the day, with which something of the ridiculous was blended, as though he were paying the penalty due to his previous folly. The bleeding continued from the exposed surface for nearly f of an hour, during which time the wound was sponged with cold water, and at length covered with lint, and the blood allowed to coagulate. When the bleed¬ ing had ceased, having previously marked with a pen and ink the exact form and dimensions of the skin to be removed from the right brow, and which were in all dimensions more than sufti- 542 MR. S&EY'S CASES IN OPERATIVE SURGERY. ciently large to cover the surface ex¬ posed,! divided around, having- a bridle directed towards the root of the nose, of about half an inch in breadth. From this flap, thus almost insulated, sundry arteries from the frontal bled considera¬ bly, and one among the largest poured out its blood, per saltum , from the point or tongue into which the flap was pro¬ longed, and which was destined for the septum. Before the flap could be finally ad¬ justed on the nose, more than half an hour was occupied in arresting* the bleeding* from it, and I was compelled, though somewhat unwillingly, to place a ligature on a vessel that bled most pertinaciously from the side of the bridle. During this process the tempe¬ rature of the flap became much reduced, and the surface of the nose was again covered with coagula. These being care¬ fully removed, the flap was turned at the bridle and laid down over the nose, which it was found to fit accurately. Fine sutures were introduced down each side, at a distance from each other of about one-third of an inch ; and, finally, I fixed up the tongue of the flap by two sutures passed across it, through its bleeding surface, and carried throug*h the lower edge of the old septum : these two last, therefore, did not penetrate the skin. The time occupied by the operation itself did not exceed twenty minutes, although the man was under the hands of his attendants for fully as long a period as I had anticipated. He had a slight attack of erysipelas in the following week, but notwithstand¬ ing this the integuments united per¬ fectly. In one or two places, a g*roove was left between the old and new sur¬ faces. These defects I have subse¬ quently amended by removal, at the same time with a view of reducing the necessary bulk of the organ within mo¬ derate dimensions, and in this I think I have succeeded. For six weeks after the operation, all the external sensations of the neworg*an were referred to the forehead, and to the exact spot which corresponded to the part touched. These, however, ceased the moment I made a division near the root of the nose, for the purpose above alluded to, and they have not returned. The man is proud of his new acquisi¬ tion, and I do not regret being the agent of his possessing it. A s the beauty of the nasal organ must ever continue a matter of taste among the community at large, I cannot speak of its relative merit in this instance, but a man has probably the best right to ap¬ preciate his own ; and he, being a vain man, is pleased, so I am satisfied ; and perhaps I may venture to add, that ge¬ neral report speaks favourably of it. The great difficulty, I imagine, in cases of this kind, arises from the dis¬ similar character of the -integuments employed, to those for which they are substituted. It is impossible, by a single operation (at least the attempt would in all probability faii), to form a nose of natural dimensions from the forehead, because the integuments of the nose and face generally are thin, whereas those of the forehead are of more than ordinary thickness. Indeed, under any circumstannes, I presume that considerable thickness would be required to insure circulation of the blood. In the above case I have succeeded to some extent in reducing the portly cha¬ racter it at first possessed, by means of a pair of forceps constructed for the pur¬ pose of obtaining lateral pressure, the two blades of which are curved to fit the nose. It appears to me impossible to complete an operation for making an artificial nose at “ one sitting;” the margins must be more or less abrupt, and the bulk large. In the above case T have reduced this by two or three sub¬ sequent operations, in each of which f have removed considerable portions of the new integument ; and we are thus enabled to make a cleaner adjustment of the two edg*es, between which the former cicatrix should be included. Considering the motives for the opera¬ tion, I do not imagine that any obsta¬ cle to these pruning incisions would arise on the part of the patient. As so much depends on the exact ap¬ position of the opposing surfaces, it appears to me that in this, as in all operations on the face, too much care cannot be bestowed in accomplishing this object. I am myself in the habit of applying, in addition to one or two large, several exceedingly small sutures, to the purpose of attaining the desired end ; these latter, however, I generally remove within about 30 hours after the operation. ANALYSES ANP NOTICES OF BOORS. 543 ON THE HEIGHT OF THE DIAPHRAGM. 7'o the Editor of the Medical Gazette. Sir, One of the most singular discoveries, to which I have been led in connexion with certain researches into physical signs, is the utter practical ignorance generally prevailing- among the medical men I have conversed with, as to the height at which the diaphragm is situ¬ ate in different individuals. Some there are who can, with a to¬ lerable approach to accuracy, state from books or lectures its average height, but who start with surprise, if not with fear, when its real height in their own case is pointed out to them. Others, with scornful incredulity, draw from their own imperfect knowledge of this point arguments to invalidate the accuracy of signs which I have, in the presence of competent judges, put to the test on the living or the dead, or in both these states. This ignorance is the more remark¬ able, as it is not confined to mere tyros in medicine, but extends to men who have been long- and successfully en¬ gaged in the study of morbid ana¬ tomy. It is not my present business curiously to inquire into the means which the great authorities on percussion and aus¬ cultation must be supposed to be in possession of, in order to give them a facility and precision of diagnosis which seem to be scarcely compatible with a want of knowledge as to the height and different degrees of obliquity of the diaphragm in the cases that come under their notice. — I remain, sir, Your obedient servant, Edwin Harrison. i Dec. 31,1836. ANALYSES and NOTICESor BOOKS. “ L’Auteur se tue a allonger ce que le lecteur se tue a abrdger.” — D’Alembert. ) Pharmacopoeia Collegii Reg a Us Medi- corum Londinensis. 1836. Printed bv Order of the College. ' In our number of the 24th ult , we no¬ ticed the appearance of the New Lon¬ don Pharmacopoeia, and we propose now to offer a few remarks on certain portions of it. We have already stated that many new and valuable remedies have been introduced, and, so far, much service has been rendered to medical science ; but as we are “ nothing if not critical,” we shall proceed to point out several objections which occur to us : and first we must say, that, considering* the length of time the work has been in preparation, a list of “ Errata and Corrigenda ” ought not to have been necessary. Yet both in the octavo and small edition we find one: a convinc¬ ing’ proof of inexcusable carelessness, more particularly as the principal errors are not attributable to the printer. For the credit of the College, it had been wiser, in our opinion, to have cancelled the leaves requiring correction, and which might have been effected at a very trifling cost. In the Preface, allusion is made to the attempted production of a British Phar¬ macopoeia — that is, a joint Pharmaco¬ poeia for England, Scotland, and Ire¬ land. The failure of this laudable at¬ tempt is ascribed to the great distance of the parties from each other ; which, however, we cannot admit to be a suf¬ ficient reason, and we cannot but sus¬ pect that other difficulties, of an entirely different nature, have also operated in preventing this desirable consummation. Articles struck out. — In the “ Ma¬ teria Medica,” we observe that a few articles contained in the former edition are now omitted — namely, Fucus vesi- culosus, Helleborus foetidus, Linum catharticum, and Ilubia tinctorum. Many other substances, in our opinion, might also have been left out ; as Ox- alis Acetosella, Rumex Acetosa, Acorus Calamus, Malva sylvestris, Cardamine pratensis, Cydonia vulgaris, Laurus nobilis, Allium porrum, Ostrea edulis (Testa), Tussilago farfara, &c. Articles introduced. — Under the bead of “ Materia Medica,” we observe the following new remedies : — Barytce carbonas, Brominium, Chimaphila co- rymbosa, Creasoton (described as “Oxy- bydro-carburetum ex oleo pyroxylico paratum”), Diosma crenata, Ergota (Acinula clavus), Ferri percyanidum (commonly termed Prussian blue), Iodi- nium, Lobelia inflata, Strychnos Nux vomica, Cissampelos Pareira, Phospho¬ rus, Potassae chloras, Potassii ferrocya- liidum (the prussiate of potash of the 544 ANALYSES AND NOTICES OF BOOKS. shops), and Helonias officinalis (Saba- dilla). Among* the “ Prceparata et Compo- sita,” the following* are the principal new articles : — Acetum Cantharadis, Acidum hydrocyanicum dilutum, Aci- dum phosphoricum dilutum, Aconitina, Morphia, Morpbiee acetas, Morphiae hydrochloras, Quinse disulphas, Strych¬ nia, Veratria, Garbo animalis purificata, Arg*enti cyanidum, Barii chloridum, Calx chlorinata, Flydrargyri bicyani- dum, Hydrargyri iodidum et biniodi- dum, Plumbi chloridum, Plumbi iodi¬ dum, Plumbi oxydum hydratum, Li¬ quor potassse effervescens, Potassii bro- midum, Potassii iodidum, Liquor Po¬ tassii iodidi compositus, Liquor sodae effervescens, and Liquor sodae chlori- matae. Botany. — In the botanical depart¬ ment of the Pharmacopoeia, we find the words bulbtis , rhizoma , and cormus , have in several places been very pro¬ perly substituted for radix ; which, in the last edition of the Phrmacopceia, was applied indiscriminately to several vegetable organs. This term is still employed to designate the officinal part of Veratrum album, but a superficial examination of this substance will con¬ vince any one that it is not applicable. The word fructus is properly introduced in several places where, formerly, the term semina was employed ; as in Ane- tlium, Anisum, Coriandrum, &c. Jalap root is declared, on the autho¬ rity of “ Don, MS.” ! to be the produce of Ipomcea Jalapa. Now it is several years since the plant yielding jalap was described by an American botanist, and declared to be a species of Ipomoea, which he named I. Jalapa. The ac¬ count has been noticed by almost every recent pharmacological writer, English, French, German, and American. “ In the year 1827, Dr. John R. Coxe, Pro¬ fessor of Materia Medica in the Univer¬ sity of Pennsylvania, received, directly from Xalappa, several small jalap plants, in a growing state; and having placed them in his garden, succeeded in raising one with all the parts necessary for a decision upon its botanical cha¬ racter. Mr Nuttall, to whom it was exhibited, had no hesitation in pro¬ nouncing it an Ipomoea, and described it with the title of Ipomoea Jalapa*.” * The Dispensatory of the United States of America, by G. B. Wood, M.D., and F. Bache, M.D. 1834. For further information, consult It is, therefore, somewhat surprising that the College should give Mr. Don the credit of discovering* the true jalap plant, which is justly due to Mr. Nuttall, and that they should prefer quoting* manuscripts to published pa¬ pers. Ergot of rye is assumed by the Col¬ lege to be a fungus, and is named “ Acinula claims J In the present state of our knowledge with respect to this product, this decision, to say the least of it, is premature- Botanists are far from being decided on its nature, and one of the latest writers on Fungi (Rev. M. J. Berkeley, in Vol. V., Part II. of Smith’s “ English Flora ,”) says, “ It appears to be only a diseased state of the grain, and has scarcely a sufficient claim to be admitted amongst fungi as a distinct g*enus. The only way of de¬ ciding the point would be to institute inquiries as to the manner in which it commences its growth, as Brongniart has done respecting* Uredo Segetum. The external coat is subfarinaceous, and very different from any thing* I have seen in Sclerotium .” Rheum palmatum is still retained in the Pharmacopoeia as the mother-plant of the rhubarb of the shops, though the statement is supported by very slen¬ der evidence. The principal argument in favour of the dictum of the College, is, that of all known species of Rheum, the palmatum yields a root which agrees best with our officinal rhubarb. But it is well known that the Bucharians de¬ clared to Pallas they were unacquainted with the leaves of Rheum palmatum, and described the leaves of the true rhubarb plant as being round, with a few incisions on the margin. Sievers also, who travelled four years in the rhubarb countries, decides against the R. palmatum. Moreover, the root of cultivated specimens of this species is always found to differ considerably from the rhubarb imported, though these dif¬ ferences are usually ascribed (without sufficient foundation, how ever) to climate, soil, &c. Our opinion is, that the true rhubarb plant, or probably plants, are yet unknown. Three species of Cinchona bark are mentioned — namely, C. cor difolia , C. lancifolia, and C. oblongi folia ; and Journal de Chifuie Medicate, tom ix. andx. (for the years 1833 and 1834), in which will he found a drawing of the plant ; also the last edition of Guibourt’s Histoire Abrege'e des Brogues. THE NEW PHARMACOPCEIA. 545 they quote as their authority Mr. Lam¬ bert’s work on the genus Cinchona. We presume that the College intend, by the above names, to designate the barks known to druggists by the terms yellow , pale, and red bark. To the assumption of the College, that the Cinchona cordifolia yields yeL low bark (that is, the bark employed in the manufacture of sulphate of quina), we reply, tffere is no evidence in its fa¬ vour. Mutis, indeed, says that the bark called by the Spaniards Quina amarilla (that is, yellow bark ) is ob¬ tained from Cinchona cordifolia ; but it must be recollected that the terms yel¬ low, pale, red, orange, &c. applied to barks, are merely relative ; and we ought not to infer, that because a bark is called yellow in one country, it will necessarily have the same acceptation in another. That the Quina amarilla is not our yellow bark , and that the Cin- cho cordifolia does not yield this latter, we think the following facts sufficiently testify : — 1. “ Many authors (says Guibourt) yet attribute the true calisaya ,” the name by which our yellow bark is usu¬ ally known in France, “ to Cinchona cordifolia, in consequence of Mutis having given the name yellow cinchona to the bark of this tree ; but the au¬ thentic specimens of the ‘ yellow cin¬ chona’ of Mutis, brought by Humboldt, prove that this bark is that know n in France by the name of Quinquina Car- t hag hie ; quite different to the Calisaya bark.” J 2. Bergen, a distinguished German writer on the Cinchona barks, had ac¬ cess to the collection of Ruiz ; and he thus speaks of the Quina amarilla : — “ The pieces found in this collection marked as Quina amarilla ( C . cordi¬ folia, Mutis), consist of some flat pieces and some fragments of quills, which are quite identical with the foregoing, de¬ scribed bard Flava ” (the China flava dura of Bergen is, as lie himself states, and as we can prove, the Carthagena bark of English commerce) ; “ and there cannot be the least doubt remain¬ ing that the C. cordifolia is the mother plant of the China flava dura” i The Cinchona cordifolia g’rows in Colombia, in the mountains of Santa Fe de Bogota, Loxa, and the ancient king¬ dom of Quito. Now the commercial outlet for Bogota, Quito, and the neigh- 475. — xix. bouring parts, is Carthagena *, from which place is exported the bark termed in English commerce Carthagena bark (by the Germans called China fl ava dura), and which is declared, by the united testimonies of Bergen and Gui¬ bourt, to be the Quina amarilla, said by Mutis to be the produce of C. cordifolia ; whereas the bark called by our drug¬ gists yellow bark, and from which sul¬ phate of quina is procured, is produced most abundantly in Bolivia (formerly Upper Peru), in the province of La Paz (more than a thousand miles south of Bogota), and is usually exported from the ports on the western coast of South America on the Pacific, though formerly it was also shipped from Buenos Ayres. “We have been informed,” sayDrs. Wood and Bache, “ by gentlemen who have been long personally engaged in com¬ mercial transactions upon the Pacific coast of South America, that the Cali¬ saya bark of commerce (yellow bark of English druggists) is originally ob¬ tained chiefly, if not exclusively, at the Port of Arica, whither it is brought from the interior provinces of Bolivia.” To this testimony we beg to add the following: during the last week we examined the import book of one of our wholesale druggists, and found that nearly all the yellow bark brought to this country for some years back was exported from Arica, Valparaiso, and Lima, and that none came from Car¬ thagena. We cannot conclude these remarks respecting yellow bark, without quoting the following passages from the Dis¬ pensatory of the United States of Ame¬ rica, decidedly the best work of the kind yet published in any language. “Au¬ thors are by no means agreed as to the particular species which yields Calisaya bark. Some, influenced simply by its officinal title of yellow bark, have attri¬ buted it to the C. cordifolia, because Mutis gave the same name to the pro¬ duct of this species. The British Col¬ leges have fallen into this error, with¬ out, however, being aware that the yel¬ low bark w hich they adopted as officinal was really the Calisaya. That it is an error, has been fully demonstrated, as no Calisaya bark is brought from those regions where the C. cordifolia most * See the work entitled “ Colombia,” published (anonymously) in two vols. 8vo, 1822, p. 293, vol. i. 2 N 54(3 ANALYSES AND NOTICES OF BOOKS. abounds * *. A curious mistake on this subject is made by Dr. A. T. Thom¬ son in his Dispensatory. Considering the C. lancifolia as undoubtedly the origin of the pale bark, and at the same time receiving, without hesitation, the assertion that the Calisaya is the pro¬ duct of this species, he has inferred that the two must be identical, and has, therefore, given Calisaya as one of the synonymes of pale bark; while he has accurately described the true Calisaya , but wuthout naming it, under the head of C. cordifolia or yellow bark.” Neither do w'e believe it to be correct to ascribe red bark to C. oblongifolia. Mutis, indeed, states that this species yields “ Quina Roxa ” ( red bark ) ; but this Quina Roxa has been found by Bergen and Guibourt to be a new kind of red bark, called “ Cinchona nova.” The red bark of European commerce is termed by the Spaniards “ Quina Colo¬ rado ,” and we believe the origin of it is unknown. Want of space prevents us from enter¬ ing so fully into the examination of the source of red as we have done with respect to yellow bark, and we must therefore refer those interested in the in¬ quiry to the w orks of Bergen, Guibourt, and Drs. Bache and Wood. We may add, that as Mr. Lambert does not pre¬ tend to an acquaintance with the cha¬ racters of the Cinchona barks of com¬ merce, his work on this point can be no authority ; though his collection, in the hands of an able pharmacologist, might be of considerable service. Kino is still declared in the Pharma¬ copoeia to be the produce of Pterocarpus erinaceus. That this is erroneous is proved by the following facts : — Kino is brought to us from the East Indies, — especially from Amboyna ; whereas Pterocarpus erinaceus is not found in the East Indies, but is a native of Senegal, in Africa. Moreover, we have jn our possession African kino (possibly the produce of the P. erinaceus), but its physical characters are quite different from the kino of commerce. Copaiba is said to be the produce of Copaifera Langsdorfii ; but it is well known that the commercial article is obtained from many species of Copai¬ fera: Martius enumerates nine, — Nees Von Esenbeck, fourteen. Many other articles of the materia medica were marked by us for notice, but those already examined have taken up so much space, that we are under the necessity of here closing our remarks on the materia medica ; and in a subsequent number we propose examining' the chemical portion of the Pharmacopoeia. Micro graphia : containing practical Essays on Reflecting , Solar, Oxy- liydrogen Gas Microscopes , Microme¬ ters, fyc. By C. R. Goring, M.D. and Andrew Pritchard, Esq. The use of the Microscope has of late done such signal service in the advance¬ ment of minute and pathological ana¬ tomy, in the discovery of so many otherwise invisible tribes in the animal kingdom, and in displaying so variously and so beautifully the perfection of nature, even in what might seem the most insignificant of her works, that it is not surprising there should be so prevalent a desire among' all classes of society to become more intimately acquainted with the instrument. To inquirers in medical science the micros¬ cope has become indispensable ; nor is it possible to appreciate the labours of Ehrenberg, Raspail, Owen, and divers others, who have, in some sense, opened and described a new w orld to us, with¬ out being more or less adepts in micros¬ copical study. The scientific public are indebted to the authors of the w ork before us, for much aid in promoting their means of optical research. In the “ Microscopic Illustrations” and “ Cabinet” they have supplied abundance of valuable hints for practice : nor will it be found that they are a whit less practical or useful on the present occasion. Dr. Goring ex¬ hibits his skill in treating popularly the intricate subject of reflecting and solar microscopes, and the methods of ascer¬ taining the comparative merits of mi¬ croscopes and engiscopes. Mr. Pritchard gives an interesting account, historical and descriptive, of the oxy-hydrogen instruments (the first we believe that has been published), and has added several practical suggestions which can¬ not fail to prove valuable. A letter in the Appendix “ on making drawings of microscopic subjects” from Mr. Bauer, will be read with interest; it is illus¬ trated with figures, as indeed the work is throughout with excellent wood-cuts and engravings. The authors, we think, CORONERS AND THEIR JURIES. 547 have conferred a boon on the* votaries and admirers of the microscope : and who is not at least an admirer of an instrument which has achieved such triumphs ? MEDICAL GAZETTE. Saturday , January 7, 1836. “ Licet omnibus, licet etiam mihi, dignitatem Artis Mediae tueri ; potestas modo veniendi in publicum sit, dicendi periculum non recuso.” Cicero. CORONERS AND THEIR JURIES versus THE MEDICAL PROFESSION. The light that medical knowledge throws on the path of justice is, not unlike many other good things in this world, freely enjoyed without much regard to its true value. Like the air itself, which men fail to hold precious, until they happen, some time or other, to be partially deprived of its use, it seems to have come at length to be considered as truly belonging' to political, as the at¬ mosphere is essential to physical, exist¬ ence. Medical men have so long’ been in the habit of bestowing their services gra¬ tuitously in aid of the law, and have in general so readily obeyed, if not antici¬ pated, the call of the magistrate, that there seems to have been formed a sort of tacit compact, implying that the assistance which medical science is capable of affording in difficult cases coming’ before the judicature, shall not in any case be withheld. Luckily, however, there is no such compact in reality,* — and the profession may be congratulated that there is not ; for a persistence iu the course just men¬ tioned has, in the natural order of things, led to a position in the route, from which to proceed further, without some new arrangement, would prove, at least to the parties on one side, a grievous hardship. An abuse, in short, has been growing up, and has attained at last so serious a magnitude, as im¬ peratively to require consideration how it may in future be best obviated. Medical science, in reference to le¬ gal, has of late made great strides ; and that kind of knowledge required for purposes of civil polity has been diligently cultivated, and may now be almost said to constitute a distinct profession. The ordinary acquirements of the practitioner of medicine or sur¬ gery, or both, are in themselves in¬ sufficient to fit their possessor for a referee in the great majority of civil and criminal cases ; other special at¬ tainments must be superadded, if the preservation of character and reputation bean object: nor can this be accom¬ plished without additional study, and the outlay of much money and time. The necessity for such preparation has been for some time recognized in the profession ; and a natural conse¬ quence is, the laying a higher value on the assistance which can be afforded to the magistrate and the judge. The in¬ creasing demands, too, made on our profession, in quarters where a fair re¬ muneration has been thriftily and mean- * ly refused, have created a reaction, sa¬ lutary inasmuch as it directs attention to the proper value of medical ser¬ vices. But the community generally are but ill acquainted with these facts : slowly and reluctantly they begin to learn that medical evidence is a thins: which of late the legislature has thought worth paying for; and the information rouses them, as if it announced the levying' of a new tax. What shifts and devices have been had recourse to, in order to escape the impost, must be familiar to every observer. How to avoid the trouble and expense of medical evidence, and whether the presence of medical men may not be altogether dispensed with on certain occasions, have been the 548 CORONERS AND THEIR JURIES. grand problems discussed among the rate- paying jurymen forming the coro¬ ners’ courts. It is almost needless, after the fre¬ quent complaints made by our corre¬ spondents, and the daily announcements through the newspaper press, to point out the peculiar position in which medi¬ cal men are at present placed with refe¬ rence to their public functions as medi¬ cal jurists ; yet a short enumeration of the particular grievances under which they labour may not be without its use, as it may tend probably to suggest the most feasible remedy. 1. It was once the regular rule to ob¬ tain medical evidence at any inquest involving a question relative to the na¬ ture of the death ; of late the practice is the reverse : medical evidence is only sought in cases of absolute necessity — where there is an utter impossibility of coming to a probable conclusion without it. There is a manifest disinclination on the part of both coroners and their juries to allow medical witnesses to be called ; the business obviously may be so much more quickly dispatched without entering into scientific inquiry : besides, there is a fee to be paid, which the majority of the jury, who have it in their power to call or not to call the witnesses, are indisposed to counte¬ nance — they being, in fact, rate-payers — contributors to the very fund from which the said fee is to be disbursed. Instances of this narrow, niggardly feeling, are frequently exhibited : per¬ haps we may take leave to notice one as an example. An inquest was held on the 27th ult., in Ebury-street, Pimlico, before Mr. Higgs. The coroner refused to summon the surgeon who had been sent for to the deceased, and who, from having investigated the circumstances of the case, (death by hanging) was prepared to throw every light on the in¬ quiry. It was obvious, moreover, that but lor the drawback of the fee, this gentle¬ man would have been deemed the most eligible witness : the coroner, however, positively refused to summon him ; whereupon the surgeon had no alterna¬ tive but to remonstrate publicly, as he did, and to announce his intention of applying to the Secretary of State for the Home Department. 2. Another meanness to which the late arrangements have led is this Whenever the coroner has any kind of pretext for calling on a medical man as a common witness, he fails not to avail himself of it — as he thus has a chance of procuring the necessary information, w ithout a special summons, which alone entitles the witness to his fee. We trust, however, that practitioners will be on their guard against this imposi¬ tion, and that in all such cases, although they be obliged to give evidence as to matter of fact, they will withhold their professional opinion, unless promised the requisite honorarium. 3. There is yet another gross abuse to be complained of, growing, in great measure, if not wholly, out of the late inadequate measures for providing re¬ muneration for medical evidence, — for we have not only to contend with the griping spirit of coroners, jurymen, and overseers, but with the mischiefs en¬ tailed by bungling legislators : the coroner, on determining to have medico¬ legal assistance in cases in which he cannot help calling for it, issues a special summons to as many medical practitioners as he sees occasion to consult ; although it is only one of the witnesses thus specially summoned who becomes entitled to a fee. This is surely something more than a mere hardship — it is a fraud practised on the members of our profession, which should in no case be silently submitted to. In our present number (p. 554) the nature of the unjustifiable trick thus put upon respectable practitioners, is well ex¬ posed by Dr. Ramsbotham ; in whose LATE OUTRAGE AT APOTHECARIES* HALL. 549 letter the reader will find a clear expo¬ sure of several other points also, con¬ nected with this subject. Lastly, in several instances where medical men have been specially sum¬ moned, they have been refused the re¬ muneration to which they were by law entitled. But what a remuneration ! supposing’ even that it were in every case promptly and cheerfully paid. A guinea for “ giving evidence,” and an additional guinea where a post-mortem examination may have been ordered, with or without a toxicological analysis of the contents of the stomach ; and should attendance on such terms be de¬ clined, a certainty of being mulcted in five pounds sterling ! Such are the blessings entailed on us by incompetent and blundering intermeddlers. But we have already sufficiently exposed the circumstances connected with this part of the question. As to the conduct of coroners and jurymen, in declining medical evi¬ dence wherever they can, there seems to be no remedy for it, save in that chas¬ tisement which the exhibition of wilful ignorance so richly merits. These peo¬ ple will probably persist in the line they have adopted, until some gross blunder awakes them to a sense of their silly indiscretion. As it is, the coroner’s court in ordinary cases is notorious for its precipitate and often nonsensical verdicts; its “ temporary derangement,” “insanity,” “ found drowned,” &c. have become the butt of well-merited ridicule. But cases may occur, as they often have occurred, where serious injury may be inflicted on accused parties by the rash¬ ness of similar awards. Should it prove that such mischief arises through the wilful rejection of medical evidence, we promise, for our parts, not to fail in set¬ ting the matter in its proper light; and we doubt not that ultimately, at all events, there will accrue to such con¬ duct its appropriate meed of public in¬ dignation. LATE OUTRAGE AT APOTHE¬ CARIES’ HALL. Mr. Charles Penruddock, the medi¬ cal student by whom the recent assault on the members of the Court of Exami¬ ners of Apothecaries’ Hall was com¬ mitted, was brought up on Thursday before Mr. Alderman Pirie. He had been remanded on the former occasion in consequence of the absence of Mr. Hardy, who was confined by the inju¬ ries he had received. This gentleman, however, was sufficiently recovered to attend the day before yesterday. No particulars of importance were elicited in addition to those we stated in out¬ last number but one. Mr. Penruddock was committed, and tbe several parties bound over to prosecute. The trial, on the charge of felony, will take place at the Old Bailey about the end of February. We cannot allow this opportunity to pass without pointing out the dis¬ graceful system of insulting the mem¬ bers of tbe Court of Examiners on their uay to the Hall, which has been for some time carried on. Certain persons, headed by some of tbe chief performers at the “ Crown and Anchor” meeting of last year, have collected every Thursday, for several successive Meeks, at a public-house opposite the Apothe¬ caries’ Hall, where they watch the arrival of the members of the Court, and insult them by the use of the most opprobrious, and sometimes of the most blackguard and disgusting epithets. Me have ascertained the names of two “ Grinders,” M'bo act as ringleaders, haranguing such individuals as they can get to listen to them, and inflaminjr their minds against the Examiners by every means in their power. 550 RECENT DISTURBANCE AT ST. THOMASS HOSPITAL. The circumstances are without parallel in this country ; and it is mortifying- in the extreme to think that any calling themselves members of a liberal pro¬ fession should be capable of conduct so much calculated to reflect disgrace upon it. The whole may be traced without difficulty to the working* of the “ Meade and Wakley” meeting-, at the Crown and Anchor, last year. The Worshipful Society ought to apply to the magis¬ trates, as the nuisance has become quite intolerable ; and it is a duty they owe to the public not less than to themselves, to have it effectually abated. RECENT DISTURBANCE AT ST. THOMAS’S HOSPITAL. On Tuesday last a true bill w?as found ag*ainst the gentlemen implicated in the late disturbance at St. Thomas’s Hospital. The parties (we forbear at present to mention the names) are to be tried at the next sessions. It is impossible not to regret, on many accounts, the occurrence of this most discreditable affair. That some of the Guy’s students acted with unwar¬ rantable violence is quite obvious ; and it wrould, therefore, have been more ju¬ dicious to have endeavoured to depre¬ cate, rather than incense, those in whose power they had placed themselves in a moment of youthful impetuosity. As it is, the event has assumed an aspect most formidable as regards the young men themselves, mo s t i n j u r i o u s t o th e i n ter e s ts of the school, and most distressing to their friends. Some of the young gentlemen have had very bad advisers ; and the part taken by the Lancet has done them infinite mischief. It never is either wise or manly to justify what is wrong-, — even if that wrong has been committed in the vindication of a right. But how infinitely more unfortunate is it in any one implicated in an affair of this kind to have such a person as Mr. Wakley mixed up in it. Although, in this in¬ stance, he may have forced himself upon them, yet, we ask, had not the parties to whom we allude penetration enougn to know that his affectation of in¬ terest and anxiety for them was but a trick of our roguish contemporary to serve his own purposes? Did they not perceive that the volunteer advocate and adviser is a mere knave, w ho makes tools of them for his own purpose ? Wakley endeavours to identify himself with the pupils even where they may be w rong, in order to g*ain popularity and to sell a few copies of his jour¬ nal ; but in this instance he accomplishes more, for he gratifies a double animo¬ sity, viz. his hatred of both the Borough hospitals ; institutions which cannot but be deeply injured if he can goad on the pupils to perpetuate the existing dissensions. As to the rest, no man can be a sincere friend of the students, who adopts that line of conduct which is, of all others, calculated to bring down the greatest rigour of the lawr upon them, instead of endeavouring to have the angry feelings on both sides soothed, and some accommodation effected. On the same principle, with reference to the pupil who assaulted the members of the Court of Examiners at Apothe¬ caries’ Hall, instead of attributing the act to insanity, or momentary excite¬ ment (the only real palliatives), Mr. Wakley actually justifies the deed ! and thus provokes the Worshipful Society to let the law take its full course against the delinquent. He says that it is not known what provocation the Examiners may have given the pupil,-— as if any provocation could possibly justify such an outrage ; and in reference to our remark, that his inflammatory writing tended to lead young men to the com¬ mission of violence, he expresses re¬ gret that the merit does not in this case MEDICO-LEGAL EXAMINATION OFTHETRUNK OF A HUMAN BODY. 551 more immediately and unequivocally belong- to him. “ Unfortunately (says this worthy member of the legislature), unfortu¬ nately the merit of treating the hags of the Hall with so much justice is not clue to us” Nothing can point out more clearly the line of conduct which the ho¬ nourable member for Finsbury would have the pupils adopt. But we ear¬ nestly advise them, setting aside all feelings of irritation and excitement, to consider what is due to themselves and to their friends ; and to remember that though Wakley may cheer them on, and call them fine fellows, yet that not all the slang- and slander the Lancet ever contained will save them from a single penalty which any illegal rash¬ ness may entail upon them. REPORT OF THE MEDICO-LEGAL EXAMINATION OF THE TRUNK or a HUMAN BODY, WHICH WAS LATELY FOUND IN THE Edgeware Road, UNDER MYSTERIOUS CIRCUMSTANCES. [We have been favoured by Mr. Gird- woodwith the following full and satisfac¬ tory report given at the inquest. That gentleman, with the permission of the churchwardens, had an opportunity of examining the mutilated remains the day after their discovery, and was thus enabled to give a deliberate account of the appearances. — Ed. Gaz.] The body was tied round with a cord, binding the arms flat across the abdo¬ men, squeezing them deep upon the surface ; and in this manner it was stuffed into a bag. The bag was very dirty, and of a very coarse texture, not closely stitched together at the edges ; there were shreds of wood-shavings clinging to the rugged edges of the seams, principally mahogany, and the bag was much saturated with blood at its lower part. The body was headless and legless. On measuring the trunk, its length from the posterior spinous process of the seventh cervical vertebra to the point of the coccyx is 24 inches ; in front, mea¬ sured from the superior edge of the sternum to the inferior edge of the sym¬ physis pubis, it is 21 inches. The skin is fair, and a considerable layer of fat exists under it throughout. There is an unusually small quantity of hair, of a light colour, on the pudenda ; the pu¬ denda want their usual external develop¬ ment. There is a slight cccbymosis, about the size of a pin’s bead, on the right labium. The carunculse myrti- formes were apparent, and a slight abrasion was seen at the posterior edge of the vag'ina. The breasts are some¬ what corrugated on the surface, the skin not now being so much distended over them by the plumpness beneath, as at an earlier period of life it must have been : there is no hair in the axilla. There is not the development of the nipple, nor are there the striated marks on the surface of the abdomen, nor does there exist any separation of the recti muscles, indicative of the female having ever been pregnant. The hand is a full woman’s size, and dirty; there is no mark of needlework on the left fore-finger; the mark of a. ring exists on the left ring-finger; the nails of the fingers of both hands are blue towards the tips; the left, how'- ever, has to that superadded on all four a red streak immediately behind the union of the nail with the flesh ; the muscles of the arms were rigidly con ¬ tracted. The length of the arm, mea¬ sured from the acromion point to the tip of the middle finger, is 30 inches. There are no marks of violence on the body, excepting on the right side of the abdomen, two inches above the groin, there exists a superficial cut, in a slanting direction, removing the skin an inch and a half. There are no marks of medical treatment. She has not been bled lately, nor blistered. The head is severed from the trunk anteriorly, about three inches above the sternum. The fifth cervical vertebra is sawn through, leaving only about the tenth of an inch of that bone. Tl ie legs are cut off immediately un¬ der the hip-joint. The cut does not present a ragged appearance. The thigh bone on both sides, about an inch under the trochanter, is sawn from 532 DR. JAMES JOHNSON ON THE PREVALENCE OF ■within outwardly half through, and then broken off. A superficial cut on the left thigh exists, running for three inches parallel to, and about one inch distant from, the one that severs the limb. A similar cut exists on the right side of the neck. On opening* the body, the viscera presented generally this remarkable ap¬ pearance — they were completely ex¬ sanguinated, no congestion in the kings, no coagula in the heart, no blood flowed, nor were there any bleeding points in the liver, or the spleen, when cut into. All these organs presented a healthy appearance, excepting one or two points of adhesion observed on the pleura, the result of some long preceding inflam¬ matory action ; there was no effusion in its cavities. The stomach was about a third part filled with fluid and half- digested matter; pieces of meat could be detected, a little pastry, and it had a slightly spirituous smell. In the smaller bowels was a considerable quantity of the pultaeeous matter called chyme, and from them could be traced, proceed¬ ing along the mesentery, the lacteal vessels filled with chyle. The surface of this portion of the intestinal canal had a slight purplish blush on its outer surface, and there was scattered over it small dark purple spots. The gullet presented internally a healthy appear¬ ance. The bladder was void of urine, and rigidly contracted. Our attention was now arrested by the remarkable fact, that this female had no uterus. The vagina was about two inches long, and terminated in a cul tie sac , having a slightly puckered appear¬ ance, where ought to have existed the os uteri; the ovaries existed in a fold of the peritoneum, on each side of the brim of the pelvis. The right ovary had a fibro-cartilaginous tumor attached to it, the size of an almond ; and the left had a hydatid, about the same size. The fimbriated extremities of the fallopian tubes were not loose, but were matted down to the peritoneum ; and tracing their course along the broad ligaments downwards into the basin of the pelvis, they were found to be joined behind the bladder by the round ligaments of either side, proceeding in their usual course from the inguinal ring; and the point of junction of those four ligaments was indicated by a slight fulness, and puck¬ ered, flat, longitudinal band, occupying the natural position of the uterus. Remarks. — The female, from her ap¬ pearance, is supposed to be between thirty and forty. Her height, on com¬ paring the length of the trunk and the arm with the length of the trunk and arms of two living women, lead me to suppose it to have been from five feet seven to five feet eight; the mark of the ring upon her finger, that she had been married. The appearance of her hands would lead me to conjecture her as a woman engaged in household work. The bloodless state of the body induces me to consider that the mutilation must have taken place shortly after death. The healthy state of the gullet proves that no acrid poison had been taken, and the contents of the stomach and bowels that food had been taken not many hours previous to death. The ab¬ sence of disease internally, and no marks of medical treatment externally, indicate her death having been a sudden one, and in all probability not preceded by disease. The remarkable peculiarity connected with the sexual formation of this female, will go far to establish her identity. This woman could never have been subject to the periodic illness of her sex. Taking every circumstance into consideration, I repeat that I think the death must have been a sudden one. Had this sudden death been natural, it must have been by apoplexy ; and supposing that to have been the case, still the throat must have been cut shortly after death, to account for the bloodless state of the viscera. In addition, I have to state that the stomach and smaller intestines were examined by Dr. Hunter Lane, who found nothing deleterious in them. Gilbert Finlay Girdwood. January 5, 1837. ON THE PREVALENCE OF CALCULOUS DISORDERS AMONG SEAMEN; IN REPLY TO MR. COPLAND HUTCHISON. To the Editor of the Medical Gazette. Sir, Mr Copland Hutchison has preached a rather lengthy sermon from a short CALCULOUS DISORDERS AMONG SEAMEN. text. The report of ray observations at the Medical and Chirurgical Society was so compressed that it omitted three- fourths of what I said, and did not clearly or exactly represent my state¬ ments in some particulars*. In the first place, I disclaimed ail idea of putting my opinions in competition with Mr. Hut¬ chison’s laborious researches ; but that I had an impression on my mind (these were my very words) that men had often been invalided from the service while actually affected with calculous com¬ plaints, and who might have repaired subsequently to civil hospitals. I never said that seamen, when known to have calculus, were invalided and sent to civil hospitals. How many hundreds have laboured for years with stone in the bladder, and only presented symptoms of bad health, till the sound was intro¬ duced and the calculus discovered ! The supposed insult to naval hospital surgeons falls to the ground; or if it can be so construed, I take it to myself, for I candidly confess, that at no period of my naval life would I have under- taken, whether afloat or ashore, the dark, difficult, and dang-erous operation of lithotomy, of which the naval sur¬ geon, according to Mr. Hutchison’s own shewing, can have no practical experi¬ ence. But let us see whether there are any apt illustrations of this supposed insult to naval hospital surgeons. With¬ in my own knowledge, two naval sur- g'eons (Sir V. Duke, and Mr. Evan Edwards, one of whom was himself a naval hospital surgeon, and cofise- quently jealous of the honour of the staff,) became affected with calculus, and after many years of suffering sub¬ mitted at last to the knife. But to whose knife? Did they go the Naval Hospital at Plymouth, to be operated on by Sir Stephen Hammick ? No. To Haslar, where Mr. Vance (an excellent surgeon) was in his prime ? They did not. Did they repair to the Royal Hos¬ pital at Deal, in order to give Mr Cop¬ land Hutchison an opportunity to flesh his maiden gorget in their bladders? Not they, indeed ! They very prudently came to the metropolis, and submitted themselves to men — who had been brought up in hospitals — who had for years been in the habit of assisting * The report to which Dr. Johnson alludes ap¬ peared in the Lancet, not in this journal. — E. G. others in this formidable operation — who had been in the long habit of dis¬ secting the parts concerned in lithoto¬ my — who had been in the habit of teaching anatomy and surgery for years — and who, after all this training, had been in the habit of operating for stone on the living body. How will this portrait apply to the naval surgeon, who, I admit, is a good operator in ge¬ neral surgery ? I may not have had the education, the talents, the intrepi¬ dity, the ambition, of Mr. Copland Hut¬ chison ; but I had a conscience in my breast which would not have permitted me to peril the life of a fellow-creature, by undertaking the operation of litho¬ tomy, which requires years of prepara¬ tion and practice to effect it well and safely — and all for the doubtful chance of obtaining some eclat for myself. If this declaration be taken as an insult to naval surgeons, it is directed against their vanity, and not their humanity. The art of cutting for the stone cannot be learnt by intuition in the navy no more than in any other place; it de¬ mands a very long apprenticeship, which few can undergo, even in civil life. But to come to the statistical question itself. Dr. Gordon suggested, and Mr. Earle and others confirmed, the real cause of infrequency of stone in seamen — namely, the period of life at which they enter and leave the service in general. Mr. Earle stated that the overwhelming majority (more than five-sixths) of li¬ thotomy operations in St. Bartholomew’s Hospital were under the age of 12, and above that of 45 or 50 years. The in¬ frequency of stone, therefore, is not pe¬ culiar to seamen, but to all people with¬ in the above periods, and who lead active lives. As for the diet, the grog, the sea air, the tobacco, and many other alleged causes for this immunity from stone, they are mere creatures of the imagination. In respect to my friend Mr. Hutchi¬ son’s suspicion that I had been reading Roderick Random just before I went to the Society, I confess my partiality for that amusing production, and that, had I much dull time on my hands, I am not quite sure that 1 would not prefer Smollett to Hutchison ■ — I am, sir, Your obedient servant, James Joiixson. December 28, 1836. 554 THE MEDICAL WITNESSES’ ACT. NOTE FROM DR. WEATHERHEAD TO DR. JOHNSON. Royal Med. and Chir. Society, Dec. 28, 1836. Dear Sir, — From being- much occu¬ pied during- the last week in preparing to remove my dwelling, I did not see either of the weekly journals. I write to say, after perusing the Ga¬ zette, that I was not the “ friend5’ who communicated any thing to Mr. Hut¬ chison on the subject of the debate. I felt assured that it never was your iutention to cast any reflection on that department of the naval service to which you belong; and, indeed, you disavowed the bare idea of it de piano. Very truly yours, G. Hume Weatherhead. Dr. Johnson , §c. <3fc. F.S. — So far from asserting that men were sent from naval hospitals to civil hospitals for the operation of lithotomy, I distinctly stated that I was present at an operation for stone in Haslar Hospi- *mt being- a gunner of a ship at that port. J. J. tal, the pati in ordinary THE MEDICAL WITNESSES’ ACT. ITS IMPERFECTIONS AND INJURIOUS TENDENCY. To the Editor of the Medical Gazette . Sir, As proofs are daily occurring of the Medi¬ cal Witnesses’ Act being misinterpreted by coroners and overseers, as well as by mem¬ bers of our profession, I trouble you with the following notice of two cases that came under my own observation, where it seems the coroners exceeded their power, in summoning more medical witnesses than the law authorizes them to do, and in giving orders for the payment of fees, which in one of the instances has been successfully resisted. More than a month ago I was requested by my friend Mr. William Pater, of the Commercial Road, to accompany him to the house of a neighbour, whose servant had secretly delivered herself during the previous night of a mature foetus. Until his arrival the family was ignorant of what had taken place; but notwithstanding the girl’s strong asseverations to the contrary, he was convinced she had recently born a child ; and after much search it was found. Leaving the infant exactly in the position in which it w-as discovered, and refraining from any further investigation for the present, he sought my advice. It was, of course, necessary that ani nquest should be held ; and anxious not to take the entire responsibility of the medical portion of the inquiry upon himself, he wished me to be associated with him. On the case being made known to Mr. Baker, the coroner for the district, he is¬ sued two distinct summonses, one to Mr. Pater, the other to myself, directing us to proceed to the examination of the body anatomically, and to attend at the inquest to be holden the following day. We acted in obedience to the command, gave our evidence before the jury, and each received an order on the overseers of Stepney pa¬ rish, signed by the Coroner, for the fee of two guineas, as awarded by the Act. When these orders were presented, the parish officers refused to pay more than one, on the ground that Mr. Baker had over¬ stepped his authority in summoning two medical men. Mr. Pater appealed to the magistrates at Lambeth -street Police Of¬ fice; but, as it was a novel case, they de¬ clined giving their decision until they had looked over the act of parliament more critically. The further hearing was fixed for last Monday, when Messrs. Hardwicke and Combe, the presiding magistrates, decided that the double order had been issued by the coroner illegally , and that the overseers were fully justified in refusing payment to more than one. Four or five weeks before the inquest just mentioned wras held, I was summoned by Mr. Payne, the city coroner, under cir¬ cumstances very nearly similar, A newly- born child wras found dead ; suspicions attached to the mother; and the medical man wrho first saw it being desirous of my opinion, Mr. Payne summoned me before the jury met, directing me to attend and give evidence. Both my friend and myself were examined, and an order for the pay¬ ment of the fee to each of us wras signed by Mr. Payne, and honoured by the parish officers. Tln>s-; sir, two coroners, both practising lawyers, have, it w-ould appear, misunder¬ stood the power with which the act invests them, and have been led into the error of giving an order for a fee which cannot be recovered if resisted. That Mr. Payne be¬ lieved he had legal authority for ordering payment to two medical men, provided he thought it necessary to summon two, I gathered from a conversation I had with him at the time I appeared before him ; and it w-as the impression I had derived 555 THE MEDICAL WITNESSES* ACT. ■om that conversation that induced me to recommend an appeal to the magistrates at Lambeth -street This construction of the Act by Messrs. Hardwicke and Combe (and on an atten¬ tive perusal of it I am persuaded their de¬ cision is correct), may perhaps bear hard on our profession, because it is impos¬ sible for any medical man to know whe¬ ther he is the only one summoned, or whether the coroner may not have required the attendance, either through mistake, ignorance, or design, of two, or perhaps halt a dozen of the profession; should such be the case, only one would receive payment, while each would be liable to a fine of five pounds if he did not attend according to the order. Under the old system, — certainly vicious to the highest degree, — the coroner had neither the power to compel the attendance of a me¬ dical witness, nor to punish for disobe¬ dience of the summons under the pre¬ sent, he may issue a summons to a dozen, having authority to remunerate one only ; while at the same time every individual called upon would be liable to be fined if he did not make his appearance. This is surely a bungling remedy for a previous glaring defect. In another respect the Act is most faulty as regards the wording. It gives the coro¬ ner authority to call in the aid of any medical man in actual practice living “ in or near the place where the death has happened.” And the jury, when assem¬ bled (provided they are not satisfied with the medical evidence befofe them), may require the assistance of as many medical men as they choose to name, without any reference to their residing “in or near” the spot. Thus, on the one hand, the extent of distance implied by the indefinite term near, is left to be construed according to the caprice of the coroner or summoning officer ; and, on the other, the jury may send for any eminent practitioner from any part of the country, affording him the very liberal fee of two guineas if he at¬ tend, and rendering him liable to a fine of five pounds, provided he decline avail¬ ing himself of their invitation. Indeed, this short piece of legislative enactment is so ill calculated to remedy the evils pre¬ viously existing, that I quite agree with the magistrate at Lambeth-street Police- office, who said he had little doubt but that in the next session of parliament a bill would be introduced to amend this Act, and place it on a more practicable footing. One of the alterations I would propose should be, that instead of the words “in or near,” a limit of distance should be speci¬ fied ; and that no practitioner should be brought further than five miles from home without an extra fee per mile being paid him, together with travelling expenses at the same rate as is allowed to the coroner; and another, that the coroner should be authorized to require the attendance of two medical witnesses independently of the jury ; for it is evident that in cases of sus¬ pected poisoning, infanticide, and many others, the concurring testimony of at least two professional persons is not only desirable, but should be had if possible. Provided the Act be left as at present, see what must result. Let us suppose the coroner to direct an analysis of the con¬ tents of the stomach before the jury meet ; either the medical men summoned to at¬ tempt this difficult operation will not think himself competent to do it, or will shrink from the responsibility, and, failing to obey, he will be fined five pounds, or he will proceed to the investigation, assisted by a friend, who will not receive remunera¬ tion, and therefore he will lay himself (perhaps unwillingly) under considerable obligation to his friend ; or, lastly, he will undertake it single-handed, and necessarily do it imperfectly ; for no one will contend that a delicate chemical analysis can be properly performed without competent assistance. His testimony will, in that case, neither be so full nor useful as it might. Again, suppose the coroner merely is¬ sues his summons for attendance, without ordering an inspection of the body ; and the jury having met, the medical witness declares his inability to give evidence un¬ less an anatomical examination is made. The jury direct it should be done, and nominate a second gentleman, to whom they have the power of granting remunera¬ tion. The inquest must be adjourned, probably, till next day; and every body concerned loses much time, which might have been avoided if the coroner could have taken upon himself conscientiously to enforce the attendance of two profes¬ sional men in the first instance. It is not impossible, however, that, in such case, the majority of the jury (im¬ panelled against their will, and anxious to make no greater sacrifice than they are absolutely obliged to do, or perhaps not wishing to burden the parish rates writh extra fees, they themselves being rate¬ payers) may decline calling in another opinion, or requiring any anatomical in¬ spection at all. If they are satisfied with doing their duty in a slovenly manner, the coroner has no alternative but to bow to their decision ; for however necessary he may consider additional testimony, the law does not empower him to obtain it against the vote of the majority of the jury ; and the ends of justice are defeated. These are some of the inconveniences 556 ON SELF-SUPPORTING DISPENSARIES, likely to arise from the operation of this ill-digested statute. Another annoyance that has been already felt, consists in making the giving evidence the sine qua non to entitle to remuneration. Medical men have been summoned by the coroner, have been kept waiting for hours in the inquest room, and have at last been told by the jury that they are quite satisfied as to the cause of death, without medical testimony. The practitioner, under such circum¬ stances, caunot claim his fee, and of course it would not be paid. Both the instances I have noticed above were peculiar, and possessed points of interest in a medico-legal view. In the last, a medical practitioner saw the infant very soon after its birth, while the body was yet warm, and tried to re-ani¬ mate it by inflating the lungs and other means. Mr. Payne’s object in summoning me, appeared to be to learn whether, after these unsuccessful attempts at resuscita¬ tion, a post-mortem examination would throw any light upon the question whe¬ ther the child was born alive. In the other case, it was evident that the infant was expelled living, although it had never breathed, and that it died from bleeding through the umbilical ves¬ sels. It was found with its head dowm- wards, in a covered slop-pail, nearly full of bloody water, in which also there were two small coagula and a quantity of indu¬ rated fasces. The funis was torn asunder at the distance of eight inches from the umbilicus, and neither was there a ligature around it, nor any appearance of one having been applied. As soon as I saw the mother, I made a search for the pla¬ centa; but it wras not to be found in any of the cupboards or boxes in the room. Suspecting it might still be in utero, I exa¬ mined the vagina, and discovered the torn end of the funis, just within the vulva : I removed the placenta from the uterus by the introduction of the hand. It wras partially adherent, and almost entirely within the uterine cavity. The whole length of the funis w as oniy 13 inches, and the twro lacerated ends tallied most exact¬ ly. Although at least eight hours had elapsed between the birth of the child and the extraction of the placenta, there did not appear to have been more blood lost than in ordinary labour. From the girl’s statement, and corrobo¬ rative circumstances, it seemed that, feel¬ ing a supposed inclination to evacuate the rectum, she sat upon the pail for that purpose, when, the child being rapidly expelled, and the uterus strongly embrac¬ ing the placenta at the same moment, the funis was put violently on the stretch by the weight of the falling body, and the jerk snapped it. That the child was born alive, I think was clear, from the fact of its body being almost bloodless; the large vessels were completely empty, and the viscera very much paler than natural. There was also a small quantity of bloody matter, exactly such as the pail contained, found in its stomach ; a convincing proof that it was not dead before its birth. But as the lungs had never admitted air, the coroner laid it dowm as a principle, that the child could not be said to have lived ex utero ; and a verdict of still-born w'as returned. I am aware that there is a question among physiologists, as to w’hat should be considered suflicient to constitute a live birth ; whether a few tremulous throbs of the heart are enough, or whether the in¬ fant must actually have respired ; but I cannot agree with the doctrine that, if a foetus be expelled from the uterus into a fluid in such a manner as to preclude the possibility of its breathing, while the unprotected ends of the broken funis per¬ mit the blood to flow out of its body rapidly (supposing the heart to be in ac¬ tion) the single circumstance of the lungs never having admitted air, will warrant us in considering it as still-born. That the girl did not intentionally mur¬ der the child, both Mr. Pater and myself were convinced ; but that she W'as guilty of causing its death by most culpable neglect, I think cannot be questioned. I am, sir, Your very obedient servant, Francis H. Ramsbotham. 14, New Broad-Street, Jan. 2, 1837. ON SELF-SUPPORTING DISPEN¬ SARIES. IN REPLY TO MR. H. L. SMITH. To the Editor of the Medical Gazette . Sir, I should be very much disposed to allow the letter of Mr. H. L. Smith, which ap¬ peared in your last number, to remain un¬ noticed, but that were it to be so, some who have not paid much attention to the subject on which he writes, might be mis¬ led by it. I cannot certainly reply to the “ Christian charity” of the man who is so liberal in charging his opponents with prejudices, misrepresentations, moral cowardice , and the want of “ honest minds these are unanswerable arguments, and I leave your honest correspondent to the full enjoy¬ ment of them. To the essential part of his letter J can and will apply myself; for — IN REPLY TO MR SMITH. 557 “ - now more bold, The Tempter, but with show of Beal and love To man, and indignation at his wrong, New part puts on.” If I can comprehend him, Mr. S. wishes me to understand that he believes there are two things in existing circumstances very prejudicial to the interests both of the community at large and of the medi¬ cal profession. The first is, “ the dealing in human life on the principle of con¬ tract, n and the second, “competition.’’ That these are evils we are all agreed; there is no dispute on this subject,— it is on the question of what is the best remedy for them that difference arises; and (though at the risk of being said to want an “ honest mind”), I shall endeavour to prove that Mr. Smith has not found this remedy. My opinion on this subject, sir, is not a “ prejudice ,” nor has it been hastily formed. The plan of self-supporting dispensaries, as they are called, because they are only principally supported by charity, has now been for some years before the profession ; during which I have considered it care¬ fully, and I may add “ honestly,” for I have had no private end to serve. If the “ contract system” be “an evil so great as to be unendurable to Christians,” it should be swept away at once— not to be revived in any shape. Mr. Smith, how¬ ever, notwithstanding his professed detes¬ tation of the principle, is endeavouring to perpetuate the evil under another form ; for is that which he recommends the less a contract because “ the annual payment is four shillings and four pence for an in¬ dividual,” than if it were 200/. per annum for some hundreds or thousands? It is the same principle differently applied, and in no degree less an evil than the sys¬ tem reprobated. But Mr. S. will say it is, because, under his plan, the poor man may choose his own surgeon, and may change him if he please. Let Mr. Smith answer this question truly, and then get out of the difficulty it involves if he can. Was he not asked, at the first meeting on this subject at the Newington School House, how many surgeons he proposed should be attached to the institution he recommended for the Southwark district; and did he not in reply say “ four or six of the seniors, and that the juniors might become attached to it as they should be¬ come worthy of it?” He did make such a reply, and I was indignant at the humbug so glaringly apparent in such a statement, conjoined with that he had just before made, that his plan would enable a poor man to choose his own surgeon ; and this, too, was the plan he had the modesty to propose to some 30 or 40 surgeons of a district in which there are between 2 and 300! I, sir, am a junior surgeon; and I could not but feel grossly insulted on be¬ ing told, as by implication I was told, some seven or eight years after receiving my license to practise, that I was unworthy to attend the poor. The effect produced on my mind by these words of the “ friend of his profession,” will never be erased from it: — all who were present can bear testimony that t do not misrepresent him. So much for the principle of contract as recommended by Mr. Smith, which is not to be despised, when monopolized by four or six seniors ! In what way Mr. S.’s dispensaries will put an end to competi¬ tion amongst medical men, he does not condescend to inform us : he does say “ he has suggested a judicious system of co¬ operation amongst them;” but how will his plan secure this? What is there in it to prevent the juniors of the profession, thrown upon their own resources by ex¬ clusion from working his “judicious sys¬ tem of co- operation,” from combining to attend the poor for three-fourths, half, or one-fourth of a penny a week?” “ They cannot dig, — to beg they will be ashamed;” but of course they will be nothing loth to follow the example set them by their seniors. 1 write to you as an individual, but I can assure Mr. S. that the members of the British Medical Association (and I have no doubt the whole of the profes¬ sion) will duly appreciate the attempts made by him to uphold the dignity and respectability of his brethren by vili¬ fying them with accusations of ruining the poor, by harshly enforcing payment of extortionate charges; and the attempted libel contained in the following passage of his letter: — “ The craft is their status, and they are naturally prone to mystify and misrepresent every attempt to liberate their dens of drugs, dregs, and darkness, from the thick clay with which they are co¬ vered.” If the animus which caused this nonsensical sentence to be penned be a sample of that with which Mr. Smith would legislate for the profession, the less he meddles with the subject the better; and if his promised scheme is to partake of this spirit, I would strongly advise him to withhold it, if he do not wish to in¬ crease the disgust entertained bv the mass of the profession at his attempts to vilify and degrade it. The misquotations and torturings of Dr. Webster’s speech require some com¬ ment. I need not, sir, tell you, or your readers, that the paragraph so shamelessly applied by Mr. Smith to his dispensaries, wras not Dr. Webster’s; it was the quota¬ tion from the Address of the Southwark General Practitioners’ Society, which you had the kindness to publish forme in No. 7 of the present volume of the Medical 558 EXAMINATIONS AT APOTHECARIES* HALL. Gazette : Mr. Smith may not know this. Mr. Smith “ would like to be told, what have Poor Law Commissioners to do with affairs that do not belong to them,” (no¬ thing, certainly !) and he goes on to say, that the preceding week . . $ 6 METEOROLOGICAL JOURNAL. Kept at Edmonton, Latitude 51° 37' 32" N. Longitude 0° 3' 51" \V. of Greenwich. Dec. 1836. THERMOMETER. BA ROMETE R. Thursday . 29 from 22 to 32 29-91 to 29 95 Friday . . 30 23 33 29 97 30 04 Saturday . 31 Jan. 1837* 20 33 30 16 30-30 Sunday . . 1 25 34 30-39 3037 Monday. . 2 6 33 30-29 30-28 Tuesday . . 3 28 40 30-22 30-20 Wednesday 4 24 36 30-20 30-24 Prevailing wind, till the morning of 2d, N. and N.W. ; since W. and S.W. Generally cloudy till the 1st inst. ; since gene¬ rally clear, except on the 4th. A little snow fell on the 29th, 30th, and 3 1st ult. The sudden and great fall of the thermometer on the morning of the 2d, has not been equalled since February, 1830; the rise on the same day was even more rapid. The thaw has continued, with the exception of the night of the 3d, and the quantity of snow is gradually diminishing. Charles Henry' Adams. December 27, 1837. Scrutator. WiLSON & 8 on, Printers, 07, Skinner* 8 1, London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JODMML OF Jleij trine ants tlie Collateral ^rintrcs. SATURDAY, JANUARY 14, 3837. LECTURES ON FORENSIC MEDICINE; f Delivered at the Aldersgate School of Medicine, Br William Cummin, M.D. Lecture XVI. Births of Children medico- legally considered — Mature and Immature Births — Legal distinctions — Privileges connected with the Birth — Viability in French law — Fama clamosa — Early instances of Maturity — Signs of sufficient Maturity — Natural and Mon¬ strous Births — Legal Definition of Monsters — Table of all known Monstrosities, with Remarks — Headless and Brainless Mon¬ sters — Double Monsters — Parasitical Foetuses — Supposed case — Transposition of the Vis¬ cera — Question of moral peculiarities con¬ nected with that state. The medico-legal considerations connect¬ ed with the births of children are nume¬ rous and highly important. Births are mature or immature, natural or mon¬ strous, single or plural, prsemature or re¬ tarded, Igve or still, legitimate or illegiti¬ mate, &c. The determination of the fact in all such cases chiefly depends on medi¬ cal evidence, and it is easy to conceive how much the result may affect the peace and welfare of families, and the safety and honour of individuals. Mature and Immature Births. The terms mature and immature suggest the idea of a certain degree of growth of the foetus, without any immediate refer¬ ence to the time at which it is born. Ma¬ ture has, indeed, another correlative in 476.— xix. the term prsemature, which includes the latter idea; but with this at present we have nothing to do. By maturity, as compared with immaturity, is implied such a degree of development in the foe¬ tus as is consistent with the power of continuing an independent existence. It may be more or less complete, and in so far recedes from or approaches to the state of immaturity. I have already described the characters which mark the mature infant*, when I also gave an account of the pro¬ gress of development in the foetus, up to the attainment of intra uterine perfection. On that occasion, 1 used the term in a more strict sense than I shall now do ; for, strictly speaking, any thing short-of that maturity just alluded to should constitute immaturity ; but the limitation now intro¬ duced will obviate any charge of inaccu¬ racy. We shall, therefore, inquire what degree of maturity is sufficient for extra- uterine life. Legal distinctions. — It ought to be premised that our laws take little or no cognizance of the maturity or immaturity of the infant at birth ; if it be born alive, and not a monster, (and both these facts are under¬ stood with great latitude,) it is generally sufficient for every legal purpose. The circumstance of bir :h merely, confirms in certain cases very important privi¬ leges acquired at an earlier date; for an infant in its mother’s womb, or ventre sa mere, to use the legal phraseology, is supposed in law, for many purposes, to be already born. It is capable of hav¬ ing a legacy, or a surrender of a copyhold estate made to it. It is enabled to have an estate limited to its use, and to take afterwards by such limitation, as if it were then actually born. It takes land by descent, though in that case the presump¬ tive heir may enter and receive the profits * Lecture iii. pp. 68, 69, present volume. 2 O 562 DR. CUMMIN ON FORENSIC MEDICINE. for his own use till the birth of the child, which seems to be the only interest it loses by its situation. These privileges date from the moment of conception : there are others, chiefly having reference to the protection extended to the infant against the infliction of injuries, (hereafter to be noticed) which commence at the time of quickening. The subsequent birth of the child has in all such cases much influence in modifying the nature of the crime. If the child be born alive, and afterwards die in consequence of injuries alleged to have been committed on it in utero , it is murder: it is, however, some¬ times, in respect to the charge of infanti¬ cide, of great consequence to be able to prove that the child was immature, or not likely to have lived, when a person is charged with having caused its death. Viability. — In France, both for civil and criminal purposes, it is absolutely neces¬ sary not only to determine whether a child has been live born, but whether it has also had a capacity for continuing to live. This is what is called its viabilite ; and an infant is pronounced viable ( from the Latin via), w'hen it is considered capable of pro¬ ceeding on the journey of life under ordi¬ nary circumstances. According to the Code civil, concerning inheritances and lega¬ cies, the child which is not born viable is placed in the same category as if it had not been begotten. Also, with reference to legitimacy, if a child, born within 180 days after marriage, be declared viable, it may be disclaimed by the husband, pro¬ vided he was not cognizant of his wife’s pregnancy at the time of marriage, nor assisted in registering the infant’s birth. The French law does not define viabi¬ lity: the determination of the fact is therefore left dependent on medical evi¬ dence. But it is curious that the French medical jurists are by no means agreed as to what should, or should not, con¬ stitute this condition of the new-born child. The definitions they give us are sufficiently vague, and even the latest and most practical of their wrriters, M. Dever- gie, after stating the several forms of ex¬ pression in which the term is defined by Fodere, Capuron, Marc, Grfila, Velpeau, and others, cannot be more explicit than this, that viability denotes “ the aptitude for extra-uterine life, characterized by the maturity of the infant, the good conforma¬ tion of the principal organs of the econo¬ my, and the healthy state of those organs at the epoch of birth.” Now here are three conditions on which viability is made to depend, each of them affording ample room for discussion. Nor is this all : some of the said jurists hold that the ques¬ tion of viability can only be raised in the case of children that have died ; Capuron, for instance, says that as long as the infant lives, it is seized and possessed of its pro¬ perty beyond the possibility of dispute ; but that in case of its death, it may be¬ come a question whether it was viable or not, in order to determine whether it was capable of transmitting its succession. Others are of a different opinion; yet it appears strange that there should be any mistake in the matter, when the law seems so plainly to indicate that a living child may be declared viable or not, not only, as we have seen, in reference to legi¬ timacy, but the succession to property ; for a presumptive heir may enter and raise the question of viability while the infant is still living. There may seem, however, one excuse for the view taken of the sub¬ ject by M. Capuron — namely, that practi¬ cally speaking, the fact of non-viability can be rarely determined (however viabi¬ lity may) during the life of the infant; and perhaps it would be in any case as unsafe to pronounce a living child to be not viable, as to decide that a wound is absolutely mortal, the individual who received it being still alive, with all those chances of recovery which nature some¬ times so henignantly provides, even in the most desperate cases. But to return to the question of maturity. Instances of early maturity. — Although it is only the infant produced at the ninth month of intra-uterine life that can be considered completely mature, instances are numerous of children born at earlier periods being sufficiently mature to run the ordinary course of human existence. The old writers supply us with some very remarkable cases, w hich ought not to be overlooked, as it is by the weight of facts, and not by preconceived theory, that the question is to be decided. We have Avi¬ cenna, Schenck, Spigelius, Valisneri, Am- manus, Diemerbroeck, and others, stating examples of children having lived to adult age, and even to the ordinary limits of human life, though born only five months after conception. Fortunio Liceti, accord¬ ing to Capuron, was born at four months and a half — at five months, according to Kiihnholz — yet lived to the age of 79. His father, says Mahon, did not despair of preserving him, though, when born, he wras no longer than one’s hand; he put him beside the fire (into an oven, as some say), and there kept him in a degree of temperature like that which favours the artificial hatching of eggs. Belloc men¬ tions his having seen a female infant, born about the sixth month, which was only a foot long, and looked like a little skinned rabbit; yet she was carefully fed, and lived to woman’s estate. Marshal SIGNS OF MATURITY. 663 Richelieu was recognized as viable by the parliament of Paris, although born only at five months. Dr. Montgomery, of Dub¬ lin, states that the earliest cases he has met with were a child born alive at the end of five months, but which only lived a few minutes; and another born at five months and a half, which lived only four hours. A curious case became the subject of dis¬ cussion in Scotland not long since. It was a case of early birth, which, coupled with the state of the child, involved matter for scandal among the maliciously disposed. A clergyman had been married to his lady only five months and twenty-one days, when he became the father of an infant — feeble, indeed, and not three pounds in weight — but which by great care was kept alive. It survived birth for several weeks, and may be still living, for aught I know ; but its mature appearance was unfortunate for the good repute of the pa¬ rents : a fama clamosa was raised, and va¬ rious presbytery meetings were held, to in¬ quire and determine how far the clergy¬ man was liable to the charge of having infringed the rules of morality. The cha¬ racter of the parties was luckily good, and there had been nothing like concealment practised: their intended marriage had been approved for months previous to its celebration, and there was nothing to pre¬ vent its taking place. When the child was born there was no preparation for it — all were taken by surprise, and nobody ex¬ pected the infant to live. Under these circumstances, and chiefly moved by the medical certificates produced in evidence, the presbytery decided in favour of the clergyman. The medical evidence adduced in this case was interesting. Dr. Hamilton, of Edinburgh, was consulted : he could not go to see the child, but sent a statement of his opinion relative to such early births. He said that his own experience wras op¬ posed to the probability of a child born in the sixth month surviving; he referred, however, to two cases where children had lived under similar circumstances of pre¬ mature birth. One of these occurred in 1710, when the wife of a clergyman was delivered of a living child within five lunar months after marriage, and the celebrated Dr. Pitcairn, and two other eminent practitioners, gave it as their opinion that it- had been procreated after the marriage of the parents. The other case occurred in 1815, when a married woman gave birth to a living child nineteen weeks after con¬ ception, and it lived a year and a half. Be¬ side this opinion of Dr. Hamilton, there was also given that of Dr. Thatcher and Dr. Reid, who saw the child in question, and examined minutely into all the cir¬ cumstances connected with its birth : these gentlemen certified that it was quite pos¬ sible that the infant was begotten after the marriage *. The opinion of Dr. William Hunter, in answer to an interrogatory which was once put to him on this subject, is worth quoting. “ A child may be born alive at any time after three months; but we see none born with 'powers, of living to manhood, or of being reared, before seven calendar months, or near that time.” It is evident from all this, that the fact of maturity or immaturity cannot be de¬ termined by the mere circumstance of the infant being born before or after a certain time ; but that we must be guided in our decision by the physical characters which we find developed. Children at seven months are often very incompletely mature, although it is an age perfectly consistent with viability; there are also numerous instances of children born at this period, well prepared for the business of life. Professor Chaussier was a seven months’ child ; George the Third, the most long- lived, and perhaps the most prolific of our kings, was born at seven months, complete; and M. Kiinholhz mentions his own wife, the mother of nineteen children, as having come into the world at the same early period. Signs of maturity. — But without referring to precedents and examples which may be readily adduced on both sides, our business as medical jurists can only be properly exe¬ cuted, in reference to the question of matu¬ rity, by a careful personal inspection of the infant. WTe must look to its length, and to what point the middle of the length corresponds : we must observe the size of the head, the growth of the hair, the state of the nails, the colour and texture of the skin, the sebaceous deposit on the skin at the time of birth, and the breadth of the fontanelles. In addition to this, we should attend, in the living infant, to the mode in which the principal vital func¬ tions are performed, — those, namely, of re¬ spiration, circulation, and digestion. The force and manner of its cries, how it sucks — whether continuously, indicating that re¬ spiration through the nostrils is free, or at short intervals, showing that there is a necessity to let go the nipple in order to get breath, — all this should be noticed at¬ tentively. Again, from the colour of the skin, the state of the umbilical cord, and the pulse, we may infer the strength of the heart’s action. And finally, we can form * Medical Gazette, vol. xvii. p. S2. 564 DR. CUMMIN ON FORENSIC MEDICINE. a further judgment of the infant’s powers from the appearance of the meconium or first fiscal matter. Should there be an opportunity of pur¬ suing the inquiry after the death of the infant, the proofs would, of course, be more tangible — especially those respecting the respiratory functions ; for it may then be freely observed and tested how much of the lungs have admitted air, and whether any part of them be diseased. But of such tests there will be a better occasion to speak when we come to treat of infanticide. Natural and Monstrous Births. In reference to the shape and structure of the infant at birth, a question may arise, consistently with the actual state of our common law, whether it is human or monstrous. Legal distinctions. — Our law recognizes monsters ; such beings, as the possible issue of human parents, are mentioned in ex¬ plicit terms. “ A monster ,” we find it stated in Coke upon Littleton, “ which hath not the shape of mankind, cannot be heire, or inherit any land, albeit it be brought forth within marriage; but al¬ though he hath deformity in any part of his body, yet if he hath human shape he may be heire. Iiiqui contra formam humani generis converso more procreautur , at si mulier monstrosum vel prodigiosum enixa , inter liberos non computentur.” Some further limita¬ tions of the term are then added — namely, that those to whom nature has given more or less parts than usual, are to be reckoned among the children, — but the increase or diminution is not to be excessive : six fingers or four only on each hand do not disqualify; nor if nature has disabled any members, or distorted them, does this con¬ stitute monstrosity *. Such is the account of monsters given us by the old legal authorities. The merest tyro in physiology at the present day could point out its imperfections, yet it is the law — the law as expounded by the great luminary Lord Coke, and from which no judge would venture to depart with¬ out grave circumspection. There can be no question however, but that there is much room for exercising a discretion oil the subject, should a case involv¬ ing monstrosity arise in the courts ; and nothing is more likely. It may be raised in a question of tenancy by the courtesy : the right of the tenant rests on the fact of his child having been born alive; but if his opponents. can only prove that the said child had not human shape, his claim is null. If a child hath not the shape of man¬ * Coke Littleton, vii. 8. 29 b. kind, he cannot be heir; but if he hath deformity only, he may inherit. This is in fact the substance of what the law says: but w7hat room is there not in these few words for dispute and litigation ! Where does deformity end, and monstrosity be¬ gin ? Besides, there are various unques¬ tionable monstrosities for which the law makes no provision. “ You will ask,” says Mr. Amos, “ how' does the lawr pro¬ vide for the case of the Siamese youths, their rights in regard to third parties and to each other? — and how for a person wrhose face may be inhuman, but may pos¬ sess reason-~say the case, real orsupposed, of the pig-faced lady ? and probably, me¬ dical men may put a number of other in¬ stances ; — I answer, that the law says nothing more than what I have just read; and that, therefore, if a case of monstrous birth should be brought before the courts, the courts will seek for all the medical in¬ formation that can be obtained, and wrill legislate for the particular occasion; only they will not call it legislation, but will pretend to found their decision upon Lord Coke’s definition; which definition, by the way, is borrowed from Bracton, who borrowed it from the civil law.” Classification of monsters. — The subject of monsters is one of great interest to phy¬ siologists, as it throw’s much light on the operations of nature in the exercise of her formative energy. For the medical jurist also, monstrous births are occasionally possessed of no small interest, inasmuch as the result of certain civil and criminal proceedings may depend on the evidence which he is enabled to give of their actual state — particularly as to whether they are live or still, in reference to questions of tenancy, or charges of infanticide. Buffon, M. Geoffroy de St. Hilaire, and others, have formed plans for grouping to¬ gether the several classes, according to those points of analogy which seem best suited to ground a scientific arrangement. But M. Breschet appears to have been the most successful in the simple but com¬ prehensive scheme which he has struck out. His plan, indeed, seems most prac¬ tical yet devised, and for that reason is eminently entitled to the attention of the medical jurist. Orfila and De- vergie both adopt it, and I give it here nearly in the form in which it has been modified by the latter. The circumstances connected with each state in reference to viability or non¬ viability, it will be observed, are subjoined in a separate column, so that at one view we have a collection of all knowm monstrosi¬ ties, with the consequences in respect to the compatibility or incompatibility of extra uterine life annexed to each. TABULAR VIEW OF MONSTROSITIES. 565 Order I. Agenetods ( /I geneses). Order II. Hypergene- TOUS • • * • Order III. Diplogene- TOUS • • • • Order IV. Heterocene TOUS . , Aceplialia . Anencephalia. Genus I. /Agenesia Congenital dropsy. — 1. Of the ventricles of the brain, with deficiency of some of its parts . . 2. Of the same ventricles, but with } complete development of the organ.. . ) 3. Of the exterior of the brain fully r developed. . *. ^ Aprosopia . * . Ateloprosopia. • • • . . Absence. — 1. Of the eyes, eyelids, or iris. Of the mouth. . . lips, tongue, outer ear. Not viable. Some have lived 20 days. Death before or at birth. Life more or less. Viable. Not viable. Not viable. Viable. Not viable. Viable. 2. Of the epiglottis, penis, scrotum, testicles, vesiculae seminales, uterus, vagina, some of the ribs, some of the vertebrae, part of a member, hand, the bladder . * . . . 3. Esophagus, stomach, liver, heart Viable. or lungs Not viable. Septum between the ventricles or auricles of the heart — the diaphragm , Fissures on the mesian line — of cranium, with large eneephalocele. . - eneephalocele— less voluminous. Viable. Genus 2. Diestenasia Not viable. Spina bifida, with hydrorachis in the upper part of the spinal column. • • • • lower down,' Fissures of the lips, jaw-bone, tongue, palate, bladder, penis, urethra, womb, vagina. . Division of the mesian line of the ab- Viable. Life for a few days. Life some months ora year or two. Viable. domen, with considerable hernia of / Not viable. Genus 3. Atresia • • • • the viscera. Exomphalia, with abdominal or thoracic hernia . Both the preceeding, in a less exagge¬ rated form. . . Ecstrophia . . . Imperforations of the urethra, vagina, uterus, mouth, anus, eyelids, mem- brana pupillaris. . of the oesophagus and in- Not viable. Viable. Viable. Viable. Genus 4. 'Symphysia { testines. Fusion of the eyes— monopsia. • • • of other parts of the body. Not viable. 5 Giants. . . ^ Persons with supernumerary organs. • • S Fused, or united by some parts of the body . United, with fusion of parts. . . United in the upper parts, and separated in the lower. . United below, and separated above.* • • t One foetus containing another, partly or ^ wholly . . f Extra uterine foetus ; or more than three , foetuses at a birth. . ' Albinoes and chacrelats . Foetus with displacement of organs, all, except — displacement ( ectoj)ia ) of the heart, thoracic, with fissure of the sternum, and hernia of the heart • • • • displacement of the heart, cepha- Not viable. Viable. Genus 1. Fusion •••• Genus 2. Penetration Viable. Not viable. Viable. Viable. Viable. Not viable. lie, or towards the head 566 DR. CUMMIN ON FORENSIC MEDICINE. Cursory Remarks. Some miscellaneous observations may be made on certain parts of the table. And, first, of the genus Agenesia, or deficiency of growth. Acephalous , or headless monsters. — These constitute a large proportion of the mon¬ strous births usually met with; they are very common in twin cases. Sometimes not only the head is wanting, but the neck; the arms, also, are occasionally de¬ ficient, and likewise the chest, the ab¬ domen and legs remaining. In such cases all those organs which ordinarily re¬ ceive their nerves from the parts that are absent, are themselves deficient. No spe¬ cies of monstrosity so completely excludes the idea of viability. Brainless , or anencephalous. — The brain may be wanting, while there may, or may not, be a cranium present. A part of the face is commonly also wanting in such cases. When the face is involved in the monstro¬ sity, one or both the eyes are usually defi¬ cient, or they are displaced ; the nose is altered, &c. Anencephalous monsters scarcely ever live beyond the second day : in general they die in three or four hours; but there are instances of their having survived for twenty days. This must depend upon the portion of the spinal column which is present or ab¬ sent. Aprosopia-and Ateloprosopia. — Absence, and imperfection of the face, (implied by these terms,) are always accompanied by a very marked deficiency of brain, accounting for the non-viability which attends those con¬ ditions. Absence of mouth, fyc. — The absence of va¬ rious organs, such as the mouth, eyes, sto¬ mach, oesophagus, heart, &c., as enume¬ rated in the table, is traceable to some primary defect in the development of the nervous system connected with those or¬ gans. The fact of viability or non-viabi¬ lity will depend on the question whether the organs wanting be essential for extra- uterine life. In the genus Diestenasia, (implying sepa¬ ration or un-union) we find spina bifida, or dropsy of the vertebral column, men¬ tioned as constituting a monstrosity. The chances of viability depend entirely on the extent of the disease, and the parts which are involved. Sometimes it is found to occupy the whole length of the column, at other times it is limited to a portion of it. Now when it occurs only in the lower portion, as the lumbar region, it does not necessarily compromise life. Hernia. — Congenital hernias resulting from disunion in the mesian line some¬ times involve not only the viscera of the abdomen and thorax, but, as Beclard has observed, the face and forehead of the in¬ fant may be divided, with protrusion of the contents of the cranium. In the genus Atresia, or im perforation, there is but one monstrosity — imperfora- tion or obliteration of the alimentary ca¬ nal — which proves fatal to the continu¬ ance of independent life. Monopsia. — One-eyed monstrosity is the only species of symphysia (or deficient deve¬ lopment with fusion) which compromises viability. It is, however, capable of de¬ grees, and the consequences must depend on the extent to which an imperfection of the brain is involved. The Hypergenetous, or overgrown mon¬ sters, include the well-known species of giants, and individuals possessed of super¬ numerary parts. Many remarkable exam¬ ples are on record, and instances both hu¬ man and animal are frequently exhibited in public. Under the Diplogenetous order, there are many curious examples to be classed — such as Helen and Judith, the Hungarian sisters, who lived to the age of 21, joined or fused together at the lower part of their bodies, and having but one anus and one pudendum between them : the Siamese twins, also, who must nowr be about 26 years of age, and whose peculiar union by a fleshy and membranous band from ster¬ num to sternum, with a common umbili¬ cus, has been well examined, and often described, by anatomists. I might also mention, as another instance, the Indian child, an account of which is given in the eightieth volume of the Philosophical Transactions, which had two heads, one on the top of the other — the upper one being inverted. But, in truth, the exam¬ ples of this kind are too numerous to admit of, or to need, further detail. Parasitical foetuses. — Of that species wherein the duplicature is effected by an original penetration — one germ get¬ ting within another— M. Dupuytren has given an account of a most interesting specimen examined by him. A foetus was found in the belly of a lad of 14; it was congenital, and lay comparatively inert until the boy was about thirteen years of age. It then became irritable, and produced inflammation of the sur¬ rounding- parts ; there was a cyst investing it, situated in the transverse mesocolon ; this cyst sloughed and opened into the colon, whence pus, with hair and other or¬ ganic matters, were discharged by stool. The lad at length sunk under it. Dupuy¬ tren, on the occasion of recording this ex¬ ample, makes the apposite remark, “ that in such cases, so contrary to ordinary experi¬ ence, while it is the duty of the philosopher, on the one hand, to admit no more than is rigorously proved, he is not, on the other, MONSTROUS BIRTHS. 567 rashly to circumscribe the powers of na¬ ture*.” Suppose a case, — that the subject of a monstrosity like the preceding were a fe¬ male, might not the contained foetus be mistaken for the consequences of impreg¬ nation ? And how should the medical jurist distinguish? — The absence of the signs of pregnancy, uterine or extra-ute¬ rine, would go far to remove doubt ; but the chief explanation would be derived from an examination of the embryo itself, when it would doubtless be found to bear evi¬ dence of its long sojourn in the place where detected; parts of it, if not all, would exhibit the appearance of being too old and too well developed for a recent conception, especially when the normal state of the uterus and its appendages would be taken into consideration. I think it unnecessary to occupy your time with an enumeration of those cases in which the penetration is incomplete. The case of the Chinese, A-ke, w ho had a small parasitical brother protruding from his abdomen, is well known: the model is familiar to all visitors of museums. In the wrorksof Pare, Bartholin, Zacchias, Wins¬ low, and others, similar monstrosities are noticed, but they have no special medico¬ legal interest. Of the Heterogenetous monstrosities, examples are sometimes met wTith which are very striking. In the last two species given in the table — ectopia of the heart, with hernia, thoracic or cephalic — the dis¬ placement is always fatal; for the heart is merely covered with a thin pellicle, and in other respects exposed. Transposition of the viscera. — Not so W'hen the displacement is within the chest, and not attended with hernia. There are in¬ stances of remarkable transpositions of this kind, where the subject has lived for months, years — nav, has attained the or¬ dinary limits of human life. Here is a representation of the state of the thoracic viscera in a child which lived Fig. 20. A, Heart (a, bristle passed through the foramen ovale;) B, Pericardium; C, Left lung: D, Dia¬ phragm; E, Trachea ; F, (Esophagus; G, Arch of the aorta ; H, Abdominal aorta ; I, Artery going to right lung; K, Vein to right lung ; L, Vena cava inferior; M, Vena cava superior ; N, Puuno- nary veins ; O, Pulmonary artery ; P, Ductus arteriosus, obliterated. * Bull, de l’Eeole ae Med. prem. part. An. xiii. 568 PROFESSOR GRATES’ CLINICAL LECTURES. for nearly ten months. It was a sickly infant, however, and suffered much in its respiratory functions, apparently from a deficiency of lung : the right lung was in a very imperfect condition. The abdo¬ minal viscera were not displaced ; but the liver was enormously large*. In a paper read last season before the College of Physicians, Dr. Watson gave a full account of all the best authenticated examples of transposition of the viscera on record. No less than thirty three cases are noticed in this elaborate memoir, which you will find full of interest on referring to it: it is contained in the eighteenth volume of the Medical Gazette. Only four of the thirty-three cases were recognized as such during life ; this is partly to be accounted for by the fact that there is nothing in the transposed condition necessarily of a morbid nature, nor requiring medical attendance ; and partly that in former days the same degree of care, as at present used in exploring the state of the viscera, was never employed. In future, there is reason to believe that examples of this kind will be more fre¬ quently detected; and we shall see, in a subsequent lecture, of how much im¬ portance it is to ascertain whether in a given case there be transposition or not, as our diagnosis of wounds must be ma¬ terially affected by the circumstance. It was attempted a few years since to raise a theory respecting the moral charac¬ ter of persons thus conformed. It was ob¬ served that in a few cases transposition of the viscera was met with in the bo¬ dies of criminals anatomised after death, and the conclusion was hastily drawn, that depravity of mind was essentially connected with this cross condition of the body. But if Smithers, wiio wras executed in i832, for attempting to set fire to his house, w'as found to have this configura¬ tion, and if one or two other malefactors were similarly situated, this was far from being a warrant to justify a general con¬ clusion. On the contrary, it so happens that as in most of the well-observed in¬ stances on record, there was no change ascertained in the bodily functions, so neither was there in the moral endow¬ ments : if any, the balance inclines to the side of goodness: some of the individuals were remarkable for a steady, upright, and benevolent disposition. I cannot conclude more appropriately than by quoting what Dr. Watson says on the subject: — “ More than one of the sub¬ jects of this change happen to have been notorious malefactors, and to have ended their lives upon the scaffold ; and hence seems to have arisen the fantastical specu¬ lation, that as in them the mechanism of the body was crossly modelled, so, by some sinister and mysterious sympathy, the mental constitution also may have been warped and perverted, and the physical prodigy have been necessarily combined with moral deformity. “ If a notion so preposterous could merit a serious refutation, it might be found in the fact that many of the persons similarly fashioned were but little remark¬ able in their lives, either for good or evil ; while one of them, at least, as we learn from the interesting statement of Sir Ast- ley Cooper, was distinguished for active benevolence and kindness of heart, and passed through a long life in uncommon freedom from the vices most incident to her social station*.” CLINICAL LECTURES, DELIVERED AT THE MEATH HOSPITAL AND COUNTY OF DUBLIN INFIRMARY, During the Session 1836-7. Bv Professor Graves. Lecture III. Erysipelas in an Epidemic form — Symmetrical spread of Erysipelas on the Body — Macu¬ lated Fever, and Irish Typhus — Dr. Lom¬ bard’’ s Remarks — Improved Treatment of Fever — Choice of a proper Nurse and Assist¬ ants — Air of the Sick Chamber — Necessity of attending to Diet and Nourishment. I shall now resume the subject of erysi¬ pelas, which I alluded to in a cursory manner at our last meeting. You will recollect I mentioned that wre had a kind of epidemic erysipelas in our fever w ards during the months of August, September, and October; this has now almost disap¬ peared, for wre have had but one case dur¬ ing the present month. The disease gene¬ rally attacked the head, commencing in the scalp, or about the nose and cheeks ; but in some cases it appeared first on the nape of the neck, particularly in those pa¬ tients wrho had been blistered in that situ¬ ation during the course of fever. The fever which now prevails seldom abates in less than fourteen or seventeen days ; and it was generally about the termination of the febrile excitement, and while conva¬ lescence was going on, that the erysipelas appeared. Usually, on the fourth or fifth day of convalescence, a change was ob¬ served in the patient, and the erysipela¬ tous attack commenced, being ushered in by a feeling of weakness and uneasiness, * Med icAi. Gazette, vol, xviii. p. 600. * Medical Gazette, vol. xviii. p. 402, ERYSIPELAS. 569 or an indistinct rigor, followed by quick pulse, headache, some increase of thirst, and in most cases by a marked change in the tongue, which became dry and parch¬ ed. The inflammation was of a superfi¬ cial character, expending itself almost ex¬ clusively on the external surface of the corium, and not affecting to any extent the subcutaneous cellular tissue. You are aware that erysipelas becomes obstinate, complicated, and dangerous, in proportion as the inflammation spreads in¬ wards. In such cases its characters are less distinctly marked, and it makes a near approach to a very formidable disease — diffuse inflammation of the cellular sub¬ stance. The affection of which I am now speaking was generally simple, and in most cases limited to the superficial appa¬ ratus of the corium. It was characterized by the ordinary phenomena of true erysi¬ pelas, namely, redness, heat, a burning sensation, and slight elevation of the af¬ fected parts. There was seldom any re¬ markable degree of oedema, except in some cases where it attacked the eyelids ; and we had no instance of abscesses forming under the skin. It was attended with a considerable degree of constitutional dis¬ turbance, and the fever generally conti¬ nued for four or five days. On looking over the cases of this affection, which have been recorded by the gentlemen who had charge of the patients, I find that in most instances the fever terminated on the sixth day. In many cases a peculiarity was ob¬ served, to which I have alluded on a for¬ mer occasion, namely, the spread of the erysipelatous redness in a perfectly sym¬ metrical manner. I believe I was the first who directed attention to the fact, that when erysipelas commences at any point of the mesial line of the body, it is very apt to spread in a symmetrical manner. Thus, in the present instance, the inflam¬ mation commenced in the majority of cases about the nose, and then extended in a perfectly symmetrical manner over the forehead and down the neck ; or when it appeared first on the nape of the neck, it travelled down between the shoulders with a very remarkable symmetry of ex¬ tent and outline. Sometimes this precise correspondence did not exist; but I can assert that in more than two-thirds of the cases it wras extremely well marked. It appears, then, that this occurrence is not so very rare as my friend Dr. Johnson supposes. When I first noticed the fact of the occasionally symmetrical spread of erysipelas, he said it was an observation of very little importance, and that it wras to be looked upon as a matter of mere curio¬ sity, a phenomenon which a man would not see twice in the course of his life. I have, however, shewn it to many of the students half a dozen times during the last two months. The treatment of this affection, which was abundantly simple, and the same in every instance, was entirely regulated by the circumstances under wiiich the erysi¬ pelatous attack occurred. No local treat¬ ment was employed, nor was any required. It was not necessary to apply leeches, cold lotions, fomentations, or mercurial oint¬ ments. The cutaneous inflammation was not either very extensive or intense; and the constitutions of the patients did not admit of any kind of depletion. The inter¬ nal treatment was determined on, more from a consideration of the circumstances under which the disease had appeared, than from an accurate analysis of the symptoms, or from any preconceived opi¬ nions of the nature of the complaint. In the practice of your profession you will be frequently called upon to treat affections, in which you will have to consider not only the existing symptoms, but also the circumstances under which they have ori¬ ginated ; and in many instances you will find that your treatment will be determin¬ ed more by the latter than the former. Here wre had a number of patients labour¬ ing under erysipelas, at a period when the system wras reduced by fever, and the powders of life at a very low ebb. No one could think of using antiphlogistic or de¬ pletory measures under such circum¬ stances. Recollecting that our patients had just emerged from a dangerous dis¬ ease, we adopted a very different mode of treatment ; and in all cases, except where the patient’s strength was unbroken, the fever high, and the local symptoms of an intense character, we had recourse at once to tonics, narcotics, and stimulants. We first gave an emollient injection, and then administered sulphate of quinine in the form of enema, to the amount of from five to ten grains, blended with mucilage of starch. This was administered twice a day, and the patient wras directed to take small quantities of wine and light nou¬ rishment. Many of the pupils at the time were surprised at this mode of treatment. From the dry state of the tongue, the occasional delirium, the restlessness, and the head¬ ache present, they were inclined to think that the patients would be injured rather served, by dietetic and medicinal stimu¬ lants of this description. I had, how ever, witnessed cases of a similar description, and had observed the tongue become clean and moist, the skin soft and cool, the thirst, fever, and restlessness subside, and the local symptoms disappear, under the use of wine. In this instance, also, the value of our mode of treatment was borne out by the result; for, with the exception PROFESSOR GRAVES’ CLINICAL LECTURES, 570 of a single case, all our patients recovered. In one instance the disease assumed a ma¬ lignant form, and carried off the patient in a few hours. She was a young girl of ap¬ parently vigorous constitution, and who had got tolerably well through a dangerous maculated fever; towards the middle of the fever she had exhibited symptoms of cerebral excitement, for w7hich we deemed it necessary to blister the scalp. At the time when the erysipelatous attack came on, she had been for several days ill, and w7as in that low state in which the skin has a great tendency to become ec- chymosed, and form bad sores. This ten¬ dency I have observed in many instances of low fever, and it is a condition w'hich is always pregnant with danger, The occur¬ rence of ecchymosis, excoriation, and su¬ perficial gangrene, in such cases, is not so much the result of pressure, as of the ge¬ neral debility, and the impaired condition of the fluids and solids of the body. It was in this state of the system, and with her scalp still suffering under the inflam¬ mation produced by the blister, that this poor girl was attacked with erysipelas of the face. Unfortunately, at the time the erysipelas attacked the sound skin of the head, the blistered surface w7as attacked with gangrene; and two dangerous local affections became thus suddenly conjoined. Under this unfavourable complication her constitution sank with great rapidity, and she died in twenty-four hours from the commencement of the attack. I shall now, in pursuance of my inten¬ tion, proceed to speak of the treatment of fever. I may observe here, that we are now at a point of time possessing no common interest for the reflection of medical observers. It is now7 nearly two years since my attention was first arrested by the appearance of maculated fever, of wrhich the first examples were observed in some hospital patients from the neigh¬ bourhood of Kingstown. This form of fever has lasted ever since, prevailing uni¬ versally, as if it had banished all other forms of fever, and being almost the only type noticed in our w7ards. Within the last four days, however, a change appears to have taken place. Scarcely any cases of maculated fever have been admitted within the last fortnight, and the majority of fever patients at present under treat¬ ment are free from the cutaneous eruption so frequently observed during the last two years. The cases which wre have recently admitted present no spots, or maculse, and have been termed, perhaps impro¬ perly, simple typhoid fever. And here permit me to observe, that it w’ould be very wrrong to conclude, from this circum¬ stance, that our recent cases are of a more favourable description than those which preceded them ; the disease, it is true, ap¬ pears to have lost a character which is al¬ ways looked upon as bad and unfavoura¬ ble, but it may be just as dangerous a mo¬ dification of fever as the eruptive typhus. During the predominance of the latter form, all cases without macula? w'ere in general simple and free from danger; but it is probable that this is not the case at present. There are two cases of this non- maculated typhus in the female ward, which are of an extremely doubtful cha¬ racter, and in which it w’ould be difficult to predict the result. Indeed, were I to make any prognosis, I should say that the chances, if not against them, are at least very fairly balanced. Now7, gentlemen, as it appears we have come to a change, and that we may have to treat a new modification of fever, it behoves us to be extremely vigilant. I in¬ vite you to wrateh and study, w7ith the closest attention, the cases of fever which come before you. Let us, in the first place, endeavour to ascertain w hether wre have seen the close of one epidemic, and are now at the commencement of another. The number of cases of simple typhoid fever have, you perceive, increased in a very remarkable manner, and the number of cases of eruptive typhus have become remarkably scarce. But there is another and a more important reason why wre should study these cases with all due dili¬ gence and attention. They may be the first examples of a new epidemic, and every new epidemic, as it has its peculiar characters, so has it its peculiar treatment. We cannot follow the same track which wTe have pursued for the last twro years — wre cannot apply our remedies with the confidence of experience — w7e must now strike into a new’ path, and for some time our practice must be tentative and experi¬ mental. It was only after a good deal of experimental observation that w7e wrere able to arrive at a plan of treatment adapted to meet the exigencies of the ma¬ culated form of fever: and it is very pro¬ bable that this new fever may prove at first extremely difficult to manage; and it may be some time before the diminished rate of mortality will show that we have at length discovered its true character, and the remedies best calculated to arrest its progress *. Let me now direct your attention to some practical points connected with the treatment of the maculated fever which has prevailed for the last two years, and which has spread to a very considerable extent in this city and its environs, attack¬ ing alike the upper, middle, and lower * Since this lecture was delivered, many cases of typhus without maculae have been admitted, hut the maculated form of fever still continues very common. FEVER. 571 classes of society. It is not ray intention to enter into a detailed history of the ori¬ gin and progress of this fever, its varie¬ ties, symptoms, and pathological pheno¬ mena ; my purpose is to furnish you with a brief but comprehensive outline of its treatment, and of the remedies which have been found most successful in its removal, as well as the most appropriate time and mode of their application. But as many of the students are unacquainted with this form of fever, I shall premise by observ¬ ing that it is the same fever which has been frequently observed in this country, and of which a full account has been given in the Report published by Dr. Cheyne and Dr. Barker. You will also find a sketch of its principal characters in one of my lectures, published in the 172nd No. of the London Medical and Surgical Journal for May 1835. It is generally in. sidious in its first attack, and the symp¬ toms are by no means proportioned to the subsequent danger. From the/ third or fourth to the seventh day, generally about the latter period, an eruption of dark red spots appears on the skin in various parts of the body. Towards the latter stage, this fever is characterized by great nervous derangement, either with or without symptoms of cerebral congestion. It rarely lasts less than fourteen or seventeen days, and very seldom terminates by a well- defined crisis. It has spread extensively through this country, and has been ob¬ served at Liverpool, Glasgow, Birming¬ ham, Manchester, Edinburgh, and London. In this country it has been for many years the prevailing type, and, although its spread as an epidemic may have been checked, and its course interrupted, by the occurrence of other diseases, it is always found in this country, and prevails in a distinct form. It may originate sponta¬ neously, or from contagion. From what I have seen of it, I have no doubt of its double origin. I am also inclined to think that it never attacks the same individual more than once, and that when a man has had the true maculated fever, he never gets it again. In this point, as well as in the eruption, it bears a close analogy to the exanthemata. It is so much more common in Ireland than in any other country of Europe, that my friend, Dr. Lombard, of Geneva, calls it the Irish typhus. Whether it be from the moisture of our climate, or from the poverty and wretchedness of the people, I know not; but it is a fact that typhus is more preva¬ lent in this country than in any other Eu¬ ropean nation. This may be easily seen by comparing the proportion of fever pa¬ tients treated in the hospitals of the vari¬ ous capital cities, with the number treated in the same way in Dublin. Dr. Lombard also states, that the British towns which have most intercourse with this country, have more of this fever than those which are more remote, or have less intercourse with us. Thus there is more maculated fever seen in Liverpool and Glasgow, than in Edinburgh, Birmingham, or London. He looks upon it as a fever peculiarly Irish, originating in this country as an endemic, from causes the nature of which are not well understood; and that when it appears in English or Scotch towns, it is the result of contagion imported from Ireland. You will find some very interest¬ ing observations on this subject in his papers, published in the 28th number of the Dublin Medical Journal. In the fever of which I speak, there is nothing which would lead to the conclu¬ sion that the disease arose from inflamma¬ tion. Many persons have regarded fever as produced by inflammatory affections of some organ or system of the body, and have asserted that it is in every instance preceded and accompanied by some form of local inflammation. One class of pa¬ thologists have placed the seat of this inflammation in the brain, another and a more numerous class in the digestive sys¬ tem ; and all have believed that inflam¬ matory action, whether limited to one or more organs, is the cause of fever. No opinion can be more unfounded, so far as typhus is concerned. Local congestion and inflammations may and do frequently arise in fever, but they are merely super- added to it, and form no part of its essence. I have now witnessed many cases in which fever ran through its course to a fatal termination without any dis¬ tinct evidence of local inflammation or even congestion ; and I have dissected numerous cases of fever in which there w;as not any appreciable trace of inflam¬ matory action in the organs of the three great cavities. Having made these general observations, I may observe, in addition, that in the wdiole range of human maladies there is no disease of such surpassing interest and importance as fever; and I cannot dwell too much on the necessity of your apply¬ ing most attentively to the study of its pathology and treatment. If you com¬ pare the mortality from fever with that resulting from any other disease in this country, }rou will be struck with the over¬ whelming fatality of this affection, and w ill readily admit the inestimable value of a thorough knowledge of its nature and treatment. Recollect, too, that fever is a disease which numbers among its victims persons chiefly in the prime of life, and during the most active and useful stage of existence, — fathers and mothers, persons w:ho are the ornament or the stay and 572 PROFESSOR GRAVES* CLINICAL LECTURES. support of their families, the intellectual, the industrious, the efficient, — those whose lives are most valuable to their friends and to society. This gives an additional in¬ terest to the study of fever, and should stimulate you to endeavour to arrive at a correct knowledge of its nature and treat¬ ment. And here let me observe, that there is nothing more untrue than the as¬ sertion, that the treatment of fever is a matter of indifference. It has been the custom to look upon every plan of treat¬ ing fever as idle and absurd, and until very lately there were many persons in this country who believed that patients recovered, not from having had the advan¬ tage of treatment, but from goodness of constitution or some favourable accident ; and it was usual with such persons to appeal to the experience of Dr. Rutty, who, in recording the history of the epi¬ demics of his own time, observes, that the mortality was greatest among those who were best attended to, and that those who were left to God’s provi¬ dence, and got nothing but cold water, recovered. And, indeed, I must ad¬ mit that the treatment of some of the cases of fever which I witnessed when a student, would seem to justify the quaint and sarcastic observation of Dr. Rutty. At that period, whether it was from bad treatment, or from what has been termed the nimia diligentia mcdici, it is a fact that the maximum of mortality was among the rich, and that those who were most at¬ tended to died most speedily. In the epi¬ demics of 1816, 1817, 1818, and 1819, it wras found by accurate computation, that the rate of mortality w7as much higher among the rich than among the poor. This was a startling fact, and a thousand dif¬ ferent explanations of it were given at the time ; but I am inclined to think that the true explanation was, that the poor did not get so much medicine, and that in them the vis medicatrix had more fair play. I could appeal to the practice of those times in proof of this opinion, and as we go along I shall have an opportu¬ nity of alluding to this part of the subject again, and contrasting the prac¬ tice of the present day with that which was generally followed thirty years ago. If you look to Dr. Cheyne and Dr. Barker’s Synopsis of the plan of treatment employed by the physicians of those days, you will be prepared, from a mere inspec¬ tion of it, to admit, that it was at least as hard to escape the physician as the dis¬ ease. Since that period our practice has greatly improved, and things are much changed; the preponderance of fatal cases is now to be found among the poor, and the mortality among the rich, or those who have proper medical advice from the com¬ mencement, is not one third of that W'hich is found among the indigent, wrho are generally neglected at the commencement of the disease. I am therefore fully pre¬ pared to deny that, in the present state of medical knowledge, our practice is a mat¬ ter of indifference ; on the contrary, there is no disease in which diligent attention and skilful treatment are more frequently successful than in fever, nor is there any affection of equal importance in winch our therapeutic means are more efficient and valuable. Now, wffien called on to treat a case of fever, there are several things which re¬ quire your attention. In the first place, you should examine the state of the family arrangements. This is a matter which men are apt to overlook or treat as a mat¬ ter of indifference, but in my mind it is of no ordinary importance, and should al¬ ways be attended to. You should never, if possible, undertake the treatment of a case of fever w'here the friends or relations of the patient supply the place of a regu¬ lar fever nurse. The mistaken tenderness of relatives, and their want of due firmness, presence of mind, and experience, will frequently counteract your exertions and mar your best efforts. Affection and sor¬ row cloud the judgment, and hence it is that very few medical men ever undertake the treatment of dangerous illness in the members of their own families. The sym¬ pathy which a nurse should have for her patient should be grounded on a general anxiety to serve, and a strict sense of duty, as well as a laudable desire of increasing her own reputation ; it is, in fact, a sym¬ pathy analogous to that which a physician should have. Again, it will not do to haye a nurse who has been usually em¬ ployed in other diseases ; your assistant must be a regular fever nurse,- and the man who undertakes the treatment of a long and dangerous case of fever without such an assistant, will often have cause to regret. I could mention to you many cases illustrative of the truth of this asser¬ tion. I could tell you, that where I have permitted the continuance of the services of one of the family, or of a common nurse, I have been almost invariably an¬ noyed and disappointed. I now make it a general rule to refuse attending any dangerous and protracted case of fever without a properly qualified nurse. In the next place, when treating a case of bad typhus, do not think that it will be sufficient to see your patient once a day. But you will say, perhaps, that our hospi¬ tal patients here do very well, and yet they are visited only once in the twenty- four hours. True, — but then we have ex¬ perienced nurses to look after them at all hours ; we have the valuable sur- FEVER. 573 veillance of our apothecary, Mr. Parr; we have the attendance of the resident pupils, and of the gentlemen who take charge of the eases. You see, then, that they do not depend on a solitary visit. How often has Mr. Parr, the resident pupil, found it necessary to change the treatment adopted at the morning visit ? Plow often have the remedies of which we had only given a hint in the morning, been actually and energetically employed be¬ fore the close of the day; and how often have lives been saved by the valuable attentions to which I have just alluded ? No one should attend a ease of fever with¬ out having proper medical assistants. My practice, in general, is to visit my fever patients two or three times a day, and w hen I have a bad or a dangerous case to manage, I always have a competent medi¬ cal assistant to stay by the patient and watch every change of his malady. I do not know how they manage this matter elsewhere, but in this city wre have so many zealous intelligent students, so many young medical friends, and so many well-edu¬ cated apothecaries, that we are never at a loss for an assistant. This fact is, I think, a sufficient answer to the objections put forward by Dr. Johnson, in the last number of the Medico-Chirurgical Re¬ view'. He says that tartar emetic is a two-edged sword, an agent powerful alike for good or evil, and in the administration of which no ordinary circumspection is demanded. All this I am willing to admit ; there is no remedy capable of pro¬ ducing more mischief when abused, but when properly wratched, it is, I am confi¬ dent, the means of saving many valuable lives. He says also, that Dr. Graves can¬ not give that share of attention to his patients which the employment of such a remedy demands. He is quite mistaken on this point. I am never at a loss for some skilful person to remain with the patient, watch the operation of each dose, and modify or change it according to circumstances. The wrant of proper as¬ sistants may be an objection to the admi¬ nistration of tartar emetic, but this objec¬ tion does not hold good with respect to Dublin. One or twro more observations of a gene¬ ral nature. Some persons have such a terror of foul air in cases of fever, that you wall find all the windows in the house th rown open, not even excepting those of the patient’s bed chamber, and wherever you turn, you are sure to meet with a current of air. Now this is an unneces¬ sary practice, likely to entail disease on the family, and local inflammation on the patient. The bed-room of a patient la¬ bouring under fever should be well aired, but without what is termed thorough air, and it should, if possible, be a quiet back room, away from the street. In the next place, it should be sufficiently large to hold two bedsteads conveniently ; and you should order the attendants to have two w'ell aired beds in readiness, from one of which the patient should be changed to the other every twelve or twrenty-four hours. You can scarcely have an idea of the comfort this affords to a person in fever. The room can be kept properly ventilated by a fire, and the temperature can be regulated by a thermometer. Some persons are in the habit of constantly sprinkling the room with vinegar, others with the chlorides. I do not know that it is necessary, and I think the use of chlorine is doubtful, if not improper, and may prove injurious to the patient. Having made these few general ob¬ servations on the steps to be taken by those wrho enter on the treatment of typhus, I shall now proceed to speak of diet and medicines. In a disease like fever, which lasts frequently for fourteen, twenty-one, or more days, the considera¬ tion of diet and nutriment is a matter of importance, and 1 am persuaded that this is a point on which much error has prevailed. I am convinced that the starv¬ ing system has in many instances been carried to a dangerous excess, and that many persons have fallen victims to pro¬ longed abstinence in fever. This was one of the errors which sprung from the doc¬ trines of those who maintained that fever depended on general or topical inflamma¬ tion. They supposed that fever arose from inflammation, and immediately concluded that to treat it successfully, it was neces¬ sary to reduce the system by depletion and low diet, and to keep it at this point dur¬ ing the whole course of the disease. Hence the strict regimen, the diete absolue, of the disciples of the physiological school, and of those wrho looked on inflammation as the essence of fever. The more the symp¬ toms appearedindicative of inflammatory action, the more rigorous was the absti¬ nence enforced. If a patient’s face was flushed, or his eyes suffused, no matter what the stage of the fever was, they said, “ here is inflammation of the brain, and nourishment wdll exasperate it.” If he had red or dry tongue, and abdominal tenderness, they immediately inferred the existence of gastro-enteritis, and all kinds of food, even the lightest, were strictly forbidden. That this proceeds from false notions on the nature of fever is beyond doubt, and I pointed out this fact many years ago, long before the appearance of Piorry’s work. Let us in the first place ex¬ amine the results of protracted abstinence in the healthy state of the system. Take a healthy person and deprive him of food, 574 DR. HAKE ON THE ORGANIC GLOBULE. and what is the consequence ? First, hun¬ ger, which, after some time, goes away, and then returns again. After two or three days, the sensation assumes a mor¬ bid character, and instead of being a sim¬ ple feeling of want and a desire for food, it becomes a disordered craving, attended with draggingpain in the stomach, burning thirst, and some time afterwards, epigas¬ tric tenderness, fever, and delirium. Here we have the supervention of gastric disease and inflammation of the brain as the results of protracted starvation. Now these are in themselves very singular facts, and well deserving of being held in me¬ mory. Read the accounts of those who perished from starvation after the wreck of the Medusa and the Alceste, and you will he struck with the horrible consequences of protracted hunger. You will find that most of the unhappy sufferers were raging maniacs, and exhibited symptoms of vio¬ lent cerebral irritation. Now, in a patient labouring under the effects of fever and protracted abstinence, whose sensibilities are blunted, and whose functions are de¬ ranged, it is not at all improbable that such a person, perhaps also suffering from delirium or stupor, will not call for food, though requiring it, and that if you do not press it on him, and give it as medi¬ cine, symptoms like those which arise from starvation in the healthy subject may supervene, and you may have gastro¬ enteric inflammation, or cerebral disease, as the consequence of protracted abstinence. You may, perhaps, think that it is unne¬ cessary to give food, as the patient appears to have no appetite, and does not care for it. You might as well think of allowing the urine to accumulate in the bladder, be¬ cause the patient feels no desire to pass it. You are called on to interfere where the sensibility is impaired, and the natural appetites dormant; and you are not to permit your patient to encounter the hor¬ rible consequences of inanition, because he does not ask for nutriment. I never do so. After the third or fourth day of fever, I always prescribe mild nourishment, and this is steadily and perseveringly continued through the whole course of the disease. ON THE ORGANIC GLOBULE; A PHYSIOLOGICAL MEMOIR. By Thos. Gordon Hake, M.D. Physician to the Brighton Dispensary, & c. To direct with enlarged views the phi¬ losophic mind through what is useful and instructive in the living science of physiology, and to pass silently over opinions which enfeeble the cause of reason, and make nature appear level with the understandings of the unin¬ formed, are the objects which the writer proposes to himself to accomplish. There is truth enough to swell the pride of volumes in the functions and disordered manifestations of the living body ; and of these so many remain unanalysed, that the task which is undertaken, of point¬ ing out the W'ay to a more intelligible system of physiology, if in any measure successful, cannot be unattended with good. Facts are numerous, but a legi¬ timate application of their value is rare in physiological inquiries. It is the character, therefore, of hypo¬ theses, but not hypothesis itself, which merits disrespect. For physiology is the most metaphysical science through¬ out the range of things ; more so than intellectual philosophy, since the mental faculties are manifestly allied to highly organized matter; but in the depths of physiology subsists an invisible world : causes are hidden altogether ; effects consequently emerge as objects of won¬ der rather than research. Those who, w ith a kindof intellectualcreativeness,display a talent of bearing analogies into the arcana of life, which casts a glimmering ray of light on the responsibilities im¬ pressed on organization, are not to be blamed as hypothetical. From a sug¬ gestion may spring a theory sufficiently important to elicit contradiction ; this swells the catalogue of facts ; and, finally, a master-spirit may appear, to arrange collected materials anew, and to re-arrange until the picture is so like to nature as to be acknowledged and re¬ ceived. Because the highest order of intelli¬ gence is seldom expended on physiolo¬ gy, it does not rank as the first of the sciences. Another*, owing its dignity to the extent of its machinery, the gran¬ deur of its parts, and not to the superior greatness of its laws, has assumed the pre-eminence, and attracted the largest share of talent, although its laws pertain to the substances of which life is formed, even before the building of its fabric has commenced. It is on the ground, then, that the laws of physiology begin where those of the physical sciences ter¬ minate, that the lovers of this branch of philosophy take their stand. Those who # Astronomy. DR. HAKE ON THE ORGANIC GLOBULE. 575 meet with no impediment in other pur¬ suits enter on this to find the measure of their understanding’, and to acknow¬ ledge, that there is none other so ex¬ pressive of nature’s great successes. The difference between an organic and inorganic body, independently of their functions or use, may be found in the nature of their composition, and expressed by what best defines, in con¬ trast, the regular contexture of the one, and the conformation of the other, as respects the disposal of the primitive elements which gives to each its state. The constituents of either may be alike; it is not, therefore, in component parts that the difference is to be discovered ; for four elements, named oxygen, hydro¬ gen, nitrogen, and carbon, may consti¬ tute animal or brute matter, their pro¬ portions being exactly the same. Nor is it to any superadded principle, as the vital, that the difference caw be traced; for organic matter retains its form after that principle is destroyed. Two equal ortions, for example, of a membrane eing separated from a living body, and the one being’ preserved, while the other is submitted to total decomposition, — fruitless as it would be to mingle the elements again, with a view to restore the organic state, no other known pro¬ cess than the one by which they were organized being competent to recover to them that past form, they still con¬ tain within themselves the capacity of being organized, for the very same ele¬ ments, in the membrane which was not submitted to analysis, remain organic after their life has ceased. Organized substances, therefore, may be considered as differing from unorga¬ nized in their contexture, of which the primordial cause has remained unknown to the most acute observation and steady perception that reasoners can command ; and although individual minds, by urg¬ ing their invincible desire after truth through the effects, may have an occa¬ sional and indistinct vision of a forma¬ tive cause, no impression of that pheno¬ menon has ever been sufficiently vivid to be retained, or to enable the philoso¬ pher to describe to others, or to satisfy mankind of his superior knowledge. Organic matter is resolvable into parts of the same, although less perfect ; and these again may be reduced to sub- organic masses ; so that, as human skill can succeed thus far, it is probable that the most perfect state of organization is built up of even hundreds of other states less perfect, and in a mutual state of de¬ pendence. Between these organic elements of the solids, and the organic globule which appears to form the basis of the living body, no intermediate state of matter has yet been found, unless the ■rudiments of those discovered in the cir¬ culating system be brought forward as shadowing forth the more perfect shapes, and affording an easier transport for the mind along the early gradations of ani¬ mal formation. In this view the fluid elements of organization may take pre¬ cedence of the solid, the liquid globules of the fixed, although we have no evi¬ dence of a less composite state in these former; so that they must be considered as indebted to their g’reater relative sim¬ plicity rather than to that of their con¬ stitution, for the intermediate grade they are here allowed to fill. It is most impressive to contemplate with due profundity the progress made in the elementary laws of matter by means of combination. A simple body alone has no apparent law ; placed be¬ side a second they both manifest a qua¬ lity ; and the same process being’ conti¬ nued through a series, a body is formed, the organic globule, which not only re¬ sembles, but in its highest type forms a part of that which is conscious of its ex¬ istence. Although the link between two king¬ doms of nature appears broken by the sudden transition from inanimate to or¬ ganic, the qualities of the first are only concentrated in the second, and render¬ ed capable of intensest action. The first step, then, made by inani¬ mate bodies towards complete organiza¬ tion is the globule. This body, however, which is no greater than one seventy- five thousandth part of an inch in dia¬ meter, is equally inanimate with the elements of which it is shaped. The formative progress which oxygen, hy dro- gen, &c. have made on attaining the organic globular state, and passing the intermediate grades of composition, is very great; even this cannot be traced ; still the globule, when formed, is as in¬ animate alone as an elementary gas, or any other simple form, and equally in¬ ert. If it is allowable to judge of the composition of the globules by that of the tissues which they constitute, the cellular tissue globule is the most sim- pie. It ultimately consists ol oxygen 676 DR. HAKE ON THE ORGANIC GLOBULE. hydrogen, carbon, and azote ; proxi- mately of gelatine, and perhaps ii brine and albumen ; but each of these sub¬ stances is composed of the same ele¬ ments, of which the proportions only differ. Of either, about one-half is car¬ It has been asserted that the globules described above may be resolved, by further microscopic aids, into other glo¬ bules of much inferior dimensions. The second globule which may be considered is the muscular tissue glo¬ bule, a body separated in its nature and composition from the first. Of this molecule it is difficult to trace the con¬ stituency, or define its limits, surround- ed as it is by so many heterogeneous tissues. Fibrine may be considered its principal component ; albumen may perhaps be added ; gelatine, extractive matter, osmazome, phosphates of soda, ammonia, and lime, sulphur and po¬ tass, muriate, phosphate, and lactate of soda. As not the globules themselves, but the fibres w hich they form, have yielded the above analysis, it is a matter of great difficulty to decide which of the substances, or if all, enter into the com¬ position of the organic molecule called muscular, and which into the connecting media. The probable truth is, that such of the above elements as belong to cellular tissue, a connecting medium of muscular fibre, pertain to it alone ; while some of the salts, not being dis¬ coverable in the blood which circulates in muscle, belong' exclusively to its sub¬ stance ; unless the analysis itself, having been carried too far, may have led to a deceptive recomposition. According to observations much to be relied on, the muscular-tissue globule is of the same magnitude as the cellu¬ lar, and — that which next follow's in the order of consideration — the nervous- tissue globule. Like the other two, the nervous- tissue globule has been found to consist of parts resolvable into parts more sim¬ ple, and these have been separated until analysis, ranging the grades of highly bon, while four-fifths of the remainder consist of oxygen and azote in nearly equal parts, hydrogen constituting the rest. This is the analysis of The- nard : — combined matter, has reached the simple elements, and expanded all its force. Vauquelin has supplied the following analysis of nervous tissue. Water . 80* White fatty-matter *• . . 4-53 Red fatty -matter . *70 Albumen . . . 7 00 Osmazome . . 1-12 Phosphorus . 150 Acids, salts, and sulphur . 5’ 15 Nervous globules, which these ele¬ ments give rise to, have been variously described. Although the correct Ed- wards has compared their size to that of muscular and cellular corpuscules, and convinced himself of their coincidence, and of the unique diameter of every species of nervous globule, it has been asserted on the other hand, that this body in its least degree of development is as much as the four thousandth part of an inch in diameter, and in its greatest the two thousand four hun¬ dredth, the median size being the three thousand four hundredth part*. The nervous-tissue globule thus di¬ viding itself into classes, observation believes that it has ascertained to which the greater corpuscules, and to which the lesser, belong, and has named, from pre-existing reasons, the former medul¬ lary, and the latter cineritious. So much uncertainty existing in re¬ gard both to the exact composition and magnitude of the organic globular cor- puscule, science would be altogether at a loss for further information on sub¬ jects whereon precision is so hopeless, but for one fortunate truth, that princi¬ ples are chiefly to he desired, and that they are deducible with as much ease from the more coarse, as from the most Fibrine • Albumen Jelly* * • • Carbon. 53365 52-883 48-881 Oxygen. 19-865 23-872 27-207 Hydrogen, 7021 7-540 7-914 Azote. 19-934 15- 705 16- 998 * Bauer. MU HILLES ON THE FUNCTION* OF MECKEl/s GANGLION. 577 precise experiments. What knowledge of analysis could teach us more than this; — organization is composed of the same elements as the rest of the uni¬ verse; its high gradations, which pre¬ sent complexities most curious, and compounds so intricately formed that the accompaniment of some extraordi¬ nary effect is demanded, are attended with functional powers both wonderful and new ; that the elements, when urged by some irresistible agency into extensive and unprecedented union, un¬ able from the vastness of the force used to blend into ordinary forms such as milder causes might induce, and still less incapable of separating each other, obey the omnipotent force, rise above the most complicated forms of ordinary matter, and are established as organic in the beautiful and surprising form of globular corpuscules, the basis of living tissue. The nervous tissue globule contains its nervous matter in cells of excessive minuteness. There is an intermediate substance, of a fatty aspect, among the nervous corpuscules. Should this be considered the fatty matter which the analysis of nervous substance yields? As we ascend in tracing the organi¬ zation of causes, those which attach to themselves effective powers equivalent to their high natural sources, it may appear surprising that so perfect a re¬ gularity should pervade systems, when slight and apparently inevitable devia¬ tions from their established harmony would proceed to more alarming de¬ rangement, and finally interfere with the continuance of order. This is pre¬ vented by the immutability of the in¬ organic pervading the organic laws. The latter enjoy a derived, the former an original fixity. So perfectly unerring are the laws of elementary matter, that philosophers have even ventured to name them eternal. This immutability per¬ vades every state of combination, and is as manifest in each result as in the simple bodies whence higher effects are obtained. Still, though the laws of matter remain immutable, their mani¬ festations vary with their union, and when this is carried to the highest point, the organic, these laws are so strengthened by each other as to appear to superficial observers suspended ; whereas they are only so actively poised among- themselves, that their united 476. — xix. forces can resist agents which, from a less perfected union, would call into visible existence the simple qualities of the parts pertaining to this now self- defend i n g organiza ti on . Thus the qualities of the organic cor- puScule are the united powers of its component elements, arranged under the influence of some agent more potent than any known, or of a series of agents, and amid a vast series also of modify¬ ing circumstances ; and the meaning of these creative causes can only be ascer¬ tained by an incessant and subtle ob¬ servation of structure, and reflection on the phenomena which are attendant on organization. ON THE FUNCTIONS OF MECKEL’S GANGLION AND THE GLOSSO-PHARYNGEAL NERVE. To the Editor of the Medical Gazette. Sir, The numerous discussions that have been held this some time past respect¬ ing the functions of Meckel’s ganglion, and the glosso-pharyngeal nerves, ancl the experiments lately performed by Dr. Alcock, of Dublin*, have induced me to bring forward the opinion which I hold on these subjects ; in doing so, I will confine myself as much as possible to the support of my own opinion, w ithout attempting to controvert those of others, as nothing, in my estimation, tends more to impede the progress of scientific research, than too free disquisitions on the opinions of others. The situation of Meckel’s ganglion, its connexion with the fifth pair of nerves, which possess so marked an in¬ fluence over the organ of vision, the distribution of its branches to the nose and palate, the remarkable course of its chorda-tympani filament, which passing backwards through the vidian canal, enters the hiatus fallopii, communi¬ cates with the glosso-pharyngeal nerve, traverses the cavity of the tympanum, and finally, emerging from it through theglaserian fissure, joins, and is lost with the gustatory nerve, are circumstances which have at all times given rise to much discussion respecting the uses of these nerves, especially when it is re¬ collected that the parts to which they * Med. Gaz. p. 295, present volume. 2 P 578 MR. IIILLES ON THE FUNCTIONS OF MECIvEl’s GANGLION, are distributed are abundantly supplied with nervous influence from other sources, both for the purposes of com¬ mon and special sensations. What can be their use? It is, in my opinion, to connect the senses of smell, sight, hear¬ ing, and taste together, — to be, as it were, the sympathetic nerve of these senses. That a remarkable sympathy exists between these senses, every day, nay every hour, affords us numerous exam¬ ples. The sight of the rose, or other fragrant substance, immediately excites in us the desire of smell ; we almost involuntarily apply it to the nose. The habitual snuff-taker, on beholding a snuff-box, perceives a remarkable titilla- tion in the nares, which can only be appeased by partaking of his accustom¬ ed stimulus. The sight of his favourite dish, and still more so the smell, arouses in the gourmand an urgent desire to gratify his taste with the object of bis wishes; he smacks his lips, and already enjoys the banquet in anticipation, whilst the salivary glands pour forth their secretions in increased quantities. The apple suspended from the tree awakens in the youth the recollection of former enjoyments, and he longs to gratify his taste with the distant trea¬ sure. A piece of cinnamon taken into the mouth and chewed, whilst the nose is kept tightly closed, tastes like a piece of deal ; an onion, under the same circumstances, like an apple. All those facts prove a remarkable sympathy be¬ tween the senses of sight, smell, and taste: how many more might be adduced! But how do we show the sympathy be¬ tween these and the sense of hearing ? _ ~ Very simply. The voice of a well- known friend recalls to our recollection his figure, and we desire immediately to behold him. The sound produced by the pouring of his favourite beverage from one vessel to another — nay, even the uncorking of a bottle — excites in the drunkard an ardent thirst, which can be only appeased by indulging in his usual propensity. The grating noise caused by cutting a piece of cork, paring a piece of slate-pencil, &c. awaken in some most unpleasant sensations, and “ set the teeth on edge.” How can we account for these varied sympathies but from the distribution of the branches of Meckel’s ganglion ? — what other use assign to them ? Some may, perhaps, attempt to ex¬ plain them through the agency of the general sympathetic system ; but why resort to a general when we can prove a direct cause of sympathy ? Others may assert, that in some of the lower tribes of animals these sympathies are present to a certain extent, in which Meckel’s ganglion does not exist ; to these I would reply, that man is the most highly organized of the animal creation, and that in no particular is the perfection of his organization more apparent than in the great, the universal sympathy, which exists between all parts of his structure, and that, what in other animals may be effected through the agency of the ge¬ neral system, requires in him additional structures ; and this observation applies to many parts of the human body, which, in this age of comparative ana¬ tomy, have been considered in him nearly or altogether useless ; because, forsooth, they are absent in, or may be removed from, the brute creation with impunity. These wholesale deductions from the inferior tribes of animals, and their application to the human system, appear to me to possess much absurdity^ Not less complicated is the distribu¬ tion of the branches of the glosso-pha- ryngeal nerve. This nerve, immediately after its exit from the cranium, sends off a band to communicate with the cborda- tympani nerve ; after this several branches proceed from it to join the seventh, pneumo-gastric, and sympa¬ thetic nerves, and pharyngeal plexus; it then distributes filaments to thestylo- pharyngeus muscle, the constrictors of the pharynx, the lingual muscle, and the constrictor isthmi faucium ; numerous branches are also derived from it which supply the mucous membrane lining the pharynx and fauces, the tonsil, and neighbouring mucous glands, the mu¬ cous membrane covering the root of the tongue and epiglottis, and the glosso¬ epiglottic folds. What an extraordinary distribution is here ! Filaments distri¬ buted to muscles, mucous membrane, and glands, and holding an intimate connexion with the neighbouring nerves ; and yet a nerve which is simple in its functions, if we may argue from the simplicity of its origin. What is, then, the function performed by the glosso¬ pharyngeal nerve? I consider that it connects in sympathy the several parts concerned in the act of deglutition, — that it, in fact, produces that sympa¬ thetic action of the muscles of the AND THE GLOSSO PHARYNGEAL NERVE. 579 tongue, larynx, fauces, and pharynx, on which the integrity of that act depends; at the same time endowing the sur¬ rounding mucous membrane and glands with a degree of sympathy which con¬ tributes to this action. There can be no doubt that this sympathetic action exists; the rapidity with which the act of deglutition is performed, requiring a consent of action and feeling between so many parts, is abundant proof of it; but many more can be brought forward. A foreign body — a feather, a portion of mucus irritating the mucous membrane lining the fauces — produces immediately a convulsive action of the pharyngeal muscles. A portion of food, or any other substance, impacted in the pha¬ rynx, causes immediate death by suffo¬ cation ; and this is produced, not by compression of the larynx, inasmuch as the cricoid cartilage, which forms a complete ring, prevents this taking place, nor by the direct irritation of the muscles of the larynx, the crico-aryte- noidei postici (dilators of the rima glottidis) being most immediately affect- -ed, but by the spasmodic action of the constrictors of the larynx, which are called into action whilst deglutition is being performed, — an action which con¬ tinues as long* as the foreign body is allowed to remain. But J have said the glosso-pharyngeal nerve communi¬ cates with the chorda-tympani nerve. Can we from this explain that convul¬ sive action produced in hydrophobic patients by the sound of water pouring from one vessel to another, or by the sight of this or other fluids? I think so. This theory respecting the use of the glosso-pharyngeal nerve is support¬ ed by the experiments performed by Dr. Alcock. He states as follow's : — “ I have divided both glosso-pharyn- geals in several dogs, with the follow¬ ing results : in two of them, each time that either nerve was taken upon a hook, preparatory to its division, a most violent action of the pharyngeal mus¬ cles was excited, resembling precisely the pharyngeal effort to reject the mat¬ ter, which most persons must have ex¬ perienced, when something nauseous or revolting has got beyond the power of the tongue, and entered the pharynx; and it was so imperative, that the ani¬ mal struggled to get upon its feet, and was W'ith difficulty restrained. In a third, a similar effect, only less marked in degree, was produced by pulling upon the nerve with a ligature passed underneath it; and in one of the three the root of the tongue wras at the same time depressed, and rendered concave side to side.” “In every instance de¬ glutition was more or less impaired.” “ But in those instances in which the nerves were perfectly divided, deglu¬ tition was so verv much interfered with, as in some cases to be impossible. The animal took and masticated the morsel as usual, and swallowed it from the mouth into the pharynx freely ; but then, after repeated and unavailing efforts to get it further, it made equal efforts to get it back again, in which it often experienced so much difficulty, as to become much exhausted, or to seem even in danger of suffocation , before it succeeded.” Tf the foregoing opinions be correct, wre possess a satisfactory explanation of the uses of the several nerves distributed to the organs of the senses. To some the nerves of the tongue may appear to form an exception to this remark, as it is difficult to decide what is the office of the gustatory nerve : does it endow the tongue with common or special sen¬ sation, or both ? I consider that it pre¬ sides over both common and special sen¬ sation. That most of the branches of the fifth nerve endow with common sen¬ sation the parts which they supply, is generally admitted ; that its gustatory branch performs this office cannot be questioned, from the fact that its branches are freely distributed to the surrounding mucous membrane, the gums, &c., which possess common sen¬ sation only. That it also presides over the special sense of taste is, I consider, equally evident, from the numerous ex¬ periments performed on this subject, the greater part of which tend to establish this position, and from the circumstance that taste is most perfect in that part of the tongue, viz. the anterior portion, in which the nerve is lost. Against this supposition I am aware that it may be stated, that division of the gustatory nerves will not wholly destroy the sense of taste ; but such an experiment cannot be conclusive, as, even after the nerve has been divided, a certain portion of the sense may be conveyed through the numerous anastomoses of its branches, unless the trunk of the fifth nerve be divided ; and even in this instance the experimenter must take into considera¬ tion, in operating on animals, which MR. PHILLIPS - THE NEW PHARMACOPEIA. 580 can only be the subject of experiment, how much of the apparent remnant of taste may depend on the integrity of the other senses, and particularly on that of smell. I have no doubt that experimenters have often been mistaken from this cause. Another objection has been brought forward against this theory — as by Mr. Noble and others, namely, that taste has frequently been lost in an individual, whilst the common sensation has not been impaired, and vice versa ; but how often do we meet with a similar occur¬ rence in other parts of the body, con¬ fessedly supplied by one nerve, with two different powers, viz. that oh sensation and motion. It frequently happens that one of these is destroyed, whilst the other remains perfect; so may it be in the tongue : either special or common sensation may be destroyed separately, whether resulting from disease at the origin of the nerve, or a disordered state of its ultimate ramifications, which may no doubt be locally affected, is not ne¬ cessary at present to be determined ; nay, the mucous membrane itself may be in so inflamed or otherwise morbid state, as to increase, diminish, or totally destroy, either or both sensations. Thickening of it, an increased deposit of mucus upon its surface, or effusion into the submucous cellular tissue, may produce all those results, without the nerves participating in the disease. In the preceding’ observations I have taken but little notice of the opinions of others: allow me to state to those who have lately written on this subject, that it is not from want of respect for them, but solely from the opinion entertained by me, as at first stated, that the cause of scientific research is frequently im¬ peded in its course by too free disquisi¬ tions on the opinions of others ; and assuredly, if we wish to illumine our path, it is an injudicious plan to com¬ mence by extinguishing our neighbour’s light. In conclusion, I hope ere long to of¬ fer some further remarks on this subject, supported by experiment and obser¬ vations on disease. Should Dr. Alcoek, or anv other individual, in the mean- time continue their investigations, I shall be most happy to receive any ar¬ guments that may be brought forward, either for or against mv opinions. From a partial knowledge of Dr. Alcock, I feel convinced that all his obsert aliens will be conducted with a single eye to the elucidation of truth, and the conse¬ quent benefit of the profession. I remain, sir, Your obedient servant, Malcolm W. FJilles, Lecturer on Anatomy and Physiology at the Westminster School of Me¬ dicine. January 5, 1837. OBSERVATIONS ON MR. EVERITT’S REMARKS ON THE NEW PHARMACOPEIA. To the Editor of the Medical Gazette. Sir, Permit me to make a few observations on Mr. Everitt’s criticism on the London Pharmacopoeia, which appeared in the last number of your journal. Intending to prove the folly of di¬ recting medicines to be prepared on a small scale, because they can be obtained more cheaply on a large one, Mr. Everitt says — “ Thus, A is a maker of carbonate of soda from salt ; he gets hydrochloric acid at the same time. B is a maker of sulphate of mag¬ nesia from bittern; he also gets hydro¬ chloric acid at the same time ; and this acid, procured from distilling sulphuric acid with muriate of magnesia, is just as good as that obtained from salt by sulphuric acid, provided care be taken to have it pure.” Now it is readily ad¬ mitted, that provided two portions of hydrochloric acid are equally strong and pure, that they are equally good, but it does not follow that the modes of procuring them are equally eligible ; and until bittern can be ob¬ tained free from common salt, the sul¬ phate of magnesia procured from it by sulphuric acid must be mixed with sul¬ phate of soda. This case has, I g’rant, but little to do with the processes of the Pharmacopoeia, but it proves that Mr. Everitt is not happy in the selection of his illustrations. Mr. Everitt afterwards says, “ we will now give a few instances illustra- tive of the (/rent care with which the work has been executed ; the italics are Mr. Everitt’s, and were not required to show that he meant the great want of ANALYSES AND NOTICES OF BOOKS. 681 care ; he then mentions, “ Ammonia li¬ quor defined 0 960,” and proceeds to state that only two fluid ounces of water should be added to one fluid drachm,* (meaning fluid ounce) of the liquor am¬ monite fortior to reduce its sp. pt. to 0960. Wh en Mr. Everitt’s correction is cor¬ rected, I admit that he is right; and it was originally stated that these propor¬ tions should be employed ; the error, I believe a misprint of tribus for duabus ; it is one which I presume Mr. Everitt will pardon, for an error somewhat more difficult of commission, he states that much of the commercial liq. amonce. contains chloride of colchicum , meaning calciumf. W ith respect to the present method of preparing liquor ammonite, Mr. Everitt says it was, “ perhaps, the worst of those in the old edition;” and he adds that “ the alterations are merely to suit the new measures ;” — that is, the altera¬ tions are no alterations at all. Thi*, however, is a very incorrect representa¬ tion of the circumstances of the cases. In the late Pharmacopoeia, eight ounces of hydrochlorate ammonia, _ six ounces of lime, and sixty-four fluid ounces of water, were directed to be used to procure twelve fluid ounces of liquor ammonite. To make a liberal allowance, let it be supposed that one-fourth of the water remained diffused through the lime un- dissolved ; we should then have to heat forty-eight fluid ounces of solution to procure twelve fluid ounces of liquor ammonite ; whereas, by the present pro¬ cess, the same quantity of solution yields eighteen fluid ounces of product. In this operation, therefore, smaller ves¬ sels, less fire and time, are employed, tii an in the former one. Mr. E veritt then shows (and I admit the accuracy of his statement, without allowing that of the inference deduced from it), that, in the present process, half the ammonia of the muriate is lost, and he proposes a method by which this is to be remedied : although an experienced person might advantageously employ some modification of this plan, especially if metallic vessels were used, yet I pre¬ fer the loss of ammonia to the compli¬ cation of Mr. Everitt’s apparatus, and the danger which is incurred in dis¬ tilling under pressure with glass ves- * So in tli e Lancet, t So in the Lancet. sels. And 1 assert that it was not from want of care that a process similar to that proposed by Mr. Everitt was re¬ jected ; though whether it was from want of judgment, is a subject fully open to discussion. The advantages which Mr. Everitt represents as to be derived from his process, show, to use his own expres¬ sion, with what facility an operation may be “ bungled .” Thus, he says, that if liquor ammonite, ofspecificgravity (P96Q = 10 per cent, ammonia, be want¬ ed, it may be obtained by passing the ammonia liberated from 10 parts of hydrochlorate into 30 parts of water, until they have increased to 35 parts ; and then he adds, “ that nearl y all the ammonia will have passed over.” Now, if 35 parts of solution of ammonia, con¬ taining 10 per cent, of the alkali, can be obtained from 10 parts of the hy¬ drochlorate, not only has the whole of the ammonia passed over and been con¬ densed, but the salt must have yielded more than it contained ; for 35 parts of solution must contain 35 parts of ammonia, requiring Il l parts of hydro¬ chlorate for their production, instead of only 10. — I am, sir, Y our obedient servant, R. Phillips, F.R.8. L. & E., &c. ■, and Lecturer on Chemistry at St. Thomas’s Hospital. Jan. 12. 1837. A NA L YSE S an d NOTIC E S or B 0 OK S . “ L’Auteur se tue a allonger ce que le lecteur sa tue a abreger.” — U’Alejirekt. Observations on the Construction and Use of the Respirator. By Julius Jeffreys. 1836. The “ respirator,” it may be necessary to explain, is an instrument intended to warm the respired air as it passes through it, so as to prevent the injurious consequences to the lungs of breathing too cold an atmosphere. It must be obvious that the low temperature of the air during a great portion of the season in this country is one of the most fertile causes of pulmonary complaints; and that any contrivance by which persons might have the benefit of fresh air and bodily exercise without the risk arising 582- ANALYSES AND NOTICES OF BOOKS. from cold, is a great desideratum. It appears to us that this purpose is in great measure attainable by means of the instrument described in the pam¬ phlet before us. The principle consists in interposing between the lungs and ex¬ ternal atmosphere at the mouth, (or at the mouth and nose jointly), a little apparatus, having metallic gauze so arranged that the air must pass through several folds of it, with minute dis¬ tances intervening. The heat of the breath is abstracted on expiration, and re¬ tained by the apparatus as the air passes out, and is as readily yielded back to that which enters on inspiration ; so that before the air reaches the lungs, even on a very cold day, it has already attained an agreeable temperature. The impression which the first description of such an apparatus communicates is, that it must be productive of a sense of closeness and confinement — • imped¬ ing the respiration, interfering with the voice, and being productive of disagreeable moisture, — in fact, some¬ thing like breathing through a piece of muslin. The number of persons who may be seen on a cold day with their hand¬ kerchiefs at their mouths, sufficiently shows that some such contrivance as the “respirator” wrould be very accep¬ table to them. Now all the advantages they could desire, are professedly af¬ forded by this little instrument. It is an ingenious, clever thing, and so far as wTe can judge, the principle appears to us excellently suited to its purpose. Two circumstances appear essential to the perfection of the instru¬ ment — that it should be sufficient to arrest the heat, and yet not calculated to impede the breathing. Both objects seem to be amply provided for in the “ respirator” of Mr. Jeffreys : the wires nearest the mouth are one three hun¬ dredth part of an inch thick, and the same distance apart from each other ; there are from eight to twenty layers of wire, and those most external are attenu¬ ated till they are no more than one six hundredth part of an inch in thick¬ ness. The following short extract will perhaps give a better idea of the princi¬ ple : — “ Since the temperature of any one substance must be lower than that of any other before it can receive heat from the latter by conduction, it is plain that a single layer of metal could only take a part of the heat from the breath ; even if the contact were of longer duration than it is, the breath would lose no heat after it had raised the metal up to its own temperature. In order to extract more heat from the breath, it must be carried through another layer of metal, which, being much colder than itself, can abstract heat from it. As the breath and this second layer approach towards the same temperature, this se¬ cond layer will not be able to abstract •/ more heat from the breath. It must, therefore, pass through a third still cooler layer, and, for the same reason, through several. In practice, six or eight will not prove too many ; and in the coldest weather double that number may be employed. In this series of laminae, each is warmer than the one in front of it, from the exterior one, which is nearly of the temperature of the atmosphere, to the innermost one, which is perhaps within ten or fifteen degrees of the temperature of the breath. These laminae would not remain one instant of time at so different states as to heat, if they were placed in contact with each other. In order to preserve the progressive difference in their stocks of heat, they must be kept apart; and it will be found, that during the short period of one respiration, a very small separation will suffice for the purpose. An interval for each of one-fortieth of an inch, including the metal, is more than enough ; six or eight layers may therefore lie in one-eighth of an inch. These layers having been warmed dur¬ ing an act of expiration, and being each warmer and warmer as they lie nearer the mouth, are enabled to give heat in the most advantageous manner to the fresh air entering from without, which takes up a parcel of heat in tra¬ versing each ; since, although it grows more and more warm, it is sure to find every layer it comes to warmer than it¬ self, which is, of course, a relative con¬ dition necessary for the communication of beat to the air.” The instrument costs two guineas (we believe), and we recommend it to the attention of those who have delicate lungs. It may be fastened without difficulty by means of a ribband round the head, and would not be more re¬ markable than spectacles must have ap¬ peared when first introduced. NEW GERMAN WORKS. 583 A Practical Treatise on the Diseases of the Skin, arranged with a view to their Constitutional Causes and Lo¬ cal Characters, including the substance of the Essay to which the Royal College of Surgeons awarded the Jacksonian Prize , and all such valu¬ able Facts as have been recorded by Continental Authors on these svbjects, to the present time. By Samuel Plumbe, &c. &c. Fourth Edition, revised, corrected, considerably en¬ larged, and with additional engrav¬ ings. Sherwood. 1837. A medical work must have some merit to come to a fourth edition, and this proof Mr. Plumbe’s Treatise on the Skin now possesses — to say nothing* of numerous other evidences of the same fact. We observe several me¬ thods to be adopted in works on the skin — one set of writers trust entirely to description, without plates (as Mr. Green) ; others depend, if not exclu¬ sively, at least principally, on plates (as Alibert); and yet others combine both methods — as Willan, Bateman, and Rayer. Mr. Plumbe’s book does not exactly belong to any of these ; he trusts principally to description, and gives but very few plates — nay, he maintains that good descriptions’ have great advantages over plates, “ unless executed with extraordinary skill and at enormousexpense.” Now w'ecannotquite agree in this opinion, and we find it contradicted by Mr. Plumbe’s own plan, W'hich combines plates with description. If our author did not feel the advantage of plates, why did he give any? The simple statement of the case we con¬ ceive to be this, — that plates render all such works so clear, that they do not meet with ready purchasers ; but no one, we conceive, who has to study dis¬ eases of the skin, will admit with Mr. PI umbe, that descriptions in wmrds are not prodigiously aided by a simul¬ taneous appeal to the eye. Neither, certainly, can we admit that the ex¬ cellent engravings of Willan and Bate¬ man “have sunk into utter inutility,” although their expense renders them less generally accessible than could be desired. Nor do we think the ar¬ gument of the superiority of verbal description quite a safe one for Mr. Plumbe, because, in this case, we ap¬ prehend that the minute, elaborate, and valuable work of Rayer, as trans¬ lated by Dr. Willis, and containing 1238 closely-printed pages for the sum of £l 8s., must be a better bargain to the purchaser than his volume con¬ taining less than one-half that number of pages, and not nearly so closely printed. But then Mr. Plumbe’s volume has four very good plates; and here again is a practical contradiction of his own position. In fact, the object of our author’s remarks about the relative value of plates and text seems to be pretty much this — to intimate that his volume contains just so much text, and just so many plates, as to occupy the golden medium between the two extremes. Though we smile at the special plead¬ ing on the above points, we by no means wish tospeak disparagingly of Mr. Plumbe’s book. Quite the reverse ; we really think very favourably of it. The present edition contains two additional figures, and has numerous extracts (some of them amounting to ten or twelve suc¬ cessive pages), from the translation of Rayer, &c. We recommend to him to follow the French author in another re¬ spect — namely, to accompany his fifth edition (for w*e doubt not we shall see it at no distant period) with an atlas, on the plan of his fellow-labourer in the same field. At present Rayer’s book is, in reference to the quantity of its mate¬ rials, by far the cheapest : next to it comes the one before us. Theoretisch-praktisches Handbuch der Chirurgie. (Theoretical and Practi¬ cal Manual of Surgery.) Herausge- geben von Dr. J. N. Rust. 1830- 1836. Berlin und Wien. Schloss. The Germans have evidently a much more enlarged idea of the nature of a manual or handbook than we have, when they call by that name a work, like that before us, in seventeen goodly octavo volumes. It is what we should call an encyclopaedia of surg*ery, alpha¬ betically arranged ; and so far as we have had an opportunity of examining some of the articles, it is a production worthy of the learned editor and his aide collaborateurs. Dr. Rust has writ¬ ten a very considerable number of the articles himself, and seems to have carefully superintended all, so as to give a uniformity and consistency to the whole. A very useful supplement, in a thin octavo, accompanies the work, presenting a systematic view of 584 THE MYSTERIOUS MEDICO-LEGAL CASE, the theory and practiee of surgery, in the shape of a catalogue raisonne , with abundant reference to the contents of the volumes. To the scientific surgeon, familiar with the German language, this publication must be invaluable. Handwor ter buck der reinen und ange- wandten Ckemie. (Dictionary of Chemistry, pure and applied.) Her- ausgfegeben von Dr. J. Liebig und Dr. J. C. Poggendorff. Erste und Zvveite Lieferungen, Braunschweig, 1837. Sch loss. Handworterhuch dec Praktischen Apo- thekerkunst. (Dictionary of Practical Pharmacy.) Yon W. L. Bachmann. Ntirnberg, 1836. Of the first of these dictionaries we are inclined to form very sanguine antici¬ pations: the names of the editors are indeed a strong guarantee for its suc¬ cess.; but there are as yet only two parts out, and the whole is announced as likely to extend to five volumes. We shall be anxious for its steady and reg'u- lar appearance until complete. Of the second work, we can only say that it is likely to be useful as a dispensatory ; it is to be completed in two volumes. Aufsdtze und Ahhandlungen aus dem Gebiete der Medicin , Chirurgie , und Staatsarzneikunde . (Essays and Pa¬ pers on Medical, Surgical, and Me¬ dico-legal subjects.) Yon Dr. J. N. Rust, &c. Zweiter Band. Berlin, 1836. Schloss. MEDICAL GAZETTE. Saturday , January 14, 1837. “ Licet omnibus, licet etiam mihi, dignitatem Artis Medicce tueri ; pntestas mod© veniendi in publicum sit, dieendi perieulum non recuso.” Cicero. THE MYSTERIOUS MEDICO¬ LEGAL CASE. Last week we* published Mr. Gird- wood’s account of the examination of the woman’s body found in the Edge- ware Road ; in the present number we give the examination of the head, for that part has since been found, under very curious circumstances. It is diffi¬ cult to say exactly how much of the mystery has been cleared up by this fresh discovery : some light, however, has been gained by it. There is a se¬ vere contused wound upon the head, apparently inflicted during life; all the other marks of violence were attributable to its having been so long in the canal, tossed about and struck by the boats passing and repassing. The leg's have not yet been found, but no pains are spared by the police to come at the “ heart of the mystery.” In time, we suppose, it will all out, though there is no immediate likelihood of such an We noticed the first volume of this col¬ lection some time ago. The papers now published are of a similar character: they are chiefly surgical; but the ap¬ pendix contains some of a miscellaneous nature, — particularly an interesting ac¬ count of hydrophobia. An excellent re¬ presentation of a dog labouring under rabies appears as a frontispiece. Handbuch der Medicinischen Klinik. (Manual of Medical Clinic.) Yon Dr. M. E. A. Naumaxn, Profesor der Med. zu Bonn. Sechster Band. Berlin, 1836. Schloss. This- sixth volume of a work much esteemed in Germany, though we be¬ lieve little known here, is chiefly occu¬ pied with remarks on urinary and Cal¬ culous diseases. occurrence. Two opinions are prevalent regarding the discovery of the body; either there has been a most deliberate and daring murder committed, or some person or persons have outraged public decency by mutilating and exposing* a dead body in a grossly wanton manner. The weight of evidence (so far as evidence has yet been attained) appears to us, we confess, to preponderate in favour of the first opinion, and we shall state briefly some of our reasons. It seems highly probable, from the appearances noticed in the medico¬ legal inspection, that the woman did not die of disease — the viscera were THE MYSTERIOUS MEDICO-LEG AL CASE. 585 sound, there was no mark of medical treatment — and what seems to indicate that the death was sudden, and oc¬ curred unexpectedly, the stomach con¬ tained food — a full meal had been re¬ cently taken. As long’ as the head was not forthcoming’, there wras cer¬ tainly room to doubt whether there might not be organic disease in that part sufficient to account for death : hut the discovery and inspection of the head has left that room no longer; the brain was found firm, and perfectly free from disease. The head, h owever, presents some¬ thing’ more than neg’ative evidence : there is a lesion on it which wras most probably inflicted during life — such a lesion as would be produced by a heavy stunning blow. This is a strong fact ; for it not only suggests the manner of death, but the revolting method adopted to make it sure. It is impossible not to imagine that the un¬ fortunate woman was suddenly stunned by a tremendous blow, that stupor en¬ sued, and that the perpetrator lost not a moment in decapitating and de¬ truncating his victim. That this was done immediately after death, there can be no doubt, from the complete haemor¬ rhage that ensued : the body was drain¬ ed of its blood ; and w hat further shows that extraordinary dispatch was uSed, the draining still continued after the headless trunk w as tied up in the sack. The supposition that the mutilation wras effected by some medical person, and the body packed up for anatomical purposes, is met by circumstantial evi¬ dence of a strongly presumptive charac¬ ter. The trunk was tied up in a sack, w hich one can scarcely refuse to believe belonged to some carpenter ; the chips and shavings of wood at the seams of the sack, the peculiar Cord with which -it was fastened — a sort of sash-line — the rags found in it, with marks upon them such as are produced by wiping edge- tools which hav^een sharpened, — when in addition to this w e consider the dex¬ terous use made of the saw, we can¬ not fail to be struck with so many cir¬ cumstances pointing out the perpetra¬ tor of the mutilation at least (whoever or whatever caused the death) as be¬ ing a mechanic, such as a carpenter or cabinet maker. The saw is not the in¬ strument which a medical* man would use for decapitation. Besides, no medi¬ cal man, unless we suppose him involv¬ ed in the guilt of being- at least an ac¬ complice, would proceed to mutilate a body, almost ere life wras extinct. But what rational ground is there for supposing that the body was intended for dissection? The occupation of the resurrectionists is w holly gone : subjects for anatomical purposes are procurable with comparative facility; and there is no inducement to secrecy : on the con¬ trary, every dissuasive from it; for a heavy pecuniary penalty attaches to any contraband or unlicensed meddling with the dead. Admitting, however, for a mo¬ ment, that there was some such contra¬ band dealing in the case, the suspicion of murder is not a whit diminished by the circumstance : whoever deposited the body at the side of the public road, and threw the head into the canal, must have known how the deceased came by her death : that death was recent; the body had never been exhumed — it was still reeking from the mutilations. Thus, taking a general view of the facts, without entering into minor con¬ siderations, which we doubt not would still further strengthen our position, there can, we think, be little difficulty, in deciding which of the two prevalent opinions is the more tenable. There may yet, possibly, be some other mode suggested of accounting for the circum¬ stances, but at present we have no idea of any such. It is now upwards of three weeks since the body was discovered ; this is 586 THE INFLUENZA. another fact in the murder scale : if the deceased had died a natural death, is it at all likely that the certainty of such an occurrence would be concealed so long P We have hazarded these brief and de¬ sultory remarks, because we think the subject is one on which every member of the community ought to bestow some re¬ flection. The object of such reflection is not mere idle speculation ; it may tend to the unveiling of guilt, or the removal of the imputation of crime. Nor can we allow that, in this stage of the inquiry, there is any impropriety in discussing the circumstances of the case. An inquest has been held ; the evidence has been laid before the pub¬ lic ; and the medico-legal reports, in their most authentic form, have been presented to our readers. Why, then, should there be any obstacle to discus¬ sion ? The case would be very dif¬ ferent if there were an accused party in question — if any particular individual awaited trial for the alleged crime. But at present judicial inquiry is at a stand¬ still ; it is difficult, then, to see how the ends of justice can be better for¬ warded than by a free canvassing of the facts already ascertained. We can only recollect one case bearing a resemblance to the pre¬ sent: we allude to the murder of M. Ramus, which occurred at Paris in the year 1832. The head of the victim was found in the Seine, his legs in another part of the river, and the trunk in the sewer of one of the streets. The disco¬ very of the mutilated remains was made within a week after the murder ; for a murder it proved to be : the unfortunate Ramus was first stupefied with brandy and prussic acid, and then immediately cut to pieces. The mutilations were effected with a butcher’s knife. In about six weeks after the medico-legal inquiries, the murderer was discovered ; he confessed the manner in which the crime was committed, and it exactly tallied with what was inferred pre¬ viously by the medical jurists. By the way, if the Edgeware Road case had occurred in Paris, we cannot help thinking what a sensation it would have produced in the medico-legal world : how many voluminous reports, and with what formality, would have been drawn up, signed, and attested ! Here there is a perfect contrast in this respect: we have no special practitioners appointed to investigate cases of this kind ; the parochial surgeon of the lo¬ cality is immediately applied to — in the present instance, fortunately, a very competent and able person to be en¬ trusted with such a task ; his reports and evidence are received as all-suffi¬ cient, and justice proceeds in her in¬ quiries without deviating in the least from her ordinary course. THE INFLUENZA. This epidemic, of the prevalence of which in Scotland the newspapers have recently given us notice, is now at length prevalent in the metropolis, to a very great extent, and in many in¬ stances with considerable severity. In addition to the symptoms of catarrh many have giddiness, pain under the sternum, or at the pit of the stomach, oppressive headache, and a frequent but generally a soft pulse. There is often much thirst, and the appetite is for the most part almost entirely gone. In all there is great feeling of languor, and the convalescence is very slow. In some the chest affection is very formi¬ dable, being accompanied by inflamma¬ tion of the wind-pipe and air-passages generally; in others there is inflamma¬ tion of the lungs or pleura. Most of the medical men in London have been in full employment for the last week, and some of them are quite over¬ whelmed with business. By the way, MEDICO-LEGAL EXAMINATION OF THE HEAD OF A HUMAN BODY. 587 the “ general practitioner ” has an im¬ mense advantage over the physician in such an epidemic. The latter, who may see, perhaps, five or six, and sometimes even more members of a family, gene¬ rally gets but his usual honorarium , of a guinea, for his visit; the former having to furnish each patient with medicine, lays all under contribution, and thus a visit to one family is as pro¬ ductive to him as to five or six ordinary patients. THE NEW UNIVERSITY. Lord Brougham has withdrawn his name from the New University — a fact strongly indicative of his opinion as to the chance of its success. Dr. Locock’s name does not appear in the published version of the charter, although he holds a seat in the Sena- tus: we presume that he has some “ friend at court,” who procured its omission as an act of kindness. REPORT OF AN EXAMINATION OF THE HEAD OF A FEMALE FOUND UNDER MYSTERIOUS CIRCUM¬ STANCES; WITH REMARKS. By G. F. Girdwood, Esq. A sealed parcel, obtained from the superintendent of the police, was open¬ ed by Mr. Girdwood, in the presence of Mr. Thornton, the churchwarden, and Mr. Bennett Lucas, Lecturer on Ana¬ tomy ; Mr. Birtwhistle, Surgeon, Mile End ; Mr. Webster, Surgeon, Con- naught-Terrace; Mr. Trewick Jones; and Mr. Parrott ; the parcel was identi¬ fied by Mr. Birtwhistle as the one found in the canal, near Mile End. The head is that of a female, and of a middling size; the skin is fair; the hair is of a brown — a dirty brown co¬ lour, with a trace of grey here and there in it, the longest tresses two feet long. The eye-brows are well marked, and, with the eye-lashes, which are not very long’, are of a dark-brown colour. The eye is grey, w ith a shade of hazel in it. The frontal sinuses are strongly mark¬ ed, and extend over the eye to the outer edge of the orbit. The nose is at the upper part flat, and a short way above the point, is depressed ; the tip itself has a slight twist to the right side, oc¬ casioning the right nostril to be some¬ what more dilated than the left. The mouth is middle-sized. The lips large, more especially the upper, and promi¬ nent. The front teeth are good; the enamel at the points of all of them is much worn from friction ; they were, of course, in life, directly opposed to each other. The chin is small, and round; but its exact shape cannot be well ascertained on account of its muti¬ lated state, and from fracture of the lower jaw, on the left side. The profile struck all of us as being very much that of the lower order of Irish. The ears are flat; and there is the mark of pressure on the upper part of the concha ; both ears are pierced for the ring ; the left ear for that purpose has been pierced a second time, the ori¬ ginal hole having apparently given way from being too near the edge of the ear. This circumstance, we are satisfied, has not been recent, the notch being com¬ pletely skinned over. The section which has removed the head from the body proceeds across the neck anteriorly through the skin, imme¬ diately under the fold formed by the junction of the chin with the neck, as far as the sterno-cleido mastoideus muscle, on each side ; it then becomes jagged in appearance, and slants down¬ wards nearly two inches, so that the posterior cut of the neck is exactly on a line with the section of the vertebral column. On examination, it is found to be the fifth cervical bone that is sawn through, leaving the posterior spinous process. The sterno - cleido-mastoidei muscles are retracted about an inch ; the carotid is also somewhat retracted. The face is very much bruised and wounded ; the under-jaw is fractured on the left side, opposite to the second bicuspid, and the coronoid process on the right side is also broken. One wound only presents an ecchy- mosed appearance. It is one received on the right eye. Around this organ exists a broad ecchymosis, extending 588 MEDICO-LEGAL EXAMINATION OF THEHEAD OF A HUMAN BODY. downwards as far as the end of the nose. The cheek under the eye is puffy. The eye itself is wounded, ru“‘ — A and collapsed, ail the humours escaped. The wounds that have no ecchymo- sis around them are, one on the nose on the rig-lit side, another over the ex¬ ternal commissure of the right eye, ano¬ ther on the right cheek under the zygoma, a large bruised one over the lower jaw on the right side (being' evi¬ dently the same injury that has frac¬ tured the bone), another on the right commissure of the mouth, tearing ihe cheek through for about half an inch, and a very large wound, in the form of a crescent, on the left cheek, extending from the internal edg-e of the orbit to about an inch external to the left com¬ missure of the mouth, and under it is another bruised wound, apparently pro¬ ceeding from the same cause that broke the under jaw on the left side; there is also a wound of the scalp, near the crown of the head, also without effusion around it. An incision w'as made through the scalp from ear to ear, and the flaps turned anteriorly and posteriorly. A large ecchymosis presented itself, three inches in diameter, on that part of the periphery of the cranium exactly op¬ posite to the right eye. There is a little coagulated blood under the scalp, and the scalp itself is thickened. On raising the calvarium, the dura mater was of a natural colour, except opposite to the situation of the bruise just alluded to it was redder, and some bloody serum was effused underneath it. The larger vessels, usually filled with blood on the surface of the brain, were empty. The arachnoid membrane pre¬ sented a few opaque patches. Sections made throughout the cerebral mass and cerebellum, presented no abnormal pe¬ culiarity. The w ound of the right eye had not injured the orbit ary plate. The body, without head and legs, on which an inquest was lately held, w'as exhumed. The head now' under exami¬ nation w'as placed with the tw'o cut sur¬ faces of the neck in apposition ; they were found in every way exactly to correspond, even to the superficial cut noticed at the inquest as existing on the right side of the neck. The head and trunk, when placed to¬ gether in a manner so as to ensure ptured, having accuracy, were found to measure in length 33 inches. The report that has already appeared in the Gazette was confined to me¬ dical facts, w'ith the exception of some allusion to the appearance of the bag. The child’s dress and pieces of rag- placed round the body, and the cords that bound it round, were minutely examined. The dress is sufficiently de¬ scribed. The two pieces of rag were coarse calico : they were in part dry, in part clotted with coagulum, and wet with serum. In addition, they were stained W'ith something black and greasy : these marks, when rubbed by the finger, so as to make a smooth surface, sbow'ed many minute glistening points, like plumbago or the oily side of a razor-strop. Most of them were without any definite shape, but several were straight in one of their edges ; and one more especially presented the impression of something whose edge must have been slightly acute — something less than a right angle. The pieces of cord consisted of a bit of common cord, a bit of blue blind-line, and a bit of sash -line, much worn at one end, and particularly on one side of the line. Referring to my former report, it may be added, that the carunculse myrti- formes existed ; and that where the spots appeared in the small intestines, there was no corresponding structural derangement on either the mucous or serous surfaces. An interesting question or two sug¬ gest themselves in relation to the body. The fact of the death being* sud¬ den, and whilst in health, and shortly after a meal, is already disposed of; how', then, has this person met her death ? The state of the wound of the eye, w'ith the bruise on the occiput corre¬ spondent with it, differing from all the other wounds and bruises, by having coagula and ecchymoses upon them, and evidently both produced by the same blow, imply their occurrence beforedeath. This blow was enough to occasion stu¬ por, if not death. The incision around the neck, the cut through the skin being two inches above the cut that separates the trachea and vertebra, implying thus much re¬ traction of the skin while the operation was going on, suggests the idea that DISTURBANCE IN THE BOROUGH. 539 the decapitation was performed with the head in a depending’ position, and so, probably, after death. Another question has occurred; — who has been the ag'ent in this affair ? The bag, the cloths, used evidently to wipe edge-tools after being sharpened • — the blind-line, the sash-line, worn ex¬ actly in the manner in which the pulley passing it would have worn it — form a group of circumstantial evi¬ dence pointing out the employment of the individual. His trade, in all pro¬ bability, was that of a carpenter. J48, Edgewnre Road, Jun. 12, 1836. DISTURBANCE IN THE BOROUGH. We cannot suffer the following1 letter to pass without some remark : what we have to say shall be subjoined. To the Editor of the Medical Gazette. Sir, By the manner in which you have al¬ luded, in your last number, to the late disturbance at St. Thomas’s Hospital, you have (perchance unwittingly) raised a pre¬ judice against an accused and unheard party, in a way which is scarcely con¬ sistent with the duties of a British jour¬ nalist. The discredit of that transaction is made by you to rest solely with the students of Guy’s Hospital, for which your only au¬ thority must be the ex parte statement of their accusers. Their defence is still un¬ known to you; and as the cause now awaits the decision of a jury, you have not only assumed as correct that which remains to be proved, but have conveyed an impression to your readers to the pre¬ judice of gentlemen who are compelled for the present to lie under an accusation, the proper opportunity for answering which has not yet arrived. None are more ready than the accused to agree with you in denouncing the dis¬ turbance as “ a most discreditable affair,” and none would have more gladly wit¬ nessed its conciliatory termination ; but the gravity of the charges publicly made against them, and the manner in which they are urged, have left them no al¬ ternative. As defendants, they court, and will now secure, the fullest scrutiny ; and no re¬ sponsibility will attach itself to them if the result should be otherwise than their accusers anticipate. Your remarks upon the unsolicited notice taken of the transaction by another journalist, plausibly as you have proffered them, and your subsequent allusion to the recent outrage at Apothecaries’ Hall (which was perpetrated by a pupil of St. George’s Hospital), are so obviously irre¬ levant to the question, that we forbear to allude to them further than to express our astonishment that you, in your editorial capacity, should have associated them un¬ der the title of “ Recent Disturbance at St. Thomas’s Hospital.” As our object is sufficiently explained by this letter, which we trust that you will insert at the earliest opportunity, we will only add the hope that your journal will not be made the vehicle of party commu¬ nications, which must of necessity be pre¬ mature, and can effect no useful purpose. The accused and their friends are well content to abide the time when the part which each has acted will be investigated in all its bearings. — We are, sir, Your obedient servants, T. Wilkinson King. Alex. Tweedie. Charles Gaselee. Guy’s Hospital, Jan. 9, 1837. It would be difficult to imagine any confirmation of the justice of the remarks which we made last week, or of the ex¬ tent to which they wrere called for, more strong than is afforded by the preceding letter. So far from being anxious to “ raise a prejudice,” or to speak harshly of the accused parties, we attributed what had passed to “ a moment of youthful impetuosity,” and expressed our deep re¬ gret that some accommodation had not been effected, as the course most accord¬ ant with the interests of all. But it is clear that our correspondents are equally indignant at the idea of any portion of blame attaching to the gentlemen of Guy’s, and at our presumption in offering them advice. The assumption that the only authority wTe can have for our opinion is the ex parte evidence of their accusers, is incorrect; wre were guided entirely by the statements on both sides, as adduced before the magis¬ trates. Neither have we any where said that the discredit of the transaction rests 590 WESTMINSTER HOSPITAL. u solely with the students of Guy’s Hospi¬ tal ;” but we remarked, that the scene which occurred was one of “ unwarrant¬ able violence,” even although it might have occurred in “ the maintenance of a right.’’ The assertion that our reference to the part taken by the Lancet, and to the affair at Apothecaries’ Hall, is “irrelevant,” leads us to doubt whether the parties un¬ derstand the meaning of the expressions they employ. Our object was to caution those concerned against supposing that they were on the right side because the Lancet happened to take up their cause ; for, as we observed, to serve his own pur¬ poses, “ Mr. Wakley endeavours to identify himself with the pupils, even where they may be wrong,” and we illustrated this by alluding to the striking fact, that he went so far as to justify the jiersonal assault made on the members of the Court of Examiners — than which, so far from being “ irrelevant,” we maintain that an exam¬ ple more apposite could not possibly have been adduced. To the hope that our journal will not be made the vehicle of “ party communi¬ cations,” we must answer by reminding our correspondents, that they were them¬ selves the parties who began, and who continue, the publication of ex parte state¬ ments; and that, to comply with the wish they now express, it would be necessary to exclude their own communications. The fact is, that so far from having been the vehicle of “ party communication,” this journal, and, this journal alone, has been equally open to the statements from Guy’s and St. Thomas’s indifferently; nor can a stronger proof of our impartiality' be given than the insertion of such a letter as the preceding. If the letter addressed to us is to be re¬ ceived as indicative of any thing more than the opinion of those who attach their names to it, we can only regret that there should be any who suffer their feelings to be so much excited as to blind their judg¬ ment. In a cooler moment they will dis¬ tinguish between the disinterested and con¬ ciliatory advice of a journal (which, how¬ ever, will never either flatter or truckle to them), and the dishonest artifices of our contemporary, who notoriously takes de¬ light in fostering every dissention, and fanning every spark into blaze. His sup¬ porting what was obviously wrong, and his unparalleled insolence towards the officers of St. Thomas’s, have done those implicated in this affair infinite mischief; and whatever the result may be with re¬ gard to individuals, we have no doubt that a total separation of the hospitals will ensue — to the irreparable injury of both. — Ed. Gaz. ROYAL MEDICAL AND CHIRUR- GICAL SOCIETY. Tuesday, January 10, 1837. Mr. Earle, President, in the Chair. A paper, by Dr. Hume Weatherhead, on the subject of Inflammation, was read this evening; but in consequence of its length, there was no time left for discussion. On the motion of Dr. Clendinning, seconded by Dr. Johnson, it was arranged that a discussion of the paper shall take prece¬ dence of other business on the next night of meeting. We are prevented this week, through want of space, from giving an abstract of the paper; but it shall be published in due time for those who wish to canvass its merits. Mr. Earle, before adjourning the meet¬ ing, introduced to the notice of the society the Mouth Respirator, lately invented by Mr. Jeffreys, with a strong testimony in its favour : he also mentioned that the in¬ ventor himself was present, and would be happy to explain the principles of his in¬ genious contrivance. Mr. Jeffreys then gave an account of the various steps by which he brought the instrument to its present state ; but as we have noticed Mr. JT.’s pamphlet in another part of this number, it is unnecessary to enter into further particulars here. WESTMINSTER HOSPITAL. Maligriant Tumor of the Mammary Gland. Dec. 24th, 1836. — This day Mr. Hale Thomson, the assistant surgeon, ampu¬ tated the nipple and a portion of the left mamma of Mary Wayland, a woman about A VIPER-BITE CURED WITH SULPHATE OF QUININE. 591 45 years old. The patient has been mar¬ ried several years, but never had any chil¬ dren, nor ever conceived; and for the last two or three years the menses have become gradually more and more scanty : they still appear regularly. In the summer of 1834 she was in ser¬ vice; and being employed in washing a dog belonging to her master, the animal, in his efforts of resistance, sprung up and struck his head against her left breast. She experienced considerable pain at the moment; this subsided in a short time, but returned at intervals for three or four months. After this lapse of time she sought me¬ dical advice. Leeches were regularly ap¬ plied three times a week to the affected part, for a considerable period, and various topical remedies were resorted to, with partial success in alleviating the intermit¬ tent pain. About twenty months ago, however, a stillation of a dark fluid, very similar to, if not identical with, venous blood, commenced from the injured nipple. This discharge has continued unremit¬ tingly ever since, and has uniformly amounted to several drachms a day. After the regular appearance of this sanguino- lent issue, the fits of pain became less fre¬ quent and pungent, but a soreness was always perceptible on handling the breast. She was admitted into this hospital on the 29tli day of last November. At this time the soreness of the breast was undi¬ minished, and a hardness of the gland was detected. The morbid secretion still con¬ tinued. Several palliatives have been used without benefit ; and to prevent the dis¬ ease from assuming a more decidedly ma¬ lignant character, amputation was deter¬ mined upon. The part was excised in the usual man¬ ner, by two elliptical horizontal incisions. The cellular tissue was removed clea» from the surface of the pectoral muscle. Upon cutting into the tumor, a third only of the mammary gland was found diseas¬ ed. The lactiferous tubes leading to the morbid portion were enlarged, and their lining membrane apparently injected. The veins proper to the part were grown as large as crow-quills. The condition of the surrounding cellular tissue was mate¬ rially changed, and, in the opinion of some judges present, possessed some characters not unlike incipient carcinoma. The con¬ sistence of the cellular membrane, for some distance indeed round the affected part, was certainly firmer than natural. Dec. 27th. — The patient has experienced no untoward symptom since the operation, and the wound promises to heal by the first intention. POISONING WITH ARSENIETTED HYDROGEN GAS. Cases of poisoning with this substance being rare — not more than one or two, in fact, being on record — the following para¬ graph, which we transcribe from a Cornish paper, will probably be considered inte¬ resting : — “ On the 5th inst. (December 1836) Mr. J. E. Bullocke, son of Mr. Bul- locke, of Penzance, who has for some time resided with Mr. Beard, chemist, in this town (Falmouth), delivered a lecture on the Gases, at the Mechanics’ Institute; and, on the 19th, performed a series of experi¬ ments in illustration of that lecture. Amongst others, he hazarded an experi¬ ment with the arsenietted hydrogen, pro¬ cured by pouring sulphuric acid on arse- niate of zinc : but the gas-jar not having as much water in it as he (being near¬ sighted) supposed it had, and the atmo¬ spheric air above the water diluting the gas, he inconsiderately applied his mouth to draw up the atmospheric air, while the process of generation was going on, and unhappily inhaled a portion of the gas ; which being highly poisonous, affected his whole nervous system, and ultimately his lungs. The case baffled the skill of his medical attendants ; and although for several days no alarming apprehension was entertained, to the great grief of his father and sister, and a circle of attached friends, he died yesterday (29th).” POISONING FROM A VIPER-BITE. CURE WITH SULPHATE OF QUININE. A countryman, forty- four years of age, was bit by a viper between the fore finger and thumb of the right hand. On the following day, when admitted into the hospital, the whole extent of the right arm was enormously swollen, and its sur¬ face was of a livid red colour. The face and trunk had a jaundiced hue, and the extremities exhibited diffused patches of redness. There was great prostration of all the vital powers; the pulse was scarce¬ ly perceptible ; the body w as bedewred with a cold clammy sweat; the face was con¬ vulsed, the pupils dilated, the breathing laborious, and there were frequent efforts of vomiting. Dr. Butazzi, calling to mind the results of some cases recently pub¬ lished in the Filiatre andSin the Revue Med,, prescribed quinine in large doses, three grains to be taken in a spoonful of wine every hour. On the following day, the arm remained as much swollen as before, the pulse was scarcely to be felt, and the patient com- 592 KILLS OF MORTALITY. - METEOROLOGICAL JOURNAL plained of pain in every part of his frame : the dose of the quinine was increased to four grains. On the next day there was a decided amendment; a copious warm per¬ spiration had taken place, the discolora¬ tion of the surface abated, and the fea¬ tures were recovering the character of health. The swelling of the affected arm gradually from this time subsided, and, under the use of oily embrocations, alto¬ gether disappeared. Two drachms in ail of the quinine were taken in the course of between two and three days, — Filial re di Napoli ; and Dublin Journal, Jan. 1837. January 12, 1837. William Corless, Preston. Arthur Bernard Macann, London. James Neale, Sandwich. William Henry Hugo, Crediton. James Malthouse, Harrogate. John Robinson Wells. Edward Sugden, Skipton. Charles Lewis Crosswell, Newport, Pembrokesh. John Parkin Payne, Loxhy, Yorkshire. NEW MEDICAL BOOKS. Practical Observations on Palpitation of the Heart. By J. C. Williams, M.D. 8vo. 6s. The Nature and Treatment of Drojisy. By E. J. Seymour, M.D. 8vo. 6«. COLLEGE OF SURGEONS. LIST OF GENTLEMEN WHO RECEIVED DIPLOMAS IN DECEMBER. J. Floyd, Londonderry. G. B. Fry, Dublin. W. N. White, Dublin, P. Rogers, Buttevant, Cork. J. Lamhrick, Whitchurch, Salop. B. U. Hamilton, Dublin. J. Springall, Guildford, Surrey. H. Jackson, Petworth. W. Pilling, Manchester. Arthur DobbS. C. Trenerry, Gibraltar. J. Holland, Yewsbury, near Uxbridge. G. Smith, Dilliorne, near Stone, Staffordshire. C. J. Cox, Finchley. W. Ainley, Leeds. W. Scott, Skaddinglield, Suffolk. J. Dowe, Skibbereen, Cork. W. T. Hu dson, Cambridge. T. James, Uxbridge. A J. Nunn, Whiteparish, Wiltshire. Edward Foaker, Calcutta. F. Nesbitt, Exeter. F. M. Walker, Chesterfield H. Taynton, Queen Sqr. Bloomsbury. G. J. Perry, Henbury, Bristol. Thomas B, Larkins, London. C. Robinson, Weston, Bath. J. W. Til I ett, Colchester. J.M. Field, Hatherley, Devon. T. Shaw, Kirkham, Lancashire. C. Ray, Finchley, J. Wood, Manchester. S. Yarrow, Loughborough. S. Garrend, Olney, Rucks. W. Percival, Northampton. A. Vallack, Sidney, N. S. W. J. B. Nottage, Lancaster. E. Boult, Chester. W. D. Beard, St Kitts, W. I. WEEKLY ACCOUNT of BURIALS, Ft • om Bills of Mortality, Jan. 10, 1837. Age and Debility . 38 Apoplexy . . 12 Asthma • . 30 Childbirth . . 3 Consumption . 49 Convulsions . 27 Croup ... 1 Dentition or Teething- 3 Dropsy . . 19 Dropsy in the Brain 5 Dropsy on the Chest 3 Erysipelas . . 1 Fever ... 4 Gout ... 1 Haemorrhage . 1 Heart, diseased . 1 Hooping Cough . 5 Increase of Burials, as the preceding week Inflammation Lungs and Pleura Insanity Liver, diseased Measles . Mortification Paralysis Small-pox . Sore Throat Quinsey . Thrush . Tumor Venereal Unknown Causes ai l Casualties 22 7 1 11 7 2 2 13 2 1 1 1 4 compared with ) gg METEOROLOGICAL JOURNAL. Kept at Edmonton, latitude 51° 37' 32" N. Longitude 0° o' 51" W. of Greenwich. Jan, 183/ TU KRHOMUTKB. Ba ROMHTBR. Thursday. 5 Friday . . 6 Saturday . 7 Sunday . . 8 Monday. . 9 Tuesday . . 10 Wednesday 1 1 • from 29 to 37 35 47 33 42 25 37 31 48 41 49 20 33 30-10 to 29-85 29-61 29-57 29 54 29 79 30-04 30-15 30 09 30 07 29-72 29-84 29 98 30.U8 Wind S. and S.W. Alternately clear and cloudy; rain on the 6th and 10 th. Rain fallen, *25 of an inch. Charles Henry Adams. APOTHECARIES’ HALL. LIST OF GENTLEMEN WHO HAVE RECEIVED CERTIFICATES. January 5, 1837. William Howett Edwards, Peterborough. George Rigden Ruding Court, Kent. Nathaniel Whitchurch, Melton Mowbray. Parmeuas Langley, Checkley. Staffordshire. Plmanuel Dominett, Frome, Somersetshire, Francis Booth, Nafferton, Yorkshire. George Octavius Hopton, Durham. John Powell Wilding, Wallybourn, Salop. William Parkinson, Hollin Grove. John Elkington, Birmingham. Martin Harsant, Earl Soham. NOTICES. Mr. Sweeting’s letter, though dated the 3d, did not reach us till the 9th inst. A Senior Student’s (L. T.) remarks are rather too severe, as he would himself confess, were he acquainted with the per¬ son against whom his strictures are di¬ rected. Errata. — In Dr. Ramsbotham’s letter, last number, page 555, col. 2. line 16, for men read man; and page 556, col. 2, line 6,j'or bloody matter read bloody water. Wilson & Son, Printers, 57*Skinner-St. London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOWHflL OF iHfti trine anti trie Collateral Jritritcrss. SATURDAY, JANUARY 21, IS37. lectures * # ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine , By William Cummin, M.D. Lecture XVII. Fui iher consideration of the Births of Children — -Single and Plural Births — Order of the Births — Earliest medico-legal case on record — Legal evidence of priority of Birth — Frequency of Plural Births — One or two old cases — Twins horn at intervals. Ques¬ tion of Sl perfcetation — Occasions for such inquiry — Conditions of Super fcetation — Illustrative Cases — Conceptions supervening at considerable intervals — Production of dif¬ ferent Races at one Birth — Objections to the Doctrine of Superfcetution — Supposed closure of the Os Uteri — Formation of a Decidua — Superfostation in a Double Uterus — Cases — General Conclusions as to the possibility of Sup erj vet at ion — Authorities for and against the Doctrine. The next point of view in which the births of children are to be considered is as they occur singly or plurally. SINGLE AND PLURAL BIRTHS. Occasion and antiquity of the inquiry. — To the medical jurist the subject of plural births is important, chiefly with reference to the order in which they occur. Where- ever the law of primogeniture prevails, as it does in this country, it is most material that when two or more children are born together, it should be observed, beyond the possibility of dispute, which of them came into the world first. It is worth noticing that the very earliest instance on record of the exercise of medico-legal functions, re- 477. — XIX. lates to the ascertaining in a twin case which child was the first born. When Tamar was in labour, one of the twins which were in her womb “ put out his hand ; and the midwife took and bound upon his hand a scarlet thread, saying, this came out first. And it came to pass as he drew back his hand, that be¬ hold his brother came out ; and she said, how hast thou broken forth ? this breach be upon thee; therefore his name was called Pharez. And afterward came out his brother that had the scarlet thread upon his hand ; and his name was called Zarah.” (Gen. xxxviii. 28.) So it appears it was a midwife who took this medico-legal precaution : but we must not be scandalized by the fact of a female practitioner being the first medical jurist of whom we have any ac¬ count, for the earliest medical practitioners, of whatever kind, of whom there is any authentic record, were neither more nor less than members of that respectable sis¬ terhood — the mid wives. Legal distinctions. — Tn cases concerning pedigree, the declarations of relatives are admitted in evidence, to the exclusion of the testimony of mere acquaintances and menials. But the evidence of the medical attendant who may have been present at the birth, is considered superior to any other that can be adduced. The proof of primo¬ geniture depends on the fact of which of the children was actually first delivered; for the ascertaining which fact no one has a better opportunity than the medical man who happens to assist at the labour. There is a remarkable case on record, which shews how the law decides the question of primogeniture, where there may be no medical evidence to be had — the testimony of an eye-witness being pre¬ ferred to that of any other authority. In a family of eight children, of which the three youngest were born at one time, and the five eldest died, the priority of birth of the surviving three was questioned in a 2Q 594 DR. CUMMIN ON FORENSIC MEDICINE. suit brought for the inheritance. The names of the children were Stephanus, Fortunatus, and Achaicus, three names which are to he found in this order at the conclusion of St. Paul’s epistle to the Co¬ rinthians. Evidence was given of the de¬ clarations of the deceased father, that this was the order of their births ; but this evi¬ dence was outweighed, in the opinion of the jury, by the evidence of a declaration of a deceased aunt, who was present at the birth, and who used to say, that she tied a string round the arm of Stephanus imme¬ diately after he was born, in order to de¬ note that he was the second son. Frequency of plural births. — A few remarks may here be made on the comparative frequency of twins and triplets : with a word or two on other plural births. The proportion of twin cases varies in different countries; thus in France and Scotland the ratio is one case of twins to every 95 births; in Germany one in 80; in England one in 92; in Ireland one in every 62. It is calculated that triplets do not occur in more than one case out of 4450 (one in 6500, according to Sliss- milch) ; nor quadruplets in above one in 100,000. Dr. Garth shore records a case in the Philosophical Transactions for 1787, where there were five children born at a birth ; and this is perhaps the largest number bora at once, recorded on good authority by any modern writer. One or two old, cases. — Were we to listen to the statements of some of the old authorities, we should find that seven, nine, nay thirty-six, have been brought forth at a birth. Sigebert, in his Chro¬ nicles, and Paul the Deacon, relate a curious history. A woman having given birth to seven children at once, they were immediately taken from her, and, like a litter of puppies, thrown into a pond; but Agelmund, King of the Lombards, hap¬ pening to pass that way, put in his spear, when one of the infants clung to it, was taken out, reared and educated, and ulti¬ mately succeeded to the throne. Erasmus and others have noticed the remarkable fecundity of Margaret, Countess of Hol¬ land, who, in 1276, brought forth at one birth a progeny as numerous as the days in the year. They were all put into a basin together, where they died the moment they were baptized. An ingenious inter¬ preter has given an explanation of this case, which brings the marvellous within the bounds of credibility. The Countess, in¬ stead of 365, gave birth to no more than two or three children ; but happening to be confined when there were only a few days of the old year left, it wans observed bv some one that she brought forth as many children as there wTere days in the year !— and so the story spread. Viability and other conditions of plural births — In plural births the children are al¬ most always diminutive, and less lively than when born singly. In twin cases, for example, each child generally vveighs less than a single birth, though taken to¬ gether they are heavier than a single child. It happens, however, that in some rare instances each of the twins is as heavy as an ordinary single child ; thus Dr. Collins, in his Practical Midwifery, mentions a case in which he says, “ both children wrere natural presentations: the first, a boy, wmighed 7^ pounds; the second, a girl, 8 pounds; with twenty minutes in¬ terval.” It will, perhaps, have been noticed in the table given in last lecture, that more than three children at a birth constitute a monstrosity , and are not capable of con¬ tinuing to live. There is, I believe, no authentic example of quadruplets surviv¬ ing for any considerable length of time. The interval that may elapse between the successive births — for the births are al¬ ways successive, though said to occur simultaneously — is uncertain. In mid¬ wifery practice it is not usual to allow any considerable time to intervene. If* after the lapse of half an hour, the mem¬ branes of the second child still remain unbroken, they are punctured, and uterine action thus excited : should tw7o hours more pass away without delivery, the feet are brought down, or the forceps applied ; for it is generally found that the second child is still born, if left longer than twro or three hours unassisted. Question of Superf station. There are instances of longer intervals between the births — so long as to raise the question, whether the children might not be the issue of successive conceptions, the product of superfoetation — or in other words, whether a woman already pregnant might not conceive again ? Occasions of inquiry. — I may give an example or two of the mode in wdiich questions of superfeetation may be raised in the courts. A widow is pregnant at the death of her husband; she marries in three or four months after ; at the expira¬ tion of nine months from the first hus¬ band’s death, she brings forth a child, and in three mouths after another. Is this a case of retarded twin birth, or one of superfoetation ? Again : a married woman, after having given birth to one child, may in the course of some months produce ano¬ ther, which is either illegitimate, or the product of superfoetation. Finally, a woman after producing a dead I child, may pretend superfoetation for the : purpose of introducing a supposititious I heir; or she may pretend to carry the; QUESTION OF SUPERFOETATION. 695 fruit of a second conception, with the ob¬ ject of enjoying the privileges and im¬ munities of pregnancy. In all such cases it will obviously be the duty of the medical jurist to inquire, irst, whether the supernumerary preg¬ nancy exist, and then to ascertain, if pos¬ sible, whether it be really a superfcetation, nr only a retarded birth. Conditions of superfoetation. — Whatever be the issue brought forth at one birth, or ibout the same time (unless it consist of lifferent races — as a white, or a negro, md a mulatto), may reasonably be im¬ puted to a single conception. Again, there are numerous examples nf mature foetuses being born along svith others which appear to be no more than three, four, five, or six months. In such cases it is not necessary to have re¬ course to the supposition of superfoetation, for we can conceive the immature off¬ spring to have ceased to be developed at the age which it indicates ; and even though such issue be born successively, they do not necessarily imply successive conceptions. Nor, if two children be born with about a month of difference in the time of birth, yet the first appear somewrhat immature, say with the characteristics of an eight months foetus, while the second is per¬ fectly mature, does this imply distinct conceptions. But when we find two mature chil¬ dren, born of the same woman, with two or three or more months between the births, the supposition is inevitable that there has been superfoetation. The interval of some days, seven, for instance, ten, seventeen, or twenty (for there are cases to this extent reported), do not war¬ rant our inferring the issue, though ma¬ ture, to be other than twrins : even a month may only leave the question doubtful. Examples. — Among the cases cited by Haller, there are the following : — Succes¬ sive births, with an interval of two months, each perfect ; a foetus born three months after another, both living and healthy; one born six months after ano¬ ther, but feeble ; tw7o lively and strong foetuses, one born on the 3 1st July, the other on the 9th February, so that the latter must have been conceived when the former was about eighty days old in intra¬ uterine life. Some cases more recent are perhaps not less remarkable. Mary Ann Bigaud,awo- man of Strasburg, aged 37, was delivered of a lively child on the 30th April. The lo¬ chia were presently suppressed, and so wras the milk : in short, on the 17th Sep¬ tember following she brought forth ano¬ ther apparently mature and healthy child, that is to say, in about four months and a half after the first,— w hich could not wrell occur without superfcetation. The woman died seven years after; and it wras ex¬ pected that she wrould be found to have a double uterus; but there was nothing ab¬ normal detected about the womb when the body wras examined. It may as wrell be mentioned here, that such a thing as a true double uterus has never been discovered in the human spe¬ cies; that is to say, two cavities, with a pair of fallopian tubes, ovaries, and appen¬ dages, attached to each ; but there have been frequent instances of bilocular uteri, with the fundus double, and a septum in some cases continued down into the va¬ gina ; the latter peculiarity, however, is comparatively rare, and the more com¬ mon form of abnormal structure is of this kind. This drawing represents a vir- Fig. 21. — Example of a bilocular Uterus . 596 DR. CUMMIN ON FORENSIC MEDICINE. gin uterus which was partially bilocular. The length from the fundus to the os uteri was 3^ inches; the greatest breadth 3 inches; and the length of the septum found between the two cavities into which the internal space was divided, measured If inch*. A very remarkable case, which can scarcely be accounted for without admit¬ ting the possibility of superfoetation, was observed by Dr. Desgranges, of Lyons. A woman was delivered of a seven months’ child; none of the usual consequences of delivery ensued ; but in five months six¬ teen davs afterwards, another infant was brought forth, which had apparently reached its full time. The only mode of evading the admission of superfoetation here seems to be, by insisting that the so- called seven months’ child was no more than a four months’ foetus; or, in other words, that the first was a mere abortion, and the second mature. But it is very unlikely that an immature foetus of four months (at which age no foetus has been known to survive birth) would be mista¬ ken for a lively infant of seven months. If, on the other hand, we admit this infant to be what it was represented, and still deny superfoetation, we are driven to the absurdity of supposing, that the period of utero-gestation with a living healthy child might extend to upwards of twelve months ! Some of the opponents of superfceta- tion endeavour to shew, that in every case so reputed, there must either be a double uterus, or the first birth is pre¬ mature, though mature to all appear¬ ance. We cannot deny the possibility of the first supposition, yet we see that it was gratuitous and unfounded in the case al¬ ready quoted, as it was in some others. But it is hard to admit that the second supposition is tenable : who can allow that a foetus of five, six, or seven months, should have all the characteristics of a nine months’ child, so as to be mistaken for such ? The development of the em¬ bryo and foetus is too regular to justify the supposition of such an anomaly in any circumstances. The late Dr. Maton published a valuable case in the fourth volume of the Transac¬ tions of the College of Physicians. An Italian lady, married to an English gen¬ tleman, gave birth to a male child, at Palermo, on the 12th November, 1807; it had every appearance of health, though it died in nine days, owing to some distress¬ ing circumstances connected with the ac¬ couchement; — the lady, it appears, was hastily delivered on a bundle of straw, in an empty house, at midnight. On the 2d of February, 1808 ( three months minus ten * Medjcai, Gazette, vol. xiii. p. 898. days from her first confinement), she was delivered of another male infant, com jsletely formed, and in perfect health. It was objected to this case, that the first child was probably not “ completely formed,” as the second alone was said to be; and that therefore it was no more than a case of twins, in which one of the foetuses came into the world at the sixth, and the other at the ninth month of pregnancy, the ova being quite distinct anti separate: the proof was deficient, it was urged, that the first child had reached the full term o( utero-gestation. Dr. Paris informs us, that in consequence of these objections (which were made by Dr. Granville), he applied to Dr. Maton for further explanation, when he was told “ that both the children were born perfect, the first therefore could not have been a six months’ child;” nor were the “ distressing circumstances” of such a na¬ ture as to cause the labour to be prema¬ ture. According to Dr. Maton, the facts were these: — “ The lady could not obtain better accommodation at the time ; the labour, although quick, was not sudden, for the accoucheur was already in atten¬ dance; nor wras it prsemature, for the na¬ tural period of utero-gestation wras sup¬ posed to have been completed.” This seems to be the most complete and authentic case of superfoetation on record — the births, mature and lively, having followed each other at such an in¬ terval as to render the admission of one conception supervening on another, after a lapse of two or three months, inevi- table. Mongrel offspring. — It is handed dowrn to us in the records of the olden time, that a woman has sometimes betrayed her adultery by bringing forth two children at a birth — one resembling her husband, the other her paramour; like Alcmoena, when she bore Hercules and Iphicles, seve¬ rally begotten by Jupiter and Amphitryon. Different races. — But this is only ques¬ tionable evidence of superfoetation, com¬ pared with the striking fact of females producing plural births of mixed varieties — for instance, a white and a mulatto at once. Haller wras not acquainted with any cases of this kind, or he would infallibly have quoted them. Since he wrote, how¬ ever, several have been placed on record. Dr. Garn, of Wittemberg, gives an ac¬ count of a woman, who, after sexual inter¬ course with a European and then with a negro, brought forth twins, one of wThich was white, and the other a mulatto. M. Delmas relates a case in the Annales de Montpellier for 1806. A woman, aged 36, wras delivered, in the eighth month of her pregnancy, of a w7hite child and a mulatto. Both died soon after. The pla¬ centae were intermixed ; and the woman QUESTION OF SUPERFOETATION. 597 confesssed that she had had intercourse with a negro when she was four or five months with child. Dr. Dewees published a similar case in 1807. A white maid servant bore twins, one of them white and of European struc¬ ture ; the other dark, and of the negro cast. Dr. Moseley tells us of a negress, who was delivered of twins in the West Indies, one of them a black, the other a mulatto. M. de Bouillon, Gsiander, and others, relate similar instances of black and tawnv twin births. J Now these are matters of fact, which cannot be invalidated by mere theory ; for the objections to the doctrine of superfoe- tation are no more than theoretical. Objections.' — PJany opponents of super- toetation deny the fact on the ground of non-access of the semen. They hold that one of the first consequences of conception is the closure of the os uteri — some say immediately, others after a short time. But what evidence is there of such an occurrence, which, if admitted, must pre¬ clude the possibility of further question ? None, I imagine, of a very conclusive na¬ ture; while the contrary supposition, that the uterus is not immediately closed, but re¬ mains open for at least some time, seems to rest on quite as good grounds. 1. Closure oj the os uteri. — This objection, old as Galen’s time, and the more obsti¬ nately maintained, perhaps, for that rea¬ son, is certainly untenable, for it is not borne out by fact or experience. Women, as we have seen, sometimes continue to menstruate for a few periods after concep¬ tion; nay, some have continued to do so all through their pregnancy. What can be a stronger proof of the patency of the uterine orifice? But there is a more direct one: the catheter and the finger have been introduced, without obstruction, into the pregnant uterus. What Haller says on the point is so clear and precise as to show that his mind was perfectly satisfied. “ Claudi quidem [os uteri] legas a conceptu, non sine analogia brutorum aniinalium. Verum nihil est ejusraodi,” And again : — “ Os uteri nunquam clausum est, ideo- que potest superfoetari non solum a die sexto ad trigessimum, aut prirnis duo- bus mensibus, sed omni omnino tempore.” In fine, after stating all the arguments for and against the doctrine, with his usual per¬ spicuity, he concludes the subject by ex¬ pressly saying that there is no valid objec¬ tion to the possibility of superfoetation oc¬ curring while yet the ovum has not become considerably developed. These are his words: — “ Nihil ergo repugnat quo tem¬ pore ovum nondum prseg ramie est, quin no\a placenta ad aliam sedem uteri se adaptet, novusque eo loco foetus subnas- catur.’’ 2. Formation of the decidua uteri. — John Hunter demonstrated the formation of a deciduous membrane lining the uterus, as one of the earliest consequences of con¬ ception. The existence of such a mem¬ brane has been urged by Roose and others, as fatal to the hypothesis of superfoetation. And are all our facts and instances to fall at once before this membrane ? Is the growth of the decidua so invariable, and when present is it so well developed and firm as always to resist the impulse of generation ? Experience is clearly one way, while theory is the other. Nor can that theory be urged now with the same force that it once was : its supporters imagained that the decidua, in lining the uterus, covered over the apertures of the fallopian tubes. That part of their doc¬ trine proves to be untrue; the decidua does not close the fallopian orifices, and any resistance which it can afford to a second conception must be over the cervix uteri ; and recollect that the os uteri is not necessarily closed. That a certain degree of resistance (perhaps even a con¬ siderable degree) is exerted by this mem¬ brane, we are by no means disposed to deny ; it may indeed be owing to this that superfoetations are not more frequent : but because the occurrence may thus be rendered impossible in many cases, does it therefore follow that it is so in all ? In a valuable paper communicated to the Medico- Chirurgical Society, by Dr. Robert Lee, the objection just referred to is revived. The case on which the paper is founded is that of a woman who died of peritonitis, eight days after par¬ turition, and who proved, on examina¬ tion of her body, to have had a double, or rather bifid, or bicorned, uterus. Here is the appearance of the uterus, as displayed by Dr. Lee. The right cornu had contained the foetus (and, by the way, the deceased had borne several living chil¬ dren previously); the left was about the ordinary size of the unimpregnated ute¬ rus. This latter cornu was lined with a deciduous membrane, forming a shut sac towards the cervix, but it is remarkable that the fallopian tube was not closed, the membrane passing into the opening and leaving it completely pervious. I he discovery of a deciduous membrane in the unimpregnated cornu, appears to Dr. Lee to be of much importance. He thinks it probable that a decidua is simi¬ larly formed in every case of double uterus where either of the cornua is impregnated, and he adduces the instance of what oc¬ curs in the lower animals, “ the mem¬ brane which surrounds the product of conception invariably occupying the DR. CUMMIN ON FORENSIC MEDICINE Fig. 22. — Double or Bijid Uterus. a. The cervix ; b, Orifice of the fallopian tube ; c. Left cornu, lined with decidua; d, Right cornu, which had recently contained a fcetus. whole inner surface of both cornua.’’ Hence he argues the impossibility of su- perfoetation, even in eases which would seem most favourable to it — namely, where the uterus is bifid. “ The disposition of the deciduous membrane,” says he, “ in the case I have now related, must have rendered superfcetation, or the conception of a second embryo during gestation, im¬ possible ; and its history tends entirely to overturn the recent speculations of M. Cassan also, on the possibility of super- foetation where a double uterus exists. Menstruation must have been equally im¬ possible in this case as in ordinary preg¬ nancy, where the inner surface of the ute¬ rus is lined with decidua I must confess, that notwithstanding these very imposing statements, it still ap¬ pears to me that the proof of Dr. Lee’s position is by no means made out. We have here but a single case, and notwithstand¬ ing the analogy from the lower animals by which it is backed, further examples will be required in the human species before a general conclusion can be drawn. Should it happen, too, that such a structure is found general, it must still be admitted that it may not be equally perfect in all cases ; for theory must be subservient to facts, not facts to theory. It may be added, that perhaps this case no more disproves the possibility of super- foetation, than it does the fact of menstru¬ ation during pregnancy. Dr. Lee says that menstruation was “ equally impossible” with superfoetation in this case. Now, as it is generally admitted by some of the most experienced accoucheurs that men¬ struation may, and often does, occur, at least once or twice, after conception, so I am inclined to infer that, in all preg¬ nant women, the decidua is not to be found exactly as in the case just described. * Mboical Gazette, vol. xi. p. 170. QUESTION OF S UPEB F CET ATIO N » 599 Bat if the existence of such a decidua as Dr. Lee found over the cervix be ad¬ mitted as an argument against superfceta- tion, another point which he noticed in the same case seems strongly in favour of it— namely, the open state of the fallopian tube. Had this been closed, it were then, indeed, perhaps impossible that superfoeta- tion should take place; but being open, what insuperable obstacle can there be to the generative influence finding its way to the ovary, and thus effecting a new concep¬ tion ? Only allow that the first ovum does not completely fill the uterus, and that there is still access to one of the ovaries through a fallopian tube, and there can be no great hazard in supposing that even it there were a decidua uteri forming a shut sac, it would not in all cases present an unimpregnable barrier. The learned Sir Thomas Browne makes some remarks on the subject, which 1 shall take leave to quote, not exactly through deference for his physiology, but for his comprehensive and sound under¬ standing. It will be observed in the out¬ set, that he is oi the number of those who believe the womb closed upon the occur¬ rence of conception; he does not, however, consider that this decides the impossibility of superfoetation. “ Although it be true that upon conception the inward orifice of the matrix exactly closeth, so that it com¬ monly admitteth nothing after, yet falleth it out sometimes, that in the act of coition the avidity of that part dilateth itself, and receiveth a second burden ; which, if it happen to be near in time unto the first, they do commonly both proceed unto per¬ fection, and have legitimate exclusions, periodically succeeding eacli other. But it the superfoetation be made with consi¬ derable intermission, the latter most com¬ monly proves abortive ; for the first being confirmed, engrosseth the aliment from the other. However, therefore, the project of Julia, seem very plausible, and that way infallible, when she received not her pas¬ sengers before she had taken in her lading, yet was there a fallibility therein ; nor, in¬ deed, any absolute security in the policy of adultery after conception. For the ma¬ trix (which some have called another ani¬ mal within us, and which is not subjected unto the law of our will), after reception of its proper tenant, may yet receive a strange and spurious inmate, as is con¬ firmed by many examples in Pliny, by Larissaea in Hippocrates, and that merry one in Plautus, urged also by Aristotle.*”' & up erf citation during extra uterine pregnancy, 1 here is another condition in which superfcetation may occur, namely, where * Inquiries in t° Vulgar and Common Errors, !'• ilo. Ed. 1686. the product of the first conception is extra- uterine. I have already noticed a remark¬ able instance in which a woman bore two or three children successively, while she had a foetus in one of the fallopian tubes. Another example may be mentioned. Dur¬ ing the existence of extra-uterine preg¬ nancy a woman conceived again, and in due time was delivered of a mature infant. It became necessary, in consequence of some accidents which supervened, to give issue to the retained foetus: gastrotomy was practised, when an infant was ex¬ tracted w'hich had been viable, but was now partially decomposed through its long sojourn in the abdomen. The patient re¬ covered. Another instance may be quoted. Dr. Cliet, of Lyons, in the year 1818, opened the body of a woman who had recently died. Behind the uterus, and a little to the right, he found a foetus weighing five ounces, three drachms, and measuringeight inches and a half long. It had attained the fifth month of development. In the uterus was a second foetus, of about the third month. Superfcetation with a double uterus. — In M. Cassan’s thesis (On Double Ute¬ rus and Superfoetation, Paris, 1826), tiieie is the history of a case which occurred in the celebrated Mde. Boivin’s practice. On the 15th of March, 1810, a woman, aged forty, gave birth to a fe¬ male infant weighing about four pounds. As the abdomen still remained bulky* Mde. Boivin introduced her hand, but could find nothing in the uterus. Further examination led her to suspect that there as anothei foetus, either extra-uterine or contained in a second cavity of the womb. At length, on the 12th May, a second fe¬ male infant was born, weighing not more than about o I Us. , feeble, and scarcely able to respire. The mother assured * Mde. Boivin that she had had no connexion with her husband (from whom she was for some time separated) except thrice in two months, namely, on the 15th and 20th July, 1809, and the 16th September fol- lowing. 1 he product of the second con- ception was here perfectly distinct and sepai ate trom the first; and the uterus was bilocular. This is, I believe, the only authentic example on record of superfoetation taking piace in a double uterus, although such a structure is generally admitted to be adapted for such an occurrence. Nor in¬ deed are tw'in cases common in bilocular uteri : when women with this form cf womb become pregnant, they generally bear but one foetus, as in Dr. Lee’s case, a case described by Tiedemann in Meckel’s Archiv for 1819, and one by Gsiander, in which both the uterus and vagina were 600 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS. completely divided. But there is at least one instance on record of double preg¬ nancy in a double uterus, — in Rust’s Magasin, Band, xxvii. II. I. Whether it was a case of superfoetation or not, seems uncertain ; but one of the foetuses, that in the right cavity, was larger than the other : the infant from the left side died on coming into the world. General conclusions. The following general conclusions seem to be warranted by what has been already said. Superfoetation is possible, — 1. When sexual intercourse is repeated soon after conception : in this way only can we account for distinct varieties, or different races, produced at one birth-— such as white or black, and mulatto children. 2. When the product of the first con¬ ception is extra uterine, or the womb par¬ tially occupied by a mole, or a dead or disorganized foetus. 3. When the uterus is double; for, not¬ withstanding the theory of a decidua, which would seem to preclude such an inference, facts just referred to cannot be disputed. Where the uterus is perfectly bilocular, and no morbid condition inter¬ feres, it is difficult even theoretically to assign a plausible reason against the doc¬ trine. 4. In every case where the uterus is not closed (and the closure, as w'e have seen, is not general), and where the product of the first conception does not, by its considerable size and the space it occupies in the womb, obstruct all access to one of the fallopian tubes, wre cannot but admit the possibility. 5. And lastly, it is unavoidable to ad¬ mit the fact of superfoetation, when we see lively and mature infants born of the same woman at an interval of three, four, five, or six months between the births. The limit of the interval between suc¬ cessive conceptions during pregnancy is uncertain : Weber hesitates not to extend it to the seventh month ; nor does Haller dissent from bis opinion. In the preceding discussion I have avoided any appeal to authorities in the shape of an argumentum ad vereeundiam , partly because I thought that a reference to facts would be far more profitable, but chiefly because the said authorities have been much divided. In conclusion, how¬ ever, I need not hesitate to mention that if Hebenstreit, Ludwig, Metzger, Roose, Schmidtmuller, and Blumenbaeh, be op¬ posed to the doctrine, there are, on the other side, the names of Haller, Harvey, Alberti, Teichmeyer, Ploucquet, Bernt, Henke, Mende, Martini, and most of the modern French school. Orfila’s opinion (in which Dcvergie coincides) is guarded in the extreme. I shall quote it, not because I approve of the cautious timidity with which it is expressed, but because, as it seems wrung from the author, it may possibly be en¬ titled to the credit of being the better weigh¬ ed. After reviewing most of the well- attested cases he could find on the sub¬ ject, he sums up to this effect, “ that the medical jurist ought to admit the pos¬ sibility of superfoetation, but he ought at the same time to recollect, that cases occur in which it is extremely difficult to prove that it has taken place, the addi¬ tional children being readily accounted for either as abortions or twins.” LECTURES ON MATERIA MEDICA, OR PHARMA¬ COLOGY, AND GENERAL THERAPEUTICS, Delivered at the Alder sgute School of Medicine , By Jon. Pereira, Esq., F.L.S. Lecture LV. In this lecture I propose to examine the family POLYGON ACE ^E, the most important officinal substance ob¬ tained from which, is rhubarb; the pro¬ duce of some species of Rheum. History. — Dioscorides speaks of a root which he calls Rha, or Rheon (pa ffiov), and which has been regarded by some as iden¬ tical with our rhubarb ; but the descrip¬ tion he has given of it does not apply to the latter substance, and it is, therefore, fair to presume some other root must have been meant. “ Rha, by some called Rheon , by the Latins Rhaponticum, growls,” says Dioscorides, “in those countries which are beyond the Bosphorus, and from which it is brought. It is a black root, similar to great century, but smaller and redder, spongy, somewhat smooth, and odourless.” Pliny gives a similar account of it, under the name of Rhacoma : it comes, he says, from the countries beyond Pontus, resembles the black costns, is odourless, and has a hot astringent taste. Prosper Alpinus w-as of opinion that the Rha of Dioscorides was the root of Rheum Rhaponticum, which Alpinus ob¬ tained from Thracia in 1608, A.D. and cultivated at Pavia. RHEUM. 601 The later Greek writers are supposed to have been acquainted with our rhubarb. Freind says Alexander of Tralles, first mentioned it in weakness of the liver and dysentery. Paulas ^Egineta seems to make a distinction between Rha and Rheon. In the first chapter of the first book of his work, he says, that, for the crudities and vomiting of pregnant women, we may §dve “ the blood- wort, boiled in water, for drink ; and likewise dill, and the Pontic root, called Rha, in the dialect oj that country. ” In the forty-third chapter of the same book, in noticing the practice of the ancients, he says, “ Alvine discharges they promoted by giving tur¬ pentine to the extent of an olive, when going to rest ; or, when they wished to purge more effectually, by adding a little rhubarb ( Rheon ).” This is the first notice of the purgative properties of rhubarb. In one of the Arabian authors (Mesue, the younger), we find three kinds of rhu¬ barb mentioned : the Indian, said to be the best, the Barbarian, and the Turkish, which is the worst of all. Botanical history. — It may not be out of place here, to offer a slight sketch of the opinions of naturalists regarding the plant which furnishes our rhubarb. For a fuller account, I must refer those inte¬ rested in this inquiry to the late Dr. Dun¬ can junior’s Supplement to the Edin¬ burgh New Dispensatory. Formerly this root was supposed to be obtained from the Rheum Rhaponticum. In 1732, the R. undulatum was sent from Russia to the Jussieus at Paris, and to Rand of Chelsea, as the true rhubarb. This is the species which Linnasus de¬ scribed as R. Rhabarbarum. About 1730, at the desire of Kauw Boerhaave, first physician to the Emperor of Russia, the senate commissioned a Tartarian merchant, a dealer in rhubarb, to procure them some seeds of the genuine plant. This he did, or pretended to do; and on sowing them, two species of Rheum were obtained — namely, the undulatum and the palmatum. In 1762, seeds of the latter species were received by Dr. Hope, of Edinburgh, from Dr. Mounsey, at Petersburgh ; they were sown, and the plants cultivated with suc¬ cess. The root of this species being found to agree, in many of its characters, with that of genuine rhubarb, led to the belief that the palmatum was the true species. The inquiries of Pallas, however, raised some doubts about the correctness of this opinion ; for the Bueharians declared themselves unacquainted with the leaves ot the palmatum, and described the true plant as having round leaves, with a few incisions only at the margin. This de¬ scription agreed best with Rheum compac- tum, the roots of which were declared, by Millar, who cultivated the plant, to be as good as foreign rhubarb. Georgi relates, that a Cossack pointed out to him the leaves of the R. undulatum as the true species. These accounts were not satis¬ factory to the Russians, and in conse¬ quence, in 1790, Sievers, an apothecary, went to Siberia, under the auspices of Catherine II., with a view of settling the question; but after four years of perse¬ vering attempts to reach the country where the true rhubarb grew, or even to obtain the seeds, he was obliged to be satisfied with negative results only. “ My travels,” says he, “ as well as my acquaintance with the Bueharians, have satisfied me that as yet nobody— that is, no scientific person — has seen the true rhubarb plant. All that is said of it by the Jesuits, is miserable confused stuff ; all the seeds procured under the name of true rhubarb are false; all the plantations, from those of the Knight Murray down to the flower¬ pot of a private individual, will never yield true rhubarb. Until further deter¬ mination, I hereby declare all the descrip¬ tions in all the Materia Medicas to be in¬ correct.’’ The inflated style of this per¬ son, does not, however, increase our con¬ fidence in his statements. Four species of Rheum, growing on the Himalayan Mountains, have been de¬ scribed by my friends, Dr. Wallich and Mr. Royle. Of these, one (namely, the Rheum Emodi , called also R. australe ) was at first supposed to be one of the sources of our officinal rhubarb, though without sufficient reason. I have specimens of the Himalayan rhubarb collected and dried by the natives, and which were given me by Dr. Wallich : they are probably the produce of R. Emodi , or Webbianum, and have hardly any resemblance to the rhu¬ barb of the shops. Mr. Royle, in his “ Illustrations of the Botany oj the Himalayan Mountains ,” after referring to the accounts of different au¬ thors, as to the precise locality of the country yielding Russian rhubarb, con¬ cludes that it is “ within 95° of E. long, in 35° of N. latitude — that is, in the heart of Tibet.” And he adds, “ as no naturalist has visited this part, and neither seeds nor plants have been obtained thence, it is as yet unknown what species yields this rhubarb.” Characters of the genus Rheum. — The ge¬ nus Rheum is characterized by having hermaphrodite flowers, consisting of a co¬ loured perianthium, composed of from six to nine pieces, arranged in two rows; nine stamina inserted on the torus at the base of the perianthium, free or subcon- nate at their base ; a simple triangular ovarium, supporting three styles, which are each furnished with a peltato- capitate 602 MR. F EREIRA ON MATERIA MEDICA AND THERAPEUTICS. stigma. The fruit is a three sided cary- opsis, winged at the angles, and surround¬ ed at the base by the perianth ; the seeds arc albuminous, with a central straight embryo. From this description it will be evident that the genus belongs to class Enneandria, order Trigynia, of the Linn man arrange¬ ment. The species hitherto known, agree in possessing large fleshy branching roots, which are brown externally, and yellow, intermixed with red, internally; radical and petiolated leaves ; membranous ochrese; and numerous small flowers, ar¬ ranged in panicles or compound racemes. The Rheum palmatum , fig. 147 (the species assumed, in the London Pharmacopoeia, as the source of the rhubarb of the shops) is distinguished from other species by the palmated form of its leaves; the clefts be¬ tween the segments being somewhat di¬ lated, the lacinim acuminate. On their upper surface the leaves are roughish, and of a dull-green colour; on their under sur¬ face, they are pale-and villous. The pe¬ tioles are slightly furrowed above, and are rounded at the edges. This species grows wild on the mountains of Chinese Tar¬ tary, and in Tibet. It is cultivated both in England and Scotland, for the root; which, when dried and properly prepared, constitutes the “ English rhubarb ” of our druggists. Fig. 147. — Rheum palmatum. Fig. 148. — Rheum comp actum. Rheum compactum (fig. 148) has very ob¬ tuse, shining, smooth leaves, somewhat lobed, with small teeth. It is a native of Tartary and China. R heum austra le or Emodi ( fi g. 1 49) has ro und¬ ish, cordate, obtuse leaves, rough beneath and Fig. 149. — Rheum Emodi or australe. on the margin, with the sinus at the base dilated, and with furrowed roundish foot¬ stalks. The branches and peduncles are papillose — scabrous ; the leaflets of the perianth oval oblong, finely crenate at the apex. It grows in Chinese Tartary and in the Himalayas. Preparation. — We are yet in want of a good account of the method followed in preparing Asiatic rhubarb for the market. It is probable, however, that the! process varies in different places, since the ac¬ counts given by Bell and Sievers do not precisely agree. Bell says, that after digging and gathering the rhubarb, the Mongalls cut the large into small pieces, in order to make them dry more readily, and make a hole in the middle of every piece, through which a cord is drawn, in order to suspend them in any convenient place. They hang them for the most part about their tents, and sometimes on the horns of their sheep. Sievers, however, states, that the roots are cut in pieces, strung upon threads, and dried under sheds so as to exclude the solar rays ; and the same author tells us that sometimes a^year RHEUM. 603 elapses from the time of its collection un¬ til it is ready for exportation. Physical projierties and varieties. — In Eng¬ lish commerce four kinds of rhubarb are known, namely, Russian, East Indian or Chinese, Dutch — trimmed, and English. 1. Russian rhubarb. — This is the kind known in the shops by the name of Tut key rhubarb, because it is said to have been brought formerly to this country by way of Natolia. It is now imported from Petersburgh. It is described in books by the names of Muscovite, Bucharian, or Siberian rhubarb. According to the treaty entered into by the Russians and Chinese, all the com¬ merce between the two nations is trans¬ acted at the frontiers. Kiachta is the Russian, Maimatschin the Chinese fron¬ tier town. All the so-called Russian rhu¬ barb is brought to Kiachta by Bucharian merchants, who have entered into a con¬ tract to supply the government with that drug in exchange for furs. It is there examined with much care in the presence of the Bucharians, by the apothecary stationed at Kiachta for the purpose. The worm-eaten pieces are rejected, the others bored to ascertain their soundness, and all the damaged or decayed parts are cut away. In accordance with the terms of the contract, the pieces which do not pass examination are burned; the remainder is then transmitted to Petersburgh, and from thence to us. It is imported in boxes or cases, covered with a pitched cloth, on the outside of which is a hide. The size of the pieces are various ; but in commerce the small pieces are preferred, and they are, there¬ fore, picked out and sold as radix rhei turcici electa , — the larger pieces and the dust being employed for powdering. Their shapes are various, being angular, rounded, irregular, & c. The external appearance of many of the pieces seems to show that the cortical portion of the root had been shaved off longitudinally by succes¬ sive strokes of a knife : hence the angular appearance of the external surface. Holes are observed in many of the pieces : some of them extend completely, others only partially through. Those which extend only to the centre of the pieces have been evidently made for the purpose of examin¬ ing the condition of the interior of the rhubarb. Externally the pieces are covered with a bright yellow coloured powder, usually said to be produced by the mutual friction of the pieces in the chests during their passage to this country, though many druggists believe it is derived from the process of rmncing (that is, shaking in a bag with powdered rhubarb), before its exportation. The odour is strong and peculiar, but somewhat aromatic : it is considered by druggists to be so delicate that in all wholesale houses a pair of gloves is kept in the Russian rhubarb drawer, with w7hich only are the assistants permitted to handle the pieces. When chewred it feels gritty under the teeth, from the presence of numerous crystals of oxa¬ late of lime; it communicates a bright yellow colour to the saliva, and has a bitter, slightly astringent taste. Beneath the dust with which the pieces are covered, the surface has a reddish w'hite tint, owing to the intermixture of white and red parts. The yellowish white parts have the form of lines or veins, which, by their union with each other, assume a reticular form. Irregularly scattered over the surface we observe small star-like spots and depressions, of a darker colour. The transverse fracture is un¬ even, and presents numerous brownish red or dark carmine coloured undulating- veins. The longitudinal fracture is still more uneven, and shows the longitudinal direction of the veins, which are often in¬ terrupted with white. The surface ob¬ tained by cutting is more or less yellow, and often exposes the veins, disposed in groups. By boiling very thin slices of the root in water, and then submitting them to the microscope, we observe cellular tissue, an¬ nular ducts, and numerous clumps of crys¬ tals of oxalate of lime(fig. 150). Turpin con- Eig. 150. — Crystals oj Oxalate of Lime in Russian Rhubai b. sidered the presence of these crystals suf¬ ficient to distinguish Russian and Chinese rhubarb from that grown in Europe; but in some specimens of English rhubarb I have met with these crystals in as great abundance as in foreign rhubarb. Accord¬ ing to Raspail, these crystals exist in the interstices of the elongated cellular tissue. The powder of Russian rhubarb is of a bright yellow colour, with a reddish tint; but as met with in the shops, it is almost invariably mixed with the powder of English rhubarb. 604 MR. PEREIRA ON MATERIA MEDIO A AND THERAPEUTICS. According to Hornemann, Russian rhu¬ barb is composed of — Rhabarbarin of Pfaff . 16 042 Yellow colouring matter of Henry . 9 ’583 Bitter astringent extract • • • • 14-687 Oxydized tannin . 1-458 Mucilage • ••«; . 10-000 Matter extracted from the fibre by potash ley* . 28 333 Oxalic acid contained in the potash ley . 1 -042 Insoluble residue . * * 14-583 Loss in drying the root • • • • 3 333 Loss in the analysis . 0-939 100-000 70 grains of the insoluble residue ob¬ tained from 1 ounce of Russian rhu¬ barb, gave 33 grains of ashes, composed of a trace of potash, 1 grain carbon, 2 grains silicic acid, 1 grain carbonate of magnesia, 1 grain alumina with a trace of oxide of iron, and 28 grains of carbonate of lime. White or Imperial rhubarb, — When Pallas was at Kiachta, the Buchanarian mer¬ chant who supplied the crown with rhu¬ barb brought some pieces of -white rhu¬ barb, which had a sweet taste, and was equal in its effects to the best sorts. It is said to be the produce of Rheum Leucorhizon of Pallas (the R. nanum of Sievers). A good account of it, with coloured figuress will be found in the “ Pharmaceulische Waarenkunde ” of Goebel and Kunze. Some of the specimens of Russian rhubarb brought to this country have a much whiter appearance than is usually ob¬ served. 2. China or East Indian rhubarb.- — The rhubarb known in commerce by the name of East Indian, or Chinese, is brought to this country either directly from Canton, or indirectly by Singapore, and other parts of the East Indies. It is imported in chests of thin wood, lined with lead. The pieces are frequently cylindrical or round¬ ish, but sometimes flattened; in trade they are distinguished as rounds and flats. They appear to have undergone a different pro¬ cess of preparation to that of Russian rhu¬ barb. Thus the cortical portion of the root seems rather to have been scraped than sliced off1, and hence the surface is not so angular ; and on the worst pieces we observe the remains of the greenish- brown or blackish cortex. Among drug¬ gists this kind of rhubarb is frequently termed half-trimmed, or untrimmed rhubarb. The pieces are generally perforated with holes, in many of which we find portions of the cords by which the pieces were sus¬ pended. These holes are smaller than those observed in Russian rhubarb, and that portion of the root forming their sides is usually dark- coloured, decayed, and of inferior quality. The best pieces of this sort of rhubarb are heavier and more compact than than those of the Rus¬ sian kind; they are covered with an easily separable yellow dust. When this is re¬ moved we observe that the surface is not so regularly reticulated, is more of a yel¬ lowish-brown than reddish- white colour, and has coarser fibres than Russian rhu¬ barb. On the finer pieces w7e notice nu¬ merous star-like spots or depressions. The fracture is uneven ; the veins, especially towards the middle, have a less deter¬ minate direction, and are of a duller or reddish-brown, and, in very bad pieces, of an umber-brown colour, with a grey substance between the veins. The odour of this species is much less powerful than that of Russian rhubarb, and is somewhat less aromatic. The taste, grittiness when chewed, and micro¬ scopic appearances, are similar to those of Russian rhubarb. The colour of the powder is of a more dull yellow or brown¬ ish cast. Hornemann analysed this species of rhubarb under the name of English rhu¬ barb. Its constituents were as follows : — • Rhabarbarin of Pfaff . 14-375 Yellow colouring matter of Henry . * • . . 9*166 Bitter astringent extract • • * * 16 458 Oxydized tannin . 1-249 Mucilage . 8-333 Matter extracted from the fibre by potash ley . 304 16 Oxalic acid contained in the potash ley . . 0 833 Insoluble residue . 15-416 Loss in drying the root . 3-125 Loss in the analysis . 0‘629 100-000 Seventy-four grains of the insoluble re¬ siduum obtained from one ounce of Chi¬ nese rhubarb gave 39 grains of ashes, com¬ posed of a trace of potash, 1 grain carbon, 2 grains silicic acid, l grain carbonate magnesia, 1 grain alumina with a trace of iron, 34 grains carbonate lime. 3. Dutch-trimmed rhubarb. — In English commerce there is met with a kind of rhubarb known by the name of Dutch- trimmed or Batavian, and which is brought from Canton and Singapore. It is well known to druggists, and is always quoted in price-currents as a distinct kind. It is not improbable that it is the kind de¬ scribed by Guibourt and others under the name of Persian rhubarb. It is imported in chests, each containing from 130 to 140 pounds. In shape, size, and general appear- RHEUM. 605 ance, it resembles the Russian kind ; for the cortical portion of the root seems to have been separated by slicing, and hence the pieces have the same angular appear¬ ance on the surface that the Russian rhu¬ barb has. The pieces are frequently per¬ forated, and in the holes are found the remains of the cord by which the root has been suspended. In the drug trade this kind of rhubarb is said to be trimmed, and according to the shape of the pieces they are called fiats or rounds. The colour and weight of the pieces are variable. 4. Himalayan rhubarb. — As already men¬ tioned, it is probably the produce of R. Emodi and Webbianum. It has very little resemblance to the rhubarb of the shops. The pieces which I have, were procured by Dr. Wallich from the natives, who had strung them around the necks of their mules. The pieces are cylindrical, and are cut obliquely at the extremities; the cortex of the root is not removed ; the colour is dark brown, with a slight tint of yellow' ; they are without odour, and have a course fibrous texture. Mr. Royle says that the Himalayan rhubarb makes its way into the plains of India through Kalsre, Almora, and Butan : it has, he says, a spongy texture, and sells for only one-tenth of the price of the best rhubarb, resembling in quality the Russian, and which is found in India. 5. English rhubarb. — Two kinds of rhu¬ barb are met with in the shops under the name of English rhubarb: one is dressed, or trimmed, so as to resemble the Russian kind, and is, I believe, the produce of Rheum palmatum; the other is sometimes called stick rhubarb, and is said by Ste¬ phenson and Churchill to be obtained from Rheum undulatum, though, in the drug trade it is believed to be procured from the young roots of the same species as that yielding the dressed rhubarb. The dressed English rhubarb is the produce of Banbury in Oxfordshire. It is the kind frequently observed in the show bot¬ tles of druggists’ windows, and is sold in some of the streets of London (particularly Cheapside and the Poultry) for “ Turkey rhubarb,” by persons dressed up as Turks. It occurs in various sized and shaped pieces, which are trimmed and frequently perforated, so as to represent Russian rhu¬ barb; some of the pieces are cylindrical in their form, and are evidently segments of cylinders ; others are fiat. This kind of rhubarb is very light, spongy (espe¬ cially in the middle of the pieces), attractive of moisture, pasty under the pestle, and has a reddish or pinkish hue not observed in the Asiatic kinds. Internally it has usually a marbled ap¬ pearance: the streaks are pinkish, pa¬ rallel, and have a radiated disposition ; and in the centre of some of the larger pieces the texture is soft and woolly, and may be easily indented by the nail. Its taste is astringent and very mucilaginous; it is not at all, or only very slightly, gritty under the teeth ; its odour is feeble, and more unpleasant than either the Russian or East Indian kinds. The microscope discovers in it, for the most part, very few crystals of oxalate of lime. The common stick English rhubarb occurs in angular or roundish pieces, of about five or six inches long, and an inch thick. When fractured it presents the radiated appearance, and the red-coloured streaks, of the kind last mentioned. Its taste is astringent, but very mucilaginous; it is not gritty under the teeth; it breaks very short. English rhubarb is extensively em¬ ployed by druggists to adulterate the powder of Asiatic rhubarb. 6. French rhubarb. — Rhubarb is procured in France from three species of Rheum, namely, Rhaponticum, undulatum, and especially com pactum. These plants are cultivated in an establishment, at a place called (in consequence) Eheumyole, at a little distance from Loriant, in the depart¬ ment of Morbihan. The cultivation of R. palmatum has been abandoned. I am indebted to Professor Guibourt for twro varieties of French rhubarb, the one which he terms fiat, the other round : the first is probably the produce of R. Rha¬ ponticum, the second of R. compactum. Hornemann has analysed a rhubarb which he terms R. Rhaponticum. It wras either French or English rhubarb (Geiger says the latter.) The constituents he found wrere : — Rhabarbarin (of Pfafif) •••• 10T56 Yellow' colouring matter (of Henry) . * . 2487 Bitter astringent extract • • • • 10 416 Oxydized tannin • • . . 0-833 Mucilage . 3-542 Matter extracted from the fibre by potash ley . . 40 208 Insoluble residuum . 8 542 Lost in the drying of the root 6 043 Loss in the analysis . P447 Rhaponticin . P043 Starch . 14583 100000 The insoluble residue yielded only one- tenth of its weight of ashes, composed of potash, lime, magnesia, and alumina. The difference betwreen this and the preceding analyses consists in the presence of rhaponticin and starch, in the absence of oxalic acid, and in the small quantity of ashes yielded by the insoluble resi¬ duum. 606 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS Chemistry of rhubarb. — Notwithstanding the numerous experiments to which rhu¬ barb has been subjected by some very eminent chemists, our knowledge of its constituents is still exceedingly imperfect. The most important analyses of it which have been made are those of Schrader, Henry, Brande, Hornemann, and Peretti, while some valuable information has been obtained from the researches of Pfaff, Trommsdorf, Henderson, Vaudin, Meissner, Runge, Nani, Caventou, Carpenter, and others. Some of these chemists have employed the term rhabarbarin to indicate a sup¬ posed peculiar principle in rhubarb; but unfortunately this term has been applied by different experimenters to different sub¬ stances, so that great confusion has been thereby produced. Thus the rhabarbarin of Pfaff is the alcoholic extract of rhubarb, prepared by digesting the watery extract of rhubarb in rectified spirit of wine. As might be expected from its mode of pre¬ paration, it is a mixture of various proxi¬ mate principles; according to Horne¬ mann, of incrystallizable sugar mixed with a calcareous salt, extractive, resin, semi-resin, and gallic acid. The same authority also tells us that the rhabarbarin of Htnry (called by some caphopicriie ) con¬ sists of a peculiar substance, similar to fat, or oil, ( rheumin ) infusible in boiling wa¬ ter, and which is reddened by an alkali ; of resin, and tannin. The rhabarbarin of Caventou is a crystallizable yellow colour¬ ing matter. These examples (which might be multiplied) are sufficient to show the confusion existing among authors, in the use of this term. In speaking of the varieties of rhubarb, I have quoted three analyses made by Hornemann. It may not be amiss to sub¬ join Henry’s analysis of China rhubarb. Peculiar yellow colouring matter (rhu- barbarin). Fixed oil. Supermalate lime. Gum (small quantity). Amylaceous matter. Oxalate of lime (one-third of the weight of the root). Potash salt (a small quantity). Sulphate lime (a small quantity). Oxide of iron. Lignin. 1. Odorous matter of rhubarb. — On what principle does the odour of rhubarb de¬ pend ? Guibourt says that the taste, co¬ lour, and odour, depend on one principle, — namely, the rhabarbarin of Henry ; which statement, however, is not very probable, since the colour and odour of this root bear no proportion to each other in the different varieties. By many, the presence of a volatile oil has been suspected. In¬ deed Bressy, a physician at Arpajon, an¬ nounced to the Acad^mie de Mode cine, that he had obtained it, but the commissaries appointed to repeat his experiments were unable to verify his statements. 2. Colouring matter of rhubarb. — The co¬ louring matter of rhubarb is extracted both by water and alcohol. Its tint is not precisely the same in all the varieties of rhubarb, being pinker in some than in others. Alkalies (potash, soda, and ammo¬ nia) give it a red colour; and on the addi¬ tion of an acid the original tint is restored, and a precipitate produced. Lime-water reddens and precipitates it. The acids (acetic excepted) precipitate it from its so¬ lutions. Various metallic solutions (as the acetate of lead, protochloride of tin, protonitrate of mercury, and the nitrate of silver), also precipitate it. It is partially volatilized by heat : thus, if powdered rhubarb be heated in a capsule over a spirit-lamp, an odorous yellow vapour is obtained, which communicates a red colour to a solution of caustic potash. Mr. Fa¬ raday has observed that solutions of boracic acid, and also of the borates made pur¬ posely acid, redden turmeric; but do not affect paper stained with rhubarb. Geiger has proposed this as a means of distin¬ guishing rhubarb which had been dyed by means of turmeric ; a fraud, I believe, not practised in this country. 3. Astringent matter of rhubarb. — In seve¬ ral analyses of rhubarb, tannin (tannic acid) is mentioned as one of the constituents. The chemical evidence of its presence is the action of the ferruginous salts and of gelatine on the infusion of rhubarb. Thus the perchloride and persulphate of iron strike a green colour with the infusion of this root; while a solution of gelatine occasions a copious yellowish precipi¬ tate, which is dissolved on the appli¬ cation of heat, or by the addition of an excess of gelatine. These effects, how¬ ever, have been said to depend on the ac¬ tion of the tests just mentioned, on the rhabarbarin of Henry ; but that tannic acid is really present seems to be highly proba¬ ble from the astringent taste of the root, and from the large quantity of this acid found in other plants of this fa¬ mily, as in Coccoloba uvifera, and Poly¬ gonum Bistorta. Moreover, the vegetable alkaline salts (as sulphate of quinia) produce a precipitate with the infu¬ sion of rhubarb, an effect which they also produce with solutions of tannic acid. If, indeed, rhubarb do not contain this acid, wre have yet to learn the real characteris¬ tics of tannin. The red veins are the seat of this presumed acid, as is shewn by brushing the cut surface of a piece of rhubarb with a wreak solution of iron : the change of colour occurs at these parts only. RHEUM. 607 4. Purgative principle of rhubarb. — The purgative property of rhubarb has been successively ascribed to extractive, to resin, to the colouring matter, and to a peculiar vegetable alkali. Further evidence, how¬ ever, is required before we can admit any one of these statements. The phenomena of the action of iodine on an infusion of rhubarb, presently to be mentioned, are certainly in favour of the presence of a basic principle. Whatever may be its precise chemical nature, it seems, as met with in rhubarb, to be soluble in water, alcohol, and mther, since all these liquids acquire purgative properties by digestion with this root. 5. Fired oil. — A bland fixed oil, in very small quantity, is said to exist in rhubarb. It becomes rancid by heat, and is soluble in both alcohol and aether. 6. Gum — Starch — Sugar. — Gum, starch, and, according to Meissner, sugar, exist in rhubarb. If a solution of iodine, or of ioduretted iodide of potassium, be added to a decoction of Russian, East In¬ dian, or Dutch-trimmed rhubarb, a green¬ ish-blue colour is immediately produced. After a little time this colour disappears, the original tint of the decoction return¬ ing; and no free iodine can be detected by the addition of starch. Hence it would appear that the iodine must enter into some new combination with a basic sub¬ stance, forming probably an iodide, and perhaps also an iodate. This is appa¬ rently proved by the fact, that the addi¬ tion of nitric acid restores the greenish- blue tinge of the solution. If a solution of iodine be added to an infusion of English rhubarb, an intense blue iodide of starch is formed, which does not totally disappear by standing; so that it would appear there is less of the basic substance in this variety than in the Rus- sian and Chinese kinds. Geiger says that the tincture of iodine produces, with the powder of Russian rhu¬ barb a dark green colour; with that of Chinese rhubarb a brown (not a dark green, except in a few instances) ; wdtli that of English rhubarb a dark-green, as in the Russian kind ; with that of French rhubarb a blue. I have several times repeated these experiments, but have never been able to obtain the above- mentioned distinction between the Rus¬ sian and Chinese kinds. 7. Oialate of lime. — The large quantity of oxalate of lime found in Asiatic rhubarb is a remarkable circumstance. It exists in the wThite veins of the root, and, as al¬ ready mentioned, according to Raspail, is formed in the interstices of the elongated cells. The crystals of this salt may be recognised by the grittiness of rhubarb when chewed, by a microscopic examina¬ tion of boiled films of the root, or by rub¬ bing these films between two plates of glass. By incinerating rhubarb root the oxalate is decomposed, and converted into carbonate of lime. Chinese is said to con¬ tain more of the oxalate than the East Indian rhubarb, though the quantity varies in different specimens of each kind. For the most part English rhubarb con¬ tains but little of this salt, though I have occasionally met with specimens pos¬ sessing it in abundance. In the labora¬ tory we are unable to produce this salt in a crystallized form ; in plants, however, it is very common in this state. Its crystallization is here probably pro¬ duced by the slowness with which its con¬ stituents are allowed to come together. I do not think it necessary to in¬ dividualize the other constituents of rhu¬ barb. Physiological effects : (a.) In small doses. — Taken in small doses, as from four to eight grains, rhubarb acts as an astringent tonic, its action as such being principally or wholly confined to the digestive organs : thus in debilitated conditions of these parts it promotes the appetite, assists the digestive process, and improves the condi¬ tion of the mucous secretions. ( b .) In larger doses, as from a scruple to a drachm, it operates as a purgative, slowly and mildly, though sometimes wfith a little griping. It never inflames the mucous membrane of the alimentary canal, as jalap, scammony, colocynth, and other drastic cathartics do. Constipation usu¬ ally follows its puugative effect, and which is referred to its astringent principle ; but the same effect is commonly observed after the employment of other purgatives. In febrile complaints and inflammatory dis¬ eases (as peripneumony), it is said to ac¬ celerate the pulse, and increase the heat of the body, and, therefore, in such cases, is considered objectionable. Modus operandi. — The colouring and pur¬ gative principles of rhubarb become ab¬ sorbed. Tiedemann and Gmelin found the colouring matter in the blood of the mesenteric, splenic, and portal veins of dogs, to whom this root had been admini¬ stered. In the urine the colouring mat¬ ter of rhubarb may frequently be detected by the high tint of this secretion, and by the red colour produced by the addition of potash, which wrould thereby distinguish the colouring matter of rhubarb from that of the bile. It does not appear, lnnvever, to affect the quantity of urine secreted. That the purgative principle of rhubarb is also absorbed, is shewn by the purgative quality of the milk of nurses to whom this root has been administered. Rhubarb has for a very long period been considered to possess a specific influence over the liver, to promote the secretion of bile, and to be useful in jaundice. Dr, 608 MR. PEREIRA ON MATERIA MEDIC A AND THERAPEUTICS. Cullen says, lie cannot find any foundation for this opinion either in theory or prac¬ tice. It seems to have arisen entirely from the absurd doctrine of signatures. Observation does not support the opi¬ nion at one time entertained, that rhubarb acted as a tonic to the system generally. Uses. — 1. As a purgative. As an ordinary purgative, rhubarb is considered objection¬ able, on account of the constipation which follows its purgative effect It is well adapt¬ ed, however, to those forms of diarrhoea in which some irritating matter is still con¬ tained in the bowels: it first evacuates this, and afterwards acts as an astrin¬ gent. Dr. Cullen has justly observed, that “ in many cases of diarrhoea no further evacuation than what is occasioned by the disease is necessary or proper, and, there¬ fore, the vulgar practice of employing rhubarb in every case of this disease, ap¬ pears to me to be very injudicious.” As an infant’s purgative, rhubarb is de¬ servedly celebrated. It is well adapted to a variety of complaints, but is especially serviceable in mesenteric affections, and in those cases accompanied by an enlarged belly. Sulphate of potash is a very useful adjunct to rhubarb in cases of diarrhoea in adults. For children, rhubarb is usually combined with magnesia or chalk; and when the object is to promote the secre¬ tions generally and produce an alterative effect, the hydrargyrum cum cretd is fre¬ quently conjoined. 2. As a stomachic and tonic. In those forms of dyspepsia depending on a debili¬ tated condition of the digestive organs, rhubarb in small doses is given with great benefit. 3. As a vermifuge. It has also been em¬ ployed against worms. 4. External use. Alibert has used rhu¬ barb by way of friction, with saliva or with lard, on the abdomen Home used it to stimulate indolent ulcers. Rumex Acetosa. As the leaves of Rumex Acetosa are officinal substances, we must not pass over this plant, though it is very rarely em¬ ployed in medicine. Common sorrel is a well-known indige¬ nous vegetable, belonging to class liexan- dria, order Trigynia of the Linnean ar¬ rangement. Its flowers are dioecious, and are composed of a six-parted calyx, the sepals being permanent and tuberculated; six stamina ; three reflexed styles, with three cut stigmas. The fruit is a nut, with three sharp angles : the embryo is on one side ; the radicle superior. The leaves are oblong and arrow-shaped. Sorrel leaves have an agreeable acid, slightly astringent taste, and contain the bin-oxalate of potash, tartaric acid, mu¬ cilage, and fecula : moreover, the green colour which the leaves produce with solu¬ tions of iron, shows the presence of tannic acid. In some countries sorrel is eaten as a salad. It acts as a refrigerant and diu¬ retic. A decoction of the leaves may be employed in the form of a whey, as a cool¬ ing and pleasant drink in febrile and in¬ flammatory diseases. Tangier has sug¬ gested that the use of aliments containing oxalic acid, as sorrel, may, under some circumstances, give rise to the production of calculi of oxalate of lime. Polygonum Bistorta. Bistort (Bistorta, — bis torta twice twisted or wreathed) is an indigenous plant, belonging to the class Oetandria , order Trigynia. Botany.-— It is about a foot and a half high. Its root is large, tortuous, and very astringent; its stem is simple, bear¬ ing one cluster ; the leaves are ovate, waved— the radicle ones tapering into a footstalk ; flowers arranged in spiked clusters, and composed of a monophyllous, divided petaloid stigma ; eight stamina, and three styles. The fruit is a triquetrous nut. Properties. — The root is twice bent on itself ; is rugous and brown exter¬ nally, reddish internally, almost inodo¬ rous, and of an austere and strongly astringent taste. It is very rich in tannic acid, as is shown by the blueish-black precipitate with the ferruginous salts, and the tannate of gelatine formed with a solution of isinglass. This root con¬ tains also a considerable quantity of starch, and, according to Seheele, oxalate of lime. Effects. — Its local action is that of a powerful astringent, depending on the tannic acid ; its remote action is that of a tonic. The quantity of starch it contains renders it nutritive; and in Siberia it is emploved as an aliment after having been roasted. A decoction of bistort may be employed as an injection in leucorrhoea and gleet ; as a gargle in spongy gums and relaxed sore throat ; and as a lotion to ulcers at¬ tended with excessive discharge. Internally it has been employed, com¬ bined with gentian, in intermittents. It may also be used in passive haemorrhages and diarrhoea. Ccccoloba uvifera. The sea- side grape is a middle-sized tree, growing in the West Indies, and belong¬ ing to the class Oetandria, order Monagynia in the Linnean arrangement. Its bark is of an astringent nature, and from it is said to be obtained an extract at one time introduced into medicine as Jamaica kino. DR. C. J. B. WILLIAMS ON PERCUSSION. 609 ON THE THEORY AND PRACTICE OF PERCUSSION AS A MODE OF DIAGNOSIS. 'To the Editor of the Medical Gazette. Sir, In the last number of your journal there is a communication from my friend Dr. Clend inning, describing* the results of certain experiments on percussion which he consideis to be opposed to my views on that subject, as they are reported in the Lancet, from a communication I made some time since to the West¬ minster Medical Society. 1 have rea¬ son to believe that my ingenious friend wiil cease to differ with me when my views are placed before him in a clearer manner than that of the report in ques- tion ; and as I venture to suppose that they may not be unacceptable to some of your readers, I solicit a few of your pages as the medium of communication. The text contains the substance of the observations which I made to the West¬ minster Medical Society, and in a note or two I will advert to the objections of Dr. Clendinning. — I am, sir, Your obedient servant, Chas. J. B. Williams. Halfmoon-Street, Jan. 9, 1837. That class of physical signs which may be obtained by attending to the cha¬ racter of the sound which different parts or organs yield on being struck, might appear, at first consideration, so simple in then nature, and so obvious in their mode of production, as to need very little attention to enable us to under¬ stand them, and but slight experience to qualify us to practise them. But when the student first applies this knowledo-e to practice,— when lie-tries to elicit from the chest and abdomen the respective sounds that are described to characterize the different regions,— he is generally disappointed with the obscurity of the results. He sees the experienced aus- cultator exhibit striking contrasts of sound as illustrations of the phenomena, and he expects in his own attempts to* obtain results as obvious and unequivo- 477.— xix. cal. But he soon finds that there is much more in the manner of using per¬ cussion than he has been led to expect. It is a long lesson of experience, and there are very few who have patience and perseverance to learn it. The ma¬ jority of those who do attempt it are content to go only so far as the results seem obvious and easily obtained, and leave a great number of cases but little elucidated by this method of diagnosis. But the difficulties of percussion, and the anomalies of its results, do not occur only to students in the practice. Puzzling and deceptive cases sometimes present themselves to the most expe¬ rienced ; and Laennec himself was con¬ strained to confess that he sometimes met with chests which sounded badly, although the parietes were thin, the re¬ spiration perfect, — and he could not assign a cause for the defective sound. The deficient resonance of the chest in certain cases of spasmodic asthma, was also to him a matter of obscurity. The great aid which M. Piorry brought to the practice of percussion, in employing a p/eximeter or percussion- plate, diminishes greatly the difficulties of percussion, by affording a uniformity and firmness of surface, which the natu¬ ral parietes of the chest do not present; and this mediate percussion with a pleximeter, or what generally answers as well, with one or more fingers of the left hand, is the method now usually adopted. But even this improved me¬ thod is not without its difficulties ; and I continually find not only students, but practitioners experienced in the art, ob¬ tain different results on percussing the same subjects ; nay, I have seen a very shrewd auscultator perplexed at finding the same spot of the chest at one moment give a dull sound, and at the next a pretty clear one, notwithstanding the usual precautions were taken to ob- tain a uniformity of result. The same difficulties having frequently occurred to myself, I was some time ago led to study the acoustic principle of percus¬ sion more fully than had hitherto been done ; and I now proceed to state some of the views and practical conclusions to which this study has led me. The deep or hollow sound which the surface of a healthy chest yields on be¬ ing struck, lias been in a general way vaguely referred to the air contained in the lungs within it. Laennec con- 2 R 610 DR. C. J. B. WILLIAMS ON PERCUSSION tented himself with this view, without tracing' *more accurately the nature of the process. Piorry and Forbes, who have written since more fully on the subject of percussion, give rather the parallel phenomena of inanimate ob¬ jects, than any exact analysis of the sounds in question. The latter writer, where he is more precise, seems to im¬ ply that the vibrations of the air diffused through the lung produce the sound so remarkable for its hollowness, and that liquid or solid effusions prevent this air from receiving these vibrations. We must complete the elements of this view before we can test its accordance with the phenomena observed. It is w ell known that different bodies yield different sounds when struck ; and it is supposed that as hollow bodies yield the loudest sound, this must pro¬ ceed from the vibrations of the air with¬ in them. Solid bodies, and those con¬ taining liquids, on the other hand, give dull sounds, from being destitute of air. So, it is supposed, the chest will yield a sound loud in proportion to the quantity of air contained within it, this air being the most sonorous body. Now this view', which, as far as vague expressions can be interpreted, is the one generally received, I conceive to be opposed by the following considerations. 1. If the sound obtained on striking the chest depended on the vibrations of the air within, it should be deepened in tone by increasing- the volume of that air, and raised by diminishing it; just as the note given by any hollow vessel when struck will be deep in proportion to the size of its interior*. Nowr chang¬ ing the quantity of air in the chest by acts of respiration does not in this man¬ ner alter the sound of percussion : slig ht chang-es produce no difference ; and a very full inspiration, instead of deepen¬ ing the sound, actually raises its tone in a very perceptible degree. 2. If the sound of striking* the chest originated in the air within it, it should be g'reatly changed by closing the glot¬ tis ; for the sound given by a hollow vessel, or India rubber bottle with its mouth closed, is totally different from that which it yields with its mouth open. Now, provided no respiratory * A convenient object for illustrating this is an India rubber bottle : when its cavity is dimi¬ nished by compressing its sides, the note which it yields will be raised in proportion. effort be at the same time made, striking the chest gives the same sound whether the glottis be shut or open. 3. The sonorous vibrations of air con¬ tained in cavities may be of two kinds. One depends on any impulse communi¬ cated to the mouth of the cavity, and resisted by the body of air within, act¬ ing in the maimer of a bottle, or of a tube closed at one end. This requires that the cavity should communicate with the external air, which we have seen is not necessary to the pectoral sound. The second kind of sound pro¬ duced in air-filled cavities, is that re¬ sulting* from the successive reflections of any sonorous impulse from side to side of the cavity; which reflections becom¬ ing regular vibrations, constitute a sound of a determftiate character. This con¬ stitutes the prolonged reverberations heard in empty casks, the tinkling* echo of the interior of bottles, cups, &c., the phenomena of metallic tinkling and amphoric resonance heard in various smooth air-filled cavities of the animal body*. But this cannot constitute the sound of pectoral percussion ; for in a cavity of the size of the chest, instead of being drum-like, it would be tinkling, as it actually is in pneumo-thorax. Further, the pulmonary tissue, as it pre¬ vents the transmission of the voice from the bronchi to the surface, except at points where these are quite superficial, so much more completely will it prevent the transmission and reflection of sono¬ rous vibrations to-and-fro, across the whole interior of the chest. The last argument will be, to those w ho are really familiar with the laws of acoustics, quite conclusive against the notion that the air in the chest is the seat of the sound elicited by percussion. There is, in truth, no air-filled cavity, but a heterogeneous sponge, eminently calculated to arrest the vibrations of air, and which does more or less completely intercept those of the voice from being transmitted to the parietes of the chest. To consider the air in the lungs to be the seat of sound of percussion of the chest, is about as reasonable as to suppose that * This tinkling resonance is interesting, as it gives rise to several instructive phenomena of auscultation. It may be illustrated by holding the mouth of an India rubber bottle to the ear, and striking the side of the bottle : each stroke is attended, or rather followed, by a metallic clink. — See Pathology and Diagnosis of Diseases of the Chest, 3d edit. p. 115. AS A MODE OF DIAGNOSIS. 611 a flute or a pan-pipe would yield its tones when filled with wool. It being thus proved that the air in the lungs is not the seat of the sound elicited on striking the chest, we are driven to the supposition that the solids are the essential seat of the vibrations, and that they derive the character of their vibrations from their own degree of tension, and from the nature of the re¬ sistance offered to them by the adjoin- ing, and . especially the subjacent, parts. This is the view which r have for some years adopted, and the follow¬ ing remarks will, 1 trust, illustrate its correspondence with the phenomena, and show how it will materially aid us in the practice of percussion. I he bony frame of the thorax, bound together by elastic cartilages and liga¬ ments, its interstices filled up by the intercostal muscles, and its whole in¬ terior lined tensely by the costal pleura, constitutes an elastic box or drum, any part of which may be readily thrown into sonorous vibrations by an impulse applied to its surface. There are, however, superimposed on this frame-work, at certain parts, various muscles, the scapula1 and the mammary glands ; and the integuments, with their fatty and cellular tissues, cover the whole exterior. The effect of these is to deaden in various degrees the sound produced on percussion ; and they do this both by intercepting and deaden¬ ing the stroke, and also by their loose mass muffling’ the vibrations. It is by bringing these soft inequalities into a firm equally tense surface, on which' percussion can be effectually practised, that M. Piorry’s pleximetcr proves chiefly useful ; and by means of it, or of the fingers of the left hand applied for the same end, any part of the walls of the chest may be brought to such a degree of tension, as when struck to vibrate according to the nature of the substance which lies beneath it. If, for example, that substance is the air-filled tissue of the lung, it offers such a yielding but elastic resistance as' gives the part struck a freedom and length of vibration ; the sound elicited is therefore clear and deep- toned. J f the substance under the point struck is solid and contains no air, as the liver, the vibrations being abruptly resisted, the sound has no depth or continuance, but is dull or mat. If a body of liquid be underneath, this will also check the vibrations, so that fhe sound yielded will be merely a short dead tap *. In pneumo-thorax, where the chest contains air instead of lung, the parietes approach more nearly to the condition of the parchment of a drum, and give, when struck, a sound unusually clear. In this sound we may often perceive a hollow or metallic charac¬ ter (u stomacal” of Piorry), which is not present in the pulmonary sound. This character truly docs depend on the vibrations of the air contained in the cavity, which here presents a con¬ dition that we have proved to be want¬ ing in the pulmonary tissue. The same character will be found in the sound obtained on percussion of the region of the stomach, coecum, and other parts of the intestines, which also present the condition of a cavity in which air vibrates, and adds its note to that of the walls percussed. * Dr* Clendinning will perceive that this view is in perfect accordance with the results of his experiments. The sound obtained on directly striking a piece of lung or of liver, must partake of that character which that piece of lung or liver communicates to the vibrations of the thoracic wails : the lung will yield a sound by ihe vibra¬ tion of its membranes distended with air; but as the distension is imperfect unless some pressure be used, the sound will be weak and short in comparison with that yielded by the walls of the chest exactly opposed to the entire air-filled lung. So likewise the liver, as it renders short and abrupt the vibrations of the walls of the chest in contact with it, will, when directly struck, yield its own dead sound, consisting of the same unrepenting vibrations. My wrorthy friend seems to imply that, according to my view, no particu¬ lar sound should be yielded by the naked lung or liver; but if this were a deduction from it, how can I suppose these organs to change the vibra¬ tions of the walls of the chest? It is by their elasticity that bodies vibrate; and this motion, if sufficiently rapid, is propagated to our ears as sound. It is this same quality of elasticity, which, in different bodies placed in contact, mo¬ difies the motions, and consequently the sounds, of any one of these bodies. Sound is resisted motion, and the nature of the sound will depend on the resistance given to the motion. The same property which modifies sound of adjoining bodies, if it be capable of producing any sound, will produce sound of the quality which it eom- mnnicates to the sound of the adjoining bodies. The naked lungs, therefore, and the liver, if they' are capable of giving any sound at all, must give that character of sound which they communicate to the stroke on the walls of the chest. Thisexpla- nation may seem unnecessarilyminute; and it may suffice to most readers that I remind Dr. Clendin- ning that I do not deny to the solids the power to give sound on percussion, but I deny it to the air in the lungs, because I find that this air is in a condition in which it cannot, according to well- established laws, produce such a sound as that resulting from percussion on the chest. The air, by modifying the condition of the solids, alters their sounds, but by percussion gives no sound of its own. 612 DR. C. J. B. WILLIAMS ON PERCUSSION We now see that the air-filled struc¬ ture of the lung' is not the only condi¬ tion requisite to render the pectoral re¬ sonance deep and clear ; a certain elastic tension of the walls of the chest, at the point struck, is also indispensa¬ ble, inasmuch as these walls are the essential seat of the sound. The ano¬ malous cases, adverted to by Laennec, of badly-sounding’ chests, where the lung’s are healthy, are referable to a de¬ fect of this latter condition — elasticity of the walls. In a few cases a peculiar laxity of these walls causes the defect of resonance; but the commoner cause is a drawing’ in of these w'alls from cer¬ tain conditions of the interior. Con¬ tractile pleurisies, by leaving- adhesions, the constant tendency of which is to shorten, draw in the parietes of the chest, so as to destroy that equality of tension which fits them for vibration ; and consequently chests thus affected rarely recover their original resonance. Another cause, which is rarer, and may be only temporary, is spasmodic asthma. In this affection the bronchial muscles are permanently contracted, so as to di¬ minish the size of the whole lung, and the walls of the chest are kept under the constant influence of unequal atmo¬ spheric pressure, either from without or from within, which much impairs the freedom of their vibrations. In all these eases mediate percussion on a plexime- ter, or on the fingers pressed firmly to the chest, will often obtain a pretty clear sound ; and this it obviously ef¬ fects by the pressure exceeding’ the force drawing from within, and by thus restoring in a measure the balance of tension. There is another cause of defective resonance that well illustrates the sub¬ ject before us. In advanced stages of phthisis, where a larg’e portion of a lung- is excavated, and a thin layer of pulmonary tissue on the pleura only se¬ parates the cavity from the parietes, this portion o! the chest will sound dull, although there is actually more air in it than exists in the healthy state. The thin layer of pulmonary tissue falling loose and flaccid on the parietes, acts as a damper upon them, checking and muffling’ their vibrations, just as a hand¬ kerchief on a violin string w ill stifle its notes. We can now understand why, on a full inspiration, the sound on percussion is higher in tone than usual : the ex¬ panded parietes are then brought to a greater degree of tension, vibrate more quickly, and therefore yield a higher note. A forcible expiration has a simi¬ lar effect, with this addition, that there is a diminution of that elastic material within, which resists like a spring the stroke of percussion on the exterior. Emphysema of the lung, when it is sufficient to give to parts of the chest that rounded convex form which is so remarkable in the extensive degrees of this affection, has an effect on the per¬ cussionary resonance similar to that of a full inspiration ; it renders the sound louder, but higher in key, the distended lung resisting with a stronger spring than usual the impulse of the parietes. But the most important application of this view is to guide us in regard to the mode in which percussion is to be per¬ formed, in order to make its results be¬ speak the condition of the internal parts. The first precaution to be ob¬ served is, that the spot percussed shall be in such a state of tension that it may vibrate; and if this be not the natural condition of the part, a degree of pres¬ sure, with the finger or pleximeter, w ill give this condition to it. With regard to the stroke of percussion, I need not repeat the usual rules, that it should be made perpendicularly to the surface, and on corresponding points on com¬ paring the two sides, &c. ; but there is one particular in the practice of percus¬ sion that deserves more notice than it has received ; I mean the force of the stroke. According as the chest is struck gently or forcibly, so will the impulse be confined to the superficial parts, or it will reach those that are more deeply seated ; and as the vibrations will he determined by the nature of the resist¬ ance which the impulse meets as far as it reaches, so will the character of the sound vary with the force of the stroke, if the superficial and the deep-seated parts differ in their densities. A w?ant of the knowledge of this fact has been a fertile source of practical error among* auscultators, especially the less expe¬ rienced ; and although, even when aware of it, we have still the difficulty of estimating accurately the degree of force used, and of judging between slight differences of sound, yet the fol¬ lowing observations will, I think, shew AS A MODE OF DIAGNOSIS. 61 ;$ that attention to this matter will often facilitate the employment of percussion, and increase the number of its useful results. In all the upper parts of the chest, the lungs in health occupy so great a depth, that the sound elicited by per¬ cussion will be of the character called pulmonary, whether the force of percus¬ sion be great or small. In the poste¬ rior regions, of course, strong mediate percussion will give the best sound, in¬ asmuch as it overcomes the deadening- effect of the thick layer of muscles in that region. But in the inferior parts, the heart and the abdominal viscera that rise in the middle of the chest, be¬ neath the vault of the diaphragm, re¬ duce the thickness of the pulmonary tissue in various degrees. On the right side of the chest strong percussion, car¬ ried from above downwards, generally detects a diminution of the sound below the fourth rib, which indicates the com¬ mon height of the arch of the diaphragm and liver in the central portions of the chest*. Below this the sound becomes more and more dull ; and in this gradual shading off of the sound, it is extremely difficult to define where the pulmonary sound ends, and the pure hepatic sound begins. Very gentle percussion will do this, and will distinctly elicit a pul¬ monary sound three or four ribs lower, down to the very thin margins of the lo wer lobesf. In the region of the heart, also, where the thin margins of the lung during full inspiration over¬ lap the organ, gentle percussion will generally indicate how far the thinnest portion of lung reaches, where stronger percussion announces the resistance of the deeper seated solid. It is not equally easy to define the limits of the lung, where it overlaps the stomach or colon; for although deeper seated, the tympa- * That the diaphragm rises thus high in the chest is a fact described indeed by anatomists, but little attended to by physicians. My atten¬ tion has been directed to this matter by my friend Dr. Edwin Harrison, who has taken great pains to investigate it. t The best mode of making this gentle percus¬ sion is by filliping on a finger of the left hand pretty firmly applied to the surface. The slight abrupt, impulse thus given does not reach the deeper seated parts, and yet gives a sound loud enough to be very characteristic of those which are more superficial. This mode is very useful in exploring the state of the abdomen. If it be done with care, the tenderest parts may be per¬ cussed in this way without giving any uneasi¬ ness. iiitic elasticity of these organs makes them susceptible of vibration from a very slight impulse. Still a very per¬ ceptible character of pulmonary sound may be elicited by gentle percussion on these regions, which differs from the simple tympanitic resonance of an air- filled sac. Such being the properties of the healthy chest as tested by these modi¬ fied degrees of percussion, wre may now see bow disease will change them. Slig’ht effusions, whether pleuritic or hydropic, occupying the lower parts of the chest, separate the lung from its close contact with the walls of the chest, without displacing it altogether. In tb ese cases the relations of the lower parts of the chest to percussion will be the reverse of what it is naturally : the stroke of gentle percussion will not pass through the thin layer of serum, and its sound will be therefore dull ; while stronger percussion will carry its im¬ pulse to the remaining pulmonary tis¬ sue, and its sound will therefore return a certain degree of pulmonary character. Even in extensive effusions into the pleura, a small portion of pulmonary tissue, into which the air can still enter, produces a perceptible difference in the sound elicited by strong percussion, al¬ though the impulse has to pass through some inches of liquid. In practising percussion on the mediastinal confines of a pleuritic effusion, the stroke should be gentle, and perpendicular to the sur¬ face ; for forcible percussion, especially if it be at all oblique, will often borrow an elastic resonance from the opposite side*. * I have been for some time acquainted with the fact, that the resonance of a portion of lung could be detected through a considerable stratum of liquid ; but the experiments of Dr. Clendin- ning and Dr. Edwin Harrison have proved this to take place to a greater extent than I was aware of. The explanation, however, is easy, in the view which I have advanced. The impulse is propagated without difficulty through a uniform mass of liquid, and if it reaches a portion of air- filled lung, whether that be on the same or on the opposite side of the pleura, that lung will affect the nature of the vibration which the impulse pro¬ duces, and the sound of the stroke on the surface will be more or less pulmonaryin character. Ob¬ serve, the sound on the surface partakes of the pulmonary character, although the lung is seve¬ ral inches distant : no sound is heard in the lung , but at a remote part of the parietes, where the stroke is applied. This is another fact illustrat¬ ing the position which I have advanced, that the sound which we hear on percussion of the chest is essentially in the parietes, although the cha¬ racter of that sound is communicated to these 614 MR. NOBLE ON THE SENSE OF TASTE. Pneumonia, or pulmonary apoplexy, situated in the margins of the lower lobes, will remove the distinction given in the natural state by degrees of force in percussion; and if the disease be, as it frequently is, circumscribed, that gra¬ dual shading off of the sound on strong percussion, which I have described as perceptible in the natural condition of these parts, will be absent. In these cases, therefore, gentle as well as strong percussion produces a dull sound; and by tracing the outlines of this dulness, we shall generally find its shape to differ from that resulting from a liquid effusion. Emphysema in the same situation will have a contrary effect, and will make it easier than usual to define by gentle percussion the limits of the lower lobes. If the emphysema be excessive, besides an unusual resonance, the sound will be higher in key than usual. In pneumo-thorax the shading off ceases, the sound having every where a tympanitic character ; and if, as is usu¬ ally the case, liquid effusion be also present, gentle percussion will shew with great precision the level of the liquid. In the early stages of phthisis, while the indurations are still of small extent, gentle mediate percussion will be the most likely means of detecting them. As tubercles most usually infest the summits of the lungs near the surface, and often produce pleuritic adhesions at those points, they will generally affect the sound of gentle percussion on the clavicles, or on the space below them ; whereas forcible strokes would over¬ come the resistance of these small super¬ ficial deposits, and give sounds not to be distinguished from those of the healthy chest. In this very obscure and difficult point of diagnosis another rule w ith regard 'to percussion deserves attention. Aggregated tubercles can be most easily detected by gentle percus¬ sion limited to the spot : miliary granu¬ lations scattered through the tissue are more likely to affect the vibrations, by parietes by the subjacent parts. When lung lies under them, the sound is what is called pulmo¬ nary ; when liver, it is dull ; hut when both liver and lung, the sound is not double, as it' proceed¬ ing from both as sources, but between both, as if consisting of vibrations which result front the elasticities of both simultaneously influencing the vibrations of the walls. So it is, also, when a jayer of liquid adds its effect. the combined resistance of many ; and the stroke should be therefore applied to a larger surface. Gentle percussion on a single finger, or a small pleximeter, will be the most likely to afford indica¬ tions of the presence of the former ; while scattered granulations may be better detected by mediate or immediate percussion by the fingers of the flat land applied over some inches of sur¬ face. In examining a doubtful case, both these methods must be used at dif¬ ferent periods of the respiratory move¬ ments; and I can state, from some ex¬ perience, that attention to these parti¬ culars will leave many fewer of the cases of incipient phthisis in that nega¬ tive uncertainty that has been the re¬ proach of even the present improved state of diagnosis. It is unnecessary to dwell on other applications of these principles, to indi¬ cate how percussion in its modifications may be rendered an easier and surer test of disease : as, for instance, flat percussion, in humid bronchitis, first stage of pneumonia, and oedema of the lungs, giving some mark of the extent of the effusion ; strong percussion giv¬ ing- an outline of an enlarged heart, or of any deep seated condensation ; gen¬ tle mediate percussion indicating with exactitude the state of the more super¬ ficial contents of the chest and abdomen ; and so forth. But having called atten¬ tion to the principle of percussion, and having, as I trust, made that principle intelligible in the more important of its applications, it remains for an accurate knowledge of pathology, and the oppor¬ tunities of a varied experience, to make it more useful than any further descrip¬ tion of mine could render it. ON THE SENSE OF TASTE. To the Editor of the Medical Gazette. Sir, I certainly had no intention to w ound the feelings of Dr. Alcock in my com¬ munication w hich appeared in the Ga¬ zette for December 17th, commenting upon the conclusions at which he had MR. NOBLE ON THE SENSE OF TASTE. 615 arrived relative to the nervous con¬ nexions of the sense of taste ; and 1 trust that much of the soreness of spirit which his reply to my remarks evinces, will be found to have originated mainly in the misapprehension of part of my meaning*, to which I may further allude in the sequel. Dr. Alcock ranges under three heads what he is pleased to call my imputa¬ tions against him. I will follow the example which he has set me, and dis¬ cuss the topics of difference between us under three distinct heads. If any ac¬ cusation of want of candour have been brought by me against Dr. Alcock, it rests upon these grounds — that he, in his paper, as published at length in the Dublin Journal, prefatory to any ac¬ count ol the experiments which he had performed, offers a variety of considera¬ tions, drawn from various sources, to show the independent character of the sense of taste, and yet omits a reference to cases demonstrating the fact. But further, it appears to me, and may ap¬ pear to others, that the first case pub¬ lished by me, in connexion with this subject, leads to inferences totally at variance with those of Dr. Alcock. In this way: the case of Mrs. Williams, to which 1 allude, furnishes an instance ol complete paralysis of the sentient portion of the fifth nerve on one side, and yet the patient tasted perfectly on the corresponding" half of the tongue. Dr. Alcock artificially induced paraly¬ sis ol the tongue in a dog, by division ol the lingual branch of the same nerve, and discovered that a very material diminution of the sense of taste was the consequence. Now I do not say that here are contradictory results, because the data are not precisely similar; but it does appear to me that the difficulty should have been fairly met by Dr. Alcock, inasmuch as he was evidently not unacquainted with my papers upon the subject. It is true, as stated by him, that whilst my own data were pathological, his were purely physiolo¬ gical ; but nevertheless, in deducing* a general inference, neither class of phe¬ nomena can be so insulated as to ex¬ clude all communication with the other, more especially when any discordance appears to exist between the two ; for in all such cases the appearance of dis¬ cordance must be made to vanish, or the conclusion is inevitable that error exists somewhere. On these grounds, then, do I regret that, in assuming to have determined the question relative to the nervous relations of the sense of taste, Dr. Alcock had not the candour to refer to what had been previously offered to the profession, in apparent opposi¬ tion, by myself. But, says Dr. Alcock, th e cases which I have published “ re¬ quire to be confirmed and put beyond doubt.” In regard to this, I have only to observe, that the experiments upon the first case have several times been repeated, with uniform results, — that, as stated by me in the Medical Gazette, the second case was furnished by Mr. Ker, before whom and Mr. Walker the particular examination was made, — and that I had the perfect concurrence of those gentlemen in the accuracy of the investigation and of the results. And in further confirmation, I may refer to the corroborative instance furnished by your correspondent, Mr. Bishop, and published in the Medical Gazette for February 6th, 1836, who, towards the conclusion of a paper written in opposi¬ tion to my own reasoniny on this sub¬ ject, most honourably and faithfully ob¬ serves — “ A case in illustration of this theory has been brought to my notice bv Mr. Roberts, in a w oman, aged about 45 years, who has nearly lust the common sensibility of the w hole right side of the lace, including the eye, nostril, and tongue, which latter part, however, re¬ tains a slight perception of touch, but the taste on that side is entirely abo¬ lished, so that neither vinegar, salt, nor ordinary aliments, produce the slightest impression, — a circumstance exactly agreeing with the experiments of Mr. Noble.” When Dr. Alcock states that “ every tyro in physiology knows that, accord¬ ing* to the popular opinion, taste is as distinct a sense as any other,” and that the doctrine, that taste is a special sen¬ sation, was received of physiologists before he was born, I am anxious that we should not misunderstand each other in the employment of terms. To avoid risk ol being myself misconceived, L will repeat that the object which I have always stated myself to have had in view in what I have written upon this subject, has been to determine that taste maintains as sp41ci.il and inde¬ pendent a character as the rest of the senses; and, accordingly, that, as in the case of sight, hearing, and smell, we must look for a special nervous. pro- GIG MR. NOBLE ON THE SENSE OF TASTE. vision. And the evidence which I have offered in support of this view is, in my own judgment, of the most satisfactory nature. Nor is mine a novel mode of deducing such an inference. The fact of feeling and voluntary motion not being impaired or annihilated simulta¬ neously, first led to the conclusion that there were distinct nerves for these functions. And so far back as the days of the celebrated Alexandrian School, founded by the Ptolemies, this was maintained on such grounds, and was even taught by Erasistratus. From pre¬ cisely similar data, from pathological facts, have 1 contended for distinctness of nerve coincidently with speciality of function in the case of taste and com¬ mon sensation. Will Dr. Alcock con¬ tend that this is a doctrine known to every tyro in physiology, or that it has descended to us from our ancestors? I think he will not. Will he, then, have the kindness to state, in terms equally definite and precise, what he means by a special sensation, and how he con¬ siders that taste is proved to be such by his own experiments. Dr. Alcock asks for my meaning when I state that it is a recognised principle in the physiology of the ner¬ vous system, “ that a simple and spe¬ cial function must have but one simple nerve for its manifestation.” In expla¬ nation, I shall be glad to adopt the “strict interpretation of the principle,” as furnished by himself — “that the manifestation of a simple and special function can have but one simple nerve.” But, he goes on to inquire, “ where among our senses do we find the con¬ firmation of this?” In reference to this matter, I join issue with Dr. Alcock upon a plain, undoubted, matter of fact; and, in opposition to him, contend that we have such confirmation in all the senses, — that the optic nerve is the sole and special medium of vision, — that the olfactory nerve is the special and exclusive medium of smell, — and the auditory nerve that of heal ing. Because I have appealed to the authority of Sir C. Bell, Dr. Alcock calls in the aid of Magendie. Now, in reference to the importance of this latter as an authority, I have to observe that Magendie, as an experimenter, must be universally al¬ lowed to rank as one of our “leading- authorities ;” but, as a propounder of principles, few, I am sure, will bow to his name. It will not surely be main¬ tained that the one talent necessarily implies the other, — that it is not one thing to hew and carve the stone, and another to arrange and raise with archi¬ tectural design. If any one should feel disposed to award to Magendie the peculiar genius of Bell, let him just refer to the section on this very subject, on the senses, in the work of the former physiologist, where, if I mistake not, be will find any thing rather than preci¬ sion of thought and consistency of state¬ ment. But Dr. Alcock appeals to direct facts in support of the consistency of his own inferences, and asserts that “ smell is not perfect without the fifth nerve.” That a material derangement of the function of the fifth nerve may, in many cases, sympathetically affect the function of the first, I feel no doubt; but that impressions of odour are com¬ municated to the brain by any other medium than the olfactory nerve, I en¬ tirely deny, and with that positiveness with which Dr. Alcock asserts the con¬ trary. Dr. Alcock next affirms that “ amaurosis is the consequence of an injury of the fifth nerve.” Is he seri¬ ous ? Why, examples are on record of even total destruction of the fifth nerve, without any such results ; and, not to pursue this matter with unnecessary prolixity, I will refer Dr. Alcock to one instance. In the Medical Gazette, for December 12, 1835, there is a paper by Air. Bishop, detailing the history of a case of facial paralysis, wherein a post-mortem examination was carefully made by him, in the presence of Dr. Roget and Air. Robert Wade; and in his account the following observations occur: — “In the case just related the wdiole of the fifth nerve w as completely destroyed, whilst both the eye and nos¬ tril of that side had lost their sense of touch, retaining the faculties of vision and smells This case during life had been seen by Dr. J. Johnson, Dr. Ro¬ get, Sir Benjamin Brodie, and Sir C. Bell. Dr. Alcock next observes that, in one of my own cases of facial para¬ lysis, the hearing was imperfect. Well, what of that ; — therein is coincidence, hut where is the consequence ? Ag-ain, Dr. Alcock asks how I reconcile with the “recognized principle” my own conclusion relative to the function of the chorda tympani, and other branches of Meckel’s ganglion, which he states to belong to the fifth. In answer to this, I can assure Dr. Alcock that I MR. MORGAN ON THE ACTION OF HYDRIODATE OF POTASS. G17 have drawn no conclusion at all upon the subject, and that far from disliking the term “ suggestion,” as he appears to think, it is what alone I can recognise as applying to myself. I have never done more than suggested a function for these nerves. But are they branches of the fifth, in the ordinary acceptation of the term? Certainly not, hut branches of the spheno-palatine ganglion ; com¬ municating with the fifth, it is true, but not being’ derived from it. As wrell may it be said that the solar plexus of nerves are branches of the par vagum. If I understand Dr. Alcock fl ight, he means to affirm, in confirmation of his own views, that although the glosso -pharyn¬ geal nerve is simple in its origin, its function must be compound, because of its distribution. This, I apprehend, is a mode of proof which few will deem admissible. When reference is made by Dr. Alcock to Magendie’s notions regarding the multifarious operations of the fifth nerve, he surely does not think that he thereby enhances the importance of this physiologist as a “ leading autho¬ rity” in the promulgation of “princi¬ ples.” With respect to the opinion of Dumeril and Serres on the nerve of smell in the dolphin, I refer Dr. Alcock to Bostock’s Physiology, where he will see good reason for believing that such is not only a mere opinion, but one rest¬ ing on very slight grounds. These, then, being the leading facts and cir¬ cumstances adduced by Dr. Alcock in support of his own physiological consis¬ tency, it is for your readers to decide how; far they tend to overthrow the doc¬ trine of Sir C. Bell and others — that a simple nerve performs only one function, and that a strictly special function re¬ quires a distinct nerve for its manifesta¬ tion. Dr. Alcock, lastly, complains that I have impeached his veracity, and am thereby equivocal and offensive. Surely such a complaint can only have had its origin in some strange misconception of my meaning. When I said that the accuracy of supposed facts must he established before a necessity arises for modifying the definition of principles, I was obviously alluding to what Dr. Alcock considered himself to have esta¬ blished as matter of fact, that “ taste had two media of perception.” I dis- i tinctly stated, that as I objected entirely to the mutilation of living animals as a i mode of “ determining the question,” I should not enter into any detailed exa¬ mination of the contents of the paper; how, then, should I be understood as questioning Dr. Alcock’s fidelity of narration ? I sincerely hope this expla¬ nation will allay the angry spirit he has evinced, and which, I would gladly hope, has only been roused by some such misapprehension. In conclusion, I can assure Dr. Al¬ cock that he is thoroughly mistaken if he considers that, in this matter, I have been influenced by merely personal considerations. I never charged him, he supposes, with want of candour as towards me ; but, considering that cer tain results, which he had obtained from what I believed to be an objection¬ able mode of investigation, were irre- concileable with those at which I had arrived by another mode, I expressed regret that Dr. Alcock had not had the candour to refer to them ; more especi¬ ally as he had drawn a similar inference to my own, from what I believed to be opposite data. It is impossible that I should have had any personal feeling’ on the puerile grounds Dr. Alcock seems to have imagined. On the contrary, had merely personal feeling influenced me, I must have felt gratified with the somewhat complimentary allusion made to myself in his original paper. But I trust that I am actuated by motives of a higher character than he appears to have supposed. I, too, like himself, am “ seeking after satisfactory knowledge,” and shall not be deterred from taking my own steps to obtain it, or from at¬ tempting’ the confutation of what I be¬ lieve to be erroneous notions, even at the risk of being misinterpreted, and exposing myself to the ireful declama¬ tion of Dr. Alcock.— I am, sir, Your obedient servant, Daniel Noble. Manchester, Jan. 14, 1837. ACTION OF THE HYDRIODATE OF POTASS, ACCORDING TO A NEW HYPOTHESIS. To the Editor of the Medical Gazette. Sir, As the purpose of your valuable journal is to afford a medium of instructive 618 MR. MORGAN ON THE ACTION OF HYDRIODATE OF POTASS. communication to its numerous readers, they, in my opinion, are justified in op¬ posing every new theory or hypothesis which appears to them erroneous, as well as to support that; which they ap¬ prove, by publishing the result of their experience. Whatever fortunate practical results Dr. Hake may observe in the adminis¬ tration of hydriodate of potass, their publication to the medical world is me¬ ritorious ; but when he attempts to esta¬ blish a new doctrine as regards disease, and an h ypothesis as to the methodus ope- randi of his remedial agent, in an unsa¬ tisfactory manner to others, those may be allowed, through the same channel, to express their motives of dissent. Un¬ der such an impression have I perused the present communication. Granting to Dr. H. that the hydrio¬ date of potassa is a tonic and stimulant —that a stimulant produces on the ani¬ mal economy an increased action, mean¬ ing- in this instance, I presume, an ab¬ normal one — and that such a condition may be either irritable, inflammatory, or debilitated, or all these occurring in a sequence ; Dr. II. having- ascertained under w hich of these diseases his patient labours, for supposition sake he it the inflammatory, he begins by converting that into the irritable, then proceeds with rendering the irritable the debili- tative, and the latter he changes into the normal or regenerative. Reasoning thus on the gradation of the primary stage of disease into the secondary, thence that into the tertiary or final one, the induction is obvious ; — the sti¬ mulant powers of the medicine convert inflammation into irritation, and the latter into debility, at which precise period come the tonic effects into force, to remove weakness, and regenerate the afflicted system. The acute stag*es of rheumatism, exanthematous diseases, and gastritis, are excepted, the former on account of “ febrile symptoms,” and the latter on that of local irritation : and in this ex¬ ception are also included “ those disor¬ ders where thefe may be no excitement of the system, although there exist local irritation of the stomach and intes¬ tinal canal.” Thence we are to infer it is not to be given when the excite¬ ment is general, nor when there is no excitement at all! This amounts to what logicians would pounce upon as a “contradiction of terms;” if not, then why could not the chemical remove local as effective as excitement, particu¬ larly since we are informed of its capa¬ city of converting- an inflammatory stage into its sequence, either resolution, sup¬ puration, or gangrene; but, I beg par¬ don, 1 mean the Doctor’s new theory — • irritation and debility. The reply is given in the paper, “ we must wait the circumstances attendant on its exhibition being adapted to this kind of action ;” by w hich, I suppose, is meant the medi¬ cinal, as that appears to me the relative to the antecedent, and not the morbid action. If I err in the former inference, then your readers are led to consider that the local irritation, or inflamma¬ tion, is first to be removed, with a vievv of establishing the sequent stage of dis¬ ease, when either the stimulant or tonic powers of the medicine come into opera¬ tion, and cure. A very facile method, yet to me not altogether satisfactorily comprehensive. In what varieties of chronic rheuma¬ tism and diseases of the skin it acts so specifically, the forthcoming cases will prove. In sympathetic gastrodynia, w e are told, the “prime remedy ” will ma¬ gically act, provided its stimulating- powers be antagonised by internal ad¬ juncts, or counter-irritants of the ano¬ dyne kind, for by these the diseased lo¬ cality is shielded from the injurious effects of an actual contact of the chemi¬ cal, while its diffusive “tonic powers are active in elevating the natural tone of the debilitated mucous tissues.” Thus the local irritation of the stomach, and the remote one of primary disease, are at one and the same moment wonder¬ fully removed. The doctor’s episode on the “ invisible lovers of science, consi¬ dering hypothesis as inimical to philoso¬ phy,” is pretty, but he cannot deny that hypothesists are too frequently like so many Tgnes Fatui, — lead the inexperi¬ enced astray, and that these “ admi¬ rable deceptions of nature” simulate Dr. H.’s favourite hypothesis. It is, indeed, an “ admirable deception ” of the intelligent hydriodate, by simulating the action of chyle to stimulate the lac- teals, who , endowed with intelligence, finding the proffered stimulus not chyle, though hungry and thirsty, refuse the nauseous medicine ; yes, even when that medicinal stimulus had aroused, excited them to the most active state for ab¬ sorption. So those Lilliputians are by the MORBID APPEARANCES IN AN AGED BEDRIDDEN PERSON. 619 Brobdignagian laughed at for the vain effort of’ absorption, without the gratifi¬ cation to act ! Tantalizing doom ! The doctor tells us this is the reason why the enlarged mesenteric glands are so easily diminished. Mirabile! the mesen¬ teric glands, then, are on the mucous surface of the intestines, surely the non- absorption of the hydriodate implies them there ! Has it never occurred to Dr. H., that his Plummer’s pills might have been, as they often are, so dry, hard, and unassimilatable, as to remain in the course of the intestinal canal, until the hydriodate was given, when chemical decomposition may have en¬ sued, and the iodate of mercury formed ; the fractional part of a grain of which, in few repeated doses, would cause the very powerful ptyalism ascribed as a newly discovered property of the hydrio¬ date of potassa. The admirable metas¬ tatic effect of this endowed chemical suits wonderfully well the thousand- and-one antipodian stages of disease, which by its beautiful mutation from stimulant to tonic, are to its foe in open plain, vigorous, and in the ambush. Since the hydriodate possesses the “wonderful” property of affecting the nervous system, we might have almost expected an electric shock — the stimu¬ lant answering the positive, and the tonic the negative pole. As Dr. H. finds it of such intelligentt.power in re¬ moving morbid “thickening structures of the bronchial mucous integuments,” we may, a priori , expect similar bene¬ ficial results from its administration in ossifications of the aorta. Your readers will easily perceive with what “ won¬ derful ” tact the Dr. supports his doc¬ trine, and deduces his inductions, for which he deserves the palm of inge¬ nuity. We have in him, sub rosa , a sup¬ porter of one of the leading principles of Hahnemannism, “ a medicine pro¬ ducing a disease it is capable of remov¬ ing.” Finally, the wonderfully intelli¬ gent hydriodate produces pain in cases of enlarged prostate, while, Oh, beau¬ tiful deception of medicinal remedial nature! with what tenderness she dimi¬ nishes the parturient throes of the ago¬ nised female. Apologising, sir, for the length to which my remarks have unwarily drawn me, I pass over others, and trusting that this letter may find a place in vour widely circulated journal, — I remain, Yours obediently, W. W. Morgan, M.R.C.S. Surgeon to the Bury Dispensary. Bury Dispensary, near Manchester, Jan. 7, 1837- MORBID APPEARANCES IN AN AGED BEDRIDDEN PERSON. To the Editor of the Medical Gazette. Sir, Having lately witnessed the post-mor¬ tem examination of an aged person, bed¬ ridden for thirty-one years, and whose case presented some very obscure symp¬ toms, I send you this outline of the inspection, thinking it might be worthy of publication. John Evans, of Towcester, ag’cd 75, died 19th September last. He was very corpulent, and large in stature ; his fa¬ culties were good almost to the last; his disposition w as irascible ; only a few months before death he attempted to cut his throat. His appetite for food was not bad, and he rested tolerably well at night, considering his infirmities. Bowels ge¬ nerally regular ; voice strong. A difference of opinion prevailed re¬ specting the disease he laboured under: soinb supposed him to be the subject of calculus, though the symptoms of this w ere obscure. Many ye§irs ago he w as a patient in the Northampton Infirmary, under the care of the late Dr. Kerr ; but after remaining there for many weeks he was discharged, his case being con¬ sidered too obscure to admit of any immediate or beneficial treatment. Notwithstanding his labouring under the above symptoms, together with an irreducible ing’uinal hernia on the left side, it was conjectured by many per¬ sons that his complaints bore stronger indications of imposture than of real disease. s On dividing the integuments of the abdomen, a thick layer of fat w as cut through, an inch in depth, before arriv¬ ing at the tendinous expansion. The parietes beingdivided, and the viscera ex¬ posed, the peritoneum w as found healthy, 620 MR. CADDY ON OPIUM IN TYPHUS FEVER. ] containing’ about half a pint of serum tinged with blood. The great omentum was curled upwards to the arch of the colon. Stomach and intestines looted healthy. The liver rather small, of a pale brown colour ; its structure by no means firm. The gall-bladder contain¬ ed forty-five calculi, the size of small eas, with a small quantity of green ile ; ducts pervious. In the right kid¬ ney were found seven calculi, embedded in its substance, each about the size of a nutmeg, forming a sort of cluster. The left kidney was devoid of such ob¬ struction, though its structure was much softer than natural. The right ureter was pervious and healthy; the left was somewhat larger, and within it were found three irregular portions of calcu¬ lous concretions, just at its entrance into the pelvis: how long’ they had been lodged there it is impossible to say. In short, the right kidney and left ure¬ ter presented an aspect totally different from the left kidney and right ureter. On cutting through the urinary bladder, a large calculus was found inclosed in the fasciculi of the viscus, just behind the symphysis pubis. When removed it appeared smooth and firm, of an ob- long shape, and weighed twelve drachms and one scruple ; composed of phosphate of lime. I think it not im¬ probable this stone had existed a great length of time. Two smaller calculi were found lying loose in the cavity of the bladder, near its base; these were of the same consistence : one weighed a drachm and a half, the other two scru¬ ples. The coats of the bladder were much thickened ; its mucous lining exhibited much redness. The prostate was not larger than usual for his age. It would appear that the urine was principally secreted by the left kidney, as being the more healthy of the two. The patient voided his urine at proper intervals, without much difficulty. I do not think he ever required the cathe¬ ter of late years ; but I am informed that he frequently had a discharge of fluid from the umbilicus, exactly re¬ sembling urine both in smell and colour. He had always been of a temperate habit. — I am, sir, Your obedient servant, John Collier, M.R.C.S. Brackley, Dec. 30, 1836. OPIUM IN TYPHUS FEVER. To the Editor of the Medical Gazette. Sir, Allow me to send you the following remarks on the efficacy of opium m typhus fever, for insertion in the Ga¬ zette, should you consider them w or¬ thy. — I am, sir, Your obedient servant, Chas. A. Caddy, M.R.C.S., &c. Bideford, Devon, Jan. 14, 1837. Vol. 14th of the Medical Gazette contains two excellent clinical lectures on typhus, by M. Chomel. The mode of invasion and appearances after death, &c. are therein accurately described ; and to them I beg to refer, as prefatory to my remarks on the treatment. In the year 1827, typhus was very prevalent in this neighbourhood, and the mortality very great. I attended at that time, amongst others, the family of a respectable farmer: five were ill, and three died. An old, experienced prac¬ titioner, visited with me. The treat¬ ment then adopted w'as the one recom¬ mended by the late Dr. Armstrong, and consisted of bleeding in the onset, with rhubarb and calomel, and purgatives, with a partial sponging of the body with cold water, &c. Not any of the preparations of opium were given. In the autumn of 1834, I had about one hundred and twenty cases of typhus under my care, and the only fatal one was that of a girl about nine years old, w ho wras in the third stage when first visited by me. The treatment adopted w'as the free use of the tincture of opium, in addition to those other means recommended. I shall endeavour briefly to illustrate the treatment by the fol¬ lowing cases : — On the 14th of November, 1835, I was called to visit John G - , a la¬ bourer, aged 32. I found him in the third stage; skin hot and dry; face dark red ; delirious ; sordes about the teeth, and the tongue brown and dry ; and with tenderness over the stomach, &c. Applied a blister over the pit of the stomach, g’ave him thirty drops of tincture of opium in a little water, and ordered free applications of cold water externally, with change of linen twice SUPPOSED RUPTURE OF THE COATS OF THE BLADDER. 621 a-day, the removal of all unnecessary furniture from the room, &c. Diet, gruel and toast-and-water. The after- treatment consisted of two grains of rhubarb and three of magnesia every four hours, with a full dose of opium twice daily. He gradually recovered. On the 16th, on my visit to the above, my attention was directed to his bro¬ ther, aged 14, who sat pale and shivering over the fire. He had com¬ plained of fatigue and shivering on the previous evening. He was ordered to bed, and took an emetic, followed in two hours by twenty-five drops of the tincture of opium. On the following- day all symptoms of fever were gone. When aperients are requred, to coun¬ teract the astringent effect of opium, or otherwise, I have found castor-oil the safest; but if the bowels are irritable, instead of rhubarb and magnesia, I substitute two grains of Dover’s pow¬ der, or the compound powder of chalk, or carbonate of soda ; restricting the diet, in all cases, to gruel, arrow-root, coffee, tea, and toast-and-water. No fruit or preserves, or animal broths, during the existence of fever. Bleed¬ ing’ is generally required after the first shock is past ; and in all cases where the first stage is fully developed, cup- nng or a blister over the stomach. I lave had many cases of typhus under my care during the last autumn, and in all opium was given, and with the greatest success; acting as a charm on the cerebral affection so generally at¬ tendant on typhus. woman in labour with her sixth child, residing at Ditchling* Common, about five miles from hence. Upon reaching her abode the nurse immediately came down stairs, and informed me that about two hours before she had had most alarming haemorrhage, from the effects of which much exhaustion ensued ; how¬ ever, on the recurrence of her labour pains she had expelled the placenta, and the foetus still remained in utero. To my great astonishment, on visiting the patient, I found the nurse’s state¬ ment quite correct. The placenta was placed in a receptacle on the bed, the funis not as yet separated, and, of course, no pulsation perceptible; and, to add to all the foregoing disasters, there was a presentation of the arm as high as the axilla. Notwithstanding which, to my great satisfaction there was powerful uterine action. After encountering some difficulty, I succeeded in turning the child, and delivered her forthwith. I attribute the child’s death solely to the expulsion of the placenta, as, from all appearances, its demise was of recent occurrence. Suffice it to say, the poor woman has had scarcely an untoward symptom since, and is now quite re¬ covered. SUPPOSED RUPTURE OF THE INNER COATS OF THE BLADDER, WITHOUT INJURY TO THE INVESTING PERITONEUM. MIDWIFERY. EXPULSION OF THE PLACENTA BEFORE THE BIRTH OF THE CHILD. To the Editor of the Medical Gazette. Sir, By inserting the following obstetric case at your earliest convenience, you will much oblige Your obedient servant, ,T. H. Bull. Lindfield, near Cuckfield, Sussex, Jan. 5, i 837. On the morning of the 7th of Decem¬ ber, I was summoned to attend a poor To the Editor x f the Medical Gazette . Sir, Should you consider the following case sufficiently interesting to the medical profession to deserve insertion in your valuable publication, it is at your dis¬ posal. I remain, Sir, Your obedient servant, Wm. T. Keal. Oakham, Dec. 20, 1836. Early on Tuesday morning, Dec. 29, 1835, I was requested by a medical friend to accompany him a few miles, to advise in the following case: the parti¬ culars were communicated by my friend in our way to the village : — 622 THE NEW PHARMACOPOEIA — NOTE FROM MR EVERITT. The subject of the case was a young’ man, about two and twenty years of age : he bad been labouring1 under stricture of the urethra about a fortnight, the consequence of a recent gonorrhoea, when he was knocked down by a horse, on the 26th, about noon. The horse in stumbling* fell upon the lower part of the patient’s abdomen ; he felt pain soon af¬ terwards about the pubic region, accom¬ panied with a more frequent desire to pass his urine, which he accomplished with no more than the ordinary diffi¬ culty. In about eight hours after the accident the difficulty increased, and soon retention became complete* Up to that period there had been no discolouration of the urine. The re¬ tention continued till Monday evening about eight o’clock, when he passed a moderate quantity, which relieved him from pain, and he slept from ten till two o’clock. On awaking there was much pain, with an extreme desire to make water. His medical attendant wa3 now for the first time sent for, and upon his ar¬ rival, finding* the retention accompanied with much agony, immediately returned home (a distance of two miles) for a catheter. On h is return the patient informed him, that during his absence, in attempt¬ ing to evacuate his urine, lie had expe¬ rienced a sudden “ crack” (to use his own expression), and an immediate sen¬ sation of cold pervading the pubic re¬ gion, at the same time finding relief from the distressing pains under which he was previously suffering. Upon our arrival we found our patient compara¬ tively easy, though there was tender¬ ness of the abdomen, with a sense of distension, but no circumscribed tumor, as in cases of retention without lacera¬ tion. I immediately suggested the in¬ troduction of the catheter, and at least two quarts of bloody urine were drawn off. The stricture caused considerable impediment to the introduction of the catheter. The patient experienced much relief after the operation. The pulse being* full, I advised a copious bleeding from the arm, to be followed by leeches to the pubic region, with subsequent fo¬ mentations. 1 also suggested a saline aperient, afterwards calomel and anti¬ mony in repeated doses, and an opiate at bed-time. It was considered essen¬ tial to pay due attention to the frequent use of the catheter. I did not see the patient again, but was informed by my friend, that after using the catheter for two days, lie was able to pass his urine without its aid, and was free from all abdominal pain ; and he considered him recovered from the injury of the bladder. The stricture was subsequently cured, as was also an attack of orchitis. The patient has con¬ tinued free from any consequences what¬ ever of the injury. THE NEW PHARMACOPCEIA. NOTE FROM MR. EVERITT, IN REPLY TO MU. PHILLIPS. To the Editor of the Medical Gazette , Sir, I am quite at a loss to see the appropri¬ ateness of Mr. Phillips placing, in relief, in his letter to you, misprints which did not occur in your journal, al¬ though they did appear in the Lancet. Mr. Phillips attributes the error in the Latin edition, of ordering three measures of water in the room of two (or more correctly, one and three-quar¬ ters), to be mixed with one measure of the strong liquor ammonite, to reduce it to the weaker, to a misprint; by a cu¬ rious coincidence, the same misprint oc¬ curs in Iris English translation. The last paragraph of Mr. Phillips’ letter, in which he apparently has me on the hip, will lose all its point when a re¬ ference is made to that part of my communication to which he alludes. Every one knows how changed the meaning* of a few words may become by separating them from their asso¬ ciates. In giving the process for mak¬ ing* liquor ammonice, it is very evident I confined myself to a general descrip¬ tion, and did not intend to give the ex¬ act strength of the product; for I said, “ put about ” (a little word omitted by Mr. Phillips) thirty parts of water into the receiver; and then, a few lines fur¬ ther on, I contended that ten ounces of sal-ammoniac can, in practice at any rate, make thirty fluid ounces of liquor ammoniac of 960, in the room of only fifteen, as prescribed. DR. GREENIIOW ON THE DISEASES OF NORTH SHIELDS. 623 Grg. of Am¬ monia. Now 10 o 7. of this salt contain . . 151 1 And 30 fluid oz. at '960 contain . . 1260 Hence very liberal allowance? (l-6th) for loss . $ Hence, I think, I did not wish to get more ammonia out of the salt than it contained ; although, on the other hand, I do contend, that the process of the Pharmacopoeia, where 881 grains out of 1511 are admitted to be lost, is one which no manufacturer w ill follow, and w hich ought not to have been in the edition of 1836. — I am, sir, Yours sincerely, Thos. Everttt. Medical School, Middlesex Hospital, Jan. 18, 1837. DISEASES OF NORTH SHIELDS, AND THE SURROUNDING DISTRICT. To the Editor of the Medical Gazette. Sir, It may not be uninteresting to some of your readers w ho reside in parts of the kingdom remote from this, to learn something of the diseases which have chiefly prevailed during the past year in this district, together with the state of the w eather during their rise and progress ; and as the weather during that period has been of a marked and unusual character, so have diseases as¬ sumed somewhat of a peculiar nature. The winter of 1835-6 was unusually mild, the thermometer being rarely be¬ low 50, except on tw-oor three occasions, when we had slight frost, which never continued more than six and thirty hours at a time; this mild weather con¬ tinued until nearly the end of February, during the whole of which time little complaint seemed to exist ; in point of fact, I have invariably found mild open winters infinitely the most healthy, in spite of the old proverb : the only com¬ plaint which manifested itself during this period was the small-pox, which I has continued to hold its course up to the i present time, apparently quite unin- i fluenced by atmospheric chang’esof any i kind. At the end of February, the east w ind set in with even' more than its usual bitterness, bringing in its train coughs, sore throats, and inflammatory com¬ plaints, more especially of the lungs and air-passages : an epidemic resembling influenza made its appearance, not un- frequently accompanied by bronchitis ; measles also prevailed, with a great ten¬ dency to croup ; acute rheumatism was also of common occurrence ; altogether a decided inflammatory diathesis per¬ vaded all diseases occurring at this time, and I had occasion to call the lancet into requisition more frequently than for three or four preceding- years. Things con¬ tinued much in this state until the be¬ ginning of June, up to which time no rain had fallen, occasioning a serious want of herbage: early in June rain began to fall, and continued with little intermission during- the whole summer and autumn, the wind bein^r for the most part W. and S. W., the weather being- cold, and thunder of frequent oc¬ currence. A visible change was effected in the nature of diseases by this altera¬ tion in the weather; the inflammatory diathesis disappeared, as also did mea¬ sles, which was succeeded by scarlet fever, and an extraordinary haemorrhagic tendency manifested itself, appearing most commonly as hoemoptysis, but also in the tendency of the exanthemata to terminate in purpura, and in the fre¬ quency of abortion and of uterine haemorrhage after delivery. I may also here state, that cutaneous diseases were more common, and strumous tumors of more than usual frequency, probably from the functions of tlie skin being im¬ paired by the state of atmosphere ; but what is not a little singular, I did not see or hear of a single case of autumnal cholera, nor even of diarrhoea. In October we had a considerable fall of snow followed by a succession of rainy weather, which abated at the beginning of December, from which time it con¬ tinued mild and dry until the 23d, when a snow' storm set in, accompanied with thunder; a severe frost succeeded, and the snow lay until the 5th of January, since w hich time we have had a rapid succession of frost and thaws. I am the more particular in noticing- this, as the influenza made its appearance on the 6th, and has gone on increasing ever since, and I am certain I do not over¬ rate it, when I say that at this moment ten per cent, of the population of this district arc labouring under it: its usual mode of attack here is, by cold rigors, intense pain in the head, coryza, irrita¬ tion about the trachea, incessant cough, 624 MR. TAYNTON?S CASE OF STRANGULATED INGUINAL HERNIA. extreme lassitude, and pains in the limbs. The best mode of treating- it seems to be, to confine the patient to bed ; diet, warm diluents ; and such re¬ medies as will keep the skin open, and promote expectoration. Mist, salinae and vin. ipecac, seems to answer both indications. I have seen no case in which bleeding- was requisite, or even admissible ; and one peculiarity of the disease is, the disposition to fainting, which is readily induced by active purg¬ ing, rendering it advisable to administer such aperients as do not lower the system. In taking a review of the diseases mentioned in the foregoing relation, we can feel no surprise that the cold east winds should have g-iven rise to inflam¬ matory complaints ; but it is by no means so obvious what could occasion so great a tendency to haemorrhage. How far cold and moisture, together with a highly electrical state of the atmosphere, is capable of producing such results, the present state of our know¬ ledge does not admit of our being able to determine; but it is a subject w^ell w orthy of attention, and one whose in¬ vestigation will probably lead to im¬ portant results. I remain, Sir, Your obedient servant, Edward Greenhow, M.D. North Shields, Jan. 14, J837. STRANGULATED INGUINAL HERNIA. OPERATION AND RECOVERY. To the Editor of the Medical Gazette. Sir, I am induced to offer the following case of hernia for insertion in your valuable journal, on account of an appearance which I believe to be unusual. I allude to the peculiarity of the contents of the sac. Samuel Hart, set. 45, drayman, states that he has been subject to a rupture (oblique inguinal) on both sides for fifteen years, which he has always been able to return with readiness. Having lately obtained a new truss, and finding the pressure from it uncomfortable, he took it off on Saturday morning, Decem¬ ber 30th. Shortly afterwards, whilst walking from the fire to his bed, the rupture on the left side came down, and he was not able to return it. He soon began to feel pain across the abdomen, attended with vomiting, which conti¬ nued with little intermission. The rup¬ ture, which at first was not larger than a walnut, had been gradually increasing; and when I saw him, forth e first time, on the following morning, at 10 o’clock, it presented these appearances : — Its form was pyramidal, measuring about six inches from the external abdominal ring downwards, and about three inches and a half in its transverse diameter ; it had a tense and elastic feel ; no pain was experienced upon pressing any part of the tumor, except at a point immedi¬ ately over the seat of the stricture. He complained much of pain in the abdo¬ men, just below the umbilicus, which was also aggravated upon pressure. The abdomen was soft and yielding; pulse 100, somewhat incompressible ; tongue moist, and slightly furred ; bowrels not open since yesterday morn¬ ing ; countenance very anxious. After fruitless efforts to return the rupture, I bled him to faintness, and again re¬ newed the attempt, but was equally unsuccessful. He was then ordered to keep ice constantly applied, and an active purgative was prescribed. At half-past two my father accompanied me to visit the patient. We found him nearly in the same state, but stercora- ceous vomiting had supervened. After ag-ain employing the taxis, a tobacco enema was administered : great depres¬ sion of the vital powers ensued, but the hernia continued irreducible. We then judged it better to leave him for an hour or two undisturbed, directing him to continue the application of ice, being determined, if after that time the hernia remained irreducible, to proceed imme¬ diately to the operation. At half-past six, having once more endeavoured to return the intestine without any better success, I proceeded to perform the operation, in the pre¬ sence of my father and Dr. Rowland. It is unnecessary to describe all the stages of the operation : the sac having been exposed, there was considerable difficulty, on account of its great tense¬ ness, in pinching up a portion for the urpose of dividing it. An opening eing made, about four ounces of serum gushed out. When the sac was laid open, a large mass of coagulable lymph presented itself, having the appearance ANALYSES AND NOTICES OF BOOKS. 625 of calf’— foot jelly, only of a darker colour, not adherent, and which totally concealed the protruded intestine. This jelly-like substance, which formed the bulk of the tumor, being1 removed in one large mass, a moderately sized knuckle of intestine was observed, in a highly vascular state, with laminae of lymph adherent to it, of the same colour as that contained in the sac. The sac itself was quite free from inflammation. The stricture being divided, the opera¬ tion was completed in the usual man¬ ner. An opiate was given at bed-time, and he passed the night without much pain. In the morning he took some castor oil, which not having produced any effect at noon, an injection of w'arm water with some salt was administered. The bowels were soon freely opened, from which time he has recovered with¬ out one untoward symptom. I remain, sir, Your obedient servant, Henry Taynton. 39, Queen-Square, Bloomsbury, Jan. 18, 1837. ANALYSES and NOTICESor BOOKS. “ L’Auteur se tue a allonger ce que le leeteur se tue a abr6ger.” — D’Alembert. Practical Observations on Nervous and Sympathetic Palpitation of the Heart ; pa7'ticularly as distinguished from Palpitation the result of Orga¬ nic Disease. To which are prefixed some General Remarks on the Use of the Stethoscope and the Employment of Percussion , in the Diagnosis of Diseases of the Heart and Lungs. By John Calthrop Williams, M.D. Edinburgh. The object of Dr. Williams is to point out tire distinguishing marks of palpi¬ tation dependent on functional distur¬ bances. We do not find, in the general remarks which he makes on the use of the stethoscope and the employment of percussion, any thing of particular in¬ terest or novelty; indeed that part of the work is almost entirely composed of of extracts, while the writers referred to are nearly all “ learned and talented,” and their works all either “ valuable” or “ very valuable.” A distinct, if not a g*eneral view, is given of nervous and sympathetic palpitation, and several very good cases adduced in illustration. In one the disease originated in the 477.— xix. sudden communication of distressing intelligence, which led to movements of the heart not violent, but tumultuous, with a thrilling sensation in the limbs : occasionally the palpitations were ac¬ companied by a “ cooing sound,” and at other times the pulse was intermit¬ tent. The patient recovered gradually under the use of aperients and tonics, particularly iron, which was freely ad¬ ministered. In the second case, a young lady addicted to starving and tight lac¬ ing, became affected with palpitation. “ She could not bear to lie down be¬ cause of the heart’s pulsations, which she was constantly counting; she had at times the fear of suffocation ; her ap¬ petite, which she had long refused to gratify, in the course of time left her; an annoj ing dry spasmodic cough, the sound of which was noisv and metallic, supervened ; her legs sw elled ; and feeding her imagination with every kind of apprehension of evil, she became so reduced and so irritable, that she was obliged to withdraw from society. She always described the movements of the heart as of a fluttering kind, accompa¬ nied with a sensation of sinking-, and a feeling of emptiness in the epigastrium. They varied much in regard to the de¬ gree of intensity ; and at times, even when she complained of them as very distressing, they were scarcely percepti¬ ble to the observer. The sound proceed¬ ing from the contractions of the cham¬ bers of the heart, always appeared clearer and louder than natural.” This patient also did well, the treat¬ ment consisting in anti-spasmodics with digitalis, followed by mineral and ve¬ getable tonics. The third case, given as one of ner¬ vous palpitation, appears to us to have been attended with organic disease, re¬ lief having been afforded for a time by the remedies employed. The case which follows next is ex¬ tracted from the Hospital Reports of La Pitie. After which comes one treat¬ ed by our author, in which the heart affection depended upon the irritation caused by tape-worm. The history is interesting. “ A young lady, 22 years of age, was affected not only with the ordinary symptoms of tsenia, viz. fixed pain in the left hypochondriac region, voracious appetite, restless nights, disturbed dreams, febrile exrcerbations, occasional syncope, and other similar phenomena ; 2 S 626 THE EPIDEMIC CATARRH. but she suffered, likewise, distressingly from periodic attacks of sympathetic palpitation, accompanied at times by great cerebral excitement — to such a degree, indeed, that she was obliged to pass the night in an upright position, in an easy chair, otherwise she became temporarily delirious — a state which on several occasions threatened to assume a lasting character. The oppression and sense of suffocation she endured during ths more violent paroxysms, were truly distressing, and would have led any one, not conversant with the diagnosis of the organic disease of the heart and lungs, to suspect that something beyond morbid sympathy created the extreme constitutional derangement she suffered. During the paroxysms, the heart, it is true, beat most violently, and with a loud clear sound ; the latter, however, proved that the organ was not affected with hypertrophy, for then the sound is generally dull and obscure. The at¬ tacks were periodic, and occurred always half an hour or so before the regular hours of repast, and were relieved by repletion. This would scarcely have been the case, had the palpitations de¬ pended upon structural disease. The action of the heart was not greater at one part of the prsecordial region than at another, nor was the sound louder in any particular situation. The action of the organ w as regular, though quicker and more forcible than in a state of health. The entire organ appeared to labour under an increase of irritability, and the consequence was, that every part acted more energetically than it should have done, The lady whose case I have just re¬ lated, was treated with daily doses of oil of turpentine, jalap, calomel, colo- cynth, and other purgatives. The ir¬ ritation of the system w as relieved by the frequent application of leeches to the temples, the employment of refrige¬ rants to the head, and the internal use of anti -spa smodics, such as valerian, castor, camphor, hyoscyamus, and opium, as the varying” circumstances of her case demanded ; and her restoration was finally completed by a course of vege¬ table and mineral tonics. During the space of fourteen months, she voided, in separate portions, many yards of tape¬ worm, varying in length from an inch to upwards of a foot and a half. She is now in the enjoyment of perfect health. The last case adduced is simply one in which the application of cold to the feet, during menstruation, was follow'ed by a sudden cessation of the discharge, after which palpitation supervened. It presents nothing remarkable. The general directions given by Dr. Williams, in judging of the nature of the palpitation in any given case, are contained in the following extract: — “ We must ascertain by the hand, ear, and stethoscope, whether the ab¬ normal action of the organ be universal or not, over the whole extent ol the pre¬ cordial region. If it be found on both sides of the heart, and not on one part more than another, it leads to the con¬ clusion that the palpitation is merely a functional disturbance ; but this does not constitute positive proof. We must examine, at the same time, by striking over the region of the heart, either by the fingers, or through the medium of the pleximeter, whether the dull sound peculiar to this region be not of greater extent than natural. This induces the conclusion that there is no dilatation, nor effusion into the pericardium.” A Bed-Sicle Manual of Physical Diag¬ nosis applied to Diseases of the Lungs , Pleurae , Heart , Vessels, Ab¬ dominal Viscera , and Uterus. By Charles Cowan, M .D. Author of the Translation of Louis on “ Phthisis.” Sherwood. 1836. This little volume has the unusual re¬ commendation of being precisely what it professes. It gives a concise but clear account of the most important physical signs of disease, as connected with auscultation and percussion. It costs half-a-crown, and will burden no one’s pocket. Pupils would do well to have it always with them, in going round their hospitals. & medical gazette. Saturday, January 21, 1837. “ Licet omnibus, licet etiam mihi, dignitatem Artis Medicce tueri; potestas modo veniendi in publicum sit, dicendi periculum non reeuso.” Cickro. THE EPIDEMIC CATARRH. Two facts connected with the prevalent epidemic must press themselves on the notice of every member of the comma- THE EPIDEMIC CATARRH. 627 nity— the numbers cut off by it, and the severity with which it attacks the old. The daily obituaries in the newspapers are swelled prodigiously beyond their ordinary dimensions, and we question whether even in the cholera times those lists were so heavy. The inference from this, perhaps, is not exactly that the mor¬ tality is greater, but that it falls more on people in the upper and middle classes. The cholera raged destruc¬ tively among the poor, and carried off comparatively few victims from the up¬ per classes; but the epidemic catarrh, in its insidious march, seizes indiscri¬ minately on all sorts of persons, and, while much less formidable in its spe¬ cific mortality, is found in its results to be little less alarming; for its absolute mortality is made up from a wider range. We mentioned last week how actively the profession have been employed since the epidemic has prevailed : their acti¬ vity and full occupation have not di¬ minished since ; but in a few weeks, we presume, their services will be less required ; the disorder will have sub¬ sided and been forgotten. This is but too frequently the history of epidemics amongst us : while they prevail, they create a sensation ; the method of treatment is attended to, but little if any notice is taken of the pro¬ ducing causes, or of the mode by which the community might be protected from future attacks. The essential features of the disorder are not observed in such a manner as that they would be recog¬ nized ag*ain on a subsequent visit, and so these epidemics come and go, free as air, and making at most but a tem¬ porary impression. Much is lost to medical science by the apathy among those who profess to cultivate it in respect to these mat¬ ters : there is no concert, no understand¬ ing, as to how diseases which widely affect the communityare to be observed, — no general inferences are drawn which might promise security to the public health. It is obvious that much good might be effected in the attain¬ ment of these ends by the impulse which an able and efficient Government Board, could give : but as it is, and proverbial almost as is the jealousy which the medical practitioners of this country have ever entertained of being govern¬ ed or directed by any Board in autho¬ rity, nothing can be expected from that source. There is still an alternative in the voluntary union of the members of the profession ; and it is with pleasure, mingled with sanguine anticipations, that w'e recollect it is one of the avowed objects to be pursued by the Provincial and Branch Associations — to gather ample information respecting epidemic disorders, to study their phenomena, ascertain their laws, and to counteract, if possible, their baneful influence. We hope that the opportunity afforded by the present malady, which prevails so extensively throughout the country, will not be lost, and that by the united la¬ bour of many, concentrated afterwards by the sound judgment of a few deputed to generalize the results, we may be¬ come perfectly acquainted with the. causes, characters, and, in short, the laws, of at least one epidemic, which seems likely to visit us often, as it has, no doubt, been with us before. Were we called upon to point out the character and distinctive features of the prevailing disorder, we should say that its chief peculiarity has consisted in the extent to which the lungs have been implicated, the mucous membrane lin¬ ing the air-passages being in many cases inflamed, and after a few days overloaded with viscid secretion, inter¬ fering with the arterialization of the blood. The oppression of breathing is in many cases urgent, and attended by 628 THE EPIDEMIC CATARRH. great pain along the lower edge of the ribs, and in the epigastrium. The pulse is for the most part soft, and depletions are borne very badly : in those in whom they are carried too far, delirium is apt to supervene. Numerous cases have proved fatal, and post-mortem examina¬ tion has shewn the membrane lining the • air passages to be inflamed, from the trachea into its minutest ramifications, w ith condensation of portions of lung, but the pleura suffering comparatively seldom. Even in slighter cases the re¬ covery is tedious, and the patients go grumbling on for many days, w ith loss of appetite, great languor, and some¬ thing of ill humour. The cause of the general seizure is freely talked of as no mystery. Tt is traced to the change which so suddenly occurred in the atmosphere, from great dryness to great humidity, both states being accompanied with a severe de¬ pression of temperature. It was not any remarkable alteration in the degree of temperature that gave rise to the morbid consequences, for we have bad scarcely an hour of warm or even tem¬ perate weather these six weeks, but the profusion of cold damp moisture with which the air became loaded on the .occurrence of the thaw, has been, un¬ doubtedly, a main source of the disorder. There may be, and doubtless are, other qualities in the air which are influential as causes of the prevalent catarrh : yet of these we must, at least for the pre¬ sent, be contented to remain in igno¬ rance ; they cannot be appreciated by any powers of analysis which our che¬ mists or meteorologists possess. A violent alternation from great cold to comparative heat has sometimes originat¬ ed an epidemic. One of themost extensive and destructive epidemic catarrhs with which Europe was perhaps ever afflict¬ ed, was owing to this cause. It com- pienced in Russia, in a locality where the thermometer, after standing for some time at — 35° Fah., rose in the course of twelve hours to 5°, indicating a change of temperature to the amount of forty degrees. Forty thousand persons were almost immediately seized with epidemic catarrh. But what happened on the spread of this very epidemic? It traversed Swe¬ den, Denmark, Upper and Lower Saxo¬ ny, and other regions farther west, without apparently requiring any simi¬ lar change of temperature in the places it visited ; at least no change in any way remarkable was observed. That cold weather is peculiarly fa¬ vourable to the rise and progress of the disorder, we know from statistical facts. M. Andral, in an able sketch of some of the chief epidemics which have prevail¬ ed in Europe, states that, of fifty-six catarrhal seizures like the present, twenty-two occurred in winter, twelve in spring, eleven in autumn, and five in summer ; while in respect to epidemics of other kinds the case has been very different, — of fifty epidemics of dysen¬ tery, for instance, thirty-six prevailed in summer, twelve in autumn, one in spring, and one in w inter. How much the winds, and certain supposed electric states of the air, may have influence, it is exceedingly difficult to say. East and north-east winds have been considered in this country as preju¬ dicial to health, yet they can scarcely be connected with the orig'in of the present catarrh, for there has been no remarka¬ ble prevalence of winds from those quarters. And as to electricity, the in¬ quiry is equally barren of satisfaction. The air changes frequently from a posi¬ tive to a negative state, without, in the great majority of instances, giving rise to any appreciable result in regard to health. The deficiency of electricity in the air, rather than any surplus of it, would seem to be favourable to the pre- COLLEGE OF PHYSICIANS. 629 Valence of epidemics ; for in those lofty flat regions, far above the level of the sea, electricity is almost wholly absent from the air, and epidemics are common. On the other hand, Volta himself ana¬ lysed and compared the atmospheres of countries attacked with, and free from, epidemic disease, without being able to find any sort of difference between them. We have noticed the fact, that in the present epidemic the persons most sus¬ ceptible to its influence are the elderly : this may be considered as a peculiarity of the disorder, for on other occasions the young and adult have been equally, if not more, exposed. But there is the greatest diversity in this respect: indi¬ viduals of every age, of every tempera¬ ment and constitution, are liable to epidemic attacks at different times. Sometimes the feeble are attacked, sometimes the robust. In one of the epidemic catarrhs which was formerly very destructive in this metropolis, per¬ sons of a sanguine temperament were its chief victims. Children were spared in the Russian influenza, while the robust and stout were the principal suf¬ ferers. What are the chances in epidemics of this kind ? It is very important to ob¬ serve, that the prognosis of a disease prevailing epidemically is always more serious than when the same disease is met with in a sporadic form: what would in the latter shape be slight, may prove in the former mortal, — in statisti¬ cal language, the cypher of the mor¬ tality is raised. But much must depend on the age of the persons attacked, and their stamina: it is to be recollected, also, that the prognosis varies consider, ably according to the period of the epi¬ demic. In the onset, or presently after, the danger is greatest; it declines as the visitation approaches its close. Ozanam, in his History of Epidemics (1817-1823), gives the following* as an estimate of the mortality of the princi¬ pal diseases which attack large numbers of mankind simultaneously : — Catarrh carries off' per cent. • • 2 Scarlatina . 5 Dysentery . from 18 to 40 Croup . 30 Typhus fever . 60 Puerperal fever • . . 66 Malignant pneumonia . 70 Yellow fever . from 75 to 80 Plague . 73 to 80 In glancing at this list, however, we must not be deceived : some of the disorders with the lowest cyphers may happen to prove the most destruc¬ tive ; and it is possible that even catar¬ rhal fever, with its low rate of specific mortality, may carry off as great a nuiiL- ber of victims as the plague. We do not ourselves rate the specific mortality of epidemic catarrh so low as it is stated in the preceding table ; but even if we did, we should still see sufficient reason for apprehension when we consider the vast numbers of persons attacked. The comparatively slight symptoms which mark its invasion, together with the many instances of escape, appear to de¬ prive it in great measure of its terrors : we doubt not, however, that were it pos¬ sible to obtain a correct return of the number of victims, the contemplation would be not a little appalling. COLLEGE OF PHYSICIANS. TRANSLATIONS OF THE PH ARMACOPCEIAS. An advertisement has been going the round of the newspapers and journals for the last month, announcing that a translation of the new Pharmacopoeia, from the pen of Mr. Phillips, is forth¬ coming, and that the College of Phy¬ sicians will “ resist” the publication of any other. Now we have always un¬ derstood that the copyright of a work did not extend to translations of it ; and it is therefore our belief that the College have no power to “ resist,” as they call it. But if any such exclusive 630 ROYAL MEDICAL AND CHIRURGICAL SOCIETY. power did exist, we should like to know why some member of their body was not entrusted with the task of edit¬ ing' the translation ? Tf this be in¬ tended as a mode of remunerating Mr. Phillips for his assistance in regard to the chemical manipulations, we must take leave to say it is about the very worst that could have been devised. On former occasions translations of the Pharmacopoeia have appeared with¬ out the College resisting ; what, then, in the name of common sense, has induced them at the present mo¬ ment, and under existing circum¬ stances, to publish such a stupid, illi¬ beral, impolitic, and empty manifesto ? We have been told, indeed, that the Colleg’ehavenot sanctioned it, and know nothing of it. We sincerely hope that this may prove to be true ; but if so, we are again compelled to ask why was it not instantly — (within the first twenty- fourhours) — contradicted? Do they think that these are times in which they may quietly repose in apathetic indolence, trusting to character, forsooth, as their safeguard ? They have active enemies in every quarter; and if they are not prepared to show a corresponding de¬ gree of energy by taking the lead in every measure which is for the general good of the profession, instead of at¬ tempting to establish any trumpery monopoly like the present, we would advise them to give up the struggle at once, and resign themselves to their fate with what degree of complacency and gracefulness they may. SEPARATION OF THE ST. THO¬ MAS’S AND GUY’S HOSPITALS. This event, to which we alluded last week merely as a probable result of the recent unfortunate occurrences, has ac¬ tually taken place, as appears from the following resolutions. W e think the cir¬ cumstance is very much to be regretted. At a General Quarterly Court of Go¬ vernors of St. Thomas’s Hospital, held on Wednesday the 18th instant, the subjoined resolutions of the Committee were confirmed, and passed unani¬ mously : — Resolved, —That the Committee hav¬ ing taken into consideration the letter received from the physicians and sur¬ geons of this hospital, and having ad¬ verted to the recent outrage committed by some of the pupils of Guy’s Hospital in the operating theatre of St. Thomas’s, are of opinion that the pupils of Guy’s should no longer be permitted to attend the surgical practice and operations of St. Thomas’s, unless they are also pu¬ pils of St. Thomas’s. In coming to this conclusion, the Committee desire to express their regret that the union of the tw'o hospitals, which existed for a long period of time, beneficially alike for the schools of both, and for the public advantage, to the year 1825, should then have been dis¬ solved by the authorities of Guy’s, w ith¬ out consultation with, or the consent of, the Governors of this hospital. ROYAL MEDICAL AND CHIRUR¬ GICAL SOCIETY. In our report of the proceedings of last meeting (Tuesday, Jan. 10th) w'e were obliged to omit the following abstract of Dr. Hume WeatherhecnVs Paper on Inflam¬ mation. The object of the paper is to illustrate and determine the essential nature of Inflammation, by an analysis of its phenomena, whether symptoms or results, deducing them all as one consecutive series of effects, dependent for their relations on one another. The author prefaced his remarks by ob¬ serving that all the phenomena of the living system, both morbid and healthy, owed their origin to nervous influence; that it wras the nerves that determined, in the first instance, the rush of blood to a part inflamed ; that the increase of tem- perature, as a symptom of inflammation, w as the result of this afflux ; that from the same source proceeded, directly and indirectly, the tension and tumefaction, and that the attendant pain had a similar origin. The first effect of an excitant or irritant, he went on to observe, was to attract the blood to the seat of the irritation ; but if this effect was kept up beyond a certain period, or carried beyond a certain degree, ROYAL MEDICAL AND CHIRURGICAL SOCIETY. 631 while the excitation continued to attract as much blood as before, the power of the capillaries to forward it diminished pro¬ portionately with the exhaustion produced by their prolonged over-action. As long as the increase of action in the capillaries was in a ratio with the increased supply of blood, inflammation could not be said to exist ; but as soon as the inverse of this took place, by which one became dispropor¬ tionate to the other, this very circumstance of itself constituted and established that morbid condition we call inflammation. The author next defined the distinction between this state and congestion. In the former the plethora existed in the capil¬ lary arteries, while in the latter, the turges- cence had its seat more particularly in the capillary veins. The paper proceeded to treat of and to exemplify the power of the arteries to determine blood to particular parts inde¬ pendent of the heart, and then deduced the increased temperature of a part in¬ flamed from the difference of capacity for caloric the blood underwent in changing from arterial into venous, and how the release and evolution of the latent caloric which went on in the capillary system, kept up the temperature of the surface in health, and how its inordinate evolution alone made it a morbid symptom as, most conspicuously, as well as conclusively, ex¬ emplified in scarlatina. However, while there existed in the acute stage of inflammation an increased determination of blood to a part, the mo¬ ment it entered vessels not intended in their natural state to convey red globules, a state of haemostasis necessarily ensued. From this state of engorgement proceeded an effusion of serosity into the cells of the contiguous cellular membrane in common phlegmon, or into serous cavities, when serous membranes were the seat of inflam¬ mation. It was from this circumstance (most manifestly exemplified in certain vesicles, and by the effects of a blister) that the author adduced proofs that pus was nothing else than serosity of a particular quality, which, by a spontaneous change its albumen undergoes, and a partial ab¬ sorption of its lymph, had been converted into pus — an opinion he sustained by quoting the celebrated experiment of Van Swieten on ulcers, the purulent change which serosity undergoes under our eyes in various exanthematous pustules, how pro¬ moters of serous secretion were also pro¬ moters of suppuration, and lastly, how' strictly pus and serosity were identical in their chemical composition. The author next took a review of ana¬ sarca and its causes, as furnishing addi¬ tional confirmatory illustrations on the morbid physiology of the capillary system ; how both oedema and anasarca invariably proceeded from vascular haemostasis, and that the former could be produced artifi¬ cially, as by a ligature; why the fluid ef¬ fused in these diseases did not change into pus (the deficiency of that which forms the globules of purulent matter, albu¬ men.) He next explained the pathological for¬ mation of an abscess, elucidating his views on the subject by analogy with the change of a vesicle into a bleb — the breaking down of the cellular septa — how that tu¬ mefaction was always greatest where cel¬ lular membrane most abounded, and was most lax — how serous and fibrous tissues seldom suppurated, and when they did it was always sparingly ; and why a common phlegmon should readily suppurate, and a boil should not. Pain as a consecutive symptom of in¬ flammation next came under notice ; and it was shewn that this was mainly at¬ tributable to the distended state of the blood-vessels extending or stretching the tissue or structure in which the inflamma¬ tion was seated ; and that, ca leris paribus, the pain wTas always most severe in those tissues that yielded with the greatest diffi¬ culty. Gangrene and sphacelation were next briefly referred to, as results rather than phenomena of inflammation, since both are to be regarded, the one as a partial, the other as a total, extinction of the vital powers of the part — results that may be induced without any previous inflamma¬ tion. The paper closed with some detached observations introduced as corollaries, and referred chiefly to serous effusions. The author was inclined to regard the princi¬ pal function of the cells of the lax cellular membrane as reservoirs spread over the surface of the body, to receive a portion of the circulation when from some morbid cause the blood in the superficial capil¬ laries was stopped or impeded in its course. The splanchnic cavities performed a similar office to the large viscera when obstructed ; and the author concluded his observations with narrating an unusual case of ascites from scirrhous liver, in which several of the exhalants opening on its anterior aspect were so enlarged, as readily to admit the end of a probe. [It has been arranged, as we mentioned in our last, that the discussion of this paper is to take precedence of other busi¬ ness at the next meeting on Tuesday next.] 032 BRITISH MEDICAL ASSOCIATION. BRITISH MEDICAL ASSOCIA¬ TION. MEETING AT EXETER HALL. A meeting of the medical profession, con¬ vened by the new Association, was held at Exeter Hall on Thursday evening last. The weather was extremely unfavourable; notwithstanding which, upwards of a hun¬ dred gentlemen were present. Many were unavoidably absent in consequence of the prevailing epidemic. A few minutes after 7 o’clock Dr. Webster, the Chairman, attended by several members of the Coun¬ cil, entered the room, and was loudly greeted. The Chairman, in opening the business of the meeting, said that it was convened for the purpose of listening to a statement of the principles and objects of the Asso¬ ciation, and of the means by which it was proposed to carry those objects into effect. At a provisional meeting which had been held, it was resolved that the Society should be called The British Medical Association; that a council should be formed, and officers appointed; and that a code of laws to regulate the proceedings of the Association should be drawn up, sub¬ ject to the consideration of a subsequent meeting. The names of the gentlemen who composed the Council would now be read, and the code of laws would be sub¬ mitted to the meeting. The names of the Council being read, The Chairman proceeded to read an address of some length, for the purpose of explaining more fully the princioles and objects of the Association. It first referred to the unsettled state of the medical pro¬ fession of England, as it regarded the consulting physician, the surgeon, and the general practitioner. Three causes were assigned for that state ; first, the neglect of medical affairs by the legislature; se¬ condly, the selfishness and misgovernment of those who ought to encourage medical science, and protect the profession; and thirdly, and chiefly, from the apathy, jea¬ lousy, and disunion, existing in the body itself. Various attempts had been made to redress their grievances, but in vain. The burden was, at length, become almost insupportable. Systematic attempts wrere still made to degrade and lower the re¬ spectability and usefulness of medical practitioners ; and the cup of endurance had risen to overflowing. The profession was now aroused to a sense of the duty it owed to itself, and the present was regarded as a most fit time to obtain redress. Many divisions and distinctions prevailed which were unnatural and degrading. The inte¬ rests of the three branches were placed in variance; and one was often accused of infringing on the other’s provisions. At the fountain heads, as they were called, of professional honour and dignity, the colleges and corporations, unseemly dis¬ tinctions prevailed, inconsistent both with what was due to the members themselves, and to the public at large. Those insti¬ tutions possessed undue powers, and were governed by defective laws. Even if the antiquated charters of Henry VIII. and of James I. also of George III. together writh more recent provisions, were duly executed, they would still be totally inade¬ quate to the wants and requirements of the profession, as well as incompatible with the spirit and intelligence of the times. In some cases the powers those institutions possessed had been employed for the purposes of persecution and op¬ pression. The address then referred to the College of Physicians, and complained of the unjust and degrading division of the Fellows and the Licentiates. The first were a sort of aristocratic rank, pluming themselves on their supposed superiority, in having been educated at Oxford or Cambridge, though the fact was, that at those Universities the facilities for acquir¬ ing a knowledge of anatomy and medicine, as well as the mode of teaching, were far less than at many other places. The Li¬ centiates, on the other hand, though de¬ graded and insulted, had generally receiv¬ ed a thorough education in all the branches ; they were nevertheless account¬ ed unworthy of a single post of honour in the College, and were generally excluded from Court and public appointments. Yet, by a recent return to parliament, the whole number of Fellows was 1 13, of whom 60 resided in London, while the Licen¬ tiates amounted to 274, of whom 142 are resident in the metropolis. But the Col¬ lege of Surgeons was still more illiberal, monopolizing, and exclusive. It was governed by a Council of 21, who were self elected, and continued for life. The members of the commonalty were said to amount to 12,274; yet the bye-laws of the College excluded all members who were general practitioners from having any voice in the election of the Council. Counsellors could only be chosen from among the consulting, or pure surgeons, who amounted to about one hundred in London, and nearly the same number in the large towns ; but the latter were not eligible. Persons, even among those, if known to be of liberal principles, were passed over, or could only take their seats by turning traitors to their princi¬ ples, and as the reward of their apostacy. Then as to the Company of Apothecaries; what monstrous and absurd powers had BRITISH MEDICAL ASSOCIATION. 633 been granted to that trading company ! — powers which were almost thrust upon them by the jealousies and impolicy of the Colleges of Surgeons and Physicians; — powers at which they themselves were greatly surprised; — powers of which they ought long ago to have been deprived. There were, it was true, some distinguished and amiable men in all those bodies, but in their corporate capacities were exhibited the natural and unfortunate effects of irre¬ sponsible powers, and the rottenness of the whole system, at present, of medical policy. The address then referred to the changes w’liich might be produced by the introduc¬ tion of w'holesome laws — by institutions properly elected and duly responsible — by due encouragement to real talent, &c. There would then be no exclusive teachers — no favourite schools, apart from real skill — the great hospitals W'ould be pu¬ rified from misgovernment and nepotism ; there would be legal competition ; ho¬ nours and dignities would be accessible to all who deserved them; unqualified and illegal practitioners would be restrained ; quackery would be put down, or greatly diminished; chemists and druggists would be duly registered, and not allowed to practise or prescribe. Then no poor-law commissioners, or their deputies, would be able to control a class of gentlemen, or introduce their pretended self-supporting clubs, | or advertise for parochial sur¬ geons, or for attending on the poor by tender. For the attainment of such ob¬ jects the Association w'as formed, and now sought the co-operation of the W'hole pro¬ fession. It w'as not intended to assume a literary or scientific character — that w’as deemed unnecessary; its intention was to confine itself chiefly to what was called the business of the profession. Its central situation, its contiguity to parliament, its vicinity to the Colleges, &c. rendered it remarkably adapted to that purpose. Meanw'hile they wished to encourage the formation of Provincial Associations, who might contribute the requisite funds, collect evidence and information as to the existing evils, w'ateh the workings of the Poor-Law' Commissioners’ schemes, for¬ ward petitions to parliament, &c. &c. The present period w as remarkably favourable to such a union of liberal-minded men. The legislature and the government seemed quite willing to interfere. They had lately afforded assistance to a highly- talented member of the profession, who was also a member of the House of Com¬ mons (Mr. Wakley), in obtaining the Me¬ dical Witness Bill; and further assistance was promised him by Lord John Russell, in the formation of a committee for in¬ quiring as to the medical relief afforded to the poor in the Unions. The great principle had also been acknowledged in the new charter of the London University, that degrees could be conferred in the me¬ tropolis, and without reference to any re¬ ligious opinions or distinctions. The address then adverted to twro pro¬ visions made in the code of law's; the first of which was the appointment of a Court of Honour, for the adjustment of any misunderstandings between members of the profession ; and secondly, the forma¬ tion of a benevolent fund, for the assis¬ tance of decayed members of the profes¬ sion, and their widow's and orphans. The address concluded by an urgent re¬ commendation of the principles and ob¬ jects of the Association, and a call upon all present for vigorous and persevering co operation. Mr. Eales, the Secretary, then read the laws and regulations of the Association. Mr. Powell proposed a resolution, to the effect that the meeting cordially ap¬ proved of the objects and intentions of the Association ; that it approved also of the code of laws w hich had been read, and recommended their adoption; and that the address delivered by the chairman be printed and distributed among members of the profession. He lamented that any jealousy or disunion should prevail amongst members of the medical profession, as that was one cause why their injuries had been so long perpetuated. They were not be¬ hind the professors of law, or of theology, in their aims to benefit their fellow' men, and yet there was no body of men so ge¬ nerally disregarded. The fault he be¬ lieved to be altogether their own. They had not stood before the public in their just position ; they had been estimated as a set of tradesmen ; and, though they la¬ boured hard, they often lived poor and died in want. He was anxious they should assume their proper station. Efforts had sometimes been made, but, because of some pecuniary loss, individuals had been discouraged, and their privileges were not obtained. He sincerely wished that invi¬ dious distinctions w'ere at an end, and that regard was had to talent, irrespective of minor considerations. Where there was real talent, it would be found out by the public, and they would patronize it. He adverted to some of the provisions made by the code of laws, and expressed his earnest expectation that, by unity of effort, they should succeed, however small their beginnings, to accomplish all they wished. Mr. Hooper dwelt on the importance of the Benevolent Fund, and lamented that the medical profession should be so far behind some of the most ordinary trades. He also adverted to the protec¬ tion which they needed against unjust 634 BRITISH MEDICAL ASSOCIATION. prosecutions. Some might say, “ Apply to the College of Surgeons to assist you hut he believed that he might as well ap¬ ply to St. Paul’s Church Yard. He se¬ conded the resolution with much pleasure. Dr. Murray, of Lincoln’s Inn, had been induced to desert the profession, be¬ cause of the difficulties which lay in the road to eminence — because empirics and quacks had been allowed to practise with impunity — and because, in the corporate bodies, a system of exclusion and nepo¬ tism prevailed, by which persevering talent was often excluded from dignity and ho¬ nour. That state of things had arisen out of the want of union in the profession, and from the want of proper laws to pu¬ nish mere pretenders, and to protect men of real talent. The proposed Court of Honour would have very little to do if such an Association prospered. The pro¬ fession would not then be subjected to in¬ sult from deputies and subalterns of poor- law commissioners, nor be treated as though they were errand boys to the poor. Then the quack, on one side, would not be able to thrust his drastic pill by hundreds down the throats of his wretched patients, nor would a fashionable quack, on the other hand, stand by the couch of expir¬ ing mortality prescribing the decillionth of chamomella. Had such an Association been formed some time ago, he should not have abandoned the profession of medicine for a profession which was far more ardu¬ ous, but which presented no barrier to persevering industry. He wished to know whether one object of the Association would be to obtain a consolidation of the various laws in reference to the profession. The Chairman, in reply, stated that such an object would be desirable, as well as the obtaining of new laws which should embrace the whole profession. He thought the profession might be divided into two general classes — the general prac¬ titioners, and the consulting practitioners. Dr. J. Johnson agreed that talent ought to form the only distinction in the pro¬ fession; but he thought that as such ob¬ jections were urged against the College of Surgeons because they excluded general practitioners from their Council, it was equally objectionable on the part of the Association to exclude surgeons and phy¬ sicians from its Council. Such exclu¬ sions were neither liberal nor politic, and though he was not personally affected bv them, he could not but think it would be best that talent should be the qualifica¬ tion, irrespective of the particular line of practice. The Chairman intimated that such an alteration ought to be introduced, if the Council saw fit, as he wished the Associa¬ tion to be placed on the broadest basis. He should wish it to preserve the cha¬ racter of a representative society. Dr. A. T. Thomson thought they had not acted wisely to set out by vilifying any individual or corporate bodies. He was not prepared to oppose the formation of the Association, nor was he prepared to go the length of what had been stated in the address. He could not thus join to vilify public bodies. The Chairman wished to know what body had been vilified. Dr. Thomson referred to what had been said about the Colleges. The Association ought to have been one of inquiry, and not of censure. Such inquiry might be pro¬ ductive of much good. Let not the Asso¬ ciation plunge at once into a radical re¬ form which can only do injury. He would fain become a member of the Asso¬ ciation, but he could not support that por¬ tion of the address, and should be very sorry to see it published. Mr. Powell replied that inquiry was altogether unnecessary where abuses were so palpable. They might proceed in a namby-pamby course of inquiry, asking the corporate bodies to assist them — currying favour with the men who had been trampling upon them for twenty years. The abuses were well known, and he would have them seek relief where alone it could be rationally hoped for — namely, from the legislature of the country. The Chairman disclaimed all intention to vilify any individuals or body of men, and deprecated all new inquiry, as alto¬ gether unnecessary. Mr. Body said that he had seceded from the Association on the very ground taken by Dr. Johnson. The address was most pleasing and delightful with that exception. He wished all distinctions to be done away with , he hated them, though he loved the men who bore them. The dubs would fain make them appear little men, that they might stride over them as so many Colossuses. Mr. Lucas contended that as pure sur¬ geons laboured under grievances in com¬ mon with general practitioners, the latter ought not to act so ungenerously to the former as to exclude them from this As¬ sociation, and thereby aid in preventing them from obtaining redress. Mr. Webb said that he read the ad¬ vertisements by which the present as¬ sembly was convened, and he determined upon appearing amongst them, and join¬ ing the Association. He had, however, been much displeased with the address wiiich had been read, and had resolved to give a silent vote against it. Observations had since been made which had led hi in to the conclusion that it ought not to ap¬ pear before the public that the general BRITISH MEDICAL ASSOCIATION. 635 practitioners unanimously concurred in the remarks which bad been made against the three corporate bodies. The chair¬ man had asked what those corporations had done for the profession ; in reply to which he (Mr. W.) would simply answer, that to them they were indebted for nearly the whole of the medical literature w hich they possessed. Mr. Meade, in reply to Dr. Thomson’s observations, contended that if they want¬ ed reform in the medical profession, they must not have recourse to milk-and w'ater speeches regarding the Colleges. If they went before those institutions cringing, they would be spurned from their doors. No spirit should induce the general prac¬ titioners to dissever themselves. The Col¬ leges of Physicians and Surgeons could not withstand the united exertions of the medical profession. They had too long borne the oppressive measures of those chartered bodies. The Society of Apothe¬ caries had opposed the most beneficial measures, and had done but little to raise the profession in the estimation of the public. They did not protect medical men from quacks, — on the contrary, they had shewn a disposition to prosecute members of the College rather than those who had no diploma whatever. He was sure that the address was sufficiently mild, and though he had listened to it with great attention, he had not heard any terms which could be construed into vili¬ fication. He was sure that on subsequent reflection Dr. Thomson w7ould come to the conclusion that the terms which he (Dr. T.) had employed were unjustly severe. He trusted that this Association would go on and prosper. Mr. Lucas was desirous of knowing whether it w7as competent to an individual to offer a motion with regard to the rules. The Chairman replied in the negative. They must remain unaltered till the meet¬ ing in March. He could assure Dr. Thomson that the address had not been drawn up in a hostile spirit. It was of no use to make inquiries : they knew that grievances did exist. What boon had the Society of Apothecaries conferred on the profession ? Did they hear of the Society prosecuting a quack, or adopting any other measures calculated to promote the interests of the profession ? With respect to the College of Surgeons, it had opposed the very act which had been lauded by Dr. Thomson — the Apothecaries’ Act. It was disgraceful to place such power in a trading body : it ought to have been invested in the hands of those who wrere neither surgeons nor phy¬ sicians. Had the power been conferred on stone-masons, they might have ap¬ pointed proper examiners, and the pro¬ fession w7ould have derived an equal amount of benefit. It was not intended that such powers should fall on the So¬ ciety of Apothecaries ; and Dr. Burrows had stated, in his parliamentary evidence, that it was not prepared to receive them. There w7as so much illiberality in the body, that Dr. Burrows was obliged to withdraw himself from them. He was sorry to be compelled to make these remarks; but having grievances of which to complain, they wrould be fools if they did not seek their redress. Dr. Thomson felt called upon to state, that he had been very greatly misunder¬ stood. He had stated that he had no ob¬ jection to the Association; so far from it, he had attended the meeting writh a view of supporting it, but he did not anticipate hearing the language which the address contained. It wras his decided opinion that the mode of gaining the object wrhich the Association had in view, w7as not that of couching their sentiments in strong terms ; they ought to speak sincerely, but calmly. The language of the address would be injurious to the Association; he regretted it deeply, because he wras anxious for the prosperity of the Associa¬ tion. It had been loosely stated that no¬ thing but talent ought to regulate the opinion of the public; but the public had not shewn themselves accurate discrimi¬ nators, and could not judge of the qualifi¬ cations of medical practitioners without the aid of some other test than their own. He conceived that different ranks w7ere still necessary in the profession. The Chairman suggested that that question had not been mooted, and that talent was not sufficient for a medical man without proper qualifications. Dr. Thomson resumed : But who were to give them tho e qualifications ? It wras now7 vested in the three corporate bodies. He thought that the Society of Apotheca¬ ries had been unhandsomely treated ; it had taken general practitioners from the low7 state in which they formerly stood, and made them scientific men. Dr. Thom¬ son then contended that the medical pro¬ fession had failed to reform itself, and that it w7as only in consequence of the present legal obligations to attain a cer¬ tain degree of education, that general practitioners w7ere better qualified than formerly. He admired the Association, and hoped that the assembly w7ould speak of their grievances like sober-minded men. Mr. Crisp argued, that if the public were unable to discern men of talent, they must be enlightened upon the subject. The Chairman admitted that a great deal of good had been done by the Apo- 63(i OBSERVATIONS ON MR. SEARLE's VIEWS RESPECTING tliecaries’ Act, but it was procured from the legislature by general practitioners themselves. He hoped that they would soon have one faculty of medicine existing in this country, having equal powers. It was the system of favouritism which had frequently prevented men of talent from succeeding in their profession. It was very rare for a Licentiate of the College of Phy- sians to become a court physician. The resolution was then submitted to the meeting, and carried almost unani¬ mously. The Chairman hoped that Dr. Thom¬ son would favour the Association with the aid of his talents. Dr. Thomson again expressed himself as friendly to the Association, but not to the address. The Chairman, in reply to a question addressed to him by Mr. Glass, one of the pupils at the London University, stated that he saw no objection to pupils joining the Association. Dr. Hull then moved a vote of thanks to the Chairman, which was carried by ac¬ clamation. The Chairman briefly acknowledged the compliment, and the meeting sepa¬ rated. OBSERVATIONS ON MR. SEARLE’S VIEWS RESPECT¬ ING THE TREATMENT OF INFLAMMATION. To the Editor of the Medical Gazette . Sir, As Mr. Searle, of Kennington, has pub¬ lished a reply in your journal, to the ob¬ servations which I some time ago made upon a paper of his, and as he seems to think I have acted disingenuously towards him, I beg that you will do me the favour to make room in your next number for the following rejoinder: — Mr. Searle commences his reply, by say¬ ing that I have assumed a name which does not belong to me ; that my proper name is “ Conservative,” because I complain “ that long-cherished medical theories and modes of practice are (being) abandoned and surely, if I am on that account to be so denominated, I may take the liberty to retort, and to call Mr. Searle a “ Radical,” because he wishes, with the besom of de¬ struction, to sweep away ‘‘theories and works of practice,” which experience has led the members of the profession to che¬ rish, and to raise in their stead “ new¬ fangled doctrines.” After bestowing upon me the appellation of Conservative, a name to which I certainly have no kind of objection, he says, that while charging him with inconsistency I do not perceive my own ; that I have opposed my “ mere words of the moment to facts which have required many years to collect and inves¬ tigate;” and then, in an indirect manner, endeavours to show that I have raised pre - judices against Mr. Radley’s method of treating fractured bones, merely because it was new to me ; but I beg to observe, that if Mr. Searle will read the papers which I have published on that subject, in your Journal, he w'ill perceive that I have ad¬ duced reasons in support of my objections to Mr. Radley’s practice, and, therefore, that I have not opposed that gentleman’s mode of treating fractured bones, merely because it was new to me. Mr. Searle then goes on to homoeopathy, and observes, that I should have been much more like a true investigator, if, before denouncing that method of treating dis¬ eases as a “ mania,” I had first made trial of it; which is just as much as to say, that no one should presume to laugh at any medical novelty, however absurd it may appear to be, without first trying it. But how is homoeopathy to be tried? Cer¬ tainly not in mild, trifling complaints, because, in such cases, nature W'ould often perform the cures, and homoeopathy re¬ ceive the credit. And I beg to observe, that the man who, in the case of a danger¬ ous disease, did nothing more than pre¬ scribe a few (“ billionth part of a grain”) doses of common sulphur, or of any other kind of medicine, in order that he might give homoeopathy a trial, would probably soon find, by the fate of his patients, that he had committed an error, the recollection of which, unless his conscience happened to be “ seared as with a hot iron,” w ould imbitter many of the moments of his fu¬ ture life. Homoeopathy is not quite so innocent in its nature as some persons imagine it to be. It is true that the exceedingly small doses of medicine which are given cannot possibly of themselves do harm, but the time w'hich must necessarily be spent in administering them, and in wait¬ ing for their effects, when other and more rational means ought, at the first, to have been had recourse to, cannot be recalled. I therefore, notwithstanding Mr. Searle’s opinion upon this point, do consider that a “ true investigator without first making experiments according to the infinitessimal system, may safely venture to call any thing which is so obviously absurd as ho¬ moeopathy a “ mania.” Mr. Searle next proceeds. to what he calls his own “ mania,” and complains that, by making too short a quotation from his paper, I have made it appear to be his THE TREATMENT OF INFLAMMATION. 637 practice, in the treatment of inflammatory diseases, to give food freely with one hand, and tartarized antimony with the other. He says, that tartarized antimony is so far from being a favourite remedy of his, that he has not recommended it to be taken in¬ ternally, above ten times, within the last six years; and that he placed it at the head of a list of sedatives, because it is most frequently employed by the profes¬ sion, and because he wished to make con¬ siderable strictures upon its use. But how could I, by reading the paper which he published in the Lancet, knowthat this was his intention ? In that paper he does not, as far as I can see, even hint at any thing like a want of affection for tartarized an¬ timony, excepting in cases where the arte¬ rial action is very high and strong; on the contrary, he never fails to name it first whenever he has occasion to recommend sedatives ; even in the very quotation re¬ specting which he thinks that I have dealt unfairly with him, he uses the following words: — “ Tf considerable pyrexia attend subacute inflammation, it is evident that the predisposing cause, excitability, is greater than the exciting cause, inflamma¬ tion. Under these circumstances, febri¬ fuge medicines, especially those of a seda¬ tive nature, as tartarized antimony , digitalis, Sec. will, in general,* produce a beneficial effect.” Now, if Mr. Searle does not, by this language, mean to recommend tar¬ tarized antimony, what does he mean ? But he says, let it be supposed that the Sec. in the above quotation (which it ap¬ pears I overlooked in my remarks upon his paper) had been really omitted by him, and that he had intended to recom¬ mend tartarized antimony only, (no matter whether he intended to recommend that medicine only or along with other things, he certainly did recommend it) that its use is restricted to cases in which considerable pyrexia attends subacute inflammation; that the patients who are subject to this form of pyrexia are either very young children, or persons of very delicate con¬ stitutions, who habitually take but little food, and who, when ill, manifest, in ge¬ neral, an insuperable aversion to it; that to children tartarized antimony is never given, nor even thought of; and therefore that there can be no inconsistency in giving that remedy, with the one hand, to very delicate persons, who have an aversion to food, because, as they cannot take nourish¬ ment, it is impossible to feed them freely with the other. Now all this appears to me to be merely an attempt to get out of a difficulty through a loop-hole. But, ad¬ mitting that the above explanation really did remove the inconsistency which Mr. Searle says I have disingenuously laid to his charge, the practice, even then, is in¬ consistent, because it is in direct opposi tion to the “ new-fangled” doctrine, which it is Mr. Searle’s object to support. But Mr. Searle does not, in every part of the paper which he has published in the Lancet, restrict the use of tartarized anti-, mony to cases in which considerable py¬ rexia attends subacute inflammation, or, in other words, to very delicate persons, who cannot take food, as the following quotation from that paper w ill show : — “ The most direct method of removing inflammation is suggested by observing the manner in wffiich it was produced. For instance, if a local phlegmasia be brought on by excitement of the general circula¬ tion, the use of an agent which, like tar- ta’ized antimony , depresses the general cir¬ culation, is the most direct method of counteracting the agency of the cause, and, as it were, of undoing the disease.” Here there is no restriction to the use of tar¬ tarized antimony. No, the treatment is to be conducted, not according to the kind of inflammation, but according to its cause; and, therefore, although a patient may not be very delicate and weak, but on the contrary, strong and robust, if the disease under which he labours has been brought on by excitement of the general circulation, he is to be lowered by means of tartarized antimony; and T must ob¬ serve, that the precepts of the “ new¬ fangled doctrine,” as far as regards the diet, are either, at the same time, to be followed or not. If they are not to be followed, the treatment is purely lowering. It is antiphlogistic ; it is the very treatment which, if Mr. Searle means any thing by what he whites, it is his avowed object to oppose ; and if they are to be followed, that is to say, if milk, beer, wine and water, eggs, or good brotb, are at the same time to be “fearlessly administered,” then the inconsistency, which he says I have disingenuously laid to his charge, becomes glaringly conspicuous. He must, there¬ fore, either admit that he recommends, at one time, a practice which, at another, he condemns, or that I have not, after all, dealt unfairly with him, by making it ap¬ pear to be his practice, in the treatment of inflammatory diseases, to give food freely with the one hand, and tartarized anti¬ mony with the other. But, after reading the paper which Mr. Searle has published in the Lancet, from the beginning to the end, it will, I think, be very difficult for any one clearly to under¬ stand what, upon the whole, he really does mean. In one part of that paper he says, that “ very high and strong arterial action cannot be controlled by sedative medicines, as tartarized antimony and digitalis ; for 638 MARYLEBONE SERF-SUPPORTING DISPENSARY. small doses of thesemedicines have no effect, while large doses occasion vomitings, which are often distressing and injurious to in¬ flamed organs, and, unless they produce a uniform sedative eflect, they are perni¬ cious, as temporary depression of the cir¬ culation induces reaction, and thus de¬ feats the object to be attained, and to nauseate the stomach, without subduing the disease, is worse than useless, as it renders the patient incapable of taking that nutriment which, of itself alone, would, “ according to Mr. Searle’s views, tend to diminish the pyrexia.” But if nutriment, in a case of this kind, be all that is re¬ quired, why speak of sedatives at all. It is not a sedative effect that is wished for, even if it could be produced. No; very high and arterial action is not, according to Mr. Searle’s views, to be lowered; on the contrary, it is to be increased, by nutri¬ ment, which, if “ judiciously and fear¬ lessly administered,” will of itself alone tend to subdue the disease. Now this, it must be admitted, is strictly in accord¬ ance with the “new-fangled doctrine;” indeed, it is the new-fangled doctrine it¬ self ; but does it agree with the practice, which, as has been shown, Mr. Searle, in another part of the same paper, recom¬ mends, of giving tartarized antimony, with the view of “ undoing the disease,” by lowenng increased arterial action ? Ret those who have read Mr. Searle’s paper, and who clearly understand what, upon the whole, he really does mean, give the answer. In this way I might go on, making quo¬ tations and animadversions upon them : f but it is not necessary that I should do so, because the new-fangled doctrine and my remarks upon it are already before the members of the profession, who, of course, will judge of both for themselves. I shall therefore conclude, by saying, that al¬ though a staunch conservative, I am not hostile to what may be called the phlo¬ gistic plan of treating inflammatory dis¬ eases, because it is new ; on the contrary, if it should so happen that T shall at some future period of my life, according to Mr. Searle’s prediction, become convinced of the soundness of his views, I beg to assure him that I shall then, instead of in¬ dulging in disingenuous observations, at once abandon “my long cherished” mode of practice, become his follower, and sup¬ port, with zeal, the “ new-fangled doc¬ trine/” — I have the honour to be, sir, Your most obedient servant, Investigator. Jan. 16, 1837. MARYLEBONE SELF-SUPPORT¬ ING DISPENSARY. DR. COPLAND’S RESIGNATION. To the Editor of the Medical Gazette. Sir, Yoijr number of the 7th instant contains a letter, signed “ W. Eales,” on the sub¬ ject of self-supporting dispensaries. In this letter there is the following passage: “ Dr. James Copland was the consulting physician of the present Marylebone Dis¬ pensary, and I have been authorized by him to tell my friends that he was com¬ pelled to withdraw his name from the in¬ stitution in consequence of finding that really poor persons did not come to it, but that the patients were such as ought and could well afford to pay their medical men.” — P. 558. This statement is so contrary to fact, and contains such a serious charge of departure from the principles of the North West London Self-supporting Dispensary, that I have been directed by the Commit¬ tee directly to contradict it. Dr. Copland’s letter of resignation states as his reason for that step, simply that his engagements prevent him from performing satisfactorily to himself the duties which devolve upon consulting physician to the Institution. In a letter written by Dr. Copland a few days since to one of the medical officers, he states, “ as to the ex¬ pression quoted by Mr. Eales, I could not have made use of that, inasmuch as I do not know, neither have I had an opportu¬ nity of knowing, whether the patients of the Self-supporting Dispensary are able or not to pay a medical man;” and although in this letter Dr. Copland expresses his belief that this and other kinds of medical charities are open to abuse, he admits that he has not seen any one instance during his connexion with the North West Lon¬ don Self-supporting Dispensary. The rules of our Institution expressly declare that no person who shall appear to the Committee able to pay a medical attendant in the usual way, shall be ad¬ mitted to the benefits of the Institution; many are refused on this account, as the means , condition, &c. of the applicants are investigated by a committee, before they are entered. Further, whenever it is discovered that the means of a benefitted subscriber are be¬ yond the limits of a scale fixed by the Committee, the name of that individual is erased from the books. Several instances of this kind have occurred ; and the Com¬ mittee will be always thankful to receive such information respecting the means of any of the subscribers as shall prevent any UNIVERSITY COLLEGE AND HOSPITAL. 639 abuse of the Institution, and may thus preclude it from interfering with the pri¬ vate practice of medical men. Those who now degrade themselves by publishing un¬ founded charges and gross misrepresenta¬ tions of fact, should apply their attention to the actual working of the Institution; they would witness the benefits which it confers on the class relieved, and the honourable position in which it places me¬ dical practitioners; and if they should discover any instances of misapplication of the benefits of the Institution, by pointing them out, they would really do somewhat to increase its utility, and serve the inte¬ rests of the medical profession. Trusting that the same benevolent and candid disposition with which you have examined into the principles of Self-sup¬ porting Dispensaries will prompt you to insert in your next number this letter, in defence ot the first institution of the kind successfully established in London, I have the honour to be, sir, Your obedient servant, Joseph Hunt, Secretary. N. W. L. Self-supporting Dispensary, 40, Manchester-St. Jan. 18, 1837. SOCIETY of APOTHECARIES and THE NEW UNIVERSITY. To the Editor of the Medical Gazette. Sir, In your last publication but one. Scrutator lavs it down as a positive rule that, be¬ cause a gentleman does not apply for a mandamus, or to the Court of Assistants, in case he considers himself unjustly rejected, he must be conscious that he could not stand the test of a fair examina¬ tion. In my opinion, sir, he jumps much too quickly to a conclusion. In the first place, there is a very general impression that the money wdiich is to be paid on such a demand, is thrown away, inasmuch as the candidate is certain of a second re¬ jection, with (of course) double disgrace. In the next place, human nature is not always composed of such tough material as to embolden a person to face the Court of Examiners with an exclamation such as this “ I am not afraid of any questions you may put to me, feeling assured that I cannot in justice be rejected ” And where is the mind so comprehensive that does not shrink from an examination in the minutiae of all the sciences with w’hich students are expected to be conversant ? _ not that I mean for it to be understood that the Examiners expect a very intimate knowledge of all the sciences ; but I would ask any one to appeal to his own feelings, and say whether he would like to challenge such a body of men, who, t; ken collectively, no doubt, are well versed in all the subjects of the examination ? Scru¬ tator also asserts that the University can-, not in any way injure the cause of the Court of Apothecaries. Again, I think he is in error. I do not say it wilt injure them, for, on the one hand, there may be a reform in the Company, where it is needed, (and is there any public Institution that can be in such good humour with itself as to flatter itself with the idea that it needs no reform ?) and on the other, the Uni¬ versity may not in any way excel — but should it rise like a beacon to the medical world, as perfect as an institution of this kind can be, having profited by the errors of its rival, then, I think, no one will deny but that it may injure the business in Blackfriars. I have much admired, sir, the temperate manner in which you have treated this subject throughout, and I consider you are not less a friend to the interests of the students, because you do not rant and rave as if you had some great private interest in the matter. The longer I live, the more I am convinced that no¬ thing of any real importance can be ac¬ complished by such a course. Your giving this insertion in your next, will gratify an admirer and constant reader, Justitia. Plymouth, Jan. 17, 1837. UNIVERSITY COLLEGE AND HOSPITAL. DR. A. T. THOMSON. To the Editor of the Medical Gazette. Sir, It is, as you are I am sure aware, utterly impossible that any system of education can be perfect, or even beneficial to those engaged in its acquirement, unless a de¬ finite understanding exists between the teacher and those taught, as regards the period and manner of conveying instruc¬ tion. An absence of this understanding, or, more properly, an unwillingness, on the part of one of the physicians of the North London Hospital, to fulfil his necessary and mutual compact, (for such it assuredly is,) exists in the person of Dr. Anthony Todd Thomson. From the foundation of the hospital it has been declared, that clinical instruction and lectures would be regulai ly given both by physicians and surgeons; and, indeed, if we except that individual whose cul¬ pable negligence has called forth this pub¬ lic exposure, that pledge has been honestly and faithfully performed. But to con¬ tinue, and to state the grounds on which Dr. A. T. Thomson is now brought before your notice — Is not his absence from the Hospital, during the days he should visit his patients, not an occasional but con- G40 BILLS OF MORTALITY. - METEOROLOGICAL JOURNAL. slant occurrence? Is not the hour specified in the prospectuses as the period he goes round the wards, invariably passed before he makes his appearance at the Hospital door? And lastly, do not weeks constantly elapse without his delivering a clinical lecture, or even making a clinical remark in his passage around the wards? These questions, which must all be answered in the affirmative, require, indeed, no com¬ ment on my part ; they may, however, not inaptly be placed as a set-off to those cases occurring, or said to occur, at other hospitals, by a cotemporary famed for his impartiality (?) but who at least shall be nameless. I may, perhaps, shortly have occasion again to intrude upon your notice — not, I anticipate, as regards the hospital, but with some strictures on a portion of the medical department of the adjoining col¬ lege. In reference to the chair of materia medica, assuredly there exists a something which, unless speedily removed, must soon effect such a change — revolution, shall I say? — as, in all possibility, will re-act in such a manner as to place the long con¬ tinuance of that building, as a medical school, in perhaps the most precarious situation. If, among the abundance of communi¬ cations with which your journal weekly teems, the present can possibly find ad¬ mittance, you will confer a favour on your obedient servant, and constant reader, Observer. January 20, 1837. [The writer has authenticated his let¬ ter.- — Ed. Gaz.] NOTE FROM DR. HARGRAVE, OF DUBLIN. To the Editor of the Medical Gazette. Sir, In the London Med. and Surg. Journal, of the 31st ult. there is an article headed “ News from Dublin being informed that it is attributed to me, I beg through the medium of the Medical Gazette to state, that neither directly nor indirectly did I ever contribute any information whatever to that or any other journal, re¬ lative to the subject of the above commu¬ nication. To Drs. Graves and Stokes, and Mr. M. Collis, of the Meath Hospital, I am under deep and lasting obligations for the honourable and disinterested support given to me in the late election to fill the surgi¬ cal vacancy in that institution. I am, sir, Your obedient servant, W. Hargrave, M.B. York-, Street, Dublin, Jan. 14, 1837. TREATMENT OF INTESTINAL FISTULA. The success attending the employment of the hot iron in the cure of artificial anus, already recommended by Dieften- bach, is confirmed by two cases related by Dr.JFingerhuth. In both, abdominal inflammation, caused by violent blows, had been followed by external abscess, to which succeeded discharge of ftecal matters. Various cau¬ teries were employed to destroy the mem¬ branes lining the fistula?, and to convert them into granulating surfaces, but with¬ out producing their complete obliteration. The fistulous openings, although some¬ what diminished by imperfect granula¬ tions, showed no tendency to become closed. Cauterization was then adopted by means of an iron, corresponding in dia¬ meter to that of the fistulas, and the tem¬ perature of which was scarcely elevated to that of red heat. Luxuriant granulations soon covered the cauterized parts, the fis- tulie diminished, and the surfaces being again destroyed by a heated iron corre¬ sponding in size to the apertures which re¬ mained, they were eventually cured. — Woch. fur die ges. Heilk. Dublin Journal , Jan. 1837. WEEKLY ACCOUNT of BURTALS, From Bills of Mortality, Jan. 17 1837. Abscess 3 Inflammation . 37 Age and Debility . 75 Bowels& Stoftiach 5 Apoplexy . 8 Brain 1 Asthma . . 54 Lungs and Pleura 20 Cancer 2 Influenza . 13 Childbirth . . 5 Insanity 4 Consumption . 84 Jaundice 3 Convulsions . 30 Liver, diseased 5 Croup . 1 Measles . 7 Diarrhoea . 3 Mortification . 2 Dropsy . 22 Paralysis . 2 Dropsy in the Brain 9 Rheumatism . 1 Erysipelas . 2 Small-pox . . 1 Fever . 18 Thrush 2 Fever, Scarlet 6 Tumor . 1 Gout 3 Unknown Causes 29 Heart, diseased . 3 Hernia . . . 1 Casualties . 6 Hooping Cough . 9 Increase of Burials, as compared with > the preceding week . . S METEOROLOGICAL JOURNAL. Jan. 1837. Thkrmomkter. Barometer, Thursday . 12 from 19 to 36 30-06 to 29 65 Friday . . 13 29 49 29-44 29-53 Saturday . 14 30 39 29-82 30-10 Sunday . . 15 26 38 30*25 30-28 Monday . . 16 25 37 30-20 30-20 Tuesday . . 17 31 43 30-19 30-17 Wednesday 18 33 39 30 08 30.01 Winds N. and N.W. Except the 14th and 5th, generally cloudy; rain on the 13th, 16th, and 17th ; snow on the afternoon of the 12th. Rain fallen, *425 of an inch. Wilson & Son, Printers, 57,Skinner-St. London, THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOTONAL OF ittfti trine anil tfje Collateral Primers. SATURDAY, JANUARY 28, 1837. LECTURES ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine, Br William Cummin, M.D. Lecture XVIII. Premature and Retarded Births — Occasions of inquiry respecting such births, in civil and criminal cases — Law of Legitimacy — Provisions of the Civil law — Ecclesiastical law — English law of legitimacy traced from the earliest period — Decisions in the English courts — French and Prussian law ■ — Question of Prematurity — Grounds for medico legal decision — Question of Retardation — Analogy in favour of the occurrence — Facts and cases in confirmation — Vagueness of the testi¬ mony in favour of a fired limit — Conclu¬ sion of the argument — Peculiarities of the Gardner peerage case — Supplejnental note. Another view which we have to take of the births of children, is as they may be premature or retarded. premature and retarded births. Occasions of inquiry : 1. Prematurity. — The question of prematurity of birth may be raised in civil or criminal cases. A woman who has been married, perhaps no more than six or seven months, brings forth a child which appears to have attained its full uterine development; if this prove to be the case, upon a proper inspection by competent medical authority, the birth is premature and illegitimate. Again, a woman is charged with con¬ cealment of the birth, and the presump¬ tion of her guilt is strengthened by the fact of her having made no preparation for her delivery ; if it can be proved that 478. — xix. the birth was premature — that labour came on unexpectedly, at the seventh or eighth month — it will constitute a strong ground of defence ; but such proof must be made out by medical evidence. It is scarcely necessary to remind you of the remark I made in a former lecture, that premature births are not to be con¬ founded with immature; the latter hav¬ ing reference solely to the condition of the foetus as to its development, while the former always implies that the infant has been born before the regular period, or the time usually allotted to a natural and lawful birth. 2. Retardation. — With respect to retarda¬ tion, a woman may bring forth a child ten, eleven, or twelve months after her husband has died, or been separated from her. Is the offspring to be considered legi¬ timate ? In other words, are we to admit the plea of gestation having been protract¬ ed through grief, and depressing passions, or, indeed, through natural causes, where none of the former can be alleged ? How wide a field is opened for medico¬ legal inquiry, in the mooting of these questions, must be obvious; nor can it be less evident how much the tranquillity and honour of families depend upon the issue, as well as the reputation, and perhajis the safety, of individuals. As the question of legitimate or illegi¬ timate birth is closely connected with those of prematurity and retardation, we cannot proceed in a more orderly manner than in giving, previously to the discus¬ sion of the latter questions, a general ac¬ count of the Law of Legitimacy. Civil law. — Our earliest arrangements for the legal determination of legitimacy were borrowed from the Roman law. Pater is est quern nupti® demonstrant” was the comprehensive dictum of the Digest. But the demonstration of paternity created by marriage appears to have been only pre- 2 T 642 DR. CUMMIN ON FORENSIC MEDICINE. sumptive; for it was liable to be defeated upon proof of the husband’s impotency or non-access. One of the presumptions of non-access, or the absence of sexual intercourse be¬ tween the husband and wife, was the abnormal duration of pregnancy. The period of gestation was very early fixed by the Romans. The Decemvirs determined that ten months constituted the utmost limits to which it could be protracted; and Justinian enacted that the child of a widow born in the eleventh month after her husband’s decease, was illegitimate. It is further stated in the Digest, upon the authority of Hippocrates, that the period of gestation could not be less than seven months. When the birth occurred between the seventh month and the eleventh month — that is, within the legitimate period —it was still allowable to dispute the legiti¬ macy on the ground of non-access; evi¬ dence might be brought forward to dis¬ prove the occurrence of sexual intercourse between the husband and wife; but it was requisite that it should be very conclusive. Proof of the mother’s adultery was not allowed to bastardize the child, as her guilt and his legitimacy were not incon¬ sistent. Nor did the declaration of the husband or the wife against the legitimacy of the child, determine its bastardy. The fact was to be made out in the manner declared by law — namely, by proving im¬ potence or non-access. Ecclesiastical law. — The Canon law esta¬ blished a ground of legitimacy more defi¬ nite, though not perhaps more easy of proof, than that just stated. In the Decretals the doctrine of access is overlooked, and the paternity of the child is made to depend on the answer to the question ■ — by whom the mother conceived ? Whether she re¬ sided with her husband or the adulterer, the child was illegitimate, if it could be proved to have been begotten in adul¬ tery. All circumstantial evidence that could possibly elucidate the fact, even the resemblance of the child to the adulterer or the husband, w as admissible. The spirit of the Canon law would, indeed, almost seem to give the preference to the pre¬ sumption of illegitimacy over that of the opposite state. English law. — Neither the civil nor the canon law have ever expressly formed part ot the law of England ; though they have unquestionably had great influence in esta¬ blishing principles for us, and in guiding the dictates of our earliest authorities. Bracton, our oldest common law writer, expresses his definition of legitimacy al¬ most in the very words of the Digest : “ Le- gitimus h mres et filius est, quern nuptiae demonstrant esse legitimum.” But the exceptions which he admits to this funda¬ mental presumption have more latitude than either the civilians or churchmen allowed : they are these four — 1, the im¬ potence of the husband ; 2, the absence of sexual intercourse at the date of the wife’s conception ; 3, the non- recognition of the child by the father ; and, 4, any conclusive presumption arising from physical or moral causes that the child is the child of the adulterer. The second ground of exception, it should be mentioned, is left in considera¬ ble obscurity: where the question could be raised, the result would depend on the period assigned for the duration of gesta¬ tion ; and the only notice of this important point in Bracton, is to be found in his ac¬ count of the writ de vent re inspiciendo. When this writ was followed by a verdict of preg¬ nancy, the female was placed in safe cus¬ tody until the truth of the fact could be ascertained, or rather until there was no possibility of any future fruit of her alleged intercourse with her husband. The dura¬ tion of her imprisonment wTas therefore necessarily bounded by the extreme limit of gestation, and what this was we are left to speculate, for Bracton only observes that in case of the pregnancy taking place, it may be “easily known whether the child is really or presumptively the child of the husband, or of another person, by com¬ puting the period between the mother’s delivery and the death of her husband, as well as the period which she had assigned as the date of her conception. It is said, indeed, although others are of a contrary opinion, that a woman cannot exceed the period of gestation by one day, unless the child should have died in the womb, or have caused, by some extraordinary mal¬ formation, imminent danger to its parent.” He admits elsewhere that if the mother’s delivery be deferred to such a period as that “it is not probable that the child can have been begotten by the deceased hus¬ band, then the child is- liable to be bas¬ tardized.” With reference to the fourth ground of exception authorized by Bracton, the pro¬ ceedings connected with the execution of the writ de ventre, as already described, are sufficient proof of the admissibility of cir¬ cumstantial evidence to controvert the presumption of legitimacy. The female whose pregnancy wTas the subject of in¬ quiry underwent a strict examination by a jury of her own sex, and was obliged to answer a series of questions relative to the legitimacy of the child of which she could prove herself enceinte. These questions being prescribed by lawr, could not contain any irrelevant matter. They are not con¬ fined to the access, or even cohabitation, or virility of the husband, but assuming these LAW OF LEGITIM AC Vo 643 facts until they are disputed, they scruti¬ nize the circumstances of the conception with such minuteness, as to shew the lia¬ bility of the child to be bastardized as the result of an adulterous intercourse, al¬ though the mother was living with the husband at the date assigned for the con¬ ception, and under no disability of having conceived by him. The jury were to in¬ terrogate her “ concerning the time of her conception — how, token, and where, it took place.” If the mother ascribed her con¬ ception to an adulterer, and satisfied the jury, from the correspondence of time and place, of the truth of her statement, there seems no reason for doubting that the fact of bastardy would be treated like any other fact, and pronounced sufficiently proved. The questions would otherwise be nugatory. Fleta, the copyist or condenser of Brac- ton, differs in no essential respect from his original. He is wholly silent on the pe¬ riod of gestation, and his only notice of the moral evidence by which the presump¬ tion in favour of legitimacy can be affect¬ ed, is with reference to the recognition or non-recognition of the child. When we look into the writings of Britton, another of our old English jurists, but comparatively more modern than ei¬ ther Braeton or Fleta (these by the way, wrote in Latin, while the former used the old Norman French), we find there some thing definite respecting the limits of ges¬ tation. It is Britton who has left us the most detailed account now extant of the process under the writ de ventre inspiciendo. We learn from him that forty weeks con¬ stituted the limit of the period during which the widow could be confined under this writ, and that the illegitimacy of the child was the inevitable result of the birth being protracted beyond that time. The heir was entitled to demand immediate possession of the fief upon the expiration of the forty weeks, and the right could not, upon any pretext, be any longer suspended. On the other hand, if it proved that the pregnancy was real, and the birth occurred within the forty wreeks, it did not follow de facto that the legitimacy was secured. The heir presumptive was still at liberty to aver that the child was begotten by an adulterer, or that the husband was absent long before its birth, or that its legitimacy was irreconcileable with any obvious or notorious circumstance : and if the heir could establish any one of these averments, it is expressly declared that he should not be deprived of the inheritance. The earliest case of contested legitimacy on record, was decided five years after Britton’s death — namely, Foxcroft’s case, 10 Edward I. (1282). An infirm sickly man, confined to his bed, was married pri¬ vately, and without the usual solemnities, to a woman who was already pregnant; in twelve weeks after marriage she gave birth to a son, but it was adjudged a bastard. The clandestine nature of the marriage, there can be little doubt, operated in deter¬ mining the verdict for the facts appear to have afforded ample ground for presum¬ ing a conspiracy, and thus constituted the strongest moral evidence that the child was illegitimate. But the subsequent practice of the Eng¬ lish courts was not in accordance with the spirit of Braeton, Fleta, and Britton. In the Year-Books we find the question of le¬ gitimacy once more cramped within very narrow limits. The fact of legitimacy was always presumed, unless it could be disproved by what was called special mat¬ ter — viz, the husband’s impotency, or his being out of the seas ( [extra quatuor ma¬ ria) during the period of his wife’s gesta¬ tion. Chief Justice Thorpe decided in a case, 41 Edw. III. “ that all matter was irrelevant which was only argumentative to prove the bastardy, for the party ought to conclude, and so bastard meaning by “ conclude” to adduce the special matter of impotence or ultra-marine absence. And this decision was held binding through several successive reigns. It may serve at once as an example of the partiality towards the civil law dis¬ played by some of the judges, and a specimen of the language of the court on some of these trials, to mention that Judge Richill (7 Hen. IV.), in giving judg¬ ment in a case, used the extraordinary ex¬ pression, more emphatic, certainly, than decorous — “ Whoever bulls my cow, the calf is mine!” The Year-Books are wholly silent as to the legal period of gestation. But Mr. Hargrave, the learned annotator of Coke Littleton, after diligently examining some contemporary sources of information, con¬ cludes, “ that the law recognized forty weeks as the usual period of gestation, but exercised a discretion of allowing a longer period where it teas required, by the opinion of physicians, or the circumstances of the case.” And this, perhaps, is as nearly as possible the actual state of our common law on the subject. Lord Coke, with some inconsistency, has stated forty weeks to be the “ ultimum tempus pariendi,” while he refers to an authority which does not altogether war¬ rant his statement: he is also at variance with some decisions of the courts in his own lifetime, which allowed forty weeks and ten or eleven days as the latest period. It is curious enough, that from this time until the year 1825 (an interval of nearly 200 years), the question was not again agitated in 644 DR. CUMMIN ON FORENSIC MEDICINE. this country. A case, Foster v. Cook, which occurred in Lord Thurlow’s time, has been sometimes referred to as sanc¬ tioning a period of forty-three weeks; but it has been rejmdiated by some of the best authorities, and pronounced to be unde¬ serving a place in our reports. It was in the year 1825 that the pro¬ ceedings on the claims to the Barony of Gardner took place before the House of Lords. 1 shall presently state the chief facts connected with that case, but may here mention, that it was attended with peculiar circumstances, in the highest de¬ gree interesting to the medical jurist. It was argued by the ablest counsel before the most learned law- lords of the day, and the testimony of sixteen accoucheurs, of the highest celebrity in London, was heard on the respective sides of the question. For¬ tunately we are possessed of an accurate report of the evidence, as well as of the opinions and judgments of their lordships. The whole has been, published in one vo¬ lume by Mr. Le Marchant, who was en¬ gaged as one of the counsel in the case ; and to this gentleman’s luminous preface J have to acknowledge myself much in¬ debted for many of the preceding remarks. In France. — The French law, previous to the Revolution, was very unsettled and vague in respect to decisions concerning legitimacy. Even so late as the year 1779, the parliament of Rouen recog¬ nized as legitimate a child born eleven calendar months and a day (nearly 48 weeks) after the death of the alleged father. But the Code Napoleon, the existing law of France, withholds the presumption of legitimacy when the child is born 300 days after the dissolution of the marriage, or when its birth has been concealed from the husband. I?i Prussia. — It may be added that the Frederieian code, without absolutely de¬ claring children born in the eleventh month illegitimate, attaches such conditions to the proof of their legitimacy as make it almost unattainable. Question of Prematurity . 1. Where the infant is apparently full grown. —The most usual form in which the ques¬ tion of prematurity is raised respecting a birth is, when a child, with all the appear¬ ance of having reached the limits of intra¬ uterine development, is born at a date too near the marriage day, or the return of the husband after a long absence. Sup¬ pose at six or seven months a married wo¬ man brings forth a child of the full size and perfect grow7th, there can be no room to doubt but that it is illegitimate; for a child of six or seven months has never been knowm to attain the development of nine. It is certain that at nine some infants are still very small, and perhaps no larger than many at six or seven months ; but still the difference is characteristic, and not to be mistaken : the nine months’ child will always be found much farther advanced in grow'th ; the colour and tex¬ ture of the skin, the nails, the hair, the re¬ lative proportions of the trunk and limbs, together with other peculiarities already described*, will serve sufficiently to mark the distinction. 2. Where it is immature. — Should the infant present obvious appearances of being incompletely formed, the question of premature birth may yet be raised if the growth attained do not correspond with the time elapsed since marriage, or the return of the husband. We had an instance of this kind in the fama cla- mosa case, noticed in a preceding lecture, where, at five months and a half after marriage, an infant w7as brought forth, which was living, and not unlikely to continue to live. The difficulty was to shew, that, though immature, it was not premature (as considered in reference to the date of the marriage), nor, therefore, illegitimate. Medical evidence wTas eager¬ ly sought, in order to decide the question ; but the moral circumstances seem to have had more weight than the physical in removing the scandal. Parturition habitually early. — There is a peculiarity in the nature of some wro- men wffiieh ought not to be forgotten — namely, that of never going to their full time; bringing forth their children, for instance, in the seventh or eighth months. Some authors add what is still more remarkable, that this peculiarity is entailed on the females of certain families, w7ho, without approaching the ninth month by several weeks, give birth to mature chil¬ dren. Of this, however, I must take leave to doubt, though we have it on the authority of La Motte. He tells us that he knew7 a young lady who, in the seventh month after marriage, brought forth a lively mature in¬ fant, to the great discomfiture of the hus¬ band, who began to suspect his wife’s chas¬ tity ; but when he again became a father, in seven months after a renewed intercourse, he was satisfied. Both these children, says La Motte, were vigorous and healthy; they grew up to man's estate, and became distinguished in the military profession. He adds, that this lady’s daughters were also regularly confined in the seventh month. With every deference for such authority, I must still hesitate to believe that these seven months’ children were not immature : on a careful inspection I doubt not it w7ould have been perceived, that by the abridgment of their sojourn in the * Lecture III. p. 69, ante. QUESTION OF RETARDATION 645 uterus, they were perhaps not a little curtailed in their growth and due pro¬ portions. 3. About the full time. — The chief diffi¬ culty connected with the question of prematurity is, perhaps, in reference to those births which anticipate the usual period by a week or two ; for this brings us at once to the moot point whe¬ ther or not there be a fixed and definite time for the human female, undisturbed by accidents, to bring forth the fruit of her womb ? Or is there, as others assert, a latitude allowed by nature, so that ma¬ ture birth, which usually takes place at the end of nine calendar months, may oc¬ cur sometimes a week or two earlier ? There is much reason for supposing that the latter position is correct; for in the first place, even granting that the deviation should extend to two weeks, this would only amount to a twentieth of the whole period, — a degree of deviation which, in respect to other periodical functions, would be generally admitted to be inconsidera¬ ble. Take, for example, menstruation : the law of nature seems to be that it should recur every twenty-eight days ; but who does not know that the menses are frequently several days earlier in some women, while in others they arrive more tardily,— and this without apparent detriment or disturbing cause ? Puberty, again, is an epoch which seems to be regu¬ lated by a law of nature, yet its approach is often premature, — often retarded. So with the capacity for bearing children, which by a law of nature seems to cease with the women of this country about the age of 45, in many is lost some years earlier, and in many several years later. And so with teething, and other phenomena, which appear to be, and no doubt are in general, subjected to a regular law — a law, however, which, so far from being abrogated, seems only confirmed by the exceptions. The analogy of what is observed to take place in animals shall be presently noticed when speaking of retardation : it need only be added, in this part of our subject, that the weight of authority is decidedly _ in favour of the possibility of maturity being attained, and of a mature birth be¬ ing effected, in some women a little earlier than in others. Haller mentions among those circumstances which are calculated to hasten the time of parturition — the large size of the foetus, and its more active growth. Where we may be called upon to give an opinion, we must have a regard to the possible operation of such circum¬ stances ; nor where the appearances of ma¬ turity seem complete, should we rashly decide that the birth has been prema¬ ture because it has not occurred at the end of the ninth month. Aristo, king of the Spartans, acted with an ignorant severity when he refused to recognize his son De- maratus, who was born somewhat sooner than the usual time after marriage. Question of Retardation. The observations already made as to what takes place in regard to other func¬ tions, will serve in some measure to show how births may be retarded, as well as precipitated, without abrogating what ap¬ pears to be a law of nature. Argument from analogy. — Every species of animals have their particular time allotted for bringing forth, — sheep at the end of the fifth month; mares on the com¬ pletion of the eleventh; cows at the ninth complete; asses at the tenth; bears to¬ wards the end of the fourth ; swine after five months; rabbits after one month; bitches after two ; &c. : yet it is certain that owing to causes not readily to be as¬ signed, deviations from the limits belong¬ ing to several of these species have been observed. Harvey, Heister, Wagner, and Professor Wildberg, have stated examples. M. Tessier, also, a distinguished mem¬ ber of the Academy of Sciences of Paris, directed his attention to this subject for many years, and found that even in those animals which are most carefully tended, and protected from disturbing influences, the varieties in the times of bringing forth have been very striking: thus — Of 160 cows, the periods of gestation were observed to be as follow7 : — Of 14 . . 241— 266 days. 3 . 270 50 . 270—280 68 . 280—290 20 . 300 5 . 308 Giving a difference of 67 days between the longest and shortest term. Of 102 mares 3 . 311 days. 1 . 314 1 . 315 1 . 326 2 • • • i . 330 47 • . . . 340—350 25 . . • • 350—360 21 . 360—377 1 . 394 Giving 83 days difference between the ex¬ tremes. And similar results were observed with regard to sheep, rabbits, and other animals. Now the argument thus deduced from ana¬ logy must be allowed to be very cogent ; for if these facts be true, of domestic and savage animals w'hich lead their lives subject to G46 DR. CUMMIN ON FORENSIC MEDICINE* so few causes that can tend to disturb tlie law of nature, how much more proba¬ ble is it that woman is not limited to a certain fixed hour for bringing forth, when we consider her moral nature, and the in¬ fluences to which, as a member of society, she is exposed. Facts and cases. — But the question seems perfectly determinable by reference to facts, even if we had no analogies in its support. Let us state a few of these. Dr. William Hunter, in a note commu¬ nicated to Mr. Hargrave, and published by the latter in his Coke Littleton, says, — “ The usual period is nine calendar months; but there is very commonly a difference of one , two, or three weeks. I have known a woman bear a living child in a perfectly natural way, fourteen days later than nine calendar months, and believe two wo¬ men to have been delivered of a child alive, in a natural way, above ten calendar months from the hour of conception.” The difficulty is in ascertaining the ex¬ act time of conception; women them¬ selves, more especially married women, can rarely state it with precision, except under peculiar circumstances — such as a single act of sexual intercourse, effected clandestinely, or where the repetition is precluded ; and it must be recollected that medical men in their cognizance of the history of any pregnancy, must derive their information as to the time of the occurrence of conception from the females themselves. In some well-authenticated instances this end of the chain has been laid hold of, and the fact of the period of gestation being occasionally protracted beyond the 39 weeks, or nine calendar months, has thus, we think, been put be¬ yond all question. M. Desormeaux has related a case which occurred underhis own observation. “Alady, the mother of three children, became de¬ ranged after a severe fever. Her physician thought that pregnancy might have a be¬ neficial effect on the mental disease, and permitted her husband to visit her, but with this restriction, that there should be an interval of three months between each visit, in order that, if conception took place, the risk of abortion from further intercourse might be avoided. The physi¬ cian and attendants made an exact note of the time when the husband’s visit took place. As soon as symptoms of preg¬ nancy began to appear, the visits were discontinued. The lady was closely watched all the time by her female atten¬ dants. She was delivered at the end of nine calendar months and a fortnight .” Professor Burns mentions “ ten calen¬ dar months and ten days dated from last menstruation ” as the longest term he has met with. Dr. Montgomery relates a case in which he had an opportunity of observing the period of gestation, where the time of conception was known with certainty. A lady who had been living at a watering place, through ill health, apart from her husband, for some months, received a visit from him on the 10th of November, 1831. He remained with her that night, but was obliged to return to town next day. The result of the visit was concep¬ tion. She quickened on the 29th of Jan¬ uary 1832, and was delivered of a healthy child on the 17th of August following, being exactly 280 days, or nine calendar months and a week, after conception. In another case which occurred in Dr. Montgomery’s practice, the gestation was, at least, 41 wreeks and a few days, and may have been 42§ or even 44; the diffi¬ culty of stating the term exactly being owing to the difficulty of deciding wffiere the reckoning should begin ; the date of the last appearance of the menses being alone certain. The term of gestation was elicited inci¬ dentally in a seduction case winch was tried at Lancaster some years ago. Sexual intercourse took place between the prosecu¬ trix and the accused on the 8th of Janu¬ ary : it was never repeated; and a child was born on the 18th of October follow¬ ing — that is to say, on the 284th day of pregnancy. The facts were positively sworn to — no observation wras made by defendant’s council on the unusual length of the pregnancy— and a verdict for 50 1, damages was returned*. Dr. Dewees, of Philadelphia, states “ that the husband of a lady, who was obliged to absent himself for many months in consequence of the embarrassment of his affairs, returned one night clandestine¬ ly, and his visit was only known to his wife, her mother, and the doctor (Dr. Dewees himself). The consequence of the visit was the impregnation of the wife ; and she wras delivered of a healthy child in nine months a?id thirteen days.” In the medical evidence given in the Gardner Peerage case, several examples are mentioned by distinguished practi¬ tioners, of births having been retarded within their experience. Dr. Blundell declared that he knew one case in w hich conception certainly took place on the 9th of November, and delivery did not occur till the 23d of August following, making an interval of 287 days, or nine months and fourteen days. Dr. Merriman deposed that he had known cases to be extended to 285 days ; in two or three instances to 296 ; in one to 303 ; and in one to 309, or nine months and thirty-six days. * Medical Gazette, vol. xi. p. 57. THE G ARD1SER PEERAGE CASE. 647 Testimony as to a fixed limit. — When we seek, on the other side, for the evidence on which the doctrine of an invariable time for delivery is grounded, we find it adduced by a small number of authorities, who, having- happened to be acquainted with some few cases in which they thought they could be sure of the date of conception, observed that the day of parturition coin¬ cided with their idea of a general law. But have we not a far greater number of cases, as just now shown, in which the delivery did not. so coincide ? And even if we had not this preponderance on the side of ex¬ perience, to what does the testimony of the party now referred to amount, more than to a certain degree of negative authority— that being assumed as not happening, which has not happened within their circle of observation ? Let us see, however, whe¬ ther, in the experienceof these practitioners, the law was so very invariably obeyed. ►Sir Charles M. Clarke, in his evidence in the Gardner case, states forty weeks to be the legitimate time, but only an average time, calculated from about the first sup¬ pression of the menses. Dr. Blegborough, on the same occasion, considers thirty -nine weeks as the exact time, but forty the ultimatum : Mr. Pen¬ nington, that forty weeks is the regular time, but that it may be three or four days later. J Dr. Gooch maintains that thirty nine weeks is the exact time, but that it may be a day or two earlier or a day or two later. Dr. D. Davis also insists on thirty-nine weeks as the period, but inclines rather to one or two days less than beyond it. And such was the whole of the evidence that could be procured in support of a pre¬ cise time for parturition: three of the wit¬ nesses being for forty weeks, two for thirty-nine, the whole five admitting that there might be a certain excess, or defect, in the measure of the duration, and, in fact, differing among themselves to the ex¬ tent of not less than thirteen days! General inference. — From all that has been stated, it seems not unreasonable to conclude that there must be a certain extent of retardation admitted — perhaps even to two, three, or four weeks, beyond the nine calendar months — particularly when : the probability of the fact is borne out by ! good moral evidence. Some have thought that there should be also physical evidence in the appearance of the child, exhibiting 1 signs of a more than ordinary degree of development, attained by its lengthened residence in the uterus. If such signs be visible, they will of course confirm the plea of protracted gestation ; but it is not cer¬ tain that a sojourn in the uterus continued beyond the average period, is conducive to a corresponding growth ; at all events, there are not sufficient grounds for our in¬ sisting on such proofs. In extending our admission of the pos¬ sibility of gestation being protracted to four weeks beyond nine months — that is, to 43 weeks, or 301 days— we go as far probably as any reasonable evidence can warrant us. When called on to admit cases of longer duration, we should require to have proof of the most convincing kind ere we give credit to alleged devia¬ tions which are confessedly so rare. Claims to the barony of Gardner. — In the Gardner peerage case, the possibility of gestation being protracted to 311 days was a ground on which it was sought to esta¬ blish the legitimacy of one of the claim¬ ants, The leading facts of the case were these: — Captain (afterwards Lord) Gard¬ ner, took leave of his wife on board ship, on the 30th of January, 1802, and sailed to the West Indies; whence he did not return until the 10th of July following. On the 8th of December Mrs. Gardner was delivered of a full-grown male child — that is, 311 days after the latest inter¬ course in which it could have been be¬ gotten by her husband. But there were other glaring facts in the case, tending to overthrow the legitimacy of this child. Mrs. Gardner was proved to have had, during her husband’s absence, an adul¬ terous intercourse with a Mr. Jadis, against whom a verdict upon that account for 1000/. damages was obtained by Cap¬ tain Gardner. It moreover appeared, that when the Captain returned in the summer, Mrs. Gardner did not conceal her preg¬ nancy, having hopes that the child might be born within a legitimate period: she even took measures for hastening parturi¬ tion, or bringing on premature labour, by riding over the stones as much as possible in her carriage. But finding these means ineffectual, she pretended that it was a dropsy she laboured under, and contrived to be delivered secretly ; nor was the child ever recognized by, or presented to, her husband. Yet this was Henry Fenton Jadis, alias Gardner, the counter-claimant of the peerage. 'Fhe remainder of the case is briefly told. Captain Gardner procured a divorce from his adulterous wife, succeeded to his father’s title in 1808, and the year follow¬ ing married a lady by whom he had issue Alan Legge Gardner, described as his only son and lawful heir. In the year 1824, Alan Legge being 14 years of age, while Henry Fenton was one-and-twenty, pe¬ titioned the King to have his rights secured to him, by inscribing his name on the par- 618 MR. RICKMAN ON THE IDENTITY OF liament roll as a minor peer. The petition of the claimant was referred to the Attor¬ ney-General (the present Lord Lyndhurst), by whom it was brought before the House of Lords. Counsel, as I have already mentioned, was heard on both sides ; evi¬ dence, 1st, of the pedigree of the claimant, and, 2dly, of the illegitimacy of Henry Fenton Gardner, was adduced ; and the matter ended in favour of the pe¬ titioner. The illegitimacy of Henry Fenton Gardner was established, 1st, by evidence of his mother’s adultery, and, 2dly, by evidence tending to show that the period of gestation was such as to render it im¬ probable, if not impossible, that Captain Gardner could be his father. It was on the latter of these points that the great body of medical evidence, already alluded to, was adduced. But it should be added, that the fact of illegitimacy was, after all, decided irrespectively of me¬ dical considerations. Henry Fenton was bastardized, not by reason of the time of his birth, but in consequence of his mo¬ ther’s adultery, and her concealment of the birth from her husband. Still the proceedings in the Gardner case must be considered interesting, as having elicited so much evidence respect¬ ing the results of medical experience ; and when we recollect that the main question is still open to discussion in any future case of a similar kind, the record of the proceedings must be deemed valuable. In Mr. Le Marchant’s book you will find am¬ ple information on the subject; and I ought perhaps to add, that thediscussionsin some of our medical societies, soon after the publication of that work, and of which an account may be seen in the periodicals of the day*, will also prove not unworthy of your perusal. I may take this opportunity of mention¬ ing that ithas been represented to me, that in noticing, in last lecture but one, the principal cases of transposition of the viscera, I omitted one which has been described by Dr. Lyons, of Brighton. I must be content to refer you to the case itself, in the 17th vol. of the Medical Gazette, p. 514, where you will see that in the instance of a living female, of about twenty years of age, the heart was ascertained to be on the right side of the chest, and probably reversed, or “ in¬ verted.” There are also some other circum¬ stances connected with the case, which render it interesting. * Medical Gazette;, vol. v. p. 337, et sqq . ON THE IDENTITY OF THE VIE PROBABLE and VIE MOYENNF. To the Editor of the Medical Gazette. Sir, A collection of the ages of 3,938,496 persons of both sexes, whose burials were registered during eighteen years (1813-1830), appears in the Population Volumes of the year 1831 ; and some notice of the result of 11,300 returns obtained from the parochial clergy of England and Wales for this purpose, was indispensable in the preface to those volumes. Knowledge of the ages of the popula¬ tion then existing had been obtained in the enumeration of the year 1821, with a view to future use, when the regis¬ tered burials should have accumulated to the year 1830 inclusive, the ages of the deceased having been first recorded in the year 1813, and 1821 being nearly a middle point of the entire eighteen years. The increase of population during* the life of man was the third element requi¬ site for ascertaining an ultimate result; and this kind of inquiry had been pushed back to the year 1700, by the parish register investigation of 1801, under the authority of the first Popula¬ tion Act. These parish register returns were deemed of unquestionable autho¬ rity from the year 1750, or for eighty years retrospectively from 1830 ; so that a small degree of uncertainty attached exclusively to those above that age, who are very few in a stationary population, and even fewer in England, where the population had doubled in the last 100 years. A statement of the progressive in¬ crease of population in England was calculated from these materials, and ap¬ peared in the preface to the Population Volumes of 1801 ; and from the further lights afforded by subsequent popula¬ tion returns, aided by reference to the prices of corn, a more accurate calcula¬ tion was made by Mr. frinlaison, and appears in the preface to the Population Volumes of 1831 [at p. xlv.] From the combination of materials THE VIE PROBABLE AND FIE MOYENNE. 649 thus obtained, Mr. Eiulaison was ena¬ bled to calculate human mortality in England from nearly four millions of burials, in like manner as Mr. Milne from 1840 burials in the city of Car¬ lisle; and it is proof of the extraordi¬ nary sagacity of the last named calcu¬ lator, that from such scanty materials he produced a table of the mortality of both sexes conjointly, which, from the age of 20, is always between the mor¬ tality of the two sexes as calculated by Mr. Finlaison, and differing very slight¬ ly from that of Mr. Finlaison’s female sex between the fourth and the twentieth years of life. Indispensable as is the knowledge of the increase of population, for the above purpose of deducing a law of mortality from national or local inquiries, such knowledge has not been obtained, ex¬ cept in Sweden, from the year 1749 (p. 396 of Milne), from which Mr. Milne has calculated Swedish mortality, in his elaborate tables iv. v. vi., at pp. 566-570 of his second volume. But similar attention to the increase of population has not been customary among continental calculators, who usu¬ ally satisfy themselves by inserting a conditional phrase, “ provided the popu¬ lation is stationary,” and do not the less proceed as if that supposition were well founded ; which, however, probablynever was true, and which certainly never has been proved to he true during the life of man, in any nation on earth. The high reputation of such men as d’lvernois, Quetelet, and Villerme, who have satisfied themselves thus easily, and in some instances produced strange results, rendered necessary a circum¬ stantial proof of the effect of the ascer¬ tained increase of population in the English counties during thirty years (1801-1831) ; and for this purpose the vie moyenne , or expectation of life in the first year, was calculated on the bu¬ rial returns of the recorded ages of the deceased in every county separately ; the results proving that by thus disregard¬ ing the very different rates of increase, the vie moyenne of adjacent sections of the county of York seems to differ as 40 to 29; and in Lancashire, where the population increases most rapidly, the vie moyenne , so calculated, sinks to 25£. [See last page of the Population preface of 1831.] 1 Thus much was requisite in support of some passages in the said pre¬ face (p. xlvi.) ; and at the bottom of the preceding page, the vie probable (the age at which one-half are dead) is shewn to differ more widely in various counties (from 12 years to 38 years), from the same disturbing cause. Further, it w as remarkable, in pursu¬ ing these investigations, that a converg¬ ing series of the vie probable and vie moyenne being constructed in the manner most consistent with fact, coincided in the several counties which indicated the smallest increase of population, or about 20 per cent, in the thirty years ; so that it was impossible not to suspect that, at a lower rate of increase, the series of the vie probable and that of the vie moyenne would diverge from that point in the same ratio as they had actually con¬ verged from 100 to 20 per cent, in¬ crease, and that such series was go¬ verned by some analogy, which, if discovered, might be expected to throw new light on the general law of human mortality. My suspicion or conjectural inference thus became worthy of practical investi¬ gation ; and a scale was prepared ac¬ cordingly, by assuming the series of the vie probable to converge at tw'ice the rate of the vie moyenne ; and in apply¬ ing this combined scale to the several counties, many of them indicated a re¬ markable agreement with it. How far this is true best appears by the following tabular scale applied to those counties which are placed in juxta-position with it; and at the bot¬ tom of these counties is added Cornwall, the most healthy of our counties, w here the actual vie probable surpasses the expected amount by 9£ years, the vie moyenne by 5 years, thus preserving the analogy of one to two. The Isle of Ely is also subjoined in contrast, as the least healthy part of England, where the vie probable is seen to fall short of the ex¬ pected amount by 11 years; the vie moyenne by 3£ years ; the latter as one to three, instead of one-half, the general rate. But exact conformity must not be expected, local healthfulness and its opposite not being the only causes by which it is liable to be disturbed. One of these causes is obvious, on considera¬ tion that the increase of population in the several counties is not known be- 650 MR. RICKMAN ON THE IDENTITY OF TABLE [.—SCALE OF COINCIDENCE OF THE Vie Probable, and of the Vie Moyenne, with the Increase of Population. De¬ crease per Cent. In¬ crease per Cent. Vie Probable Vie Moyenne. Incr per ( ease 3ent. Vie Probable- Vie Moyenne. Increase per Cent. Vie Probable. Vie Moyenne Theory Fact. Years. Years. Theory Fact. Years. Years. Theory Fact. Years. Years. 19 0 48-2 44-4 14 33 35-0 37*8 49 68 21 0 30-8 18 1 47-8 44-2 15 34 34 6 37 6 50 69 20-6 30 6 17 2 47-4 44-0 16 35 34-2 37-4 51 70 20-2 30-4 16 3 47-0 43 8 17 36 338 37-2 52 71 19-8 30-2 15 4 46-6 43 6 18 37 33 4 37-0 53 72 19-4 300 14 5 46*2 43-4 19 38 330 36-8 54 73 19 0 29-8 13 6 45-8 43-2 20 39 32 6 36-6 55 74 18 6 29 6 12 7 454 43*0 21 40 32-2 36-4 56 75 182 294 11 8 450 42-8 22 41 31-8 36-2 57 76 17-8 29-2 10 9 44-6 42*6 23 42 31*4 36-0 58 77 17 4 29-0 9 10 44-2 42*4 24 43 31-0 35-8 59 78 17-0 28-8 8 11 43 8 42-2 25 44 30 6 35-6 60 79 16 6 28 6 7 12 43 4 42-0 26 45 30-2 35 '4 61 80 16-2 28-4 6 13 430 41-8 27 46 29 8 35-2 62 81 15-8 28-2 5 14 42-6 416 28 47 29 4 35 0 63 82 15-4 280 4 15 42-2 41-4 29 48 29 0 34-8 64 83 15-0 2 7-8 3 16 41-8 41-2 30 49 28-6 34.6 65 84 14-6 2 7 6 2 17 41-4 41-0 31 50 28 2 34-4 66 85 142 27-4 1 18 410 40-8 32 51 27-8 34-2 67 86 13 8 27-2 — -- - - - • - - 83 52 27-4 34-0 68 87 13-4 27-0 0 19 40-6 40 6 34 53 27-0 338 69 88 13-0 26-8 In- i rcase. - - - — 35 54 26-6 336 70 89 12-6 26 '6 1 20 40*2 40 4 36 55 26-2 33-4 71 90 12-2 26-4 2 21 398 40-2 37 56 25 8 33-2 72 9i 11-8 26*2 3 22 39-4 400 88 57 25 4 33-0 73 92 11-4 26 0 4 23 39*0 39-8 39 58 25-0 32*8 74 93 11*0 25-8 5 24 38-6 39*5 40 59 24-6 32-6 75 94 10-6 26-6 6 25 38*2 39-4 41 60 24-2 32-4 76 95 10 2 25 4 7 26 37-8 39*2 42 61 23'8 32-2 77 96 9-8 25*2 8 27 37*4 39-0 43 62 23 4 32-0 78 97 9*4 25-0 9 28 37-0 38-8 44 63 23-0 31’8 79 98 9'0 24-8 10 29 36-6 38-6 45 64 22-6 31-6 80 99 8-6 24-6 11 30 36-2 384 46 65 22-2 31 '4 81 100 8 2 24‘4 12 31 358 38-2 47 66 21-8 31-2 13 32 35 4 380 48 67 | 21’4 31-0 TIIE VIE PROBABLE AND VIE MOYENNE 651 TABLE II. Comparison of Increase of Population , Vie Probable , and Vie Moyenne. England and English Counties. Per C 0 entag f Popu 3 Increase ilation. Vie Probable. Vie Moyenne. 1801 1811 1821 1801 Accord- Accord- Accord Accord- to to to to ing to ing to ing to ing to 1811 1821 1831 1831 Scale. Fact. Scale. Fact. 1 Rutland .................. 1 4 a: 19 40-6 38-4 A f\.ft 39- 1 1 o O 40 O 2 North York *7 1 1 O 21 39-8 38-2 402 403 7 1 i z 3 Wilts . 1 Q Q 29 36-6 35-7 38 6. 38-1 o lo 0 10 1 o •7 32 35*4 35-9 38 0 392 Jt» * » Oo l HiUl ltlllU •**§**♦«»#•• LZ 7 A Suffolk . 11 1 ft 9 41 31-8 31-9 36-2 369 LO 12 i £ 13 44 306 31-4 356 36-2 lo 12 1 R 11 44 306 296 356 350 / • xjLcIIi Us *••••••••••••••••••• lo ft (Tin mhprl nrwl . . 14 1 7 10 45 302 28-4 35-4 353 i / O Hertford . . . 1 ft 1 l 47 29*4 28- 1 350 346 14 lo 1 1 1 0 Hertford . . . . . . t . . . f . . 1 1 l n 1 A 50 28-2 26-6 34-4 34-3 1 1 10 14 T.pippetpr . . . 1 ft i ft 1 Q 52 27-4 25*6 340 33-3 I 0 10 1 0 10. T.i npol n ............. .... 1 A i o 1 O 52 27*4 256 34 0 33-3 1 Z 13 Kent . O 1 1 A 1 O 56 25-8 24 2 33-2 31-5 Z 1 let 1 z England and Wales . . . . 15 0 1 16 1 7 15 1 n 57 72 254 19-4 25-4 18-5 33-0 300 33-0 292 1 4 Stafford •••••*••*«--*****. Z 1 i / j y 15 West York - -•■••••*>>«>• t > 1 ft oo OO 190 18*3 29-8 Oft.O ID zz zz i O Zo 0 23 07 QQ 8-6 1 1 .ft ■Uuii Olio Lvi ******** ****** z / z / 110 74 0 Zo b Cornwall . 15 19 17 1 ft 60 ft 4 24-2 OO -ft 33-7 138 32-4 31-6 375 27-9 14 24 IO Ol ZZ 0 ond the last thirty years ; that is, not eyond the birth of two-thirds of the existing- population (6528 in 10,000, ac¬ cording to the census of 1821), for no¬ thing can be less consistent with Tact than an equable ratio of the increase of population, a species of assumption I which was carried back by King (one of the fathers of English statistics) to i the Norman Conquest, and which lias not quite disappeared to the present time. It happens, indeed, that the in¬ crease of population in England and Wales having been 57 per cent, in thirty years (1801-1831), has arrived at that amount by an annual increment, differing very little at any time from 15 per cent., which gives the above total increase very accurately. But in the twenty-one years preceding 1810, 652 MR. RICKMAN ON THE IDENTITY OF it is pretty well ascertained by parish register returns, that the actual incre¬ ment (supposing it to have been uni¬ form) was not much more than half the above, or about ‘85 per cent., the total increase from 1780 to 1801 having been between 17 and 18 per cent. Nor is there any thing like uniformity in the increment of the several counties in the three decennial periods between 1801 and 1831, as may be seen in the forego¬ ing table, and is still more evident in Berkshire and Salop, which counties shew an equal increase of 33 per cent, in the thirty years ; but the decennial increment of the former was 8, 12, 10 ; of the latter, 16, 6, 8, — a dissimilitude which could not but produce a discre¬ pancy in the ages of those who have died, and of those who survive, in the two counties. This cause, in combina¬ tion with salubrity or insalubrity (before noticed), permits us not to expect regu¬ lar conformity to the combined scale, which yet agrees well enough with fact in the fifteen counties enumerated in the comparative view annexed to the scale of coincidence. But why should the converging lines of the vie probable and vie moyenne meet at 19 or 20 per cent, increase of population ? This bears the aspect of caprice or accident rather than of any established law, and if it be supposed (for the sake of argument) that such meeting or coincidence takes place in any given state of population, the qui¬ escent state of no movement in advance or retreat, in progress or regress, bids fairest for preference ; the very state, in fact, to which every respectable calcula¬ tor endeavours to approximate in his apparatus for determining the true law of mortality, and the expectancy of life resulting from it ; and as not one of th ese calculators has bad in his thoughts any coincidence of the vie probable and the vie moyenne , it is fair to examine in support of such supposed coincidence the results at which calculation has actually arrived. First in priority of date is the law of mortality and its results, as calculated by Mr. Milne from Swedish documents, after deducing the stationary from the actually progressive population (pp. 537 — 8). In his Table V., p. 569, both sexes are combined, and the expectation of life in the course of the first year of life is 36 12, to which adding half unity, (3612 + *5 = 36 62) the average duration of life including the entire first year, is 36 years 32 weeks ; and as the vie probable falls between 36 and 37 years, but nearer to the last, the coinci¬ dence is exact. Mr. Milne’s Carlisle Tables II. and III., pp. 564 — 5 may next be examined : and in these the expectation of life in the middle of the first year being 38'72. the average duration of life and annual mortality is 39 years 11 weeks. The vie probable (one-half dead) falls on the 4lst year of life, so that the discrepancy is one year and three-quarters; but on this it may be remarked that Mr. Milne assumes the mortality of the first year of life very low, at 1539 in 10,000, (though he compensates for this in the next four years) whereas the Swedish mortality is 2015. A middle term may be found in the latest experience of Prussian mortality, which is rather less than 1700 in the first year of life, and if this were adopted Mr. Milne’s radix would be increased to 10,161 (1539-f- 1 61 = 1700) whereby the annual mor¬ tality and the vie probable would agree very well at the 40th year of life. Mr. Finlaison, in his law of morta¬ lity, deduced from the population re¬ turns, (after correcting the effect of pro¬ gressive increase) appears to have assumed the Prussian lawT of mortality for the first year of life, the registration of infant burial in England being defec¬ tive from a known cause ; and he assumes the mortality of males in the first year of life at 1826 in 10,000, their annual mortality at one in 40‘5, and their vie probable at 435. Of his females, 1568 die in their first year; their annual mortality is one in 437, and their vie probable is 48 5. These differences of three years and five years respectively, are considerable, and ad¬ verse to my opinion of the identity of the rate of annual mortality with the vie probable : but, in truth, nothing certain can be predicated of the mortality of the first year; and if Mr. Finlaison had made use of the Swedish estimate of 2015 deaths in 10,000 born, his an¬ nual mortality of the combined sexes might have decreased from one in 42 to one in 39 or 40, and his vie probable have fallen from 46 to the same level: and I shall take the liberty to add here, , in support of the superiority of the j Swedish estimate, that burial registers j seldom fail to err on the side of defect, , and (if faithful) cannot be redundant. After speaking thus freely of the ; ignorance under which we labour of the law of mortality of the first year of life, it is necessary to enter into expla¬ nation, lest this uncertainty should be< supposed by the uninitiated to pervade THE FIE PROBABLE AND VIE MOYEN NE. 653 the whole science of what Laplace calls statistiques vitales , (the statistics of human life) where he announces that the annual mortality of any nation or society expresses the vie moyenne at birth, (the average duration of life) and leads to the amount of its population by an easy process, when once this multi¬ plier of the burials is obtained. “ But, continues he, “ La determination de ce faeteur est le point le plus delicat;” — this is a point of much difficulty; a difficulty which arises thus. Insurances are seldom or never effect¬ ed on the first years of life, and the nominees in government Tontine annui¬ ties are not numerous until they have fully reached the most advantageous expectation of life, which occurs from three to six years of age. Yet enough are enrolled in their first year for the purpose of calculation, if they were equably spread over that year; but the intensity of mortality is such at the commencement of human existence, that one-half of such deaths occur in the first three months; whence it happens that no Tontine annuitants can pru¬ dently be enrolled till after that period, nor indeed until the the greater portion of the first year has been by them sur¬ vived. Thus the usual authority of enrolled lives here fails us, and we have no unquestionable basis on which to calculate the mortality of the first year of life, including as it does the first days, and weeks, and months after birth ; and the difficulty stated by Laplace becomes insuperable, unless by an exactness and severity of registration not easily en forced*. But all this does not affect the calcu¬ lated expectation of life beyond the age of infancy, because the scries of such calculations travels downwards from the highest ages, which, indeed, are much exaggerated, only two individuals hav¬ ing’ been discovered by the collectors of authentic records of mortality in France, England, and Hollandf, although the number of such recorded deaths is not less than 27,000, while common repute (as expressed by the relatives of the aged deceased) represents one in 2072 in England as having attained to that great age; in Sweden, (ad. 1754 — 1763), on the same kind of authority, the proportion is one in 1017 ; and Mr. Milne, in the Carlisle Table, seems to have assumed one in 909. Similar ex¬ aggeration in a minor degree is known to prevail from the age of 85, and may be detected, and even measured by com¬ parison with recorded deaths which have occurred in sufficient number at and after that age. T add a Table to this effect, as it also affords general in¬ formation of the expectancy of life in old age; but it is not to be inferred that the expectation of life in all preced¬ ing classes of age is materially affect¬ ed by the overstated 5 or even 10 years in the ages of the very few indi¬ viduals w ho, according to the most ex¬ aggerated statement, approach or sur¬ pass their hundredth year. Age. Mr. Finlaison. Gov. Annuitants. Equitable Assurance Average. Mr. Finlaison. Parish Registers. Carlisle Table. Average. Age. Males. Y. Females. Y. BothSexes Y. Years and Decimal. Males. Y. Females. Y. BothSexes Y. Years and Dec. parts. 70 922 1099 899 973 8-94 966 9 18 9 26 70 75 7*12 8-46 7-00 7-53 6 78 733 7-01 7-04 75 80 4-94 6-50 5-51 565 5-05 5*46 5 51 534 80 85 312 4-81 402 3 99 3 85 4’22 4 12 406 85 90 1-95 2-83 216 231 3 42 3 70 3-28 3-47 90 95 118 1-55 1*36 3 05 3-20 353 326 95 100 •50 •25 2*78 2-72 2-28 2-59 100 * In Belgium, where the registration is said to t One individual of one hundred (sex uncei- i be exemplary, 2250 die in their first year, which tain) is recorded by Deparcieux; one female ol materially exceeds the Swedish registration of 103 by Finlaison. 2015, MR, RICKMAN ON THE IDENTITY OF G54 From the above Table it follows that, at 70, 75, and 80 years of age, selected lives (those of such persons as are con¬ cerned in money transactions) maintain a small and very probable superiority in expectation of life. At 85, exagge¬ ration is barely perceptible in the ba¬ lance slightly inclined to the other side. At 90, the exaggeration of com¬ mon repute appears to be 1T6 = 60 weeks, and the comparative expectation as 3 to 2. At 95, it is 1*90=99 weeks, or as 7 to 3. At 100, it seems to be ten¬ fold ; but with such uncertainty, that it were well if all calculators assumed one male, two females in 10,000 to attain to their hundredth year. After what has been said, and espe¬ cially after what I have quoted from Laplace, showing* the extreme difficulty of ascertaining the annual mortality in any nation or district, the writer of an article in the British Medical Almanack for 1837 will learn to moderate the severity of his remarks on the annual mortality ascribed to the several coun¬ ties of England in more than one pre¬ face to the Population volumes of vari¬ ous dates. The mortality there stated is avowedly founded on results drawn from Parish Registers, and therefore liable not only to the variation which arises from every different ratio of increase of population in the several counties, but also to defect of registry, which in some places is considerable, in others trifling in amount. Why, then, was a falla¬ cious statement admitted? Partly as popular information which could not be w'ell be w ithheld ; partly because the mortality of the same county at several periods is good authority for compa¬ rison with itself, and the prevalence of health or sickness in various seasons may safely be thus inferred. Beyond this, if the writer alluded to is a precise reasoner, let him never rely on annual mortality thus loosely alleged, until he has examined the authority on which it is founded, always mindful that a mere mortuary register is of no value for any general inference whatsoever. I now return to my main argument founded on the tables inserted at a for¬ mer part of this letter; and in the first place I must advert to the difficulty of inferring the coincidence and identity of annual mortality and vie probable in a stationary population from tables which seem to show that it takes place where the increase has been 20 per cent, in 30 years. I am aware that I have to combat this objection, and I acknow¬ ledge that the first table seems to prove, on inspection, that the annual mortality would be 44, the vie probable 48, in case of stationary population. In explanation of this, I must be per¬ mitted to observe, that the vie moyenne is reduced to about 25 in Lancashire, and that such decrease is caused by the disproportionate number of infants who are born, and consequently die, in a rapidly increasing population ; whence it follow's that a large omission in the registry of infant burials (of those infants wdio die before they are bap¬ tised) cannot but have the effect of push¬ ing* down the several counties from the position assigned to them by a calcula¬ tion of the vie moyenne and vie probable founded on such defective registry of infant deaths ; and I hope to convince the reader that this occurs in such a degree as to lessen the seeming dura- tion of life in Rutland and North York to 38 years, and to render probable the alleged coincidence at the age of 40 or 41 years, in case of stationary popu¬ lation. The annual mortality of England cannot differ materially from this last amount, which is expressed by 40*6 in the first table. Mr. Milne, in the Car¬ lisle table, assigns 37*14 as the expecta¬ tion of life, or vie moyenne , of the first year of human life, for the two sexes combined ; Mr. Finlaison assigns to males 39*96, to females 43*20, expecta¬ tion of life in the first year ; and these three authorities averag'e at 40*13. But it must not be forgotten that such vie moyenne is applicable not to the begin¬ ning, but to the middle, of the first year ; so that annual mortality is always half a year more than the vie moyenne , as usually expressed, and the above average becomes 40*63, which is as near to the 40*6 of the tables as can be de¬ sired ; and it is to be understood, that the tables are founded on this assumed coincidence, from which the vie probable and vie moyenne are made to diverge, so that at 57 per cent, increase of popula¬ tion, w hich is assignable to the whole of England and Wales, the tabular num¬ bers agree with the fact of vie probable 25*4 ; vie moyenne 33. Nor will it be denied that what is accurately true of the whole, is fairly applicable as a test or measure whereby to discover the com- THE VIE PROBABLE AND VIE MOYENNE . 655 parative effect of variously increased population in the several counties. It may be worth while to remark, upon this appropriate occasion, that the vie moyenne , or expectation of life, does not, strictly speaking, apply to the middle of the year, but to the middle of the mortality of the year of which it is asserted ; and this, in the first year of life, occurs at the end of the first three months, instead of six months. But such minutiae are of little value; nor does the attention bestowed on still-born infants ( morto-nes ) by some calculators, appear to me of importance : the en¬ trance into life will always remain somewhat undetermined, and it is but lost labour to approach the mysteries of Juno Lucina ; we must remember that in the commencement of the history of nations, as well of individual man, we are compelled to rest satisfied under some degree of obscurity. Nor is the other end of human life without its dif¬ ficulties (already suggested), arising from the customary errors of common repute, and the paucity of authentic ex¬ amples of extreme old age ; whereas, in infant life, the calculator is embar¬ rassed by the crowd who die and are forgotten. Thus have I brought under notice the two sources of error which tend to re¬ present the duration of human life be¬ yond the truth ; inasmuch as these for¬ gotten infants would increase the num¬ ber of individuals who have lived — that is, the divisor of the total years lived ; and correction of the overcharged ages of individuals who survive 85, would diminish the number of years lived — that is, the dividend — and lessen the quotient or average duration of life ac¬ cordingly. Thus, if ninety individuals lived 3600 years, the quotient would prove their duration of life {vie moyenne) to have been forty years. But if the divisor be increased to 100, and the dividend diminished to 3500, the quo¬ tient will show their duration of life not to have exceeded thirty -five years. This example is overcharged, but will explain the tendency of such corrections ; nor must we forget that M. Quetelet calcu¬ lates the mortality of infants in Bel¬ gium, in their first year, to be 2249 in 10,000* *; so that the similar Prussian * See M. Quetelet’s “ Recherche s sur la Po¬ pulation, fyc. dans le Royaume des Pays-bas,,> p. 32 [100,000-77,507 = 22,493] ; and it' is pro¬ per to add, that the mortality of the first year of mortality taken at 1700, and even the Swedish mortality at 2015 in 10,000, may be erroneous results, arising from defective registration of infant deaths. I say this to prove that the duration of life in England may possibly be over¬ rated at 40 years, and that if reduced to 38 years, my speculation in favour of the coincidence of the vie probable with the average duration of life, is not in¬ consistent with it. 1. 1 do not undertake to offer a po¬ sitive demonstration in support of my opinion, but negatively i infer that it is well founded; for I have already shown in tabular form, the tendency of which cannot reasonably be disputed, that al¬ though the actual duration of life {vie moyenne) cannot really be affected by increase of population, the burial re¬ gister in that case exhibits the short lives of infants in a proportion so pre¬ ponderating’, that in the given case of Lancashire (where the populationhasbeen increasing at the rate of 2 6 per cent, annually), human life seems to be shortened from 40 to 24 years ; and a moiety of the recorded deaths {vie pro¬ bable) to have approached within 12 years of the birth of these numerous infants. I have shown also that the population of England collectively , ex¬ hibits the same kind of result, an in¬ crease at the rate of 15 per cent, annu¬ ally, having diminished the vie moyenne from 40 to 33 years, the vie probable from 40 to 25-4 years ; and that the counties, generally speaking, show similar gra¬ dation of cause and effect. From this it follows that the converging series of vie moyenne and vie probable must some¬ what meet ; and we are authorized to assume that they cross each other, by the example of two Swiss villages, where the vie moyenne is found to be 45 years, and the vie probable 55 years* ; the effect of decreasing population being probably augmented by the frequent migration of young Hel¬ vetians, and their returning home in mature age, when competence for re¬ tirement from busy life has been ac¬ quired elsewhere. Granting* the oppo¬ site effects of increasing and of de¬ creasing population, it is difficult to believe that the point of actual coinci- lifeis not affected by his L’Hypothese d'une po¬ pulation stutionnaire , which invalidates all Ms calculations of mortality, except that of the first year of life. * Sir Francis D’lvernois, Sur la Mortality proportionate de quelques populations, 1832. 656 MR. RICKMAN ON THE VIE PROBABLE AND VIE MOYENNE , deuce is not also that of stationary po¬ pulation. 2- Further, I have to suggest, that as the mortality which occurs in every year oflife settles the age of the dead de¬ finitively in that year, their vie moyenne and vie probable are no longer subject to doubt or calculation, and are evidently the same. By an equal division of the number of all the individuals who have died at various ages*, the particular age or middle point will be found, on either side of which a preponderance of years or age must ensue from the in¬ crease or decrease of population ; and it is evident that the seeming duration of life, as well as the seeming age at which one- half die, will depart from the truth accordingly. 3. Next let us consider that the entire science which deduces the expectation of human life from the law of mortality, rests upon the average mortality which happens to all collectively : upon the ideal one man, who is thus made to re¬ present his whole species; and that the vie moyenne and vie probable of anyone man cannotpossibly differ from each other in amount. All scientific attempts to as¬ certain the law of mortality from na¬ tional or local mortuary registers, must first assume a stationary population, as an indispensable corrective ; and they usually represent it by dividing this ideal man into 10,000 parts, and assign¬ ing to every age a due apportionment of vitality, as far as facts in the possession of the calculator authorize his conclu¬ sions. But the ideal man of stationary population seems to me still to retain unaltered his vie moyenne and vie pro¬ bable ; which, therefore, I hold to be identically the same. 4. The foregoing argument, I think, may be placed in another point of view. Every one, when first he reads or hears of any difference of amount between the average duration of life and the proba¬ ble extent of life (the vie moyenne and vie probable ), is incredulous, or at least perplexed, until he has tried the experiment on some accredited table of the law of mortality; after which he yields his assent to the result of his own calculation. But when his author tells him that such table is not accurate, un¬ less on the hypothesis of stationary popu¬ * See Mr. Milne’s process for settling the mor¬ tality of Sweden, had the population remainod stationary, vol. ii. p. 038. lation, and does not undertake to assure him that such has been the fact in the nation or city, or other society, from the mortuary register of which the said table has been compiled, the same au¬ thor tacitly allows that the variation between the vie moyenne and vie proba¬ ble may arise from want of certainty in this essential preliminary ; a point which seems to need the following' illustration. The condition of stationary popula¬ tion requires that a new person, a new actor, shall be introduced upon the stage of life, whenever and as soon as a va¬ cancy occurs by death of an established actor, whether old or young; and, speaking cumulatively, such deaths constitute the law of mortality in the drama of human life. Supposing no actor to have entered unless on vacancy, nor without notice taken, and regular enrolment of the fact, the vie moyenne and vie probable of any one of these enrolled actors could not but be identi¬ cal, and therefore also of all the actors collectively, supposing the process of death and replacement not to have been disturbed by unauthorized absentees or intruders, who, by “ their exits and their entrances,” cannot but produce a perplexing variation in the average amount of life (vie moyenne), and its probable extent (vie probable ) ; for it cannot be denied that a superfluity of unnoticed exits and entrances of the young* (which represents an increasing population) will sink the vie probable towards non-age, and that a superfluity of exits of the old, not replaced by in¬ fants (which represents a decreasing’ po¬ pulation), will enhance it beyond its due amount. Hence it follows that a pre¬ tended law of mortality, calculated on a mere mortuary register, will seldom exhibit similitude of amount in the vie moyenne and vie probable , and con¬ versely that a calculation founded on the mortality of a stationary popula¬ tion, will not fail to exhibit an identity of these amounts. If the foregoing arguments shall be established on higher authority than mine, I think the symmetry of science will he improved, and its consistency established, by ascertaining that an iden¬ tity of the vie moyenne and vie probable must occur, if the stationary population has been accurately assumed by the calculator, who will thus be enabled to verify his work. Such consistency or MR. WORMALD ON DISLOCATION OF THE HEAD OF THE FEMUR 657 Agreement of the vie moyenne and vie probable would also tend to improve real science, by manifestly annulling- the authority of all tables which purport to assig'n a known duration of life to France (excepting- always the table of Deparcieux), to Holland (excepting- that of Kerseboom), to Belgium, to Bran- denburgh (North Prussia), and to Swis- serland ; to Paris, to London, to Vienna, to Berlin, to Brussels, and to Amster¬ dam. These tables, indeed, cannot be again quoted, unless by authors who do not know that such calculations, founded on mortuary registers exclu¬ sively, assign forty years as the dura¬ tion of life in some of the counties of England, but give no more than twenty- four vears to Lancashire ; and that the vie moyenne of North York exceeds that of West York by eleven years, although the climate and manner of living in two adjoining portions of the same county cannot be dissimilar : one of them, in¬ deed (North York), has acquired an in¬ crease of population of 21 per cent.; the other (West York) of 73 per cent., since the commencement of the present century *. This brings cause and effect distinctly into view-, and shows that in¬ stead of inferring the average duration of life from mortuary registers, we should rather attempt to estimate, and even to measure, the probable increase of population from the amount of difference between the vie moyenne and vie proba¬ ble ascribed to the inhabitants of places which have produced tables of the ex- Jiectation of life, constructed on the fal- acious basis of mortuary registers ex¬ clusively. Science should not be dis¬ graced by referring to such documents for purposes to which they are quite in¬ adequate, and even inapplicable, unless combined with consideration of the in¬ crease of population, as well as with the amount of existing population, and its classification into ages suitably to a similar classification of corresponding mortuary registers on which reliance may be placed, or which have been sub¬ jected to correction by analogy drawn from well-ascertained facts. I remain, sir, Your most obedient servant, John Rickman. January, 1837. * See Population Prtface of 1831, p. li v. 478. — xix. CASES OF DISLOCATION OF THE HEAD OF THE FEMUR. By Thos. Wormald, Esq. Demonstrator of Anatomy at St. Bartholomew’s Hospital, &c. &c. Case I. — Dislocation of the Head of the Femur downwards and backwards upon the Tuber Ischii. A maniac, who eluded the vigilance of his keepers, leaped from a third story window. Besides dislocating* his thigh, he received other injury, of which he died in about an hour. On examining the dislocated limb it was found considerably shortened and inverted, forming about half a right angle with the body. The shaft of the femur, crossing the symphysis pubis, was fixed immoveably in this situation. As the patient was evidently sinking, no attempt was made at reduction. Twelve hours after the death of the patient I commenced the dissection, by reflecting the gluteus maximus, when I found some of the fibres of the gluteus Fig. 1. A, head of the femur partly covered by B, the obturator internus, the tendinous fibres of which are separated from t.he muscular. C, the tro¬ chanter major concealing a great part of D, the acetabulum. E, the obturator externus crossing the neck of the femur. F, the iscliiatic nerve pressed by the head of the femur against G, the tuber ischii. H, t.he gluteus medius, partly torn. I, the shaft of the femur much inverted, and crossing the symphysis pubis. 2 U ! / 658 MR. WORMALD ON DISLOCATION OF THE HEAD OF THE FEMUR. metlius and minimUs ruptured at their posterior edge. The pyriformis and the gemelli were also partially torn ; but the four portions of the tendon of the obturator interims, which pass through the lesser ischiatic notch, were drawn out and separated from their connexions with the muscular fibres. The head of the femur presented it¬ self through a rent of the capsule, oppo¬ site to the upper part of the tuber ischii, above the quadratus, so that the great ischiatic nerve was somewhat displaced, and pressed against the tuber ischii. In this case there was no difficulty in detecting the nature of the injury, as, besides the symptoms already described, the head of the femur could be felt rest¬ ing on the tuber, covered by the outer edge of the gluteus maximus. If this patient had been in a condition to at¬ tempt reduction of the dislocation,— by fixing the pelvis and employing exten¬ sion in the direction of the shaft of the bone, at the same time everting the limb, the head of the femur would have been brought opposite to the rent in the capsule, and would in all probability have been replaced in the acetabulum without greater difficulty than is usually experienced. Case II. — Dislocation of the Head of the Femur , with displacement of a portion of the Cotyloid Ligament , without Rupture of the Ligamentum Teres. During* the summer of 1829, a man about 40 years of age was admitted into St. Bartholomew’s Hospital, labouring under pneumonia, of which he died. On examining his body, I observed that the left limb was somewhat everted, a little separated from the right, and shortened to the extent of half an inch. The head of the bone could be felt rest¬ ing upon the ileim, between the aceta¬ bulum and the anterior inferior spine. On dissecting the muscles about the hip-joint, I found them in a healthy condition, excepting the obturator ex- ternus, which was small, of a brown colour, with fat deposited between its fibi ■es, and the tendon was torn from its attachment to the femur. The head of the femur, surrounded by the capsular ligament, rested upon the ileim, between the acetabulum and the anterior inferior spine, in a cavity which was thert formed, partly by a preternatural growtli of bone, and partly by what appeared tc me to be the upper position of the origi¬ nal cotyloid ligament, which was pro¬ bably displaced at the time of the acci¬ dent. The original acetabulum was contracted and filled up by a fibrous substance. The ligamentum teres was entire, elongated, and flattened. The cartilage covering the head of the fe¬ mur was in its natural condition, where it was in contact with the cavity in which it was lodged; but at the rotular aspect of the head of the bone, the car¬ tilage was irregularly absorbed. The head of the thigh bone (1) separated from the new cavity (2), which i9 bounded superiorly by the cotyloid ligament (33), and a preternatural growth of bone (4). The ligamentum teres (5) attached at one extremity to the head of the femur, at the other to each side of the notch of the aceta- bulum (6). On inquiring into the history of this case, I ascertained, that when the sub¬ ject was about fourteen years of age, he fell from a ladder, which produced the injury I have described. At the time of the accident, he experienced considera¬ ble pain, and for many months much difficulty in walking; buthe eventually recovered, and at the time of the attack of inflammation, which destroyed him, he was actually engaged in carrying out beer for a publican who resided in Portugal-street. In this case, at the time of the acci¬ dent, the cotyloid ligament must have been partially separated, and probably | MR. CORY ON MIDWIFERY PRACTICE. G59 a portion of the acetabnlura was sepa¬ rated at the same time, which $ would allow the head of the bone to occupy the situation which it maintained, with¬ out the ligamentum teres being neces¬ sarily ruptured. I cannot conceive it possible that any dislocation can take place without rupture of the ligamen- tum teres, provided it be of the usual length, unless, indeed, a portion of the acetabulum be separated at the same time. In all the other cases which have come under my observation, where there has been fracture of the acetabu¬ lum, with displacement of the head of the femur, the ligamentum teres has been destroyed. In this case, had any attempt been made to replace the head of the femur, perhaps much difficulty might have occurred in keeping it in its position, as in cases where the acetabu¬ lum has been fractured, although the head of the femur has been readily replaced, I have seen it impossible to maintain it in its proper position. This difficulty, I apprehend, will depend upon the size of the portion of the ace- bulum which is separated. MIDWIFERY PRACTICE. PLACENTAL "PRESENTATION AND EX¬ PULSION. To the Editor of the Medical Gazette. Sir, The interesting communication of Mr. Bull, inserted in the last number of your useful publication, relative to the expulsion of the placenta whilst the foetus remained in utero, brings to my recollection a similar case which oc¬ curred to me some time since, and which was attended with very extraor¬ dinary circumstances. My attendance was requested on a i woman named Phipps, about 38 years i old, a patient belonging to the East London Lying-in Institution, who was ( reported to have suffered the pains of parturition for some hours. On having (recourse to the usual vaginal examina-’ 'tion, a substance possessing the charac¬ teristic peculiarities of the placenta was i discovered occupying the vagina, being at the same time entirely extra-uterine. 1 1 could hardly imagine it to be the pla¬ cental mass, as there was scarcely any attendant haemorrhage. A more parti¬ cular examination, however, soon satis¬ fied me as to its reality, and that, more¬ over, there existed an arm presentation. The liquor amnii had been discharged, and the os uteri was fully dilated. The operation of version was immediately attempted to be performed ; but so firmly was the foetal body embraced by the uterus, that it would have been im¬ possible to have effected it without risk¬ ing the infliction of severe injury upon that organ. In this most unenviable position I requested the co-operation of my expe¬ rienced friend and neighbour, the late Mr. Bennett, senior, who also endea¬ voured to reach the feet of the child, but his efforts were alike ineffectual. He coincided with me in the opinion that the woman ought to be delivered as soon as it could be accomplished with safety, as it was evident that we were indebted for the absence of haemorrhage to the unusual contractile power exerted by the uterus; and that any sudden or gradual diminution of its contractility, although it might facilitate the opera¬ tion of turning, yet would in all proba¬ bility give rise to a copious haemorrhage, highly dangerous to the life of the pa¬ tient ; and as the want of pulsation in the umbilical cord demonstrated that the foetus no longer possessed vitality, it was therefore determined to eviscerate the chest and abdomen, according to the plan proposed by Douglas, of Dublin. The operation was immediately com¬ menced, and after the necessary interval the delivery completed. On the third day after the operation some symptoms of uterine inflammation were experienced, which soon yielded to venesection, leeching, fomentations, with the free exhibition of calomel, opium, and tartarized antimony, &c. At the expiration of seven or eight days all dangerous symptoms had disap¬ peared. She perfectly recovered. What renders this case so remarkable is the almost incredible fact, that there was no more haemorrhage than in an ordinary parturition ; and the deficiency of this formidable symptom can only be attributed to the powerful contraction which the uterus so beneficially exerted on the foetal body. It may be proper to remark, that the placenta was'gcom- pletely expelled from the vagina before THE BRITISH MEDICAL ASSOCIATION. BGO the operation. It was nearly of the na¬ tural size. — I am, sir, Your obedient servant, Edward Augustus Cory, M.R.C.S., Surgeon to the E. L. Lying in Institution. Cannon-Street Road. St. George’s East, Jan. 24, 1837. EFFICACY OF CHLORINE IN SCARLATINA. To the Editor of the Medical Gazette. Sir, Owing to the constant prevalence of scarlet fever, I am induced again to call the attention of the profession to the employment of chlorine in this too often fatal disease. A few years ago, when I resided at Bromley, in Kent, I published in the Medical Gazette some very remarkable cases of scarla¬ tina, treated by my partner, Mr. Wil¬ liams, and myself, in which the chlorine appeared to be highly useful. Not hav¬ ing the Gazette by me, I cannot re¬ collect the exact time, but 1 think it was in September, 1830. However, I will venture to trouble you again with the particulars of one very striking case. It was that of a young woman in the service of Lord Farnborough. She had been to visit her parents in the country. Whilst there, her brother and sister died of malignant scarlatina. Soon after her return to Bromley Hill she fell ill, and had the disease in its worst form. I visited her first on a Sunday evening : I gave her an emetic of ipeca¬ cuanha, and then directed her to take a glassful of the chlorine mixture as fre¬ quently as she could sw allow it. Under this treatment the dangerous symptoms soon gave way, and on the Saturday following she w'as down stairs. I could relate many more cases, in which equal success attended the use of this medicine. In short, out of a great number of patients who were at that time attacked by the disease, two only died, both in the village of Wick¬ ham, one an infant, the other a spoiled child, ten years old, whose parents would not allow either medicine or nou¬ rishment to be given against the child’s inclination. I hope I shall be excused for again expressing a wish that medical meu will give this medicine a fair trial, as other means so often prove ineffectual. My practice is to give, in the first place, an emetic of ipecacuanha, according to the age of the patient; to avoid active purgatives, which are injurious to chil¬ dren (particularly large doses of calo¬ mel); and then to give the chlorine a3 frequently as possible. As it appears to me highly important that the chlorine should be well pre¬ pared, I will subjoin the formula for that which I use, which was given to me by Air. Brown, surgeon, at Lew'is- ham : — R Potass. Oxymur. 3ij ; Acid. Muriat., Aquas Distillat., aa. ^ij- Th e acid and water to be mixed, and the oxymuriate dissolved in them. It is to be kept in a stopper bottle, in a dark place. Two drachms of this solu¬ tion are to be put into half a pint of distilled water, to make the chlorine mixture. — I remain, sir, Your obedient servant, R. T. Taynton. 39, Queen Square* Jan. 259 1 &37t MEDICAL GAZETTE. Saturday , January 28, 1837. “ Licet omnibus, licet etfam mibi, dignitatem Artis Medico: tueri ; potestas modo veniendi in pablicum sit, dicendi periculum non recuso.” ClUGUO. THE BRITISH MEDICAL ASSO¬ CIATION. The proceedings of the “ British Medi¬ cal Association,” at Exeter Hall, were at least satisfactory in this respect- — they were perfectly explicit. We confess that wre had conceived, in the commencement, some favourable expectations of what might be the re¬ sult of a well-ordered association of professional men, combined for their mutual advantage : and such, as w’e un¬ derstood it, was the rallying principle announced by the managers of this scheme. But they have now thrown off THE BRITISH MEDICAL ASSOCIATION. 631 the mask; nor is it without some feel¬ ing1 of regret and disappointment that we discover what proves to be the real character of the society — a mere politi¬ cal union, distinguished by all the vices of ultra radicalism. This being the ease, it cannot but be gratifying to every steady member of the profession, to learn that the meeting was what it deserved to be — a misera¬ ble failure. Notwithstanding all the previous announcements, and blowing of trumpets — and desperate were the blasts as the time approached — calling upon all persons from the highways and by-ways to be present, and upon all medical pupils to quit their studies and take a part in the proceedings — notwithstanding all these efforts made by interested parties for upwards of th ree weeks, nothing could be more wretched than the meeting. There were not above a hundred persons col¬ lected together, including about a dozen students ; and among that hundred, not a soul was there of either name or note, unless we except Drs. J. Johnson, and Anthony Todd Thomson, both of whom felt called upon to protest against a part of the laws, involving a fundamental principle of the society. Perhaps we should not exactly say that there was nobody else of note there, for we perceive that there were some of the figurants of the late Meade-and-Wakley meeting present ; and though the latter eminent performer did not appear in person, he was amply represented in the spirit : the “ address” was wholly Wak- leyan. The honourable member for Finsbury shone conspicuous in every line of it ; and it was evident that though for obvious reasons he did not choose to be of the dramatis persona? during the evening, the entertainment was gut up chiefly under his direction, and that he had been at the rehearsal. 1 From the first, indeed, it has been notorious, how a certain number of the general practitioners of the borough have been urged on by Wakley to their present awkward predicament: from a mere dinner-party they have been prompted by that worthy to erect them¬ selves into an Association, and to as¬ sume a denomination as ridiculous as it is gratuitous. But who except the ca- joledtthemselves, cannot see und the preceding week . . J 6 METEOROLOGICAL JOURNAL. Kept at Edmonton, latitude 51° 37' 32" N . Longitude 0° 3' 51" W. of Greenwich. Jan. 1837. Thkrm om htrr. Barometer. Thursday. 19 from 30 to 39 29-89 to 29 80 Friday . . 20 30 37 29-71 29 64 Saturday . 21 33 43 29 59 29 54 Sunday . . 22 37 51 29-41 29-28 Monday. .23 45 51 29-38 29 35 Tuesday . . 24 44 51 29-44 29 57 Wednesday25 41 44 29 55 29.59 1 Winds S. and S.E. Cloudy, with frequent showers of rain. Rain fallen, *825 of an inch. Charles HenryAdams. Notices. — The sketch of Mr. Liston is too broad and personal for our pages. A Pupil of the Borough Hospitals, too late for this number. Wilson ik Son , Printers, 57, Sic inner- St. London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOUKMAL ( OF iWrtnnnc anti tfse Collateral ^notres. SATURDAY, FEBRUARY 4, 1837. LECTURES ON FORENSIC MEDICINE; Delivered at the Aldei'sgate School of Medicine , By William Cummin, M.D. Lecture XIX. Live and Still Births. Statistics of the still-born — Question of live birth: 1. In Civil cases — Legal distinctions — Law of 1 enancy by the Courtesy — How modified by the C cesarean section — Success of this opera¬ tion on the Continent , as compared with what has happened here — Notice of a celebrated English case. 2. In Criminal cases — Proli¬ cide. Abortion or Miscarriage — Present state of the law on this subject in need of amendment — Objects of inquiry in cases of alleged Abortion — Medico-legal inspection of the Ovum or Foetus — Examination of the suspected female — Methods usually employed for procuring Abortion — Their precarious effects — Circumstances under which it may be sometimes justifiable to cause miscarriage. There remains one other point of view in which the births of children are to be medieo-legally considered, and that, though last, far from being least in im¬ portance. Whether children are born alive or dead, often becomes a question Iraught with the weightiest interest, both before our civil and ‘criminal tribunals; and competent medical evidence can alone give it a satisfactory solution. LIVE AND STILL BIRTHS. Statistics. — In the ordinary course of na¬ ture a certain proportion of children are l still born. What that proportion is, it i may be worth while to inquire, previously • to our entering on the consideration of the 6 479.— xix. fact in particular instances. In criminal cases, more especially, it may be impor¬ tant in favour of mothers accused of de¬ stroying their offspring, to know that a certain number of children are usually dead before delivery, subject to variation according to the operation of predisposing causes. M. Quetelet, of Brussels, has made some interesting inquiries on this subject, and has found that there is a material dif¬ ference in the mortality according as the births take place in cities or in the coun¬ try, and according to the sexes of the in¬ fants. The number of still births occur¬ ring in towns is double that in the country; in the latter it is but one in every 31 births, while in the former it is one in about 16; and more boys perish than girls, in the proportion of three to two. Dr. Buck, of Hamburg, confirms those returns : on an average of eight years, he found the number of still-born to be to the number of births as one to 16; but the mortality of males was not quite so much — five to four expressed the ratio. According to Dr. Denman, the propor¬ tion of still born in this country is, or was, not more than one in 16, or perhaps be¬ tween that and one in 20. The returns of some of our lying-in institutions have of late given a much lower rate, such as one in 25, or even 28. In Ireland the morta¬ lity is greater. We find in Dr. Collins’s work, which contains so many valuable statistical facts relating to midwifery practice, that of 16,654 children born in the Dublin Lying-in Hospital, 1121 were still-born, and 614 were males; that is, the still births were to the entire number of births in the proportion of above one in 15, and the males to the females nearly in the ratio of six to five. Some other facts worth noticing in this place are men¬ tioned by Dr. Collins. Of the 1121 still¬ born children, 527 were putrid (one in 24), and 299 were expelled prematurely (one in 3*8). It is well to have some idea of the 2 X 674 DR. CUMMIN ON FORENSIC MEDICINE. proportion born putrid — namely, about half the number of still-born ; for where appearances of uterine putridity are pre¬ sent, the question of live or still-birth can scarcely be entertained, and our duty as medical jurists is accordingly much expe¬ dited and abridged. The general conclusion from these data may be thus briefly expressed. Of the number of children born, from five to seven per cent, is the proportion of still births ; and of these about half are putrid, and nearly a fourth premature. 1. In Civil Cases. It will be convenient to divide the sub¬ ject of live and still births, as it may hap¬ pen to be inquired into, in civil cases or in criminal. Legal distinctions. — The fact of live birth must be ascertained in all cases where property is transmitted through a new-born child. I have already men¬ tioned that an infant in ventre sa mere may become possessed of property as a legatee, may have a surrender of a copy- hold estate made to it, or may even take land by descent; but all this on the pre¬ sumption of its subsequent live birth: hence the importance of being able to de¬ termine, in doubtful cases, whether it be live or still-born. What is to be understood by live birth is variously interpreted by civilians and cri¬ minalists, and also by the jurists of dif¬ ferent countries. Mr. Chitty says, “ we would define it to be the arrival of the child at that stage after parturition, when its existence and capacity to continue life, separate and apart from the mother, has been distinctly established ; and which consists not merely in breathing, but also in the exercise, at least for once, of all the functions essential to the continuance of life, and, amongst others, principally the circulation of the blood, the existence of which, at least prima facie , is essential to prove the infant’s capacity to continue life.” But this limitation of live birth, however applicable to the case of in¬ juries inflicted on the new-born child, implies a much higher standard of vi¬ tality than is requisite for securing the privileges of infants in a civil point of view. For the latter purpose it seems sufficient that the infant should ex¬ hibit any sign of life; nor is it necessary that it should be proved to possess a capa¬ city for continuing to live. In France and other countries, the fact of viability must be made apparent, in order to secure the rights and privileges of the child. Here, even in criminal cases, the absence of via¬ bility is a circumstance which may or may not be taken into account, at the dis¬ cretion of the court; but the mere fact of birth, with any appearance, however slight, of not being still, is all that is requisite to constitute the infant a transmitter of pro¬ perty. Law of Tenancy by Courtesy. — There is a curious provision in the arrangements of our common law, for securing certain privileges to a husband who survives the marriage, and has had issue live- born. It may be best explained by an example. A man marries a woman possessed of real or landed property ; they have a child, still-born, and the wife after¬ wards dies. The property will go to the remotest relation of the wife — nay, in de¬ fault of relations, it will become a for¬ feiture to the king rather than the hus¬ band shall have it. But let us suppose the child born alive, and to have lived even only an instant, the wffiole affair is altered ; the husband then has a claim superior to that of any relative ; he has a right to en¬ joy the property during his life; he be¬ comes, in short, “ tenant by the courtesy of the law of England.” In Scotland, in order to establish a te¬ nancy of the kind, it must be proved that the child cried, that being considered re¬ quisite as sufficient evidence of vitality. In this country, too, it has been attempted to introduce the same necessary proof, but without success. Lord Coke objected to the position that the crying of the child should be held requisite ; but his reason was an odd one — because the child might be deaf and dumb ! There can be no doubt but that the cry¬ ing of the child after birth would be re¬ garded by a jury as conclusive evidence of its being born alive ; but much less proof has sometimes been held sufficient. In a very remarkable case, Fish v. Palmer, tried in 1806, the plaintiff had by his wife a child, supposed to be still born : the wife died, and there being no issue of the mar¬ riage, the estate went to the wife’s brother- in-law. The husband, however, w as after¬ wards induced to contest the fact of the child having been born dead. The accou¬ cheur, Dr. Lyon, had died before the trial, but it appeared in evidence, that he had declared the child to be living an hour before the delivery ; and having directed a warm bath to be prepared, gave the child to the nurse to be immersed in it. It nei¬ ther cried nor moved., nor did it shew any signs of life; but two women swore that, while in the hot wrater, there twice ap¬ peared a tw7i telling and tremulous motion of the lips ; and, upon informing Dr. Lyon of this, he desired them to blow into its throat; but it never exhibited any other signs of vitality. Drs. Babington and Haighton, who were examined on the trial, declared that the muscular motion of LAW OF TENANCY BY COURTESY, o/o the lips could not have happened if the vital principle had been quite extinct, and that, therefore, the child was born alive. J)r. Denman, however, gave a contrary opinion, and declared that the child was not born alive; and he attempted to esta¬ blish an important distinction between uterine and extra-uterine life, and consi¬ dered that the tremulous motion of the lips might arise from some remains of the former. The jury, however, did not agree with the latter witness, but found that the child was born alive. Had Dr. Lyon acted in this case with more promptitude and energy, it is proba¬ ble he would have saved some litigation ; but as it is, the case affords a good illus¬ tration of the actual state of the law, and of the importance attaching to contempo¬ raneous evidence. It shews the expe¬ diency of taking notes of wdiat occurs at b rths, especially when children are born in a doubtful condition, or do not at all events live long. The circumstances at¬ tending the labour should be noted, and some memorandum preserved of the per¬ sons who may happen to be present. There have been instances of accoucheurs, after the lapse of many years, being called on to give evidence before the highest tribunal in the land, concerning births at which they may have assisted, and where the mothers were at the time in an humble rank of life. It was in contemplation a few years since, among other projected alterations in the laws relating to real property, to ren¬ der tenancy by the courtesy independent of issue — to enable the husband to be¬ come tenant without having had any children by his deceased wife. But no alteration of the kind has taken place; the law remains as it was, allowing the same latitude as ever for medical evidence and judicial discretion. How modified by the Ccesarean section. — The occurrence of birth through the (Caesarean operation may affect the tenancy, 'notonlyas thechild may not be brought into : the world alive, but as the mother may have died before the operation. The law :is clear on this point: “ If the woman in iher travel dieth,” says Coke Littleton, i“ and the child is ripped out of her body 'alive, yet shall the husband not be tenant by the courtesie; because the child was Inot born during the marriage, nor in the (lifetime of the w ife, but in the meantime the land descended; and in pleading he must allege that he had issue during the marriage.” But suppose the operation performed 'before the mother has expired, and that the child has lived, though it be hut for an instant, tenancy is evidently created ljust the same as it would be were the child born otherwise. It is easy to see, however, in what way litigation might ensue, should the mother expire under the operation, or should it be attempted to extract the child while the state of the mother as to life or death wras unequivo¬ cal. The main question would be one of fact, — whether the child were extracted alive, the mother surviving the operation were it but for an instant ? There is obviously a strong inducement in the present state of the lawg to have the operation performed on the yet living- mother, where it appears not improbable that she may perish before the birth can be effected in the usual manner. And per¬ haps I may take this opportunity of throw¬ ing together some remarks on this formi¬ dable operation, which, indeed, claims the attention of the medical jurist scarcely in any other way than as now contemplated. It may, no doubt, be wantonly and mis¬ chievously had recourse to, and the mo¬ ther’s life be compromised in consequence ; in which case certainly a medico-legal question would arise as to the propriety of having attempted, and the amount of vio¬ lence effected by, the operation *; but the consideration of questions of this sort belongs to a subsequent part of the course. Here we may briefly inquire as to the chances of the operation creating a te¬ nancy by the courtesy. “ I think,” says Coleridge, in his Table- Talk, “ there are only twTo things wanting to justify a surgeon in attempting the Caesarean operation : first, that he should possess infallible knowledge of his art; and secondly, that he should be infallibly certain that he is infallible.” The doubt here so emphatically intimated, of the un¬ justifiable nature of the operation, seems not to have been peculiar to Coleridge alone ; it appears to be the national feel¬ ing. While other nations have been freely practising the caesarean operation, and boasting of their success in its perform¬ ance, it has been comparatively seldom attempted among us, and then apparently with results not such as to justify more frequent trials. It is curious that there is no mention of the caesarean operation in the writings of the ancient medical authors; probably be¬ cause it w^as only performed on the dead. There was a lawr, however, as early as the time of Numa, that no pregnant wro- man should be buried until the fruit of her womb was extracted. Traditions, too, wrere prevalent, of various eminent persons who w-ere thus “ untimely ript” from the uterus. Esculapius was cut out of his mother, Coronis, after she had been slain by Apollo; Scipio Africanus, the * See Med. Gaz., vol. xi. p. 55 6. 676 DR. CUMMIN ON FORENSIC MEDICINE. conqueror of Hannibal, was born in this way ; Julius Caasar also, it is said, but er¬ roneously ; and the bold Macduff seems to have owed no small share of his success in combating his fierce antagonist, to the superstition attaching to his artificial birth. Up to about the sixteenth century, it seems never to have been contem¬ plated that the operation should be per¬ formed, save where the mother died undelivered. Rousset, a contemporary of Ambrose Pare’s, first published a trea¬ tise, in which there was igven an ac¬ count of some cases of the operation being successfully performed, the women re¬ covering. It was a sow-gelder, of Ales- paclien (as Bauhin reports), who first set the example of it on the living woman — his own wife — and she afterwards bore several children. Without entering into a detailed notice of subsequent authorities, I may come at once to comparatively recent times. Baudelocque has given an account of 73 operations, 31 of them successful; Spren- gel mentions 106 cases, 61 of which were prosperous ; and Simon, in the Memoirs of the Academy of Surgery of Paris, has noticed 64 successful cases, in 13 of which the operation was repeated; some of the patients having undergone it five or six, and one even seven times. Notwithstanding this, the practitioners of Great Britain have not felt themselves much encouraged to practise the opera¬ tion. They have rarely, if ever, resorted to it, except in cases of necessity, where, through pelvic distortion, or tumors, there was no chance of delivering the mother otherwise ; nor have they thought them¬ selves justified, like their continental neighbours, in substituting gasterotomy where craniotomy seemed adequate to effect the delivery. Hence, and not from any peculiarity in our climate or the con¬ stitution of our females, their little suc¬ cess. It appears, that out of about thirty instances in which the cresarean section has been tried in this country, only one or two have terminated favourably, so far as the preservation of the mother has been concerned : and in the first and chief of these it has been doubted whether the operation was truly caesarean — whether, in fact, gastro-hysterotomy, or section of both uterus and abdomen, was effected in it. The case to which I allude is related at length by the operator, Mr. Barlow, of Blackburn, in the Medical Records and Researches : a brief outline of it may not be uninteresting. Jane Foster, a healthy woman, forty years of age, and who had had several children, fell from a loaded cart, the wheel of which passed over her pelvis as she lay on her back. One of the ossa ilii was fractured, and much injury done to the ossa pubis. There was an elevation of the head of the thigh-bone on the left side, which, with her other sufferings, rendered the patient lame. She afterwards became pregnant, and was taken in labour 22d November, 1793, Three or four days passed without prospect of delivery ; the waters were discharged, and no part of the child could be ascer¬ tained to present within reach. A consul¬ tation was held, when Mr. Barlow, on ex¬ amining per vaginam, found, to his great surprise, that he could barely pass his fin- ger between the pubis and last lumbar vertebra, while the outlet was so con¬ tracted as scarcely to admit the introduc¬ tion of three fingers. On a more strict ex¬ amination, he felt a very evident depres- sion of the ossa pubis, “ with a protube¬ rance in a direction somewhat more to¬ wards the hollow of the sacrum than in an exact line with the last lumbar vertebra.” Mr. Barlow was induced to consider this protuberance as a deposit of bony matter, produced after a separation of the symphy¬ sis pubis caused by the accident; but in whatever way it originated, it projected to within half an inch of the sacrum. After four days’ suffering, the pains of labour ceased : matters now became almost des¬ perate, and the caesarean operation was proposed. The woman herself consented to it without hesitation, and it was accord¬ ingly performed on the morning of the 27th. On laying open the “ uterus,” which was observed to be “ very thin, scarcely exceeding that of the peritoneum,” the child presented with its breech, and was extracted dead. The placenta and mem¬ branes were then removed without dif¬ ficulty; nor did any haemorrhage follow. The wound of the abdomen was united with a few sutures, and was healed by the sixth day. The womb contracted well ; the lochia were as abundant as in ordinary cases, and, in short, no material acciuent having occurred, the woman was able to leave her bed by the 10th of December, and to resume her usual occupations on the 17th. She enjoyed good health afterwards, and survived for several years. When she died, her pelvis came into the possession of Mr. Barlow, and this drawing, the ori¬ ginal of which was copied from nature, i represents its malformed structure. You observe the tuberosities of the is- chia (a, a,) greatly approximated, and an almost complete obliteration of the arch o the pubis. The symphysis pubis projects outwards very remarkably, and the conju¬ gate diameter is in consequence extremely: contracted. In the pelvis stripped of its soft parts, this diameter was not morei than an inch and an eighth, and throng ( ABORTION OR MISCARRIAGE. 677 the greatest portion of its extent, the brim did not measure above seven-eighths of an ineh. Fig. 23. This case, — though suspected to be one in which the membranes merely were divided, and not the uterus — that organ being previously ruptured — may serve as a good example of the sort of contingency in which British practitioners conceive they may venture on the operation ; they limit their employment of it to those cases only in which, from the extreme dispro¬ portion of the pelvic diameter to those of the child’s head, there is no hope of ex¬ tracting the infant by any other method. But it deserves to be considered whether this reluctance, or scruple, on the part of our surgeons, may not be carried too far, in the face of that success which continen¬ tal practitioners (Locher, Muller, and Grafe, for example) have had, and whe¬ ther gasterotomy might not safely be resort¬ ed to, with every prospect of preserving both infant and mother, in many cases where the usual method is to procure delivery by “ lessening the head,” or in other words, by deliberately destroying the child. Of the desirableness of divesting such an ope¬ ration of its terrors, I need not say ano¬ ther word, as you must all be aware that, upon its timely performance, so much of the worldly happiness of the patient and her relatives depends. We now proceed to consider the ques¬ tion of live or still birth, as it may be raised 2. In Criminal Cases. If wilful injury be done to a live-born child, it is murder ; but in proof of the crime it must be shown that the child was born alive. To enter into an inquiry as to what is meant by being born alive, in reference to criminal charges, would lead us at once into the subject of infanticide. It will be more profitable, however, before we come immediately to that subject, to take a view of the injuries which are frequently offered to the foetus, or embryo, before birth ; for both topics may be considered as comprehended under one general head, with a common appellation — that of Pro¬ licide, or the destruction of offspring; a term which I only wonder has not been more generally adopted. Prolicide, then, embraces criminal abor¬ tion (or miscarriage, as the law terms it) and infanticide. I shall treat of each in order. ABORTION, OR MISCARRIAGE. The physiology as well as the morality of the ancients was so loose, that little or no compunction was experienced relative to the procuring of untimely births. The legislators, in certain of the old commu¬ nities, enjoined it as a duty on their citizens to check the population by the practice of infanticide, whenever their families attained a specified number; and they frequently did not wait for na¬ ture to complete the course of gestation, but practised foeticide, or, as it appeared to them, the mere removal of a visceral obstruction, as a thing not only conveni¬ ent, but praiseworthy. No wonder it was so. Hippocrates, or rather the author of a tract attributed to him, held that the foetus was not endowed with life till thirty days after conception, if it were male, and not till forty-two, if female. Galen sup¬ posed that the foetus was not animated till forty days after conception ; others were of opinion that it required fora male forty days, and for a female eighty days, before it possessed a vital principle. The Stoics, strangest of all, maintained that the foetus was destitute of life until the moment it respired ; that is to say, that it was an unanimated though organic substance dur¬ ing the period of utero -gestation. It is easy to see to what consequences such doctrines must have led wherever they were entertain¬ ed. But even amongthemoderns,andwhere the advancement of knowledge should have taught people better, opinions much akin to those just noticed have been adopted and acted upon. Zacchia, the eminent Roman medical jurist, laid down sixty days as an equitable period within which abortion might be practised without any breach of morality or religion. This was probably a necessary allowance for the lax state of morals that still prevailed in the ec¬ clesiastical communities, notwithstanding the purifying effects of the Reformation. Legal distinctions. — But what shall we say of the English law, which, even at the present day, does not recognize the foetus in utero as endowed with life, till the time of quickening has been ascer¬ tained to have arrived ? Portio viscerum matins is the designation by which it has been noticed in the older law books : 678 DR. CUMMIN ON FORENSIC MEDICINE. and some very material distinctions are made in our statute law, according to the period and circumstances of pregnancy. In the earlier condition of our jurispru¬ dence, abortion under any circumstances did not amount to murder ; it constituted, however, in certain respects, a high misde¬ meanor. But Lord Ellenborough’s Act (43 Geo. II L, c. 59) introduced a change: if abortion was wilfully effected before quickening, it was accounted a felony, punishable with fine and imprisonment, or transportation for life : but abortion, after the period of quickening, when cri¬ minally procured, was punished as a capi¬ tal crime with death. The law which is now in force (9 Geo. IV., c. 31, s. 13) is almost identical, and is word¬ ed as follows : — “Be it enacted, That if any person with intent tp procure the miscar¬ riage of any woman then being quick with child, unlawfully and maliciously shall administer to her, or cause to be taken by her, any poison or noxious thing, or shall use any instrument or other means whatever with the like intent, every such offender, and every per¬ son counselling, aiding, or abetting, such offender, shall be guilty of felony, and being convicted thereof, shall suffer death as a felon. And if any person, with in¬ tent to procure the miscarriage of any woman not being, or not being proved to be, then quick xvith child , unlawfully and mali¬ ciously shall administer to her, or cause to be taken by her, any medicine or other thing, or shall use any instrument or other means whatever with the like intent, every such offender, and every person counselling, aid¬ ing, or abetting, such offender, shall be guilty of felony, and being convicted thereof, shall be liable, at the discretion of the court, to be transported beyond the seas for any term not exceeding fourteen years nor less than seven years, or to be imprisoned, with or without hard labour, in the common gaol or house of correction, for any term not exceeding three years; and if a male, to be once, twice, or thrice publicly or privately whipt (if the court shall so think fit) in addition to such punishment.” The absurd distinction here preserved in accordance with the old ideas about quickening, is disgraceful to our legisla¬ tors; but I have it from good authority, that this is to be one of the very first points amended in the criminal code now in preparation: one punishment, and that not capital, is to be awarded for the crime, at whatever period of pregnancy it may be committed. A case which may serve to illustrate the law in its actual state, occurred not very long since on the Norfolk Spring Circuit, before Mr. Baron Vaughan. John Coe was indicted for feloniously administering according- put into In a short miscarriage savine to Henrietta Freeman, for the pur¬ pose of procuring miscarriage. Prosecutrix, who was but sixteen years of age, stated that the prisoner was the father of the child. When she told him she was pregnant, he said he would give her “ some stuff to make her unwell, as shh ought to be.” She consented to take it, provided it did not hurt herself. The drug to prisoner’s direction, was boiling water, and drunk off. time she was unwell, and a took place. It was proved that the prisoner had purchased a quantity of sa¬ vine, and some of it was found in his box. A surgeon proved that miscarriage had taken place, and stated that no drug what¬ ever could be administered for the purpose of procuring a miscarriage without en¬ dangering the life of the person by whom it w as taken, — a fact which, he thought, ought to be generally known. The prisoner was found guilty, and sen¬ tenced to seven years’ transportation. He obviously owed his escape from capital punishment to its not being proved that the child was quick. Objects of inquiry. — Whenever a question concerning a criminal abortion is raised, there are in general three points on which justice will require to be satisfied. 1. Whether there has really been an abor¬ tion ; in other words, whether a corpus de « licti can be made out. 2. Whether it has taken place naturally or by criminal inter¬ ference. And 3. Whether it may not have been justifiable, owing to some peculiar circumstances in the physical condition of the female. On each of these heads I shall make a few remarks. 1. The fact of abortion. — The main proof that abortion has occurred, is the pre¬ sence of the foetus or the ovum. Without this the investigation is defective, and halts at the very outset. The embryo may happen to be expelled at a very early period, when the ovum, coming away entire, presents a shaggy appearance on immersing it in water. At a later period the membranes may burst, and the foetus alone be found in the dis¬ charges. Sometimes the entire ovum is enveloped in a clot of blood, and may ea¬ sily escape detection, unless much care be taken in searching for it. It may even be necessary to steep the suspected clot for a day or two in wrnter. In general w-e should examine an early ovum with the greatest caution. By gentle agitation and the use of the syringe, the coagulated blood may be removed ; after which, by delicate dis¬ section under water, and using fine, but not sharp, instruments, its real nature may be made out. A careful search of this kind, not only to ascertain whether there be an embryo ABORTION OR MISCARRIAGE. 679 present, but whether it be normal or the contrary — blighted, is absolutely neces¬ sary in such cases as eome under the cog¬ nizance of the medical jurist. Here, for example, is an ovum which, by being pre¬ pared in this way, tells its own story. You perceive, from the relative dispro¬ portion of the embryo (c) and its envelopes (/;, «), that the general structure is abnor¬ mal. It is, in fact, an ovum which was expelled about the eighth or tenth week of pregnancy; and the embryo (c) perished about the fifth or sixth week, probably from the deposition of too much gelatine (d) in the funis, the vessels of which were thus compressed. Appearances of this description should go far towards annul¬ ling a charge of criminal abortion, for they imply strongly that the event oc¬ curred in the ordinary course of nature. The rules already laid down in a former lecture* will suffice to enable you to form an opinion of the age of the foetus, and to statein every case, if not at what time during the pregnancy the miscarriage occurred, at least at what period the foetus perished. I shall therefore not detain you longer on these points. The next step is to trace the ovum or foetus to the source from which it came. Some female is suspected. We must exa¬ mine her, — when, according to the period that shall have elapsed from the occur¬ rence of the abortion, the appearances will be varied. If there be symptoms of recent haemorrhage, — if a locliial discharge be present, — if the vagina, os uteri, labia externa, and the mammae, be in those con¬ ditions which I described in a former lec¬ ture on tire signs of recent delivery, — the proofs are strong. It may happen that the supposed mother has died, in which case the examination of her body may throw additional light on the circumstances of the case : the uterus will probably be found enlarged, and thickened, and vascular, and a placental mark may be found, and per¬ haps a corpus luteurn ; but above all, in the examination of the mother, we must be able to satisfy ourselves that the period indicated to have past since abortion cor¬ respond with that which has appeared to have elapsed since the foetus was expelled ; and the foetus must accordingly be scru¬ tinized with reference to these points, as well as to any marks of violence discover¬ able upon it. 2. Mode in which effected. — When we have thus been satisfied that the charge of abor¬ tion is not groundless, our next inquiry, and one that must be entered upon with¬ out loss of time, is — to what the occur¬ rence of abortion has been owing ? We must recollect that such an event may have been wholly accidental and involun¬ tary, and yet that nothing may have been more natural than its conceal ment in cer¬ tain moral circumstances. With this saving clause, however, it wall probably be in most cases our painful duty to detect much vicious and wicked manoeuvring on the part of females to bring on the expulsion of an ovum. I happen to be acquainted with one instance of a lady who, at a certain period of her pregnancy — about the tenth or twelfth week — regu¬ larly took a short sea voyage, which never failed to enable her to abort. And it is a very common practice for women to have recourse to drastic cathartic medicines, to large bleedings, to eantbarides, savine, and other drugs, for the accomplishment of their depraved and dangerous purpose. Nay, we shall sometimes detect the marks of blows on the abdomen and loins, and the appearance of mechani¬ cal injury inflicted on the foetus itself. To what extent, however, personal vio¬ lence may be employed without procuring abortion, is well exemplified by a case that occurred not long since in Dr. Wagner’s practice at Berlin. “ Among the remark¬ able cases which came before us,” says the Professor, in his half-yearly report, “ was one of attempted abortion. A young woman, seven months with child, had employed savine and other drugs, with a view to produce miscarriage. As these had not the desired effect, a strong leather strap (the thong of a skate) wjas tightly bound round her body. This, too, avail¬ ing nothing, her paramour (according to his own confession) knelt upon her, and compressed the abdomen with all his strength : yet neither did this effect the desired object. The man now trampled on the girl’s person while she lay on her * Lecture III. p. 67, ante. 080 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS. back ; and as this also failed, lie took a sharp-pointed pair of ►scissors and pro¬ ceeded to perforate the uterus through the vagina. Much pain and haemorrhage ensued, but did not last long. The woman’s health did not suffer in the least, and pretty much about the regular time a living child was brought into the world, without any marks of external injury upon it.” Not rarely does it happen that the females who are so abandoned as to prac¬ tise these methods of procuring mis¬ carriage, pay the forfeit of their lives for their wickedness. All the means which I just now enumerated are attended with extreme danger to the mother, whom they often destroy, not only without concealing the nature of her guilt or letting it die with her, but perhaps causing a dreadful exposd of her guilty object first, and then producing an agonizing death, with all the tortures of remorse. Fodere cites a remarkable case: — A woman, finding her¬ self pregnant, and no longer able to con¬ ceal it, procured half an ounce of powder¬ ed cantharides, which she mixed with an ounce of sulphate of magnesia. She took this horrible dose in order to procure abortion. In a short time after she was seized with violent colic, and brought forth a living child in the most excru¬ ciating pains. During the succeeding night she died. 3. Question of necessity. — I have only a few words to say on the third question — namely, whether it be ever justifiable to cause miscarriage, or, in other words, whether a midwife or an accoucheur may bring on artificial labour? According to the strict interpretation of the law, they may not, even in cases of haemorrhage or convulsions : but no doubt, if such an oc¬ currence were pleaded on an indictment for alleged procural of abortion, the in¬ tentions of the accused and the circum¬ stances of the case would have due weight with the jury; and the probability is that no grand jury would find true bills. But this is supposing a case of manifest danger to the mother. What if the preg¬ nant woman be not in immediate danger, but from the configuration of her pelvis, or some constitutional peculiarity, it be thought advisable by her medical attend¬ ant to bring on premature labour ? Is it justifiable in such a case ? Opinions are divided upon it; and the French autho¬ rities have argued the point at much length. Fodere strongly advocates such a discretionary power in the accoucheur : while Capuron as strongly opposes it ; and his reasons are these — 1. That it is always impossible to be certain that there is such a disproportion between the diameters of the pelvis and the bulk of the child as to war¬ rant artificial delivery; and we know not what extraordinary efforts nature may make for the unaided relief of the mother. 2. That these premature labours frequently kill the child, and may the mother. And 3. That a supposed danger is not to be combatted with a real one. He concludes by deliberately stating, that it is better by far to have recourse to the caesarean sec¬ tion, which, he says, saves one in three , — or even to symphysiotomy, — than to an arti¬ ficial or forced delivery. It seems to me that Capuron carries his notions on this point to a very unrea¬ sonable extent ; and I believe I am borne out in saying so, by referring to what seems to be the practice of some of the best authorities amongst us on these matters. Dr. Hamilton, of Edinburgh, for example, is in the habit of bringing on premature labour in cases where he has reason to suppose that the child will not live, or may be born still, if the mother be allowed to go to the full term of gestation *. And others might be quoted to the same effect. LECTURES ON MATERIA MEDICA, OR PHARMA¬ COLOGY, AND GENERAL THERAPEUTICS, Delivered at the Aldersgate School of Medicine} Br Jon. Pereira, Esq., F.L.S. Lecture LYI. We shall now examine — DMBELLIFERiE, Or APIACEAE, one of the largest, and, in reference to structure, one of the most natural families of the vegetable kingdom : moreover, it is a most interesting one for the physician, inasmuch as it contains a variety of die- tetical, medicinal, and poisonous sub¬ stances, in common use. The roots are annual or perennial ; the stems herbaceous and fistular; the leaves usually divided (though sometimes sim¬ ple), and sheathing at their base; the flowers small, and arranged in umbels, from which circumstance the name of the family has been derived. At the base of the general umbels there is usually an involucre ( involucrum ) ; and in the same position in the partial umbels an involu- cellum. The calyx is superior, commonly five-toothed ; the corolla is composed of * Medical Gazette, vol. v. p. 344. ANETHUM GRAVEOLENS, OR DILL. 681 five petals, usually inflexed at the point. There are five stamina, and usually two carpels ; so that umbelliferous plants be¬ long to class Pentandria , order Digynia , of the Linnean arrangement. The fruit, called by botanists cremocar- pium, or diakenium , is usually termed by the Linneanists, though very improperly, seeds. Thus, in medicine we find the fruit of coriander, dill, caraway, cumin, anise, carrot, fennel, hemlock, &c. generally termed seeds ; but in the new edition of the London Pharmacopoeia this has been corrected. The fruit consists of two parts (termed achenia, carjiella , or mericarps), adherent to a common axis by their face (the commissure.) Each carpel is traversed by ridges, of which five are primary ( costce seu juga primaria), and four are intermediate or secondary ( juga secundaria ) : the spaces between the ridges are called channels or interstices (valle- culce.) In the substance of the pericarp there are usually linear receptacles of a brown colour, filled writh volatile oil ; they are called vittce , or, by Decandolle, reservoirs en cacum ; they are considered to be dilata¬ tions of the intercellular spaces. Com¬ mencing from above, they extend down¬ wards in different species, one-third, half, or three-fourths, the length of the fruit. They are often visible both on the com¬ missure and in the channels. By a trans¬ verse section of the fruit, they appear as dark points. The fruit of the parsnip ( Pastinaca sativa, fig. 151) is well adapted for observing the vittas, especially if it be previously immersed in wrarm water. Fig. 151. — Fruit of Pastinaca sativa. A, Dorsal surface. B, Horizontal section of the fruit. a,b b, c c, juga primaria ; 1, 2, 3, 4, 5, 6, vittse. Vittae are not invariably present; the fruit of conium, and of some other genera, being without them: the carpella of such plants are said to be evittata. Of course they are without aroma. Fruit with only four dorsal vittae is said to be pauci vittatum , as in Pastinaca; when more than this number, multi vittatum. The aromatic properties of the fruit of Umbelliferae (as of coriander, anise, dill, caraway, fennel, carrot, &c.) depend on a volatile oil secreted into, and contained in these vittae. The seeds of Umbelliferae are albumi¬ nous : the albumen maybe flat ( Umbelli - ferae, orthospermce), or it may be rolled in¬ wards at the edges ( U . campy lospermcc ), or it may be curved inwards from the base to the apex (U. crdospermce.) The embryo is minute. Anethum graveolens, or Dill ( Pastinaca Anethum of Sprengel). This plant was employed by Hippocrates under the name of avp&ov, it is. mentioned by Dioscorides and Pliny. It is said by Campbell to be alluded to in the New Testament, though our translators have, by mistake, rendered the original word anise. It was introduced into this country in 1570. Dill is a native of the south of Europe, as of Spain and Italy. It greatly resem¬ bles our common fennel, though its odour is less agreeable. The mature carpella (the semina or fructus anethi of the shops) are oval, flat, dorsally compressed, about a line and a half long, and from a half to one line broad; they are of a brown colour, and are surrounded by a lighter-coloured membranous margin (ala.) Each carpellum has five primary ridges, but no secondary ones. In each channel is one vitta, and on the commissure are two vittas. These vittas contain the aromatic oil. The odour of the fruit is strongly aromatic ; the taste warm and pungent. By distillation a pale yellow volatile oil (the oleum anethi) is obtained, the quantity of which varies with the maturity of the fruit. This oil has a specific gravity of 0-881, a penetrating odour analogous to that of the fruit, and a hot sweetish taste. It is readily soluble in alcohol and sether, and dissolves, according to Tietzmann, in 1440 parts of water. The effects of dill are carminative and stimulant. Taken with the food it may be regarded as condimentary ; that is, it assists the digestive process. For this purpose it is used by the Cossacks, and some other inhabitants of the Russian empire. It excites a sensation of warmth in the stomach, expels wind, and relieves some painful affections of the alimentary canal, of a spasmodic nature : hence it is used by nurses in the colic of children. It has also been employed to relieve hic¬ cough. It has been supposed to promote the secretion of milk. It is usually given in the form of dill water (aqua anethi.) For adults the oleum anethi may be employed in the dose of a few drops on a lump of su¬ gar, or dissolved in spirit. Loudon says the leaves of dill “ are used to heighten tlje relish of some vege- f>82 MR. PEREIRA ON MATERIA MED SO A AND THERAPEUTICS. table pickles, particularly cucumbers ; and also occasionally in soups and sauces.” Pimpinella Anisum, or Anise ( Sison Ani- sum of Sprengel). This plant was used by Hippocrates, who calls it avvpaov ; it is also mentioned by Pliny and Dioscorides. ft was intro¬ duced into this country in 1551. In our translation of the New Testament the word anise occurs ; it should have been dill. Anise is a native of Egypt and the Le¬ vant. It is largely cultivated for its fruit in Malta, Spain, and at various places in Germany, as at Erfurt and Miihlhausen, in Thuringia, at Magdeburg, &c. This fruit is imported into this country from Alicant and Germany. The fruit (called in the shops semina or fructus anisi ) is slightly compressed at the sides. The separated carpella are ovate, of a greyish green colour, with live paler, thin, filiform, primary ridges (there are no secondary ones), and covered with downy hairs. In each channel are* three virtue. The odour is aromatic, and similar to that of the fruit of Illicium anisatum , or star anise, a plant belonging to the family Winteraceae. The taste is sweetish and aromatic. A very elaborate analysis of the fruit has been made by Brandes and Reimann, in 1826. The following are their results : AEtherial oil . 3-00 Stearin combined with chloro- phylle . 012 Resin . 0T7 Fatty oil, soluble in alcohol • • 3-37 Semi-resin . Q’40 Phyteumacolla . 7-85 Incrystallizable sugar . 0-65 Gum . 6-50 Extractive . o-50 Substance analogous to ulmin ( Anis-ulmin ) . 8"60 Gummoin . 2*90 Lignin . 32-85 Salts (acetate, malate, phos¬ phate, and sulphate, of lime and potash) . . . 8 17 Inorganic salts, with silicic acid and oxide of iron . . 3*55 Water . 2300 101 63 Oleum Anisi. — The oil of anise of the shops is imported into this country from Germany and the East Indies. It is pro¬ cured by distillation from the fruit, in whose pericarp it resides. When carefully prepared it is transparent and nearly co¬ lourless, having a slightly yellow tinge. It has the odour and taste of the fruit from which it is obtained. Its specific gravity increases with its age: thus Martius says when the oil is fresh distilled, the specific gravity is only 0979; but after keeping it for a year and a half, the specific gravity increased to 0-9853. It congeals at 50° F, ; and does not liquify again under 62°. It is soluble in all proportions in alcohol ; but spirit whose specific gra¬ vity is 0-84, dissolves only 0-42 of its weight. By exposure to the air it forms resin, and becomes less disposed to con¬ crete. It is composed of two volatile oils, — one solid at ordinary temperatures (stearoptene) ; the other liquid ( eleoptene ), in the following proportions: — Eleoptene . 75 Stearoptene . . . 25 300 The oleum badiani, or the oil of star anise ( Illicium anisatum ), has the odour and taste of the oil of anise ; but it preserves its fluidity at 35 6 F. It is said to be sometimes substituted for the oleum anisi. Spermaceti, which is sometimes added to oil of anise, to promote its solidification, may be distinguished by its insolubility in cold alcohol. Camphor, w hich is said to be added for the same purpose, may be re¬ cognised by its odour. Effects. — The effects of anise are similar to those of dill, before mentioned; that is, they are condimentary, stimulant, and carminative. The odour of the oil is said to be recognized in the milk : moreover, the urine, we are told, acquires an unplea¬ sant smell when anise has been taken : hence it would appear that the oil of anise becomes absorbed. It has been supposed to promote the secretion of milk, urine, bronchial mucus, and of the menses, though without sufficient evidence. Vogel says that he accidentally discovered pigeons are readily killed by a few drops of the oleum anisi. Uses. — Anise is used to flavour liqueurs, sweetmeats, confectionery of various kinds, ragouts, &c. In medicine it is employed to relieve flatulence and colicky pains, especially of children. Nurses sometimes take it to promote the secretion of milk. It has also been employed in pulmonary af¬ fections. The aqua anisi is the preparation of anise commonly employed. In the Pharma¬ copoeia there is a formula for a spiritus anisi, the dose of which is one or two drachms. A spirit of anise, sweetened with sugar, is sold by the liqueur dealers : a somewhat similar compound is prepared in France, under the name of creme d' anise. In the Dublin Pharmacopoeia there is a compound spirit of anise, containing an¬ gelica: it is nearly the composition of the Irish usquebaugh, which is coloured yellow by saffron, or green by sap green. CUMINUM CYM1NUM, OR CUMIN. 683 Canon Carui, or the Caraway. Caraway (fig. 152, b ) is not mentioned in the writings attributed to Hippocrates. Pliny and Dioscorides, however, speak of it : the former ca’ls it Careum, from Caria, its native country, the latter Kayos. Fig. 152. — (a.) Coriandrum sativum, (b.) Carum Carui. It is a native of this country, and is largely cultivated in Essex, for medicinal and other purposes — as for distillation with spirituous liquors, and for confec¬ tionary. The ripe carpella (the semina, or fructus carui, of the shops) are partly sup¬ plied from Germany, the remainder be¬ ing the produce of this country. They are from 1§ to 2 lines long, usually separated, slightly curved inwards, of a brownish colour, with five lighter coloured primary ridges ; there are no secondary ones. In each channel is one vitta, and on the com¬ missure are two. The smell is aromatic and peculiar, the taste wrarm and spicy. By distillation, a volatile oil ( oleum carui ) is obtained, of a pale yellow colour. The action of carawray is analogous to that of dill and anise, already mentioned, and it is employed in similar cases — namely, in flatulent colic of children. It is used in domestic economy, confectionary, &c. on account of its flavour ; but it is also useful as a condiment. The officinal preparations of this sub¬ stance are the aqua, the oleum, and the spi- ritus carui. The spirit, swreetened with su¬ gar, is taken in Germany as a dram. Cara¬ way in substance, or in the form of oil, enters as an adjuvant, or corrective, into various officinal preparations ; as the con¬ nection of opium, of rue, and of scammony ; the compound tincture of cardamom and of senna ; the compound pills of aloes and of rhubarb; and the compound spirit of juniper. Coriandrum sativum, or Coriander (fig. 152,o.) This is the uopiavvov of Hippocrates. It is mentioned also by Pliny and Dioscorides. It is a native of the south of Europe, and is cultivated in Essex. The ripe fruit (semina , or fructus cor iandri), as met with in the shops, is globular, about the size of white pepper, of a greyish-yellow colour, and is finely ribbed. It consists of two hemispherical carpella, adherent by their concave surfaces. Each carpellum has five primary ridges, which are depressed and wavy ; and four secondary ridges, more prominent and carinate. The channels are without vittse, but the com¬ missure has tw o. The odour of coriander is peculiar and aromatic. By distillation, a volatile oil is obtained ; on this the odour, taste, and medicinal properties of the fruit depend. It resides in the vittrn of the pericarp. The effects and uses of coriander are similar to those of the preceding fruits. Cullen considered it as more powerfully correcting the odour and taste of senna than any other aromatic; and hence at one time it was a constituent of the compound infusion of senna, though now ginger is substituted for it. There are no distinct preparations of coriander; but it enters into one officinal compoum^U-namely, confection of senna. Besides its medical uses, coriander is employed by confectioners and distillers. Cuminum Cyminum, or Cumin. This plant is mentioned in both the Old and New Testament, and by Hippo¬ crates, who calls it Kvpuvou ai&nn.Kov. It is also noticed by Pliny and Dioscorides. It is a native of riEgypt, where, as well as at Sicily and Malta, it is cultivated, and from which place all the cumin of commerce is brought. The ripe carpella (semnia, or fructus cumini ) are larger than anise, and of a light brown colour. Each carpellum has five primary ridges, which are filiform, and furnished with very fine prickles. The four secondary ridges are prominent and prickly. Under each of these is one vitta. Like the preceding umbelliferous fruit, cumin yields a volatile oil (oleum cumini) by distillation. Its medicinal properties and uses are similar to the substances of this family already described. As there is now no preparation of cumin in the new Pharma¬ copoeia (the emplastrum cumini of the preceding editions being omitted), I am surprised that the College has still retained this substance in the list of the materia mediea. It is principally employed in veterinary surgery. 684 MB. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS Daucus Carota ; the Carrot. The carrot plant is too well known to require much description. Hippocrates speaks of the bavKos, which some consider to be the Athamanta cretensis, whose fruit is termed semina dauci cretici. The carrot is a native of this country. For medicinal uses we employ the well- known root and the fruit. (a.) Radix dauci. — Carrot- root consists principally of lignin, sugar, starch, a vo¬ latile andtixed oil, acolouring matter, and a super-malate of lime. Waekenroder obtained half a drachm of colourless aetherial oil out of thirty-four pounds of the fresh root: it had a peculiar penetrat¬ ing odour, and an unpleasant taste. The expressed juice, evaporated to dryness, is composed, according to the same autho¬ rity, of Uncrystallizable sugar, with some starch and malic acid . 93 71 Albumen . 435 Fixed oil, mixed with some mthe- rial oil . TOO Red crystallizable resinous sub¬ stance (carotin) . 0'34 Ashes composed of alumina, lime, and iron . 060 100-00 By the action of alkalies on tj^e ligneous tissue of the carrot, Braconnot procured pectic acid. The dietetical uses of this root are well known. In medicine we sometimes em¬ ploy it in the preparation of a poultice, the cataplasma dauci of the Dublin Phar¬ macopoeia. It is prepared by boiling the root in water until it become soft enough to form a cataplasm. In this state it is used to correct the foetid discharge, allay the pain, and change the action of ill- conditioned, phagedenic, sloughing, and cancerous ulcers. If prepared by merely scraping the root, it is much more stimu¬ lant, and is sometimes applied to chapped nipples. (b.) Fructus dauci : semina dauci of the shops. The fruit is from one line to a line and a half long, brown, oval, convex on one side, flat on the other. The five primary ridges are filiform and bristly: three of them occupy the convex back, the remaining two are on the plane of the commissure of the carpellum. The four secondary ridges are much larger and more prominent than the primary ridges; they are furnished with prickles. Under each of the secondary ridges is a vitta, and on the plane of the commissure are two, making in all six. The odour is peculiar and aromatic, the taste bitter and warm. By distillation, a volatile oil is procured. Carrot fruit exerts a similar influence over the system to the before-mentioned umbelliferous fruits; but it is supposed to act more particularly on the urinary organs, and is in consequence recommended in some nephritic complaints. Fceniculum vulgar e : common fennel. It grows wild in the south of Europe. The fruit (semina focniculi vulgaris of the shops) is scarcely two lines long, oval, and of a dark or blackish aspect. Each car¬ pellum has five obtusely- keeled pale yel¬ lowish grey primary ridges. In each channel is one vitta, (on which the brown colour of the channel depends), and on the plane of the commissure are two. The oil, obtained from the fruit by distillation, is called in the shops the oil of wild fennel. The fruit of this species is not used in me¬ dicine. I ig. 1 53. — Fceniculum vulgare. FERULA ASAFCETIDA. 685 Foeniculum dulce. Sweet fennel is by some regarded as a va¬ riety of the preceding species : but Decan- done considers it a distinct species. Its fruit is much longer, some of the specimens being nearly five lines in length, less compressed, somewhat curved, and paler, than the kind before-mentioned, with a greenish tinge. The oil obtained from it is called the oil of sweet fennel. The effects and uses of sweet fennel are similar to those of the before-mentioned nmbelliferas. Theonly officinal preparation is the aqua foeniculi ; but the fruit enters into the composition of some of the prsepa- rata — as the confection of black pepper and spiritus juniperi compositus. Ferula Asafoetida. History. — It is uncertain at what period asafoetida was either first known or de¬ scribed. The difficulty in determining its history arises from the uncertainty as to the ancient synonymes of this substance. Hippocrates, Theophrastus, and Diosco- rides, speak of a plant which they term cri\882, three measures of solution of sp. gr. 0960 are obtained. It is remarked by Mr. Everitt that I have omitted the word “ about f used by him in directing the quantity of MR. WAKEFIELD ON INFLUENZA. 705 water to be employed in a process : I admit the charge, but deny that the omission in any way affects the point at issue. He says that he did not in¬ tend to give the exact strength of the pro duct : “ I said, put ‘ about ’ (a little word omitted by Mr. Phillips) 30 parts of water.” I shall not question Mr. Everett’s intention, but I must main¬ tain that his directions are precise for obtaining solution of ammonia of sp. gr. 0 960; the word about applying only to the quantity of water to be put into the receiver, and not to the whole quantity to be obtained ; for Mr. E. says, “ by the time that the 30 parts of water in the receiver bottle have in¬ creased to 35 parts, nearly all the am¬ monia will have passed over.” There is no about as to the sp. gr. of the solu¬ tion, nor any as to its quantity; and either by putting water into the re¬ ceiver, or by distilling it with the am¬ monia, directions are distinctly given for obtaining 35 parts of solution of ammonia of sp. gr. 960, from ten parts of muriate of ammonia. Permit me to add, that corrections of some errors occurring in the translation, may be had ofMr. Highley, the publisher. I remain, sir, Your obedient servant, R. Phillips. Jan. 31, 1837. INFLUENZA, AS IT HAS PREVAILED IN THE HOUSE OF CORRECTION. _ s To the Editor of the Medical Gazette. Sir, Since my letter addressed to you on the 5ih of November last, remarking upon the almost total absence of active or inflammatory disease in the metro¬ polis, we have been visited by one of the most direful scourg’es, in the form of influenza, that has occurred within the memory of the oldest practitioner, and which in its consequences will be found to have been far more fatal than the cholera. This disease, upon its first appear¬ ance, so much resembled inflammation of the bronchial passages, that the pro¬ fession in many instances were induced to recommend bleeding. It is for the purpose of entering my protest against this treatment that I have troubled you with this letter. I shall confine myself to the treat¬ ment of the severe cases which have occurred in the House of Correction, and which have amounted, since the 27th of December to this period, to one hundred and five. Of these, ten have terminated fatally ; the remainder either have recovered, or are in a fair way of doing so. The urgent symptoms of fever, head¬ ache, and pains in the limbs, were soon relieved by the use of saline aperient effervescing medicine, which also quiet¬ ed the nausea of the stomach. The op¬ pression of the chest and difficulty of respiration were removed by the fre¬ quent applications of mild mustard poultices. In one instance only was I induced to bleed : no amelioration of the symptoms supervened. The blood shewed no appearance of inflammation, and a post-mortem examination con¬ vinced me that none existed. As soon as the febrile symptoms were subdued, even when the subsequent cough re¬ mained, T upon every occasion gave nutritious food, consisting- of milk, broths, and most frequently the stimu¬ lants of wine and porter. This sup¬ porting plan I was induced to recom¬ mend from the fear of typhus fever fol¬ lowing the great prostration of strength induced by the poison, and of w'bich I had seen so many melancholy cases as the sequelae of’ cholera. The atmosphere still continues to be loaded with this fatal poison ; it makes its attack upon the mucous lining of the bronchial passages, but does not deserve the appellation of bronchitis, a term which has been freely applied to it by the profession, very unscientifically I think, and likely to be productive of very erroneous treatment. The rapidity w ith which some of the cases were carried off, where previous disease of the lungs existed, is hardly credible, and shews the concentrated character of the poison. I should very much like to be informed w hat the treat¬ ment has been in the large public insti¬ tutions in London and the neighbour¬ hood, and whether depletion has been employed to any extent. I remain, sir, Your obedient servant, H. Wakefield. Lansdowne Place, Feb. 2, 1837. 479. — xix. 2 Z 706 ANALYSES AND NOTICES OF BOOKS. ANALYSES and NOTICESof BOOKS. “ L’Autenr se tue a allonger ce que le lecteur se tue a abreger.” — U’Alkmbkkt. Compendium of Lithotripsy ; or an Account of Removal of the Stone from the Bladder without Incision; adapted for general comprehension , with a Series of Statistical Tables , and numerous Wood- cuts represent¬ ing the most important Instruments and Improvements up to the present time. By Henry Belinaye, Esq. Surgeon Extraordinary to her Royal Highness the Duchess of Kent, &c.&c. During the last ten years, we have taken frequent opportunities of laying before our readers an account of the progressive advances in that most im¬ portant improvement of modern surgery — the art of removing calculi from the human bladder through the urethra. The progressive steps in the discovery have been made so rapidly as to require considerable activity to keep pace with them, and on some occasions we had scarcely described one invention ere another yet more important had been added to it. Some account of the pre¬ sent state of the art, and some descrip¬ tion calculated to bring the subject within the grasp of all, had become a great desideratum. Inventors are often influenced by a natural affection for their progeny, which leads us to receive their testimony with some degree of reservation ; and they themselves fully understanding' all the details, some¬ times take for granted an equal degree of familiarity with the subject on the part of their readers, which has led to their descriptions being’ occasionally less complete and elementary than might be desired. Now from these two causes of imperfection, lithotripsy has suffered, as regards its literature, and we think that a very important service has been rendered to this interesting branch of surgery by the author of the “ Com¬ pendium” before us. Mr. Belinaye having none of the weaknesses of pa¬ rentage to mislead his judgment, gives a description of the instruments which (to use a phrase more pithy than ele¬ gant) is “ adapted to the meanest capa¬ cities,” while his opinions regarding them, and his general estimate of the operation, is evidently the result of mi¬ nute observation and research. Here, th erefore, we have the testimony of a competent and intelligent witness, free from any personal bias ; and his evi¬ dence is of a nature to convince the most sceptical, not only of the abstract merits of the operation, but of the extra¬ ordinary mechanical genius and manual dexterity of Baron Heurteloup. We strongly recommend the volume to those who are anxious to become ac¬ quainted with the progressive stages of discovery which have conducted to the present improved state of the art. For ourselves, we purpose merely to touch on one or two points, in order to show the manner in which our author has execut- * ed his task — not without the hope of inducing our readers to add the “ Com¬ pendium” to their libraries. Before we proceed to describe the in¬ struments employed by Baron Heurte¬ loup, it may be as well to make our readers acquainted with the bed (fig’. 1) invented by him for the performance of his operations. Three pieces of wood (A, B, C, fig’. 1.) form the sides of the bed, and they are so joined as to form two right-angled tri¬ angles. They are united in front at the right angle, by a strong piece of wood (D D), and also by another of smaller size (E). The bed may be made to rest on the hypothenuse of the triangle by folding up the moveable portion (K K), which is done by unfastening the bar (M) which is fixed by a bolt at G. When this has been done, the bed rests upon B, which will now lie upon the ground. O, represents the mattress; S S, two pieces of wood, with slippers (U U), for the feet of the patient. In the space between D, P, D, is seen projecting a contrivance called the “ support fixe,” for giving steadiness to the instruments employed. It is also represented de¬ tached from the bed at 5, 3, 3.* The next important step in the im¬ provement of this operation seems to have been in the mode of g’rasping the stone, or rather of seizing it first, and then fixing it. To facilitate this, he in¬ vented an instrument having* four branches instead of three, as had previ¬ ously been the case, each admitting of being moved separately or simultane- * For a full account of the “Lit Rectangle,” and its numerous contrivances, we refer to the Medical Gazette, vol. v. p. 266, el seq. MR. BELINA1E ON LITHOTRIPSY. 707 Fig. 1. ously ; so that when the stone had been caught, each branch could be individu¬ ally adjusted, so as to render its hold more secure. The fourth branch had a button-shaped extremity, which formed the termination or point of the instru¬ ment when shut, while, being- open, it assisted in grasping- the stone (see fig- .’2.) Sometimes the branches laid hold of the calculus in some awkward manner, not admitting of its proper adjustment by any of the ordinary means ; and here vve think one of the most ingenious and simple contrivances in the whole range O of improvement presents itself. It is not difficult to imagine a person at¬ tempting to grasp in one hand a ball, very large in proportion to the length of his fingers, and having originally laid hold of it in the dark, in some 708 ANALYSES AND NOTICES OF BOOKS. awkward way, he finds it impossi¬ ble to improve his grasp without first letting- it g-o — impossible, that is, unless he brings his other hand to his assistance. This is precisely what Baron Heurteloup does: he gives the instrument another hand , by introducing down through its centre a small three- Fig 3. branch pincers, which he calls the “ pince servante,” and which may be seen represented in the above engrav¬ ing, fig. 3. By this contrivance the calculus is adjusted within the branches of the longer instrument, in the manner desired by the operator. The “ pince” being withdrawn, he proceeds to act with the borer. But a better idea than any verbal description can convey will be gathered from the engraving fig. 2, which represents a large spherical cal¬ culus g'rasped by the four branch in¬ strument, and perforated by the drill, — the latter being in outline. When the caculus has thus been bored to a suf¬ ficient depth (a circumstance judged of by graduated marks upon the portion of the instrument which remains external), the drill is withdrawn, and an instru¬ ment called the excavator introduced in its place. The object of this contrivance is to scoop out the interior of the stone, so as to reduce it to a mere shell here, too, however, we prefer appealing to the eye, fig. 4 exhibiting the action of the excavator when it has done its work effectually. Still there was the shell to get rid of; and the necessity of accom¬ plishing this seems to have been the means of leading to a most important improvement in the principle of ope¬ rating, — at least on stones of a certain size, — namely, that of breaking or crushing, instead of the slower process of rubbing or wearing' them down. The instrument with four or even with three blades no longer served, and more sim- pie and stronger mechanism became requisite. The desideratum was an in¬ strument which might be closed upon the calculus it" small, or its shell-like fragment, if it had required to be hol¬ lowed,-— and farther, which might bo MR. BELINAVE ON LITHOTRIPSY 709 * closed with considerable force. For with power sufficient to pulverize a cal- th is purpose lie invented a kind of for- cuius of ordinary consistence. This was ceps, with. two blades, so contrived that the brise coque ; and here it is (fig. 5): the they could be drawn back into a sheath blades of which, so formed as to retain Fig. 5. their hold, are jerked back by means of however, is still better adapted for seiz- a click and spring- into the tube through ing a moderate-sized and long or oval which they pass. This instrument, stone ; as seen in fig. 6. Fig. 6. 710 ANALYSES AND NOTICES OF BOOKS. But the manner of breaking’ the stone, — at least where it is of a certain size and consistence,-— -was destined to undergo another improvement, in which the simplicity of the process is still far¬ ther advanced. This consists of pro¬ viding- it with a hammer. This sounds rather formidable, to be sure, when we reflect that it is to be used in the human bladder, and that, too, when the org-an has been rendered irritable by disease : nevertheless, the problem has been solved. It consists in establishing- a fixed point, against which the calculus is to be supported when it receives the blow, — a moveable blade, capable of striking it with sufficient force, — and lastly, keeping the whole clear of the sides of the bladder, that they may escape injury. Imagine fig. 4 in the centre of the bladder, distended by pre¬ vious injection, and you have the “ per* cussor” of Baron Heurteloup. Like the recto-curvilinear sound, it consists of a straight and a curved portion. As the reader looks upon it(fig.7), the extreme portion on the lei t is the fixed point, — the other the moveaJble blade or hammer, which, sliding in a straight stem (cut short in the figure), admits of being- pulled back and driven in again upon the calculus with sufficient force to break it. At one time M. Heurteloup thought of employing a screw, by which, the plates should be gradually but very powerfully forced together, and the stone thus crushed ; but the tendency of the steel to bend, and other reasons, induced him to abandon this — we believe entire¬ ly. Still there was some inconvenience, from the fragments, when broken off, being, as it were, lost in the bladder. This induced M. Heurteloup to give the instrument a hollow or spoon shape, with Fig. 8. QUARRELS OF QUACKERY- — THE NEW UNIVERSAL MEDICINE. 71 1 boles in it (fig-. 8), so that when closed upon a frag ment, and a few blows of the hammer are given “ cautiously and judi¬ ciously,” the superabundant portions are forced out through the apertures and at the edg’es of the instrument, which being then completely closed, is withdrawn with its carg'o through the passage of the urethra, without risk or difficulty, as may be at once understood by glancing at the preceding figure. Here we must close our account of this interesting volume. It is illus¬ trated by nearly fifty wood-cuts, ren¬ dering the action of the instruments perfectly intelligible ; and contains, in addition to the demonstrative part, many important considerations both theoreti¬ cal and practical, together with nume¬ rous statistical tables connected w ith the subject of calculous disorders. Reform der Heilkunst. (Reform of Medicine.) Von Dr. M. J. Bluff. Leipzig, 1837. Schloss. Du. Bluff is a diligent observer of the actual state and progress of medicine. He gives us here the result of his obser¬ vations for several years back, and without meddling with the question of external arrangements (which is of late usually implied by the term Medical Reform,) points out what he conceives to be the material alterations undergone by the medical art w ithin the present century. His remarks are interesting, and though not often profound, are characterized in general by their aim at practical utility. Das Auge von dem Standpunkte der Medicinal Polizei betrachtet. (The Eye, in reference to Medical Police.) Von Dr. .J. H. Beger. Heidelberg and Leipzig. 183G. Schloss. A very curious essay on eye-quackery, eye-hospitals, the care which govern¬ ments ought to bestow iu preserving the eye-sight of their respective communi¬ ties, eye-epidemics, &c. Ueber die Anwendung der Ligatur bei Schlagaderwunden. (Application of the Ligature to Arteries.) V011 Dr. K. J. Beck, Professor der Chirurgie, See. Freiburg. 1830. Schloss. We have in this brief monograph the results of the experience of a distin¬ guished operator, wdiose object it is to determine under what condition of wounded arteries the ligature is to be applied, in a remote or a neighbouring- situation. The illustrative cases will be read with interest. Die Lehre von den A ugenkra n hheiten. (Elementary Treatise on Diseases of the Eye.) Von Dr. J. C. Juengken, Professor der Heilkunde in der Uni- versitat zu Berlin, &c. Berlin, 1836. Schloss. This is a second and enlarged edition of Professor Jiingken’s excellent text¬ book. It forms in its present shape one of the best works of reference ; the lite¬ rature is copious and well digested; and the tabular views of the diagnosis of inflammations of the eye are well calculated to convey much nractical in¬ formation. MEDICAL GAZETTE. Saturday , February 4, 1837. “ Licet omnibus, licet etiam mihi, dignitatem Artis Medico: tueri ; potestas modo veniendi iu publicum sit, dicendi periculum nonrecuso.” Cicero. QUARRELS OF QUACKERY. THE NEW UNIVERSAL MEDICINE. “ When rogues fall out,” says the old proverb, “ honest folk come by their ow n.” We wish the simple honest folk who are so easily duped out of their health by designing’ knaves, could be equally fortunate ; but they must be content if the quarrels of those rogues let them into a secret — howr to keep “ their own.” We observe, by the public prints, that a grand schism or defection has taken place among the Morisonian quacks. Salmon, the man who was convicted of manslaughter for having dosed to death Captain Mackenzie with “ universal medicine,” or, as he describes himself, “ whose name has appeared so prominent in con- 712 QUARRELS OF QUACKERY — THE NEW UNIVERSAL MEDICINE. nexion with Morison’s pills,” has split from his employers, and made some curious disclosures. He gives us an insig'ht, for which we are much obliged to him, into the sort of traffic carried on by the “ hygeian” party, and informs us of the kind of persons engaged in that trade. The most cu¬ rious part, however, of this “ plot disco¬ vered,” consists in Salmon’s confession of the badness of the pills which have for a long’ time been administered to the public. He says he frequently com¬ plained to the Morisons (for it seems there is a plurality of them) that the pills were not all right; but the hygeian presidents denied this, and would not admit that there was any imperfection : whereupon Salmon has appealed to the public, and exposes the alleged imper¬ fections seriatim. It was long ago shown in this journal that the pills in question, even were they harmless and fit to be exhibited, when carefully prepared, were likely to be rendered highly deleterious from the mode employed in manufacturing' them on a large scale : one batch containing almost nothing but cream of tartar, for instance, while others belonging to the same lot were wholly composed of aloes or gamboge, yet all being professedly of the same degree of strength. It was thus, we argued, that the mischievous effects of the nostrum could readily be accounted for — some swallowing fifties together w ithout damage, while others suffered death from the virulence of perhaps a smaller dose. All this is fully confirmed by Salmon. Having stated first his suspicions, and then his detection of the spurious nature of the pills, he thus sums up the points to w hich he attributes the mischief : — 1, to the slovenliness with which the drugs are prepared ; 2, the carelessness in mixing and compounding them, each pill not possessing the due and requisite quantity of each drug, and hence pro¬ ducing, as its natural consequence, a want of uniformity of operation ; 3, the extremely large quantities required to be taken, owing to these defects [and the extremely sm«//quantities, he should have added, which ought to have been taken in other cases, when the strong drug's fell to the lot of the unfortunate patient] ; 4, the irregularity of size and shape of the pills, making it impossible to regulate properly the doses ; 5, the extortionate price charged, and the short quantity given. Honest Salmon, no doubt, thinks this last item quite as bad as any in the list; and resolving to make pills of his own in future, promises to give better measure than the Mori¬ sons do, and for less money. Of the badness of the old pills, he tells us he was quite convinced, and with the assistance of two other men, of the names of Bygrave and Hall, he is now resolved, he says, to offer for sale better pills than Morison’s. This an¬ nouncement, made in the public papers, is, of course, wormwood to the grand “ hy- geist,” and forth comes a counter-state¬ ment from the latter, warning the public against the new firm, and telling us who Messrs. B. and H. are : one of them, it seems, having’ been Mr. Mori¬ son’s footman, and the other a carpenter employed in the pill manufacture. It is amusing* to see how coolly these people set themselves to work in get- ing up their new purging establishment. Salmon explains the process adopted in the present instance. He was com¬ punctious, we presume, about the mischievous properties of the old pills — those, namely, by which he committed manslaughter, and which led to his pun¬ ishment— and “ knowing that Messrs. Bygrave and Hall were principal assis¬ tants to the late Mr. Moat, and that they must necessarily be better acquainted with the compounding’ than either of QUARRELS OF QUACKERY — THE NEW UNIVERSAL MEDICINE. 713 the two junior Mr. Morisons, who had no practical experience, and were not in the firm while Mr. Moat had the ma¬ nagement,” he got some medicine “ brought out,” as he calls it, by Messrs. B. and H., and “ tested” (qu. by tasting, swallowing, &c.) its merits. The result is, that Messrs. Salmon, Bygrave, and Hall, have formed a coalition, and in the most patriotic manner offer to supply the public with the only genuine Mori¬ son’s pills. In other words, the matter may be thus stated : — Salmon, the tobacconist, and hitherto one of Morison’s agents, having reason to know that he could make as good, if not better, pills than his employer, resolves to set up for him¬ self ; and having* discovered the old original assistants — otherwise the foot¬ man and carpenter of “ the firm,” — all three (viz. the tobacconist, the carpenter, and the footman) determine to manu¬ facture, for the use of the public, pills more truly Morisonian than Morison’s own. These pills are, of course, to cure every disease, and to be suited for every age, sex, and constitution : even “ the babe of a day old may take them with perfect safety.” But the most remarkable circumstance yet remains to be noticed. These peo¬ ple have no difficulty in being regularly licensed to sell their new compound, and to tamper as much as they please with the health of the liege subjects. What a picture is this of the care be¬ stowed on tbe public health by the government of the British Empire, and at such a time ! It is but the other day, as we remember, that his Majesty was induced to grant a charter for the esta¬ blishment of a new University, one of the avowed objects of which was to aid the cultivation of medical science, “ in accordance with the spirit of this en¬ lightened age,” — yet at this very time the royal sanction is granted to any quack who chooses to compound pills and offer them for sale. One hand is thus held out for the encouragement of the medical art, while the other receives the tribute, and affords protection to the most barefaced quackery. How the Minister can reconcile this with the w7is- dom of an age so superior as be has de¬ scribed it, to that of the seventeenth cen¬ tury, is a problem which we fancy he might not, if pressed, find it very easy to solve. But to return to the licensed marauders. It was our first impression, as it still is, on observing the mutiny in the Morisonian camp, that it w ould be bene¬ ficial for the public ; the captain of the gang is no longer to have all the booty, — his lieutenant thinks he has just as good a right to be leader, and to be in¬ dulged with a larger share of the spoil ; but this produces a deadly feud, and the parties “ peach” and inform on each other. The result of this, it were easy to foresee, in any well-ordered community ; but it is rendered doubtful, when we recollect the facility with which “ honest folk” among us are gulled by the most shameless impostors. If any thing could open the eyes of a British public to the gross humbug practised on them by these so-called “ hygeists,” it would be by the self-exposure committed by these fellows. Salmon, the tobac¬ conist, the faithful, tried , and accre¬ dited agent of the Morisonian firm, has confessed the “ imperfections” attaching to the pills as manufactured hitherto, and offers a better article instead ; he forms a new connexion with a footman and a carpenter, — and lo, the public are forthwith informed that they are to be supplied with a new and better “ uni¬ versal medicine,” and with “ cleansing powders” — good weight and measure — at a “ saving of twenty per cent. 1” We cannot but think that the hint is broad enough for the meanest capacity. Salmon’s “ new light” must illuminate a large portion of the community. 714 DIVORCE OF THE BOROUGH HOSPITALS. TRIAL OF MR. PENRUDDOCK. At page 715 will be found an account of the trial of Mr. Penruddock for an assault committed on certain members of the Court of Examiners at Apothe¬ caries’ Hall. The Worshipful Society proceeded against the prisoner for the capital offence, and had he been found guilty he could not have escaped with any punishment short of being trans¬ ported as a felon. Now, however un¬ justifiable such an assault might be, still we apprehend that no dispassionate person can regard it as having been preconcerted, or as otherwise than the momentary ebullition of an impetuous temper, irritated by the disgrace of re¬ jection ; and viewing it in this light, we think it was both a hard and an injudicious measure to proceed against the prisoner on the capital charge. Had Mr. Penruddock been condemned be would immediately have become an object of sympathy, but this feeling can in no degree exist now that the capital indictment has been discharged, and he is merely to be prosecuted for the com¬ mon assault. DIVORCE OF THE BOROUGH HOSPITALS. To the Editor of the Medical Gazette. Sir, Your last number contains a resolution purporting to proceed from the General Quarterly Court of Governors of St. Thomas’s Hospital, held on Wednesday, the 18th instant. I am aware that you are not likely to be deceived on such a subject; nevertheless, -common justice to the governors of St. Thomas’s compels me to suspend my judgment respecting the authenticity of this document, — first, because T find, by application at the Steward’s Office of Guy’s Hospital, that no copy of it has been transmitted to the persons whose interests are most directly affected by it; secondly, because some facts which, as an old student of Guy’s Hospital, I have been able to ascertain with perfect cer¬ tainty, make me unwilling to impute such a resolution to any body of respectable gentlemen. In the year 1760 it was pro¬ posed that the pupils of each hospital should have the advantage of attending the operations in the other. In 1768 regulations were passed, and engagements entered into, for the purpose of enabling the pupils of each hospital to profit still more extensively by the practice of the other, and of securing the discipline and good order of the students ; and by one of these regulations it wras provided, that the pupils in each house should be subject to the control of the treasurer of that house. In 1825, the Committee of Guy’s Hos¬ pital remonstrated against some acts of the Committee of St. Thomas’s Hospital which seemed to be a violation of the existing compact. The appeal was with¬ out effect; and the Committee of Guy’s Hospital, after duly apprising the other party of their intention, built an ana¬ tomical theatre, and took other steps for the completion of their own school. None of these steps, however, in the least inter¬ fered with the privileges previously gua¬ ranteed to the students. They were con¬ firmed by an express resolution of the St. Thomas’s Committee, passed subse¬ quently to the transactions in 1825; and every student, in each hospital, pays his money upon the faith that he possesses them . These being the facts of the case, I submit to you, sir, that the Court of St. Thomas’s Hospital cannot have passed the resolution which you have printed; — they cannot have taken advantage of a transaction respecting which a law-suit is still pending, for the purpose of doing injustice to a large body of students who were in no wise concerned in the disturb¬ ance complained of; — they cannot have committed the gross prevarication of saying that they were not consulted about the measures adopted by the Guy’s Com¬ mittee, in 1825, which they know were the result of a long previous negociation ; • — they cannot have said that the union between the schools was dissolved in 1825, when it has existed for all purposes in which the public and pupils are interested till the present time. With these doubts respecting the au¬ thenticity of the paper in question, I am, sir, Your obedient servant, A Pupil of the Surgical Schools of Guv’s and St. Thomas’s Hospital. Guy’s Hospital, Jan. 26, 1837. [Sceptical as our correspondent may be, the document we published wras authentic. — Ed. Gaz.] TRIAL OF MR. PEN RUDDOCK. 715 CENTRAL CRIMINAL COURT— WEDNESDAY. (Before Mr. Justice Williams and Mr. Justice Coleridge.) Charles Wadiiam Wyndiiam Penrt d- dock, aged 22, described as a surgeon, was capitally indicted for feloniously wounding Thomas Hardy, with intent to do him some grievous bodily harm. Mr. Adolphus (with whom was Mr. Jerningham) stated the case for the pro¬ secution. In detailing the facts of the case, as proved in evidence, the learned counsel stated that he felt bound to say that the young gentleman, the prisoner at the bar, was of a highly-respectable family, and be-' longed to a most honourable profession. The prosecutor was Mr. Thomas Hardy, one of the examiners at Apothecaries’ Hall. On the day the prisoner committed the offence charged, he was a candidate for a medical certificate necessary to qualify him at Apothecaries’ Hall. It appeared to the examiners that the young gentleman was well acquainted with surgery, which he had studied with credit to himself; but the examiners were of opinion that he was deficient in his knowledge of phar¬ macy, and the certificate he applied for was refused. The prisoner then, in a passionate state of excitement, inflicted a blow with an instrument, strangely called a “ life preserver,” and which would be produced to the jury— a blow that endan¬ gered the life of Mr. Hardy. Mr. Thomas Hardy examined. — I am a surgeon retired from practice, and reside at Walworth. I am one of the examiners at Apothecaries’ Hall. I was there on the day in question and saw the prisoner, who was one of the candidates for a certificate. I observed something very peculiar in his manner ; he appeared to be labouring un¬ der much excitement. He hastily took up pieces of sarsaparilla, which he bit and then threw down. I was in the room when the certificate sought for by the prisoner was disallowed. I saw the prisoner strike at Dr. Merriman, but I saw no weapon in his hand. I saw an in¬ strument afterwards which I was told had been taken from the prisoner. During the time I wras near the prisoner he looked hard at me, and said, “You are one of those who were hard with me.” Immedi¬ ately after that I received a violent blow on the head, but I am unable to state whether the blowr was struck with an in¬ strument or not. I became faint and I partly unconscious in consequence of loss ' of blood. By Mr. Phillips, for the prisoner. — There appeared to be a great degree of excitement about the prisoner. He spoke deridingly of the examiners. He said he wrould not be degraded by them in the eyes of his family ; he would die, or he would swing first. Mr. Randall, surgeon, confirmed the greater part of the above testimony, and proceeded to state that while the prisoner was under the examination of Mr. Este, he was asked the use of cubebs. The prisoner in reply said, “ I know it very well.” A person is not fit for an apo¬ thecary who does not know the use of it ; but he did not seem to know the purpose for which it should be applied. Mr. Este said, “ Don’t you know that it is used for a specific discharge ?” The prisoner replied, “ Oh, yes.5’ Knowing that he had been at St. George’s Hospital, Mr. Este asked him if he had not seen it used there ? He again said, “ Oh yes.” He was again asked as to its use, but he made no reply. He not answering, I said to the prisoner, “ The gentleman means in what form and in what proportion is it to be used ?” The prisoner turned round to me, and said, “ how the devil can 1 answer questions if you are all badgering me in this kind of way ?” My conduct to him at the time was mild and friendly, and not tending to irritate. After other questions were put, the prisoner attempted to excuse him¬ self by saying, “ I never could answer questions, even when at school, although I knew as well as any other boy.” He was told that the answer was required, in order to show that his knowledge quali¬ fied him for practice. The examiners never wish to hurt the feelings of any can¬ didate, but they have a very important public duty to perform, and he told the prisoner so. The prisoner replied hastily, ‘‘ Sir, you have behaved very gentlemanly, and so has that gentleman (pointing to Mr. Este). The prisoner then said, “Pray examine me in anatomy ; I understand that, for I have lived in a dead-house.” I he Court of Examiners is competent to examine in the science of anatomy, but it is the usual custom first to examine as to materia medica. Mr. Randall refused to examine the prisoner in anatomy, ob¬ serving at the time that that branch of in¬ quiry came more properly under the cog¬ nizance of the College of Surgeons. He (Mr. R.) said, if the first anatomist in the world was ignorant of matera medica and pharmacy, he would not be a fit person to receive a certificate of practice. It was then suggested that a few simple questions should be put to the prisoner, which not being promptly answered, Mr. Este, the chief examiner, observed that he could 716 TRIAL OF C. W. W. PENRUDDOCK not, consistently with his duty, con¬ sent to grant the required certificate. The prisoner then said to the examiners, “ Your certificate is of no advantage to me in a pecuniary point of view, as I am going abroad and have good resources ; but do you think I am going to be disgraced in the eyes of my family by such a set as you are ? No, I’ll be d — d if I will, I’d die first — I’d swing first !” The prisoner then arose from his chair, raised his right arm above his head, and aimed a blow at Mr. Hardy. I did not see any¬ thing in his hand, but afterwards I saw an instrument which is called a life pre¬ server, which was said in the prisoner’s hearing to have been taken from him. The witness was cross-examined at con¬ siderable length, but nothing was elicited to shake his examination in chief. Mr. Tegart.— I am an apothecary, and live in Pall-mall, and am one of the exa¬ miners at Apothecaries’ Hall. I was on duty there on the day named in the indict¬ ment. I heard the questions put by Mr. Este and others to the prisoner, who did not answer them. Mr. Bacot stated that he was present when Mr. Hardy was struck. The blow appeared to have been struck with a blunt instrument. That now produced would inflict such a contusion. Has un¬ derstood it to be called a life-preserver. Mr. Justice Williams said he had seen such instruments exposed for sale in shop- windows ; hence he feared they were very common. The witness continued — There was a good deal of blood flowed from the wound, and Mr. Hardy was attended daily by him for about a fortnight. The wound was not in its nature dangerous in the first in¬ stance, but serious consequences might have arisen, and loss of life, had inflamma¬ tion ensued. By Mr. Phillips. — Medical students were in the habit of being out at all hours of the night, and might require an instru¬ ment for self-defence. Mr. Phillips replied at great length in an energetic speech. The learned counsel argued against the possibility of the wea¬ pon which he then held in his hand — used by a powerful young man — having caused the wound. A child of twelve years of age would have caused, with such an instrument, a greater injury. But with a powerful arm, bones must have been fractured by a blow from such an instru¬ ment. Mr. Phillips contended that the blow was inflicted with the naked fist, used in a moment of passion. Mr. Justice Williams. — Perhaps you had better have the surgeon recalled. Mr. Phillips.— Then, my lord, I wish he may be called now. Mr. Bacot, recalled, gave the same de¬ scription of the wound as he had in his testimony in chief, stating his opinion to be that it could not have been produced by the knuckles of a man: it was just such a wound as he had seen produced hun¬ dreds of times by a spent ball. Mr. Phillips resumed.— He was not sorry Mr. Bacot had been recalled, for it proved that he was not fully aware how the wound had been inflicted. He said it was like a gun-shot wound. Why, had not the jury, in street broils and fights, seen wounds exactly similar to the one de¬ scribed ? In making the observation, he did not wish to disparage the professional .reputation of Mr. Bacot, who was eminent for his long experience. The learned coun¬ sel appealed to the feelings of the jury to restore the young gentleman at the bar to the highly respectable family to which he belonged, and to acquit him of the grave charge made against him, and which he and his family so severely suffered under. That the prisoner had been guilty of a most imprudent and desperate assault, he (Mr. P.) would not deny or palliate, but he called upon the jury for an acquittal on the indictment before them. If their verdict should be favourable, yet would the unfortunate young gentleman be removed back to his dungeon to await another in¬ dictment, which, no doubt, would be pre¬ ferred against him. The learned counsel concluded by observing, that there was no proof of malice as to the prisoner having the life-preserver in his possession ; it was necessary even in the well-guarded metro¬ polis, for medical students, who were out late at night, attending lectures, to have defensive weapons for their protection. Mr. Bodkin called Dr. Seymour and several gentlemen in the medical profes¬ sion, who gave the prisoner an excellent character for humanity and general good conduct. Mr. Justice Williams summed up at length, with much perspicuity, stating the law, recapitulating the evidence, and com¬ menting thereon. The jury retired to consider their ver¬ dict, and on their return pronounced a verdict of Not Guilty. The Court was moved to detain the pri¬ soner to give time for an indictment of assault to be preferred against him. The Judges assented, and ordered the prisoner to enter into his own recognisance of 200/., and two sureties of 100/. each. ASSISTANT SURGEONS IN THE NAVY. 717 OPERATION OF THE ANATOMY ACT IN DUBLIN. To the Editor of the Medical Gazette. Sir, About two years since a statement of the Dublin teachers of anatomy was published approving of the Anatomy Bill. It must gratify the author of that law to find that longer experience confirms their good opi¬ nion. It is effecting a slow but certain revolution in favour of the whole profes¬ sion, and removing the odium which the outrages of resurrection-men attached to medical students. I inclose the resolu¬ tions of the teachers of the eight schools of Dublin, at their first meeting this year, and remain, sir, Your obedient servant, Arthur Hassall. Harcourt Place, Dublin, Jan. 1837. We the undersigned teachers of anatomy in the city of Dublin, consider ourselves called upon to state for the information of his Majesty’s government that the most satisfactory results continue to follow the enactment of the Anatomy Bill. The sup¬ ply of bodies is amply sufficient for the purposes of instruction; the practice of exhumation is rendered unnecessary, and if perpetrated at all, is only resorted to by persons seeking for teeth for the use of dentists. For these most satisfactory consequences we consider ourselves indebted principally to the judicious arrangements, official firmness, and praiseworthy impartiality, of Sir James Murray, and we here venture to express a hope that thg Chief Secretary will have the goodness to continue that support and countenance to his exertions which the government has hitherto been pleased to afford. Arthur Jacob, Professor of Anatomy, Royal College of Surgeons. RobertHarrison, Professor of Anatomy, Royal College of Surgeons. John Nolan, Demonstrator of Ana¬ tomy, University of Dublin. H. Carlisle, A.B. Demonstrator of Anatomy, University of Dublin. William Hargrave, M.B. Lecturer on Anatomy and Surgery, Digges- street. John Hart, M.D. Lecturer on Ana¬ tomy, &c. Park-street. Andrew Ellis, Lecturer on Surgery, Peter street. G. T. Hayden, Lecturer on Anatomy and Surgery, Peter-street. John H. Power, Lecturer on Ana¬ tomy and Physiology, Richmond Hospital. John Denham, Lecturer on Anatomy, Marlborough- street. Dublin, Jan. 1837. ANOMALOUS CONDITION OF AS¬ SISTANT SURGEONS IN THE NAVY. To the Editor of the Medical Gazette. Sir, May I beg the favour of your inserting in your journal the inclosed letter to Sir William Burnett, which, by calling his attention publicly to the lamentable con¬ dition of the naval assistant surgeon, may lead to an investigation, and probably some improvement. I remain, sir, Your obedient servant, B. M. W. Clifton, January 1837. Sir, — Considering the high and influ¬ ential station you hold in the navy, being placed at the head of one of its most im¬ portant offices, I conceive you to be the proper person to whom we must apply for the removal of certain evils existing in the department over which you preside. I cannot for a moment doubt that you feel due interest in the welfare of every officer, and that you will spare no efforts to render their condition equal to their expectations. The curriculum of studies issued of late years, and which demands from the can¬ didate for the naval service more than any other institution in the kingdom, reflects the greatest credit upon those with whom it originated ; and I refer to it with the more pride, as showing that in you, sir, we have a friend who, guided by the dic¬ tates of benevolence, has commenced an improvement calculated to be as beneficial to the medical officers themselves as to the naval service in general. But promising as it bids to be, and bright as the future may be expected from its salutary influence, I much fear the grand tendency of this im¬ provement will be curtailed, or altogether frustrated, by the evils which exist in a quarter where its objects should be most promoted. In the endeavour to increase the extent of medical knowledge in the 718 MEDICO-BOTANICAL SOCIETY. navy, proper care seems not to have been taken to cherish its strength in the very cradle of its existence : the young candi¬ date is informed that he is expected to be prepared in such and such branches of science ; he observes that the amount of professional knowledge required is actu¬ ally more than that demanded at the Col¬ lege of Surgeons, London, or the Univer¬ sity of Edinburgh; and he very naturally concludes, that, after passing his exami¬ nation at such a board, he will be ex¬ pected to retain and increase it, and that every facility will be afforded him to do so; and few can tell how great his disappoint¬ ment on finding the case otherwise. There can be no doubt that this period of his life, that which immediately succeeds his entrance into the navy, is the most impor¬ tant to him ; for as this season is employed or neglected, he will become either a cre¬ dit to himself and his profession, or an annoyance to both. It has always been a subject of much regret to me, that the assistant-surgeon should be stationed with the midshipmen; their habits being necessarily so different to his own as to preclude the hope of all serious study. But independent of this, his accommodations are by no means what they should be. It is no apology to say that all who enter the navy must com¬ mence at the bottom and climb to the top, for true and justifiable as the observation is, yet the assistant-surgeon belongs to his own department; and though all naval officers collectively come under the same regulations, nevertheless each department has its peculiar exemptions. The medical man neither enters as a midshipman nor expects the treatment of one; but he en¬ ters as the member of an honourable pro¬ fession, and claims that protection and re¬ spect which I trust it will ever deserve. If we followed the example set us in the army, the assistant-surgeon would at once he sta¬ tioned in the wardroom; it is nothing more than a compliment he merits, and one which at least, out of decency, should be paid him. I think, sir, you must allow that this arrangement ought to have been made long ago, but now it becomes im¬ perative, if, at least, the improvements which you have so wisely commenced are to effect any ultimate good; and I may here observe — and I do so with all respect —that whatever increase you make in the acquirements of candidates, and leave this evil unreclaimed, it will only be heaping sorrows on his head, and, instead of im¬ proving his condition, will increase the amount of his misery. Indeed, the idea of expecting better educated men than ordinary to enter this service, without any security for their future comfort, or the prosecution of their studies, seems too un¬ reasonable to require comment. It is for the remedy of this grievance that I have taken the liberty of addressing you, but I am sure you must see the ne¬ cessity of a change, and the disastrous consequences which attend the present state of things, far better than I am able to point out. — I have the honour to be, Your obedient servant, B. M. W. To Sir Wm. Burnett , M.D. S~e Sc. Royal Navy. MEDICO-BOTANICAL SOCIETY, Wednesday, Jan. 11, 1837. On the Coroivattt. A paper, by Dr. John Hancock, on the Corowatti of British Guiana, and its uses by the natives, was read. This plant be¬ longs to the natural order Drymyrrhizse of Decandolle, a large and very elegant herbaceous perennial growing in sandy soils, on the sides of hills and ravines. It is a species of Alpinia ; but whether it be new, or the A. exaltata of Meyer, is uncer¬ tain; for great confusion prevails through¬ out this natural family. The plant in question is bitterish, pi¬ quant, and sub-acrid : both the root, leaves, and fruit, are held in high esteem by the natives, for their medicinal properties, be¬ ing with them a sort of panacea, as is the ginseng amongst the Chinese and Tartars, although the fruit is chiefly valued on ac¬ count of its fine purple dye. A strong in¬ fusion of the bruised root, which is diapho¬ retic, diuretic, and in large doses emetic, is used in dropsies, rheumatism, dysentery, fevers, colic, pains, hooping cough, &c. In the latter disease, a convincing proof was adduced of its great efficacy in a large family, all of whom were speedily cured by taking an infusion and syrup of the root. The residence of this family was far distant from the settlement, in the woods of Pomeroon, and having no com¬ munication whatever with any one in¬ fected ; this was regarded by the author as one evidence of the epidemic origin of the disease (hooping cough) ; or that it is propagated by a peculiar condition of the air, rather than by contagion. In dropsy, the natives both take the root internally, UNIVERSITY COLLEGE DR. A. T. THOMSON. 719 and cover the parts affected with the leaves, and not unfrequently they envelope the whole body with them, which brings on a profuse perspiration, which often leaves them quite free from their com¬ plaint, In cases of poisoned wounds, the bruised root is laid on the part, and its de¬ coction taken internally. Dr. Hancock remarked on our remedial practice in dysentery and hooping cough, and urged it as a matter of the utmost importance, to procure perspiration, especially by the use of external stimulants, the vapour bath and diaphoretic ptisans, saline aperients, and topical or general bleeding, as indi¬ cated by symptoms*. Such means, with¬ out incommoding the stomach, rouse the absorbents into action, and by exciting the exterior surface, incline the fluids thither, and thus by revulsion relieve in¬ ternal congestions, with more certainty than by any other method, and often, in¬ deed, when internal remedies alone would be utterly useless. The paper concluded by remarking on the propriety of attending to the indige¬ nous remedies of the country, the impor¬ tance of which had been illustrated by the learned president, Earl Stanhope, in his discourses before the Society; and the au¬ thor could not doubt that much advantage might be gained from the external appli¬ cation of large leaves of certain plants of this country, in a similar manner to those mentioned above, as, for instance, the Chelidonium majus, Rumex, Arum ma- culatum, &c., in aid of internal medica¬ ments. Wednesday, Jan. 25, 1837. Analysis of Bitter Almonds. Mr. Everitt, the Professor of Chemistry, stated some curious facts at which the French chemists have lately arrived, re¬ specting the analysis of bitter almonds. The substance called amygdaline was ob¬ tained by macerating the bruised seeds in alcohol or cether ; but it was proved that no hydrocyanic acid, or essential oil, was contained in them ; and that these princi¬ ples are not educts, but mere products, formed by water or by mastication : that benzoic acid is formed in the volatile oil by its union with oxygen, and the bitter principle is developed only by attracting azote or nitrogen. ROYAL INSTITUTION. Friday, Jan. 27, 1S37. Processes of Embossing. Mr. Brande this evening gave an inte¬ resting lecture on the various processes at present employed in the embossing of paper, cloth, leather, &c. Many beautiful specimens were exhibited, and some were actually produced in presence of the au¬ dience, by expert workmen who were in attendance. The ingenious methods of making splendid metallic papers were de¬ monstrated, and the whole art of manu¬ facturing gold, silver, and jewels, for the¬ atrical use, was laid open. To Messrs. De la Rue the lecturer acknowledged his obligations, for the opportunities of illus¬ tration thus afforded him from their mag¬ nificent establishment. PRESENTATION OF PLATE TO SIR C. BELL. A letter has been received by a member of the Committee of Management, . from Sir Charles Bell, dated Edinburgh, De¬ cember 31, part oi which we have been requested to publish : — “ My dear sir,— I have to-day received the most gratifying proof of esteem from my friends in London. The inscription on the vase touches me sensibly, and ex¬ presses all that I have coveted during my toilsome life in the metropolis. “ Convey to the subscribers my lively sense of this mark of their remembrance. You cannot use words sufficient to express the importance I attach to this new proof of their esteem. — I am, my dear sir, “ With all sincerity, yours, (Signed) “ Charles Bell. “ To Dr. LocockP UNIVERSITY COLLEGE AND NORTH LONDON HOSPITAL. DR. A. T. THOMSON. * The same practice he has found to be most [The following communication reached beneficial in the present epidemic. us at a very late hour in the afternoon of 720 BILLS OF MORTALITY.— METEOROLOGICAL JOURNAL Friday. We have inserted it at great in¬ convenience. Of the circumstances of the charge against Dr. Thomson we repeat that we know nothing ; we merely pub¬ lished the authenticated statement of a pupil of the North London Hospital. — Ed. Gaz.] We, the undersigned students at the London University, having observed an article in tbe last number of the Medical Gazette, which attempts to impute a want of attention on the part of our es¬ teemed professor, Dr. A. T. Thomson, to the duties of his station, feel ourselves called upon to express, most distinctly, our firm conviction of the utter untruth of such imputation, and thankfully to ac¬ knowledge the advantages we have de¬ rived from the constant and unwearying attention bestowed by the Professor, in promoting the instruction of the students as well at the hospital as in the class¬ room ; — an instruction enforced not less bv the talents of the Doctor than by the urbane and gentlemanly manner in which that instruction is at all times conveyed. [Here follow 1 12 signatures.] NEW MEDICAL WORKS. A Clinical Treatise on the Endemic Fevers of the West Indies. By W. J. Evans. 8vo. 9s. Lectures on Local Nervous Affections. By Sir B. C. Brodie. 8vo. 4s. Illustrations of the Comparative Ana¬ tomy of the Nervous System. By Joseph Swan. 4to Part II. 7s. COLLEGE OF SURGEONS. LIST OF GENTLEMEN WHO RECEIVED DIPLOMAS IN JANUARY. George Daniel, Manchester. James B. Melhuish, Hoxton. John Baker,A. Wm. B. Hart, London. Henry P. Palmer, Winterborn. John Ashford, London. Barnard Garnliam, Lewes. Wm. Rickitt, Boston. Charles Brnorton, Salisbury. Wm. F. Barker, North Wych. John Small, London. Augustus Slight, Portsmouth. Robert H. M’Keand, Manchester. Wm- S. Taylor, Leeds. Digory W. Sargent., Launceston. Arthur O. B. Jones, Bromley, Kent. Henry W. Livett, Trowbridge, Wilts. APOTHECARIES’ HALL. LIST OF GENTLEMEN WHO HAVE RECEIVED CERTIFICATES. February 2, 1837. John Sutton, Yoxall,near Lichfield, Staffordshire. William Denne, Canterbury, Kent. John Jones, Gravesend. Peter Hudson, Warham, Norfolk. Benjamin Carrington, Walton on Naze, Essex. William Clapham Meates. William Gale. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Jan. 31, 1837% Abscess . . 2 Heart, diseased . 7 Age and Debility . 121 Hernia . . . l Apoplexy . 6 Hooping Cough . 34 Asthma . 97 Inflammation 81 Cancer . . 3 Bowels& Stomach 3 Childbirth 9 Brain 4 Consumption 127 Lungs and Pleura 51 Constipation of the Influenza 99 Bowels . . 1 Liver, diseased , 8 Convulsions 56 Measles 8 Croup . . 2 Mortification . 7 Dentition orTeelhing]3 Paralysis . . 6 Diarrhoea 1 Rheumatism . 2 Dropsy 23 Small-pox . 7 Dropsy in the Brain 10 Sore Throat and Dropsy on the Chest 4 Quinsey . 2 Epilepsy 2 Spasms 5 Erysipelas . 2 Thrush 1 Fever . . . 12 Tumor . . 1 Fever, Scarlet 5 Unknown Causes 28 Gout . . . 1 } Haemorrhage 2 Casualties . 6 Decrease of Burials, as compared with J , . the preceding week . . 5 1 METEOROLOGICAL JOURNAL. Kept at Edmonton, Latitude 51° 37' 32" N. Longitude 0° o' 51" W. of Greenwich. Jan. 1837. Tuermometf.r. Barometer. Thursday . 26 from 39 to 44 29-55 to 29 60 Friday . . 27 34 39 29 67 29-75 Saturday . 28 31 37 29 79 29 81 Sunday . . 29 28 35 29-70 29 69 Monday. .30 25 42 29 70 29 72 Tuesday . . 31 Feb. 33 48 29-82 29 89 Wednesday 1 33 44 2989 30.06 Winds N.E. and S.E. Cloudy, with frequent showers of rain. A little snow on the 28th and 29th ult. Rain fallen, *8625 of an inch. Charles Henry Adams. Wilson & Son, Printers, 57> Skinner-St. London. THE LONDON MEDICAL GAZETTE, BEING A # WEEKLY JOURNAL OF ittrtn'rine anil tfjc Collateral ^n'eitrrs. SATURDAY, FEBRUARY 11, 1837. LECTURES ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine, By William Cummin, M.D. Lecture XX. Infanticide. Causes of its frequency in civilized communities — Among ancient na¬ tions — Prevalence in the East — In the western world; hut no where among savage tribes. Legal positions and distinctions re¬ specting child murder — Born alive; various decisions as to the meaning of the phrase — Law of concealment of the birth — Ob¬ jects of medico -legal inquiry: 1. Was the infant born alive ? — Obvious signs of survival oj' birth — Certain sign of still birth — Ques¬ tion of respiration — External and internal appearances. Proofs from the state of the lungs ■ — Their colour, volume, consistetice, absolute weight, and specific gravity. Ploucquet's static lung-test — Its value , as modified by subsequent and recent observers. We now proceed to the consideration of a subject which is usually held to be as intricate as it is important in medico¬ legal science— namely, that of infanticide. Infanticide, or child murder, implying in its ordinary acceptation the wilful and violent death of the new-born child, is a crime which, from its heinousness, its fre¬ quency, and the difficulty that often at¬ tends its proofs, demands the most earnest attention of the medical jurist. Causes of Infanticide in civilized communi¬ ties. — It is worth remarking, that infanti¬ cide has been observed to be most frequent in states or communities which are said to 480. — xix. enjoy the blessings of civilization ; and the causes which lead to it are perhaps not diffi¬ cult to be assigned. “ To parents,” says Professor Beckmann, “who are just able by incessant labour to procure those things indispensably necessary to support life, the birth of every child increases the fear of starving, or of being reduced to beggary. Those who have secured to them a scanty subsistence, but who live in servitude, wish to the new-born child a speedy dissolu¬ tion, before it can know that it has had the misfortune of being brought into the world, in order that they may not bequeath to it their poverty. A young female, who has acquired by education the most deli¬ cate sense of honour and shame, finds her¬ self, on the birth of an illegitimate child, exposed at once to the utmost disgrace and contempt. Her misfortune, though viewed with an eye of pity by the compas¬ sionate, excites {he hatred of the greater part of her relations and friends, by whom she was before loved and respected, and who endeavoured to render her happy ; and often amidst the most poignant feel¬ ings, and an agitation bordering on mad¬ ness, she sees no other means of saving her honour than the total concealment of her error by destroying the child ; a reso¬ lution which, notwithstanding the vigi¬ lance of the laws, is too often attended with success. A young woman who at this moment finds herself suddenly de¬ spised and neglected by her admirer, who gained her affections by the most powerful of all means, love and confidence, and ob¬ tained from her what she cannot recover, is often induced, in a fit of despair, to vent her fury on the consequences of her seduc¬ tion — the child of her seducer.” Its frequency in ancient times. — Previous to the Christian aera, and until the morals of mankind began to be improved under the influence of Christianity, the practice of in¬ fanticide prevailed to a monstrous extent. Among the Greeks it was not only tolerated, but in some states enforced. The Romans, 3 A 722 DR. CUMMIN ON FORENSIC MEDICINE. however, seem to have surpassed all other nations in this kind of cruelty ; nor was it till a comparatively late period of the empire that the vice was eradicated by the terrors of capital punishment In the Justinian code, the crime of murder was imputed to the father who strangled, starved, or abandoned his new-born infant, or who exposed him in a public place, “ to find that mercy which he himself had de¬ nied.” “ But,” as Gibbon says, “ if the father could subdue his own feelings, he might escape, though not the censure, at least the chastisement, of the laws; and the Roman empire was stained with the blood of infants, till such murders were included by Valentinian and his colleagues in the letter and spirit of the Cornelian law.” Tacitus mentions it as a circumstance deviating from the Roman manners, that the old Germans considered child-murder as a crime; and where he speaks of the peculiarities of the Jews, he does not fail to relate the same thing of them, — al¬ though, by the way, it is curious that there is no law in the Pentateuch whereby child- murder is prohibited. Prevalence in the East. — In certain Eastern countries infanticide is still very preva¬ lent. In Hindostan, for example, parents sacrifice their children to the Ganges, or to any power wrhom they wish to propi¬ tiate; but the practice has been much re¬ strained by the interference of the English government, particularly under the aus¬ pices of the Marquis Wellesley. There is, however, a race of Rajpoots in Western India, who are said to have been in the ha¬ bit of immolating all their female children ; nor have the benevolent exertions of the English residents and missionaries in any considerable degree succeeded in suppress¬ ing the cruelty. The motive is supposed to be a religious or superstitious one. But even among the better and more enlight¬ ened classes of Hindoos, and where the parents have no poverty to plead, the prac¬ tice of destroying newly-born children, particularly females, prevails to a great extent: it is persevered in apparently through a calculating spirit of domestic po¬ licy ; and the unfeeling manner in which the death-sentence is pronounced by the fa¬ ther, when he is informed of the birth of a daughter, shows at once the familiarity of the custom and the levity with which it is regarded. “ Give it milk !” is the fatal mandate ; whereupon the child is drowned in a pail of milk, or, as others report, a milk vessel is forced over the infant’s head, so as to produce suffocation. Other methods of effecting the child’s death are mentioned by Buchanan, in his Christian Researches. As soon as it is found that the infant is a female, a piece of opium is put into its mouth ; or the umbilical cord is drawn over its face, which, by prevent¬ ing respiration, destroys it. The Chinese also are notorious for the numbers of children, chiefly female, which they destroy, or expose. In Pekin alone, it is said that several thousands annually are thus got rid of. In Ceylon it is rare to find more than one daughter in any family, and the last general census of the island, in 1821, shows that the number of males exceeds that of females hy 20,000. The difficulty of marrying their daughters, and giving them marriage portions, is generally alleged as an excuse for destroy¬ ing them. In the western world. — Among the old American nations — the Peruvians and Mexicans, for example, the sacrificing of children is said to have been a com¬ mon custom; and travellers record the names of several tribes belonging to the southern continent, such as the Abipones and Araucanians, who were in the habit of murdering their infants. But, as Dr. John Beck observes, “ to the honour of our North American Indians, it deserves to be mentioned that they are not known to be guilty of this horrid crime. Mr. Heckewelder, in his interesting ac¬ count of the Indians who inhabited Pen- sylvania and the neighbouring states, says, ‘ I have never heard of any nation or tribe of Indians who destroyed their children, when distorted or deformed, whether they were born so or come to be so afterwards.’” This, however, is only in accordance with the observation which has already been made — that it is the artificial re¬ straints of society, and the difficulties ap¬ prehended in rearing offspring accord¬ ing to the usages of civilized communities, that lead to the perversion of one of the most natui’al of our instincts : for in the savage state, parents require no more for themselves and their children than they can easily obtain, and are thus exempt from those influences which would, in other circumstances, interfere writh the kindliest feelings of nature. Legal positions and distinctions respecting child murder . — The term child-murder has sometimes been applied in an extended sense to fatal injuries inflicted by the mother, or other persons, on the foetus in utero. It appears to amount, as I mentioned in a former lecture, to homi¬ cide, or manslaughter at least, if, on the subsequent birth of the child, those inju¬ ries prove to be of such a nature as to cause its death. According to Lord Coke, if the child be born alive, and afterwards die in consequence of injuries wilfully in¬ flicted on it while in the womb, it is mur¬ der. In a case where a midwife injured a INFANTICIDE. 723 child’s head before it was born, she was found guilty of manslaughter ; the child having been born alive, but having died soon after of the injury. But the more ordinary charge of infan¬ ticide occurs in cases where the mother is supposed to be guilty of the murder of her child after it is born. It has been decided, that in order to substantiate this charge, “ the whole body of the child must have been brought into the world prior to «the extinction of life.” When this is left doubtful, the mother will most probably be acquitted. It has also been decided, that the child cannot be considered as born alive until it has had “ an independent circulation.” On which decision a question might arise, whether, if the umbilical cord wrere not severed, there could be infanticide ? And hence also, though it should be proved that the child breathed, that fact is not sufficient to constitute the killing child- murder; for the child might have breathed before it was born (wholly), or had an in¬ dependent circulation. The fact of respiration is commonly held to be proof of live birth. But with respect to the evidence of breathing, it has sometimes been considered not sufficient to prove that a child has breathed, when circumstances leave it doubtful whether the breathing was not merely during the birth, and before the establishment of an independent circulation. According to the decision in an im¬ portant case, Rex v. Poulten, (5 Car. and Payne, 329), “ Being born must mean that the whole body is brought into the world, and it is not sufficient that the child respires in the progress of birth.” Mere proof of having breathed is not enough : for, according to the evidence in this case, First, it may happen that the child is born as far as the head is con¬ cerned, and breathes, but death takes place before delivery is complete; secondly, death might have occurred when the child was partly born, if no medical man was present to assist delivery ; and thirdly, it may be impossible to say when the child respired ; the breathing may have occurred during parturition. On the other hand, infanticide may be committed after birth, though before the child has breathed. The circumstance of its being proved that a child has never breathed is not conclusive that the mother has not been guilty of infanticide. In the trial Rex v. Brain (6 Carrington and Payne, 349) it was decided that proof of breathing was not essential, the child having been wholly born, and alive; but the jury must be satisfied that the child was wholly born. Two surgeons proved that the child had never breathed ; but it was urged that many children are horn alive, yet do not breathe for some time after birth. However, upon all trials for infanticide by a mother, the question whether a child has breathed or not is a material topic of inquiry. If it has not breathed, acquittal is almost sure to follow ; it is, therefore, very important, in order to support a pro¬ secution, to establish the fact that the child has breathed ; and the medical wit¬ nesses both for the prosecution and defence ought to be able to speak very minutely as to the breathing. Generally the point of discussion is, whe¬ ther a live child, (that is, as usually under¬ stood in criminal cases, one that has breathed) has been killed or not. But sometimes it is reduced to this, whether supposing a live child has been killed, it has been killed by pure accident. I believe there is no case in the annals of English jurisprudence, where, upon a trial for infanticide, the question has turned on the point, whether the child having been killed, the death was caused by the gross negligence of the mother; nor is there an instance that I am aware of, where the mother has, through any omission, been found guilty of man¬ slaughter. The charge has either been murder, or concealment, or nothing. The law of concealment of the birth is so closely connected with our present subject, that it may without impropriety be intro¬ duced here. By the 14th section of the JLansdowne Act, (9 Geo. IV., c. 31) “ If any woman tried for the murder of her child shall be acquitted thereof, it shall be law¬ ful for the jury by whose verdict she shall be acquitted, to find, in case it shall so appear in evidence, that she was deli¬ vered of a child, and that she did by secret burying, or otherwise disposing of the dead body of such child, endeavour to conceal the birth thereof, and therefore the court may pass such sentence as if she had been convicted upon an indictment for the con¬ cealment of the birth.” It is added, that when a prisoner is tried for the concealment, “ it shall not be necessary to prove whether the child died before, at, or after the birth.” Hence, on an indictment for this crime, it must ap¬ pear that the mother was delivered of a child, and that the child was dead; though whether it died before , at, or after the birth, need not be proved. The special mention here of proof as to when the child died, seems distinctly to imply that such proof is essential on the capital charge of infanticide. One other circumstance connected with indictments for concealment of the birth is worth noticing. No costs are allowable on such trials. In consequence of which, 724 DR. CUMMIN ON FORENSIC MEDICINE. as Sir Gregory Lewin observes, in his con¬ cise and excellent Northern Circuit Re¬ ports, “ it is sometimes the practice to in¬ dict the party for murder, though it is well known the evidence will not support the charge ; and by this stratagem the prosecutor contrives to get the usual costs allowed for a felony prosecution, notwith¬ standing the jury negative the murder, and find only the concealment.’’ But the impro¬ priety and cruelty of this mode of proceed¬ ing have been severely censured from the bench, and the costs refused. Objects of medico- legal inquiry. — From the preceding summary of the legal distinc¬ tions respecting infanticide, we may gather that the usual defence set up in all such cases is, that the child did not live — that it was born dead. And this, in fact, is the general plea advanced for the prisoner ; the onus probandi of live birth resting with the prosecution. Unless it can be proved that the child actually sur¬ vived birth, arrd died in consequence of certain violence inflicted on it, the charge of murder cannot be supported. Whoever attempts to reconcile the de¬ cisions on the law books as to the amount of proof requisite in cases of infanticide, will find himself not a little bewildered ; the evidence of live birth itself, or what is to be considered as such, is far from being precisely determined ; and the bench and bar have here, as in many other points of forensic medicine, a wide discretion se¬ cured to them. It may be stated, however, in general, that the main objects of inquiry in cases of infanticide are twofold : — 1 . Whether or not the infant was born alive ; and 2. Whether death was occasioned by natural causes or the infliction of violence. 1. Was the Infant born alive ? Following this simple arrangement of the subject, we shall proceed to consider, in the first place, the proofs of live and still birth in criminal cases ; or, to describe our purpose more in accordance with the spirit, if not the letter, of the law, we shall inquire what grounds there may be for con¬ cluding that the child died before, at, or after delivery. The appearances presented by the body afford us the best means of forming a just conclusion. Question of maturity. — One of the first points that deserve our notice is the age of the foetus in respect to intra-uterine life. Is it a mature infant or immature ? For in proportion to its immaturity may we presume that there was the less chance of its being born alive. I have already described the characters derived both from the external and in¬ ternal inspection of the body of the foetus, by which we can arrive at certain conclu¬ sions respecting its age from conception *. Sure signs of having survived birth. — But it may happen that there shall be certain ap¬ pearances observable which shall decide at once the question of survival of birth. For example, certain conditions of the umbili¬ cal cord, and of the cuticle. These have been noticed in a former lecture, in refe¬ rence to the age of the new-born child ; but it may not be improper to repeat the description of them here, however briefly. Should it appear that the umbilical cord has sloughed off, — not from putrefac¬ tion, — not only was the child born alive, but it must have lived four or five days. If the cord has not only sloughed off, but the navel has become cicatrized, The in¬ fant cannot exactly be considered as new¬ born, for it must have lived about ten days. As to the cuticle, the process of desquamation begins to take place when the child is a day old. If, then, desquamation of the cuticle (which must not be confounded with peeling off of the skin from putri¬ dity) be observed, the infant certainly came into the world alive, and continued to live above a day at least. In either of these cases, the labour of the me¬ dical jurist is materially abridged ; he need not apply the tests, hereafter to be mentioned, for live or still birth, but merely confine himself to the question, whether the death of the infant was natural or ow¬ ing to violence. Another obvious case of the same kind would be, when, upon examining the sto¬ mach, it should prove to contain milk or other food partially digested. Such cases have happened : the body of a child has been found, evidently dead for some time : before applying any other test, the sto¬ mach has been opened, and, in conse¬ quence of the appearances there ob¬ served, further inquiry has been deemed unnecessary — the fact of survival of the birth being indubitable. Should the bowels be found destitute of meconium, this also would denote that the child had lived for a time. Other distinc¬ tive characters, chiefly anatomical, may here be omitted, as we shall have to notice them farther on. Obvious sign of still birth. — Previously to entering on the important question, whether a new-born infant, found dead, had ever respired or not, it is to be ob¬ served, that there are some cases in which it is obvious and proper to presume that the infant could not have been born alive — in fact, that it must have died, perhaps some time, before birth. There is one ap¬ pearance which serves to remove all doubt, namely, that of uterine putrefaction. * Lecture III., p. 66, et sqq. INFANTICIDE. 725 When a child dies in the womb, and is ex¬ pelled, as it generally is, aftersomedays.it is found to have undergone changes as strik¬ ing and as characteristic as if it had been exposed to the open air. There is a loose¬ ness and flaccidity of all the structures; the bones, especially those of the head, have no firmness in their union with one another; they yield with their own weight, and that of the contents of the skull. The skin is decomposed, the epi¬ dermis peeling off, and when newly re¬ moved, leaving the integuments beneath of a bright reddish colour. The belly is generally of a brownish hue, without any mixture of green. The umbilical cord is wholly relaxed, untwisted, and full of a brownish liquor. Beneath the scalp, also, will generally be found an effusion of serum, which has been compared to a thickish raspberry vinegar. It is said that in some instances the dead foetus, ere it has been expelled from the uterus, has been converted into adipocire. But all these appearances will be better appreciated by an experienced eye, or by a person who has even only once or twice observed them, than from any mere description. The preceding detail applies to the case of the dead infant not being expelled for several days; but suppose the infant born on the same day, or the day after, it has died — what then becomes of our indubitable sign ? It does not hold good : we can then only have recourse to the ordinary tests of live or still birth. Has the Infant respired ? This, after all, is usually the main question to be determined, where the inquiry is, in criminal cases, whether the infant was bora alive. In civil cases, as I have already observed, where tenancy by the courtesy of England is at issue, it is sufficient proof of live birth that the infant has exhibited any sign of voluntary mo¬ tion ; nay, mere muscular irritability seems, in one instance, to have been held decisive. The courtesy of Scotland requires proof that the child has cried. The proofs of respiration are founded on the phenomena which are observed to take place when uterine is changed for extra- uterine life. An alteration occurs in the structure and functions of several parts of the body ; but the lungs, the heart, and the liver, are the viscera chiefly affected. Before proceeding to an internal exa¬ mination, the external condition of the chest ought to be noted. In a child which has never breathed, this part of the body is narrow' and flattish ; where respiration has taken place, on the contrary, the chest is 'ample and arched. Internal Inspection of the new-born Child. Chaussier, in his Recueil de Mimoires , gives some excellent remarks on the open¬ ing of bodies, to which I shall have to re¬ fer more particularly hereafter. The chest he recommends in all cases, wdiether adult or infantine, to be laid open as widely as possible, so as to display its contents fully. In the new-born child, the ribs can be most conveniently divided with a pair of scissars, where a saw would have to be employed in the adult. As it is desirable, in many instances, to obtain a view of the contents of both abdomen and thorax at once, the conical-shaped sections of the sides may be continued down to the pubes, so that the w hole surface of the trunk may be removed in one piece, in the form of an elliptical flap. In detaching this covering from the cavities, its connexions with the diaphragm must be separated with the scalpel ; after which, the umbilical liga¬ ment of the liver is to be carefully cut through. The viscera are then freely ex¬ posed. Those of the thorax at present demand our attention. With respect to the state of the lungs, the principal points to be attended to are, 1st, their colour ; 2dly, their volume ; 3dly, their consistence ; 4thly, their absolute weight ; and 5thly, their specific gravity. 1. Colour of the lungs. — The colour of the lungs of infants born dead is a dark purplish or chocolate hue : some call it a liver colour; and it certainly does corres¬ pond with the tints of the adult liver. In a still-born child, also, the lungs are gene¬ rally found to resemble the thymus in colour; and though the latter is some¬ times more pale than the former, yet the comparison is worth attending to : for as the thymus remains unaltered on the occur¬ rence of respiration, or artificial inflation, it affords a sort of standard w hereby to judge whether either of these processes has taken place or not. The introduction of air into the lungs completely alters then- colour : they become a florid red on in¬ flating them by a tube introduced into the trachea, and natural respiration gives them a bright red or rosy hue. Very frequently, the exact portions of the lungs into which air has been admitted can be easily dis¬ tinguished from the other parts, by* their difference of colour. But it must be kept in mind, that if the lungs be diseased, or gorged with blood, the appearances just mentioned may be greatly modified. On those diseased conditions which may lead to fallacy, I shall subsequently have some remarks to offer. 2. Volume of the lungs. — The cavity of the chest of a still-born child presents a very different appearance from that of a child which has been born alive. Where the 726 DR. CUMMIN ON FORENSIC MEDICINE- lungs have never received air, they appear to occupy but a comparatively small por¬ tion of the chest; the pericardium and thymus hold a prominent place in front, while the lungs are placed altogether late¬ rally and posteriorly. This will be better understood from the following figure. In this figure, a and a represent the horns of the thymus; b b, the clavicles, with their ante¬ rior portions removed ; c, the body of the thy¬ mus ; ef, the lungs ; h, the diaphragm j and g, the pericardium. On the other hand, the change effected in the volume and situation of the lungs, by the admission of air, may be readily comprehended from this sketch. It will be seen that the pericardium is here nearly covered ; the diaphragm is less convex ; and the lungs ( d d ), in every direction, more voluminous, and largely extending over the latter. Let it be recollected, however, that in forming a judgment respecting respiration from the volume of the lungs, as well as from their colour, disease may materially interfere in preventing a diagnosis. Thus the lungs of still born children may be filled with a serous fluid, which considera¬ bly increases their volume, and might lead an inexpert observer to fancy, without further examination, that they were filled with air. In such cases our acquaintance with pathology must come to our aid. 3. Consistence of the lungs. — Lungs which have been inflated with air, naturally or artificially, acquire a spongy and crepitous character; they feel soft and light; their edges are rounded off; they appear vesicu¬ lar, and frothy fluid may be squeezed out of them. Putrefaction or emphysema will also render their surface vesicular ; but the vesicles, in this case, are large and irregu¬ lar, and confined to the surface; being contained, not in the air-cells, but in the cellular substance beneath the pleural lining: and, moreover, the gaseous pro¬ duct of putrefaction, or emphysema, may be totally expelled by pressure, while atmospheric air in the air-cells cannot. The lungs of the still-born are dense, and their edges sharp (particularly the left upper and right middle lobes), and no¬ thing can render them of the consistence and appearance just now described but natural breathing or artificial inflation. If there be reason to know that the latter process has not been had recourse to, the soft spongy feel, the vesicular character, and the discharge of air-bubbles by pres¬ sure under water, will strongly indicate that the child has breathed. 4. Absolute weight of the lungs.- — When re¬ spiration begins, it is not merely air that enters the lungs, another fluid gains ad¬ mittance also — blood which is propelled by the action of the heart. This, by the ■way, is a circumstance which does not at¬ tend artificial inflation, .unless it be prac¬ tised ere the motion of the heart has ceased. But confining ourselves to the effect of the admission of blood into the lungs of the live-born infant, it obviously increases the weight of those organs — in many cases it is found to double it; that is to say, if the lungs, previous to respiration, weighed an ounce (which is about the average weight in the still born), they weigh, after breathing is established, two ounces. The reason of this change is ob¬ vious : the heart of the live-born infant must be always more or less active, and, immediatelv on the commencement of the new process of inspiring and expiring air, will propel blood into the vessels of the lungs, which had hitherto been unexpand¬ ed : the result is, that the respiratory organs are increased in weight (by that of the blood admitted) as well as in volume. But the case is different with the lungs of PROFESSOR GRAVES* CLINICAL LECTURES. 727 the still-born. If, upon the artificial in¬ troduction of air into them, their vessels receive any blood, they do so only* pas¬ sively : there is no action of the heart to supply them, and consequently their weight is not materially, if at all, increased. Ploucquet, of Tubingen, thought that this change occurred so generally, that it would afford a good test of the fact, whether respiration had or had not taken place. He accordingly, about the year 1777, founded upon it and proposed what is commonly called The Static Lung Test. Ploucquet’s device was to compare the absolute weight of the lung«, with that of the body, of the infant ; and in doing this, he found that, in the case of still-born children, the lungs were no more than about one seventieth of the weight of the body, while, in the live-born, they weighed one-thirty-fifth. From this he inferred that respiration doubled their weight. But his inference was deduced from too few7 facts to warrant its general acceptance as a truth. Other observers and experi¬ mentalists came after him, and found that his conclusion was not very correct. Schmidt, at Vienna, and Chaussier, at Paris, entered into a special scrutiny of the nature of the true ratio, and the result of their researches (for they correspond pretty closely) has been, that, in the still¬ born, the average weight of the lungs is about one-fiftieih of the weight of the body, w7hile, in the live-born, it is the one- fortieth. M. Devergie, who has still more recently inquired into the subject, thinks that the averages would be more exactly stated at ^ and Jg. CLINICAL LECTURES, delivered at the MEATH HOSPITAL AND COUNTY OF DUBLIN INFIRMARY, During the Session 1836-7. By Professor Graves. Lecture V. Treatment of Typhus fever— Tympanites often the consequence of inattention to diet or to overdosing with purgatives— Thirst in fever frequently dependent on the state of some in¬ ternal organ— Blisters, employed as stimulants or evacuants, eicite the vital action of the capillaries — An important remedy where cere¬ bral affection is apprehended — Signs of ap¬ proaching cerebral symptoms — Tartar emetic solution, and ointment— The latter used with success in some desperate cases. Before I proceed to speak of the diet and remedies to be employed in the treat¬ ment of typhus, allow me to make a few observations. There is a patient at present in the fever ward, whose case show's the necessity of strict attention and incessant watchfulness on the part of tho e who have the management of bad cases of fever. A man who has been labouring under delirium, with symptoms of cerebral excitement and congestion, was ordered the tartar emetic solution, with the view of reducing the increased vascular action ; but on inquiry this morning, we find that he has taken no medicine, and that his symptoms have been allowed to go on un¬ checked for twenty-four hours. He refused to take his medicine, and the nurse very improperly neglected to report the cir¬ cumstances of the case, in order that pro¬ per steps might be taken to remedy so dangerous an omission. Thus a w hole day has been lost at a most critical and im¬ portant period of fever. There can be no excuse for such negligence as this, for it could be easily remedied. Patients in this state have always more or less thirst, and a spoonful of the tartar emetic solu¬ tion could be mixed with w7hey or cold water, and administered in this way with¬ out his knowledge, or if he refused to drink any fluid, it might be given in the form of enema. There is no excuse, therefore, for such negligence ; and when you recollect the state that such patients are in — theirnervous excitement, incessant raving, agitation, struggling, and sleep¬ lessness — you w7ill be able to appreciate the dangerous, and even fatal, conse¬ quences that may arise from culpable ne¬ glect of this kind. At our last meeting I spoke of the use of food and drink, and laid before vou my views of the most appropriate articles of diet in the various stages of fever. I told you that I attributed much importance to the use of a proper regimen, and that I looked upon the observance of this principle as a main cause of success in the treatment of typhus. I think it is chiefly ow'ing to our care in this respect, that so few of our patients have tympanites. Now and then we have cases of fever w ith tym¬ panites and diarrhoea, but in the majority of instances, these are persons who have been under treatment before admission, and who have been too much purged. The use of drastic purgatives in the early and middle stages of typhus, is one of the most fertile sources of subsequent evil, and there are few7 evils of greater magni¬ tude than tympanites with diarrhoea, and gastro-enteric inflammation, particularly in the latter stage of fever. Now7, if you inquire into the history of the cases in w7hich these symptoms are most distinctly marked, you will find that in at least two-thirds, powerful cathartics have been 728 PROFESSOR GRAVES’ CLINICAL LECTURES. employed, not once, but repeatedly, in the commencement of the disease. Almost all cases, in which calomel and colocynth, or aloes, followed by black draught, have been liberally used in the commencement, become tympanitic, frequently at a very early period. The same mischief, but in a less degree, is apt to occur where a system of strict abstinence has been en¬ forced, and continued undeviatingly for a considerable length of time. Want of food, even in the healthy state of the system, is apt to produce .flatulence, weakness, and distention of stomach, and in many in¬ stances gives rise to very serious forms of gastro intestinal irritation. The diete ab¬ solve is very apt to produce the same effect in fever. Even the abuse of drinks of the simplest and most innocent description, is apt to produce flatulence, distension, and a tendency to tympanites. Hence the value of the rule which I laid down in a former lecture, viz. to allow the patient only small portions at a time, and to order him to swallow them slowly. The abuse of the ordinary drinks, as common water, whey, barley-water, soda and Selzer waters, and effervescing draughts, is a fre¬ quent source of tympanitic swelling in fever. In this hospital we seldom pre¬ scribe effervescing draughts, and never give them in the ad libitum quantity which some persons recommend. Thirst can be sufficiently assuaged by the use of whey, or common water, acidulated with currant jelly or raspberry vinegar, given in small portions, and at certain intervals. Sometimes you will succeed effectually in controlling feverish thirst by the use of a very light infusion of cas- carilla, acidulated with a small quantity of muriatic acid. I have seen this em¬ ployed with success by Mr. Kirby, and I have often prescribed it myself with the best effects. Very often you will find that a small quantity of some light bitter, slightly acidulated, will appease the mor¬ bid thirst of fever more effectually,' and for a much longer period, than large draughts of water, or any of the fluids usually employed for the same purpose. You should always bear in mind, that thirst in fever does not exclusively depend on a dry or parched state of the mouth or fauces, but lies much deeper in the system, and has its origin in some peculiar de¬ rangement of the nerves, most probably of those belonging to the ganglionic system. In going through a fever ward, you will meet with numerous illustrations of the truth of this position; for you will find one man with a moist tongue and fauces, and yet labouring under insatiable thirst, while you will observe another with parched tongue and throat, and yet with¬ out any desire whatever for fluids, or any choice as to their temperature. We had two examples of this in the fever ward during the past week. One patient with a moist tongue was incessantly calling for drink, while another man, who had his tongue almost perfectly dry, exhibited a very remarkable indifference to fluids. There is one curious circumstance con¬ nected with the sensation of thirst in in¬ flammatory diseases, which deserves atten¬ tion. I lately attended a fatal case of metritis after delivery, in consultation with Mr. Hayden and Dr. Ireland. These gentlemen pointed out to me the singular fact, that the patienTs thirst was instantly increased to an intolerable degree, by pressure applied to the womb. I merely notice the fact here as being extremely curious, leaving the explanation of it to those who are more conversant with such investigations. Having said so much of food and drink in fever, I come now to speak of external and internal remedies, and first of blisters. Blisters are employed in a variety of dis¬ eases, but are followed by very different physiological effects, and capable of serv¬ ing very different purposes, according to their mode of application. In fever they are generally employed either as stimu¬ lants, or as evacuants and derivatives. As stimulants, they may be used with the in¬ tention of rousing the depressed energies of the system in general, by their action on the nervous and circulating systems, or of stimulating the torpid functions of some particular part or organ. With this object in view, they are applied as flying blisters — that is to say, for a space of time not exceeding two or three hours, and solely with the intention of producing a stimulant effect. You have seen some cases of fever in our wards, in which the powers of life were greatly de¬ pressed, the extremities cool, the action of the heart feeble, the pulse weak, respira¬ tion short and imperfectly performed, and a tendency to faintness and sinking; and you have observed that in such cases we derived great benefit from the application of flying blisters over the region of the heart, the epigastrium, chest, and inside of the legs and thighs. We applied our blisters in these situations, left them on for two or three hours, and then removed them ; and you have seen them, when em¬ ployed in this way, succeed in rousing the vital energies, the depressed action of the heart and capillary system, and the flag¬ ging state of the respiratory function, as shewn by the increased strength of the pulse, the more general diffusion of heat, ■ and the renewed play of the various func¬ tions. In such cases, where the stimulant ef¬ fect alone is required, it would be wrong TREATMENT OF FEVER. 729 to leave the blisters on longer than two or three hours; it will be quite sufficient if they prove merely rubefacient, or, at most, ves:eate so slightly as to give to the blis¬ tered surface the appearance of a miliary eruption. Here you have all the stimulant e fleets of blistering, but not followed by their debilitating consequences. You are aware that blisters applied in the ordinary way have a twofold effect ; they first rouse, and then depress; acting primarily as stimulants, and secondarily as evacu- ants. They first act as stimulants, pro¬ ducing pain, heat, and redness of the part; after a few hours these symptoms diminish, and are followed by an effusion of serum — in fact, a quantity of white blood is abstracted from the cutaneous ca¬ pillaries, and in this way an evacuation is produced, calculated to diminish any ac¬ cidental congestion in neighbouring parts. The capillaries, by means of their in¬ creased action, draw a quantity of white blood to the part; and in saying this, I think I am only using a perfectly physio¬ logical expression ; for the quantity of cir¬ culating fluid in any part of the body must depend on the vital action of the capillary vessels of that part. It is to the peculiar state of the capillary vessels that the quan¬ tity of blood in any part is to be referred, and not to the force or frequency of the heart’s action. It is by means of changes produced in them that the phenomena of active congestion and inflammation are produced : the capillaries of the affected part enlarge, increase in number, and mul¬ tiply, and those which were invisible be¬ come visible. These phenomena have been falsely attributed by Hastings and others to debility and impaired action of the capillaries. Enlargement or distension of the capil¬ lary vessels, w'hether the result of active local congestion or inflammation, is quite a different process, and bears a very close analogy to the enlargement of the anasto¬ mosing arteries of a limb in which the principal vessel has been tied. The afflux of blood, and the vascular distension, are not the consequences of debility or of re¬ laxation, but of an actual increase of vital action. In the enlargement of the anas¬ tomosing arteries which takes place in cases of collateral circulation, the increase of size is not confined to the arteries con¬ nected with the main trunk; it commences simultaneously in the more distant set of branches, beginning in the smaller ones, and then gradually extending to the larger. This is a proof that the enlarge¬ ment of the vessels depends solely on a vital action inherent in themselves, and is not the result of a mere passive distension, i or of an increased determination of blood • to the part, produced by the action of the heart. Dr. Houston, in a very important paper on the circulation in a monstrous foetus, without head or brain, published in the last number of the Dublin Medical Jour¬ nal, has proved almost to a demonstration, that, in the case referred to, the circula¬ tion in the placenta could not be carried on, unless by the vital attractive power of the capillaries. It is owing to this power that vascular tumors bleed so profusely when wounded or scratched; and yet, if you cut through the artery which supplies them, there will not be any considerable haemorrhage. When you divide the artery, the capillaries cease to draw blood to the part, and the haemorrhage is slight ; but if you wound the tumor itself, the blood is attracted to the part as fast as it drains off, and a profuse haemorrhage is the result. You should also bear in mind, that there are many animals which are without a heart, and yet in which the functions of the circulation are adequately performed. We have numerous instances of human monsters born without any trace of a heart* and yet well nourished and developed. In cases of this description how is the cir¬ culation carried on, or by what power is the blood impelled through the vessels? I do not see what cause we can refer it to, except the vital agency and attractive power of the capillary system. I mention these facts because, in the treatment of in¬ flammatory and febrile affections, it is important that you should have correct physiological views, and that you should bear in mind, that each part and organ of the body may have its vital action de¬ ranged, or, in other words, may become congested and inflamed, independently of the action of the hegrt or the general cir¬ culation. Blisters, then, produce first increased action of a part, and then act as evacuants. They also stimulate the system generally; but if left on until full vesication is pro¬ duced, they act as evacuants and" deple¬ tives, and lower the general tone of the economy. I have frequently observed this succession of events in chronic cases, in which it was found necessary to blister repeatedly during the course of the dis¬ ease. The patients generally told me that they felt better and lighter on the day on which the blister was applied, but on the next day they usually felt weaker and more depressed ; and this state sometimes lasted more than a single day. You may therefore apply blisters as excitants and stimulants, or you may employ them as evacuants and depletives; yet there are many persons who seem to forget this dis- 730 PROFESSOR GRAVES’ CLINICAL LECTURES. tinction. If in a case of inflammation, occurring in a low state of the system, you propose to apply a certain number of leeches over the inflamed organ, they say no; but they have no hesitation in apply¬ ing a large blister, leaving it on until it produces full vesication, and thus abstract¬ ing a considerable portion of white blood from the system. You will not expect me to lay down any general rules for the use and applica¬ tion of blistering in fevers ; you will find all these matters sufliciently explained in your books and manuals. I am not giving any thing like a regular outline of the treatment of fever ; in fact I pass, per sal- tum, from one point to another, without any attention to order or method. You can read methodical treatises, and then compare them with such detached obser¬ vations as I shall make. And here allow me to make some detached observations on that peculiar state of the brain which we most commonly observe in the middle stage of typhus, and in which blisters form one of our most eflicient, and in some instances our only mode of relief. In many of the cases of typhus which come under our observation in hospital, we frequently meet with a train of symp¬ toms strongly calculated to perplex and puzzle, and which should seldom exist in fever regularly treated ; these are chiefly cases which are admitted in the middle or latter stage of the disease, and at a period when the patient’s state of intellect is such as to preclude the hope of obtaining any satisfactory information from a personal examination. A man in the lowest class of life, and at a distance from medical aid, is at¬ tacked with fever; for the first eight or ten days he is either improperly treated or altogether neglected, and in this state symptoms arise and superinduce others, giving rise to the most unfavourable com¬ plications, and rendering the cure difficult, if not impossible. Now of all the symp¬ toms which occur in cases of fever, where the state of the principal organs has been neglected, there are none more formidable, or more fatal, than the cerebral ; nor is there any local affection in fever, in which the value of prevention is so unequivocal and decided. What I wish to impress upon you is, that you should always anti¬ cipate the cerebral symptoms in fever. Never allow the cerebral symptoms to ex¬ plode — watch the first scintillas of cerebral excitement — repress the commencing mis¬ chief, and do not allow your patient to be overtaken by formidable inflammation of the brain. This is one of the points in which I have changed my practice I never allow cerebral symptoms to become established in any of the cases which I have treated of late. Every writer will tell you that when the patient’s face is> flushed, his eyes suffused, and when he complains of headache and intolerance of light, you should leech and blister his head, give him purgatives, tartar emetic, James’s powder, and the medicines calcu¬ lated to bring down cerebral excitement : but a careful and observant paactitioner will anticipate all these symptoms, al¬ though there is as yet no particular flush¬ ing of the face, headache, or suffusion of the eyes; and though the patient is still quite rational, he will recognize threaten¬ ing disease of the brain long before it commences, and take proper steps to pre¬ vent its explosion. Watch the functions of the brain attentively, and they will in¬ form you, in almost every case, of the ap¬ proach of cerebral symptoms. You will find in patients who are about to have cerebral symptoms, a degree of restless anxiety, and a higher degree of energy, than accords with their condition ; and they either do not sleep at all, or their sleep is broken by startings and incohe¬ rent expressions. When you speak to a person in this state, he answers in a per¬ fectly rational manner; he will tell you that he has little or no headache; and were you to be led away by a hasty review of his symptoms, you would be very likely to overlook the state of the brain. If you inquire closely, you will find that he scarcely ever sleeps, or even doses — that he is irritable, excitable, frequently incohe¬ rent, and muttering to himself. Under such circumstances, although there is no remarkable heat of scalp, suffusion of the eye, or headache, I am frequently led to suspect the supervention of cerebral symp¬ toms, particularly about the ninth or tenth day of the fever (for it is generally about this period that cerebral symptoms begin to manifest themselves); and when¬ ever I observe these premonitory indica¬ tions, I never hesitate in taking proper measures to anticipate the evil. I imme¬ diately order the hair to be shaved off, and blister the whole scalp. Thus, at the pe¬ riod when disease of the brain would most probably have set in, I have the whole external surface of the head pour¬ ing out serum, or even suppurating : and when by this treatment I have opposed a barrier to the further progress of the dis¬ ease, the exhibition of a little tartar eme¬ tic will soon remove every trace of it. In laying down this plan of treatment, I have supposed that the patient has been pro¬ perly treated from the beginning, and that the earlier symptoms of inflammatory ex¬ citement have been combated by bleeding, leeching, and other appropriate depletory measures. There is, on the other hand, an opposite TREATMENT OF FEVER. 731 state of the patient, which in like manner informs me that danger to the brain is at hand. In this case, the patient is almost continually sleeping. When you enter his chamber in the morning, and ask how he does, his attendant generally tells you that he has passed the night most favourably, and that he has slept without almost ever waking since your visit on the preceding afternoon. If he awakens to take drink, he quickly drops asleep again, and when you arouse him he looks rather heavy ; there is some slight effusion of the tunica adnata, and some appreciable congestion about the external parts of the face and head. Persons in this state, though appa¬ rently doing well, and even where they have been properly treated in the begin¬ ning, about the ninth or tenth day begin to rave, and exhibit undoubted proofs of congestion and excitement of the brain. Now, in all cases of this description be on your guard, and do not allow symptoms of dangerous import to steal on you. Here you will derive great benefit from the use of blisters. I was lately called to a very remarkable case of this kind, at some dis¬ tance from Dublin. The patient slept almost constantly, and complained of no headache or heat of scalp. From an at¬ tentive examination of the case, however, I was led to predict the approach of cere¬ bral symptoms. Observe, this was a case of spotted fever ; and in this form of fever you can predict the occurrence of such symptoms with a greater degree of confi¬ dence. The patient’s pulse was 96, his tongue presenting nothing worthy of re¬ mark, his behaviour and speech rational, and his sleep almost constant. Recollect¬ ing, however, the period of the fever, and observing carefully the condition of the cerebral functions, 1 had his head shaved and blistered. Notwithstanding this pre¬ caution, his cerebral symptoms had pro¬ ceeded so far that he subsequently got a slight attack of paralysis of the face and tongue, accompanied by a fixed state of the pupils, which would neither contract nor dilate. After having blistered his head extensively, I gave him the tartar emetic solution, to the amount of one eighth of a grain every second hour. These measures were completely successful in removing the cerebral symptoms, and I have no doubt that the activeprecautions whicli had been taken were the means of saving his life. Now there is one symptom connected with cerebral excitement in fever which is i well worthy of your notice, as its existence is often sufficient of itself to give timely intimation of the approach of irritation or inflammation of the brain. This is, the t state of the respiratory function. In ) fever, the breathing will often announce i the approach of cerebral symptoms for days before their actual occurrence. When, in cases of typhus, you find the pa¬ tient’s breathing permanently irregular, and interrupted by frequent sighing — when it goes on for one or two ipinutes at one rate, and then for a quarter or half a minute at another rate, you may rely upon it that sooner or later an affection of the brain will make its appearance. You will frequently observe the same kind of breathing preceding attacks of apoplexy and paralysis, and indeed it was the oc¬ currence of this symptom, in these and other cases in which the functions of the brain were deranged, that first drew my attention to this kind of breathing. The first time it engaged my attention was in a remarkable case of an apoplectic nature, w hich I sat up a wdiole night to w>atch. On recollection, I found that I had frequently observed an analogous state of the respira¬ tory function in fever, on several ocasions, although its connexion with excitement of the brain had not struck me before. I speak here of irregularity of breathing, in¬ dependent of any pectoral affection. But when the patient breathes in a permanently irregular manner, at one time at a certain rate, and at another at a different rate, — when his respiration is suspicious and heaving, without any disease of the chest or great debility, — you will have some grounds to suspect the existence of cere¬ bral derangement. I am in the habit of calling this kind of breathing cerebral re¬ spiration, because my experience has told me that it is almost invariably connected wdth oppression and congestion of the brain. To recapitulate : — When you find a patient in fever lying constantly awake, or when, on the contrary, you find him continually slumbering,— when there is a certain quickness of manner and irrita¬ bility, — and w hen the cerebral respiration has been noticed for some time, without any concurrent debility or pulmonary dis¬ ease, — under such circumstances, you may, in cases of maculated typhus, predict the approach of cerebral symptoms; and the period about which they generally mani¬ fest themselves, is the eighth, ninth, or tenth day. Nowr, in cases of this descrip¬ tion, — if you have previously used leeches and antiphlogisties to a sufficient extent, — your best plan will be to shave and blister the whole scalp. Dr. Little, of Belfast, and Mr. Kirby, of this city, have fallen into the same train of ideas, and employ blisters at a very early period'of the dis¬ ease, with the view of combating cerebral excitement. In a recent instance, in private practice, I think I saved the life of a young gentleman in Harcourt- Street by extensive blistering of the scalp on the fourth day of fever. We were not accustomed to blister at this early period of fever. Formerly it 732 PROFESSOR GRAVES’ CLINICAL LECTURES. was the practice to bleed and apply leeches for several days together, and never to have recourse to blistering until towards the latter stage of the disease. In common inflammation, or in arachnitis, we do not blister until we have carried depletion by the lancet, leeches, and purgatives, as far as the patient’s strength will allow. But this is not the case in fever : the cerebral congestion and irritation, or inflammation, (call it which you will), which accompanies typhus, differs essentially from ordinary arachnitis or encephalitis, and requires very often a treatment strikingly dif¬ ferent. One physiological fact connected with sleep may be noticed here. It has been stated by Mr. Mayo, that the pupils are contracted during sleep. This is in itself a very curious fact, and I was anxious to verify it. Now we had ari ex¬ cellent opportunity yesterday morning of trying what the state of the pupil was in two patients who lay soundly sleeping in the fever ward. We came up softly to them as they lay on their backs, and in a most favourable situation for observation, just under one of the windows ; and having opened the eye lids, found that the pupil was actually contracted to the size of a pin-hole. It remained in this state for a while, and then expanded when they awakened. This is a very curious fact, and appears to be a very beautiful in¬ stance of the protective care of nature. To protect the eye while we sleep, nature, as it were, draws the curtain, and thus de¬ fends the delicate organ from any acci¬ dental dazzling, at a period when con¬ sciousness slumbers, and is off its guard. Blisters applied extensively to the shaven scalp, are not only valuable in fever, but also in other diseases, and that under cir¬ cumstances in which little benefit could be expected. The same effects may be pro¬ duced by rubbing the whole scalp with tartar emetic ointment ; but from the pain and inflammation it produces, this proceed¬ ing is seldom adopted. I have, however, occasionally employed it ; and on two recent occasions with the most fortunate results. A friend of mine had lost two children from hydrocephalus. About five weeks ago another child, an extremely fine boy, was attacked with symptoms of the same disease. After having laboured for a fortnight under fever, with great rest¬ lessness, vomiting, and diarrhoea, he was observed to utter frequently that faint cry which is so characteristic of hydrocepha¬ lus, and to roll his head constantly from side to side. These symptoms were soon afterwards succeeded by constant motions of the right arm and leg, and subsequently by paralysis of the opposite side. I was consulted before the paralysis occurred, and advised the child’s father to have the whole of the blistered scalp well rubbed with tartar emetic ointment. The boy re¬ covered completely. I derived also a very striking advantage from the use of the same remedy in a very remarkable epi¬ demic which attacked a family in the neighbourhood of Rathmines, and which was witnessed throughout its whole course by my friend Dr. Burke and myself. One of the family, a young lady, was attacked with symptoms of fever, accompanied by pain in the back of the head and stiffness of the neck. After a few days, symptoms of inflammation of the cerebellum and upper part of the spinal cord became de¬ veloped. About the seventh day she got strabismus, and soon aftemards was at¬ tacked with convulsions : the pupil be¬ came permanently dilated, and she was quite blind. I was called to see her at this period, and found her almost in a state of insensibility, with involuntary discharge of urine and fasces, cold extre¬ mities, and irregular pulse. Thinking that nothing could be done for her, I was about to leave the room, when I asked the nurse, could she swallow7 ? She replied she could, and immediately proceeded to offer the young lady some drink, w7hich she swallowed without any difficulty. This at once arrested my attention. I said to myself, if this patient can swallow, she must be still conscious, and wffiile she is so, there is a chance of saving her. I ordered the whole of the scalp, which had been previously blistered, to be rubbed with tartar emetic ointment ; violent in¬ flammation ensued, and she recovered completely. But the curious part of the case is this : — Her brother and sister wrere attacked, in exactly the same way, a few days afterwards, although less formidably, and were cured by the same treatment. Shortly afterwards two of the servants got pain in the back of the head and stiffness of neck, followed by signs of an inflamma¬ tory affection of the cerebellum and spinal cord. They were treated in the same wray, and recovered. What could be the cause of this pecu¬ liar fever, manifesting itself in exactly the same way in all the individuals of the family who were attacked ? I endeavoured to arrive at the cause, but could not; and I merely state the facts, without wishing to attempt any thing like an explanation. But the history of this extraordinary form of disease is exactly as I have told you. It has been witnessed by Mr. King and Dr. Burke, and they, as well as myself, vyere very much struck with the novelty of the phenomena. CASE OF GANGRENE FROM “ DISEASE OF THE HEART.” 733 A CASE OF GANGRENE FROM “ DISEASE OF THE HEART.” To the Editor of the Medical Gazette . Sir, If you deem the inclosed case worthy of insertion in your journal, it is very much at your service. — I am, sir, Your obedient servant, William Clark, Surgeon. Devizes, Jau. 29, 1837. Mrs. Brown, set. 50 years, of rather plethoric habit and florid complexion, was attacked on Saturday week last, whilst walking- from her cottage into this town, a distance of about a quarter of a mile, with, as she expressed it, a fluttering- of the heart and difficulty of breathing-, so severe that she was scarcely able to return home. From that time to Friday last, December 3, she says she did not feel positively ill, but occasionally experienced a sense of suffocation, with a disposition to faint- ing-s, and especially so after any exer¬ tion, such as walking- up stairs, &c. Be¬ ing-, however, an active woman, she continued to perform her daily house¬ hold duties, and did not call for medical aid. According- to her own account she had previously en joyed g-ood health, not having- suffered from the ordinary com¬ plaints of colds, &c. more than other people. On Friday night one of her sons returned home very late, and all the family having- retired to bed, she went down stairs without her stocking’s to open the door for him, and in do¬ ing- so placed her rig-ht heel on the damp brick floor. At that time she was in a profuse perspiration, but did not feel chilled or otherwise ill on her re¬ turn to bed. On Saturday morning- she rose as usual at eight o’clock. Between ten and eleven, a.m. she had severe pain in her right foot, darting upwards to the thigh ; this pain increased until her foot and leg became benumbed, and she told a neighbour she was sure she was “ death-struck ;” she also had severe pain in her bowels. Mr. Mayo was then called in, who found the foot and leg to the knee cold, and sensation al¬ most or entirely gone. She was able to move it slightly. Her pulse was to a remarkable degree irregular, varying’ from extreme rapidity to the opposite extreme of slowness ; atone time strong, at another scarcely perceptible. Her bowels were costive, and had been so for a week previously, having had only one or two stools during’ that time, and those very scanty, dark- coloured, and foetid. Tongue furred; skin hot, and covered with clammy perspiration ; dysp¬ noea and pain over the region of the heart. Mr. Mayo conceived that, from the costive state of the bowels, an accumu¬ lation of hardened faecal matter might possibly have taken place in the colon, and pressure from this cause'might have obstructed the circulation in the limb. No tumor could, however, be found in the right iliac region ; there was slight tenderness on pressure. He ordered — 01. Ricin. ^j. statim. This had no effect on the bowels. At two, p.m. ol. ricin. ^j. with a drop of croton oil, also without effect. At nine, p.m. V.S. ad ^x. and an injection. This brought away only a small quantity of faecal matter. R Hyd. Subm. grs. iij. : Ext. Colocynth. c. gr. x. Omni tertia bora. After taking two doses, the bow'els acted freely. The evacuations were ex¬ tremely foetid and dark-coloured. All this time the leg remained in the same state ; bottles of hot water were con¬ stantly kept to the foot and leg, and the whole limb wrapped in flannels. A mustard plaster was also applied to the sole of the foot. Sunday morning. — Mr. Mayo being out of tow n, I saw the patient at his re¬ quest. On examining the limb I found it of a leaden hue ; from the toes to the knee it was cold, and w ithout sensation. No pulsation could be felt in the popli¬ teal or posterior tibial arteries, but slight action remained in the femoral, immediately under Poupart’s ligament. Her pulse at the wrist was very irreg’u- lar, and not at all synchronous with the action of the heart, the pulsations of the latter being (at times) as three to one of the former. There was no unnatural sound in the heart’s action, none that enabled me to name any specific disease of that organ ; but there was no pause between the diastole and systole, the 734 MR. CLARK ON A CASE OF one following- the other in rapid and constant succession, or rather, the one seeming- to run into the other. It ra¬ ther appeared as if the heart had not sufficient power to propel the blood through the body, in consequence of its being overloaded. Dyspnoea, with pain over the pericardiac region ; no head¬ ache or vertigo ; the warmth of the left leg perfectly natural. The sinapism had no effect on the sole of the foot. Four o’clock p.m. — I requested Dr. Seagrim to see the patient with me. The case struck him as being very sin¬ gular, inasmuch as there was no assign¬ able exciting cause for gangrene at¬ tacking- that particular limb. He order¬ ed a small blister to be applied over the heart, and a lotion of Tine. Lyttoe and Opii to be rubbed into the limb. Bottles of hot water and flannels to be conti¬ nued. A tingling sensation was felt after the application of the lotion. Monday morning-. — The leg was co¬ vered with patches, irregular in shape, about the size of a crown piece, of a dark purplish hue, and extending about th ree inches above the knee, on the inner side of the thigh. The pain being very severe, R Mur. Morphia? gr. iss. every four or five hours. Tuesday morning. — The morphine has given the patient a quiet and com¬ fortable night. The patches which ex¬ isted yesterday have spread into each other, and the whole limb has now assumed a dark leaden hue. The femo¬ ral artery cannot be felt. Constant thirst ; tongue thickly coated. No head¬ ache or vertigo ; pulse somewhat less¬ ened as to rapidity, but irregular as be¬ fore ; complains of frequent pains dart¬ ing from her foot to her thigh. Dr. Brabant saw the patient this morning, with Dr. Seagrim and myself. He was also struck with the singularity of the case, and declared his inability to assign any cause for the w'ant of circu¬ lation in that limb. He examined the heart with the stethoscope, and remark¬ ed upon its rapid and unusual action, but could not say whether it was prima¬ rily on secondarily affected. Ten, p.m. — The patient lies in the same state ; she is composed in her mind, and does not complain of much pain. Bowels not open ; pulse rather softer. On the anterior part of the thigh she complains of severe paiu when the part is touched. The jugular veins much distended. Wednesday morning. — The pulse to¬ day is more frequent, and the general symptoms of constitutional irritation more urgent ; gangrene has not extend¬ ed up the thigh, but the leg itself is of darker hue. Complains of darting pains. Seven, p.m. — Restless and uneasy; pain over the cardiac region. She is, and has been, taking port wine. Dr, Tomkins saw her with me this evening. Thursday morning, 10, a.m. — There is no improvement; pulse more feeble, and general symptoms stronger ; she speaks with difficulty; great dyspnoea. There appears to be contraction of the features, the nose and mouth parti¬ cularly ; there is, and has been, a pallor around the mouth from the beginning, but which is more apparent this morn- ing. Three, p.m. — About three inches above the knee nature is attempting a line of demarcation ; there is a certain hardness and tenderness upon touching it, which truly indicates an attempt at separation. It will be recollected that gangrene has not extended for the last two days. Bow els have not acted. 01, Ricini, 3ss. Eight, p.m. — Bowels have acted. The patient complains of flatulence; pulse rather stronger ; port w ine and arrow root ad libitum. Friday morning. — Much the same as to general symptoms; complains of severe pain in the limb. Bowels have again acted ; the faeces natural in co¬ lour and consistence. Yeast poultices. Eight, p.m. — The thigh considerably enlarged, without any other symptoms of inflammation. There is no vesica¬ tion of cuticle ; pulse as before, very irregular. The abdomen is distended with flatus. 01. Ricini, ^ss. Saturday, 11, a.m. — This morning her bowels have acted twice ; constitu¬ tional irritation diminished ; pulse firmer, but irregular. Tongue cleaner, and tolerably moist. Gangrene not ex¬ tended. R Sulph. Quinae, grs. xxiv.; Mucilag. q. s. Divid, in pil. xii. ; cap. i. omni tertia hora. Wine and arrow root continued. Eig-ht, p.m. — Continues better; her bowels acted after each pill. A blush GANGRENE FROM “ DISEASE OF THE HEART.” 735 of redness has in some degree supplant¬ ed the dark hue which before existed. Two or three small vesications on the anterior and middle part of the tibia. Tongue moist ; pulse increased in vo¬ lume, but irregular; slight pain or soreness (as she terms it) over the abdo¬ men ; frequent eructations ; there was a tinge of blood with the last stool. The limb to be enveloped in yeast poultices. Mur. Morphise, gr. ss. to night. Sunday morning.— The limb has again assumed its dark hue. The patient did not sleep well during the fore part of the night, and her nurse gave her another dose of the morphine. She is now under its influence. Pulse not so firm as yesterday. Sunday evening. — No alteration. Monday morning.— Nausea; singul¬ tus. The general symptoms are not more urgent than they have been for the last two or three days, but the limb has again undergone a remarkable change as to colour. It has the appear¬ ance of a limb in the first stage of erysi¬ pelas, pervading almost all the surface which was before livid. No change of colour was produced by compression at any time. It is perfectly cold and senseless. Gangrene has not extended, and nature is continuing the attempt at separation. The nurse says, that dur¬ ing the night she muttered in her sleep, and that she had observed her picking at the bed-clothes. Pulse not materially altered ; tongue moist and clean. Monday evening. — No alteration since the morning. Tuesday morning. — Florid aspect of the leg continues ; vesications rather more numerous, but in other respects the same. General symptoms worse. Tuesday evening. — The limb has a more shining appearance, and varies in colour; cuticle of a bright red. Wednesday morning*. — No altera¬ tion in general symptoms. The leg has partly reassumed its leaden hue. Above the knee, on the inner side, there is a bright red patch, irregular in shape, and extending downwards over the interior condyle to the anterior and upper part of the tibia, and bounded externally by a distinct black margin. (It should be remarked, that during these frequent i changes in colour, the limb has re¬ mained perfectly lifeless). * At this period Mr.Waylen’s sketch was made. Wednesday evening. — The margin of black which existed this morning has disappeared. Thursday morning. — The patient has passed a comfortable night. Pulse fee¬ ble ; tongue furred ; decomposition ra¬ pidly advancing in the leg. Thursday evening. — Pulse still more feeble, and decomposition extended. Chloride of Lime as a lotion. Friday morning. — The patient has slightly rallied. Saturday. — There is an extensive slough on the inner side of the thighs, and the points at which nature attempt¬ ed a separation, apparent to the eye; it seems as if the limb had been tightly girt with a cord, the depression re¬ maining. Pulse scarcely perceptible ; her intellect continuing perfect; no headache; occasional nausea, without actual vomiting. Tuesday morning. — Since my last re¬ port, the patient has remained in the same state as to constitutional symp¬ toms. The sloughing has advanced rapidly on the inner side of the thigh, and under the ham ; sinuses also exist, running upwards for two or three inches under the sound integuments. The se¬ paration has proceeded in such a ragged and irregular way, that no healthy part is to be distinguished. She is stiil able to take port wine, but rejects the arrow- root. She has also taken strong beer. Muriate of Morphia continued omni nocte. Poulticing, with the lotion kept constantly to the slough. Premonitory symptoms of death have made their appearance. There is little to add ; our patient continued to exist until this morning (Sunday). On Fri¬ day night delirium came on, which con¬ tinued till her decease. The sloughing had made great progress on the inner and under part of the thigh ; the femur was perfectly bare from the interior con¬ dyle to the extent of four inches. Autopsy. — On opening the chest and slitting up the pericardium, we did not observe any unnatural quantity of se¬ rum, but the heart itself was considera¬ bly enlarged; on dividing the great vessels and withdrawing it, we found the enlargement to depend upon the immense dilatation of the sinus of the right auricle, which was filled with blood, and presented the appearance (if I may so term it) of a large venous aneurism. On opening this cavity, 736 CASE OF GANGRENE FROM “ DISEASE OF THE HEARTS which was at least four times its natural size, it was observed to be very muscu¬ lar, and gave rather the aspect of the internal structure of a ventricle than the smooth internal surface of a sinus. The tricuspid valves were slightly thickened, but could not be pronounced actually diseased. The right ventricle natural, as were the semilunar valves of the pulmonary artery. The left auricle twice its natural size, and the mitral valves cartilaginous at their edges. The left ventricle contracted without any hypertrophy. Aortic valves heal¬ thy. The lungs healthy in structure ; the liver somewhat darker and firmer in texture than usual. We now' proceeded to examine the vessels leading to the gangrenous limb. The common iliac artery on the right side was unusually small, certainly not larger than the axillary, and the femoral under Pou- part’s ligament did not exceed an ordi¬ nary brachial. We concluded from this that the vessels on the opposite side would be proportionably large, but, upon examination, we were mistaken ; both were equally small. In tracing the femoral artery down the thigh, it gradually tapered until its cavity became obliterated above the part where the sloughing* commenced. The coats perfectly healthy. The veins were unusually large, as if to make up for the deficiency in the size of the arte¬ ries. The iliac veins forming the abdo¬ minal cava were in direct contrast with the smallness of the arteries, bifurcating from the aorta. I have thus endeavoured to give in detail a case which has excited much interest amongst the medical men in this town from its singularity. T do not Know of any case (published) of gan¬ grene arising from disease of the heart. Tts mysterious and sudden appearance w'ithout any sufficient exciting cause, the remarkable irregularity of the pulse, and the history of previous symptoms, all pointed to the heart as its source, although w e could not discover any spe¬ cific or certain disease in that organ. The rapidity of its action, with other constitutional symptoms, indicated dis¬ ease. The result of the post-mortem examination has clearly proved that disease of the heart is a most formidable predisposing cause of gang*rene of the extremities, inasmuch as the only excit¬ ing cause (at least if we take the his¬ tory) was the woman’s placing her right foot on a damp brick floor. I men¬ tioned that the contrast of development between the arteries and veins was re¬ markable. If the former were half their usual size, the latter W'ere at least double their natural calibre ; and this may account in some measure for the immense dilatation of the right au¬ ricle — (a large apple has been placed in its cavity, which it held with ease) — whilst the smallness of the arteries may be accounted an auxiliary predisposing cause for the commencement of gan¬ grene. There were many points in this case which differed from the ordinary course of gangrene: — 1st. Vesication of cuticle was the last symptom that ap¬ peared. 2dly. The extraordinary change in the colour of the limb — not, indeed, the gradual variation indicating the natural progress of mortification, but the entire change. In the morning I should find the limb of the usual leaden appearance; in the evening a bright scarlet blush suffused its whole surface, and this blush would again be lost the next morning. We were quite unable to account for this phenomenon : it could not have been the effect of capil¬ lary circulation, for the limb was cold, and perfectly senseless; neither could it have been, as at first supposed, the con¬ sequence of exposure, since the parts enveloped in poultices were equally changeable. 3dly. The abatement of constitutional irritation. Those g*entle~ men who kindly gave me their assist¬ ance and advice predicted a speedy ter¬ mination of the case, from the high degree of irritative fever w hich prevail¬ ed ; but as soon as gangrene was thoroughly established, and its further extension up the thigh checked by a line of demarcation, the clammy perspi¬ ration, the thickly-coated tongue, the constant thirst, and the difficulty of breathing, all gave place to a more natural heat of the skin, to a moist, tongue, to a moderate w'ish for fluids, and to a comparatively easy respiration. During the first ten days there appeared to be a struggle against the disease; but when this was fruitless, and gan¬ grene rapidly advanced, nature came to her assistance in another way, and tried to support her through the sloughing stage. It was at this time that the ex¬ pediency of amputation was slightly agitated, — not, indeed, with much hope of ultimately saving life, but rather to remove a positive nuisance to herself MR. TRAVERS ON A METHOD OF OPERATING FOR HYDROCELE. 737 and attendants. The state of the heart, and an impartial review of the case, at once decided us against its attempt. It has fallen to my lot to have wit¬ nessed, within the last five years, two of these melancholy cases. The first happened during my pupilage in Lon¬ don. The patient was a servant girl, set. 19 years, who died on the tenth day from the first appearance of gangrene. T should have been glad to have added the notes of this case, but fear that I have already taken up too much room. I may, however, mention, that in this instance the tricuspid valves were obli¬ terated. i ACCOUNT OF A METHOD OF OPE¬ RATING FOR HYDROCELE. To the Editor of the Medical Gazette. Sir, In the first number of a new periodical, entitled “ The Annals of Medicine,” which I saw lying on a friend’s table a few days ag*o, is an account of an ope¬ ration for hydrocele invented by a Mr. Lewis, with observations by Mr. King, lecturer at the Blenheim Street School of Medicine. Having been in the habit of perform¬ ing this operation publicly in the wards of St. Thomas’s Hospital for nine months past, and never having heard or read of such an operation prior to my performance of it , precisely in the man •* ner described by Mr. King , I had re¬ garded my claim to the priority as es¬ tablished, and waited only the time requisite to test its real value, before submitting the matured results to the profession. I ought, however, to men¬ tion the following fact. On Saturday, May 6th, a fortnight after my perfor¬ mance of the operation with the acu¬ puncture needle in the presence of the pupils with a satisfactory result, a letter, as I was informed by one of them, appeared in the Lancet, describing the exact process, as Mr. Lewis’s new plan of treating hydrocele. In the summer of 1835 I first con¬ ceived the opinion, from an observation made in private practice, in a case of old hydrocele simply punctured, that the puncture ol the tunica vaginalis would be followed by an inflammatory change of the contents of the sac from a serous to an albuminous secretion. In lec¬ turing* on hydrocele in the surgical course of the ensuing session, 1835-36, after describing and canvassing the various modes of treatment, and g'iving* a decided preference over these to that of Sir James Earle, I mentioned the particulars of the case alluded to, and the opinion 1 had formed, and stated the probability that this more simple method of treatment might be found effectual, but that time, and extended observation and careful comparison of results, would be necessary to show that it was as little liable to failure as the operation by injection. In the spring of 1836 I commenced the prac¬ tice of the operation ; first, making a single puncture with a trochar ; second¬ ly, with a fine sharp-pointed probe; thirdly, with an acupuncture needle of the 1 argest size ; and then planting* several punctures at equal distances, according to the bulk of the hydrocele. A drop or two of fluid escaping at the several needle orifices, a rag dipped in cold lotion was laid on the part, and the general result was more or less oedema of the scrotum, and in three days a total disappearance of the swell¬ ing. I soon ascertained that it was not by adhesive or any other mode of in¬ flammation that the change was effected, but that the tunica vaginalis was left perfectly free and natural in its relation to the testis, and the scrotum of its proper weight, size, and figure, so that relapse was more to be apprehended. 1 was at first impressed with the idea that the tense condition of the tunic was essential to the curative effects of the puncture, and thus explained the difference of result from that obtained by complete evacuation and collapse of the sac. But this opinion 1 have had occasion to modify, finding that a freer discharge than could be obtained by the round needle, and the consequent par¬ tial collapse of the sac, was on the con¬ trary more immediately and certainly productive of the infiltration of the cellular membrane, and consequent ab¬ sorption of the fluid. I h ive therefore since employed a very fine trochar, smaller than any in common use, as the preferable instrument. My mode of proceeding is to put the scrotum on the stretch, in front of the testis, by B 9 738 MR. TRAV1 RS ON A METHOD OF OPERATING FOR HYDROCELE. embracing- it with the extended thumb and fore fing-er of the left hand; and placing- the patient opposite a window on which the sun falls, or at all events a, strong- light, I command the view of the transparent bag- so perfectly as to avoid veins and any point of accidental adhesion or thickening-, which is always marked by a corresponding- opacity. The punctures are made in a perpen¬ dicular direction and in quick succes¬ sion, about equi-distant from each other, while the tunic is kept tense by graduated compression. Of several cases thus treated some have remained cured ; others, apparently cured, have relapsed after a fortnight or three weeks, and one after three months ; but I do not consider this a fair criterion of the value of the practice, because from the shape and size of the acupuncture needles chiefly used in these cases, the points on which I believe the success of the operation mainly depends were hot accomplished. These are, a freer col¬ lapse of the sac by the removal of a sufficient portion of the fluid which the trochar puncture ensures, and the more complete diffusion of the remainder into the surrounding cremaster and cellular tunics, obtained by the multi¬ plication of the punctures, while the tension of the sac is preserved. On the third day the fluid is absorbed, and the two sides of the scrotum are uniform: indeed, this is sometimes the case on the second day; but if the punctures are so small as not at once sensibly to reduce the bulk of the swell¬ ing, a single drop only exuding at each orifice, the reduction is generally much slower, or even fails altogether. Now every body knows that the drawing off of the fluid of a hydrocele through a canula is almost invariably followed by its reaccumulation, and it is not uncom¬ mon for elderly men, who are timid, or averse to injection, to call upon their surgeon to have the tunica vaginalis relieved of its contents once in a year or in two years. Assuming that the simple puncture as above described is in a certain pro¬ portion of cases a permanent cure, to w hat is the difference of result attribu¬ table ? This is a fair question, and not as it appears to me very obvious of solu¬ tion. But it is needless to conjecture about the modus operandi of a supposed remedy, or to discuss the advantages, real or comparative, of an hypothetical cure. Let the premises, therefore, be well ascertained. I may mention two probable sources of fallacy as to the facts ; first, the want of a sufficient interval of time and ex¬ tent of observation to establish such a difference of result ; and secondly, the false impression which the surgeon re¬ ceives from the disappearance of the fluid, in whole or in part, by absorption, that it is the institution of a curative process, instead of a natural and neces¬ sary result of the effusion of an innocu¬ ous fluid into the cellular membrane. I confess myself so far unprepared to decide the fact of a permanent cure, that it seems idle to set about the ratio- nale. Negatively, the question when we are ripe for it,, might be reduced by observing- that there is no evidence of inflammation following the transfer of the fluid from the tunica vaginalis to the cellular membrane, in either texture, and the effused fluid is too rapidly ab¬ sorbed to operate with any permanent effect in the way of compression, thus converting the disease into the remedy. The puncture is the same whether the canula is employed or not, so that in fact the only difference in the circum¬ stances of the two cases is that between the gradual and the sudden evacuation of the sac of the hydrocele. What is essential to justify the con¬ clusions so readily adopted by Mr. King, is, evidence of a positive process by which the disease is not only removed 'for a time, but removed altogether. The second part of the action is want¬ ing — the removal of the fluid, artifi¬ cially or naturally, or by a half-and-half process, falls far short of the cure ; and it is a priori against the probability of cure, that the parts are left in a perfect state, and that no impediment conse¬ quently presents itself to the recurrence of the dropsy, which is confirmed by all analogy and pathology of dropsies. Otherwise I g-rant it is easy to see and point out the advantages of a perfect as of a morbidly altered condition of parts after operation, and to enumerate other disadvantages attending other success¬ ful modes of proceeding- as compared with this, if this be equally so, but the superiority of the method as well as the theory of cure, may as well be de¬ ferred until the fact is placed beyond MR. Hutchinson’s case of extra-uterine pregnancy. 739 doubt. Mr. Lewis, indeed, says, (May 7, 1835,) that he has tried the plan of single puncture with a needle for the last two years, and therefore can vouch for its success in every case of hydrocele. If by success is meant the disappear¬ ance of the fluid for a week or a month, or two months, I do not mean to ques¬ tion the statement, though a startling one ; but if it means, what alone it should mean, a radical cure of the com- {flaint, I can only say that his practice las been too singularly fortunate to be a safe precedent for others, even though their cases be not numerous. As matters stand, the merits of the proposal (it signifies little to the public to whom it belong-s) will soon be cor¬ rectly appreciatad by my colleagues, the surgeons of hospitals. It recom¬ mends itself by its safetyand simplicity. A similar mode of proceeding- with dropsical bursae has proved perfectly successful, when followed by pressure, and it is probable that this addition to the treatment in hydrocele for a short time subsequent to the puncture, and which though not so easy of adjustment may still be efficiently employed by means of a narrow roller, would be available against relapse. I am, sir, Your obedient servant, Benjamin Travers. Bruton Street, Feb.l, 1837. SEQUEL OF A CASE OF EXTRA-UTERINE PREGNANCY, IN WHICH A FULL-GROWN FOETUS WAS RE¬ MOVED BY AN OPERATION FOURTEEN MONTHS AFTER CONCEPTION. ' With Remarks. To the Editor of the Medical Gazette. Sir, I shall feel obliged by the insertion in your journal of the continuation of the case of extra-uterine pregnancy, the former part of- which is given in the 17th volume of the Medical Gazette, p. 169. I have appended some observa¬ tions, principally with a view of point¬ ing out a more correct diagnosis than has hitherto prevailed, and to improve the method of treatment of these unfor¬ tunate deviations from the ordinary course of nature. — I am, sir, Your obedient servant, Francis Hutchinson. 92, Farvingdon Street, Feb. 1, 1837. From the date (26th Oct. 1835) of my former report, which included the treat¬ ment during the first month after the operation was performed, the size of the wound of the abdomen, and the quantity of discharge therefrom, have gradually decreased. My patient had gained such an increase of strength, that she was enabled to walk a considerable distance without feeling fatigued ; her appetite was good, and her general health con¬ tinued improving up to January 14th, 1836, nearly four months after the opera¬ tion, when she was seized with sick¬ ness, and vomited three or four times; complained of a sense of languor ; of her feet and legs swelling- towards even¬ ing; of pains across the loins, and of a general soreness over the body ; slight feverishness present ; action of the bowels regular. January 15th. — Continuation of sick¬ ness; other symptoms enumerated re¬ main much the same. 17th. — Vomiting this morning more severe than before, accompanied with an increase of pain in the lumbar region. About 12 o’clock (meridie) the cata¬ menial discharge manifested itself, the first time of its appearance since the operation ; it was of a darker hue than usual, and mixed with small clots of blood. 18th. — Continuation of catamenia, which have now assumed a more natu¬ ral appearance ; subsidence of pain, sickness, &c. The patient expresses herself much relieved. 2ist. — Catamenia have disappeared; decrease of discharge from the wound of the abdomen. March 7th. — Aperture of wound scarcely admits the extremity of a probe; discharge very small in quantity, and of a healthy quality. Patient states that she has increased considerably in bulk, and more especially so in the abdominal region. I recommended the applica¬ tion of a bandage, to be worn round the abdomen as tight as could be borne without inconvenience. 740 SEQUEL OF MR. HUTCHINSON S CASE OF 15th. — Patient called to inform me that the wound was quite healed. I examined the part, and found the cica¬ trix firm and complete. Patient ob¬ serves that she sleeps well ; that her appetite is good; that her catamenia recur with regularity and without pain; that she is as stout and strong as before becoming pregnant ; and, in short, that she never was in a better state of health. Nov. 16th. —I saw her yesterday; she continues in the enjoyment of g*ood health. Remarks. By extra-uterine pregnancy is meant the development of the foetus out of the cavity of the uterus. At the period of impregnation, the ovum, instead of be¬ ing transferred to the uterus, according* to the natural process of gestation, is either detained in the ovarium, or, at its expulsion from the ovarium, escapes into the cavity of the abdomen, where it lodges; or, on leaving the ovarium, is detained, in transitu , by the fallopian tube. These constitute the three dif¬ ferent species of extra-uterine preg¬ nancy which are generally enumerated by writers; the first of which is termed ovarian , the second ventral , and the third tubal . Dr. Ramsbotbam mentions the existence of a fourth species, which he terms utero- tubal , where the foetus lodges in the uterine portion of the fal¬ lopian tube. Burns, in his Principles of Midwifery, observes, that “ of all the species of extra-uterine pregnancy, the tubal is the most frequent, and the ventral the most rare.” Dr. Davis, in his work on Operative Midwifery, has entered large¬ ly into the subject, and refers to about ninety recorded cases of extra-uterine pregnancy, in which list the proportion of the several kinds are as follows : — - Ventral . 9 Ovarian . 16 Tubal . 40 Of pregnancies extra- uterine, ) but of uncertain locality . . 5 ^ “All the cases of ventral gestation, which are not numerous, and of the ex¬ istence of which, as a special variety of extra-uterine pregnancy, some writers have expressed great doubts, have, with¬ out a single exception, terminated fa¬ tally within the period of natural gesta¬ tion, and the greater number within the earlier weeks. “ All the examples of ovarian gesta¬ tion terminated fatally, and the greater number at an early period. One had arrived at the fourth month, and ano¬ ther, that of Forrestiers, at the sixth or seventh month of gestation.” Tubal pregnancy is commonly fatal from about the sixth week to the third month, the tube giving* way by ulcera¬ tion, and the patient dying* from haemor¬ rhage into the peritoneal cavity. “ The subjects of about one-fourth of the whole number,” according to Dr. Davis, “ survived the full period of gestation.” “ Amongst the results of cases under the last division of extra-uterine con¬ ception, viz. that of uncertain locality, we have happily many examples of re¬ covery after years of various affliction from the presence of extra-uterine cysts w ithin the peritoneal cavity.” From the nature of the fluid dis¬ charged on tapping, which was of a chocolate colour, tbickish, and similar to the fluid met with in some diseases of the ovarium, I wras at first induced to consider this a case of ovarian gestation ; but on more mature deliberation, and for the following reasons, I am at present inclined to place it under the head of ventral gestation. 1st. We know that of the recorded cases of extra-uterine pregnancy which have attained the full period of develop¬ ment, the greater number belong to the class of ventral g*estation. 2d. The locality of the foetus in the present instance was very high up in the abdomen, and from its lying trans¬ versely, with the head to the left side, we might naturally suppose, if it had belonged to the ovarian division, that it would, during its development, have been more likely to have been situated lower down, towards, and perhaps occu¬ pying some portion of, the pelvis. 3d. The sac was well circumscribed, as far as could be ascertained from the fing'er being passed into and moved over its inner surface. 4th. During the performance of the operation, nothing but the abdominal parietes and the foetal sac were divided. The assigned causes of extra-uterine foetation seem altogether hypothetical ; such a state of things as might give rise to the occurrence is very readily EXTRA-UTEiUNE PREGNANCY. 741 conceivable, when wc consider the mi¬ nuteness and consistence of the germ, the smallness of the tube throng’ll vvhicli it ought to pass, and the complex nature of the gestative apparatus; and surprise might naturally be excited in the occur¬ rence of so few cases of this particular deviation from the ordinary course of nature. Imperviousness of the fallo¬ pian tube, produced after impregnation, irom whatever cause; adhesions be¬ tween the sides of the tube and other parts; malformation; fright at the time. ofconception,&c. are mentioned amongst the probable causes. - Treatment. The cases of extra-uterine pregnancy on record in which recovery has been effected, are not very numerous. This fact may be accounted for from the ex¬ treme difficulty of forming a correct diagnosis, in conjunction with the com¬ parative variety of these cases ; the fatality may likewise have been in¬ creased by the prejudice which has hitherto pretty generally prevailed, in regard of making incisions into the peri¬ toneal cavity, under the dread of in¬ ducing- fatal inflammation of this mem¬ brane — a dread which has perhaps been the principal stumbling-block to the advancement of abdominal surgery, (especially in this country) notwith¬ standing the vast importance of the subject*. That the assertion in reference to the expression prejudice is well founded, will, I think, be amply supported by referring to the experiments and opi¬ nions of Dr. Blundell, embodied in his work entitled “ Researches, Physiologi¬ cal and Pathological,” undertaken with a view to the improvement of the sur¬ gery of the abdomen in the human being*. Dr. B. instituted a series of important and valuable experiments on rabbits; amongst these the following may be mentioned. Prom some rabbits he re¬ moved the left kidney, from others the spleen ; in some he punctured the fundus vesicoe, and tied the aperture with a ligature; in two he cut off at least one quarter of the bladder at the fundus, * Vide Barns, who stsites, “ we are justified in the highest degree in trusting to the powers of nature, rather than to the knife of the surgeon.” &c. &c. : some of the rabbits in each of these experiments completely recovered. Dr. B. infers, I think fairly, from these experiments, that large apertures into the peritoneal sac in the rabbit are not necessarily, nor perhaps generally productive of fatal inflammation; that the kidney, the spleen, and a larg’e piece of the bladder, may be extirpated without necessarily causing death, though death under the first operation is probable; and that success in the ab¬ dominal operations on the rabbit fur¬ nishes a presumption in favour of suc¬ cess in similar operations on the human abdomen. In the treatment of extra-uterine pregnancies, much will always depend upon the character and circumstances of each case ; but in the cases which have advanced to or near the ninth month of gestation, does it not seem probable that in some instances much suffering and danger might be avoided by a prompt and early recourse to an opera¬ tion for the removal of the fetus and appendages, where the diagnosis is sufficiently indicative of the nature of the case? and does not that opinion seem to be both justified and strength¬ ened on referring to the cases of ventral and ovarian gestation detailed by Dr. Davis, all of which, being left to nature, terminated fatally? We know that in cases which have arrived at the ninth month of gestation, symptoms, from the attempts at expul¬ sion, as in natural labour, manifest themselves also in extra-uterine preg¬ nancy ; a little blood comes away, and if the tunica decidua is formed, it is ex¬ pelled at the same time ; would not this occurrence of simulated labour, with a close attention to the sudden remission of symptoms, conjoined with a careful examination of the state of the uterus, lead to the presumption of a correct diagnosis being formed in the generality of cases? For support of the latter position, I must again refer to the testi¬ mony of Dr. Blundell, who states, “ that a finger or two may be inserted into the uterus at this time, and the ab¬ sence of the fetus easily ascertained,” and which statement is well borne out by the following interesting case, kindly communicated to me by my friend Dr. Blundell. A woman in the end of a reputed 742 SEQUEL OF MR. HUTCHINSON^ CASE OF pregnancy was seized with symptoms of an incipient parturition, and Dr. B. was called in. On making- examina¬ tion, he gave it as his opinion that the womb did not contain a foetus, tor both the fundus and the mouth of the uterus could be felt, and the bulk of the organ, not exceeding' that of two months, was obviously insufficient for the purpose. A day or two afterwards, violent par¬ turient efforts supervening-, Dr. B. was summoned in all haste, with a hurried intimation that the child would probably be born before his arrival. Of course this intimation was accompanied by a smile and a sneer. On reaching- the chamber, Dr. B. found the patient labouring under vehement uterine efforts; but on repeating- the examina¬ tion, the os uteri being open, he suc¬ ceeded, without difficulty, in intro¬ ducing the fore finger of the left hand into its cavity, and gently depressing the whole womb by the action of the right hand applied externally upon the fundus, he was enabled to touch the in¬ ternal surface of the fundus with the tip of the finger already introduced, satisfying- himself beyond a doubt that no foetus was there. The size and situation of the womb being in this manner ascertained, together with the absence of an uterine ovum, the abdo* men was further examined externally, when, behind the uterus, a large tumor of the size of a nine months’ impregna¬ tion could be clearly distinguished. Further assistance from Dr. B. was de¬ clined ; but the patient dying appa¬ rently from peritonitis, a fine foetus of the size of nine months was found lodging externally to the uterus, and with its cyst forming the tumor. The stethoscope has been frequently and successfully used in the detection of natural pregnancy ; might it not also be employed to assist in forming a cor¬ rect diagnosis in cases of extra- uterine gestation ? As to the danger of making incisions into the peritoneal sac, though not to be undervalued, yet surely it is not sufficient to set aside the operation, if we refer to the many successful cases of the Caesa¬ rean operation, extirpation of the womb, of the spleen, and of the ovaries, stran¬ gulated hernia, &c., &c., as well as to Dr. Blundell’s Experimental Enquiries, before alluded to ; and we shall have proof sufficient, that the risk of fatal peritonitis from these incisions has been greatly exaggerated, and that it ought not to deter us from abdominal opera¬ tions, when the urgency of the case seems to demand them. The correctness of these inferences being granted, as founded upon the arguments advanced in support of our views relative to the expediency of an operation for the removal of the foetus and appendages in cases of extra-uterine pregnancy arrived at or near the ninth month of gestation, the important question as to the period most eligible for the adoption of such operation pre¬ sents itself in the next place for our consideration. The answer to this question properly restricts itself to two periods : the first of which would be indicated by the symp¬ toms of expulsion becoming manifestdur- ing- the continuance, or immediately after the subsidence, of these symptoms ; the second, commencing at the termination of the first period, renders the time of operation less definite, and altogether circumstantial. Let us examine what inducements we have for selecting- one or the other of these periods. Now, as to the first, viz. that of the manifesta¬ tion of the expulsive symptoms, &c. I think we may consider the advantages derivable, under three divisions. 1. The chance of preserving the lives of both mother and child; the latter of which would be only possible at this period , while that of the former would be rendered more probable at this than at any subsequent time. That such is not only a tenable but a justifiable anticipation, cannot, 1 think, be better substantiated than by referring to the many analogous cases of abstrac¬ tion of the foetus by the Csesarean sec¬ tion, which have been performed with a happy result. One example to this ef¬ fect, of recent occurrence, will, it is hoped, serve as an ample illustration of the rationality of the principle. This case is recorded in Part III. of the Bri¬ tish and Foreign Medical Review, edited by Drs. Forbes and Conolly, pp. 71, 72, 73. The Coesarean section was performed thi •ee several times on the same' indi¬ vidual, by Dr. Michaelis, of Kiel. On the first operation a dead foetus was ex- EXTRA- UTERINE PREGNANCY. 743' tracted ; under the two latter the lives of both children were saved, and the mother recovered and did well*. 2. The constitutional powers are in a better condition for sustaining an operation , the constitutional irritation being less , and least to be dreaded at this period. No further argument need be adduced to support this position, than that the longer the case is protracted, the greater must be the risk of constitutional dis¬ turbance and consequent debility, and in the same ratio dangerous to the mo¬ ther ; and this would surely be a suffi¬ cient inducement to operate at as early a period as possible. 3. By operating at such time the occur¬ rence of intestinal ulceration would be obviated , a result not unusual as a concomitant of protracted gestation ( extra-uterine. ) This untoward event happened in the case under con¬ sideration. That this circumstance cannot occur for some time after the death of the child, will, I think, appear evident, when we consider the process which nature has to set up for its decomposi¬ tion ; and from analogy we can readily conceive such a condition to be replete with the most imminent danger: this risk, by operating early, would be avoided, and add another powerful auxiliary to the chance of preserving the mother’s life. Thus the intention would be to en¬ deavour by an operation, as near the ninth month as possible, to save the lives both of the parent and her off¬ spring: and although the death of the child might have previously taken place, still the life of the mother w'ould be brought into a position more favourable for recovery. Let us now consider the second pe¬ riod for operating, viz. that commenc¬ ing* shortly after the termination of the expulsive efforts, and which renders the time for so doing less determinable. We must be guided by the urgency of the symptoms, and never lose sight of the advantages derivable from an operation, in even protracted cases, as proved in the present instance, where * For an excellent detail of this case see the journal just referred to. such an unfavourable event as ulcera¬ tion of the intestine supervened, accom¬ panied by considerable constitutional irritation ; yet the patient’s life was pre¬ served, and she regained her wonted g*ood health and faculties. As to where an incision ought to be made, whether through the abdominal parietes or through the vagina, must depend entirely upon the locality of the foetus; but in the majority of instances the former situation would be prefera¬ ble, and 1 think justly so, because, in operating with a proper degree of care, the free peritoneal cavity might be avoided. We know that the opposite surfaces of living* tissues, more particularly those of a serous character, when brought into close contact in states of inflamma¬ tion, are apt to become mutually adhe¬ rent ; and thus it is in extra-uterine pregnancy. The sac containing the foetus occasions some degree of inflam¬ mation or irritation, which has the ef¬ fect of causing* lymph to be thrown out, and producing*, in tubal and ovarian cases, adhesion between the peritoneum covering the sac, and that portion of it which is reflected over the abdominal parietes ; and by the termination of the full period of gestation, the union be¬ tween the tw'o surfaces is generally complete to the extent of nearly the anterior half of the sac. But in ventral cases, the germ, being lodged in the cavity of the abdomen, separates the two layers of the peritoneum as far as its circumference, where they become united by means of lymph, w hich forms a boundary, and assists in supporting the proper membranes of the placenta, and in preventing* the escape of the contents of the ovum into the free ca¬ vity of the abdomen. In those cases where adhesion has taken place, that part of the abdominal parietes included between the superior and inferior boundaries of the sac need alone be divided ; and I would recom¬ mend that an incision should first be made, large enough to admit the finger, at that part where fluctuation could be most distinctly felt, for the purpose of ascertaining the extent of the sac ; and that the aperture be enlarged accord¬ ingly. Thus, by not laying open the free cavity of the peritoneum, the risk (so much dreaded) of producing inflamma- 744 ANALYSES AND NOTICES OF BOOKS. tion of that membrane by the extrava¬ sation of blood, the effusion of other fluids, or the lodgment of any irritative matter, would be greatly diminished, and the objection raised by Sabatier, in his “ Medecine Operatoire,” as to the danger of extravasation of fluids, &c. into the cavity of the abdomen, would under such circumstances be obviated. I have been asked how the placenta could be removed without incurring the risk of great haemorrhage, there being no contractile power, as in the uterus, to close the mouths of the vessels, when the placenta is detached from the cavity of the sac in which it and the foetus are contained ? I should here express my belief that the death of the foetus takes place at, or very soon after, the period when the fruitless efforts at expulsion are made ; so that the foetus becomes an extraneous body, devoid of vitality. It may be presumed that the placenta, having no further functions to perform, soon loses its vitality and operates as an extra¬ neous body too, and, on the well-known principle of the animal economy, in ana¬ logous instances, occasioning- closure of the vessels at that part where the living surface comes into contact with the dead ; and this state of things would necessarily preclude the danger to be dreaded from the occurrence of haemor¬ rhage : but, for the sake of argument, admitting the existence of a vital con¬ dition of the contents of the sac, after the separation of the child, this is my answer : — I would not extract the pla¬ centa immediately, but would leave it for a few' days ; when I confidently be¬ lieve that the usual process of separation would be set up by nature in this case, as is exhibited in the removal of extra¬ neous bodies from the system, or of parts that have become mortified ; for, as be¬ fore stated, the child being separated, and the placenta having no further function to perform, must necessarily lose its vitality and become an extra¬ neous body. Another question here suggests itself: might not leaving the placenta for a few days, or till its death supervened, in con¬ tact with a vital surface, be likely to lead to the same baneful results as oc¬ curred under Dr. Wm. Hunter’s- prac¬ tice of leaving the placenta in the ute¬ rus, in order that nature might complete the process for its expulsion ? The only answer I can, or think need give, to this interrogative, is by referring to what really occurred in the case under consideration, where not only the pla¬ centa, but likewise the child itself, were placed in this relation to the living or¬ ganism, since both had been, at the time of their extraction, dead for nearly five months: still no untow'ard event or evil consequences resulted ; nor yet are we prepared to say how far the analogy betw'een the interior of the sac of an ex¬ tra-uterine impregnation and of the uterus holds good ; but T think we may conjecture, from the results observed in th ese two instances, that their physio¬ logical conditions are very different. It may be well to observe, in dis¬ missing this case, that the recovery of the patient, under abdominal injury so great, surely gives increased strength to the opinion that the abdomen will bear much, and that an abdominal surgery, cautious, yet more enlarged than the sur¬ geons of the preceding’ century have ventured to exercise, might not be wholly unattended with success. ANALYSES and NOTICESof BOOKS. ** L’ Auteur se tue a allonger ce que le lecteur se tue a abreger.” — D’Alembert. The Works of John Hunter , F.R.S. ; with Notes. Edited by James F. Palmer. In 4 vols. Bvo. illustrated by a volume of Plates, in 4to. Yol. I. Longman and Co. The opening of the new College of Surgeons, and the approach of the annual oration consecrated to the fame of Hunter, are epochs happily chosen for the appearance of this work. It is, in fact, a monument to the genius of that master-spirit whose labours and whose creations it records, and can scarcely fail to be acceptable to the pro¬ fession generally, but more particularly to that great mass of listeners who will shortly be congregated within the walls of the most splendid professional institu¬ tion, and adjoining the most compre¬ hensive and valuable physiological and pathological museum in Europe. The first volume (the only one yet published) contains an original and w ell-written life of Hunter, in which the POOR-LAW THICKER V PRACTISED ON THE PROFESSION. 745 unmeasured panegyrics, and the shame¬ less detraction of preceding biographers, are alike avoided. This is followed by “ Lectures on the Principles of Sur¬ gery,” in correcting* and preparing which great pains seem to have been taken to collate the best and most au¬ thentic MS. copies extant. The work is altogether one which promises to confer an important service on the profession, — a service which will not be appreciated the less on account of the modest and unassuming manner in which the Editor speaks of himself and his labours. We shall probably bring some of the most interesting parts of the work before our readers in some future numbers of the Gazette. MEDICAL GAZETTE. , Saturday , February 11, 1837. *' Licet omnibus, licet etiam milil, dignitatem Artis Medicce tueri; potestas niodo veniendi in publicum sit, dicendi periculum non recuso.” Cjcuro. POOR-LAW TRICKERY PRAC¬ TISED ON THE PROFESSION. If we have said nothing for some time <7 past on the subject of the vile new Poor- Law and its abominable working, it has not been, heaven knows, for want of material to illustrate its nature, for daily and hourly the examples are mul¬ tiplied of the mischiefs resulting to the community from this pernicious system; but we began to feel, we must con¬ fess, the hopelessness of opposition in a cause which so deeply concerns the welfare of the medical profession throughout the country, as well as that of the public at large, yet in which those who are actually so much in¬ terested exhibit themselves so luke¬ warm. Since the publication of the ex¬ cellent report of the committee ap¬ pointed hy the Provincial Associa¬ tion, there has been a dead silence ; we have heard of no steps being taken, or proposed to be taken, in any quarter, to follow up the recommendations of the committee. Parliament is now assem¬ bled, yet not a stir seems to be even contemplated in any locality to get up petitions. The session, no doubt, will slip by> as many preceding ones have; and then, in the usual course of things, meetings will be held to complain of grievances, which, with a little more energy on the part of the complainants, might have been averted. The members of the medical profes¬ sion seem to be waiting on the will and pleasure of the public, thinking, doubt¬ less, that the frightful examples of in¬ humanity constantly coming before them will ere long work an abolition of the law. But they miscalculate the effects of such stimulants, which only become weaker in their operation the more frequently they are administered. What can be more horrifying than the instances every day brought under the recognizance of our magistrates, of wretched people of all ages starving to death, in a country which could hitherto so proudly boastof its provision for the poor? Unfortunate creatures, in the last state of destitution and dis¬ ease, are hourly besieging the police offices for that relief which the ma^is- trates can no longer order, and the pa¬ rish overseers deny. Mothers are obliged to carry their dying children in their arms, making application to one overseer after another, and treated with unfeeling brutality by all, until at last the infants perish. A case of this kind is even now before us : a wretched couple, with a sick child, wishing to stop at Brentford, on their way from Croy¬ don, were refused a bed in any of the lodging-houses, lest the baby should die, and thus become chargeable to the Union for its burial: the lodging-house keepers were warned on this point hy POOR-LAW TRICKERY PRACTISED ON THE PROFESSION. 746 the overseers. The consequence was, that the child died in its mother’s apron. Nothing1 can in general surpass, in the wa y of cruelty and inhumanity, the conduct of the overseers, relieving offi¬ cers, and all the functionaries connected with the new system : it would seem, indeed, as if there was something in the measure itself infectious, in this re¬ spect, for the employes no sooner get into office than they almost invariably become case-hardened, and lost to all sense of shame. There are but few exr ceptions. This heartlessness and cruelty, how¬ ever, are not the only characteristics of the new poor-law officers ; their inhu¬ manity and injustice are frequently combined with trickery and insult. In all their dealings, with medical prac¬ titioners especially, the Boards of Guardians have displayed a singular propensity for exercising an insulting tyranny : they have bullied and threa¬ tened, and have found, unfortunately, in too many instances, that they could thus succeed in carrying their point. That disgusting affair which was transacted at Somerset-house a few months ago, when a poor-law medical officer was thrown overboard as a tub to the whale, to miti¬ gate the public indignation, then at its height, should serve as a warning to all practitioners unhappily tempted to en¬ ter their service. But we were not pre¬ pared for the gross amount of trickery which the Poor-Law functionaries do not think it amiss sometimes to practise, un¬ til we met with a striking instance in a provincial paper. It would seem that wherever the system is introduced, not only, as we have said, are officers pro¬ curable endowed, or speedily endowable, with the requisite w'ant of feeling, but these persons soon show that they are everywhere actuated by the same spirit precisely : a Board of Guardians in the remotest corner of Somersetshire is a physical and moral miniature of the Board in Somerset House ; and every little knot of functionaries, however small, has its Chadwick to regulate its proceedings. The same jesuitry and disposition to overreach those who too candidly confide in its deceptive pro¬ mises, are everywhere observable. The case to which we more immedi¬ ately allude is one which has lately occurred near Castle Cary, in the Win- canton Union. On the 6th October last, a carter in the service of the Rev. H. F. Yeatman fell from a waggon and broke his thigh. Mr. Knight, a surgeon, being on the spot, was request¬ ed by the overseer of Ashford (to which place the patient was conveyed “for convenience,” after a lapse of two hours, during which time he lay in an ex¬ hausted state in the open highway) to attend the case. The medical man ap¬ parently knowing the sort of people he had to deal with, desired the overseer to apply to the relieving officer for in¬ formation as to the course to be pursued ; ■whether a union doctor was to be sup¬ plied, or he, Mr. Knight, to be recog¬ nized as having charge of the case. The answer was, that no decided arrangement could be made before the next meeting of Guardians, when the matter would be laid before them : but that in the meantime Mr. Knight was to see that the man was provided with “ what might be required.” The Chairman of the Board was also apprized of the facts of the case, w hen he wrote a letter to his friend, Mr. Yeatman, to the follow ing effect : — “ I am sorry to hear that your carter has met with so severe an accident. The case shall be duly attended to by our Board to-morrow” (observe, this was on the 11th October, five da}rs after the accident), “ when your letter, and the letter of Mr. Knight, the surgeon, shall be read by the clerk. As the accident PRICE CURRENT OF DRUGS. 747 happened at Pitcombe, where Mr. Gate¬ house, of Bruton, is the medical man, it is fair that Mr. Knigdit should have some remuneration for his professional services.” But what happens when the Board meets at length, six days after the acci¬ dent ? Why, that no order is made either to direct the medical man of the union to visit the patient, or to disconti¬ nue Mr. Knight’s services. The reliev¬ ing officer, indeed, paid him one visit during his illness, and the allowance of half-a-crown and a loaf of bread was granted weekly. No arrangement was made, further than has been already mentioned, respecting* medical attend¬ ance ; so that Mr. Knight conceived himself in possession of the case with the full sanction of the Board. But what was his surprise when, upon the cure being completed, and a bill deli¬ vered in, amounting to no more than six guineas for his six weeks’ attend¬ ance, he found that no notice was taken of his application ; but at the end of a month a letter was officially written to Mr. Yeatman in these terms, in which one knows not which to admire most, the dishonesty of principle, or the sneering malignity which they display : — “ The Board cannot recognize any charge made by Mr. Knight” — “ but while they are resolved on this, they are also resolved never to de¬ prive any gentleman of the opportu¬ nity of providing medical care and skill for a long-tried and faithful servant, should he have the misfortune of be¬ coming a casual pauper within their union.” Misfortune, indeed, for any pauper ! But what shall we say to the palpable trickery here practised, of re¬ fusing a just demand for services which were in the first instance engaged — hired, by one of the overseers, and then continued with the more than tacit sanction of the Board ? The ground on which these worthy Guardians of the Poor say they cannot recognize Mr. Knight’s claim is, that “ by so doing they would introduce a most dangerous precedent.” A dan¬ gerous precedent to abide by the terms of their contract ! — for a contract it was, to all intents and purposes — morally at all events, if not legally ; and Mr. Yeatman, in a letter to the Editor of the Dorset Chronicle, cites a strong case in point, wherein it was decided by Lord Ellenborough, that a parish officer who did not repudiate the attendance of a medical man situated like Mr. Knight, in effect commanded it. The issue of the affair may be easily conjectured. The Board, of course, did not alter their resolution ; and it only remained for the Kev. Mr. Yeatman, if he thought proper, to pay Mr. Knight for his services to the parish pauper. The money was generously paid, at the same time that the hardship of the case has been laid before the public. Whatever may be the general destiny of this odious and disgraceful Act, its medical merits, we trust, will be put to the test ere long. There is every probability that a parliamentary com¬ mittee will be appointed in the course of the present month, to inquire into the actual state of medical attendance on the country poor, when we hope that all practitioners who have been wit¬ nesses of the iniquitous working of the system, will be prepared to come forward and give their testimony. PRICE CURRENT OF DRUGS. In our last number but one we gave a tabular view of drugs on sale in the English market, with their several prices and duties annexed. We wish to say, in reply to several inquiries, that it is our intention to give a similar table in the number for the last week in each month. Thus our subscribers in distant parts of the country, and abroad, will be regularly supplied with a species of information which we have reason to believe they must have long felt as a desideratum. 748 REPORT ON THE LOWER EXTREMITIES OF A HUMAN BODY. HUNTERIAN MANUSCRIPTS. NOTE FROM SIR B. BRODIE. To the Editor of the Medical Gazette. Sir, I have just been informed that, in a weekly medical publication, which I am not in the habit of reading, it has been lately insinuated that I was in some way or another privy to the burning of Mr. Hunter’s papers by the late Sir Everard Home. I take the liberty of stating to the pub¬ lic, through the medium of your journal, and in the most unequivocal manner, that this is "wholly and absolutely false. I knew nothing whatever of the transaction until I was made acquainted with it by vulgar report. — I am, sir, Your obedient servant, B. C. Brodie. 14, Saville Row, Fob. 9, 1847. [Since the above was received, the Lan¬ cet of this day has come to hand, in which the same dastardly insinuation is re¬ iterated. The motive which leads the anonymous scoundrel by whom the arti¬ cles in question are written to choose the present moment for inventing this slander, is too [obvious to require any remark. — Ed. Gaz.] REPORT ON THE LOWER EXTREMITIES OF A HUMAN BODY, POUND UNDER MYSTERIOUS CIRCUMSTANCES j With Remarks. By G« F. Girdwood, Esq. [As some labourers were at w ork in an osier field, close by Cold-harbour-lane, Camberwell, one day last week, they found a large parcel' wrapped in sack¬ ing ; and on opening it, discovered the leg’s of a human being. The police immediately instituted inquiries, and a Coroner’s inquest was held on the limbs at Brixton. The result was, that they were identified as belonging, beyond^ question, to the trunk found some time since in the Edgware Road. Mr. Girdwood read the following report at the inquest, and has been good enough to forw ard it to us in a corrected form, thus enabling us to preserve in our pages an authentic account of the three several pieces de conviction. — • Ed. Gaz.] Decomposition has hardly begun. The complete draining of the blood and other fluids from the cut surfaces of the thighs has prevented the formation of red lines along the course of the blood¬ vessels, so usual as the incipient marks of putrefaction. The cuticle only is re¬ moved at those places where the limbs have been in contact with the bag, and a slight nfoisture bedews the surface w here it is so denuded. The contour of the leg is round, plump, and fleshy; the thigh is full, the knee well formed, and somewhat approximating its fellow' ; the ankle and foot are w’ell shaped, the plantar arch W'ell turned, the instep high, the toes very regular, except the second on the right foot, which rides a little over the great toe. Altogether, in its general character, it may be said to be a hand¬ somely-proportioned female limb. On the shin of the left leg there is a blueish red mark, about the size of the hand, which, with a small dark spot, the size of a fourpence, on the calf of the other, are the only discolorations on the surface, except some dirt on the upper parts of the thighs, and stains on the feet and leg’s of a purple dye, such as are seen on the legs of those who are in the habit of wearing black stock¬ ings. There is a gash, about two inches long, under the knee inside, on the right leg, but which merely separates the skin and cellular membrane under¬ neath. The surface around it is not eccbymosed. The thigh bone on the right side is, from where it is sawn across, denuded some way down ; the flesh is w anting, and appears to have been eaten aw'ay. There is a circular mark of pressure under each knee, such as is seen on th ose who wear their garters there. The length of the foot is ten inches and a quarter, the circumference at the broadest part of the left foot is eight inches and three-quarters, that of the right is half an inch more. The cir¬ cumference of the calf, at its thickest part, is thirteen inches and a half. The length of the whole limb, taken from the sawTn extremity of the thigh. bone to a plane rested on by the sole of the ROYAL INSTITUTION. 749 foot, is ascertained to be thirty-two inches and a half. The section of the bone in both limbs has been made so alike near to the hip joint, that the nicest examination cannot detect the difference of the eighth part of an inch in the length of either limb. The upper portions of the thigh bones which were removed from the trunk of the female body found six weeks ago at the Pine Apple Gate, and kept in my possession since, being placed, the left portion to the left femur, and the right to the right, they were found to corre¬ spond exactly in all the irregularities of their half-sawn, half-broken surfaces. The cloth in which the limbs were found wrapped up is ascertained to be the lower half of a grain sack, on which are painted in red the following- letters: se ley (on one side) irwell (on the other) The sack has been apparently used latterly for other purposes than th ose for which it was at first employed. It is smeared on what has originally been the outside, with paint, principally white, but it has been turned outside in, the surface having the letters on it be¬ ing that which was inside when dis¬ covered with the limbs. In one of the corners was found about half a handful of common deal shavings. The mouth of the sack was tied round with a piece of thick cord, such as is used to tighten bed-sacking, and at intervals along’ the rope might be seen parts worn, and per¬ manently bent, so as to have a knuckled appearance, as if it had been long kept in a zig-zag direction. strong confirmation by the present in¬ quiry. In addition to the lines, and cloths, and shavings, formerly no¬ ticed, we have now again the trade of a carpenter denoted by the bed¬ line, the shavings, and the bag* smeared with different sorts of paint. It is possible that the head may have been thrown into the canal in this neighbourhood, and, the hair having be¬ come entangled on some hook or nail, been conveyed by a barge to Stepney ; but not very probable. Most likely it was thrown in there. It might almost be considered that some plan was arranged to place the different portions of the body as far as possible apart : certainly, had the Map of London been taken as a guide, and three equidistant points dotted off in the suburbs, none could have corresponded to the angles of an equi¬ lateral triangle more exactly than the three different places we have mentioned. The three points are full seven miles from each other : tw'enty-one miles must therefore have been traversed. This circumstance, with the weight to be carried, would imply that some mode of conveyance had been used ; and this, again, would lead one to the conclusion that more than one person had been employed in the matter. G. F. G. 149, Edgeware-Road, Feb. 8, 1887. ROYAL INSTITUTION. Remarks. — This third inquiry com¬ pletes what was left wanting by the two forme]1 reports. The legs now dis¬ covered in Cold-harbour- lane, and the trunk found at Paddington, and the head taken from the canal at Stepney, are proved to form together an entire human body — that of a female. We now ascertain her exact stature: an inch and a half is to be added to the ascertained length of the leg, so as to bring the measurement up to the plane of the symphysis pubis. We have thus 34 to add to 33 inches. An inch may be deducted with propriety, to allow for the elongation after death of the verte¬ bral column ; and thus we find the height of the female to be 5 feet 6 inches. The opinion expressed on a former occasion, of the occupation of the agent, or it may be of an accomplice, or the assassin himself, has received Friday, Feb. 3, 1837. Dr. Grunt on the Glandular System in the various classes of Animals. The subject chosen by Dr. Grant for the lecture of this evening possessed much novelty and attraction. It comprehended a view of the glandular system as deve¬ loped throughout the various classes of animals, from the lowest to the highest. But the lecturer judiciously confined him¬ self chiefly to the glands concerned in digestion ; he first noticed in a general way the functions of those other glands employed in secreting tears, serous fluid, poisons, &c., and then proceeded to a spe¬ cial description of the organs in the lower animals engaged in the function of nutri¬ tion. Dr. Grant proved that all animated beings had a liver, or at least the rudi¬ ments of that most important gland. In the simplest form of animal, w hich seemed to be nothing more than a digesting sac, 750 DEATH BY ASPHYXIA. tlie liver existed as a mere follicle. In the monas termo, hydra, and other infusoria, those numerous stomachs, some of which admitted indigo, and others vermilion and other pigments, are nothing but so many follicles, in which glandular functions subservient to nutrition are performed. The higher we proceed in the scale of ani¬ mals, the more complicated those sto¬ machs or follicles are observed to become; and what is commonly called a gland is only a combination of follicles. In the lower animals the glandular apparatus, which is essentially liver, is immediately connected with the digestive tube. Among the higher it is only mediately connected, and opens into the alimentary canal by a duct. This is a necessary provision for animals which have to endure long fasts, or have not their food always before them ; and hence the reservoir for the secretion of bile, in the carnivora and man, for ex¬ ample. In the human species, which pos¬ sesses the liver in its highest state of per¬ fection, the organ attains its ultimate con¬ dition by passing through a number of phases, from the simple form which it ex¬ hibits in the embryo to that observed in the adult man ; and all these phases are analogous to conditions found to exist in lower and less perfect animals. That the brain of the foetus undergoes successive changes, being at one time that of a tadpole, at another that of a fish — again that of a crocodile, and so forth; and that in like manner the heart of the human foetus is at first a simple tube, then a cavity, then two cavities, and lastly an organ containing four, resembling in the successive stages the heart of mollusca, fishes, reptiles, &c., are facts familiarly known. But the announcement made by the lecturer to-night respecting the liver, came upon his hearers with considerable novelty. In the human embryo, the first appearance of any thing indicative of the future liver is a mere thickening of the in¬ testine at a particular spot ; that thickening then becomes more and more defined, is found to be follicular, glandular, lobular, and at length apart from the alimentary canal, to which it is connected merely by a duct. Dr. Grant, towards the conclusion of the lecture, gave a short notice of Mr. Kiernan’s researches, and endeavoured to show that the consideration of the complex structure of the liver was involved in that of the hepatic duct simply. This duct, he said, was essentially the liver; as, indeed, in every instance the duct is the gland — its ramifications and complications being unessential to its nature. In conclusion, Dr. Grant gave a sketch of the formation of glands from the blastema, and took a rapid view of the structure of the skin, jointing out the immensity of follicles and glands of which, it is com¬ posed. The whole was illustrated with a profu¬ sion of diagrams and drawings, which were referred to and removed with the utmost rapidity. It occurred to us more than once during the lecture, and we are sure others must have thought as we did, that it would have been far better— less bewildering, at all events — if Dr. Grant had made a selection of his illustrations, and only presented those to the audience which were necessary to elucidate his sub¬ ject. DEATH BY ASPHYX[A ; FROM INHALING THE FUMES OF CHARCOAL. ( Extract of a Letter.') I have copied out, and take the liberty of sending you, the details of a case, indis¬ putably authentic, as it is grounded on the prods verbal made out by the Commis- saire de Police of the Quartier, who w^as the first to enter the premises of the de¬ ceased. It is almost like a voice from the grave of one who relates his passage through the gates of death, and, as a case of physical experience, is highly curious. On breaking open the door of his bed¬ room, Deal wras found sitting in a chair, in the attitude of one asleep ; his head reclined on a table before him, on w'hich were also placed a wratch, an inkstand, a lamp, a candle (extinguished), and at his feet a pen, which seemed to have dropped from his hand. Two .large tubs, which contained a quantity of cinders and some half-consumed charcoal, w ere in the room, every aperture to which was carefully stopped up. On raising up the corpse of Deal, a paper was discovered, on which the wTetched man had described, minute after minute, the gradual progress of his lingering agony. He begins first by an explanation of his religious tenets; and adds, that he has taken every precaution that his death may produce no sort of embarrassment to his friends. He then goes on to say, that he had conceived it might be useful to the in¬ terests of science that the effect of charcoal in producing death might be properly as¬ certained, and he wras further actuated by a wrish to prove that his suicide wTas an act of sane and premeditated intention. I now give you his own words: — “ J’ai ete derange plusieurs fois. Au Diable les importuns ! ils ne peuvent meme pas laisser mourir les gens tran- quillement. C’est egal ! J’allume mes fourneaux, et place sur la table ma lampe, et ma chandelle, ainsi que ma montre, et je commence aussi la cer6monie. — II est PORTRAIT OF HUNTER. 751 dix heures quinze minutes. Les charbons s’allument .difficilement ; j’ai, cependant, mis sur chacun des fourneaux un tuyau, qui doit aider l’action du fen. “ Dix heures vingt minutes. — Lestuyaux tombent, je les rel&ve; cela ne va pas k mon idee. Ils retombent encore ; je les replace de nouveau. Cela va mieux. Le pouls est calme, et ne bat pas plus qu’a l’ordinaire. “ Dix heures trente minutes. — Une va- peur epaisse se repand peu a peu dans la chambre. Ma chandelle paroit prete a s’eteindre; la lampe va mieux. Je com¬ mence a avoir un violent mal de tete; mes yeux se remplissent de larmes ; je ressens un malaise general ; j’eprouve quelque soulagement, a me broucher le nez avec un mouchoir. Le pouls estagite. “ Dix heures quarante minutes. — Ma •chandelle est eteinte, la lampe brule. Les tempes me battent comme si les veines vouloient se rompre. J’ai envie de dormir. Je souffre horriblement de l’estomac. Le pouls donne quatre-vingt pulsations dans une minute. “ Dix heures cinquante minutes. — J’etouffe ! Des ideesetrauges sepresentent a mon esprit. Je puis a peine respirer. Je n’irai pas loin. J’ai des symptomes de folie.” (Here he confounds the hours with the minutes.) “ Dix heures soixante minutes. — Je ne puis presque plus ecrire ; ma vue se trou¬ ble. Ma lampe s’eteint ; je ne croyais qu’on dut autant souffrirpour mourir. “ Dix heures soixante deux minutes.” (Here are some illegible characters traced, and it is probable that, with the last gleam of his lamp, the life of the wretch¬ ed man was extinguished *.) FLAGELLATION IN CASES OF POISONING. [A correspondent, a professor in one of our medical schools, has directed our at¬ tention to the following case in the third volume of the Medical Repository, pub¬ lished in New York in 1800, which was communicated by Dr. Valentine Seaman, of that city. It will be perceived that the treatment w^as similar to that used in Dr. Barratt’s case, published in No. 13 of the [Dublin] Medical Journal, although we have no doubt that the idea was original with Dr. B.* The following is the substance of the case referred to, which is published merely as an additional proof of the value of the remedy so successfully used by Dr. * Times, Jan. 3!, 1887. t See the case alluded to in Professor Graves’ 4th Clinical Lecture, Medical Gazette, pre¬ sent volume, p. G68. Barratt.] “The wife of - Head, in Wa¬ ter-street, had about two hours before swal¬ lowed ^j. laudanum, and then lay in a deadly stupor, from which all the efforts of her friends could not awaken her. At¬ tempts had been made to get some vinegar into her stomach, with little effect; nor did I (says Dr. S.) succeed much better in endeavouring to give a dose of white vitriol. I then procured a small switch, and applied it pretty freely to her arms and shoulders, which were defended only by a thin covering. I also applied some strokes to her legs. In the course of a short time, indeed almost immediately upon the application of the remedy, she roused up, and begged me to desist. She continued for a time much confused, writh involuntary turns of laughter. Two scru¬ ples of white vitriol were then administer¬ ed, followed in about fifteen minutes by 3ss. ipecacuanha; notwithstanding which, and having tickled her throat repeatedly with an oiled feather, it was nearly an hour before she could be made to puke ; however, finally she did puke, and by the assistance of frequent draughts of warm water, her stomach was pretty thoroughly evacuated. By the assistance of her friends she was kept awake, or, at least, slept but little at a time, during the night, and this [next] morning appears entirely recover¬ ed.” — Boston Journal ; and Dublin Journal of Med. Science , Jan. 1837. PORTRAIT OF HUNTER. Hunter’s friends had long been desirous to engage him to sit to Sir J. Reynolds for his picture; but he had always" hitherto declined to do so, not choosing that it should be done at the expense of others, and thinking the price too high for him¬ self to pay. He was, however, at length induced to comply, chiefly to oblige Sharp, the eminent engraver, who had received much notice from Hunter, and was very anxious to be permitted to make an en¬ graving from Sir Joshua’s picture Rey¬ nolds found Hunter a bad sitter, and had not been able to satisfy himself with the likeness, when one day, after the picture wras far advanced, Hunter fell into a train of thought, in the attitude in which he is represented in the present portrait: Rey¬ nolds, without saying a word, turned the canvas upside down, made a fresh sketch, with the head between the legs of the for¬ mer figure, and so proceeded to lay on over the former painting the colours of that which now graces the walls of the library at the College of Surgeons. From this portrait Sharp executed his engraving, which is admitted by the best judges to be one of the finest, if not the very finest, spe¬ cimen of the art ever executed. — Life , in new edition of Jlunter's Works, 752 BILLS OF MORTALITY. - METEOROLOGICAL JOURNAL. TREATMENT OF INFLAMMATION. CHALLENGE TO INVESTIGATOR. To the Editor of the Medical Gazette. Sir, Since Investigator treats the reply I have made to his censures upon the system of treatment I adopt for inflammatory dis¬ eases as mere idle words, I will, with your permission, propose to him, that he should sink all the idle words between us, and come to facts. If Investigator’s real object is to arrive at truth, and not to cavil, he will with me embrace the opportunity which the present season affords us of comparing the respective results of our treatment of cases which are sufficiently similar, if confined to those of the prevailing epide¬ mic. Such a comparison, I should think, cannot fail to produce a fair conclusion as to which of our opposite systems of treat¬ ment is the more correct, for they cannot both be right. It would save you, Mr. Editor, unnecessary trouble, if Investigator would drop me a line, by post, stating- the day he would send his communication, authenticated by his name and address, to your office; mine should be forwarded on the same day, so that they might both ap¬ pear in the same Gazette. This would lie the fairest plan ; after which there need be no further discussion between us on the subject. — I remain, sir, yours, &c. H. Searle. Queen’s-Place, Kennington, Feb. 6, 1 837. COLLEGE OF SURGEONS. The Hunterian oration will be delivered by Sir B. C. Brodie, Bart., at five o’clock in the afternoon of Tuesday next. The museum wrill be opened, to the members only, for that day, and on the 1st of March to the members and the public generally. The library of the new building, it is announced, will be thrown open on the 15th of February (the day after the Hunterian oration) to members and visitors, as usual. A reading-room, for members only, is to be open from 7 until 10 o’clock in the even¬ ing, on Mondays, Wednesdays, and Thurs¬ days. APOTHECARIES’ HALL. LIST OF GENTLEMEN WHO HAVE RECEIVED CERTIFICATES. February 9, 1837. William Dalla Husband, York. Thomas Johnson, Manchester. James Edward Nevvall, Aberystwyth. Henry Laxton, Bristol. William C'heesewright, Bristol. James Stephens, Manchester. Edwin Chabot, Lambeth. Charles James Jam]), Wisbeach. James Parkerson, East Dereham. Henry Lacy Pomfret, Manchester. Richard Baker Bellyse, Audlem, Cheshire. Thomas Mark Hovell. John Gilby, Alford, Lincolnshire. George Kinghorn Prince. Jamaica. Alfred Baker, Birmingham. THE LATE DR. LEY. We regret to have to record the decease of Dr. Hugh Ley, physician- accoucheur to Middlesex Hospital, and lecturer on mid¬ wifery at St. Bartholomew’s. He had suffered from rheumatic fever many years ago, and had latterly been frequently sub¬ ject to rheumatic inflammation of the limbs, with pain and swelling, though not usually so bad as to confine him to bed. 'Lhe heart had been damaged in one of the early attacks, and progressively became hypertrophied, attended with so much palpitation and distress as to render it dif¬ ficult for him to attend to business. For some months before his death, the symp¬ toms had been gradually getting worse, but he had recovered a little, and gone down to the house of his father-in-law, Major Kelly, near Stilton, in the hope of farther improvement : here, however, he suffered a relapse, which carried him off on the 24th of last month. Dr. Ley was a man of skill and talent, well informed in his profession, and having a very remarkable command of language; indeed he was one of the most fluent lec¬ turers and public speakers we ever met with. His professional reputation was without blemish, and his sentiments, on all subjects, were those of a gentleman. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Feb. 7, 1837. Age and Debility . 113 Apoplexy . . b Asthma . . 62 Cancer . . 1 Childbirth . . 4 Consumption . 86 Convulsions . 37 Croup ... 6 Dentition orTeething!2 Dropsy . . 17 Dropsy in the Brain 9 Dropsy on the Chest 1 Erysipelas . . 1 Fever ... 9 Fever, Scarlet . 1 Fever, Typhus . 6 Heart, diseased . 4 Hernia . . . 1 Hooping Cough . 14 Inflammation . 82 Bowels& Stomach 6 Brain . . 2 Lungs and Pleura 19 Influenza . . 63 Insanity . . 3 Liver, diseased , 3 Measles . . 10 Miscarriage . . 1 Mortification • 5 Paralysis . . 3 Rheumatism . 1 Small-pox . . 2 Sore Throat and Quinsey . . 2 Spasms . • 1 Thrush . . 1 Venereal . Unknown Causes 2 Casualties Decrease of Burials, as compared with the preceding week 262 Errata. — In Mr. Hird’s paper in last number, p. 702, 1. 12, for “ abdominal ar¬ tery,” read “ abdominal aorta;” 1. 34, for “ subclavians,” read “ subclavian ;” p. 703, 1. 27, to “ cutting edge of the knife,” add “ directed downwards.” Wilson & Son, Printers, 57>JSkinner-St. London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY J©TO1ML OF iHetu'cine aitti tf it Collateral J>nence5. SATURDAY, FEBRUARY 18, 1837. LECTURES ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine , By William Cummin, M.D. Lecture XXL Infanticide continued. The hydrostatic lung-test — Its origin not ancient — Contro¬ versies to which it has given rise — Haller’s testimony to its worth — Dr. W. Hunter’s, ob¬ jections— -Mode of applying the hydrostatic test Swimming of the lungs , haw jar a proof oj respiration — Objections answered — Mode of distinguishing between the effects of in¬ flation and respiration — Sinking oj' the lungs, how jar an indication of still-birth— Objec¬ tions answered — Live-birth without respira¬ tion— Modji cations oj the hydrostatic test — Haniel s Bernt’s — Proofs of respiration from the state oj the circulatory apparatus — State of the ductus arteriosus ( the Vienna tost') Foramen ovale — Durtus venosus — It h ether a test may be j'ounded on the state of the liver ? Conclusions respecting the vali¬ dity of the several tests. I concluded the last lecture with an ac¬ count of the static lung test, and showed in what manner it was defective. Like most of the tests for determining the ques¬ tion of respiration, it deserves to have but little reliance placed upon it per se, but in combination with others it is often capa¬ ble of giving consistency to the whole, and of contributing a certain portion of proba¬ ble evidence for or against the fact in question ; for which reason it ought never to be neglected in investigations concerning child murder. We shall now proceed to consider the fifth point to be attended to in examininv not. Foramen ovale. — The state of the foramen ovale may also serve in some degree to show whether foetal life had ceased, and extra-uterine, by respiration, had begun. The situation of this aperture, between the right and left auricle of the foetal heart, is represented in the subjoined figure. Fig. 29. The foetal heart, suspended by the superior cava. The interior of the right ventricle ( d ) and auricle (a) displayed ; c is the valve, and b the foramen ovale. Through this opening ( b ) a portion of the blood from the right side of the heart is sent to the left side, without being pre¬ viously circulated through the lungs. In some infants it becomes closed as early as the first day after birth; but this is not very usual : more frequently several days elapse, and in certain instances even years, without its closing. For medico-legal pur¬ poses, therefore, the fact of the closure of the foramen ovale can be of little or no value; but there is another fact connected with the same opening, which is rather better deserving of notice. The position of the foramen on the valve (c) is said to change Another view of the right auricle, laid open to display the foramen ovale. This figure, and figure 28, are taken from sketches by Dr. J. Beck. gradually after birth. It is originally situ¬ ated in the centre ; but as soon as respira¬ tion begins, it is on the right side, whence it subsequently proceeds, from below up¬ wards, towards the left side; thus revolv¬ ing, as it were, round the right edge of the valve. It must be confessed, however, that the ascertainment and appreciation of these facts require a degree of anatomical dexterity not commonly met with among practitioners,— wrhich must be a bar to the practical utility of the test, even though it were better recommended to us than it is by the experience of good observers ; for such have not always found the reality to correspond with the doctrinal statement. Venous canal. — This vessel (s, fig. 27) is rarely found impervious before the fifth day after birth, and its changes consequent on re¬ spiration occur so slowly, as to be scarcely, if at all, available for the purposes of the medical jurist. It must be recollected, that the question in reference to infanticide generally is, whether the infant was still born, or lived afew moments orhours. Now the process of obliteration does not begin to be observable in the venous canal till about the second or third day. The Liver. — It has been attempted to found upon the changes undergone by the liver in consequence of respiration, another test for ascertaining whether an in¬ fant ever respired or not. The liver, dur¬ ing foetal life, is known to be an impor¬ tant organ; it is comparatively larger and heavier at this period than it is after¬ wards ; it forms a large reservoir for the blood, where perhaps some important al¬ terations are effected in this fluid before it 762 DR. CUMMIN ON FORENSIC MEDICINE. is sent on to the heart. Now, when the lungs are expanded by respiration, they receive a large quantity of the circulating blood, and it is generally supposed that in this way they take upon them, in some measure, certain functions which the liver had previously performed : at all events, the latter organ is found, in most cases, to be more contracted in size, and less loaded with blood, than it usually is ante¬ rior to birth. Hence it was suggested that probably a static liver- test, on the principle of Ploucquet’s /ang-test, might be contrived — by determining the ratio of the weight of the liver to that of the whole body. According to Henke ( Abhandlungen , Band 5.), this suggestion was first made by Autenrieth, of Tubingen, in 1806; and afterwards, in America, by Dr. John Beck. The Medical Faculty of Tubingen actu¬ ally proposed it as a prize question, a few years since, to ascertain whether there was not a constant ratio between the weight of the liver, before and after death, and that of the body. Some very valuable disser¬ tations were the result. But the conclu¬ sions were unfavourable to the esta¬ blishing of a liver-test. And such a test, obviously, were it possible to esta¬ blish one, must always be secondary and subordinate to the lung-test ; for not only is the lessening of the absolute weight of the liver dependent on the increase of that of the lungs, but the alteration can never be so strongly marked in the liver as in the lungs ; the latter bearing originally so small a proportion to the weight of the body, and not being, on an average, above a third part of the weight of the liver. It has already been shown that the static lung-test is suffi¬ ciently precarious; but from a few exam¬ ples it will readily be understood that a static liver- test, were there one, must be infinitely more so: for it appears to be materially modified by the kind of death which the infant suffers, and to have some special relation to the size and condition of the placenta. Dr. Koch, of Hamburgh, author of one of the Tubingen prize dissertations *5 sup¬ plies us with the following facts : — Liver to Lungs to Lungs to * body. body. liver. Still-born, heavy and large child, labour ? very difficult . <■ . £ 1 : 13 1 : 57 1 : 4 Died in birth — artificial labour . 1 : 94 1 : 87 1 : 1 Born dead, child large, pelvis deformed, suo gillations . 5 1 : 40 1 : 80 1 : 2 These cases, Dr. Koch confesses, were of the entire number no more than 17 ap- the most striking and remarkable among proached to what is commonly allowed to the 79 (26’still-born and53 live-born) which be about the average standard, namely — he examined; but then it appears that Liver to Lungs to Lungs to body. body. liver. In the still-born . 1 : 22 1 : 65 1 ; 3 In the live-born . . . 1 : 25 1 ; 30 1 : 1 From these circumstances we may fairly conclude that no liver-test, exact enough for medico-legal purposes, has hitherto been, or is likely soon to be, established. Yet, though our observations on the state of the liver may not of themselves war¬ rant us in forming a reasonable presump¬ tion for or against the fact of respiration, they should by no means, in inquiries of such vital interest as those relating to in¬ fanticide, be neglected ; for the inference they would authorize, however slight in itself, might have much force, taken in conjunction with other deductions from other premises. In short, that rule ap¬ plies here, which can scarcely be too fre¬ quently repeated, that the medical jurist, in his researches connected with the serious charge of infanticide, must never rely solely upon any one test, or particular mode of proof, but observe how far this corresponds in its evidence with the other tests, for in the multitude of these, consentient and combining, there is safety. * Dis, inaug. medico-forensis, &c. Tubing. 1831. MR, PEREIRA ON MATERIA MEDIC A AND THERAPEUTICS. 763 LECTURES ON MATERIA MEDTCA, OR PHARMA¬ COLOGY, AND GENERAL THERAPEUTICS, Delivered at the Aldersgate School of Medicine, Br Jon. Pereira, Esq., F.L.S. Lecture LVII. Another and an important umbelliferous plant is' the Conium maculatum. History — This plant is usually supposed to be the n&veiov of the Greek writers, the celebrated Athenian state poison, by which Socrates and Phoeion died, and the cicuta of the Roman authors. Various reasons contribute to give the common opinion on this point a high degree of probability. Dioscorides described the plant sufficiently well to prove it must have been one of the Um belli ferae ; and he tells us it had a heavy odour, and a fruit like that of anise. The latter simile applies to our Conium, for a very intelligent druggist mistook, in my presence, the fruit of the hemlock for that of anise. Dioscorides also tells us that the kwvziov of Crete and Megara was the most powerful, and next to this came that of Attica, Chio, and Cilicia. Now Dr. Sibthorp found Conium ma¬ culatum growing near Constantinople, not unfrequently in the Peloponnesus, and most abundantly between Athens and Megara. So that the locality of our Conium agrees, as far as has been ascertained, with that of the ancient plant. We may gather from the poetical account ol the effects of k&vziov given by Nicander, that this plant “ brings on obliteration of the mental faculties, dimness of sight, giddiness, staggering, stifling, coldness of the limbs, and death by asphyxia ; a view of its effects,” says Dr. Christison, “ which differs little from the modern notions of the poisonous action of the spotted hem¬ lock.” It is also remarkable that the an¬ cients regarded k&vziov as having the power of discussing tumors — a virtue which has been assigned to hemlock by writers of the present day. I am fully aware that the characters of the ancient plant, as given us by Dios¬ corides and Pliny, are insufficient to dis¬ tinguish it from some other Umbellifera?, vet I think the evidence of its being our Conium maculatum is deserving of much greater confidence than Dr. Christison is disposed to give it. The absence of all notice, in the writings of the ancients, of the purple spots on the stem, has been urged against the probability of this opi¬ nion. “ Pliny’s term nigricans, applied to the stem, is but a feeble approach,” says Dr. Christison, “to the very remarkable character of the modern plant, the purple spotted stem.” It is somewhat remarka¬ ble, however, that a celebrated modern writer has employed a very analogous term in describing the hemlock plant. In Mr. Waller’s translation of Orfila’s Toxi- cology, the inferior parts of the stem of Conium maculatum are said to be covered “ with spots of a brown purple, or black¬ ish f so that Pliny is not alone in his erroneous account of the colour of the stem. One fact strongly in favour of the iden¬ tity of the ancient and modern Conium is, that there are no other poisonous Umbel- liferm growing in Greece, to which the de-' scription of Dioscorides and Pliny could ap¬ ply, than our Conium : at least none others were found by Dr. Sibthorp, otherwise he would have noticed them in his “ Prodomus Flora Greece.” Thus we may infer that the Cicuta virosa (which, according to both Halier and Dr. Christison, “ comes nearer the ancient description than any other” of the poisonous Umbelliferm) ; the CEnan- tha crocata, CEthusa Cynapium, Chaero- phyllum temulentum, and Phellandrium aquaticum, are not natives of Greece. Now this fact taken in conjunction with another— namely, that Conium maculatum grows in the very spot indicated by Dios¬ corides, is strongly in favour of the iden¬ tity ot this plant with the Kcnveiov of the Greeks. Etymology. — It is evident that our gene¬ ric term Conium is derived from the Greek word K&veLov. Linmeus has been censured by Lamarck for using this name, since the Latin authors call our hemlock Cicnta , which he, therefore, contends ought to be its designation now. But it ought to be recollected that Linnteus has only restored its ancient name, for the word Cicuta is unknown in the Greek language. By modern botanists the term Cicuta is applied to a distinct genus of plants, and when, therefore, we meet with it in bota¬ nical works, we must not confound it with the Cicuta of the Romans. Botanica l characters. — C oniummacu latum is an indigenous plant, frequently found growing in waste places, banks, and under walls, flowering usually in June and July. Its root is biennia], fusiform, whitish, and from six to twelve inches long, having some resemblance to a young parsnip. I he stem is from two to six feet high, round, smooth, shining, hollow, and 764 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS spotted with purple. The leaves are tripinnate, with lanceolate pinnatified leaflets, of a dark and shining green co¬ lour, smooth, very foetid when bruised, with long, furrowed footstalks, sheathing at their base. The umbels are many rayed, furnished with a general involucre of seve¬ ral (usually from three to seven) lanceolate leaves, which are membranous at their edges : the partial involucre is composed of three leaves on one side. The calyx is obsolete : the corolla consists of five white obcordate petals, inflexed at the points : the stamina are five, epigynous, and as long as the corolla : the ovarium is ovate, two-celled, striated : there are two fili¬ form spreading styles, each furnished with a round stigma. The fruit is ovate, and compressed laterally : eachofitsmericarps, or carpels, has five primary (but no secon¬ dary) ridges, wrhich are undulato-crenated : the channels have many strife, but no vittse. The seed has a deep hollow groove in front. In distinguishing hemlock from other Umbelliferae, the following characters should be especially attended to ; the large, round, smooth, spotted stalk — the smooth, dark, and shining green co¬ lour of the lower leaves — the disagreeable smell when bruised (compared by some to that of mice, by some to fresh cantharides, by others to that of cat’s urine) — the general involucre usually of from three to seven leaves — and the partial involucre of three leaves. The indigenous Umbelliferse most likely to be confounded with Conium maculatum are CEthusa Cynapium, or fool’s parsley, and Anthriscus vulgaris, or common beaked parsley. CEthusa Cynapium is distinguished from hemlock by its smaller size, by the absence of the strong disagreeable smell of the leaves, by the non existence of spots on the stem, by the want of a general in¬ volucre, and by three long, narrow, unila¬ teral drooping leaves composing the par¬ tial involucre. Anthriscus vulgaris is distinguished by the lighter colour, and slight hairiness of the leaves, by the absence of spots on the stem, by the swelling under each joint, by the absence of a general involucre, by the roughness of the fruit, and by want of the strong unpleasant odour when the leaves are bruised. Chemical composition. — Schrader, of Ber¬ lin, has published a comparative analysis of wild and cultivated hemlock, but with no important results. He tells us that the juice of hemlock has a striking resemblance to that of our common cab¬ bage ; and he gives the following as the constituents of the two. Hemlock. Cabbage. Extractive . . 27-3 • • • • 23-4 Gummy extract . * 352 •••• 28-9 Resin . 1 ’5 • • • • 05 Vegetable albumen . 34 •••• 29 Green fecula . 8‘0 • • • • 6 3 Water, with acetic acid, sulphates, chlorides, nitrates, and phos¬ phates of potash, lime, magnesia, iron, and manganese . ' 10000 1000-0 It will be evident from this analysis that Schrader did not succeed in isolating the active principle of the plant. Peschier has asserted the existence of a new organic salt in hemlock, which might be termed coniate of conia, since he says it consists of a peculiar acid, wrhich he calls coniic acid, and an alkali. His statements, however, require confirmation. Brandes also analysed hemlock, and gives as its constituents — A peculiar basic substance ( [conicine ). Very odorous oil. Vegetable albumen. Resin. Colouring matter. Various salts. In 1827, Giseke obtained the active principle of hemlock (conia) in combina¬ tion with sulphuric acid, and made vari¬ ous experiments with it. In 1831, Geiger procured the conia, for the first time, in an isolated form, and described some of its properties and effects on animals. Tt has subsequently been more fully investigated by Dr. Christison, and by MM. Boutran- Charlard and O. Henry. Let us pass in review some of the principal constituents of hemlock. 1 . Odorous priciple. — The activity of hem¬ lock does not depend on its odorous prin¬ ciple, for the distilled water of hemlock, which possesses in a high degree the odour of the plant, is scarcely, if at all, poison¬ ous. The odorous principle is volatile oil. 2. Conia. — This alkali, which has also been termed cicutine, coneine, and conicine , was, as I have already mentioned, first obtained in the isolated state by Geiger in 1831. Its properties were carefully examined by Dr. Christison in 1836. In 1834, Deschamps, an apothecary at Avil- lon, asserted that the conia of Geiger owed its alkaline properties to ammonia, and that the odorous principle which ac¬ companied the ammonia could not satu¬ rate acids. His assertions, however, have CONIUM MACULATUM. 765 been completely disproved by MM. Bou- tran-Charlard and O. Henry, during the last year (1836). Conia has been found in the leaves and fruit, and probably exists in all parts of the plant. Dr. Christison obtained 2§ ounces of hydrated conia from 40 lbs. of the green seeds (mericarps). The leaves contain a less quantity than the fruit. Conia exists in hemlock as a salt, — that is, in combination with an acid. Hence the use of the alkali (soda, potash, or lime) employed in the process is to ab¬ stract the acid, and thereby to set free the conia. It is uncertain what acid is combined with the conia: Peschier, as already related, says it is a peculiar organic acid ( coniic acid), crystallizable in six-sided prisms, insoluble in aether and alcohol, and capable of decomposing the calcareous and barytic salts. Preparation. — One method of preparing conia, and which yielded Dr. Christison the largest product, is to distil the alco¬ holic extract of the seeds (mericarps) with its own weight of water and a little caustic potash. MM. Boutran-Charlard and O. Henry have procured it by another process with¬ out the use of alkalies. Properties. — When pure, conia is an oily-looking transparent liquid, lighter than water. Its odour is strong and pene¬ trating, and is said to be like that of hem¬ lock, of tobacco, and of mice, combined : its taste is acrid. It is sparingly soluble in water, but is entirely soluble in alcohol and aether. It reddens turmeric, and neutralizes the dilute acids, forming salts. While saturating, the liquors have a bluish- green tint, which subsequently passes to a reddish-brown. It combines with about a fourth of its weight of water to form a hydrate of conia. When placed in a vacuum, in the presence of bodies very attractive of water, it in part volatilizes, and leaves a reddish, very acrid, pitchy residue, which appears to be anhydrous conia. The vapour of conia is inflamma¬ ble. By exposure to the air, it acquires a dark colour, and is resolved into resin and ammonia. Its boiling point is 370w F., but it readily distils with water at 212° F. Composition. — According to Liebig, it consists of — Carbon . 66*91 Hydrogen . 12-0 Oxygen . 8-28 Nitrogen . 12-8 99-99 These numbers nearly correspond to — 1 1 atoms carbon . . . . 66 12 atoms hydrogen . 12 1 atom oxygen • • • . . 8 1 atom nitrogen . . 14 100 But until its saturating powers be ascer¬ tained, its atomic weight cannot be deter¬ mined with accuracy. Characteristics. — That it is an alkali, is shewn by its action on turmeric paper, and by its neutralizing acids. Like am¬ monia, its vapour produces white fumes with the vapour of hydrochloric acid. It agrees with the other organic alkalies in producing a copious white precipitate (tannate of conia) with infusion of galls. From ammonia it is distinguished by its odour and inflammability, and by the solubility in alcohol and deliquescent cha¬ racter of its sulphate. From the other vegetable alkalies it is distinguished by its liquidity at ordinary temperatures, by its volatility, and by its odour. It is not red¬ dened by either nitric or iodic acids. Salts of conia. — Several of the salts of conia are crystallizable: they are deli¬ quescent and soluble in alcohol. When we evaporate solutions of these salts with a gentle heat, they lose, like the ammonia- cal salts, a part of their base, the odour of which may be readily recognized. The nitrate of conia, when decomposed by heat, yields brown pyrogenous products. If potash be added to an inodorous salt of conia (as the sulphate), the conia is imme¬ diately set free, and may be recognized by its odour. Effects of conia. — On animals. — The effects of conia have been tried on various ani¬ mals, namely — Mammalia, as the dog, cat, rabbit, and mouse. Aves, as the pigeon, kite, and sparrow. Reptilia , as the slow worm. Amphibia, as the frog. Annelida, as the earth worm. Insecta, as the fly and flea. One drop placed in the eye of a rabbit killed it in nine minutes ; three drops used in the same way killed a strong cat in a minute and a half ; five drops poured into the throat of a small dog began to act in thirty seconds, and in as many more motion and respiration had entirely ceased. The following are the symptoms pro¬ duced, as detailed by Dr. Christison. “ It is, in the first place, a local irritant. It has an acrid taste; w'hen dropped into the eye, or on the peritoneum, it causes red¬ ness or vascularity; and to whatever texture or part it is applied, expressions of pain are immediately excited. But these local effects are soon overwhelmed by the in- 766 MR. PEREIRA ON MATERIA M EPIC A AND THERAPEUTICS. direct or remote action which speedily follows. This consists essentially of swiftly-spreading palsy of the muscles, — affecting first those of voluntary motion, then the respiratory muscles of the chest and abdomen, lastly the diaphragm, and thus ending in death by asphyxia.” Con¬ vulsive tremors, and twitches of the limbs sometimes, though not invariably, are observed. The external senses do not appear to be affected until respiration is impaired. If a rabbit be lifted up by his ears when under the influence of the poison, he makes the same kind of struggles to be released that he does when in health. So also if we place him in an uneasy posture, he makes attempts to alter his position, proving that his senses are un¬ impaired. After death the muscles are susceptible of the galvanic influence. MM. Boutran-Charlard and O. Henry state that most of the animals to whom they gave conia became “ a prey to the most dreadful convulsions. The plaintive cries, the contortions, and the rigidity of the limbs, which have always preceded death, leave no doubt as to the cruel pains which this kind of poisoning brings on.” This account agrees neither with my own observations, nor with those published by Dr. Christison. Does conia become absorbed ? In favour of the affirmative view of this question may be mentioned the fact, that this alkali acts on all the textures admit¬ ting of absorption; and that the quick¬ ness with which the effects occur are in proportion to the absorbing power of the part. But the rapidity of its action when introduced into the veins is a barrier to the supposition of its acting on the nervous centres by local contact; for Dr. Christison states, that two drops neutralized by dilute muriatic acid, and injected into the femoral vein of a young dog, killed the animal in two or three seconds at farthest. The primary seat of the action of conia is probably the spinal cord. In this conia and strychnia agree; but in the nature of theeffect, they seem, as Dr. Christison has observed, to be the counter-parts of each other. Conia exhausts the nervous energy of the cord, and causes muscular paralysis; strychnia irritates it, and produces perma¬ nent spasm of the muscles. Both kill by bringing on asphyxia, the first by the paralysis, the second by the spasm, of the respiratory muscles. Antidote. — At present we know no anti¬ dote to this poison. Probably the infusion of galls would be the best remedial agent, since the tannic acid contained in it pre¬ cipitates the conia. To prevent the as¬ phyxia, artificial respiration should be performed. Might not strychnia be em¬ ployed with advantage, since it appears to produce a condition of the spinal cord opposite to that of conia. Uses. — The known effects of conia would suggest its employment in tetanus, and in poisoning by strychnia and brucia, or by substances containing these alkalies. 3. Green fecula. — This constituent of hemlock is not distinguishable from the green fecula of other plants. 4. Vegetable albumen. — This also is like the albumen of other plants. 5. Extractive matter. — This is brown, and soluble in water. It attracts oxygen slow¬ ly from the atmosphere, has a peculiar hemlock odour, and a bitter taste. Its ashes contain carbonate of lime, with traces of carbonate of magnesia, sulphate of potash, and chloride of potassium. 6. Resin. — This is soft, yellowish brown, and somewhat acrid. Physiological effects. — (a). On vegetables. Marcet placed a haricot plant ( Phaseolus vulgaris ) in a solution of five grains of the extract of hemlock. In a few minutes the* two lower leaves curled at their extre¬ mities; the next day they were yellow, and subsequently died. (&). On animals generally. The effects of hemlock on animals have been tried by Harder, Wepfer, Orfila, and Schubarth. The animals experimented on were the dog, wolf, rabbit, and guinea pig. From the observations of Orfila, hemlock is a local irritant (though this action was not constantly observed), and produces giddi¬ ness, convulsions, loss of sensibility, palsy, and coma. This account, as Dr. Christi¬ son observes, does not agree with the symptoms induced by conia, which does not seem to affect the senses so long as the respiration goes on. “But it is pos¬ sible,” he adds, “ that the difference is more apparent than real, and that hemlock has been supposed to extinguish sensa¬ tion, merely because, by inducing paraly¬ sis, it takes away the power of expression ; at least, in some experiments I have made, sensation did not appear to be affected ; and the whole phenomena were identical W'th those produced by conia. In these experiments I used very strong extracts, prepared by absolute alcohol from the fresh leaves or the full-grown seeds; and each of them occasioned, in doses of thirty grains or thereabouts, paralysis of the voluntary muscles, with occasional slight convulsions, then paralysis of the respi¬ ratory muscles of the chest and abdomen, and finally cessation of the action of the diaphragm : sensation appeared to continue so long as it was practicable to make an observation on the subject; and the heart contracted vigorously for a long time after death.” CONIUM MACULATUM. 767 (c.) On man. — In small or medicinal doses, hemlock has been frequently adminis¬ tered for a considerable period, with ob¬ vious relief, in certain diseases (tumors of various kinds, for example), without any other evident effect: hence the statement of some authors, that hemlock acts in¬ sensibly on the system. “ It seldom purges (says Storck), “and very rarely vomits. Sometimes it increases perspira¬ tion, and often it occasions a copious dis¬ charge of viscid urine. In many patients, neveUheless, it does not sensibly augment any of the excretions.” Long-continued use, especially if the doses be increased, will sometimes occasion disorder of the digestive organs or of the nervous system, dryness of the throat, thirst, and occasion¬ ally, it is said, an eruption on the skin. Choquet mentions the case of a man who gradually increased the dose of the extract . half a drachm: it produced slight delirium and syncopes, which obliged him to suspend its use. In large ^ or poisonous doses, the symptoms are those indicating disorder of the cere- bro-spinal functions. In some of the best recorded cases the leading symptom was coma; the effects beingaltogetheranalogous to those of opium. In other instances, convulsions, or violent delirium, or both, were the prominent symptoms. As an illus¬ tration of thecomatose condition sometimes brought on by this poison, I shall quote a case recorded by M. Haaf, a French army surgeon, and which occurred to him while in garrison at Torrequemada, in fepain, in March 1812:— A soldier having eaten of some broth, into which hemlock had been put, went to sleep immediately after his supper. In an hour and a half he was found groaning' and breathing with difficulty; in conse¬ quence of which M. Haaf was sent for. He found his patient in a profound sleep, without sense, respiring with extreme dif¬ ficulty, and lying on the ground. His pulse was 30, small, and hard ; the extre¬ mities cold ; the face bluish, and distend¬ ed with blood, like that of a person stran¬ gled. Twelve grains of emetic tartar were given, and occasioned some fruitless at¬ tempts to vomit. He became gradually worse, had violent palpitations of the heart, and died in three hours after his fatal supper. Several other cases in which coma was the leading symptom might be quoted, but the one just related is the best. We have no well detailed cases in which delirium was the leading symptom. The following must suffice, by way of illustra¬ tion ; it is from Kircher. Two priests ate hemlock root by mistake : they became raving mad, and mistaking themselves for geese plunged into the water. For three years they suffered with partial palsy and violent pain. As illustrations of the convulsions caused by hemlock, I may refer to the cases men¬ tioned by Limprecht and Ehrhard. The first states that an old woman suffered for three months with abdominal pain and convulsive movements of the limbs, in consequence of eating hemlock root. Ehrhard mentions trismus as one of the symptoms in another case. Dr. Watson has related two cases in which giddiness, coma, and convulsions occurred. Uses. — The following are some of the cases in which hemlock has been em¬ ployed: — 1. In cancer and scirrhus. — The ancients seem to have been of opinion that hemlock exercised a specific influence over the breasts and testicles. “ It extinguishes the milk,” says Dioscorides, “ and pre¬ vents the development of the mammae of virgins : moreover, in boys it causes wast¬ ing of the testicles.” Pliny gives a simi¬ lar account of it, and adds, “ it reduces all tumors.” The same notions of its effects seem to have been entertained by the Arabians, for Avicenna praises it as a remedy for tumors of the breasts and tes¬ ticles. At the head of modern authors who have written on hemlock, stands the re¬ nowned Baron Storck, physician to the Pazmarian Hospital, at Vienna; who, in 1761, published the first of his essays on the medicinal uses of hemlock in various diseases, but more especially in cancerous and scirrhous affections. Of these essays very exaggerated accounts are frequently found in pharmacological works. Storck is represented by some as declaring hem¬ lock a remedy capable of curing every cancer, and the charge is repeated in a re¬ cently published work : but surely the au¬ thors cannot have read his essays. In his second work, he says, “ Many misunder¬ stood my opinion of hemlock, from my first essay; as they thought that I had offered a remedy which I believed to be universal and sufficient, when given alone, in all cases. But I by no means meant so.” In his Sujrplement, Storck desires “ that no physician whatever mav imagine that it is my opinion these disorders must in general, and every where, be cured by hemlock. I say, and acknowledge openly, that I have also had patients in every kind of them who have received no benefit from it; though, from the similitude of the disease, the use of it was indicated.” The most candid and fair criticism of Storck’s essays will be found in the Materia Me- dica of Dr. Cullen; and I quite agree with the opinion therein expressed, that 768 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS. Storck £‘ has represented the virtues of hemlock as much greater than ever they were, or ever will be found to be.” Storck, however, is not the only .modern writer who has asserted that cancer and scirrhus were sometimes cured, at other times ameliorated, by hemlock. Cases illustrative of its beneficial effects were published by Marteau, in 1761 ; by De- cotes, jun. in 1762; by Ehrhard, in 1763; by Larranture, and by Hoff mann, in 1764 ; by Ranard, in 1765 ; by Masars de Ca- selles, in 1770; by Lemoine, in 1772 ; by Collin, in 1779; by Buissonal, in 1787; and, much more recently, by Recamier. Bayle, in his “ Travaux Therapeutiques ,” has collected accounts of no less than forty-six cases of cancerous diseases, said to have been cured by hemlock, while twenty-eight were ameliorated. With this evidence before us, we can hardly refuse to admit that in diseases reputed can¬ cerous, hemlock has, on several occasions, been beneficial. But it is also not the less true, that in the hands of a large majority of practitioners it has completely failed ; and I believe that at the present day no surgeon has any confidence in it as a cura¬ tive means, though he may occasionally employ it as a palliative — that is, to alle¬ viate pain. Whether the failures ought, in part, at least, to be ascribed to imper¬ fect modes of preparing this plant, we are as yet unable positively to affirm. One fact, however, is quite certain — that the preparations of hemlock in ordinary use, are in nine cases out of ten inert, or nearly so. The remark made by Dr. Christison, with respect to the physiolo¬ gical effects of this plant, applies well to the point under discussion. “ If,” says this writer, “ physicians or physiologists would acquire definite information as to the physiological effects of hemlock, in small or medicinal doses, they must begin the inquiry anew. Little importance can be attached to any thing already done in this field, as I have no doubt whatever, that by far the greater proportion of the preparations of hemlock hitherto employed have been of very little energy, and, in the doses commonly used, are absolutely inert.’ ’ 2. Scrofula, — Another disease in which hemlock has gained considerable celebrity is scrofula, in consequence of the favoura¬ ble reports of Storck, Marteau, Dnpuy de la Porcherie, Lemoine, Collin, Hufeland, Fothergill, and others. It is a remedy, however, which is far from being univer¬ sally, or even generally, efficacious. It is best adapted for persons of an irritable constitution, and is employed to improve the discharge, and to heal scrofulous ulcers, and to diminish the size of enlarged absorb¬ ent glands. It is objectionable where ac¬ tive inflammation is going on, as well as when the digestive functions are much disordered. 3. In visceral enlargements , which are nei¬ ther scrofulous nor carcinomatous, hem¬ lock has been employed with occasional advantage. Thus in enlarged liver it has been used. 4. In hooping cough. In 1781, we are told, there reigned at Warsaw an epidemic of this disease : it was very obstinate, and resisted all the usual means of relief. Dr. Schlessinger obtained very beneficial re¬ sults from the combined use of tartar eme¬ tic and extract of hemlock. In this coun¬ try hemlock has been strongly recommend¬ ed in hooping-cough by Dr. Butter: he says, it has an advantage over opium in not being so liable to check expectoration. The violent and periodical fits of coughing in this disease being apparently of a spas¬ modic nature, we can readily believe they may be relieved by hemlock, as well as by some other narcotics ; but experience has fully proved that the disease is one which will run through a certain course inde¬ pendent of, or at least very little influ¬ enced by, hemlock or any other remedial means. 5. /4s an anodyne. The relief sometimes experienced in troublesome coughs by the use of hemlock is best referrible to the diminished sensibility of the bronchial membrane to the influence of the cold air. In various painful diseases, as coma, scirrhus, rheumatism, and neuralgia, hem¬ lock is occasionally serviceable as an ano¬ dyne. 6. In syphilis. Storck, Collin, and others, have related cases illustrative of the bene¬ ficial effects of hemlock in syphilis. It is sometimes useful in alleviating nocturnal pains, and in diminishing the disposition to spread of irritable sores: beyond this it hardly deserves notice as a remedy for syphilis. I must refer to Mr. Pearson’s “ Observations on the effects of various articles of the Materia Medica ” for some illustrative cases of its useful effects. There are various other diseases in which hemlock has been recommended. I may mention only chronic diseases of the skin, dropsies, satyriasis, and nym¬ phomania. Aretasus supposed hemlock had the power of extinguishing the vene¬ real feelings, and St. Jerome tells us that the ^Egyptian priests rendered themselves impotent by taking daily a little hemlock : hence the proposed use of it in satyriasis and nymphomania. Its effects in this way have, however, been denied. Storck ap¬ plied for information on this point to women whose husbands had used hemlock, and says, “ they were all content on their CONIUM MACULATUM. 769 part, and protested on their consciences that they had not found any diminution of their husbands’ vigour.” * Both Bergius and Storck have mentioned cases in which hemlock restored the venereal feelings. The following table is taken from Bayle’s ‘‘ Travaux Therapeutique :” it shows the results obtained in a number of dis¬ eases by the use of hemlock. Diseases treated by Hemlock. 1. Cancerous maladies . 2. Scrofula . . . 3. Tumors and obstructions . . 4. Ulcers neither scrofulous nor can-, cerous . 1 11 5. Syphilis . ! 6. Tetters (Dartres) . . 7. Tineas (Teignes) . 8. Pulmonary phthisis . 9. Asthma . . . 10. Leucorrhoea . . 11. Scorbutus . . 12. Cataract . 13. Hemeralopia . 14. Amaurosis . . . . 15. Dropsy . . . 16. Amenorrhoea . 17. Ophthalmia, called serous (scro- } fulous?) . (j 18. Epilepsy • * . . . . 19. Rickets . . . . . . . . . 20. Hasmorrhoids . 21. Nasal polypus . . . 22. Vomiting . . . 23. Neuralgia . . - . 24. G out . 25. Chronic cystitis, with strangury • • Number oi Cases. Cured. Ame¬ liorated. Un¬ successful. 341 46 28 267 43 34 4 5 40 35 4 1 20 17 2 1 27 20 3 4 11 11 0 0 6 6 0 0 6 5 1 0 5 4 1 0 5 4 0 1 4 4 0 0 6 3 0 3 3 3 0 0 2 2 0 0 2 2 0 0 2 2 0 0 1 1 0 0 '3 1 ' 0 2 I 0 0 1 1 1 0 0 1 1 0 0 1 1 0 0 1 1 0 0 2 0 2 0 1 1 \ 0 0 535 205 45 285 Administration. — The usual mode of ex¬ hibiting hemlock internally is in the form of powder or extract. The powder is ob¬ tained from the leaves, and has, when carefully prepared, a very fine green co¬ lour, and the peculiar odour of the plant. The finest samples which I have seen were sold by Mr. Batley, of Fore-street. It should be preserved 'in well-corked bottles, in a dark cupboard, or in a bottle enve¬ loped in dark coloured paper. It ought to evolve the odour of conia when treated with caustic potash, especially if heat be applied ; and we ought not to use it if it have been kept beyond the year, as its powers become much diminished or lost by keeping. The dose of it is three or four grains twice or thrice daily, the quantity being gradually increased until some ob¬ vious effect on the system is produced. The extract is prepared by the evaporation of the expressed juice. Most of what is procured in commerce is inert. £< We were one day,” says Orfila, “ in the shop 481. — xix. of an apothecary, who had several times furnished us with the extract of hemlock which we had administered to dogs to the dose of ten drachms, without producing any serious accident. We endeavoured to prove to him that the medicine was badly prepared; and, in order to convince him effectually, we swallowed, in the presence of several persons who happened to be in his shop, a drachm of this extract (seventy- two grains) dissolved in two drachms of water. We felt no effect from it, whilst twenty or thirty grains of the extract, well prepared, would have probably proved fatal to us. Let it be conceived now what advantage a person is likely to derive from such an extract, who takes one or two grains of it per day, or even thirty or forty, with the hope of getting rid of a scirrhous tumor, or of any other disease.” The extract of hemlock usually contains very little conia; this has been shewn by Geiger and by Christison, and lias been verified by myself. From extract, pro- 3 D 770 MR. PEREIRA ON MATERIA MEDIO A AND THERAPEUTICS. cured from one of the most respecta¬ ble drug houses in town, I was unable to procure any sensible quantity of this alkali “ From what has come under my own observation,” says Dr. Christison, “ the extracts of hemlock may become fee¬ ble, if not even inert, in one of two ways, — either by the heat being continued after the concentration has been carried to a certain extent, or by long keeping. On the one hand, I have always observed, that from the point at which the extract attains the consistence of thin syrup, ammonia begins to be given off in abundance, together writh a modified odour of conia. And, on the other hand, I have found extracts, which wrere unquestionably well prepared at first, entirely destitute of conia in the course of a few years, — a remark which applies even to the superior extract pre¬ pared by Mr. Barry, of London, by evapo¬ ration in vacuo. The mode of ascertaining the presence of conia is simply to triturate the extract, or other preparation, with so¬ lution of potassa, upon which an odour of conia is given off.” The tinctura conii of the London Phar¬ macopoeia is prepared by digesting the dried leaves with some bruised cardamoms in proof spirit. Its dose is half a drachm to a drachm. Geiger, however, observed that the dried leaves of hemlock do not contain conia, and therefore this, like the powder and extract, is an objectionable preparation. One of the best pharmaceutical prepara¬ tions of hemlock would probably be an alcoholic tincture of the bruised ripe fruit. Dr. Christison says he procured from tw7o hundred and twenty grains of the alcoholic extract of the ripe seeds (mericarps) up¬ wards of five grains of colourless hydrate of conia. A poultice of hemlock is sometimes em¬ ployed as a soothing anodyne application to cancerous, scrofulous, and venereal ulcers. There are several modes of mak¬ ing it. The directions of the London College are, to mix two ounces of the ex¬ tract of hemlock with a pint of water, and then add as much linseed meal as will make a poultice. The Dublin College di¬ rect it to be made by adding the powdered leaves to the strained decoction of the dried leaves. Some prepare it with the un¬ strained decoction and linseed meal ; and occasionally the bruised leaves are used as a poultice. The ointment of hemlock is ordered to be prepared, in the Dublin Pharmacopoeia, by boiling the fresh leaves of hemlock in prepared hog’s lard. It is employed as an anodyne application to foul, painful, and cancerous sores, to glandular and scirrhous swellings, and to painful piles. An ex¬ temporaneous substitute may be prepared with lard and the extract of hemlock. Antidotes. — No chemical antidote is known for hemlock, though it is not im¬ probable that an infusion of galls might be serviceable, as mentioned for conia. The first object, therefore, is to evacuate the poison from the stomach; this is to be effected by the same means as directed for poisoning by opium. If the poison be suspected to have passed into the bowels, a purgative is to be administered, unless diarrhoea have come on. The subsequent treatment will depend on the symptoms : blood letting is frequently required, to re¬ lieve the congested state of the cerebral vessels. Opium is generally prejudicial. Artificial respiration may be resorted to in extreme cases. Recognition in medico-legal inquiries. — — Hemlock can only be properly recognized by its botanical characters, already de¬ scribed: yet its remarkable odour may sometimes be of considerable assistance in recognizing the plant or its preparations ; nor is the fact to be lost sight of, that potash developes a strong smell of conia. In some cases it might be possible to ob¬ tain some conia by distilling the alcoholic extract of the suspected substance with water and caustic potash. MENISPERMACEjE. In this family there are several sub¬ stances requiring notice : I shall com¬ mence with Coceulus palmatus. History. — Franciscus Redi, in 1685, is the first writer who mentions the root of this plant: he praises it as an alexi- pharmic or antidote for poisons. Car- theuser afterwards examined it : but Dr. Thomas Percival gave the best account of it in his Medical Essays, published in 1773. This root has been known by vai’i- ous names, such as Calumba, Colombo, (a- lomba, and Colombo. It was at first sup¬ posed to come from Colombo, a town of Ceylon, and from which it was said to de¬ rive its name. But it is now known to be the produce of Mozambique; and we are told its African name (from which our designation is derived) is Kalumb, — which the Portuguese spell Kalumbo, the o in their language being mute. Botanical history. — The Calumba plant is dioecious, and grows naturally and in great abundance in the thick forests that cover the shores of Oibo and Mosambique on the east coast of Africa, as well as in¬ land for fifteen or twenty miles. Its root is perennial, and consists of several fasci¬ culated, fusiform, fleshy tubers. Exter¬ nally it is covered with a brown warty epidermis ; internally it is of a deep yel¬ low colour, odourless, and of a very bitter taste. The stems are annual, herbaceous. COCCULUS PALMATUS. 771 and twining, — in the male plant being simple, in the female branching : at the lower part they are beset with long glan- duliferous hairs. The leaves are alternate, nearly orbicular, deeply cordate, from five to seven lobed, wavy on the margin, hairy on both sides, and supported by long, hairy footstalks. The flowers are small, and are arranged in racemes : those of the male plant consist of a calyx, composed of six ovate sepals, arranged in two rows or series, a corolla of six green petals, and six stamina. The female flowers consist of a calyx, composed of six sepals, a corolla of six petals, and three pistilla. The fruit is drupaceous. Fig. 155.- — Cocculus palmatus. From the preceding description it is evident the plant belongs to the class Diczcia, order Hexandria , in the Linnean arrangement. Preparation. — The natives never cultivate In the ashes of the root, Planche found calcareous and potash salts, oxide of iron, and silicic acid. The non-existence of tannic or gallic acid in this root, is shown by the absence of any change when sulphate of iron, tar¬ the plant, the spontaneous produce being sufficient. The root is dug up in March, cut in slices, strung on cords, and hung up to dry in the shade. Physical properties. — Columba root is met with in flat circular or oval pieces, of from half an inch to three inches diameter, and from one to three or four lines thick. It occurs also in cylindrical pieces of from one to two inches long. The epidermis covering the sides of the pieces is of a yel¬ lowish-grey or brownish colour, smooth or irregularly rugous. The transversal sur¬ faces are of a greenish or greyish-yellow colour, depressed in the middle from the great shrinking of the medulla in the dry¬ ing process, and consist of three or four concentric layers. The outer or cortical portion varies in thickness, but is usually about two or three lines thick. It is sepa¬ rated from the ligneous portion by a dark- coloured layer, not exceeding a hair in thickness. The internal or medullary portion is light, spongy, and shrunk. The radiating lines observed on the transversal surfaces offer some resemblance to those of the root of Cissampelos Pareira. The odour of Calumba is faint, but somewhat aromatic : the taste aromatic, and very bitter. In the larger and thicker pieces small holes are occasionally observed, which have been made for the convenience of drying. Chemical composition. — The chemical pro¬ perties of Calumba root wTere first exa¬ mined by Cartheuser, afterwards by Josse and Percival ; and in later times by PfafiT, Planche, Buchner, and VVittstock. The following are the constituents of the root, according to two chemists : — tar emetic, or gelatine, is added to an in¬ fusion of it. Unlike many other roots, Calumba does not contain any free acid for its infusion does not redden litmus. Odorous principle. — The odour of the root has by some been supposed to depend cm a Planche. Buchner. Bitter matter . . 13 10 to 12 Animal matter, soluble in wrater and ? 0 not in alcohol . £ Yellow resinous extractive . 0 5 Volatile oil . . . a trace 0 Wax . . . 0 2 Gum . . . 9 3 to 4 Starch . . . . . 33 30 to 35 Vegetable medulla . . 0 17 Woody fibre . 39 12 Water . 0 9 to 10 100 97 MR. PEREIRA ON MATERIA MEDIC A AND THERAPEUTICS. volatile oil, traces of which are said to have been obtained by Planche. Water distilled from the root possesses the odour of the latter. Active principle of Calumba. — The active principle of Calumba, whatever may be its nature, is, as it exists in the root, so¬ luble in both water and alcohol. According to Planche it is a yellow bitter matter, which he says is soluble in water and alcohol, and gives no precipitate with either the salts of lead or with infusion of galls. Some have suspected the existence of a vegetable alkali, and- in favour of this opi¬ nion two facts have been adduced— namely, the precipitate caused by an infusion of the root with an infusion of galls, and the solubility of the active principle in alco¬ hol. But these reasons are hardly suffi¬ cient. Starch, which exists in Calumba, gives, with infusion of galls, a precipitate. The late Dr. Duncan suggested that the active principle might be of the nature of picrotoxia, as the plants which yield ca- lumba and cocculus indicus belong to the same genus. This opinion has also been expressed by Buchner, who endeavoured to strengthen it by experiment. One grain of the aetherial extract, purified from the waxy matter by repeated solution in water, was applied to a wound in a rab¬ bit, and in ten hours proved fatal to the animal. In another similar experiment, three grains were not fatal. In the Ame¬ rican translation of MM. Edwards and Vavasseur’s “ Manuel de Matiere Medicate ,” we are told that Dr.'^Conwell has obtained an alkaline principle which he terms Co¬ lombia. Wittstock states that he procured sixty grains of a crystallized, odourless, very bitter substance, which was neither alka¬ line nor acid, from eight ounces of Ca¬ lumba root. This substance he has termed Columbine. It is fusible ; very slightly so¬ luble in water, alcohol, aether, or the vo¬ latile oils; but dissolves in acids and caus¬ tic alkalies ; its best solvent being acetic acid. It is unaffected by metallic solu¬ tions, and by infusion of galls. If this be the active principle of Calumba, it is clear that its properties must be modified by the other substances found in this root. Starch. — This, as will be evident from the analyses of Planche and Buchner, forms a considerable portion (about one-third) of Calumba root. Its presence is readily de¬ tected by iodine ; if the root be moistened with water and then touched with the tine ture of iodine, a black spot is immediately produced. The infusion or decoction of Ca¬ lumba becomes blue when iodine is added to it. The large quantity of starch in Calum¬ ba root renders it an easy prey to insects. False Calumba ; American Calumba ; root of the Frasera Walteri. — The Frasera Wai¬ ted, a plant belonging to the natural order Gentianacece , and to class Tetrandria , order Monogynia, in the Linnean arrangement, is a native of the southern and western por¬ tions of the United States, and is very abundant in Arkansas and Missouri. From the resemblance of the root, both in appearance and medicinal properties, to that of the Cocculus palmatus, it has received the popular name of Ameiican Calumba. Dr. Duncan states, that a false Calumba root, the produce of this plant, h&s been imported from the United States into Liverpool ; but I have never met with any samples of it in this country. Some years since, it was introduced into France, and sold for genuine Calumba. Guibourt pointed out its distinguishing characters ; he called it fausse racine de Co- lumbo, and from an erroneous notion of its origin, it was sometimes called Colombo d' Afrique. It is said to resemble very strongly the true Calumba; but the samples I have re¬ ceived from France, would not, in my opinion, be confounded in this country with the real calumba. The pieces very closely resemble those of gentian root. The root of Frasera Walteri may be readily distinguished from the true Ca¬ lumba by the following characters : — 1. It undergoes no change when touched with tincture of iodine; hence it contains no starch. 2. It becomes blackish green when treat¬ ed with sulphate of iron, and slightly precipitates gelatine ; showing that it con¬ tains tannic acid. Now I have already stated and demon¬ strated that the true Calumba contains about one-third of its weight of starch, and gives no indications of containing tannic acid. The root of Frasera Walteri is officinal in the Pharmacopoeia of the United States. Its effects and uses are like those of gentian. Physiological effects. — Calumba is an ex¬ cellent tonic ; it promotes the appetite, assists the digestive process, and improves the quality of the secretions from the gastro-intestinal mucous membrane. By some it is considered as specifically influ¬ encing the liver. It is not a stimulant; for Dr. Percival took a scruple of it on an empty stomach, but did not observe that it had the least effect on the regularity, fulness, or velocity of the pulse. In ano¬ ther experiment he swallowed half a drachm : in ten minutes his pulse was fuller, and slower by three beats, and con¬ tinued so for three-quarters of an hour. In consequence of the quantity of starch and gum which it contains, it is ranked by some pharmacological writers among what they term mucilaginous tonics, in which COMPARATIVE MORTALITY OF THE RICH AND OF THE POOR. 773 list they place the Cetraria islandica and Simaruba bark. From both these, as well as from quassia, it is distinguished by its aromatic properties. In some respects (namely, in its tonic and aromatic quali¬ ties) it approximates to rhubarb, but is devoid of the purgative and astringent properties of the latter. Its want of astringency distinguishes it from the astringent tonics, as cinchona. Full doses of powdered Calumba, given when the sto¬ mach is very irritable, cause vomiting. It does not appear either to constipate or relax the bowels. We are not acquainted with the effects of very large doses of Ca¬ lumba ; but if Buchner’s experiments, already detailed, with the extract of this root, be correct, it is a dangerous remedy. Further observations, however, are re¬ quired in order to confirm his state¬ ments. Uses, — The following are the principal uses to which Calumba is applied : — 1. To check vomiting. — The power pos¬ sessed by Calumba of cheeking vomiting has long been remarked. It is, however, principally observed in those cases of what we may call sympathetic vomiting ; that is, vomiting depending on the sympathy existing between the stomach and some distant organ, as the uterus or kidneys. Thus it is frequently serviceable in the nausea and vomiting which frequently oc¬ cur during pregnancy; in children, when vomitings take place during dentition, Calumba is oftentimes serviceable, espe¬ cially when combined with chalk or mag¬ nesia ; occasionally it gives temporary re¬ lief in the vomiting arising from disease of the kidney. There are several other cases in which its tendency to allay sickness is observable, as in bilious colic and habitual vomiting. I have seen the most satisfac¬ tory results from the combined use of infusion of Calumba and effervescing draughts (composed of citric acid and bi¬ carbonate of potash), in those occasional vomitings especially observed in delicate females, and which are commonly termed bilious attacks. The violence and conti¬ nuance of the vomitings are diminished by these remedies; and after the attack, the continued use of the Calumba has reduced the frequency, and in some cases prevent¬ ed the occurrence of future attacks. In order to satisfy himself of the anti¬ emetic qualities of Calumba, Schwilgue gave ’it when vomiting had commenced, after the use of emetic tartar or ipecacu¬ anha. “ Frequently, but not constantly,” says he, “ I have seen the vomiting ar¬ rested. I have often administered the Calumba along with the emetic tartar and ipecacuanha : vomiting in general oc¬ curred, but it was milder, and was more slowly produced.” 2. In diarrhoea and dysentery. — The Ger¬ man name for Calumba root is Ruhrwurzel, that is, dysenteric root. You would, there¬ fore, be led to imagine that Calumba had some specific influence in this disease. That it is frequently serviceable there can be no doubt, but not in that degree to warrant the name applied to it. It is adapted to the latter stages of dysentery, when all the inflammatory symptoms have subsided. In habitual diarrhoea it is ex¬ ceedingly useful, when there are marks of inflammation. 3. In a laiiguid state of the stomach , at¬ tended with want of appetite, indigestion, nausea, and flatulence, Calumba root, says Dr. Percival, is extremely beneficial. The experience of the last sixty years has fully justified the praise bestowed on it by this eminent physician. It is of all tonics the least likely to disagree with the stomach, and is frequently tolerated when any other would be immediately rejected. Administration. — Tt may be given in powder in doses of ten grains to a scruple or half a drachm. But the most eligible form for exhibiting Calumba is that of infusion , in doses of one or two fluid ounces. The strength of it is, according to the London College, one drachm of the root to four ounces of boiling distilled water. It very speedily undergoes decomposition, owing, as Planche says, to the substance which he terms animal matter. The tincture of Calumba is a very useful adjunct to the infusion ; or it may be taken alone in doses of one or two drachms. COMPARATIVE MORTALITY OF THE RICH AND OF THE POOR. To the Editor of the Medical Gazette. Sir, In the beginning1 of last year my no¬ tice was attracted by a paragraph which appeared in all the newspapers, and afterwards in y our Medical Gazette, announcing the new doctrine of Dr. Casper, who had endeavoured to esta¬ blish the superior longevity of married ersons, male and female ; whereupon sent you a letter (see Medical Ga¬ zette, March 19, 1836), showing that no such result was deducible from the Mortuary Register of S. Sulpiee (in¬ serted by Deparcieux), on which Dr. Casper founds his main argument; and, moreover, that the same work of De¬ parcieux contains a complete refutation ol it, in the recorded ages of nearly 10,000 monks and nuns who were bound to celibacy. Probably I should not have concerned myself with Dr. Casper’s bold specula¬ tion, had it not threatened serious in¬ jury to civilized Europe by the virtual discouragement of life insurance and valuation of leases, and other survivor 774 MR. RICKMAN ON THE COMPARATIVE ships to an immense amount; for the contingency of marriage is evidently incalculable, and yet, according to Dr. Casper, is an element which ought to be taken into account in all such calcu¬ lations. Dr. Casper’s Lebensdawer has since found its way into England, and ano¬ ther of his speculations has attracted public notice, by a contrast of the dura¬ tion of life among the rich and among the poor, which he exhibits in a table, and also by lithographed lines of life, ac¬ companied by a commentary of his own. “ We cannot see without astonish¬ ment,” says Dr. Casper, “ that the com¬ forts enjoyed by the rich extend the du¬ ration of life itself. Compared with the poor, twice as many of the rich attain to the age of 70 ; three times as many the age of 85 ; and four times as many th e age of 90. In other words, the average duration of the life of the rich is 50 years, of the poor little more than 32 years; a difference of 18 years of life between the prince and the pauper.” This result, which excites the asto¬ nishment of Dr. Casper, may reason¬ ably excite in others attention to the materials on which it is founded ; and herein the novelty of having recourse to genealogical tables, as printed in an al¬ manack, is first to be noticed. Indivi¬ duals who die unmarried, or without is¬ sue, have little to do with the family tree, being always noticed significantly as S. P. (sine prole), and, unless person¬ ally conspicuous in family occurrences, are not likely to appear in any tran¬ script of genealogy, much less in an almanack ; the printer of which, of course, aims at brevity in his compila¬ tion. Much less likely to be recorded, or even noticed, are those who die in in¬ fancy and childhood ; and accordingly Dr. Casper’s table assigns no more than 44 deaths among 713 children under ten years of age. But there is no instance in any other published table of morta¬ lity, of less than one-third dying* in the first ten years of life — that is, 238 in 713, or 333 in 1000; and Dr. Casper cannot, therefore, be dissatisfied if, in favour of the select class, and for the sake of obvious calculation in a subse¬ quent table, their mortality is assumed to be 287 in 1000, instead of 62 in 1000, as assigned in his table*. In the foregoing extract from Dr. Casper, we are told that the expecta¬ tion of life among the rich is 50 years; so that the total number of years lived by his 713 individuals must have been [36006*5. = 50-5 — *5 = 50 yrs.] But if his radix, by adding 243 to his 44 deaths, becomes 1000 instead of 713, and the number of years lived (by a reasonable assignment of three years of life to each of the 243 added indi¬ viduals dying* under ten years of age) becomes 36,735, the result assigns to the rich no more than 36^ years as their ave¬ rage duration oflife, instead of50years — [36006 + 729 = 36735 = 36 735 - *5 == 36 235 yrs.] 1000 It is true that the average life of the select class in Germany (as elsewhere) probably exceeds 40 years ; but tbe ano¬ malies in Dr. Casper’s entire table are such as invalidate any result deduced from it, — as he himself will candidly confess on comparing it with the Law of Mortality in Belgium according to M. Quetelet, and with that of Sweden, which ditfer but little from our English tables ; but I prefer them, as nearer to Germany, as well as being founded on very ample materials. Age. Law of Mortality in each period. Dr. Casper. M. Quetelet, 1532. Swedish, 1795. 30—35 - 31 29 29 35—40 - 41 29 30 40-45 - 51 30 35 45_50 - « 48 31 37 50— 55 - •• 66 36 41 55 — -60 • • • • 47 40 | 47 * It is remarkable that Dr. C. himself (p. 39 of ten years of life. This mortality may exist in a his Lebensdawer ) shows, that, in Berlin, 461 populous city j but the superiority of male life ia males in 1000, 469 females in 1000, die in the first unexampled. MORTALITY OF THE RICH AND OF THE POOR. 775 Your readers, in examining- the above columns, are requested to understand that they are all worked on the common radix of 1000; and the irregular aber¬ ration of Dr. Casper’s column from the other two succeeding columns, suffi¬ ciently proves that, from whatever cause, the Genealogical Almanack is not a secure basis on which to construct any calculation of the expectation of life; and I request attention to the re¬ markable fact, that the select class of Dr. Casper exhibits, in some instances, a much greater mortality between the ages of 30 and 60 years than the entire population of Belgium and Sweden, — a fact entirely subversive of his arg’ument, even supposing his data to be of any value. I know not whether, after this expo¬ sition, I am justified in asking the fur¬ ther attention of your readers to Dr. Casper’s column exhibiting the morta¬ lity of the poor of Berlin, —of those who, in case of disease, are attended by medical officers at the expense of the public. The poor do not often accept such aid unless attacked by a dangerous disease ; and to rely on the duration of life among such persons as a general rule, is quite as novel as the applica¬ tion of a Genealogical Almanack in the case of the rich. I really cannot ima¬ gine by what process of ratiocination Dr. Casper can advisedly ascribe to pa¬ tients who die in a public hospital the same duration of life as to others gene¬ rally, many of whom either escape dis¬ ease or survive it, and die of old age. I forbear to examine into the aberra¬ tions of a table founded on such an assumption. Dr. Casper has sufficiently approved himself, by his medical sta¬ tistics, and his Lebensdawer , to be an industrious collector of information, and has displayed his results in well- arrang-ed tables and diagrams ; but his good qualities will not be conducive to the public good until he has banished from his mind that love of the marvel¬ lous which, once admitted, puts to flight all other considerations. I can very well understand, perhaps I have myself felt in my own experience, that when the mind has been led into a hopeful investigation, in the progress of which the same mind happens to dis¬ cover its own error of induction, — or when an impossible or absurd result of calculation demonstrates the unsound¬ ness of the materials on which it has proceeded, — I can understand that in such a case it may cost the inquirer a pang in destroying the abortion and re¬ jecting the intellectual labour of days or weeks. But this kind of sacrifice is absolutely required by the moral sense, which is conventionally ascribed to all those who undertake to instruct man¬ kind in useful knowledge ; for to say that such knowledge is not advanced by the publication of error, does not ex¬ press the whole truth : the mischief is of a positive description, because the reader is thereby drawn aside from better occupation, and his time must be afterwards expended in refuting or pe¬ rusing the refutation of the unfounded speculation which has unadvisedly been placed before him. Still worse will be the result, if those who rely on an accredited author are misled into an unlimited train of error practically injurious to mankind. Dr. Casper himself furnishes an example of this, when he imputes to marriage con¬ sequences which, unrefuted, would go near to abolish all life assurances ; and, in the present instance, into a specula¬ tion subversive of amity and good will between the different grades of human society ; and regarding which I shall only add, that as the population of Eng¬ land and that of Prussia have increased at the same rate since the peace of 1815, the difference of condition betw een the rich and the poor cannot be very unlike in the two nations ; and that in Eng¬ land the advantage of the select class, of those who are concerned in pecu¬ niary transactions with government, is not very great. In the opinion of Mr. Finlaison (whose calculations on the lives of upwards of 20,000 public annuitants are known to be unimpeach¬ able), the expectation of life throughout the entire population of England, in the year 1821, had reached that of the select class in the year 1786, — a fact which w’ould be incredible, unless wre knew that the annual number of deaths in England did not increase during thirty-six years (from 1780 to 1815), although the population increased from 7,814,000 to 11,525,000, or 47 per cent., during that time. It is true that this remarkable prolongation of human life may have extended in some degree to the select class; but it would be out¬ raging probability to estimate the life of the select male as more than equal to that of females generally in all classes of 770 DR. HARRISON ON THE ERRORS OF LAENNEC AND OTHERS society. The experience of the Equitable Assurance Society (published in 1834), where a great majority of the insured are males, confirms Mr. Finlaison’s cal¬ culations. This mention of a Life Assurance Of¬ fice reminds me that I ought not to con¬ clude this letter without stating', that in the opinion of those most conversant in life assurances, the usual certificates of health required of the insured, and upon which Dr. Casper places great reliance, are fully balanced and counteracted by insurances effected by individuals con¬ scious of concealed disease, and some¬ times, though (we may hope) rarely, by the flagitious practices of those who in¬ sure lives which they intend to shorten afterwards. — I remain, sir, Your obedient servant, John Rickman. Feb. 14, 1837. ERRORS OF LAENNEC AND OTHERS RESPECTING THE REGIONS OF THE CHEST. To the Editor of the Medical Gazette. Sir, Some apology may be necessary for bringing the following subject so often before your readers ; but if they consi¬ der how much it has been practically misunderstood, and the perplexity and errors which have been the result — if they consider the respectable authorities who have contributed to the spread of incorrect opinions concerning it — if they consider what an apparently fair ground the consequent mistakes have furnished to many, for treating the phy¬ sical signs with neglect or disdain — and finally, if they consider that the expo¬ sure of error often facilitates the esta¬ blishment of truth, they will perhaps feel disposed to view any efforts to throw light upon it with some degree of indulgence. I might have avoided much repeti¬ tion in the notice of Laennec’s regions, by putting under the same head those that yield similar results; but I have preferred the risk of being tiresome to that of being charged with intentional, or unintentional, misrepresentation of his views. With regard to other fre¬ quent repetitions I cannot offer so legi¬ timate an excuse. In his “ Traits de l’Auscultation mediate,” Laennec has given a division of the surface of the chest into different regions, with the characters of sound on percussion which, according to him, be¬ long to each. There are, in his account of these regions and sounds, some er¬ rors, either direct or implied, which I shall now endeavour to point out, ar¬ ranging' my remarks under a few heads. He says, first, that in the mammary region, which commences “ au-dessous de la quatrieme cote et finit a la huitieme,” percussion cannot be employed “ chez la plupart des femmes,” and that in men it seldom yields as much sound as the “ region anterieure-superieure,” on ac¬ count of the thickness of the lower edge of the great pectoral muscle. A much better explanation of this comparative dulness will be found in the position of the heart and liver, the latter of which is, with few exceptions, near the surface in the greater part of the said mammary region, on the right side, and very frequently also on the left. The circumstance of Laennec not hav¬ ing taken the heart into consideration in his account of the regions of the chest, has been pointed out by M. Andral. 2. That in the “ region sous-mam- maire,” which commences “ au-dessous de la huitieme cote,” and ends “ au rebord des cartilages des fausses cotes,” the sound is almost always “ peu clair” on the right side, “ a cause du volume du foie.” That on the left side, on the contrary, it is often clearer than natu¬ ral, and almost tympanitic, from disten¬ sion of the stomach by gases. 3. That in the “ region laterale,” which commences “ au-dessous de la quatrieme cote,” and ends “ a la hui¬ tieme,” the sound is always clear on the left side ; that “ souvent il Test no- tablement moins” on the right ; “ ce qui indique toujours que le foie remonte plus haut qu’a l’ordinaire, et que le poumon droit refoule enhaut, en devient un peu plus dense et moins rempli d’air. Car le foie ne remonte jamais reellement , au moins lorsqiCil est sain , plus haut que le niveau de la sixieme ou cinquieme cote au plus.” It is to be hoped that Laennec is mis¬ taken when he asserts that the healthy RESPECTING THE REGIONS OF THE CHEST. 777 liver “ ne remonte jamais plus haut” than the level of the fifth rib ; as, on that supposition, diseased livers are as much the order of the day amongst us, as was ever dreamed of by the strongest partizans of hepatic affections. The general rule, the more than ge¬ neral rule, is, that the liver does rise above the level of the fifth rib*, which explains very well the fact, that the sound in the “ region laterale, & droite,” is not only often, but almost always, especially in its lower parts, “ notable- ment moins clair qu’a gauche,” unless there is disease on the left side dimi¬ nishing the natural quantity of air, or emphysema or pneumo-thorax on the rightf. 4. That in the “ region lateral e-infe- rieure,” which commences “ au-dessous de la huitieme cote,” and ends “ au rebord des cartilages des fausses cotes,” the sound is, “ par la raison que nous venons d’exposer,” often “ tout a fait mat” in the “ region laterale-inferieure droite,” and that it is almost always “ beaucoup moins sonore” than in the left ; that in this last, on the contrary, the sound is often clearer than natural when the stomach is distended by gases; and that “ cette resonnance claire peut encore avoir lieu en pareil cas, lors- meme que la partie inferieure du pou- mon gauche serait engorgee, ou qu’il existerait un epanchement dans la plevre de ce cote.” If we consider what is said aud what is omitted, concerning the stomach, in the account of the regions “ mam- maire,” “ sous-mammaire,” “ laterale,” and “ laterale-inferieure,” it will be evident, I think, that there is a remark¬ able oversight. We are taught that, in the left “ region sous-mammaire,” the distension of the stomach by gases pro¬ duces a sound clearer than natural, and almost tympanitic ; and also, that in the left “ region laterale inferieure,” the distension of the stomach by gases pro¬ duces a sound clearer than natural. This is perfectly true ; but when com¬ pared with the total silence as to the stomach producing any effect on the sound in the “ region mammaire,” and the “ region laterale,” we may fairly * This is not offered a3 an original remark, anatomically speaking. t The preceding remarks have solely reference to the level of the fifth rib as the standard of the healthy liver; but do not Laennec’s words imply that he considered this as the exception, and the level of the sixth as the utmost average height ? infer that Laennec supposed its influence on the sound not to extend above the eighth rib in these two regions, even when the stomach was distended by gases. Now the fact is, that when the sto¬ mach is distended by gases, it affects the sounds as high up as the sixth, the fifth, or even the fourth rib. The cases in which the stomach gives its sound no higher than the eighth rib are mere exceptions, and that not only when there may be said to be distension of the stomach by gases, but in the or¬ dinary state of things. It is extraordinary that Laennec should take no notice of the intestines in this account, although their presence high up often produces a very marked increase of “ sonoreite.” The circum¬ stance of his stating that in this lower lateral region, the stomach distended by gases might produce a clear resonance, even though the lower portion of the left lung should be “ engorgee,” or though there should be an “ epanche¬ ment” in the pleura of that side, is not calculated to diminish our surprise, when compared with his want of know¬ ledge as to its influence high up. He mentions, however, that in the “ region dorsale inferieure,” which com¬ mences “ a la hauteur” of the inferior angle of the scapula, and ends “ a celle de la douzieme vertebre dorsale,” the sound on the left side often presents over the whole extent of that region “ la sonoreite trompeuse” before men¬ tioned, and which he attributes to the stomach being distended by gases. It should be borne in mind that Laennec scarcely* employed mediate ercussion ; but the points on which I ave ventured to criticize him might, I think, have been made out by imme¬ diate percussion, especially as he was unrivalled in that respect. In the ‘‘Notes et Additions au Traite de l’Auscultation mediate de Laennec,” by Mons. Meriadec Laennec and Mons. Andral, this latter thus expresses him¬ self regarding Laennec’s account of the sounds of the chest, with the exception as to the heart above mentioned : — • “ Dans cette appreciation, si nette et si vraie, des differences de sonoreite que pr£sentent les parois thoraciques dans les divers points de leur etendue,” &c. * I am not quite sure whether he employed it at all. 778 DR. HARRISON ON THE ERRORS OF LAENNEC AND OTHERS The almost unqualified praise which M. Aridral gives on this occasion is perhaps quite as surprising as the ori¬ ginal errors of Laennec, which he thus adopts as his own. I shall now make a long quotation from M. Piorry, which will serve to show that mediate percussion did not save him from error as to the ordinary height of the liver and its relative situation. “ A droite et lorsqu’ap’res avoir percute le haut de la poitrine, on explore plus in- ferieurement, on trouve ordinairement a quelques pouces au-dessousdu mamelon, un peu plus de resistance au doigt et de la matite. Cela n’est bien sensible qu’a l’aide d’une percussion assez forte ; a mesure qu’on descend la durete et le son obscur deviennent de plus en plus apparens, de telle sorte que tout a fait en bas, dans le thorax, se retrouvent les caracteres plessimetriques dus a la pre¬ sence du foie ; c’est, en effet, cet organe qu’on rencontre sur ce dernier point*.” The opinion that you must ordina¬ rily descend “ quelques pouces” below the nipple before you find “ un peu plus de resistance au doigt et de la matite,” and that “ cela n’est bien sen¬ sible qu’a l’aide d’une percussion assez forte,” is so utterly contrary to what al¬ most daily observation teaches me, that it might, combined with the opinions com¬ bated above, lead to the supposition of there being some difference in the struc¬ ture of the inhabitants of Paris and Lon¬ don with regard to the height of the liver and the diaphragm generally. At page 162 of the same work we are told that it is in general “ a un ou deux pouces au-dessous du mamelon droit,” that the liver commences in the greater part of mankind, and that its lower edge terminates “ au rebord costal.” In connexion with M. Piorry and mediate percussion, I may take the op¬ portunity of stating, that the practice of percussing on one of the fingers was first proposed by Dr. Skerrett, who, with myself and several others, attended the early public demonstrations of M. Piorry in the dissecting-rooms near La Pitie. I speak from personal and posi¬ tive knowledge of the circumstances; and I recollect perfectly his urging the subject on the attention of M. Piorry, who appeared to me at the time indis¬ posed to entertain the proposal, and who seems subsequently to have forgotten * l)u precede operatoire, &c, p. 53. the particular individual with whom it originated. It has been mentioned to me by gen¬ tlemen who have attended the clinique of M. Louis, that he gives a rule for estimating the average height of the liver; but their information is not suf¬ ficiently positive and precise to justify me in venturing to give any definite opinion about it. In those individuals whose diaphragm on the left side runs at a considerable distance from the ribs, some tact in per¬ cussion is requisite, in order to make the stomach or intestines tell through the lung high up*. Sometimes, too, the liver, extending far to the left, renders the stomachal or intestinal sound from per¬ cussion in front distant and feeble; still, with a certain degree of skill, it is often possible to ascertain, not only through a portion of liver, but also through a portion of the heart, when this organ lies in a slanting direction on the diaphragm, the intestinal or stomachal sound behind them. I may mention, that in such cases also the kind of revolving or tilting motion al¬ luded to in a former number f, will, even through the heart, frequently indi¬ cate the height of the diaphragm be¬ hind it, and consequently that of the stomach or intestines. An objection is sometimes made, that the height of the diaphragm varies so much during respiration as to render fallacious any practical conclusions at¬ tempted to be drawn from a supposed knowledge of it at any given moment. To this I would answer, 1st, That the variations during the ordinary act of re¬ spiration are too slight to lead to any practical mistake. 2d, That even in strong abdominal inspiration the move¬ ment is not one of much depression, but of the tilting or revolving character above mentioned ; and that this last motion, properly understood, renders more easy a knowledge of the dia¬ phragmatic level. 3d, That opinions drawn from living animals whose abdo¬ minal parietes have been cut through, are not conclusive on the subject. In a note to his communication “ On the theory and practice of Percussion as a mode of Diagnosis j,” my friend Dr. * In speaking of the stomach or intestines, I do not mean to imply that they cannot exist high up together, t Dec. 10, 1836. X Medical Gazette, Jan. 21, 1837. RESPECTING THE REGIONS OF THE CHEST. 779 Williams, in speaking- of the height to which the diaphragm rises in the chest, represents me as having taken great ains to investigate this matter. Per- aps I may be excused for stating that I have taken great pains, not to ascer¬ tain simply the height of the diaphragm, but those marks and movements, whe¬ ther appreciable by sight or touch, which indicate in different individuals, not only the height of the diaphragm, but, to a certain extent, the distance at which it lies from the ribs in different parts of its course ; thereby rendering it possible to foretell in any particular case, with considerable practical accu¬ racy, the degrees of resonance on per¬ cussion, and the state of the respiration in those parts of the chest which lie be¬ low the diaphragmatic level, and of course to estimate any marked deviation from the healthy state. If, on the other hand, the inquiry has been begun by the general and local signs, this method may be found useful in confirming or invalidating the con¬ clusions drawn from those sources. The difficulty of describing the indications furnished by sight or touch as to the course of the diaphragm, deters me from attempting it at present, but I hope to be able to do so before long with some degree of success. Tn the meantime, any one who may feel inclined to inves¬ tigate the subject practically, will meet with a corresponding disposition on my part. By the remark, that the fact of the diaphragm rising thus high up in the chest had been little attended to by phy¬ sicians, Dr. Williams did not, I believe, mean to convey an assertion that he had ever known it to be attended to either much or little by any physician or phy¬ sicians. The perusal lately of an article by Dr. Stokes, in the 7th number of the Dublin Journal of Medical and Chemi¬ cal Science, induces me, in the hope of preventing the recurrence of such a mistake, and dissipating a little of the obscurity which sometimes hangs about such cases, to make some remarks, and throw out some conjectures which I should otherwise have reserved for further examination. In that article there is mention made of an operation for empyema, in w'bich the diaphragm was pierced, from the instrument having been introduced too low down. It has been for some time an object with me to ascertain how far that lateral depression* which, in the majority of individuals, indicates the level of the diaphragm on the corres¬ ponding side, would be affected by consolidation of the lungs or effusion into the chest. The cases, whether of tuberculization or hepatization, which I have had an opportunity of examining, appear to justify the positive conclusion that this depression is not changed by those diseases, and that it there also in¬ dicates in general the diaphragmatic level. With regard to effusion into the chest, I wish to be understood as speak¬ ing with hesitation, but on the one hand some cases of the kind that I have seen appear to favour the idea that either the lateral depression is not affected, or that it is merely thrown a little higher up ; and on the other, I am not aware of having met with a single exception to this rule. If this opinion proves to be correct, it will sug¬ gest the practical caution of not intro¬ ducing the instrument below such de¬ pression, unless there shall be circum¬ stances which prove that the diaphragm is displaced downwards to a sufficient degree. In the case mentioned by Dr. Stokes, the diseased side at the time of the operation was in a state of contraction, and it is possible that this circumstance may cause some doubt and difficulty. However, if it is recollected that as a general rule the depression is a little higher on the right side than on the left, an examination of its height on the sound side may lead to a probable con¬ clusion as to its natural height on that w hich is diseased. There is one point which I must not omit to mention. Although it may be inferred that the diaphragm, unless displaced downwards by disease, rises as high as the lateral depression, it cannot be inferred that it rises no higher. I would venture to propose an hypothe¬ sis which will go far, I think, towards explaining a great number of cases, and reconciling some apparent contra¬ dictions. It is this ; that there is in every individual a depression on each side corresponding to the natural height of the diaphragm on that side, and that this depression remains, although from some cause, such as diseased liver, effusion into the abdomen, &c. the diaphragm should be either temporarily or permanently thrown higher up than * Med. Gaz. Dec. 10, 1836. 780 DR. CLENDINNING ON THE natural. In this last case, however, the diaphragmatic level is, I think, appreciable to sight or touch by marks or movements which require further investigation before I attempt to speak very positively about them. If, however, it should happen, as I am inclined to believe, that the revolving or tilting motion still accompanies the diaphragm at this unnatural height, it may become a valuable sign in this respect. As I am now in the region of con¬ jecture, I will suggest another. If the revolving motion is directly connected with the presence of the diaphragm, such motion will not be perceptible when the diaphragm is thrust down, or will, perhaps, by the highest points at which it can be felt, indicate that the diaphragm exists at the same height within a moderate dis¬ tance from the ribs. I have had some thoughts of inquir¬ ing how far our own authors on auscul¬ tation and percussion have adopted the errors of Laennec commented on above, but the task would be a delicate one, and those who have their works can easily decide this question for themselves. It would be rash in me to assert that no work of the kind contains correct views on this subject, but those that I am acquainted with afford proofs, in this as in too many other respects, of the facility which the great talents of Laennec so often met with, in mislead¬ ing his faithful followers. Your obedient servant, Edwin Harrison. Grove Terrace, Lisson Grove. February 13, 1836. NOTICE OF THE INFLUENZA OF JANUARY AND FEBRUARY, 1837. To the Editor of the Medical Gazette. Sir, It is reasonable to suppose that some such disease as the influenza has exist¬ ed in all ages, yet no tolerable account is generally understood to be extant of any of its visitations before the sixteenth century, nor in England before 1658, (Willis de Febribus, c. 17.) nor any dis¬ tinct notice w hatever of its existence in very early times. Yet it is no unim- Iiortant disease now, and must have )een, if it happened at all, much more important still in tlje darkness of Grecian and Roman civilization, and in the middle ages. For there is undoubtedly at present a much greater average vigour of health and tenacity of life than were enjoyed of old, and there is a greatly improved knowledge of the physiognomy and laws of disease, and, of necessary conse¬ quence, a greatly diminished mortality attending epidemics. Doubtless the short duration of its more urgent symp¬ toms, and its comparatively small mor¬ tality, when uncomplicated with orga¬ nic disorder, have contributed very much toward the inattention that influenza has experienced at the hands of the ear¬ lier writers, and perhaps in some mea¬ sure justified likewise that inattention. If ague were still epidemic in Britain every spring* and autumn, and dysentery and cholera common in harvest, and plague a frequent visiter, and confluent small-pox, as they have been within little more than a century and a half or so of the present year; in that case I make no doubt epidemic catarrh would still, as heretofore, appear to most men too insignificant for particular notice. Happily we are now, at least in this country, little liable to be deafened by the roar of those great guns, and can note the report of the small arms. Ac¬ cordingly, within the last century, more especially within the last 50 or 60 years, very numerous notices have appeared, by practitioners in all parts of these islands, of irruptions of influenza. Conductors of influential periodicals also, as the edi¬ tors of the Medical and Physical Journal, (vol. 9.) have instituted extensive in¬ quiries on the subject amongst then- correspondents ; and the Medical Society of London (Mem. Med. Soc., vol. 6.) has collected a valuable mass of communi¬ cations from various members of their body; while spirited individuals, espe¬ cially Dr. Beddoes and Dr. Fothergill, (Med. Phys. Journ. vol. 10, and Med. Obs. and Inq. vol. 6.) have exerted them¬ selves successfully for the same laudable purpose. By such inquiries much in¬ formation has been obtained, in addition to what was previously recorded, as to the pathology, aetiology, and treatment of infl uenza; yet much remains uncer¬ tain, or unknown, regarding its causes, remote and proximate and its methodus medendi is still unsettled in some points of importance ; so that it is to be hoped that the observers of the epidemic just expiring w ill not suffer their experience to he lost by neglecting to be put on re- INFLUENZA OF JANUARY AND FEBRUARY. 781 cord whatever original facts they may possess, throwing* new light on tlie dis¬ ease, or capable of deciding disputed, or clearing up obscure, points in its history. The following is a summary of what has been observed in the prac¬ tice of the St. Marylebone Infirmary, with regard to the epidemic just dis¬ appearing*. Grand Total , from 30t/i December , 1836, to 10£/t February , 1837. 1* Admissions into the Infirmary, in¬ cluding all cases, surgical and medical, during the above period . 465. 2. Admissions on the out-door list, to be visited at home, during* the same pe¬ riod . 661. 3. Out-patients, mostly severe cases, transferred to the in-patient list, and included in the No. 465 . 48. 4. In addition to the above, there were prescribed for ofout-patientsattend- ingat the infirmary every morning, and of whom no particular account is kept, on an average during the six weeks, 81. 5. Also by the Infirmary house sur¬ geons, three times weekly in the work- house wards, exclusive likewise of the preceding, and on an average during the six w eeks. . . . Ill, Total influenza. — Of No. 1, or admis¬ sions into the Infirmary, more than half were influenza cases, simple or compli¬ cated, generally the latter ; in all about . 250. Of No. 2, or out-patients visited by the assistant house-surgeons at their own homes, about 450 were cases of in¬ fluenza, mostly uncomplicated and slight . 450. Of Nos. 4 and 5, a large proportion must have been influenza cases, from the verbal statements of the house-sur¬ geons, and the large number of bad and mostly complicated influenza cases re¬ ceived from the workhouse, but the exact number I have no means of esti¬ mating. I should suppose from a com- arison of the numbers with the num- ers recorded under the same heads for December and January, 1836, (which latter they much exceed) and for other reasons, fully one-half were instances of the epidemic. So that there must have been a grand total in the six weeks of something not far short of 1000 cases of influenza treated in the various depart¬ ments of the practice of the Infirmary. Progress of the epidemic.— The first cases of influenza adjnitted into the In¬ firmary, and noted in the official journal, occurred January 2d. Cases admitted in week ending 6th January • • - * . . 15 Ditto, ditto, 13th . . . 64 Ditto, ditto, 20th . . 66 Ditto, ditto, 27tli . 46 Ditto, ditto, 3d February . 32 Ditto, ditto, 10th, about . 20 244 By a statement with which I have been favoured by my friend, Dr. Boyd, of the St. Marylebone Infirmary, it ap¬ pears that between Monday, January 9, and Saturday, February 4, 414 cases of influenza were admitted 011 the out¬ patient home-list, viz.— Week ending 14th January .... 161 Ditto, 21st . 139 Ditto, 28th • • • . . . . 84 Ditto, 4th February . 34 And the workhouse practice and morn¬ ing out-patients’ room practice advanced numerically, and receded apparently along with the Infirmary and home practices. So that the epidemic would appear to have begun with January, and declined in about the usual period of 5 to 6 weeks. Symptoms.— Of course, amongst such a number, various combinations of symp¬ toms must have happened. Confining my remarks to those that were admitted into the Infirmary, of whom only I had personal cognizance, I should say'- that the cases varied principally according as they were simple or complicated,— the former being tolerably uniform in their symptoms, the latter various as the complicating diseases. Of the former the symptoms are familiar, and require no detailed description from me, viz. at first chilliness, lassitude, and depres¬ sion or anxiety, followed in some hours by more or less of heat, gravedo, head¬ ache, coryza, pain of back and limbs, soreness, sometimes extreme, of the chest and throat, with cough, smart fever, often coated tongue, nausea, and vomiting; sometimes gastro - enteritic irritation, with diarrhoea ; occasionally transient delirium ; generally w andering pains of trunk, especially about the sides. Such were the principal symptoms of the un¬ complicated cases for twenty-fourjthirty- six, or forty-eight hours after admis¬ sion ; after which expectoration became easier, the skin softer and moister, and cough and headache less troublesome, when the fever gave way, so that in 782 DR. CLENDINNING ON THE three or four days nothing- but weak¬ ness, with a tiresome cough, remained in the majority of instances, — a weakness, however, greatly disproportionate to the duration or danger of the disease. Two- fifths of the cases noted as influenza by the house-surgeon were of the kind just glanced at; the remaining three-fifths were complicated as follows; viz. with Pleuropneumonia . 36 Bronchitis, mostly chronic, and I combined with Emphysema V 52 Pulm. and Morb. Cord. • • • • ) Phthisis . 25 Pleuritis . 5 Fever, in several instances Typhoid 25 Rheumatism, Chron. . 2 Morb. Chron. Yentriculi . 3 Croup . 3 Ptyalism . 1 Encephalitis . 1 Morb. Chron. Cord. . . . 3 Pericarditis . 1 Of course the symptoms must have varied much in the second class, or complicated cases. In numerous in¬ stances the complicating diseases were at first so masked by the influenza, as not to be easily recognizable. Without the aid of the pleximeter or finger and ear-tube ; indeed, it appeared to me nearly impossible in several cases to arrive at a safe or satisfactory diagnosis, more especially in persons advanced in life. The irregularity observed in the course of the functional signs did not in any material degree of course extend to the physical signs ; so that pneu¬ monia, phthisis, disease of the heart, and hypertrophy of the ramifications of the bronchus (or emphysema pulm. c. catarrh, chron.), which were the most frequent and formidable complications, were generally as easily identified as usual. In every case the influenza, if distinguished at all, was readily detect¬ ed, whatever its complications, if at¬ tended to within the first day or two; after that period it often, in bad cases, became absorbed in the effects of the graver complicating disease. Mortality. — The mortality with us, as elsewhere, amongst populations em¬ bracing indifferently individuals of all ages, sound and unsound, was very considerable during the period so often specified above. I do not know that any simple case was lost from influenza unaided by previous disease or subse¬ quent complication ; but so larg*e a por¬ tion of the subjects of our influenza had bad previously tuberculated lungs, diseased bronchial ramifications or hyper¬ trophy of the heart, and the instances in which pleuropneumonia was excited were so numerous, that We lost in the six weeks, from 31st December, altogether • • • • 118 Cases, to which must be added, deaths in the infirm wards of the Workhouse, same period* • 21 In the out-door practice also there were some deaths (exclusive of the mortality of the cases transferred to the Infirmary), amounting in the same period to . 40 Giving a grand total mor tality of . . 179 Table of Ages of all Cases treated in the Wards of the St. Marylebone Infirmary , from 30 th Dec. 1836, to 10 th Feb. 1837. Living. Dying. Ages of all Cases. Influenza Cases : Sh O both Sexes. Male. Female. Male. Female. a> S Under 12 months* • 5 4 1 2 C/3 »\ 5 1 to 5 years* • • • 15 5 — — 0> c n 3 5 — 10 . 17 24 — 1 O £ _> 15 10 — 20 . 40 33 5 2 N *rH § "Ph 35 20 — 30 . 21 40 5 4 3 S o 28 30 — 40 * * . C O 34 26 12 6 hH 33 40 — 50 . 27 27 13 8 & *-> 26 50 60 . 36 25 15 10 o C/3 41 60 70 . 22 30 10 14 be < 35 70 and upwards • • 21 11 9 2 26 INFLUENZA OF JANUARY AND FEBRUARY. 783 Remarks on the Table of Ages. From the preceding- table it would ap¬ pear that aged persons have enjoyed no such immunities during the late epide¬ mic as they have been found, or, for want of counting, perhaps, supposed to do in former epidemics *. More than half of the cases were above 40, while a fourth part nearly were above 60. But the table represents the case too favourably for the other extreme of life, owing to the nursery and school children having usually not been so se¬ verely affected as to require hospital treatment. Another generally received opinion, however, is confirmed by our experience, viz. the potency of pectoral disease as a predisposing cause ; this appears strikingly from the table of complications. For though the compli¬ cated cases were received into the Infir¬ mary in much larger proportion, of course, than the simple cases, yet the number of the former is too considerable to be overlooked, or attributed to uni¬ versality of diffusion of the epidemic causes, rather than to peculiar suscepti¬ bility in the subjects. I have added the deaths of all dis¬ eases, but none for influenza separately, for the obvious reason that influenza proper produced no deaths. Amongst the causes I have seen no reason to reckon contagion ; perhaps I have not looked sufficiently, or inquired for it. Like all other epidemic diseases, the present, whether contagious or not, certainly commenced at first without contagion, and has probably, as I think, been exclusively reproduced and conti¬ nued by recurrences of one or more of its first causes : what those first and essen¬ tial causes are, I think with Pringle (Med. Obs. and Inq. vol. vi.) is still a problem for solution. Morbid Appearances. During the epidemic numerous oppor¬ tunities presented themselves of investi¬ gating its anatomical characters ; and in every instance I found that the fatal result might be attributed to previous disease, or to organic deterioration from lapse of years. The young-est was a female, 8 years old, who sank under double pneumonia supervening on tu- berculation. There were a male and a female between 20 and 30; a male and a female between 30 and 40; a male and * Hancock } Cycl. Prac. Med., art. Influenza, p. 5. two females between 40 and 50; be¬ tween 50 and 60 there were five males and two females ; and between 60 and 70, six males and one female. The complicating diseases were — Chronic disease, with enlargement of the heart and bronchial ra¬ mifications, without acute pul¬ monic disease . 9 Chronic disease of the heart and bronchia, with recent pleuro¬ pneumonia . 6 Chronic disease of the heart, with phthisis (1), or recent pericar¬ ditis (1) . 2 Pneumonia and pericarditis . 1 Phthisis with pneumonia . 1 Pneumonia . j Pneumonia with suppuration of kidneys . * . j Pneumonia, morb. cord., and arachnitis . . j I observed nothing constant in the post-mortem appearances but extreme injection of the trachea and all its branches, and in several cases thicken¬ ing of the mucous lining of the passages. But those are nothing more than are, according to my observation, to be met with in a greater or less degree in al¬ most every case of asthma, chronic catarrh, and old disease of the heart. It may be thought singular that disease of the heart should have occurred so often, much oftener than phthisis, being eigh¬ teen times out of twenty-two ; and I should probably, some twelvemonths or more since, have been struck myself by such a statement. But it is undoubt¬ edly true, that disease of the heart fre¬ quently escapes the observer who trusts to his eye as a means of admeasurement. \\ hen, as often happens, there is no peri¬ carditis, nor any valvular disease, and when hypertrophy, if existing, is distri¬ buted pretty equally over the org’an, there is a great chance of its escaping notice, unless very considerable; more espe¬ cially if the inspector have defective information respecting the health of the deceased. To guard against error from that quarter, I have for some time weighed every subject inspected on account of disease of the heart, entire in the first instance, and then after a careful examination of the pectoral viscera, weighed the heart separately', after washing, and in this way have satisfied myself that amongst the labour¬ ing classes at least, hypertrophy of that organ is a still more common and fatal 784 DR. MACLEOD ON THE INFLUENZA. disorder than many or most physicians believe. Treatment . — Regarding- the simple influenza cases I have little to say. With warmth, water gruel for food, and repose in bed for a couple of days, they were usually convalescent, or about to be so, whatever might be the medica¬ tion employed, provided only that medi¬ cation were not energetic. “ Res fuit hercle dioetse potius accurate ac debiti regiminis plerumque, quam medicinee elaborate,” (Huxham de sere, &c.) like its predecessor of 1743: occasionally, however, like the epidemic just referred to, “ multo plus curse atque diligeutise poposcit.” In a great majority of cases, nearly all indeed, it was thought ad¬ visable to blister the chest, which usually gave to the bronchial irritation the relief desired. In some also leeching or cupping wras cautiously employed ; where the pain under the sternum was urgent, or pneumonia or pleurisy was apprehended, or where gastro-enteritic irritation was well marked. The ordinary internal medicine was antimonial mix¬ ture (gr. f- to ^iss.) with 2 or 3 drops of laudanum 4tis boris, which was gene¬ rally found to answer well ; but in several cases, probably 20, half a grain or a grain was prescribed with benefit. Purges were often called for by consti¬ pation at the commencement, and were at all times used without hesitation, according to circumstances. As soon as fever abated, animal food, beginning with broth, if not previously in use, was employed, with porter, wine, or other cordial according to circumstances. In 15 or 20 cases saburra and op¬ pression were treated at first with emetic doses of antimony ; and frequently the ordinary antimonial mixture operating on an irritable stomach, caused vomiting, which was found to be of service ulti¬ mately, however inconvenient in some cases at the moment. I do not know that bleeding was ever employed in uncomplicated influenza, but pneumonia or other visceral inflammations originat¬ ing in influenza were encountered as usual. Into the treatment of the com¬ plicated cases it is unnecessary for me to enter, partly on account of the tedi¬ ousness of a detail of so many various plans, but principally because influenza, not the diseases with which it was in¬ cidentally associated, is the subject of this communication. Suffice it in a general way to say that such cases were treated variously of necessity, but always with a double regard to the graver as well as to the transient and minor dis¬ ease. Pneumonia and pleurisy were the complications that most frequently compelled us to deviate from our general method, and those were encountered by bleeding', both general aud local, espe¬ cially the latter, blistering, antimonials, and when less tractable on account of disease of the heart, age, &c. by mer¬ cury likewise, with or without opium. John Clendinning, A.M. & M.D. Physician- to the Mary-le-bone Infirmary, &c. Wimpole Street, Feb. 13, 1837. NOTE ON THE INFLUENZA. To the Editor of the Medical Gazette. Sir, If the papers which have appeared in the medical journals are to be received as indicative of professional opinion, considerable difference exists both in the theoretical and practical views taken by different men reg'arding the nature of the epidemic recently so prevalent. I am induced to trouble you with this communication, not from having' any thing new in the way of hypothesis to present to your readers, but simply from the desire to place on record a few facts, on which I leave it for others to theorize if they think proper. I presume that the cases I have seen, taken altogether, have been of more than the average degree of severity, first, because they have been treated partly in St. George’s Hospital, where the slighter cases were not admitted ; and secondly, because a certain pro¬ portion of the others have been patients, to whom I have been called by general practitioners, who have done me the favour to ask for my assistance. Now, setting aside the mere catarrhal affections of i i few days’ duration, the great mass of the others w hich I have seen has been made up of unequi¬ vocal examples of inflammation of the air tubes. This has principally been developed in the minuter branches, but not unfrequently has extended into the trachea, and sometimes even to the larynx. The inflammation, however, has not been limited to the parts just mentioned, but in a certain number of cases has affected other mucous mem- DR. MACLEOD ON THE INFLUENZA. 785 branes in addition to the simultaneous participation of the air passages. Thus, taking 40 of the more severe cases, I find that 3 had well-marked symptoms of laryngitis ; 3 had pleurisy; 4 had otitis, which in three terminated in pu¬ rulent discharge of several days’ dura¬ tion ; 1 had inflammation of the con¬ junctiva in both eyes ; 4 haveliad inflam¬ mation of the posterior fauces; 2 have had swelling and inflammation of the parotid and submaxillary glands on the subsidence of the pulmonary affection ; and in 3 erysipelas has followed on the subsidence of the primary attack. As in all the above there was a pulmonary affection, the result is, that 25 had bron¬ chitis of different degrees of severity, and 15, in addition to this, had simulta¬ neous inflammation of some other and for the most part analogous texture ; while 5 had other forms of inflamma¬ tion as sequelae of the original attack. Of the entire number here referred to, 5 have died, 3 of whom, however, 1 saw only at a very advanced period of the disease, and therefore cannot speak of its early stage ; 1 was a case in which erysipelas supervened upon laryn¬ gitis, and scarcely, I think, to be called a fatal case of “influenza;” the other 4 were cases of bronchitis, attacking per¬ sons who had been previously subject to pulmonary affections, and in whom the disease ended in suffocating effusion into the air tubes. The general symptoms were, at the onset, chilliness (in one amounting to violent rigor), severe headache, great lassitude and depression, cough, with hur¬ ried respiration and feelingofdistress, re¬ ferred to the chest generally, with much pain, (as if the parts had been bruised,) extending along the diaphragmatic marg’in of the ribs, aggravated by coughing or deep inspiration. The cough was at first dry, but after a few days became loose, in favourable cases, and afterwards accompanied by free mu¬ cous expectoration. The crepito-mucous rale was for the most part pretty general in both lungs, and a graver ronchusin the larger tubes; while, in not a few cases, a kind of tremor or vibration was felt, by merely laying the hand flat upon the chest, over the situations of the larger bronchi. The pulse was in general considerably increased in frequency, but (unless in the cases in which pleurisy was combined) was soft land compressible. There was heat of 481. — xix. skin, but this diminished as the disease advanced, even in those cases which were running an unfavourable course. In some of the published opinions of this epidemic, it has been argued that it was not essentially of inflammatory nature, because the patients did not bear bleeding well ; but this I apprehend to be very frequently the case in bron¬ chitis, as it also is occasionally in other inflammations— such as various forms of erysipelas. The disease in the present instance, as in bronchitis generally, has been by far most severe on those ad¬ vanced in life, and it is familiar to all, that in them inflammation of the pas¬ sages very rarely assumes the plastic form which it presents in early life. The principal source of danger, if I may so express myself, consists not so much in the activity of the inflamma¬ tion as in one of its effects — namely, the increased secretion into the minute bronchi, by which the air is prevented from coming into contact with the pulmo¬ nary vesicles, so that the arterialization of the blood is arrested. Many of the patients whom I have seen, had more or less of a leaden tint, and all the four who died were deeply tinged — one of them as blue as I ever saw' in cholera. Of the four fatal cases alluded to, I had only an opportunity of examining tw'o. The disease in one had lasted ten days, in the other a fortnight; in both the appearances w’ere the same— namely, dark vascular redness of the mucous membranes, extending’ from the larynx to the minutest ramifications of the bronchi which could be traced. The smaller air tubes seemed to be literally soaked with fluid, while the larger were smeared over with viscid mucus, as ad¬ hesive as bird-lime. The lungs gorged with blood. In one, old adhesions of the pleurae ; but in neither any evidence of recent pleuritic inflammation. The general treatment consisted in confining the patient to bed, exhibit¬ ing a draught containing 3 ij . of liq. acet. ammonite, every four or six hours, acting gently on the bowels, and pro¬ moting expectoration by means of oxy- mel of squill and ipecacuanha. In the great majority of cases perspiration came on within the first two days, after which the symptoms gradually, though but slowly, abated. If the disease assumed a more inflam¬ matory character, that is, if there was more than the average degree of fever, 3 E 786 REMARKS ON THE INFLUENZA. with hard dry cough, calomel, with James’s powder, ortartarized antimony, wras prescribed, which, in the more acute cases, was pushed to the extent of twelve grains of calomel, and two of tartar emetic, in twenty-four hours. In such cases blisters were also applied to the chest. If, on the other hand, the inflammatory symptoms were less mark¬ ed, or had been subdued, the expecto¬ rants were strengthened bv the addition of spirit, selheris nitrici, and compound tincture of camphor. Where the debi¬ lity was great, a draught, containing f. Qij. spirit, eetheris sulphurici, with IRvj. of dilute sulphuric acid, sweetened with some syrup, was of service, and was afterwards followed up by some bitter tonic, particularly cinchona, as soon as the pulmonary symptoms were subdued. Where there was much oppression of the lungs early, and before effusion had taken place into the air-passages, leeches to the sternum, followed by blistering, were efficacious. When the larynx and trachea were implicated, too, leeches were applied ; but, guided by former experience, If abstained from general blood-letting in all the cases, except those in which the pleura was impli¬ cated ; but even here the venesection w'as not well borne, producing a greater degree of subsequent debility than we are accustomed to witness from similar depletions ; and in one of those, where the patient required to be bled three times to twelve ounces, although the leuritic symptoms were thus overcome, e was seized two days after with ery¬ sipelas of the scrotum, and thighs adja¬ cent, which speedily produced partial sloughing, and required the1 exhibition of bark and wine. So, too, with regard to the affection of the throat ; this has rather shewn a flabby and relaxed condition of the membrane than acute inflammation. It has usually been attended with great pain in the deglutition of the saliva, while a mouthful of food could be swallowed without the same diffi¬ culty. Most relief was afforded in such cases by stimulating and astringent gargles. In the cases where otitis took place, although the bronchial inflammation had not subsided when the former came on, yet it was no more complained of, and had disappeared when the discharge from the ear was established. Nearly the same thing was observed with re¬ spect to the inflammation of the glands about the jaw — that is, by tbe time they were considerably swollen, the breath¬ ing was entirely relieved. I am, sir, Your obedient servant, Roderick Macleod, M.D. 23, Henrietta-Street, Cavendish-Square, Feb. 14, 1836. REMARKS' ON THE INFLUENZA of 1837. To the Editor of the Medical Gazette. Sir, If you think the annexed remarks on influenza of sufficient interest, perhaps you will give them a place in the Medical Gazette. — I am, sir, Your obedient servant, R. J. P. Kensington, Feb. 15, 1837* Th e cases of the epidemic may be di¬ vided into three classes, according to the aspect of the symptoms. 1. Those cases, chiefly occurring in young persons, having the features simply of mild catarrh. 2. Those assuming more the aspect of rheumatic fever, to which catarrhal symptoms are attached only in a trifling degree, occurring also chiefly in the young and middle aged. 3. That severe form, prevailing most amongst the old, and more especially those who have the chronic bronchial affection so common to elderly persons. In the first form there is generally chilliness or rigors, succeeded by heat; pain, often severe, in the frontal sinuses and nostrils, with feeling of suffocation from swelling of the membrane lining the back part of nostrils — often with bleeding from that part. Troublesome cough, from irritation referred to the lower part of trachea ; especially teaz- ing during the night; not relieved in the usual way by expectoration. The pulse w eak, not much quickened; tongue slightly furred, and generally moist. Treatment. — By confinement to bed, or to a room of equal temperature, these cases soon pass over. Recovery seems to be chiefly retarded by the depression REMARKS ON THE INFLUENZA. 787 so marked in this disease, together with the persisting dry cough. Saline and mucilaginous medicines, as mucil. tragac., or acacise, mist, amygd., or oxymel, with small doses of antimony and nitrate of potass. The night cough much relieved by ten grains of pulv. ipecac, comp, at bed-time, in mucilage, with spt. seth. nitr. 3ss., or made into pills with mucilage ; by which a quiet night’s rest is procured with great relief. The bronchial irrita¬ tion may be much mitigated by mustard poultices applied (from half an hour to two hours) to the upper part of chest. Secretion may be promoted by the fol- lowing pill every four or six hours : — Ext. Conii. Pil. Scillae C. aa. gr. ii.; Pulv. Ipecac, gr. i. Diet, arrow-root, gruel, whey, beef tea ; with meat early in the convalescence. In the second form the early symp¬ toms are the same as in the first, but more severe: there is headache, much pain in the aponeuroses of loins, scapulae, and limbs, often round the margin of chest, apparently in the tendinous struc¬ tures external to the chest, sometimes extending over one side and suddenly shifting to the other; the pulse quick, and generally small and weak ; the tongue furred, white 'and moist, often dry and yellow ; trifling cough, and uneasiness in the air passages; the cerebral symptoms in some cases severe, often amounting to delirium. There is generally much depression ; often syn¬ cope. The urine is small in quantity, and loaded with lithate of ammonia. Treatment. — Saline aperients, with calomel and antimony at night. Leeches to the forehead in many cases, and to the chest, followed by blisters, when the pains about the chest are severe. Bleeding does not seem more effectual in giving relief than leeches, and is not well bo rne. Vinum colchici, in half¬ drachm doses, relieves the pains in the head and limbs; 10 grs. of Dover’s powder, with nitre, at bed-time, is very : useful in allaying pain and procuring i rest. Where the tongue is much furred, , great relief is obtained by purging the j liver with calomel, followed by warm aperients, as rhubarb, magnesia, and dec. aloes, or rhubarb and tartrate of potass, or sulph. and carb. magnesite, w ith tr. card. co. As soon as the febrile ( symptoms have subsided, and the tongue gets clean, quinine is1 the best tonic. The diet should be as nourishing as the sto¬ mach and system will bear. In both these forms the depression of strength and spirits is very remarkable — * quite out of proportion to the other symptoms. In the third form the chief danger is from the large quantity of tenacious mucus secreted by the bronchial sur¬ face ; the depression of strength caus¬ ing gTeat difficulty in its expectoration. The attack frequently appears but as an aggravation of symptoms previously existing, but whose features it rapidly changes. The strength sinks; the ap¬ petite fails; the circulation becomes lan¬ guid ; the strength is inadequate to ex¬ pel the large quantity of bronchial se¬ cretion ; the lips get blue, the intestines cold, and the patient soon sinks,— often in a few hours. In less severe cases, there is a lighter shade of these symp¬ toms ; the tongue is much furred — often br< swn and dry. Treatment.— Much benefit is derived from blistering the chest, which should be done early in the case, so as to anti¬ cipate the severe symptoms. Squills, ipecacuanha, antimony in small doses (avoiding its depressing effects) ; and where antimony cannot be borne, the lobelia inflata (tincture) appear ser¬ viceable in clearing the bronchial tubes, in doses of 3ss. every six hours, w ith aether and ipecac. Where the tongue is much furred (as it is almost always), one or two doses of calomel, followed by hyd. c. creta, combined with rhu¬ barb, or at night with Dover’s powder. This form of opium appears to agree better than any other in this disease ; perspiration is promoted and rest is pro¬ cured, without that binding effect on the secretion which follows the other preparations of opium. Nourishment must be cautiously given from the first; such as beef-tea, jelly, yelk of egg, with warm milk, or w hey ; and where there is much prostration, with wine, or brandy. There is in many cases very troublesome vomiting ; this is relieved by potass, soda, or ammonise carb. ; effervescing with lemon juice. Warm milk, with soda-water added to it, is a pleasant be¬ verage in these cases. Amongst the young, one fatal case only occurred, in a publican of intempe¬ rate habits, and unhealthy condition. T. C., aged 30. —He suffered a few 788 MR. LEWIS ON A NEW METHOD OF TREATING HYDROCELE. days from the simple catarrh, and ne¬ glected it. Rather suddenly the symp¬ toms took a formidable aspect. Hoarse¬ ness, hurried short respiration, frequent cough, with trifling expectoration of mucus; quick and very weak pulse; the voice soon diminished to a whisper; the stifled cough became almost con- stant; the skin clammy; lips blue; hands and feet cold ; tmd nails blue. The chest throughout was dull to per¬ cussion, and the respiration scarcely audible. The extreme prostration forbade de¬ pletion in any form ; calomel offered the only chance, and it was given freely ; 3 grains every 2 hours, with carbonate of ammonia every 4 hours. Warm wine whey was the only thing he would take. A blister applied to the chest be¬ came gangrenous soon after vesication. He died 48 hours after the commence¬ ment of severe symptoms. Post-mortem. — The lungs did not collapse when the chest was opened ; they still crepitated on pressure; were thickly spotted over with petechise un¬ der the pleura. The lungs, trachea, and larynx, were removed for examination. The mem¬ brane lining the larynx was of a deep red colour, with flakes of lymph in the ventricles, and on the chordese vocales. Trachea intensely injected throughout, and coated with glairy adhesive mucus, as also the large bronchia ; a red mucous fluid poured out of the trachea on in¬ verting the lungs. The lungs con¬ gested and gorged with serous and mucous fluids, which oozed out abun¬ dantly on incising them. In some parts, especially in the lower lobes, consolida¬ tion of the structures had ensued, being the first stage of peripneumonia. Heart sound. Liver filled with yellow tuber¬ cles, and very hard. NEW (?) METHOD OF TREATING HYDROCELE. IN REPLY TO MR. TRAVERS. To the Editor of the Medical Gazette. Sir, In the Lancet of the 7th of May last I pointed out to the medical profession a new method of treating hydrocele — namely, by puncturing with a very fine needle, until a drop of fluid oozes out on withdrawing the needle, and in three days the hydrocele will completely dis¬ appear, no matter in what quantity the fluid might have been collected. In the last number of the Medical Gazette there is a letter from Mr. Travers, in which he seems to insinuate that he was the discoverer of that method, be¬ cause he had punctured a hydrocele with an acupuncturation needle a fort¬ night prior to the date of my letter. Such may have been the case I am not in a position to deny, although I must in justice to myself declare that I never heard of Mr. Travers deviating from the ancient routine of practice in the treatment of hydrocele or any other disease. But lest the public should imagine, like Mr. Travers, that my dis¬ covery and the appearance of the letter in the Lancet to be synchronous, I can bring forward evidence at any time that the operation had been performed two years before Mr. Travers conceived it, as he terms it. I even spoke of it in public to several medical gentlemen, who will, I have no doubt, vouch for the accuracy of the statement. It was not until I perfected the operation, and had seen many cases, that I dared to make public the extraordinary fact that a single puncture with the point of a fine needle into an encysted cavity is sufficient to cause the absorption of the fluid contained therein. The practice of making many punctures is not only useless and dangerous, but actually less likely to succeed than a single puncture ; of this the profession in general (I mean general practitioners as well as hospital surgeons) will be convinced by experi¬ ence. If Mr. Travers had read my letter attentively, he would have seen that I first introduced the method as a palliative cure ; although I have seen cases where a radical cure was effected by the simple operation of puncturation. As the method of puncturation for the radical cure of hydrocele differs in some respects from the palliative, as soon as I have satisfied my mind on the subject, I shall rejoice, though an humble individual, to contribute my mite towards the advancement of science. — I am, sir, Your obedient servant, D. Lewis. 28, Artillery-place, West, BunhiH-row, Feb. 14th, 1837. ANALYSES AND NOTICES OF BOOKS. 789 TREATMENT OF HYDROCELE. NOTE FROM MR. KEATE. To ilie Editor of the Medical Gazette. Sir, On looking- over the contents of your last number (for 11th inst.), I saw “Account of a new method of operating* for Hydrocele, by Benjamin Travers, Esq., Surgeon to St. Thomas’s Hos¬ pital.” My hopes of gaining* informa¬ tion naturally led me to refer to his letter at page 737 of the Gazette, where I read the account, I must con¬ fess, with some disappointment, and was rather surprised to find that there w'as another claimant for the merit of discovering* this supposed new method. While 1 do not mean to intimate any doubt of the same ideas having oc¬ curred to each of these gentlemen without any knowledge of the other’s theory or practice, or of any previous operation of the kind, I trust it will not he offensive to either of them if I assure you that the plan and the prac¬ tice have been known and acted on for very many years by myself, and I dare say by others. By one other person I know it W'as performed I dare say twenty years ago, namely, by a friend of mine, who for some years practised as a physician in this town, and is now living in retirement in the country. This gentleman performed the opera¬ tion on himself as he was nervous about the injection, and fancied, as he said, that if he could convert ascites into anasarca, absorption from the cellular structure might cure the malady ; and in his owti case it was perfectly suc¬ cessful. At his suggestion I tried it frequently, both at the hospital and in private practice ; sometimes successfully, but more frequently the collection of fluid in the sac returned, and I generally found the patients impatient of the nu¬ merous punctures, and of the time re¬ quired for the absorption. I remember talking to Sir Astley Cooper on the subject, and, as far as my recollection serves me, the plan appeared not to be new to him. I cannot venture to mention the name of the physician in this letter, as I have no time to write and ask his "consent before the appearance of your next number ; but I can have no hesi¬ tation in stating it to you in confidence, or to any gentleman who may think it worth while to ask me. I am, sir, Your obedient servant, Robert Ki^ate. Albemarle-Street, Feb. 15, 1837. [The name of the physician above alluded to is mentioned in a post¬ script, but as it is marked “ confiden¬ tial,” we of course abstain from pub¬ lishing it. — Ed. Gaz.] ANALYSES and NOTICESof BOOKS. “ L’Auteur se tue a allonger ce que le lecteur se tue a abreger.” — D'Alembert. Pharmacopoeia Collegii Regalis Medi- corum Londinensis. 1836. Printed by order of the Colleofe. We resume this week our remarks on the new edition of the London Pharma¬ copoeia ; and in the first place propose offering some further observations on the Materia Medica. In various places the College quotes De Candolle as its authority, though most arbitrarily, and sometimes incor¬ rectly. Thus his name is attached to Aconitum paniculatum, when, in fact, Lamarck should have been quoted ; also after the different species of Citrus, we have “De Candolle” instead of “Risso;” and even the old Linnean name, Amyg- dalus communis, has “ De Candolle” attached to it. If the College intended merely to indicate that De Candolle has adopted these names in his Prodromus, why omit quoting him after Boswellia serrata, Papaversomniferum, Astragalus verus, and many others? But in some cases the name of this celebrated botanist has been attached to species which he has never mentioned. Thus the Oleum Bergamii is said to be procured from Citrus Limetta Bergamiurn , on the au¬ thority of De Candolle, although there is no species of this name in his Pro¬ dromus ! We are at a loss to conceive why the College has thought proper in some instances to follow De Candolle, in others to retain the old names, in 790 ANALYSES AND NOTICES OF BOORS, defiance of him and of other modern authorities: thus Myrtus Pimenta is still retained, though De Candolle, whom they profess to follow, calls it Eugenia Pimenta. In the Pharma¬ copoeia we are told balsam of Peru, and the balsam of Tolu, are obtained from the same species, namely, Mvroxylon peruiferum : yet De Candolle, their pro¬ fessed authority, distinctly says that the first of these balsams is from M. peruife¬ rum, but the second from M. toluiferum. Til some instances wrong plants have been quoted : Lavendula spicafor Laven- dula vera ; and Foeniculum vulgare for Eoeniculum dulce. The latter is a gross error, since De Candolle him¬ self was the first to separate the F. dulce from the F. vulgare, for pre¬ viously they had been regarded as va¬ rieties merely ; so that it would seem the name must have been quoted in the Pharmacopoeia without the Prodromus having been consulted. There are- many other errors of a less important hind, but strongly indicative of a slovenly, loose, and careless mode of getting up. Thus Radix is put for Rhizoma, under Aspidium ; Amyris elemifera is printed Amyris Elemifera; Castor fiber is written for Castor Fiber; Strychnos nux vomica is put instead of Strychnos Nux vomica ; and Terebiu- thina Canadensis for Terebinthina ca¬ nadensis. These mistakes, though slight, ought not to have been allowed to have occurred. In the first column of the Materia Medica the names of the different sub¬ stances are sometimes put in the sin¬ gular, sometimes in the plural number, shewing a great want of uniformity in the plan of proceeding. Thus we have Myristica, a nutmeg, but Mora, mulber¬ ries ; while the syrup of the latter is called Syrupus Mori, syrup of a mul¬ berry ! Chemical nomenclature . — It has been cast as a reproach on former editions of the Pharmacopoeia, that the nomencla¬ ture employed was not in accordance with the then state of chemical know¬ ledge ; and in this edition an attempt has been made to remedy the defect. Thus in most instances the word chlori- dum has been substituted for murias ; though in a few cases the term hydrochloras has been properly pre¬ ferred, as in sal ammoniac and the hy¬ drochlorate of morphia. The quondam alkaline carbonates are now either sesqui or bicarbonates , which is all very proper. But we may here remark, that the College has fallen into an error in denominating the common magnesia of the shops a carbonate “ Magnesia alba,” says Berzelius, “ is a chemical compound of carbonate and hydrate of magnesia. When we precipitate the solution of a magnesian salt by an al¬ kaline carbonate, we ought to obtain a neutral carbonate ; but the wrnter de¬ composes it, so that the alkaline carbo¬ nate incompletely precipitates the earth, some bicarbonate of magnesia remain¬ ing in solution.” The nomenclature of the double salts has been altered : thus tartar emetic is now called antimonii potassio-tartras ; the quondam, cuprum ammoniatum is now cupri ammonio- sulphas ; ferrum ammoniatum is altered to ferri ammo- nio-chloridum ; soda tartarizata is term¬ ed sodce potassio-tartras ; and so on. In naming these substances, the Colleg’e has followed the last edition of Dr. T. Thomson’s “ System of Inorganic Che¬ mistry. ” But, with all due deference to the College, and to Dr. Thomson, the names are very objectionable. Let us illustrate our meaning, by refe¬ rence to the preparation called in the Pharmacopoeia the “ Ferri Potas- sio-Tartras.” This salt is a double tartrate ; — that is, its basic or elec¬ tro-positive constituent is the tartrate of potash, while its acid, or electro¬ negative ingredient, is the tartrate of iron. That the iron really does perform here the function of an acid, seems proved by the fact that it is not recogni¬ zable in a solution of this double salt, by either the ferrocyanuret of potassium (unless, indeed, an acid be added, to disengage the tartrate of iron), or by alkalies. Now the constitution of the salt being* admitted, what ought to be its name ? In the denomination of the single salts, we always put the name of the acid, or electro-negative ingre¬ dient, before that of the basic or electro-positive one : thus we say, sulphate of magnesia, not magnesi- ate of sulphuric acid. If the same principle be extended to the double salts, we ought to designate the above mentioned chalybeate salt, the iron-tar¬ trate of tartrate of potash , which may be conveniently shortened to the iron- tartrate of potash , while tartar emetic THE NEW PHARMACOPOEIA. 791 <4 would be the antimony-tartrate of pot¬ ash. Berzelius’s nomenclature is not well adapted for our language, but it is formed precisely on the principles we are here advocating*. Thus he calls soluble tartar, the “ tartrate potas- sique the ferri potassio-tartras of the Pharmacopoeia is “ tartrate ferrosi-po- tassique and emetic tartar is “ tartrate antimonico-potassique .” By the way, we may remark that the College has not adhered to Thom¬ son’s method of nomenclature in the case of all the double salts. Thus they describe alum as be¬ ing “ sulphas alumince et potasses ,” whereas Thomson calls it “ potash- sul¬ phate of alumina .” According to our notions it ought to be “ alumina-sul- phate of potash a name which in spirit agrees with that of Berzelius, sulfate aluminico-potassique .” Prussian blue is most improperly, as we conceive, termed “ Ferri Percyani- dam .” In Mr. Phillips’s translation, the following sentence occurs : — “ Percy a- nide of iron, usually called Prussian blue, and sometimes Ferrosesquicyanide of iron,” -See. Now any person would fancy from reading this passage, that while the vulgar name for this substance is Prussian blue, the usual and proper term is percyanide of iron, and that the phrase ferrosesquicyanide is sometimes but less properly employed. How stand the facts ? 1st. Prussian blue is called in no chemical work of repute that we have consulted, percyanide of iron. On this point we have referred to the works of Thomson, Turner, Henry, Ure, Braude, Fyfe, Berzelius, Tbenard, Du¬ mas, Gay-Lussac, Lassaigne, and Gme- lin. In not one of these have we met with the collegiate name of Prussian blue, even among the synonymes for this substance. 2dly. The term percyanide is incor¬ rectly applied to it, on two grounds: the first is, that there is another compound to which this name more properly belongs ; and secondly, Prussian blue is a double cyanuret. if we turn to the “ Table Synoptique ” of Berzelius, published in 1835, we find a substance is there mentioned by the name of Cyanure ferrique (equivalent to our term percy¬ anide of iron), containing 59 33 per cent, of cyanogen ; while Prussian blue contains only (according to Mr. Phillips) 54*4 per cent. It is true this Cyonure ferrique has not been obtained in the separate state, but of its existence in certain compounds, no chemist, we be¬ lieve, entertains a doubt. 3dly. The term Ferrosesquicyanide (or Ferrosesquicyanuret) of iron, which we are modestly told “ sometimes” occurs, is the name by which it is designated in every modern chemical work. Prceparata et composita. — For the same reasons that the College has not thought it necessary to give formulae for the preparation of sulphuric acid, sul¬ phate of magnesia, acetate and phos¬ phate of soda, chlorate of potash, ferro- cyanide of potassium, and many other chemicals, we think they might have left out various formulae still retained in the Pharmacopoeia. We allude now to those for making such articles as chlo¬ ride of lime, hydrochloric acid, acetate of lead, tartaric acid, &c. ; and others which are manufactured on a very large scale, their uses not being confined to the medical profession. We are g’lad to see formulae for the preparation of the vegetable alkalies introduced. We may remark that the production of aconitina is a delicate process, and requires a dexterous and experienced manipulator to succeed. The article sold as aconitina, made by Pelletier, is almost inert, and for reme¬ dial purposes useless. The manufacture of the disulphate of quina without the use of spirit has long been a desideratum with chemists, which we are afraid the formula of the College will not remove. It is a modi¬ fication of M. Henry’s process, which did not succeed in France, and failed, as we know, in the hands of an expe¬ rienced English manufacturer, in con¬ sequence of the small product obtained by it ; for he found the old process in which spirit is employed to be cheaper. The process given in the Pharmaco¬ poeia for the manufacture of the binio- dide of mercury, is, in our opinion, in¬ ferior to the one usually followed — namely, the mixture of solutions of the bichloride of mercury and the iodide of potassium in atomic proportions. The product by the latter process has a much finer colour than that obtained by rubbing iodine and mercury together, as directed by the College. The mode of procuring bromide and iodide of potassium, as given in the 792 ANALYSES AND NOTICES OF BOOKS. Pharmacopoeia, is objectionable, — a much purer article being- obtained by other methods. By the Colleg'e pro¬ cess, it is difficult to procure the iodide free from some carbonate. It is well known that a considerable portion of the iodide of potassium of commerce is largely adulterated with carbonate of potash, — frequently the latter ingredient constituting more than 70 per cent, of the so-called iodide. Now the presence of this carbonate may be instantly ascer¬ tained by pouring a little lime water over a suspected crystal placed in a wine-glass. We are surprised this test was not mentioned in the short notes introductory to the “ Praeparata.” It is true the non-solubility of the carbonate in alcohol would show the presence of some impurity by the College test, but the test we have mentioned is more simple, and can be more expeditiously applied. Manufacturers frequently make the sesqui-carbonate of soda, and the bi¬ carbonate of potash, not by the processes given by the College, but by boiling the sesquicarbonate of ammonia with the carbonate of soda or of potash. The process is given in the “ Pharmacopee Haisonnee ” of Henry and Guibourt, p. 409, tom. ii., and should have been noticed by the College. There are two most absurd compounds introduced into this edition, — namely, a compound mixture of cascarilia (com¬ posed of infusion of cascarilia, vinegar of squills, and the compound tincture of camphor), — and the compound mixture of gentian (containing compound infu¬ sion of gentian, compound infusion of senna, and compound tincture of carda¬ moms). We presume these are the favourite prescriptions of some Fellow of the College, who wishes to save him¬ self the trouble of writing their com¬ position every time he orders them. We could raise many objections to, and point out several errors in, the arrangement of the different prepara¬ tions : our space, however, only permits us to notice the following : — Tinctura ferri ammonio-chloridi and tinctura ferri sesquichloridi ought to have been in¬ serted along with the tinctura iodinii composita and other tincturae : many articles have been omitted in the index ; as the above-mentioned two tinctures of iron, &c. In concluding these remarks on the Pharmacopoeia, we may add, that while there are undoubtedly many very great improvements in it, as compared with the previous edition, as a whole it has dis¬ appointed us; and we must add, that the parties who undertook to prepare it for the press have not performed their duty in a creditable manner either to them¬ selves or to the College. The Works of John Hunter , F.R.S. ; with Notes. Edited by James F. Palmer. In 4 vols. 8vo. illustrated by a volume of Plates, in 4to. Yol. I. Longman and Co. In our last number we briefly noticed this work, and the coincidence of its appearance with the re-opening of the Hunterian museum, and the delivery of the Hunterian oration. In our present notice we propose adverting to some particulars of the “ Life but shall first call attention to the nature of the work itself. This is not merely a reprint of Mr. Flunter’s published works and miscel¬ laneous papers, but a complete collec¬ tion of all his writings, printed as well as manuscript, systematically arranged, and preceded by a new life of the au¬ thor. We are informed by the editor, that nearly a volume and a half of this collection appears now for the first time in print ; and that he has been enabled, chiefly through the liberality of the Royal Society in allowing’ him the use of their plates, to complete the entire series of illustrations, amounting to not less than sixty-three engravings, among which are many of a very costly and magnificent description. Undoubtedly the peculiarity of the work consists in the plan of grafting on the text of the author a series of annotations illustra¬ tive of the various subjects treated of — a plan which cannot fail to be generally useful, and which, in our judgment, was the only thing required in order to ren¬ der Hunter a popular author. Inde¬ pendently, however, of this, the work was much required, and we are glad to see it presented to- the profession in so accessible a form. One circumstance cannot fail to strike every one in the least acquainted with Hunter’s life, which is, that he had not only extraordinary difficulties to con¬ tend with during his life, but that, after palmer’s edition of hunter’s works. 793 his death, the same difficulties seem to have conspired against bis fame. More tardy and incomplete justice was never rendered to any one possessing the same claims to distinction. Nearly fifty years have elapsed since his death, and yet, until lately, his museum has never been adequately displayed, or illustrated by catalogues, his writings have never been collected, his manuscripts have been destroyed, and his life has been in¬ competently written ; — we say incom¬ petently written ; not but that Sir Eve- rard Home possessed the ability, as well as materials, to have done justice to the subject, but that he did not choose so to employ them. The memoir which he has left us, prefixed to the Treatise on Inflammation, is meagre in the last de- g’ree, and totally destitute of those cha¬ racteristic traits of character which give interest to biography. Mr. Jesse Foot’s production is a gross libel, and Dr. Adams’ a fulsome and undisting’uishing panegyric. It requires no mean qualifications to become the biographer of such a man as Hunter. Praise and blame are easily dispensed, but without sufficient g’rounds for these verdicts the former becomes mere compliment, and the latter absolute temerity. The celebrated artist, Barry, observed, “ that no portrait painter could paint a better head than his own.” The mere outline of the face may be given, by any artist of mediocrity, with tolerable precision ; but the man of ge¬ nius only can animate his canvas with the mental character and energy of his subject; the exterior indications of deep feeling and powerful intellect being only to be perceived, felt, and expressed, by a kindred genius. We do not mean by these observations to imply that Hunter and his biographer are at all comparable, but that there is something in the composition before us which leads us to judge very favourably of the au¬ thor. His subject is well arranged, his anecdotes are aptly introduced, and his style is manly and perspicuous, ft is evident that he has an adequate ac¬ quaintance with comparative anatomy, as well as with medical literature, to form a correct judgment of the various subjects which come before him. He is always impartial, and in doing jus¬ tice to Hunter, does no injustice to others. His characters are justly con¬ ceived and boldly drawn, and particu¬ larly that of Hunter, which stands out with an individuality of form which marks the skill of the artist. In fact, the Life before us completely supplies what we wanted, and we cannot but consider it as a fortunate circumstance that it has been written while it was yet possible to rescue so many anecdotes from oblivion. A very few years more, and it would have been impossible to have written such a Life. If it be the prominent characteristic of a superior mind to select a grand and useful object of pursuit, and to follow that object with indefatigable perseve¬ rance and well-directed toil through a long life, regardless of, or surmounting, innumerable impediments, harassed by petty enmities and jealousies, little aid¬ ed by friends, interrupted by the duties of an arduous and anxious profession and by bodily diseases induced by the intensity of his exertions ; little cheered by even the most candid of his scienti¬ fic contemporaries, who could only dimly scan the scope of his views, and could not appreciate his ability to ac¬ complish them ; if such singleness of object and vigorous perseverance in its attainment mark the highest order of intellectual and moral energy (and the fame of Columbus is founded on these claims), no age or nation can pro¬ duce a name that would be robbed of its dignity by a comparison with that of John Hunter. Taking him alto¬ gether in the combined character of a physiologist and surgeon, and contem¬ plating him under these accumulated difficulties, we cannot but consider him as an instantia singularis among’ men, which would have marked a new era in science in any age or country in which he might have happened to have lived. That Hunter was indifferent to fame cannot be asserted, although it is proba¬ ble that he was less ambitious of present renown, and especially of mere popu¬ larity, than most men of his calibre. His object, like that of his brother, Dr. William Hunter, appears to have been more remote, and to have been directed to posthumous celebrity. This probably arose from the habitual tendency of his mind to form grand conceptions, and to look forward to some remote but unde¬ fined period for their ultimate accom¬ plishment, and partly also, it may be ^resumed, from a consciousness that he jtad outstripped the age in which lie 794 COLLEGE OF PHYSICIANS — HUNTERIAN ORATION. lived, and which he therefore considered as incompetent to judge of his merits. This appears by his bequeathing1 his two great works (his Museum, and his work on Inflammation, the grand embo¬ diment of his experience and labours) to posterity ; trusting', in the manly confi¬ dence of his nature, that they would he justly appreciated after his death. He was not unaware of the impulse which his labours had already imparted to science, and hence he formed the con¬ clusion that a time would soon arrive when his pretensions would be estimated as they deserved. Perhaps his eag-er pursuit after knowledge was of the same nature as that of some men after wealth, which leaves them no time to enjoy it. Certain it is, that he spared no pains in completing' his Museum, and no labour in perfecting' his work on Inflamma¬ tion, although he left the one without a catalogue, and the other to be published after his death — a clear evidence of the noble kind of ambition by which he was animated. It appears to us that Mr. Ottley has too slightly passed over that part of his subject which at first may strike us as of most importance— namely, to mark the limit to which physiological know¬ ledge bad reached at the first outset of Mr. Hunter’s career, and then to trace the influence of his example and discoveries on the subsequent rapid ad¬ vancement of that science ; and also, that he has omitted to draw that large and ample sketch of Mr. Hunter’s genius, and to institute those parallels between him and other great men, which the case seems to have required. We believe, indeed we are assured, that these defects arose from a desire to limit the memoir to a reasonable size, and not from any oversight on his part. It must be evident that such objects could not have been attained without considerable amplification, and also that much accurate research would have been necessary, in order to adjust the respec¬ tive merits of physiological claimants, which could scarcely have been insti¬ tuted in a provincial town. We are in¬ formed, however, that the first of these omissions will be compensated by a preliminary dissertation to the fourth volume of the present edition, from the pen of Mr. Owen, and than whom, no one in this country, or perhaps in any other, is more competent to the task; and with regard to the second, we pro¬ pose ourselves, in a future notice of the work, to endeavour to supply the defi¬ ciency. MEDICAL GAZETTE. Saturday , February 18, 1837. “ Licet omnibus, licet etiam mihi, dignitatem Artis Meclicce tueri ; potestas modo veniendi in publicum sit, dicendi periculum non recuso.” Cicero. COLLEGE OF SURGEONS. HUNTERIAN ORATION. The re-opening of the College of Sur¬ geons at the present moment is an event of some interest and importance to the profession generally. The, building has been greatly enlarged, and in many respects better fitted for the accommo¬ dation of the great body of members. The library is a splendid room, which is to be open not only during the day, as formerly, but in the evening also three times a week. It contains 20,000 vo¬ lumes, which are rendered easily acces¬ sible by the attendance of an excellent librarian, and is altogether a very im¬ portant addition to the professional re¬ sources of the metropolis. But the principal improvement relates to the museum, to which a much more ex¬ tended space is allotted ; and many pre¬ parations which have long been buried in dust and gobwebs are once more per¬ mitted to “ revisit the glimpses of the moon,” or rather of the meridian sun, in which, thanks to the labours of Mr. Clift and Mr. Owen, they now shew to great advantage. The pathological por¬ tion of the collection is separated from the physiological, and the facilities of study are thus greatly increased. But still more important is the advance made in the Herculean labour of con¬ structing a catalogue raisonnee, which, in conjunction with the lectures about to COLLEGE OF PHYSICIANS — HUNTERIAN ORATION. 795 be delivered by Mr. Owen, in illustra¬ tion of the museum, will give a practi¬ cal value to the possession of this mag¬ nificent collection far greater than any which has hitherto been derived from it. Under any circumstances, then, the re-opening of the College, with such prospects, would have been an event of interest, hut it has been rendered doubly so by the changes which have taken place during the interval of its tempo¬ rary closure. It is evident that if the present government endure for but a few years, a struggle must take place between the present institu¬ tions and the rival one which is in embryo — the new University, in which the tripartite faculty of physic, surgery, and pharmacy, is to be attempt¬ ed, not in conjunction with the present Colleges and the Worshipful Society, but in direct opposition to them ; so that the old or the new must necessarily fall. Of the existing institutions connected with the medical profession, the College of Surgeons is in various respects by far the most important. The building is worthy of a great national establishment ; the library is a magnificent addition, which has grown up of late years; the museum is a monument worthy of the name it bears, and creditable to the na¬ tion. Nor do the names of many among* its present members reflect less honour upon English surgery than the greatest of their predecessors ; while of the existing Council it is but justice to add, that they have shewn their determina¬ tion to keep pace w ith the march of in¬ tellect and the improvements of the times. In these respects — we mean in setting aside ancient prejudices — in gathering wisdom from passing events — and in rendering their institution available to great national objects — we must say they have far outstript their elder brethren in Pall Mall, and accordingly are their character and in¬ fluence as a public body proportionally greater. It is in Lincoln’s Inn Fields that the battle between the new and old race of practitioners must be fought; and if we may judge from the number of members, and from the nature of the feelings manifested on Tuesday last, he will be a bold man who leads the forlorn hope in storming their citadel. But it was our intention merely to have given some account of the proceedings of Tuesday ; and to these we now turn. Never, probably, since the oration sacred to the genius of Hunter was first insti¬ tuted, has it excited more general in¬ terest ; indeed, the crowd was so great, that many were unable to procure ad¬ mission ; but this was unavoidable, as the members of the College are now so numerous that it is quite impossible for all of them to be accommodated at once. We understand, however, that by placing additional benches, and other arrangements, what in the language of the theatres is called “ sitting-room,” had been provided for considerably more than 500 persons. Among those present were the Duke of Wellington, Sir Robert Peel, Lord Stanley, 'the Bishop of London, the Lord Chief Justice Denman, the Presi¬ dent and Censors of the College of Phy¬ sicians, the Director-General of the Army Medical Department, the Physi¬ cian-General of the Navy, and many other distinguished visitors. On the entrance of Sir Robert Peel, the whole company rose and cheered him in the most enthusiastic manner, and a like compliment was paid to the Duke of Wellington, on his entering the theatre immediately afterwards. The same ani¬ mating scene was repeated on their leav¬ ing the room after the oration w as con¬ cluded ; and nothing could possibly ex- 796 THfe LATE M. DESGENETTES. ceed the warmth of the reception with which the presence of those distin¬ guished statesmen was hailed. On the orator of the day (Sir Benja¬ min Brodie) entering, he was greeted in a manner that must have been most gratifying to him — such, indeed, as the most callous man must have felt as a willing tribute of cordial and friendly feelings, on the part of the immense body of his professional brethren as¬ sembled on the occasion. Before com¬ mencing the oration, he stated that Sir Astley Cooper had been prevented, by sudden illness, from taking the chair as President; and the manner in which the compliment which he took the opportu¬ nity of paying to the character of his distinguished compeer, as “ the greatest of English surgeons,” was received, showed how true is the sentiment that laudari a laudato viro is the highest tribute which merit can receive. The oration was very interesting. It began with an allusion to the two friends, William Cullen and William Hunter, leaving’ the obscure village which was the field of their early career, to become pre-eminent in the capitals of Scotland and of England. The pro¬ gress of John Hunter, “ the raw un¬ couth Scotch lad,” from the idle ha¬ bits of his boyhood till he became the most industrious student and greatest philosopher since the days of Newton, was next rapidly sketched, and inter¬ spersed with numerous anecdotes and illustrations. The labours of Hewson, Cruikshank, Baillie, and Home, w'ere next successively spoken of. To Baillie the orator gave just and warm praise for his sagacity and skill, but above all for his surpassing disinterestedness, his entire abandonnement de soi in all his professional conduct. To Home, too, he hesitated not (despite the “ shade” which certain transactions of his latter years have cast upon his memory) to give the meed of praise which was due to some parts of his professional character. Lastly, he spoke of Sir William Blizard, whose habits and disposition he pourtrayed as those of chivalrous simplicity, and a conscientious but mis¬ taken love for all that belonged to a former age. Sir Benjamin concluded by some appropriate remarks addressed to the younger portion of his audience ; but neither of these, nor of any part of the address, do wre give more than a mere notice, because we understand that it will be published — w hen we shall have an opportunity of bringing it before our readers in a correct form. The oration was frequently interrupted by applause, and the whole scene was one which could not fail to be very gratifying to the friends of the College ; while it must have been gall and wormw ood to those who for the last three or four weeks have been labouring to produce a very different result. THE LATE M. DESGENETTES. This distinguished veteran died at Pa¬ ris, on the 4th instant, after a long and painful illness. A deputation from the Academy of Medicine attended his fu¬ neral, on which occasion several com¬ plimentary discourses were pronounced over his grave, according to the French fashion of doing honour to the dead. One of these eulogies was heard to pro¬ ceed from the “ voix enchanter esse''1 (as the Gazette des Hopitaux has it) of M. Pariset, another from the “noble et robuste organe ” of M. Broussais, and the third was marked “par V eloquence male'1'' of M. Bouillaud. In M. Desg’enettes the French have lost one of the most illustrious orna¬ ments of their medicine and their mili¬ tary renown. His name has long been distinguished in the page of history : it was widely known, and was popular in Egypt, in Syria, in Spain, in Russia, as well as in France. With a higher and better feeling than THE LATE M. DESGENETTES 797 Hippocrates, as some of his panegyrists have said, he bestowed his professional care indiscriminately on the sick of all nations; on the Turk as well as the Christian — on the inhabitants of the north as well as of the south. The tact with which he treated the moral as well as the physical evils inci¬ dent to suffering- human nature, was well exemplified by his memorable pro¬ ceeding' in Egypt. He there adopted a remedy for the plague, which acted as if by enchantment. The soldiers had become panic-struck on the appear¬ ance of the pestilential malady among them — their mental depression was ex¬ treme. The mortality was tremendous, and raged precisely in proportion to the despair which seized the victims. What was to be done ? How was confidence to be inspired ? The thought struck Des- genettes that there was but one way of safety. He went among the troops, and assured them that those hideous buboes were not infectious; and in proof of this, in the presence of the French army, inoculated himself with the plague. It was a daring expedient: rash and desperate, without being de¬ cisive; but it was the salvation of the soldiers. Their courage was restored, and the mortality immediately dimi¬ nished. The noble part which he played in Syria did him still greater honour. He refused to obey the inhuman mandate of Buonaparte, who sought by his means to rid himself of the sick at Jaffa. It was suggested that they should be despatched with opium. “ My art teaches me to save men, not to destroy them,” was the heroic answer of Desgenettes ; nor does his boldness seem to have lost him the favour of his master. For five and twenty years he was confidentially engaged about the person of Napoleon : from the rise of the victor in Italy to his setting at Waterloo, Desgenettes was with him in all his campaigns. In the memorable retreat from Russia, | Desgenettes was made prisoner ; but he ' proudly demanded his liberty, “ not as a boon, but as a right;” he appealed to the character of his profession, and in parti - . cular to the care which he had bestowed S indifferently on Russians as well as Frenchmen. An imperial ukase soon set him free. The Emperor Alexander made I; a special communication to him, and ex¬ pressed the high esteem which lie enter¬ tained for his character. The King of Sweden shortly after sent him the order of the Polar star. A similar tribute, it will be recollected, was paid to the merit of Baron Larrey, at Waterloo. This eminent surg’eon, and distinguished confrere of Des- g'enettes, was taken prisoner by the English in the retreat after the bat¬ tle; but he soon obtained his liberty through the same honourable feeling : he had been indefatigable in exerting his professional services in behalf of both English and French. Desgenettes was born at Alencon, in 1762, and educated chiefly at Paris. He visited this country about the year 1785, and enjoyed the friendship of Sir Samuel Romilly, Sir Joseph Banks, and all the eminent persons of the day. Mirabeau w'as in England at the same time, and it was here that Desgenettes made his acquaintance. After this he travelled a good deal in Italy, but returned in 1789, and graduated doctor in medicine at Montpellier. In 1793 he obtained an appointment in the Army of Italy ; and during the subsequent campaigns of Egypt and Syria was raised to the rank of Physician-General ( Metlecin en chef.) The professorship of Physique meflicale et (V Hygiene, in the Faculty of Paris, was bestowed on him in 1799. In the sweeping changes made in the profes¬ sorships under the Frassinous admini¬ stration, in 1822, Desgenettes, along* W'itb Chaussier, Dubois, Pinel, and Vauquelin, were ousted from their chairs ; but Desgenettes was reinstated some years since, and retained the of¬ fice till his death. The character of his mind was that of sterling good sense and sagacity. His sturdy independence and liberality of sentiment were also generally appre¬ ciated. As a teacher, he was clear and systematic ; and his lectures abounded with original and striking’ views. As a speaker, his manner was familiar, and to the point ; in discussion, particularly in the Academy of Medicine, he has always displayed a ready command of reasoning power, combined with an animated elo¬ cution. He wrote several things; such as the Analysis of the Absorbent and Lympha¬ tic System, and his Medical History of the Army of the East; but his life was rather spent in action than in study, although the business of the camp did not prevent him from reading 798 ROYAL MEDICAL AND CHIRURGICAL SOCIETY. much, and of gathering' from books a solid erudition, which he always knew how to use with discrimination. ROYAL MEDICAL AND CHIRUR¬ GICAL SOCIETY. Tuesday, February 14, 1837. Mr. Earle, President, in the Chair. There were three papers read this even¬ ing. The first was— , On the Constitutional Treatment of Exostosis with Mercury ; conjointly written by F. C. Skev, Esq,, Assistant-Surgeon to St. Bartholomew’s Hospital, and Dr. Bostock, F.R.S. The author (Mr. Skey) detailed the particulars of a case under his care in St. Bartholomew’s Hospital, which had been treated by mercurial inunction. The disease occupied the upper part of one humerus, where it formed a considera¬ ble tumor, and likewise the region of each knee, bony growths being apparent from both femur and tibia. The subject was a young woman, in every other respect appa¬ rently healthy. The author stated that the tumor had progressed very apparently up to the period of his application of the above treatment, from which date the bony enlargements ceased to extend, and that by perseverance in the remedy there was some reason to hope that a positive dimi¬ nution in the general mass of the diseased growth had occurred. This he inferred from the cessation of a degree of numbness in the hand of the affected limb, which had been occasioned bv the pressure of the tumor on the brachial nerves, below the axilla. Mr. S. also stated that the treatment of exostoses by mercury was not new, and that he had employed it without any sanguine hope of advantage to be derived from it; he had resorted to it, not with the view to obtain absorption by its local application to each tumor, but by its general influence on the arterial system. During the treatment of the above case, the urine of the patient was analysed by Dr. Bostock, and was found to deviate far from the standard of health. It ap¬ peared from the interesting statement of Dr. B., that the specific gravity of the urine was, on his first examination, as low as 1005, (we understood) and that it was deficient in phosphatic salts, and in gene¬ ral solid contents, prior to the treatment by mercury, and that it approached the healthy standard, containing more solid matter, and rising in specific gravity, as the patient’s constitution became influ¬ enced by the remedy. When the applica¬ tion of the medicine was suspended, the urine again relapsed into its morbid state, and again improved when the mercurial inunction was resorted to. Dr. B. was not aware whether this condition of urine was a general attendant on the formation of the disease under consideration, but that under all circumstances it would form an interesting subject for inquiry, and for chemical investigation. Mr. B. Phillips washed to know whe¬ ther the exostosis mentioned in the case might not possibly be connected with a syphilitic taint in the system, which would account, perhaps, for the efficacy of the mercury. The President said, that in the ab¬ sence of Mr. Skey, he would answer the question which had just been asked, and with the less hesitation, as the case had originally been under his own care. The patient, he was confident, was free from any venereal taint; she was a strictly vir¬ tuous young woman, and, he had no doubt, was perfectly pure and chaste. He could add also, with fegard to the ap¬ parent malignity of the disease, that he and his colleagues, at St. Bartholomew’s, were unanimous as to the propriety of operating for removal of the exostosis, and only awaited the permission of the girl and her parents to carry the operation, should it prove necessary, to the extent even of disarticulating the shoulder. About this time, however, the dresser who had charge of the case discovered that there were other similar tumors in divers parts of the body ; upon which the idea of em¬ ploying the knife was abandoned. It was then that Mr. Skey came into possession of the case, and treated it with so much success. He (Mr. Earle) thought the ob¬ servations on the urine were very judicious and valuable. Mr. Arnott protested against the sup¬ position that it was a new thing to use mer¬ cury successfully in non— syphilitic exosto¬ sis. For his part, he had been in the habit, for some time, of noticing the practice in his lectures, and wras familiarly acquainted for years with the imputed efficacy of the remedy. He had even seen cases cured in this manner; but he added (in reply to a question from Mr. Earle), that no obser¬ vation had been made as to changes in the urine. Dr. Copland was surprised that there should be any doubt as to the alleged effi¬ cacy of mercury in cases where there was no venereal taint. 'There w’as certainly no novelty in the practice ; it wras at least as old as the time of Van Swieten, who used to give corrosive sublimate, in a tonic tincture or mixture, for the discussion of tumors of the bones. He (Dr. C.), how¬ ever, was not very sanguine as to the TREATMENT OF HERNIA. 799 certain success of such treatment. He had at present under his care a lady, hav¬ ing an exostosis, the size of a walnut, on the os frontis, and neither mercury nor iodine had any effect upon it. As to the changes produced in the urine, in Mr. Skey’s case, he could not but withhold his assent to the supposition that they origi¬ nated in the medicine merely, until he should be fully informed as to the nature of the ingest a, in the shape of food and drink, taken daily by the patient ; also as to the time of day at which the urine was voided, and in what quantity it was passed. Dr. Weatheehead also expressed some doubts as to the changes said to have been effected in the urine. After this, a short paper on a Case of Osteosarcoma, by Mr. Lawrence, was read ; but no discussion followed. And in conclusion, an anonymous paper was introduced to the notice of the Society. The author, it appeared, was anxious to have it read, but discreetly declined giving his name. The President put it to the meeting whether they would permit the paner to be read. It was unusual to bring for¬ ward anonymous communications ; but the Secretary, Mr. Partridge, had been entrusted with the author’s name in con¬ fidence. Leave being granted, the paper proved to be a lengthy and very stupid essay On Small-Pox, in which the notable idea was started, that in the disease in question there is great excitability of the system, but the remedy is in our power, — small doses (homoeopathic ?) of tartarized anti¬ mony ! The announcement of this fact (which constituted the substance of what the author had to say) was given in so prosy and verbose a form, that the pa¬ tience of the hearers was soon exhausted, and many left the room. ROYAL INSTITUTION. Friday, Feb. 10, 1837. Dr. Ritchie on the Velocity of Sound. Some expectations were raised that this | would be an interesting lecture : the sub¬ ject seemed to promise favourably, and an I account of new facts and experiments was i anticipated. But we must say that Dr. Ritchie made any thing but a popular ! lecture of it : he began bv announcing Newton’s theory of the propagation of i sound, and then told us of the number of : eminent philosophers, Euler, Laplace, Herschell, &,c., who were opposed to that theory. He, Dr. Ritchie, considered that Newton was right, and all the others wrong; and accordingly undertook to de¬ fend the Newtonian hypothesis, and refute that of the anti-Newtonians forthwith. But what with the needless display of ma¬ thematical symbols, chiefly from the inte¬ gral calculus, and the eternal reference to the chalk and black board, with which the Dr. is so familiar, the audience were far more confused in their ideas of the sub¬ ject at the end of the hour than at the beginning of it. We have no idea of attempting to give an analysis of Dr. R.’s views; it were a hopeless task, and pro¬ bably as useless as hopeless. Common sense surely ought to have dictated to any lecturer how such a subject as the velocity of sound might be made both interesting and instructive to a mixed assemblage : we say nothing of the ladies, who evi¬ dently expected something of a musical treat. TREATMENT OF HERNIA. Hernta is of such frequent occurrence, that every hint for its palliative or curative treatment deserves to be promulgated. The application of cupping-glasses, or dry¬ cupping, to facilitate the taxis, has been recommended. How this application acts has not been ascertained ; it is said to be most serviceable when the hernia is small, the cupping- glass being large enough to cover the tumor ; but the treatment has been had recourse to with good effect even in large herniae. The plan of Gerdy for radically curing diseases of this class has been tried with fresh modifications by several surgeons, and is represented to have answered well in small hernias : ex¬ periments have likewise been made by Belmas, in support of the same practice. The most recent proposal for the radical cure of hernia is the employment of a firm wooden block (in the place of the usual soft pad) with the truss ; and a most ex¬ cellent report upon the subject has been drawn up by Dr. Reynell Coates and other American surgeons. In reference to opera¬ tions in this branch of pathology, it occurs to me to mention, that a pound and a half of irreducible omentum has been removed; the very thickened sac of a strangulated umbilical hernia cut away after exposure and reduction of the intestine; the un¬ opened sac of a navel rupture removed by ligature, in more than one instance, after Dessault’s method : all said to have been felicitously done. A hernia formed solely of the appendix vermiformis, which was found enlarged to four times its natural bulk, produced most of the usual signs of strangulation, and required the opera¬ tion. — Mr. Crosse's Retrospective Address. 800 BILLS OF MORTALITY. - METEOROLOGICAL JOURNAL MR. S. COOPER and MR. LISTON. In consequence of a letter in the Lancet of last week, representing it to be the wish of the students at University College that Mr. Liston should be associated with Mr. S. Cooper in the Chair of Surgery, a meeting of the gentlemen attending the lectures alluded to took place on the 15th, at which a resolution denying the truth of the assertions, and strongly disapprov¬ ing of the sentiments expressed by the anonymous advocate of Mr. Liston, was unanimously passed. Mr. Cooper’s theatre on Wednesday evening was crowded to overflowing, and he was received in such manner as to shew that he had lost none of his well deserved popularity. From the nature of the address which he made at the close of his lecture to the assembled students, it is quite clear that the plan of forcing a colleague upon him has no chance of success. To use his own words, the chair is not large enough to hold them both, and — if Mr. Liston once got into it, there would be no room for him. George Jones, Birmingham. George Evan Evans, Tiverton. James Probert, Lydbrook, Gloucestershire. Edward William Holland, Emsworth, Hants. Arthur William Franklin, Wincanton, Somerset. Thomas Blanchard, Sunderland. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Feb. 14, 1837. Abscess . . 3 Age and Debility . 99 Apoplexy . . 6 Asthma . . 68 Cancer . . 1 Childbirth . . 2 Consumption . 102 Convulsions . 30 Croup . . . 1 Dentition or Teething1 7 Dropsy , . 19 Dropsy in the Brain 12 Epilepsy . . 1 Erysipelas , . 1 Fever ... 8 Fever, Scarlet . 1 Fever, Typhus . 1 Hooping Cough . 12 Inflammation . 56 Bowels & Stomach 2 Brain . . 3 Lungs and Pleura 13 Influenza . • 35 Insanity . . 8 Liver, diseased . 2 Locked Jaw . 1 Measles . . 6 Mortification . 3 Paralysis . . 3 Small-pox • • 2 Thrush . . 2 Tumor . . 3 Unknown Causes 38 Casualties • 7 Decrease of Burials, as compared with > the preceding week . . 1 PROFESSORSHIP OF ZOOLOGY IN KING’S COLLEGE. Mr. Rennie having been under the ne¬ cessity of resigning the professorship of Zoology, Mr. Thomas Bell, the distin¬ guished naturalist, has been appointed to the vacated chair. This is decidedly a good hit on the part of the College. THE LATE DR. E. TURNER. We regret to announce the death of Dr Turner, Professor of Chemistry in Uni¬ versity College. A more able teacher, or one of higher character as a chemist, will not readily be found as a successor. He had been in a declining state for a considerable time. His funeral, which is to take place this day, at the Kensal Green Cemetery, Harrow Road, will be attended, we understand, by a procession of the students. APOTHECARIES’ HALL. LIST OF GENTLEMEN WHO HAVE RECEIVED CERTIFICATES. February 16, 1837. Richard Gardiner Jay, Badley, Suffolk. Thomas Neats Moody, Woolwich. John Morgan, Bath. James George Tatem, High Wycombe, Bucks. METEOROLOGIC AL JOURNAL. Kept at Edmonton, Latitude 51° 37' 32" N. Longitude 0° 3' 51" W. of Greenwich. Feb. 1837. Thermometer. Barometer. Thursday. 2 from 36 to 46 30-15 to 30 22 Friday . . 3 34 45 30 22 30-28 Saturday . 4 25 39 30 28 30-25 Sunday . . 5 29 38 30-25 30 24 Monday . . 6 21 34 3025 30-24 Tuesday . . 7 22 34 30-20 30-16 Wednesday 8 24 45 30 09 Stat. Thursday . 9 from 36 to 49 30-10 to 30 00 Friday. . . 10 41 51 2991 29.67 Saturday . 1 1 44 49 29-48 29 08 Sunday . . 12 31 45 29 35 29-38 Monday . . 13 34 51 29-18 29-23 Tuesday * 14 29 47 29-25 29-64 Wednesday 15 23 45 29-88 30-00 Winds S.E. and S.W. Except the 4th, 6th, and 7th, generally cloudy, with frequent and heavy showers of rain. Hail on the afternoon of the 12th. Rain fallen, 1 inch and *075 of an inch. Charles Henry Adams. Erratum. — In Mr. Hutchinson’s paper, last number, at p. 741, 1. 22 , for “ compa¬ rative variety of these cases,” read “ com¬ parative rarity of these cases.” Wilson & Son, Printers, 57,Skinner«St. London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOTONIAL OF iHetitnnf anti tl)t Collateral ^rtrmesf* SATURDAY, FEBRUARY 25, 1837. LE CTURE S ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine, By William Cummin, M.D. Lecture XXII. Infanticide concluded. Summary of the signs of respiration and non-respiration — 2. Whether the infant died a natural or a violent death? — Appearances indicative of Natural Death — Diseases of the new-horn child, congenital and acquired — Atelectasis — Signs of Violent Death — Strangulation — Suffocation — Drowning — Fractures of the Shull — may occur accidentally at birth — or during uterine life — Cases in illustration — Wringing the neck — Wounds, whether inflicted before or after death — Detruncation — Burning — Poisoning. — Question of death from omit¬ ting to tie the funis — Fxposure — Conclusion, with a summary of the signs of Natural and Violent Death. In the last lecture I completed my re¬ view of the tests by which the fact of re¬ spiration or non-respiration is usually as¬ certained. Before proceeding to the second important question involved in inquiries respecting infanticide, it will perhaps be useful to sum up, in a general wray, the 1 signs by which we are led to conclude i whether or not the infant ever breathed, or, if the former, whether respiration took place perfectly or imperfectly. This enu¬ meration of the signs cannot fail to revive ‘ your recollection of the several tests, and I the modes of applying them. Signs of non respiration. — The appear¬ ances of uterine putridity would of course be decisive; but putting these out of the question, and taking the more ordinary circumstances occurring in practice for 482.— xix. our data, wre conclude that an infant has not respired, 1. When the form of the chest is flattish and contracted ; 2. When the lungs are seen to occupy but a small portion of the chest, and the diaphragm is remarkably convex ; 3. When the colour of the lungs is a dark liver tint, and their texture dense and compact, with sharp edges ; 4. When the lungs are not above a fiftieth of the weight of the body; 5. When, immersed in water, wholly and in part, they sink — not being putrid, or diseased ; facts which observation can readily determine ; 6 When the foramen ovale of the heart, and the arterial duct, have evidently un¬ dergone no change — the latter being cylin¬ drical in shape, and in calibre nearly equalling the pulmonary artery; and 7. When, in addition, there are none of those signs present which would indicate some continuance of life after birth — such as incipient inflammation about the root of the umbilical cord, or the intestines void of meconium. Signs of respiration. — The ease is clear where those signs are present which ob¬ viously show that life subsisted for some hours, and consequently that breathing must have been established ; but we should say, with confidence, that an infant has respired — 1. When the chest is full, and arched externally; 2. When, on opening the chest, the dia¬ phragm is not strikingly convex, but the lungs are voluminous, of a bright red or pinkish colour, and crepitous to the touch ; 3. When the lungs, heart, and thymus, taken together, swim in water, and all the fragments of the lungs float, even though strongly compressed by the fingers under water, and persist in floating, though re¬ duced to the minutest fragments; 4. When the arterial duct appears to be 3 F 802 DR. CUMMIN ON FORENSIC MEDICINE. diminished in size, and perhaps altered in shape, being conical towards the aorta ; and 5. When, in addition, the meconium is found to have been expelled, and certain changes have begun about the umbilicus, conclusive of the fact of some survival of the birth. Signs of partial respiration. — Unless there be reason to believe that the lungs have been artificially inflated, we may infer that an infant has partially or imperfectly breath¬ ed, from the following circumstances: — 1. That the lungs are but partially ex¬ panded, not filling as much space as they usually occupy in the chest ; 2. That the colour of the lungs is not uniform, part being of a dark red or cho¬ colate hue, and part of a lighter or pinkish tint; the latter portions at the same time vesicular and crepitous, while the former are dense ; 3. That at least some portions of the lungs float in water, though strongly com¬ pressed between the fingers previous to their immersion ; 4. That the arterial duct is found to be somewhat altered, at least in shape, if not in size ; 5. And that there is no marked appear¬ ance of any vital process having begun about the root of the umbilical cord. So much for the proofs of live birth required on trials for infanticide We shall now proceed to the second and more especial inquiry connected with our sub¬ ject,— 2. Did the Infant die a natural or a violent Death ? Supposing the fact of respiration, or of live-birth, to be determined, there still re¬ mains a most material question to be de¬ cided— namely, whether the infant’s death resulted from violence ? Unless this can be established in the affirmative, the charge of infanticide must be held to be unfounded. (a.) Question of Natural Death. Humanity suggests that before entering on an investigation of the proofs of mur¬ der, we should first be satisfied as to whe¬ ther the infant might not have died a natural death. There will, of course, be a strong pre¬ sumption in favour of this supposition, when there is a total absence of marks of violence on the body. Rut such a conclu¬ sion ought to be founded on a strict and minute search: for wounds of a deadly kind have sometimes been so ingeniously inflicted as to escape discovery on a moderately careful examination : of this, however, we shall have something further to say presently. 1 . From feebleness. — The infant may have perished from feebleness. The labour may have been tedious and severe, and the child, consequently, though born alive, may have sunk through exhaustion. Of the probability of this, we must judge from the circumstances. Are there marks of a difficult birth on the infant? — the allega¬ tion of a tedious labour is admissible. Does the infant, judging from principles already laid down, appear to have been immature? — the plea that it perished through exhaustion and debility is a fair and may be a valid one. 2. From congenital disease. — An infant in the womb may labour under certain dis¬ eases, which possibly may become aggra¬ vated at birth, and cause death soon after. Where this is supposed to be the case, the medico-legal examiner must exercise his skill in appreciating the morbid appear¬ ances which may be present : and he will not only have to satisfy himself of the actual presence of disease, but of disease arrived at such a height as to occasion death. We shall briefly notice the chief maladies found to affect the new-born infant. (a.) In the head. — Hydrocephalus may exist in different degrees of intensity : the fluid may be simply effused into the cavity of the arachnoid membrane, with¬ out influencing in any manner the sub¬ stance of the brain itself: or, in addition to the effusion into the arachnoid, some may have made its way into the ventricles ; in either of these cases life is not necessa¬ rily compromised; the infant, unless there be some other obstacle to its surviving, or the lymph poured out be present in very large quantity, can scarcely be sup¬ posed to perish immediately after birth, from either of these causes. But sup¬ pose the quantity and quality of the serous fluid such as manifestly to have interfered with the development of the brain, — this must be equivalent to an incapacity to live, and in the absence of signs of violence may be considered as having led to natural death. In its ordinary state the infant brain is very soft, and the w'hite substance is compara¬ tively more vascular, or richly supplied with blood-vessels, than in the adult. This fact is worth remembering in medico-legal examinations. A morbid softness of the infant brain is characterized by an almost semi-fluid condition of the parts, of a yel¬ lowish, sometimes a blood-stained colour, and having a foetid odour, resembling that of sulphuretted hydrogen. The same sort of softening is sometimes observed in the spinal marrow: and this state is generally accompanied by extensive marks of dis¬ ease in other organs of the body. (b.) In the Lungs. — When mentioning the QUESTION OF VIOLENCE. 803 objections sometimes urged to the hydro¬ static test, the existence of certain diseases of the lungs was alluded to. There may be tubercles found in those organs in a con¬ siderably advanced state: but this will rarely constitute a cause of death soon after birth. Not so with engorgement of the lungs. An infant, to all appearance, may be well formed in every respect, and ma¬ turely born : yet it dies immediately after birth, though the delivery may have been easy. The lungs will here most probably be found very voluminous, but gorged with a colourless serous fluid preventing respiration. Sometimes the lungs are, wholly or in part, filled with sanguineous fluid; they are generally at the same time flaccid, and of a granular texture. Hepatization of the lungs is not uncom¬ mon in new-born infauts: it is supposed to be the result of inflammation during uterine life. The pulmonary tissue is hard and compact, heavy, sinking speedily in water, and not imparting any consider¬ able colour to that fluid when left im¬ mersed in it. In short, the lung in this condition strongly resembles the liver: nor is it in general difficult to distinguish such a state of the organ from its natural state, either before or after respiration. There is a disease described by Dr. E. Jorg, of Leipzig, which it is important here to notice. It is a morbid condition of the lungs of new-born infants which may lead to their speedy death. It results from the imperfect manner in which re¬ spiration is performed after birth, a part only of the lungs being filled with air, the remaining part sloughing or becoming he- patized, or otherwise diseased. This state of the lungs Dr. Jorg has denominated Atelectasis (from aTeA)/y, incomplete , and eKTacris, extension or expansion) ; and he con¬ ceives it to originate in the too rapid and easy delivery of the mother. It is the opinion of this physician, that a slow and rather difficult labour is a process salutary at least to the child ; that during the suc¬ cessive stages the foetus is gradually de¬ prived of its dependence on the placenta, so that when ultimately sent into the world it is in a state nearly resembling that of asphyxia in the adult, and is thus under a powerful necessity to breathe. Children, in other respects of a healthy ap¬ pearance, are often observed to be weak and unexciteable after what is commonly called a lucky labour; their extremities hang flac¬ cid and powerless, and their cry (if they cry at all) is feeble and whimpering. Such infants sometimes perish, notwithstanding all the efforts that may be made to revive them, and the lungs are then found in the equivocal condition just now alluded to *. * Die Ftituslunge im gebornen Kinde, geschil- dert von Dr. Eow. Joerg. Griinma, 1835. Without entering into any discussion of the physiology or pathology of Dr. Jorg, I have no hesitation in giving full credit to the correctness of his observations. To the medical jurist it is obviously of great importance that the symptoms and ap¬ pearances of atelectasis should be readily recognized when present; for they not only indicate imperfect respiration, but in many instances non-viability , or incapacity for continuing to live — a condition in which no proofs of infanticide, short of the most direct and conclusive, should be sufficient to sustain the charge. It is worth remarking, that the mucous membrane of the trachea and bronchia is often found red in new-born infants, that the pleura is occasionally injected, and the pericardium not unfrequently contains a lemon-coloured serum. (c.) In the Abdomen. — The stomach and intestines, as well as the oesophagus, some¬ times present appearances which betoken the existence of disease anterior to birth. Certain marks of inflammation in the oesophagus might even be mistaken for the effects of a ligature applied externally before death, were there other reasons for suspecting that strangulation were at¬ tempted. In the stomach, also, it deserves to be noted, ulcerations have been observ¬ ed, attended with ruddy or dark-coloured discharges, which might easily give rise to suspicion of poisoning. Such are the principal morbid appear¬ ances which might induce the medical ex¬ aminer to form an opinion relative to the probable occurrence of natural death. It is scarcely necessary to add how much it behoves him to be scrupulous in his infe¬ rences, and to recollect that his pathologi¬ cal inquiries may be the means of saving the life of the accused. We now come to consider the (b.) Question of Violence. There are many ways of destroying the new-born infant; yet the methods usually adopted are not numerous, the deliberate murderer generally taking care to leave as few marks of injury as possible. The mode most commonly had recourse to is — Strangulation.— It will be kept in mind, that in considering the question of violence offered to the new-born infant, we suppose the fact of respiration already established, and that the child had begun to have an independent existence. The signs, there¬ fore, of the present mode of death must be expected to resemble those indicative of strangulation in the adult, but of course in a less strongly marked form, in conse¬ quence of the diminutive size of the parts affected. It were premature here to give a detailed description of the appearances characteristic of death by strangulation : 804 DR. CUMMIN ON FORENSIC MEDICINE. but it may be stated, in general, that the gorged condition of the lungs, and of the right side of the heart, filled with dark- coloured blood, may almost always be ob¬ served. But the outward signs— will there al¬ ways be some mark of ligature or pressure on the neck ? This is a point upon which much has been said by modern authorities. It wras thought, and therefore fairly ob¬ jected, that marks on the neck, resembling those produced by wilful violence, might be owing to the compression exerted by the mouth of the uterus during labour, or to the umbilical cord encircling the child’s throat. But experience contradicts such an hypo¬ thesis. An eminent German authority (Klein), whose opinion on the subject, founded on very extensive observation and experience, is now generally adopted by the most distinguished medical jurists, thus expresses himself on the point “ I have never met with an instance of marks of injury of the kind supposed — ecchy- moses or sugillations — produced by the orifice of the uterus, or by the umbilical cord, although I have known a great num¬ ber of cases in which the neck of the in¬ fant had been strongly girded by the funis once or twice twisted round it, strangula¬ tion having thus been either actually pro¬ duced, or rendered most palpably immi¬ nent.” He then goes on to speak quite as decidedly regarding the pressure of the neck of the uterus ; not a bruise, as he tells us, nor mark of any kind, being left on the infant which has perished in this way. We are indebted to the same authority, as well as subsequently to M. Esquirol and others, for a knowledge of the important medico-legal fact, that, even in the adult, strangulation by suspension may be effect¬ ed in many instances without leaving any appearance whatever of a depression, at¬ tended with the least ecchymosis or livi- dity, on the part of the neck to which the ligature has been applied. When, however, certain appearances in¬ dicating violence are observed on the neck of a new-born infant, we should satisfy ourselves respecting their nature : whether they are the marks of fingers, or of a cord used for murderous purposes. We should scrutinize well the form and position of these marks, and note whether they seem to have been principally directed to the compression of the air-passages. Whether pressure has been exercised on the parts during life, or after death, is only to be determined by the appearance of an effusion of blood into the subcutaneous tissue, which is usually met with in the former case. The following is M. Orlila’s summary of the signs of strangulation in the new¬ born : — 1. That a circular mark round the neck, with a corresponding effusion into the subjacent cellular tissue, indicates strangulation during life. 2. That though it be impossible to deny that this mark was produced by the orifice of the uterus, or the umbilical cord, yet since no well- authenticated case warrants us in admit¬ ting it, it is a natural supposition that the mark in question is the result of criminal violence. 3. That if this mark be com¬ bined with appearances denoting that re¬ spiration had been previously completely established, our inference must be so much the stronger ; for stricture by the neck of the uterus, or by the funis, cannot be sup¬ posed to have proved fatal with such ap¬ pearances. 4. That dark spots on the neck, without corresponding subcutaneous effusion, do not warrant the conclusion that the infant was strangled ; but, 5. That, on the other hand, neither does the absence of such spots, or such effusion, or of both together, strictly authorize us to conclude that strangulation did not take place. Suffocation — Drowning. — Considerable difficulty may sometimes attend the inves¬ tigation of death by suffocation. But the circumstances of the case will, in general, throw much light upon it. A child, for instance, may be suffocated after birth by smothering in the bed clothes; by the face falling into the mother’s discharges; or b_y being accidentally dropped into a privy or a night-chair : such accidents are not rare, nor perhaps, in general, will they present any intricacy to the medical jurist. Smothering in the bed-clothes, however, is an accident which, in suspected cases, there is no possibility of distinguishing from the same kind of death produced design¬ edly. There is not (in the opinion of an eminent northern critic*) a more easy, effectual, or secret mode of committing child-murder, than this; but fortunately it is hardly ever resorted to; for here, as in most cases of homicide, a great deal more mischief is done than is necessary to effect the purpose in view7. Where substances have been found thrust into the back part of the mouth, with the apparent object of causing suffo¬ cation, it is important to determine whether they have been introduced before or after death. When the former is the case, there are generally marked appear¬ ances of congestion about the fauces. Sup¬ pose a plug or pledget of linen cloth pushed into the pharynx, it must exercise compression on the parts, in proportion to the force employed in introducing it. Hence a peculiar appearance of the mu¬ cous membrane— a difference of colour in the situation of the fore and back part of the plug: the membrane is white, and destitute of its natural quantity of blood, * Edinburgh Medical and Surgical Journal. QUESTION OF VIOLENCE. 805 where the compression has been greatest — that is, in the farthest situation ; whereas, anterior to this, it is red or violet-coloured, thickened, and swollen. Drowning in the discharges, or other fluids, may be recognized by the ordinary signs of death by drowning, together with the peculiar appearance of the contents of the mouth, gullet, stomach, and air-pas¬ sages. . It is not necessary that we should here enter into a detail of the signs of death by drowning : the discussion of that sub¬ ject will be more appropriately entered upon hereafter. Let it suffice at pre¬ sent, that on dissection the lungs and right side of the heart are generally found full of blood, the brain will probably be congested, and in the air-passages a watery froth will be perceived. This last sign is not always present; but when it is, it indicates unquestionably the fact of death by submersion. Also the presence of fluid in the stomach, of the same kind as that in which the body has been found, is a strong proof that degluti¬ tion was effected, and therefore that the infant was still living when submerged. Fractures, blows, and wounds . - — Infants have frequently been found with extensive fractures of the skull, such as to raise the strongest possible suspicion that murder¬ ous violence had been employed. But in such cases it has commonly been alleged that the fractures were the result of acci¬ dental injury — the child, for example, hav¬ ing been expelled from the mother by a sudden labour pain. The late M. Chaussier made a series of experiments to determine whether falls of this description were capable of causing the serious injuries referred to. Fifteen still-born children were allowed to fall perpendicularly, and head foremost, from a height of eighteen inches, on a paved floor. In twelve of them one or other of the parietal bones was broken. When the height was three feet and upwards, the fractures were pro- portionably greater. In an interesting trial for infanticide which took place at New York a few years since,* the principal question was, whether a severe fracture of the skull, causing the death of the child, might not have occurred accidentally at delivery. The accused was a young woman of colour, who endeavoured to conceal the fact of her having given birth to a child: but its body was soon found. “ The body,” as was stated in the evidence at the inquest, “ was that of a full-grown male child, which had breathed, i and no external marks of violence were I visible about it, excepting some effusion * American Journal of Med. Sciences, Feb. i 1836 j and Med. Gaz., vol. xviii. p. 41. of blood, partly, fluid and partly coagulated, under the scalp covering the frontal bones, The parietal bones were both fractured, the left in three places, (fig. 31, 1, 3, 4.) Fig. 31. radiating from a central point, the right in one (2) which was evidently a continua¬ tion of the middle fracture crossing the ver¬ tex.” Opinions were divided as to the manner in which this injury was produced ; one or two of the medical witnesses thought that it was the result of a blow inflicted wuth a stick or some hard substance, but admitted the possibility of its being caused by a fall from the mother on the frozen ground. Others testified to the probable truth of the prisoner’s statement, that she was delivered suddenly, standing in the barn yard, and that the child dropped from her on the frozen gravelly soil : the fractures, too, it w7as argued, were in the very place where wre might expect to find them, had they resulted from such an acci¬ dent. The court and jury seemed to be satisfied with this view of the case, and the prisoner w7as acquitted. Thus it would seem to be satisfactorily shown that, in sudden labours, fatal injury may befal the child from the accident of its dropping from the mother. But it should be mentioned that experience does not al¬ ways warrant this conclusion. Dr. Klein, just now quoted, availed himself of the opportunity he possessed, by his official station in the kingdom of Wirtemberg, to procure returns of all such labours occur¬ ring w'ithin his jurisdiction. The result wras, 183 well authenticated cases, in 150 of which the mothers wrere suddenly deli¬ vered standing ; yet there was not a single case of death among them, nor of fracture of the skull, or other mischief happening to the infant; though some of the children had fallen on bare boards, and some on the part:. The reason of the difference between the experiments and those cases occurring in nature is supposed to be, that in the latter the direction in which the body of the infant is projected is. oblique, and 806 DR. CUMMIN ON FORENSIC MEDICINE the fall is not so instantaneous as in the experimental essay. We cannot, however, deny the possibility of fracture thus occurring during a natural labour. In connexion with this subject it ought to be mentioned, that M. Chaussier made some further observations, to show the dif¬ ference between fractures caused by acci¬ dental falls, or during labour, and those produced by violence. The chief differ¬ ences are, that where wilful violence has been employed, the injuries will most likely be found much more numerous and extensive — for the murderer generally goes on striking till the child expires ; and fractures and bruises in this case will com¬ monly be found in parts of the head where the accidents alluded to could not possibly produce them ; for example, the bones of the face may be found fractured, or the frontal and occipital bones, or even the base of the skull itself. I have alluded to the possibility of frac¬ tures of the head occurring during labour. It should be stated, that there is authority for asserting that such fractures may be caused by pressure, or by the violent con¬ traction of the uterus during parturition ; nay, there are well-authenticated cases on record, of children coming into the world with fractures of the skull, which must have happened during uterine life. In an able essay recently published by Dr. Schworer, professor of midwifery at Frei¬ burg*, we have an account of nine such cases, eight of them happening wdthin the experience of Schmitt, Jorg, Siebold, and others ; the ninth in the author’s own prac¬ tice. Schmitt met with two cases ; the first was one in which, from the fall of a drunken husband, his head striking the belly of his wife four weeks before delivery, the skull of the foetus was fractured : the child was born alive notwithstanding, though it soon died ; but, as Dr. Schmitt observes, had it been born elsewhere than in the Lying- in Hospital, or under circumstances of concealment, the suspicion might have been readily formed that it was destroyed deliberately., In Schmitt’s second case, the left parietal bone was fractured during labour, in consequence of the arm coming down while the head was being expelled. Meissner relates a case which happened in Jorg’s clinique, where two fissures of the skull were occasioned during labour ; and in Siebold’s practice the left parietal was se¬ verely fractured, the labour being extremely difficult, attended with convulsions, without any possibility of employing instruments. In the case which occurred to Dr. Schwo- rer, and which gave rise to his clever dis- * Beitrage zur Lehre von dem Thatbestande des Kindermordes uberhaupt, und den nngewis- sen Todesarteu neugeborner Kinder insbeaondere. Von Dr. J. Schworer. Freiburg, 1836. Sertation, the woman was delivered by the efforts of nature alone, in the Lying-in Hospital of Freiburg. She was subject to hysterical fits, and about four weeks before labour had a fall out of bed during a pa¬ roxysm : to this accident the injury found on the child’s head at birth was attributed. A large ecchymosis w7as observed over the right parietal bone, corresponding to a fracture in the part to the extent of about an inch. The child never breathed, though its movements shewed that it was alive at birth. There is a species of violence wffiich kills an infant at once, and yet may elude the ob¬ servation of a moderately diligent exa¬ miner ; namely, the effect of twisting the head on the vertebral column. Here there would pro¬ bably be not the slightest external mark to engage the attention of the medical jurist, nor would the loose moveable condition of the neck form any better guide, — for this is common to all new-born children, espe¬ cially when the weather is not very cold. The only practical caution that can be given on this point is, that an opportunity of inspecting the internal state of the upper part of the neck ought never to be neglected. The wounds inflicted on the new-born infant, for murderous purposes, are gene¬ rally confined to the head and neck. Punctures, however, of the heart have been detected, as well as similar injuries done to the head. The story in the Causes celebres of the diabolical French mid¬ wife, who used to despatch her victims by thrusting a long needle into the fon- tanelle as soon as it presented, is well know7n. In cases of detected punc¬ ture, the wound should be carefully traced in all its extent, w7hen it will be generally found that it widens as it departs from the surface, the murderer employing a rotatory motion of the instrument, the more effectually to accomplish the purpose intended. A very important inquiry respecting blow7s and w ounds is, whether they w7ere inflicted before or after death ; nor must it be denied, that there is considerable diffi¬ culty, if not an utter impossibility, to decide the question — w7hen, especially, there is reason to suppose that the injuries were inflicted soon after death ; for then there will be little or no appreciable dif¬ ference between such injuries and those done a short time before. But suppose the wounds produced some hours before death, there ought then certainly to be decided appearances present ; sw’elling and redness, for instance, — and still more marked phe¬ nomena, if the injuries were of longer standing. Another point worth attending to is, to ascertain by what sort of weapon, or in- SUMMARY OF THE SIGNS OF NATURAL AND OF VIOLENT DEATH. 807 strument, the wound was made ; the form, length, breadth, and depth of each wound should be carefully examined; likewise whether its edges are smooth, or lacerated, or bruised. Too much care, in¬ deed, can scarcely be bestowed on the ex¬ amination of wounds. Detruncation and burning. — Deeds of vio¬ lence of this nature are usually perpetrat¬ ed for the purpose of conveniently getting rid of the body of the infant. It may be urged that such methods were taken with the simple object of concealment, the child having been born dead. The question then is, can we say whether the body was thus treated anterior or subse¬ quent to death ? Proofs of death by detruncation can only be ascertained on the principles which ap¬ ply to wounds generally : the signs will be the more manifest the more tedious the process employed, and the more early begun before dissolution. Of death by burning we are better sup¬ plied with the means of proof. Experi¬ ment and observation show that the ap¬ pearances of burns, as inflicted before death and after, are very characteristically distinct. After death, the application of fire, or red hot irons, merely chars the part ; and if vesicles be produced, they are filled only with air, unless the subject be dropsical or anasarcous, when they may contain fluid. But when burns are effect¬ ed before life is extinct, decided marks of vital reaction are observable ; a blush of redness forms round the part in a few seconds, which, though not wholly per¬ manent after death, never fails to leave a deep crimson line of redness round the burn, not removeable by pressure. Vesi¬ cles also are generally raised, which are found to be filled with serum. Poisoning. — Poisoning has sometimes been enumerated among the acts of fatal injury practised with a view to infanti¬ cide. But there is, probably, not a single case on record to show that such a mode of murdering the new-born infant has ever been had recourse to. It is, however, by no means impossible that cases of poison¬ ing may occur; and therefore the examina¬ tion of the contents of the stomach, where there is room for suspicion, ought not to be neglected. Chemical analysis will, of course, be necessary for establishing the proofs; but an account of the particular processes to be adopted must be reserved for another part of the course. Question of Omission. There are two other modes of wilfully procuring the death of the new-born child, a notice of which ought not perhaps to be omitted, although they cannot be immediately classed with the preceding forms of criminal violence, nor do they amount to infanticide, in the interpre¬ tation, or perhaps the spirit, of our laws. Most of the continental medical jurists divide infanticide into two kinds — as it is effected by commission or by omission. But infanticide by omis¬ sion, implying that the infant has been wilfully lost through gross negligence, or by denying it certain necessary atten¬ tions, is not recognized as a crime by our penal statutes : we indict for murder, or concealment, or not at all. Yet wilfully omitting to tie the umbilical cord, though not always fatal, deserves to be considered as a very criminal act, espe¬ cially when taken in connexion with con¬ cealment. Much controversy has existed re¬ lative to the importance or non-importance of putting a ligature on the funis after it has been lacerated, or cut. But though it were demonstrated in ninety-nine cases out of a hundred that no mischief followed the omission, the fact of its proving fatal, even in a single instance, is sufficient to show the danger of omitting it. The in¬ fant may perish by haemorrhage, the signs of which are obvious in the blanched and almost bloodless state of the body, both internal and external ; a state which is more likely to occur after the cord has been severed in the usual way, than when torn by the hand. Exposure — Death procured by wilful ex¬ posure of the living infant, though not absolutely amounting to child-murder with¬ in the meaning of our law, must greatly aggravate the crime of concealment of the birth. The signs by which the medical jurist is guided in forming an opinion in such cases, must chiefly be gathered from the circumstances, — such as the time and place, together with the appearance of the body — destitute perhaps of covering, and (though the meconium be all expelled) having no alimentary matter in the sto¬ mach. Having thus examined all the principal points connected with the second question involved in inquiries respecting infanti¬ cide, T shall conclude the whole subject by giving, as l did at the end of the first sec¬ tion, a brief resume of the signs of natural and of violent death. Signs of natural death. — We infer that there is no ground for the charge of in¬ fanticide, but that the child, though born alive, sank in the course of nature — 1. When there is a complete absence of marks of violence ; or when those disco¬ vered may fairly be attributed to accident, or can be proved to have been occasioned after death. 808 PROFESSOR GRAVES’ CLINICAL LECTURES. 2. When the child is malformed, weakly, or immature, and has apparently perished in consequence of a tedious labour. 3. When there are evident marks of disease, and of a character likelv to have terminated fatally. Signs of death by violence. — Some of these are so obvious as to need no particular de¬ scription : but where the circumstances are such as to warrant at least suspicion in the first instance, we may be led to a more determinate view of the case — 1. When, with or without distortion of the features, or unnatural aspect of the body, the internal examination shows that some foreign substance was introduced, by means of which respiration was impeded. 2. When the signs of asphyxia, or smothering, are found in the chest, with traces of injury — pressure, with ecchymo- sis, for instance — about the throat. 3. When, together with the appearances of asphyxia, there is froth in the air-pas¬ sages, and water, or some of the fluid in which the body was found, in the stomach. 4. And lastly, when the marks of wounds, or blows, or burns, are observed on such parts of the body as would not be likely to suffer from accidental injury; and when such wounds, blows, or burns, indicate, by the appearances of vital re¬ action, that the infant was not yet dead ■when they were inflicted. CLINICAL LECTURES, DELIVERED AT THE MEATH HOSPITAL AND COUNTY OF DUBLIN INFIRMARY, During the Session 1836-7. By Professor Graves. Lecture VI. Further remarks on the Treatment of Fever — Management of Delirious patients — Advan- * tages of Tartar Emetic in the form of Enema — Subsultus tendinum sometimes from disturbance of the nervous extremities, inde¬ pendently of the brain or spinal cord — Vomit¬ ing and purging at the commencement of Fever , indicative of cerebral affection — Scro- fulous inflammation of the brum — Chronic scrofulous fever , In speaking of the use of drinks in fever, I alluded to the abuse of soda or Seltzer water, and effervescing draughts. It is very much the custom, both in hospital and private practice, to look upon the latter as a remedy which may be adminis¬ tered at the pleasure of the patient, or the discretion of the nurse. They are cer¬ tainly to many persons a most grateful means of cooling thirst; but the cautious physician will never allow his patient to indulge too much, for he knows that their frequent use distends the stomach, and produces a tendency to tympanites and bowel complaint. I am also of opinion that the exhibition of large quantities of free carbonic acid is a very doubtful, if not a dangerous, practice in fever, and may increase that tendency to narcotism and functional derangement of the nervous and respiratory systems, which is observed in every case of genuine typhus. In addi¬ tion to this, the evolution of a large quan¬ tity of fixed air in the stomach frequently causes a very disagreeable sense of disten¬ sion and suffocation, and acts injuriously on the mucous membrane. Allow me here to digress a moment from my subject, and make a few observations on a case which terminated fatally in our wTards within the last twenty-four hours. I wish to call your attention to this case more particularly, as I think a different plan of treatment might have succeeded in saving the man’s life. This man was ad¬ mitted into the fever ward about the seventh or eighth day of his illness. I cannot exactly state how he was treated in the commencement, but I believe he wras very badly attended, and that the state of the principal organs wTas wholly neglected. It will be sufficient to state, that when he came under our care the chief features of his case wrere delirium, accompanied by total wrant of sleep, and a violence of con¬ duct and behaviour calling for the re¬ straint of the strait wraistcoat. Now under circumstances of this nature the most di¬ ligent attention and promptitude are im¬ peratively demanded on the part of the physician, and every step calculated to anticipate danger should be instantly taken ^ I regret to say that I did not at the time take a correct view of the treat¬ ment, or precautions necessary to be adopted under such exigencies. I did not expect that the case would terminate fa¬ tally in such a short time, and I antici¬ pated benefit from the remedy prescribed. He was ordered to take the tartar emetic solution in full doses; but on visiting him next morning, wre found that he had obsti¬ nately refused to take his medicine, and that his symptoms were greatly aggra¬ vated. In delirium of this kind it is certainly very difficult to manage the patient, and wre are frequently obliged to have recourse to force or stratagem to make him take his medicines. I regret extremely that this man’s head wras not leeched on his ad¬ mission, as, from the state of his pulse, I think he would have borne it well. Eight TREATMENT OF FEVER. 809 leeches might have been applied to his temples, and repeated two or three times the same day, according to the state of his pulse and strength. I think I was wrong in contenting myself with ordering the tartar emetic solution and a blister to his head, and I should have anticipated from the violence of his behaviour that it would be very difficult to manage him. In cases of this kind, where it is neces¬ sary to give tartar emetic (and this is one of the best remedies you can employ in cases of cerebral excitement in fever,) you should be always prepared to obviate any omission arising from the obstinacy of the patient; and when he will not take his medicine voluntarily, you may secure its effects on the system in two different ways. In the first place, it may be secretly mixed with the patient’s ordinary drink; and as such persons are generally thirsty, and sel¬ dom refuse drink altogether, an intelligent nurse will readily find means to make the patient take a sufficient quantity of it to secure its full effect on the cerebral circu¬ lation. Another expedient which you may re¬ sort to on similar emergencies, is to give the tartar emetic in the form of enema. I had recourse to this plan some time back, in a similar case of delirium, and with the best results. After leeching the head, I gave the solution of tantalized an¬ timony in enema ; and this can be always done, whether the patient likes .it or not, if you take care to prevent his struggles by confining him in a strait waistcoat. The best way of administering it is to dis¬ solve two or three grains of tartar eme¬ tic in four or five ounces of mucilage of starch or isinglass, and inject it with the aid of a long flexible tube, so as to make the contents of the syringe pass high up into the bowel. In this way you can secure all the good effects of tar- tarized antimony in overcoming the con¬ gestion of the brain, and procuring sleep. In all cases of alarming congestion of the head in fever, I have been long in the habit of using tartar emetic in this way, if the stomach be deranged, and incapable of bearing it safely ; and I can assure you that it is a most fortunate thing to have such a powerful resource in all cases of the kind. I have also not unfrequently given expectorant medicines in the same way, where from the state of the stomach, or the debility of the patient, the ordinary remedies could not be administered by the mouth with sufficient rapidity, or in suffi¬ cient quantity to produce the desired effect. In this way I have often given the infusion of ipecacuanha — a remedy of very conside¬ rable value, and not sufficiently appreciated by most modern practitioners. I may also remind you that vomiting, and all the benefits derivable from it, may be likewise produced in this way. Now where the stomach is irritable, and yet there exists a necessity for such remedies, it is a very for¬ tunate circumstance to be in possession of a means of employing them without in¬ flicting any injury on the stomach, and thus counterbalancing the good effects of the remedy by the injury done to the stomach. Of course the cases in which these expedients are required are compara¬ tively rare, but the practical physician must be always prepared for such exigen¬ cies, and be provided with every means of meeting them. Another of our patients died also within the last few days in the fever ward. He laboured under a very bad form of macu¬ lated fever, and when admitted, was evidently in a hopeless state. I shall not say any thing about this case, except to use it as an occasion for making a few ob¬ servations on a particular state of the cerebro-spinal system, which we not unfre¬ quently observe in cases of maculated typhus, and occasionally in other varieties of fever. Now you observed that this man had not the slightest tendency to sleep; that he lay with his eyes constantly open, raved incessantly, had subsultus tendi- num, floccitatio, and cold extremities, and often attempted to get out of bed. Yet we could not find in him any thing like decided evidence of cerebral inflammation. The tunica adnata was of a clear pearl- white, the face pale, and the scalp and in¬ teguments of the face cool. You perceive, then, that sleeplessness, delirium, and sub¬ sultus tendinum, may depend on a state of the nervous system having no connexion with congestion of the brain, or determina¬ tion of blood to the head. This occurrence has struck me very forcibly in many cases of fever. But I have been most particu¬ larly struck with the occurrence of sub¬ sultus tendinum in such instances. In the present case we had a patient with sleep¬ lessness and subsultus. But this concur¬ rence of symptoms does not always exist. You recollect the case of the boy in the small fever ward, who laboured under ex¬ cessive subsultus, and to whom we gave the spirit of turpentine in drachm doses with so much benefit. Yet this boy, as you all remember, slej)t remarkably well. I have frequently pointed out to the class patients labouring under subsultus tendi¬ num, who slept well, and in whom the tunica adnata was of a pearl-white colour, without the slightest suffusion. We have subsultus, therefore, occurring in two very opposite states of the nervous system; we have it accompanied with loss of sleep, and we have it existing in that condition of the system where the patient slumbers long and heavily, and cannot be easily 810 PROFESSOR GRAVES’ CLINICAL LECTURES. roused. Hence I am inclined to think that the cause of subsultus resides not so much in the nervous centres as in their extremities. I would even go so far as to advance the proposition, that if it were possible for the fever to go on, and life to continue after the removal of the brain and spinal cord, I am quite sure that the subsultus would continue. I am almost confident that subsultus tendinum is the result of some derangement of the nervous extremities. I have shown on a former occasion, when lecturing on the subject of paralysis, that the nervous periphery may become diseased primarily, and without any antecedent affection of the brain or spinal cord. I think it extremely proba¬ ble that in fever the nervous centres are subject to certain derangements producing coma, sleeplessness, and delirium, but that there are other nervous symptoms which are to be referred rather to a de¬ rangement of the nervous extremities, and among the latter I would particularly in¬ clude subsultus tendinum, a symptom which we find co-existing with such oppo¬ site conditions of the nervous centres. But to return to the case to which I first alluded. Never blister in the early stage of fever, until you have applied leeches in suiiicient quantity. In this case, it is true, we could not well ascer¬ tain what the period of the fever was ; for the man was brought in in a state of deli¬ rium, and there was nothing known re¬ specting his previous history. Yet you are all aware that a great deal must depend on our knowledge of the period of the fever, and the medicines which have been em¬ ployed. Had we been acquainted with these circumstances, it is probable we would not have fallen into the error we committed. What I wish to impress on you, is, that in all cases of maculated ty¬ phus, you should be careful in examining the head and ascertaining whether there are any evidences of cerebral congestion present. If there is headache, strong pul¬ sation of the carotids, suffusion of the eyes, and heat of the face and scalp, along with the other signs of functional lesion of the brain present, you should always have recourse to leeching; beginning cautiously, and continuing their application as long as the patient will bear it with safety. When you have the symptoms already mentioned, and the patient is in the early stage of fever, you may commence by ap¬ plying one or two leeches to the nostrils, or six or eight to the temples, or behind the ears, repeating them two or three times a day, according to the exigency of the case. The best way of using leeches is to apply them in small numbers every six or eight hours, so as to keep up a constant drain from the head. After you have leeched sufficiently, you may then have recourse to blisters. In making this change, much will depend on the sagacity and skill of the practitioner; for it re¬ quires no ordinary tact to hit on the pro¬ per time when you should give up leech¬ ing and commence with blisters. I shall make no apology for introducing here what I consider to be an important observation, with reference to the patho¬ logy and treatment of fever. We had a strikiug instance of the fact on which I am about to offer some comments, in the case of a little girl who died lately here, in a very remarkable manner. I mentioned in a former lecture, that vomiting and purging in the commencement of fever are, generally speaking, indicative of a cere¬ bral affection. Every fever which com¬ mences with vomiting and diarrhoea, whe¬ ther it be scarlatina, or measles, or typhus, is a fever of a threatening aspect ; and in all such fevers the practitioner should be constantly on the watch, and pay the most unremitting attention to the state of the brain. There is much difference be¬ tween the vomiting and diarrhoea of gas- tro enteritis and this cerebral diarrhoea and vomiting. The latter sets in gene¬ rally at a very early period of the disease, perhaps on the first or second day, and is seldom accompanied by the red and furred tongue, the bitter taste of the mouth, the burning thirst, and the epigastric tender¬ ness. which belong to gastro-enteric in¬ flammation. There is also another source of diagnosis, but of a less valuable kind ; and this is founded on the results of treat¬ ment. Gastro-enteric vomiting and diar¬ rhoea are relieved by leeching the belly; but I need not tell you that this mode of treatment can have no effect on the vomit¬ ing and purging produced by cerebral dis¬ ease. There is also another source of di¬ agnosis : the vomiting and diarrhoea which results from gastro-enteric inflammation is never accompanied by such copious dis¬ charges of bile as that which depends on disease of the brain. In diarrhoea from derangement of the brain, the quantity of bile passed is very remarkable; and it is equally curious, that when vomiting fol¬ lows derangement of the cerebral circula¬ tion, in ordinary cases, and without fever, bile is thrown up in very large quantities. This is frequently observed in persons who become sick from swinging, or sailing. Tn such instances, a larger quantity of bile is vomited than could occur from mere gas¬ tric irritation. Now in the commence¬ ment of cerebral disease, where conges¬ tion or inflammation is present, one of the first symptoms is copious vomiting, and purging of a bilious character. This is very often the case in scarlatina, and there are few cases in which there is more TREATMENT OF FEVER. 811 danger to be apprehended. We had these symptoms, under very unfavourable cir¬ cumstances, in the little girl to whom I have just alluded. From the imperfect history of the case which we were able to obtain, it appeared that she had been ill of fever for fourteen days before her ad¬ mission, and had in addition a severe at¬ tack of bronchitis and pneumonia. She then got inflammation of the stomach, and finally congestion of the brain, as indicat¬ ed by the cerebral vomiting and purging. We employed every means in our power to check these symptoms, but without suc¬ cess ; she went on from bad to worse, and she ultimately sank under a combination of affections, which you will frequently observe in many forms of disease as well as in fever; and it is to this point in particular that I wish to direct your atten¬ tion. You will frequently observe that a certain period of fever, whether it be in¬ flammatory, nervous, bilious, or typhoid, — and very often in other forms of disease, whether depending on a general affection of the system, or connected with inflam¬ mation of important organs, when the pa¬ tient has been going on pretty wrell for some time, — you wall find that about the period w'hen you would naturally expect that the fever would go off, and conva¬ lescence begin, a new form of fever makes its appearance, and carries off the patient in spite of all your exertions. To this form of secondary fever I w7ould give the name of scrofulous, because it resembles in its chief features the intractable form of fever which is frequently observed in per¬ sons of an originally scrofulous habit, or who have become so from the abuse of mercury or other debilitating causes. This is a form of fever which is not wrell under¬ stood, and I am not acquainted w ith any author who has devoted to it that share of attention to wrhich, from its great import¬ ance, it has such decided claims. Its chief characters are, that the patient, dur¬ ing its existence, exhibits a strong ten- denc}r to inflammatory affections, which bear a close analogy to the scrofulous, both in their intractable character, in the facility with w’hich they pass from one organ to another, and in their frequently unfavourable termination. A patient of this description, while labouring under fever, will frequently exhibit a very re¬ markable succession of inflammatory af¬ fections. If, during the course of his fever, he gets an attack of gastro-enteritis, you will have great difficulty in managing it ; and no sooner is this overcome, than he is seized with bronchitis or pneumonia; and when, by great care and the most skilful treatment, you have overcome this also, he gets scrofulous inflammation of the brain, and dies. Now you will fre¬ quently meet with patients who, during the course of typhus, will be attack¬ ed with this bad form of fever, and get what may be termed scrofulous inflam¬ mation of the brain, which carries them off in five or six days, in spite of all your care. You are aware that persons wrho are much in the habit of observing dis¬ eases of the brain, can generally distin¬ guish between scrofulous inflammation of the brain and its membranes and that in¬ flammation which occurs in persons of healthy habit. In cases of the latter description, the treatment, if commenced at the first appearance of the disease, is simple and successful. Appropriate bleed¬ ing and leeching, wdth the use of calomel and James’spowder,are almost alwrays sufficient to accomplish a cure. When once you have succeeded in touching the gums wdth mercury, the patient’s safety is tolerably certain, and recovery is in general rapid ; but in the scrofulous affection of the brain, although you may have fully mercurialized your patient, you will too often discover that you have merely retarded the pro¬ gress of the complaint for a brief period ; it returns again, and carries him off in spite of all your efforts. In the scrofulous hydrocephalus, a much greater time elapses from the appearance of coma and strabismus until death takes place, than in the ordinary forms of meningitis. This fact wras well illustrated in the case of the little girl to which I have just now re¬ ferred : she continued to live on for a long time after the appearance of symptoms wdiich you would think ought to terminate fatally in a few hours after they had be¬ come developed. There is also a great deal of irregularity in the way the symp¬ toms come on in cases of scrofulous in¬ flammation of the brain. Sometimes blindness is one of the first symptoms. I recollect having been called, with Dr. Beatty, to see a very fine boy, living in Merrion- Square, and was very much struck, on entering the drawdng-room, to find him walking about, and in apparent good health, but quite blind. Here amau¬ rosis was the first symptom. This was subsequently succeeded by others, and he died in a convulsive fit about a fortnight afterwards. We have many excellent observations on the chronic scrofulous fever, but I think that there is no author who has described this acute form with the precision and care which it deserves. It is, however, a very frequent form of fever, and you w ill see many examples of it among the chronic patients in the medical and surgical wards. You wTill frequently observe per¬ sons who are labouring under acute dis¬ ease from accidents or other causes, be¬ come feverish and ill again at a time when 812 DR. HOPE'S REMARKS ON THE you expected a remission of their symp¬ toms, or even recovery ; and, without any assignable cause, they will get scrofulous inflammation of some other part or organ, and quickly fall into a state of hopeless and incurable disease. REMARKS ON THE NATURE AND TREATMENT OF RHEUMATISM*. By J. Hope, M.D.,F.R.S. In speaking formerly, gentlemen, of the “ varieties of inflammation according to tissues,” I said that acute rheumatism presented the most striking exemplifica¬ tion of inflammation of the fibrous tissue, viz. tendon, ligament, fascia, aponeurosis, the dura mater, and pericardium (of which the external layers are fibrous), the valves of the heart (which contain fibrous tissue between the reduplication of the lining membrane), periosteum, neurilema, and the sclerotic coat, and cornea of the eye. I told you that any one of these parts might be inflamed individually, and that then the disease was not called rheumatism, but i n fl am m ati on of th e p ar t . B u t i f th ere be a general tendency throughout the whole system to inflammation of the fibrous tis¬ sues, the disease is then denominated rheumatism. Forms. — Rheumatism, like other inflam¬ mations, is, 1. Acute; 2. Chronic: and the chronic presents two varieties, a. Active, i.e. increased local action and heat, mostly with, but sometimes without, constitutional fever; b. Passive , i.e. diminished local ac¬ tion, with coldness, and without fever. I shall consider each of these forms in suc¬ cession. I. Acute rheumatism, vulgarly called rheumatic fever.— Under this head I do not comprise rheumatism of the periosteum, the neurilema, and the eye — of which, hereafter; but I allude to rheumatism of tendon, ligament, fascia, aponeurosis, dura mater, and the pericardium and valves of the heart. Local symptoms. — The parts usually at¬ tacked are the three great joints of each extremity; more rarely the small joints. There is heat, pain of an obtuse yet severe kind, and, in most, but not all, there is redness and swelling: in short, there are the four local signs of inflammation. The * Being an abstract of a lecture delivered re¬ cently at the Aldersgffte School of Medicine. pain is aggravated when the patient is heated in bed, especially at night ; also by pressure and motion ; whence, and from the swelling, there is more or less rigidity of the joint. Constitutional symptoms. — The constitu¬ tional symptoms are peculiar and very remarkable. The pyrexia, in severe cases, is far more violent than corresponds with the degree of local inflammation, and also of danger, provided no internal organ be affected. The pulse is from 90 to 110 or 120, full and bounding — not hard — not tense, and incompressible, as you see it in inflamma¬ tion of serous membranes and inflamma¬ tory fever; but compressible, and bound¬ ing like the pulse of a healthy person ac¬ celerated by running; and by this bound and its speed, it indicates great arterial action. The respiration is accelerated in proportion to the rate of the pulse. The tongue is singularly white, and has a pasty surface, yet without being thickly furred. Bowels confined ; urine scanty and high co¬ loured, early depositing a copious lateri- tious sediment. Skin hot — hotter, indeed, than in most other inflammations; but what is very remarkable, and I believe unique, it usually perspires freely — often profusely ; and, in a day or two, the per¬ spiration becomes offensively sour, so that some say they can diagnosticate acute rheumatism by the nose. These perspirations I regard as an essen¬ tial part and peculiarity of the disease; for they commence simultaneously with it, and, instead of relieving, they only exhaust the patient. The tolerance cf blood letting is great; that is, the patient bears much loss of blood without fainting. Finally, the blood is, in general, buffed and cupped in an extraordinary degree ; and I have often seen this continue, though the patient was bled to the last ounce that could safely be drawn. Causes of the swelling. — The swelling is occasioned by vascular turgescence, and by serous effusion into the fibrous and cellu¬ lar tissue — that is, oedema ; and with this you will sometimes find a little synovial effusion into any contiguous •'synovial membranes — namely, of sheaths, of ten¬ dons, bursae, and joints. This you would naturally expect, as the inflammation is propagated from the fibrous tissue to the synovial membranes by contiguity of tissue, according to the well-known principle of Bichat. # The swelling from these causes is inconsiderable. This is the kind of swelling in the great majority; my im¬ pression would lead me to say in 19-20ths. In the remaining l-20th there is little or no serous effusion into the fibrous and cellular tissue, but a very copious synovial effusion. This fact was, I believe, first NATURE AND TREATMENT OF RHEUMATISM. 813 noticed and taught, in his lectures, and in the wards of St. George’s Hospital, by Dr. Chambers ; and he made it the ground of a practical distinction into “ flbrous” and “ synovial ’’ rheumatism. In “ Jibrous ,” the swelling is diffuse, pits on pressure, and is inconsiderable in de¬ gree; and this variety alone is attended with the violent constitutional fever, such as I have described it. In “ synovial” the swelling takes the form of the particular synovial membrane affected: it is elastic and fluctuates, and may enlarge the joint even to double or triple its natural size. Dr. Chambers remarked that the fever was not of the violent kind which attends fibrous rheu¬ matism, but a much milder degree. I have noticed, that though the fever is oc¬ casionally smart at the onset, it subsides as soon as the effusion becomes considerable, — that is, within three or four days ; a cir¬ cumstance attributable, I presume, to the effusion relieving the inflammation, which is nature’s own mode of affording relief. After the effusion has taken place, the complaint assumes a more chronic form, with little symptomatic fever; is removed more slowly than fibrous rheu¬ matism, and is more benefited by local treatment : in short, it becomes more strictly a local complaint — more a mere effusion into the joint. The knee is, be¬ yond comparison, the most frequent seat of synovial rheumatism, but any other joint may be affected; and thesmail joints are, according to my observation, more obnoxious to this than to the fibrous va¬ riety. The lower classes, indeed, know it practically under the name of rheumatic gout, though there be no gout in the case. Rheumatism rarely suppurates. — A pecu¬ liarity of rheumatic inflammation is, that it scarcely ever ends in suppuration — some say, never ; and that when suppuration does occur, it arises from some other in¬ flammation, either accidentally present or excited by the rheumatism. Thus Bouil- laud relates two cases of what he considers to be acute rheumatism, terminating in suppuration ; but in both, phlebitis at¬ tended the rheumatism, and was pretty evidently the cause of the purulent effu¬ sion amongst the muscles and tendons. Dr. Macleod also mentions two cases of purulent effusion into the synovial mem¬ branes (Med. Gaz. vol. xvii. p. 655); but, in both, the disease had become “persistent” in the joints affected — the hip and shoulder in one, and the hip in the other. Here, then, the rheumatism may have degenerat¬ ed into mere chronic inflammation, which, of course, may suppurate. The strength of the whole argument turns principally on this point — that if rheumatic, did not differ from common inflammation, we ought to find suppuration in the acute stage. Of this, however, I have never myself met with an instance, though I have seen no small number of cases ; nor have I been able to find a case on record which did not seem to admit of a double explana¬ tion. On the whole, therefore, I think we may conclude that rheumatism has the peculiarity of not tending to suppuration; and that when it occurs, it is an exception to the general rule. Mortification is still rarer than suppuration. Migration of acute rheumatism. — Migration is another striking peculiarity of acute rheumatism. In general, two, three, or more joints, are primarily affected: then it leaves some of these, and attacks others, or other parts ; and occasionally it re¬ visits the joints originally affected. The joint which it leaves is promptly eased of pain, but not necessarily so of the swell¬ ing ; for if the oedema is considerable, a day or two may be necessary for its ab¬ sorption. By far the most important of its migra¬ tions is to the fibrous tissue of the peri¬ cardium and valves of the heart. That to the dura mater is comparatively less im¬ portant, because very rare : I have never seen an instance: whereas migration to the heart is exceedingly common. It oc¬ curs in perhaps one-half, if not counter¬ acted by suitable treatment. Thus M. Bouillaud rates it at half, including the cases of inflammation of the valves, which he says with truth is almost invariably overlooked by non-auscultators. If, then, you consider that, independent of the immediate danger of pericarditis and endocarditis, an adhesion of the pericar¬ dium, or a disease of a valve, so frequently entailed by these diseases, necessarily cripples a man for life, and often con¬ tracts his existence within the span of a few years, you at once see that acute rheu* matism, formerly considered harmless to life, is really a disease of the first magni¬ tude and importance, and always to be re¬ garded with anxiety. Metastasis. — The migration of rheuma¬ tism to the heart or head used to be called and considered “ metastasis,” — that is, a change of seat, — a total desertion of the external parts, and a concentration of the disease on the internal organ. But this idea is erroneous, and, I trust, be¬ coming obsolete ; for I have often seen the heart attacked while the disease was in its full intensity in the limbs, — nay, I have even seen the heart attacked first ! The disease, therefore, merely extends or migrates to the internal fibrous tissue, just as it does from joint to joint, by what Bichat calls the affinity of tissue. Rheumatism a specific inflammation. — Rheu¬ matism has long been considered a “ spe- 814 DR. HOPE’S REMARKS ON THE cijic” inflammation, — by which I mean, one not presenting the usual phenomena, nor running the usual course of common inflammation. John Hunter was of this opinion. It has of late, however, been questioned with ability; yet I confess I adhere to the old opinion, and on the fol¬ lowing grounds: — 1. The migration to all parts of the fibrous tissue is unique. You see it not in inflammation of any other tissue, nor even in common inflammation of the fibrous tissue. 2. The very slight tendency to suppu¬ ration, ulceration, and adhesion, is pecu¬ liar; for all these processes are common in ordinary inflammation of fibrous tis¬ sues, as from injuries, &c. 3 The perspirations are unique ; even the whiteness of the tongue is singular. 4. The excessive buffing and cupping of the blood, sometimes even after the utmost possible venesection, is extraordinary, and seems to indicate something peculiar in the constitution of the blood. 5. Experience shows that this disease is less certainly and uniformly relieved by antiphlogistic treatment than other in¬ flammations. All these circumstances evince, I think, something peculiar — “ specific” — in the system, or, if you please, in the vital con¬ stitution of the blood, which, I believe, is M. Andral’s opinion. I have dwelt a little on this subject, not from the love of idle speculation, but be¬ cause, if the inflammation be specific, we are not rigidly bound in the treatment by the ordinary principles of inflammation, if we find them less than usually successful; but are justified in circumspect deviations, approved by experience. II. Chronic Rheumatism. — This, I said, may be “ active” or “ passive.” The symptoms of active chronic rheu¬ matism are much the same in quality as those of acute, but less in degree. Though the disease has lasted many months, you may still find the parts, from time to time, more or less painful, hot, swollen, and even red, and the pain aggravated by heat. There may also be a moderate degree of symptomatic fever, the pulse ranging from 80 to 90. Sometimes, however, there is no symptomatic fever, the activity" being strictly local. You will seldom find per¬ spirations, as they cease after the few first weeks. This chronic form may either be the se¬ quel of the acute, or be primitively chro¬ nic ; and I have often noticed repeated chronic recurrences in those who had once had acute. * * * Age. — I have not found acute rheuma¬ tism very frequent before set. G, and after GO. The most common period of its prevalence is from ast. 8 to 35, during which it is, beyond comparison, the most frequent cause of peri- and endo-carditis. I have ascertained this almost numerically in a great number of cases. Modes of Treatment. — The treat¬ ment of acute rheupiatism has been — nay, is — very unsettled. There is the bleeding and purging plan ; the forced sweating plan; the stimulant plan — that is, with bark, guaiacum, &c. ; the colchicum plan ; the calomel and opium plan; and these variously combined. The importance of this disease, especially with reference to inflammation of the heart, has led me to pay much attention to its treatment for the last eight or ten years; and I have made brief notes of between two and three hundred cases, and observed many more. My object wras to curtail, if possible, the exhausting six weeks’ treatment of the old school, and to ascertain what mode would best obviate that truly formidable compli¬ cation, inflammation of the heart. As my opinion is now pretty decidedly formed, I shall offer you the results of my exjie- rience. 1. The bleeding and purging, or pure anti¬ phlogistic plan. — From ten to twenty years ago, this and the diaphoretic plan were in full vogue, especially in Scotland; and I saw them carried to their maximum in the Edinburgh Infirmary, during a residence of two years in that institution. Now many cases, I admit, were promptly and effectually cured — even annihilated at once, by the antiphlogistic plan ; but, in many others, active bleeding was carried to the very last ounce that could be drawn ; yet the enemy clung to the joints wTith a chronic grasp, and proceeded triumphant in his crippling career. Add the pale emaciated frame, and the slow convales¬ cence, sometimes of two or three months’ duration, and too often, I fear, the perma¬ nently shattered constitution ; add, above all, inflammation of the heart not pre¬ vented : nay, it is a trite remark, and by none made more strongly than by Dr. Alison, “ that large and repeated bleed¬ ings in the beginning of rheumatism, he is convinced, increase the risk of this metas¬ tasis.*” Dr. Macleod has, however, inge¬ niously and fairly met this argument, by saying, that it is only in the worst cases, and consequently those in which migration to the heart is most likely to occur, that copious bleeding has been employed. Still the fact remains, that inflammation of the heart is not prevented, and prevention is the great desideratum. The forced sweating plan. — Dr. Gregory, * Cyclopaedia of Medicine : Hist, of Med., Part xxiv., page 45. NATURE AND TREATMENT OF RHEUMATISM. 815 the great advocate of this plan, premised venesection and purging till the pulse was lowered to 100 ; but “ with these appliances and means to boot,” I have seen patients stewed and parboiled (if you will excuse a culinary trope) for four, six, or eight weeks, and gain — what ? — a wan attenuated frame, chronic pains, and a confirmed susceptibility of rheumatic attacks on the slightest variations of temperature. This plan is now, I think, almost universally abandoned, — by those at least who keep pace with modern science. The stimulant plan. — It was principally Morton, Fothergill, and Haygarth, who gave bark from the first, or nearly so; and 1 have seen others give guaiacum (a stimu¬ lant and diaphoretic) in the same way. L have not myself tried these remedies, because I never think myself justified in employing remedies distinctly opposed to reason when I know of others equally efficacious which are consistent with reason; but I have looked on the treatment of others; and it has always appeared to me that the patient has recovered in spite of the remedy, and in virtue of the bleeding, purging, calomel, or low diet, which was simultaneously employed, and to which in some cases the practitioner was compelled to resort at an advanced period of the treatment. Bark, however, is good in a weakly convalescence, just as after any other inflammation. The colchicum plan. — Colchicum is a powerful remedy, and, with antiphlogistic treatment, often succeeds well. Those who are most partial to it generally consider that its most striking effects are produced when it purges ; and to promote this they often conjoin with each dose magnes. carb. 3j. or some other neutral salt. It is apt, however, in full doses of 3ss. to 3j. or ij. to produce an intractable dysenteric diarrhoea, which upsets all your plans. I have so often been foiled by this circumstance, that I now use coichicum only as an auxiliary, in small doses of TRxv. to xx. frequently repeated. In this way I use it much. Calomel and opium plan. — This was introduced for acute inflammation in general, and for acute rheumatism in particular, by Dr. Hamilton of Lyme Regis, fifty years ago*. He bled once or twice, and touched the salivary glands w ith mercury, with brilliant success. But there is an objection to unnecessary sali¬ vation. A modification of this plan, by which ptyalism is avoided, I first saw employed by Dr. Chambers, at St. George's Hospital. It is to this plan that I wish * In 1783. See Med. Commentaries. particularly to call your attention ; and, leaving the merit to him, I shall give you my own experience of it during the last six years, in about 200 cases of acute or active chronic rheumatism. 1. Acute. — After a full venesection, or even two, in the robust, but without bleed¬ ing in the feeble and delicate, I give every night gr. vij. to x. of calomel with jss. to ij. of opium, according to the age, and the severity of the case; and every morning a full haust. sennas, to act four or five times at least. In addition I generally give the following draught, thrice a day, as it has appeared to me to expedite the cure— partly, perhaps, by the additional opiate, and partly by the sedative effect of the colchicum. R Vini colch. TRxv. ad xx. ; Pulv. Doveri, gr. v.; M. salin. 3x. ; Syrupi, 3j. M. When the pain and swelling are greatly abated, if not almost gone, (which often happens within two days, and almost always within four,) I omit the calomel ; or if the gums become in the slightest degree tender, I omit it even earlier. The opium I continue to the extent of gr. j. or jss. at bed-time; and in severe cases I add a grain at noon ; for without an anodyne the pains are apt to recur. I also continue the colchicum draught and the haust. senna?, as before. No local treatment is necessary beyond warm or cold application, according as the patient finds them agreeable. If the patient is not well in a week I consider it a case of exception ; and the exceptions are generally in those who are subject to rheumatism, and who therefore usually have it in a more obstinate chronic form. The advantages of this plan are, 1, that a patient is generally sound, well, and fit for work in a week or ten days after the pains have ceased; 2, that the gums are rarely affected, especially if you previously ascertain that the patient has not a morbid susceptibility of mercury ; 3, that it is rare to see inflammation of the heart if the treat¬ ment is early begun (I think that one case in a dozen w'ould be the maximum in my practice) ; 4, if the slightest symptom of endo- or peri-carditis does supervene, a few extra doses of calomel and opium, as gr. v. c. op. gr. j. every four or six hours, will generally affect the constitution in twenty or thirty hours, which, with two or three cuppings or leech ings on the region of the heart, almost always places the patient in a state of safety. I have never lost a patient by rheumatic pericarditis since I employed this plan; and I have been told by other hospital practitioners that they 816 CHARACTER OF THE PREVAILING INFLUENZA. have been equally successful bv the use of calomel and opium. 2. Chronic active. — Here calomel and opium may be given in smaller doses, as calomel, gr. v. and opium, gr. j. every night ; but they require to be continued for a longer time, as five or six nights. Take care, however, to stop short of ptyalism, especially in the scrofulous. Local treatment, too, is more beneficial than in the acute form : viz. bleed locally rather than generally, and ultimately em¬ ploy blisters, liniments, &c. Trials of modifications. — I have tested this plan by successively omitting the venesec¬ tion, the purging, the calomel, and the opium ; and with each omission I have found the recovery less expeditious and certain. I cannot doubt that the opium contributes importantly to the cure, — perhaps by allaying the pain, and thus diminishing the irritative fever dependent on it; or, possibly, by modifying the vital state of the blood : but this is yet hypo¬ thetical. I have, however, assured myself of the fact, that opiates and purging alone wfill cure many cases of acute rheumatism remarkably well. Others, too, have used narcotics with success. 1 think Dr. Hue, of St. Bartholomew’s Hospital, treats acute rheumatism with large doses of coni urn, as Qj. or more daily; and my friend Dr. Lombard, physician to the hospital of Geneva, states that he has had remarkable success with the spirituous extract of aconite, in doses of gr. ss. gradually increased to two or even three grains, every two hours. Treatment of synovial rheumatism. — Calomel and opium produce less striking effects on purely synovial rheumatism, because the inflammation soon relieves itself by the effusion, and the effusion requires time for its absorption. Yet I am satisfied that mercury does expedite absorption in this as in any other effusion. Colchieum, however, has the reputation of producing its best effects in synovial rheumatism. I have oft looked for “heroic” effects, in vain ; and I suspect that they are rather over-rated : yet it is a good remedy. Whether you use calomel and opium, or colchicum, or both, for synovial rheuma¬ tism, you will find that local applications are more necessary and serviceable than in fibrous rheumatism, viz. leeches, c. cruenta, cold lotions, hot fomentations, and poul¬ tices; and later, blisters, stimulant lini¬ ments, a.i. plasters, &c, Leeches and blisters should never be placed immediately upon a superficial joint — I have seen them create ulcers which penetrated the joint and proved fatal. * * CHARACTER OF THE PREVAIL¬ ING INFLUENZA. To the Editor of the Medical Gazette. Sir, Having perused in your valuable journal of the 4th inst. the letter of Mr. Henry Bullock, on the Nature and Treatment of Influenza, wherein he ascribes the former to specific contagion, permit me, through the same medium, to dissent from him, basing my objection on the immediate percursory atmospheric change. I am awrare at the same time that there are very high, though not undeniable authorities against me, viz. Cullen, who designates it in his Noso¬ logy and First Lines, Catarrhus conta- giosus ; and Dr. Gregory, in following him, admits there are many opponents to such an opinion. Here, at the latter end of December and beginning of January the cold w as extreme — considerable quantity of snow fell in a comparative short time ; this was succeeded by a hard and severe frost, then again as sudden had we a rapid thaw, followed by strong westerly gales, and much rain. Quick upon this change the list of my dispensary patients increased during the last week of December to 13 more than ordinarily, 45 in the whole of January, and 40 in this fortnight of February, all of which were catarrhal cases. I could not help noticing at that time the prevalence of a similar epidemic among the quadrupeds in general. One may at first be inclined to ascribe «/ so universally undiscriminating an effect to contagion, but is not the rapid and extensive atmospheric mutation pre¬ ceding the disease most apparently the true origin. Have we not in that change the cause? and can we find any con¬ tending' difficulty against designating’ this sequent epidemic as the effect? Since it is admitted that a partial sudden atmospheric change produces benign catarrh, it is but reasonable we should conclude that a more powerful, more sudden, and more illimitable vicissitude, conjoined with concomitant humidity of the weather, will be an efficient cause for the origination of our present prevailing epidemic, without searching- for the additional aid of specific contagion. Perhaps Mr. B. can explain CHARACTER OF THE PREVAILING INFLUENZA. 817 in which maimer this contagion propa¬ gates, whether by visitorial intercourse — by exposure to the local sphere of the am¬ bient poison — or by the universal exten¬ sion of undefined, subtile, atomic particles of a contagious something floating in the air. If the latter, we are far more likely to have influenza raging duringthe eestival than the brumal pe¬ riod of the year; in the former season con- tagionists could avail themselves of much collateral acquisition in support of their peculiar opinion. Were we to reason by analogy respecting the con¬ tagiousness of this disease, we might have naturally expected to receive the poison by respiring the morbific atmo¬ sphere, by actual contact or cuticular imbibition, as in rubeola, scarlatina, ty¬ phus, and others. » Extending this analogy a little fur¬ ther, we might reasonably anticipate the morbid secretion of the mucous mem¬ brane of the nose possessing the capa- cif.y? by inosculation, of superinducing a similar disease, as the endermic ab¬ sorption of a like morbid mucous secre¬ tion produces glanders in horses; and again, as canine saliva the hydrophobia. Ihese facts establish an axiom, that contagious diseases exciting morbific secretions are capable of generating their kind; but this epidemic has not such a power. Ascribing catarrh us communis to cold and change of weather, yet denying it to catarrhus epidemicus, seems to me evincing a warped judgment. Does not every person know that he risks a common cold by rushing from a caloric temperature of about 90°, in crowded theatres and overheated rooms, to a fri- gorific one of about 40°, in the external air ? Then, if each individual is liable to catarrh from so partial a cause, is it not consonant with common observation to expect, in the populace at large, the aggravated symptoms of a similar dis¬ ease, when the cause of it only differs in its universality ? . Now to the treatment. Both Cullen and Gregory describe the influenza as an inflammatory disease, that being considered by them the characteristic symptom ary difference between it and the catarrh us benignus: hence, as Mr. Bullock adopts their nosological views we might have been led to expect his treatment in accordance. On the con¬ trary, he finds bleeding (which they re- 482. — xix. commend) decidedly injurious, and pro- tractive of recovery, by exhausting the constitutional powers. I have much pleasure in bearing testimony to the justice of Mr. B.’s denunciation of the full depletory plan in London ; but here in the country, even when the symptoms only similate inflammatory action, one general bleeding, or repeated if requi¬ site, is had recourse to ; and when the local pain in the forehead or temples is acute, or a feeling of heaviness and gid¬ diness in the head, the topical applica¬ tion of leeches has been attended with the happiest effect. Why there should be such a dispa¬ rity in treating- the same disease in town and country, may be very easily ex¬ plained, by considering that the sta¬ mina of the constitutional powers of the metropolitans are not so vigorous as those in the country. This is one, and, I think, a cogent reason, why Dr. Arm¬ strong changed the opinions he promul¬ gated in his works on Fevers soon after lie practised in London; for it is gene¬ rally known that he recanted his pub¬ lished theory, and altered his practice. I he adoption of his views proved very uniformly successful with me, where one of the largest country practices offered me the ample means of putting Dr. Armstrong’s practice to the test of experience ; and no doubt Mr. B. will feel the truth of my assertion, on learn¬ ing it was the seat of his first pupilage. I Imve also had considerable experience, during two years of hospital study in Loudon, around Mr. B.’s immediate neighbourhood, among the lowest of the low — poorest of the poor — a g-enuine colony of gin-tipplers. Impressed with a firm conviction of the excellence of Dr. Armstrong’s prac¬ tice, f carried it into operation among those individuals; but I quickly found my error, lor the result of my treatment was the distressing- collapse and pro¬ tracted recovery of those in whose cases bleeding was fully resorted to, though the extent of such depletions was not carried so far there as I had priorly done in the country, with decided bene¬ fit, in similar acute inflammatory dis¬ eases. I also discovered that my town patients could not endure the powerful effects ol my country doses of purg-a- tives, were salivated quicker, and by lesser doses than I had been in the habit of prescribing. Surprised at this, I mentioned it to my friend Mr. Clarke, 3 G 818 DR. ALLNATT ON ABSCESS OF THE LIVER. the then surgeon for the parish of St. Olave, and now for the Union ; he ex¬ plained, and to convince me the more, he, in the next cases, commenced a milder plan, viz. less depletion, and when repetition was required, careful not to abstract indiscriminately : the medicinal auxiliaries were the same, but diminished in the dose. These in¬ stances, thus treated under Mr. Clarke’s surveillance, to my infinite surprise and pleasure, rapidly recovered without a decimal portion of comparative debility. I have intruded these observations to corroborate the aptitude of Mr. B.’s treatment for citizens, and to mark more widely their inaptitude for country adop¬ tion. I felt this the more necessary since your extensive publication may induce junior country practitioners to follow those measures which I hesitate not to declare they will find full of dis¬ appointment. The present epidemic has raged in this country very univer¬ sally, and with unusual severe symp¬ toms of the inflammatory kind ; inso¬ much that private practitioners have been dubious whether to class it as the catarrhal epidemic, or purely as one of its own kind — a general inflammatory one ; for three- fourths of the cases attacked with all the usual precursory symptoms of catarrh, set in pneumonitis, pleuritis, bronchitis, and rheumatismus acutus. I would also observe, that in all the town- ships to the extent of 12 miles around Manchester, I have ascertained that the mortality is, and has been, very great. The majority have died from uncon¬ trolled inflammations; some of apo¬ plexy. Several old people, chronically affected with bronchitis and asthma, have had these diseases so aggravated by the prevailing epidemic, as ultimately led to their deaths. I have several cases of idiopathic and symptomatic epilepsy, much aggravated both in fre¬ quency and severity of the fits. To specify the symptoms of influenza as I have found it here, would be only reiterating what has been better ex¬ pressed by yourself; suffice it to state that they have been with variations of the inflammatory kind, for which my treatment has been in accordance. When they have come to me, suffering under the oppressive stage, with much congestion in either organ, I have bled as freely as the urgency of the symp¬ toms demanded, guided by the relief it afforded to the patient’s feelings, and produced on the action of the heart; and did my attendance happen to be re¬ quired when the second stage had super¬ vened, then ag’ain I bled to diminish the high and general excitement : of course the stomach and bowels were also promptly attended to, succeeded by the use of antimonial and saline adjuvants. Such has been my practice, and I flat¬ ter myself with its uniform success, not having had one death in near one hun- <“7 dred patients. Should this letter be deemed worthy of space in your valuable periodical, its insertion will oblige Your humble servant, W. W. Morgan. Bury Dispensary, Feb. 16, 1837. ABSCESS OF THE LIVER. To the Editor of the Medical Gazette . Sir, It has been suggested to me since I had the honour of transmitting to the Medical Gazette of the 4th inst., the brief account of a post-mortem examina¬ tion of a woman who died of an exten¬ sive encysted abscess of the liver, that no notice was taken in the report of the state of the gall ducts ; and as the same observation may probably have occurred to other of your readers, perhaps I may be allowed to state a fact which had previously escaped my memory. Upon first viewing the extensive de¬ struction which the liver had sustained, it was a matter of surprise that no de¬ cided symptom had manifested itself during life upon which to ground a probable diagnosis, but it appeared on a more minute investigation that the ducts, viz. the ductus hepaticus, the ductus choledochus communis, aild the ductus cysticus, although surrounded on all sides by disease, were pervious, and perfectly free for the transmission of bile into the duodenum . This cir¬ cumstance, coupled with the fact of the comparatively healthy state of the digestive canal, accounts for the absence of jaundice and discoloured skin, (from both of which the patient was free,) one or other of which has been de¬ scribed by some authors as the invariable concomitant of' hepatitis. I am, sir, Your most obedient servant, R. H. Allnatt. Wallingford, Feb. 15th, 1837. INFLUENZA TREATED IN THE MARYLEEONE INFIRMARY. 819 INFLUENZA AT THE ST. MARYLEBONE INFIRMARY. To the Editor of the Medical Gazette. Sir, In reading- your last number, I have observed one or two inaccuracies in my “ Notice of the Influenza,” which I should be gdad to be allowed to rectify. In g’iving- the total of deaths in the wards in the six weeks ending- Feb. 10 last, I have included about 20 not be¬ longing to the admissions of that period, but to those of the last year, without having sufficiently distinctly stated the circumstance, although important in its relations to the question of mortality. In the table of ages also the same inac¬ curacy occurs from, I believe, the same cause, viz. — haste. You will oblige me by g'iving early insertion to the accom¬ panying more correct statement. Per¬ haps I may mention before concluding, that the total of cases of influenza occur¬ ring- during six weeks in all the depart¬ ments of the practice of the infirmary, which I estimate in round numbers at between 900 and 1000, does not, from want of data, include any attacks occur¬ ring in persons resident, whether as offi¬ cers, servants, or patients in the infirmary, at the beginning of that period, althoug-h such instances were numerous. Let me add that, with us at least, the epidemic may he considered as gone by now for a week or ten days: during the last week only twocases havingbeen admitted for that disease. — I remain, sir, Your obedient servant, John Clendinning. Wimpole Street, Feb. 21, 1837. Total of patients in the Maryle- bone Infirmary, Dec. 31, 1836 .... 216 Total admissions, medical and surgical, between Dec. 30, 1836, and Feb. 10, 1837 . 465 Total treated in the Infirmary in the six weeks ending February 10, 1837 . . 681 Total of deaths in the six weeks in the 1 nfirmary . . 118 Of which belonged to the admis¬ sions of the year 1836 . 20 Leaving- on the admissions of the six weeks ending February 10, 1836, deaths . 98 Or a mortality on the admissions of4^ = 22 per cent, nearly. Table of Ages of all Cases admitted into the Wards of the Infirmary , between Dec. 30 th, 1836, and Feb. 10th , 1837. Ages of all Cases. Admissions. * Deaths of the admitted. Influenza Cases : both Sexes. Male. Female. Male. Female. Under 12 months - • 5 4 1 2 5 1 to 5 years- • • • 15 5 — — 3 5—10 . . 17 24 — 1 15 10 — 20 . 40 33 3 2 35 20 — 30 . 21 40 3 5 28 30 — 40 . 34 26 11 4 33 40 — 50 . 27 27 10 7 26 50 — 60 . 36 25 14 8 41 60 — 70 . 22 30 6 10 35 70 and upwards • • 21 11 9 2 26 820 ANALYSES AND NOTICES OF BOOKS. ANALYSES and NOTICES or BOOKS. “ L’ Auteur se tue a allonger ce que le lecteur se tue a abreger.” — D’Alembert. Anatomic der Mikroscopisc lien Gehilde des MenscJilichen Kor per s ( Anatomia Partium Microscopicarum corporis Humani). Yon Dr. Joseph Berres, Professor der Anatomic an der Wiener Universitat. Wien, 1836. Schloss. We have here a portion of a splendid work, which we foresee will have an extensive celebrity ere long', wherever medical science is cultivated. Without anatomy there can he no physiology ; this is now an old truth. But it is only comparatively recently that it has become generally acknow¬ ledged that there can he no rational ac¬ count given of the functions of any part until the structure of its tissues is thoroughly known. Who, for example, would attempt to explain the action of the lymphatics in digestion without being familiarly acquainted with the texture of the parts, suitably injected and microscopically examined ? Can the secretions of any membrane, gland, or organ, be even plausibly accounted for, without an accurate demonstration of the parts concerned ? The value of microscopic investiga¬ tion has long been admitted; but not universally. The sceptics have always been in the majority : they have refused to believe what they had not themselves an opportunity of seeing ; and in some instances they have refused to see what, if acknowledged as real, would overturn their theories. Leeuwenhoek, Ruysch, Lieberkiihn, Prochaska, Spallanzani, and others, have left us admirable examples of what could be done by talent employed in this way, even with inferior instruments. But since their time much has been achieved. In our own day we have had a number of observers, whose discoveries will perhaps never pass into oblivion. Every physiologist is familiar with the names of J. Muller, Burdach, Ehren- berg, Purkinje, Weber, Krause, Bres- chet, $^c. These distinguished ex¬ plorers of structures have presented us with the results of their invaluable re¬ searches ; but it must be confessed that when combined, their works do not always exhibit uniformity or harmony with each other. It is with a view to obviate this im¬ perfection that Dr. Joseph Berres, the eminent Professor of Anatomy at Ber¬ lin, has undertaken to give a complete and uniform series of microscopic ob¬ servations of the minute structures of the human body. In a learned preface he developes his plans, and states his appliances and means. He tells us that his emulation was excited by the treasure- of microsco¬ pical preparations which they possess at Vienna, from the hands of Lieberkiihn, Barth, and Prochaska. With the com¬ pound microscope of Plossl (an artist whom he praises in the highest terms), he was enabled to appreciate the ex¬ cellence of these, but at the same time to see that they were far from being- perfect. His present criterion of the excel¬ lence of a preparation suited for micro¬ scopical purposes is this — to be able to distinguish the anastomosis of all the vessels even in the minutest twigs, and to discern their perfect detachment or separation from the surrounding organic matter. Every vessel is to be traceable continuously and without interruption through its entire course. How he and his assistant Dr. Hyrtl manage to effect these exquisite preparations is fully ex- jnained. We ought to state Dr. Berres’ ar¬ rangement. He divides the work into three chapters. In the first, which is introductory, he explains all that appears essential for the better understanding of the subse¬ quent parts ; every thing- relating to the use of the instrument which he employs, and to the mode of instituting the ob¬ servations with the best effect, is laid down for those who wish to verify the results themselves. In the second, the minutiae of the va¬ rious organs are microscopically ex¬ plored, and the most prominent and important objects among- them depicted and described. Those among- them which seem to claim most attention in a surgical or physiological point of view, are dwelt on more particularly. The third chapter is to contain a sort of digest of the materials collected. It will be an attempt to arrange, in a phi¬ losophical order, the numerous and won¬ derfully various observations, so as to palmer’s edition of hunter’s works. 82i found upon them a fair induction, with as little risk as possible of any ill con¬ certed theory. With respect to the instrument — the Plosslische miliroskop — used by Dr. Berres, it is figured in the first plate, and would not be considered by micro- scopists here as more than an ordinary instrument in its external appearance. It possesses four aplanatic eye-glasses, composed of two achromatic lenses each, and is furnished with six object-glasses, all of them achromatic and aplanatic. The power of enlargement commonly used by the Doctor is 110 diameters; but he frequently applies a power of 750, as in viewing the globules of the blood, and he says he can augment his magni¬ fying power to double that number. As an instance of the exaggeration which at no distant period was to be met with in describing the powers of instruments, the author tells us that he has in his possession Prochaska’s mi¬ croscope, which was said to magnify 400 times lineal measure ; but upon ex¬ amining it carefully, its powers are found not to exceed 28. Each fasciculus contains two plates, fine specimens of the powers of litho¬ graphy, with letter-press in German and Latin. In the first plate we mentioned that the microscope is represented. The se¬ cond is devoted to plexuses of midute veins and arteries, beautifully delineated in their principal varieties of form. The power here employed is 110 dia¬ meters. Plate the third exhibits various vascular net-works, some of them seen by a power of &40 linear. In the fourth we have the elementary parts, such as the lymph vesicles, the globules of the blood seen under different aspects : they are shewn, by the way, to be flattish discs, not glo¬ bules, and to have a central depres¬ sion. The elementary vesicles of fat are also figured here. Osseous, horny, cartilaginous particles, are also dis¬ played. In plate five we have nervous, vascu¬ lar, and muscular elements. The parts of muscular fibre are shewn at rest, con¬ tracted, and loosened into further fila¬ ments : the two former conditions are exhibited as seen with a power equal to 540 diameters; the latter with one of 750. Plates six and seven exhibit the skin and its elementary details. Eight and nine, display the tissues connected with the organ of taste. Ten, exhibits miscellaneous textures, among' them a vertical section of the kidney, exqui¬ sitely delineated. The eleventh and twelfth plates shew the structures con¬ nected with the organ of vision. But the work requires to be seen and minutely examined, in order to be ap¬ preciated according to its merits. The Works of John Hunter , F.R.S. ; with Notes. Edited by James F. Palmer. In 4 vols. 8vo. illustrated by a Volume of Plates, in4to. Vol. I. “ Faber quisque fortunoe suee,” is a maxim which those who have been successful in life are generally found willing enough to adopt, as it implies a compliment to their own discretion, and excludes fortune from any share of their success. The art of rising in life, how¬ ever, is a compound game, consisting of chance and skill, in which chance is often found to over rule the most con¬ summate skill. “ The battle is not al¬ ways to the strong, nor yet favour to men of skill, but time and chance hap- peneth to all.” This is more especially true of medical men, who have always received the credit of being fully as de¬ pendent on the general affability of their manners and the lucky incidents of for¬ tune, as on the skill and knowledge which they possess in their profession. For our parts, we see no reason to ques¬ tion the accuracy of popular belief on this subject, or to doubt that the ave¬ nues of fortune are as diverse in pro¬ fessional as they are in common life. In most respects, Hunter’s entrance on his professional career was commenced un¬ der the most favourable auspices. He had studied under the ablest surgeons of the day, had associated with the most emi¬ nent characters of the ag'e, and had ac¬ quired a considerable reputation for his anatomical knowledge ; and yet the drawbacks inherent in his own character prevented his reaching to any great degree of popularity until a late period of his life, and would probably lave restrained his flight beyond the vul¬ gar bounds of mediocrity to the end of his days, had those days been a little less short than they were, or the powers of his intellect been a little less vigorous. “ Hunter was, however, destined to 822 ANALYSES AND NOTICES OF BOOKS. undergo a long trial of those qualities of passive fortitude and active perse¬ verance, of which few situations in life demand a larger share than that of a young man commencing practice in the higher branches of the profession of law or medicine in London ; for as¬ suredly it needs no small degree of forti¬ tude to bear up against the disappoint¬ ment a young man so placed must ex¬ perience, in finding his merits over¬ looked, whilst the world is showering wealth on many around him whom he, at least, thinks far less deserving than himself. It requires, too, much steady perseverance, constantly to keep in view the destined goal; resisting the allure¬ ments which have so often led men of superior talents to desert the arduous contest, and devote themselves to the pursuits of literature or of science — pursuits which, though delightful, can seldom be extensively followed without The neglect of objects more essential to those who seek for fortune, as well as fame, from the practice of a profession.” It may shrewdly be suspected that most of the events of life are the off¬ spring of circumstances, and gradually grow out of one another. Historians and biographers' commit a great error in ascribing1 the principal revolutions of public and private history to deep-laid schemes of policy; whereas, in truth, the difference in men’s fortunes chiefly consists in the sagacity with which they seize, or the aptitude with which they turn to advantage, the common inci¬ dents of life. Some there are, indeed, in whose lives there is a sort of “ tide, which, taken at the full, leads on to fortune;” but with the generality, life may more aptly be compared to the galaxy or milky way, which consists of clusters of innumerable stars, or to a river which is fed by innumerable small streamlets; the great secret of self- wisdom being to keep a steady eye to one’s own advantage, and to turn the least circumstances to account ; and, under due restraint, no one can object dishonour to this mode of proceeding, although nothing can be more contemp¬ tible than the base shifts to w hich some men resort, for the purpose of lifting themselves into public notice. “ Hunter had also a great contempt for those minor tactics which constitute so large a part of what has been aptly called the act of rising in the w orld ; and they who have carefully watched the progress of men to fortune, know full well how much of their success has often been due to the judicious manage¬ ment of these auxiliary means. It would be egregious folly to suppose that a man could ever attain to high repute as a surgeon in London, without pos¬ sessing a large share of the essential re¬ quisites for the practice of his profes¬ sion; but, on the other hand, it requires no great penetration to perceive that the vast difference in the amount of her favours, vouchsafed by Fortune to her different votaries, must be accounted for in some other way than by the amount of professional talent possessed by each. * Lie that is only real , had need have exceeding great parts of virtue,’ says Bacon, ‘ as the stone had need be rich that is set without foil ;’ and we need not a better illustration of thetruth of this observation than is afforded by Hunter’s tardy progress to the path of fortune, com¬ pared with the rapid strides of others, wjio, in professional attainments, w ould be the first to acknowledge themselves but the humble disciples of this great master. “ But after all, perhaps, the princi¬ pal reason why Hunter was so long in obtaining a large share of practice, was, that he looked not, as most men do, to the acquisition of fortune, as the end for which he was labouring; but, on the contrary, considered wealth only as a means by which he might advance the far more important objects he had in view. His powerful mind was unceas¬ ingly stimulated by an ardent desire to forward the acquisition of those branches of knowledge which, to him, appeared best fitted to promote the improvement of his profession : to this object was devoted every hour that he could spare from his daily avocations, or snatch from the time allotted by others to sleep ; and, to promote this end, he was always ready to sacrifice the claims of worldly prudence and self-interest. To witness an interesting and extraordinary case, he would take any trouble, or go almost any distance, w ithout a chance of pecuniary recompence ; but to the daily routine of practice he always returned unwillingly, and even wrhen he had acquired a lucra¬ tive and extensive business, he valued it only as affording him the means of pur¬ suing his favourite studies. This feel¬ ing he would often express to his friend, palmer’s edition of hunter’s works. 823 Mr. Lynn, when called to see a patient, by saying-, as he unwillingly laid by his dissecting- instruments, ‘ Well, Lynn, I must g-o and earn this d - d g’uinea, or I shall be sure to want it to-morrow. 5 ” During- the interval which occurred between Hunter’s return from the Peninsula and his extensive private engagements in business, he was compelled to eke out his slender for¬ tune by receiving pupils into his house. Most of these attained to considerable eminence in their profes¬ sion in after life; thus proving- the ex¬ cellence of the instructions which they received under his roof, and the zeal with which his example w as able to in¬ spire them. The following' just re¬ flections occur on this subject : — “ All of these gentlemen have risen to high reputation in their various stations, and it is not unworthy of remark, that, of the eminent surg'eons of which this country has had to boast, by far the greater number have pursued the most important part of their professional education un¬ der the roofs, and as the private pupils, of the most able of their predecessors in the art. This may, no doubt, in some cases be accounted for by supposing that the disciple had previously shewn such talent as to lead his friends to seek the best situation for its improvement ; but more has been probably due to the stimulus imparted to their energies by the examples before them, and still more to the advantages derived from daily witnessing the best modes of prac¬ tice, and receiving information on those nicer distinctions in treatment which can never be fully conveyed in lectures, but the knowledge of which forms a dis¬ tinguishing mark of the accomplished surgeon. Thus w'e find that most of the surgeons who, in the present day, enjoy the largest share of the public confidence, are, as it were, the direct mental descendants of the men who, a century ago, introduced the first impor¬ tant improvements into modern surgery. Cheselden, Nourse, and Douglas, were then the leaders of our profession; of whom Sharp, Pott, and the Hunters, were the immediate pupils. They, again, became the instructors of Cline, Lynn, Home, Abernethy, Carlisle, Macartney, Sir James Earle, and Cooper ; and from them the mantle has ^ descended to a Brodie, a Lawrence, a Green, an Earle, and others, who now occupy, w'ith so much credit to them¬ selves, the places which their great pre¬ decessors adorned.” Among Mr. Hunter’s pupils, none appears to have won so much on his af¬ fections as Dr. Jenner, with whom he ever afterwards maintained a friendly and cordial correspondence. Perhaps no part of Mr. Hunter’s history exhibits in so striking a light the untiring' ar¬ dour with which he prosecuted his phy¬ siological pursuits, as this correspond¬ ence. As models, indeed, of epistolary composition, we are compelled to say that they are deficient in that ease and fluency which constitute the chief charm of this style of writing, but they every where evince the vigour and ori¬ ginality of his thoughts, while his ex¬ pressions are often characterized by great terseness and force. We quote a couple of these letters as specimens of the rest. “ Dear Jenner, — I own I was at a loss to account for your silence, and I was sorry at the cause. I can easily conceive how you must feel, for you have two passions to cope with, viz. that of being disappointed in love, and that of being defeated; but both will wear out, — perhaps the first soonest. I own I was glad when I heard you was married to a woman of fortune; but ‘ let her go, never mind her.’ “ I shall employ you with hedge¬ hogs, for I do not know how far I may trust mine. I want you to g-et a hedge¬ hog in the beginning of winter, and weigh him; put him in your garden, and let him have some leaves, hay, or straw, to cover himself with ; which he w ill do. Then weigh him in the spring, and see what he has lost. Secondly, I want you to kill one in the beginning of winter, to see how fat he is ; and another in spring, to see what he has lost of his fat. Thirdly, when the wea¬ ther is very cold, and about the month of January, I could wish you 'would make a hole in one of their bellies, and put the thermometer down into the pelvis, and see the height of the mer¬ cury ; then turn it upwards towards the diaphragm, and observe the heat there. So much at present for hedge-hogs. I beg pardon, — examine the stomach and intestines. “ If Hewson’s thing's go cheap, I will purchase some that I think proper for you ; those you mention will, I am 824 ANALYSES AND NOTICES OF BOOKS. afraid, be every body’s money, and go dear. — Ever yours, “J. Hunter.” (Postmark, Jan. 29, !789.) “ Dear Jenner, — I wish you joy: it never rains but it pours. Rather than the brat should not be a Christian I will stand godfather, for I should be un¬ happy if the poor little thing- should go to the devil because I would not stand godfather. I hope Mrs. Jenner is well, and that you beg*in to look grave now you are a father. — Yours sincerely, “ J. Hunter.” Resides an Appendix at the end of the Life, containing a chronological list of Mr. Hunter’s writings, the author has, in the course of his history, inter¬ woven an account of these various pro¬ ductions, accompanied in most cases with some judicious reflections on their nature and value. The following, on the work on Inflammation, are well de¬ serving of consideration : — “ This work is the one on which, above all his other writings, Hunter’s fame has hitherto rested, perhaps too exclusively so, since it has arisen from the circumstance that, with the excep¬ tion of the Treatise on Syphilis, his other works have been less generally read than they deserve, in consequence of having been published either in an ex¬ pensive form, or in detached treatises, scattered through the volumes of the Philosophical Transactions, or of the Medical and Ch irurgical Society. There are not, however, any of his writings which do not w-ell deserve the attentive perusal of professional men, not only for the information they furnish, but as models of bold and sagacious reasoning; and hence the present edition, which places w ithin the reach of every profes¬ sional man the whole of his works, heightened, too, ;n value, by the com¬ mentaries of the able men to whose revi¬ sion they have been severally entrusted, cannot fail to be viewed as a tribute justly due to the merits of Hunter, and as a highly important accession to our medical literature. The treatise on Inflammation and Gun¬ shot Wounds must be considered as com¬ prising the results of forty years, assidu¬ ous attention to the subject, since from his introduction we learn, that the doc¬ trines it unfolds first suggested them¬ selves to his mind at the time he was a student in the London Hospital, and were based on observations collected during that period. These doctrines he continued during his whole professional career to submit to the test of his own increasing experience, and the experi¬ ence of others, to whom he taught them in his lectures, ever carefully and can¬ didly correcting them where more accu¬ rate observations proved them to be faulty, and extending them where fresh information shewed them to be deficient; and having thus brought them to as high a degree of perfection as his abili¬ ties and opportunities would permit, he at length submitted them to the test of public opinion in the condensed and systematic form in which we now possess them. Notwithstanding the time and attention he bad devoted to the comple¬ tion of a work on which his future fame was mainly to depend, he was himself fully sensible of its still possessing many defects, and rather desired it to he con¬ sidered “ as a new figure composed- from rough materials, in which process little or no assistance could be had from any quarter,” than as a perfect work which no farther experience could have amended. It must, indeed, be acknow¬ ledged that it does, in many parts, exhi¬ bit imperfections of style and diction, as well as repetitions, which not unfre- quently obscure the author’s meaning; and illog'ical errors, such as that of con¬ founding proximate and final causes, or employing such imaginary causes as the “ stimulus of necessity,” “ the sti¬ mulus of death,” “ the force of a nega¬ tive impression,” &c., to account for certain effects ; phrases which cheat the ear with a seeming explanation, but leave the mind no whit the wiser as to the real causes of the phenomena to be accounted for. These defects, though they do unquestionably detract some¬ what from its value, are, however trifling in comparison with the g’reat and varied excellence of this work, which, for the originality and variety of its experi¬ ments, the accuracy of its observations, and the importance of its deductions, can with difficulty be paralleled in the whole range of medical literature. As an instance of the zeal w’ith which Hunter sought and procured every object of curiosity calculated to enrich his museum, the followingis sufficiently in¬ teresting: — MEDICAL ATTENDANCE ON PAUPERS UNDER THE POOR-LAW. 825 “ The late Dr. Clarke had a prepara¬ tion of an extra-uterine pregnancy, in which the fetus had been detained in the fallopian tube, and had there under¬ gone partial development, when the mother died from internal haemorrhage, consequent on the rupture of the tube. On this specimen he set a high value, and H unter had often viewed it with longing eyes. “ Come, Doctor,” said he, “ I positively must have that prepa¬ ration.” “No, John Hunter,” was the reply, “you positively shall not.” “You will not give it me, then?” “No.” “ Will you sell it ?” “ No.” “ Well, then, take care I don’t meet you with it in some dark lane at night, for if I dp, I’ll murder you to get it.” We pass over Sir Everard Home’s atro¬ cious conduct in burning the Hunterian MSS. with this single observation, that as the Venetians have placed a black tablet in the place of the portrait of their traitor doge, so a black tablet in the Hunterian Museum would be a fitter record of Sir Everard Home’s base¬ ness than the bust which at present stands in the hall of the College. “ O tempora ! 6 mores ! Senatus hcec intelligit, consul videt : hie tamen vixit; vixit? imo verb etiam in sena- tum venit.” We conclude with the following* ex- tract, which contains a hint which we hope to see acted upon before many more years have elapsed. “It may be thought that the author of the Hunterian Museum needs no other memorial of his worth than the proud one he has himself erected; nor does be, to perpetuate.}} is fame: still, it would be a fitting act of respect to his memory, from those who enjoy the bene¬ fits of this rich legacy of his genius, to enrol his name amongst those of the other gifted men whose worth stands recorded in Westminster Abbey.” DESGENETTES. When the French were at Moscow, the Emperor gave an order to have the Foundling Hospital converted into a barrack; but Desgenettes, as bold in Russia as formerly in Syria, told him to take care how he allowed posterity to compare him with Herod. “ Herod !” said Napoleon, “ what resemblance is there between me and Herod ; what do you allude to?” — “ To the massacre of the innocents!” replied Desgenettes. The or¬ der for the barrack was countermanded. — Bouillaud’s dloge. MEDICAL GAZETTE. Saturday , February 25, 1837. ** Licet omnibus, licet etiam mihi, dignitatem Artis Medical tueri ; potestas modo veniendi in P'lblicum sit, dicendi periculum noarecuso.” Cicero. MEDICAL ATTENDANCE ON PAUPERS under THE POOR-LAW. We make no apology for once more calling the attention of our readers to this important subject. Notices of mo¬ tions have been given in Parliament for committees to inquire both into the ge¬ neral and medical working of the amended Poor-Law, and every man who possesses a spark of national feel¬ ing ought to take an active interest in the result. Medical men are more especially im¬ plicated in the consequences ; for if the Poor-Law be allow’ed to continue in its present state, it must entail permanent disgrace and degradation on the pro¬ fession. Three things are loudly complained of by those practitioners in the provinces who have the best opportunity of observing the operation of the Union system ; these are, first, the utter insufficiency of medical attendance on the pauper popu¬ lation ; next, the miserably wretched remuneration which the district medical officers (or slaves rather) are obliged to accept ; and, lastly, the perpetual in¬ sults and indignities cast upon the members of the profession by the Poor- Law functionaries — w ho no doubt calcu¬ late that if they can only lower medical practitioners in the public estimation, they can then accomplish their purposes of thrift and meanness with perfect cer- taintv of success. •/ These are no vague and groundless assertions ; they are facts proved over and over again in the pages of this journal, but not the less worthy of repe¬ tition for that reason. Medical men 826 MEDICAL ATTENDANCE ON PAUPERS UNDER THE POOR-LAW. often require to have their memory jogged, and to have the same truths reiterated occasionally before the requi¬ site impression is made. At the present moment every medical man should be broad awake ; and not only individuals of the profession, but the corporate bodies, should be up and stirring", if the character of the healing" art be^in any way dear to them. The active Committee of the Provin¬ cial Association have just put forth a second edition of their valuable report*; to that summary of the state of the case between the Poor-law- and the medical profession, we strongly recommend at this juncture the attention of the Col¬ leges, the Hall, and every individual practitioner ; even the most cursory pe¬ rusal of its contents must convince the reader how deeply the interests of medi¬ cine are involved in the proper adjust¬ ment of the question. On a former occasion we noticed the body of the Report, and made some ex¬ tracts from it; we have not much space at our command just now, or we should be tempted to select some more, espe¬ cially from the fresh matter incorporated with the new edition. There are a few passages, however, for which we must make room, as they shew in a striking manner the difficulties in which many of our unhappy brethren in the pro¬ vinces are placed under the existing regime. For those who are trammelled in the new arrangements to speak out, or to complain in any manner of their griev¬ ances, were as much as their frail tenures are worth ; it w ould be deemed a sort of high treason to the Somerset House au¬ thorities, and, if discovered, would be summarily dealt with. The following * The Report of the Poor Law Committee ap¬ pointed by the Provincial Medical and Surgical Association. Read at the Anniversary Meetiug, held at Manchester, July 1836. Second Edition, with an Appendix, containing Selections from the Evidence furnished from numerous Parochial Unions, respecting the Medical Arrangements and their Effects. letter sent to the Committee w ill serve to show how even medical men not im¬ mediately connected with the Unions are situated : — “Though the statement I gave you, dated October 23rd, is decidedly correct, and I could undertake to prove it in every particular, yet, situated as I am at the present time, it might be ex¬ tremely injurious to me if I allowed that statement to be published, knowing that it came from me. In the first place, the Vice-chairman of the union is a most excellent patient of mine, and thinks very highly of the Newr Act, and perhaps that statement might displease him; if it did, the mischief might not end there ; he could influence others. Again, wrould not that statement be a libel on the district medical man, and therefore actionable, so that I might be dragged into law proceedings. I can have no objection to the statement being published, if neither name nor place be mentioned. I have every wish to ren¬ der the Committee all the information I possibly can, but having a family to provide for, and entirely dependent on my exertions, I do not think I ought to risk any thing. “ I feel equally with the Committee, the degradation brought on the pro¬ fession by the Poor Law- Commissioners, and nothing- would give me greater pleasure than to assist my medical brethren, in any way I can, to extricate us from it. — I am, 'See. &c. “Dec. 13, 1836.” At the conclusion of the present arti¬ cle we shall give a similar letter just received by ourselves, in which the working of the same degrading influ¬ ences will be recognized. We have alluded to the insufficiency of the medical aid provided for w-retched paupers in the keeping of the Commis¬ sioners. Who can read the following facts W’ithout heing" convinced of the mischievous tendency of their present arrangements. “ In the Cookham and Bray unions, two medical men were appointed under the new system, in place of seven who previously attended. —In the Newbury union, consisting of eighteen parishes, MEDICAL ATTENDANCE ON PAUPERS UNDER THE POOR-LAW. 827 one individual undertook the duties for¬ merly performed by twelve; he had no assistant, and had a space to ride over measuring sixteen miles by ten. — In the Bampton district of the Witney union, ten miles in diameter, eight me¬ dical men were formerly employed ; now only one. — In one of the districts of the Aylesbury union, the surgeon resides at a distance of seven miles from one part of the district, where medi¬ cal assistance might be obtained with¬ in two miles. — In another district of the same union, the nearest point to the surgeon’s residence is seven miles, and the most remote twelve. Under the old system sixteen medical men were employed for the parishes of this union, containing forty parishes and four dis¬ tricts ; under the new system three me¬ dical men only, one of whom was like¬ wise appointed to an extensive district in another union. — In the Wheaten- hurst union, comprehending fourteen lavishes, and necessarily much travel- ing, the Commissioners induced the Guardians to waive a contract with the established practitioners, and to engage one young man from the schools, who had neither a horse nor instruments. — In the Faversbam union, including twenty-five parishes, only one medical man was employed. — Numerous cases of a similar kind could be adduced.” As to the proofs of the degradation suffered by practitioners who have the misfortune to be connected with the existing Poor-law unions, they abound in the Report. The subjoined passages are among the conclusions on the sub¬ ject drawn by the Committee : — “ Medical officers are liable, in the discharge of their duty, to receive a summons from the Board of Guardians on occasion of any supposed neglect; they are thus subject to be reprimanded by persons w ho cannot be supposed ca¬ pable of judging correctly as to the due performance of medical duties. Your Committee have received information of several oppressive proceedings of Guar¬ dians in this respect. “ Again, if a medical opinion is con¬ sidered necessary to guide the Board in any of its deliberations, which not un- frequently occurs, the medical officer is summoned to attend in the same man¬ ner as are the inferior officers of the Board. “ Lastly, those medical men who have presumed to express an opinion unfavourable to the new medical ar¬ rangements, have frequently been mark¬ ed for oppression by the authorities, and some have even been induced to withdraw or withhold their names from petitions to parliament against the sys¬ tem, from apprehension of injurious consequences to themselves.” The meanness of the Commissioners in taunting medical men with accepting (what in many instances they cannot help) appointments by tender , when they themselves arbitrarily dictate this as the sole mode of obtaining an ap¬ pointment in certain localities, is well exposed by the Committee. The Com¬ missioners say, “ We may be sure that the medical practitioner will, in fixing upon his terms, do nothing which he considers will not, on the whole, be ad¬ vantageous to his own profession;” thus endeavouring to cast solely on the medical officers of Unions the discredit of the miserably low stipends awarded to them. But, say the Committee, with excellent good temper and pointed shrewdness, — “We have only to reply, that were the system of tender intro¬ duced into any other profession, the same injurious results would ensue; if even the office of the Poor-Law Com¬ missioner were to be submitted to the same degradation, there would be found needy speculators, not destitute of ability, who would gladly, for the tenth part of the salary, undertake its duties.” We intended to have noticed some of the facts in the Appendix, but find we have only room to give the letter w'e promised. To the Editor of the Medical Gazette. Sir, The following very singular and offensive note was received, a few days ago, by a respectable practitioner in 828 ROYAL INSTITUTION. Ibis neighbourhood from a relieving officer : — “ Sir, — You are requested to attend to the case of S. G. immediately , who is said to be in a state of mental derange¬ ment. You are also requested to call on the overseer (i. e.) Mr. M., and re¬ port the case to him, that he may report the same to-morrow at the Board at C— - . ( Fail not at your peril.) “ W. C., Relieving Officer.” It was sent to me as affording an ad¬ ditional proof of the degradation to which the profession are subjected under the operation of the present abominable system. If you think its publication will operate as a wholesome lesson to those members of the profession who are so anxious to fill th e highly respectable (?) office of medical officer under a Board of Guardians, as to tender their services for a wretched pittance, you will oblige me by giving it insertion. As the case is also an admirable spe¬ cimen of the medical merits of this wonder-working system, I cannot for¬ bear mentioning it. A poor widow, eet. 47, whilst washing in the house of the overseer of her own parish, is taken ill on the Monday ; she gets worse on Tuesday and Wednesday ; is in a state of violent derangement on Thursday (no doubt arising from active disease within the head) ; persons are employed by the overseer to take care of her botli day and night, and yet, sir, she was allowed to remain without medical assistance until the following Monday, one week after the commencement of this serious attack, when a humane gentleman in the neighbourhood, hear¬ ing of the case, sent a surgeon to attend her at his own expense. On the follow¬ ing day (Tuesday) the relieving* officer ays his weekly visit to the parish, and y way of making up for the previous neglect, sends the above-mentioned in¬ solent note to the medical officer, who in duty bound immediately attends, and on his arrival finds the poor woman already under the care of another prac¬ titioner as a private patient, by whom she had been bled, leeched, blistered, head shaved, and physicked ! She has since died. It is but justice, how'ever, to the Board of Guardians, to state, that when the case was brought before their notice, they reprimanded their officer, and passed a resolution unanimously de¬ claring their disapprobation of his con¬ duct. — I am, sir, Your most obedient servant, A Constant Reader. Cerne, Feb. 20, 1837. P. S. 1 send you my name in con¬ fidence, as I do not think any commu¬ nication of this sort should be sent without it, but I do not wish it to appear in public. ROYAL INSTITUTION. Friday, Feb. 17, 1837. Dr. Marshall Hall’s "Reflex Action of the Spinal Marrow. Dr. Faraday undertook this evening to give a popular exposition of Dr. Hall’s views on the “ reflex function,” and effect¬ ed it wfith brilliant success. He apologized for meddling with a subject so strictly physiological and out of his province ; but it was one of the objects of these evening meetings to bring even the most abstruse topics familiarly before the members of the Institution and their friends. After point¬ ing out the functions of the brain, and showing, in accordance wfith Dr. Hall’s theory, that the brain is the sole seat of sensation, he passed to the conside¬ ration of the spinal cord and its reflex ac¬ tion. It wrould be superfluous in this journal, in which Dr. Hall’s views have so often been stated, to repeat the account given of them by Dr. Faraday, of which not its novelty but its total freedom from technicalities wras the principal charm. Dr. Hall’s experiments on the turtle, the snake, the frog, the stunned horse, &c., w'ere described; and diagrams were exhibited wrhich wrere wrell adapted to give a general idea of the subject to a popular audience. The viewrs of other waiters corroborative of those of Dr. Flail were alluded to. Mr. Mayo’s distinct notice, in a book of his published in 1823, of the identical function of the spinal marrow, so fully afterwards developed by Dr. Hall, was quoted ; and Dr. John Muller’s opinions, as given in his Physiology, wrere stated to be strongly confirmatory of the same doc¬ trine. By the way, we have before us an ex¬ tract from Muller’s account of the reflex function, recently published by Dr. Hall, with remarks; we cannot, perhaps, do better than close this brief account of a . very interesting evening wfith the summary given by Dr. H. of those points in which he differs, to a certain extent, from Profes¬ sor Muller : — CAESAREAN OPERATION SUCCESSFULLY PERFORMED. 829 1. I view the reflex function as the distinct and peculiar or proper function of the medulla spinalis, equally independent of the brain, the sympathetic, and of the anastomoses and the mere origins of nerves ; 2. - I regard this function as residing in the medulla, as the axis of a distinct system of excitor and motor , and excito motory nerves ; 3. I consider this function and its sys¬ tem of nerves as presiding over the orifices and the exits or sphincters of the animal frame, and over ingestion and egestion ; 4 The brain is the central organ of sensation and volition, the organ of mental relation with the external world ; the spinal marrow, on the contrary, is the central organ of excito-motory phenomena, and of the physical appropriation of certaiu external objects; 5. Respiration even is a part of this peculiar function : it is excited on ordinary, and on extraordinary occasions, through appropriate excitor nerves, especially the pneumo-gastric, but also the fifth and spinal nerves; 6. Volition may modify the acts of the reflex function, and these acts may be attended by sensation ; but this function is, otherwise, independent both of volition and sensation, of their organ the brain, and of the mind or soul; 7. The passions, in an especial manner, demonstrate themselves through the me¬ dium of the true spinal marrow ; and thus pain may induce surprise or fear, and appear to occasion excito-motory act ; 8. The brain sleeps ; but the spinal mar¬ row never sleeps ; 9. Finally, the excito-motory system of nerves are the peculiar seat of action of certain diseases, and of certain causes and remedies of disease. AD CAPTANDUM SURGERY. A fondness for certain operations, and a degree of over-zeal in seeking for occasions to perform them, are modern traits of professional character, which, it is to be hoped, will become obliterated or obscured by the daily improvements in pathology and the diagnosis of diseases. The mere operator ought not to be ranked amongst the best of surgeons, and the kidnapping of such patients as furnish conspicuous cases for an hospital- theatre, or for the more private assembly of a coterie of young operators, should be discountenanced and denounced by every conscientious cultiva¬ tor of surgical science. — Mr, Crosse's Retro¬ spective Address, HOSPICE DE LA MATERNITE, ARRAS. CESAREAN OPERATION SUCCESSFULLYPER- FORMED, WITH SAFETY BOTH TO THE MOTHER AND CHILD. By A. R. Duchateau, M.D. Surgeon in Chief to the Hospitals of Arras, Pro¬ fessor in the School of Medicine, &c. Stephanie Brassart, aged 22, is a na¬ tive of Arras. Her parents were both well formed ; her height is forty-three inches ; her general aspect that of a ricketty person. The vertebral column is very convex anteriorly; the thighs are short, and the legs much curved. General health good on entering the hospital. We learned that the catamenia had made their first appearance when she was 18 years of age, and had continued abun¬ dant and regular since. The first time I saw her at the Maternite, whither she came in order to be let blood, in the eighth month of her first pregnaney, I was struck with her figure, and thought it requisite to make some inquiry as to the state of the pelvis. Mde. Delarue and I instituted an examination accordingly, and found that the crests of the ilia were in one line, and that from one anterior superior spinous process to the other measured 8 inches 9 lines; also that the sacro-vertebral angle was directed towards the pubes, and a lit¬ tle to the right, and that the upper strait was but two inches in its antero-posterior diameter. On the 20th of April, 1836, Stephanie returned to the hospital, being at her full time ; she complained of pains about the loins. No regular labour-pains, however, occurred till five in the morning of the 24th, when they came on decidedly but slowly. At six, the os uteri might be felt turned to the right and forward, with a dilatation of from 10 to 12 lines. The membranes now began to present, but no part of the child could be reached in any way by the finger. A lavement was ad¬ ministered, and the patient put into a bath. A meeting of my colleagues was sum¬ moned, and assembled at nine a.m., when all were satisfied that the Caesarean ope¬ ration wras indispensable. The patient was taken, without loss of time, into the operating theatre, and there, in presence of the civil and military offic ers de santt of the hospital, Mde. Delarue, and our pupils 830 CAESAREAN OPERATION SUCCESSFULLY PERFORMED. of the Maternite, and upwards of sixty pupils belonging to the school, I had Ste¬ phanie placed on a hair mattress, with her body horizontal, her head slightly raised, and her lower extremities a little apart — the feet being on the margins of the bed. My four assistants being duly appointed to their several posts, I took up my posi¬ tion on the left of the patient, when I commenced by making an incision on the abdomen, extending from two inches above the pubes, along the linea alba, a little to the left, avoiding the umbilicus, to two and a half inches above the navel. In completing this incision, the several aponeurotic expansions were laid bare. The peritoneum was at length arrived at, when it was opened with great caution by means of a straight and buttoned bistoury, along the whole length of the original in¬ cision. I then raised the omentum which covered the uterus and intestines ; an assistant kept it raised : upon which the uterus was found having its centre in the middle of the incision of the abdomen. I cut into it with a slightly convex bistoury, when the fibres of the womb were ob¬ served separating from each other as fast as they were divided. As soon as I reach¬ ed the interior surface, 1 found by the jet of black blood which immediately took place, that I had cut down on the pla¬ centa. The opening was forthwith dilated with a buttoned bistoury; the membranes wrere then seen, upon which I opened them cautiously, the assistants taking care that the liquor amnii should not be effused into the cavity of the abdomen. The infant was in the first position for delivery; I withdrew it by the legs, supporting the trunk with the left hand ; it cried pre¬ sently, and the funis was divided. Mde. Delarue took charge of the child ; it was a boy, and weighed 6 ho 4 oz. We then waited for three minutes, when finding the uterus contracting, I detached the placenta, and removed it along with the, membranes ; nor were there any clots of effused fluid left in the viscus. I put my forefinger through the os tineas from within, and met the finger of one of my assistants from without : we were thus sa¬ tisfied that there was no mechanical ob¬ stacle to the lochia, should they occur; we also ascertained that the structure of the promontory was such as we judged it to be wrhen we determined on the operation. The borders of the abdominal incision w'ere brought together with three points of suture. A seton covered with cerate was placed at the lower angle of the wound ; five pieces of sticking-plaster were placed between the sutures; a compress was laid over this; and charpie, with a general bandage methodically applied, completed the process of dressing. The operation lasted altogether about twenty minutes. No artery that required tying was divided. The patient during the whole of the time displayed much for¬ titude and resignation. After the opera¬ tion she was removed to another bed on the same floor, where she was placed in a horizontal position and left to repose, after getting a sedative draught. About three hours after the operation acute jtains were felt in the right iliac region, which required the application of fifteen leeches. This had a good effect. Vomiting and feverish symptoms during the afternoon. On the second day, the vomiting continuing, with much disturb¬ ance of the system, the dressing was re¬ moved, when a portion of the omentum was found protruding at the upper angle of the wound ; it was returned into the abdomen, and secured there by adhesive plaster laid above its place of egress. A large poultice was applied to the abdomen, which alleviated the vomiting and pain. Third day.' — The lochia are established; the disturbance of fhe system much abat¬ ed ; the bowels largely moved. Poultice renewed. The symptoms were variable during the succeeding days, but not alarm¬ ing at any time. Ninth day. — Total absence of fever; wishes for cafe au lait, which is given her. Sutures and seton removed. Union of a great part of the wound ; a little pus, how¬ ever, flows from the lower angle on the accession of cough. The poultice still applied daily. From the tenth to the twenty-first day, when the cure was complete, the dietary regimen was gradually improved ; all the functions were naturally performed. An appearance of oedema was noticed about the fifteenth day, but was remedied by medicinal treatment. After this Ste¬ phanie began to leave her bed, and to walk about the wards, and in the garden of the hospital. She did not return home till sixty-three days after the operation, hav¬ ing waited, indeed, to be present at the distribution of prizes which took place at the Maternite on the 2oth June. The child is well ; it has been sent out to nurse at the charge of the administra¬ tion of hospitals, the mother having had no secretion of milk*. * La Presse Medicate, ancien Journal Hebdo- madairej Jan. 1837. LIST OF DRUGS, ON SALE IN THE ENGLISH MARKET, With their Prices and several Duties. (From the Official Returns up to Tuesday, Feb. 21, 1837.^) Aloes, Barbadoes, d.p . c Hepatic (dry) bd . c Cape, bd . c Aniseed, Oil of, German, d.p _ lb E. 1 . lb Assafostida, b.d . . . c Balsam, Canada, d.p . lb Copaiba, bd . lb Peru, bd . lb Benzoin (best) bd . . . c Camphor, unrefined, bd _ _ _ c Cantharid.es, d.p . lb Carraway, Oil of, d.p . .• - lb Cascarilla or Eleutheria Bark,D.p.c. Cassia, Oil of, bd . lb Castor Oil, East India, bd . lb West I. (bottle) d.p. ljlb Castoreum, American . lb d.p. Hudson’s Bay lb Russian . lb Catechu, bd . c Cinchona Bark, Pale (Crown) .... lb bd. Red . lb Yellow . lb Colocynth, Turkey . lb d.p. Mogadore . lb Calumba Root, bd . c Cubebs, bd . c Gamboge, bd . c Gentian, d.p . c Guaiacum, d.p . lb Gum Arabic, Turkey, fine, d.p... c Do. seconds, d.p. .. c Barbary, brown, bd. c Do. white, d.p . c E. I. fine yellow, bd. c Do. dark brown, b.d. c - Senega] garb lings, d.p . c - Tragacanth, d.p., . c Iceland Moss (Lichen), d.p . lb Ipecacuanha Root, b.d . lb Jalap, bd . lb Manna, flaky, bd . lb Sicilian, bd . lb Musk, China, bd . oz Myrrh, East India, bd . c Turkey, bd . c Nux Vomica, bd . lb Opium, Turkey, bd . lb Peppermint, Oil of, F. bd . lb Quicksilver, bd . lb Rhubarb, East India, bd. . . . lb Dutch, trimmed, D.p. lb Russian, bd . - lb Saffron, French, bd . - lb Spanish . . lb Sarsaparilla, Honduras, bd, . lb Lisbon, bd. .. ....lb Scammony, Smyrna, d.p... .... lb Aleppo . ....lb Senna, East India, bd . ....lb Alexandria, d.p . .. .. lb Smyrna, d.p . ....lb Tripoli, d.p . ....lb Price. £ s. d. £ s. d. 12 0 0 to 30 0 0 5 0 0 14 0 0 i 10 0 1 16 0 0 9 0 0 9 6 0 7 0 0 7- 6 0 2 10 0 5 0 0 1 3 0 1 4 0 2 7 0 5 0 25 0 0 50 0 0 9 0 0 0 6 6 0 9 0 1 15 0 0 9 0 0 0 6 0 0 10 0 2 3 1 15 0 1 0 0 1 4 0 none 1 0 0 0 2 0 0 3 6 0 3 0 0 6 0 0 1 6 0 2 6 0 4 0 0 3 0 1 4 0 2 5 0 3 0 0 5 0 0 15 0 0 1 4 0 • - - 0 1 0 0 1 8 8 0 0 9 0 0 5 0 0 7 0 0 3 19 0 4 15 0 3 0 0 3 10 0 1 15 0 2 5 0 4 15 0 5 0 0 13 0 0 20 0 0 0 0 2J 0 0 3 0 3 0 0 1 10 0 5 0 — 0 1 7 1 0 0 1 8 0 5 0 0 14 0 0 2 0 0 11 10 0 0 8 0 0 9 0 0 15 0 0 16 0 1 0 0 0 3 8 0 2 0 0 3 6 0 3 6 0 4 6 0 8 3 — - 1 1 0 1 1 0 0 1 0 0 1 9 0 2 0 0 12 0 0 15 0 0 0 3 0 0 4 0 1 6 0 1 0 0 1 3 0 1 0 0 1 3 Duty Paid Duty In 1837 t< Same time last week. last year. s. d. I B P lb 0 j F. lbO 2? 8$ 18,253 13,643 F. lb 1 4 E. I. 1 4 129 31 c 6 0 • - 4 lb 0 1 226 c 4 0 16 54 lb 1 0 142 589 c 4 0 3 21 c 1 0 63 57 lb 1 0 3,514 4,105 lb 4 0 291 225 lb 0 1 1,836 3,168 lb 1 4 669 952 c 1 3 ^ 1104 924 0 6 147 610 c 1 0 8,495 2,127 }lb 0 1 38,495 16,788 ^lb 0 2 1,694 5,883 lb 0 2 4,898 4,694 lb 0 6 6,889 4,875 c 4 0 33 19 c 4 0 65 70 c 6 0 16 — — jc 6 0 784 2,123 6 0 437 300 c 6 0 69 84 c 6 0 42 10 lb 0 l 810 774 lb 1 0 2,398 6,713 1,498 lb 0 6 6,956 \ lb 0 3 7,754 4,701 oz 6 0 335 418 \c 6 0 10 — Mb 2 6 — _ _ lb 1 0 5,184 7,947 lb 4 0 129 148 lb 0 1 39,829 41,644 lb 1 0 5,503 4,600 i F. lb 1 0 1,936 1,035 ^lb 1 0 1,243 1,393 * lb 0 6 13,406 17,555 Mb 2 6 1,791 2,448 ' E.I.lbO 6 15,137 10,754 l Other ^ sorts 0 6 14,754 10,578 %§% bd. In Bond. — c. Cwt. — B. P. British Possessions. — F. Foreign.— d. p. Duty paid. 832 BILLS OF MORTALITY.— METEOROLOGICAL JOURNAL NOTE FROM MR. FERRIER, OF YARMOUTH. To the Editor of the Medical Gazette. Sir, Ha ving made your journal the medium of circulation for the railings of Mr. Aldred, of this place, against myself, an individual of whom you can have nb knowledge *, I claim so much of editorial courtesy from you as will prompt you to insert this mv reply, with which I should have troubled you before, had I not been much and severely occupied of late. In answer to your comments, and Mr. A.’s letter, I beg to say, I am the corres¬ pondent of no individual journal, and feel myself at liberty to reply to the application of one journalist without becoming the ob¬ ject of unmerited abuse from another. I beg to reiterate my former statement, and at the same time I unhesitatingly place my character for veracity (which no abuse of Mr. A.’s can injure or destroy) upon the truth of every word thereof; and, in fur¬ therance and proof of such statement, I beg to refer to the clerk of the peace, the clerk to the magistrates, and the officers in court, who were present at both the in¬ quest and the previous interview with Mr. A. to which I alluded. Were the circulation of your journal confined merely to the locality in which your original correspondent and myself reside, I would not thus trouble you. I am, sir, Your obedient servant, Wm. S. Ferrier, Coroner of Great Yarmouth, and Senior Surgeon to the Dispensary. Great Yarmouth, Norfolk, Feb. 20, 1S37. DESGENETTES. It was in his tent at Acre, that Bona¬ parte suggested to Desgenettes the pro¬ priety of despatching his plague patients with opium : nor did the noble refusal of the latter turn the general from his pur¬ pose ; he soon found others more compliant. “ On our return to Jaffa,” says Desgenettes, “ I found that laudanum, in a strong dose, had been administered to about five and- twenty or thirty of the sick. Some of them vomited it, were relieved, recovered, and then told what happened.” LITERARY ANNOUNCEMENT. biology; founded on Lund’s Physiologische Resultate der Vivisectionen neuerer Zeit; with considerable additions. ByR. B.Todd,M.D. Professor of Physiology in King’s College. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Feb. 21, 1837. Abscess 1 Haemorrhage 1 Age and Debility . 53 Heart, diseased . 3 Apoplexy . . 8 Hooping Cough . 9 Asthma 34 Inflammation 28 Cancer . 1 Bowels & Stomach 7 Childbirth . . 4 Lungs and Pleura 15 Consumption . 63 Influenza 20 Convulsions 33 Jaundice I Croup . 4 Liver, diseased . 4 Dentition or Teeth in g 4 Measles . . 2 Dropsy 11 Mortification 1 Dropsy in the Brain 7 Scrofula 1 Dysentery 1 Small-pox . 1 Epilepsy 1 Stone & Gravel . 1 Erysipelas . 1 Unknown Causes 9 Fever 12 Fever, Scarlet 1 Casualties • 5 Fever, Typhus 3 Decrease of Burials, as compared with ) the preceding week . . 5 “ METEOROLOGICAL JOURNAL. Kept at Edmonton, Latitude 51° 37' 32" N. Longitude 0° 3' 51” W. of Greenwich. Feb. 1837. Thursday . 16 Friday . . 17 Saturday . 18 Sunday . . 19 Monday . . 20 Tuesday . . 21 Wednesday 22 Thu RMOMETF.lt. from 41 to 55 36 50 27 49 28 51 34 45 39 50 32 45 Barometer, 30-01 to 30 01 3013 30 18 29 98 29 57 29-68 29 19 29-38 29-68 29-47 29 62 29-75 29 90 Winds W. and S.W. Except the 20th and 22d, generally cloudy, with frequent and heavy showers of rain. Bain fallen, 1 inch and ’1 of an inch. Charles Henry Adams. NOTICES. The letter from the British Medical Association, sent through their Secretary, is unsuited for our columns; we shall publish it extra-limites, if the parties please, or it may go on our wrapper as an adver¬ tisement. But no doubt Mr. Wakley, their patron, will be delighted to publish it for them ; or Dr. Ryan, who “ entreats the well-wishes of the British Radical As¬ sociation.” (See his No. for Feb. 11th.) Preparing for publication on or before the 1st of October, Experimental Piiy- * Mr. Ferrier will excuse us. Who does not know the Medical Coroner of Yarmouth? Mr. Aldred’s letter, by the way, was published on the 10th of last December. Mr. Sandall’s article on Spillans Trans¬ lation of the Pharmacopoeia is inadmissi¬ ble: were it on the Pharmacopoeia itself, we might be induced to give it insertion. _ _ i _ _ _ — Wilson &Son, Printer s, 57,Skinner-St. London THE LONDON MEDICAL GAZETTE, BEING A WEESCLY JOUMML OF ifletucutr anft tig Collateral J'dfnres. SATURDAY, MARCH 4, 1837. LECTURES ON MATERIA MEDTCA, OR PHARMA¬ COLOGY, AND GENERAL THERAPEUTICS, Delivered at the Aldersgate School of Medicine , By Jon. Pereira, Esq., F.L.S. Lecture LVIII. In ray last lecture I commenced the ex¬ amination of the family Menispennacem, and noticed the Cocculus palmatus, which yields us Calumba root. I shall in the next place examine Cocculus suberosus. History. — According* 1 2 3 4 5 6 7 8 9 10 11 to Sprengel, the fruit now usually called Cocculus indicus was introduced by the Arabians, and was described by Avicenna and Serapion under the name of Maheradsch. It is sometimes termed the Levant nut, or bacca orientalis. Botanical history. — The plant yielding it is a native of Malabar, and is called, by Linnaeus, Menispermum Cocculus, by Wight and Arnott, Anamirta Cocculus, and by Decandolle, Cocculus suberosus. It is a dioecious, perennial, twining plant, with a corky cortex, leaves cordate, trun¬ cated at the base, firm and lucid. The inflorescence is a many-flowered panicle. The plant belongs to class Dioccia, order Hexandria , in the Linnsean arrangement. The fruit is by some called a berry, by others a drupe. It is reniform, purplish red, and fleshy. Physical characters. — As met with in com¬ merce, Cocculus indicus is rather larger than a pea, rounded, or slightly reniform. It consists externally of a dried, thin, blackish brown, rugous, acrid and bitter layer, which envelopes a thin, bivalved, 483. — xix. white, ligneous shell. If the fruit be re¬ garded as a drupe, the shell will be formed of the endocarp, and no seed coats will be recognizable : whereas, if the fruit be con¬ sidered as a one-seeded berry, the shell must consist of two altered seed coats. In the middle of this shell arises a central placenta, which is contracted at its base, but enlarged and divided into two cells superiorly. Between this placenta and the shell is an oleaginous, yellowish, very bitter nucleus, of a semilunar form. This nucleus never w'holly fills the cavity of the shell, — at least in the Cocculus indicus of commerce ; for by keeping it gradually becomes atrophied, and in old samples it is not uncommon to find the shell almost empty. This change is observed also in other oleaginous seeds. Chemical composition. — Iodine colours the nucleus brown. The cold watery infusion of the whole fruit is slightly acid, and produces a dark grey precipitate with chloride of iron. Infusion of galls feebly precipitates it. Boullay made an analysis of Cocculus indicus in 1812, and in the year 1834, another analysis was made by MM. Pelle¬ tier and Couerbe. 1. Analysis of the nucleus. — The following are the substances recognised by MM. Pelletier and Couerbe in the nucleus of cocculus indicus. 1. Picrotoxine. 2. Resin. 3. Gum. 4. A fatty acid substance. 5. An odorous matter 6. Malic acid. 7. Mucus. 8. Starch. 9. Lignin. 10. Malate of lime. 1 1. Inorganic salts (nitrate and sulphate of potassa, and chloride of potassium) by incineration yield carbonates of potash, and of lime, manganese and iron. 2. Analysis of the envelope of the nucleus 3 H 834 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS. (pericarp). — The following substances w^ere found by the same chemists in the covering of the nucleus. 1. Menispermine. 2. Paramenispermine. 3. Yellow alkaline matter. 4. Hypopicrotoxic acid. 5. Wax. 6. Starch. 7. Chlorophylle. 8. Resinous matter. 9. Gum. Several of the above-mentioned sub¬ stances have not hitherto been detected in any other plants, and therefore will require a brief notice. Picrotoxine. — This is a white, crystalline, intensely bitter substance, soluble in 150 parts of water at 57° F., in 25 parts of boil¬ ing water, in a third of its weight of alcohol, and in less than half its weight of aether. It is insoluble in the fixed and volatile oils ; but it is soluble in acetic acid. It does not combine with acids, but forms combinations with alkalies. It seems, therefore, to be an acid, though a feeble one. It is composed of — Carbon . 60-96, or 12 atoms = 72 00 Hyd rogen • • 5-80, or 7 atoms = 7-00 Oxygen • • • • 33 24, or 5 atoms = 40*00 100-00 11900 The poisonous effects of the nucleus de¬ pend on the picrotoxine. Menispermine. — This is an opaque, white, crystalline substance, soluble in alcohol and tether, but insoluble in water. It fuses at 248u F., and at a higher tempera¬ ture is decomposed, leaving an abundant charcoal. It dissolves in, and saturates acids ; and from these solutions alkalies precipitate it. Concentrated sulphuric acid has little action on it: hot nitric acid con¬ verts it into a yellow resinous substance, and oxalic acid. It is composed, accord¬ ing to Gay-Lussac, of — Carbon . 71 -80, or 18 atoms = 108 Hyd rogen • • • • 8-01, or 12 atoms — 12 Nitrogen . 9 57, or 1 atom — 14 Oxygen . 10*53, or 2 atoms — 16 9991 150 It does not appear to have any marked action on the animal economy. Paramenispermine. — This is a crystalline solid, insoluble in water, scarcely soluble in aether, but dissolving readily in alcohol. It is volatile, and may be sublimed un¬ changed. It does not saturate acids, and, therefore, differs in this respect from the preceding substance. Notwithstanding this, how ever, its composition is the same : hence menispermine and paramenisper¬ mine are isomeric substances. Hypopicrotoxic acid. — This acid is an amorphous solid, insoluble in water (cold or boiling), insoluble in aether, soluble in alkalies, and precipitable from its solution in them by the mineral acids. It is com¬ posed of — Carbon . 6414 Hydrogen . 6 09 Oxygen . 29" 17 9940 This composition differs but little from that of picrotoxine. Physiological effects. — (a.) On vegetables. A solution of the aqueous extract of Coc- culus indic-us killed a haricot plant in tw'enty-four hours. ( b .) On animals generally. It is poisonous to all animals : at least it has been found to be poisonous to dogs, goats, cows, croco¬ diles, birds, and insects. Goupil considered it to be a local irritant ; but the correctness of this opinion is denied by Orfila. When introduced into the stomach, its irritant effects were confined to the production of nausea and vomiting. It acts on the cerebro- spinal system, causing stagger¬ ing, trembling, tetanic convulsions, and insensibility. Goupil states, all fish who eat it die, — roach being killed very easily, barbel with more difficulty. “ The bar¬ bel,” we are told, “ is, of all fish, that whose flesh the most frequently occasions accidents in those animals who eat it, pro¬ bably because these fish, taking a longer time to die, the poison is longer subjected to the action of the digestive juices, and a considerable quantity of it is consequently absorbed.” Orfila says Cocculus indicus acts like camphor on the nervous system, and principally on the brain. ( c .) On man. Its effects on man have not been accurately ascertained. Hill says three or four grains of it have brought on nauseas and faintings. It is frequently added to malt liquors, for the purpose of increasing their intoxicating powers; but from some accounts which I have received, from an Excise officer, of the effects of beer thus adulterated, the action appeared to be rather on the voluntary muscles than on the intellectual powers. The operation of Picrotoxine is analo¬ gous to, though stronger than, that of Cocculus indicus. Ten or twelve grains, given by the mouth, are sufficient to kill a dog. A grain and a half, injected into the jugular vein of a dog, killed the animal in tw-enty minutes. Uses. — Cocculus indicus is rarely em¬ ployed in medicine. It has, how-ever, been used as an external application, in the form of pow^deror ointment, to destroy parasitic animals, (hence the Germans call these berries Luusekorner — that is, Louse CISSAMPELOS PAREIRA. 835 grains), and in some skin diseases, as porrigo. Notwithstanding the severe prohibitory statutes against the employment of Coecu- lus indices in brewing, the officer just alluded to, assures me he has frequently discovered this poison in beer, and has fined the parties for using it. It is, howr- ever, now commonly employed in the form of pow der or solution, and is not so readily recognized. He also referred ine to Morrice’s “ Treatise on Brewing ,” which has passed through many editions (a proof of its extensive sale), and in which are given full directions for the employment of this drug. In the manufacture of porter, this author directs 31bs. of Cocculus indicus to be added to every 10 quarters of malt. “ It gives,” says this rascal, “ an inebriat¬ ing quality, which passes for strength of liquor and he also says it prevents “ second fermentation in bottled beer, and consequently the bursting of the bottles in warm climates.” Administration. — The ointment of Coccu¬ lus indicus is prepared with one part of the powdered berries to two parts lard. Jager has employed in the same cases an ointment composed of ten grains of picro- toxia to an ounce of lard. Antidote. — In a case of poisoning by either Cocculus indicus or picrotoxine, the first object is to expel the poison from the stomach ; and for this purpose we should administer emetics. No antidote is known, though acetic acid appeared to Boullay to diminish the effect of picrotoxine. Cissampelos Pareira. History. — The root of this plant was first mentioned by Piso, in 1658, under the name of Caapeba. It was introduced into Paris in 1688 by M. Amelot, the French ambassador at Portugal. It is usually termed Pareira (Parreyra) brava, which means literally wild or bastard vme, on account of its supposed resem¬ blance to the root of the wild vine. The Germans call it Grieswurzel ( i . e. gravel root), on account of its beneficial effects in stone or gravel. Botanical history. — Cissampelos Pareira is a climbing shrub, a native of South America, — particularly of Jamaica, Mar¬ tinique, St. Domingo, &c. The root is woody and branching, — the stem round and smooth, — the leaves peltate, subcor- date, ovato-orbiculate, on the under sur¬ face silky pubescent (on wffiich account, says Dr. Wright, the plant is called velvet leaf.) The flowrers are small, yellow, and dioecious: the fruit is reniform, hairy, and red. In the Linnean arrangement, Cis¬ sampelos belongs to class Dioccia, order Monadelphia. Physical characters. — The officinal part or root occurs in more or less cylindrical pieces, sometimes flattened or bluntly angular. Some of the pieces are as thick as a child’s arm, — their length often a foot or more long. Externally they are covered w ith a dark brown rind or cortex, which is furrowed longitudinally, and wrinkled transversely. The wrinkles have very much the appearance of large, trans¬ versely elongated lenticellse. The surface of the transverse section of the root is of a yellowish-grey colour, and presents a number of concentric circles (the annular layers), traversed by numerous radiating lines (medullary rays) ; between these lines are triangular bundles of woody fibres and ducts, — the latter are large, and being cut transversely, constitute the numerous holes or apertures presented by the cut surface. The number of concentric circles varies with the age of the root. The fracture of the root is coarsely fibrous. The taste is sweetish — aromatic, afterwards bitter and unpleasant. The root is without odour. Substitution. — Kunze, in his “ Pharma - ceutische Waarenkundef remarks, that “ on the whole, the Pareira has more the con¬ dition of a stem than of a root.” In the Medical Gazette* for September 24, 1836, wre are told, on the authority of a highly respectable drug firm, that a spuri¬ ous article (probably the stem of the Pareira) had been imported. In conse¬ quence of this notice, Ihaveprocureda sam¬ ple of it: it is certainly a stem, since it has a distinct medulla ; wffiile the cortex is partially covered with a yellowish white crustaceous lichen. Its age must be about seven years, since it has seven annual layers : it presents the same circles, rays, and duct apertures, observed in the genuine pareira root. The diame¬ ter of the stem is nearly three inches. Doubtless its effects are similar to those of the root, though from the larger quantity of ligneous tissue, it must con¬ tain a great deal of inert matter. “ It yields,” we are told, “ only a very minute quantity of the extract ; and the decoction prepared from it, according to the usual formula, has only a slightly bitter taste, instead of the strong bitter of the decoc¬ tions of the root.” Chemical composition. — The only analysis of this root w ith wdiich I am acquainted, is that of Fenuelle, made some years since. According to this chemist, the constitu¬ ents are — 1. A soft resin. 2. A yellow bitter principle, analogous to eathartin ,- soluble in alcohol and wa¬ ter, and precipitable by tincture of galls or subacetate of lead. 3. A brown colouring matter, 4. Vegeto-animal matter. 836 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS. 5. Fecula. 6. Super malate of lime. 7. Nitrate of potassa. 8. Ammoniacal and mineral salts. The presence of starch, or fecula, in this root, is shown by the action of iodine on it. The infusion is precipitated by the infusion of galls, and is made brown by the chloride of iron. The active principle of the root is said to be the yellow bitter principle above mentioned : but the presence of nitrate of potash may contribute to the diuretic effect. In all probability the yellow bitter matter is a mixture or compound of vari¬ ous principles. Physiological effects. — I am acquainted with no experiments made to determine the effects of this root in the healthy state of the body. From its taste, botanical affinities, and effects in diseases, we may infer it to possess a tonic operation. Occa¬ sionally it acts as a diuretic. It has been supposed to exercise a specific influence over the mucous membrane lining the urinary passages. In large doses it is said to be aperient. Uses. — It was originally introduced into medicine as a lithontriptic. Its powers in this way were at one time highly vaunted, and Helvetius even went so far as to assert that calculi the size of an olive had dis¬ appeared under its use, and that the opera¬ tion for lithotomy was no longer neces¬ sary ! We now employ it in the follow¬ ing cases : — 1. As a tonic in dyspepsia, where there are no symptoms of gastric irritation. 2. In discharges from ihe urino-genital mu¬ cous membrane.— It has been employed in gonorrhoea, leucorrhcea, and chronic in¬ flammation of the bladder. In the latter of these diseases, Sir B. Brodie says he has seen more good done by this root than by the uva ursi. “I am satisfied,” says this eminent surgeon, that it has a great influence over the disease which is now under consideration, lessening very mate¬ rially the secretion of the ropy mucus, which is itself a very great evil, and, I be¬ lieve, diminishing the inflammation and irritability of the bladder also.” Mode of administration. — This root may be given in the form of powder, in doses of half a drachm or a drachm. The infusion of the Pharmacopoeia is prepared by di¬ gesting six drachms of the root in a pint (twenty ounces) of boiling water. The dose of this preparation is one or two fluid ounces. Sir B. Brodie recommends a de¬ coction of the root, which he directs to be thus prepared : — “ Take half an ounce of the root of the pareira brava; add three pints of water; let it simmer gently near the fire until reduced to one pint. The patient may add to it some of the tincture of hyoscyamus ; and in those cases in which there is a deposit of the triple phos¬ phates, you may also add some of the mu¬ riatic or diluted nitric acid.” The extract, which is now an officinal preparation, may be used either alone or in conjunction with the infusion. A tincture, or essence, as it is sometimes called, has been prepared by digesting one part of the root in five parts of rectified spirit. It is reputed diuretic and anticatarrhal, and has been given in doses of a fluidraehm. AURANTIACEAE. Two genera of this family require to be noticed — namely, Feronia and Citrus. Feronia Elephantum. This is a large tree, found in most parts of India. It belongs to class Decandria, order Monogynia, in the Linnean arrange¬ ment. From the stem there exudes a gum, which, according to Dr. Ainslie,is used for medicinal purposes by all the practitioners of Lower India, and very closely resem¬ bles the gum of the Acacia, commonly known in this country by the name of Gum Arabic. It is not improbable, therefore, that part of the gum brought to us from India, and which is known in this country by the name of East Indian Gum Arabic, may be the produce of this tree. Further infor¬ mation on this point is, however, required. When I describe the Acacia gum, I shall notice that brought from India. Citrus. Under this generic name is included a considerable number of plants. Botanists, however, are not quite agreed as to which of these form distinct species, and which merely varieties. Characters of the genus. — The plants are trees, or shrubs, with simple, alternate, petiolated leaves. The calyx is pitcher¬ shaped, and from three to five cleft ; the corolla consists of from five to eight petals ; the stamina are numerous (from twenty to sixty), their filaments being combined into several fasciculi, and their anthers being oblong; the style is round, the stigma is hemispherical. The fruit is baccate, with from seven to twelve many seeded, pulpy, cells. The rind of the fruit is considered by Decandolle to be analogous to a torus, but by Mr. Bindley is, perhaps more cor¬ rectly, regarded as the union of the epicarp and sarcocarp, analogous to that of the drupe : the external yellow portion of the rind is termed flavedo, and, by the French, zeste ; in it are found the vesicular, or round¬ ed receptacles (formed by the dilatation of the intercellular passages), which contain an essential oil. The internal portion of the rind is white and spongy ; the cells of CITRUS LIMONUM. 837 the fruit are filled with little pulpy bags, which contain an acid juice, and may be rea¬ dily separated from each other. The seeds are exalbuminous, and usually show very distinctly the raphe and chalaza. Thus, on the external surface of an orange or lemon seed, the markings of the raphe are very evident, and when the external coat of the seed is removed, the place of the chalaza is indicated at one end of the seed by the dark-coloured spot on the inner coat. In the Linnean arrangement, the plants of this genus belong to class Polyadelphia, order Polyandria. The officinal species are four in number — namely, 1. Citrus Limetta ; var. Bergamium. 2. Citrus Limonum. 3. Citrus Aurantium. 4. Citrus vulgaris. But to render the account more perfect, we may notice another species — namely, Citrus medica. I shall speak of them in the order they are described in Decandolle’s Prodromus. 1. Citrus medica. — The fruit of this spe¬ cies is denominated the citron. It is sup¬ posed to be the yyXia pyS iny of Theophras¬ tus, and the malus Assyria vel medica of Pliny. Risso has noticed three varieties of it. The following are the distinguishing characters of the species : — The petioles are naked ; the leaves are oblong, acute, and very finely dentate ; the flowers have forty stamina ; the fruit is oblong, rugous, with a thick rind, and a slightly acid juice. Those fruits which preserve their pistilla are called pitima: they are sought after, says Risso, by the Jews, who suspend them to palms at the feast of the taber¬ nacle. Tiie leaves are interposed between linen, to which they communicate a fragrant odour: moreover, they are said to keep away insects. By distillation, there is obtained from the rind of the fruit a fragrant oil ( oleum essentiale citri), lighter than that procured from the lemon : it is employed by per¬ fumers. There is another oil met with in com¬ merce, under the name of the essential oil of cedra, and in most books it is erroneously stated to be identical with the oil of citron. Tt has the combined odour of the citron and bergamot. Itisemployed byperfumers. It has the same elementary composition as the essential oil of lemons, presently to be mentioned. 2. Citrus Limetta. This species is characterized by naked petioles; ovate, roundish, serrated leaves; flowers with thirty stamina ; the fruit (commonly termed the lime ) is globose, with a firm cortex and sweet pulp. Fig. 157. — Citrus Limetta ; the Lime. Risso mentions seven varieties : one of these is the Bergamium , from the flavedoof the fruit of which is obtained an essential oil — the essence or oil of bergamot of the shops — called in the Pharmacopoeia the oleum bergamii. This oil has a pale yellow colour, a remarkable odour, and a specific gravity of 0885. Its elementary composi¬ tion is similar to that of the essential oil of lemons. It is used in medicine only on account of its odour. • 3. Citrus Limonum . This species is characterized by its pe¬ tioles being somewhat winged. Its leaves are oblong, acute, and dentate; its flowers have thirty -five stamina, but are often without pistilla; the fruit (called the lemon) is oblong, has a very thin rind, and a very acid juice. Risso includes no less than twenty-five varieties in this species. 838 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS Fig. 158. — Citrus Limonum ; the Lemon. We employ in medicine the rind, the essential oil obtained from the rind, and the juice. From the latter is procured citric acid. 1. Essential oil of lemons. — This is the oleum limonis of the London Pharmaco¬ poeia. It is prepared as follows: the lemons are rasped to remove the flavedo, which is afterwards expressed in hair sacks. The oil which is thus procured is received in flasks, where it is allowed to deposit ; it is then decanted and filtered. As thus procured the oil is very fragrant, but some¬ what turbid, and liable to undergo change from the mucilage present. It may be obtained also by distillation, and the oil is then more permanent, but its flavour is less pleasant and sweet ; and hence this process is rarely practised. The greater part of the oil of commerce is brought from Portugal and Italy ; some, however, is procured from France. When quite pure it is colourless, limpid, and of a fragrant odour, like that of lemons. Its specific gravity at 70° F. is 0-847. It is soluble in all proportions in anhydrous alcohol; it boils at about .345° F. When the commercial oil is exposed to a tempe¬ rature of 4° F., it deposits white crystals, whose nature is not known ; but rectified oil does not thus deposit. This oil is composed of two other iso¬ meric oils; one (called by Dumas Citrene; by Blanchet and Sell Citronyle) capable of forming a crystalline compound with mu¬ riatic acid ; the other oil (called Citryle) does not form a crystalline compound with this acid. According to the analysis of Dumas, the oil of lemons is composed of — 10 atoms carbon . • 60 8 atoms hydrogen . 8 This composition is analogous to that of the oil of turpentine, but the condensa¬ tion is one half less. The oils of cedra, bergamot, and probably of orange, have a similar composition. When hydrochloric acid gas is passed through this oil, a crystalline compound is formed, which has been termed artificial camphor of the essence of lemon , or hydrochlo¬ rate of citrene. It is composed of — ■ 10 atoms carbon . 60 9 atoms hydrogen . 9 I atom chlorine . 36 105 Or, we may consider it as composed of — 1 atom citrene . 68 1 atom hydrochloric acid . 37 105 This oil is employed as a perfume, as a flavouring ingredient, and, when distilled, it constitutes the scouring drops of the shops, used for removing grease spots from silks, and other textures. It is regarded as diaphoretic. 2. Lemon peel , — the cortex limonum of the Pharmacopoeia. The flavedo of this cor¬ tex is of a pale yellow colour, rough from the presence of the oil receptacles, of a strong peculiar odour, and an aromatic bitter taste. The internal portion of the cortex is white, spongy, and almost without odour or taste. The watery infusion of lemon peel becomes of a greenish brown colour, on the addition of the chloride of iron. If water be distilled from this freely, we ob¬ tain the water of lemon peel of the Edin¬ burgh Pharmacopoeia, which, however, is rarely used in medicine. Lemon peel may be regarded as a stomachic and aromatic substance. It is employed more as a flavouring ingredient than for its proper medicinal effects. It is one of the ingredi¬ ents of the compound infusion of orange peel , and of the compound infusion of gentian. 3. Lemon juice : succus limonum. — Lemon juice is composed, according to Proust, of — Citric acid . 177 Malic acid, gum, and bitter extractive . 0 72 Water . 97 51 10000 On account of the presence of mucilage and extractive, it is very apt to undergo decomposition, though various methods have been resorted to for the purpose of preserving it. As a substitute for lemon juice, we may employ the following : — Water, 16 fluid ounces, 68 CITRUS L1M0NUM. 839 Citric acid, 8^ drachms, Oil of lemon, a sufficient quantity, to give it the proper flavour. Lemon juice owes its medicinal proper¬ ties to the citric acid contained in it : it is refrigerant, and when properly diluted, and slightly sweetened, is a most agreeable and refreshing beverage. The only officinal preparation of this juice is the syrup of lemons of the Pharma¬ copoeia. 1 st. In the preparation of refrigerant drinks. — Thus it is added to barley-water, or it is mixed with sugar and water, to form the beverage called lemonade (the hy droit de citrons of the French pharmacologists). The proportions of the ingredients for making this latter compound are two lemons sliced, two ounces of sugar, and two pints of boiling water : digest until cold. These drinks are most refreshing and grateful in febrile and inflammatory diseases, in hemorrhages, 8ec. 2. In the formation of the effervescing draught. — A table-spoonful, or four fluid drachms, of lemon juice, are about equal to seventeen grains of crystallized citric or tartaric acid. The effervescing draught made with lemon -juice, or citric acid and bicarbonate of potash, is one of the best remedies we possess for allaying irri¬ tability of the stomach. 3. As an antiscorbutic , lemon-juice has long been regarded as invaluable. On account, however, of the difficulty of pre¬ serving it, the crystallized citric acid and oil of lemons are usually substituted. Sir Gilbert Blane says, “ those only who have made themselves acquainted with the early part of the naval history of this country, or those who have perused the interesting, popular, and eloquent narrative of Com¬ modore Anson’s voyage, can duly appre¬ ciate the value of this simple remedy” (lemon-juice). 4. As an antidote to poisons. — In cases of poisoning by alkalies, the vegetable acids are the antidotes, and the most convenient and easily procurable acidulous substances are commonly vinegar and lemon-juice. In poisoning by narcotic substances, as opium, after the poison has been evacuated from the stomach, lemon-juice may be given to counteract the effects. Citric acid : History, — This acid was first procured in the solid state by Scheele, in 1781. Mixed with little or- no malic acid, it is found in the fruit of the Lemon, Orange, Citron, Dulcamara, Dog Rose, Bird Cherry, red Whortleberry, and Cran¬ berry. Mixed with about an equal quan¬ tity of malic acid, it is found in the Gooseberry, red Currant, Bilberry, Pyrus Aria, Cherry, Strawberry, Raspberry, and Cloudberry. According to Vauquelin it exists in the Tamarind, mixed with malic and tartaric acids. Citrate of potash is found in Aconitum Lycoetonum,in the fruit of the Gooseberry and Capsicum, in the root of Asarum europaeum, rnd the tubers of Helianthus tuberosus Citrate of lime is met with in Asarum europseum (Salanura tuberosum) and also in the bulbs of Gar¬ lic, and the herbaceous part of Isatis tinctoria. Preparation — It is obtained from lime or lemon juice, the latter of which is imported for the purpose in pipes and hogsheads. This juice, placed in a large vat, is saturated with chalk or whiting. The supernatant liquor is then drawm off, the precipitate (citrate of lime) passed through a sieve, and frequently washed with warm water, until the mucilage and other soluble im¬ purities be entirely w ashed off'. The citrate of lime is then decomposed by sulphuric acid diluted with water ; sulphate of lime separates, and citric acid remains in solution. The clear solution is then to be evaporated (manufacturers use for this pur¬ pose leaden boilers), and the concentrated solution set aside to crystallize. To purify the acid the crystals are to be re- dissolved, and the solution, again put by to crystal¬ lize; this process is to be repeated until the crystals have the requisite degree of whiteness. Properties. — Anhydrous citric acid is w hite and odourless, and strongly reddens litmus. It consists of — 4 atoms carbon . 24 2 atoms hydrogen . 2 4 atoms oxygen . 32 38 The primary form of crystallized citric acid is the right rhombic prism. Those crystals w'hich are procured by the cooling of a hot solution of the acid consist of — 1 atom anhydrous citric acid • • • • 58 1 atom water . 9 67 Berzelius says that the crystals of com¬ merce, formed by spontaneous evaporation, usually contain one-third of an atom of water more than is here stated. The crystals absorb moisture from a damp atmosphere; and Dumas, therefore, is in error when he says they are unaltera¬ ble in the air. When they are distilled in a retort, they yield among other pro¬ ducts an acid liquor, from which has been procured a peculiar substance called pyro- citric acid. Characteristics. — A solution of citric acid does not produce any precipitate with lime water: hence it maybe readily dis¬ tinguished from a solution of oxalic acid. From tartaric acid it may be distinguish¬ ed by its not forming a crystalline precipi¬ tate when an excess of it is added to a solution of carbonate of potash, It forms 840 MR, FEREIRA ON MATERIA MEDICA AND THERAPEUTICS. with barytic water a white precipitate (citrate of barytes), soluble in excess of acid. With a solution of acetate of lead it also causes a white precipitate (the citrate of lead.) Adulteration. — Not unfrequently citric acid is adulterated with tartaric acid ; this is especially the case when it is sold in a pulvercnt form. The fraud may be easily discovered : dissolve the suspected acid in water, and to the solution thus ob¬ tained add cautiously a solution of carbo¬ nate of potash, taking care that the acid be in excess. If any tartaric acid be pre¬ sent, a white crystalline precipitate (bitar¬ trate of potash) is formed. Saturating power. — As this acid is fre¬ quently employed in the making of effer¬ vescing mixtures, it may not be useless to mention the quantities of the alkaline car¬ bonates necessary to saturate it. 20 grains of s3uSl^"al^?^am.mo.n.ia.Tiu l 24 srains citric acid- Carbonate of potash . . • • • 17 ditto. Bicarbonate of potash . . 14 ditto. Carbonate of soda . nearly 10 ditto. Sesquicarbonate of soda, rather more 16f ditto. Physiological effects : (a.) On vegetables — I am not acquainted with any experi¬ ments made with citric acid on vegetables ; but its effects are doubtless analogous to those of tartaric acid, to be noticed here¬ after. (b.) On animals generally. — Orfila ranks citric acid among the irritant poisons; but Drs. Christison and Coindet gave drachm doses to cats, without observing that the animals suffered any inconvenience. (c.) On man . — We are not acquainted with the effects of large quantities of this acid on man. Dissolved in water, and taken in moderate doses, its effects are analogous to those of the dilute mineral acids before mentioned; that is, it allays thirst, diminishes preternatural heat, checks profuse sweating, and promotes the secretion of urine. Vogt says it acts more on the skin than tartaric acid (in this respect being similar to acetic acid), and less on the alimentary canal and urinary organs. Continued use gives rise to disor¬ ders of the digestive organs. Uses. — The uses of citric acid are the same as those of lemon juice already men¬ tioned, and for which it is employed as a substitute. A solution of citric acid has also been used as a solvent for opium, by Dr. Porter, of Bristol. 4. Citrus Aurantium. The essential characters of this species are, petioles nearly naked; leaves ovato- oblong and acute ; flowers containing twenty stamina; fruit (the common sweet orange) globose, with a thin cortex and sweet pulp. Risso enumerates no less than nineteen varieties. The leaves of the orange-tree are feebly bitter, and contain a volatile oil. They have been used in the form of powder, or infusion, in spasmodic diseases. Distilled with water, they yield a very fragrant oil, called the essence de petit grain. Formerly, the oil sold under this name was procured Fig. 159. — Citrus Aurantium ; the Orange. from unripe oranges, but, as thus obtained , it is very subject to decompose. Orange flowers ( flores aurantii ) are now officinal articles. According to Boullay they contain eetherial oil, yellow, bitter, extractive, gum, acetic acid, and acetate of lime. They yield, by distillation, a very fragrant oil, called, by perfumers, the oil ofNeroli, but which is termed, in the Phar¬ macopoeia, oleum aurantii. The essence de petit grain, being much cheaper, is fre¬ quently substituted for it. The oil of Neroli is used in medicine, on account of its flavour. The small green fruits of the orange- tree, which fall during the great heats of the summer, are carefully collected and dried. They form the orange berries, the baccre aurantii of the old Pharmacopoeia. Their size does not exceed that of a cherry; their colour is dark greyish or greenish brown ; they have an aroma¬ tic odour and bitter taste. When smoothed by a lathe, they constitute^the issue peas of the shops: they are preferred to ordinary peas for keeping up the dis¬ charge of an issue, on account of their plea¬ sant odour. An infusion of orange berries is rendered green by the chloride of iron : PROFESSOR GRAVES* CLINICAL LECTURES. 841 this arises from the presence of some gallic may be given in substance, in doses of half acid. Two analyses of them have been a drachm to a drachm. The compound in- made — one by Lebreton, the other by fusion may be given in ounce doses ; the Brandes. The bitter matter is called, by confection is usually employed as an adjunct the latter chemist, Aurantiin. Lebreton to tonics or purgatives; the tincture is a speaks of a crystalline matter which he useful flavoring ingredient, — as is also the terms Hesperedin, and which appears iden¬ tical with what Brandes called a peculiar neutral crystal l izable substance. The ripe fruit of the sweet orange is useful either for its rind or its acid juice. The rind is ordered in some pharmaco¬ poeias, though not in that of London. It is a mild tonic and aromatic, principally useful for its flavour. “ Large quantities,” say the editors of the United States Dis¬ pensatory, “ are sometimes productive of mischief, especially in children, in whom colic, and even convulsions, are sometimes induced by it. We have known the case of a child, in which death resulted from eating the rind of an orange.” A very fragrant oil (the essential oil of sweet orange of the perfumer) is obtained from the outer rind. The juice of the sweet orange consists of citric mixed with some malic acid, citrate of lime, mucilage, albumen, sugar, and water. It is a very refreshing and grate¬ ful beverage in febrile complaints. The seeds yield by expression a bland oil. 5. Citrus vulgaris. The petioles of this species are winged; the leaves are elliptical, acute, and crenu- late ; the flowers have 20 stamina ; the fruit (termed the Seville or bitter orange ) is globose, with a thin and scabrous cortex, and a bitter acrid pulp. Risso mentions eleven varieties of it. The exterior rind of the Seville orange {cortex aurantii ) is directed in the London Pharmacopoeia. It is much more bitter than the rind of the sweet orange, and therefore may be regarded as more power¬ fully tonic. It is, however, principally employed on account of its flavour. It syrup. CLINICAL LECTURES, > DELIVERED AT THE MEATH HOSPITAL AND COUNTY OF DUBLIN INFIRMARY, During the Session 1836-7. Bv Professor Graves. Lecture VII. Scarlatina without eruption, followed notwith¬ standing by desquamation — Thoughts on the nature of desquamation — Latent Scarla¬ tina, followed by Anasarca — General pro¬ position respecting the symptoms of animal poisons — Morbid appearances after delirium in fever — Treatment in anticipation of cere¬ bral symptoms — Great advantage of blisters judiciously employed — Notice of the old mode of blistering. Before I resume the thread of my dis¬ course, permit me to mention some curious facts recently observed. Dr. Marsh and I attended, not long since, a lady wrho had been affected for some days with fever and sore throat. She had no eruption on any part of her body, .but from the character of the fever, and the peculiar appearance of the throat, we suspected she was labouring under an attack of scarlatina. Her family were very anxious to ascertain the precise nature of her complaint ; and I visited her twice a day for the first four or five clays of her illness, carefully examining the skin at each visit, but could not dis¬ cover the slightest trace of an efflorescence of any description. She continued for se¬ veral days to suffer from the fever and sore throat, and was at one time in a dangerous condition, but ultimately recovered by great care and the use of appropriate re¬ medies. Now I watched this case from the sixth hour after its commencement to its termination, and repeatedly examined the skin, particularly that of the breast, abdomen, and inside of the knee and elbow joints, places in which the eruption shews itself when it appears at all, but could not discover any vestige of it. You will often find a diffused redness about the knees and elbows, in cases where the eruption does not appear on any other part of the body; but in this instance there was not the slightest deviation from the natural hue. Yet the result proved that it was scarlatina; for the desquama¬ tion of the cuticle, which always attends this disease, took place, and the lady com- 842 PROFESSOR GRAVES’ CLINICAL LECTURES. municated the infection to several mem¬ bers of the family. A young gentleman residing in the house got a bad attack of scarlatina, two of the servants were also attacked, and the lady’s father got sore throat ; in fact, there could be no doubt as to the nature of the disease. During her convalescence she had desquamation of the cuticle ; and this is a point to which I would particularly call your attention. We are taught to look upon desquamation as the result of cutaneous affections of an inflammatory character; and it is an opi¬ nion very generally maintained, that in scarlatina, as in psoriasis, the peeling off of the cuticle depends on a peculiar state of the skin produced by inflammation. It is stated that the increased vascularity of the skin occasions a morbid secretion, and subsequent detachment, of the epidermis, and that the same phenomenon is observed in all cutaneous affections of an inflamma¬ tory character. This may be generally, but not universally, true; for here we had an extensive desquamation of the cuticle without any eruption, without any pre¬ vious redness, pain, or remarkable heat; in fact, without any of the phenomena which are regarded as constituting in¬ flammation. This seems to prove that there is something more than inflamma¬ tion concerned, as preparatory to that process which is termed desquamation, and that the change which the skin un¬ dergoes is not to be looked upon as a mere consequence of inflammation occupying the external surface of the corium. Another curious fact observed in this lady’s case : since the attack which I have just described she has been shedding her nails; that is to say, the nails of the fin¬ gers are all dropping off, and yet there is no appearance of inflammation of any kind about the hands to explain the oc¬ currence. You are, of course, all aware that the dropping off’ of the nails is a spe¬ cies of desquamation. From the peculiar structure of the nail, and the mode in which it is formed in the matrix, it does not drop off at once like a scale of epider¬ mis; still I think we are authorized in looking upon the shedding of the nails as a species of desquamation. This affords a very curious subject for investigation, as connected with the history of fever. It is an opinion entertained by many persons, that desquamation of the skin takes place at a particular period of typhus, and that this is not an occasional, or varying, but a constant and general, phenomenon. This statement has been put forward most strongly by Dr. Perry, of Glasgow ; and he is also of opinion, that the period in which typhus is most contagious, is during the desquamation of the cuticle. It is also asserted, that scarlatina is more conta¬ gious during desquamation than at any other period of the disease. This is at least the popular idea; how true it may be my experience or observation does not enable me to decide ; nor am I prepared to offer any thing like an explanation of the occurrence. All I shall say on the present occasion is, that the occurrence of desquamation of the cuticle in typhus, and in cases of scarlatina without erup¬ tion, has greatly altered my ideas as to the connexion between it and cutaneous in¬ flammation 1 think, at least, that the process of desquamation in such cases is very different from inflammation, and that the morbid action of which desquamation is the result, has very little in common with the ordinary process of inflammation of the cutaneous surface. A gentleman who is in the habit of at¬ tending my lectures informs me that he has seen three cases of this form of scarla¬ tina, characterized by the absence of the external efflorescence. They occurred in young persons, after puberty, and between the ages of 15 and 25. Each of these cases exhibited a considerable degree of fever, with increased quickness of pulse, thirst, heat of skin, diminution of the urinary secretion, and, after the first or second day, much depression, which continued for twm or three days, and then yielded to treatment. The tongue was moist, but pointed, tremulous, red, and injected. The velum, isthmus faucium, tonsils, and up¬ per part of the pharynx, wrere somewhat swollen, and of a very peculiar dark- red colour, the redness being general, and equally diffused over the wrhole of the upper part of the pharynx as far as it could be examined. But the following case, which was very lately communicated to me by a practitioner of very great emi¬ nence in this city, is still more curious. Some years ago scarlatina broke out in this gentleman’s family, and attacked all his children with the exception of one young lady, who, although in constant at¬ tendance on her sisters during their illness, did not exhibit any symptoms whatsoever of the disease. When all the children had become convalescent, they were removed to the country for the benefit of air, whither she also accompanied them. Here she wras, much to the astonishment of her family, attacked by the peculiar anasarca observed in persons who have recently laboured under scarlatina. Her father, under w hose observation she had been during the wrhole time, was very much struck with the oc¬ currence ; he paid particular attention to the case, and feels convinced that it wras the result of latent scarlatina. This case, connected with those already detailed, are of great, interest in a general pathological point of view. They appear to prove the fact, that in some instances diseases pro¬ duced by contagion do not give rise to the TREATMENT OF FEVER. 843 whole train of phenomena by which they are ordinarily characterized. Let us turn for a moment to some of those diseases caused by the action of ani¬ mal poisons on the system, as for instance measles. The symptoms which generally attend and characterize measles are uni¬ versally known. After an attack of fever, on the third or fourth day, coryza, sneez- iirg, hoarseness, and cough, are complained of, and then a rash appears, first on the face, and afterwards on the body and limbs. But it is not necessary that all these symptoms should appear, and that the se¬ quence of morbid phenomena should be uninterrupted throughout; on the con¬ trary, it frequently happens at particular periods, and in certain constitutions, that some of the most usual symptoms are scarcely observed, or altogether absent. You will find this point insisted on by Dr. Bateman, who has given a detailed description of a form of measles in which the catarrhal symptoms are wanting, and which he has termed Rubeola sine catarrho. The same remark applies to many other forms of disease. Thus we may have pneumonia without cough, and pleuritis without pain in the side. Those who have witnessed the course of the late epi¬ demic cholera in this country, will recol¬ lect that many cases occurred in which vomiting, purging, or cramps, were not observed. If we turn to fever, we find that the animal poison to which it owes its origin generally exhibits a certain number of symptoms, congregated to¬ gether, or observing a determined order and succession ; and these we meet with in most of the cases which come before us in practice. But we now and then see fever patients in whom one or more of the most prominent symptoms are absent. Thus occasionally there is no quickness of pulse or appearance of vascular excite¬ ment ; in some there are no cerebral symptoms; in others no increase in the temperature of the skin. Indeed, I might go through the whole group of symptoms which accompany fever, and show that almost every one of them may be occa¬ sionally absent, and yet the fever of a severe and dangerous type. I recollect pointing out to the class last year the case of a man labouring under chronic enlarge¬ ment of the spleen. He had been working for two or three seasons in some of the marshy districts of England, and had been occasionally ill, but never had symp¬ toms of regular intermittent; in fact, he had escaped the intermittent itself, but not what are usually deemed the conse¬ quences of it. We have been in the habit of explaining the enlargement of the spleen by referring it to the conflux of blood to¬ wards the internal organs, particularly the liver and spleen, during the cold stage of in¬ termittent; and we have endeavoured to ex¬ plain the subcutaneous oedema which fol¬ lows scarlatina, by attributing it to pre¬ vious inflammation of the skin and sub¬ cutaneous cellular tissue ; but the observa¬ tions and facts which I have now brought forward will show that these opinions were founded on erroneous ideas. Turning to cases of chronic disease, we find in some, as for instance syphilis, that the poison taken into the system gives rise in most cases to a determinate order of symptoms, e. g. bubo, sore throat, eruptions on the skin, nodes, and syphilitic cachexy. Mr. Hunter has been at great pains in deter¬ mining the order of the parts, and point¬ ing out the tissues which are successively affected, and it is of considerable import¬ ance to have correct notions on this point; but although the number and order of symptoms marked out by Mr. Hunter and others maybe observed in most cases, they are not so in all ; and the same remark which has been made on the occasional absence of one or more important symptoms in scarlatina w ill apply with equal force to syphilis. Now and then the morbid poison which excites syphilis does not affect the constitution in such a manner as to occasion the production of all the symp¬ toms which usually characterize this dis¬ ease, and thus a variety of venereal is formed, which often proves a source of great embarrassment not only to the young and inexperienced, but even to the senior members of the profession. It is of great consequence, in a practical point of view% to bear in mind the general proposition I have announced, viz. that in both acute and chronic diseases a constitu¬ tional affection may display its existence by only one or two of the numerous symptoms which usually accompany it ; and this occurrence seems more frequent in the case of diseases produced by contagion and morbid animal or vegetable poisons, than in the case of maladies generated by causes developed in the system itself. I spoke at my last lecture of a man named Cassels, w ho died in the fever ward wdth symptoms of cerebral excitement, and stated that I regretted having omitted to leech his head, and prescribe tartar emetic in the form of enema. Since that time we have had an opportunity of exa¬ mining his body, and the results of the dissection are well wmrthy your attentive consideration. He was a young man of a robust habit and apparently good con¬ stitution, and laboured under the ordinary form of maculated typhus. Shortly after his admission he was attacked with de¬ lirium, which wras soon afterwards fol¬ lowed by coma and death. Now, suppose you were called to see a patient, not labouring under typhus, but exhibiting a 844 PROFESSOR GRAVES’ CLINICAL LECTURES. similar train of symptoms, — that is to say, violent delirium, accompanied by flushing of the face, suffusion of the eyes, headache, and a tendency to get out of bed — in fact, a state of furious excitement requiring the restraint of the strait waistcoat, — what idea would you be likely to form of the condition of the brain ? If a patient of this kind had no typhoid symptoms, you would certainly say that he was labouring under meningitis or cerebritis ; and if the ease proved fatal, you would naturally expect to And lesions of the brain fully sufficient to account for all his symptoms. And you would in all probability find ex¬ tensive thickening of the membranes of the brain, with subarachnoid effusion, or you would discover softening, increased vascularity, and suppuration of the ence¬ phalic mass. But, here, a man in fever exhibits all the symptoms of cerebral in¬ flammation ; the cerebral affection runs on to a fatal termination with great rapidity; he dies comatose. And what do we find on dissection ? Doubtful signs of con¬ gestion, and no distinct evidence of in¬ flammation ; a slight opacity of the arach¬ noid at the base of the brain, and about a tea spoonful of clear subarachnoid effusion. Now this is a point to which T would earnestly call the attention of every in¬ quiring student. A patient, during the course of typhus, is seized with symptoms which are generally regarded as characte¬ ristic of congestion and inflammation of the brain ; he dies to all appearance in consequence of the intensity and violence of these symptoms, and on dissection little or no trace of cerebral disease is found. In the case under consideration, the symp¬ toms present were strongly indicative of congestion if not of inflammation ; and had the man been free from typhoid symp¬ toms, you would expect to find decided traces of inflammatory mischief. This seems to prove that in the production of cerebral symptoms in typhus, some cause not to be recognized by the production of cerebral lesions, or in other words, some¬ thing besides mere congestion or inflam¬ mation, exists. I have now examined a great number of eases of this description, and the examination has brought home to me a strong conviction, that the delirium of fever depends upon something more than mere inflammation or congestion. There is another fact, the study of which is well worthy of attention, as it appears to support very strongly the views I have put forward; and this is the occurrence of analogous symptoms under opposite con¬ ditions of the cerebral circulation. Take, for example, the phenomena of vertigo and headache. Now, these symptoms are found in states of the brain which are directly opposite, In incipient congestion of the brain, in that turgescence of the cerebral vessels which precedes apoplectic seizures, one of the most frequent symp¬ toms is vertigo, and the same thing may be affirmed with respect to headache. But we observe the very same symptoms under circumstances totally dissimilar. Fre¬ quently, while bleeding a patient for some affection of the lungs or bowels, or for some accident, we find that after a certain quantity of blood has been lost, the patient becomes pale ; and while the pallor is coming on, he often gets quite giddy, and sometimes complains of headache. Gen¬ tlemen who are attending lying-in hos¬ pitals are well acquainted with the head¬ ache, giddiness, and tinnitus aurium, so constantly complained of by females who have suffered from excessive uterine haemor¬ rhage. Hence you perceive facts are not wanting to show that opposite states of the cerebral circulation, a superabundance or deficiency of pressure on the brain, may give rise to similar phenomena. You saw an illustration of this in the case of one of our patients in the fever ward this morn¬ ing. He was quite free from headache as long as he remained in the horizontal posture, but the moment he sat up in bed he complained of headache. Yet this was a man who had not the slightest symptom of determination to the head, and who had been sufficiently depleted during his ill¬ ness. You will also recollect the fact, that persons who have had a long illness, and remained for many days in the horizontal posture, generally get weakness, giddiness, and sometimes headache, at first when they attempt to sit up during convales¬ cence. This is a point which should al¬ ways be borne in mind. You are consult¬ ed by one person who complains of giddi¬ ness, tinnitus aurium, and frequently- recurring headache. You examine the patient carefully, and you find all the symptoms of unequivocal determination to the head. You are applied to by another person labouring under the same symp¬ toms ; but how different is the state of the brain found to be on a careful examina¬ tion. One patient is robust, of florid com¬ plexion, and with a hard bounding pulse ; the other is a weak chlorotic female, who has been ailing for months, and whose pulse is so weak, that a slight degree of pressure obliterates the canal of the artery. Yet the tinnitus aurium, giddiness, and headache, complained of by the latter, is just as bad and as troublesome as in the case of the former. From a consideration of these points, you will perceive that, for the production of cerebral symptoms in typhus, there must be something more than mere con¬ gestion or inflammation of the brain ; but you are not to infer from this that there is TREATMENT OF FEVER. 845 no necessity for taking any steps to obviate or remove congestion of the head in fever. On the contrary, I am of opinion that in typhus one of the principal sources of dan¬ ger is connected with the head, and that the cerebral symptoms should be always watched with the most unremitting and anxious attention. It is this which con¬ stitutes the great difference between the mortality in private and hospital practice. In private practice the physician is called at an early period of the disease, and has an opportunity of checking the cerebral symptoms before they rise to a dangerous height; but hospital patients, in general, are admitted at an advanced stage of fever, and in many instances have been improperly treated, or wholly neglected from the commencement. I am also of opinion, that when there is any evi¬ dence of determination to the head, the best way of preventing dangerous cerebral symptoms is to deplete the head bv the application of a sufficient number of leeches, and then to proceed to the use of blisters. You should direct your attention as much to the head as to the bowels, and one of the best modes of doing this is to apply six or eight leeches behind the ears, and repeat them every six hours until relief is obtained. You should then order the head to be shaved, and kept constantly covered with cloths wet with warm vine¬ gar and water, and at the same time have recourse to the internal use of tartar eme¬ tic and nitre, or blue pill, with James’s powder. Should this plan fail in giving relief, you have a powerful aid in the application of blisters to the scalp, and this must be done extensively, and at once. Most of the fatal cases of typhus at pre¬ sent die of cerebral disease. But in the majority of instances you will find that these were cases in which the head was neglected, and in which the appropriate remedies were used too late. In cases treated from the commencement with judgment, decision, and attention, al¬ though the head may be threatened, you will not have one-twentieth of the mor¬ tality observed in those cases where the early prevention of cerebral symptoms has not been an object of care. One of the worst cases of cerebral disease which I have witnessed for many months, and which would have probably terminated fatally before the seventh day, I saw in i consultation with Mr. Daly, and yet this , case was saved by prompt and decided measures calculated to counteract the eere- ' bral symptoms. I have also very recently i witnessed another very remarkable case of this description at Bray. The patient, a gentleman very full and plethoric, but remarkably temperate, aged 35, was attacked after exposure to cold by intensely violent maculated fever, for which aperients of an active nature were exhibited. I saw him in consulta¬ tion with I)r. Pleffernan on the 5th day. His headache had been relieved by leech¬ ing, but his breathing was very quick, and he was almost constantly asleep. Skin very hot; eyes somewhat suffused; most copious crop of maculse. We at once blistered the whole scalp; and on the 8th day blistered it again, and also the nape. On the 9th day the cerebral symptoms, which we had been endeavouring to anticipate, came on, but probably our treatment pre¬ vented them from being fatal; for when they appeared, the application of tartar emetic ointment induced a purulent dis¬ charge from the wrhole surface of the twice blistered scalp, in the course of a few hours, and three grains of tartar emetic given in divided doses that day procured a complete cessation of the symptoms, after — mark, after — the pupils had been dilated, and one fit of slight paralysis of the mouth and tongue had taken place. The result of all my experience in fever is, that the majority of fatal cases are ren¬ dered so, in this country at least, by severe cerebral symptoms supervening sooner or later in the disease. Delirium, sleepless¬ ness, stupor, convulsions, extreme subsul- tus, jactitation, sluggish and dilated, or else extremely contracted, pupils; these are the symptoms we have to fear after the fever has lasted some time; and let me repeat it, the chief art of the physician consists not so much in remedying these symptoms, as in anticipating them. When he judiciously attempts this, he may not, indeed, always succeed in altogether pre¬ venting their supervention, but he will, in the great majority of cases, be successful in diminishing their violence, and prevent¬ ing their usual disastrous effects. I shall now resume the subject of blis¬ tering in fever, on which I made some ob¬ servations in ray last lecture. I have spoken of it chiefly as a powerful revulsive remedy in the treatment of cerebral con¬ gestion; let us now treat of its employ¬ ment with other objects in view. In the first place, as has been already explained, blisters may be used as most energetic stimulants in cases where the powers of life flag, and threaten a sudden cessation. Occasionally, in fever, you will find the vital tone reduced to a very low pitch, the heart uncertain in its action, the pulse irregular, the respiration feeble, the skin cool, and the patient so weak that he can¬ not be lifted up, or even turned in bed without having a tendency to faint. Here we have to superadd to the ordinary treat¬ ment of fever the prompt exhibition of remedies calculated to meet such emer- 846 PROFESSOR GRAVES’ CLINICAL LECTURES. gencies, and in addition to internal stimu¬ lants, we have recourse to powerful stimu¬ lation of the cutaneous surface by what are termed flying blisters. One of the best remedies in such cases is a large blister applied over the region of the heart, to be left on for two or three hours, or until the vascular action of the skin is sufficiently excited. When the patient appears to labour not only under sudden weakness of the heart, hut also of the capillary and nervous systems, as shown by coldness of the ex¬ tremities and sinking of the pulse, it will be necessary to apply flying blisters, not only over the region of the heart, but also over various parts of the chest, the epigas¬ trium, and the inside of the legs and thighs. You will find this plan of treat¬ ment frequently succeed in cases which have a very unpromising aspect. I have now witnessed manv instances of this description, in which, from cold, neglect, or debilitating treatment, the patients ap¬ peared moribund, with lividity of the ex¬ tremities, hippocratic face, cold skin, and failing pulse; and I have seen them saved, as it wrere miraculously, by the use of carbonate of ammonia, musk and wine, and the application of warm fomentations to the limbs, followed by a succession of flying blisters. The next use to which we apply blisters is in the treatment of those pulmonary affections which arise during the course of typhus. From what you have seen of the present epidemic, you must be convinced that bronchitis is one of its most frequent complications, and that few patients pass through fever without having some affec¬ tion of the bronchial mucous membrane. You are also aware, that when bronchitis attacks the more minute ramifications of the bronchial tubes, it is very apt to pro¬ duce congestion and engorgement of the lung. We meet with pneumonia much less frequently in fever, but it is occasion¬ ally observed, and requires the most prompt and decided treatment. In pneumonia, as well as in congestion of the lungs, accom¬ panied by inflammation of the smaller bronchial tubes, blisters afford us a most valuable adjunct to the other means which we employ, and admit of being used in cases where no other mode of depletion could be safely borne. The affections of the lung in fever are of no small import¬ ance, and the stethoscope has not conferred a greater benefit on practical medicine, than by indicating, in diseases of the chest, not merely the existence of disease, but also its locality, extent, and precise nature. It points out to us the portion of the chest in which the bronchial tubes are chiefly engaged, and informs us with cer¬ tainty when the affection of the smaller tubes and air-cells has given rise to pulmo¬ nary engorgment. The experienced ste- thoscopist will in such cases be aware of the exact site and nature of the affection, where the mere symptomatic practi¬ tioner would be unable to acquire any thing more than a loose and undefined notion of pulmonary disease. The latter employs his depleting means at random, and frequently abstracts a large quantity of blood, with little benefit to his patient; the former, aware of the ex¬ act situation and extent of the disease, applies his leeches or cupping glasses im¬ mediately over the engorged or inflamed portion of the lung, and relieves his pa¬ tient at the expense of a comparatively small loss of blood. The same observa¬ tion will apply, with equal force, to the use and application of blisters. A good and accurate knowledge of the various ste- thoscopic phenomena is besides of so much more value in the treatment of fever, as, at certain seasons of the year, almost every case of fever will be complicated with pulmonary derangement; and it may happen, during the course of an epidemic, that the lungs may be the organs which are chiefly engaged. Although cerebral disease is at present the principal source of danger in fever, it may not be so al¬ ways. A change may take place in the character of the epidemic ; the cerebral symptoms which are now of such frequent occurrence may become infrequent or in¬ consequential, and we may have the orga-. nic affections chiefly limited to the viscera of the thorax. I have seen many cases of fever in which the principal source of danger was connected with the chest, and where an accurate knowledge of the ste¬ thoscope was indispensable to a correct and successful plan of treatment. Now when you have recourse to blisters in treating pulmonary affections, whether these affections be simple or complicated with typhus, it would be well to recollect that much good may be effected without leaving the blisters on fora long time, or until they rise fully ; and also that when risen, it will not be necessary to cut them at once, and let out the effused serum. In treating the bronchitis of children, and in the bronchial affections of fever, I have frequently directed the blister to be left unopened ; and I can state, from experi¬ ence, that this plan answers very well. The effused serum forms one of the best dressings for the excoriated surface of the skin, and the formation of troublesome sores is avoided. I frequently have re¬ course to this mode of treating blistered surfaces in children, and persons of irrita¬ ble habit, in whom the cutis is extremely tender and vascular. Such persons, when blistered, wall often have profuse dis¬ charges, first of serum and afterwards of TREATMENT OF FEVER. 847 *ero- purulent matter, from the denuded surface, accompanied by torturing pain, loss of rest, and considerable irritation of the general system. I have seen the dis¬ charge continue to flow profusely for five or six days ; in fact, to such an extent as to wet several napkins in the course of a day, and expose the patient to the risk of an aggravation of the pulmonary symp¬ toms, in consequence of his linen becom¬ ing so frequently moistened as to require repeated shifting*. In all cases of chil¬ dren and persons of an irritable habit, I would therefore advise you to let the blis¬ ters alone, particularly where they have been applied to the fore part of the chest, or any other part not exposed to pressure or friction. As soon as the blister rises, apply over it a piece of lint, smeared with spermaceti ointment, which can be re¬ newed as occasion requires, and leave the rest to nature. I was forcibly struck, some time since, with the difference of re¬ sult between this and the ordinary prac¬ tice, in the case of a young gentleman re¬ siding in Cambden-street, who had a severe attack of bronchitis towards the termination of fever. A blister had been applied to his chest in the morning, and another in the middle of the day. The first had been opened freely, and dressed in the usual way ; but the other, which had risen about the time I was called in, was left untouched at my request. The one which had been opened caused such a de¬ gree of irritation and restlessness, that it was found necessary to give him an opiate every night ; the other gave little or no in¬ convenience, and healed up much sooner. If I have done nothing better, I think I deserve some merit for being the first to reprobate the practice of keeping on blis¬ ters for twelve, eighteen, and twenty-four hours, and for having shewn, by nu¬ merous experiments, that a much shorter period of time was required to ensure the full effect of these remedies. When I commenced the practice of medicine, blistering was looked upon by most sick persons as one of the severest trials of their patience, and the agony which it caused in some irritable habits was almost insup¬ portable. Blisters were left on for twelve, eighteen, and even twenty four hours, and i when at length they were removed, the i whole epidermis of the blistered part came, ; or was torn, away, leaving behind a raw irritable surface, from which large quan¬ tities of serum and pus were effused for i several days, to the great torture and in¬ * In pulmonary diseases, this continued dis- I charge is often very useful, and should be en- i couraged ; but in fever the production of such » an effect from blisters must be avoided, as a sur- i face thus denuded of its cuticle and inflamed, may be converted into a dangerous sore. convenience of the patient ; and, not content with this, the practitioners of that time generally dressed the excoriated sur¬ face with some sharp stimulant ointment, so that the blistered surface most com¬ monly resembled that of a severe burn. Ask those who are our seniors in practice, and they will tell you what blistering was twenty or thirty years ago. They first produced excessive irritation of the skin, by leaving the blisters on too long, they then irritated the denuded surface with stimulant ointments, and in this way brought on extensive sores of a bad cha¬ racter, which remained long after the dis¬ ease for which the blisters were applied had disappeared, and which formed, in fact, a new ailment, requiring new* medi¬ cines and additional attendance. If you look over Mr. Moore’s account of the prin¬ cipal remedies employed in the practice of Dublin physicians, about the period I allude to, you will find that nothing was more common then than the application of stimulant and, as they were termed, digestive ointments, to blistered surfaces. I was among the first who assailed this barbarous treatment, and showed that all the good effects of blisters might be secured by leaving them on for a much shorter space of time. I proved by nu¬ merous experiments, that in many cases it was not necessary to leave them on more than four or five hours, in the adult*, and that they might then be removed and the blistered part dressed with spermaceti oint¬ ment. Under this dressing the blister rises well, and there is no danger of tear¬ ing away the cuticle, or producing an irri¬ table sore. In addition to this, you en¬ tirely avoid the irritating effects which blisters are known to produce on the uri¬ nary organs. You will very rarely meet with dysuria, or hsematuria, where the blister has been left on for the spaces of time [ have mentioned. Blistering is then to be used with the restrictions I have mentioned, and you will find it a most valuable aid in the treatment of fever and its complications. It may be employed either as a derivative and revul¬ sive, or you may have recourse to flying blisters over various parts of the body, in certain forms of fever, where there is marked and sudden depression of the powers of life. Speaking of depression of the powers of life reminds me of a curious incident, which occurred some time since in my practice, and which shows the value * Of course, blisters applied to the scalp must be excepted. They require at least twelve hours. In old persons generally the skin is much less vascular than dining youth and middle age ; and consequently, in the old, blisters require a much longer time to produce the required effect. 848 M03S0TTI ON THE FORCES WHICH REGULATE of being acquainted with the peculiar habits and idiosyncrasies of families. I attended, with Mr. Kirby, about three years since, a gentleman of middle age and active professional habits, who had been attacked with fever. I was first called to see him on the ninth day of fever, and found him apparently moribund. His pulse was intermittent and irregular, the action of the heart tumultuous, the respi¬ ration feeble, and the extremities cool. Mr. Kirby had instantly ordered internal stimulants, and blisters over the region of the heart and epigastrium. The patient rallied, and ultimately recovered. It is to be observed, that the group of formidable symptoms just enumerated had supervened quite out of the usual course, and without any previous warning. They were conse¬ quently not only alarming but unexpected. About a month afterwards, Mr. Smyly and I were called to see this gentleman’s brother, who was living at Dun drum, and who was supposed to have caught fever from his close attention to his brother during his illness and convalescence. What was most remarkable in the case, was, that his pulse began to flag and intermit, and he likewise suddenly and unexpectedly got the same symptoms of depression of the vital powers on the very same day and hour as his brother. His symptoms also continued for the same length of time, and yielded, or spontaneously ceased, under the same plan of treatment. In some families you will find a very curious coincidence be¬ tween the play of the various functions in disease as well as in health, and you should neglect no opportunity of making yourself acquainted with the family pecu¬ liarities and idiosyncrasies of your patients, as knowledge of this description is of the greatest value and importance in the treat¬ ment of disease. ON THE FORCES WHICH REGULATE THE INTERNAL CONSTITUTION OF BODIES. By O. F. Mossotti. The following are only the popular preli¬ minary remarks of Signor Mossotti: we have borrowed them from the “ Scientific Memoirs,” Part III. just published, by Mr. R. Taylor. The reader who washes to study the body of the paper — a most im¬ portant production, but wholly mathema¬ tical — had better procure the valuable periodical referred to. The study of the phenomena ofnaturehas led philosophers to consider bodies as being composed of molecules held in a state of fixed equilibrium at a certain distance from each other. Such a state requires that they should be endued with a certain action. Some peculiarities of this action wre are already able to assign, but its complete characteristics are not yet wTell defined. As the resistance opposed by bodies to compression increases indefinitely with the reduction of their volume, though their molecules have not come into contact with each other, it shows that the force which they exercise is repulsive at the least distances. At a distance greater than these, but still imperceptible, it must vary with great rapidity, and become attractive, in order that a steady equilibrium of the molecules may be possible; and finally, when it has become perceptible, it must decrease in the inverse ratio of the square of the distance, in order to repre¬ sent the universal attraction. The limits of the distance at which the negative action becomes positive vary according to the temperature and nature of the molecules, and determine whether the body which they form be solid, liquid, or aeriform. There is a class of phenomena, rather singular at first sight, in which, however, it appears that nature designed, by se¬ parating the forces which she employs, to present herself in all her simplicity. Such are the phenomena which constitute what wre denominate statical electricity. It is well known with what admirable facility Franklin explained these pheno¬ mena, by supposing that the molecules of bodies are surrounded by a quantity of fluid or aether, the atoms of which, wdiile they repel each other, are attracted by the molecules. It is known also how Coulomb subsequently proved that the force with which the repulsion of atoms and the attraction of the molecules are produced, is, like universal attraction, regulated by the lawr of the inverse ratio of the square of the distance. Indeed, the latter phi¬ losopher has substituted for the hypothe¬ sis of Franklin, which is that generally followed in England, Germany, and Italy, another hypothesis, in which a second fluid is supposed to perform the part assigned to matter in that of Franklin ; and this mode of explaining the phenomena has been more generally adopted in France. It is even asserted that the latter hypothesis is the only one that should be received, inas¬ much as it has been completely confirmed by the results of the beautiful analysis with which M. Poisson has begun to enrich the Memoirs of the Academy of Sciences. But they who put forward this assertion have not paid due attention to the fact, that, although this illustrious 849 THE INTERNAL CONSTITUTION OF BODIES. geometer has, for the purpose of establish¬ ing his calculations, adopted the language of his school, the inferences drawn from them are not more applicable to the one hypothesis than to the other. He sets out, in fact, with the principle, that “ If several bodies, being electric conductors, are placed in presence of each other, and attain a permanent state, the result of the actions of the electric layers which cover them, on a point taken anywhere in the interior of a body, must, in that state, be null ; otherwise the combined electricity which exists in the point under considera¬ tion would be decomposed; but this is contrary to the supposed state of per¬ manence.” Now if for this principle the following be substituted : “ If several bodies, being electric conductors, are placed iu presence of each other, and thus attain a permanent state, the result of the actions of the layers of electric fluid which cover them, and of the exterior layers of matter which are not yet neutralized, on the electric fluid at a point taken any where in the interior of a body, must, in that state, be null ; otherwise the electric fluid which exists in that point would be displaced, which is contrary to the sup¬ posed state of permanence;” — and if we interpret accordingly the literal denomina¬ tions employed by M. Poisson and his equations, — all his results will be equally true on Franklin’s hypothesis. In general, the action of the condensed electric fluid will stand for that of the vitreous fluid; and the action exhibited by the matter, in proportion'as it is deprived of a quantity of its electric fluid, will stand for that of the resinous fluid. There is one circum¬ stance, however, which makes a difference between the hypothesis of Dufay or Coulomb and that of Franklin: it is this — that, according to the one, the two fluids are moveable in the bodies, while accord¬ ing to the other the electric fluid is, but the matter is not, moveable. As the equi¬ librium, however, requires that we should only regard the relative position, the mobi¬ lity of the electric fluid alone is sufficient for its establishment. iEpinus, who has reduced Franklin’s hypothesis to the form of a mathematical theory, was the first to remark, that if it be the requisite condition for the equi¬ librium of the electric fluids of two bodies, ! in their natural state, that “ the attraction I of the matter and the repulsive action of i the fluid of the first body on the fluid of i the second should be equal, and vice versa,” i there are but three forces in operation; i two of which are attractive, and but one repulsive. In other words, each of the i two bodies attracts the fluid of the other, I while the mutual repulsion of the two i fluids constitutes only a single force, equal 483. — xix. to each of the two attractive forces. If, then, with the equilibrium of the fluids, it is desired to find the equilibrium of the masses also, an equal repulsion must be allowed between the molecules ; since the bodies would otherwise forcibly attract each other. But such an attraction is contrary to what we learn from expe¬ rience. He felt at first a strong objection to the admission of such a repulsive force between the material molecules, as being opposed to the idea entertained of their mutual attraction, which was so clearlv demonstrated on Newton’s principles. But a little reflection satisfied him that this admission contained nothing that was op¬ posed to facts, or, as he might rather have said, that was not confirmed by facts. Universal attraction itself may follow as a consequence from the principles which re¬ gulate the electric forces: for if we sup¬ pose that, the masses being equal, the re¬ pulsion of the molecules of matter is a little less than their attraction of the atoms of the aether, or than the mutual repulsion of the atoms themselves, this will be sufficient to leave an excess of at¬ traction, which, being directly as the pro¬ duct of the masses and inversely as the square of the distance, would exactly re¬ present the universal attraction. While reflecting on these principles, in a course of lectures on natural philosophy wffiich I gave at the University of Buenos Ayres, I conceived the idea, that if the molecules of matter, surrounded byr their atmospheres, attract each other when at a greater, and repel each other when at a less distance, there must be between those two distances an intermediate point at wffiich a molecule wrould be neither at¬ tracted nor repelled, but would remain in steady equilibrium ; and that it is very possible this might be the distance at which it would be placed in the composi¬ tion of the bodies. I thought the idea of sufficient importance to fix it in my memory, but did not at the time pursue its development further. On my return to Europe I learned, th rough the reading of some memoirs, and in the course of conversation with men of science, that the attention of geometers was particularly directed to the molecular forces, as being those which may lead us more directly to the knowledge of the intrinsic properties of bodies. I was thus led to recall my ideas on the subject, and to set about subjecting them to analysis. The results of my first investigations I here submit to the judgment of philo¬ sophers. I have supposed that a number of mate¬ rial molecules are plunged into a bound¬ less aether, and that these molecules and the atoms of the aether are subject to the 3 T 850 EFFICACY OF THE STRYCIINOS NUX VOMICA actions of the forces required by the theory of iEpinus, and then endeavoured to as¬ certain the conditions of equilibrium of the aether and the molecules. Consider¬ ing the tether as a continuous mass, and the molecules asisolated bodies, I found that, if the latter be spherical, they are surrounded by an atmosphere, the density of which decreases according to a function of the distance which contains an exponential factor. The differential equation which determines the density being linear, is satisfied by any sum of these functions, answering to any number of molecules. Whence it follows that their atmospheres may overlay or penetrate each other without disturbing the equilibrium of the tether. Proceeding in the next place to the conditions of equilibrium of the molecules, I observed, that for a first approximation (which may be sufficient in almost all cases), the reciprocal action of two mole¬ cules and of their surrounding atmospheres is independent of the presence of the others, and possesses all the characteristics of mo¬ lecular action. At first it is repulsive, and contains an exponential factor wrhich is capable of making it decrease very rapidly : it vanishes soon after, and at this distance two molecules would be as much indisposed to approach more nearly as they wrould be to recede further from each other ; so that they would remain in a state of steady equilibrium. At a greater distance the molecules would attract each other, and their attraction would increase with their distance up to a certain point, at which it would attain a maximum: beyond this point it would diminish, and at a sensible distance would decrease di¬ rectly as the product of their mass, and inversely as the square of their distance. This action, possessing all the properties with which we can presume that molecu¬ lar action is endued, is the more remark¬ able as it has been deduced from those forces only w7hose existence was already admitted by philosophers, and whose law is characterized by such extraordinary simplicity. When tested in the explana¬ tion of the varied phenomena which are proper to it, it must lead, in case of failure, to the exclusion of those forces from amongst physical principles; or, in case of success, establish their reality ; and thus mark in a striking manner the admi¬ rable economy of nature. To apply the formulae which we have found, for the purpose of representing molecular action, to the phenomena of the interior constitution of bodies, re¬ quires methods of calculation which are not yet developed, and which must be¬ come still more complicated when the arrangement of the molecules, their form, and their density, are taken into consider¬ ation. I have thought it advisable, however, in consideration of the use to which it might be applied bv able geome¬ ters, not to postpone the publication of this mode of viewing molecular action. It is a subject which appears to me enti¬ tled to the greatest attention, because the discovery of the laws of molecular action must lead mathematicians to establish molecular mechanism on a single principle, just as the discovery of the law of univer¬ sal attraction led them to erect on a single basis the most splendid monument of human intellect, the mechanism of the heavens. We mentioned that Professor Faraday, in his popular account of Mossotti’s law, at the Royal Institution, quoted a passage written nine years ago by Dr. Roget, in which the probability of the existence of such a law is alluded to. The following is the passage: it occurs in the treatise on Electricity in the Library of Useful Know¬ ledge : — “ (239.) It is a great though a common error to imagine, that the condition as¬ sumed by iEpinus, namely, that the parti¬ cles of matter when devoid of electricity repel one another, is in opposition to the law of universal gravitation established by the researches of Newton ; for this law7 applies, in every instance to which inquiry has extended, to matter in its ordinary state; that is, combined with a certain proportion of electric fluid. By supposing, indeed, that the mutual repulsive action between the particles of matter is, by a very small quantity, less than that be¬ tween the particles of the electric fluid, a small balance would be left in favour of the attraction of neutral bodies for one another, which might constitute the very force wrhich operates under the name of gravitation ; and thus both classes of phe¬ nomena may be included in the same law.” EFFICACY OF THE STRYCHNOS NUX VOMICA IN AFFECTIONS of the DIGESTIVE ORGANS. To the Editor of the Medical Gazette. Sir, In a complaint occurring' under so many and varied aspects, and not unfrequently bidding* defiance to the best directed efforts of the practitioner, it will not, I think, be deemed an unprofitable ser- IN AFFECTIONS OF THE DIGESTIVE ORGANS. 851 vice if I shall have contributed in this brief communication any thing- towards the more successful treatment of what has hitherto ocqasionally proved one of the opprobria^of our art. Amidst the multiplicity of remedies with which the storehouse of our materia medica is at the present day so amply supplied (some of them, doubtless, of inestimable value, while others seem destined to possess a more ephemeral reputation), it becomes a gratifying- part of our duty to endea¬ vour to rescue from unmerited oblivion a therapeutic ag-ent which has long- been familiar to the medical world, but whose efficiency has been crippled by a too limited application of its powers; — I allude to the strychnos nux vomica. Very few, indeed, of the practitioners with whom I am acquainted are in the habit of employing- this remedy other¬ wise than for the relief of certain forms of paralysis, where it has undoubtedly been productive of the most beneficial effects in some instances, as I have mv- self had occasional opportunities of tes¬ tifying-. In the valuable lectures of Mr. Pereira contained in the present volume of the Medical Gazette, a very cursory notice is taken of this drug- with reference to its effects in dis¬ orders of the alimentary canal, although its application to the cure of paralysisis fully and ably discussed. In the “ Pharmacopee Universelle,” too, which contains a great variety of formulae for its several modes of exhibition, little mention is made of its properties and uses further than as they may be ren¬ dered subservient to the removal of the graver affections of the nervous system, such as paralysis, epilepsy, chorea, &c. It does, indeed, appear from the same work that M. Niemann had successfully employed, in what he calls spasmodic cardialgia, a pill composed of one- fifth of a grain of the alcoholic extract of nux vomica. This statement, however, is merely made incidentally, and without any importance being- at¬ tached to the exhibition of the remedy as a curative means in the above de- rang'ed condition of the system. With the view, therefore, of endeavouring to extend its utility to another class of dis¬ orders, less immediately interfering, it is true, with the continuance of life, but frequently, when unalleviated at an early period, paving the way for the encroachment of a long catalogue of organic changes*, that lam desirous of submitting these few remarks to the notice of the profession. The difficulty oftentimes experienced in the removal of dyspeptic ailments, and the consequent uncertainty attaching to each and all of the multiplied remedies which expe¬ rience has proved to be alike in their turn available, must be generally admitted ; and hence we are frequently doomed to witness the inefficacy of the most scien¬ tific treatment, whilst a cure is perhaps finally effected by the employment of some old woman’s recipe. It is now several years since my attention was first struck with the very decided bene¬ fit resulting from the exhibition of this remedy in disorders of the digestive functions; and subsequent experience, which has certainly been ample, has tended only to confirm the confidence originally reposed in it. The cases in which it has been productive of the most decided benefit, are those of pyro¬ sis, resulting from simple functional dis¬ order of the stomach. In examples of this nature, indeed, I consider it almost a specific; so immediate, and in most instances so prominent, has been the re¬ lief obtained. I have the less hesitation in making this avowal, from having so frequently witnessed the almost total in¬ efficacy of every means previously put in practice, and the patient consequently harassed with a vexatious disorder, de¬ pressing alike the energies of both mind and body. In pyrosis also, symptoma¬ tic of organic disease of the stomach, the powers of nux vomica are of essen¬ tial service ; although, of course, in this instance we can in general hardly ex¬ pect to do more than regard the ad¬ vances of those morbid changes which are going forward. It is not, however, for the removal of the above symptom’s alone^that I would restrict the employ¬ ment of this remedy; although I be¬ lieve, that in the subjugation of that symptom its virtues are more frequently and conspicuousl y manifested. In almost all cases of disordered digestion, unac¬ companied with any inflammatory con¬ dition of the mucous membrane, and where the symptoms appear to depend upon a diminished vigour of the nervous and muscular powers of the stomach, as indicated chiefly by pain and disten¬ sion after eating, acid eructations, &c., * See Dr. Wilson Philip’s work on Indigestion, passim , 852 EFFICACY OF THE STRYCHNOS NUX VOMICA, See. the tongue frequently exhibiting1 little or no/ur on its surface, it may be pre¬ scribed with the fairest prospects of ad¬ vantage. In a decidedly febrile state of the system accompanying the dyspeptic ailments, I should of course consider its use contra-indicated. But if we attentively consider the phenomena of indigestion, I am fully persuaded that in a larger majority of cases we shall be sensible of the impropriety of having recourse to any antiphlogistic measures ; but on the contrary of the expediency of endeavouring to impart a greater de¬ gree of tone to an organ already suffer¬ ing from diminished excitation. From the experiments which have been made with nux vomica upon animals gene¬ rally, and upon man, it is established that its first effects, when given in mo¬ derate doses, are those of an active stimulant to the nervous system, without producing any marked influence upon the pulse ; whilst, if given in larger doses, its effects are manifested “ by a disordered state of the muscular system;” and if persevered in still further, tetanus and asphyxia are the result. But with¬ out further allusion to its various phy¬ siological effects, I shall merely add, that however energetic a poison it may in some instances have proved, I have never found its exhibition, even in toler¬ ably full doses, productive of the slightest inconvenience, either when given in the form of powder, extract, or tincture. And this leads me to remark, that of the three modes of exhibition above alluded to, that of the powder appears to be by far the best, as its effects are far more uniform and certain : this may be given in doses of three, four, or five grains, suspended in cinnamon water, with mucilage, to which an aromatic, as the tinctura cardamomi comp, may be added, or, combined with a little calum- ba; and carbonate of soda, in the form of a powder, three times a day. If, as is usually the case, costiveness be present, this condition may be best obviated by continuing with each dose of the remedies above indicated, two or th ree grains of the pulvis rhei : if, on the contrary, diarrhoea be an accom¬ panying- symptom, this state constitutes no objection to the employment of the nux vomica, which may still be exhibit¬ ed, in combination with chalk or opium, until the healthy action of the bowels be restored. I have here purposely abstained from making any allusion to those auxiliary remedies, to whose efficacy in correcting the depraved secretions of the intesti¬ nal canal multiplied experience has borne the most ample testimony — such as the several preparations of mercury — my object being- rather to direct the attention of practitioners to the singular value of a therapeutic agent, without the co-operation of which their curative efforts, however scientifically directed, will now and then be frustrated. Jn order, however, that the efficiency of this drug be duly exemplified, it is very important that the powder have been recently prepared, and free from all adulteration. With this view I have generally been in the habit of laying a strict injunction upon the druggist to supply me with a genuine article, offer¬ ing* at the same time a somewhat higher price to insure this object, many of the specimens which I have met with hav¬ ing proved, upon trial, to be almost worthless. I am unwilling- to occupy more of your space by detailing any cases in which I have found the above remedy so very serviceable, particularly as I trust, from what has been already said, the indications for its use will appear sufficiently evident. Before concluding, I must not omit to mention that the late Dr. Belcombe, of York, was in the habit of employing the nux vomica for the relief of indigestion, but in what particular form of this complaint I am not at present prepared to say. Mr. Wass also, of Tbirsk, prescribed it in similar cases, without however, so far as I am aware of, attaching any very great importance to its exhibition. I am happy in being able to add the tes¬ timony of Mr. Fawdington, of this town, in favour of its remedial powers; the latter gentleman having, in the course of an extensive practice, enjoyed repeated opportunities of verifying its utility, especially in the removal of pyrosis. It now only remains for me to state, that in advocating- the claims of a truly valuable remedy to the notice of the profession, as adapted to a class of dis¬ orders in which it has hitherto been very rarely tried, I am impressed with a strong conviction that, unlike many fashionable remedies of the day, it is destined to hold a very high rank in the 853 MR. HULBERT’s CASE OF CONCUSSION OF THE BRAIN. scale of our remedial agents, an antici¬ pation which I hope to see in part re¬ alized, by its admission into a future edition of the Pharmacopoeia. I remain, sir, Your obedient servant, Thomas Mellor, Demonstrator of Anatomy at the Royal School of Anatomy and Medicine. Manchester, Feb. 15, 1837. CASE OF TYPHUS FEVER — CON¬ CUSSION OF THE BRAIN — AND GORING BY A BULL. To the Editor of the Medical Gazette. Sir, The publication of some cases I re¬ cently sent you, has induced me to communicate the following, thinking it may be interesting to many of the readers of your excellent journal, — to some of whom it may resemble a bio¬ graphical sketch rather than the simple detail of facts relating to the medical history of an individual in the lower ranks of society, and for the greater part of his life the inhabitant of a re¬ tired country villag’e. Soon after I commenced practice, I received an order from the overseer of a neighbouring parish to that in which I resided, to attend some families afflicted with fever. In one of the cottages (a miserable hovel, containing only two rooms, one above and one below, and both badly protected from the incle¬ mency of the weather,) I found two young persons already dead ; another in the last stage of typhus, who expired during the ensuing night ; and three or four others in different stages of the same disease, who subsequently re¬ covered. Although I had never before seen such distress in private practice, I had ■witnessed the direful effects of typhus fever upon an extended scale, having been one of the medical attendants on the sick and wounded troops who re¬ turned to Plymouth after the death of their lamented commander, Sir J. Moore, at Corunna. The treatment I had re¬ course to I will not detail, as it might render my communication unnecessarily tedious ; suffice it to mention, that in many respects it resembled that adopted by one of my excellent colleagues on that memorable occasion, and which he has so ably described in the fifth volume of the Edinburgh Medical and Surgical Journal. One of my patients, who recovered, was a lad about ten years of age, named George James. The symptoms had been of an alarming character, and he had been considered to be in imminent danger. A few months after his recovery, I was again called upon to attend him. He had fallen from a lofty tree, which he had ascended to take a rook’s-nest; was taken up insensible, and in that state conveyed home. Upon examina¬ tion, I could not discover any fractured bone, or any depression of the cranium. The dilated state of the pupil, and its incontractility on the admission of light, with other symptoms, denoted concussion of the brain ; and I treated the case accordingly. The only sensi¬ bility he displayed, was taking into his mouth and swallowing what supplies of food or medicine were given him ; and he w;as restless when necessitated to at¬ tend to the calls of nature. At first I gave him calomel and antimonials iti combination, to which 1 added a strong infusion of senna, with small doses of the compound spirit of ammonia. When the pulse, which was at first feeble, in¬ creased in force and number, I had re¬ course to general and topical bleeding; at which times he would open his eyes and look about him, and then relapse into his state of insensibility. He con¬ tinued in a similar state of torpidity, breathing without difficulty, and resem¬ bling any one in profound sleep, for above a week; when he gradually be¬ gan to take notice, and at length to make inquiries respecting himself, hav¬ ing no recollection of any thing that had occurred after the branches of the tree had given way with him. He soon after regained his health and strength. From this period I had no call to at¬ tend this unfortunate youth until he had attained the age of nineteen; but he had in the interim some narrow escapes, as he had connected himself with a gang of depredators who infested the neighbourhood ; and, being detected in some burglaries, had sentence of death twice recorded against him, which was each time commuted for a term of im¬ prisonment, on account of his youth. 854 GORING BY A BULL. Oil this occasion he had received a severe wound in the abdomen, from an enraged bull, which he had been occa¬ sionally in the habit of irritating ; and being at work in the field where the animal was grazing, he commenced throwing stones, &c., when it closed upon him, and tossed him into the hedge. Fortunately for him, he fell on the opposite side, otherwise a second at¬ tack might have occasioned his death on the spot. He rose from the ground, with the intention of reaching the ad¬ joining farm-house, but found that a considerable portion of his bowels were protruding through a wound occasioned by the horn of the bull ; and, after calling for assistance, fell down, unable to proceed any further. In this state he was discovered and conveyed into the house. On my arrival, I found him reclining on a bed on the floor ; his coun¬ tenance pale, respiration quick, pulse small and very rapid, and a clammy coldness on the surface of the body, particularly of the extremities. The haemorrhage had been very copious. Upon examining the wound, I found that it commenced about the centre of the right iliac region, and extended ob¬ liquely upwards, for five or six inches in length. The intestines were pro¬ truding in a considerable mass, equal¬ ling in size the head of a child eight or ten years of age, and consisted of nearly the whole of the colon, and at least two feet in extent of the ilium ; but upon tracing* them minutely, I could discover no other injury they had received, ex¬ cepting a laceration of several of the mesenteric vessels, from whence the haemorrhage had proceeded. The omen¬ tum, which appeared as if rent in seve¬ ral directions, wras lying on one side. Having reduced the intestines, and extended the omentum over them as evenly as possible, I closed the wound, and secured its edges in contact with sutures, and straps of adhesive plaster; a fold of linen was laid over the dress¬ ing*, and a band six or eight inches in breadth surrounded the abdomen, over which I directed a large compress to be applied, frequently wrung out of cold water. A degree of reaction taking place, as the pulse was increasing in force, I had recourse to venesection ; and in this, as well as in the subsequent bleedings, was governed more by the effect upon the vascular system than influenced by the quantity of blood ex¬ tracted. I directed his taking a solu¬ tion of sulphate of magnesia every three hours, combined with small doses of the antimonium tartarizatum. About seven hours after the accident I again saw him ; his countenance was somewhat flushed ; the pulse above 100, and full; the skin warm and dry; and the bowels had not been evacuated. I had again recourse to venesection, and directed a perseverance with the other means before recommended. The following morning I found he had passed a tranquil night. The con¬ stitutional irritation, though somewhat increased, did not exist in any consider¬ able degree ; the tongue was covered with a white crust, and he complained of thirst ; the skin was dry and hot ; the pulse 110, and increased in hardness; the bowels had not heen relieved, al¬ though he had voided his urine several times, and the surface of the abdomen betrayed an increased degree of tender¬ ness. I bled him again, and directed a grain of calomel, and the same quan¬ tity of antimonial powder, to be taken every four hours, and a dose of a saline cathartic mixture in the intermediate time, and likewise the administration of the common domestic enema every four or six hours, with the repetition of the application of cold externally. A call to a particular obstetrical case fnevented my seeing him until the fol- owing morning (forty-four hours after the accideut). I found him apparently in a hopeless state ; his countenance was deeply flushed, and displayed a complete personification of anxiety, his sight being directed from one object to another in quick succession; he had been delirious at intervals during the night, a troublesome hiccup distressed him, and he had vomited several times. The skin was dry, and parched with heat ; the tongue covered with a dark brown coating ; the pulse very irregular in force and number, but averaging about 150 per minute ; and the abdo¬ men felt tense, and was excessively tender, as the slightest touch gave him severe pain. He told me he should die, and thanked me for the attention I had shewn him on this and former occa¬ sions. I directed an occasional dose of ol. ricini, which I subsequently found his stomach retained ; the enemata to be continued, injecting a solution of sulphate of soda in strong infusion of senna, and to repeat the application of MR. CASWALL ON THE TREATMENT OF HYDROCELE BY IODINE. 855 cold water to the abdomen as frequently as could well be effected. Oil my seeing- him in the evening-, he exclaimed with animation, “ I am better, sir.” His countenance was expressive of less anxiety ; his skin felt softer, was cooler, and disposed to a g entle perspira¬ tion ; the tong-ue was whiter and cleaner ; the pulse regular, though much too full and quick ; the other symptoms more fa¬ vourable; and the bowels had been re¬ lieved several times. I directed the continuance of the cold applications, and the repetition of the oleum ricini, with his taking- plentifully of whey and soft gruel, the only articles of diet he had taken since the occurrence of the accident. I had likewise recourse to another bleeding, abstracting the blood to a greater extent than at any time before. The following morning I was grati¬ fied by finding considerable amendment. The pulse was about 90 ; the tempera¬ ture of the skin lessened, and it was be¬ dewed with a gentle perspiration ; the abdominal tension was nearly gone, and the wound (which I now examined for the first time after closing- it,) pre¬ sented a favourable appearance. Seve¬ ral evacuations had taken place during the night. From this time the symp¬ toms continued to improve, and my pa¬ tient gradually recovered. On discon¬ tinuing my attendance, I ordered his wearing continually a wide band or belt, by wa y of support and protection ; and also cautioned him to be attentive to the state of his bowels, carefully avoiding a state of constipation, and whatever would be likely to occasion irritation. A few months after his recovery he left the neighbourhood for London, where he married and resided three or four years ; when he again returned to his native place. Some time afterward I received an urgent request to visit him as expeditiously as possible. I went immediately to his house, but he had expired before my arrival. He had suffered extreme pain in his stomach and bowels, with great sickness and re¬ laxation. The abdomen was somewhat distended and tense, but the body did not present any external appearance of injury. I left the house, saying I should call the next morning to make a further examination of the body. Mean¬ time it was reported he had been poi¬ soned by his wife; and the following morning I was requested to attend a coroner’s inquest, who were assembled to investigate the affair. I went accord¬ ingly to meet the coroner and jury, and having stated what I knew of the case, proceeded thence with my assistant to examine the body. Upon laying open the abdomen, the intestines appeared extensively inflamed, but more so on the right side than on the left, the mesenteric vessels being lull or distended, and the peritoneum reddened in several parts. At the part where he had been wounded by the bull there was a deficiency of the peritoneal lining of the abdominal parietes, the internal parts being simply covered by an expansion of integument, for an ex¬ tent of five or six inches in length, by two or three in breadth. We removed the stomach and duodenum, with por¬ tions of the intestines, and examined their contents ; and being unable to de¬ tect any poison, we called upon the coroner and jury to request their ad¬ journment till the following day, in order to allow us time for a deliberate examination by tests, &c. We con¬ veyed the stomach, &c. home; and after a minute examination by tests, and em¬ ploying- every method of analysis for the detection of poison, as recommended on such occasions, without success, we made our report to the jury, who, with¬ out much hesitation, returned a verdict of — “ Died by the visitation of God.” The only account given by the wife relative to the sudden illness of the de¬ ceased, was, that he had gone to work at a stone quarry without wearing his belt, and that he had drank a quantity of cider, a beverage to which he was unaccustomed. — I am, sir, Yours very respectfully, J. F. Hulbert. 6, Trinity Square, Southwark, Feb. 7, 1837. TREATMENT OF HYDROCELE BY IODINE. To the Editor of the Medical Gazelle . Sir, The following observations exhibit the good effects produced by iodine in a case of hydrocele, no other remedy hav¬ ing been ever employed for the cure of the disease in this patient. 856 A COMBINATION OF PATHOLOGICAL STATES I had intended to have transmitted this case for your notice soon after the cure had been accomplished. I could not, however, at that time give an ac¬ count of any other similar case in which the effects of iodine had been esta¬ blished ; since that period I can bear testimony to the same favourable result in two other cases ; and at this present time I have another case (which has ex¬ isted for the last seven years), under similar treatment, doing well. I have had my attention drawn to this particu¬ lar case (the account of which I now have the pleasure of forwarding to you), from having the same patient at this time under my care, he having recently met with an accident, the consequence of w hich has been phi egmonous erysi¬ pelas of his right hand and arm. It is more than sixteen months since he was cured of the hydrocele, and he has not experienced any symptoms of its return. I consider these facts worthy of re¬ mark; and if you coincide with me in this opinion, perhaps you will find space for them in your journal. I am, sir, Your obedient servant, Charles Caswall. 18, Woburn Place, Russell Square, Feb. 21, 1837. William Soper, set. 58, a stout robust man, employed by Messrs. Tyler and Co., the extensive coppersmiths in War¬ wick Lane, became a patient of mine on the 4th of June, 1835, with a hydrocele about the size of the egg of an ostrich. The fluid had been accumulating for the previous twelve or thirteen months, and was perfectly transparent. No re¬ medy whatever had been employed to remove it, neither had any but the ope¬ ration of tapping been suggested ; and to this the patient was greatly averse. I therefore recommended him to pursue the following treatment : — June 4th. — R Pulv. Jalapas, gr. xij. ; Hydrarg. Submur. gr. iij. M. eras mane. 6th. — R Ung. Potass. Hydriod. 5j. This portion of ointment to be rubbed into the scrotum every night and morn¬ ing, and at all other times some of the ointment to be spread on lint and ap¬ plied around it (the scrotum, of course, to be constantly suspended in a ban¬ dage.) The ointment was composed in its proportions, of one drachm of the hydriodate of potash to one ounce of hog’s lard. 11th. — Rep. Ung. et Pulv. Cath. 16th. — Rep. Ung. R Trse. Iodinse, n]xx. ter quotidie ex Aq. Distill, ^iss. 23d. — Rep. July 2d. — Tinct. Iodinse, TTfxxx. ut antea sumend. 1 1th and 21st. — Rep. Aug. 1st, 13th, and 25th. — Rep. Sept. 3d and 12th. — Rep. Oct. 3d. — Cured. The patient was considered quite well on the 12th of September, but he was desirous of continuing the same reme¬ dies for a short time longer; he has de¬ sisted employing them, however, since the 3d of October. The treatment of hydrocele by tapping and subsequent injections is not at all times unattended by danger. I witnessed on one occa¬ sion death ensue in consequence of this treatment, at St. Bartholomew’s Hospi¬ tal. I am not aware of any ill effects succeeding to the use of iodine in this disease, which can be in anywise attri¬ buted to its employment. P.S. — I dated this communication as if written on the 21st of this month, not intending- to send it to you till that day. It was written, however, y ester day (Feb. 17tb); and it is somewhat singu¬ lar that, in perusing your Gazette of this day, I find two letters, one from Mr. Keate, and another from Mr. Lewis, on the treatment of hydrocele by punc¬ ture. Perhaps the mode of treating this disease as here prescribed, may super¬ sede that of puncture. Feb. 18, 1837. A COMBINATION OF PATHOLO¬ GICAL STATES, OCCURRING IN ONE AND THE SAME INDIVIDUAL. Hydatids and their Origin. To the Editor of the Medical Gazette. Sir, T send you the following case for inser¬ tion, if you think the variety of morbid appearances co-existing therein suffi¬ ciently curious to merit a place in your journal. John Kemp, cet. 68, labourer, was ad¬ mitted into the Birmingham Dispensary OCCURRING IN ONE AND THE SAME INDIVIDUAL. 857 in October last, with fever, yellowness of skin, pain in right hypochondrium, and cough— in short, with the usual symptoms of acute hepatitis, for which he was bled with leeches to the anus, and over the side, with great relief. Still the pain and tenderness, though lessened, were not removed, and the cough continued unabated, with great dulness on percussion, over the lower part of the right side, and with absence of the respiratory murmur. Similar at¬ tacks recurred frequently, and were re¬ lieved by the same means ; but as the cough on each occasion became worse, though there was no decided crepita¬ tion, nor were the sputa mixed with blood, I changed the diagnosis from hepatitis to pneumonia. The last attack occurred about three weeks ago, with intense pain and tenderness over the whole side ; urgent dyspnoea, so that he could not lie down ; dulness on per¬ cussion over right side of the chest, with absence of respiratory sound, and segophony opposite the middle lobe, and puerile respiration over the left side. The sputa were rusty, and very viscid. He had leeches to the side, and took Ant. Tart., and the next day the subcre¬ pitant or mucous rattle was heard over the front and upper part of the right lung, below which, behind, the cegopho- ny continued, and below that, all was dull. In a few days afterwards- the segophony had ceased, and nothing but a mucous rattle was heard at the upper part of the lung, before and behind. From this time his strength gradually failed, and he died on the 9th inst., after a violent attack of dyspnoea, his side continuing* very tender to the last. Some years ago he had a paralytic attack that affected the muscles of the right side of the face, so that he had no power to close that eye, which remained w’ide open even during sleep, and was unable to whistle or blow, the cheek being quite flaccid ; and for some time before his illness, his appetite had failed, and he had some difficulty in swallow¬ ing, and often vomited his food, which gave him great pain. During his ill¬ ness, and particularly towards the close, his urine was very scanty, and nearly ceased for a few days. He always lay on his right side. Sectio caduveris , seventy-two hours , p.m. — Body not greatly emaciated ; chest barrel-shaped, as usual in persons of his age, but more prominent in front, from the absence of flatus in the intes¬ tines. Upon raising the sternum and false ribs, the former broke off below the clavicles, and exhibited its cancelli, filled with a bloody purulent fluid, which also was observed in the ribs, which were extremely brittle, and easily cut with the cartilage knife. The right side of the chest was quite dull on per¬ cussion. The sternum having been re¬ moved, a large substance was found oc¬ cupying the right side of the chest, and projecting downwards as far as the kidney that adhered to it. It was covered at its upper and front part by the condensed and flattened lung, and at the lower portion by the right lobe of the liver, which, from the thickness of about an inch at the fissure, was thinned arid flattened out over the tumor, till at its edge it was only 1^ inches thick ; the middle portion was covered by the adherent pleura and diaphragm. Not being able to remove the contents of the chest in consequence of their firm adhe¬ sions to the tumor, I opened it, when out flowed a quantity of hydatids, which, when all collected, filled a common wash-hand basin. They were of all sizes, from a turkey’s egg' to a grain of sand, and contained either a yellow or a limpid fluid. In many that were not burst, smaller ones, containing the yel¬ low fluid, might be seen floating about with shreds of the lining membrane. They were all ovoid or globular, and without pedicles, but some were spotted on their surface with a single opaque spot. The large were g'rey and opaque, the middle sized transparent, and the smallest yellow, the colour of oil. The cyst being removed, was found to be formed by the peritoneum below, and by the diaphragm and pleura above, con¬ sisting externally of a dense laminated membrane, l-8th of an inch thick, co¬ vered internally with plates of calcareous matter, from one to three inches in diameter, and lined with thick layers of condensed lymph. The right lung was not so much condensed as to sink in water; and between its lower edge, all round, and the cyst, was a layer of lymph opposite the part where segopbony was heard, and extending forwards to the pericardium. In the cells of this lymph were a number of hydatids, ex¬ actly similar to those contained in the cyst. The left lung was hypertrophied, and rather emphysematous, and the bronchi of both sides were inflamed and 858 HYDATIDS AND THEIR ORIGIN. clogged with mucus. The heart was natural, and contained some ante-mortem clots. The aorta was ossified half an inch square at the arch, with commencing ulceration and dilatation. The stomach was large, and, about four inches from the pylorus, at the lesser curvature, was a round elevated ulcer, with sharp edges, l-4th of an inch thick ; the bottom being formed by the hypertrophied transverse muscular fibres. There was another ulcer close by, which had not perforated the mu¬ cous membrane, and was covered with pus ; and another in its commencement at the pylorus, which was much thick¬ ened. The mucous membrane was ge¬ nerally congested and thickened, but not softened. The left lobe of the liver was twice its usual size, and lay in the left hypochondrium. It had the nut¬ meg* appearance, but there was no dif¬ ference in the texture of the two lobes. Both the liver and lungs were friable. The middle portion of the right kidney was softened, mottled, and had lost its tubular state. The left was healthy, but was compressed by the liver into a triangular shape. The spleen was healthy. The intestines and brain were not examined. Upon further inquiry, I ascertained that the patient had been subject to pain in the right side for thirty years, and, about fifteen years ago, had broken one of his ribs on that side. The paralysis of the seventh pair came on suddenly one cold night, while he was going to his club, and was unattended with any apoplectic symptoms. Upon a close examination of the hy¬ datids, I found that the major part were collapsed and empty, but entire. The largest consisted of three coats easily detached from each other, and contain¬ ed numerous smaller hydatids, and atheromatous matter, besides a number of minute yellow cysts, the walls of which were composed of cholesterine, coloured by the yellow fluid within; which, at a cursory view, I had pre¬ viously mistaken fora gelatinous matter. I established the fact of the unbroken state of the empty hydatids, by piercing them with a blow-pipe and inflating them. As the foregoing case exhibits a coin¬ cidence of a great variety of pathologi¬ cal states, and appears to me to add somewhat to our knowledge of the ob¬ scure subject of the degeneration of tissues, I venture to append the follow¬ ing remarks. All the authors I have consulted upon the subject of hydatids, describe them as containing a limpid fluid, colourless, or yellow, when the liver is the seat of disease ; and Cruveilhier, whose account in the Diet. Pratique is by far the most complete, says that they are always in¬ cluded in a parent cyst, which lines the dense and fibrous one that is formed around them. He also rejects entirely the notion that they owe their origin to inflammation. In this case there were very few, out of some thousands, that were not empty, or nearly so ; indeed, had they been full of fluid, the sac could not have contained the tenth part of them : besides that, they were care¬ fully ladled out with a saucer, and their integrity was proved by the blow-pipe. There was no “ mother cyst,” and all the larger cysts contained atheroma, and so much cholesterine that the fingers were spangled over by it, and felt greasy after touching them. Not having an opportunity of consulting their works, I cannot say upon what grounds Vitel and Jager support their opinion of the inflammatory origin of hydatids, nor does Cruveilhier mention them ; but in none of the numerous cases quoted by him is there reason to believe that the disease was of recent occurrence, nor is the recent effusion of lymph in the part ever mentioned. Yet, in the case above, although the first deposition of hydatids was probably referrible to the injuries sustained many years before, the se¬ cond (indicated by the acute pleuro- pneumony, with effusion of fluid and lymph, as diagnosticated by ausculta¬ tion and percussion,) could not be con¬ sidered to be of older date than the last attack, three weeks before the death of the patient. The lymph occupied the most dependent part of the right pleural cavity, and was quite soft and floccu- lent, having all its areolae filled with hydatids of a small size, very few of which contained any fluid. All these circumstances are in favour of the re¬ cent production of the hydatids; and this idea is borne out by a comparison with Mr. Sherwin’s case, in vol. xix. of the Edinburgh Medical and Surgical Journal. In this case, the tumor was punctured several times, at about a week’s interval, and Mr. S. remarked, that after the first two evacuations of' the contents, the hydatids were much FRENCH MIDWIFERY PRACTICE. 859 smaller, though almost as numerous as before; and therefore he concludes that they had been formed between the ope¬ rations. This is the only case I have been able to find in which the date of the origin of the hydatids can be fixed within any certain limits ; except one which occurred in my own practice, where the patient began to expectorate hydatids just two months after two acute attacks of pneumonia, with intercurrent pericarditis, which occurred during sali¬ vation, and left a permanent bellows- sound. In this instance, also, the cysts were collapsed and empty, and admitted of inflation. A quantity of pus, but no serous fluid, was expectorated with them. From Mr. Sherwin’s and my own two cases, therefore, I should conclude, in opposition to Cruveilhier, that in¬ flammation has considerable influence upon the production of these parasitic animals, and that there may he an hy¬ datid as well as a cancerous or scrofu¬ lous diathesis, &c. This brings me to the other interesting points of this case, — viz. the deposition of calcareous mat¬ ter in the cyst, the cancer of the sto¬ mach, and the existence of Bright’s disease in the kidney. But as I have al¬ ready trespassed considerably upon your columns, I will leave the consideration of these morbid states to another occa¬ sion. — I remain, sir, Your obedient servant, T. Ogier Ward, M.D. Physician to the Birmingham Dispensary. Birmingham, Feb. 12, 1837. FRENCH MIDWIFERY PRACTICE. To the Editor of the Medical Gazette. Sir, In looking over my note-book of last year, I find a few remarks which may possibly interest those of your readers who practise midwifery, as showing that there still exists a considerable dif¬ ference between our practice and that of our continental friends, particularly as to the kind of instruments used in de¬ livery, and the manner of employing them. — I am, sir, Your most obedient servant, George S. Lilburn, M.D. 24, Harley Street, Feb. 23, 1837. Rouen. — The Hotel Dieu, in this city, contains 600 beds. One ward is appropriated for women during their confinement, who are admitted by the physician, and kept as long as he thinks judicious (generally one month). The woman, when in labour, is taken into a small room, and there delivered on her back, with the head and shoulders a good deal raised, in the presence of the pupils. Immediately after delivery she is carried to a room appropriated for her reception, and the infants to one adjoin¬ ing*. In that for the latter their little beds are arranged round the room with canopies; they are dressed in swaddling clothes, confined all but their arms. One woman had been delivered the day before I arrived with forceps (Baude- loque’s). She had lacerated perineum, and laceration through the vagina into the rectum. The Interne, who accom¬ panied me round the hospital, and very politely explained the whole progress of the case to me (bringing me specimens of the instruments then in use), said, that the accoucheur, in employing the forceps, although a very powerful man, and exerting the whole of his strength, had the perspiration running down his face, and was more than an hour in extracting. The ergot had been pre¬ viously given, and the patient bled largely. I remarked that the mischief might probably have been avoided by the pa¬ tient lying on her left side, and by the use of the curved forceps, invented by Dr. Osborne, and modified since his time, as there was no deformity of the pelvis. He told me that perforation of the head of the child, when necessary, was effected with a long sharp-pointed bistoury, and the brain removed prin¬ cipally by the operator’s fingers ! Paris. — The Hopital de la Maternite, for the reception of women, married or unmarried, during their confinement, who are attended gratuitously. No male pupils are allowed in the house. This establishment is intended for the instruction of “ Sages-Femmes pour tons les Departemens du Royaume.” The patients may keep their children, or, if they prefer it (no rare occurrence), send them to the Hopital des Enfans trouves. Five of these unfortunates were beiug sent when I first visited the hospital. They were enclosed in a sort 8C0 DR. DICK ON MOLLUSCUM ,* WITH ofp artitioned box, with a high lid, and a blanket over each. The infants, when not sent away, remain in the same room with their mother, but in separate beds, with canopies ; those of the latter with¬ out. The physicians are— Mons. Dubois, Med.-en-Chef. _ Moreau, > Medecins. — Jerardm, S Mde. Le Grand, Ire Accoucheuse. There were 96 female pupils, who re¬ main from one to tw o years in the house. Mons. Dubois gives them clinical lec¬ tures and examinations ; and from the great reputation of this accomplished physician, his instruction must be valu¬ able. Mde. Le Grand lectures every day on the theory and practice of Midwifery, and the Pharmacien-en- Chef twice a week on Botany. Pa¬ tients may get out of bed the fifth day, and the ninth day may sit up. For the first five days after confinement, if every thing- g-oeson well, and the woman suckles her child, she is allowed, per diem, 2 pints of soup, 1 ditto potage, and 1 ditto bouillon at night ; after the fifth day, meat and wine. Women are ad¬ mitted as patients at all times before labour, night or day, without recom¬ mendation. Madame Le Grand em¬ ploys the forceps when requisite, and all the pupils are taught to bleed and vac¬ cinate. Fifteen grains of the ergot is the common dose, and Mons. Dubois only is allowed to give it. In 1000 patients the instruments are used about 40 times. I was indebted for my admission to the hospital to the politeness of Mons. Jourdan, Inspector-in-Chief of Hos¬ pitals. A FEW REMARKS ON MOLLUSCUM; WITH TWO CASES OF MOLLUSCUM NON- CONTAGIOSUM. By Walter Dick, M.D. Formerly House-Surgeon to the Glasgow Infirmary. Dr. Bateman, who was the first to par¬ ticularize Molluscum, has described two varieties of it, apparently little allied to each other — the Molluscum contagiosum, and the Molluscum non- contagiosum. Notwithstanding his ac¬ knowledged acumen in observing and diagnosing cutaneous diseases, Mons. Rayer is of opinion that the two cases, which he details as instances of conta¬ gious molluscum, were nothing* else than a diseased state of some of the se¬ baceous follicles. It is much more pro¬ bable, however, that Bateman was cor- rect, in viewing them as cases of a distinct disease; and this view has subsequently been strengthened by Dr. Carswell, who (as we learn from Caze- nave and Schedel) had an opportunity of observing a case in every respect analogous to those described by Bate¬ man. It occurred in a child, to whom the disease seemed to have been com¬ municated by bis brother, who had re¬ ceived it at school from one of his com¬ panions. The child died ; and as the nature of the disease is altogether ob¬ scure, it is unfortunate that Dr. Cars¬ well, so justly distinguished for his pathological researches, was not per¬ mitted to examine the structure of the molluscous tubercles. This variety of the disease is charac¬ terized by sessile tubercles, seldom larger than small beans, which, accord¬ ing to Dr. Bateman, discharge a small quantity of milk-like fluid on pressure, from minute orifices in their summits. This fluid he presumes to be the me¬ dium of contagion. The non-contagious molluscum is characterized by tumors of various sizes, some of them as large as a hen’s egg, or larger even. This variety of the disease does not seem to have been observed by Bateman. As an instance of it, he alludes to the remarkable case described by Professor Tilesius*. One of the cases which we have met with was so similar to it, that the plates which Tilesius has g*iven of his patient would, with a few trifling alterations, exactly represent ours ; and we think ourselves fortunate in having* had an opportunity of examining the texture of the tumors. Dr. Bateman states that molluscous tubercles contain atheromatous matter. He does not seem, however, to have had any warrant for saying so ; and we have ascertained that such is not the fact, in * Historia Pathol. Singularis Cutanew Turpi- tudhiis. 1793. TWO CASES OF MOLLUSCUM NONCONTAGIOSUM. 861 non-contagious molluscum at least. Hi¬ therto, so far as we are aware, no ana¬ tomical description of the disease has been made public, unless, with M. Rayer, we suppose the disease, which M. Velpeau has described under the title “ tumeurs speciales de la peau,” to have been molluscum, which it does not seem to have been. It is probable that several dis¬ similar diseases have been described under the title molluscum, as is gene¬ rally the case with complaints of infre¬ quent occurrence. And some may per¬ haps say that the cases given below are not instances of molluscum. However, as Dr. Bateman has applied that term to the disease described by Tilesius, and as we find that our cases, particularly the first, agree so exactly with it, we think that they may with propriety be ranked under the same name, although, at the same time, we are of opinion that the disease cannot, without grossly vio¬ lating cutaneous nomenclature, be ranked as a tubercular disease. Rayer has done right in removing it from the Tubercula, and placing it with those diseases which he comprehends under the head of “ vices de conformation de la texture.” Our first case occurred in a Highland woman, unmarried, aged 36, a native of Skipness. She was admitted into the Glasgow Royal Infirmary, in Sep¬ tember 1834, more as an object of cu¬ riosity than from any prospect of her being benefited by medical treatment. Her case was entered by me in the hos¬ pital journal. Her state on admission was as follows: — Face is thickly studded with tuber¬ cles, varying in size, from a barley-corn to a small bean, of a round or oval form, with broad bases, and of the colour of the surrounding skin. Some of them are slightly transparent, so that they have some resemblance to bullae at a distance. They feel soft, and most of them can be pressed nearly level with I the surrounding skin, but immediately i rise again when the pressure is removed. On left eye-brow there is a very promi¬ nent one, of the size of a Spanish nut; it feels firm, and is of a light-red colour. Wh en cut into (which was done to I ascertain its structure), nothing but blood flows from it. This is the case t with some of the others which were i similarly treated. They all appear to > be solid. Scalp presents a furfuraceous appear¬ ance, from chronic eczema. The tu¬ bercles of face are influenced by the state of this eruption, .becoming rather larger when it becomes more active or irritable ; they then occasionally dis¬ charge a little watery fluid, but not from visible orifices. There is a soli¬ tary tubercle, about the size of a pea, on centre of palate, covered with healthy mucous membrane. At vertex capitis there is an elevation of the scalp, denuded of hair, of the size and shape nearly of an ordinary-sized watch. Over anterior part of sagittal suture is another similar protuberance, but rather smaller. Both have a tense elastic feel, as if they contained matter. Th is, however, on puncturing one of them, is found not to be the case. * Scalp over origin of trapezii muscles is a good deal thickened, hard, and intersected with pretty deep transverse rugae. Has some uneasiness in this part. Neck and trunk of body, both before and behind, but particularly the back, are covered with an almost countless number of tumors. On the neck they are small ; on the shoulders and upper half of back they vary in size from a pea to a pigeon’s egg. A few of them have narrow necks, and are slightly pendulous ; the rest have broad bases, and are of a semi-spherical appearance ; some are soft, others rather hard to the touch. They have all more or less a reddish appearance. On lower part of back and haunches they are very nume¬ rous, and fully larger than those above, but possessing the same appearance. On breast and belly the tumors generally are not quite so numerous as on back, and feel softer. Attached to inside of left mamma there is a pendu¬ lous one, of a pyramidal form, nearly the size of the fist, soft, and somewhat flaccid, containing a congeries of small pea-like bodies, apparently the lobules of the mammary gland enlarged. Lowrer extremities below upper third of thighs are free of tumors. On upper extremities they are pretty numerous, and about elbows and wrists unusually large. One over- lower extremity of left radius equal in size to a goose-egg, and has a soft spongy feel ; the others vary in size, from a walnut down- wards. There is a vesicular eruption, of an eczematous appearance, over body, which has existed for two years back. 862 DR. DICK ON MOLLUSCUM. With the exception of tingling* pain and itching from it, and the occasional un¬ easiness felt in tumors on head, she feels well. The tumors on trunk and extre¬ mities give her no uneasiness. Her hue of skin is naturally dingy. General health good. Her parents are healthy Highlanders, and none of her relations have been affected with any similar complaint. All the tumors, with the exception of those on face, have existed since birth, and have gradually increased to their present size. The tubercles on face ap¬ peared between five and six years ago ; for the last two years they have been stationary. As it was deemed of importance to as¬ certain the structure of the tumors, she was persuaded to allow one of them to he removed. One, about the size of a walnut, on lumbar region, was selected. An elliptical incision was made, and tumor, which was attached to the sub¬ cutaneous cellular tissue, without any distinct cyst, was dissected out, its base requiring to be divided with the scalpel. The wound, after a slig'ht attack of ery¬ sipelas, healed kindly. On examining tumor, skin covering it was found firmly united by subjacent tissue. It was not thickened, and its texture seemed normal. The substance of the tumor itself seemed firm and solid. A section of it showed that it was composed externally of dense cel¬ lular tissue, of a light colour, resembling in some measure fibrous tissue. More internally,- its structure was less dense, and appeared merely cellular tissue, with a little fatty matter. In fact, the tumor appeared to us to be a sort of hypertrophy of the subcutaneous cellu¬ lar and adipose tissue. This poor unfortunate woman, after remaining a week or two in the hos¬ pital, was dismissed in same condition as when admitted, excepting the ecze¬ matous eruption, which was cured by appropriate treatment, prescribed by Dr. Burns, under whose charge she was. With respect to the tubercles on the face in the above case, it may be doubt¬ ed by some whether they were the same in structure as those seated on other parts of the body. We have not had an opportunity as yet of seeing the Grecian elephantiasis, but, judging from the descriptions given of that disease, the facial tubercles of our patient did bear some resemblance to those which cha¬ racterize that disease before it has made great progress ; and had the tumors on head, and thickening* of scalp at nape of neck, appeared simultaneously with them, we might have been inclined to believe that our patient had elephantia¬ sis superadded to her molluscum. But when we know that the tumors and thickening of the scalp long preceded the tubercles on the face, we are led to think that the latter ought to be con¬ sidered in their nature the same as those seated on the other parts of the body. The second case occurred in a woman between 30 and 40 years of age, who was admitted with paralysis shortly after last patient. On her breast, shoulders, and back, there was a con¬ siderable number of tumors, varying in size, from a pea to a filbert ; some of them a little larger. They felt soft. Some had broad bases, but the majority were pendulous, with narrow necks or pedicles. They generally were of the colour of the surrounding* skin. A few small ones of similar characters on scalp, and one or two on side of face. They had existed from birth. She died a few days after admission of the head affection for which she was admitted ; and an opportunity was thus obtained of examining the structure of the tumors which were scattered over her body Their structure was found very simi¬ lar to those of last case ; and to be more particular in their description, would be just to repeat what we stated respecting the previous ones. As already stated, the first of these cases bears an exact resemblance to the one described by Professor Telesius. We may shortly notice a few of their more remarkable coincidences. In the German’s case, as in ours, there was a large tumor extending, as he says, “ ex scrobiculo cordis et a processu zyphoi- deo sterni usque ad regionem umbilica- lem.” It was purse-shaped (“ marsupi- formis.”) In our patient we remarked that the tubercles on the face at times became irritable, and discharged a little watery fluid. In Tilesius’s case some¬ thing analogous to this occurred, but at more regular intervals : generally every month, he states, some of the tumors w7ere attacked with sense of formica¬ tion, and on friction “ humor quidam acrimoniosa lympha infectus effluat.” On the head of this patient there was ai MR. BULLOCK ON ERYSIPELAS. 863 tumor of the same appearance as those which our Highlander had on her’s. He, too, was born with the disease, of healthy parents. Tilesius did not ascertain the struc¬ ture of the tumors, as the man (perhaps wisely enough) would not consent to have any of them either punctured or excised. We have no doubt, however, that if they had been examined, they would have been found such as we have described, and not atheromatous, as Bateman, and some other authors, un¬ advisedly affirm. “ The disease,” says Tilesius, “ a lympha trahit originem.” This statement does not seem either very satisfactory or intelligible. Its etiology is altogether obscure. May not these congenital humours depend upon some modification of the “ nisus formativus ?” Will the transcendentalists be able to throw any light on this subject? The above cases, in a practical point of view, are of no value, but as they may prove interesting to those who are espe¬ cially engaged in the study of cuta¬ neous diseases, and perhaps also to the general pathologist, we have been in¬ duced to record them. Glasgow, Feb. 1837. ERYSIPELAS ; ITS NATURE AND APPROPRIATE TREATMENT. To the Editor of the Medical Gazette. Sir, Dr. Fordyce, Dr. Wells, and the subsequent physicians of St. Thomas’s Hospital, were, I believe, among the first to establish by many striking in¬ stances that erysipelas was propagated by contagion. This doctrine has re¬ ceived much valuable support from Dr. Cullen, Dr. Baillie, and from many other quarters, and is now universally admitted by the medical officers of this institution, and I think I may venture to assert also, by the majority of the profession in this country. As this sub¬ ject involves important consequences, it is not perhaps unnecessarily multiplying facts in proof of the highly contagious nature of this disease, to mention a few cases of recent occurrence. Ann Verdon, aged 64 years, was ad¬ mitted into Dorcas ward, on the 9th of June, 1836, with indolent ulcers of the leg. In the adjacent bed there was a patient convalescent from an attack of erysipelas, which had commenced on the 24th of May. On the morning of the 19th of June, Verdon was attacked vvith erysipelas of the face. The disease followed its usual course, and lasted about five days, extending to the head, neck, and shoulders, while the consti¬ tutional symptoms ran high. She was successfully treated by wine, and from my notes T find that the cuticle of the affected part was desquamating, and she was completely convalescent on the 26th. As the general health of this patient, at the time of her admission, was good, I apprehend no doubt can exist of the disease, in this case, having been occasioned by contagion. Philadelphia Rason, aged 50 years, whose thumb had recently been ampu¬ tated in Dorcas ward, whence she was removed to Naples ward on the 3d of May, at the opposite extremity of the hospital. In this latter ward erysipelas had prevailed for some time, and she remained there until the 1 1th, when she returned to Dorcas ward. On the 29th, without having been exposed to any fresh source of contagion,’ she wras attacked with erysipelas of the face, which spread rapidly over the head and upper trunk, attended with much consti- - tutional excitement. This patient was also put on wine, and the case terminated favourably about the fifth day. Two other patients also who were removed with Rason from Dorcas to Naples ward, likewise on their return to Dorcas fell ill of erysipelas within two days of the case recorded ; they were similarly treated, and with the same happy result. I presume, therefore, that the three last cases must have been infected in Naples ward, and that the period which elapsed from the time of their leaving Naples ward to the appear¬ ance of the disease, is quite explicable on the ground of the latency of the poison. The number of instances which are thus fast gathering around the doctrine of the contagious nature of erysipelas, have satisfied my mind that it is founded m truth ; and I am equally convinced, from all I have seen, that it follows as a necessary consequence that bleeding is the exception, and not the rule of treatment of the class of diseases to which it belongs. But although vene- 864 MR. BULLOCK ON ERYSIPELAS. section may not be the rule of practice, it does not result that a tonic plan is necessarily successful. I have on this account been induced to pay much at¬ tention to the cases of erysipelas treated during- the last year in St. Thomas’s Hospital, and I apprehend that in the following' facts the most sceptical mind must find strong' reasons for believing' that the tonic treatment, if it still leave something- to be desired, is certainly the most efficient of all the modes yet re¬ ceived by the profession. From January to June inclusive of last year, thirty-two cases occurred in this hospital which were treated by wine, either alone, or combined with tonics, from the first appearance of the disease, and all, except two, recovered ; of the two that died, one, in consequence of her late admission into the hospital, did not receive any treatment until a late period of her attack, and rapidly sunk ; while the other was a woman far ad¬ vanced in ovarian dropsy, and consi¬ derably emaciated, so that her life must have closed in a few weeks, had she not sunk under the severe form of erysi¬ pelas with which she was seized. At the time the above cases were treated by wine, I had an opportunity of wit¬ nessing- several others treated after the antiphlogistic manner, and on a com¬ parison of the results of the two systems, I should most unequivocally say that the wine or tonic plan of treatment was infinitely the most successful. It appears, however, from your journal of the 7th and 14th of January last, that the treatment of erysipelas by wine has not been confined to St. Thomas’s Hospital, but that Dr. Graves, of Dublin, also a contag'ionist, either by a happy coincidence, or in consequence of the lecture on this subject published by Dr. Williams, in the St. Thomas’s Hos¬ pital Reports, has adopted a treatment essentially the same, or by wine and quinine enemata, and with such success, as that out of twenty cases only one died. Dr. Graves also states that this patient was at the time of attack labour¬ ing' under fever, with dangerous cerebral symptoms, and which consequently greatly diminished the probability of the patient’s recovery. I have Mr. Hewlett’s* permission also to state, that since reading Dr. Williams’ lecture, he has adopted the treatment there recom¬ mended, and he informs me with the best effect. Here are, then, upwards of fifty cases with only three deaths, and those occur¬ ring in patients whose condition was hopeless from the first, either from ne¬ glect of all treatment, or else from pre¬ viously existing disease. I submit, therefore, that they are in sufficient number to constitute a body of evidence, supported as it is by many authors of the highest repute, fairly establishing not only the great utility of a tonic treatment, but also, as a general prin¬ ciple, its superiority over the antiphlo¬ gistic practice. In opposition to this principle, it has been contended by one learned critic, that every case of erysipelas ought to be treated according to the symptoms. The objection to this rule I conceive to be,jthat no disease depending on a mor¬ bid poison has ever yet been success¬ fully treated by following up the symp¬ toms, as it is termed ; neither do I imagine, except in very extreme cases, that we possess any such satisfactory prognosis as will enable us to deter¬ mine on the first appearance of idiopa¬ thic erysipelas, what will be its course or termination. Another authority has contended, that, whatever may be the success of this treatment in London, it will not do in the country ; here I think the inge¬ nuity of the party has been displayed at the expense of his discretion ; for what must we think of medicine, if its laws and principles change in every district ? Can it be true that within the circuit of the walls of Chichester or Warwick, quinine, mercury, hydriodate of potash, &c. produce other effects than the same medicines when exhibited in London ? I should think not. And I feel satisfied that the pupils of St. Thomas’s Hospital, or of the metropolis generally, will not have to unlearn in the country, as erro¬ neous and injurious notions , those prin¬ ciples of treatment in erysipelas which they have seen so successfully practised in London : but I must apologize for trespassing so long and so often on the columns of your valuable journal. I am, sir, Your obedient servant, Henry Bullock. * Surgeon of Harrow, Middlesex. St. Thomas Hospital. Feb. 27th, 1837. mr. Thomson’s case of immature birth. 865 LOCOMOTION IN PARALYSIS. To the Editor of the Medical Gazette. Sir, I applied a few days since, and with the effect anticipated, the following sim¬ ple arrangement, to facilitate locomotion in paralytic affections of the lower ex¬ tremities : — A grooved thin wrood wheel, four inches in diameter, and adapted to run in an appropriate block, was suspended to a band encircling the neck, and ad¬ justed to correspond to the site of the sternum. A line corresponding to that of the sash having* * been passed over the wheel, had the one extremity steadily secured above the patella, to a laced cap sur¬ rounding the knee of the palsied limb; while the other end was made fast to a convenient handle, so designed as to extend the line when drawn. The beneficial effect of the process consists in its enabling the paralytic limb to advance naturally, in a right line with the trunk, when the invalid with the sound arm draws the cord at the period of progression ; and thus makes his step without exhibiting* the rotatory motion of the limb which other¬ wise takes place. The shortening of the extremity, which the double flexion of the hip and knee produces, readily explains why the above affords the advantage expe¬ rienced. Time with practice are both more or less requisite for paralytic peo¬ ple to employ the apparatus usefully. I am, sir, Your obedient servant, John Elderton, Surgeon. Northampton, Feb. 15, 1837. PLACENTAL PRESENTATION. To the Editor of the Medical Gazette. Sir, On perusing the late numbers of your i journal, I observed tw o very interesting • cases of placental presentation, treated with success, which remind me of a case ; almost similar I witnessed in the prac¬ tice of my relative, Mr. Collier, ofShip- » ston on Stour, Worcestershire, in Octo- 483. — xix. her 1833. This gentleman’s atten¬ dance was requested on the woman, be¬ tween 30 and 40 years of age, residing about a mile and a half from the above place, who had been in labour for some hours: considerable haemorrhage had taken place, by which the patient ap¬ peared much exhausted. The pulse was weak, the countenance pale. On examining per vag’inam, the placenta was found occupying the whole of that canal, distending it and the os uteri; the foetus lay across the superior aperture of the pelvis. We decided upon immediate delivery ; but, to pre¬ vent alarming collapse, wine and other stimuli were placed, ready at hand to be administered, in order to keep up the force of the circulation. This part was assigned to me (keeping my hand constantly upon the pulse, and closely watching its strength — losing no time in giving wine or brandy, w hen flagging* or extremely low) ; whilst my friend proceeded steadily to perform the ope¬ ration of turning, and which be succeed¬ ed in accomplishing in a short time. A most favourable circumstance ob¬ served, was the proper degree of ute¬ rine contraction accompanying the birth of the child : when born, it ap¬ peared full-grown, and no doubt had been dead some hours. The poor woman bore the operation extremely well, and was watched for some hours after. She was visited the four following days ; no untoward symp¬ toms occurred ; her recovery, I am happy to say, was speedy. By inserting this communication in your valuable journal, you will oblige, Sir, Your obedient servant, John Collier, M.R.C.S. Brackley, Feb. 21, 1837. IMMATURE BIRTH. A LIVING FCETUS BORN SOON AFTER FIVE MONTHS. To the Editor of the Medical Gazette . Sir, Cases of the immature foetus living are so rare, and prove so important in cer¬ tain mcdico-legal inquiries, that I make no apology for sending* you the fol¬ lowing. 3 K 806 TREATMENT OF HYDROCELE BY PUNCTURE. On Friday, the 27th January, 1837, I was called to Mrs. In tyre, seiatis 30, a shepherd’s wile. According to the woman’s own account, she is about five months gone with child, and has felt frequent motion of the foetus during the last fortnight. I found her labouring under a severe attack of bronchitis, which had gone on for some days, and threatened to cause abortion. Notwith¬ standing the treatment adopted, the violent cough continued, and my patient gave birth to a foetus on the morning* of the 30th, at one o’clock. Considering all the circumstances of the case, and the woman’s account, I was prepared to find the foetus dead, and was much sur¬ prised to hear it cry very distinctly the moment it was expelled from the uterus. The foetal circulation was allowed to go on until a warm bath was prepared for the child, and into this it was put after separation from the mother. It now began to breathe freely while in the bath, and afterwards being rubbed with spirits and wrapped in wool and flannel, was held near the fire. The motions of the extremities were strong* and fre¬ quent ; and a little sugar and water being* mixed, it sucked and swallowed with all the instinctive power of a full- grown child. Respiration continued to go on with considerable regularity for three hours and a half, when it died without a struggle on the nurse’s knee, having lived from 1 o’clock till half- past 4 A.M. The following appearances were noted after death :■ — The length of the body is 12^ inches ; the middle point of the length being* at the lower extremity of the sternum ; and the weight one pound eig'ht ounces and three-quarters, imperial standard weight. The skin is soft to the feel, and of a purplish tinge, with very little fatty matter beneath. The head round and comparatively small, with a few silky hairs scattered over it. The eyes were unopened, and the external ear com¬ plete and of a circular shape. The nails are not apparent. The labia are full, and distinctly separated by a clitoris, large and prominent. This foetus was probably some weeks older than the mother supposed, but we leave to others, more versant in such matters, to deduce from the particulars given the real age: the father says the exact age of the child is five months and seven days. The case, as bearing upon the early viability of the foetus, seems not devoid of interest. The writer has seen chil¬ dren born at the full time, in natural labour, who exhibited less vitality, and in whom the respiratory process was carried on with less regularity and com¬ pleteness than in this case, who yet struggled on to advanced ag*e. It is to be regretted that the extreme coldness of the house, and the want of a proper nurse, with the absence of other “ appli¬ ances and means ” gave the little indi¬ vidual no chance of longer surviving*. I am, sir, Your obedient servant, J. B. Thomson. Alva, Stirlingshire, Feb. 19, 1837. TREATMENT OF HYDROCELE BY PUNCTURE. To the Editor of the Medical Gazette. Sir, By inserting the following communica- tion in an early number of the Gazette,. you will very much oblige, Your obedient servant, A Constant Reader. Glasgow, Feb. 24, 1837. In consequence of the several papers which have of late appeared in the pages of your valuable journal regarding the proposal of treating hydrocele by simple puncture, and the allusion made by Mr. Travers to a similar mode of proceed¬ ing with ganglion, which he says has proved perfectly successful when fol¬ lowed by pressure, I was induced to look into the original paper of Dr. Cumin, of Glasgow, on this subject, in the Edin¬ burgh Medical and Surgical Journal for 1825*. That gentleman, after explain¬ ing his mode of introducing a cataract needle into the g'anglion, freely divid¬ ing its sac, and then pressing the con¬ tents into the neighbouring tissue, briefly narrates a case in which this mode of practice was successfully pur¬ sued. Dr. Cumin, at the close of his paper, makes the following suggestion: — “ It has occurred to me that a similar mode * Vol. xxiv. page 97. INQUIRY INTO THE WORKING OF THE POOR-LAW. 807 of operating- might be applied to hydro¬ cele, and that a cure of that disease might be accomplished by opening a communication, by means of the cataract needle, between the cavity of the tunica vaginalis and the cellular tissue of the scrotum. No suitable opportunity has presented itself of putting this idea to the test of experiment; but the trial is one which, in the hands of a cautious surgeon, would in all probability effect at least a temporary cure, and which could not be productive of any injurious or unpleasant consequences.” It thus appears that the idea of ex¬ posing the fluids of ganglion and of lydrocele to the action of the absorbent vessels of the cellular tissue, and thus effecting- their removal, was submitted to the medical profession, in the pages of a widely-circulated journal, about twelve years ag-o. MEDICAL GAZETTE. Saturday , March 4, 1837. “ Licet omnibus, licet etiam mihi, dignitatem Artis Medicos tueri ; potestas modo veniendi in publicum sit, dicendi periculum non recuso.” Cicero. INQUIRY INTO THE WORKING OF THE POOR-LAW. By this time, we suppose, the newly- elected Committee for inquiring into the operation of the present Poor-Law have regularly commenced business. We mentioned last week that notices of motions for Select Committees of In¬ quiry were pending- in the House of Commons, and that one was for a gene¬ ral investigation into the merits and demerits of the amended law, while the other merely sought an examination of the measure as to its alleged efficiency in providing for the wants of the sick poor. It has so happened that nei¬ ther motion was carried. Lord John Russell, with a tertium quid in the shape of an amendment, stepped in and threw his lusty buckler over the Poor-law Commissioners ; he would not allow a hair of their heads to be touch¬ ed : the law must remain as it is, and the Commissioners are to be held sacred and inviolable. The minor details, however, may be meddled with, and the smaller fry of functionaries may be overhauled, if sufficient proof of their delinquency be forthcoming. The amendment of the Home Secretary, in short, led to the appointment of a Com¬ mittee, to inquire into the whole work¬ ing of the act under the autocrats who are intrusted with its supreme direction. Thus was the motion of the honourable member for Berkshire wholly defeated, and that of the member for Finsbury strangled even before birth. lar be it from us to talk lightly of the defunct, but we cannot help being- amused with the source of consolation which the parent of the latter nonen¬ tity has found for himself. He fore¬ saw' its fate last week, rang its passing knell, and then told us very coolly, somewhat in the style of Sir Fretful Plagiary, that he was “ rather pleased than otherwise” at what was about to happen. For what — says our legislator — what would have been gained, after all, if my motion w’ere carried? — the Committee would have been granted, the inquiry would have been instituted, the report drawn up and presented ; but w hat would it have been worth ? It w ould be said in the end, that the committee w'as partial, &c., “ and thus, in the minds of many persons, the report w ould have been set at nought, and the evidence rejected as consisting of materials w hich had been collected or received by gen¬ tlemen whose prejudices unsuited them for conducting an impartial inquiry.” An honest confession, truly ! But w'hat are we to think of all this, after the glorification which has gone on for months — the mighty promises made of complete exposure and reform of evils — Jthe self-laudation and advertising-, all founded on the notice of a motion w hich 868 INQUIRY INTO THE WORKING OF THE POOR-LAW. has been disposed of by a side-wind from Lord John Russell ? It is so much the better, says Mr. Wakley, changing his note with the most admirable adroit¬ ness — we shall now have a government inquiry ; mine would have been good for nothing-. We confess we were inclined to give the member for Finsbury some credit for his alacrity in endeavouring to make his promised motion ; but it appears now that it was fortunate he was baffled, and that another arrangement lias put his wholly out- of the way. So says Mr. Wakley, and we suppose we must believe him this time ; but let him not blame us for putting only small faith in any of his schemes for the future. One word more on the funeral speech by anticipation of last week. The mem¬ ber for Finsbury congratulates the me¬ dical profession on Lord John Russell’s amendment having been carred. Now Mr. Walter’s motion was for a thorough inquiry into the whole system of the ex¬ isting poor-lav/ — its principles and its operation — to investigate the nature of the extraordinary powers committed to a few individuals who have already contrived to render themselves odious throughout the country, by their des¬ potic and cruel severity. Lord John Russell’s motion, or amendment, on the other hand, professes to have no objec¬ tion to any inquiry short of touching- on the principle of the law, and meddling with the conduct of the despots, its prime movers: the law itself must remain as it is, its operation in minor matters may be improved — that is, if it appear to require improvement. Yet this is the result on which the profes¬ sion is congratulated ; at the same time that medical men are informed that it does not signify in the least what may be the general upshot of the inquiry — “ inasmuch as Ministers will be the authors and regulators of the proceed¬ ings,” it matters “ not one straw as to the tenor of the report only let there be evidence, plenty of medical evidence brought forward, and the evil will work its own cure. Who must not admire this virtuous zeal of the Finsbury patriot ? Who does not appreciate the statesman¬ like view he has taken of the question ? Let ministers keep their bill — let them persist in their retrenchment, or starva¬ tion, principle, which has rendered the amended Poor-law odious and abomina¬ ble in the sight of every worthy mem¬ ber of society; what cares the patriotic Finsburian ? — “not a straw,” so as there is a government committee, and he in the number of the elect. For our part we can form any thing* but sanguine anticipations of the result of this inquiry. Limited, as it is to be, to exploring* defects and grievances, and suggesting remedies, while the causes of those grievances, originating in the vile and unnational system which has been introduced amongst us, must be left wholly untouched, what can be expected ? And in what way can me¬ dical men, who are unhappily tram¬ melled in tbe system, be benefited, when the degradation under which they labour is part and parcel of that very system which is not to be permitted to be touched ? We should not despair, however. The inquiry will proceed, and its success will depend 011 the energy of those practitioners who are well informed on the subject, and will not hesitate to bear testimony publicly to the facts with which they are acquainted. The whole profession should be alive to the pro¬ ceedings which are about to take place, for, be it remembered^ they do not con¬ cern merely a few medical men living in distant parts of the country, but all indiscriminately, in town and country ; the very character of the profession in England, so far as it is involved in that of the mass of its practitioners, is at stake. INQUIRY INTO THE WORKING OF THE POOR-LAW. 869 A correspondent asks us (pag'e 876), in reference to what we said last week of the propriety of the medical corpora¬ tions interfering- at the present juncture — whether the Colleges and the Hall can do any thing ? We certainly think that they can do much if they please, and that they ought to do their utmost. We do not wonder at the question : for the apathy of those three bodies in regard to all external things relating to the comfort and convenience of their licentiates has long been remarkable : it would seem as if their precamur tihi omnia fausta were an eternal adieu, or a piece of advice to the diplomatist to consider how he should henceforth shift for him¬ self, having nothing further to expect from the institution which had just be¬ stowed upon him its honours. An emergency, perhaps it may be said, has never arisen, of a sufficiently important nature, to call forth the cor¬ porate energy of our medical establish¬ ments. But that excuse can hardly at present serve their turn ; for the prin¬ ciple of the act is spreading, — spread¬ ing with a cancerous malignity wherever it can gain access ; — the ramifications of the system are protruding themselves every where; nor will the metropolis it¬ self be able to escape them much longer. The consequence will be that a large number of needy, wretchedly remune¬ rated, degraded practitioners, will be found in every quarter, aud that a per¬ manent character of a more or less dis¬ reputable kind will thus be impressed on the whole profession. The licen¬ tiates of the Hall will be reduced be¬ neath the level of the officiers de sante in France ; and if this be the fate of the great mass of medical men in England, W'hat may we presume will be the destiny of those comparatively few who aim at maintaining a higher rank ? The Colleges and the Hall, then, we say, are imperatively called upon to in¬ terfere. If it be a part of their mission to support the respectability and dig¬ nity of the healing art, now is the time to show that they do not slumber at their posts: now is the time to show that those relations entered into between them and their alumni , when certain trials are made and fees disbursed, do not cease for ever. As corporate bodies, demanding jus¬ tice for those enrolled on their registers, we are satisfied that our medical insti¬ tutions, in appealing to the legislature, would produce a powerful effect. We wish we could announce that some step of the kind is likely to be taken, but we regret to say that we can as yet per¬ ceive no sign. How gratifying is it, in the midst of this sluggishness in the higher quarters, to observe the benevolent zeal of a dis¬ tinguished veteran in the profession ; we allude to Dr. Yelloly, of Norwich, who has just made public an excellent letter, addressed to Lord John Russell, “ 011 the arrangements connected with the relief of the sick poor.” In a tern-, perate but firm spirit, he points out to his Lordship the mockery of the relief (so called) under the existing Poor- law ; the cruelty of the system in rela¬ tion to paupers requiring medical assis¬ tance, and the gross injustice and hard¬ ship imposed by it on members of the medical profession. We regret that w;e have not space to extract largely from Dr. Yelloly’s observations, but we re¬ commend them to the best attention of every medical man. To the valuable paper of Messrs. Rumsey and Ceeley, in our present number (see page 874), we would also direct attention, affording, as it does, the highest proof of the zeal of these gentlemen in labouring to construct what appears to be an admirably im¬ proved plan of medical relief under the Poor-law. 870 ROYAL MEDICAL AND CHIRURGICAL SOCIETY. It is gratifying, we repeat, to meet with demonstrations like this, and some others to which we could also refer, showing that there are at least indivi¬ duals, of high feeling and high stand¬ ing, to whom the character of their profession is dear. Why have we no such demonstration from any of the Cor¬ porate bodies? Is it beneath their dig¬ nity, beside it, or inconsistent with it ? We cannot believe that it is either. Let us therefore observe what passes, and calmly await the event. LIST OF THE SELECT COM¬ MITTEE APPOINTED TO CARRY INTO EFFECT THE OBJECTS STATED IN CORD J. RUSSELL’S AMENDMENT. Lord John Russell, Mr. Walter, (who has declined to act) Mr. Fnzakerly, Sir James Graham, Mr. P. Scrope, Mr. Baines, Mr. Hume, Sir T. Freeman tie, Mr. Cartw right, Mr. Barneby, Mr. Est- court, juh., Mr. Ponsonby, Mr. J. Loch, Mr. Wakley, Sir O. Mosley, Mr. Villiers, Mr. R„ Gordon, Mr. Miles, Mr. D. Harvey, Mr. Hodges (of Kent), Mr. Chichester (Barnstaple). THE LATE MR. ATKINSON RANSOME. This much respected surgeon died at his residence, Old Trafford, in Stretford, on Friday, the 10th ult. He was born at Norwich, on the 4th of March, 1779. He served his apprenticeship at Lynn, and proceeded afterwards to Lon¬ don, where he continued for some time. He first commenced business in Ipswich, and after residing for -a short interval in Bury St. Edmunds, finally removed in 1805, to Manchester, where he was very soon after his arrival, and at about twenty-seven years of age, appointed one of the surgeons to the Infirmary. Mr. Ransome has been long known as a very experienced and skilful sur¬ geon; and it may be truly observed, that as an operator, in the most delicate and dangerous cases which professional men can have to undertake, few indivi¬ duals have possessed so high a reputa¬ tion, or so well deserved it. He com¬ menced at an early period his career as a lecturer on some departments of his profession. He lectured on surgery in the Pine-street School since 1825, the year after the establishment of that insti¬ tution ; and his clearness, simplicity, and information, combined wdth much suavity of manners, rendered him a g-ene- ral favourite with the students. He was appointed by his colleagues to deliver, at the commencement of the present session, the general introductory address, a task which he performed in a manner to reflect much credit upon him, in refe¬ rence particularly to the extent and varie¬ ty of his intelligence, the liberality of his sentiments, and the practical importance of the instruction and advice which he imparted to the rising members of the profession. It is w'ell remembered that, on the opening of the Manchester and Liver¬ pool railroad, Mr. Huskisson was killed by an accident. On tbatoccasion Mr. Ran¬ some was immediately sent for ; and notwithstanding the fatal result, so ably did he discharge his professional duties, and so highly was that ability estimated, that Mrs. Huskisson presented to him, with expressions of acknowledgment and gratitude, a handsome gold snuff¬ box. Fie was interred on Thursday the 16th, the funeral procession being formed by the members of the medical staff of the infirmary, the lecturers of the Royal School of Medicine and Surgery, and the students of the Pine-street School. ROYAL MEDICAL AND CHIRUR¬ GICAL SOCIETY. Tuesday, February 28, 1837. Mr. Earle, F.R.S., President, in the Chair. A paper wras read, on — “ Long continued contraction of the Lower Extremities, from an affection of the Spine ; with observations. ” By R. A. Stafford, Esq., Surgeon to the St. Marylebone Infirmary. The author opens his communication with some preliminary remarks upon the influence which the spinal cord possesses in cases of local hysteria, between the vari¬ ous symptoms of which, and those which are produced by acknowledged disease, or injury of the spinal cord, he draws ROYAL MEDICAL AND CHIRURGICAL SOCIETY. 871 a close parallel, with the express object of proving that pains, spasms, palsy, or want of muscular effect, muscular contractions of the limbs, and other symptoms, are com¬ mon both to cases of local hysteria, and to diseases or injuries of the spinal marrow ; and accordingly the author infers that both classes of cases have a common origin or cause in a congested or inflamed condi¬ tion of the spinal cord, or of the roots of the spinal nerves, or of the membranes which invest these parts. And he supports his opinion by shewing that the most successful treatment is that which is direct¬ ed to allay such congestion or inflam¬ mation of the spinal cord, and not that which is employed with a view to relieve the mere local symptoms. The author illustrates his opinions by numerous examples, and especially quotes four cases, two of which he considers instances of local hysteria, terminating in a contracted state of the limbs, but chiefly of the lower extremities, and to such an extent, that the toes became closely bent on the foot, the foot on the leg, and the leg on the thigh. In both cases the patients were young females. The other two cases are examples of dis¬ eased vertebras, producing muscular con¬ tractions similar to those of the two pre¬ ceding cases; and, in all four, the symp¬ toms equally arose, in the author’s opinion, from a deranged condition of the spinal cord. In conclusion, Mr. Stafford divides the period of the complaints which are the subject of his paper into three stages: — 1st, the acute state, marked by spasms, and pains, more or less severe, in various parts of the body, where he employs anti- phlogistics, bleeding, purgatives, &c. ; 2dly, the chronic stage, where blisters and other counter-irritants are used ; and 3dly, the curative stage, where it is only neces¬ sary to restore, by suitable extension, the contracted limbs to their natural position. At the conclusion of the evening, the President, in an eloquent speech, addressed the meeting upon his retirement from the chair, and took a survey of the progress of the Society during his Presidency, and of its prospects for the future. Mr. Earle began by noticing the few resignations and deaths which occurred during the past year. There were but two of the former — three of the latter; and he made honourable mention of the deceased. Of Dr. Hugh Ley, Mr. Earle said, he had not been long enrolled a Fellow, which might account for his name not having appeared in the Transactions. He was born at Abingdon, in Berkshire, in the year 1790. He was the son of Dr. Ley, who afterwards practised at Pen¬ zance, in Cornwall, where he died in the year 1826. The family of the Leys is of great respectability and antiquity in the west of England, and a branch of it was ennobled in the person of Lord Treasurer Ley, w'ho was created Earl of Marlborough by Charles the First. Dr. Ley, the son, wms educated at Abingdon, under the celebrated Dr. Lempriere, and being in¬ tended for the medical profession, studied assiduously at the Borough hospitals, and was admitted a Fellowr of the Royal Col¬ lege of Surgeons, but afterwards went to Edinburgh, and graduated in the year 1813, having first published an inaugural dissertation, “ De Natura intima Phthiseos Pulmonalis,” in which he exhibited much research and discrimination. Dr. Ley re¬ turned to London about the time of the death of the late Dr. Thynne, who had been Physician to the Westminster Lying- in Hospital, for which appointment Dr. L. became a candidate, and w as elected by a large majority, although opposed by Dr. Blegborough, a physician of extensive practice in London. Subsequently to this he became associated with Dr. Merriman, in giving lectures on midwifery and the diseases of women and children, at the Middlesex Hospital, and was appointed assistant physician accoucheur to that in¬ stitution ; and on Dr. Merriman’s resigna¬ tion, he was unanimously elected phy¬ sician in his stead. In the Medical Gazette there are several valuable communications from the pen of Dr. H. Ley. His only separate publication is an Essay on Laryngismus Stridulus, together with a dissertation on the Pathology of the Nerves, in which he places in a new point of view the nature of an obscure and doubtful disease. It is, indeed, a wrork abounding with practical information, and demonstrating in every page the acumen and sagacity for w hich the author was remarkable. But it was in the lecture-room that Dr. Ley shone forth most conspicuously, as few have ever possessed greater powers of language, or greater clearness in the arrangement of his matter. Of him it may be said with truth, “ Eratin verborum splendore elegans, com- positione aptus, facilitate copiosus.” Dr. Ley was appointed to the obstetric chair at St. Bartholomew’s in the autumn of 1835, and speedily acquired the respect and re¬ gard of his class, who will long regret his untimely end. He died of an affection of the heart consequent on acute rheumatism. His professional character was deservedly high, and without blemish ; his conduct and sentiments on all subjects were those of a gentleman. 872 ROYAL MEDICAL AND CH1RUKGICAL SOClfc/TY. Mr. Earle then gave a short biography of the late Mr. Charles Millard, similar to what has already appeared in our pages. We are obliged to economise our space, and shall therefore pass on to the notice of the late Dr. Henry, of Manchester. Dr. William Henry (said Mr. Earle) is the third and last Fellow whose death I have to announce. He was a graduate of the University of Edin¬ burgh, and was contemporary with Brougham, Jeffrey, and Mackintosh. He was educated to the medical pro¬ fession, and was appointed Physician to the Manchester Infirmary, The deli¬ cate state of his health led him, at an early period, to relinquish the practice of his profession, and to devote himself to the same lucrative pursuits in which his fa¬ ther had been for many years engaged, and to which his taste for chemical re¬ search naturally inclined him. The Transactions of this Society con¬ tain three papers from his pen. The first, which was published in the second volume, contains some accurate observations on the chemical properties of diabetic urine. The second, published in the eighth volume, is a short paper on the comparative morta¬ lity of measles. The third, which will be found in the tenth volume, is on urinary and other concretions. Dr. Henry is de¬ scribed by those who were intimate with him as having been a most agreeable and instructive companion ; possessing great conversational powrers ; being always anxious to encourage talent, and draw it forth, without any unnecessary display of his own : in a word, he is described as having been the life and ornament of po¬ lished society. In all the relations of private life he was exemplary; in his conduct he was open, generous, and sin¬ cere. He united with great and success¬ ful attention to business an unabated and ardent love of science. He delivered se¬ veral courses of lectures on chemistry, and published a volume on that science, which passed through many editions, and is equally precise in its information and elegant in style. Besides the papers and works already mentioned, he was a contri¬ butor to the Philosophical Transactions, and to the Memoirs of the Literary and Philosophical Society of Manchester. Among his literary productions, his cha¬ racter of Priestley, Davy, and Wollaston, rank deservedly high. I would gladly pass over in silence the last tragical scene which closed his career, but that it has already become a matter of history ; and his biographer has even thought proper to adduce the examples of Brutus, Cato, and Seneca, in extenuation of the act. As a Christian, I cannot but condemn the sentiments which are ex¬ pressed in the memoir to which I have alluded. The attempt to palliate a deed committed at a moment when reason had. lost her salutary control, by adducing ex¬ amples of heathen heroism — the cool and deliberate act of minds on which the light of Christian revelation had never shone — is, to say the least, equally injudicious and injurious to the memory of the departed. It appears that Dr. Henry had taken a very active part in the proceedings of the British Association, which had been held at Bristol, and returned home in a state of great excitement. For several weeks, “ tired nature’s sweet restorer, balmy sleep,” scarcely ever visited his eye-lids: his active mind was kept too constantly on the stretch, and at length gave way ; and, in a moment of temporary insanity, he rushed unbidden into the presence of his Maker. “ Fuit hoc luctuosum suis — acer- bum Patriae— grave bonis omnibus.” But let me quit this painful and un¬ grateful theme, and turn your attention to the more pleasing prospect which the in¬ creasing numbers of our associates and ris¬ ing prosperity of the Society afford. To supply the places of our departed brethren, I have to report that thirty-five new Fel¬ lows have been elected during the past year, making, with those elected during the first year that I had the honour of holding this chair, a total of seventy-two members, of whom fifty-eight have en¬ rolled their names, and to whom, with your authority, I have had the gratifica¬ tion of extending the hand of fellowship; to many of whom, from their rank and talent, we may confidently look for up¬ holding the character and extending the sphere of usefulness of this Society. In addition to these seventy- two contributing members, I may add eighteen Honorary Fellows, including some of the brightest ornaments of medical science in various quarters of the globe, and who have all expressed their grateful acceptance of the honour which has been conferred on them. As might be expected from so large an accession of members, I have much plea¬ sure in being enabled to give a very fa¬ vourable report of the funds of the Society, which have been not only adequate to the entire ordinary disbursements, and to liquidate some debts and extraordinary expenses which had gradually accumulat¬ ed, but likewise leave a considerable ba¬ lance in the hands of our Treasurer : but I will not anticipate further the auditor’s report, which will be laid before you to¬ morrow. Gentlemen, there has been considerable delay in the production of the 20th volume ROYAL MEDICAL AND CHIRURGICAL SOCIETY. 873 of our Transactions, which, however, I now have the pleasure of presenting to you. Having called the attention of the So¬ ciety to several matters relating to the internal management, Mr. Earle said, in conclusion — Gentlemen, I cannot quit this chair without endeavouring to express the high sense I entertain of the honour which you conferred on me in appointing me your President during the two past sessions. I trust that I may, in re¬ tiring, be allowed to hope that the punc¬ tuality of my attendance, and the impar¬ tiality with which I have endeavoured to preside over the meetings, and to regulate the discussions, has justified you in the nomination, although I feel that, in many other respects, I may have fallen short of my predecessors. In taking a careful retrospect of those meetings, and recalling to my mind the discussions, there is but one opinion which fell from me as chairman which has caused me any regret, and which I could wish to recal ; and it is singular that the paper read this evening should be from the very same author onwffiose former paper I pro¬ nounced what I now believe to have been an erroneous opinion. In a paper on Fractures of the Spine, Mr. Stafford adduced a case, and pro¬ duced the patient in this room, with an angular projection of her first lumbar spine, the result, as he supposed, of fracture, but which appeared to me to be a case of caries of the bodies. I subsequently had a patient in St. Bartholomew’s, in whom a similar appearance proved after death to be from fracture by contre coup, which was the consequence of a fall on the buttocks. In explanation, I can only assure the author, and any gentleman whom 1 may have misled by my opinion, that it was at the time I delivered it as much the honest conviction of my mind, as my present apology to him is frank and sincere. Gentlemen, I shall always consider the appointment to this chair as one of the most honourable which can be conferred by a large body of independent scien¬ tific men on one of their colleagues. To be deemed worthy to follow “ hand passibus aqus ,” indeed, a Cline, an Aber- nethy, or a Cooper, is in itself most flattering and honourable, but in my case there were other sources of sincere and heartfelt gratification. Having succes¬ sively filled the office of Secretary for seven years, and of Treasurer for five, I could not but accept the appointment to the highest office in the Society, as affording satisfactory proof that my previous humble efforts for the common weal were appre¬ ciated bv the Fellows generally. In retir¬ ing once more into a private station, to cultivate in common with yourselves the ample fields of medical science, I beg to assure you that I shall at all times consider it my duty to submit to this Society any new facts or opinions which can in any wTay promote our common objects — the in¬ vestigation of truth, and the alleviation of human misery. As this Society kindly fostered many of my earlier fruits, I shall not fail to offer for their acceptance those of my maturer judgement t and should the plan which I ventured to suggest last year, of forming Sub-Committees for the investigation of particular subjects, and for clearing up any doubtful or disputed points of practice, be carried into execu¬ tion, I trust I shall not be found wanting in zeal in aiding, and promoting to the best of my abilities, any inquiry in which it may be supposed that my services can be of any avail. Gentlemen, once more let me beg you to accept my thanks, and suffer me to ex¬ press ray wrarmest wishes for the general prosperity of the Society, and for the health, happiness, and success of each in¬ dividual Fellow. On Wednesday, March 1st, the Anni¬ versary Meeting took place, when the fol¬ lowing officers and members of the Coun¬ cil wTere elected : — President. — Richard Bright, M.D. F.R.S. Vice-Presidents. — Robert Williams, M.D. ; Thomas Addison, M.D. ; John F. South, Esq. ; J. P. Vincent, Esq. Treasurers. — Samuel Merriman, M.D. ; J. M. Arnott, Esq. Secretaries. — John Clendinning, M.D. ; J. G. Perry, Esq. Librarians. — John Thomson, M.D.; William Coulson, Esq. Other Members of the Council. — Henry Earle, Esq. F.R S.; Thos. Nelson, M.D. ; J. G. Andrews, Esq. ; G. H. Weatherhead, M. D. ; Thomas Copeland, Esq. F.R.S. ; Richard Pinckard, M.D.; Richard Par¬ tridge, Esq.; Henry Lee, M.D.; Joseph Moore, M.D.; Thos. Davis, Esq. (Hamp¬ stead). From the Auditor’s report, it appeared that — L s. d . The receipts of last year } g-,^ ^ g amounted to. . £ Expenditure . 618 11 3§ Balance in hand .... £60 13 2| The sum total of debts amounting to no more than about 41. 874 OBSERVATIONS ON THE PRESENT CONDITION OF OBSERVATIONS ON THE PRESENT CONDITION OF MEDICAL RELIEF FOR THE SICK PAUPERS; WITH RECOMMENDATIONS FOR AN ALTERED AND IMPROVED SYSTEM. (For the Medical Gazette .) A considerable proportion of the gene¬ ral practitioners of medicine in this coun¬ try are engaged by the Poor-law authorities to supply medical attendance and medi¬ cine to the sick paupers. Many practi¬ tioners who are not thus employed at present, have been so formerly, or are ex¬ pecting to be so in future. The appointment to the medical care of a pnion, or district, affords the readiest opportunity for obtaining or preserving “ private practice” in the locality of such appointment, and thus for securing a means of livelihood. There is a vast and an increasing num¬ ber of unemployed young men in the me¬ dical profession. Under the present system, therefore, the majority of medical men are found to sub¬ mit to any regulations, however degrading to their professional station, and to accept any remuneration, however insufficient in itself to secure the required aid, in order either to preserve their former sphere of practice from encroachment, or to enlarge that sphere, or to procure an advantageous introduction into an entirely new sphere. It is therefore obvious that the influence, direct and indirect, possessed by the ad¬ ministrators of the Poor-law over the great O body of general practitioners, is immense, and if not wisely exercised, must have an injurious effect upon their moral position, and their station in society. This influence is, however, much in¬ creased, by the fact that the professional reputation of the medical officers of unions is at, the mercy of the Poor-law Commis¬ sioners, and the Boards of Guardians, both of which parties, although destitute of medical knowledge and information, possess the power of deciding as to the proper performance of medical duties, of exculpating any practitioner employed by them from any charges affecting his pro¬ fessional conduct, or of branding him as unskilful in his vocation, or negligent of his duty. So long, indeed, as the present unlimited powers of appointing and dismissing — of summoning and judging — of justifying and condemning medical practitioners, continue to be vested in parties necessarily so incompetent, (even although a fairer remuneration for the duties performed were conceded) the medical department of the Poor-law must continue a fruitful source of degradation to the profession — of contention and complaint in every loca¬ lity — and of suspicion and dissatisfaction, not only towards the Poor-law administra¬ tion, but towards the government of the country. It has long been found expedient that medical men employed in the public service should be placed under medical supervi¬ sion. For this reason, and to remedy the serious evils just noticed, as well as to in¬ troduce some uniformity and regularity* into the medical arrangements for the sick poor, we recommend that the general superintendence and control of the medical department of the Poor-law administration be entrusted to a medical board, similar to the army and navy medical boards, and composed of persons practically acquainted with medico-parochial duties. 2. The remuneration awarded to union medical officers, is either determined by tender, or is fixed by the Poor-law Com¬ missioners. The first of these modes has the effect of reducing the remuneration (for reasons relating to private practice already mentioned) to a mere nominal amount, and therefore cannot be relied on as a means of ascertaining what is just to the profession, or of insuring proper at¬ tendance to the sick poor. It is, besides, universally considered by medical men as disgraceful to them, and is not prac¬ tised in any other learned profession, nor in the army and navy, nor in any civil office, nor in any liberal occupation; and if introduced into any of these departments, would produce the same dissatisfaction and sense of degradation to the persons employed, and the same inferior perform¬ ance of duty. The second of the abyve- named modes is frequently combined with the fi rst ; that is, if the “tenders” offered are not considered low enough, the Poor- law Commissioners, or the Boards of Guardians, arbitrarily reduce the amount to their own ideas of adequacy. Thus, nei¬ ther are medical men allowed to fix their own terms under competition, as has been professed, nor are they permitted to have a voice in deciding what is just to them- *The present entire absence of any thing like uniformity and regularity in the medical arrange¬ ments of the Poor-law Commissioners, may be seen by a reference to the Reports of the several Assistant Poor-law Commissioners, contained in the Appendix to the Second Annual Report of the Central Boa; d. MEDICAL RELIEF FOR THE SICK PAUPERS. 875 selves, this decision being entirely com¬ mitted to the other party in the contract, viz. the Poor-law authorities. We therefore propose either that the legislature, as a supreme impartial autho¬ rity, should fix the rate of remuneration; or that this be entrusted to a Board, to whom both parties might confidently look for justice. If the latter alternative were adopted, and if it were agreed that the Medical Board, already recommended for other purposes, should also exercise this important func¬ tion, it would be reasonably expected by the medical profession, one member at least of this Board should be appointed by, and responsible to the profession. 3. At present, weekly Medical returns are required to be made to the Board of Guardians, with specifications, not merely as to the names, ages, date of illness, and general state of the pauper patients; which is an unobjectionable regulation, but also as to the nature and designation of the ill¬ ness, the frequency of medical visits, and even the treatment of the disorder, which latter three particulars must be, for the most part, unintelligible to the parties by whom they are required, and are felt, on this ground, to be inquisitorial by the medical attendants. While, therefore, the first four particulars continue to be reported to the Boards of Guardians, it is highly important that complete reports of cases under treatment be made to the proposed Medical Board. Such reports would afford evidence of the nature and amount of duty, and the efficiency of its performance; they would also constitute a check against abuses of every description ; and if periodically completed and published by the Medical Board, would prove valuable to scicpce, and useiul to the public. 4. Under the present system it is a com¬ mon practice to entrust the care of exten¬ sive districts of parishes, and sometimes of entire unions, to individual medical offi¬ cers. By this arrangement, so detrimental to the sick poor, and so injurious to esta-^ blished practitioners, the Poor- law authori- ties are enabled to offer “ wider fields” for competition, and thus to attract a greater number of unemployed adventurers, and to reduce still farther the rate of remunera¬ tion. But however destructive to the in¬ terests of the present race of practitioners, and to the safety of sick paupers, such temporary expedients may prove, it is ob¬ vious that, ultimately, there can be no other reasonable method of supplying me¬ dical aid to the paupers, but by means of the nearest medical residents — men whose ordinary range of practice includes the parish for which a medical officer is re¬ quired. We therefore consider it essential that the present arbitrary distribution of the parishes into medical districts be abo¬ lished, so that the medical officer be ap¬ pointed for each district separately. No surgeon should be permitted to un¬ dertake more than a certain amount of parochial duty, nor to act unless possess¬ ing certain qualifications as to length of practice, &c. &c. ; both which should be regulated by the Medical Board. If any surgeon, not previously resident or living at a distance, be appointed to the care of a parish or workhouse, the reasons for such appointment should be trans¬ mitted to the Medical Board. No election to be valid unless confirmed by the Medi¬ cal Board. No medical officer should be liable to any investigation of his official conduct, or to be dismissed from office, ex¬ cept by the Medical Board. Every medical officer should be per¬ mitted to resign at any time, upon giving reasonable notice. 5. At present, the relieving officer is per¬ mitted to usurp the proper functions of the medical attendant, by deciding on the necessity of medical aid in sickness or ac¬ cident, and thus to interfere with the effec¬ tive treatment of the sufferer. In giving orders for medical rehef, the relieving officer is naturally guided only by the desire to retrench immediate expen¬ diture; and, especially wrhere the contract is at a sum per case, he is frequently in¬ duced to deny relief to most important ailments in their incipient stages; and thus, with the intention of saving a few shillings at the time, may probably inflict a permanent charge on the rates of some pounds; — not to dwell upon the inhuman neglect and aggravation of disease which such a practice necessarily occasions to the pauper. On the other hand, where the contract is at a fixed sum, this officer feels no check, and therefore generally distri¬ butes the orders for medical relief reck¬ lessly, without consideration either for the ultimate effects upon the rate-payers or the present loss to the practitioner, and often without visiting at the time, or subse¬ quently, the person for whom he gives the order. We propose, therefore, that the present practice be entirely discontinued, as afford¬ ing no security to the rate payers, no safety to the sick paupers, and no justice to the medical officer ; and that the fol¬ lowing arrangement be substituted : — Every sick pauper to apply in the first instance to the medical officer, who should be authorized to relieve him at once, if ne¬ cessary ; and, in that case, to furnish him with a certificate stating that the case re¬ quired treatment, 'i bis certificate should be sent bv the patient to the relieving effi- 876 NECESSITY OF PETITIONING AGAINST THE POOR-LAW ACT. eer in a specified time after receiving it — say twenty-four hours. The relieving offi¬ cer should inquire into the circumstances of the patient (if he he not already receiving relief in money or in kind) before the next meeting of the Board of Guardians, and should made a report thereon at that meeting; and thus enable the Board to divide the patients attended into two classes — the one to which the medical re¬ lief should be unconditionally giveii, and the other to which it should be merely afforded by way of loan, the cost being recoverable according to the provisions of the Poor-Law Amendment Act. The Board of Guardians might, of course, if they thought proper, refuse the continu¬ ance of the loan of medical relief to such persons. The cost of the relief thus af¬ forded might be calculated at so much per diem, with an additional charge for journeys ; and should be distinct from any arrangement for the regular paupers. The result of the whole plan, as sketched out in the foregoing observations, would be, that medical attendance on paupers would be placed under effective superin¬ tendence and control; that the just rights of medical practitioners would be protect¬ ed ; that the rates would be secured from expenditure on improper objects; that the sciences of medicine and of vital statistics would be enriched by an extensive and valuable collection of facts ; “ that the community would have the satisfaction of knowing that the sick paupers would be promptly and efficiently attended by men with local attachments, established prac¬ tice, and matured experience, affording the surest guarantee for the possession of the many moral and professional requi¬ sites for such varied, arduous, and respon¬ sible duties.” (Signed) Nath. Rumsey. Robert Ceely. H. W. Rumsey. Feb. 23, 1837. NECESSITY OF PETITIONING AGAINST THE POOR-LAW ACT. To the Editor of the Medical Gazette . Justum, ac tenacem propositi virum. Non civium ardor prava jubentium. Non vultus instantis tyranni Mente quatit solida. Hor. Sir, I entirely agree with you, that “ if the Poor Law be allowed to continue in its present state, it must entail permanent disgrace and degradation on the profes¬ sion.” You have done the utmost to place this clearly before the eyes of the profession from first to last, and I, in common with my brethren at large, sincerely thank you. May your efforts prove successful ! I do hope your last appeal will be cordially responded to at least by the great body of practitioners. But can we confidently look to the Colleges or to the Hall ? I fear not. Are they impotent, indifferent, or unwilling ? What have they done ? — Nothing. What can they do ? — They say, “ Nothing.” Then must we help our¬ selves. Well I know the grievous thraldom in which a great number of my brethren are now involved; — well I know the galling slavery many of them are compelled to endure. Deeply I regret that dire neces¬ sity dooms so many of them to submit with silent loathing and concealed disgust to worse than Egyptian bondage. Many of them are, indeed, deserving of deep commiseration. But can they expect re¬ dress without complaint ? — Can they hope for aid without putting their shoulders also to the wheel ? Let their conduct at this important period justify their claims on the active sympathy of their more for¬ tunate or more independent brethren. To them, indeed, may they then confidently appeal. “ If the character of the healing art be in any way dear to us” — if it be desirable to prevent the perpetuation of a most de¬ grading thraldom, the general infliction of a most disgraceful slavery, and the con¬ tinuance of a most detestable tyranny — let all those who desire to be free, and dare to be honest, manly, and just, speak out — expose the enormities of the present sys¬ tem, especially as regards the medical department — respectfully but earnestly demand redress, and redress must come. Is it, sir, in the nineteenth century, at a time when every class of the community is so active in acquiring, and so vigilant in maintaining its rights, that an indus¬ trious, useful, educated, enlightened, and liberal profession, which is daily confer¬ ring on the public unrequited obligations, should allow its just rights to be infringed, and its legitimate privileges to be assailed, by arbitrary and reckless authority, with¬ out making timely, adequate, and com¬ bined resistance ? Have we advanced in science and utility only to retrograde in character and station ? God forbid ! Let, then, the Provincial Association, which, to its eternal credit, has accom¬ plished so much, still persevere. Let it arouse its members to a sense of duty and of danger. No time should be lost. Let its councils, in every part of the kingdom, instantly get up petitions to parliament, after the excellent form adopted by the TREATMENT OF THE INFLUENZA 877 meeting at Manchester, and again urge on its members the necessity of promptly af¬ fording that aid, in the approaching in¬ quiry, which so many have it in their power to bestow. Let every one of us, by petition, or by evidence, to the utmost of his ability heartily co-operate at the pre¬ sent crisis, remembering that wrhile we are asserting the rights and privileges of the profession, we are at the same time supporting the cause of truth, justice, and humanity. — I am, sir, Your very obedient servant, A Country Practitioner, but no Slave. Feb. 28, 1837. TREATMENT OF THE INFLUENZA. REPLY TO MR. SEARLE. To the Editor of the Medical Gazette. Sir, As the treatment of the epidemic catarrh, which still to some extent prevails, is the test by which Mr. Searle wishes his new¬ fangled doctrine to be tried, I beg, through the medium of your journal, to inform him, that I do not consider that disease to be a criterion by which we ought to judge of the correctness of the views wdiich he entertains respecting the treatment of in¬ flammatory diseases. The inflammation which attends the influenza is very dif¬ ferent in its nature from acute, idiopathic pneumonia, or bronchitis. It is modified by the debilitating epidemic disease, of which it is, in fact, merely an effect; and in order to illustrate this point, I may ob¬ serve, that in typhus fever, inflammation of the brain or of its investing membranes, occasionally takes place at some period of the disease. I have witnessed many cases of this description, and the treatment which I have found to be most successful is to take a little blood from the temples by leeches, or from the nape of the neck by means of cupping-glasses ; to shave the scalp, — to cover it with cloths, which ought to be kept constantly wet with cold water ; to apply a large blister to the nape of the neck ; and to administer anti- monials. When this practice, which in some respects differs materially from that which I would recommend in pure ence¬ phalitis, is followed, the fever in some cases runs quickly on to a favourable ter¬ mination, — in others it proves fatal ; but in all, the cerebral affection, as every practitioner of experience well knows, is very different in its nature from acute idiopathic phrenitis. It is not, therefore, the kind of inflammation which we occa¬ sionally meet with in such diseases as typhus fever, and the present epidemic, that we are to look for proofs of the sound¬ ness of Mr. Searle’s doctrine; nor is it to acute idiopathic peritonitis, enteritis^ pneumonia, or phrenitis, that wre ought to turn our eyes. And I w'ill venture to say, that if a physician, wThen called on to pre¬ scribe for a patient, the symptoms of whose disease are intense headache, wild delirium, red fiery eyes, flushed face, and burning skin, were to prohibit the use of the lancet, which I consider in such cases to be the anchor of hope, and to recom¬ mend the “ fearless administration of nourishment,” he would soon discover that the fruit of such a plan of treatment, in most cases, would be death. And until Mr. Searle can convince me that I should be enabled either more speedily or more certainly to cure such a disease as the one I have just described by his nourishing inode of treatment, I must remain in my unbelief, and continue to oppose the new'- fangled doctrine, which I consider to be a kind of an idol which Mr. Searle has set up for himself, and ' which he has worshipped and adored until he has be¬ come so blind as to be unable to perceive its imperfections, even when they are clearly pointed out to him. In this re¬ spect, howover, he is not singular; for true it certainly is, that in all ages some even of the most distinguished members of the medical profession have also bad their idols, before whi(i they have bowed writh the same kind of blind enthusiasm; and as I have reason to believe that Mr. Searle is an exceedingly well-infonned practi¬ tioner, I beg to say that it will afford me much pleasure to continue the present controversy, in the hope that he may either speedily make me a convert, or that I may in the end succeed in dispelling the mist which prevented him, as I at present believe, from perceiving that the new¬ fangled doctrine which he has promul¬ gated is unsound and dangerous. I cannot, however, for reasons that need not at present be mentioned, comply with the- request which he has made in your journal ; indeed, I do not see of what use the avowal of my name possibly can be. My object is “ not to cavil,” but, if pos¬ sible, to find out the truth ; and I am surely just as likely to succeed in discover- • ing the object of my search bv the name of Investigator as by anv other name. Mr. Searle must, therefore, rest satisfied for the present with the name which I have thought proper to assume ; but as soon as my conversion takes place, if destined I am to be converted, I beg to assure him that I shall at once not only inform him 878 CASE OF SUCCESSFUL CAESAREAN SECTION of my real name, and acknowledge the error of my present opinions, but to the utmost of my power assist him in his endeavours to establish the new' doc¬ trine, — a doctrine which, notwithstand¬ ing all that has been said respecting it, I still consider to be my duty strenuously to oppose. — I have the honour to be, sir, Your most obedient servant, Investigator. London, Feb. 20, 1837. CASE of SUCCESSFUL CAESAREAN SECTION. By Dr. Meyer, Of Minden. This is the fourth time Dr. Meyer has performed this operation, and three of his cases have terminated favourably. The subject of the following wras the wife of a shoemaker, named Holle, residing at Min¬ den, a woman of small size and slender make, aged thirty- eight, who had pre¬ viously enjoyed good health, and borne th ree children easily and without any bad consequences. After this she was attacked with an arthritic affection, which, from poverty, privations, grief, and want of timely assistance, had increased to such a degree, that, for the space of a year, she only left her bed occasionally, and was then merely able to crawl about her room, bent double and holding by the chairs. In this state she became again pregnant ; an occurrence, of which the first intima¬ tion was given by the motions of the foetus in utero. On the evening of the 19th of June, labour came on, and towards morn¬ ing, the midwife in attendance, having di ^covered an abnormal state of the pelvis, advised her to have the assistance of an accoucheur. A neighbouring physician, Dr. Heilbronn, was called in, who, finding the pelvis so deformed as to render arti¬ ficial delivery by dismamberment, or the Caesarean section, unavoidable, ordered the patient to be blooded, and requested Dr. Meyer to take charge of the case. An examination per vaginam showed that the pelvis was excessively deformed. On introducing the finger, which was done with difficulty, owing to a bending in¬ wards of the ossa ilii and pubis, the sum¬ mit of a round solid body was felt, which at first might be taken for the head of the child, but a more accurate examination proved it to be the distorted promontory of the sacrum, which projected close to the retreating symphysis pubis. Hence it w as immediately concluded that the child lay entirely in the false pelvis; a circumstance which also explained the extreme pro¬ minence of the belly, which rested wdth the navel touching the external parts of generation. Besides that the child was still living, the impossibility of getting at it through the vagina determined Dr. Meyer to aban¬ don at once the idea of dismemberment, and he decided on this plan of operation, which the mother also pressed for ; al¬ though, from her unfavourable condition, there was little hope of saving her. The further proceedings are thus described by Dr. Meyer : — “ The patient was carried to the table, and placed on a straw mattress. The thighs could be separated only so far as merely to afford room for the hand of an examiner; the lumbar vertebras appeared to be anchylosed with each other and with the sacrum, and it was impossible to place her in an horizontal posture. In this half¬ sitting posture, the abdomen presented a space of only about four inches from the umbilicus to the pubes. Notwithstanding this, and the presumption that the pla¬ centa lay in the line of the proposed in¬ cision, [ made choice of it for reasons which seemed to me conclusive. “ Two assistants stood, one on each side of the patient, with large soft sponges, warmed and slightly oiled; while Dr. Heilbronn stood at her feet, ready to hand the instruments and take hold of the child. The abdomen was then firmly and power¬ fully drawn up, and an incision, about four inches in length, was made through the integuments, commencing as close as possible to the umbilicus, and terminating at the pubes. The division of the linea alba and the peritoneum, to the same ex¬ tent and in the same direction, gave exit to a considerable quantity of water, show¬ ing the coexistence of ascites. The dis¬ charge of this fluid, however, diminished the enormous tension of the abdomen, and contributed to facilitate the delivery. In all my former cases I had found the uterus extremely thin, scarcely thicker than stout paper, and easily divided : in the present instance, howrever, the walls were unusual¬ ly firm, and three lines in thickness. A new obstacle here arose: in cutting through the uterus, the knife entered the placenta, which was attached exactly opposite the line of incision. The consequences were, a division of the larger vessels which are collected about the centre of the placenta, giving rise to a considerable haemorrhage, and a further interference with the pre¬ viously limited space for the introduction of the hand and the passage of the child. No time, however, was to be lost : the sec¬ tion of the anterior wrall of the uterus was speedily completed, the necessary detach¬ ment of the placenta was accomplished without any excessive haemorrhage, and OPERATIONS ON VEINS. 879 the right knee of the child presented. As the opening in the womb was scarcely large enough for the passage of tire head, it was necessary to extract the arms ; after which the head followed, not without some resistance, yet without any laceration of the uterus. The extraction of the child was followed instantly by a remarkable contraction of the womb, and the bleeding stopped. “ Vomiting came on, accompanied by spasmodic contractions of the abdominal muscles, so that the assistants were obliged to direct their whole attention to the intestines, which were protruded with great force, and which were returned and kept in with much difficulty by the oiled sponges. When the blood and aqueous fluid were removed from the cavity of the abdomen, the uterus was soon contracted to about the size of two fists ; and, as the somewhat swollen edges of the incision were tolerably approximated, the external wound was united by suture without fur¬ ther delay. After it was finished, a repe¬ tition of the vomiting forced a piece of omentum, about two inches long, through an interval between the sutures, two inches below the umbilicus : this was removed with the scissors without any hesitation. Immediately over the pubes an opening was left, about an inch in length, into which a tent of lint was inserted ; com¬ presses were placed at each side of the wound, a twelve-tailed bandage applied, and, in half an hour from the commence¬ ment of the operation, the patient, who during the whole time neither stirred nor uttered a single moan, was laid com¬ fortably in bed ; the vomiting had ceased, and the eough was less troublesome. The child, a male, come to its full time, and twenty inches in length, but imperfectly nourished, had breathed immediately after delivery, cried, and was doing well. About half an hour afterwards, during a violent paroxysm of coughing, a full half-ell of intestine was forced through the opening at the lower end of the wound, and lay be¬ tween the thighs distended with flatus. Dr. Meyer, unwilling to undo the bandage in the absence of proper assistants, fortu¬ nately succeeded in reducing it by the taxis, and secured the opening with a com¬ press and strips of adhesive plaster.” The patient ultimately got quite well. From the successful termination of this and two other cases, Dr. Meyer is led to the conclusion that the Caesarean section is much less dangerous than is generally supposed; that, when we have recourse to it in time, and under favourable circum¬ stances, it is oftener followed by a happy result than other violent modes of artificial delivery, adopted in case gf great contrac¬ tion, and abnormal formation of the pel¬ vis; and that, generally speaking, when there is great probability of saving the mother, it should be preferred to dismem¬ bering the living child. Leaving the ques¬ tion undecided, whether the lateral in¬ cision should be selected, because the sec¬ tion of the anterior wall of the uterus is likely to meet the placenta, his experience inclines him in all cases to make choice of the linea alba. Finally, he corrects a statement made by him in a paper in¬ serted in Siebold’s Journal, 3d Band. 1st Heft, that “ in such operations, only one intelligent assistant is necessary;” and declares it to be his conviction, that three intelligent assistants are requisite, — two to prevent the protrusion of the intestines, and a third to remove the placenta and foetus *. OPERATIONS ON VEINS. Several eminent surgeons have lately exercised their ingenuity about certain operations upon the veins, even more than upon the arteries. When the veins be¬ come varicosely enlarged, every one knows the serious consequences, and the great difficulty experienced in finding out a mode of treatment at once safe and effectual. It is not admissible for me to enter into a history of what has been done for varicose veins ; I can indeed but briefly allude to the most modern proposals. We cannot surely expect much from an electric shock conveyed along the enlarged vessels. Breschet’s plan of pinching the veins, whether of the cord or of the extremities, by forceps constructed for the purpose, has frequently answered, and has not been often followed by the severe and dange¬ rous symptoms of phlebitis; I am, how¬ ever, assured, that repeatedly the parts in¬ cluded in the forceps, not excepting even the vein itself, have sloughed, the ulcer afterwards healing, and all doing well. Sanson has constructed forceps for the same purpose, writh the blades so broad, that he keeps the sides of ihe vein in con¬ tact for the extent of nearly an inch ; it is said to be not absolutely necessary that the vein should be included between the blades of the instruments, nor that adhesive in¬ flammation should arise; it is sufficient that the vein be compressed so as to stop the course of the blood, when a clot forms, which is subsequently absorbed, leading to obliteration of the cavity of the vessel. The passing of the needles through the varicose vein, after the ingenious manner first practised by Mr. Phillips, of London, for obliteration of the arteries, and for which proposal he has received such * Neue Zeitschriftfur Geburtskumle ; and Dub¬ lin Journal, Jan. 1837. 880 BILLS OF MORTALITY.— METEOROLOGICAL JOURNAL. honourable distinction in another country, has been recently tried by Lallemand, Da- vat, and Velpeau. The last of these expe¬ rienced surgeons has also passed needles beneath the vein, and twisted a ligature circularly or in eight under the projecting ends of each needle, so as to compress the vein. I have myself adopted this plan, and although there was suppuration in the cellular substance, neither general fever nor phlebitis arose, the patient being quickly cured of a troublesome ulcer, and the dilated vein either restored or oblite¬ rated. — Mr. Crosse’s Retrospective Address. INFANTICIDE BY POISONING. To the Editor of the Medical Gazette. Sir, In the 22d of Dr Cummin’s excellent lec¬ tures on Forensic Medicine, published in your last number, he states it as probable, that there is not a single case on record to show that poisoning has ever been had recourse to as a mode of murdering the new-born infant. Dr. Cummin may be correct in making this statement if he confines his remark to medical records ; but if he means to be understood generally, as stating that no such case has ever oc¬ curred, I apprehend, if my memory does not greatly deceive me, that there exists at least one exception to the truth of his re¬ mark. In the records of the Justiciary Court at Glasgow, I think it will be found that such a case did occur some twelve, perhaps, or fourteen years ago. The poisonous substance which was employed on this occasion was the yellow powder called orpiment, or sulphuret of arsenic. Dr. Corkindale, of Glasgow, if applied to, would be able to furnish all the details of the case, as he is always employed by the authorities upon such occasions in that city, his medico-legal knowledge and ex¬ perience being of a very high order. It is very likely, too, that Dr. Ure’s services were required at the trial. — I am, sir, Your obedient servant, William Maclure. 14, Harley-Street, Feb. 27, 1837. NEW MEDICAL BOOKS. A Treatise on Painful and Nervous Dis¬ eases. By A. Turnbull, M.D. Third Edition, 8vo. 6s. The Medical Properties of the Bladud Spa Waters. By C. T. Edwards. 8vo. 3s. The Works of John Hunter. By J. F. Palmer. 4 vols. 8vo., with 4to. vol. of Plates. Vol. I. 17s. 6d. The Surgical Works of John Hunter. By J. F. Palmer. 3 vols. 8vo., with the Plates inserted. Vol, I. 17s. 6d. LITERARY ANNOUNCEMENT. The Hunterian Oration, delivered in the Theatre of the Royal College of Surgeons in London, on the 14th of February, 1837. By Sir Benjamin Brodie, Bart., F.R.S. APOTHECARIES’ HALL. LIST OF GENTLEMEN WHO HAVE RECEIVED CERTIFICATES. February 23, 1837. William Pilling, Manchester. Edwin Fagg, Cheltenham. Robert Lyons Campbell, London. William Ashcombe, Winchester. John Strudwicke Bunce, Bridgewater. Henry Gordon Harbord, Kingston-upon-Hull. John Samuel Charlton, Rochester. William Rowland, Anglesea. March 2, 1837. Peter Raven, of Leteham. Thomas Skeel, of London. William Cross, of Clifton, Bristol. Peter Walsh. Richard Edward Cooke, of Southwell. Joseph Manlove, of Nottingham. Alfred Harmer, of Ipswich. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Feb. 28, 1837. Age and Debility . 50 Apoplexy . . 10 Asthma . . 24 Childbirth . . 1 Consumption . 67 Convulsions . 33 Croup ... 3 Dentition or Teething 5 Dropsy . . 8 Dropsy in the Brain 11 Dropsy on the Chest 1 Epilepsy . . 1 Erysipelas . . 1 Fever ... 6 Fever, Scarlet . 1 Heart, diseased . 3 Hooping Cough . 18 Inflammation . 27 Bowels & Stomach 3 Brain . . 2 Lungs and Pleura 11 Influenza . . 8 Insanity . . 4 Liver, diseased , 6 Measles . . 7 Mortification . 2 Paralysis . . 2 Spasms . . 1 Thrush . . 1 Unknown Causes 3 Casualties . 2 Decrease of Burials, as compared with > the preceding week . . i METEOROLOGICAL JOURNAL. Kept at Edmonton, Latitude 51° 37' 32" N. Longitude 0° 3' 51" W .'of Greenwich. Feb. 1837. Thermometer. Barometer. Thursday . 23 from 34 to 49 29-62 to 29 33 Friday . . 24 29 45 29-60 29 90 Saturday . 25 27 42 29 98 3010 Sunday . . 26 25 41 30-10 30 07 Blonday . . 27 26 41 29-96 29-88 Tuesday . . 28 30 41 29-95 30-09 March. Wednesday 1 24 39 30-24 30-31 Winds N.W. and N.E. Except the 24th, 25th, and morning of the 26th ult. cloudy; rain on the 23d and 28th. Rain fallen, *25 of an inch. Charles Henry Adams. Wilson & Son, Printers, 57,3kinner-St. London THE LONDON MEDICAL GAZETTE, being a WEEKLY JOURNAL OF iMrtitrinc attit tfje Collateral JmrwesL SATURDAY, MARCH 11, 1837. LECTURES ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine , By William Cummin, M.D. Le CTURE XXIII, Opening of a new division of the Course — Dis¬ eases and Injuries medico -legally considered: First, those of the Mind — Unsoundness or Mind — Psychology a mixed science, peculiarly adapted to the study of medical men — Legal distinctions and decisions re¬ specting Unsoundness of Mind: 1, In Civil cases — Varying judgments of successive Lord Chancellors — Present arrangement for issuing Commissions ; 2. In Criminal cases — Dis¬ tinction between right and wrong. The dif¬ ferent forms of Unsoundness of Mind— Sim¬ plification introduced by the French and Germans — Tabular view of the principal forms : 1 . Idiocy and its characteristics ,* 2. Imbecility — How Jar consistent with a disposing memory and understanding— Re¬ markable trial in illustration. With the present lecture I open a new and very important division of the course. W e have hitherto considered man either with reference to structure simply, whereby the requisite characters of age, sex, variety, and identity, are deter¬ mined ; or we have contemplated him in regard to the exercise of certain functions, chiefly those of reproduction ; but always as in the enjoyment of health. The scene changes, and we shall now proceed to view the human being as the subject of disease or injury which may possibly give rise to questions in courts of justice. In treating of diseases, we shall have to notice those of the mind as well as of the body ; and even giye the precedence to the 484,— xix. former, as well for other reasons, as because of their superior medico-legal interest. In the remarks and illustrations which shall presently be offered, proof enough will be adduced of the extreme complexity and difficulty of the subject ; nor should you be ignorant that it has proved a quicksand of late years, on which more than one me¬ dical reputation has been wrecked. Medico-legal psychology. — It has been sometimes questioned whether medical men (probably from their being found so fre¬ quently at fault) have any title to be considered as essential referees on inqui¬ ries respecting soundness and unsound¬ ness of mind, — whether, in fact, they have better means of being well informed on the subject than any other well edu¬ cated members of society. In Germany the question has been discussed with much energy and heat; some of the disputants maintaining that the tribunals should be guided solely by medical men, others vindicating that prerogative for the pure philosophers of mind. Metzger dis¬ tinguished himself as one of the chief advo¬ cates of the former, Kant of the latter, opinion. But each took an extreme view of the case, and, as often happens, over¬ looked the truth lying between; neither party was exclusively right, but the pre¬ ponderance certainly was towards the me¬ dical side, and for these reasons : — 1. Because the philosophers are purely theoretical, while medical men study psy¬ chology as a mixed science — that is to say, they keep in view the connexion of mind and body. 2. Medical men have by far the best opportunity of personally observ¬ ing the phenomena of mental disorder. And 3, because in most cases, if not in all, the unsoundness of mind depends on some physical cause. For the thorough investi¬ gation of the subject, therefore, the medi¬ cal man is best qualified by reason of his practical as well as general attainments; and d fortiori, when he has made mental disease a principal; or a special study. 3 L 8 82 DR. CUMMIN ON FORENSIC MEDICINE. UN SOUNDNESS OF MIND. I use the purely English denomina¬ tion, unsoundness of mind, as compre¬ hending all the varieties and devia¬ tions from the ordinary rational stand¬ ard which are commonly met with. Like the French alienation menlale , (but with more propriety) it embraces idiocy and imbecility, as well as the various forms of derangement. But as Lord Coke, and some of our highest law authorities, have pronounced the term non compos, or insance mentis, (literally, of unsound mind) to be the most sure and legal, there can be no hesitation in adopting it as the generic term. Legal distinctions and decisions respecting unsoundness of mind. — What is said in Coke Littleton on the varieties of mental un¬ soundness is worth quoting in the first in¬ stance. “ Non compos mentis is of four sorts : 1, Idiota, which, from his nativity, by a perpetual infirmity, is non compos mentis; 2, He that by sickness, grief, or other acci¬ dent, wholly loseth his memory and un¬ derstanding ; 3, A lunatic, that hath some¬ time his understanding, and sometime not, aliquando gaudet lucidis intervallis, and there¬ fore he is called non compos mentis , so long as he hath not understanding. Lastly, he that by his own vicious act for a time depriveth himself of his memory and un¬ derstanding, as he that is drunken.” — Coke , Littleton , 247, a. A person who labours under unsound¬ ness of mind is not contemplated by the laws as other people are : he is not held responsible for his actions. If he possess property, it may be taken out of his hands ; at least he may be deprived of the ma¬ nagement of it. If he marry, the mar¬ riage is not valid ; if he make a will, his executors are not bound by it. Again, if such a person commit an act of aggression, or violence, it is not imputed to him as a crime; he is acquitted of the guilt on the ground of insanity. But the proofs of insanity required in civil and criminal questions are very dif¬ ferent; for which reason it will be neces¬ sary to consider them separately. In all cases coming before the tribunals, the question of unsoundness is ultimately determined by the verdict of a jury, and that in most instances turns on the evi¬ dence of medical witnesses. In civil cases. — “ An idiot, or natural fool,” says Blackstone, “ is one that hath had no understanding from his nativity; and therefore is by law presumed never like¬ ly to attain any.” For which reason the custody of him and of his lands is given to the King, by whom it is entrusted to the Lord Chancellor. In the old common law there is a writ de idiota inquirendo , to inquire whether a rhan bean idiot or not: which must be tried by a jury of twelve men : and, if they find him put us idiota, the protits of his lands and the custody of his person may be granted by the king to some subject, who has interest enough to obtain them. A man is not an idiot (continues Black- stone), if he hath any glimmering of reason, so that he can tell his parents, his age, or the like common matters. But a man who is born deaf, dumb, and blind, is looked upon by the law as in the same state with an idiot ; he being supposed incapable of any under¬ standing, being destitute of those sources by which the human mind is furnished with ideas. A lunatie, or non compos mentis, is one who hath had understanding, but by dis¬ ease, grief, or other accident, hath lost the use of his reason. A lunatic is indeed properly one that hath lucid intervals: sometimes enjoying his senses, and some¬ times not, and that “frequently depending upon the change of the moon.” But under the general name of non compos mentis (which sir Edward Coke says is the most legal name) are comprised not only luna¬ tics, but persons under frenzies, or who lose their intellects by disease; those that grow deaf, dumb, and blind, not being born so ; or such, in short, as are judged by the Court of Chancery incapable of conducting their own affairs. To these also, as well as idiots, the king is guardian, but to a very different purpose. For the law always imagines, that these accidental misfortunes may be removed ; and there¬ fore only constitutes the crowm a trustee for the unfortunate persons, to protect their property, and to account to them for all profits received, if they recover, or after their decease to their representatives. On the first attack of lunacy or other occasional insanity, while there may be hopes of a speedy restitution of reason, it is usual to confine the unhappy persons in private custody under the direction of their nearest friends and relations : and the legislature, to prevent all abuses in¬ cident to such private custody, has fre¬ quently thought proper to interpose its authority by statutes, particularly 9 Geo. IF. c. 40 and 41, regulating mad-liouses. But, when the disorder is grown perma¬ nent, and the circumstances of the party will bear such additional expense, it is proper to. apply to the royal authority to warrant a lasting confinement. The method of proving a person non compos is very similar to that of proving him an idiot. The lord chancellor, to whom, by special authority from the king, the custody of idiots and lunatics is en¬ trusted, upon petition or information, grants a commission in nature of the wrrit de idiota inquirendo , to inquire into the UNSOUNDNESS OF MIND. 883 party’s state of mind ; and if he be found non compos, he usually commits the care of his person, with a suitable allowance for his maintenance, to some friend, who is then called his committee. However, to prevent sinister practices, the next heir is seldom permitted to be this committee of the person ; because it is his interest that the party should die. But it hath been said, there lies not the same objection against his next of kin, provided he be not his heir ; for it is his interest to pre¬ serve the lunatic’s life, in order to increase the personal estate by savings, which he or his family may hereafter be entitled to enjoy. The heir is generally made the manager or committee of the estate, it being clearly his interest by good manage¬ ment to keep it in condition, accountable however to the Court of Chancery, and to the non compos himself, if he recover, or otherwise to his administrators*. But when we come to inquire on what principle the writ de lunatico is granted, we find that it depends, for the most part, on the discretion of the Lord Chancellor for the time being. One grants it, as is now usually the practice, in cases of imbecility or weakness of intellect, but another has strenuously refused to consider a case of this kind as coming under the distinction of insance. memorise. The following decisions of Lords Hard- wicke, Eldon, and Lyndhurst, will exem¬ plify the differences of opinion which have prevailed among eminent judges during the last half century: — “ In ex parte Barnsley, upon a petition to quash an inquisition, finding the petitioner, from the weakness of his mind, incapable of governing himself, his lands and tenements, the petitioner’s counsel ob¬ served that there were but two distinc¬ tions in law, viz. idiocy and lunacy; and although the latter had been since described by other words, i. e. non compos mentis, insauce memorice, of unsound mind and memory, yet that the wrords only were changed, and not- the law. “ Upon which Lord Hardwick e observed that it was so, and that nothing could change the law therein but an act of parliament. JVon compos mentis, or, since the proceedings have been in English, ‘ of unsound mind,’ which mean the same thing, are legal terms of a determinate signification, un¬ derstood by courts of law, importing not weakness of understanding, but a total deprivation of sense. God forbid! conti¬ nued his lordship, that weakness of mind only, should be a sufficient reason for granting the custody of persons and their estates, for that would take in violent people, drunkards, careless, and silly : and I the material part of the traverse is, not to I the incapacity of judgment, but to the : more material words of unsound mind, or insance memorice, which all persons must understand to be a depravity of reason, or the want of it; but weakness does not carry that idea along with it, and would be expressed in Latin by injirmitas mentis, rather than insanitas mentis. In the notion of the old writs, a person must be found either idiot or lunatic; and the courts en¬ larged the manner of finding, to avoid the difficulty of obliging the jury to find ex¬ press lunacy, when they might think the case rather that of idiocy. If a man is so wreak as to be imposed upon in the execu¬ tion of a deed by the artifice of another, or spends his money foolishly, or weakly, he does not come within the meaning of the law in cases of this sort; but if men or women, through the weakness of their minds, are drawn in to execute convey¬ ances by fraudulent means, they are re- lievable in the Court of Chancery ; and bills are frequently brought by such per¬ sons to avoid their acts, on the ground of fraud. Commissions of lunacy are not intended for such men ; their relief is by decree*.” But Lord Eldon, from the same bench, pronounced a very different opinion : — “ Of late (says his Lordship) the ques¬ tion has not Been, whether the party is absolutely insane ; but the court has thought itself authorized to issue the com¬ mission, provided it is made out that the party is unable to act with any proper and provident management, liable to be robbed by any one, under imbecility of mind, not strictly insanity, but, as to the mischief, calling for as much protection as actual insanity. In the case of Mr. Charles Palmer, he was not insane, but his mind, by years and attention to business, was worn out. Epileptic fits, too, may pro¬ duce a mind in the same state at a much earlier period. Such cases, therefore, have been thought proper subjects of this writ — de lunatico inquirendo. In another recent case, the commission stood upon the same principle. The party, when he could be kept sober, was a very sensible man, but in a constant state of intoxication he was perfectly incapable. No one can look at the present case without seeing that every person about this lady is satisfied that some care should be throw'n round her. If clearly it is fit to protect her against executing powers of attorney, that she should not decide wThere her person, or with what trustees her property ought to be, all agreeing that she should not choose the persons wTho are to have the care of her property, it is fit for me to put a control upon those who may be proper persons to have the control of her property. I will not subject her now to another com¬ mission, but will direct two physicians, who have not been concerned and con¬ sulted, to see the evidence, and afterwards * 1 Blackst. Comm. 302, et seq. * Collinson on Lunacy, p. 61. 884- DR. CUMMIN ON FORENSIC MEDICINE. in the most tender manner to find the means of visiting her without alarming her, for the purpose of determining whe¬ ther her state of mind is competent to the management of her affairs, for this does not seem a case of insanity ; and I should think myself bound to do this, if it was only made out that it is not fit she should have the management of her pecuniary af¬ fairs*.” We shall now contrast a judgment of Lord Lyndhurst’s. After citing the pre¬ ceding decision, his Lordship proceeds : — “ The law, as thus stated, has been act¬ ed upon for years ; it has been acted upon in the view of the legislature; the legisla¬ ture has not thought proper to interpose; and we must therefore take the law to be as thus expounded. Yet I think it unsafe that this verdietf should stand. The find¬ ing here is similar to what was found in Cranmer’s case. There the verdict was, * that H. C. was so far debilitated in his mind as to be incapable of the general ma¬ nagement of his affairs.’ What did Lord Erskine say on that occasion ? ‘ How can I tell what is so far debilitated in his mind as not to be equal to the general manage¬ ment of his affairs? Suppose he was a farmer, and his understanding was so far debilitated that he could not manage his farm, though competent to common pur¬ poses.’ What are the affairs to the ma¬ nagement of which he is incompetent ? Those affairs may be of such a nature that a certain degree of impairment of memory may render him incompetent to the ma¬ nagement of them, and yet he may not be of unsound mind. The inference of the jury — ‘ and consequently he is of unsound mind’ — does not satisfy me — it does not follow necessarily from the premises : I cannot, therefore, allow the verdict to standj;.” It is satisfactory, however, to be able to add, that a recent enactment has put an end to much of the ambiguity which thus prevailed respecting weakness of intellect. The statute 1 Wm. IV. c. 60, relative to trustees and mortgagees, has introduced a power to issue a commission of lunacy in all cases where an individual is “incapable of managing his affairs,” although he be neither proved to be an idiot nor lunatic. In criminal cases. — The law is more pre¬ cise and determinate in laying down the grounds of responsibility or irresponsibility for crime. The statute 39 and 40 Geo. III. c. 35, enacts, that when, upon the trial of a person charged with treason, murder, * 8 Vcsey, Ridgeway v. Darwin. t The verdict was, “ that the party was not lunatic, hut partly from paralysis, and partly from old age, his memory was so much impaired as to render him incompetent to the management of his affairs, and consequently that he was of un¬ sound mind, and had been so for the term of two years.” t 4 Russell Rep. 183. or felony, it shall he given in evidence that the prisoner was insane at the time of the commission of the offence, and such person shall be acquitted, the jury shall be required to find specially whether such person was insane at the time of the com¬ mission of the off ence, and to declare whe¬ ther the acquittal has been in consequence of such insanity; and if they so find, the prisoner is to be kept in custody till his majesty’s pleasure is known. But in order to prevent the jury from being embarrassed by technicalities respecting the import of the term insane, the ques¬ tion which is usually presented to them in all such cases, is, whether at the time the alleged criminal act was committed, the prisoner was incapable of judging between right and wrong, and did not then know that he was committing an offence against the law of God and nature ? Thus should it appear that the accused possessed such capability, although the mental delusion might be connected with the crime, and have stimulated him per¬ haps to commit murder in revenge for an imaginary injury, yet, being shewn to be capable of knowing that he had no right so to revenge himself, he must be held criminally responsible. The different forms of unsoundness of mind. — The want of definitions and of precise appellations is no where more seriously felt than in treating of the various forms of mental disease. We have seen in the short sketch just given, of the legal dis¬ tinctions respecting unsoundness of mind, how vaguely the several terms lunacy , un¬ sound memory , imbecility, &c. are employed even by the bench ; and it is a general complaint that lawyers take no pains to fix the meaning of expressions which they so commonly use : they seem, indeed, more inclined to secure for themselves a convenient latitude in this respect, so that when they please they may, as it were, play fast-and-loose with the medical witnesses, badgering them (as we too often see them, do) to state mi¬ nutely what is to be understood by such negative denominations as unsoundness or insanity, when they themselves would with much more propriety endeavour to fix the ideas comprehended under the posi¬ tive term soundness of mind. In the end this probably will be done, and the ex¬ ample has already been set by eminent legal authorities on the continent; but meantime we are not to remain idle, expecting such a consummation : medical men are deeply interested in procuring all the light that*can be had on the sub¬ ject, and from them, no doubt, will be ultimately derived all that information which is requisite to guide and deter¬ mine the construction of our common and statute law. Unsoundness of mind, as including every PRINCIPAL FORMS OF UNSOUNDNESS OF MIND. 885 remarkable deviation from the ordinary healthy standard, is obviously a term of wide application; but as in regard to bodily disease we have our classes and or¬ ders to refer to, whereby each individual case can be readily recognized, so in de¬ termining the nature of particular in¬ stances of mental disease, we have an ar¬ rangement which seems well adapted to serve our purpose. To the French and Germans we are much i ndebted for theirpsychonosological labours; they have simplified a subject which was hitherto all chaos ; they have supplied us with a nomenclature at once adequate and perspicuous ; and they have already, we may say, so far displaced the old system of confusion, that in treating henceforth of mental disorders it will be possible for authors to be generally intelligible, with¬ out using terms in senses peculiar to them¬ selves. Only a few years since, it was necessary, in proceeding to peruse the re¬ marks of any English writer on insanity, to settle in the first instance in what sense he employed his terms; for it was sure to be different from that of any one else even of his contemporaries: but of late a uni¬ formity has begun to prevail, which can¬ not but be attended with the most bene¬ ficial results. Medical jurists ought to be well ac¬ quainted with the prominent characteris¬ tics of the several forms of mental un¬ soundness I shall here offer a sketch w hich will be found useful in appreciating the features of the leading varieties ; but first let me call your attention to this table, w'hich exhibits at a glance the rela¬ tions of the different forms to each other : — TABULAR VIEW OF THE PRINCIPAL FORMS OF UNSOUNDNESS OF MIND. r Idiocy , f Deficiency of mental power. C fc. o m m — £ Q £ P o m £ P Imbecility (Congenital— with little, if any, develop¬ ment. From arrested development — perhaps with some congeni¬ tal defect. The deaf-and- dumb state. ( Mania, or General insa¬ nity. Insanity ; with excitement. \ Derangement, or Alienation of mental power. ^Monomania; Partial insa¬ nity. With fury ; Furor. v Without fury. ( With depres¬ sion ; Melancholia. Demonomania. WTith terror. With pride. j Theomania. W ith hilarity or ) Erotomania cheerfulness. “Otomama. VDementia, or Fatuity ; the mind broken down. /Consecutive on some other form of de¬ rangement. From Epilepsy, &c. \ Senile ; Dotage . With vanity. 886 DR. CUMMIN ON FORENSIC MEDICINE. This arrangement explains itself. Un¬ soundness of mind, the generic term employed as “ the most safe and legal,” is in the first instance considered as con- sistingeitherin deficiency or derangement — the mind having never attained, or having departed from, the ordinary sound state. Deficiency of mind is then divided accord¬ ing as it arises from congenital imperfec¬ tion, or from some obstacle supervening which permits only of a partial develop¬ ment. We have thus the two forms of idiocy and imbecility. In derangement, the mind may be looked upon either as morbidly excited, or as having its powers abated : hence we arrive at the several forms of mania, monomania, and the different kinds of dementia. Mania, again, is distinguished according as it is attended with fury or not; and mono¬ mania, as it exhibits a depressed condition or the reverse. Of some of these varieties it will be necessary to offer a more detailed descrip¬ tion, and particularly of the following five — namety, idiocy, imbecility, mania, mono¬ mania, and dementia. By making our¬ selves familiar with their characters, we shall find our task of distinguishing and classifying particular cases submitted to us, will be materially facilitated. Idiocy — its characteristics. — Absolute idio¬ cy, for it admits of some slight degrees, is always connected with more or less of personal deformity or disease. The head is generally remarkable for its dispropor¬ tion to the stature — sometimes extremely small, with retreating and narrow fore¬ head, sometimes voluminous, with obtuse facial angle; the features are heavy, often hideously ugly; the eves meaningless; the smile stupid. The body is mostly short and ill-shaped, very thin, or very fat. In regard to mental power, the little portion of mind which the idiot possesses is almost a perfect blank; there is no understand¬ ing, no faculty of articulate speech, a few parrot like words probably are the utmost that can be uttered. The will is in similar abeyance, no emotions, no desires, scarcely even an instinct. Where the idiocy is not so thoroughly deplorable, there are some slight glimmerings of ideas of sense, and of feelings of pleasure and pain ; sometimes even a trace of gratitude towards a kind keeper may be observed. Cases of this description can scarcely give any difficulty to the medical jurist; being congenital, and their history known, there is commonly no mystery about them. It might so happen, however, that in some isolated instance an attempt at imposture might be made : not that a person who had already been known to enjoy reason could well put on this form of unsound¬ ness — for it were a clumsy character to assume — the broken down mind, such as his should be, displaying the lineaments of dementia, not those of idiocy: but some wandering impostor might endeavour to play the arrant fool for some mischievous purpose. Where there is reason for sus¬ picion of this kind, seclusion and secret watching of the party would soon afford evidence of his real state. Imbecility. — This is a state of mind which often affords ample room for discussion and litigation. The imbecile possesses only a limited portion of mental power: his' intellectual and moral development has proceeded only to a certain extent — some bodily disorder then probably in¬ terfering, or his original stock of mind being capable of cultivation no further. Some, however, are capable of a consider¬ able degree of intelligence, — may be taught certain mechanical trades ; some can even learn to write, or to read, and perhaps may be made to comprehend the rudi¬ ments of arithmetic. But almost every thing they do is performed in a slovenly, unfinished manner. They are destitute of a reasonable degree of attention ; their memory is accordingly very imperfect, and their powers of comparison and association most limited. We often observe marked shades of variety in the imbecile : a propensity to music and mimickry is sometimes dis¬ played ; and while some are extremely peaceable and orderly, others are cunning — given to theft, and sometimes carried away even to acts of assassination. Their passions are frequently violent and un¬ manageable: grief also, and the appear¬ ance of strong religious feeling, have been noticed among their characteristics. The great difficulty attending these cases in medico-legal practice is to trace out the limits whereby persons of this class are distinguished from others who are competent to regulate their social and moral conduct. In criminal trials there is reason to believe that imbeciles have often (not so often, however, in this coun¬ try as on the continent) been found guilty, where they were really not responsible; and in civil suits, the decision of the validity of acts done by the imbecile has sometimes turned on points perhaps scarcely comprehensible by the jury them¬ selves who pronounced the verdict. An example of the latter kind is afforded by a remarkable trial which took place not long ago on the Western Circuit. It was an action to set aside a will made by a young woman (Frances Smith) of weak mind: the heir at law was plaintiff, the legatee (Ann Smart) defendant. Counsel on either side admitted that there was imbecility in the case; but the question was whether it existed to such an extent as to incapacitate for making a will, — whether, in fact, the testatrix possessed a “ disposing memory,” so as to be able to bequeath her property with understand- UNSOUNDNESS OF MIND. 887 ing and reason. Much evidence was ad¬ duced on both sides, for it was necessary to inquire into the whole tenor of her life: a witness was produced who was present at her birth, and various others testified to her habits during her girlhood and married state. Frances, or Fanny Smith was a farmer’s daughter ; her head was misshapen at birth, owing to some injury received dur¬ ing delivery; and she very early exhibited signs of inferior intellect; she required as¬ sistance in all the common affairs of life, was uncleanly in her person, and very simple minded. Her proper station seemed to be in the farm-yard, where it appears she often used to work hard with her mother. Many of the farm labourers and rustics gave a pretty fair account of her understanding, according to their ideas of sound mind; but the Rev. Mr. Benson, the clergyman who celebrated her mar¬ riage, while he considered her capable of entering into the married state, and even of disposing of her property, admitted that her appearance induced him to think she was weak in her intellect, and “ a very weak person.” The evidence of the solicitor who drewr her will and attested a previous execution of a mortgage deed, was strongly in favour of her “ diposing” capacity; but he went so far as to say that there was nothing even in her countenance to indicate weak¬ ness of mind. Dr. Grove, too, a physician who saw her relative to an insurance on her life, thought she was competent to make a will ; but he stated in his cer¬ tificate that she had a degree of eccen¬ tricity of mind, though nothing approach¬ ing to anxiety. On the other hand, in addition to abundant testimony regarding the slovenly, uncleanly, childish, and unmeaning habits of the testatrix, it wras proved that at school, where she w as sent at the age of 10, she had not the capacity of a child of five, — she could scarcely be taught any thing: it was impossible to teach her to sew — yet she learned to write a little. Mr. W. H. Coates, surgeon, of Salis¬ bury, gave evidence to this effect: — “ I attended Fanny Smith at times, from 1819 till her death, during wrhich period my attention w'as drawn to her mind. No one could attempt to converse wuth her without seeing that she was imbecile in a low degree. I gave a certificate in 1828 and 1829, after I had considered the state of her mind: those certificates state she is very nearly an idiot. I examined her a third time, with Dr. Finch, at my house. I put questions to her. We first wished to ascertain whether she under¬ stood the nature of disposing of property, but we could not discover that she did. I put down a few figures which a child of six years could sum up, but she could not do it. She was incapable of doing simple addition. I should say she was incapable of any important transaction. She did not appear agitated or confused. She con¬ tinued in the same state to the time of her death. I performed an operation on her breast ; I then remarked that she ex¬ pressed no sensation of pain, and at her confinement she did not exhibit the same feelings as other persons. There was a defect of sensibility, which frequently ac¬ companies a defect of mind. “ Cross-examined. — Women suffer pain better than men. She scarcely made an¬ swers to any of our questions. I think those she did give were not rational. She possessed some mind, but of a very inferior description. “ Re-examined. — She had not a mind to protect herself from fraud. I put, the ordinary tests to ascertain the state of her mind.” Dr. Finch was next examined. u I am a physician, and have kept a lunatic asylum for thirty years. I at¬ tended with Mr. Coates, and the certificate describes my opinion. “ Cross-examined. — An idiot can have no idea of numbers, or of the value of money.” The trial lasted four days. In his ad¬ dress to the jury the learned judge (Mr. Baron Gurney) commented at considera¬ ble length on the evidence “ The law,” he said, “ had been correctly stated, that it was not requisite on one side, in support of the will, that it should be made out that the person was an idiot; and it was stated on the other side, that it was not requisite to establish that the person was of superior understanding, or even of the average understanding of mankind. But there must be mind, there must be me¬ mory, there must be judgment; and it wras for them to say, upon the examination of all this evidence, whether this woman, Frances Smith, had a‘ disposing mind, memory, and understanding. The case was one of the most extraordinary nature, for the evidence on one side and the other w7as most completely at variance ; the one placing her understanding perhaps higher than it ought to be, and the other putting it possibly lowrer than it ought to be; but it was confessed that she was a person of very weak mind, and they were to say to w'hat extent that weakness went, whether it was that degree of weakness which in¬ capacitated her from the disposal of her property by will; and there wras this re¬ markable observation to be made, that the greater part of the witnesses in the lower class of life, in support of the will, stated that she had no weakness at all. Op the 888 MR. ALLAN S CASE OF OBSTRUCTED URETER, WITH other hand, the witnesses against the will placed her low, very low indeed. They had to contrast this ; and it was for them to decide which was correct.” The jury, after a short consultation, re¬ turned a verdict for the defendant — that is to say, for the validity of the will*. CASE OF OBSTRUCTED URETER; WITH ULCERATION OF THE KIDNEY AND ABSCESS. By Bobert Allan, Esq. Staff Assistant Surgeon. John Gourlay, private in the detach¬ ment ‘29th Regiment, stationed at Black River, aged 30 ; a native of Stirling (N.B.), of robust constitution* nine years in the tropics, and addicted to the free use of ardent spirits ; went to bed in his usual good health on the evening of the 4th October, 1835, and awoke about th ree o’clock in the morning-, complain¬ ing of violent pain, increased on pres¬ sure, in the site of the descending colon. Pul se 104, full; skin moist; thirst. He voided small quantities of urine, highly tinged -with blood, every few minutes. Venesectio ad bbij. Fomentat. abdom. frequenter. Hab. 01. Ricini, ^j. The blood was buffed and cupped ; and about noon the pulse fell to 98. Having vomited the castor oil, a stimu¬ lating enema was thrown up. The pain ceased, and he slept two hours ; it, how¬ ever, returned at intervals during the day, while the abdomen became tumid, and tender on pressure. He slept seve- i-al hours in the Following night, but on the morning of the 6th suffered more severe abdominal pain, with the pulse 100, very full; skin hot and dry; less blood in the urine. Rep. Venesectio ad fbij. Hab. Sulph. Magnesite, J et^ injec. Enema Ca¬ thartic. The bleeding produced syncope, and the cathartic operated twice. In the evening the pain shifted towards the left loin, and the pulse was 106, feeble. * An excellent report of this ti'ial may be found in the Times newspaper of March 16, Hab. Haust. Anodyn. He passed a sleepless night ; and on the 7th the pain was very severe about the sigmoid flexure of the colon. He obtained relief by bending the body forwards. Ardor urinse ; urine very bloody. Pulse 114, weak ; bowels slow. Descend. Bain. Tepid., et hab. Sulph. Mag. cum Carbon. Magnes. In coming out of the bath he voided, per urethram, a triangular piece of gra¬ vel, the size of a split pea, after which he felt much easier, and slept a few hours. Pulse rose to 120, and the. ca¬ thartic operated. He now complained of pain in the left testicle. In the af¬ ternoon the urine was voided perfectly clear, and without pain. Pulse 100. During the two following days the pulse remained about 100. He had a few slight attacks of abdominal pain ; urine natural. Warm baths, and fre¬ quent doses of nitrous sether, were ad¬ ministered. On the evening of the 9th the pain returned suddenly, and with great vio¬ lence, in the course of left ureter, ex¬ tending to the testicle and orifice of the urethra, while no change of position brought the slightest relief. There was cold clammy perspiration, and tumid abdomen ; urine clear, and in moderate quantity. The pain and fever di¬ minished in a few hours. From the above date a swelling w'as observable in the left iliac region, which daily increased, and the discharge of urine diminished. The bowels re¬ quired to be frequently stimulated. He continued to pass sleepless nights, and there w7as great anxiety, while the pain in the tumor sometimes increased con¬ siderably. The stomach became irri¬ table, and his strength declined rapidly. Emollient poultices were applied to the tumor, and opiates nightly administered. On the 30th the tumor was very pro¬ minent at the left linea semilunaris, and there was a prickling pain ; pulse 96, soft; urine of natural colour, but voided in small quantities. Taking into consideration the extent of the swelling, which threatened to burst into the abdomen, the many sleep¬ less nights and consequent exhaustion, it was advisable that an attempt should be made to give exit to the contents of the tumor without delay ; and Dr. Stewart (assistant-inspector of hospitals) ULCERATION OF THE KIDNEY AND ABSCESS. 880 having1 arrived from head-quarters, on the 31st October the following opera¬ tion was performed : — The skin, cellular membrane, and abdominal muscles, were divided to the extent of an inch and a half, in the direction ot the fibres of the internal oblique, and about two inches distant from the crest of the ilium, in the line of the umbilicus, and on the iliac side of the apex of the tumor, with the view of keeping clear of' the peritoneal ca- vity. The fascia transversalis appear¬ ing tense, a large trocar and canula were thrust through it ; the trocar be¬ ing withdrawn as the canula was pushed in. Seven pints of urine flowed out, all of which, with the exception of the last few ounces, which were gela¬ tinous, and evidently the exudation from an inflamed surface, was perfectly clear. An elastic-gum tube was intro¬ duced, and tbe canula withdrawn ; ad¬ hesive straps, compress, and bandage, applied. In a few hours after the operation he complained of uneasiness in the wmund, caused by the point of the tube; the pulse rose to 120, and he voided some clear urine by the urethra. The severe pain and tension were completely re¬ moved, and he slept the greater part of the following: nigdit. On the third day after the operation, tbe elastic-gum tube was withdrawn, as nothing had passed by it. He voided urine in small quantities frequently, and with burning pain ; pulse 120, and ab¬ domen rather tense. On the 3d November he vomited re¬ peatedly, and the abdomen was much swollen. Pulse 122, very feeble. Hab. Mist. Camphor, frequenter. On the 4th there was constant vomit¬ ing and hiccough, while the swelling in the iliac region was as great as before the operation. The trocar and canula w'ere again introduced through the wound, and six pints of clear urine came away, which was followed by the slow discharge of two pints of well- formed pus. An elastic-gum tube was retained in the wound. The report on the evening of the 4th, states, that “ a considerable quantity of clear fluid and pus came along the tube, at frequent intervals, during the day ; vomiting ceased, and he slept a little; pulse 120.” Emaciation and debility increased rapidly; be had no appetite; tbe dis¬ charge of urine from the wound ave¬ raged two pints and a half, with one of pus, in the twenty-four hours, — while the urine by urethra amounted to a pint. Bowels required to be kept open by laxatives. On the 13th November a large elastic- gum catheter was passed by the wound eleven inches and a half, and retained there a few minutes. The appetite improved, and, owing to the emaciation and great discharge of pus, his diet was increased. He now had chicken soup, two eggs, and a pint of porter, daily, and took sulphate of quinine with sulphuric acid. At this time he was in an extreme state of debility, and had an ulcer on the sacrum from pressure; pulse 120, but he slept tolerably well. About the middle of December the quantity of pus began to diminish, — the appetite continued to improve, and his mind became easy. Anxious to ascertain if the ureter was pervious (for it was imagined that the opening led into it), an elastic-gum catheter was again introduced by the wound eleven inches, and a pint of milk and water injected with consider¬ able force, none of which entered the bladder, but flowed back by the side of the instrument. A gradual and very visible improve¬ ment was going on in his general health, and about the end of December he was able to sit up an hour daily. There were several symptoms of stone in the bladder, such as ardor u rinse, and great pain at the meatus urinarius while voiding the last drops of urine, along with a mucous deposit. He was sound¬ ed ; the instrument gave great pain in passing the prostatic portion of urethra, but no stone could be felt. In January he remained out of bed two hours daily, and was able to walk about the room ; appetite continued good, and the pus from the wrnund did not exceed four ounces in the twenty- four hours. Sometimes very little urine came by the wound, while the quantity per urethram was increased; for in¬ stance, it is reported on the 9th Janu¬ ary, that “only three ounces of urine, with four of pus, flowed by the wound, and six pints of pale urine by urethra, during the last twenty-four hours; pulse 114; thirst; bowels regular. The elastic-gum tube is still in the wound.” DR. GREEN’S CASE OF LEPRA AND PSORIASIS. 800 On February the 1 1th, it is noted that “ he sleeps well ; pulse 128, feeble ; thirst ; skin hot and dry ; appetite very bad ; has not been gaining- strength for some time past ; feet oedematous. From two to three ounces of pus discharged by the wound daily.” Towards the end of February he suf¬ fered a smart attack of dysentery, but under the use of blue pill with opium, and small doses of castor oil, the severe symptoms subsided in a few days. Emaciation and debility again in¬ creased ; appetite fell off ; he had griping, tenesmus, and vomiting. The urinary affection underwent no change, but he was so weak that he could not sit up even in bed. On 8th and 9th of April he voided a quantity of muco¬ purulent matter by stool ; on the two fol¬ lowing days the stools were yellow and thin. He sank rapidly, and died on the evening of the 11th. Post-mortem examination. — Body much emaciated ; no disease in the head. Chest. — Both lungs attached to the pleura costalis by old adhesions. Ahtlomen. — Peritoneum natural, ex¬ cept over the left kidney and lumbar muscles, where it was of a dark blue colour. This kidney, which was en¬ larged to tw ice its ordinary size, adhered strongly to the surrounding parts ; its tubular portion was destroyed, or con¬ verted into little cells, having a common communication with the pelvis of this organ, and opening besides, by ulcera- ration in the cortical substance at two points, into a sac capable of containing a pint, occupying the cellular membrane in the lumbar region. The mucous lining* of the kidney was thickened by inflammation, and the commencement of the ureter similarly changed in struc¬ ture, and completely closed at this point by coagulable lymph, while in the remainder of its course it was contracted, but pervious. An elastic bougie inserted by the external wound, after taking a direct course for two inches centred in close contact with the outer surface of the peritoneum, turned up into the abscess behind the kidney. Right kid¬ ney of ordinary size, but paler than usual ; its ureter natural. Bladder small ; mucous coat inflamed ; and two superficial ulcerations near the fundus. Mucous membrane of descending co¬ lon and rectum slightly inflamed, soft¬ ened, and covered with pus. There are several points in this case worthy of remark, and a few of w hich it will be difficult to give a satisfactory explanation. The sudden attack, and bloody urine from the commencement, until he voided per urethram a small calculus on the third day. There can be little doubt that the passage of this stone caused the pain and haemorrhage; and the symptoms which supervened would have led us to imagine that the ureter was blocked up, either by ano¬ ther calculus or coagulable lymph, but the appearances on dissection fully prove it was the latter which caused all the disturbance which followed. He had no pain in the loins during the first eighteen days, although the tumor was very manifest between the false ribs and crest of the ilium on the 5th ; at this time the urine was probably con¬ tained in the kidney, and the consequent inflammation terminating in abscess be¬ hind that organ, may account for the pain becoming acute *in the lumbar reg’ion after such a lapse of time*. The patient lived five months and eleven days after the operation, without any great degree of suffering, and might have existed for years with a urinary fistula, if the continued discharge of pus and the dysenteric affection, coming on when in a debilitated state, had not exhausted him. Port Louis, Mauritius, June 14, 1836. CASE OF LEPRA AND PSORIASIS, TllEATED WITH SULPHUR FUMIGATIONS. To the Editor of the Medical Gazette. Sir, With some hope of reclaiming for fumi- gatory baths that justice which is indis- * Dessault observes, “ ces depots ne se mani- festent au dehors que lorsqu’il s’est fait dans les cavites du rein une crevasse par laquelle l’urine et le pus se sont epanches dans le tissu cellulaire, et y out form6 un nouveau foyer qui a us6 ou d6truit en partie les muscles abdominaux. Alors il n’est pas rare de voir paroitre dans les lombes, entre les fausses cbtes et le rebord de l’os des isles, une turneur cireonserite plus ou moins volumineuse.-’ — Traite de maladies des votes u r ina ires. 891 DR. GREEN’S CASE OF putably their due, I send you briefly the treatment and results of an obstinate case of skin malady lately under my care. The subject, a lady aged about 24 or 25, had been afflicted for upwards of nine years. The limbs and body were covered with leprous round spots, from the size of a crown to that of a shilling, with raised red edges, depressed in the centres, and covered with scales. In some parts were large patches of psori¬ asis, irregular in shape and at the edges, not depressed in the centre, but sur¬ mounted by thick scales. The face, and palms of the hands and feet, were the only parts of the body exempt from the disease. The general health had always been remarkably good, save a proneness occasionally to severe headaches. This long-standing disease had come on in the first instance without any apprecia¬ ble cause, but underwent some diminu¬ tion in degreed uring the summer months. The skin was unperspirable and stiff with this encasement, but the itching by no means so distressing as in those assailed with prurigonous diseases — that is, those of the order papillae, ex¬ anthemata, &c. &c. The health, as pre¬ viously stated, was good ; she was quite a stranger to functional derangement, or stomach complaint. I particularize the latter, as that organ has so often to bear the onus of being the cause, or at least the cause of the continuance, of many of these complaints ; whilst on the contrary, in cases of lepra and psoriasis, I have commonly found the stomach in an enviable degree free from dyspeptic ailment. This I know to be at variance with the recorded opinions of most, if not all, writers on the diseases of the skin. After this statement, an apology may seem needful for the medicines that were ordered in this case, in conjunction with the fumigating baths. In short they were ordered empirically, in the hopes that they might occasion or assist in effecting that change or alteration in the system which in the end might prove beneficial to the patient. The lady commenced by taking half a dozen simple vapour-baths, with the view of softening the surface, lessening the ten¬ sion, and detaching the scales; and this was effected. She then took a usual pur¬ gative dose, and the next day com¬ menced with the sulphur fumig’ation, and the following medicines : — LEPRA AND PSORIASIS. R Liq. Hydrarg. Oxymuriat. ^ij. ; Po¬ tass* Hydriodat. gr. xxxij.; Spt. Cinnam. jy.; Aquae Distill. Jv. M. sumatcochl. magnum, mane nocteque. The fumigations were taken, almost without interruption, one daily for six weeks, the time the lady remained un¬ der my care; and to the patches of psoriasis, and the most unyielding of the leprous spots, she used an ointment composed of one drachm of the hydrio- date of potass to an ounce of grease, applied night and morning-. I omit dates in this detail, as needless, occa¬ sioning prolixity, and occupying- more space than you can allow. At the end of six weeks the lady re¬ turned to the country, greatly amended ; and, on her arrival at home, was to leave off the medicine and application, and substitute for them the following: — R Liq. Arsenical, gtt. xviii. ; Liq. Po¬ tass*, 3j.; Spt. Cinnam. Js. ; Infus. Aurantii, ^viiss. M. sumat partem sextam bis die. Pil. Hydr. Submur. gr. v. omni nocte sumenda. The dose of the arsenic to be gra¬ dually increased under proper guidance, and for the former ointment the follow¬ ing was substituted: — R Hydrarg. Oxymuriat. 3ij. pulv. substit. levegat. Vit. Ovi No. iij. Mist. Cer*. Jij. M. To be used night and morning. She was directed to adhere to the last prescription for a month, and then to leave it off and resume the former ; thus alternating the medicines and applica¬ tions, and which, I think, is often at¬ tended with advantage. At the end of two months I received the following letter from the parent of the young lady : — “ Sir,— The time having elapsed that you mentioned before you wished to hear from me, I now have great satis¬ faction in saying that your baths and treatment of my daughter’s complaint have even exceeded our most sanguine expectations, and if it continues, will equal our greatest wishes. The spots have almost totally disappeared, leaving at present a little redness behind, which no doubt time will wear away. When I look back on the length of time she has had the spots, and the total failure of so many eminent medical men’s at¬ tempts to remove them, I must confess I came to you certainly expecting some relief, but not with the most distant 892 DR. GREENES CASE OF LEPRA AND PSORIASIS. hopes of a cure being- effected ; and I shall ever feel thankful that we came to London. She took the medicines as directed, and often uses the Jekyll steam bath, and finds it an invaluable comfort. The skin has peeled off, she thinks, two or three times,” &c. &c. * I do not send you this brief detail as embracing any thing- novel in the com¬ plaint, hut rather to show that by the properly-regulated administration of the sulphur fumigations, a commonly in¬ tractable form of disease may be made to yield in comparatively a short time, but which, under ordinary circum¬ stances, will resist the most judicious means of treatment for a lengthened period, as in this lady’s case. When the sulphur, or other fumiga¬ tions, are not well advised or well managed, they as often do no good ; and by setting up a febrile state of the system, are frequently mischievous in their effects, — disappointing alike the patient and the medical adviser. Yet the fault rests not with the fumigations, but mostly with the adviser, in not duly preparing the patient for their use, or in the case being one for which at first the fumig-ations are too stimulating, — in short, inadmissible, and the latter I very often find to be the case. These means are commonly advo¬ cated for diseases of the skin gene¬ rally speaking ; yet disappointment in the results will always follow in cases of eczema and prurigo, when proper treatment, as rest, mild diet, and per¬ haps bleeding or purging, has not been previously resorted to ; and I do not hesitate to say, that for the success¬ ful treatment of various diseases by the fumigatory method, a practical know¬ ledge of its effects, and of the best way of managing the apparatus, is as need¬ ful as a due knowledge of diseases and their remedies in any other cases where the art or science of medicine is called in aid. Unquestionably it is a powerful the¬ rapeutic agent ; and when any such means are misapplied, we ought not to be surprised if our own errors lead us to disappointment. I am led to these re¬ marks in hopes that, through the in¬ fluence of your excellent and widely circulating journal, they may tend to disabuse the fumigatory treatment from the ill report that now attends it, and * I>r. Green has forwarded to us the original letter.— Ed. Gaz. which is spreading in this country ; and which, if not rectified by medical prac¬ titioners themselves making it a subject of more consideration and interest to them, these excellent means of relief, not only for maladies of the skin, but for a great majority of other chronic complaints, will certainly be brought undeservedly into disrepute in England. How shall we, then, appear to our con¬ tinental neighbours, opposed to this methodus medendi ; whilst each suc¬ ceeding year has shewn more and more the increasing estimation in which these remedial means are held in the treatment of diseases? Witness the astounding- number of upwards of one hundred and eighty thousand of these baths, which have been administered annually at the Hospital of St. Louis alone, during the last three years; and the precision, discrimination, and order, with which they are administered, shew that the treatment after this method has become part of a regular system of therapeia. What are we to expect, then, but disappointment, if not discredit, if any person, however deficient in the neces¬ sary knowledge, shall be allowed to assume to advise, and to administer, fumigating baths, and those baths im¬ properly constructed, and mal-managed ? Yet such is the case here; and at pre¬ sent I know but of one redeeming cir¬ cumstance that tends to check this growing evil, and by which its other¬ wise baneful tendency is abated, viz. the knowledge, the constant care and atten¬ tion ; and, not the least circumstance, the expenses which are necessarily attend¬ ant upon the conducting of a correct fumigatory establishment, are such as to stamp with an almost certainty of failure every employment of the re¬ medy where these essentials are want¬ ing-. And I cannot help expressing my conviction, that it is the duty of every medical man who recommends the em¬ ployment of a powerful therapeutical agent, to assure himself that the agent is correct, and properly administered ; and so protect his own reputation by shielding- his patient from the conse¬ quences of its improper application. I am, sir, Your obedient servant, Jonathan Green. 40, Great Marlborough-Street, March 6, 193 7. dr. edwin Harrison’s strictures on laennec. 893 STRICTURES on certain PHRASES AND CONFLICTING OPINIONS, IN laennec’s celebrated work. To the Editor of the Medical Gazette. Sir, I purpose, in the following’ paper, to make a few passing remarks on the work of Laennec, but without entering into many of those nice and difficult questions concerning which the most experienced auscultators frequently hold different opinions. By placing together, under the eye of the student, some quotations remarka¬ ble for their extravagance, he will per¬ haps be more strongly impressed with the necessity of exercising a reasonable scepticism on this subject in general, than he w ould be by reading them se¬ parately. Those which contain contra¬ dictory opinions are naturally calcu¬ lated to produce the same effect. These considerations may serve in some degree as an excuse for the great proportion of Laennec’s remarks intro¬ duced into this article. Had I con¬ tented myself with merely referring to them, there is little probability of their having been looked into so far as re¬ gards my present object. They may serve, too, as a starting- point for future observations, more espe¬ cially if any injudicious admirer of Laennec should attempt to defend him, or to follow his example in these re¬ spects. If some of the assertions con¬ tained in his work had not so utterly bid defiance to every thing like modera¬ tion, the task of criticism might have been an easier one ; but what can be said in refutation of statements which might almost remind one of the extra¬ vagances of romance ? If I speak strongly on this subject, it is because I feel strongly, and know too well the great evil which may result from' the manner in which auscultation has been presented by Laennec, not to mention many others who have assisted in injuring a really good cause, by putting forth exaggerated pretensions iii its favour. Introduction. u Some of the signs given by mediate auscultation are very easily perceived (tres faciles a saisir), and it is sufficient to have heard them once in order to recognize them ever afterwards. Of this kind are those that indicate ulcers of the lungs, great hypertrophy of the heart, fistulous communication between the pleura and the bronchi, &c. Further on he says, “ It is sufficient to have watched a disease tw7o or three times to learn to recognize it with cer¬ tainty ; and the greater part of the affections of the lungs and heart are so common, that after having sought for them for a week ( pendant huit jours ) in an hospital, there will only remain a few rare cases to be studied, which, with few exceptions, will be met with in the course of a year if almost all the patients are examined with attention.” He admits that a medical man entirely devoted to private practice can¬ not be expected to follow an hospital for so long a time, but suggests that the physician should inform his “ confreres” when he meets with any rare or interest¬ ing case. “ In this way any practitioner may learn in a short time to recognize with certainty, not only the cases men¬ tioned above, but also peripneumonia, pleuritis, latent catarrhs, — the least ru¬ diments of these affections .” Can the English language supply terms sufficiently strong to characte¬ rize the extravagance of the greater part of the preceding assertions ? De VInspection des Parois de la Poitrine. On this subject the expressions of Laennec seem to have been strongly in¬ fluenced by his own invention and highly valuable discoveries. With re¬ gard to phthisis in particular, the flatten¬ ing of the upper part of the chest cor¬ responding to the disease, and more especially, perhaps, the heaving of the shoulders, and the dragging up instead of the expansive motion of the ribs, oug-ht seldom to leave much doubt as to its nature. After some attention to these points, the diagnosis may fre¬ quently be made with little diffificulty, even through the ordinary clothing of the patient, especially when the shoulders are thrown back. Chap. II. — On Percussion. It must be recollected that Laennec had in view immediate percussion. His remarks are excellent, although leaning to the side of severity. We shall here¬ after see, that upon particular occasions lie viewed this subject in a more fa- 894 pr. Edwin haurison’s strictures on laennec. vourable light, and seemed almost to forget that “practice, dexterity, and great attention, are requisite for obtaining ac¬ curate results by percussion” (la percus¬ sion ne donne de resultats exacts qu’au- tant que Ton y apporte de l’habitude, de la dexterite, et une grande atten¬ tion.) De V Auscultation de la respiration. After statfng that in persons whose lungs are very healthy the respiratory sound is sometimes very weak, or al¬ most inaudible, and mentioning some of the circumstances in which this oc¬ curs, Laennec advises that in these and all other cases where that sound is very feeble, the patient should be made to cough, in order to produce a full inspi¬ ration ; the same result being some¬ times obtained by making him speak or read, and especially recite, some phrases consecutively. These directions are very proper; but in attempting to act upon them, it will often be found difficult to make patients either cough, or speak, or read, or re¬ cite, in such a way as to produce an inspiration fitted for the object in view. After giving some rules for exploring the respiration, he adds — “ All these precautions, however, are only neces¬ sary for beginners. In a month or two the ear becomes accustomed to distin¬ guish, amidst the sounds that reach it at the same time, that particular one of which it is in search, and to hear it in some degree exclusively, even when it is weaker than all the others.” I suspect that few can justly boast of such success as this. “ When the respiration is heard dis¬ tinctly, and with nearly equal strength, in all parts of the chest, we may affirm that there is neither effusion in the pleura, nor engorgement of any kind in the pulmonary tissue. “ When, on the contrary, the respira¬ tion is inaudible over a certain extent, it may be affirmed that the correspond¬ ing part of the lung has, from some cause, become impervious. This sign is as well marked, and as easily per¬ ceived ( aussi caracterise et aussi facile a saisir) as the existence or absence of sound distinguished by percussion, ac¬ cording to Avenbrugger’s method, and it indicates precisely the same thing.” The manner in which percussion is spoken of in this last sentence will no doubt restore the spirits of those who might have been somewhat discouraged by reading the chapter on that subject. If we now turn to the Section troisieme — Des productions accidentelles deve- loppees dans le Pounion , we shall find something scarcely reconcileable with one of the preceding remarks. “ When any tumor is of rather con¬ siderable size — that of an egg, for ex¬ ample, the stethoscope indicates its pre¬ sence by the absence of respiration in that part. But when the tumors are small, however numerous they may he , auscultation affords not the slightest indications (V auscultation n indique plus rien ), if the pulmonary tissue between them is otherwise healthy. “ I have often heard respiration ef¬ fected with equal force and clearness (avec une force et une nettete eg ales), on both sides, in individuals who, when opened, presented one lung’ in a healthy state, or containing only some tubercles of very small volume, and the other filled with tumors of the same kind, varying’ in size from a millet seed to a filbert, and so numerous, that this, lung was at least doubled in weight.” But to return to “ l’auscultation de la respiration,” — respiration caverneuse, Of this I shall content myself with say¬ ing that a long course of study will be found requisite for attaining such a de¬ gree of skill as shall justify a decided opinion about it in general ; nor will even this exempt any one from the necessity of great caution in many in¬ stances. As to the remark, that, in cases of doubt, other phenomena afforded by the voice or cough speedily remove all un¬ certainty, it would have more value if the voice and cough were not them¬ selves of most difficult interpretation. De Vegophonie. Let the student recollect, that, ac¬ cording* to Laennec, eegophony cannot be fully relied upon as a sign, unless it consists in a bleating, shrill, and silvery resonance, at the surface of the lung, (l’egophonie n’est vraie et sur comme signe que quand elle consiste dans une resonnance chevrotante legere et argen¬ tine a la surface du pounion,) and he will not lightly pronounce as to its pre¬ sence. Such an eegophony is, I apprehend, of rare occurrence ; and perhaps Laennec has rather limited than too much ex¬ tended the powers of auscultation in dr. edwin harrison’s strictures on laennec. 895 this instance. There are superficial “ fremissemens,” scarcely accompanied by the other characters mentioned, which appear to be sufficient proofs of the existence of liquid in the pleura. De V Auscultation de la Toux. To distinguish the resonance of the cough in a large bronchus from its re¬ sonance in a cavern, is, in many cases, a most difficult task, and the attempt too often serves to lead into doubt or error. When a timid patient coughs only from the throat, without producing any resonance in the bronchi, the remedy proposed is to invite him to take a deep inspiration, and then to cough. On a former occasion we were taught to make a patient cough, in order to produce an inspiration ; and now we must make him take a deep inspiration, in order to reach the cough. It happens rather unfortunately that these difficul¬ ties generally occur in the same indi¬ viduals. De /’ Auscultation du Rale en general. Speaking of a sort of“ leger fremisse- ment,” which each species of rale im¬ parts to the cylinder, whenever the point where the rale takes place is situated under that to which the cylinder is ap¬ plied, he says, among other things, that when the rale exists (■“ a son siege”) in a part distant from the point where the cylinder is applied, although it may be heard distinctly, and even strongly, the “ fremissement” in question cannot be perceived ; and that when it cannot be perceived on any point of the surface of the chest, the “ rale” is situated in the most central parts of the lung. “ This sign may, in the reading, ap¬ pear to be a refinement (subtil a la lec¬ ture) ; but I can affirm that nothing is more easily perceived (que rien n’est plus facile a saisir), and that some minutes’ study are scarcely necessary for learn¬ ing to distinguish, with the help of the stethoscope, the distance of the point where the rale is produced (le degre d’eloignement du point ou le lAle a lieu).” To criticize an assertion which no one will probably be so unwise as to defend, might seem an useless task. De la Dilatation des Broaches. When the dilatations occupy the ordinary situation of tubercular ca¬ verns, auscultation may be a source of error. When, however, they are con¬ fined to the lower and middle portions of the lungs, without caverns or dilatations in the upper, auscultation may throw much light upon the nature of the dis¬ ease. Signes physiques de la Pleuresie aigne. It is scarcely necessary to prove that one of the most valuable signs of the presence of liquid in the pleura is a va¬ riation in the sound from percussion, accompanying a change of posture in the patient, and which variation is well explained by the situations occu¬ pied by the lung, and the liquid in those different postures. That a satis¬ factory result cannot always be obtained by this means, either from the patient’s debility, his unwillingness to facilitate the inquiry, or from other circumstances, is very true, but notwithstanding* these exceptions, this sign is deserving of the utmost attention • CorviScirt, in liis commentaries on the work of Avenbrug*- gei, has spoken with decided approba¬ tion of this means of diagnosis, and has descuoed his own mode of employing it. Laennec, who has quoted Corvisart onseveial other occasions, contents him¬ self here with saying, that he had seen quelques medecins” try to obtain a distinguishing sign between pleuritis and peripneumonia, by placing the patient m different positions, and that he had made the experiment himself, without obtaining any satisfactory re¬ sult. This, I will venture to affirm, was not the fault of the method, which is fiequently applicable even in cases where the quantity of fluid is very con¬ siderable. Adhesions may destroy its value, or the contrary, according to their extent and situation. In the article, however, “ Des signes et des symptomes du Pneumothorax,” the skill of Corvisart in percussion, and his failing to recognise the disease by its means, are not forgotten. “ Here I shall merely remark, that during my attendance on the instructions of Corvisart (pendant que je suivais les leqons de Corvisart), I witnessed the opening of many subjects affected with pneumothorax, in none of whom had the disease been suspected.” “ The talent for observation of this celebrated professor, and his skill in 898 DISCOVERY OF CILIARY MOTIONS IN THE CAVITIES OF THERRAIN. profiting’ by percussion (a tirer parti de la percussion), will not be denied by any one ; and consequently the best proof of the insufficiency of that method for re¬ vealing’ the existence of pneumothorax, is the circumstance of its not having* been recognized in those cases.” Exploration des organes cle la Circula¬ tion. “ The application of the band, the sole means of exploration before Aven- brugger, seldom gives any result, and frequently leads into error as to the real force of the heart’s impulse.” I apprehend that the force of the heart’s impulse can be as well judged of in general by the hand as by the stethoscope, whilst the former gives a sensation of the volume of the heart as a whole, and of the left ventricle in parti¬ cular, much more accurate, perhaps, than the latter. That gradual heaving, so characteris¬ tic in many instances of a large and powerful left ventricle, can be felt at a given time over a greater space by the hand than by the stethoscope*. The different “ bruissemens,” whether in the heart or arteries, have been the source of much ingenious speculation. With regard to the disturbance of the currents of blood by diseased valves, disproportioned outlets, projections into the arteries, &c., as a cause of these “ bruissemens,” one consideration rather embarrasses me. On looking* up the aorta, there may be seen at a moderate distance from the heart, three openings (to the arteria innominata, left carotid and subclavian arteries), with edg-es apparently calculated to produce whirls and eddies every time the blood is sent from the left ventricle with any degree of force, and yet “ bruissemens ” are only occasional there, as well as at other divisions of the arteries. This objection may, however, have been already made and refuted, without my being at present aware of it. Edwin Harrison. Grove.Terraee, Lisson Grove, March 7, 1837. * For a practical conviction of the valuable information to be derived from applying the hand to the cardiac region, and also from attending to the mode of respiration in phthisis, I am indebt¬ ed to Dr. Chambers. DISCOVERY of CILIARY MOTIONS IN THE CAVITIES of the BRAIN. By Purkinje. I have succeeded at last in discovering the Ciliae and their motions in the ven¬ tricles of the brain in the mammalia. Last summer, while examining the Chordae Bergmanni, I perceived, on fine sections of the epithelium, a struc¬ ture resembling the ciliary membranes* and suspected that this epithelium pos¬ sessed a similar function. I thereupon made numerous investigations with this object in view, but without any result until the 23d of May, when I succeeded in discovering the ciliary motions in a state of the most beautiful activity, on the edge of the Tenia Hippocampi, in the tolerably mature foetus of a sheep thirty hours after slaughter. They now appeared quite distinct over all the wind¬ ings of the ventricles, and they could be plainly distinguished, even where they did not appear in motion. I followed the motions, without difficulty, through the third ventricle to the infundibulum, to the olfactory tubercles, and finally tbroug'h the aqueduct of Silvius into the fourth ventricle. Here the motion ceased, but the cilice were still distinctly observable, although somewhat shorter than in the foregoing situations. The ciliae are proportionably long, pointed (not ragged, as in the bronchial tubes), and exhibit a whip-like vibra¬ tion ; we perceive also a layer of gra¬ nules to which they are attached, and which are very easily rubbed off with¬ out destroying the continuity of the epithelium. The other day I examined the brain of a sheep, in which they could also be perceived with great faci¬ lity. They have been seen likewise by Dr. Valentin, in the tolerably matured foetus of a sow ; in another foetus of the same description, at a much earlier pe¬ riod, they could not be distinguished: probably the parts are too delicate for our clumsy instruments. On the whole, I have perceived from these few ex¬ aminations, that the cilice found in the ventricles of the brain possess a finer degree of sensibility, and are much more easily destroyed, than those of any other organ. I have not been able to discover them in the brain of a sparrow, or of a carp, which I examined ; but cannot, on this account, draw any con- DR. DICK. S CASE OF HYPERENCEPHALOUS MONSTROSITY. 897 elusions as to their non-existence. I co uld not detect any traces of them in a deceased human brain which was sent me : probably they are very tran¬ sient, (as appears to he ascertained from the female ovary, and the mucous mem¬ brane of the nose), blit as easily repro¬ ducible. I could not find any ciliae in the membrane of the choroid plexus ; but I have made long since a very in¬ teresting- observation on this membrane. The whole plexus is covered by a pecu¬ liar matter, like the granular substance of the ganglions, and composed of the most regular granules, each of which contains a small corpuscle in its centre. This membrane appeared to me at the time as belonging to the nervous tis¬ sues, although at present I see many reasons to look upon it as epidermal *. CASE OF HYPERENCEPHALOUS MONSTRO¬ SITY; CONJOINED WITH OTHER MONSTROUS FORMATIONS. To the Editor of the Medical Gazette. Sir, The following abnormal conformations were met with lately in a dead-born foetus of the 7th month, the product of a first pregnancy in a young' married female. The cranial bones were deficient above plane of occipital protuberance, so that a great part of occipital bone, the whole nearly of both parietals, and almost the whole of frontal bone, were wanting. Beyond the margins of these hones a large nodulated cerebral mass protruded, covered with a smooth, fibrous-like mem¬ brane, of a dark red colour, continuous with the scalp. The inside of this firm membrane presented a villous or pulpy appearance, with cord-likebands running along it in different directions. Through the interstices of these bands the brain formed several encephalic swellings, giving it, as above stated, a nodulated appearance. One of these encephalo- celes, situated where the posterior fonta- nelle ought to have been, was nearly * Dublin Journal, March 1837. 484. — xix. the size of a small hen’s egg, formed by the protrusion of a considerable part of right posterior cerebral lobe. In its centre a clot of blood of considerable size was found. At the summit of mid¬ dle lobes of cerebrum there were two other smaller protuberances, of a flat¬ tened form. The one on right side was larger of the two, and attached to its base there was a portion of membrane in every respect resembling’ the foetal envelopes, forming a sort of open, elon¬ gated pouch. This membranous pouch in structure bore no resemblance to the membrane investing brain, nor did it present the characters of common false membrane, but seemed really part of the foetal membranes, with which we pre¬ sume the brain had, at this part, during an early period of intra-uterine life, be¬ come united. Two or three additional small ence¬ phalic swellings were observed above and behind ears, and one about the size of a nut, at lower part of middle of fore¬ head. The substance of brain was very soft and congested, containing a few small bloody extravasations, in addition to the one above-mentioned. Its convolu¬ tions were not very distinct. It was fully larger than is commonly found in a well-formed foetus of the same age. It appeared low and narrow anteriorly. The base and central parts were well developed, and the nerves sent off from it well formed and regular. Cerebellum, as to size, natural, but covered with a thin layer of coagulated blood. Bones forming base of cranium perfect, as also spinal column. The face, which was of a brownish red colour, presented a very unnatural appearance. The eyes were wide apart, and prominent. In place of the usual conformation of nose, there were two small roundish apertures, corresponding to nostrils, sufficiently large to admit the point of a common quill, through which the spongy bones were visible. These apertures were about half an inch apart, and from each of them a fissure, or groove, between three and four lines in width, passed obliquely upwards and outwards, running close to inner canthi of eyes, and terminating about half an inch above superciliary ridges. These grooves were lined with mucous mem¬ brane, continuous with that lining inter- 3 M 898 DR. DICK’S CASE OF HYPERENCEPHALOUS MONSTROSITY. nal nares. Superiorly they became gra¬ dually more superficial, till lost in the adjacent skin. A narrow bridle of skin was stretched obliquely across the upper part of the one on right side. The right side of upper lip was cleft in same line as corresponding groove in cheek, and the traces of consolida¬ tion of a similar division on left side were visible; the line of junction being slightly depressed and irregular. The ossa nasi and nasal cartilages were defective. The other bones of the face were well developed, and the con¬ stituent parts of superior maxillary bones firmly united. There was a fis¬ sure in fore-part of hard palate, not ex¬ tending through the hone. Its edges "were thick and slightly everted. The abdominal parietes, from inferior extremity of sternum to the insertion of umbilical cord, were patent, and even¬ tration of liver, stomach, with the spleen and intestines, existed. The liver was large, and somewhat different in shape from what it usually is. It extended from upper part of right side of chest, obliquely downwards, to the left of um¬ bilical cord, with a deep notch in its in¬ ferior extremity, into which umbilical vein entered. It w^s slig'htly attached to diaphragm at its posterior surface. The other abdominal viscera presented nothing* worthy of particular notice. The ribs on right side, in place of arching forwards to be articulated wdth sternum, were bent downwards, form¬ ing a very acute ang'le with the ver¬ tebra;, reaching to the spine of ilium. The upper ones were slightly twisted upon themselves. From the unusual direction of ribs the pericardium imme¬ diately came into view, on the integu¬ ments being raised from front of chest. Heart normal. Two-thirds of right side of sternum defective. Right superior extremity was want¬ ing. On dissection, we found the cla¬ vicle in a rudimentary state, balanced between the sterno-mastoid and subcla- vius muscles. There was no scapula; but a little below' distal extremity of clavicle, lying on lateral aspect of two of the upper ribs, a small cartilaginous body, of irregular form, was found, to which the trapezius, rhomboideus, and serratus magnus, wrere attached. The latissimus dorsi and pectorales muscles were wanting. The cervical nerves on this side were scarcely perceptible filaments. The cirteria innominata , as usual, divided into two branches. The carotid coursed up the neck as usual, but the other branch, corresponding to the sub¬ clavian, after giving off" the inferior tbyroideal, passed upwards and out¬ wards under internal jugular vein, and entered the transverse processes of the vertebrae, at points where the vertebral usually enters. No branches correspond¬ ing to the transversalis colli, internal mammary, or supra-scapular arteries, were given off" from the above artery, before entering the vertebrae to ascend to the encephalon. At its origin it was nearly as large as the carotid. We may state that the placenta pre¬ sented no pathological lesions, and the labour w7as natural. Although several irregularities of or¬ ganic formation are not unfrequently conjoined in the same subject, it is not often, we believe, that such a combina¬ tion as the above is met with. The monstrosities which the face exhibited are of rare occurrence. Klein and Nicati were the first who particularly noticed them ; they have since been described by M. Laroche under the title of congenital fissures of the cheeks. According’ to M. Isid. St. Hilaire, they arise “ du defaut de soudure ou de la soudure tres-tardive de deux des cinq pieces principles, qui, d’apres MM. Serres et Beclard, composent la ma- choire superieureehez l’embryon, coniine le bec-de-lievre depend du defaut de soudure ou de la soudure tres tardive de l’inter-maxillaire et du maxillaire Like hare-lip, these fissures or grooves may be simple or double, and vary in extent. They are seldom observed ex¬ tending so high as in our case. Much light has of late been thrown on the laws which regulate the produc¬ tion of monsters. Meckel, St. Hilaire, Serres, and others, have shown that arrested, retarded, and excessive de¬ velopment of the various organs, are sufficient to account for a large propor¬ tion of these irregular beings ; but as it would be out of place to enlarge on this subject, w7e may be allowed to state, that the hypertrophy of the brain pro¬ bably originated from the increased * Trait6 de Teratalogie, t. i. p. 552. INQUIRY INTO THE WORKING OF THE POOR-LAW. 899 quantity of blood sent to it through the subclavian artery, which, as has already been stated, took the usual course of the vertebral, and that, by the teratological law of antagonism, or “ balancement,” the cranium was corresponding'ly atro¬ phied. St. Hilaire is of opinion that adhesions between the ovum and its envelopes are occasionally the cause of congenital deformations ; and those of the head in our case might partly be de¬ pendent on this cause. Nicati has described a monster, which, like ours, was affected with fissure of the cheeks and hare-lip, and in which the umbilical cord, after its exit from the abdomen, was rolled round the head, and con¬ nected with a prolongation on top of head, which he supposed to be a branch of the umbilical cord, but which was probably merely something analogous to what was met with in our case. On Nicati’s case St. Hilaire makes the fol¬ lowing remarks : — “ On peut supposer avec beaucoup de fondement, comme l’a fait mon pere, que la pretend ue- branche cranienne du cordon ombilical etait un simple cordon tegumentaire etabli entre le placenta et la region de la fete qui presentait le vice de con¬ formation; en d’autres termes, une de ces brides d’adherence que 1’ ou voit si souvent etendues entre les parties frappees d’anomalies et le placenta ou les membranes de l’ceuf, et qui, par le tirage qu’elles ont pu exercer sur ces parties, auraient mis obstacle a leur developpement regulier The absence of the upper extremity is satisfactorily accounted for by the de¬ viation of the subclavian artery, and so far supports M. Serres’ opinion, that all organic deviations result from irregu¬ larity or deficiency of the vascular sys¬ tem, — an opinion supported by many strong arguments, but not altogether free from objections. The foetus above described is now in the possession of my friend Mr. J. Douglas. — I remain, sir, Your obedient servant, Walter Dick. Glasgow, Feb. 27, 1837. MEDICAL GAZETTE. Saturday , March 11, 1837. “ Licet omnibus, licet etiam rnihi, dignitatem Artis Medico; tueri ; potestas modo veniendi in publicum sit, dicendi periculum nonrecuso.” Cl OE RO. PARLIAMENTARY INQUIRY INTO THE WORKING OF THE POOR LAW. Several letters have been sent us, during the last week, on the subject of the medical arrangements under the present Poor-Law : we publish a selection from them which we think will be found interesting, and to which, we have no doubt, a high degree of im¬ portance would be attached were we at liberty to disclose the writers’ names. The “Retired Practitioner” may be excused on the score of his position for not being aware of our having antici¬ pated him on some of his topics : it is satisfactory, however, to find him re¬ commending the very same kind of ex¬ pedients that we have proposed — parti¬ cularly with reference to the propriety of the corporate bodies interfering in behalf of their licentiates and alumni. The members of the corporations have the same opportunity of knowing, in their corporate as in their individual capacity, the grievances by which the great mass of the profession in the pro¬ vinces are oppressed — while their means' of being useful are certainly not the more circumscribed by belontrina- to those institutions which originate the- different orders of practitioners. “ Chi- rurgus,” indeed, who is manifestly in the councils of “his order,” informs us that the College of Surgeons has inter¬ fered, but ineffectually. Does it follow, however, from this, that they set the right way to work ? Were the steps of their procedure prudent and well ad¬ vised? Have they yet presented any * Loc. cit. p. 5!)3. 900 INQUIRY INTO THE WORKING OF THE POOR-LAW. petition to parliament, praying’ for a redress of those abuses and grievances to which their licentiates are so notoriously exposed ? Society rings with the com¬ plaints made of the mode in which the Poor-Law functionaries have misma¬ naged the medical part of the system : their “ tendering*” and intimidations, their threats, insults, and degrading treatment of medical practitioners, are every where talked of. Now it appears to us that the corporate bodies, if they have any doubt as to the facts, ought to inquire into them, — the occasion justifies almost any depar¬ ture from old rules : and should \ they in the course of their researches obtain, as we have no doubt they would, the amplest confirmation of the hard¬ ships and indignities suffered by men undeserving of such treatment — men who hold their diploma, and who are in great measure reduced to such extre¬ mities by being thus connected with an overstocked profession — we repeat, that those bodies are bound to intercede, with all discretion certainly, but with¬ out bating a jot of firmness or determi¬ nation to have justice. Important, however, as it is, that the medical corporations should take a lead¬ ing part in asserting the rights of the profession, it must mainly depend on the general body of practitioners throughout the kingdom to crown the object with success. As our correspon¬ dent, who subscribes himself “ Per¬ sonally unaffected,” recommends, peti¬ tions should be got up in every town and village where there are medical men : the appeal for justice should be made to both Lords and Commons : no apathy should be displayed in an hour so critical. Facts and evidence should be forthcoming ; the views of individual practitioners, wrho have bestowed time and attention on the consideration of the subject, should be submitted to parliamentary cognizance; and above all, where plans for adjusting the com¬ plicated difficulties of the question have been devised, they should be laid be¬ fore the legislature without the loss of a moment. It is well known that what is everybody’s business is no¬ body’s business, and that unless some two or three persons consult together, to perform that which it is the interest of the community to see accomplished, the work will always remain undone. Luckily this disposition to shift off one’s own shoulders the business of me¬ ditating and acting for the common good does not universally prevail amongst us. We were last week ena¬ bled to point out some exemplary in¬ stances of the contrary. In our last number we published the observations of the Messrs. Rumsey and Mr. Ceeley, regarding1 an improved plan of medical relief for sick paupers. These gentlemen, with most commendable zeal, have deeply reflected on the diffi¬ culties embarrassing' the present system, and have arrived at some expedients which seem well adapted to remove im¬ pediments. Their demonstration of the necessity of a Medical Board, on the plan of those directing the medical concerns of the army and navy, is con¬ clusive ; and their strictures towards the abolition of the “ tender” and lowest possible remuneration system, have much force. But our readers, we trust, have perused the document for themselves ; our reason for at present noticing it is to draw' attention to an Appendix since published by the same authors. Dur¬ ing the w'eek, the Observations, together with the Appendix to which we allude, have been presented to the public in a pamphlet shape ; we may therefore com¬ plete our edition by at least some ac¬ count of the additions, regretting that our space will not allow us to give them more at length. INQUIRY INTO THE WORKING OF THE POOR-LAW. 901 The first paper in the Appendix is from the pen of Mr. Robert Ceeley, of Aylesbury, in which the author pro¬ poses, as a sort of fundamental princi¬ ple, that medicines and medical attend¬ ance for paupers should not be supplied from the same source. “ Medicines, leeches, and other ap¬ pliances, should be purchased at the joint expense of all the parishes of a Union, be deposited in an appropriate place, in a Dispensary, in a convenient part thereof, and be put under the care of a proper person (a Dispenser), who should dispense the same according* to the directions only of the several medi¬ cal officers of the Union. “ Each distant parish should have a sufficient supply of medicines, prepara¬ tions, &c. for ordinary use, deposited in an appropriate place, for the wants of the paupers of that parish, and under the care and direction of the parish medical officer. “ In all urgent cases, sick paupers would thus be spared the trouble, time, and delay of sending* to a distance for medicine; other cases not so urgent might, if necessary, be dispensed for at convenience, at the central Dispen¬ sary. Thus the delay in the adminis¬ tration of important remedies would be prevented, and all temptation to with¬ hold suitable medicines, or the suspicion thereof, \ would be completely removed.” With regard to the fitting remunera¬ tion for medical attendance — a most dif¬ ficult and complicated problem — Mr. Ceeley lays down a scale which seems moderate and fair. Number j of Population. At per Head, Total. s. d. £ s. d. 150 1 0 7 10 0 300 0 11 13 15 0 500 0 10 20 16 8 1 ,000 0 9 3? 10 0 2,000 0 8 66 13 4 3,500 0 7 102 l 8 5,000 0 6 125 0 0 “ Distant parishes to pay in addition the customary charge for journeys ; onejourney only being charged to any village on the same day, with the ex¬ ception as before mentioned. Thus, while no adequate inducement to need¬ less attendance is offered, the important item of distance is fairly and easily provided for.” In workhouses, he proposes that the payment should be per head per annum, graduated according to numbers : jour¬ neys also being’ chargeable where the medical officer resides at a distance, and is suddenly called on. Midwifery cases, dislocations, fractures, and capital opera¬ tions, to be liberally paid for extra. Mr. H. W. Rumsey, in the second document of the Appendix, states his views on the same subjects — provision of medicine, and remuneration for medi¬ cal attendance. Like his colleague, he thinks that medicine and attendance should proceed from different sources, but very properly suggests the difficulty of establishing depots of medicine in other places than tolerably larg’e towns and Union workhouses. “ In rural districts, where none of these methods could be adopted, — for instance, in places where no one competent to dispense medicines con/d be procured , or where the expense of a separate esta¬ blishment would be out of proportion to the benefit, or where only one medical officer might reside, — the alteration would appear hardly practicable, and the medical officer might himself con¬ tinue to provide the medicines.” The scale for remuneration proposed by Mr. H. W. Rumsey does not seem to differ much from that of Mr. Ceeley. He calculates by the number of cases per annum; and his graduation is as follows : — Number of Cases. At per Case. Sum Total. 5. d. £. s. d. 25 6 0 7 10 0 50 5 6 13 15 0 100 5 0 25 0 0 200 4 6 45 0 0 400 4 0 80 0 0 800 3 6 140 0 0 1,600 3 0 240 0 0 902 EVENING MEETINGS AT THE COLLEGE OF PHYSICIANS. A second method is also proposed, by a payment, per head, on the average number of regular paupers, or those who are in the receipt of relief in money or in kind. Mr. W. H. Rumsey says again, “ The scale for payments according to the number of paupers should be com¬ piled on the same principles as the fore¬ going .scale for a payment per case; but in estimating the respective amounts, it should be remembered that, owing to the chang-e in the administration of relief, the term “ pauper” is becoming more and more exclusively confined to the aged , the infirm, and the diseased ; - — thus of course the rate of remunera¬ tion must be increased proportionally.” Journeys, midwifery, and capital ope¬ rations, to be paid for much in the same manner as proposed by Mr. Ceeley. The two other papers in the Appen¬ dix chiefly relate to the formation of the governing Boards. A Board is re¬ commended consisting' of three medical men, two of them appointed by the government, and the third by the medi¬ cal faculty. But whether the latter ap¬ pointment should be vested in the heads of the profession or in the whole faculty, the writer does not venture to decide. We think he needlessly raises a question on this point which might lead to much unpleasantness and trouble. EVENING MEETINGS AT THE COLLEGE OF PHYSICIANS. The first evening meeting of the season took place on Saturday the 4th. It was very numerously attended, and we observed among the company Lord Melbourne, Lord Goderich, Lord Stanley, several dignitaries of the church, and many other distinguished persons. But it was remarkable — and we beard it made the subject of remark — that very few either of the Fellows or Licentiates of the College were present on this oc¬ casion. The arrangements were in several re¬ spects exceedingly bad. The President’s chair was placed at one end of the room, of which a portion was separated from the rest by a row of chair? almost as com¬ pletely as if it had been railed off. Be¬ hind this barrier the company (with the exception of the fortunate few) collected in a dense mass; and as they could not hear, they had recourse to talking, so that there was a constant and rather loud buz of conversation, by which the voice of the orator was sometimes nearly drowned. It answers much better, and has much less of an exclusive appear¬ ance, to place the President’s chair in the centre of the room; and it would be a great accommodation, as well as one very easily procured, to have a number of benches (such as are let out for routes) arranged round the sides of the apartment. Neither can we compliment the party who ma¬ nages the purveyor’s department on his success. There were not nearly enough of attendants, and various parts of the equipage (particularly the very necessary one, of teaspoons) were lamentably defi¬ cient. We mention these apparently trifling circumstances, because, taken collectively, they tended to produce an unfavourable impression. The learned President, on whom the task of supporting these meetings seems almost exclusively to rest, read a paper “ On the Effects of Cold on the Human Frame.” It was remarkable for tbe same display of literary lore by which Sir Henry’s former Essays have been characterized. We subjoin the paper nearly as it was read, with the exception of some of the more lengthened classical quotations. On the Effects of Cold. By Sir Henry Halford, Bart. &c. &c. Thelearned Presidentbegan by allud¬ ing’ to Dr. Hawkesworth’s account of Captain Cook’s voyag’e round the world, in which we find it stated that Sir Joseph Banks and Dr. Solander landed on Terra del Fuego, and determined to make an expedition into the country in pursuit of some objects of natural his¬ tory. They were accompanied by a draftsman, and nine other attendants; but previously to commencing their walk. Dr. Solander, a native of Sweden, and well acquainted with the effect of ex¬ treme cold in the mountainous country between Norway and Sweden, thought it proper to warn the party ag'ainst yielding to a propensity to sleep, which the extreme cold and fatigue would ine¬ vitably occasion in them, as, if they in¬ dulged it, they would wake no more. SIR HENRY HALFORD ON THE EFFECTS OF COLD. 903 This inclination to sleep the Doctor him¬ self was the first to feel, and finding* it irresistible, implored the party to go on, and to allow him to follow in half an hour. This could not be permitted after such a warning as he had pro¬ nounced, and they dragged him along, and carried him for some time. Never¬ theless he slept for five minutes, and it was discovered that the muscles of his feet were become so contracted, that his shoes dropped from them, and he could wear them no more. The party lost their way in a snow storm, and were detained on shore two days and nights, with a very meagre inadequate stock of provisions, and the unhappy result of the expedition was, that a black servant, and two others of the party, were left behind dead in the snow. You may remember, perhaps, con¬ tinued Sir Henry, that Xenophon, in his modest and beautiful narrative of the return of the 10,000 Greeks after their invasion of * Persia under the younger Cyrus, whose death in the bat¬ tle of Cunaxa (near the site of the modern Bagdat), rendered their retreat necessary, encountered some unusually severe weather in Armenia, which proved fatal to a part of the army. It had marched three successive days in the snow, and on the last a strong north wind having* arisen, which blew in the faces of the men, thirty soldiers died in one night, seared, as if burnt, and stiff¬ ened by cold. The word an oKaiwv, which is used by the Greek author, is notable, and Virgil expresses the same idea in terms so alike as to be almost a literal translation of Xenophon’s account — “ Boreas penetrabile frigus adurat.” We have also the same effect of cold described by Livy, in speaking of its influence on the animals passing over the Alps — “ Torrida membra gelu j” And Milton has it — “ And frost performs the effect of fire.” But there are some other military ex¬ peditions in modern times, by which we may exemplify the effect of cold on the human frame, operating more disas¬ trously, and more extensively, than on the army of Grecians commanded by Xenophon. When Charles the. XHth, of Sweden, was killed at the siege of Frederickshall, in Noiway, General Ahrenfield, who lay before Drontheim, resolved immediately to withdraw his army to Sweden. It had been reduced by casualties and by desertion to 7300 men, and his enemies, the Danes and Norwegians, were in possession of all the principal roads which led to Sweden. He was compelled, therefore, to make his retreat over a desert, eight leagues in length, lying between Maragher Fidelen and Handeslock. Accordingly on the 11th of January he began to march with his forces. When they had hardly made two leagues of their way, they were overtaken by a storm of snow, which lasted three days and three nights, without intermission. On the 13th January, a lieutenant and fifty men were observed lying dead in a heap with cold. On the 14th, whole squadrons of the Swedes were sunk in the snow ; some were trodden under foot by their horses; others had pitched upon their heads, being oppressed by their arms and accoutrements ; others lay in whole troops upon each other, still holding their horses, which perill¬ ed likewise, nothing appearing of some of them but here and there a head raised above the snow*. General Ahren¬ field himself retired over the mountain of 1* id al with 5250 men, of whom only 2000 lived to reach Handel, a fortified town, and that in so miserable a condi¬ tion that 564 more died soon after, and the remaining 1436 were obliged to march over mountains almost inaccessi¬ ble ; so that only 870 Finlanders arrived at Donnaschantz, in Sweden. In short, the number of those who perished in this march amounted to 5200, out of an army which mustered 7300 when they broke up from Drontheim*. But the disastrous effect of cold on a retreating army was never more remark¬ ably exemplified than in the return of Bonaparte from Moscow. You remem¬ ber the insolent triumph with which, after having captured several of the capitals of the continent of Europe, he marched to invade the Russian empire, at the head of an army of nearly half a million of soldiers. He did, indeed, possess himself of the ancient capital of that empire also — seel quads rediit ? The determination of the Russians to resist the aggressor to the utmost, and * From the Historical Register for the year 1719; vol.iv. p. 203— 210. 004 EVENING MEETINGS AT THE COLLEGE OF PHYSICIANS. at the expense of any sacrifice, even the voluntary burning' of their ancient be¬ loved city, compelled him to remeasure his steps over a country which he him¬ self had laid waste, at a period of the year when frost and snow co-operating with the strenuous efforts of his ene¬ mies, so harassed and discomfited him, that out of that immense army not more than 10,000 Frenchmen, and 25,000 auxiliaries, lived to return to their na¬ tive country; and notwithstanding re¬ peated desperate efforts, made in vain for a while afterwards — “ He left the name, at which the world grew pale, To point amoral, or adorn a tale.” No doubt if the great moralist had lived in these days, he would have found a better parallel for Xerxes in Bona¬ parte’s fate, than in that of any other disappointed ambitious monarch who had been arrested in his course, and compelled to desist from his pursuit of what the world has not yet ceased to call glory. The Emperor of the French left Mos¬ cow on the 19tb October, when he had ascertained the extent to which the fire had destroyed the resources on which he had depended for the subsistence of his army during the winter; and by the time he had reached Smolensko the frost was become intense ; and although he had left Moscow with 120,000 men, and the fragments of various divisions besides had assembled here, it was with great difficulty that 40,000 men could now be brought together in fighting order. The troops often performed their march by night, by the light of torches, in the hopes of escaping their merciless pursuers. When they halted, they fell asleep by hundreds, to awake no more. Their enemies found them frozen to death, around the ashes of their watch- fires. The horses having been ill fed for some time, were equally unable to resist the united effects of cold and fatigue: they sank and stiffened by hundreds and by thousands. The starv¬ ing soldiers slew others of these ani¬ mals, that they might wrap themselves in their warm skins, or mitigate the severity of the blast by taking refuge within their disembowelled carcases. — - But enough of these horrors. The immediate cause of death by cold is apoplexy. The heart is arrested and paralysed in the exercise of its office, and no longer supplies the brain with arterial blood. Nor is the blood thrown with sufficient force to the extre¬ mities. It accumulates, therefore, in the large vessels proceeding immedi¬ ately from the main spring, and there is no ingress for the blood returning from the brain. The large sinuses, therefore, become over-gorged, and apo¬ plexy follows. Portal spoke decidedly, many years ag’o, of apoplexy, as the fatal effect of cold. Dr. Cooke doubted this, because, he said, it had not been demonstrated. Since he wrote, Dr. Kelly has demon¬ strated it by the post-mortem examina¬ tion of the bodies of three persons who were found dead upon the sands of Leith, after a night of extraordinary cold. The philosophy of death by breathing foul or mephitic air, is different. Here the lungs are intercepted in their func¬ tions. No oxygen is admitted to the blood, whilst the heart, retaining its ac¬ tivity, sends the blood to the braiii charged with carbon ; the smallest por¬ tion of which is a fatal poison to it. This is the case when death takes place by drowning’. The lungs are precluded from receiving oxygen air, and cannot throw off the carbon. Under such cir¬ cumstances, it has been thought probable that life is extinguished in less than th ree minutes; unless, happily, the suf¬ ferer should have fainted. Then, the heart’s action being stopped, the carbon is not thrown upon the brain, and, in such instances, animation has been re¬ stored to the apparently dead body, even half an hour after its immersion in water. The transition from life to death is easy in all these cases. Death by cold is longest in accomplishing his work ; but the period of suffering is much abridged where despondency, priva¬ tion, and fatigue (all of which are likely to be the fate of a retreating army), combine with cold. The unhappy be¬ numbed being feels quite easy ; he com¬ plains that he cannot move, in answer to solicitations to exert himself, and only desires to be left quiet. Insensibility steals softly over all his system, as the pressure upon the brain increases, and death at length sets his imprisoned spirit free. When the cold has not been severe enough to destroy life entirely it muti¬ lates the extremities, and mortification ensues from a want of circulation. The Lascars who arrive in this country from SIR HENRY HALFORD ON THE EFFECTS OF COLD. 905 India in the winter season are very prone to this effect of a climate so much colder than their native one, as the re¬ cords of the hospitals in the city abun¬ dantly prove. Analogous to this is the mortification which sometimes occurs to elderly per¬ sons, from ossification of the arteries of the extremities. The blood- vessels hav¬ ing become impervious, the vital prin¬ ciple no longer pervades the feet and the toes, and they perish in consequence. In confirmation of this opinion of the effect of cold, in a severe degree, upon the human frame, under depression of spirits, and privation, and fatigue. Sir Henry related a hitherto unpub¬ lished narrative of the misfortunes en¬ countered by four English gentlemen, in a pedestrian expedition from Con- tamine to Col-de-Bonhomme, in Swit¬ zerland. The walk is one of about three hours, in common circumstances : one of the party was a clergyman, who had lately lost his wife, and bad been re¬ commended to travel in order to dissipate his sorrows. He set out, with his com¬ panions and a guide, on the 12th Sep¬ tember, 1830, at six o’clock in the morning’, after a light breakfast. It had snowed in the night, and was rain¬ ing a little when they started ; but in a short time it began to snow again, and continued to snow during the whole of their passage. The path was soon ob¬ literated, and they lost their way. After walking seven hours, the clergy¬ man complained of his inability to pro¬ ceed further. He said he could not move his legs. The danger of stopping, however, was pointed out ; he was en¬ couraged to go on, and was supported, assisted, and carried ; but at length he en¬ treated that he might be left, adding that he was quite easy, ready to fall asleep, and must stay where he was. They then wrapped him up in his cloak, and left him, and proceeded as well as they were able; but at the end of eight hours, when they had at last regained the path, and had arrived w ithin a quar¬ ter of an hour’s w alk of the place of their destination, another of the gentle¬ men failed in his strength, and could go on no Ion g*er. The other two, and the guide, attempted to carry him, but they fell headlong continually into the snow ; and further exertions to assist him ap¬ pearing vain, and only to endanger their own safety,he too wasleft, wrapped upas w ell as they could wrap him, and seated upon two knapsacks, and they redoubled their efforts to reach the Col-de-Bon- homme. in order to send assistance to him. They soon reached it, and in¬ stantly dispatched seven men to bring him in. He was brought in in the course of an hour, alive, it is true, but he died the next day. A third lost three of his fingers soon after, at Geneva; and the fourth escaped unhurt. We need not add that the poor clergyman was found a corpse. Yet a cold climate, with the appli¬ ances of art, is not insalubrious, nor even incompatible with long life. The proportion of deaths annually in Switzer¬ land is 1 in 59. The proportion in this country is 1 in 60; though in the me¬ tropolis, and in Birmingham, it is 1 in 40, if we may believe the latest statis¬ tical account. In France, throughout the whole of it, it is said to be 1 in 40; in Italy, 1 in 33; in Rome, 1 in 28, ow ing, perhaps, to a malaria there. But what shall we say of Russia? Sir Henry w as informed by the late Russian ambassador, that there was a level country, of about one hundred leagues square, sloping to the south, on the borders of Siberia, where a year rarely passed in the course of which some person did not die at the age of 130. On inquiring whe¬ ther they could depend upon their regis¬ ters, the reply was, “any body who knows the practices of the Greek church will tell you that the bishops are more careful of their registration there, if possible, than your parochial clergy are in Great Bri¬ tain.” Is it, then, that these people are longer in coming to their maturity than the inhabitants of southern latitudes, and proportionally slower in their de¬ cline and decay, as the oaks of the forest are compared with other trees? Or are they the Hyperborei of the an¬ cients ? of whom Pomponius Mela says; “ Diutiusquam ulli mortalium etbeatius vivunt,” — and of whose happiness we read in the Choephori of iEschylus, as if it were proverbial — T axrra /xev d> irai Kpztaova Xpv&ov MeyaXrjs 5e t6xvs> Ka virepfiopeov ixsi^ova (pccvtis. We must presume that these people have the power of counteracting the effects of great cold by artificial re¬ sources, as experience and modern in¬ genuity contrive to provide for the safety of our mariners, who have been exposed frequently of late years, ' almost with 906 CHARTERED MEDICAL BODIES - PETITION TO THE LEGISLATURE. impunity, to the rigors of a winter, even at the pole. Such precautions were not known at the time that Sir Hugh Willoughby sailed on a voyage of discovery in those regions, in the reign of King Edward VI. in 1555 ; and he perished by cold, with all his crew, in Lapland. But now every practicable appliance, on shipboard, is made available as a shelter and protection against great cold, — whilst the soldier on a march, not caring to embarrass himself with cum¬ brous defensive clothing against only a contingent evil, has no resource against frost and snow, if they should occur, by which he can resist their effects ; and he is sometimes arrested and surprised thereby into his destruction. Yet it is found that the life of a soldier is more favourable to longevity than that of the sailor. By the returns of the establish¬ ments of Greenwich and Chelsea Hos¬ pitals, it appears that the former (Greenwich) contains 2710 pensioners, * — the latter (Chelsea) only 509. Now it has been stated to me (said Sir Henry) that of the 2710, several reach the age of 80, and even 90 years, but very rarely indeed, 100. Whereas at Chel¬ sea, containing only 509, scarcely a 3Tear passes in which some one does not die at 100. This remark on the comparative value of life in the two services is not new, — it is as old as Homer. In the Odyssey, when Ulysses, having fallen in with the cele¬ bration of some games in one of the islands which he traversed in his way home, after the surrender of Troy, was requested to perform some of those feats of activity and of personal prowess for which he had made himself so famous during the siege; — it was remarked, “ No ; you forget that he has been a good deal at sea since that time, than which nothing contributes so much to melt and break down a man.” Homer’s words are — Ol» yap eyaye n (fyrjjui KaK&Tepov aAAo QaXacrcrrjS AvSpaye crvyx^vai , €l leal jaaXa Kaprepos €17} *. For I declare there is nothing like the sea To break a man, however strong he be. Sir Henry put it to the judgment of his hearers to decide whether a better reason than the accidents of the two services for the greater facility of reach¬ ing old age on the part of the soldier than the sailor, may not be found in this consideration — that the soldier does not commence his military life before his frame has completely developed it¬ self; whereas the sailor enters upon his duties whilst yet a youth, his manhood remaining to be perfected on harder and less wholesome fare. In conclusion, the learned President urg’ed that they who would really re¬ lieve the poor, should not limit them¬ selves to supplying them with food, but also take care to g’uard their frames from the baneful, but often neglected, in¬ fluence of cold. CHARTERED MEDICAL BODIES; PETITIONS TO THE LEGISLATURE. To the Editor of the Medical Gazette. Sir, As there is now a Parliamentary Com¬ mittee of the House of Commons, sitting on the subject of the Poor lawrs, I would beg to suggest whether it would not be desirable for petitions to be presented from medical men in all quarters, and such other persons, not of the profession, as may choose to join them, praying that the arrangements connected with the me¬ dical relief for the poor should be put on a more efficient and satisfactory footing than at present. It would be important, in my opinion, to direct the prayer to two simple points — one, the doing away entirely with the un¬ worthy and degrading method of tender; the other, the having a fair and moderate remuneration for services, independently of the value of the medicines, so as that there should be no temptation held out, as at present, to do without or be sparing in the use of efficient medicines. A report of the Provincial Medical As¬ sociation, and a letter lately addressed, by Dr. Yelloly, to Lord John Russell, have called the particular attention of the pub¬ lic to the subject; and I would submit, wdiether it would not be worthy of the chartered medical corporations of the country — the Royal College of Physicians, the Royal College of Surgeons, the Apo¬ thecaries’ Company (or rather the Court of Examiners), and the Royal Medical Chirurgical Society, and also of the other medical societies of the metropolis — to petition the legislature on a measure so much connected with the credit of the profession of physic, in all its branches. * Odyssey, 8tli Book. THE MEDICAL CORPORATIONS AND THE PROFESSION. 907 If you, sir, with your accustomed public spirit, would join in the recommendation of this procedure, or any other that you may approve more, I have every expectation that the advantage would be considerable. But again, I would submit that the me¬ dical view of the subject, as connected with the credit of the profession and the advantage of the poor, should be kept en¬ tirely clear from every other. It is of suf¬ ficient magnitude and importance to have an independent position of its own. I have the honour to be, sir, Your obedient servant, A Retired Physician. March 7, 1837. THE MEDICAL CORPORATIONS AND THE PROFESSION. PLAN OF PAUPER RELIEF. Ta the Editor of the Medical Gazette . Sir, I cannot see how the Colleges or Hall can act or interfere about the poor laws, unless in cases referred to them for their opinion. They have no voice in the legis¬ lature, and were not consulted by the framers of the measure on the best mode of aff ording medical aid to the poor ; nor can they know any thing about it, except from hearsay, or from references made to them by the government or commissioners, or from particular cases referred to them by individuals ; and, as far as the College of Surgeons is concerned, they have al¬ ways acted on every such case. How can the College of Surgeons ini¬ tiate any proposition ? The Commis¬ sioners contend that a person legally qua¬ lified to exercise the medical profession need not be a member of the College; and the legislature has always declined to make it imperative on those who choose to call themselves surgeons to undergo any examination, and to prove their fitness. How can the College, therefore, interfere, where members or licentiates of the Apo¬ thecaries’ Company are employed by the Commissioners, those licentiates not being members of the College of Surgeons ? And if the College was to interfere, many of those who now blame them for apathy would be the first to accuse them of offi¬ ciousness, in interfering with the interests of their members, who would be pro¬ claimed as being fully competent to take care of their own interests and concerns, The College has made representation to the Secretary of State, and has received answers (of which correspondence any member of parliament may move for co¬ pies), and the value of their interference under the existing powers of the Commis¬ sioners may then be estimated. It is to be recollected, also, that the general prac¬ titioners must all of them be licentiates of the Hall, and are not of necessity members of the College; but even when they are members, they are still belonging to two learned bodies ; and how is the College to act, or to propose regulations for licen¬ tiates of the Hall, unless on complaints or representations of circumstances connected with their position as members of the College ? I have read the proposed regulations by Messrs. Rumsey and Ceeley ; I have long thought that it would be a good thing to have medical inspectors under the Poor- law Act, like the inspectors of army hos¬ pitals, to make periodical visits — say six inspectors for the whole kingdom — who would collect the returns or reports of the various medical officers, and embody them in specific reports to the Commissioners. A Medical Board may perhaps be better — or, better still, if one of the Poor-law Com¬ missioners were a medical man. The ge¬ neral education and habits of a medical man would render him as competent as any other man could be to the general du¬ ties of a Commissioner, while his particu¬ lar professional education would supply a sad want in the establishment. 1 think there ought to be a medical man attached to every union workhouse or prison, as there is to every other jail in the king¬ dom ; that this person should be of supe¬ rior attainments ; that he should be pro¬ vided w7ith a house close to the workhouse, with medicines, instruments, and appli¬ ances of every sort ; that he should have an infirmary attached to, or within the walls of, the workhouse, w'here out-door paupers might also be received ; and that he might also attend the paupers at their own houses, within a certain distance, having a house also allowed him for those duties ; and that he should be restricted from all private practice. This wrnuld insure good medical aid as far ns it extended, and it would prevent any jealousies from the resident practi¬ tioners. He would be the best aid to the Guardians in pointing out the proper mode of having medical aid supplied to the more distant parts of the union ; and reports, or returns, might be made to him from all the other medical men employed therein. This might save the expense of a Medical Board, or of inspectors, but a medical Commissioner would still be a desideratum, — or two. “ Si quid novisti rectius istis Candidus imperti — si non, his utere mecum.” Your obedient servant, ' Chirurgus. March 5, 1837. DOS ST. GEORGE S HOSPITAL. necessity * " OF ENDEAVOURING TO AVERT THE EVILS OF THE MEDICAL WORKING OF THE POOR LAW. To the Editor of the Medical Gazette. Sir, It seems to me, that while the great mass of the profession are crying out continu¬ ally against the working of the medical department of the Poor-law system, they are doing next to nothing to get rid of it! so degrading, and at the same time so in¬ human, as its effects will prove if allowed to continue in operation. Why not, as you propose, let every town in England get up a petition to Parliament, signed by all the medical men, with the solitary ex¬ ception of the hired slave?— and not only would the medical men come forward, but there are many, and I may truly say most of the enlightened inhabitants, who will, for the sake of humanity, affix their names. There is scarcely a Medical Gazette published but there is shewn, in its own true colours, the danger of the system, not only to the well-being of' our profession, but also to the lives of our fellow-crea¬ tures. Degraded enough we are, and have been for many years, without the necessity of having the Poor-law Bill introduced among us, as an artifice to entrap the poor in pocket, but far more slavish in mind. Should the corporate bodies do nothing to avert the deadly stroke that now threatens us with destruction, I think there will be little doubt that they will soon see the day of their downfal; for al¬ though some portion of the profession may be silent, and want individual energy in such a cause, yet they are silent specta¬ tors of the scene, and have doubtless weighed the question and formed their opinion ; and these very persons who now lie dormant, as it were, will, when they see the real state of things, at some future time be roused to action. I hope and trust we shall rise from this state of de¬ gradation improved, by having seen for ourselves what our enemies would do to us, had they the power; but it is impos¬ sible that this can be the case if we are silent spectators only: we must be up and doing if we wish to save our already falling but noble profession. Should you think this worthy a place in your valuable journal, by giving it inser¬ tion you will oblige me, although Personally: Unaffected. March 6, 1837. ST. GEORGE’S HOSPITAL. Amputation of the Leg. The operations on Thursday, February 16th, were an amputation of the leg by Sir Benjamin Brodie, and an amputation of the leg and lithotomy by Mr. Hawkins. Both the amputations were the usual cir¬ cular ones below the knee, except that both operators removed the angle of the tibia, according to their usual practice, to avoid the ulceration of the skin that other¬ wise not unfrequently occurs. Sir Ben¬ jamin’s case was one of fungus heema- todes of the foot, — a bleeding and ex¬ cessively painful fungus following a punc¬ ture made in what appeared some time previously to be an abscess. On dissec¬ tion, the tumor had all the characters of malignant disease, and seemed to be inti¬ mately connected with the os caleis, but attached also to some of the other bones of the ankle. The patient suffered a good deal after the operation from fever and delirium traumaticum, but is now doing well. Mr. Hawkins’s amputation was per¬ formed for disease of the ankle, which had commenced in the os caleis. In the autumn Mr. Hawkins had performed the usual operation for necrosis, cutting down upon the inner surface of the bone, and removing about a third of it, which had died, and wjas surrounded by living bone, except on one side. lie had left the hospital much benefited by this treatment, but lately returned with abscesses and disease of the joints. On dissection of the limb, the joint between the os caleis and the astragalus was found extensively ulce¬ rated, and both bones much diseased, and the joints of the astragalus in the ankle, with the cuboid and navicular bones, were beginning to show some inflamma tion and thinning of the cartilaginous surfaces. Case of Lithotomy — no Stone found. The case of lithotomy w'as a little child of two years old, who w as admitted with the usual symptoms of stone, irritation of the penis, pain, and stoppage of urine, which was sometimes mixed with blood, and occasionally with pus, and which was sometimes loaded with the lithates, and was at other times alkaline. The child was sounded by Mr. Hawkins, with his colleagues, Mr. Keate, Mr. Babington, and Mr. Cutler, all of whom believed they felt a small stone; and previous to the first incision, Mr Keate and Mr. Haw'kins again thought they felt it with the staff. The incision into the bladder was then made by Mr. Hawkins, the only instru- 909 ST. GEORGE S HOSPITAL. ment used being a common scalpel and staff. No stone was, however, felt by the linger, nor could it be distinguished by a sound which was introduced through the urethra, unless Mr. Keate was right in thinking that he still felt it. Some water was then injected into the bladder, and the child sent to bed, and the child was walking about the ward before a week had elapsed from the operation, at which time all the water passed by the urethra. It remains, therefore, doubtful whether there was really a stone, which was small enough to come away with the first gush of urine, and escaped observation, or whether a stone still remains in the blad¬ der, or whether all these gentlemen had been deceived in the sounding, and the symptoms arose from disordered secretion only. Mr. Hawkins at the time remarked to the pupils that the stone could hardly be encysted at that early age, and there¬ fore he thought if there was a stone it might be among the folds of the bladder, and might come away after the operation, as had been the case in some other in¬ stances on record This, however, has not happened. The child, since it has been walking, has sometimes had some sus¬ picious symptoms, which have now lessened, and it has been sounded without any impression having been felt similar to that experienced before the operation *. Removal of a Cicatrix. On Thursday, the 23d, the operations were, the removal of a cicatrix by Mr. Walker, and one for ectropeon by Mr. Hawkins. The cicatrix was that of a burn of the chin, which drew down the lower lip in an everted state, preventing the mouth from closing, and occasioning a good deal of inconvenience. A cicatrix from one angle of the mouth had been removed in this girl some weeks pre¬ viously, and the other angle was operated on in the same way ; a triangular pot tion, including the cicatrix, being removed by a bistoury, as in the operation for cancer of the lower lip, and the edges brought together by hare-lip pins and sutures. The former operation succeeded well, but the girl is at present suffering from an attack of erysipelas, so that the ultimate result of this second operation is still somewhat doubtful. Operation for Ectropeon. The operation for ectropeon was that of Mr. Crampton, as modified by Guthrie. The poor girl who was the subject of it * We have been thus diffuse with regard to this case, because it has formed the subject of one of those tissues of exaggeration and misrepi e- sentatiofi for which our contemporary is so re¬ nowned. had been tortured by the chronic inflam¬ mation of the disease for the whole of her life, and had been several times submitted to operation before her admission, having had portions of the eyelids cut out, and having also had the tarsal cartilages re¬ moved (though incompletely), as recom¬ mended by Jaeger and Saunders ; but when admitted under Mr. Hawkins’s care, she was still unable to lift her head up or open her eyes, and was nearly blind in both eyes from opacity of the cornea. The right eye had been operated on by Mr. Hawkins a few weeks ago, and the patient had been so far benefited by the operation, as to be nearly free from the sufferings of twenty years’ duration. The same operation was now done on the left eye, though with less chance of success, from the small quantity of eye lid which re¬ mained, and which was partly adherent to the globe ; and from the degree to which the cornea was vascular and opaque. Two perpendicular incisions were made in the upper lid, about half an inch in depth, one close to the punctum, the other near the outer canthus ; and a portion of the skin of the eye-lid, and of the fibres of of the orbicularis muscle, was cut off with a pair of curved scissors. The edges of the skin, where thus divided, were brought together with three ligatures, and the ends of the silk fastened to the forehead with adhesive plaster, with so much force as to hold the eye-lid nearly everted. The girl has now only a very slight pain, which is entirely removed by pinching up a little fold of the skin close to the outer angle (and which will be cut off) ; and the cornea is already less inflamed, and vision more perfect. On Thursday, March 2d, the operations were— lithotomy, by Mr. Hawkins; am¬ putation of the thigh, and an operation for necrosis of the tibia, by Sir Benjamin Brodie; after which Mr. Keate removed three encysted tumors from the scalp, and Mr. Hawkins performed a slight operation on the foot. Lithotomy. The operation of lithotomy was per¬ formed on a lad of 1 9, by passing a double- edged knife with a beak along the staff, after the urethra was opened, and then a blunt gorget was introduced to enlarge the opening made by the knife in the pros¬ tate gland; and the staff being withdrawn, the forceps were passed along the gorget. The stone was a large one (which was the reason for the division of the prostate on both sides), and composed of a good deal of triple phosphate, very soft and brittle, with apparently a lithic acid calculus in the centre. The urine was very albumi- 910 ROYAL INSTITUTION. nous and alkaline, and the bladder very irritable before the operation, making the case an unfavourable one for any operation, and rendering it (together with the large size of the stone) unfit, as it was thought, for lithotrity. There was a good deal of haemorrhage after the operation, and con¬ siderable inflammation of cellular mem¬ brane in the wound, making it necessary to keep a catheter in the bladder. On the fifth day the patient had a rigor, with some haemorrhage from the wound, but appears now to be free from dangerous symptoms, though the kidneys continue to secrete urine in the same diseased state. Amputation of Thigh. The amputation of the thigh was per¬ formed for extensive abscesses connected with disease both of the ankle and knee joints. A large abscess was divided by the operator, who dressed the stump by filling it with charpie, so as to avoid all union. The boy has since gone on well. Operation for Necrosis. The operation for necrosis was perform¬ ed very near the tubercle of the tibia, though not interfering with the knee-joint. A sinus leading into the cancellated struc¬ ture of the bone having been exposed, the orifice was enlarged by a trephine, and some small pieces of dead bone removed from the cavity, which was dressed to the bottom with lint. The boy has unfortu¬ nately been seized with erysipelas of the leg, of rather a severe character, which disease has been prevalent during the late cold north winds; but he appears to be now getting better. Removal of Encysted Tumors. The encysted tumors were of the usual character, in an elderly woman ; and were removed by cutting into them and empty¬ ing their contents, and then removing the cysts. One of them gave a good deal of trouble, in consequence of its having been opened at some former period, which had condensed it, and caused it to adhere inti¬ mately to the skin ; and the vessels, from the same cause, bled a good deal after the woman returned to her ward. The operation on the toe consisted of the removal of an irritable ulcer round the root of the great toe nail, together with the nail itself in a soft and diseased state, and the portion of cutis from which the nail grows. The girl was very anxious to have the toe amputated, in consequence of the suffering she had experienced from the disease, but was persuaded to have this done instead ; and it appears, by her free¬ dom from the pain she used to feel, that the operation is likely to answer. ROYAL INSTITUTION. Friday, March 3, 1837. On the Polarization of Light. Mr. Woodward, President of the Isling¬ ton Literary and Scientific Institution, gave an interesting account of some of the properties of polarized light, illustrated by pasteboard models, and by the hydro¬ oxygen polarizing apparatus. The lecturer began by noticing the two theories of light, and the changes which have occurred in the opinions of philo¬ sophers with respect to the physical cause of luminous phenomena. After mention¬ ing the Newtonian objections to the undu- latory theory, the lecturer replied to them, and adduced the phenomena of inter¬ ferences as fatal to the corpuscular hy¬ pothesis. Fresnel’s theory of the two rectangular planes of vibration was illustrated by pasteboard models, and Cauchet’s third rectangular plane also alluded to. By the same models were explained, on the principles of the undu- latory theory, the differences between po¬ larized and unpolarized light, and in what way the properties of sides possessed by the former might be accounted for. The in¬ terference of polarized light was then re¬ ferred to, and the production of colour in certain experiments thereby explained. The two rays produced by doubly refract¬ ing bodies were shown to be polarized, and their relative position and properties explained on the undulatory theory, by models. The hydro-oxygen polarizing apparatus consists of two parts — one for the produc¬ tion of an intense light, the other for its po¬ larization. The light is produced by the ignition of a cylinder of lime, (contained in a wooden box,) by the hydro-oxygen flame ; the mixed gas is placed in a Gurney’s blow-pipe, the safety portion be¬ ing two fold — namely, a Hemming’s jet, and a chamber filled with numerous layers of wire gauze. In the front of the box is a circular aperture, to which the optical apparatus was attached. For shewing the two images produced by double refracting crystals, one doubly convex lens was used, of If inches focus ; and in front of this was placed the calc spar. The two images wrere thrown on a white opaque screen. For other polarizing experiments, three lenses were employed, not actually plano¬ convex, but what are technically termed crossed, the first in the proportion of If to 6, and the second and third in those of l-f’g to 4. The diameter of the first lens was If inches; of the second and third 1| inches : the focus of the first, 2 inches ; of the second and third, If inches. The first and second lenses form a positive eye¬ piece, and are so placed that their sides of EIGHTEEN TAPE-WORMS IN A SINGLE PATIENT. 911 reatest convexity shall not quite touch, 'he third lens is brought within a quarter of an inch of the second, by which means a strong light is produced, which is po¬ larized by transmission through a plate of tourmaline ; and when a crystal is placed between this polarizing and the second, or analyzing, plate, the light is thus strongly condensed on the crystal. By this apparatus the lecturer was ena¬ bled to shew many of the splendid pheno¬ mena of polarized light with the most brilliant success. The coloured rings caused by calc spar, topaz, borax, nitre, arragonite, and quartz, were shewn of colossal size, and of great brilliancy, on the opaque screen. On the whole, it was one of the most successful exhibitions of polarized phenomena yet attempted in the lecture room. EIGHTEEN TAPE-WORMS IN A SINGLE PATIENT! Communicated by Dr. Ettmuller to Dr. Radius. The patient in this case was a young woman, aged 22, of a robust constitution, and who had never laboured under any re¬ markable affection. Soon after the ap¬ pearance of the catamenia, she was at¬ tacked at irregular intervals with pain in the abdomen, and a gnawing sensation in the intestines, alternating with diarrhoea, sometimes referrible to errors in diet, sometimes occurring without any apparent cause. On many occasions, she was sud¬ denly attacked during her meals with uneasiness and vertigo, which, how¬ ever, were in general of brief duration. She wras also from time to time seized with a violent pain in the belly, which she could not accurately describe, and on such occasions obtained instantaneous, but transitory relief, by taking a draught of very cold water*. She frequently laboured un¬ der heartburn, but never vomited; and was subject to fits of oppression of breath¬ ing, sighing, and sometimes constant yawning. She suffered much from hemi- crania of the right side, particularly over the eye and forehead, a constant sense of pressure on the globe of the eye, dilata¬ tion of the pupils, and swelling of the upper eyelids, giving to her eyes a half- closed, sleepy look. She also complained of pain running from the point of the left shoulder along the collar bone to the ster¬ num, a feeling of stiffness in the limbs, and cramps in the calves of her legs. The catamenia were slow, usually only once every five weeks, and occasionally alter¬ nated with leucorrhcea. Her complexion * Rosenstein regards this as a pathognomonic sign . was yellowish and clay-coloured, her dis¬ position very variable, being sometimes peevish and irritable, sometimes extremely mild. There was no abdominal tender¬ ness present. She had been treated for amenorrhcea and disease of the liver, and subsequently by Dr. Ettmuller for derangement of the digestive system, for the space of tw’o years, during which no trace of tape- worm appeared. In February 1836, she began to pass small pieces, and this induced him to have recourse to anthelmintics. The treatment employed w’as that recommend¬ ed by Schmidt. The preparatory mix¬ ture brought away several pieces, from a quarter to half an ell in length. On the 8th of March she took one of Schmidt’s pills every hour, from six to eleven o’clock, a.m. She vomited twice during the day, and passed several fluid evacuations, con¬ taining several joints of tape-worm. At two, p.m. she wras obliged to discontinue the pills, in consequence of the violent retching and gastrodynia which they pro¬ duced, and took castor oil in half-ounce doses, which she also gave up after the third dose. Towards evening the vomit¬ ing ceased, and she fell asleep for about an hour. On awaking she passed a knot of w'orms, which, wben uncoiled, proved to be four entire tape-worms. About one o’clock in the morning, she awoke again with a violent pain in the abdomen, and passed nine more*. She took the same medicine again twice during the two fol¬ lowing w eeks, and had several slimy dis¬ charges from the bowels, without any trace of tape-worm, so that her cure was considered to be complete; and, with the view of improving the digestive function, she wras ordered to the medicinal waters at Eranzensbrunn. Two days, however, be¬ fore her departure she passed a portion of tape-worm, and another in July. On her return to Oberwiesenthal in August, she passed twro more entire worms. She was now ordered to take the decoct, corticis granati, Jiij. ad Oj. night and morning. This was continued for five days, and then followed by an active purgative, which brought away three entire worms. In order, however, to render the cure more certain, she was directed to take the de coetion a few days longer, and afterwards the compound infusion of senna occasion¬ ally. Up to the 24th of December no further traces of tape-worm had been ob- servedf. * These worms were sent to Dr. Radius, and exhibited by him to the Medical Society at Leip¬ zig. They were all furnished with heads, but had contracted so much from lying in the spiiits of wine, that the longest did not measure more than two feet. •f Clarus and Radius’s Journal, Band. 3, Heft, 2 ; and Dublin Journal, March 1837. 912 BILLS OF MORTALITY.— “METEOROLOGICAL JOURNAL. TONGUE SWALLOWING. APOTHECARIES’ HALL. A curious case lias been related whicb links physiology with practice. An infant was labouring under symptoms suddenly arising, and seeming to threaten death by suffocation; the physician, fortunately, discovered that the tongue was retroverted, its apex reaching into the oesophagus; the tongue was readily replaced, with relief to all the symptoms, but the trouble recurred frequently. Many authors Jhave mention¬ ed this swallowing of the tongue ; I knew one instance where it could be done at will without any serious inconvenience. This occurred in a lad, who, in the playful period of his recovery from fever, was asked to shew his tongue and presented his open mouth with no tongue visible ; as soon as his mouth was shut, he asserted that his tongue was in its right place, proving it to be so : there was such facility in retroverting the tongue into the pha¬ rynx, that he frequently repeated the trick afterwards. The only other recent in¬ stance I have found related, is somewhere recorded on the authority of Magendie. YetM. Blandin (Art. Langue, in Dictionnaire de Med. et de Chir. Pratiques ) follows Boyer in denying that such a displacement can be thus produced, and places the accounts of slaves suffocating themselves by tongue¬ swallowing “ amongst the romances of ot^r science.” — Mr. Crosse’s Retrospective Address. POOR-LAW COMMITTEE. The members of the Parliamentary Poor- law Committee commenced their labours on Monday last. It is understood that thomedical part of the inquiry will not be entered upon till after Easter. COLLEGE OF SURGEONS. LIST OF GENTLEMEN WHO RECEIVED DIPLOMAS IN FEBRURY. LIST OF GENTLEMEN WHO HAVE RECEIVED CERTIFICATES. March 9, 1837. William Wardlow Howard, of Glossop. William Matterson, of York. William Veal. James Fletcher, of Oldham. Thomas Mousley, of Ellesmere, Salop. John Cozens Kent, of London. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Mar. 7, 1837- Abscess 1 Inflammation # 23 Age and Debility . 32 Bowels & Stomach 3 Apoplexy . . 2 Brain • 3 Asthma • . 20 Lungs and Pleura 9 Cancer . 3 Influenza . • 4 Consumption 64 Insanity . • 3 Convulsions 26 Jaundice • 2 Croup . 1 M easles * 2 Dentition or Teethin g 6 Mortification • 1 Dropsy 8 Paralysis • 2 Dropsy in the Brain 5 Small-pox . • 3 Fever 6 Sore Throat and Fever, Scarlet 6 Quinsey . • 1 Fever, Typhus 3 Spasms . « I Gout . . 1 Thrush • 1 Htemorrhage 1 Unknown Causes 4 Heart, diseased . Hooping Cough . 1 10 Casualties • 4 Decrease of Burials, as compared with ' the preceding week 59 METEOROLOGICAL JOURNAL. Kept at Edmonton, Latitude 51° 37' 32" N. Longitude 0° 3' 51” W. of Greenwich. March. Thursday. 2 Friday . . 3 Saturday . 4 Sunday . . 5 Monday. . 6 Tuesday . . 7 Wednesday 8 The rmomktf.r. from 25 to 41 25 43 32 43 2d 47 33 44 29 46 25 48 Barometer. 30-26 to 30-16 30-18 30-11 29- 97 30-04 30- 02 29 83 29-84 29 93 29- 96 30 06 30- 10 30 06 Winds N.E. and W. by N. Except the 7th and morning of the 8th, gene- raily cloudy; a little rain on the evenings of the 4th and 5th. Charles PIenry Adams. Alfred Jones, Havre-de-Grace. S. Lupton, Thame, Oxfordshire. William Kemm, Averbury House, Wilts. Morgan Williams, Llandelo. Edwin Haward, Halesworth. R. Druitt, Southampton Buildings. Isaac Reaney, Sheffield. E. V. Austin, Norwood. T. Maitland, Exeter. Richard Shelan. J. B. Robertson, Demerara. Henry Mansell, E. I. F. Palmer, Great Yarmouth. C. Wood, Smyrna. E. Smiles, Newcastle-upon-Tyne. M. Nightingale, Bengal. C. Hawkins, Montague Place, Montague Square. W. H. Barnwell, Queen Charlotte Row, Lisson Grove. C. T. Hamilton, London. H. Samuel, Mansell-street, Goodman’s Fields, G. W. Pinchin, Limerick. James Gibsou, Hull. Corrigendum. — In Investigator’s letter, last number, p. 877, line 1, col. 2, for “ It is not, therefore, the kind of in¬ flammation which we occasionally meet with in such diseases as typhus fever and the present epidemic, that we are to look for proofs of the soundness of Mr. Searle’s doctrine; nor is it to acute idiopathic peri¬ tonitis, enteritis, &c.” read thus — “ It is not, therefore, to the kind of inflammation which we occasionally meet with in such diseases as typhus fever and the present epidemic, that we are to look for proofs of the soundness of Mr. Searle’s doctrine : no, it is to acute idiopathic peritonitis, enteritis, pneumonia, or phrenitis, that we ought to turn our eves.” Wilson & Son, Printers, 57, Skinner-St. London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JJOUIRMAL OF JMrtrt'rmr anti tfte Collateral ^rtcittes. SATURDAY, MARCH 18, 1837. LECTURES ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine , By William Cummin, M.D. Lecture XXIV. Unsoundness of Mind further considered. Imbecility and its characteristics — Commis¬ sion de lunatico inquirendo — Miss Bagster’s case — Medical evidence on that inquiry — The money and fgure test to be applied with dis¬ cretion. Demi- imbeciles. Deaf and Dumb state — how fur connected with imbecility — Persons in that state sometimes not respon¬ sible, nor capable of being put on their trial. Cretinism. Mania and its characteristics — Plausible reasoning of some maniacs — Exam¬ ple from the Scotch judicature. Monomania : its characters — With depression — With gaiety — Predominant ideas often changing — Case in illustration — Difficulty sometimes in dis¬ covering the subject of the delusion — A necdotes by Lords Mansfield and Erskine. In the last lecture I pointed out some of the difficulties which have long beset the subject of unsoundness of mind ; and I endeavoured to show how, by the adoption of a series of well-defined terms, and a proper classification, they might in great measure be removed. I also laid before you a plan, which at one view exhibited the mutual relation of all the principal hinds of mental disorder at present recog¬ nized by the ablest psychologists, and I went into a detailed account of idiocy and imbecility, — forms of unsoundness which essentially consist in deficiency of mental power. Imbecility. In resuming my observations on imbe- 48o. — xix. cility, I must remind you of the remarka¬ ble trial which I adduced in last lecture as illustrative of the extent to which weak¬ ness of intellect may exist, without disqua¬ lifying the individual for making a valid will. The medical evidence in that case would seem to have been sufficient to con¬ vince any tribunal that there was a decided lack of disposing memory, and a deficiency of reason and understanding inconsistent with a sane devise. But the verdicts of juries are very precarious on these Occa¬ sions, as may be exemplified by the case of Miss Bagster, a young lady of weak, or rather grossly neglected, mind, (though certainly possessed of a much higher capacity than Frances Smith), who upon contracting an objectionable marriage, was found non compos , and afterwards divorced. Miss Bagster’s case. — The proceedings in this case were interesting and instruc¬ tive, particularly in displaying the me¬ thods adopted by some of our “ mad doctors,” in ascertaining the existence of imbecility with incompetence for managing one’s own affairs. The young lady in question, who was about twenty- two years of age at the time of her elopement and marriage, had been a spoiled child from infancy. She was an only daughter, and treated with a foolish fondness by her grandfather, from whom she was to inherit a very large property. She was brought up in a complete state of dependence on others ; all her wishes wrere gratified without any exertion of mind on her part : she was taught nothing that could give her the least trouble or annoy¬ ance in the learning. The management of her temper was also neglected, and school-mistresses and governesses could abundantly testify to various unseemly ebullitions which they had witnessed. In this state of things, though she cannot be said to have ever arrived at years of discretion, she attained her majority, be¬ came legally the mistress of herself and her 3 N 914 DR. CUMMIN ON FORENSIC MEDICINE. property, had her speculations of marriage on hand, and was persuaded by one of her suitors to elope with him. But the person whom she got in this way for a husband, happened to be no favourite of her mother’s; and the latter was known to have vowed that he should have her heart’s blood rather than her child. There was but one mode of dispossessing him after the union, and that was by proving that the marriage was contracted while the lady wras unsound of mind. A writ de lunatico inquirendo was obtained, and after an investigation, which lasted eleven days, the desired verdict was returned *. Let us direct our attention for a few minutes to the medical evidence. Dr. Mac- michael wras first examined, and deposed that he visited Miss Bagster, in company with Dr.Munroe. She did not appear to be a person of sound intellect, or to possess the ordinary moral perception of a person of her age. The conversation was of a very general and diversified nature: she related all the circumstances of her elope¬ ment. “I examined her respecting figures, but she seemed perfectly ignorant of how many pence there were in a shilling. I think she has no reasoning faculty what¬ ever. She said there were six weeks in the year, and six days in the week, and as for Sunday, that was kept holy. I wrote down a common sum in addition, but she could not manage it, and said she was very stupid. She could not add shillings and pence together. I do not think she is competent to manage her own affairs, nor to be trusted with any money. In my opinion she is of unsound mind.” It must be confessed that this looks very like jumping to a conclusion : the girl had been almost wholly uninstructed in arith¬ metical calculations, and her “ tables,” it seems, she had always been excused from committing to memory : yet her defi¬ ciency in these points, her ignorance, is set down to deficiency of mental power, and she is pronounced incompetent to manage her own affairs. Dr. Munroe said he was struck with her appearance and manner, w hich were quite childish : from her physical development, she semed to be no more than sixteen or seventeen years of age. He and Dr. Macmichael were introduced as friends of Alderman Kelly, in whose house Miss Bagster then resided. She talked freely about the elopement and marriage at Gretna Green. “At another visit, I put to her some arithmetical questions : she knew that two and two made four, and four and two made six; but six and four, she said, made eleven, but corrected herself after¬ wards, and said ten. She could not tell * Medical Gazette, vot. x. p. 519. how many shillings were in a crown, or a sovereign, nor how many tens in an hundred. She said there were six weeks in a year, and when I expressed my dis¬ satisfaction, asked me, * Is not that right, sir?’ Her fortune, she said, added to the Alderman’s, would be immense ; her’s was 700Z. a year, his 100Z. I asked, ‘ No more ?’ She then said 150Z. She knew not how many months in the year. She is de¬ cidedly of unsound mind, -and not in any degree fit to take care of herself or her pro¬ perty. I should not call her idiotic, or lunatic, but I should describe the state of her mind as that of extreme imbecility. The power of learning language to the extent that Miss Bagster knows French, is consistent with what is called imbeci¬ lity. I have not the slightest doubt that she is imbecile.” Drs. Sutherland and Gordon deposed to having had very free and confidential con¬ versations with Miss Bagster, relative to the matrimonial trip : she considered it as “a bit of fun.” The former gentleman tried her by the arithmetical test , and both found her imbecile and of unsound mind. Another physician improved on the figure test ; he examined her touching the interest of money, the expenses of a car¬ riage and horses, and the price of quartern loaves ! Only think of Miss Bagster, wTith the education she received, being asked such a question as this, — we give it from the report of the trial. “ I asked her, if she had 10,000/. in the four per cents., how much ought to be her income ? She an¬ swered, 100/. a-year. She said she should take a great house at the West End, and keep a number of servants ; but she doubt¬ ed if she could afford to keep a carriage at the same time. . . Among other questions, I asked her, what w'ould she give for a quar¬ tern loaf? She said two shillings. She wyas aware that twenty shillings made a sovereign, and twenty pence one and eight- pence ; but she said that fifty sovereigns were twice as much as a 50/. note . I asked her what would be the expense of a carriage and pair of horses ? She said, ‘ I should think, from 20/. to 30/. a year.’ He considered her to be of insane mind.” That the arithmetical and money test affords, in many instances, a valuable means of estimating the degree of imbeci¬ lity, there can be no doubt ; but the quo¬ tations just made must satisfy most persons that it may be resorted to very absurdly in those cases where the individual has never had an opportunity of acquiring ideas of numbers. But let us contrast the money-testing method of the physicians just cited with the mode adopted by two other eminent authorities, in the same case. Dr. Alexander Morison, the present physician IMBECILITY. 915 to Bethlem Hospital, visited Miss Bag- ster four times previous to the inquiry. “ On my first visit,” said the Doctor, “ she received me politely ; said she was in good health, but that she was a little deaf, as she thought, from nervousness. I pro¬ ceeded to ask her some questions. She told me she had neglected her arithmetic, and was not fond of it. She talked about the Opera, Paganini, Sir W. Scott, and the Exhibition; of a journey she had once taken to Wales. She asked me what was a mad- doctor, and if I was one ? I told her no ; that I cured all diseases if I could. I then asked her if she had any money in her purse ? She said, no ; I have no occasion for any, for every thing is bought for me. On my second visit she shook hands with me, and asked after the health of my daughters. She complained of being very nervous, from seeing so many persons, and having to answer so many questions as to her state of mind. She said that Dr. Haslam had frightened her very much, by telling her be was a mad -doctor. On ask¬ ing her how she became so defective in her arithmetic, she said that her grandfather was very fond of her, and Indulged her too much, and would never allow her to be teased about it. She said she could read French, and “ Telemachus,” fluently. Talking of her trip to Gretna-Green, it was a foolish thing, she said, but you know one reads such things in novels ; but 1 am sure I would not have done so if I thought there would have been all this trouble about it. After some further conversation, she asked me, What do you think of my ca¬ pacity ? I told her that I considered her to be very deficient in her arithmetic, but that I did not think her possessed of less sense than many young ladies of her own age. She asked me if I thought she had as much capacity as was necessary ? I said I thought she had. Speaking of her fortune, she said her mother never let her have any money — not even a penny to give to a beggar ; and that she had no oppor¬ tunity of knowing the value of money. After this, she asked a great many ques¬ tions about the law proceedings which were about to take place ; and, finally, without any question, said, ‘ I have been very violent, and passionate, and undutiful to my mother, for 1 have sometimes pulled and slapt her, and I am very sensible of the impropriety of my conduct.’ My third visit was a very short one. I ex¬ amined her again upon figures : she put down the first four figures under each other, and in a little time made out ten. She com¬ plained of being unwell, from the effect of seeing so many doctors. At my last visit I said, now you are married, how do you think you ought to sign your name ? She said I think it ought to be Newton ; but those about me say it was not a marriage, as it was not done in church. I am told by those about, me, particularly by Miss Clayton, that Alderman Kelly is in love with me, and will marry me in three months, and I may be Lady Mayoress next year. I said, well, do you think that your marriage with Mr. Newton is not a good one, that you may marry Alderman Kelly? She said, no. 1 asked her what would her marrying be ? She replied, adultery. I have directed much of my attention to insanity of late years, and have written two works on the subject. Miss Bagster is a little deaf, and in that respect only is different from other young ladies. 1 did not observe the slightest disposition to laugh without cause : she had not the unmeaning laugh and titter of those who are weak in mind. The statements she made I believe to be true, believing her to be a reasonable creature, and that she would not deceive me. I do not believe that her governess had fallen upon the proper mode of instructing her, and I would undertake in six months to teach her arithmetic and the use of money. She has begun to think now, and her mind is more opened than it was a year ago, and 1 think if pains were taken with her, she might be in¬ structed. Such a communication as she is represented to have made to Captain Kelly was very indecent and strange, but in my opinion not inconsistent with sanity. I think that late occurrences, coupled with the repeated conversations with the medi¬ cal men on these indelicate subjects, have so lessened her sense of modesty, as to account for it. A deficiency of education will account for all the appearances ob¬ served in Miss Bagster. Her incompetency to manage her affairs arises , not from un~ soundness of mind , but from ignorance. She is capable of instruction, so as to be able to manage her affairs. The indulgence of her grandfather, the conduct of her mother towards her, and the frequent change of her teachers, were calculated to produce the results which we see. I hold her to be a responsible agent. She has this proof of soundness of mind, that she is sen¬ sible of the deficiencies under which she labours ; one test of non-insanity is a con¬ sciousness of deficiency.” Such evidence as this is highly satisfac¬ tory, consisting, as it does, of a body of facts and opinions collected in an honest straightforward manner, without any de¬ ception practised on the alleged imbecile. We find it confirmed, too, by the evidence of Miss Bagster herself before the Commis¬ sioners, which is extremely well worth 910 DR. CUMMIN ON FORENSIC MEDICINE- perusing, and very remarkable, considering the circumstances under which it was given. But I must not conclude my notice of this case without quoting some passages from Dr. Haslam’s evidence. The Doctor has long professed to be a master of evi¬ dence, and of the conduct befitting a wit¬ ness when placed in the box; yet somehow it has frequently befallen himself to be be¬ trayed into extravagances, and unseemly sparring with counsel. In the following extracts, which bear more immediately on the question under consideration, will be observed one or two passages which may serve to point out certain things which ought to be carefully avoided in giving evidence before courts of justice. Dr. Haslam visited Miss Bagster thrice. On the first occasion the conversation was very general ; on the second, Dr. H. an¬ nounced that he was a “ mad doctor,” and rendered the lady very nervous ; she shed tears, &c. “ At my next visit, continued the Dr., I opened a Prayer-book, and desired her to read the seventh com¬ mandment, which she did correctly. Do you know, I said, what is meant by committing adultery ? Her answer was, when persons are married they shall not have any thing to do with any other man than their own husband. Of her own ac¬ cord she lamented her deficiency in arith¬ metic, and her ignorance of the value of money. I then said to her, Do you think you could soon acquire it under proper tuition ? She took up those words — Yes ; under proper tuition, being allowed to have money and keep accounts, I have no doubt I could learn like other persons : my grandfather was so fond of me that he would not allow the teachers to snub me for neglecting my lessons. From these three interviews I am able to form a cor¬ rect opinion of her state of mind. She is not a lunatic, she is not an idiot, nor is she of unsound mind. “ Mr. Pollock: Is she of sound mind ? — I never saw any human being who was of sound mind. That is no answer to my question : is she of sound mind? I pre¬ sume the Deity is of sound mind, and he alone. Is that your answer, sir ? 1 pre¬ sume that the Deity alone is of sound mind. How many years have you been a mad-doctor ? About forty. Where did you learn that the Deity was of sound mind? From my own reflections during the last fourteen years, and from repeated conversations with the best divines in the country. Is Miss Bagster of sound mind ? Competently sound. Is she capable of managing herself and her affairs ? I do not know what affairs she has to manage. Is she competent to act as the mistress of a family ? When properly instructed, T think she would be : I mean to state that when certain defects have been supplied, she would be as capable to conduct her affairs as any other woman. Do you un¬ derstand that with the exception of her defects in education, she is competent to the ordinary affairs of life ? I do. Do you think that a part of her disabilities might be removed by education? I am persuaded of it. Supposing she was taught in the best manner, and by the ablest masters, what length of time would it take ? You must state the quantity of learning to be obtained ; she is particularly deficient in arithmetic. And what else is she deficient in ? Music. Those qualifi¬ cations are not necessary to enable her to manage the affairs of life ? They are cer¬ tainly not essential. How often have you given evidence before commissioners of lunacy and a jury ? I cannot tell ; I don’t know. Have you any notion ? Notion is very much like knowledge, and I don’t know. Have you any idea ? An idea is a visible perception, and a direct recollec¬ tion^). Have you any belief ? I cannot say that I have any belief, for that is a direct recollection. Can you, from any faculty of your mind, give information on the sub¬ ject ? Many times and oft I have given evidence on a commission of lunacy ; but when I was first examined, or how much time has intervened since, I cannot tell. I did not visit Miss Bagster to repeat arithmetical questions, because she told me she knew nothing about them. I did not go there to puzzle her, though I could easily have done that with many others besides. She is competent to learn arith¬ metic, but she has not been allowed the materials — I mean money, the great source of all arithmetic.” I have already mentioned what was the issue of the inquiry — a verdict of unsound¬ ness of mind, and incompetency to the management of her affairs. It was cer¬ tainly a popular finding, for had the ver¬ dict been otherwise — had Miss Bagster been found of competent understanding— her person and property would have re¬ mained at the disposal of the party who had clandestinely contrived the marriage. Doubt, however, may still be reasonably entertained, whether the verdict was cor¬ rect, or in strict accordance with truth and justice. Before I quit the subject, I ought to mention that you may see one or two ex¬ cellent cases in Dr. Abercrombie’s book on the Intellectual Powers, in which the money and number test was judiciously employed in “ cognoscing” imbeciles. Demi imbeciles. — Orfila describes a class IMBECILITY — CRETINISM. 917 of unfortunates whom he considers as irre¬ sponsible, although they frequently be¬ come objects of punishment before the cri¬ minal tribunals. They are demi-imbeciles, he says, of very limited mental power, and most imperfectly acquainted with those great truths on which social order is based. Among the lower classes, these persons may find a variety of occupations, which require no particular talent for combining ideas ; some of them even learn simple trades. Though they may not pass as wholly imbecile among their equals, they are looked upon as singular beings — simpletons — and are made the subject of a thousand tricks and jokes. Many of these individuals, not being re¬ strained by any principle, are given to drink, laziness, or debauchery ; and more of them probably fall into the hands of justice than the public are generally aware of. They are dexterous in thieving, and are thought to be very cunning : on leaving prison they begin their old trade afresh, and are thus accounted inveterate culprits. They are sometimes violent, passionate, committing homicide or arson upon the least provocation : those, too, who have strong sexual propensities, are easily be¬ trayed into outrages on modesty. “ I have had occasion to notice several individuals of this description in our prisons, who were pronounced reasonable and respon¬ sible, yet whose demi-imbecility was to me quite manifest.” It is to be feared that many of the young desperadoes who figure frequently before our police magistrates, and are as often sent to the treadmill or solitary confine¬ ment, are of this description of demi- imbecile. Our magistrates, however deep observers of character, are generally not gifted with a discrimination whereby nicely to distinguish between the respon¬ sible and irresponsible ; nor in the pressure of business have they the needful leisure for such distinctions. Deaf und dumb state. — You will recollect that when stating the legal distinctions respecting unsoundness of mind, I men¬ tioned that the person who was born deaf, dumb, and blind, was held in the rank of an idiot, being precluded from the prin¬ cipal ideas of sensation, the foundation of all knowledge. An individual who is deaf and dumb, however, is recognized as re¬ sponsible when there is evidence of his being able to comprehend the difference between right and wrong, and may be put on his trial, if he can be made to under¬ stand the nature of pleading guilty or not guilty. In Dr. Beck’s Elements you will see a full account of the proceedings adopted some years ago in one of the cri¬ minal courts of Scotland, for putting a deaf and dumb woman on her trial, charged with destroying her infant child by drowning. She was in the end suffered to go at large, untried. The question of dumbness must be de¬ termined by a jury before it can be ad¬ mitted as a plea for declining trial. If it be proved malicious and pretended, the plea of “ not guilty” is to be entered, and the trial proceeded with. Formerly the obstinate pretender was forced to plead by whipcord bound round his thumbs : one form of the “ thumb torture.” 'file matter has long since been put be¬ yond a question, that where proper methods of education, like those of the Abbe Sicard and others, have been applied to the deaf and dumb, they are capable of being ren¬ dered intelligent and virtuous members of society ; and individuals of this class have even evinced powers of mind remarkable for acuteness and sagacity. But, on the other hand, when such beings have been neglected, their uncultivated minds have sometimes rendered them a curse to their fellow creatures: they have indulged in every vice within their reach, and have not hesitated to commit violence when it seem¬ ed necessary to enable them to attain their purpose. Such persons are obviously imbecile, and cannot be held accountable for their actions. The difficulty in dis¬ posing of them when they come before the legal tribunals, consists in ascertaining the extent of their mental culture, and above all, to determine whether they do not dissemble their attainments in respect to education. Experienced persons must be entrusted with this inquiry; and by such means many desperate impostors have been detected, as we shall hereafter have occasion to notice more particularly when treating of feigned and dissembled states. Cretinism. — I cannot close this sketch of imbecility without reading for you Dr. Abercrombie’s account of the modifications of intellect found among the Cretins of the Yallais. It shows very distinct grada¬ tions of deficiency in connexion with bodily disease. “ These singular beings are usually di¬ vided into three classes, which receive the names of cretins, semi-cretins, and cretins of the third degree. The first of these classes, or perfect cretins, are, in point of intellect, scarcely removed above mere ani¬ mal life. Many of -.them cannot speak, and are only so far sensible of the common calls of nature as to go, when excited bv hunger, to places where they have been accustomed to receive their food. The rest of their time is spent, either in bask¬ ing in the sun, or sitting by the fire, with¬ out any trace of intelligence. The next class, or semi-cretins, show a higher degree of intelligence ; they remember common 918 DR. CUMMIN ON FORENSIC MEDICINE. events, understand what is said to them, and express themselves in an intelligible manner on the most common subjects. They are taught to repeat prayers, but scarcely appear to annex any meaning to the words they employ ; and they cannot be taught to read or write, or even to num¬ ber their fingers. The cretins of the third degree learn to read and write, though with very little understanding of what they read, except on the most common topics. But they are acutely alive to their own interest, and extremely litigious. They are without prudence or discretion in the direction of their affairs, and the regulation of their conduct ; yet obstinate, and unwilling to be advised. Their me¬ mory is good as to what they have seen or heard, and they learn to imitate what they have observed in various arts, as ma¬ chinery, painting, sculpture, and archi¬ tecture; hut it is mere imitation without invention. Some of them learn music in the same manner ; and others attempt poetry of the lowest kind, distinguished by mere rhyme. It is said that none of them can be taught arithmetic, but I do not know whether this has been ascertained to be invariably true ; there is no doubt that it is a very general peculiarity.” Mania.. The essential character of this form of derangement (we have now disposed of the forms of deficiency) is a general confusion and incoherence of ideas, succeeding each other with a morbid rapidity, and without any apparent connexion. The perceptions are erroneous. Many maniacs mistake their relations and friends for strangers and enemies : they suppose a window a door, and thus precipitate themselves into the street. These are illusions affecting the senses; they have hallucinations also, or perceptions of the imagination, without corresponding external objects. They see multitudes of objects which do not exist. They hear voices addressing them, and frequently prompting to the perpetration of some crime. They are subject to vio¬ lent passion, contempt, suspicion, anger, and hatred ; permanent hallucinations, however, are rare : the attention cannot be fixed, the memory is greatly disturbed, and consciousness of existence seems lost. The sense of taste is frequently perverted, and maniacs often refuse wholesome food, preferring offal or any kind of garbage. From the quick succession of their ideas, those who are given to talk have a most plentiful volubility of words, and those who can still write produce compositions of enormous length in a very limited space of time. Their powers of volition are vague and unsteady, and there is an irre¬ sistible tendency to motion. The muscu¬ lar power is frequently increased : there is a strong disposition to act from the im¬ pulse of the moment ; and exacerbations of excitement, giving rise to fits of fury, are frequent. But there are shades and varieties among maniacs ; they do not all labour under perversion of all the senses ; some¬ times but one, sometimes two, or three, or four, of the senses are involved. Power of comparison is more or less wanting, ac¬ cording to the degree of deficiency of attention and memory. Mania has, in fact, been subdivided into three species: — 1. Where there is the greatest confusion of the intellectual powers; the ideas erroneous, rapid, and incoherent ; illusions and hallucinations prevalent, with a tendency to be readily excited to fury. The maniac recognizes nothing around him ; cries aloud, sings, and is constantly in motion; forgets the first wants of nature, and seems destitute of all feeling of cold, heat, or pain. 2. In the second species the maniac is in a state of disturbance, hut not to such a degree as to be incapable of having his attention fixed; his answers are correct and to the point, but short. More length¬ ened conversation discovers the nature of his derangement : ail his thoughts are observed to be extravagant ; he laughs, sings, becomes excited, and readily flies into fury. 3. In the third kind we have a sort of “ reasoning madness,” as some have erroneously described it. The individual talks, writes, judges, and appears to reason ; w hile,by a singular contrast, he commits the most obviously extravagant or outrageous actions, yet always finding some plausible plea to justify his proceedings. Perhaps one of the best examples of this species may be found in the well-known case of a Scotch clergyman, wrhi eh is thus concisely related and commented upon by Dr. Abercrombie : “ A clergyman in Scotland, after show¬ ing various extravagances of conduct, was brought before a jury to be cognosced; that is, by a form of Scotch law7, to be declared incapable of managing his own affairs, and placed under the care of trus¬ tees. Among the acts of extravagance alleged against him wras, that he had burnt his library. When he was asked by the jury what account be could give of this part of his conduct, he replied in the fol¬ lowing terms: — ‘In the early part of my life I had imbibed a liking for a most un¬ profitable study, namely, controversial di¬ vinity. On reviewing my library, I found a great part of it to consist of books of this description; and I wras so anxious that my family should not be led to follow the same pursuit, that I determined to burn the whole.’ He gave answers equally plausible to questions which wrere MONOMANIA. 919 put to him respecting other parts of his conduct. [Among other strange acts, he dug up and destroyed a fine orchard, but pleaded that digging was good for his health, and that he preferred a garden to an orchard.] The result was, that the jury found no sufficient ground for cog¬ noscing him ; but, in the course of a fort¬ night from that time, he was in a state of decided mania. “ It is, therefore, incorrect (continues Dr. Abercrombie) to say of insanity, as has been said, that the maniac reasons correctly upon unsound data. His data may be unsound, that is, they may con¬ sist of a mental image which is purely visionary, as in the state of perfect mania lately referred to; but this is by no means necessary to constitute the disease; for his premises may be sound, though he distorts them in the results which he deduces from them. This was remarkably the case in the clergyman now mentioned. His pre¬ mises were sound and consistent, namely, his opinion of the unprofitable nature of the study of controversial divinity, and his anxiety that his family should not pro¬ secute it. His insanity consisted in the rapid and partial view which he_ took of the means for accomplishing his purpose, — burning his whole library. Had he sold his library, or that part of it which con¬ sisted of controversial divinity, the mea¬ sure would have been in correct relation to the object which he had in view ; and if we suppose that, in going over his li¬ brary, he had met with some books of an immoral tendency, — to have burnt these, to prevent them from falling into the hands of any individual, would have been the act both of a wise and a virtuous man. But to burn his whole library, to prevent his family from studying controversial divinity, was the suggestion of insanity ; distorting entirely the true relation of things, and carrying an impression, in itself correct, into consequences which it in no degree warranted.” Monomania. That form of derangement first distin¬ guished by Esquirol with the appropriate appellation of monomania, is characterized by a delusion relating to a small number of predominant and exclusive ideas, the judgment being often sufficiently sound on every other subject. In monomania the attention is generally fixed on the predo¬ minant wrong ideas, while in mania there is such an incoherence and diversity of ideas and actions, as to show that the pa¬ tient thinks and acts at random. In monomania with depression, the melancholia of the old writers, or lypemania of Esquirol, the expression of the counte¬ nance is anxious ; the complexion is some¬ times a dark red, the features being gather¬ ed up and motionless; sometimes the tint is sallow. Ideas of terror, distrust, suspi¬ cion, and gloominess, prevail ; hallucina¬ tions are frequent : the patient seeks to be alone, avoids exercise, talks but little; all the bodily functions proceed heavily. In that form which is marked by gaiety or cheerfulness, the chaeromania of Esqui¬ rol, the countenance i^ animated, and the eyes often brilliant; the patients are full of activity, bold, petulant, noisy, boast¬ ing ; and their functions are carried on as in health. They often fancy themselves magnificent, rich, and prosperous, great kings, princes, and ministers : sometimes they personate the Deity himself: some are poets, orators, or great discoverers. Some again are victims to the passion of love, and are carried away by correspond¬ ing illusions. Hallucinations also are frequent with them. From this description of monomania it must be perceived that the variety of which it is susceptible is indefinite, and accordingly there are frequently met with examples of the most novel and extraor¬ dinary kind. It is worth observing also, that the predominant ideas often shift and change in the same individual ; he labours under a succession of delusions, each pre¬ vailing for a time. A very curious instance of derangement of this kind is displayed in the following case, wrhich will also serve to shew in what a condition of mind a jury may be disposed to consider a person capable of performing a valid or legal act. There is also involved in it the question of a lucid interval , one of much importance in legal medicine, which will have to be noticed more particularly hereafter. In the sittings at Nisi Prius in the King’s Bench, in 1809, an action on an annuity bond was brought by a Miss Faulder against the executors and heir of Thomas Clerk Jervoice : the defence was lunacy of the obligor. The young lady had been the mistress of Mr. Jervoice from the age of eighteen, cohabiting with him for twelve years, and conducting herself throughout with singular propriety, and paying every possible attention to his wel¬ fare. When he executed the bond in her favour, he did it with peculiar caution, and the preparers of the instruments and the attesting witnesses bore strong testi¬ mony to his competency for the act. The bond bore date 1808. The following facts were adduced in evidence by the defend¬ ants. The lunatic, on the death of his grandmother in the year 1802, became pos¬ sessed of an estate in Hampshire, whither he immediately repaired, and whilst the corpse was yet unburied, pulled down the ehimnevs and levelled the walls of the 920 DR. CUMMIN ON FORENSIC MEDICINE. mansion, himself living in a marquee, sleeping in a stable or a summer house, andcookinghis victuals with his own hands under a tree in a favourite vessel, which he called his conjuror. The carriage of his grandmother was painted black, by his directions, and exposed for sale under the name of Black Jack. Upon the death of his father, he came into the possession of the family estate and residence, situated at West Bromwich, in Staffordshire, whi¬ ther he repaired, and made a bonfire of all the furniture, himself superintending the conflagration . It was his practice to ride about the country on a jackass, dressed in a white hat, blue trowsers, red morocco slippers, with a flannel shirt next his skin, and over that a white linen shirt, without either coat or w aistcoat, wearing sometimes a wraggoner’s frock. His usual places of residence were tents, stable-yards, or coach-houses, w here he cooked his victuals, and even shaved himself, in his beloved conjuror , occasionally sleeping on the boards of a parlour, or the stones of a hall. Much of his time was spent in travelling — his carriage being always filled wTith pots, pans, silver plates, old china, a bunch of large keys, picklocks to the number of one hundred and fifty, and his inseparable conjuror. A carriage which he once made use of was unpainted, until a sudden freak induced him to order three female do¬ mestics to paint it on a Sunday, and then he rode out in it, the paint being wet. Fishwomen wrere frequently called to him as they were passing by, whose fish he purchased, and whom he employed in mending the., lining of his carriages with the peticoats of his maid- servants. His female domestics, particularly a wroman of the name of Elizabeth Savage, whom he picked up at Birmingham, were the com¬ panions of his journeys ; and he would fre¬ quently stop at night on the high roads, making tea and cooking his victuals ; on one occasion he performed the process of cooking at midnight on Bagshot Heath, with numerous candles burning around him, to the no small surprise and enter¬ tainment of travellers. Staircases became the objects of his aversion, for he thought them unsightly things; and caused the staircase of his house at Egham to be taken down, substituting a ladder in its stead ; passages were moreover cut through the ceilings, through which his servants were sometimes obliged to raise themselves into their chambers by ropes and pullies : himself occasionally sleeping on the boards of the ground-floor. To his own chamber (when he made use of one) he clambered by means of a chest of drawers filled with large nails drawn out progressively like steps, from the top of which he ascended by ropes. In one of his houses a staircase turning on castors was erected, to serve as a crane, for the purpose of raising his car¬ riage into his chamber windows. Win¬ dows were frequently converted into doors, and the doors blocked up. At length he conceived an aversion to the presence of servants; and, to obviate their attendance, caused the door leading to his chamber from below to be cut in two, so as to form a bar, over which his domestics were never allowed to pass; but they placed his victuals on a table in the inside, connect¬ ed by a rope and pulleys with that on which he was sitting, and thus were his victuals conveyed to him. He was confined in a madhouse on the 2d of January, 1809, where he continued to the day of his death. Lord Ellenbo- rough observed to the jury, that although the inquisition which found Mr. Jervoice a lunatic during the period w hen the instru¬ ments in question were executed, was evi¬ dence of his insanity, yet that such evi¬ dence was presumptive only, not conclu¬ sive ; and if they should be of opinion, that when he granted the annuity lie had such possession of his intellects as rendered him perfectly aware what he was doing, and in making such a disposition of his property had followed the dictates of his mind w'hen fully possessed of reason, their verdict should be in favour of the annuity ; provided, on the contrary, they believed him to have been, during the w7hole period covered bv the inquisition, in a state of decided insanity without any lucid inter¬ val, the defendants wrere entitled to a ver¬ dict. — Verdict for plaintiff *. There is sometimes considerable diffi¬ culty in detecting monomania, when the particular subject on which the mind is deluded is not immediately known, or does not happen to be accidentally touched upon. Lord Erskine, when acting as counsel for Hatfield, who shot at the King in Drury-lane Theatre, related the follow¬ ing interesting anecdotes, which had been told him by Lord Mansfield. “ A man of the name of Wood indicted Dr. Monro for keeping him as a prisoner wdien he wras sane. He undement the most severe examination by the defendant’s counsel without exposing his complaint ; but Dr. Battye having come upon the bench by me, and having desired me to ask him what was become of the Princess whom he had corresponded with in cherry- juice, he showed in a moment what he was. He answered, that there was nothing at all in that, because, having been (as every body knew) imprisoned in a high tower, and being debarred the use of ink, he had no other means of correspondence but by w'riting his letters in cherry-juice. * Law Magazine, No! VII. DR, PHILIP ON THE POWERS OF LIFE. 921 and throwing them into the river which surrounded the tower, where the Princess received them in a boat. There existed, of course, no tower, no imprisonment, no writing in cherry-juice, no river, no boat ; hut the whole the inveterate phantom of a morbid imagination. I immediately (continued Lord Mansfield) directed Dr. Monro to be acquitted; but this man, Wood, being a merchant in Philpot-lane, and having been carried through the city in his way to the mad-liouse, indicted Dr. Monro over again, for the trespass and imprisonment in London, knowing that he had lost his cause by speaking of the Princess at Westminster; and such (said Lord Mansfield) is the extraordinary sub¬ tlety and cunning of madmen, that when he was cross-examined on the trial in Lon¬ don, as he had successfully been before, in order to expose his madness, all the inge¬ nuity of the bar, and all the authority of the court, could not make him say a single syllable upon that topic, which had put an end to the indictment before, although he still had the same indelible impression upon his mind, as he signified to those who were near him ; but, conscious that the delusion had occasioned his defeat at Westminster, he obstinately persisted in holding it back.” And the following may be added, which Lord Erskine related on the same occa¬ sion, as having occurred in his own practice. “ I well remember that I once examined, for the greater part of a day, an unfortu¬ nate gentleman who had indicted a most affectionate brother, together with the keeper of a mad house atHoxton, for hav¬ ing imprisoned him as a lunatic ; whilst, according to his evidence, he was in his perfect senses. I was, unfortunately, not instructed in what his lunacy consisted, although my instructions left me no doubt of the fact; but, not having the clue, he completely foiled me in every attempt to expose his infirmity. You may believe that I left no means unemployed which long experience dictated ; but without the smallest effect. The day was wasted, and the prosecutor, by the most affecting his¬ tory of unmerited suffering, appeared to the judge and jury, and to a humane Eng¬ lish audience, as the victim of the most w anton and barbarous oppression : at last Dr. Sims came into court, who had been prevented by business from an earlier at¬ tendance. From him I soon learned, that the very man whom I had been above an hour examining, and with every possible effort which counsel are so much in the habit of exerting, believed himself to be the Lord and Saviour of mankind ; not merely at the time of his confinement, which was alone necessary for my defence, but during the whole time that he had been triumphing over every attempt to surprise him in the concealment of his disease. I then affected to lament the in- decenc) of my ignorant examination, w hen he expressed his forgiveness, and said, with the utmost gravity and emphasis, in the face of the whole court, ‘ 1 am the Christ;’ and so the cause ended.” ON THE POWERS ON WHICH THE FUNC¬ TIONS OF LIFE IN THE MORE PERFECT ANIMALS DEPEND, AND ON THE MANNER IN WHICH THEY ARE ASSOCIATED IN THE PRODUCTION OF THEIR MORE COMPLICATED RESULTS. By A. P. W. Philip, M.D. F.R.S. L. & E. &c. [From the Philosophical Transactions, with large additions, communicated to the Medical Gazette by the Author.] In considering the powers of life, I shall in the first place inquire into the seat, the functions, and the nature of each of these powers ; and then point out the manner in which they are associated in the production of their more complicated results*. * The following paper comprehends the results of a task, not of a few months or years, but, with the exception of the time devoted to the more ac¬ tive duties of my profession, of the greater part of not a short life. As far as I can, to render what I have done useful, it is necessary that the various facts should be compared, and thus the inferences they afford ascertained. They are dis¬ persed through so many publications, eleven papers in the Philosophical Transactions, pub¬ lished in the course of twenty years, an Inquiry into the Laws of the Vital Functions, a Treatise on the Influence of Minute Doses of Mercury in restoring the Functions of Health, my Gulstonian Lectures on the more obscure affections of the Brain, &c., that although they are frequently re¬ ferred to, it has almost always been, more or less, under mistaken views ; because the writer, in commenting on one part, has been unacquainted with others with which it is intimately connected, for in so protracted an investigation, few will take the trouble to keep pace with the inquirer. It will appear from the references in the follow¬ ing paper, how each of the various facts, dispersed through so many publications, has contributed to fill up" the great outline of the laws that regulate the animal functions, which has been the object of my labours; and from which the topics of the day have never induced me to swerve. It is evi¬ dent that this outline must be ascertained before the functions of particular organs can be success¬ fully investigated; all of which, more or less, de¬ pend on the general laws of our frame. The following, I believe, is the first attempt which has been made to ascertain experimentally the seat, the functions, and the nature of al! the powers of the more perfect animal, and the vari¬ ous relations they bear to each other, by which 922 DR. PHILIP ON THE POWERS OF LIFE. Of the Seat, the Functions, and the Nature of the Powers on which the Phenomena of LiJ'e depend. Of the powers of the living animal, the simplest is that by which the motion of its various members is effected, and which essentially contributes to all its more com¬ plicated functions, the contractile power of the muscular fibre, the healthy action of which is not a state of uniform contrac¬ tion, but of a constant and generally rapid succession of contractions and relaxations, probably the cause of its moderate excite¬ ment being (in opposition to the laws which regulate the excitability of the organs of the sensitive powers) followed by no sensible exhaustion of excitability, on which we shall find the most important results depend. Its permanent contrac¬ tion, we have reason to believe, is always a state of disease. It is followed, unless of very temporary duration, by a sensible ex¬ haustion of excitability * * * §. Many of the older physiologists supposed that all the powers of the living animal reside in the nervous system. Haller was the first who, in a way that command¬ ed general attention, maintained that the muscular power resides in the muscular fibre itself, and made experiments for the purpose of establishing this opinion. several, and in some functions all of these powers being enabled to cooperate, their more compli¬ cated results are effected. In the latter part of the subject, I have found much care required in rendering the language sufficiently explicit ; and if in any instance I have failed in this attempt, I hope it will in some degree be ascribed to the very complicated nature of the subject, arising from the great variety of facts on which the con¬ clusions are necessarily founded. It will be admitted with respect to the conclu¬ sions themselves, that the circumstance of the present inquiry embracing the whole of the sub¬ ject, is in favour of their accuracy; because in that case, and where, as in the present instance, all the parts are intimately connected, few in¬ ferences consequently resting on any single posi¬ tion, an error may betray itself in so many ways, that it can hardly escape detection. In the Treatises above mentioned, the cor.elu. sions being founded on many of the experiments to which I shall have occasion to refer in the fol¬ lowing paper, it was necessary as far as this is the case, to refer to their results in these Trea¬ tises. As the conclusions of the present paper constitute the object I had in view in all I have done on the subject, it is necessary in it to refer to the results of all these experiments, either as essential to, or tending to illustrate, those con¬ clusions. There is no other branch of medicine in which misstatements find so ready currency as in the less familiar departments of physiology. Thus it is that the subjects which require the most deli¬ cate handling are most exposed to rough usage; and, except among those who make them a seri¬ ous study (which is not easily done amidst the fatigue and anxieties of a laborious profession), in¬ volved in inextricable confusion. * See papers on the Nature of Sleep and Death, published in the Philosophical Transactions for 1333 and 1834, and republished in my treatise On the Nature of Sleep and Death. His conclusions, however, were not generally admitted, and the principle on which the point was argued could lead to no decision. It was as easy to affirm as to deny that the remaining nervous influence is the cause of the power which exists in the detached muscle, for it was impossible to separate from the muscular fibre the minute extremities of the nerves with which it is blended, and to them it was alleged that it owes the power, which for a short time it retains after its separation from the brain, spinal marrow, and larger nerves. The only conclusive means of determin¬ ing the question, appeared to be an appeal to such experiments as are capable of directly ascertaining whether the effect of the nervous influence on the muscular fibre be that of maintaining, or analogous to the effects of other stimulants, of ex¬ hausting its excitability. It appears from the 32nd experiment, detailed in my Inquiry into the Laws of the Vital Functions*, that the latter is the case to a degree that leaves little doubt respecting the result f ; which was con¬ firmed by other experiments, in which I found in many trials, that when the powers of the nervous system are destroyed by opium or tobacco, the loss of power in the muscles is not proportioned to the de¬ gree in which the powers of that system are impaired, but simply to the degree in which their contractions had been excited through it + ; and that the removal of both the brain and spinal marrow, which we shall find are the only organs employed in the formation of the nervous influence, does not in any degree impair the action of the heart and vessels, as long as the healthy state of the blood can be main¬ tained by artificial respiration §. , From the whole of these experiments, it appears that the opinion of Haller is correct, that the power of the muscular fibre is not derived from the nervous svs- tern, but resides in that fibre itself; a con¬ clusion which we shall find of no small importance in judging of the nature * In referring to my Inquiry into the Laws of the Vital Functions, the ’-eference is always to the third edition. t When two sets of muscles of the same de¬ scription were exposed to the action of the same artificial stimulant, and one of them at the same time to the effects of the nervous influence, it was found that the excitability of the latter was most rapidly exhausted; and this was sometimes the case to so great a degree, that in one instance the excitability of the muscles exposed to both was exhausted in half the time required for its ex¬ haustion in those exposed to the artificial stimu¬ lant alone. t The fourth edition of my Treatise on Fevers and Inflammations. § Philosophical Transactions for 1815, and my Inquiry into the Laws of the Vital Functions, Part II, DR. PHILIP ON THE POWERS OF LIFE. 923 of the nervous influence, and con¬ sequently of other functions of the living animal, beside the function of the muscu¬ lar fibre. The powers of the nervous system, pro¬ perly so called, which cooperate with the muscular fibre in all the more complicated functions, next demand our attention: and it will appear that there is no other branch of physiology in which the gene¬ rally received opinions have been, and in¬ deed still are, so much at variance with simple matter of fact. That what in common language is call¬ ed the nervous system, embraces two dis¬ tinct sets of organs, is evident; because not only do the functions of the sensorial and nervous organs, properly so called, essentially differ in their nature, but, as we shall find, their localities also are dif¬ ferent. Now it has generally been taught that the nervous functions, properly so called, only administer to those of the sensorial powder; that they are limited to the conveyance of impressions to and from the sensorial organs, and to the excitement of the muscles of voluntary motion*. I shall in the first place inquire into the nature of the functions of the ner¬ vous system, properly so called, and then endeavour to ascertain to what parts of that svstern the powers on which those functions depend, belong. The mere structure of the parts might have led physiologists to suspect that the oigans of this system possess other^ powers 'tnan those just enumerated. We find two d\stinct classes of nerves, to one of which the functions subservient to the sensorial powers evidently belong, and it has never been proved that the other at all partake of these functions. Besides, it had appear¬ ed from experiments relating to this second class of nerves, although their results wTere differently reported by differ¬ ent writers, that they must possess func¬ tions of a wholly different nature. Such were the circumstances which called my attention to this, as it were, superadded class of nerves ; and I think it will appear from the facts I am about to adduce, both what are their functions, which we shall find much more compli¬ cated than those of the former class, and why the results of the experiments just re¬ ferred to have been so differently repoited. The most evident peculiarity of struc¬ ture relating to these nerves is, that while * See in the Report of the British Association for the Advancement of Science for ? by Dr. Henry, of Manchester ; and a Dissertatio on the state of Medical Science from fhe termina¬ tion of the 18th century to the present Dr. Allison, Professor ot the Institutes ot Med cine in the University of Edinburgh, m the Cyc o- pjedia of Practical Medicine, published in 18S4. all the former class proceed either from the brain or spinal marrow, directly to the parts they influence, or which influence them, they either enter or send branches which enter a chain of protuberances call¬ ed ganglions, from which nerves are sent to the parts influenced by them. Hence they are termed ganglionic nerves, a term, however, which has not been employed in a very strict sense ; because, besides the ganglions just mentioned, which receive nerves from different parts of the brain and spinal marrow, there are other protu¬ berances also termed ganglions, which are formed on particular nerves, but which appear to have no relation to any nervous filaments but those of the particular nerve to which they belong. It is therefore necessary that I should define the sense in wrhich I use the terms ganglion and gan¬ glionic nerve. By ganglion, I mean a nervous protuberance which receives nerves from different sources; and by ganglionic nerve, a nerve which either enters or sends branches to such ganglions, or proceeds from them, whether it have or have not, any such protuberance belonging to itself. It may be stated, however, that there is reason to believe that all nerves having such protuberances contribute towards the formation of the ganglions in the sense in which I use the term *. One of the most evident peculiarities of the ganglionic nerves, in the sense in which I use the term, is, that while the cerebral and spinal nerves supply the sen¬ sitive organs and the muscles of voluntary motion, the ganglionic nerves supply the muscles of involuntary motion and the other vital organs. Haller, finding that the heart cannot be influenced through its nerves in the same way as a muscle of voluntary mo¬ tion, was led to the conclusion that the former cannot be directly influenced through the nerves. But M. Le Gallois has shown that he was deceived in this in¬ ference, the heart being immediately sub¬ ject to the influence of the spinal marrow ; and the latter author further inferred from his experiment*, that the spinal marrow is not only capable of directly in- fluencing the heart through its nenes., but that, through the same channel, it bestow's on both the heart and blood-vessels all their powers; an inference refuted both by experiments already referred to, and others, an account of which appeared in the Philosophical Transactions for 1815, and has since been republished in my In¬ quiry into the Laws of the N ital I unc¬ tions ; and some of wrhich were at the * See a paper on the function of the nervous system, in the Philosophical Transactions for 1829, which was republished in my treatise On the Nature of Sleep and Death. 924 DR. PHILIP ON THE POWERS OF LIFE request of the Royal Society, repeated with the same results by Mr. Clift; Mr. Clift’s confirmation of them being pub¬ lished in the same volume of the Trans¬ actions. The circumstance of the brain and spinal marrow only, as we shall find, in¬ fluencing the heart under peculiar circum¬ stances, is probably the cause of the fact ascertained by Haller, that it cannot be excited through its nerves in the same way as a muscle of voluntary motion, an observation which applies to all muscles of involuntary motion, a want of attention to which has misled some physiologists*. From the whole of the experiments which have been referred to, it appears, on the one hand, that neither the brain nor spinal marrow bestows any power on the heart or vessels; but, on the other, that each of the former organs is equally capable of directly influencing both, (the vessels, even to their utmost extremities,) and that not only by exciting their powers, but also by impairing, and even wholly destroying them, according to the nature and power of the agent operating on the brain or spinal marrow f; although in their usual functions the heart and vessels, like the other muscles of involuntary mo¬ tion, obey neither of these organs, but agents peculiar to themselves];. Thus it appeared that the ganglionic, like the cerebral and spinal nerves of mo¬ tion, may administer towards the contrac¬ tion of the muscular fibre, unless, what I conceive to be more probably the case, although not yet ascertained, branches of the latter nerves are bound up in the same sheath with the ganglionic nerves, as we shall find there is reason to believe is the * See my reply to MM. Breschet and Milne- Edwards, in the Philosophical Transactions for 1829, entitled, “Some Observations relating to the Function of Digestion.” + It appears, from direct experiment, that both the nervous and muscular powers may he instant¬ ly destroyed by suddenly crushing either the brain or spinal marrow. When the experiments on which these positions are founded were first made known to Mr. Andrew Knight, the Presi¬ dent of the Horticultural Society, so celebrated for his discoveries in vegetable physiology, partly from motives of humanity and partly to render the flesh of the animals immediately fit for the table, he adopted the practice of killing all the smaller animals by suddenly crushing the brain. Thus, by the instant destruction of the contrac¬ tile power of the muscles, all stiffening after death is prevented, the flesh at once being ren¬ dered permanently tender; a sti iking proof of the influence of the nervous over the muscular system ; and in the account of his mode of killing the animals, published by Mr. Knight, in the newspapers of his neighbourhood, he states that the flesh is thus rendered both more tender and of a better flavour than can be done by the usual method of keeping the dead animal. t See two papers published in the Philosophi¬ cal Transactions for 1815, and republished in my Inquiry into the Laws of the Vital Functions, case with respect to the nerves of sen¬ sation*. Physiology has been much in¬ debted to the experiments of Sir Charles Bell, M. Magendie, and Mr. Mayo, from which it appears that the nerves of motion and those of sensation, although often bound up in the same sheath, are distinct nerves, having different origins. What are the functions which are pecu¬ liar to the ganglionic nerves, in the sense in which I use that term ? This question is answered respecting one of the most important of the vital functions, the process of secretion, in pa¬ pers published in the Philosophical Trans¬ actions for 1815 and 1822, and republished in the last edition of my Inquiry into the Laws of the Vital Functions. It appears from the experiments detail¬ ed in those papers, that when part of the eighth pair of nerves in their passage along the neck is removed, or these nerves are divided, and one end of either portion is raised from its place, the secretion of gas¬ tric juice soon begins to fail in its proper¬ ties ; and if the animal survives for a cer¬ tain time, the contents of the stomach are found not only undigested, but quite dry, proving that there had been no secretion from it whatever for some time. From these experiments wre also learn how it has happened that such various accounts of the effects in the stomach of dividing the eighth pair of nerves is given by different experimentalists ; because it wras found that digestion was more or less completely interrupted in proportion as the divided ends of the nerves were kept at a considerable distance from each other. Even when the distance was a quarter of an inch, provided the divided ends were no otherwise displaced than in consequence of the retraction of the nerve on its divi¬ sion, digestion, although more or less deranged, was not interrupted, a subject to which I shall have occasion to recurf . Now as this was a point which never par¬ ticularly demanded attention, accident must always have more or less influenced the result. * It appears from the anatomical researches of Mr. Mayo (Outlines of Human Physiology, fourth edition, page 260,) that nerves of motion are bound up in the same sheath with ganglionic nerves. I was not aware that this fact had been ascertained by direct observation at the time the passage to which this note belongs was printed in the Philosophical Transactions. My opinion, as there expressed, was an inference from the general laws of the animal economy. t In some organs, when the nervous influence is to a certain degree impaired, while the proper¬ ties of the secreted fluid are altered its quantity is increased, when the nervous power is impaired to a greater degree, the quantity also is impaired ; and at length the secreting power wholly fails, no discharge whatever from the secreting surface taking place. The results of the experiments here referred to are well illustrated by some of DR. PHILIP ON THE POWERS OF LIFE. 925 But secretion is not the only vital func¬ tion that is influenced by the division and separation of the divided ends of the eighth pair of nerves in the neck. It appears from experiments detailed in a paper published in the Philosophical Transac¬ tions for 1827, and republished in my treatise On the Nature of Sleep and Death, that, under such circumstances, all the assimilating functions are so deranged that in many parts of the lungs, in the space of fifteen or twenty hours, not a vestige of their healthy structure remains. Such, it appears, are the effects on the stomach and lungs of depriving them of a considerable portion of the influence of the brain. They are organs well adapted for such observations. In the stomach we have certain means of judging of any con¬ siderable deviation in the process of secre¬ tion ; and from the peculiar structure of the lungs, they are well adapted for obser¬ vations on changes of structure. That the effects are proportioned to the degree in which the influence of the brain is with¬ drawn, appears from comparing those of dividing and separating the divided ends of one or both nerves. It is not, however, to the brain alone that similar observations apply, for it was found that depriving the stomach and lungs of the influence of the spinal marrow is attended with the same effects. When the lumbar portion of this organ was de¬ stroyed, the functions of the stomach and lungs, and the structure of the latter, were as much impaired as by the division and separation of the divided ends of one of the eighth pair of nerves ; and when the lower half of the spinal marrow was de¬ stroyed, as much, as by the division and separation of the divided ends of both those nerves *. It thus appears that the powers on which the secreting and assimilating functions depend reside in the brain and spinal marrow, and equally in these organs; nor does either of them receive their impressions or act through the other in in¬ fluencing the vital organs, as the brain is found to do through the spinal marrow with respect to many of its impressions, and in influencing many of the mus¬ cles of voluntary motion ; the heart and vessels in every part being equally influenced by agents acting either on the brain or spinal marrow, when the other has been removed, as while both, with all their connexions, remain. And the complete division of the spinal marrow at the symptoms of the disease, called the Asiatic cholera, which appears, from what I have saicl An a pamphlet on that disease, to be the effect or le continued operation of a cause, impairing alone the nervous powers, properly so called. * See my Inquiry into the Laws of the vital Functions, Part II. its middle having no effect in imped¬ ing the functions of either the stomach or lungs except in a hardly perceptible de¬ gree, proportioned to the small part of that organ necessarily destroyed in its divi¬ sion, the lower contributing to the functions of both the stomach and lungs precisely as it did before its separation from the upper half*. The sensitive functions cease in all parts below the division, because in these functions the spinal marrow only transmits the influence of the brain f. The question which next presents itself is, how far are the brain and spinal mar¬ row assisted in the foregoing functions by the nerves, ganglions, and plexuses ? In a paper, published in the Philosophi¬ cal Transactions for 1833, and republished in my treatise On the Nature of Sleep and Death, I have entered into this question at great length, where such observations and experiments will be found, as far as I am capable of judging, as render the follow¬ ing inferences unavoidable. That the nerves, ganglions, and plexuses, in no degree contribute to the formation of the nervous influence; the spinal and cerebral nerves being merely the means of convey¬ ing the influence of the parts of the brain and spinal marrow from which they pro¬ ceed, and of conveying to these organs the influence of impressions made on their extremities ; while the ganglions and plexuses are only the means of combining the influence of all parts of the brain and spinal marrow, through all parts of which the organs of the nervous power properly so called, are distributed ; the nerves pro¬ ceeding from the ganglions and plexuses being the means of conveying this com¬ bined influence to the muscles of involun¬ tary motion and the other vital organs. The question here arises, For what pur¬ pose is the influence of every part of the brain and spinal marrow thus combined to be bestowed on these organs ? This question is answered by the experi¬ ments just referred to, which prove that the influence of every part of the brain and spinal marrow is necessary to the due performance of the functions of secretion and assimilation; and by other facts to which I shall have occasion to refer, which prove the necessity of the muscles of in¬ voluntary motion being under the control of the same power, on which these func¬ tions depend. All of them, as we have just seen, fail when any considerable part of the in¬ fluence either of the brain or spinal mar¬ row is withdrawn, the failure of function being proportioned to the degree in which * Inquiry into the Laws of tlie \ ital Functions, Part II. Exp. 62. t Ibid, Part II. 926 DR PHILIP ON THE POWERS OF LIFE, the influence of either is withdrawn, proving that the influence of every part of them is essential to the due performance of those functions *. Important and extensive as these func¬ tions are, there is still another, hardly less so, dependent on the powers of the nervous system properly so called. Sir Benjamin Brodie f proved by direct ex¬ periment many years ago, that animal temperature is under the influence of the nervous system, and various observations evince that a debilitated state of the brain is accompanied with a diminished tem¬ perature. I made many experiments on this sub¬ ject, detailed in my Inquiry into the Laws of the Vital Functions, from which it ap¬ pears "that in this, as in all the other vital functions, the spinal marrow shares with the brain. If the power of either organ be impaired, the temperature sinks in precisely the same proportion as the secre¬ tions are deranged. A particular organ may be deranged by preventing its due supply of nervous influence, and there may be no general diminution of temperature. The due nervous influence is prevented reaching the particular organ, but there is no diminution of the power of the brain or spinal marrow. When, on the other hand, the power of either of these organs is im- paired, there is an immediate diminution of temperature,— -a proof that the main¬ tenance of animal temperature is effected through the medium of the ganglionic nerves, they alone conveying the combined influence of both the brain and spinal marrow. By this means we can by easy experiments ascertain through which class of nerves any function is maintained, and consequently its organs supplied, in cases where the parts are too minute for the la¬ bours of the anatomist. It was thus that it was ascertained that the vessels, even to their minutest extremities, are supplied by ganglionic nerves. When the lower half of the spinal mar¬ row was destroyed the animal shivered, and would probably soon have died of cold, if it had not been kept in a high temperature; and even when the lumbar portion alone was destroyed, a considera¬ ble but less diminution of temperature ensued Thus it appears, from the whole of the * See papers which appeared in the Philosophi¬ cal Transactions for 1815 and 1827, and my In¬ quiry into the Laws of the Vital Functions, Part II. It appears from what is said in the third part of the third edition of my Inquiry into the Laws of the Vital Functions, that a successful practice in diseases of the spinal marrow was suggested by this fact. t See the Philosophical Transactions for 1812 and 1814. t Inquiry into the Laws of the Vital Func¬ tions, Part II. facts which have been referred to, that on an influence derived from the brain and spinal marrow, and not from any part, but from the whole of these organs, the secreting and more immediately assimi¬ lating functions and the maintenance of animal temperature depend. This in¬ fluence, therefore, performs a still more important part in the vital than in the sensitive functions. In the latter we find it acting only a subordinate part ; while in the former it must be regarded as the great agent, to which all others employed are subservient. Has the nervous influence any imme¬ diate dependence on any of the other powers of the animal frame ? The muscular, we have seen, has no immediate dependence on the nervous power, the only power on which its imme¬ diate dependence can be supposed. In like manner the sensorial is the only power on which any immediate depen¬ dence of the nervous power can be sup¬ posed. I made an extensive set of experiments, detailed in my Inquiry into the Laws of the Vital Functions, to which I shall soon have occasion to refer more parti¬ cularly, from which it appears that all the functions in which the nervous power, properly so called, is employed, survive the removal of the sensorial power, with the exception, of course, of those in which that power is associated with it. After the removal of the sensorial power the nervous influence still retains all its pro¬ perties. It is still capable of exciting the muscles both of voluntary and involuntary motion, of, for a short space of time, form¬ ing the secreted fluids, performing the various functions of assimilation, so far as to preserve the structure of the parts where it would otherwise have been im¬ paired, and, to a certain degree, of main¬ taining animal temperature. The ner¬ vous, like the muscular power, therefore, is an independent power, having its seat in its own organs, and having no other dependence on the other powers of the living animal than for the due structure of those organs. Such are the powers of the nervous and muscular systems of the more perfect ani¬ mals, and the seat and functions of these powers. They possess, however, two other sources of power, for the sensorial power and the powers of the living blood have no imme¬ diate dependence on either of the former powers, or on each other. That the only dependence of the sen¬ sorial power is for the maintenance of its organs, is evident on the most cursory re¬ view of the animal economy. The nature of the functions of that power alone DR. PHILIP ON THE POWERS OF LIFE. 927 evinces that the living animal possesses no others from which it can be derived; and that the powers of living blood have no direct dependence on its other powers, is proved by the fact, that the blood retains its vital properties after it is separated from the body *. With respect to the locality of the latter powers, the powers of the living blood, it appears from the fact just stated, existing in itself, must be coextensive with the functions of secretion and assimilation. At first view it would appear that the functions of the sensorial power, like those of the living blood, pervade every part of the system ; the power of sensation seems to pervade the whole frame. On observing the phenomena with more care, however, we find the seat of the sensorial power confined to a small space, when we com¬ pare it with that of the nervous power pro¬ perly so called, the organs of which, we have seen, pervade the whole of the brain and spinal marrow. The nerves of sensation, in which are included, of course, the nerves of the ex¬ ternal senses, and the immediate organs of the sensorial powers, are not parts of the same organ, but distinct parts, having dif¬ ferent localities and performing functions of a wholly different nature; that is, the sensorium does not pervade the whole sys¬ tem, but belongs to particular parts. To what parts has never been correctly ascer¬ tained, but we know that in man they are confined to certain parts of the brain, with little if any participation by the spinal marrow ; although in some of the inferior animals the spinal marrow largely par¬ takes of them, a proof that the sensorium is not, as some have supposed, confined to a physical point, but is of a considerable extent. Our sensations are referred to certain parts of the body by experience alone. Hence the well-known facts that infants are not aware of the part of the body in which the cause of any sensation ori¬ ginates; and when a limb has been lost, at whatever part the separation is made, we continue to refer to the lost part sensations excited by causes affecting the nerves of the stump. The function of the nerves of sensation has relation to the sensorial organs alone. The influence they convey is the means by which the sensorium is impressed by dis¬ tant parts, and such is their only func¬ tion. The more perfect animals, then, possess four distinct powers, having no direct dependence on each other, but each we * See Mr. Hunter’s experiments on the Blood, and the experiments detailed in the last chapter of the second part of my Inquiry into the Laws Of the Vital Functions. shall find indirectly dependent on the other three, namely, for the maintenance of its organs. I am now to inquire how far we can advance in determining the nature of these powers, how far they are peculiar to the living animal, or the same which ope¬ rate in other parts of nature. We are in the habit of regarding life as a power of peculiar mystery, but do we find any other principle of action less mys¬ terious? It is not the principle but 'its properties which are the objects of our senses. A knowledge of the former is not merely beyond the limits, but the nature of our minds. Do we know more of the principle of electricity or gravitation than of life, or is there more uncertainty in noting the property of resistance to fer¬ mentation and congelation without any sensible peculiarity in the substances pos¬ sessed of this property, than that of weight or light ? It is not that the nature of life is more obscure than that of any other principle of action, all are equally so, but that its phenomena, being more varied and bearing less resemblance to those of other principles than these bear to each other, are less familiar objects of contemplation. The subject thus appears invested with an obscurity which does not belong to it, and the perplexity has been increased by vain attempts to remove it; attempts on principles having no relation to the laws by which the phenomena of life are regu¬ lated. What possible relation can the laws of mechanics, or any other principle which operates in the inanimate world, bear to the phenomena of life properly so called ? It is as much a distinct principle as any of those which operate in that world, and the same method which leads to a knowledge of other sciences must guide us here. There are no means but a study of its phenomena by which we can attain a knowledge of life, that is, of its properties, the only knowledge we can at¬ tain of any principle of action. But if our object be to attain a correct knowledge of it, we must first determine with accu¬ racy what are the phenomena of life; for, in the complicated functions of the living animal, it requires not a little patience, labour, and circumspection, to distinguish what part depends on vital powers proper¬ ly so called, and what on a modification of the powers of inanimate nature. Even the most cursory view must convince us that many of the functions of the living animal partake of the latter powers. Respiration is performed, that is, the air is drawn into and expelled from the lungs, by means which act on the same principle as the bellows. The blood in the circula¬ tion, moves on the same principle as the 928 DR. PHILIP ON THE POWERS OF LIFE. water in a set of water pipes. It obeys a propelling' force, and is subjected to the same laws of gravitation. The motion of our limbs is effected by the same mechani¬ cal laws by which bodies are put in mo¬ tion in the external world. Here, as in inanimate nature, velocity can only be obtained by the sacrifice of power. Simi¬ lar observations apply to the various pro¬ cesses of secretion and assimilation. We can trace in these processes the same che¬ mical laws which obtain in the laboratory of the chemist ; but there is at the same time, in all the foregoing functions, some¬ thing more in operation, analogous to which we find nothing in inanimate nature. The force, indeed, by which the air is drawn in and expelled in respiration, ope¬ rates on the same principle as in the bel¬ lows ; but the powers by which the ma¬ chinery is worked are the contractile power of the muscular fibre, and the powers of the nervous system, by which the stimulus which excites it is both pre¬ pared and applied. The motion of the blood depends on the same principle as that of the water in its pipes, but it is the contractility of the muscular fibre which supplies the moving power. The same ob¬ servation applies to the motion of the vari¬ ous members of our body. In like manner, in the processes which maintain the organs of all these functions, and effect the separation of those parts of them which have become useless, and therefore noxious, while we trace the same chemical laws which operate in other parts of nature, we can perceive that they are constantly modified by the powers peculiar to the living animal ; for it is not only im¬ possible, by any chemical arrangement, to produce the same results in inanimate nature, but, even by the principles which regulate its phenomena, to trace all the steps by which they are effected. We can neither, for example, imitate the process by which the temperature of living blood is raised above that of the surrounding medium, nor, on the principles of the che¬ mistry of inanimate nature, trace all its steps. No position can be more erroneous than that the chemical processes of the living animal depend alone on the same laws with those of inanimate nature. The properties of life are as peculiarly its own as the properties of gravitation. I am now to attempt to draw the line of distinction between the powers which the living animal possesses in common with inanimate nature, and those peculiar to itself. With respect to its mere mechanical powers, to which I have just had occasion to refer, there can be but one opinion, that they are powers common to the living ani¬ mal and inanimate nature ; but with re¬ spect to the powers we have been more particularly considering, all of which ap¬ pear, at first view, to be powers peculiar to the former, the question is not so easily answered. Until it is answered, however, it is evident that we cannot draw the line which correctly separates the phenomena of life from those which result from other principles of action; a line essential to an accurate view of the properties, that is, to a knowledge, of that principle. The question which I am here to con¬ sider, then, is, how far are the sensorial, nervous, and muscular powers, and the powers of living blood, peculiar to the living animal, or possessed by it in com¬ mon with inanimate nature ? It requires but little consideration to answer the question respecting the sensorial and muscular powers, anol the powers peculiar to the living blood. Where do we find, in inanimate nature, a powrer which can be mistaken for any of them ? But even the most cursory review of the func¬ tions, which, it appears from the experi¬ ments above referred to, are those of the nervous power properly so called, makes us pause. That the oxygen and carbon of the blood combine by the same agency as in the laboratory of the chemist, is a position too probable to be hastily dis¬ missed ; and if such be the case, to what other functions of the nervous influence will the same observation apply ? The following, it appears from experi¬ ments above referred to, comprehend the nervous functions properly so called 1. The excitement of the muscles of voluntary motion in all their functions. 2. The excitement of the muscles of involuntary motion in some of their func¬ tions. 3. The maintenance of the processes on which animal temperature depends. 4. The formation of the various secreted fluids. And 5. The more immediate processes of assimilation by which the structure of our various organs is both effected and main¬ tained. Of these functions, the excitement of the muscles alone is the only one which may be supposed to be the effect of either a chemical or mechanical agent. In all the healthy functions of life, how¬ ever, in which the muscular power is em¬ ployed, the stimulus which excites it, if we except the mere powrer of distension, appears to be of the former description. Even those stimulants which maintain the functions of the alimentary canal, which, remotely depending on the stimulus of the food, may at first view be supposed to be the effect of a mechanical agent, appear to be wholly of a chemical nature. The DR. PHILIP ON THE POWERS OF LIFE. 929 ingesta will not excite a secretion of gas¬ tric juice unless they possess chemical pro¬ perties of a certain description, and the muscular coat of the stomach is not duly excited unless the food has been converted into a healthy chyme, the formation of which, it appears from direct experiments, depends on the healthy state of the influ¬ ence supplied by the brain and spinal marrow*. In like manner, the healthy action of the intestines, as appears from a thousand observations, can only be main¬ tained when their healthy stimulant has been duly prepared by the chemical pro¬ cesses which take place in the duodenum ; which also depend on the influence sup¬ plied by the brain and spinal marrow. It is evident that all the other functions just enumerated are of a chemical nature. It thus appears that all the nervous func¬ tions are chemical processes, and conse¬ quently that there may be an expectation of finding an agent in inanimate nature capable of them. It was found that in proportion as the nervous influence, properly so called, is withdrawn, all these processes fail. It is evident, therefore, that on this influence the changes observed depend. Whatever, therefore, that influence may be, all its functions, in their general nature, are iden¬ tical with the effects of the chemical agent, whatever that agent may be, which ope¬ rates in inanimate nature. This step, therefore, appeared to be gained. Further reasoning, however, was unnecessary, be¬ cause it was not difficult to submit the question to the test of direct experiment. I was thus led to consider what power of inanimate nature it was most probable might be successfully substituted for the nervous influence. An important point had been ascer¬ tained. It had been found that of all the powers of inanimate nature, voltaic elec¬ tricity is most capable of the excitement of the muscular fibre, that is, of one of the functions of the nervous influence. This, indeed, went but a short way towards es¬ tablishing the identity of the two powers, so many other stimulants being capable of exciting that fibre. It is not to be over¬ looked, however, that feeble as this argu¬ ment is towards proving the identity of the nervous influence and voltaic electri¬ * Philosophical Transactions for 1815 and 1822, and Inquiry into the Laws of the Vital Functions, Part II. In an animal which has survived the division and separation of the divided ends of the eighth pair of nerves till the contents of the sto¬ mach, from the failure of nervous influence, have become quite dry, however much distended with food it may be (the circumstances under which the greatest mechanical stimulus is applied to the muscular fibres of the stomach), not even the slightest degree of its healthy action is excited, no part of the undigested food being propelled into the duodenum. 485. — XIX. city, it is powerful respecting the general nature of that influence; because, on the supposition of the nervous influence being a vital power, properly so called, we have here a vital power possessing a property in common with a thousand inanimate agents. Is there any unequivocal instance in which any of the properties of a vital principle, properly so called, is not essentially dif¬ ferent from those of any of the principles of inanimate nature? On the whole, the property in question was sufficient to sug¬ gest the trial how far voltaic electricity is capable of the other functions of the ner¬ vous influence. No hope of success, of course, could be entertained, unless the artificial agent were employed under the same circum¬ stances under which the nervous in¬ fluence operates; that is, while the struc¬ ture of the organs is entire, and their vital properties unimpaired. Under such circumstances, I substituted it for the nervous influence in the various functions of secretion and assimilation, with success. It was admitted by those who witnessed the results, that these func¬ tions were as effectually performed by it, as by that influence itself; and the experi¬ ments were afterwards publicly repeated both in London* and Paris f; in the lat¬ ter, on a great variety of animals, and in both instances with the same results. In the first of my papers published in the Philosophical Transactions for 1829, en¬ titled, “ Some Observations relating to the Function of Digestion,” several cir¬ cumstances are enumerated which it is necessary to keep in view in conducting such experiments ; a want of attention to which has involved the subject in much confusion. Only one of the functions of the ner¬ vous influence now remained which had not been effected by voltaic electricity-— the process by which animal tmeperature is maintained. For the purpose of deter¬ mining how far it is capable of this func¬ tion, it was judged the most satisfactory means to expose the living blood to its ef¬ fects, both in its arterial and venous state. If voltaic electricity operate on the same principle as the nervous influence, it will raise the temperature of the former, but not of the latter, which has already undergone the operation of that influence. Such was * Philosophical Transactions for 18:2. The Journal of the Royal Institution of London for 1822. See also the London Medical and Physical Journal for May, 1820, vol. xliii. p. 1185. f De Plnfluence du Systdme Nerveux sur la Digestion Stomachale; par MM. Breschet,D.M.P. Chdfde Travaux Anatomiques de la Facultd de Mddecine de Paris, &c. ; H. Milne Edwards, D.M.P. ; et Vavasseur, D.M.P. (Mdmoire lu k la Socidtd Phllomatique, la 2e Aoftt, 1823.) Extrait des Archives Gdneralesde Mddecine, Aoflt, 1823. 3 O 930 DR. PHILIP ON THE POWERS OF LIFE. found to be the case. The arterial blood immediately rose several degrees on com¬ ing into contact with the voltaic wires, but there was no increase of temperature in the venous blood, although, in both in¬ stances, the blood was subjected to them as it flowed from the vessels; it having appeared, from previous experiments, that the delay of even a few minutes, although no apparent change had taken place in the blood, and no elastic fluid had been disen¬ gaged from it, prevented any rise of tem¬ perature ; so rapidly do some of the pro¬ perties of living blood undergo a change after its removal from the vessels *. Such being the facts, I could no longer doubt that the nervous influence and vol¬ taic electricity are powers of a similar na¬ ture, and it appeared to me that this would be most convincingly illustrated, by caus¬ ing the nervous influence to pass through other conductors than the nerves ; because such a fact would, independently of all others, prove that it is not a vital power properly so called, it being acknowledged on all sides that no such power admits of separation from the texture to which it belongs in the living animal. With this view I made many vain at¬ tempts, and hardly escaped the ridicule of my associatesfor expecting that the nervous influence could exist in any texture but that to which it belongs in the living ani¬ mal. In the third edition of my Inquiry into the Laws of the Vital Functions, the reader will find the circumstances detailed which led to the successful experiment, the result of which was publicly confirmed both in London and Paris ; and those who in the first instance ridiculed my expectations, joined me in stating that such is the fact. The cause of failure in my first experi¬ ments on this subject, was the circumstance of having made a wrong choice of the nerve on which I operated, which was a nerve of voluntary motion. It will appear on reflection that this was a wrong choice. Before we can expect that the nervous influence can be made to pass through any other conductor than that to which it belongs in the animal body, there must exist a powerful cause soliciting it to some particular point. In a muscle of voluntary motion there can be no such cause. The nervous influence is not attracted to the muscle, it is sent to it by an act of the sensorium, carried into effect by the powers of the nervous organs, which are subjected to its influence; those organs which, on the one hand, prepare that influence, and those which, on the * See the second part of my Inquiry into the Laws of the Vital Functions, Experiments 80, 81, §2, 83, 84, and 85. other, convey it when duly prepared *. The muscle is altogether passive till the influence is applied to it. But the case is wholly different with respect to the seat of many of the functions of the ganglionic system. We know, from direct observa¬ tion, that in many of them there is a cause continually operating, which solicits the nervous influence to their organs. In these organs the living blood and nervous influence co-operate in the func¬ tions of secretion and assimilation ; and it is an acknowledged fact, that when an increased determination of blood to secreting organs takes place, there is, in the same proportion, an increase of their secreted fluids ; a result which cannot arrive without a corresponding supply of nervous influence. Thus we know (as, indeed, we had reason to expect) that the presence of the living blood in the secreting organs solicits a proportionable supply of that influence; and thus it was, that whereas, while I operated on the nerves of voluntary motion, my attempts were wholly fruitless, the very first attempt with the ganglionic nerves was crowned with success; nor, since the repetition of the experiments in London and Paris, has the fact been questioned. If the facts I have stated be correct, we can have little doubt that the nervous influence is of a nature similar to the in¬ animate agent which was substituted for it; for to say nothing of the circumstance of the nervous influence being capable of existing in a texture different from that to which it belongs in the living annual, we cannot suppose that there are two dis¬ tinct powers, the one of which is capable of all the effects of the other; or I would rather say, that such a supposition amounts to a contradiction in terms, because as it is acknowledged that we know nothing of any principle of action but by its proper¬ ties, it necessarily follows, that by these alone it can be distinguished. In discussing the nature of the nervous influence, too much has been ascribed to electric tests, which are referred to as if they possessed a power equal to that of chemical tests. A correct chemical test will give evidence of what we are in quest of under all circumstances; and is there¬ fore capable, in all instances, of detecting its presence, and consequently its absence also. This arises from there being but one counteracting power, that of affinity. If the affinity be stronger in the test than in any other substance, the effect of all other affinities is destroyed. We possess no such electric test, because here there may be other counteracting causes beside the * See the second of my papers in the Philoso¬ phical Transactions for 1829. DR. PHILTP ON THE POWERS OF LIFE. 931 power of affinity — opposing currents, for example. Besides, we know that the properties of electricity are so modified b}r the powers of life, as greatly to interfere with its relations to our tests. The elec¬ tricity of the torpedo and other electric animals does not affect the common electrometer, yet no one has doubted its identity with the electricity of inanimate nature. Although electric tests, therefore, give evidence of the presence of electricity, we cannot by their means prove its absence; a fact with which we should not have been acquainted, were it not, under cer¬ tain circumstances, possible to prove the presence of electricity without their aid ; that is, the presence of electricity may under certain circumstances be proved, where it is not indicated by any of the properties generally admitted to be pecu¬ liar to it. Suppose it were said, for example, that wre cannot admit that electricity is the agent in the combination of oxygen and carbon, because there is no test by which its presence can be detected ; the reply of Dr. Faraday, I conceive, would be — we cannot at present, whatever we may do hereafter, make the electricity employed in effecting this combination evident to any of our tests ; but I consider its pre¬ sence as a necessary inference, because I have adduced facts which prove, either that electricity is the agent in such com¬ binations, or that nature here deviates from the simplicity observed in all her other works. Either electricity is the agent in the combination in question, or t ere are two kinds of chemical affinity. - Under such circumstances, can any other reply avail except either disproving the facts, or pointing out the fallacy of the inference ? What I have done is strikingly illus¬ trated by the late investigations of Dr. Faraday. It is more than twenty years since 1 found that voltaic electricity is capable of all the functions of the nervous influence; it now appears from the facts, on which he has founded his doctrine of electro chemical equivalents, that electri¬ city is the agent in all chemical processes*. According to the inferences of Dr. Fara¬ day, therefore, the experiments, which prove that the nervous influence is the agent in the functions we have been con¬ sidering, all of which we have seen are chemical processes, are sufficient to prove its electric nature ; and we are now also, on the other hand, furnished with direct proof that the brain is capable of col¬ lecting and applying, even according • Dr. Faraday’s papers in the Philosophical Transactions for 1832, 1833, 1834, and 1835. to the dictates of the will, the electric power. Dr. Davy, in his last paper on the Tor¬ pedo*, observes, that “ when the brain has been divided longitudinally, the fish has continued to give shocks f ; when the brain has been entirely ex¬ tracted, the fish instantly lost this power, though the muscles generally continued to act powerfully from which it appears that the electric power is not like the muscular, independent of the brain, but, on the contrary, immediately depending on it; proving that in this, as in all the other nervous functions, as appears from the facts stated in a paper which the Royal Society did me the honour to pub¬ lish in 1833, and which was republished in my Inquiry into the Nature of Sleep and Death, the nerves are merely the pas¬ sive, the brain one of the active, parts of the nervous system J. In the foregoing positions we here find, as in other similar instances, that when truth is once arrived at, other facts, beside those which led to it, arise (and still others will present themselves as we proceed) to ive it their aid. Dr. Davy made no experiments to de¬ termine how far the spinal marrow, the only other part of the nervous system con¬ cerned in the formation of the nervous in¬ fluence, partakes of the function in ques¬ tion. Were we to reason from the analogy afforded by all the other nervous functions properly so called, we should ex¬ pect to find the spinal marrow sharing it equally with the brain. It is not unlikely that the removal either of the brain or spinal marrow would destroy this func¬ tion, as is found to be the case with respect to the more complicated functions properly termed nervous — a point which can only be determined by an appeal to direct ex- * Philosophical Transactions for 1834. t A fact analogous to the division of the spinal marrow leaving unimpaired its influence on the secreting and assimilating organs. t The electric organs in the animals called electric are either the means of both collecting and applying the electric power, or of applying it only. As it appears from the experiment of Dr. Davy, referred to in the text, that the brain is essential to the electric function, it follows that this organ either itself supplies the electric, power, or enables the electric organs to perform this office. That the former is the case, and con¬ sequently that the electric organs are only the means of the application of the electric power, appears from our finding from direct experiment that all the other nervous functions of the brain, properly so called, can be pei formed by the e ec- trie power supplied by other means, and that in all tli“ nervous functions, the nerves (which so copiously enter into the composition of the elec¬ tric organs, the great supply of nerves being pro¬ portioned to the intensity of the electricity re¬ quired for th« function of these organs) are only the means of conveying the influence supplied by the brain or spinal marrow. 932 DR. PHILIP ON THE POWERS OF LIFE. periment; or, like the excitement of the muscles, it may belong to either organ separately, or it may, being a function of volition, belong to the brain alone. In addition to the foregoing statements I may refer to the success which has at¬ tended the employment of voltaic electri¬ city in those diseases which depend on a deficient supply of nervous influence*. That we may have a clear view of the line of distinction between the sensorial and nervous powers, a more particular consideration of the former is necessary. The following points, we have seen, are made out from the phenomena of every day’s experience, that the organs of the sensorial power and the nerves of sensa¬ tion, in which, of course, are included the nerves of the organs of the external senses, are distinct organs ; the former being the immediate organs of those powers, the latter the organs which excite them. We have just seen reason to believe that the influence conveyed by the nerves which excite the muscles, and maintain the se¬ creting and assimilating functions and the due temperature of the animal body, is a power which operates in inanimate na¬ ture; because, on the one hand, we have found such a power capable of all the functions of the nervous influence, pro¬ perly so called ; and, on the other, that this influence is capable of existing in other textures than those to which it belongs in the living animal, proving that it is not a vital power, properly so called. Are the properties of the influence con¬ veyed by the nerves of sensation the same with those of any of the powers of inani¬ mate nature, or can this influence exist in any texture but that to which it belongs in the living animal ? It is enough to say that its only pro¬ perty is that by which it is enabled to co¬ operate with the immediate organs of the sensorial power. To such a property we not only find that there is nothing analo¬ gous in any of the properties of inanimate nature ; but, as will more fully appear from what I am about to say, that the organs of the sensorial power are, in their healthy functions, unapproachable by any of its agents : it is therefore perhaps un¬ necessary to add, that we know of no tex¬ ture in which the influence conveyed by the nerves of sensation can be supposed to exist, but that to which it belongs in the living animal. The nerves of sensation, therefore, be¬ long to the sensorial, not to the nervous * See my paper in the Philosophical Transac¬ tions for 1817, and Inquiry into the Laws of the Vital Functions, Part III., and my Treatise on Indigestion, 7th edition. power. They convey an influence of a wholly different nature from that con¬ veyed by the nerves of the latter power ; and the only analogy which can be traced between their function and the operations of inanimate nature is, that it is excited by impressions received from the agents of the external world ; to which we are in¬ debted for all our knowledge of that world. The action of the immediate or¬ gans of the sensorial power, we have seen, being thus excited by one vital part acting on another, and by its vital properties alone, all analogy with the operations of inanimate nature here disappears. While the other functions of the living animal are the results of inanimate agents acting on living parts, or living parts on them, in the sensorial functions we see the effects of vital parts acting on each other, and that by their vital properties alone. Hence the analogy between the former and the operations of inanimate nature, and, with the exception just point¬ ed out, the total loss of all such analogy in the latter. Whence is it possible to conceive that such analogy can arise, except from the operation of some of the agents of the in¬ animate world ? As no analogy can exist where there is not some property in com¬ mon, and where any property is observed, there the agent to which it belongs must operate, it necessarily follows that in all cases where any analogy can be traced between the functions of life and the ope¬ rations of inanimate nature, there some of the agents of the latter must operate. When the phenomena of the living animal are carefully compared with the preceding facts, it will be found that in every in¬ stance in which any analogy between its functions and the operations of inanimate nature is observed, the interference of such an agent may be detected. We have now considered, individually, the various powers of the more perfect liv¬ ing animal. We have found in it, beside the mechanical powers which, it will be admitted on all hands, it evidently pos¬ sesses in common with inanimate nature, four distinct powers ; three of them vital powers, properly so called— that is, powers having properties essentially different from those of the agents which operate in inani¬ mate nature. In the fourth alone we recognize one of these agents; for we find it can exist in other textures than those to which it belongs in the living animal, and that we can substitute for it one of the powders of inanimate nature, without de¬ ranging the functions of life. As it is admitted that the living animal partakes of the mechanical, should it sur¬ prise us to find that it also partakes of the MIDWIFERY CASES. I 933 chemical powers of inanimate nature ? It appears from the experiments of Dr. Fa¬ raday, above referred to, that it is only as it partakes of the electric, that it can par¬ take of the latter powers. All the foregoing powers are employed, although in a very different way, in the construction of two systems in a great de¬ gree distinct; the end of the one being the maintenance of our bodies, of the other our intercourse with the world which sur¬ rounds us. In the remaining part of this paper, I am to consider the various relations those powers bear to each other in the main¬ tenance of the foregoing systems; and the way in which these systems themselves are so related, as to form the animal body into a. whole, in which no part can be affected without tending more or less to influence every other. This part will appear in the next num¬ ber of the Gazette. SUCCESSFUL LABOUR, WHERE THE PELVIS WAS GREATLV DE¬ FORMED AND CONTRACTED. To the Editor of the Medical Gazette . •V 1 Sir, The accompanying’ case will, I think, prove interesting to your readers. Your obedient servant, Geo. S. Lilburn, M.D. 24, Harley-street, March 10, 1837. The wife of a respectable engraver was recommended, by a celebrated sur- g'eon of this metropolis, to place herself under my care on her approaching- con¬ finement with her first child. She is a short woman, and has deformity of the pelvis, from protrusion of the sacrum anteriorly, which could be distinctly as¬ certained on a common examination per vag-inam. On the 4th April, 1834, the labour pains began, and lasted fifteen hours ; during which time I bled her freely. When the child was born, its head was considerably elongated, the parietal hones overlapping, and the animation suspended : by bleeding' it from the um¬ bilicus, inflating the lungs, using the hot-bath, and external stimuli, it cried after little more than three quarters of an hour. The mother suckled her in¬ fant, and had not one unfavourable symptom during her convalescence. She again became pregnant, and ap¬ plied to me to attend her. The labour pains began on the 23d June, 1836, On examination, 1 found the deformity had considerably increased, the antero¬ posterior diameter of the pelvis measur¬ ing certainly less than three inches. She had neglected to send for me until the membranes were ruptured, and the child’s head was fixed at the brim of the pelvis. The pains were severe, and having remained with her more than six hours with no advancement, and the head so firmly impacted that I feared rupture of the uterus, I determined, if no advancement took place within ail hour, to perform craniotomy. I had bled b er, and in some degree produced relaxation of the os uteri and vagina. After waiting the full time, I sent to my friend Mr. Wooldridge, of Jermyn- ' Street, to assist me in the operation, having experienced his valuable ser¬ vices on previous occasions. We had met but a very short time when the pa¬ tient gave a most piercing shriek, and I dreaded what might have taken place (rupture of the uterus). To my g’reat surprise and satisfaction, however, I found the child’s head in the cavity of the pelvis, and in half an hour it was in the world — the animation suspended. We moulded its head (which was sadly mis-shapen), bled it from the umbilicus, inflated the lungs, used the hot-bath, See. for upwards of an hour and a half before any signs of animation appeared ; the child then gasped, the left eye opened, then the left arm twitched, then the left leg ; the right side was entirely paralysed, and remained so five hours. I kept the mother upon water-gruel for five days ; she suckled her child, and had no unfavourable symptom during convalescence. Both this and her first child are strong, and as fine healthy boys as any in London. DEATH OF THE FCETUS, FROM WINDING OF THE UMBILICAL CORD ROUND THE NECK. To the Editor of the Medical Gazette. Sir, In the Medical Gazette, part the second, session 1836 — 7, p. 231, is a note from the Editor, desiring to be 934 BARK OF THE ROOT OF POMEGRANATE IN TAPE-WORM. favoured with the particulars of the case “where the child was strangled by the umbilical cord,” &c. &c. ^ In consequence of which, I beg1 to furnish you with a case to the point, and which occurred to me 26th Novem¬ ber last, in this town, where I have practised as an accoucheur for more than the last fifty years. On the day above-named, I was requested to attend on a lady, whom I found in labour of her third child, which labour was rather premature, as she did not expect to be confined, by her own reckoning , for six weeks. On examination I found the breech presenting*, and between the pains I could to a certainty perceive the child move, and therefore alive, the lady her¬ self noticing* that her child was alive, that she felt it strong* at the beginning of, and during labour. The os uteri being fully dilated, the child was soon forced down by the pains to the os ex¬ ternum, and there it rested (contrary to my hopes and expectations, the child be¬ ing so small) for several pains; for I concluded its expulsion w ould be almost immediate, as one of the nates, or ischia, had protruded a little through the os externum : this circumstance was easily accounted for after the birth of the child, as the umbilical cord was tightly wound round its neck many times, which, in my opinion, retarded the ex¬ pulsion of the child, and was the direct cause of its death. After I had sepa¬ rated the child from the placenta, I found it loose in the vagina. In my long practice I do not recollect such a clear case of strangulation at the birth, from the umbilical cord being twisted round the child’s neck, as I have detail¬ ed to you ; nor should I have taken notice of this one, had I not read your note at the foot of Mr. Thompson’s case. I recollect pointing out to the husband of the lady, who is a young surgeon, and who was in the room at the child’s birth, that the child was dead, and shewed him how the nav 1- string was wound round the child’s neck so tight, and that it was the cause of its death. — I remain. Your obedient servant, W. C. Hunt. Dartmouth, March 6, 1837. In a subsequent note, Mr. Hunt writes : — . I beg to correct an expression in my letter, sent two days ago. I think the word strangulatiou is misapplied ; it ought to be, that the circumvolutions of the umbilical cord round the child’s neck, made such a pressure on the ves¬ sels of the funis as to stop the circula¬ tion of the blood; thereby destroying the child’s life. Had the infant ever breathed, then the word strangled would have been properly used. March 8, 1837. BARK OF THE ROOT OF POME¬ GRANATE IN TAPE-WORM. To the Editor of the Medical Gazette. Sir, From reading the account in your last nu nber of the extraordinary case of the eighteen tape-woims, I observe the last me icine prescribed was — Decoct. Gianati, 3iii. ad. Oj., which brought away three entire worms. My object in addressing you is to state, that the infusion of the f resh bark of the root of the pomegranate tree is considered as almost a certain cure for tape-worm in India, both with the Europeans and natives; and also to add the mode of preparing and administer¬ ing* it, as, if any practitioner, from the case related, should use the infusion of the bark of the fruit, w hich is known to be useful in chronic cases of dysentery and diarrhoea, he would feel disap¬ pointed, as I believe it is not of the slightest use in tape-worm. R Cort. recent. Radic. Punic. Granati, ^viij., Coque in Oiij. Aquae ad Oij. Cola. Of this decoction the patient is to drink a wine glassful, and to repeat that quantity at longer or shorter inter¬ vals, as the sickness and faintness, which it generally produces, w'ill allow, until he has drunk the whole. The worm is generally voided in a few hours after the patient has begun to take the medi¬ cine, and not unfrequently comes away alive. — I remain, sir, Your obedient servant, P. Leslie, M.D,,M.R.C.S.L. Wilton-Place, Belgrave-Square, March 14, 1837. PROSPECTS OF LEGISLATION FOR THE PROFESSION. 935 ANALYSES and NOTICESof BOOKS. “ L’Auteur se tue a allonger ee que le lecteur se tue a abreger.” — D’Alejmbert. Practical Observations on the Venereal Disease , and on the Use of Mercury. By Abraham Colles, M.D., Surgeon to Steevens’s Hospital, and late Pro¬ fessor of Surgery in the Royal College of Surgeons in Ireland. 8vo. pp. 352. Medical authors are in general divisi¬ ble into two classes— first, those w'ho write to get a name, that it may be said — “ Mr. so-and-so is an author;” — and secondly, those who write for the sake of communicating to the world the results of their experience, and so affording to others the means of partici¬ pating* in the benefits resulting from the opportunities which they may have en¬ joyed. To this latter class belongs the author of the work before us. Dr. Colles has been long in the enjoyment of the highest reputation as a practical sur¬ geon : not content with having, as Pro¬ fessor of Surgery to the Dublin College, communicated his precepts to a large number of the present and rising gene¬ ration of Irish surgeons, he now comes forward, while yet in the full vigour of his intellect, to narrate what he has seen and learned in the course of a long and extensive practice among all ranks, for the benefit of his junior professional brethren. It may be presumed that this is a purely practical book: we have here a good practical description of the various forms in which venereal symptoms, both primary and secondary, present them¬ selves, and most valuable observations on the inode of treatment. The author’s second chapter, “on the administration of mercury,” highly deserves an atten¬ tive perusal : he insists upon every patient being put through a preparatory process prior to a course of mercury, and attributes much of the disrepute into which this remedy has fallen to the neglect of this process. We have not space to give an analysis of the subjects treated of in this work, but we cannot omit a particular reference to the chapter on syphilis in infants, which contains the most complete and interesting history we are acquainted with of the phenomena of that disease at this early period of life. A second part of the work is devoted to the use of mercury in diseases not venereal : this part might have been somewhat more extended without being tedious ; nevertheless, it contains the narrations of several cases highly illus¬ trative of the efficacy of the remedy. We can with perfect sincerity say that we have read every part of the book with much interest and instruction, and recommend it as highly deserving a place in every practical man’s library. MEDICAL GAZETTE. Saturday , March 18, 1837. “ Licet omnibus, licet etiam mihi, dignitatem Artis Medicos tueri; potestas modo veniendi in publicum sit, dicendi perieulum nonrecuso.” Cicero. PROSPECTS of LEGISLATION FOR THE PROFESSION. MR. WARBURTON’S LABOURS. Seventeen to four in a Committee of twenty-one, is a proportion which promises at least despatch of busi¬ ness. Seventeen Poor-Law suppor¬ ters will make quick work with four opponents, while upon these four the task of bringing* the merits or demerits of the medical arrangements of the system before Parliament, almost en¬ tirely devolves. The Committee, it may be said, was formed in the usual way, and without any view* to partiality. How odd, then, that upon its formation, when the real state of things w* as made manifest, a motion, expressly intended to balance inequali¬ ties, or at all events to approach such a desirable end, was discountenanced. Mr. Walter’s simple and fair expedient of adding six members more to the Committee, whereby the friends of thorough inquiry would have been in¬ creased to ten, still leaving seven majority on the other side, was rejected on a division. But the numbers that divided on the occasion afforded a satisfactory demonstration. Allowing for the votes of the adherents of the party in power, 930 PROSPECTS OF LEGISLATION FOR THE PROFESSION.: so tenacious of the present Poor-Law, and clinging to it as they clo to other things much more substantial, the mi¬ nority was sufficient to show that there is still hope of success, when the pre¬ sent aspect of affairs is altered. We have long since said that it was impos¬ sible to entertain any very sanguine anticipations from the embodiment of Lord John Russell’s scheme ; nor has any thing since occurred to induce us to modify our opinion. In the event of a dissolution, however, hopes must rise, and the prospect decidedly brighten. In looking over the list of the Committee, many, we doubt not, will have been struck with the absence of Mr. Warburton’s name. What has become of Mr. Warburton, that great patron of the profession, the late presiding genius of the Medical Education ' Committee ? Is he laid up with the grippe or the gout; or why is he not forthcoming ? Such must have been the affectionate inquiry after the honourable member for Bridport, by those who afar off were charmed and enchanted with the loudly - trum- petted exertions of the famous chair¬ man — by those who fancy that a patriot and a great man ought never to slumber or sleep, but that he should persevere to the death in the glorious path in which for a time he moved. But is human nature capable of this? Is it not possible that even the inde¬ fatigable Mr. Warburton should have changed his mind in the course of time, and that he may have formed the opi¬ nion that he has had quite enough of trouble with medical affairs, and of credit as much as he had any title to. It should not be forgotten neither, that he is now a regular senator — a Fellow of the University of London — while he still holds his shares and his proprietor¬ ship in the Gower-street College. After such labours and such appoint¬ ments, is it not natural that the honour¬ able member should enjoy his “ ease in his inn,” and trouble himself as little as possible in future with the perplexities of medical legislation? True, he is pledged to report on the mass of infor¬ mation gathered on that invaluable inquest at which he presided. But the whole of the evidence has not yet seen the light ; a portion only of it has had that privilege, leaving behind all that relates to the profession in the pro¬ vinces, and the education pursued in the provincial schools. Till this comes forth it would, of course, be premature to report : the evidence must first be laid, in its entire form, before the me¬ dical practitioners of the empire. To take this preliminary step Mr. War¬ burton has not yet had leisure, — which must be a source of consider¬ able annoyance to him, as wre hap¬ pen Jo be aware of his having years ago promised several parties the al¬ most immediate publication of their evidence ; nor did the conflagration of both Houses of Parliament interfere to prevent his performing his promise. By the way, we recollect the level¬ ling part of the medical press about that time rang aloud the changes on the “ providential” escape of the docu¬ ments of the Committee: there would be no interruption of Mr. Warburton’s labours ; the evidence would be pub¬ lished ; the report — the long-expected report, diu multumque desideratum — - would appear in due time. How grati¬ fying that the immense expense of time and money bestowed in collecting so splendid a mass of evidence did not go for nought, but that, as they said, we might still look forward with con¬ fidence to the sweeping changes to be effected by the member for Bridport, and the snug prospect of a “ one Fa¬ culty.” Patient w aiters on Providence, what is it you any longer expect from Mr, Warburton? See you not the hon. DUTY OF THE MEDICAL CORPORATIONS AT THE PRESENT CRISIS. 937 member comfortably settled in the coun¬ cil seat of the New University ? — See you not his ill-disguised solicitude to become its major-domo, by procuring the place of registrar for a certain creature of his own P — And think you that he will pull down that house about his own ears, in order to set up for you a sort of “liberty-ball”? or that even if he would, he could, procure a charter for another establishment different from that which has been lately with so much difficulty obtained ? But in sober seriousness, what has be¬ come of the mass of evidence gathered from the lips of many of the most dis¬ tinguished physicians and surgeons of Scotland, Ireland, and the provinces? Is this a time when such a heap of valuable information should remain in abeyance ?— Now, when the constitu¬ tion and character of the profession throughout the empire is subject-matter to be seriously considered in connexion with the yoke and brand which the Poor-Law potentates are endeavouring1 to fix upon it ? Is this a time for such documents to be allowed to lie useless, as so much waste paper, while we are patiently to expect them hereafter when they come forth obsolete and flat? Will the report compensate us, — a re¬ port, of the possibility of constructing which we long ago expressed our doubts, and now entertain them more strongly than ever ? What report, we ask, can Mr. War- burton possibly draw up, having the least tendency to a remodelling of the medi¬ cal grades, or levelling them all into one, when, in addition to his original position of proprietor and shareholder in the University College, he has accepted the appointment of a C oun¬ cillor of the University of London; both establishments being recently chartered with his full concurrence? Let the honourable member forBridport alone, when he has got into a comfortable birth : ibit qui zonam perdidit , we doubt not, would be his reply, were he pressed on the subject, like that of the old soldier in Horace, who had got quite enough of warfare as soon as he stocked his purse. Had Mr. Warburton not suc¬ ceeded in finding that “port” where he may “ bid adieu to hope and chance,” we should have better expectations of his future exertions. As it is, we despair of ever seeing a line of this once deeply-longed-for re¬ port, but which nobody now ever dreams of. Our despair is luckily not of a sombre cast ; we are merely amused at the verity of our own predictions. Amusing, however, as may be the non- appearance of the report, it is otherwise in respect to the evidence ; nor can we lay down our pen without once for all demanding to know why is not the whole of the medical evidence given to the public ; for this is precisely the time, if ever, when its publication can be of any use ? DUTY OF THE MEDICAL COR¬ PORATIONS AT THE PRESENT CRISIS. To the Editor of the Medical Gazette. Sir, Your correspondent Chirurgus, “ who is manifestly in the councils of his order,” has taken some pains to convince your readers that the general practitioner, being placed between two stools, must inevitably come to the ground — that the natural re¬ lation between him and the medical cor¬ porations does not entitle him to look to either of them for protection and sup port j because — it The child whom many fathers share. Hath seldom known a father’s care.” A gratifying announcement, truly ! There has long been, it must be con¬ fessed, a growing conviction in the minds of general practitioners, that such was the case; and recent events have forced the most moderate men to this unwelcome conclusion, and to the admission, that such a state of things urgently requires a remedy. 938 ROYAL MEDICAL AND CHIEURGICAL SOCIETY. The College and the Hall had better look to this ; the eyes of the profession are now upon them. Stat sua cu:que dies. Why should either of these bodies waste any time in vain and fruitless disputes* with a pack of jesuits, on the literal mean¬ ing, or the spirit, of a clause relating to the qualification of medical officers ? Could no better occupation be furnished? Have not all these bodies been officially and repeatedly informed, from respecta¬ ble and authentic sources, of the injuries and insults received by their Licentiates from the Poor-law authorities ? Do they doubt the representation of facts as noto¬ rious as the sun at noon-day ; or have they no sympathy for men suffering such un¬ merited and intolerable grievances ? Will they permit the profession to be deeply degraded, and its usefulness seriously im¬ paired, without making one well-directed effort at resistance ? Whet they will do, remains to be seen. What they can do, has been stated. What they might and should do, you have pro¬ perly indicated. Let us hope, then, they will arouse, at length, from their lethargy, and declare to the legislature, even in these dog-days of political economy, that the present system of medical relief to sick paupers is destitute of humanity, inju¬ rious to the community, and intolerably de¬ grading to the profession. Such a step must lead to the best re¬ sults. It must command attention and ensure respect; it must raise the hopes and augment the efforts of the whole pro¬ fession. If, at any period, active union and cor¬ dial co-operation can be useful to the pro¬ fession, now surely is the time. If it be desirable that one sentiment should ani¬ mate the entire body of the profession, that sentiment should be— “ He who allows oppression, shares the crime.” — I am, sir, Your very obedient servant, A Country Practitioner, but no Slave. March 13, 1887. ROYAL MEDICAL AND CHIRUR- GICAL SOCIETY. Tuesday, March 14, 1837. Dr. R. Bright, the President, in the Chair. Dr. Bostock on the Pathology of Ihe Urine. A paper was read containing some sug¬ gestions, by Dr. Bostock, of a plan for * Vide 2d Annual Report of Poor-law Commis¬ sioners ; Appendix C. obtaining with greater precision a know¬ ledge of the principal pathological con¬ ditions of the urine. The author adverts to the fact, that our knowledge of the changes in the chemical and physical pro¬ perties of the urine, and of the relation which these bear to the morbid changes in the constitution, is less than might have been anticipated from the numerous ex¬ periments performed upon it. To obviate this defect, he suggests to practitioners to institute a series of what may be called statical experiments, made precisely in the same mode, and consequently ad¬ mitting of direct comparison with each other. In the prosecution of this plan, an individual was selected, as the standard of comparison, of sound constitution and re¬ gular habits. The average healthy state of the urine of this individual was first ascertained, and afterwards the nature and amount of the occasional deviations, with the causes to which these were re- ferrible. This object being first attained, we may compare this standard case with other individuals, noting the differences of constitution, habits, &c. The circum¬ stances which the author has selected for experiment are the following -.—External characters, including colour, odour, clear¬ ness, specific gravity, &c. ; degree of acidity ; presence and amount of albu¬ men ; amount of residuum after evapora¬ tion ; proportion of this soluble in alcohol ; amount of saline contents ; of calcareous salts ; and spontaneous changes. As a specimen of the tabular form, the author subjoins a synopsis of some experiments performed on the urine of the healthy in¬ dividual, and also on that of the patient with exostosis, whose case was read at a late meeting. A paper was then read, containing — ggQ METEOROLOGICAL JOURNAL. March. Thursday . 9 Friday . . 10 Saturday . 11 Sunday . . 12 Monday . . 13 Tuesday . . 14 Wednesday 15 Thermometer. from 32 to 50 35 48 30 46 20 42 27 43 26 43 30 44 Barometer. 30-01 to 29 89 29-64 29 30 29 29 29 27 29- 28 29 46 29 70 •- 30-08 30- 21 30-20 30-11 30 01 Prevailing wind S.W. Except the 14th, generally cloudy, with rain at times ; a little snow in the morning of the 13th. Rain fallen, 025 of an inch. Wilson & Son, Printers, 57, Skinner- St. London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JJOTOIMAL OF illflurine attir tfte Collateral ^mitres. SATURDAY, MARCH 25, 1837. LECTURES ON MATERIA MEDTCA, OR PHARMA¬ COLOGY, AND GENERAL THERAPEUTICS, Delivered at the Aldei'sgate School of Medicine , By Jon. Pereira, Esq., F.L.S. Lecture LIX. I propose to commence, in this lecture, the examination of LEGDMINO^iE, OR FABACEiE, one of the largest, and, in point of struc¬ ture, one of the most natural families of the vegetable world ; and one also which offers many points of interesting inquiry. Botanical characters. — Leguminous plants present themselves under three forms ; some are herbaceous, some are shrubby, while others form large trees. The leaves are usually alternate, with stipules, often compound, and in some instances, as in Mimosa pudica, are very irritable. The flowers are usually bisexual, rarely poly gamous, or dioecious. The calyx is five- parted, toothed or cleft, inferior, with the odd segment anterior. The petals are five, or by abortion, four, (rarely less than this number, or wanting) inserted into the calyx or torus. A considerable number of the plants of this family have papiliona¬ ceous flowers ; the large upper petal of which forms the vexillum or standard ; the two lateral ones are called alee or wings, while the t^o lower ones are united by their margins, forming what is called the carina or keel. Although all leguminous plants have not this kind of flotver, yet all plants with papilionaceous flowers belong to this family. The stamina are usually 486. — xix. Fig. 161. — -Papilionaceous flowers. (not invariably) ten in number, and they may be distinct, monadelphous, diadel- phous, or occasionally, though rarely, tria- delphous. The ovarium is simple, supe¬ rior, one celled, with a simple style and stigma. The fruit is either a legume or a drupe. Fig. 162. — Legumes ofl Cerutonia Siliqua. The term leguminosse, used to designate this order, is evidently objectionable, since all the plants have not leguminous fruit; and, on the other hand, all plants which have leguminous fruit do not belong to this order, for some Amyridaceas have legumes. The seeds are (with one or two excep¬ tions) destitute of albumen : the embryo 3 P 946 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS is either straight, (rectembrice) or the radicle is bent on the cotyledons ( curvembrice ). e Fig. 163. — Common garden bean. a, Plumule. b, b, Cotyledons, or seed lobes. c, Radicle bent on the cotyledons (curvembrice) . Division. — Decandolle thus sub-divides this extensive family into four sub- orders. Legumi- nos£e. Curvembriae. Rectembriae. 1. Papilionacae 2. Swartzieas. 3. Mimosas. 4. -Caesalpinese. Properties. — Notwithstanding the remark already made, that with regard to struc¬ ture, leguminosse form one of the most natural families of the vegetable creation, yet it must be confessed that, considered with reference to their chemical, dieteti- cal, and medicinal properties, they offer little uniformity. To illustrate this, we may compare the properties of similar organs (seeds, for example) of different leguminosas : and we shall find that some are valuable articles of food, as peas and beans ; while others are medicinal, or even poisonous. Thus the seeds of Spartium junceum in small doses are diuretic, in larger ones, emetic and purgative ; and in some other instances we find leguminous seeds having a specific influence over the nervous system : for example, the seeds of Cytisus laburnum are narcotico-acrids, or in some cases almost pure narcotics. Five grains of Cytisine, the active principle of these seeds, act as powerfully as three grains of tartar emetic ; eight grains acted on Chevallier in a very alarming manner. Bread made of flour containing the seeds either of Lathyrus cicera or Ervum ervilia has in several instances operated in a poisonous manner, giving rise to paralysis or convulsions. Even plants of the same sub-order will hardly admit of comparison. Thus among Papilionacege we find nutrients, demulcents, tonics, astringents, emetics, purgatives, diuretics, narcotico-acrids, and pure narcotics. Csesalpine®, for the most part, possess purgative properties, yet with many exceptions ; and so with respect to Mimosas (from the stems of which we obtain gum and astringent mat¬ ters), substances of varied properties are procured. SUB-ORDER. — PAPILIONACEiE. Spartium junceum. History. — Theophrastus and Dioscorides speak of a plant which they call airagnov , or (nrdgrov, which was probably what Pliny terms Genista, though the Roman historian was himself doubtful on this point. The plant referred to is commonly supposed to be the Spartium junceum, or Spanish broom, which, according to Dr. Sibthorp, is now termed in Greece, cirdoro. Botanical characters. — Spanish broom is a deciduous shrub, a native of the south of Europe, having opposite round branches, flowering at the end, leaves lanceolate, but few in number, papilionaceous yellow flowers, in terminal racemes, stamens mo- nadelphous, legumen piano-compressed, many-seeded, glandless. Fig. 164. — Spartium junceum: Spanish broom. In the Linnean classification, this plant belongs to class Diadelphia, order Decan - dria. Physiological effects. — The seeds are eme¬ tic and purgative in large doses, and diure¬ tic in smaller quantities. The two first of these effects are stated by Dioscorides to be those of cnrdoTiov. Dr. Pearson calls broom a tonico-diuretic, since it improves the appetite, and invigorates the whole system. Uses. — They have been employed by Dr. Eccles, of Birmingham, in dropsical cases. Their advantage over other diure¬ tics is their tonic operation, inconsequence of which they may be persisted in for an indefinite length of time. Administration. — The best method of ex¬ hibiting these seeds is in the form of tinc¬ ture, prepared at the Birmingham hospi- GLYCYRRHIZA GLABRA. 947 tal, of two ounces of the bruised seeds to eight ounces of proof spirit. The dose of this preparation is from one to three drachms. The powder of the seeds may¬ be taken to the extent of ten or fifteen grains three times a day, in cold ginger tea, or mint water. Cytisus scoparius. History. — Some have fancied that the < TragTLov of the Greeks was our common broom, (Cytisus scoparius), but it is much more likely to have been Spanish broom (Spartium junceum)as already mentioned. Common broom is termed in some botani¬ cal works Spartium scoparium, in some, Genista scoparia, in others, Cytisus sco¬ parius. Botanical history. — This indigenous shrub grows in great abundance in dry gravelly thickets and fields. It is from three to six feet high. Its branches are numerous, long, straight, angular, smooth, and green : the leaves are ternate, stalked, the upper ones simple, the leaflets oblong. The papilionaceous flowers are axillary, stalked, large, of a bright yellow colour: calyx two-lipped ; standard large and broad, ovate, keel blunt : stamina ten, connected at the base, and, therefore, really monadelphous, though the Linneanists place this plant in Diadelphia : pistillum solitary. The legume is flat, hairy at the margin, and contains fifteen or sixteen seeds. In the Linnean classification, it is placed in class Diadefhia, order Decandria. Officinal. — The fresh tops of this plant are officinal in the new London Pharma¬ copoeia : they have a bitter nauseous taste, and when bruised, a remarkable odour. Chemical properties. — Cadet de Gassicourt has analysed the flowers of this plant, but I am not acquainted with any analysis of the stems or leaves. The ashes of the plant coptain carbonate of potash, which, when procured from this source, is termed salt of broom, or sal genista. Hill says, a pound of the green twigs of broom, with the leaves and flowers, yields a drachm and a half of this salt. Hence, therefore, some vegetable salt of potash exists in broom, and which, by incinera¬ tion, is converted into the carbonate. Physiological effects. — (a). On animals gene¬ rally, In some part of Europe broom is em¬ ployed as winter food for sheep ; and Withering says that it prevents the disease called rot, and is salutary in dropsy, to which sheep are liable. According to Loudon, it is apt to produce disease ot the urinary organs, — to prevent which, some recommend the plentiful use of water. ( 'b ). On man. Broom has been cele¬ brated as a diuretic by Mead, Cullen, and others. “ Though very little in use,” says Dr. Cullen, “I have inserted this in my catalogue from my own experience of it. I found it first in use among our common people; but I have since prescribed it to some of my patients in the manner follow¬ ing : — I order half an ounce of fresh broom tops to be boiled in a pound of water till one-half of this is consumed, and of this decoction I give two table spoonfuls every hour, till it operates by stool and urine ; and by repeating this exhibition every day, or every second day, some dropsies have been cured.” Having very frequently employed broom in dropsies, I can add my testimony to its powerful effects as a diuretic. I cannot call to mind a single case in which it has failed to act power¬ fully on the kidneys. In some cases it produced a most marked and beneficial effect on the dropsical effusion. Accord¬ ing to my experience it is the most cer¬ tain of all diuretics in dropsies. In large doses, broom is emetic and purgative. Uses.— It has been principally or solely employed in dropsies, and, as already mentioned, sometimes with great benefit. Of course its chance of cure depends on the nature of the cause of the dropsical effusion. 1 am not aware of any contra¬ indications to its use, though it is not im¬ probable that it might be prejudicial in inflammatory cases, or dropsy depending on diseased kidney. Administration. — The infusion of broom of the Pharmacopoeia is prepared with an ounce of broom and a pint (20 ounces) of water. The simple decoction may be pre¬ pared in the way recommended by Dr. Cullen. There is a compound decoction in the London Pharmacopoeia : it is com¬ posed of broom, juniper berries, and root of dandelion, of each half an ounce, water a pint and a half (30 ounces) : boil down to a pint. The dose of all these prepara¬ tions is one or two ounces. The extract of the Dublin Pharmacopoeia is given to the extent of half a drachm or a drachm. The seeds of Cytisus scoparius may be given in tincture or powder, as Spartium junceum. Dr. Pearson remarks “ broom-seed is not adapted to thoracic dropsy, especially when that form of dropsy is combined with pul¬ monary congestion, or with any degree of inflammatory affection of the chest.” Glycyrrhiza glabra. History.— The yXvKvppfa of Hippocrates and of Dioscorides arc doubtless identical; the latter is supposed by Sprengel and others to be our Glycyrrhiza glabra, by Dierbach to be G. glandulifera, but by Dr. Sibthorp it is said to be the G. echinata, which is now termed in Greece yXonipfa.. Botanical characters. — Glycyrrhiza glabra is a native of the south of Europe. It is a perennial plant, with an erect, smooth 948 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS stem, four or five feet in height The leaves are pinnate, with a terminal leaflet : the leaflets are ovate, blunt, petiolated, of a yellowish- green colour, clammy on the under side. There are no stipules. The inflorescence is a pedunculated raceme (Decandolle calls it a spike.) The papi¬ lionaceous flowers are bluish or purplish. The fruit is a smooth, oblong, three or four-seeded legume. The Linnean class of til is plant is Diadelphia , and the order Decandria. Officinal. — The oflicinal part is the root, or rather the underground stem ( rhizome ), commonly termed in the shops liquorice root, and which has been latinized into radix liquiritice. Its physical properties are too well known to need description. Extract of liquorice. — By boiling the roots (or rhizomes) in water (generally in copper vessels), and evaporating the decoction, we obtain an extract called in the shops liquorice juice, or, accord¬ ing to the countries from whence it is brought, Spanish or Italian juice. In Spain it is said to be procured from the roots or underground stems of G. ecbinata. It occurs in cylindrical or flattened rolls, of five or six inches long, and about one inch in diameter. When pure it is black and dry, with a shining fracture, and a sweetish taste: it is completely soluble in water. As met with in commerce, however, it is rarely pure. Neumann obtained 460 of wratery extract from 480 of Spanish liquorice. It contains the soluble principles of the root, with some copper scraped off from the boiler by the spatula employed to stir the extract during its preparation. Fee says that four pounds of this extract yield two drachms and a half of metallic copper; but I suspect there must be some exaggera¬ tion in this statement. Several prepara¬ tions of refined liquorice are kept in the shops : one is sold in a pipe form, (pipe, or refined liquorice ) which is an inferior sub¬ stance, a second is the Pontefract lozenges, and a third has been recently introduced under the name of quintessence of liquorice. Composition. — Two analyses of liquorice root have been made: one by Robiquet, another by Trommsdorf. The consti¬ tuents, according to the first of these che¬ mists, are — Wax. Acrid soft resin. Asparagin (Desvaux’s Agedoite). Glycyrrhizin (Glycion). Starch. Ligneous fibre. Brown nitrogenous substance. Albumen. Malates, phosphates, and sulphates of lime and magnesia. The substance termed Glycyrrhizin, or liquorice sugar, is remarkable for its ten¬ dency to form difficultly soluble com¬ pounds with acids. It is not susceptible of the vinous fermentation. Physiological effects. — Liquorice root and its extract are emollient, demulcent, and nutritive. Uses. — The powder of the root is employ¬ ed in the preparation of pills, either to give them a proper consistence or to pre¬ vent their adhesion. The decoction is em¬ ployed as an emollient in irritation of the mucous membranes, — especially in catarrh, — and as a vehicle for the exhibition of other medicines. There is a formula for its preparation in the Dublin Pharma¬ copoeia. On account of its emollient pro¬ perties and saccharine taste, the root enters into several officinal preparations — as the compound decoction of barley, com¬ pound decoction of sarsaparilla, compound in~ fusion of linseed, &cc. The extract of liquorice is employed in the form of lozenges, to allay tickling cough. It is also used to cover the unpleasant flavour of certain substances — as of aloes, in the compound decoction of this substance. Tephrosia Apollinea. The leaves and legumes of this plant are frequently found in Alexandrian senna. Astragalus verus. History. — Dr. Sibthorp tells us that the TpayaKavOa of Dioscorides, and of the modern Greeks, is the Astragalus arista- tus, the gunf from which is a species of tragacanth annually sent to Italy. Botanical history. — The tragacanth of commerce is the produce of several species of Astragalus. Tournefort says that on Mount Ida, in the Island of Crete, it is procured from A. creticus; on Mount Le¬ banon, in Syria, the Astragalus gummifer yields it, according to La Billardiere ; while in Asia Minor, Armenia, and Nor¬ thern Persia, Olivier tells us it is pro¬ cured from Astragalus verus. Astragalus verus is a small shrub, not more than two or three feet high, with a stem about an inch in thickness. The branches are covered with imbricated scales and spines, the remains of former petioles. The leaves are pinnate, com¬ posed of from six to eight pair of op¬ posite, small, pointed, villous leaflets. The yellow papilionaceous flowers are axillary. Astragalus gummifer has leaves composed of from four to six pair of oblong, linear, smooth leaflets. The flowers are from three to five, axillary, sessile. The pod is woolly. In Astragalus creticus the leaves consist of from five to eight pair of oblong, acute, TRAGACANTH. 949 tomentose leaflets, with axillary sessile flowers. Fig. 165. — Astragalus creticus. The Linnean class of the genus As¬ tragalus is Diadelphia, the order Decun- dr ia. Production. — Tragacanth is a natural exudation from the stem of the before- mentioned plants. The cause of the exu¬ dation of this as of other gums, is thus explained by Decandolle. The gummy matter of the stem resides in the bark and alburnum ; it is the nutritive juice of the plant; and its escape, therefore, is analogous to haemorrhage in animals ; hence plants in whom it spontaneously occurs are always in a sickly state. The mechanical cause of the expulsion of this juice is dependent on the unequal hygrometric properties of the different parts of the stem. The wood absorbs more moisture from the air than the bark, and hence it swells more. In consequence of its enlargement it dis¬ tends the bark, which, by the internal pressure of the wood, gives way, and the gummy matter escapes. This explanation is quite in conformity with the facts men¬ tioned by La Billardiere, — that tragacanth flows only in abundance during the night, and a little after sunrise. A cloudy night, or a heavy dew, is, he thinks, necessary for its production; for the shepherds of Lebanon only go in search of this sub¬ stance when the mountain has been covered during the night with thick clouds. Varieties and physical properties. — Two kinds of tragacanth are met with. (a.) Flaky Tragacanth : Smyrna Tragacanth (Marti us) : Tragacanth of the Astragalus verus ? — This is the tragacanth usually found in English commerce. It occurs in mode¬ rately large, broad, thin pieces, marked with arched or concentric elevations. ( [b .) Vermiform, Tragacanth : Morea Traga¬ canth (Martius): Tragacanth of the Astra¬ galus creticus? — This variety is rarely met with in this country, but is common on the continent. It occurs in small, twisted, filiform, spiral pieces. There is more starch in it than in the first variety. Both sorts occur of a white, yellowish, or yellowish-brown colour. Both are hard, tough, odourless, tasteless, very slightly soluble in water, though they swell consi¬ derably in this liquid, forming a thick tenacious mucilage. The fracture is dull and splintery. Chemical composition and properties. — The following is the ultimate analysis of dry tragacanth, according to Hermann : — Carbon . . - -40-50, or 10 atoms = 60 Hydrogen -- 6 61, or 10 atoms == 10 Oxygen . . . .52-89, or 10 atoms = 80 100-00 150 With respect to the proximate analysis some difference of opinion exists among chemists. According to both Bucholz and Guerin, tragacanth consists of a gum soluble in water, analogous to gum arabic, and, therefore, called Ardbine ; and a gum insoluble in water, analogous to gum bassora, and, in consequence, termed Bassorine. Bucholz. Guerin. Arabine . 57 53 Bassorine . 43 33 Water and oxa- ? late lime ♦ • • • £ 14 100 100 Starch is also a constituent of traga¬ canth ; the quantity, however, is small. It is recognizable by iodine. According to Guibourt, tragacanth con¬ tains neither arabine nor bassorine, but is essentially formed by an organized gelati- niform matter, very different to gum Arabic both in its physical and its chemi¬ cal properties, and which swells and di¬ vides in w-ater, so as in part to pass through a filter. The insoluble part of tragacanth is, according to the same au¬ thority, a mixture of starch and lignin, which has nothing in common with bas¬ sorine. Decandolle suggests that the in¬ solubility and swelling of tragacanth in water may arise from the gummy matter being contained in cells. Mucilage of tragacanth is precipitated by alcohol, subacetate of lead, protochlo¬ ride of tin, protonitrate of mercury, and infusion of galls. Oxalate of ammonia indicates the existence of a calcareous salt. Physiological effects. — Tragacanth is emol¬ lient, demulcent, and nutritive. Uses. — The pouder of tragacanth is used rather as a vehicle for active aud heavy medicines, than on account of its own 950 MR. PEREIRA ON MATERIA MEDICA AND THERAPEUTICS. proper effects. Mixed with gum Arabic and starch, it constitutes the compound powder of tragacanth of the Pharmacopoeia. Mucilage of tragacanth may be employed as an emollient in irritation of the mucous membranes. It is likewise used for the suspension of other substances. Mucuna pruriens : Cowhage. This plant, called by Linneus, Dolichos pruriens, by Persoon, Stizolobium pru¬ riens, is a native of the East Indies, and perhaps also of the West Indies. Its root is perennial and fibrous ; its stem is her¬ baceous and climbing, rising to a consi¬ derable height by twisting rouhd the neighbouring trees. The leaves are ternate, stand upon long foot stalks, anu are placed alternately at the distance of a foot from each other. The papilionaceous purple flowers are in racemes. The fruit (called in the shops siliqua hirsuta ) is an oblong pod, shaped like the letter J\ four or five inches long, covered with brown bristly hairs (the seta, siliqua hirsuta of the shops), and containing from four to six seeds, of a brownish colour. In the Linnean clas¬ sification the plant belongs to class Dia- detphia, order Decandria. The officinal part of the plant is the hairs of the pod. They have been cele¬ brated for their anthelmintic properties. The best mode of exhibiting them is in treacle, syrup, or honey. The quantity of hairs should be sufficient to give the syrup, or treacle, the consistence of honey, or of an electuary; and of this mixture a tea-spoonful may be given to children, and a table-spoonful to adults: this dose should be taken twice a day — namely, at going to bed, and in the morning, an hour before breakfast. Chamberlaine says it usually operates more effectually where a gentle emetic has been premised. After continuing the electuary for three or four days, a brisk purgative of jalap, or senna, should be taken, which will in general bring away the worms. This remedy has been principally celebrated for the expulsion of the large round worm (Ascaris lumbri- coides), and the small thread-worm (Oxyuris vermicularis). It is not equally serviceable against the tape worm. The action of the hairs is thought to be mechanical — that is, they are supposed to pierce and torment these parasites, and thereby to oblige them to let go their hold. In support of this explanation, Mr. Chamberlaine tells us he sprinkled some of the hairs in a calabash full of very large round worms (Ascaris lumbricoides), and that in a little time the animals began to writhe and twist about, evincing there¬ by extreme torture. On examining them with a magnifying glass, the hairs were found sticking loosely in various parts of their bodies. The intolerable itching caused by the contact of these hairs with the skin, is also referrible to their mechanical opera¬ tion. Their want of action on the in¬ ternal coat of the intestines is ascribed to the mucous secretion which defends the subjacent membrane from injury. In one case, diarrhoea followed the use of a very large dose of the electuary, and in another instance enteritis came on, after taking this preparation once ; but it is not cer¬ tain that these were the consequences of the operation of the hairs. Mucuna urens. This is a native of the West Indies. The hairs on the outside of the pods are used as a vermifuge, like those of the last mentioned species. The pods are distin¬ guished by their transverse lamellse. The seeds are called Yeux bonrrique , or asses* eyes. Butea frondosa. It is probable that this tree yields one kind of Catechu, termed, by the French, “ Cachou en musse”. or “ Cachou lucide .” The grounds for this opinion are, 1st, that from natural fissures and wounds made in the bark, there exudes during the hot sea¬ son an astringent juice, which soon hardens into a ruby coloured, brittle, astringent gum, which has been confounded with kino ; 2dly, that the kind of Catechu before alluded to, is imported enve¬ loped in leaves, which Professor Gui- bourt has ascertained to be those of Butea frondosa; and lastly, that this kind of Catechu is not obtained from either Acacia Catechu or Nauclea Gambir, since the astringent extracts of these trees pos¬ sess very different physical properties, as will hereafter be shown. In deciding on the validity of these circumstances, we ought also to take into consideration the fact that the Butea being a common tree in India, and its leaves being large, they might be employed to envelop the extract of other trees, whose leaves were not suffi¬ ciently large for the purpose. I propose to notice all the varieties of Catechu when we speak of the tree men¬ tioned in the Pharmacopoeia as yielding Catechu— namely, Acacia Catechu. Butea frondosa is a middling-sized tree, common in Bengal and in the mountainous parts of India. The leaves are alternate, petiolated, ternate, from eight to sixteen inches long; the leaflets are emarginate, or rounded at the apex, the pair obliquely oval, the exterior one obovate. The pa¬ pilionaceous flowers are in terminal racemes; their colour is deep red, shaded CERATONIA SILIQUA, 951 with orange and silver-coloured down. 1 lie legume is pedicelled and pendulous. Fig. 166. — Butea frondosa. In the Linnean classification, Butea belongs to class Diadelphia, order Decandria. Pterocarpus santalinus. This tree is a native of Ceylon and Co¬ romandel. It belongs to class D'adelphia , order Decandria, in the Linnean classifica¬ tion. Its leaves are ternate, with subro¬ tund smooth leaflets j the flowers are in axillary racemes. The wood of the stem is the red soun¬ der’s ivood, the Lignum santali rubri of the shops. It is imported in angular billets, blackish externally, but of a blood-red colour internally : it is compact, heavy, and of a fibrous texture. The colouring matter of the wood is of a resinoid nature, and is termed santulin. It is hardly soluble in cold water, more soluble in boiling w'ater ; very soluble in alcohol, aether, acetic acid, and alkalies. It is almost insoluble in the fixed and volatile oils ; the volatile oils of lavender and rosemary excepted. This wood is employed in medicine only as a colouring agent. Thus it is one of the ingredients of the compound tincture of lavender. Pterocarpus Draco. This tree is said to be the source of what has been termed American or Carthagena Dragon’s blood. Pterocarpus erinaceus. This plant is erroneously inserted in the London Pharmacopoeia, as the source of the kino of the shops. Kino is now brought to us from Amboyna; whereas this tree is a native of Senegal. In some works there is an African kino described, which is said to be the produce of this species of Pterocarpus. In the w arehouse of an old drug firm in London, I met with a substance marked gummi rubrum astringens, and which I w as told formerly fetched a very high price. It is probably the gummi adstringens garn- biense of Fothergill, and which Murray calls kino. 1 sent specimens of it to Pro¬ fessor Guibourt, who has described it as Goinme astringente de Gambie. It consists of small elongated tears, having an astringent taste,- — externally blackish, with fragments of bark adhering: if small pieces be exa¬ mined by transmitted light, they are ob¬ served to be ruby red. It is partially solu¬ ble in water, and appears to be a mixture of a gummy with a red astringent juice. It is probably the produce of Pterocarpus erinaceus. SUB-ORDER : SWARTZIEJE. None of the plants of this sub-order yield any pharmacological agents; and their medicinal properties are but little known. SUB-ORDER: C^ES ALPINE-®. This is an important tribe, and contains several plants deserving of notice. To it belongs Ceratonia Siliqua. This is the Carob tree, or St Johns Bread , a native of the south of Europe and of Asia. Its leaves are abruptly pinnate, its leaflets oval and obtuse. The flowrers are racemose and small ; the fruit is an in- ciehiscent legume, four or five inches long, an inch broad, of a brownish -grey colour, and containing several seeds. Fig. 167. — Ceratonia Siliqua. It belongs to class Polpgamiu, order Tricecia, in the Linnean arrangement. The pods contain extractive, gum, sugar, tannic and gallic acids : they have been used as fodder for horses. The tree received its name, St. John’s bread, from a supposition that the so-called wild honey on which St. John the Baptist fed, was the pulp of these pods. Moreover, it has been sug¬ gested that the shells of the pods might be the husks which the prodigal son desired to partake of with the swine. 952 DR. PHILIP ON THE POWERS OF LIFE ON THE POWERS ON WHICH THE FUNC¬ TIONS OF LIFE IN THE MORE PERFECT ANIMALS DEPEND, AND ON THE MANNER IN WHICH THEY ARE ASSOCIATED IN THE PRODUCTION OF THEIR MORE COMPLICATED RESULTS. By A. P. W. Philip, M.D. F.R.S. L. & E. &c. [From the Philosophical Transactions, with large additions *, communicated to the Medical Gazette by the Author.] [Concluded from page 933.] Of the manner in which the Powers of Life are associated in the production of their more complicated results. In order to ascertain the seat of the power on which muscular contractility depends, it w7as necessary, in an early part of this paper, to enter on the relation which sub¬ sists between the muscular and nervous systems; and it appears from what is there said, that the nervous influence, whether in its effects on the muscles of voluntary or involuntary motion, stands only in the relation of a stimulus or directly debilitat¬ ing power to the muscular fibre, according to the manner in which its organs are im¬ pressed ; a result, I may observe in pass¬ ing, peculiarly in accordance with all the other facts which have been stated re¬ specting the nature of that influence, be¬ cause the same observation, we shall find, applies to all the agents of inanimate na¬ ture which are capable of influencing the muscular fibre. For a similar reason it was necessary to point out the inde¬ pendence of the nervous on the sensorial power. The relation which next demands our attention is that wffiich subsists between the organs of the nervous influence and the living blood. The first thing wdiich here strikes us, is, that the blood-vessels and nerves uniformly accompany each other; from which wre are led to infer that they co-operate in functions of very general necessity. The powers of the nervous system, pro¬ perly so called, wre have seen, are all of a chemical nature. Of this nature, there¬ fore, must be all processes in which they immediately co-operate. It is evident, that where such powers are employed, to render them efficient, materials must be provided on which they may operate ; and * The additions were also intended for the Philosophical Transactions, but were too late for insertion in the new volume. there must also, of course, be means by which these materials are duly exposed to their action. The materials wre find in the blood ; the means, employed for the purpose of duly exposing them to the action of the nervous influence, in the capillary vessels, on wdiich the minute extremities of the nerves (which we know, from numberless obser¬ vations, are those parts of the nervous system by which its powers are imme¬ diately applied in the functions of secre¬ tion and assimilation, as well as the main¬ tenance of animal temperature, and the excitement of the muscular fibre,) are dis¬ tributed. As we find from experiments above referred to, that the central are the only parts of the nervous system properly so called, employed in the formation of the nervous influence, it appears from numberless observations that the ex¬ tremities of the nerves are the only im¬ mediate organs of its powers in all its functions. The motion of the fluids in the capillary vessels, as appears from many experiments related in the Philosophical Transactions for 1815 and 1831, and my Inquiry into the Laws of the Vital Functions, depends on a pow’er which resides in themselves, in no degree depending on the powrer of the heart or arteries, except as far as is neces¬ sary for the due supply of blood to the latter, wdiich form the Teservoirs, from which the capillary vessels draw their sup¬ ply. When, in the newly dead animal, a ligature is thrown round all the vessels attached to the heart, and this organ is removed, the motion of the blood in the capillaries continues unimpaired, and only fails in proportion as the supply from the large arteries fails*; the cause of the emptiness of the latter some time after what we call death. By such means the materials on wdiich the nervous influence operates are supplied and presented to it ; and the means of sup¬ ply, namely, the powder of the heart and arteries, as wrell as that of the capillary vessels themselves, being, as wre have seen, under the immediate influence of the same powTer which effects the chemical changesf , the supply is proportioned to the demand under the various conditions of the ever- changing functions; and under the same influence are the means of removal, whether of secreted fluids or solid parts become un¬ fit for the purposes of life. Such are the circumstances above referred to, which * See a paper On the Powers of Circulation, in the Philosophical Transactions for 1831, repub¬ lished in my Inquiry into the Nature of Sleep and Death. See also my Inquiry into the Laws of the Vital Functions, Part II. t See experiments detailed in the Philosophical Transactions for 1815 and 1822, and my Inquiry into the Laws of the Vital Functions, Part II. DR PHILIP ON THE POWERS OF LIFE 953 render it necessary that the muscles, whether directly or indirectly, employed in these functions should be subjected to the same power on which depend the functions of secretion and assimilation, namely, all muscles of involuntary propulsion, that is, with a very few exceptions, all muscles of involuntary motion. It appears from some lately ascertained facts* that the secreted fluids are formed from the blood while still in its vessels, and not in the act of their separation by the secreting organs. That such must necessarily be the case appears from what has been said. The act of separation must be posterior to the changes effected by the chemical powers of the nervous influence. It is only while the blood is still in its vessels that it can in its entire state, or only mechanically divided by the diminishing size of the vessels, (a division which, taking place in every secreting organ, we must regard as necessai'y to its function,) be exposed to their operation; and we have reason to believe that it is only as the due changes have been effected, that is, only as the secreted fluid has acquired its due properties, that it applies the due stimulus to the particular vessels by which it is dis¬ charged : on the same principle that the due action of the intestines, by which they dis¬ charge their contents, is not excited if these contents have notacquired their due proper¬ ties by the chemical processes which take place in the stomach and duodenum. Thus we have reason to believe that all secretions are formed in the circulating fluids, and are separated by the different secreting organs, in consequence of the action of the secreting vessels of each of these organs being excited only by the fluid which it is their function to convey. Such are the nature and functions of the nervous power, and its relations to the muscular power and the powers of the living blood. When we turn to the sensitive system we find ourselves in a new world. Here voltaic electricity, which we so successfully substitute for the nervous influence, can do nothing. The immediate organs of the sensorial power, we have seen, are as it were hedged in and defended from contact with any of the agents of inanimate nature. On the one hand, we find the nerves of sensation, which so far partake of the nature of the external world that they are capable of receiving and propagating im¬ pressions from its agents, but in all other * See a paper by MM. Prevost and Dumas, Ann. Cliim. et Phys. tom. xxiii. p. i>0, et seq. ; and Mr. Phillips’s paper on the Secretion and Uses of the Bile, read at the Royal Society, Dec. 20, 1882, of which an abstract is given in the Proceedings of the Royal Society, vul. iii. p. 100. respects are allied to the organs with which they are associated. By their vital powers they influence the immediate organs of the sensorium, and the functions thence resulting are the effects of one vital organ influencing another, and that by its vital properties alone ; for it is evident that the properties operating here have nothing in common w ith those of any of the princi¬ ples of inanimate nature. In the re¬ sults consequently, we have seen all ana¬ logy with the phenomena of these princi¬ ples, for the first time, lost ; and necessa¬ rily so, none of the properties of the external world being immediately em¬ ployed in their production. The nerves of sensation, it appears from what has been said, convey not the nervous influence properly so called. The in¬ fluence they convey is of a nature essen¬ tially different from that by which the muscles are excited, and the functions of secretion and assimilation maintained. They sufficiently partake of the nature of the sensorial organs to be capable of directly impressing them, and thus the latter receive all their impressions w'hether originating from without or within our own bodies. On the other hand, — that is, that the sensorial organs may, without contact with any of the agents of the external wmrld, impress those agents, — a more com¬ plicated machinery is required. The various nerves of sensation are the only means required for conveying impressions to these organs ; but so simple an appa¬ ratus is not sufficient to convey to, and impress on, the materials of the external world, the dictates of volition. The pow’ers of the nervous system are here called into operation by the sensorial powers, to which they are subjected; for it appears from many experiments, de¬ tailed in the Philosophical Transactions for 1815, and in my Inquiry into the Laws of the Vital Functions, that as the muscu¬ lar is independent of the nervous power, but subjected to its influence, the nervous is independent of the sensorial power, but, in like manner, subjected to the influence of this power. In the case before us the nervous, influenced by the powers of the sensorial organs, supply a certain set of nerves with the stimulus which excites the muscles of voluntary motion, the immediate agents by which the mate¬ rials of the external world are impressed. I have had occasion to refer to the great variety of the phenomena of life, as one cause of their apparent obscurity. Such is their variety that we are at first view lost in attempting any arrangement or even enumeration of them. An essential step towards their arrangement, as appears from what has been said, is their division into those which are the immediate results 954 DR. PHILIP ON THE POWERS OF LIFE. of the cooperation of the principle of life with the principles of inanimate nature, and those which have no immediate de¬ pendence on the latter powers ; for all our functions mediately or immediately de¬ pend on the operations of the agents of inanimate nature. All are more or less directly excited by impressions originating in their agency. The most purely sensorial functions, our pleasures and pains, are as dependent, though more remotely, on the excitement maintained by them, as the functions of the organs immediately impressed by them. Have not the excitements of memory, for example, as much originated in their im¬ pressions, as their more direct effects on the part impressed? And when the na¬ ture of our bodies and the circumstances in which we are placed are duly considered, what other result could be expected ? Our organs, being composed of the same materials as the world which surrounds us, can only be directly influenced by agents of their own nature ; and from that world, and by the medium of those organs, all the materials, not only of our acquired knowledge*, but of our enjoyments and our sufferings, are derived. And as on the one hand, all our func¬ tions are more or less immediately excited by impressions made by the agents of the external world on organs composed of materials of their own nature, on the other, we have no power of influencing them, but through similar means. The only means of exciting our mental func¬ tions are the impressions of those agents on the organs of sense, and our only means of operating beyond our own bodies are through our organs of motion. Even when by our mental powers we influence those of other sentient beings, it is as much, though not so directly, by impressing the agents of the external world by the latter organs, as when we raise a weight or throw a stone. Such is the general outline of the vital and sensitive systems ; and the manner in which the various powers of the living animal are related in the formation of these systems. By the foregoing means, the nervous power maintains the vital functions properly so called; and the sen¬ sorial power is brought to cooperate with the powers of inanimate nature, powers whicfyhave no properties in common. The functions by which these objects are effected include the more complicated functions which belong to the individual • We are born with the knowledge which is immediately essential to our existence. The infant knows as well how to suck and how to breathe as the adult, and these are as much acts of volition as those which are the results of ex¬ perience. See my paper on the Nature of Death. systems. But the most complicated re¬ main to be considered — those functions in which both systems so co-operate that they can hardly be said to belong to either. Before entering on them, however, it will be necessary to make some observations on the differences of the laws which regu¬ late the two systems, and consequently essentially modify all the functions in which they co-operate. It appears from the facts adduced in my paper on the Nature of Death, pub¬ lished in the Philosophical Transactions for 1834, that the vital and sensitive sys¬ tems obey very different laws, the differ¬ ence depending on the vast difference in the nature of the sensorial and nervous powers, the leading powers which pervade all their departments, and to which all their other powers are subservient. These other powers, it appears from what has been said, are the same in both, namely, the muscular power and the powers of the living blood, and, in the sensitive system, the nervous power itself ; for in this system all the other powers of the living animal are directly subjected to the sensorial power, while none of the powers of the vital system have any direct influence on it, their influence on the sen¬ sorial power being through the medium of its organs, the structure and well-being of which immediately depend on the vital powers. In other respects also the laws of the two systems essentially differ. Nor will these differences surprise us, when it is recollected, as appears from the facts which have been stated, that while the leading power in the vital system is one of those powers which operate in the external world, that of the sensitive system not only possesses no properties in common with the agents of inanimate nature, but depends on a set of organs unapproachable in their healthy functions by any such agents. When the facts adduced in the paper j ust referred to, and that on the Nature of Sleep published in the Philosophical Transactions for 1833, are duly considered, it will appear that a principal cause of difference in the laws of these systems de¬ pends on the difference of the laws of ex¬ citability in the organs of their leading powers. In those of the leading power of the sensitive system, all degrees of excite¬ ment are followed by a rapid proportional exhaustion of excitability; so that the effect of the usual stimulants of life for a few hours, renders a state of inactivity essential to the maintenance of their health : while the exhaustion of the ex¬ citability of the organs of the leading power in the vital system by those stimu¬ lants, ip the operation of many times as DR. PHILIP ON THE POWERS OF LIFE. 965 many years, the one determining the re¬ currence of sleep, the other the natural duration of life. The properties of the muscular fibre, and the relations it bears to the other or¬ gans, admirably adapt it to cooperate with the leading powers of both systems. This fibre, it appears from many of the pheno¬ mena of life, experiences no sensible exhaustion from moderate excitement*. In health its excitement in the vital sys¬ tem is always such ; and it is evident from what is said in the papers just referred to, that, were not this the case, the continu¬ ance of life would necessarily be of very short duration. We know from the phe¬ nomena of disease that even in slight de¬ grees of exhaustion of the muscular fibre employed in the vital system, its due ex¬ citability is restored with difficulty ; and that no great degree is necessary to prove fatal. That its due excitability may be restored, it must still retain such a degree of it as is necessary to the continuance of the vital functions, however feebly per¬ formed. Under such circumstances, if the operation of the offending cause be removed, the organs of those functions gradually though slowly, in proportion to the degree of exhaustion which has taken place in the muscular fibre employed in the vital functions, and the organs of the nervous power properly so called, regain their due excitability. The moderate effect and uniformity of the stimuli which, in health, excite the muscular fibre in the vital system, se¬ cure it against sensible exhaustion. It is otherwise in the sensitive system, because there this fibre is often ex¬ posed, in the ordinary functions of life, to a stimulus exceeding in its effects the limits of moderate excite¬ ment; but the exhaustion consequent on this excitement is here attended with little inconvenience, because the organs of the only stimulus which excites it in this system suffering a corresponding ex¬ haustion, its stimulus is withdrawn ; and thus it is allowed to recover its excitability, its continued action here not being essen¬ tial to the continuance of life, and means being provided in the healthy functions of the system for the restoration both of its excitability, and that of the organs which supply the stimulus which excites it. In those, in whom, from habits of dissipation, extreme labour, or other causes, the excitability of the vital system is to a certain degree exhausted, but who, as they approach middle life, cease to be exposed to such causes, and during that portion of life, that is from thirty to fifty or fifty-five, feel little incon. * My papers on the Nature of Sleep and Death. venience from the effects of their early habits, there still being in the vital system sufficient excitability for the usual func¬ tions of life; after this period, when the defect of excitability begins to be felt sooner or later by all, feel the effects of its expenditure which had been so profuse in early life : many striking instances of which I have witnessed. Similar observa¬ tions apply to long protracted illness, severe misfortunes, or any other cause which at any period of life in a great de¬ gree, and for a considerable length of time, tend to exhaust the excitability of the vital system, although for a certain time the individual may enjoy his usual health after such causes have ceased to operate*. The organs of the leading power in the vital system, as appears from the facts stated in my paper on the Nature of Death, possess at birth a high degree of excita¬ bility, a degree beyond that proportion which constitutes the firmest state of health — the cause, as there pointed out, on which the growth of the body ap¬ pears to depend, and the source of many of the most fatal diseases of infancy — which is by the operation of the usual stimulants of life gradually reduced till it bears a due proportion to those stimulants, by which the powers of the constitution are confirmed. At length from their con¬ tinued operation the fault is a defect, not a redundancy, of excitability, to which every day necessarily adds, till they can no longer excite the organs on which that power depends ; for in every instance the immediate cause of absolute death, which is very different from what we call death, is the failure of that powerf . And here as there are no means in the constitution, as in the case of the organs of the leading power in the sensitive system, of restoring the excitability of its organs, they at length finally cease to be excited. Thus it is that in almost all cases of great longevity we find that there has been little exposure during life to powerful causes of exhaus¬ tion of either body or mind, for we have seen that the nervous is immediately under the influence of the sensorial power ; and that such instances are most frequent in the colder of the temperate climates; heat, on the one hand, tending to exhaust ex¬ citability, and extreme cold, on the other, to render us less capable of excite¬ ment. In considering the laws of excitability it is necessary to bear in mind an essential property of all those agents which are capable of calling it into action, and * See what is said of the excitability of the two systems in my papers on the Nature of Sleep and Death. f My paper on the Nature of Death. Philoso^ phical Transactions for 1834, D5G DR. PHILIP ON THE POWERS OF LIFE. which has obtained less attention than its great importance in the treatment of disease demands. There is no agent capable of influencing either of the two systems into which the functions of the living animal arrange themselves, whether it be such as makes its chief impression on the mind or body, which is not capable of acting either as a stimulating or directly debilitating power according to the degree in which it is applied. There is none which may not be applied in so small a degree as to act as a stimulant, and in so great a degree as to act as a directly debilitating power. The most depressing passion in a comparatively small degree will excite, the most exciting in an ex¬ cessive degree directly debilitate; and the same stimulus by which either the nervous or muscular fibre is directly excited, will by its' excessive application directly de¬ prive it of power. I know of no exception to this law. All medicines within a certain range, excite, and unless the excitement exceeds the degree which pro¬ duces no correspondent depression, (for such a degree of excitement, we have seen, is compatible with the laws of the vital though not with those of the sensitive system*,) it acts as a permanent tonic. All, beyond their stimulant range, act as directly, and although within that range, if of a certain intensity, as indirect¬ ly debilitating powers with respect to both systemsf . Thus it is that tonics never produce much immediate excitement. They have little of the effect of mere stimulants. Their peculiarity is in the permanence, not the power, of their stimulant effect ; and on this both their good and bad effects depend; and thus also it is, that a medi¬ cine, debilitating in the usual dose, in a lessened dose acts as a tonic. This I have found to be, in a striking degree, the case in the instance of mercury J, by which means we are enabled permanently to re- ♦ My paper on the Nature of Sleep in the Philosophical Transactions for 1833. t See what is said on this subject in my treatise On the Influence of Minute Doses of M- rcury in restoring the Functions of Health, and my Gulstonian Lectures on the more obscure affections of the Brain, also in the recapitulation at the end of this paper. All my treatises, to which I have occcasion to refer, are more or less founded on the principles here recapitulated ; and conse¬ quently in them more or less copious references to the facts on which these principles rest, became necessary. In order to arrive at the conclusions of the present paper, it was necessary to state the whole of those facts with their various bearings, which l have done in as concise a manner as the requisite perspicuity appeared to admit of. In the less familiar parts of the subject, it requires some care to avoid being misunderstood. t See my Treatise on the Effects of minute doses of Mercury in restoring the Functions of Health. lieve a class of diseases which have hitherto resisted all our means. I have been at much pains to ascertain the largest dose of mercury wrhich acts as a perma¬ nent tonic ; that is, provided it is not al¬ lowed to produce salivation, w'hich, for evident reasons, how'ever produced, is itself debilitating, and which the following doses are as capable of as larger ones, and under certain circumstances more so*; but from their use it never suddenly supervenes; there is always, under what¬ ever circumstances, sufficient warning to prevent it by discontinuing the mi¬ nute doses for one or two days ; nor, in¬ deed, do any of the other bad effects of a course of mercury attend their use. They neither open the skin as a course of mercury does, nor does the sudden closing of the skin, under their use, from cold or any other cause, ever do harm, the quantity of mercury at any one time in the habit never being such as to cause inconvenience to whatever part directed. The doses here referred to, I found, in most constitu¬ tions, to be the twentieth part of a grain of calomel, or half a grain of blue pill, according as best suits the constitution, repeated three times in twenty-four hours. These doses possess about the same power, the former perhaps being rather the more powerful. Many circumstances detailed in my treatise on these doses must be attended to in order to secure their good effects. We have hitherto been employing mer¬ cury in its debilitating doses only ; that is, doses which either produce a directly debilitating effect, or such excitement as, in the vital system, is followed by a cor¬ responding depression ; and hence has arisen the prepossession against it, which, however, such are its healing powers, has not prevented its being more generally em¬ ployed in this country than any other medicine ; in which the best informed countries of Europe are gradually follow¬ ing our steps. It is evident from many facts, stated in my papers on the Nature of Sleep and Death, that each of the foregoing systems is a whole, which cannot be influenced in any one part without a tendency to be affected in all others; a property which perhaps more than any other influences the progress of their deviations from the healthy state ; for every part more or less feeling the change effected in any one, if there be any from accidental causes more liable to disease than the rest, this part particularly feels the cause which operates on all ; and, as I shall soon have occasion to point out more particularly, is even the means of diverting its effects from every * Ibid. 957 DR. PHILIP ON THE POWERS OF LIFE. other part. Thus it is that diseases of continuance often become complicated, and that an affection, attended with little risk in the part first impressed by the offending' cause, may become formidable by its se¬ condary effects. The power which operates here has been termed the sympathy of parts, the effects of which I have considered at length in a treatise on the more obscure diseases of the brain, being the Gulstonian Lectures de¬ livered at the College of Physicians in 1835. I am now, after referring to its more prominent effects, to consider the nature of this function, and the powers on which it immediately depends ; which will lead us to the last part of the subject of this paper, — the means by which the most complicated functions are effected. As it appears from the experiments above referred to that the organs of the sensorial and nervous powers, the leading principles of the two great systems, the functions of which comprehend all the functions of life, although both belonging to the brain and spinal marrow, are dis¬ tinct sets of organs; the one set being confined to a comparatively small portion of these organs, the other distributed through the whole of them, from the uppermost surfaces of the brain and cerebellum to the lowest portion of the spinal marrow ; and as numberless obser¬ vations evince that the immediate cause of sympathy exists in the central organs alone*, it follows that these systems must have different centres of sympathy, that if the different parts of each system sympa¬ thize, it cannot be through the same centre. f Now it appears from the pheno¬ mena of disease, compared with the results of the experiments just referred to, that each of the centres of these systems is often influenced with so little disturbance to the other, that disease of either system, es¬ pecially when of a chronic nature, often spreads to distant parts of the system in question, without much affecting the other ; a favourable result in the sensitive system, because it is only in proportion as the organs of the vital system are implicated that life is endangered ; but in the vital system the most fruitful of all causes of obscurity, and that in diseases of the most formidable nature, to which many have fallen, and still fall a sacrifice ; for so ill supplied are some of the vital organs with nerves of sensation, that in them diseases of sympathy often make a fatal progress without the state of the part originally affected having attracted attention, and without its restoration, that of the part secondarily, but more prominently, affected is impossible*. Thus also it is, — that is, in consequence of the one system often suffering with little disturbance to the other, — that extreme suffering not unfre- quently continues for years without mate¬ rially impairing the functions of life, the organs of suffering belonging to the sensi¬ tive system; while in other instances immediate danger presents itself with so little previous suffering, that even the medical attendant is unprepared for it. The latter evil can only be obviated by a careful study of the laws of sympathy in the vital system, and particularly by ascer¬ taining what organs are most inclined to be affected by what others; for although the function of sympathy is, like other functions, influenced by causes peculiar to the individual, it is in a great degree regu¬ lated by principles which more or less pre¬ vail in allf. From the facts just referred to we easily perceive the cause of the sympathy by which every part of each of the foregoing systems is capable of influencing every other. Each is regulated by a leading principle, and in consequence of this, under an influence by which the affection of any one part tends to affect all others ; because as all parts of each system both influence this principle, and are influenced by it, it necessarily follows that all must, through it, — that is, through the central organs of ea^h system, which alone are the immediate organs of its leading prin¬ ciple, — feel the affections of each. Such, together with the laws I am now to consi¬ der, is the source of the function to which the term sympathy has been applied, a principle, as I have just had occasion to observe, which perhaps more extensively than any other regulates the course of disease. As each of the preceding systems is formed into a whole by its leading prin¬ ciple, the relation which these systems bear to each other have a similar effect with respect to the whole frame; for the affection of any one of its parts tends more or less, though much less powerfully than in the individual systems, to influence all * The internal water in the head of children, for example, has till within the last thirty years, been almost uniformly fatal, having been treated as an original affection of the brain. Dissection having now proved it to be a secondary affection depending on the state of the liver, there are few serious diseases in which the treatment is more uniformly successful, if it has not been allowed to arrive at its last stage. The original affection, which does not betray itself by any prominent symptom, being removed, its consequences yield to the means, which are powerless while it con¬ tinues to operate. Other affections of the head, ceitain forms of pulmonary consumption, and many other diseases, might be adduced as illustra¬ ting the same principles. Ibid, t My Gulstonian Lectures. * My.Gulstonian Lectures. + Ibid. 968 DB. PHILIP ON THE POWERS OF LIFE. others. The means by which the relation between the sensitive and vital systems, and consequently the most complicated functions, are maintained, we are here to consider ; to some of them I have already had occasion to refer. We have seen that the nervous power properly so called, the leading power in the vital system, is immediately under the in¬ fluence of the sensorial power, the leading power in the sensitive system, and consti¬ tutes the medium through which all that part of our intercourse with the external world, by which the latter power influences it, is maintained. This therefore is the first bond of connexion to which I shall refer between the sensitive and vital systems. The second is the means by which the organs of both systems are maintained; for, as I have already had occasion to observe, the sensitive has a dependence on the vital system, for the maintenance of its organs, as the latter, we shall find, has a more remote depen¬ dence on the former, for the maintenance of its organs ; the connexion thus esta¬ blished between them being increased by both systems equally depending for the maintenance of their organs on the muscular power and the powers of the living blood ; both of which are in their turn subjected to the nervous, and the former certainly, and the latter, wre have reason to believe, through the nervous, also to the sensorial pow'er. The sympathy which prevails through all parts of each system also contributes to the influence of these systems themselves on each other; because the state of the parts secondarily affected in consequence of the power of sympathy, more or less influences both systems, all parts being more or less supplied with nerves from both. But we have sufficient evidence in the symptoms of disease, compared with the results of the experiments referred to, that in the phenomena of sympathy, as in the instances just pointed out, the central organs of the sensitive directly influence those of the vital system. A sympathetic pain it is well known referred to any part will at length produce actual inflammation of the part. Nowr while the pain alone exists, we know that the derangement which produces it is in the central organs alone of the sensitive system, and in no degree in the part to which it is referred ; and we also know from the facts which have been stated, that there is no channel through wrhich this derangement can in¬ fluence either the vital nerves or the vessels of the part, but through the central organs of the vital system. When the affection of the nerves or vessels of the part is the original disease it influences the central organs of both systems by the actual disease of the part, every part being supplied with nerves belonging to both systems; but in the former case there is no other channel of communication than that just referred to, The central organs of the sensitive, having no direct power over either the vital nerves or the vessels, can only influence them through the central organs of the vital system. Thus arises a double bond of connexion between the twm systems, the central organs of the sensitive system directly influencing those of the vital sys- > tem, and the nerves of the sensitive system being necessarily influenced by all devia¬ tions from a state of health in whatever part, for all parts may be affected through the central organs of the vital system, the degree to which the effect in the sensitive system takes place being proportioned to that in which the part is supplied with nerves of sensation. As the central organs of the sensitive, directly influence those of the vital system; the latter, through the extremities of the different nerves writh which the two sets of organs are associated, influence the former. Hence we have just seen the fatal obscurity of many dis¬ eases of those vital organs, wdiich are ill supplied with nerves of sensation; and as the more chronic the disease, the less it disturbs the sensitive nerves, it is in the more chronic cases that the obscurity is greatest, and consequently attended with the greatest risk. Different parts of the central organs of the sensitive system correspond to differ¬ ent parts of the general frame. This is perhaps sufficiently proved by our being enabled by experience to refer our sen¬ sations to the seat of the cause which excites them ; but in many of the inferior animals, where both the brain and spinal marrow partake of the organs of the senso¬ rial power, it may be proved by direct ex¬ periment, because after the removal of the brain wre find the sensorial power lost only in those parts which derive their nerves from that organ. But how comes it that the central organs of the vital system also have a peculiar relation to certain parts of the general frame, the nerves associated with these organs conveying, as appears from what has been said, their combined influ¬ ence, which is bestowred alike on all vital organs ? It is a lawr of the animal economy, amply illustrated by the phenomena of disease, , that when an impression influencing the i system generally is, by previous debility or : any other cause, directed to a particular : part, its operation is diverted from all j others. Now it appears from a thousand i DR. PHILIP ON THE POWERS OF LIFE. 959 phenomena that the suffering of the sen¬ sitive system, referred to any particular part, is sufficient, under certain circum¬ stances, in consequence of the influence of the central organs of the sensitive, over those of the vital system, and, through the latter system, over all parts of our frame, to direct to that part the effects of derange¬ ment excited in this system. Thus even a diseased organ will often regain its healthy state, when the disease has spread to another, particularly if in the latter, it takes deeper root, if I may use the expres¬ sion. It is a daily occurrence for a dis¬ ease of function to be finally removed by a disease of structure being established in another organ. Hence the good effects of artificially exciting disease in external parts to relieve those more immediately essential to life ; and the still more salu¬ tary effect, when the laws of our frame themselves produce the same effect, be¬ cause here it is the uninfluenced result of those laws, whereas in the former case their tendency is constrained by artificial means. Thus for example it is that the inflammation of a gouty joint or other external disease often relieves the de¬ rangement of a vital organ, and that arti¬ ficially repelling this effort of the con¬ stitution to save a vital part, has so often proved fatal. On the facts that the central organs of the vital system directly influence the functions both of the vital nerves and of the vessels of every part, while those of the sensitive system have no direct influ¬ ence on either, many of the phenomena of disease depend; because it is only in pro¬ portion as these nerves and the vessels of the part are influenced, that any disease of the part itself exists, and consequently that there is any tendency to derangement either of function or structure in the part ; of function alone if the nerves alone are affected, of structure also as soon as the vessels partake of the disease. Hence it is that the tendency to change of structure, except where it takes place by impercep¬ tible degrees, is, cceteris paribus, always pro¬ portioned to an inflammatory tendency which may be detected in the part, this tendency being the first indication that the vessels partake of the disease ; and hence the importance of carefully wratching and checking its approach, if the part be one essential to life, in all cases of deranged i function of, or even of painful sensations I referred to, particular parts ; for the long i continuance of either may through the ! foregoing channels excite the most tormi- . dable diseases in vital parts, which will r generally be obstinate in proportion to the length of time the previous symptoms have lasted. The longer continued the habit of disease of whatever nature and whatever part, the more obstinately the parts concerned retain the morbid action. Extensive as the foregoing relations of the vital and sensitive systems are, they are not the only ones. To determine the w hole of them it is necessary to review7 the functions of the more perfect animals, and in particular correctly to ascertain the line of distinction between those of the two systems; in order to ascertain whether there be any beside those just pointed out in which they cooperate, and which consequently contribute to their de¬ pendence on each other. I made many experiments with a view to draw the line of distinction between the vital and sensitive functions ; and that the result might be the more certain, the attempt was made by twro sets of experi¬ ments, conducted on different principles. By the one it was. attempted to ascertain what functions remain when the sensorial powrer is withdrawn ; by the other, w’hat functions fail wflth the failure of the nervous powers ; and the correspondence of the results of these sets of experiments tends to confirm the inferences from both*. Much confusion had arisen from physio¬ logists having neglected to ascertain this line. M. le Gallois, one of the most acute, soon found his difficulties from this cause such, that he was obliged to confess him¬ self unable to proceed, and leave to his successors the task of removing them. He had adduced sufficient proof of the spinal marrow, to which the nerves of respiration belong, being capable of its functions in¬ dependently of the brain ; yet on the re¬ moval of a part of the brain, the medulla oblongata, respiration ceases. This diffi¬ culty he acknowledges he sees no means of removing, calling it “ un des grands mysteres de la puissance nerveuse, myst^re qui sera devoile tot ou tard, et dont la decouverte jettera la plus vive lumiere sur le mechanisme des fonctions de cette mer- veilleuse puissance.” If the preceding facts be kept in view, it is evident without much consideration that none of the functions of the sensitive have any other dependence on the powders of the vital system, but for the due struc¬ ture and w ellbeing of their organs. The nature of the functions of the vital system here requires more consideration. They include respiration ; circulation ; those processes by which the secreted fluids are formed; those, namely the more imme¬ diately assimilating processes, by wffiich our food is converted into the various organs of our bodies, and such parts of them as have become unfit for the pur- * Inquiry into the Laws of the Vital Functions, Part II. 960 DR. PHILIP ON THE POWERS OF LIFE. poses of life are separated and expelled, for all are in a state of change ; and those by which the due temperature is main¬ tained. Does the sensitive cooperate with the vital system in any of these functions ? From the line of distinction, determined by the? experiments just referred to, it appears that in one of them only is there such a cooperation. I have in the last of my papers pub¬ lished in the Philosophical Transactions for 1829 considered at length the nature of respiration, and have, as far as I am capable of judging, adduced such facts as prove that the muscles employed in this function are, in the full sense of the word, muscles of voluntary motion. The first act in respiration is the impression made on the sensorium, the sensation excited by the want of fresh air in the lungs. We are enabled to supply it and remove the uneasiness, by exciting, through the nervous system properly so called, certain muscles subject to the will. Respiration thus depending on the com¬ bined operation of both systems, is as ef¬ fectually destroyed by a failure of the sen¬ sation which makes us will to inspire, as by that of the nervous or muscular power by which the will effects its object. Thus the difficulty of M. le Gallois disappears. It is true that the spinal marrow and its nerves are capable of their functions in¬ dependently of the brain, and that the nerves which excite the muscles employed in respiration are supplied by the spinal marrow, but in this function it is an act of volition which excites them. They are quiescent till this act takes place. Hence it is that respiration ceases on the removal of the medulla oblongata, because by the removal of this part of the brain the power of sensation in all parts below the head and consequently of volition, as far as relates to those parts, is destroyed. Hence also the fact, above referred to, that the vital has a remote dependence on the sen¬ sitive system, independentl)' of the means of obtaining nourishment, for the main¬ tenance of its organs. If the muscles of respiration were not in the strictest sense muscles of voluntary motion, our powers of volition would in an essential respect be imperfect; for the due regulation of their action is essential in the formation of articulate sounds, the chief means by which our sensorial powers are enabled to influence those of other sentient beings. In many of the less perfect animals, res¬ piration like circulation is performed by powers of involuntary motion, as in the still more imperfect, sustenance is obtained by the same means, the functions of the lowest class of animals thus in their nature approaching to those of the vegetable. In proportion as the animal ascends in the scale of being, the vital have a greater dependence on the sensitive powers ; that is, in proportion as the latter powers im¬ prove, the former become more dependent upon them. In the papers on the Nature of Sleep and Death, published in the Philosophical Transactions for 1833 and 1834, I have pointed out how much the functions of the more perfect animal are influenced by this peculiarity of respiration, the only vital function, properly so called, in which the sensorial power cooperates ; a circumstance which more generally perhaps than any other, which is equally of a local nature, influences the phenomena both of health and disease. In this function therefore we find a powerful bond of connexion be¬ tween the sensitive and vital systems, and one, as appears from the papers just re¬ ferred to, of the most extensive operation. Such are the means by which the frame of the more perfect animal is formed into a whole, and the function of sympathy and its other more complicated functions above enumerated effected. A powerful connexion is established among all parts of each of the systems into which the functions arrange themselves, depending on each being regulated by a leading power which influences every part of the system to which it belongs, and in its turn is in¬ fluenced by every part of it: and these systems themselves are intimately related in consequence of the nervous, the leading power in the vital system, by means of the control which the organs of the sensorial power exercise over it, being employed in the accomplishment of many of the sensitive functions; and the sen¬ sorial power, the leading power in the sensitive system, being employed in one of the most important of the vital functions; by both symptoms not only de¬ pending for the maintenance of their or¬ gans on the same powers, but more or less directly on each other ; by the powers common to both systems being under the influence of the leading principles of both; and by all affections of whatever part, whether original or sympathetic, necessa¬ rily influencing both its sensitive and vital nerves, and consequently the central organs of the systems to which they belong. From the whole of the facts referred to in the preceding paper, the great outline of the laws which regulate the functions of the more perfect animal is derived. The parts of which it consists, from the complicated nature of the subject, being very numerous, it is necessary, in order to place it in a clear point of view, concisely DR. PHILIP ON THE POWERS OF LIFE. 961 to recapitulate them ; and as in the pre¬ ceding paper, I commenced with the more simple, and was, by their intimate con¬ nexion with the more complicated powers, led to them ; I shall in the recapitulation, that they may be viewed in both directions, begin with the more complicated, which by the same means will lead us to the more simple powers. Beside the mechanical powers, of which the living animal evidently partakes in common with inanimate nature, it pos¬ sesses, we have seen, four distinct powers, apparently peculiar to itself, having no direct dependence on each other, but each depending on the other three, for the main¬ tenance of its organs ; the sensorial, the nervous, and the muscular powers, and the powers of the living blood. By these powers are maintained the two systems into which the various func¬ tions arrange themselves, the vital and sensitive systems, the object of the one being the maintenance of our bodies, of the other, our intercourse with the external world. The organs of the sensorial power in man have their seat in the brain. They can be excited by no other means than the influence conveyed by the nerves of sen¬ sation, in the most extended sense of the expression, in every instance called into operation by impressions made on their extremities by agents which belong to in¬ animate nature, either existing within our own bodies, or making their impression from without; and, on the other hand, there are no means by which the sensorial organs can influence those agents but through the intervention of the powers of the nervous system properly so called. The nature of the sensorial power, we have seen, admits of no direct intercourse between its organs and the agents ofinanimate nature, because none of the properties by which it operates have any thing in common with those of such agents; and as these organs can only receive impressions from the ex¬ ternal world through the nerves of sensa¬ tion, with which they associated, they can only impress the agents of that world through the muscles of voluntary motion, excited by the nerves associated with them. Thus it is necessary, as we have by direct ex¬ periment found to be the case, that the organs of the nervous system should be placed under the control of the sensorial power. Through the same channel, we have seen, this power also, in some of their functions, controls the muscles of in¬ voluntary motion ; and we have reason to believe, although the point has not been ascertained by direct experiment, all the powers of the living blood. And such, as 486. — xix. appears from facts above referred to, is its influence on the nervous, and through it, on the muscular power, and we have rea¬ son to believe on the powers of the living blood, that it can not only excite, but im¬ pair and instantly destroy all these powers, according to the nature and power of the causes which influence its organs. The circumstance of the muscular, as appears from facts above referred to, being the moving power of the blood in the vessels as well as the heart, greatly extends the influence of those powers which con¬ trol it, namely, the nervous power properly so called, and the sensorial power acting through it. The only respects in which the sen¬ sorial power is related to the subject of this paper, are in the impressions it re¬ ceives from the nerves of sensation, and the functions in which it co-operates with the nervous and muscular powers. Sen¬ sation and volition are the only sensorial powers employed in the maintenance of life. While the organs of the sensorial power are thus capable of more or less directly influencing all the other organs of the living animal, they more or less feel in their turn, through the medium of the nerves of sensation, which, we have seen, convey an influence of wholly a different nature from that conveyed by the nerves associated with the organs <% the nervous power properly so called, all changes effected in any part of our frame By these means, this power constitutes the leading principle in the sensitive system, of which its organs form the central parts. *c. rl he organs of the nervous power pro¬ perly so called, have their seat equally in the brain and spinal marrow, and through¬ out all parts of them ; and are excited, on the one hand, by the direct influence of the sensorial power, and on the other, by agentsinfluencingthe vital organs through¬ out every part of the frame; all of which, as in the case of the impressions made on the nerves of sensation, whether existing in our own bodies or making their im¬ pressions from without, are agents of inanimate nature. The immediate functions of the unaided nervous power are the excitement of the muscles of voluntary motion in all their functions, of the muscles of involuntary motion in some of their functions; and the im mediate functions of this power in co-operation with the muscular power and the powers of the living blood, all the powers of both of which are directly sub¬ jected to its influence, are the formation of the secreted fluids, the maintenance of animal temperature, and the various more 3 Q Dll. PHILIP ON THE POWERS OF LIFE. 9G2 immediately assimilating functions, — namely, the functions by which, on the one hand, our food is converted into our various organs, and, on the other, those parts of them which have become useless, are separated and expelled, — which ren¬ ders it necessary that the muscles of in¬ voluntary motion as far as they co-operate in these functions, which with few excep¬ tions include the whole of these muscles, should, as we have seen from direct ex¬ periment is the case, be under the im¬ mediate influence of the nervous power. Neither the brain nor spinal marrow in the functions of the vital system acts through the other of these organs, as the brain is found to do through the spinal marrow in many of those of the sensitive system ; each directly influencing every part. The direct influence of the nervous power, it appears from what has been said, extends to all the functions of the system, with the exception of those of the sensorial power, which it only influences through other functions. It directly influences, and is directly influenced by, all the vital func¬ tions properly so called, and hence consti¬ tutes the leading principle of the system to which they belong, therefore termed the vital system, of which its organs form the central parts. The circumstance of each of the fore¬ going systems being under the influence of a leading power, which is both capable of influencing and being influenced by every part of it, is the cause of that powerful sympathy which exists among all its parts, and which we have seen often essentially influences either system with but little disturbance to the other, on w'hich many of the most important phenomena of disease depend. The muscular power, which has its seat, we have seen, in the muscular fibre itself, and the powers of the living blood, which have their seat in the blood itself, perform subordinate parts. They are equally em¬ ployed in both systems for the maintenance of their organs. The latter supplies the materials endowed with the principle of life on which the nervous power operates in the formation of the secreted fluids, the maintenance of animal temperature and the various more immediate functions of assimilation ; while the former, to which the vessels as well as the heart owe their power, supplies the means by which these materials are duly exposed to the operation of the nervous power, by which their necessary changes are effected ; that is, to the influence of the extremities of the nerves, by which the nervous power ope¬ rates in all these functions, as well as in the excitement of the muscles ; for as the brain and spinal marrow, as we have seen proved by direct experiment, are the only parts of the nervous system employed in preparing the nervous influence, the mi¬ nute extremities of the nerves are the only immediate organs of its functions ; as the extreme p^arts of the sanguiferous system, the capillary vessels, are the organs by means of which the blood is immediately exposed to its influence. That the capillary vessels may be, as little as possible, influenced by adventitious causes in functions of such importance in the animal economy, we find on the one hand, as appears from experiments above referred to, that the motion of their blood depends wholly on their own powers, the larger arteries which depend for their sup¬ ply of blood on the heart, being only the reservoirs from which they draw their supply 5 and that, on the other, they are not controlled by the nervous influence through the medium of the heart, but re¬ ceive this influence directly from its source : and so correct are these positions, that even the removal of the heart, if effected with¬ out any considerable loss of blood, produces no immediate effect either on the action of the capillaries, or the control which the nervous power exercises over them. Such are the individual powers of the living animal, their seat, the relation they bear to each other, and the manner in which their several functions are effected. But the most complicated functions, it appears from what has been said, de¬ pend on the relations which subsist be¬ tween the two systems themselves, into which the functions of all these powers are arranged. They are related to each other, w^e have seen, by the nervous, the leading power in the vital system, in consequence of the control exercised over it by the sensorial, the leading powTer in the sensitive system, being employed in many of the functions of the latter ; by the sensorial being em¬ ployed in one of the most important of the vital functions, this peculiarity of respira¬ tion, for in no other of those functions is there any such co operation, extensively influencing the phenomena both of health and disease; by both systems depending for the maintenance of their organs on the same powers, and more or less directly on each other ; by the powers common to both systems, the muscular power and the powders of the living blood, being under the influence of the leading powers of both ; and by all affections of whatever part ne¬ cessarily influencing both its sensitive and vital nerves, and consequently the leading powers of both systems. As the various parts of each system are DR. PHILIP ON THE POWERS OF LIFE. formed into a whole by all parts of each influencing and being influenced by its leading principle, so all parts of the ani¬ mal body are formed into a whole, no part of which can be affected without tending more or less to affect all others, by the means just enumerated, by which these systems influence each other. Such are the foundations on which the laws of sym¬ pathy depend, a principle which, as I have endeavoured in a cursory way to point out, more than any other, influences the course of all deviations from a state of health. The functions of allthe powers of the living animal, we have seen, are mediately or immediately excited by organs belong¬ ing to inanimate nature. Our organs are composed of the same materials with the external world, and can only be imme¬ diately impressed by agents of their own nature. It is true that the sensorial func¬ tions are the results of one vital part act¬ ing on another, the sensitive nerves on the immediate organs of the sensorial power; but the impression these nerves convey is in every instance received from the agents ♦of inanimate nature. Here both the agent and the organs impressed are of the same general nature, being composed of similar materials with our other organs. The peculiarity of the results depends on vital properties alone being employed in their production, whereas in all other functions of the living animal, the vital properties of the organ co-operate with the properties of the inanimate materials of which it is composed. Hence it is that its functions admit of being immediately excited by the agents of inanimate nature, which, having no properties in common with the only properties employed in the sensorial func¬ tions, cannot directly co-operate in their production ; and hence, we have seen, the analogy, which all the functions of the living animal, with the exception of the immediate functions of the sensorial or¬ gans, bear to the operations of inanimate nature, and the total loss of all such ana¬ logy in the latter. Every agent capable of exciting any of the functions of the living animal, we have seen, acts as a stimulant or directly debi¬ litating power, according to the degree in which it is applied. In the sensitive system their stimulant effect is always followed by a proportional exhaustion of excitability ; in the vital system, only when the excitement exceeds a certain limit. I speak in the latter case of a sensible ex¬ haustion, an exhaustion beyond that pro¬ duced by the usual stimulants of life, which, in the vital system, is loo gradual to be perceived, and as far as relates to any particular stimulant employed within 933 such limit, is so trifling that it may be safely overlooked. Hence it is that the vital system appears to possess an excita¬ bility which is not exhausted by stimulants except when applied in excess. It is essential, we have seen, in the treatment of disease, to keep in view these properties of all agents capable of influencing the functions of life, that we may, as much as the nature of the case admits of, keep within the stimulant range of our reme¬ dies; and within that range, as far as possible, avoid the degree of excitement which produces sensible exhaustion of the vital organs ; under which circumstances medicine always operates as a permanent tonic, more or less powerful according to its peculiar properties. With respect to the nature of the powders of the living animal which we have been considering, the sensorial and muscular powers, and the powders peculiar to living blood, wre have found to belong to the living animal alone, all their pecu¬ liar properties being the properties of life. The functions of life may be divided into two classes, those which are effected by the properties of this principle alone, and those, by far the more numerous class, wdiich result from the cooperation of these properties with those of the principles which operate in inanimate nature. The nervous powder we have found to be a mo¬ dification of one of the latter principles, because it can exist in other textures than those to which it belongs in the living animal, and we can substitute for it one of those principles without disturbing the functions of life. Late discoveries have been gradually evincing how' far more extensive than was supposed, even a few' years ago, is the dominion of electricity. Magnetism, che¬ mical affinity, and (I believe, from the facts stated in the foregoing paper, it will be impossible to avoid the conclusion) the nervous influence, the leading power in the vital functions of the animal frame, properly so called, appear all of them to be modifications of this apparently univer¬ sal agent; for I may add, we have already some glimpses of its still more extensive dominion *. In the preceding paper my objects have been to review' the whole of the functions of the more perfect animal, to ascertain the nature of the powers on which they depend, the seat of each of these powers, the manner in w hich they are employed in effecting their several functions, and the manner in which they are associated in * See Dr. Roget’a Treatise on Electricity. 904 ANALYSES AND NOTICES OF BOOKS. producing their more complicated results. Nothing in any part of the subject has been taken for granted, no position having been advanced without a reference to the observations or experiments on which it is founded. I have here for the first time made an attempt, which could not be done till all the facts on the subject had been ascer¬ tained, to point out the manner in which the different powers of the living animal influence each other, and thus conduce to their more complicated results ; by which, being enabled to analyse these results, it might easily, were this the proper place, be shown, that we better see the operation of its different powers in the various devia¬ tions from a state of health, and can, under certain circumstances, better regu¬ late the means of obviating them. STRYCHNOS NUX VOMICA IN DYSPEPSIA. To the Editor of the Medical Gazette. Sir, In a late communication to your jour¬ nal, by Mr. Mellor, of Manchester, upon the curative effects of the strychnos nux. vomica in certain diseases of the digestive organs, that gentleman ob¬ serves, “ that the late Dr. Belcombe, of York, was in the habit of using it for the relief of indigestion, but in what particular form of this complaint, I am not at present prepared to say.” I beg to state that my late father prescribed the strychnos very generally, and with almost constant success, in those forms of stomach affection denominated pyro¬ sis and gastrodynia, particularly when the disease appeared to proceed from some morbid irritability of the nerves of. that organ ; and that he was preparing a detailed account of bis observations upon this medicine when be was at¬ tacked by a severe illness, from which he never recovered. I promise myself some time the plea¬ sure of laying this and other details of his successful practice before the medi¬ cal profession. Since the introduction of the alkaloid principle, which I am happy to see has obtained a place in the Pharmacopoeia, I have been in the habit of employing it in doses of to | of a grain with the same unvarying effect ; and 1 can safely second Mr. Mellor’s remarks, and re¬ commend it to the profession as a serviceable and excellent remedy. I remain, sir, Your obedient servant, PI. S. Belcombe, M.D. Minster-Yard, March IS, lb37. ANALYSES and NOTICESof BOOKS. “ L’Auteur se t.ue A allonger ce que le lecteur se tue a abreger.” — D’Alembekt. 1. A Translation of the Pharmaco¬ poeia of the Royal College of Physi¬ cians of Loyidon , 1836; with Notes and Illustrations. By Richard Phillips, F.R.S.L. & E., &c. (By permission.) Highley. 2. The Pharmacopoeia Collegii Regalis Medic orum Londinensis. Translat¬ ed, , with a Commentary , Chemical , Pharmaceutical , and Medicinal , by D. Spillan, M.D., &c. The above are the only translations of the new London Pharmacopoeia which have as yet made their appearance, though a third has been most pompously announced, and subscriptions for it so¬ licited. Mr. Phillips’s work deserves on all hands to be first noticed. Dr. Spillan very properly observes, that “ no one is better qualified than Mr. Phillips to give a translation of, and commentary on, the Pharmacopoeia. His well- earned reputation as a scientific che¬ mist, and the fact of bis having been appointed by the College a member of the Committee for its arrangement, pe¬ culiarly entitle him to the right of ex¬ plaining* the rationale of processes in conducting which he himself acted so considerable a part.” When, however, we compare the present position of Mr. Phillips, with respect to the College, with that he formerly occupied (a few years back), we cannot help exclaim- ing— “ Tempora mutantur et nos mutamur in illis.” The principal value of Mr. Phillips’s book consists in the notes and illustra¬ tions. They are concise, and for the most part very clear, accurate, and va¬ luable. We cannot, however, compli¬ ment him on his diagrams explanatory TRANSLATIONS OF THE NEW LONDON PHARM ACOPCEI A. 965 of the theory of the processes; they are had and confused. It would have been much better bad he constructed them on the plan followed (we believe not in¬ vented) by Dr. Boswell Reid. Meiss¬ ner’s diagrams (in his Handbuch d. Allgemein und tec/in. Chemie ) are much superior to those used by Mr. Phillips. There is an omission in these dia¬ grams which we much regret ; we mean the number of the reacting equivalents. By the way, why has Mr. Phillips omitted to g'ive diagrams illustrative of the chemical changes which occur in the manufacture of hydrocyanic acid, oxysulphuret of antimony, &c. ? They could be readily fo