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-Project Gutenberg's The London Medical Gazette; December 27, 1828, by Various
-
-This eBook is for the use of anyone anywhere in the United States and most
-other parts of the world at no cost and with almost no restrictions
-whatsoever.  You may copy it, give it away or re-use it under the terms of
-the Project Gutenberg License included with this eBook or online at
-www.gutenberg.org.  If you are not located in the United States, you'll have
-to check the laws of the country where you are located before using this ebook.
-
-Title: The London Medical Gazette; December 27, 1828
-       Being a Weekly Journal of Medicine and the Collateral Sciences
-
-Author: Various
-
-Release Date: November 5, 2016 [EBook #53450]
-
-Language: English
-
-Character set encoding: UTF-8
-
-*** START OF THIS PROJECT GUTENBERG EBOOK LONDON MEDICAL GAZETTE, DEC 27, 1828 ***
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-Proofreading Team at http://www.pgdp.net (This file was
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-  TRANSCRIBER'S NOTE
-
-  Italic text is denoted by _underscores_.
-
-  The 'Apothecary System' of measurement was used in the original text.
-  The etext uses the following Unicode symbols:
-      ℞      Prescription symbol
-      ʒ      Dram
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-      ℳ      Scruple
-  Roman numerals, and 'ss.' for 'half', are retained, so for example
-  '℥iss.' indicates 'one and a half ounces'.
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-  Obvious typographical errors and punctuation errors have been
-  corrected after careful comparison with other occurrences within
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-
-
-  THE
-  LONDON MEDICAL GAZETTE,
-
-  BEING A
-  WEEKLY JOURNAL
-  OF
-  Medicine and the Collateral Sciences.
-
-  SATURDAY, DECEMBER 27, 1828.
-
-
-
-
-PATHOLOGICAL ESSAYS
-
-ON SOME
-
-DISEASES OF THE HEART;
-
-_Being the Substance of Lectures delivered before the College of
-Physicians_,
-
-BY P. MERE LATHAM, M.D.
-
-Physician to St. Bartholomew's Hospital.
-
-[Continued from p. 7.]
-
-
-ESSAY II.
-
-_Morbid Anatomy of the Internal Lining Membrane of the Heart._
-
-The membrane which lines the cavities of the heart is very liable
-to disease, but not equally so in every part. Where it is thin
-and transparent, and admits the colour and character of the
-muscular structure upon which it is spread to be seen through it,
-it is seldom found diseased; but where it is of a denser texture,
-either in itself or from an admixture of other structures, whether
-cellular or fibrous, with its own, it is frequently, and often
-exclusively diseased. This latter character of a denser texture
-belongs to it where it forms the tough white circles which surround
-the apertures of communication between the auricles and ventricles;
-also where it is reflected upon itself, and forms the loose
-duplicatures of membrane, which are given off, as it were, from
-the internal surface of the heart, either at the fibrous circles
-intermediate between the auricles and ventricles, constituting the
-tricuspid and the mitral valves, or at the commencement of the
-pulmonary artery and aorta, constituting the semilunar valves.
-
-It is remarkable how curiously disease is apt to limit itself to
-the spaces just pointed out. Of the fibrous circle between the
-auricle and ventricle, of the valves which originate from it, and
-of the tendinous cords which connect the valves with the carneæ
-columnæ, there will not be the smallest space free from disease;
-but the disease will abruptly stop where the tendinous cords cease
-and the carneæ columnæ begin[1].
-
-The membrane, however, where it covers the fleshy columns of the
-heart, is not exempt from the possibility of disease: but when
-disease actually affects it, it has seldom originated there,
-but has generally spread from other parts of the same membrane,
-although (as we have just remarked) it is apt to stop short before
-it reaches this.
-
-Of the two sides of the heart, the membrane which lines the left is
-unquestionably the more liable to disease. But my own observation
-would never have led me to conclude that the membrane of the right
-side was so far exempt as it is commonly thought to be. Speaking
-from the best recollection I have of the specimens which have
-fallen under my examination, I should say that, in one-third of the
-cases where disease has been found on the left side, it has existed
-on the right side also, and been essentially of the same character.
-But there has been a remarkable difference in the extent to which
-it has proceeded on each side respectively: while on the left it
-has gone so far as to be the undoubted cause of death, on the
-right, although essentially of the same character, it has been only
-just beginning.
-
-It very seldom happens that disease appertains to the lining of
-the right cavities of the heart exclusively; and, where it affects
-both, the disease in the right cavities is very seldom found in
-advance of that in the left.
-
-It should seem, indeed, according to the ordinary course of things,
-that disease does not begin in the lining of the right cavities of
-the heart, until it has already advanced to an extreme degree in
-the left.
-
-The internal lining of the heart, as well as of the arteries, is
-often found to have become of a red colour. This redness, so well
-known to all who are accustomed to examine dead bodies, used to be
-regarded as a mere stain imparted to it by the colouring matter
-of the blood after death. Yet a due consideration of various
-circumstances connected with it will hardly warrant this conclusion.
-
-It has been found whether the heart or artery be full or empty of
-blood; and if blood be present it has been found, whether it is
-liquid or clotted; and if it be clotted, whether it does or does
-not retain its colouring matter. External temperature, and length
-of time between the death of the patient and the dissection of his
-body, have not made any difference in the frequency with which
-this peculiar appearance occurs. Lastly, no artificial methods,
-such as washing of any kind, can get rid of it; nor will inclosing
-blood within an artery for any period produce it[2]. This simple
-redness is sometimes seen universally in both sides of the heart
-and throughout the whole arterial system, and sometimes in patches
-only, of greater or less extent, whether in the arteries or in the
-heart.
-
-Now, when all these circumstances are considered, although in some
-instances it may be a mere stain imparted by the colouring matter
-of the blood after death, it is plainly impossible that it should
-be of that nature in any large proportion of the numerous instances
-in which it is found.
-
-But if the appearance in question implies (as I believe it
-generally does) a morbid condition, of what kind is that condition?
-There are the same objections to considering mere redness as
-equivalent to inflammation here as in the pericardium, or in any
-other part of the body: here, as elsewhere, in one case it may
-be the condition out of which inflammation is to spring; while in
-another it may not be destined to give origin to any change in the
-structure of the part beyond itself, and may itself constitute the
-whole disease.
-
-It appears to me, that this mere redness of the internal lining
-of the heart and arteries has become a matter of undue perplexity
-to pathologists, because they have laboured to infer from it
-more than the simple fact itself will authorize. All I wish to
-establish concerning it is, first, that it is not always (probably
-very seldom) a mere stain imparted by the colouring matter of the
-blood after death; secondly, that it alone does not constitute
-inflammation.
-
-It may not be improper to mention the circumstances under which
-it has occurred to myself to find it. I have met with it most
-frequently, and to the largest extent, in subjects whose previous
-disease has produced a constant and habitual impediment to the
-transmission of blood through the heart and through the lungs,
-and that impediment has gone on increasing to the hour of their
-death; also in those, whatever might have been the nature of
-their disease, whose dissolution (I mean the actual process of
-dying) has been tardy and agonizing, and marked by great labour of
-respiration; in the apoplectic, for example, in whom, after sense
-and consciousness were extinct, life had been protracted, with
-stertorous breathing, for many days.
-
-In such subjects the countenance, the lips, and the whole skin,
-give evidence during life of blood pushed beyond the natural sphere
-of the circulation, and detained in the extreme blood-vessels.
-Hence it is obvious that the causes which have loaded and distended
-the capillaries in every part of the body have had a like influence
-upon the vasa vasorum.
-
-I do not mean to say that I never met with this peculiar condition
-of the heart and arteries under other circumstances, or that
-other causes may not produce it; but that I am not acquainted
-with it under any other with which, from frequent coincidence, it
-has seemed to have a natural connexion, or which have afforded a
-reasonable explanation of the phenomenon.
-
-This condition of the heart and arteries, considered as
-inflammation, has been assigned by some as the cause of fevers
-of the more malignant kind. The frequency with which it has been
-found in some particular epidemic, must have led to the conclusion.
-But, however this may be, from my own observation, not restricting
-myself to the fever of any particular season, but taking into
-account all complaints called febrile, and belonging to all
-seasons, also from the result of inquiry among medical men who
-have had large acquaintance with morbid dissections, and from the
-experience of those who have made this particular point a subject
-of investigation (Laënnec and Andral) I venture to conclude that it
-has no essential connexion with fevers of any kind, either as cause
-or as effect.
-
-On some occasions the internal membrane of the heart and arteries,
-wherever it exhibits the appearance described, will allow itself to
-be peeled off from the subjacent structure with the least possible
-force; this facility of separation ceasing entirely beyond the
-boundary of the red tinge.
-
-Here unquestionably is further evidence of a diseased condition:
-but of what nature? Most pathologists would consider this to be of
-the nature of inflammation--and I believe justly.
-
-There is indeed much difficulty in pronouncing upon the nature of
-minuter changes of structure detected in the internal parts of the
-body after death. We are obliged to arrive at conclusions by help
-of analogies drawn from morbid processes, which we have watched in
-their progress during life, upon the external surfaces; for during
-life we have the functions and sensibilities of the part to aid us
-in forming a right judgment concerning its disease. When, during
-life, one tissue is separated from another, as the periosteum from
-the bone, or the cuticle from the skin, or the mutual cohesion
-between different tissues is sensibly weakened, we find it to be
-owing to the intervention of serous fluid which does not belong to
-their healthy state; and this, together with increased vascularity,
-or redness and heat, and pain, is enough to bespeak the presence
-of inflammation. All these conditions cannot remain after death.
-Hence, if we desire to form positive opinions concerning much
-which is unfolded by dissection, we must supply the defect by
-analogy. Thus, whenever, in any part of the heart or arteries,
-the cohesion between the internal membrane and the subjacent
-structure is manifestly lessened, and the membrane is unusually red
-at that part, we may regard these appearances as the vestiges of
-inflammation, without thinking that we go too far in so regarding
-them.
-
-The internal lining of the heart and arteries is often found red
-solely in the neighbourhood of ulcerated spaces, when there can be
-no doubt concerning the existence of inflammatory action.
-
-But the internal lining of the heart and arteries gives the most
-unequivocal evidence of its inflammation when it is found of a deep
-red colour, with coagulable lymph adhering to its surface. This
-condition is represented, as it was found in the aorta, in one of
-the beautiful plates, illustrative of the diseases of arteries, by
-Mr. Hodgson[3]. And the same condition, in the heart, I have seen
-in a preparation of Dr. Farre's, where lymph is deposited, upon the
-circular zone, which forms the aperture of communication between
-the left auricle and ventricle. These appearances denote the most
-acute inflammation: they are, I suspect, very rarely met with. In
-the few instances in which I have heard of them, they have been
-found where death has taken place after short and severe suffering,
-and with symptoms which characterize inflammation.
-
-But the specimens of disease most frequently met with in the
-internal lining of the heart, consist in an entire change of its
-natural structure, and in the formation of new products upon it or
-within it. Many of these, from the analogy of morbid actions in
-other parts of the body, must be considered to result from chronic
-inflammation.
-
-In any of those situations which have been stated as especially
-liable to disease, the membrane will become thick, tough,
-inelastic, puckered and shrivelled; and cartilage or gristle, and
-bone, will enter into its structure; excrescences will sprout out
-from it, resembling warts and fungus; and it will become ruptured
-and ulcerated.
-
-Cartilaginous depositions are often found beneath the membrane
-where it is single; or between its folds where it is double, in
-the situation of the valves; and thus they seem rather to belong
-to some structure contiguous to the membrane than to the membrane
-itself. Such depositions will proceed to a considerable extent,
-while the membrane still remains free from disease. From a valve,
-which has been thick, opaque, and cartilaginous, I have seen the
-membrane separated on both sides, and transparent; the opaque and
-cartilaginous matter being left behind. Where, in cartilaginous
-depositions, the lining of the heart has become puckered and
-uneven on its surface, and the valves shortened and altered in
-their shape, the membrane itself participates in the disease,
-and is generally incapable of being separated from the subjacent
-structure. But great thickening may take place in the situation of
-the valves, from deposition of cartilage, without any unevenness
-of their surface or alteration of their shape; and under these
-circumstances the membrane itself you may expect to find hitherto
-exempt from disease[4].
-
-Osseous depositions are always, I believe, originally formed
-beneath, or exterior to, the membrane, both in the heart and in
-the arteries. There are two circumstances especially worthy of
-remark in this process of ossification: sometimes it is a pure and
-unmixed process: bone is formed, and nothing else. It is deposited
-in minute granules, or little brittle scales, or in plates of a
-larger size; and the intermediate spaces, whether in the heart or
-arteries, preserve their natural and healthy appearance. At first,
-these granules or scales, or plates of pure bone, are covered by a
-delicate pellicle, which is in fact the internal membrane of the
-heart or artery, separating them from the immediate contact of the
-circulating blood. But in process of time, as they increase in
-size, and become rough and unequal on their surface, they cause a
-rupture of the internal membrane, and have now nothing to separate
-them from the immediate contact of the blood[5].
-
-Sometimes ossification is a mixed process, or rather, I suspect,
-the result of another morbid process preceding it. With the
-cartilaginous depositions already described there is an admixture
-of bone. The quantity of bone generally bears a very small
-proportion to the cartilage when they both occur together, as if
-the bone proceeded from the cartilage, and not the cartilage from
-the bone. It is sometimes seen growing from the surface of the
-cartilage, and is sometimes deposited in its substance, and only
-detected by the knife.
-
-Simple ossification, as it occurs in the heart and arteries, has
-been classed among the natural changes which the parts in question
-are liable to undergo after a certain period of life. Of persons
-above the age of sixty years the proportion is that of seven in ten
-according to Bichât, in which ossification is discovered in some
-part of the arterial system. It very rarely happens that simple
-ossification is found before the period of old age: still it is
-difficult not to regard it as a morbid process.
-
-But ossification, when it is a mixed process, is unquestionably
-the result of disease. It is met with at all periods of life; and
-probably constitutes one of the terminations of inflammation. The
-kind of morbid structures with which the bone is united leads to
-this belief.
-
-Fungous, and wart-like excrescences, are found in all those parts
-of the internal lining of the heart, which have been already
-mentioned as most subject to disease. They seem to be the result
-of a new morbid action set up in parts already disorganized; for
-I have not met with them where the membrane has been otherwise
-healthy, but only where it has been thickened or cartilaginous, or
-ossified, ruptured, or ulcerated. They grow either from the surface
-of the membrane, or from its ruptured or ulcerated edges, and are
-always in immediate contact with the circulating blood[6].
-
-According to my observation, when a fungous or warty excrescence
-has grown from the ruptured edges of the membrane, it has been from
-them exclusively, and from no other part of the lining of the same
-heart. And as rupture of the membrane seldom occurs in more than
-one situation at a time, the heart of the same individual seldom
-presents more than one excrescence of this kind: and as the aortic
-valves are the parts most liable to rupture, it is there that this
-single excrescence is most frequently found; not that rupture may
-not take place elsewhere. I once saw a single _chorda tendinea_
-ruptured; and a single fungous excrescence of considerable size
-hanging from it into the cavity of the left ventricle.
-
-Now, this morbid growth is evidently connected with the lacerated
-state of the membrane in the conditions of its production, whereby
-it is limited to a small space.
-
-It is probable that the membrane is first ruptured; that its
-lacerated edges inflame, and then throw out unhealthy lymph, or
-unhealthy granulations, in the shape of these fungous or wart-like
-excrescences. When they have sprung from a ruptured membrane, they
-have, in the specimens which I have examined, been larger than when
-they have arisen under other conditions.
-
-But when such excrescences grow from the surface of the membrane
-which is thickened and cartilaginous only, but not lacerated, they
-are more apt to occur in many parts of it at the same time. I have
-seen the valvular apparatus between the auricles and ventricles on
-both sides, as well as the aortic valves of the same heart, studded
-with them. They were all about the size of hemp seeds: they adhered
-to the membrane with different degrees of tenacity, and wherever
-they were capable of being detached, they left a rough surface.
-The lining of the arteries has been known to give origin to morbid
-growths of the same kind, which have obstructed the passage of
-blood, and given occasion to the formation of a coagulum, which has
-obliterated the pulse.
-
-The internal lining of the heart is liable to ulceration, not as
-a common consequence of simple inflammation, but as an occasional
-consequence of some of those diseased conditions which have been
-described.
-
-It is most commonly found around scales and spiculæ of bone, and
-under such circumstances as to leave no doubt that the bone itself
-has furnished the source of irritation from which it springs. The
-ulceration commences from the very border of the bony scale, as if
-it was a process of nature for detaching it, and to a considerable
-distance around the ulceration the membrane is reddened, and easily
-detached from the subjacent structure. Where there are several
-distinct scales of bone, it is not uncommon to find a circle of
-ulceration around each of them.
-
-Ulceration is also met with where there is a thickened and
-cartilaginous state of the membrane without ossification. Under
-these circumstances, as far as I know, it affects no definite form.
-It is often a very destructive process of disease, obliterating
-large portions of the valvular structure, and penetrating deep into
-the muscular substance of the heart.
-
-Rupture of the internal lining of the heart is not easily
-distinguished from ulceration. In collections of morbid anatomy,
-many unquestionable specimens of ulceration are described as
-specimens of rupture. Rupture must always be looked for in the
-valvular apparatus of the heart, _i. e._ in the valves themselves,
-or in the chordæ tendineæ which are their appendages. It is
-probably incapable of taking place elsewhere, except as a part of a
-rupture, which involves the whole organ.
-
-That solution of continuity which is evidently without loss of
-substance; that of which the separated edges when they are brought
-together are completely adapted to each other; also that which
-is unaccompanied by any thickening or other morbid condition of
-the valve; the solution of continuity which is found under these
-circumstances, may safely be considered to proceed from rupture,
-and not from ulceration[7].
-
-But it is probable that these characteristic conditions do not long
-remain after the occurrence of the rupture. Complete specimens of
-them are very rare; but specimens are numerous where the solution
-of continuity, by its form and direction, bespeaks rupture, while
-its rounded edges and the general thickening of the valve denote
-ulceration. These, it may be fairly conjectured, do in fact exhibit
-a compound of both. The membrane was originally ruptured, but
-disease has subsequently arisen and obscured the character of the
-mechanical injury.
-
-The greater number of those concretions, which were regarded by
-the older anatomists as polypi of the heart, were unquestionably
-portions of mere blood, which had undergone coagulation after
-death. The blood remaining in the heart after death discharges
-itself of its colouring matter as it coagulates, and, giving off
-processes between the muscular fasciculi, assumes a shape which has
-suggested the name of polypus[8].
-
-I have often found (I presume, therefore, that it is not an
-uncommon occurrence) coagula of an irregularly laminated texture
-having their colouring matter not entirely discharged, but
-unequally distributed through them, which have been most intimately
-adherent to some part of the lining of the heart. Of these some
-have admitted of separation, while the surface of the membrane and
-the surface of the clot were left rough at the place of contact,
-and others were incapable of being detached without the membrane
-being detached along with them. The appendix of the left auricle is
-a situation in which they are apt to occur, and they are generally
-accompanied by an extensively diseased condition of the lining
-membrane. These coagula, from their laminated texture, and from
-the intimacy of their union with the internal lining, seem to be
-essentially different from polypi of the heart. They appear to be
-connected with a process of disease in the membrane, and to have
-obtained their union with it long before the death of the patient.
-
-I once saw two separate tumors, entirely resembling what are called
-polypi, between the carneæ columnæ of the left ventricle, and
-firmly adherent to the heart; and in the centre of each a distinct
-formation of pus. The heart was otherwise healthy[9].
-
-There are three preparations in the museum of the College of
-Surgeons, put up by Mr. Hunter himself, and noted by him as
-exhibiting "Tumors on the inner surface of the right ventricle,
-seemingly composed of layers of coagulable lymph one upon another,
-the central part having the appearance of glary mucus." This last
-appearance (the mucus) no longer remains in any of the three, but
-in its stead there is a cavity. The tumors which I have mentioned
-as originally containing in their centre a distinct formation
-of pus, also now present in its stead a cavity. The preparation
-preserved at St. Bartholomew's, and those at the College of
-Surgeons, are probably specimens of the same disease.
-
-Here what in the recent parts seemed to be pus or glary mucus, and
-the cavities still remaining in the preparations, must suggest the
-suspicion, that these tumors, whether they grew from the surface or
-were deposited from the blood, had become organized, and afterwards
-inflamed; and that the inflammation had terminated in the formation
-of an abscess.
-
-
-
-
-ESSAY III.
-
-_Morbid Anatomy of the Muscular Substance of the Heart._
-
-Dr. Baillie, speaking of inflammation of the substance of the
-heart, says, "When the pericardium covering its surface is
-inflamed, the inflammation sometimes passes a little way into
-the substance of the heart:" and then he gives these as the
-characteristic marks of such inflammation--that "it (the substance
-of the heart) becomes much more crowded with small vessels than in
-its natural state, and there are sometimes to be seen a few spots
-of extravasated blood." Now, this undue vascularity, and these few
-extravasated spots, where inflammation unquestionably belongs to
-a contiguous structure, may be deemed sufficient evidence of the
-muscular substance of the heart participating, or beginning to
-participate, in the same disease; but, absolutely and exclusively,
-it may be doubted whether more is not required to give a certain
-assurance of its inflammation. Here, as elsewhere, we must look
-for some of the proper products of inflammation; or for some of
-the permanent changes of texture which naturally result from it,
-according to its several modes of disorganizing.
-
-It is a very rare event to find pus among the products of
-inflammation of the substance of the heart: yet this event has
-occurred twice to my observation. In one instance the whole heart
-was deeply tinged with dark-coloured blood, and its substance
-softened; and here and there, upon the section of both ventricles,
-innumerable small points of pus oozed from among the muscular
-fibres. This was the result of a most rapid and acute inflammation,
-in which death took place after an illness of only two days. In
-another instance, after death, which terminated an illness of
-long duration and characterized by symptoms referable to the
-heart, a distinct abscess was found in the substance of the left
-ventricle, closed externally by a portion of adherent pericardium,
-and connected internally with an ossified portion of the lining
-membrane.
-
-This diffusion of pus, or rather its formation in innumerable
-separate points, throughout the muscular structure of the heart, by
-a rapid and acute inflammation, is a singular occurrence. No such
-case has ever fallen within the knowledge of the most experienced
-in morbid anatomy, of whom I have made inquiry; neither has any
-such (as far as I can learn) been recorded in books[10].
-
-A single collection of pus[11], constituting an ulcer or abscess of
-the heart, and resulting from chronic inflammation, is also a rare
-occurrence, yet not so rare but that a specimen of it may be found
-in most collections of morbid anatomy[12].
-
-But independent of the formation of pus, softening and attenuation,
-as well as induration and thickening of the muscular substance of
-the heart, do, in different cases, according to the circumstances
-under which they are found, both bespeak inflammation.
-
-Together with the unequivocal evidence of inflammation in other
-parts of the heart, the muscular fibres have at the same time been
-found very soft and loose, and easily torn; and with this looseness
-of texture the heart has sometimes presented a dark and almost
-black appearance, and sometimes it has been almost blanched and
-colourless. The deep dark tinge shews that the muscular substance
-is unnaturally loaded with blood; whereas the absence of colour
-shews that it is destitute of its natural quantity. These different
-appearances do, in fact, belong to different stages of the same
-disease. The first indicates inflammation of the muscular substance
-in its present state of activity; the second, an irreparable
-disorganization of the muscular substance left by inflammation,
-when it has been unarrested in its earliest stages. The first is
-found when death takes place _in a few days after_ the accession
-of the disease; the second, when the patient survives the first
-attack, and dies at a remoter period.
-
-The inflammation, which produces softening and attenuation of the
-muscular structure, is, I believe, always of an acute kind.
-
-But induration and thickening of the muscular substance of
-the heart is also the result of inflammation. This must be
-distinguished from hypertrophy, or mere augmentation of bulk, of
-which we shall speak hereafter. In this induration, which proceeds
-from inflammation, there is, besides increase of bulk and firmness,
-a manifest alteration of texture. A substance[13] is produced
-offering a peculiar resistance to the knife. This condition
-unquestionably must result from an interstitial deposition of new
-matter among the muscular fibres. From concomitant circumstances,
-as well as from its own character, I presume that it proceeds
-from chronic, not from acute inflammation. I confess that I never
-saw a specimen of what I now allude to. It is described with some
-minuteness by Corvisart; but it may be presumed to be very rare,
-since Laënnec admits that it never fell under his observation.
-
-These opposite states of softening and attenuation in one case, and
-induration and thickening in another, are known to those conversant
-with morbid dissection as the evidences of inflammation in other
-parts of the body besides the muscular substance of the heart.
-
-But there are changes of structure incident to the muscular
-substance of the heart which are independent upon inflammation,
-or, perhaps, upon any process which can properly be called morbid.
-They consist of simple augmentation and simple diminution of bulk
-and consistence. This simple augmentation of bulk and consistence
-is owing exclusively to a more ample development of natural
-structure. The muscular substance is more red than natural, its
-carneæ columnæ are increased in thickness, and its proper fibrous
-texture is every where more strikingly manifest; but there is no
-interstitial deposition of matter new in its kind. It has been
-called hypertrophia of the heart, and the name conveys a tolerably
-just idea of its actual condition.
-
-The simple diminution of bulk and consistence is a condition the
-exact opposite of the former. The muscular substance is less red
-than natural; its proper fibrous texture less distinguishable; but
-there is still the appearance of muscle shrunk and withered, as
-if from an insufficient supply of nourishment. It may be called
-atrophia of the heart.
-
-Conjoined with augmentation, as well as with diminution of strength
-and bulk in the walls of the heart, there is almost always an
-increase in the capacity of its cavities; and in whichsoever part
-of the heart the walls are thus augmented or diminished, it is the
-cavity appertaining to the same part which undergoes the increase
-of capacity. Hence it appears either that one of these conditions
-is the immediate and necessary consequence of the other, or that
-both are the simultaneous effects of the same causes.
-
-Dilatation of any cavity of the heart, with thickening of its
-walls, is called _active dilatation_; and dilatation of any cavity,
-with attenuation, is called _passive_[14].
-
-Active dilatation may appertain to every cavity of the heart
-simultaneously; and so may passive dilatation. But such occurrences
-are very rare: for one cavity being naturally more liable to this
-species of dilatation, and another to that, it most frequently
-happens that specimens of both conditions are found in the
-different cavities of the same heart.
-
-The left ventricle is much more liable to active dilatation than
-the right; and the right ventricle more so than either of the
-auricles; and of the auricles unquestionably the left. Upon the
-whole, perhaps, the fact may be truly stated thus--that the left
-ventricle commonly gains an increase of bulk and strength, with an
-increase of capacity; and that all the other cavities, at the time
-that they expand, are rather apt to become attenuated.
-
-It sometimes (though rarely) happens, that, with an increase of
-strength and bulk in its muscular structure, the left ventricle
-suffers a diminution of capacity in its cavity. In a case reported
-by Laënnec, the left ventricle was an inch and a half thick at
-its broadest, and an inch thick at its thinnest part; and yet its
-cavity was only capable of containing an unblanched almond. I have
-seen the same condition in a less degree.--(_Laënnec_, vol. ii.
-698.)
-
-The circumstances under which these opposite conditions, this
-hypertrophy and atrophy of the heart, with the enlargement or
-diminution of its cavities, arise, must be explained hereafter. At
-present I would only remark that they are often found conjoined
-with actual disease in other structures of the heart, such as
-osseous or cartilaginous thickening of internal lining, adhesion
-of the pericardium, and ossification of the coronary arteries, to
-which they owe their origin; and, moreover, that they are often
-found where the heart is otherwise perfectly sound in texture, and
-where their cause must be sought in other parts of the body.
-
-The heart is liable to undergo a simple dilatation of its cavities
-without either thickening or attenuation of its muscular substance.
-This simple dilatation is sometimes of the whole organ, sometimes
-of one side, and sometimes only of one auricle or ventricle. When
-it is of one cavity only, it may be complicated with active or
-passive dilatation of another, or of all the rest.
-
-There is reason to believe that the heart sometimes undergoes a
-temporary dilatation, and again returns to its natural capacity;
-but that the dilatation can only subsist for a short time without
-becoming permanent.
-
-The power of thus enlarging its cavities, and restoring them to
-their natural condition, belongs more especially to the right side
-of the heart.
-
-A large accumulation of fat is sometimes met with about the heart.
-
-The healthy heart is always more or less marked upon its external
-surface with streaks of white, and this appearance results from
-the deposition of fat in the cellular texture, which unites the
-serous covering with the subjacent muscular structure. It is found
-principally where the venæ cavæ unite to form the right auricle;
-also at the base of the ventricles, and along the line which
-marks the boundary between the two, and around the origin of the
-great blood-vessels as they emerge from the heart. But when fat
-is deposited in more than these situations, and in more than the
-natural quantity, it is not so much added to the healthy substance
-of the heart, as existing at its expense and detriment, and the
-muscular structure is that which especially suffers. The fibre
-of the fat heart is pale and wasted, like that of a paralytic
-limb.--_Mus. of the Coll. of Surg._ 327.
-
-A rupture of the heart is sometimes met with; but all the cases of
-reputed rupture are not such in reality. An aperture in the walls
-of the heart, through which blood escapes into the cavity of the
-pericardium, may result from ulceration as well as from rupture,
-or from a mixed process of one and the other; but whatever be the
-precise nature of the process by which this perforation of the
-heart is effected, it is undoubtedly of rare occurrence.
-
-Where it has been found, there has generally been at the same time
-some peculiar condition of the organ, which might be presumed
-favourable to its production. Its muscular substance has been
-so soft and loose of texture, that it could be pierced through
-by the weight of a probe[15]; or it has been converted into, or
-greatly intermixed with fat[16]; or its muscular fibres have been
-absolutely defective, leaving a certain transparent space, where
-the internal lining and the pericardium have been in contact,
-and served to maintain the completeness of the cavity, until the
-rupture has taken place[17].
-
-Not that a rupture has not been found where the texture of
-the parts has seemed to offer no natural facilities to its
-occurrence--as in the case related by Harvey himself, who found a
-lacerated aperture in the left ventricle, capable of admitting his
-finger, through which blood had escaped into the pericardium, the
-walls of the ventricle being increased in thickness and strength,
-while an obstacle existed at the entrance of the aorta[18]. Here
-the heart must have torn itself asunder by the simple violence of
-its contraction, in contending against the impediment to the egress
-of blood from its cavity. This is an effect which would hardly be
-thought capable of being thus produced; but I can well believe it
-possible after having seen one of the recti muscles of the abdomen
-literally torn in twain, in a man who died of tetanus[19].
-
-[To be continued.]
-
-
-
-
-DILATED ŒSOPHAGUS.
-
-
-_To the Editor of the London Medical Gazette._
-
-  SIR,
-
-Permit me to send the following case to you for insertion in the
-Gazette.
-
-
-Mary Blores, æt. 33, was admitted into the Middlesex Hospital on
-the 16th of November. She was in a state of extreme feebleness and
-emaciation. Those who brought her said that during the preceding
-month she had appeared to swallow nothing: what she took as food
-seemed to her to stop in the gullet, and after a few minutes
-returned. I found, however, that a large œsophagus-bougie passed
-readily into the stomach, meeting with no obstruction beyond a
-spasmodic resistance in the pharynx. A draught of milk and water
-was given her--she swallowed it without much effort, but it quickly
-returned. In the course of the afternoon a pint of beef tea was
-injected through an elastic tube into the stomach--it was thrown up
-directly.
-
-I now learnt from her that she could swallow liquids much more
-readily than solid food; that when she took a small quantity,
-it seemed to her not to reach the stomach, and in three or four
-minutes was invariably thrown up; that on taking a large draught
-she had an impression that it reached the stomach--in this case
-vomiting did not follow so soon, and some part of the draught was
-permanently retained; that she craved food and drink, and was
-literally dying of hunger and thirst; that the vomiting which took
-place was not preceded by nausea, although in its progress it had
-all the appearance of ordinary retching; that the matter vomited
-was not thrown up at once, but by successive efforts; it consisted
-of the food she had last taken, mixed with colourless mucus. The
-belly was so shrunk that the umbilicus was not more than an inch
-distant from the spine, upon which the pulsations of the aorta
-were readily felt: there was no enlargement or hardness about the
-stomach, no particular tenderness on pressing the epigastrium, no
-sensation of pain or heat now or formerly.
-
-The complaint had began ten years ago, during pregnancy, since when
-she had never been free from it, although at times her sufferings
-had been less, and she had been able to retain some portion of her
-meals. She had borne in this period three children; the vomiting
-had lasted during the whole period of her pregnancies, and during
-her confinement. The principal remedies which had been used for her
-relief were a succession of blisters on the pit of the stomach--but
-they had produced no benefit. Latterly her symptoms had been
-greatly aggravated.
-
-This patient was attended by Dr. Watson and myself. But the means
-which we tried to enable her to retain her food, and to support her
-expiring strength, had scarcely a temporary effect. She died on the
-2d Dec. sixteen days after her admission. The body was carefully
-examined, at the expressed wish of her relatives.
-
-The unusual appearances found in the abdomen were--1. the smallness
-of the first part of the duodenum, which was but half the ordinary
-size of the ileum; 2. the capaciousness and fulness of the gall
-bladder,--from which, however, on compressing it, the bile flowed
-readily into the intestine; 3. a contraction of the middle of
-the stomach of the length of two inches, for which extent the
-peritoneal coat was thickened and opaque, and the inner membranes
-folded in deep longitudinal rugæ, the mucous surface of which was
-partially suffused with circular spots of red. The breadth of the
-contracted part of the stomach, as it lay collapsed, was an inch
-and a half.
-
-[Illustration]
-
-[Illustration]
-
-But it was in the chest that the most remarkable circumstance
-presented itself. The œsophagus gradually enlarged from the
-pharynx, which was perhaps rather narrower than usual, to an
-extraordinary degree of dilatation; the greatest breadth which it
-attained was situated about four inches above the cardia: the tube
-then contracted more abruptly, so as to render the termination
-of the œsophagus, like its commencement, of nearly the usual
-dimensions. The structure likewise of the cardiac extremity for
-about an inch, and of the pharyngeal end for about half an inch,
-was healthy. The intermediate part presented, when inverted, the
-following curious appearance:--The inner membrane was thickened
-and opaque, and had _the appearance_ of having partially yielded
-from dilatation; at the upper part the furrows or thinner parts of
-the membrane followed in some degree a longitudinal direction; at
-the lower part the surface was pitted with shallow depressions of
-various figures. I have represented in the adjoined sketches these
-appearances, which on the middle of the œsophagus passed from one
-into the other; at the furrows or depressions the membrane seemed
-of the natural thickness and colour; the intermediate raised and
-thickened part was opaque and whitish. The muscular fibres of the
-œsophagus were of the natural colour and thickness.
-
-  I remain, Mr. Editor,
-  Your obedient servant,
-
-  HERBERT MAYO.
-
-  19, George-street, Hanover-square,
-  Dec. 6, 1828.
-
-
-
-
-HYDROPHOBIA.
-
-
-_To the Editor of the London Medical Gazette._
-
-  SIR,
-
-As the following case may throw some additional light on the
-pathology of hydrophobia, I have sent it you for publication.
-
-  I am, Sir,
-  Your obedient servant,
-
-  F. GODRICH.
-
-  Grove House, Little Chelsea,
-  Nov. 29, 1828.
-
-
-On Thursday morning, the 25th ult. I was called up about seven
-o'clock to see a man who I understood was exceedingly ill, and
-waiting in the surgery very impatiently for my arrival. I found
-my patient (Mr. Barham), a fine looking old man, about 60,
-labouring at intervals of about five minutes under strong spasmodic
-paroxysms, affecting the muscles concerned in breathing and
-deglutition. There was a wildness and an impatience depicted in his
-countenance, totally different from any thing I had ever observed
-in other spasmodic affections. His bowels were open, tongue clean,
-skin moist, pulse full and a little accelerated. I took away
-twenty ounces of blood, and prescribed a mixture containing ʒss.
-of laudanum for a dose every hour until I should see him again.
-He walked home half a mile from my house (Gloucester Road, Old
-Brompton), and left me ruminating on the possible cause of so much
-mischief occurring suddenly in a fine healthy subject. At ten a
-message was sent, saying that he was much worse, and requesting
-me to call as soon as possible. He received me tranquilly, and
-said he was very glad that I had come to see him, for he was very
-ill. His symptoms were now more distressing than when I first saw
-him: he looked wildly and suspiciously at every one entering his
-apartment, and his breathing was accompanied by a short convulsive
-sobbing. On looking at his medicine I perceived he had taken none,
-and expressing my surprise, he assured me it was impossible for
-him to swallow a single drop, as the attempt had been followed
-by violent spasms, and produced so much distress, that he had
-desisted. At this period no one had the slightest idea of the
-origin of his malady. I poured out some medicine into a tea-cup,
-the very act of which produced much excitement and alarm. My first
-impression as to the true nature of his disease arose at this
-period, from the circumstance of his requiring a tea-spoon, with
-which he endeavoured to take some of the medicine. The attempt
-produced much excitement and alarm, and after two or three painful
-efforts at deglutition, with one desperate effort he swallowed a
-tea-spoonful, threw away the spoon, and begged, unless I wished
-to destroy him, that he might have nothing more to swallow. I
-now left his room, and inquired of a bystander whether any thing
-particular had occurred to him within the last few weeks. On
-recollection she said, "About a month since, late at night, a
-strange dog came into the premises and fought with his own dog; he
-got out of bed to separate them, and the strange dog bit him in
-two places, on the left arm and hand; and bit a puppy, which died
-about a fortnight after in a strange way, which was thought to be
-some kind of a fit." To ascertain if this occurrence had produced
-any effect on his mind, while again bleeding him I said, "You have
-been in the wars, Sir, and had your hand and arm torn; how did
-it occur?"--"Oh!" said he, carelessly, "that was done by a dog a
-long time ago, but it healed." The circumstance was never again
-mentioned to him, and he died in total ignorance of the cause of
-his malady. The wounds were perfectly cicatrised, and there was not
-the least action going on indicative of recent absorption. He bore
-the bleeding pretty quietly: 40℥. were removed, which on cooling
-presented strong marks of inflammation.
-
-    Ordered ℳiv. Acid. Hydrocyan. omni horâ, in a little water.
-
-Twelve o'clock.--With much difficulty he has taken two doses of the
-acid; pulse full and hard, 110. 30℥. more blood were removed.
-
-Three o'clock.--Has taken two more doses; complains of a dreadful
-sense of suffocation, and implores that nothing more may be given
-him. Pulse full, and beating at 120 to 130. Continue the acid.
-
-Eight o'clock.--Pulse full and hard. Has taken in all 24ℳ. of the
-acid, but so painfully distressing has the deglutition now become,
-that all attempts at repeating his medicine are discontinued.
-
-    V. S. ad ℥xxx.
-
-During the bleeding he looked wildly at the basin, and begged
-that no more might be spilt (a drop or two had fallen), repeating
-frequently, in great agitation, as the blood was running, "Take
-care! take care!"
-
-Between two and three o'clock next morning my assistant (Mr.
-Davies) visited him. He found him tolerably passive, but observing
-every movement with intense anxiety. Pulse full and hard, face
-flushed, eyes denoting cerebral irritation. He had been at times
-outrageous. On its being intimated that bleeding was again
-necessary, a paroxysm came on more intense than any preceding,--and
-with great effort he submitted. As the blood flowed he became
-more and more alarmed, till at length he got quite unmanageable;
-he raged violently at his nephew, who was holding the basin, and
-ordered it peremptorily to be removed. 30 or 40℥. were taken
-away. It was found necessary to put on the straight waistcoat.
-About four o'clock Mr. Davies wished him to take some more of his
-medicine. He said, "I can take no more," and on reaching the bottle
-to put out a few drops, he became violently agitated, threw himself
-from side to side, and, as well as the incessant spasmodic sobbings
-would allow, he begged that not one more drop of any thing might be
-offered him, and that the bottle might be taken from his sight. He
-did not become tranquillized until its removal. He lingered on till
-ten A.M. in the same state, a few minutes before which he insisted
-on getting up, and walked a short way down his garden, returned,
-laid down on his bed, and died.
-
-Mr. Frederick Salmon, of Old Broad Street, and Mr. Wilson, of
-Chelsea, were kind enough to assist me in conducting the post
-mortem examination. On opening the chest, the heart was free from
-disease, with rather more water in the pericardium than natural;
-the lungs were completely gorged with grumous blood, and the pleura
-adherent on the right side. On removing the cranium, which was
-remarkably thin, and cutting the substance of the brain, numerous
-red spots presented themselves in the medullary portion; about a
-table-spoonful of water in each ventricle; the plexus choroides was
-turgid; the corpora, striata, thalami, and basis of the brain every
-where preternaturally injected; the cerebellum, crura cerebri, and
-cerebelli, in a high state of inflammation. On removing the spinous
-process of the vertebra, the whole cord was considerably inflamed;
-and opposite the two last cervical and dorsal vertebræ the cellular
-substance was studded with dark patches of coagulated blood, the
-theca vertebralis thickened, and the cord in an active state of
-inflammation. The larynx and pharynx bore not the slightest vestige
-of disease. The preparation of the cord is deposited in the museum
-of the London University.
-
-The post mortem examination of this case tends to prove the
-correctness of Professor Thompson's theory of the proximate cause
-and seat of this afflicting malady; and the plate accompanying a
-case recorded by him, in the 13th volume of the Med. Chir. Society,
-gives a faithful delineation of the state in which the spinal cord
-was found in this case.
-
-
-
-
-CASE OF LONG PROTRACTED CONSTIPATION.
-
-
-_To the Editors of the London Medical Gazette._
-
-  GENTLEMEN,
-
-Perhaps the following case may interest some of your readers, and
-if you think so, its insertion in your Journal will oblige
-
-  Your obedient and
-  humble servant,
-
-  S. D. BROUGHTON.
-
-  12, Great Marlborough Street,
-  Dec. 3, 1828.
-
-
-On Tuesday, Nov. 25, I was called upon at the St. George's and St.
-James's Dispensary to advise for an infant at the breast, of five
-months and fourteen days of age, that had not passed any fæces
-during six weeks up to the day before I saw it. After its birth
-it had no passage till the fifth day, and this had apparently
-been effected by the introduction of a bougie, and which was
-subsequently continued at intervals for a short time. The infant
-was otherwise healthy and strong at its birth, and remained so
-until it had gone about three weeks without any evacuation, when it
-was observed to be weak in the lower extremities; and at the period
-of my seeing it the legs were much fallen away in flesh, hanging
-flaccid and inert. Many aperient enemas and medicines had been
-given, and, as a last resource, one drop of the croton oil had been
-prescribed the preceding evening. The infant appeared to suffer
-from distention, and to be disposed to coma, and the croton oil had
-distressed it much some hours after it was given. The fæces could
-be felt blocking up the intestine, but the irritation of the finger
-produced no attempt at evacuation; very small pieces only having
-been brought away. Hot baths also had frequently been used some
-time ago.
-
-Considering the case as one of paralysis in the parts naturally
-employed to relieve the bowels, I recommended the suspension of
-all purgative remedies by the mouth, and a table-spoonful of the
-following injection to be substituted, and to be thrown up with
-three table-spoonfuls of thin gruel occasionally during the day, by
-means of a syringe.
-
-  ℞ Spir. Terebenth. ʒiij.
-  Træ Zinzib. ʒj.
-  Aquæ, ℥iss. M.
-
-The following liniment was also directed to be rubbed in frequently
-along the course of the spine.
-
-  ℞ Linimenti Saponis, ℥iss.
-  Liquor. Ammon. Comp. ℥ss. M.
-
-The result justified my expectations; for, during the night after
-this prescription, two injections having been given, some large
-and hard ash-coloured lumps came away, and these were shortly
-followed by a forcible spouting out of a continued stream of
-feculent dark liquid; a brisk diarrhœa having been kept up till
-the Saturday following. The infant's appetite is become voracious,
-its appearance lively and healthy, and its legs as firm and strong
-as is usual at such an age. Cold water is recommended to be dashed
-upon the loins, the liniment to be continued occasionally, moderate
-doses of magnesia and rhubarb to be given when required, and the
-turpentine injection to be used if any return of the complaint
-should be threatened.
-
-
-
-
-DISLOCATION OF THE PATELLA.
-
-
-_To the Editor of the London Medical Gazette._
-
-  SIR,
-
-Having seen a case of dislocation of the patella, reported by
-Mr. Mayo, in your Journal a few weeks since, in which there was
-experienced some difficulty in the reduction of the bone, I beg
-leave to send you the following, in case you may think it worth
-insertion.
-
-On Saturday last, I was called to a young woman who had dislocated
-the patella of the left knee joint outwards; the inner edge
-rested upon the outer surface of the external condyle, and was
-immoveably fixed, and caused great pain when touched. She says it
-was occasioned by her foot slipping backwards from one stair to
-another, and she immediately fell down.
-
-I commenced the reduction, as stated by Mr. Mayo, but I could only
-produce semiflexion, and that gave her great pain; insomuch that I
-was obliged to desist, and the patella remained in _statu quo_. But
-when the knee was thus semiflexed, I desired my assistant to extend
-the leg suddenly; and having my fingers on the patella at the time,
-and pressing it inwards, it immediately returned to its natural
-position.
-
-I must confess, sir, that I should have been afraid to have
-continued the flexion as described in Mr. Mayo's case, "by bending
-the knee to the utmost," fearing that the remedy might be worse
-than the disease, and the result proved that in this case it was
-not necessary.
-
-  I remain, Sir,
-  Your obedient servant,
-
-  P. M. HOSKINGS.
-
-  168, Fleet-Street,
-  Dec. 3d, 1828.
-
-
-
-
-VACCINATION.
-
-
-_To the Editor of the London Medical Gazette._
-
-  SIR,
-
-The mistake of the printer in substituting the word "every" for
-"even," in the paper on Vaccination (p. 40), so materially affects
-the sense of the passage, that I must request the favour of the
-following insertion:--
-
-"3d. That while the vaccine cicatrix retains even one distinct
-fovea or depression, the individual continues unsusceptible both of
-small pox and of re-vaccination; but that," &c.
-
-  I am, Sir,
-  Your obedient servant,
-
-  THOS. H. BURDER.
-
-  2, Brunswick Square, Dec. 15, 1828.
-
-
-
-
-SINGULAR BICEPS MUSCLE.
-
-
-_To the Editor of the London Medical Gazette._
-
-  SIR,
-
-The valuable paper communicated to your Journal, by Mr. Stanley,
-last week, has brought to my recollection a singular appearance of
-the parts in front of the shoulder-joint which I dissected about
-two years ago. It is a fact worth recording; and perhaps you will
-be kind enough to insert it in your next number.
-
-The circumstance was this--that in the right arm, instead of there
-being a biceps muscle having two origins, the one the shorter from
-the corocoid process, the other the longer from the upper part of
-the glenoid cavity of the scapula, there was simply a one-headed
-muscle arising from the corocoid process. I could find no tendon
-passing through the joint answering to the long head of the
-biceps, neither was there any appearance of a biceptical groove;
-the capsular ligament was, perhaps, thicker than it is found in
-ordinary cases.
-
-I knew nothing of this man during life, and am therefore unable to
-give any account of the use which he made of this arm.
-
-  I am, your obedient servant,
-  C. M. BURNETT.
-
-  House Surgeon's Apartments,
-  St. Bartholomew's Hospital, Dec. 8th.
-
-
-
-
-STETHOSCOPE.
-
-
-_To the Editors of the London Medical Gazette._
-
-  GENTLEMEN,
-
-As you did me the honour, on a former occasion, to publish some
-remarks in defence of _auscultation_, against its enemies and
-detractors, I trust you will permit me to say a few words in
-reference to a communication in a late number, from a gentleman
-who appears to be a friend of that method of diagnosis, but whose
-ignorance of the subject is likely to be more injurious to the
-cause than either open enmity or secret detraction. The case in
-question (page 780, vol. ii.) appears, from the dissection, to
-have been clearly _emphysema of the lungs_, as there stated; but
-I appeal to every one practically acquainted with the physical
-signs of diseases of the lungs, whether the results of the
-exploration with the stethoscope, as narrated in the case, were
-those pathognomonic of that disease? I say they were not only
-not pathognomonic of this affection, but they were actually
-incompatible with its existence. The same ignorance of the subject
-is shewn in relation to the disease of the heart, which, I boldly
-maintain, no one was justified in pronouncing to be _hypertrophy of
-the left ventricle_ from the stethoscopic indications stated in the
-case.
-
-It is just possible that the writer of the case may have made
-further explorations on which his diagnosis was founded; but if he
-had such in his case-book, it is equally unfortunate for the credit
-of the stethoscope and his own, that he suppressed them in his
-printed case.
-
-  I have the honour to be,
-  Gentlemen,
-  Your obedient servant,
-
-  A STETHOSCOPER.
-
-  Nov. 25, 1828.
-
-
-
-
-MECHANISM OF VOMITING.
-
-
-_To the Editor of the London Medical Gazette._
-
-  Glasgow University, Nov. 26, 1828.
-
-  SIR,
-
-Having lately perused, in the 35th Number of the Medical Gazette,
-some observations "on the mechanism of the act of vomiting," by
-Dr. Marshall Hall, in which, after controverting the different
-opinions which have been entertained by physiologists on this
-question, he endeavours to prove that vomiting is an effort, not
-of _inspiration_, but of _expiration_, and advances this opinion
-as having originated in himself, I beg, through the medium of
-your Journal, to refer that gentleman to Richerand's Physiology,
-where, on the subject of vomiting, page 70, he says, "Sometimes the
-action of the muscular fibres of the stomach is quite inverted;
-they contract from the pylorus towards the cardia; and this
-antiperistaltic motion, in which the contractions act with more
-force and rapidity, and in a manner decidedly convulsive, produces
-vomiting. The action of the abdominal muscles then connects itself
-with that of the stomach; the viscera are propelled upwards and
-backwards, by the contraction of the large muscles of the abdomen;
-_the diaphragm ascends towards the chest; if it descended, in
-contracting, the œsophagus that passes between its two crura would
-be compressed, and the expulsion of food through the cardia could
-not be effected_. It is also observed, _that during expiration
-only, any thing can pass from the stomach into the œsophagus_."
-Again, on respiration, page 147--"_In every effort of expiration_,
-as coughing and _vomiting_," &c. Here, then, we see that Dr. Hall's
-views, as far as regards vomiting being an effort of expiration,
-have long since been advanced by Richerand.
-
-The profession are certainly much indebted to Dr. Hall for his
-corroboration of these views; at the same time he should not have
-taken to himself the merit of having first suggested them.
-
-  Sir,
-  Your most obedient servant,
-
-  A SUBSCRIBER.
-
-
-
-
-CHARACTER OF THE LANCET.
-
-
-_To the Editor of the London Medical Gazette._
-
-  Dec. 19, 1828.
-
-  SIR,
-
-The events disclosed during the late trial in the Court of King's
-Bench, must fill every well-disposed mind with astonishment and
-horror. The moral aspect of the case is marked by every feature
-capable of exciting a sense of shame for our profession, and of
-sorrow for our kind. Can it be that a publication conducted in the
-spirit of the extracts produced at the late trial of Cooper against
-Wakley should be fostered and encouraged by a large proportion of
-the medical public? Is it indeed true that no feeling of loathing
-and disgust should have induced the purchasers of the Lancet to
-protest against its glaring injustice, its undisguised ferocity and
-malignity?
-
-I am not a reader of that work myself, and but for the disclosures
-recently made in our courts of justice, together with what I have
-learned from your own pages, I should know little about it. Some
-of its early numbers convinced me that it was a production not
-deserving of support, whatever ability there might be connected
-with it; subsequent events have amply justified this decision, and
-I now address these few hasty lines to you, to express my humble
-hope that all the respectable medical men throughout the kingdom
-will arise, and with one voice oppose this moral pestilence, which
-at once corrupts and degrades their profession.
-
-The _odium medicum_, bitter and vindictive as it unfortunately has
-been, never, I believe, appeared in a form so repulsive. Are we
-living in the nineteenth century? Have arts and sciences, which
-are asserted of old to soften the manners and temper the violence
-of our nature, produced no such fruits amongst us? Is serious, and
-perhaps irremediable injury, to be inflicted on reputation; and is
-the sufferer thereafter to be dared to mortal combat, and this too
-by the wrong-doer? Is it thus that professional justice is to be
-awarded? Is it thus that knowledge is to be advanced, the dignity
-of our profession to be maintained, its benefits enlarged, and
-its usefulness transmitted? Is it thus that the young men are to
-be taught how to acquire an unworthy and discreditable notoriety;
-to disregard all the decencies, charities, and higher virtues
-of life; and to bring into the exercise of our art the insidious
-cunning of the knave, the vulgar dishonesty of the pilferer, and
-the audacious bearing of the bravo?
-
-I know not how others may feel on the present occasion: I am
-entirely unacquainted with the parties who have been at issue in
-the late suit--I have no bias of any kind, but what must arise in
-the mind of every man who has any regard for the profession to
-which he belongs, or who loves truth and fair dealing--I am sure
-that it is not less for the interests of society at large than for
-the advancement of medical science, that just principles should
-regulate all our dealings, both with the public and with each
-other. It is manifest that of late we have signally and woefully
-departed from them; and it is most distressing to know that this
-departure has been sanctioned by so many members of the profession.
-I now entertain a confident hope that all who reflect on the
-character of the late libel will feel that their own _character_ is
-at stake if they do not mark their disapprobation of it in every
-possible way. Sure I am that, if the principles which guide the
-Lancet become generally acceptable, it will mark an æra of moral
-degradation which no surgical dexterity, no medical acquirements,
-however eminent, could possibly redeem.
-
-  VERITAS.
-
-
-
-
-DURATION OF HUMAN LIFE IN RUSSIA.
-
-
-Cases of longevity are not only much more common, but also more
-extraordinary in respect to a greater duration, in Russia than in
-any other part of Europe; thus, from the report of the holy synod,
-published in 1827, it appears that there were living in 1825, among
-those who professed the Greco-Russian religion throughout the
-empire, not fewer than 848 males who were 100 and more years old;
-among whom, 32 had passed the age of 120, 4 were between 125 and
-130, and 4 others between 130 and 135 years of age. Out of 606,881
-males who died in 1826, 2785 had passed the age of 90 years; 1432
-that of 95; and 818 that of 100. Among the latter, 38 were more
-than 115 years of age; 24 more than 120; 7 more than 125; and one
-was 160 years old at his death.
-
-
-
-
-MEDICAL GAZETTE.
-
-_Saturday, December 27, 1828._
-
-    "Licet omnibus, licet etiam mihi, dignitatem _Artis Medicæ_
-    tueri; potestas modo veniendi in publicum sit, dicendi
-    periculum non recuso."--CICERO.
-
-
-
-
-ANALYSIS OF WAKLEY'S DEFENCE ON THE LATE TRIAL.
-
-
-We last week presented our readers with a full[20] and, we trust,
-accurate account of the trial for libel, which has recently excited
-so much interest; and we offered some remarks of a general nature
-upon its result and tendency. We had purposed at the same time to
-subject Mr. Wakley's mode of conducting his cause to a critical
-investigation, but this we were prevented from doing by want of
-time and space. We thought it likely, too, that the Editor of the
-Lancet would have fairly met the question in his next publication,
-and himself put the facts of the case, at least, on record: instead
-of this, however, he has devoted his pages to compliments to
-himself, and scurrilous and absurd abuse of Sir James Scarlett,
-in which he informs us that in his opinion that gentleman is
-"prodigiously overrated even as a lawyer," and says many other
-things, which serve only to shew how dreadfully Wakley himself had
-smarted under his lash.
-
-We find the general opinion to correspond with that which we
-expressed last week--that the defendant had managed his cause in
-a very bungling manner; and the estimation in which he and his
-witnesses were held by Judge and Jury is apparent from the charge
-of the one, and decision of the other. Both, indeed, regarded the
-asseverations of his whole _family party_ as dust in the balance
-against the testimony of one single competent and honourable
-man--Mr. Callaway; for on his evidence the result obviously hinged.
-Our contemporary affects to look upon the verdict as a triumph on
-his part--so he would if the damages had been five hundred or a
-thousand pounds, for in truth he has nothing else for it; and with
-all our hearts we wish him many such victories.
-
-With regard to the amount of damages, we certainly should have been
-better pleased had it been larger; but we did not expect that it
-would--nay a reference to our number which was published while the
-trial was going on, will shew that we were even doubtful of the
-verdict, because we know how extremely difficult it is for a jury
-to comprehend such a complicated question--how easy for a knave to
-impose upon their ignorance by misrepresentation and falsehood. It
-is quite obvious that if the jury had believed one syllable of the
-evidence of Wakley's witnesses, they must have given the verdict
-in his favour. In a case like this, where _one individual only_,
-and he the plaintiff, can be fully aware of the difficulties which
-had to be overcome, it is almost impossible to bring evidence
-into a court of justice capable of satisfying the minds of twelve
-unprofessional men. From this circumstance alone it was that we
-expressed a doubtful opinion of the result. But besides all this,
-it is well known to all--_that one talesman might go determined to
-starve out the rest--that ten special jurymen might wish to give
-500l. and yet that, by the absurd constitution of the English law,
-their verdict might be thus controlled by one individual friendly
-to the defendant_.
-
-Most fortunately for the cause of truth, Wakley had the vanity and
-folly to conduct the defence himself, and, judging of other men's
-estimation of moral character by his own, he did not hesitate to
-place in the box witnesses whom no counsel would have suffered to
-go there, and who, being unable to stand the cross-examination,
-led to what must have been to Wakley a most humiliating exposure.
-Next to this, the most beneficial effect produced was that of
-the defendant's cross-examination of his opponent's witnesses:
-it was amusingly absurd, and shewed a lamentable want of tact,
-always eliciting something which he ought to have avoided. Lastly
-came the reply, of which he tells us he is himself ashamed--"We
-may state most unfeignedly," says he, "that we look back with
-regret to our errors in point of omission." Nor is this the only
-part of it for which he has cause to blush, for any thing more
-miserably deficient we never heard: it was a mass of confusion
-throughout--a repetition of the same ideas and expressions--and a
-most injudicious betrayal of rancorous feeling, at the very moment
-he was profanely invoking heaven to witness that he bore enmity to
-no man. In speaking of his reply in our last number, we declared
-it to be "false in statement--sophistical in argument--coarse
-in language--and diabolical in tendency;" and we now proceed to
-illustrate these several qualifications, in doing which little more
-will be necessary than to select a few passages, and arrange them
-under their appropriate heads.
-
-_False in Statement._--One of Wakley's principal objects was to
-impress upon the Jury a belief that he had not in any way attempted
-to influence his witnesses, nor even spoken to most of them,
-anterior to the trial. "Out of nine witnesses I have placed in the
-box, (says he) I never saw five of them, nor even spoke to five
-of them till yesterday." We appeal to any man of common sense,
-whether it be probable that this is true. It is possible indeed,
-and only just possible, that he was contented with employing
-others to question his witnesses, and ascertain what evidence they
-would give; but even if it were so, the assertion was not the
-less false in a moral point of view, because his intention was
-to convey the belief that he had inquired no farther than merely
-whether or not the witnesses had been present at the operation.
-But incredible and absurd as this was, he ventured a step farther,
-and assigned a reason for the choice made of one witness--(Lee the
-potatoe-merchant.) "I had heard (said Wakley) he was present at the
-operation--an honest man, and that he was a friend of Mr. Bransby
-Cooper, under the highest obligation to the Cooper family. Without
-asking him a single question I put him into the box, as I was most
-anxious you should hear all the evidence that could be adduced, and
-from _unsuspected and untainted quarters_." This lie carried with
-it its own refutation; for Lee swore that he had never even spoken
-to Mr. Cooper; and we are therefore amazed that Wakley should
-have hazarded so gross an assertion, as it could only have been
-effective on the supposition of his addressing a jury of absolute
-simpletons. But again--"Who were my witnesses? not men whom I had
-trained and lectured on models, and sketches, and drawings. Has
-it been shewn to you that I was closeted with any person or set
-of persons?" Yes, Mr. Thomas Wakley, it has been shewn, and by no
-less an authority than that of your _fidus Achates_, Mr. James
-Lambert. "The defendant (says the worthy author of the libel), the
-defendant was there whilst I was explaining the parts to persons
-who were to be witnesses--_the defendant also explained them to
-the same persons_." And again, "I have heard explanations given to
-persons who were to be witnesses in this cause FOUR OR FIVE TIMES
-within the last six weeks." So also that excellent thorough-going
-witness, Mr. Jeffry Pearl: "a _gentleman_ of the name of Lambert
-introduced me to the defendant; THE DEFENDANT _and Mr. Lambert
-endeavoured to shew that the forceps had passed between the bladder
-and the rectum_." So much for placing men in the box because they
-are friends of Mr. Cooper--so much for procuring evidence from
-"untainted quarters!"
-
-This is only to be matched in effrontery by the statement of some
-wise-acre at the radical meeting on Tuesday night. Being asked why
-no notice had been taken in the Lancet of a successful operation of
-lithotomy performed by Mr. B. Cooper, soon after the publication
-of the libel, he assigned as the reason that Mr. Wakley thought it
-might increase the damages, and otherwise injure Mr. Cooper! What a
-noodle the man must be to expect any one to believe him[21]!
-
-Mr. Wakley asserted that the evidence of his witnesses remained
-"untouched--wholly uncontradicted;"--whereas there was scarcely a
-single point in their statements which was not contradicted either
-by Mr. Callaway, who was present at the operation, or Mr. Key and
-Dr. Hodgkin, who examined the parts after death. But what is more
-remarkable, there was scarcely a circumstance on which his own
-witnesses agreed--for example, they differed with regard to the
-nature and direction of the incisions; with regard to the manner
-and frequency of introducing the forceps; with regard to the number
-of instruments used, and the mode of applying them; with regard to
-the size of the wound; with regard to the degree of force employed,
-and with regard to the appearances after death. Yet, in the face
-of all this, Wakley had the impudence to tell the jury that his
-evidence remained "uncontradicted." We have no hesitation in
-asserting that his own witnesses (putting Mr. Cooper's out of the
-question) advanced no charge of which they did not also furnish the
-refutation.
-
-Mr. Wakley asserted that Mr. Cooper was incapable of telling why
-he could not extract the stone, even "while he had his finger in
-the bladder." This is false: neither Mr. Cooper nor Mr. Callaway
-were able to reach the bladder with the finger at all, owing to the
-depth of the perineum.
-
-Mr. Wakley told the jury that the plaintiff did not like the
-bladder to be exposed, "because to surgeons there is indisputable
-proof that Bransby Cooper did not perform that operation as he
-ought," and that "Mr. Key and Mr. Callaway knew it." This is false:
-Mr. Key, Mr. Callaway, and Dr. Hodgkin, who had examined the parts,
-all deposed that there was nothing in them indicative of the
-operation having been improperly performed. Indeed, had it been as
-Wakley asserted, the plaintiff would not have been so foolish as to
-have had the parts preserved at all.
-
-_Sophistical in argument._--One of the pieces of sophistry on
-which Wakley seems chiefly to have depended, inasmuch as he went
-over it _six times_ in the course of his speech, was, that if his
-account of the operation had been incorrect more of those who were
-present would have been brought forward to prove it so. But, as
-we stated in our last Number, to have objected to Wakley bringing
-forward pupils, on the ground of their being incompetent, and then
-to have done the same thing, would have been grossly inconsistent.
-Lord Tenterden, in his charge, said, "he did not see whom he (Mr.
-Cooper) could, with propriety, have called besides Mr. Callaway;
-the others were all young men, only pupils, and probably too young
-and inexperienced to form any judgment on the case that could
-be relied on." There is also another person who has objected to
-these witnesses whom we may mention--not, indeed, one for whose
-authority we have the highest possible respect, but of whom the
-defendant in this case probably thinks more favourably--we mean
-Mr. Thomas Wakley, who, speaking of the Letter formerly published
-by Mr. Cooper's pupils on the subject of this operation, says,
-"their united opinion of the skill, dexterity, and self-possession
-exhibited by Mr. Bransby Cooper on this occasion, is not likely to
-influence the judgment of the profession, whatever it may effect
-with the public."
-
-The use made by Wakley of Sir Astley Cooper's expression, "give
-him time," is another specimen of sophistry. Sir Astley evidently
-meant merely to say that, _ceteris paribus_, a man who had been
-twenty years surgeon to an Hospital would be more experienced than
-one who had held the situation but one-fourth of that period.
-This we believe to have been his sentiment, though nothing was
-ever less happily expressed. Accordingly it was not lost upon the
-defendant, who exclaimed, "Is that the way in which our hospitals
-are to be conducted? Is that the mode in which your poor patients
-are to be treated?--that young and inexperienced men are to be
-placed there to _learn their profession_--not to know it before
-they get there, but are to go there to learn it--and learn it
-upon whom?--upon individuals who are as much entitled to the
-best and most scientific practice of surgery as any nobleman in
-this land." All very fine--but we should be glad to know how or
-where a practical acquaintance with surgery is to be acquired
-but in public hospitals--and if no man is to be appointed till
-after he has gained experience, where are such men to come from?
-Where are ready-made surgeons to be found fit to operate even
-before Lambert, without his being able _to make a hole_ in their
-reputation?
-
-One of the most knavish attempts in the whole speech, to take
-advantage of the jury, was exhibited in his description of the
-operation. How different from the clear, perspicuous, and candid
-narrative of Sir James Scarlett. You are told, says Wakley, that
-the stone was shelved _above_ the pubes and _behind_ the pubes;
-but, continued he, (placing a pelvis in the position in which it is
-during the operation,) a stone cannot be lodged above the pubes,
-because, you see, the pubes is above the bladder! This was, indeed,
-calculated to confuse men unaccustomed to the subject, and who
-did not probably reflect that above and below are merely relative
-terms, which must change with every change of position, and that
-it was not meant that the stone was between the pubes and external
-integuments, which, in the position for lithotomy, would be the
-literal meaning of _above the pubes_, but that it was in such a
-situation as, in the ordinary position of the body, was above the
-pubes. But Wakley assured the jury that it was impossible for any
-stone to be _above_ the pubes, for there was a tendon to prevent it
-which no force could overcome; and he affected to ridicule the idea
-of there being anything unusual, any extraordinary shelf behind the
-pubes, in which the stone could have been lodged. "Had there been
-a shelf here," said he,--"had there been a crooked passage--had
-there been a cavity, or any place for the deposition of the stone,
-do you suppose that shelf would not have been produced? Had there
-been any thing particular in the formation of the pubes, would they
-not have cut out the man's bone as well as the bladder?" It is
-probably impossible for any but medical men to appreciate fully
-the impudent imposition--the fraud of this statement,--this knavish
-artifice to mislead the jury. No attempt was made in any part of
-Mr. Cooper's case to show that there was such malformation, or that
-the stone was in the position which Mr. Wakley demonstrated it
-could not occupy--_thus answering an argument which had never been
-advanced_.
-
-The following is a good specimen of sophistry and stupidity.
-Finding it proved that there was no opening between the bladder
-and rectum, Wakley wanted to make out that he never had said
-otherwise, having stated the cellular membrane to be _lacerable_,
-and therefore not _lacerated_. And then, forgetting the nature of
-his argument, immediately added, "remember this; the gorget is not
-as wide as the finger, and that it is not an uncommon thing for an
-unskilful operator to drive the gorget in between the bladder and
-rectum." Thus insinuating what had been proved to be false, and
-what he had just argued, from the words of the libel, he could not
-have meant.
-
-_Coarse in language._--This scarcely requires illustration. But as
-specimens, on the present occasion, of vulgar slang and miserable
-attempts at wit, we may mention his talking of "hole and corner"
-proceedings,--his comparing Sir James Scarlett to sour milk,
-and which happy thought he has, in hand-bills pasted about the
-town, converted into "Knight and Professor of Sour Milk,"--his
-explanation of the term _bat_ as applied to surgeons, "because
-they live in the dark, they suckle their young, and live in creaks
-and crevices of old walls, hospitals, and dungeons, _thriving and
-fattening on their own species_,"--his address to the "_gang_" of
-hospital surgeons, whom he represented as wading "through blood
-up to the neck,"--and lastly, his exclamations, several times
-repeated, perhaps with _prophetic_ phrenzy, that he "would die in
-a dungeon and expire in a ditch."
-
-_Diabolical in tendency._--The general tendency of Wakley's
-writings, and especially of his address to the Jury on this
-occasion, so far as such ravings can have any influence, is to sow
-distrust between men in every class of society and their medical
-attendants; to poison the sources of public charity, and arrest
-the hand of benevolence; to contract the relief afforded to human
-suffering, leading the poor and uninformed to suppose themselves
-the objects of cruel and wanton experiment, thus encouraging them
-rather to suffer disease to run its course than seek relief in such
-abodes of blood and horror as he most falsely represents our public
-hospitals to be.
-
-One of the first ebullitions of this demoniacal effort consisted
-in representing to the Jury, which he did in two different parts
-of his address, that the patient had been kept _bound_ during the
-operation, as if some unusual degree of coercion had been employed.
-"Yet, in opposition to the patient's cries--in opposition to his
-repeated entreaties to be unbound, still the operator kept him upon
-the table."--"Gentlemen," continued he, "I should like to know
-upon what principle it was that the man was kept _bound_ upon the
-table when he implored to be loosened. Was he not a free agent?"
-And then he goes on to put into Mr. Cooper's mouth not only words,
-but a sentiment he never uttered.--"No, no, (says the operator,)
-my _reputation_ is concerned. You were brought here to have the
-stone extracted, and extracted it shall and must be--_if you were
-to die upon the table_." Unless Wakley was intoxicated we cannot
-in any other manner account for an argument at once so absurd, so
-unprofessional, and so malignant. It evidently excited no feeling
-but that of disgust in the minds either of the Judge or the Jury.
-
-The next paragraph to which we shall allude is a masterpiece
-of hypocrisy--"Let me ask you (said he) what you have heard
-respecting the miseries of the individual on whom the operation was
-performed? Not one word has escaped the lips of the counsel on that
-subject--not one word from the mouth of one of the witnesses. No,
-gentlemen, they are hospital surgeons themselves, and they know too
-well what the practices of our hospitals are, and the sufferings
-_patients are in the habit of enduring at their hands_, to feel
-for this man, or for any other man placed in a similar situation!"
-Canting hypocrite! this from the man who in the very case before
-us published his account of the patient's sufferings in the form
-of a drama, mingled with low and scurrilous gibes. Mark also the
-following--"Give such a verdict as shall satisfy the _poor_--as
-will shew that men are not to go into offices of this sort where
-the _poor are to be killed_, and that they shall not be at liberty
-to wade and ride through blood up to their necks to eminence in
-their profession. Ah! gentlemen, give such a verdict as shall
-satisfy the _poor_!"
-
-There is in the various paragraphs we have quoted, more deep-rooted
-malice--more abandoned violation of the truth--more hypocrisy--and
-more open outrage of common sense, decency, and feeling, than we
-ever remember to have met with, even in the pages of the Lancet.
-It is now quite obvious that Wakley, alarmed at the change which
-has taken place in the estimation of his work within the last few
-months, finds it necessary to adopt a new system; he therefore
-throws off the mask, and openly declares himself the champion of
-the ignorant and illiterate[22]--conjuring up to their imaginations
-evils which do not exist--denouncing the medical profession as
-one of blood and murder--medical men as "thriving and fattening on
-their fellow-creatures"--and calling upon the "humane contributors
-to our hospitals and infirmaries" to support him.
-
-Why really now, if the times of political turbulence were to
-return, and radical reform again to come into vogue, Cobbett
-and Hunt would have a most valuable coadjutor; but as it is, we
-almost think the sphere he has chosen is too limited for such a
-genius. Humbug, to be successful, ought not to be very open to
-detection; alleged abuses ought not to be of a kind which every
-man can satisfy himself are entirely without foundation; and he
-who professes disinterested motives ought not to begin by raising
-a subscription for himself. We offer these few hints to Wakley, in
-hopes they may be of use to him in his new career; above all, we
-advise him to be sparing in protestations: there are some already
-who look upon his sincerity with a suspicious eye; for although
-it is no doubt true, that he would "rather die in a dungeon, and
-expire in a ditch," than injure any man, yet somehow an idea has
-got abroad, that his constant habits of lying and slandering are
-not quite in keeping with these assertions. Nay, we have heard
-of some even of the "humane contributors" to our charitable
-institutions, who have been so unreasonable as to disbelieve all
-Wakley's stories about the _cannibalism_ of hospital surgeons, and
-to look upon the whole system of the Lancet as one of knavery and
-imposition.
-
-
-
-
-WAKLEY'S SUBSCRIPTION MEETING.
-
-
-A most amusing scene took place at the Freemasons' Tavern on
-Tuesday evening, of which we subjoin an account. The object of
-the meeting was, "to present Mr. Wakley with some decided mark of
-their approval of his spirited conduct in his late trial;" or, in
-other words, if possible, to raise a little money, and bolster
-up the Lancet a little longer. The persons present were small in
-number, but great in zeal; and as much noise, hissing, laughter,
-and shouting, took place as would have done credit to a much larger
-assembly. As this is a merry season, and it may amuse our readers,
-we subjoin the speeches of the principal orators on either side:
-it will be perceived that both the Gazette and Lancet had some
-handsome compliments paid them; and that Wakley got thoroughly
-abused even by some of those who went to the meeting as the
-champions of reform. There was not a single individual present of
-any weight in the profession, and the chair was occupied by a young
-man wholly unknown, except as secretary to the meetings held two
-years ago on the subject of surgical reform. Could no one whose
-name might sound familiar in the public ear be prevailed upon to
-go?--could none be found but Pateys, Wallers, Mills, Elliots,
-Childs, and the Lord knows who? Where was he, the idol of the
-Lancet, who on other occasions graced the chair--where he who first
-ycleped that Journal the "invaluable"? Alas! poor Wakley, what an
-exposure of a sinking cause! even thy former friends tremble for
-their reputations, and desert thee.
-
-
-SURGICAL REFORM.
-
-A meeting was held yesterday evening at the Freemasons' Tavern, in
-pursuance of an advertisement calling on the "Friends of Surgical
-Reform, the Supporters of a free Medical Press, and the humane
-Contributors to our Hospitals and Infirmaries," to meet there,
-in order to adopt measures for presenting Mr. Wakley, the Editor
-of the Lancet, with some decided mark of their approval of his
-spirited conduct, in his late trial in the Court of King's Bench,
-at the suit of Mr. Bransby Cooper, and of the principles which he
-so powerfully advocated on that occasion.
-
-[Mr. Patey, who was called to the chair, stated the object of the
-meeting; but as his speech was rather long, and contained nothing
-of the least interest, we omit it.]
-
-_Mr. Waller_, in proposing the first resolution, adverted to the
-terms of the advertisement, and remarked that the question for
-them was not whether they would support Cooper against Wakley, or
-Wakley against Cooper; but whether they would have a free medical
-press or not--(cheers). Every body must admit that there was
-only one medical publication that was entitled to be considered
-free--only one that dared to tell the truth. Another had been
-attempted to be set up against it, but this wretched rival was
-gagged and manacled, and its reports were only a medium which
-distorted truth, and were almost unintelligible. It was not,
-however, to support any particular man, or publication, that he
-came to that meeting, but to support the general cause in which
-they were all interested. He concluded by moving, as the first
-resolution, that "the best interests of the medical profession and
-of the public are identified with the cause of medical and surgical
-reform; and that Mr. Wakley, as Editor of the Lancet, having given
-the first impulse to that cause, and having subsequently advocated
-it with undeviating firmness and fidelity, is entitled to the
-cordial thanks and support of this meeting."
-
-_Mr. Mills_ seconded the resolution.
-
-_Dr. Shiel_ said this was an important meeting, in his opinion;
-for, if this resolution were passed, it would identify the medical
-profession with the Editor of the Lancet. If the principle
-embodied in that resolution went forth to the world, it would be
-attended with consequences deeply injurious to the profession.
-He knew neither Mr. Bransby Cooper nor Sir Astley, and therefore
-he was perfectly impartial. The first question was, how far the
-medical press was conducted with advantage to medical science and
-the members of the profession. Now he contended, but with great
-respect, and disclaiming all personal hostility, that the Lancet
-had nowise contributed to the progress of medical science or the
-improvement of the profession--(loud hissing, and some cheers).
-He trusted that the meeting had not been got up by a few of the
-friends of Mr. Wakley, and he was sure that that gentleman was
-too respectable and too dignified in his proper person to need
-any such attempt--(applause). He trusted that the meeting was
-before the British public to ascertain how far the Lancet was
-useful or advantageous to medical science; and he hoped that,
-however partial the gentlemen present might be to Mr. Wakley, they
-would be governed in what they should do by the real interests of
-science--(hear, hear). The question was one of great interest; for
-it was one that embraced not only the freedom of the press but the
-advancement of medical science. With respect to the freedom of the
-press, they lived in a country where the law always maintained
-that principle. When Mr. Abernethy had applied for an injunction
-against the Lancet, Lord Eldon said that there could be no doubt
-that the Lancet was a most useful publication--(applause). He did
-not know whether that observation had been brought forward at the
-late trial; but taking the case--what was it? It appeared that the
-operation was one of peculiar difficulty, as stated upon oath by
-some of the most experienced surgeons of the day. This operation
-was laid hold of by the Lancet, and published not as a medical but
-as a tragical performance, in which all persons without science
-or knowledge were appealed to, and no opportunity afforded to Mr.
-Cooper to vindicate himself. Here, then, was a low and pitiful
-attempt made through the medium of malice and calumny (loud hisses
-and uproar). Here was a rude and pitiful attempt by malice and
-calumny (renewed signs of disapprobation). And yet it was contended
-that this had advanced the medical profession. The evidence on the
-trial went to shew that the dangers by which the operator had been
-surrounded were not small, and that there was no just reason to
-accuse him of unskilfulness in what he did; and was it then to be
-said, in the face of the British public, that a Meeting had been
-held at the Freemasons' Tavern to offer praise and reward to the
-individual whose conduct had, by the verdict of the Jury, been
-stamped with the accusation of untruth (hear, hear! and hisses)?
-He would not deny that there was a degree of talent displayed in
-the Lancet; but neither could it be denied that it was a public
-depredator by means of reports surreptitiously obtained; and the
-title of "literary raven," which had been applied by Sir James
-Scarlett, appeared to him to truly depict its character (great
-hisses and uproar). Was it to be contended that any one had a right
-to come into a private lecture-room, and catch up all he could
-hear, and then to publish what he had thus surreptitiously and
-fraudulently obtained (immense uproar and hisses)? As far as the
-medical interest was concerned, he looked upon the Lancet as one of
-the most injurious publications that had ever appeared (hisses).
-All the best writers on the subject had dwelt with peculiar
-emphasis on the necessity of secrecy among the members of the
-profession, but the Lancet broke through this good rule, and made
-public whatever came within its notice; and he had no doubt that
-if it could get at the cases that occurred in private practice, it
-would give them without any scruple (uproar).
-
-The _Chairman_ begged to remind the speaker that at all events Mr.
-Wakley had not as yet done so.
-
-_Dr. Shiel._--I am arguing on the principle which appears to
-actuate Mr. Wakley.
-
-_Mr. John Elliot_ rose to order. He could not allow Dr. Shiel to be
-going upon suppositions; the thing that he supposed had never been
-done.
-
-_Dr. Shiel_ was sure that whatever turn might be given to the
-subject in England, that at all events the conclusions that the
-Meeting appeared to be coming to would be resisted abroad. The
-weight of Sir Astley Cooper's name abroad would overpower any
-such attempt, and, in fact, would render it contemptible; so that
-any attempt to prop up so low, pitiful, and mean an attack, must
-inevitably be attended with disgraceful failure (hisses).
-
-A gentleman observed, that he was much surprised at what had fallen
-from Dr. Shiel. He had been induced to suppose that the Lancet
-possessed talent, as he had heard it praised in so many directions,
-and he certainly had never heard till that evening that it was
-only to be found in the hands of the illiterate (hear, hear! and
-a laugh). He had always understood that it was only destined for
-the use of students and other members of the profession, and that
-it was likely to be of great use in reforming the abuses of the
-medical practice (hear, hear! and cries of "So it will!"). For his
-own part, he was glad that medical men were occasionally cut up,
-because when they did what was wrong it was proper that they should
-be told of it; and when they did what was right, it added a fresh
-stimulus to their exertions (applause).
-
-_Mr. Thomas_ observed, that he had not intended to say any thing at
-the present meeting; but as Dr. Shiel, in the course of his speech,
-had thought proper to make some remarks tending to calumniate Mr.
-Wakley's witnesses on the trial, of which he was one, he felt
-called upon to say a few words (hear, hear!). Dr. Shiel seemed to
-consider them all as the mere scum of the earth--as a miserable
-band, collected together to support Mr. Wakley, whatever might
-be the consequence; as though he was desirous of going the whole
-length of the Medical Gazette, which stigmatised them for what it
-called "their deep-laid contrivances--their rankling enmities, and
-their bitter revenge." For himself he could say, that it was not
-till the evening previous to the trial that he had been supœnaed,
-and that he had previous to that time never seen Mr. Wakley.
-
-_Dr. Shiel_ said that he could not have alluded to the gentleman
-who was speaking, as he did not even know his name.
-
-_Mr. Thomas_ then went on to observe, that as Dr. Shiel appeared
-to be the advocate of the opposite party, he also supposed that he
-was a contributor to the aristocratical (Medical) Gazette ("No,
-no!" from Dr. Shiel). If he were not, at all events he had put
-forward ideas that were quite consonant to the sentiments expressed
-in that Journal. In giving his testimony, he had not spoken of the
-instruments employed in the operation, but of his own impression
-on the subject, having been present thirty-five minutes; and that
-impression certainly was, that the operation had been performed in
-a bungling and unscientific manner (loud applause, mingled with
-hisses). Was he then, because he happened to be a witness on the
-occasion, to be put down, pell-mell, by the unfounded imputations
-of any one? The highly-principled, honourable-minded Medical
-Gazette, that had determined never to admit any personalities, had
-loaded Mr. Wakley and Mr. Lambert with all sorts of abuse. Was
-this what they intended to call acting on principle (applause,
-and cries of "No, no!")? He certainly had heard that Mr. B.
-Cooper was an amiable man in private life; but what had that
-to do with the question at issue? What had they to do with the
-private character of a man in a public office (cheers)? Surely the
-witnesses of Mr. Wakley were as competent to speak of the manner
-in which the operation was performed as those who had not been
-present (applause); and as he had seen many operations performed
-he conceived that he was a competent judge of the skill of the
-operator (applause).
-
-A gentleman, who appeared to be a student, thought that the
-introduction of any attack upon the witnesses, or indeed of
-anything that occurred at the trial, was irrelevant (hear,
-hear!). The way to answer a speaker was not by hisses, but by
-disproving his arguments and rebutting his facts (applause). If
-questions were to be settled merely by strength of lungs, he
-was afraid that instead of the right side prevailing, success
-would uniformly attend those whose physical powers probably much
-exceeded their mental (laughter and applause). He could not agree
-with the gentleman who had stated that the law of England was
-the protector of the freedom of the Press; for it was well known
-that the Judges had decided, over and over again, that truth was
-a libel (applause). It was only the vehicle that conveyed public
-sentiment, and not the force that impelled it forward. He was
-convinced that any attempt to connect medical reform with Mr.
-Wakley should be studiously avoided and disclaimed. As a friend of
-free discussion in every case, and anxious to uphold the principle,
-whatever he might think of the instrument, he intended to propose,
-as an Amendment, "That the latter part of the Resolution, relating
-to Mr. Wakley, should be omitted." This would save the cause of
-medical reform from being identified with Mr. Wakley, of whose
-impartiality he would give a specimen. In the last number of the
-Lancet, the report of the late trial was given from the Times, but
-with a remarkable omission. The Lord Chief Justice had rebuked
-one of the defendant's witnesses for not answering the questions
-in a straightforward manner, and this passage was omitted. If Mr.
-Wakley would do this on such an occasion, would he be more candid
-when the public eye was less upon him? He, therefore, wished to
-have the question of medical reform kept separate from Mr. Wakley
-individually. The first part of the Resolution would be carried
-without a dissenting voice, as on that principle they were all
-agreed, whatever they might think of the conduct of individuals.
-
-[One or two persons then made speeches for or against the
-amendment; which was negatived, and the original motion carried.]
-
-_Mr. Hensley_ then, after observing that Mr. Wakley's conduct
-was highly praiseworthy, because it tended in every way to the
-benefit of humanity, moved the second Resolution, which was to the
-following effect:--
-
-"That the purposes for which the Hospitals and Infirmaries of
-the Metropolis were founded, and that the views of the humane
-contributors to their funds, are materially promoted by the
-weekly publication of reports detailing the medical and surgical
-treatment of the unfortunate patients; and that Mr. Wakley having
-originated the practice of publishing Hospital Reports, has
-conferred important benefits on Medical Science, and on the cause
-of humanity."
-
-The resolution was then carried unanimously.
-
-_Mr. John Elliott_, on moving the third resolution, said that he
-did not come there to interfere in the quarrels of Wakley and
-Cooper. They had acknowledged that Mr. Wakley's exertions had been
-very conducive to medical reform, by the last resolution they
-had passed. Indeed, there could be no doubt that he had greatly
-served the cause of humanity, by preventing idleness on the part of
-medical persons, and compelling attention to the poor placed under
-their care. It was his opinion that the editor of the Lancet ought
-to be indemnified for the whole expense entailed on him by the
-late trial, including the damages awarded against him. This would
-not be a private subscription, like Brodie's, but one open to the
-world, and not to be questioned in a court of justice. He would not
-support Mr. Wakley if he had attacked private character; but he
-would, as the editor of the Lancet and the representative of the
-medical free press. He concluded by moving--
-
-"That the independent and impartial principles on which the Lancet
-was first established, have been preserved by Mr. Wakley at all
-risks; and as it was acknowledged at the late trial, that the
-legal expenses of his opponents on another occasion have been
-defrayed by certain hospital physicians and surgeons[23], it is
-farther resolved, that a subscription be opened for the purpose of
-defraying the expenses of the late action."
-
-[Dr. Shiel here spoke very strongly against entering into a
-subscription--while some spoke in its favour.]
-
-A discussion then arose about the question of whether an account
-of a second operation for lithotomy by Mr. Cooper (in which he had
-been successful) had been sent to Mr. Wakley? It was stated that
-such was the case, but as the action for the present libel was then
-commenced, _Mr. Wakley thought that he perceived something in that
-second report that might tend to aggravate the damages, and which,
-at the same time, would be farther injurious to Mr. B. Cooper_.
-
-The third resolution was then carried by an immense majority, only
-five hands being held up against it.
-
-_Mr. Evans_ moved, "That the statement of professional facts in an
-unprofessional form, such as the dramatic instead of the narrative,
-is highly reprehensible in the individual, and detrimental to the
-best interests of science."
-
-This resolution, after some turbulent discussion, was withdrawn.
-
-_Mr. J. L. Stevens_ then moved, as the fourth resolution, that "In
-accordance with the feelings this meeting has expressed, Mr. Wakley
-be invited to attend a Public Dinner, and that a Committee be
-forthwith nominated to arrange the same."
-
-_Mr. Rogers_ seconded the resolution, and it was carried
-unanimously.
-
-The members of the committee were then named, and power given to
-them to add to their number.--The chairman then vacated his office,
-and the meeting separated.--_Morning Chronicle, Wednesday._
-
-
-In the course of the evening, the conduct of one of the speakers
-gave for a short time an amusing turn to the discussion, which for
-a great part had appeared to many extremely dry and tedious. The
-gentleman in question, (not a medical man), in order to show the
-opinion he had entertained of the object of the meeting, proposed
-to read for the audience a letter which he himself had written to
-the chairman of the committee, asking permission to attend. He
-began, but he had scarcely got through a few words when he declared
-he was not able to make out his own writing, and requested the
-chairman to assist him. The chairman made the attempt, but was not
-more successful. Another gentleman then undertook the task, but
-with no better effect. The audience received each unsuccessful
-effort with loud laughter, which so much annoyed the writer that he
-took back the letter, and again tried to go through with it, but
-not being able to make it out, he proposed to read for the meeting
-two letters which he wrote on the same subject to the editor of a
-Sunday paper. (Loud laughter followed this proposition, which was
-increased, when, on an attempt to read one of them, he had no more
-success than before.) The gentleman, after complaining of the want
-of courtesy in the meeting, resumed his seat, declaring that he
-would give the letters to the reporters.--_Times, Wednesday._
-
-
-
-
-HOSPITAL REPORTS.
-
-
-GLASGOW ROYAL INFIRMARY.
-
-_Injuries of the Head._
-
-D. M'Millan, æt. 40, seaman;--while he was employed in the hold
-of a vessel, a heavy iron block, of a round form, fell from the
-rigging, a height of 20 feet, and struck him on the head. He was
-knocked down and stunned, but was able to rise and to walk with
-a little support. He was brought about a mile and a half in a
-hackney-coach to the hospital, and admitted by Mr. Cowan at one
-o'clock P.M., half an hour after the accident. At this time he
-had a stupified look, but was quite collected, and was able to
-walk across the ward; breathing and pupils both natural; pulse 75,
-of moderate strength. There was a wound in the scalp, commencing
-nearly over the centre of the sagittal suture, and running about
-three inches backwards and towards the left; along this a portion
-of skull, corresponding to the wound in size, was felt fractured,
-detached, and irregularly depressed. His right arm was benumbed and
-nearly powerless, but no mark of injury was observed on it.
-
-It was determined to remove the detached piece of bone, and the
-original wound being extended lengthwise in both directions, an
-incision was made through the scalp at right angles to it over the
-left parietal bone, thus bringing the fractured portion into view.
-This was found to be broken down into several fragments, some of
-which were firmly impacted under the surrounding cranium, and one
-spiculum, driven through the dura mater, had penetrated the brain.
-The trephine was applied a little to the left of the fracture, and
-the intermediate part removed with Hey's saw; the detached pieces
-of bone, ten in number, of various sizes and irregular shapes,
-were removed with the forceps, the scalp replaced and retained in
-position by a stripe of adhesive plaister and very light dressings.
-During the operation one artery required ligature, and about ℥v. of
-blood were lost: he had lost perhaps as much before. He remained
-quite sensible, bore it well, and shortly afterwards had half a
-glass of port wine in warm water.
-
-Ten P.M.--Has been tolerably easy; complains of pain of fore-part
-of head; pulse 82, firm.
-
-    Fiat V. S. ad ℥xviii.
-
-    Sumat statim Submur. Hydr. gr. viii. Pulv. Antimon. gr. vi.
-
-    Applic. Capiti Lotio ex Alcohol. et aq. calcis.
-
-Second day.--After bleeding, thought feeling of numbness of right
-arm somewhat lessened, and to-day has rather more power of it.
-Passed a tolerable night; a little head-ache; countenance pretty
-natural; tongue slightly loaded; thirst; no stool.
-
-    Sum. stat. Sulph. Magnesiæ ℥j. et rep. vesp. si opus.
-
-Third day.--From an aversion to use the bed pan, he rose to stool
-last night, and fell forwards on the floor, seemingly from having
-entangled himself in the bed clothes; he got into bed without
-assistance; had a shivering fit shortly after, but has had a pretty
-good night; bowels freely opened; head-ache slight; pulse 84, soft;
-tongue dry in middle. Towards the evening of this day he appeared
-drowsy; and on the fourth day he is reported as seeming confused
-and uneasy; countenance anxious; articulation difficult; the right
-arm was more paralysed, and indeed the whole right side seemed
-now to partake in the paralysis; a small part of the wound had
-adhered, the remaining part was flabby, discharging thin serum.
-In the evening the difficulty of articulation and drowsiness had
-increased. Twelve leeches were applied to each temple, and in a
-short time he seemed a little livelier.
-
-Fifth day.--Much in the same state; took a little beef tea.
-
-Sixth day.--Paralytic symptoms increased; breathing laborious.
-Blister to the neck. It may be worthy of remark, that in the few
-words he now spoke he never made use of the English language, but
-of the Gaelic, which was his native tongue; and even when told that
-he was not understood, he persisted in repeating the Gaelic phrase.
-
-Seventh day.--A small fungus was observed in upper part of wound,
-to which lint dipped in lime water was applied, and moderate
-pressure. The fungus continued to increase.
-
-On the eleventh and twelfth days he had slight bleedings from the
-scalp, which stopped spontaneously. Stupor, &c. greatly increased,
-but he still recognised his friends; took a very little chicken
-soup or beef tea daily, with lemonade, &c. for drink.
-
-On the evening of the thirteenth day bleeding to the extent of
-℥iv. or v. took place from fungus: it was checked by application
-of saturated solution of alum, but he sunk rapidly, and died that
-night.
-
-_Inspection 36 hours after death._--The fungus protruded
-considerably beyond the scalp, and was rather larger than a hen's
-egg, of a dirty brown colour, and a soft spongy consistence; it
-completely filled up the opening made in the skull by the trephine
-and removal of detached bone. The pericranium to the inferior side
-of this opening was found detached from the bone, to the extent
-of a crown piece, and beneath it the bone was rough, and covered
-with thin purulent matter. The dura mater, for two inches around
-the fungus, was covered with pus; this membrane, by sloughing,
-had allowed the fungus to protrude, and its edges adjacent to the
-aperture were thickened. On removing the dura mater, the fungus was
-observed to arise, partly from the middle, but chiefly from the
-posterior lobe of the left cerebral hemisphere: it occupied a space
-about three inches in length, and an inch and a half in breadth,
-extending to within a line or two of the roof of the ventricle;
-at its anterior part was an abscess, containing ℥ss. of pus. The
-fungus seemed to be a degeneration of the cerebral substance;
-sections of it showed the cerebral matter first dotted with an
-unusual number of bloody points, then assuming a greyish colour,
-which gradually passed into a dirty brown. With the exception of
-these bloody points, the brain presented no unusual vascularity:
-it was quite firm, except in the immediate neighbourhood of the
-fungus, where it gradually became softer as the colour of the
-cerebral substance became deeper, till in the centre of the fungus
-it was nearly of a broken down consistence. A quantity of serum was
-found in each ventricle.
-
-
-Another man who had been struck by the piece of iron which
-fractured M'Millan's skull was brought up to the hospital at the
-same time. He had received the blow on the vertex of his head. On
-admission he was in a state of fury, requiring the efforts of
-several men to hold him. His head was bruised out of all shape,
-quite depressed behind, and a fracture also of the frontal bone;
-there were evident symptoms too of fracture of the base of the
-skull. The case was hopeless. Several large depressed and detached
-pieces of bone were removed, but he died a few minutes after the
-operation.
-
-
-During the same week an old woman was brought up to the infirmary,
-who, the day previously, had fallen headlong down a stone
-staircase. She laboured under the severest symptoms of concussion,
-and besides had a comminuted fracture of the humerus into the
-elbow joint, and of the radius into the wrist joint of left arm.
-She was past all treatment, and died on the second day. The case
-is mentioned chiefly to remark, that although no external injury
-of the head could be observed, on inspection a fracture was found
-extending completely across the anterior part of base of cranium.
-
-
-There are no dispensaries in Glasgow, but such of the poor as are
-unable to obtain admission into the Royal Infirmary, and those who
-are not so ill as to submit to the confinement of an hospital,
-or for other reasons prefer remaining in their own houses, are
-prescribed for, and, if necessary, visited at the public expense.
-For this purpose the city is divided into districts, and a surgeon
-appointed to each. The "district shop" thus resembles a dispensary,
-where the surgeon prescribes in the presence of his pupils, who
-indeed, under his superintendance, have the management of many
-of the cases, both among the patients who receive advice at the
-"shop," and those who are visited at home. Although under the care
-of a surgeon, the diseases treated are both medical and surgical,
-for there is little distinction made between the two branches of
-the profession here.
-
-The following case occurred under the care of Mr. Stirling:--
-
-W. M. æt. 28, while returning home during the night in a state
-of intoxication, fell from a height of ten feet, into a court
-paved with stone. He was rendered insensible for some time, but
-on recovering was able to crawl to the nearest door, and was
-conveyed home. Medical assistance was immediately procured. On
-the forehead, about an inch above the nasal process of the frontal
-bone, was a cut an inch and a half in length, extending obliquely
-downwards from the right side; through this a triangular fracture
-was felt, the base of which was in the direction of the external
-wound, and the apex pointing downwards; the fractured portion
-of the bone was slightly depressed; the bones of the nose were
-also fractured, and there was great discharge of blood from the
-nostrils. One third, or nearly, of the upper lip was cut off, and a
-good deal of blood had been lost from the labial artery; the lower
-jaw at the symphysis was fractured and comminuted, and several
-pieces were perceived to be loose. Was quite sensible, remembering
-every thing up to the period of the accident. Pulse 80; has vomited
-frequently. Wound of forehead was dressed with adhesive plaister;
-the loose pieces of bone were removed from the lower jaw, and it
-was afterwards retained in juxta-position by a chin bandage.
-
-Early next morning he was bled to ℥xii. and had a purge of jalap
-and calomel, by which his bowels were freely opened. That night he
-felt considerable pain of head; pulse 90, full, and strong. He was
-bled again to ℥xxv. Blood first drawn had the buffy coat. After
-the bleeding the pain of head diminished, and he continued to do
-well. When the swelling and tenderness of face had subsided, it was
-observed that the fracture communicated with the frontal sinus. On
-holding his nose and attempting to blow it, matter and air escaped
-by the fracture. The man was anxious for a speedy cure, and for
-this purpose an operation to remove the depressed piece of bone was
-at one time thought of; there was no constitutional disturbance,
-however, and the case was left to nature. The discharge gradually
-diminished, and the wound healed up in about a month. The bones
-of the nose retained their position, and the broken ends of the
-jaw, after the swelling had subsided, were kept in their proper
-situation by a pasteboard splint till re-union took place. The lip
-also healed easily, and no deformity is now observable.
-
-
-GUY'S HOSPITAL.
-
-_Inflammation of Hernial Sac._
-
-The previous report of this case (Gazette, No. 51) conducted it to
-Nov. 18th, the tenth day from the operation, and the third on which
-fæces had been discharged from the wound; that discharge continued
-on the 19th, but on the 20th pus only was seen.
-
-Nov. 22.--Yesterday the dresser, Mr. King, observed a portion of
-_solid_ fæces make its escape, and to-day a similar discharge, in
-the fluid form, is manifest.
-
-Nov. 26.--Since the 22d, nothing but healthy pus has been seen; the
-wound is rapidly healing, and the patient's general condition as
-good as can be desired.
-
-Dec. 4.--He has begun to wear a truss, and is to-day allowed to
-leave his bed.
-
-Dec. 8.--As regards his original complaint, the man is perfectly
-convalescent, but he now discloses a small abscess in the scrotum,
-which has been gradually forming, and will detain him in the house
-some time longer.
-
-If it be a sound surgical maxim that, in strangulated hernia,
-the patient's safety depends upon an early operation, it is also
-a maxim no less sound, that where the evidence and symptoms of
-strangulation are imperfect, or dubious, the benefit of the doubt
-should be given to the operation, and it should be performed: for
-it is better that buboes should be laid open, or inflamed sacs cut
-into, twenty, aye, fifty times in succession, than that in one case
-a man should be suffered to die with strangulation of the intestine
-unrelieved.
-
-These remarks apply strikingly to this case of Mr. Key's, in which,
-although no hernia was found, they perfectly justify the operation.
-No case of strangulation could be more distinctly marked, or
-more clearly call for the knife, than did this; and had Mr. Key
-refused to use it, he would have deserved the scoff which, by a
-contemporary, has so preposterously been thrown on the "no hernia
-case." But, more than this, the operation was not only justifiable,
-but beyond a doubt _beneficial_--beneficial inasmuch as it at
-once relieved the distress of the patient, secured him from more
-extensive suppuration, from farther sloughing of intestine, and
-probably from extravasation of fæces into the abdomen; rendering
-also the process of reparation more easy and rapid.
-
-
-_Hereditary Hare-Lip._
-
-Dec. 4th, Mr. Key performed the operation for hare-lip on a child
-a few months old, whose case was remarkable only as it afforded an
-instance of _hereditary_ malformation. The father of the child had
-congenital hare-lip, for which no operation had been performed, and
-of his six children _two_ were born with the same malformation.
-
-_Queries._--1. If the father's lip had, in his infancy, been
-restored to the natural form, would the malformation in that case
-have descended to his children?
-
-2. Is the casualty in these cases to be traced _directly_ from
-the father to the incipient embryo, or _indirectly_, through the
-medium of the mother's imagination--It has been said that paternal
-resemblances are produced in the latter mode.
-
-  G.
-
-
-PARIS HOSPITALS.
-
-_Hôtel Dieu._
-
-_Cases of Gangrene of the Lungs._
-
-Some interesting cases of gangrenous suppuration of the lungs were
-published by Dr. Chambers, about eighteen months ago, in which he
-particularly pointed out the horrible fœtor of the breath as a
-diagnostic mark of the disease. The following cases which recently
-occurred at the Hôtel Dieu are good illustrations of more extensive
-destruction of the lung by a similar disease.
-
-CASE I.--A man, aged 32, of good constitution, laboured under
-bronchitis for some weeks, to which he paid little attention,
-when he was suddenly seized with pain in left side, dyspnœa,
-considerable cough, and a rigor, followed by fever. He was admitted
-into the Hôtel Dieu next day. Crepitation was perceptible over the
-whole extent of the left lung, posteriorly, and reaching to the
-site of the pain in the side, which was increased by percussion;
-great oppression, with frequent cough, and expectoration of
-violet-red colour, mixed with mucus; pulse frequent and small;
-constant chilliness; cheeks flushed.
-
-Next day the symptoms remained unabated, and _fœtor of the breath_
-was observed. Two days after it is stated that the expectoration
-maintained the same appearance, but _was now fœtid_; the breath
-was, however, still more offensive, and during the fits of coughing
-particularly so. In the evening the breath is said to have become
-_gangrenous_.
-
-21.--The cough was small, difficult, and painful, producing an
-expectoration of violet-coloured matter, approaching to chocolate,
-_with a characteristic odour_.
-
-22 to 25.--Expectoration and breath emit an _intolerable stench_.
-On the latter day the patient died.
-
-_Examination._--The body not emaciated. Strong adhesions of the
-left lung to pleura costalis. At its posterior part a large
-gangrenous layer, occupying the two superior thirds of the lung,
-covered at some points by a false membrane. The lower third, and
-the parts round the gangrenous portion, in different degrees of
-inflammation, and hepatised; the putrid mass was in great part
-black or violet-coloured, containing fragments of the pulmonary
-texture; the smell gangrenous, but less so than that of the breath
-during life; pus might be squeezed from the adjacent part of the
-lung.
-
-CASE II.--A man, aged 55, enjoyed good health till the beginning
-of May, at which time he experienced pain in the left side of
-the thorax after exposure to cold. During the next few days the
-cough was frequent, and the expectoration tinged with blood. A
-rigor now came on, followed by a distinct exacerbation of fever,
-and he came to the Hôtel Dieu. At this time he presented symptoms
-of inflammation of the lungs, and was bled with relief; he left
-the hospital in twelve days, being sufficiently well to resume
-his occupation. Scarcely had he done this, however, when he had a
-relapse, accompanied by great lassitude, oppression of breathing,
-and frequent cough. At the end of a week he returned. He was now at
-the twenty-first day of the attack. His skin was yellowish; face
-pale or of leaden hue, and greatly altered; his cough frequent,
-with abundant expectoration of matter like chocolate, with small
-specks resembling pus, and little bodies about the size of peas,
-which appeared to be portions of the lung. This putrid mass exhaled
-a _gangrenous odour_, and the expired air was impregnated in a
-high degree with an equally disgusting smell, which surrounded the
-patient's bed with a contaminated atmosphere. Percussion gave a
-clear sound over the whole extent of the chest; auscultation did
-not discover the pulmonary expansion on the right side. The pulse
-was weak, but not frequent; the patient was in a state of extreme
-prostration. Next day the odour of the breath and expectoration
-was, if possible, more dreadful. He lingered two days longer,
-during which time the fœtid smell somewhat diminished, and the
-proportion of pus in the expectoration increased.
-
-_Examination._--The left lung had contracted firm adhesions,
-particularly above and behind. It was torn in attempting to
-remove it, and there issued from the middle and posterior part a
-large quantity of dark-coloured matter, similar to what had been
-expectorated. An incision was made along the back part of the
-lung, and laid open a large cavity, occupying all the extent of
-the pulmonary organ, and still in part filled with the same kind
-of dark putrid matter. On washing out the cavity it was perceived
-that it was lined with a smooth and white membrane, to which were
-still adherent, at some points, dark filamentous shreds; these
-were removed by the least touch, and left the surface smooth
-beneath. The boundary was formed by a false membrane, about a line
-in thickness, which separated the mortified from the sound parts.
-The lung was reduced to a kind of bag, the parietes of which were
-on an average about an inch thick. In the upper part of the lung,
-which was hepatized, an incision discovered a number of smaller
-tubercles, which in the centre were in a crude state; and at one
-point several had suppurated, forming a cavity large enough to
-contain a nut.
-
-[The Editors of the _Journal Hebdomadaire_, from which these cases
-are abridged, add, in a note, that although the fœtor of the
-expectoration, such as above described, is usually dependent on
-gangrene of the lungs, yet that this is not invariably the case.
-In confirmation of this assertion they refer to three instances
-of fœtid expectoration--in the first, the patient is still alive;
-in the second, there was chronic bronchitis, with considerable
-dilatation of numerous bronchi; and in the third, bronchitis with
-some appearances of chronic pneumonia. Laënnec gives a case of
-dilatation of the bronchi, with remarkably fœtid expectoration.
-The argument derived from the first patient having survived we
-consider to be altogether erroneous, as patients more frequently
-recover from this than other forms of purulent expectoration.--ED.]
-
-
-
-
-PROCEEDINGS OF SOCIETIES.
-
-
-WESTMINSTER MEDICAL SOCIETY.
-
-December 6th, 1828.
-
-JAMES ARNOTT, ESQ. IN THE CHAIR.
-
-Pursuant to announcement, Mr. MacKelcan introduced the subject of
-concussion of the brain. After remarking on the several symptoms,
-and mentioning the other affections of the head with which
-concussion is apt to be confounded, Mr. M. directed the attention
-of the society more particularly to the treatment in the stage of
-collapse, adopted by Professor Andrini of Florence.
-
-Dr. Duffin stated, that having been in Florence, he had witnessed
-the employment of three, four, or six ounce bleedings employed
-by the Professor in the stage above-mentioned. The principle on
-which they were used was that of their acting as a stimulus to the
-brain; and really the plan was not apparently attended with any bad
-effects. When re-action has ensued, the practice of M. Andrini is
-the same as that resorted to in this country.
-
-The discussion then wavered between apoplexy and concussion, and
-ended by some good-humoured sparring between Dr. Addison and Mr.
-Gilbert Burnett, on the capability of the brain containing more
-blood at one time than another.
-
-The President announced from the chair that a special meeting would
-take place on Friday evening, December 12, at 7 P.M.
-
-
-December 20th, 1828.
-
-CÆSAR HAWKINS, ESQ. IN THE CHAIR.
-
-After some business had been dispatched, to which we shall allude
-in another place, Mr. Jewel related the particulars of a case of
-"supposed extra-uterine fœtation." The case, which is one of much
-interest, is as follows:--
-
-Mrs. F. a robust, healthy woman, ætatis 27, had been married one
-year, and aborted once; when, in the month of September 1827,
-she quitted her husband in London, and accepted a situation in
-the country. After the expiration of a few weeks she received
-permission to come to London for a day; and, naturally enough,
-passed that night, (November 8th), with her husband, returning
-again to the country next morning. Soon afterwards, the
-morning-sickness, heart-burn, and other sympathetic affections
-of pregnancy, appeared; but the catamenia still returned at the
-regular periods, though scanty and paler in colour than natural.
-She now quitted her situation, returned to her husband, and
-engaged a midwife to attend her in her expected confinement. The
-circumstance of quickening occurred in the latter part of February,
-and was accompanied by a severe paroxysm of fainting, whilst the
-abdomen gradually enlarged, and the motions of the child (as was
-imagined) could not only be easily detected with the hand, but were
-visible to the eye. On the 9th of August, making a period of 274
-days, she was seized with the usual premonitory symptoms of labour;
-the midwife arrived; found her walking her chamber, and concluded
-that the process had considerably advanced. Three distinct uterine
-contractions took place subsequent to the midwife's arrival, the
-last of which was so severe as to compel the patient to grasp
-firmly the back of a chair, and induce, after its subsidence,
-excessive faintness. From this time no further parturient effort
-was made; no examination per vaginam was instituted; neither was
-there noticed any sanguineous vaginal discharge. When Mr. Jewel saw
-her, examination detected nothing unusual in the os uteri, and the
-symptoms she presents are these. The abdomen is about the size of a
-woman's in the sixth or seventh month of pregnancy, the enlargement
-being general. Her general health is much disturbed: she complains
-of pain in the left hypogastric region, particularly when the
-abdomen is compressed by the hand or stays--and she also complains
-of weight in the abdomen, especially on leaning forwards. The woman
-herself has a strong prepossession that "something is to come
-away," or that she might be relieved by an operation. The woman
-believes that she still feels the motions of the child, though
-feebly.
-
-Having read this case, Mr. Jewel concluded by offering some
-observations on the subject of extra-uterine fœtation. He
-considered this as probably an instance of "graviditus
-abdominalis," and remarked that the uterus not having expelled its
-dezidua, was no conclusive proof to the contrary, Dr. Blundell and
-Mr. Langstaff having examined cases where this was wanting.
-
-Dr. Locock never saw a case where laceration occurred in the
-early months of pregnancy. Dr. L. remembered the particulars
-of a case where the uterus was lacerated in the fourth month,
-and the ovum escaped into the cavity of the abdomen, and the
-symptoms of pregnancy were exceedingly strong. Dr. Locock almost
-doubted whether Mr. Jewel's was an instance of pregnancy at all,
-for frequently women enjoying sexual intercourse have enlarged
-abdomens, and many of the other symptoms of pregnancy, which a few
-doses of purgative medicine will remove.
-
-Two remarkable instances of extra-uterine fœtation were related
-by Mr. Burnett and Mr. Cæsar Hawkins; and towards the conclusion
-of the evening the discussion turned on the powers of the ergot
-of rye. Dr. Locock had frequently tried it in amenorrhœa, and, on
-the whole, without any very good effects. In one remarkable case,
-where the lady particularly wished to have children, Dr. Locock
-having boiled an ounce of the ergot in a pint of water down to half
-a pint, gave an ounce and a half of this decoction three times a
-day. After the young lady had taken about half a pint, the most
-violent convulsions succeeded, which placed her life in imminent
-hazard, and from which it was long before she completely recovered.
-She menstruated twice after that, but then the discharge again was
-arrested, and has never since returned, nor has she become pregnant.
-
-The practice of "bougieing the uterus" in cases of dysmenorrhœa
-was brought upon the tapis, and excited a good deal of laughter,
-the members appearing to consider the proposal ridiculous in the
-extreme.
-
-
-MR. LAMBERT.
-
-At the last meeting of this Society it was proposed, on the
-recommendation of the Committee, that Mr. James Lambert should be
-expelled; and after some discussion it was agreed that the sense
-of the members should be taken by ballot at the next meeting,
-Saturday, January 3, 1829. It was thought that proceeding at
-once to his expulsion might give the appearance of the measure
-originating with a party, and that the delay would enable the
-deliberate judgment of the whole Society to be passed upon his
-conduct.
-
-
-HUNTERIAN SOCIETY.
-
-Dec. 10, 1828.
-
-DR. BILLING, PRESIDENT, IN THE CHAIR.
-
-Mr. Leese, Jun. exhibited to the meeting a specimen of medullary
-sarcoma, taken from the forehead of a man after death, with a
-portion of the os frontis. The man was fifty-eight years of
-age, long asthmatic, and appeared to die of hydrothorax. He
-never suffered any pain in the tumor, but expressed a sense of
-distention. It was immoveable at the base, and there were some
-fissures in the os frontis, from caries. The dura mater at the
-corresponding part adhered firmly to cranium, and on its being
-removed some spiculæ from the carius inner table remained adhered
-to it. There had never been any symptoms of cerebral affection. A
-tumor of the same nature had formed on the scapular extremity of
-the clavicle, and had occasioned anasarca of the limb.
-
-Mr. Key supposed that the tumor had originated from the diplöe,
-and believed that the only chance of relief in such a case
-would be trephining; but he acknowledged that there was little
-encouragement to operate in these cases, owing to the tendency of
-the disease to return in some other part. He related an instance
-of the true medullary fungus taking its origin from the cancellous
-structure of the os femoris. The limb was removed, but the patient
-died. A circle of fungoid glands was observed at the base of the
-heart, and some of the bronchial glands were in the same condition.
-
-Dr. Conquest expressed his belief that carcinoma was always a
-constitutional affection, and stated that at least in nine cases of
-cancer uteri out of ten, there was carcinomatous affection of the
-pylorus, mesenteric glands, or liver.
-
-Mr. Key and Dr. F. Ramsbotham had not observed, in their
-examinations, the coincidence noticed by Dr. Conquest.
-
-The remainder of the evening was occupied by a discussion on the
-different kinds of ulceration that occur about the os and cervix
-uteri, and the circumstances under which the removal of the uterus,
-or the amputation of the cervix, may be warrantable.
-
-Dr. Babington adverted to the occasional existence of a family
-disposition to carcinoma. He had known three sisters successively
-die of cancer in the breast.
-
-
-MEDICAL SOCIETY OF LONDON.
-
-Dec. 13th and 20th, 1828.
-
-DR. HASLAM IN THE CHAIR.
-
-The subject of discussion, at the first of these meetings, was
-stricture of the rectum, when the diagnosis and treatment of
-carcinoma of that part came under consideration. There was a
-remarkable discrepancy in the opinions of Messrs. Lloyd and Salmon
-as to the symptoms and management of carcinomatous affections of
-the rectum. Mr. Lloyd maintained that these affections of the
-intestine were sometimes attended with pain and sometimes not, and
-that the patients were often materially benefited by the use of
-bougies; while Mr. Salmon affirmed, that the disease was always
-painful, and not to be mitigated by the employment of these means.
-
-A variety of subjects came before the society at the next meeting.
-The president read a letter from Mr. Wansborough, of Fulham,
-describing the "original stomach-pump," a specimen of which
-accompanied the letter: the instrument Mr. W. stated to be of 25
-years' standing.
-
-Mr. Shearly exhibited, among other morbid specimens, a uterus,
-on the external surface of which the disease termed the "white
-tubercle" was in progress: there was also a small polypus near the
-os uteri. Mr. Pereira exhibited to the society a fine specimen of
-medullary sarcoma of the liver. The organ was so enlarged as to
-have occupied two-thirds of the abdomen. The other viscera were not
-involved in the disease. The progress of the disease, as far as
-it could be ascertained, was excellently detailed by Mr. Smith, a
-visitor. The symptoms were obscure.
-
-Mr. Armstrong read an extract of a letter from Mr. Morgan, of
-the Bristol Infirmary, a corresponding member of the Society,
-describing a curious conformation of the œsophagus in a child,
-which lived 106 hours only, during which period every attempt to
-swallow food produced considerable distress. The œsophagus was
-found to be divided into two portions; the upper or pharyngæal
-extremity terminating in a _cul de sac_ behind the bifurcation of
-the trachea; and the lower or ventricular extremity arising from
-the trachea at this point, between the bronchi, proceeding down the
-spine, and terminating, as usual, at the cardiac orifice of the
-stomach. Mr. Drysdale mentioned a somewhat similar malformation
-occurring in two children in one family. Mr. Callaway related a
-case of concussion of the brain, which terminated fatally, after
-the restoration of the intellectual functions. The whole of the
-anterior lobes of each hemisphere of the brain was broken down, and
-mixed with effused blood. The remarkable feature of the case was,
-the return of consciousness, and the possession of this power for
-six days, under the disorganization of the brain described; and the
-questions particularly agitated were, Did this extent of mischief
-exist immediately after the concussion? What was the degree of
-laceration of the brain at that period? and, How could the recovery
-of the intellectual faculty be reconciled with so much injury of
-the brain?
-
-The Society then adjourned to the 12th of January, 1829.
-
-
-
-
-COOPER _v._ WAKLEY.
-
-
-Notes of the Cause, Cooper _v._ Wakley--We understand that Mr.
-Cooper is about to publish a verbatim account of the above trial,
-from Mr. Gurney's short-hand notes.
-
-
-
-
-ERRATA.
-
-
-The Advertisement of Mr. B. Cooper's, in our last Number, ought
-to have been dated "_December_ 15," instead of "_Oct._ 15." Also,
-for "_Mr. Elton_," the name of one of Mr. Cooper's witnesses, read
-"_Mr. Hilton_."
-
-In our last leading article, _for_ "can no friend of Wakley be
-named?" _read_ "can the name of no friend of Wakley be mentioned?"
-The alteration is necessary, to connect it with the conclusion of
-the paragraph.
-
-
-W. WILSON, Printer, 57, Skinner-Street, London.
-
-
-FOOTNOTES:
-
-[1] General thickening of all the valvular apparatus on both sides
-of the heart. (St. B. 33.)
-
-[2] Andral, vol. iii. p. 411.
-
-[3] Pl. 1, fig. 5.
-
-[4] Opacity and thickening of the lining membrane on both sides of
-the heart, without unevenness or alteration of form. (St. B. 33).
-
-Opacity and thickening in the valvular apparatus between the left
-auricle and ventricle, with shortening of the chordæ tendinæ, and
-such alteration of structure and form as to produce a considerable
-contraction of the aperture. (St. B. 26).
-
-Such thickening of the whole valvular apparatus as to narrow the
-aperture of communication between the left auricle and ventricle to
-a mere slit. (St. B. 19).
-
-Shrivelled and contracted state of the semilunar valves, in which a
-cartilaginous substance has entirely taken the place of the natural
-structure. (Hodgson, pl. 1, fig. 6).
-
-[5] Osteum aortæ almost closed by ossified valves. (St. B. 15);
-(Hodgson, pl. 1, fig. 2).
-
-[6] Fungus growing from the aortic valves, which are thickened and
-shortened. (St. B. 6, 20).
-
-Fungus form the aortic valves, which are ulcerated. (St. B. 21).
-
-Larger specimens of fungus, growing from the ulcerated edges of two
-of the valves of the aorta. (Hodgson, pl. 1, fig. 7).
-
-[7] Dr. Baillie's plate.
-
-[8] Polypous coagulum in the ventricle. (Coll. of Phys. 4, A. 16).
-
-Coagulum firmly attached to the lining of the left auricle, with
-enlargement of its capacity. (St. B. 19).
-
-[9] (St. B. 13).
-
-[10] It occurs sometimes in the uterus.
-
-[11] Memoir. de l'Acad. des Sciences. Morand, 1732. Morgagni,
-Epist. 27.
-
-[12] Andral, v. 3, 466; Hodgson, plate 1, figure 7; St. B. 14.
-
-[13] Corvisart, cap. 4. sect. 1.
-
-[14] Active dilatation of the left ventricle. (College of Phys. 4,
-c. 10.)
-
-The thickened walls of the left strikingly contrasted with the
-attenuated walls of the right ventricle. (St. B. 9).
-
-Active dilatation of the left ventricle. Its capacity is strikingly
-contrasted with that of the right. (College of Phys. 4, c. 11.)
-
-Passive dilatation of both ventricles, especially of the right.
-(St. B. 10).
-
-[15] Morgagni, Epist. xxvii. 7.
-
-[16] Ibid. 2.
-
-[17] Ibid. 3.
-
-Rupture of the left ventricle, with attenuation of its muscular
-structure. (St. B. 18).
-
-Rupture, without attenuation, but with softening and looseness of
-texture in the muscular substance. (St. B. 22).
-
-[18] Harvey, Exercit. altera.
-
-[19] Rupture of the left ventricle without change in its structure.
-Bone deposited at the commencement of the aorta. (St. B. 27).
-
-In turning over the Memoirs of the Royal Academy of Sciences, I
-find two cases of rupture of the heart, reported by M. Morand. They
-both occurred in the year 1730; and, strange to say, one was that
-of a Duchess of Brunswick, who was of the same family as George II.
-who also died of a ruptured heart. In the one, that of the Duchess,
-there was a manifest ulceration through the walls of the right
-ventricle, its structure being otherwise unimpaired; in the other,
-where the aperture was in the left ventricle, there was probably
-a simple rupture, for the flesh of the heart was so soft that the
-point of a probe would pass through it wherever it was rested.
-(Mem. de l'Acad. Roy. des Sciences, Ann. 1732).
-
-[20] The trial as published in the Lancet occupied less than 21
-pages--in the Gazette it extended, in the same type, to 33 pages
-and a half. In the Lancet, those parts, both of the evidence and
-speeches, which told most against Wakley, were omitted.
-
-[21] See passage in Italics, page 137.
-
-[22] The defendant, on leaving the court, was cheered by the
-populace in Palace Yard.--Lancet, Dec. 20.
-
-[23] This we believe is false; nothing of the kind either occurred,
-or was stated at the trial.--E. G.
-
-
-
-
-  TRANSCRIBER'S NOTE
-
-  Obvious typographical errors and punctuation errors have been
-  corrected after careful comparison with other occurrences within
-  the text and consultation of external sources.
-
-  Except for those changes noted below, all misspellings in the text,
-  and inconsistent or archaic usage, have been retained.
-
-  Pg 116, 'immedate contact' replaced by 'immediate contact'.
-  Pg 119, 'and attennuation in' replaced by 'and attenuation in'.
-  Pg 126, 'Tue valuable paper' replaced by 'The valuable paper'.
-  Pg 132, 'probably impossibly' replaced by 'probably impossible'.
-
-
-
-
-
-End of the Project Gutenberg EBook of The London Medical Gazette; December
-27, 1828, by Various
-
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+*** START OF THE PROJECT GUTENBERG EBOOK 53450 ***
+
+  TRANSCRIBER'S NOTE
+
+  Italic text is denoted by _underscores_.
+
+  The 'Apothecary System' of measurement was used in the original text.
+  The etext uses the following Unicode symbols:
+      ℞      Prescription symbol
+      ʒ      Dram
+      ℥      Ounce
+      ℳ      Scruple
+  Roman numerals, and 'ss.' for 'half', are retained, so for example
+  '℥iss.' indicates 'one and a half ounces'.
+
+  Obvious typographical errors and punctuation errors have been
+  corrected after careful comparison with other occurrences within
+  the text and consultation of external sources.
+
+  More detail can be found at the end of the book.
+
+
+
+
+  THE
+  LONDON MEDICAL GAZETTE,
+
+  BEING A
+  WEEKLY JOURNAL
+  OF
+  Medicine and the Collateral Sciences.
+
+  SATURDAY, DECEMBER 27, 1828.
+
+
+
+
+PATHOLOGICAL ESSAYS
+
+ON SOME
+
+DISEASES OF THE HEART;
+
+_Being the Substance of Lectures delivered before the College of
+Physicians_,
+
+BY P. MERE LATHAM, M.D.
+
+Physician to St. Bartholomew's Hospital.
+
+[Continued from p. 7.]
+
+
+ESSAY II.
+
+_Morbid Anatomy of the Internal Lining Membrane of the Heart._
+
+The membrane which lines the cavities of the heart is very liable
+to disease, but not equally so in every part. Where it is thin
+and transparent, and admits the colour and character of the
+muscular structure upon which it is spread to be seen through it,
+it is seldom found diseased; but where it is of a denser texture,
+either in itself or from an admixture of other structures, whether
+cellular or fibrous, with its own, it is frequently, and often
+exclusively diseased. This latter character of a denser texture
+belongs to it where it forms the tough white circles which surround
+the apertures of communication between the auricles and ventricles;
+also where it is reflected upon itself, and forms the loose
+duplicatures of membrane, which are given off, as it were, from
+the internal surface of the heart, either at the fibrous circles
+intermediate between the auricles and ventricles, constituting the
+tricuspid and the mitral valves, or at the commencement of the
+pulmonary artery and aorta, constituting the semilunar valves.
+
+It is remarkable how curiously disease is apt to limit itself to
+the spaces just pointed out. Of the fibrous circle between the
+auricle and ventricle, of the valves which originate from it, and
+of the tendinous cords which connect the valves with the carneæ
+columnæ, there will not be the smallest space free from disease;
+but the disease will abruptly stop where the tendinous cords cease
+and the carneæ columnæ begin[1].
+
+The membrane, however, where it covers the fleshy columns of the
+heart, is not exempt from the possibility of disease: but when
+disease actually affects it, it has seldom originated there,
+but has generally spread from other parts of the same membrane,
+although (as we have just remarked) it is apt to stop short before
+it reaches this.
+
+Of the two sides of the heart, the membrane which lines the left is
+unquestionably the more liable to disease. But my own observation
+would never have led me to conclude that the membrane of the right
+side was so far exempt as it is commonly thought to be. Speaking
+from the best recollection I have of the specimens which have
+fallen under my examination, I should say that, in one-third of the
+cases where disease has been found on the left side, it has existed
+on the right side also, and been essentially of the same character.
+But there has been a remarkable difference in the extent to which
+it has proceeded on each side respectively: while on the left it
+has gone so far as to be the undoubted cause of death, on the
+right, although essentially of the same character, it has been only
+just beginning.
+
+It very seldom happens that disease appertains to the lining of
+the right cavities of the heart exclusively; and, where it affects
+both, the disease in the right cavities is very seldom found in
+advance of that in the left.
+
+It should seem, indeed, according to the ordinary course of things,
+that disease does not begin in the lining of the right cavities of
+the heart, until it has already advanced to an extreme degree in
+the left.
+
+The internal lining of the heart, as well as of the arteries, is
+often found to have become of a red colour. This redness, so well
+known to all who are accustomed to examine dead bodies, used to be
+regarded as a mere stain imparted to it by the colouring matter
+of the blood after death. Yet a due consideration of various
+circumstances connected with it will hardly warrant this conclusion.
+
+It has been found whether the heart or artery be full or empty of
+blood; and if blood be present it has been found, whether it is
+liquid or clotted; and if it be clotted, whether it does or does
+not retain its colouring matter. External temperature, and length
+of time between the death of the patient and the dissection of his
+body, have not made any difference in the frequency with which
+this peculiar appearance occurs. Lastly, no artificial methods,
+such as washing of any kind, can get rid of it; nor will inclosing
+blood within an artery for any period produce it[2]. This simple
+redness is sometimes seen universally in both sides of the heart
+and throughout the whole arterial system, and sometimes in patches
+only, of greater or less extent, whether in the arteries or in the
+heart.
+
+Now, when all these circumstances are considered, although in some
+instances it may be a mere stain imparted by the colouring matter
+of the blood after death, it is plainly impossible that it should
+be of that nature in any large proportion of the numerous instances
+in which it is found.
+
+But if the appearance in question implies (as I believe it
+generally does) a morbid condition, of what kind is that condition?
+There are the same objections to considering mere redness as
+equivalent to inflammation here as in the pericardium, or in any
+other part of the body: here, as elsewhere, in one case it may
+be the condition out of which inflammation is to spring; while in
+another it may not be destined to give origin to any change in the
+structure of the part beyond itself, and may itself constitute the
+whole disease.
+
+It appears to me, that this mere redness of the internal lining
+of the heart and arteries has become a matter of undue perplexity
+to pathologists, because they have laboured to infer from it
+more than the simple fact itself will authorize. All I wish to
+establish concerning it is, first, that it is not always (probably
+very seldom) a mere stain imparted by the colouring matter of the
+blood after death; secondly, that it alone does not constitute
+inflammation.
+
+It may not be improper to mention the circumstances under which
+it has occurred to myself to find it. I have met with it most
+frequently, and to the largest extent, in subjects whose previous
+disease has produced a constant and habitual impediment to the
+transmission of blood through the heart and through the lungs,
+and that impediment has gone on increasing to the hour of their
+death; also in those, whatever might have been the nature of
+their disease, whose dissolution (I mean the actual process of
+dying) has been tardy and agonizing, and marked by great labour of
+respiration; in the apoplectic, for example, in whom, after sense
+and consciousness were extinct, life had been protracted, with
+stertorous breathing, for many days.
+
+In such subjects the countenance, the lips, and the whole skin,
+give evidence during life of blood pushed beyond the natural sphere
+of the circulation, and detained in the extreme blood-vessels.
+Hence it is obvious that the causes which have loaded and distended
+the capillaries in every part of the body have had a like influence
+upon the vasa vasorum.
+
+I do not mean to say that I never met with this peculiar condition
+of the heart and arteries under other circumstances, or that
+other causes may not produce it; but that I am not acquainted
+with it under any other with which, from frequent coincidence, it
+has seemed to have a natural connexion, or which have afforded a
+reasonable explanation of the phenomenon.
+
+This condition of the heart and arteries, considered as
+inflammation, has been assigned by some as the cause of fevers
+of the more malignant kind. The frequency with which it has been
+found in some particular epidemic, must have led to the conclusion.
+But, however this may be, from my own observation, not restricting
+myself to the fever of any particular season, but taking into
+account all complaints called febrile, and belonging to all
+seasons, also from the result of inquiry among medical men who
+have had large acquaintance with morbid dissections, and from the
+experience of those who have made this particular point a subject
+of investigation (Laënnec and Andral) I venture to conclude that it
+has no essential connexion with fevers of any kind, either as cause
+or as effect.
+
+On some occasions the internal membrane of the heart and arteries,
+wherever it exhibits the appearance described, will allow itself to
+be peeled off from the subjacent structure with the least possible
+force; this facility of separation ceasing entirely beyond the
+boundary of the red tinge.
+
+Here unquestionably is further evidence of a diseased condition:
+but of what nature? Most pathologists would consider this to be of
+the nature of inflammation--and I believe justly.
+
+There is indeed much difficulty in pronouncing upon the nature of
+minuter changes of structure detected in the internal parts of the
+body after death. We are obliged to arrive at conclusions by help
+of analogies drawn from morbid processes, which we have watched in
+their progress during life, upon the external surfaces; for during
+life we have the functions and sensibilities of the part to aid us
+in forming a right judgment concerning its disease. When, during
+life, one tissue is separated from another, as the periosteum from
+the bone, or the cuticle from the skin, or the mutual cohesion
+between different tissues is sensibly weakened, we find it to be
+owing to the intervention of serous fluid which does not belong to
+their healthy state; and this, together with increased vascularity,
+or redness and heat, and pain, is enough to bespeak the presence
+of inflammation. All these conditions cannot remain after death.
+Hence, if we desire to form positive opinions concerning much
+which is unfolded by dissection, we must supply the defect by
+analogy. Thus, whenever, in any part of the heart or arteries,
+the cohesion between the internal membrane and the subjacent
+structure is manifestly lessened, and the membrane is unusually red
+at that part, we may regard these appearances as the vestiges of
+inflammation, without thinking that we go too far in so regarding
+them.
+
+The internal lining of the heart and arteries is often found red
+solely in the neighbourhood of ulcerated spaces, when there can be
+no doubt concerning the existence of inflammatory action.
+
+But the internal lining of the heart and arteries gives the most
+unequivocal evidence of its inflammation when it is found of a deep
+red colour, with coagulable lymph adhering to its surface. This
+condition is represented, as it was found in the aorta, in one of
+the beautiful plates, illustrative of the diseases of arteries, by
+Mr. Hodgson[3]. And the same condition, in the heart, I have seen
+in a preparation of Dr. Farre's, where lymph is deposited, upon the
+circular zone, which forms the aperture of communication between
+the left auricle and ventricle. These appearances denote the most
+acute inflammation: they are, I suspect, very rarely met with. In
+the few instances in which I have heard of them, they have been
+found where death has taken place after short and severe suffering,
+and with symptoms which characterize inflammation.
+
+But the specimens of disease most frequently met with in the
+internal lining of the heart, consist in an entire change of its
+natural structure, and in the formation of new products upon it or
+within it. Many of these, from the analogy of morbid actions in
+other parts of the body, must be considered to result from chronic
+inflammation.
+
+In any of those situations which have been stated as especially
+liable to disease, the membrane will become thick, tough,
+inelastic, puckered and shrivelled; and cartilage or gristle, and
+bone, will enter into its structure; excrescences will sprout out
+from it, resembling warts and fungus; and it will become ruptured
+and ulcerated.
+
+Cartilaginous depositions are often found beneath the membrane
+where it is single; or between its folds where it is double, in
+the situation of the valves; and thus they seem rather to belong
+to some structure contiguous to the membrane than to the membrane
+itself. Such depositions will proceed to a considerable extent,
+while the membrane still remains free from disease. From a valve,
+which has been thick, opaque, and cartilaginous, I have seen the
+membrane separated on both sides, and transparent; the opaque and
+cartilaginous matter being left behind. Where, in cartilaginous
+depositions, the lining of the heart has become puckered and
+uneven on its surface, and the valves shortened and altered in
+their shape, the membrane itself participates in the disease,
+and is generally incapable of being separated from the subjacent
+structure. But great thickening may take place in the situation of
+the valves, from deposition of cartilage, without any unevenness
+of their surface or alteration of their shape; and under these
+circumstances the membrane itself you may expect to find hitherto
+exempt from disease[4].
+
+Osseous depositions are always, I believe, originally formed
+beneath, or exterior to, the membrane, both in the heart and in
+the arteries. There are two circumstances especially worthy of
+remark in this process of ossification: sometimes it is a pure and
+unmixed process: bone is formed, and nothing else. It is deposited
+in minute granules, or little brittle scales, or in plates of a
+larger size; and the intermediate spaces, whether in the heart or
+arteries, preserve their natural and healthy appearance. At first,
+these granules or scales, or plates of pure bone, are covered by a
+delicate pellicle, which is in fact the internal membrane of the
+heart or artery, separating them from the immediate contact of the
+circulating blood. But in process of time, as they increase in
+size, and become rough and unequal on their surface, they cause a
+rupture of the internal membrane, and have now nothing to separate
+them from the immediate contact of the blood[5].
+
+Sometimes ossification is a mixed process, or rather, I suspect,
+the result of another morbid process preceding it. With the
+cartilaginous depositions already described there is an admixture
+of bone. The quantity of bone generally bears a very small
+proportion to the cartilage when they both occur together, as if
+the bone proceeded from the cartilage, and not the cartilage from
+the bone. It is sometimes seen growing from the surface of the
+cartilage, and is sometimes deposited in its substance, and only
+detected by the knife.
+
+Simple ossification, as it occurs in the heart and arteries, has
+been classed among the natural changes which the parts in question
+are liable to undergo after a certain period of life. Of persons
+above the age of sixty years the proportion is that of seven in ten
+according to Bichât, in which ossification is discovered in some
+part of the arterial system. It very rarely happens that simple
+ossification is found before the period of old age: still it is
+difficult not to regard it as a morbid process.
+
+But ossification, when it is a mixed process, is unquestionably
+the result of disease. It is met with at all periods of life; and
+probably constitutes one of the terminations of inflammation. The
+kind of morbid structures with which the bone is united leads to
+this belief.
+
+Fungous, and wart-like excrescences, are found in all those parts
+of the internal lining of the heart, which have been already
+mentioned as most subject to disease. They seem to be the result
+of a new morbid action set up in parts already disorganized; for
+I have not met with them where the membrane has been otherwise
+healthy, but only where it has been thickened or cartilaginous, or
+ossified, ruptured, or ulcerated. They grow either from the surface
+of the membrane, or from its ruptured or ulcerated edges, and are
+always in immediate contact with the circulating blood[6].
+
+According to my observation, when a fungous or warty excrescence
+has grown from the ruptured edges of the membrane, it has been from
+them exclusively, and from no other part of the lining of the same
+heart. And as rupture of the membrane seldom occurs in more than
+one situation at a time, the heart of the same individual seldom
+presents more than one excrescence of this kind: and as the aortic
+valves are the parts most liable to rupture, it is there that this
+single excrescence is most frequently found; not that rupture may
+not take place elsewhere. I once saw a single _chorda tendinea_
+ruptured; and a single fungous excrescence of considerable size
+hanging from it into the cavity of the left ventricle.
+
+Now, this morbid growth is evidently connected with the lacerated
+state of the membrane in the conditions of its production, whereby
+it is limited to a small space.
+
+It is probable that the membrane is first ruptured; that its
+lacerated edges inflame, and then throw out unhealthy lymph, or
+unhealthy granulations, in the shape of these fungous or wart-like
+excrescences. When they have sprung from a ruptured membrane, they
+have, in the specimens which I have examined, been larger than when
+they have arisen under other conditions.
+
+But when such excrescences grow from the surface of the membrane
+which is thickened and cartilaginous only, but not lacerated, they
+are more apt to occur in many parts of it at the same time. I have
+seen the valvular apparatus between the auricles and ventricles on
+both sides, as well as the aortic valves of the same heart, studded
+with them. They were all about the size of hemp seeds: they adhered
+to the membrane with different degrees of tenacity, and wherever
+they were capable of being detached, they left a rough surface.
+The lining of the arteries has been known to give origin to morbid
+growths of the same kind, which have obstructed the passage of
+blood, and given occasion to the formation of a coagulum, which has
+obliterated the pulse.
+
+The internal lining of the heart is liable to ulceration, not as
+a common consequence of simple inflammation, but as an occasional
+consequence of some of those diseased conditions which have been
+described.
+
+It is most commonly found around scales and spiculæ of bone, and
+under such circumstances as to leave no doubt that the bone itself
+has furnished the source of irritation from which it springs. The
+ulceration commences from the very border of the bony scale, as if
+it was a process of nature for detaching it, and to a considerable
+distance around the ulceration the membrane is reddened, and easily
+detached from the subjacent structure. Where there are several
+distinct scales of bone, it is not uncommon to find a circle of
+ulceration around each of them.
+
+Ulceration is also met with where there is a thickened and
+cartilaginous state of the membrane without ossification. Under
+these circumstances, as far as I know, it affects no definite form.
+It is often a very destructive process of disease, obliterating
+large portions of the valvular structure, and penetrating deep into
+the muscular substance of the heart.
+
+Rupture of the internal lining of the heart is not easily
+distinguished from ulceration. In collections of morbid anatomy,
+many unquestionable specimens of ulceration are described as
+specimens of rupture. Rupture must always be looked for in the
+valvular apparatus of the heart, _i. e._ in the valves themselves,
+or in the chordæ tendineæ which are their appendages. It is
+probably incapable of taking place elsewhere, except as a part of a
+rupture, which involves the whole organ.
+
+That solution of continuity which is evidently without loss of
+substance; that of which the separated edges when they are brought
+together are completely adapted to each other; also that which
+is unaccompanied by any thickening or other morbid condition of
+the valve; the solution of continuity which is found under these
+circumstances, may safely be considered to proceed from rupture,
+and not from ulceration[7].
+
+But it is probable that these characteristic conditions do not long
+remain after the occurrence of the rupture. Complete specimens of
+them are very rare; but specimens are numerous where the solution
+of continuity, by its form and direction, bespeaks rupture, while
+its rounded edges and the general thickening of the valve denote
+ulceration. These, it may be fairly conjectured, do in fact exhibit
+a compound of both. The membrane was originally ruptured, but
+disease has subsequently arisen and obscured the character of the
+mechanical injury.
+
+The greater number of those concretions, which were regarded by
+the older anatomists as polypi of the heart, were unquestionably
+portions of mere blood, which had undergone coagulation after
+death. The blood remaining in the heart after death discharges
+itself of its colouring matter as it coagulates, and, giving off
+processes between the muscular fasciculi, assumes a shape which has
+suggested the name of polypus[8].
+
+I have often found (I presume, therefore, that it is not an
+uncommon occurrence) coagula of an irregularly laminated texture
+having their colouring matter not entirely discharged, but
+unequally distributed through them, which have been most intimately
+adherent to some part of the lining of the heart. Of these some
+have admitted of separation, while the surface of the membrane and
+the surface of the clot were left rough at the place of contact,
+and others were incapable of being detached without the membrane
+being detached along with them. The appendix of the left auricle is
+a situation in which they are apt to occur, and they are generally
+accompanied by an extensively diseased condition of the lining
+membrane. These coagula, from their laminated texture, and from
+the intimacy of their union with the internal lining, seem to be
+essentially different from polypi of the heart. They appear to be
+connected with a process of disease in the membrane, and to have
+obtained their union with it long before the death of the patient.
+
+I once saw two separate tumors, entirely resembling what are called
+polypi, between the carneæ columnæ of the left ventricle, and
+firmly adherent to the heart; and in the centre of each a distinct
+formation of pus. The heart was otherwise healthy[9].
+
+There are three preparations in the museum of the College of
+Surgeons, put up by Mr. Hunter himself, and noted by him as
+exhibiting "Tumors on the inner surface of the right ventricle,
+seemingly composed of layers of coagulable lymph one upon another,
+the central part having the appearance of glary mucus." This last
+appearance (the mucus) no longer remains in any of the three, but
+in its stead there is a cavity. The tumors which I have mentioned
+as originally containing in their centre a distinct formation
+of pus, also now present in its stead a cavity. The preparation
+preserved at St. Bartholomew's, and those at the College of
+Surgeons, are probably specimens of the same disease.
+
+Here what in the recent parts seemed to be pus or glary mucus, and
+the cavities still remaining in the preparations, must suggest the
+suspicion, that these tumors, whether they grew from the surface or
+were deposited from the blood, had become organized, and afterwards
+inflamed; and that the inflammation had terminated in the formation
+of an abscess.
+
+
+
+
+ESSAY III.
+
+_Morbid Anatomy of the Muscular Substance of the Heart._
+
+Dr. Baillie, speaking of inflammation of the substance of the
+heart, says, "When the pericardium covering its surface is
+inflamed, the inflammation sometimes passes a little way into
+the substance of the heart:" and then he gives these as the
+characteristic marks of such inflammation--that "it (the substance
+of the heart) becomes much more crowded with small vessels than in
+its natural state, and there are sometimes to be seen a few spots
+of extravasated blood." Now, this undue vascularity, and these few
+extravasated spots, where inflammation unquestionably belongs to
+a contiguous structure, may be deemed sufficient evidence of the
+muscular substance of the heart participating, or beginning to
+participate, in the same disease; but, absolutely and exclusively,
+it may be doubted whether more is not required to give a certain
+assurance of its inflammation. Here, as elsewhere, we must look
+for some of the proper products of inflammation; or for some of
+the permanent changes of texture which naturally result from it,
+according to its several modes of disorganizing.
+
+It is a very rare event to find pus among the products of
+inflammation of the substance of the heart: yet this event has
+occurred twice to my observation. In one instance the whole heart
+was deeply tinged with dark-coloured blood, and its substance
+softened; and here and there, upon the section of both ventricles,
+innumerable small points of pus oozed from among the muscular
+fibres. This was the result of a most rapid and acute inflammation,
+in which death took place after an illness of only two days. In
+another instance, after death, which terminated an illness of
+long duration and characterized by symptoms referable to the
+heart, a distinct abscess was found in the substance of the left
+ventricle, closed externally by a portion of adherent pericardium,
+and connected internally with an ossified portion of the lining
+membrane.
+
+This diffusion of pus, or rather its formation in innumerable
+separate points, throughout the muscular structure of the heart, by
+a rapid and acute inflammation, is a singular occurrence. No such
+case has ever fallen within the knowledge of the most experienced
+in morbid anatomy, of whom I have made inquiry; neither has any
+such (as far as I can learn) been recorded in books[10].
+
+A single collection of pus[11], constituting an ulcer or abscess of
+the heart, and resulting from chronic inflammation, is also a rare
+occurrence, yet not so rare but that a specimen of it may be found
+in most collections of morbid anatomy[12].
+
+But independent of the formation of pus, softening and attenuation,
+as well as induration and thickening of the muscular substance of
+the heart, do, in different cases, according to the circumstances
+under which they are found, both bespeak inflammation.
+
+Together with the unequivocal evidence of inflammation in other
+parts of the heart, the muscular fibres have at the same time been
+found very soft and loose, and easily torn; and with this looseness
+of texture the heart has sometimes presented a dark and almost
+black appearance, and sometimes it has been almost blanched and
+colourless. The deep dark tinge shews that the muscular substance
+is unnaturally loaded with blood; whereas the absence of colour
+shews that it is destitute of its natural quantity. These different
+appearances do, in fact, belong to different stages of the same
+disease. The first indicates inflammation of the muscular substance
+in its present state of activity; the second, an irreparable
+disorganization of the muscular substance left by inflammation,
+when it has been unarrested in its earliest stages. The first is
+found when death takes place _in a few days after_ the accession
+of the disease; the second, when the patient survives the first
+attack, and dies at a remoter period.
+
+The inflammation, which produces softening and attenuation of the
+muscular structure, is, I believe, always of an acute kind.
+
+But induration and thickening of the muscular substance of
+the heart is also the result of inflammation. This must be
+distinguished from hypertrophy, or mere augmentation of bulk, of
+which we shall speak hereafter. In this induration, which proceeds
+from inflammation, there is, besides increase of bulk and firmness,
+a manifest alteration of texture. A substance[13] is produced
+offering a peculiar resistance to the knife. This condition
+unquestionably must result from an interstitial deposition of new
+matter among the muscular fibres. From concomitant circumstances,
+as well as from its own character, I presume that it proceeds
+from chronic, not from acute inflammation. I confess that I never
+saw a specimen of what I now allude to. It is described with some
+minuteness by Corvisart; but it may be presumed to be very rare,
+since Laënnec admits that it never fell under his observation.
+
+These opposite states of softening and attenuation in one case, and
+induration and thickening in another, are known to those conversant
+with morbid dissection as the evidences of inflammation in other
+parts of the body besides the muscular substance of the heart.
+
+But there are changes of structure incident to the muscular
+substance of the heart which are independent upon inflammation,
+or, perhaps, upon any process which can properly be called morbid.
+They consist of simple augmentation and simple diminution of bulk
+and consistence. This simple augmentation of bulk and consistence
+is owing exclusively to a more ample development of natural
+structure. The muscular substance is more red than natural, its
+carneæ columnæ are increased in thickness, and its proper fibrous
+texture is every where more strikingly manifest; but there is no
+interstitial deposition of matter new in its kind. It has been
+called hypertrophia of the heart, and the name conveys a tolerably
+just idea of its actual condition.
+
+The simple diminution of bulk and consistence is a condition the
+exact opposite of the former. The muscular substance is less red
+than natural; its proper fibrous texture less distinguishable; but
+there is still the appearance of muscle shrunk and withered, as
+if from an insufficient supply of nourishment. It may be called
+atrophia of the heart.
+
+Conjoined with augmentation, as well as with diminution of strength
+and bulk in the walls of the heart, there is almost always an
+increase in the capacity of its cavities; and in whichsoever part
+of the heart the walls are thus augmented or diminished, it is the
+cavity appertaining to the same part which undergoes the increase
+of capacity. Hence it appears either that one of these conditions
+is the immediate and necessary consequence of the other, or that
+both are the simultaneous effects of the same causes.
+
+Dilatation of any cavity of the heart, with thickening of its
+walls, is called _active dilatation_; and dilatation of any cavity,
+with attenuation, is called _passive_[14].
+
+Active dilatation may appertain to every cavity of the heart
+simultaneously; and so may passive dilatation. But such occurrences
+are very rare: for one cavity being naturally more liable to this
+species of dilatation, and another to that, it most frequently
+happens that specimens of both conditions are found in the
+different cavities of the same heart.
+
+The left ventricle is much more liable to active dilatation than
+the right; and the right ventricle more so than either of the
+auricles; and of the auricles unquestionably the left. Upon the
+whole, perhaps, the fact may be truly stated thus--that the left
+ventricle commonly gains an increase of bulk and strength, with an
+increase of capacity; and that all the other cavities, at the time
+that they expand, are rather apt to become attenuated.
+
+It sometimes (though rarely) happens, that, with an increase of
+strength and bulk in its muscular structure, the left ventricle
+suffers a diminution of capacity in its cavity. In a case reported
+by Laënnec, the left ventricle was an inch and a half thick at
+its broadest, and an inch thick at its thinnest part; and yet its
+cavity was only capable of containing an unblanched almond. I have
+seen the same condition in a less degree.--(_Laënnec_, vol. ii.
+698.)
+
+The circumstances under which these opposite conditions, this
+hypertrophy and atrophy of the heart, with the enlargement or
+diminution of its cavities, arise, must be explained hereafter. At
+present I would only remark that they are often found conjoined
+with actual disease in other structures of the heart, such as
+osseous or cartilaginous thickening of internal lining, adhesion
+of the pericardium, and ossification of the coronary arteries, to
+which they owe their origin; and, moreover, that they are often
+found where the heart is otherwise perfectly sound in texture, and
+where their cause must be sought in other parts of the body.
+
+The heart is liable to undergo a simple dilatation of its cavities
+without either thickening or attenuation of its muscular substance.
+This simple dilatation is sometimes of the whole organ, sometimes
+of one side, and sometimes only of one auricle or ventricle. When
+it is of one cavity only, it may be complicated with active or
+passive dilatation of another, or of all the rest.
+
+There is reason to believe that the heart sometimes undergoes a
+temporary dilatation, and again returns to its natural capacity;
+but that the dilatation can only subsist for a short time without
+becoming permanent.
+
+The power of thus enlarging its cavities, and restoring them to
+their natural condition, belongs more especially to the right side
+of the heart.
+
+A large accumulation of fat is sometimes met with about the heart.
+
+The healthy heart is always more or less marked upon its external
+surface with streaks of white, and this appearance results from
+the deposition of fat in the cellular texture, which unites the
+serous covering with the subjacent muscular structure. It is found
+principally where the venæ cavæ unite to form the right auricle;
+also at the base of the ventricles, and along the line which
+marks the boundary between the two, and around the origin of the
+great blood-vessels as they emerge from the heart. But when fat
+is deposited in more than these situations, and in more than the
+natural quantity, it is not so much added to the healthy substance
+of the heart, as existing at its expense and detriment, and the
+muscular structure is that which especially suffers. The fibre
+of the fat heart is pale and wasted, like that of a paralytic
+limb.--_Mus. of the Coll. of Surg._ 327.
+
+A rupture of the heart is sometimes met with; but all the cases of
+reputed rupture are not such in reality. An aperture in the walls
+of the heart, through which blood escapes into the cavity of the
+pericardium, may result from ulceration as well as from rupture,
+or from a mixed process of one and the other; but whatever be the
+precise nature of the process by which this perforation of the
+heart is effected, it is undoubtedly of rare occurrence.
+
+Where it has been found, there has generally been at the same time
+some peculiar condition of the organ, which might be presumed
+favourable to its production. Its muscular substance has been
+so soft and loose of texture, that it could be pierced through
+by the weight of a probe[15]; or it has been converted into, or
+greatly intermixed with fat[16]; or its muscular fibres have been
+absolutely defective, leaving a certain transparent space, where
+the internal lining and the pericardium have been in contact,
+and served to maintain the completeness of the cavity, until the
+rupture has taken place[17].
+
+Not that a rupture has not been found where the texture of
+the parts has seemed to offer no natural facilities to its
+occurrence--as in the case related by Harvey himself, who found a
+lacerated aperture in the left ventricle, capable of admitting his
+finger, through which blood had escaped into the pericardium, the
+walls of the ventricle being increased in thickness and strength,
+while an obstacle existed at the entrance of the aorta[18]. Here
+the heart must have torn itself asunder by the simple violence of
+its contraction, in contending against the impediment to the egress
+of blood from its cavity. This is an effect which would hardly be
+thought capable of being thus produced; but I can well believe it
+possible after having seen one of the recti muscles of the abdomen
+literally torn in twain, in a man who died of tetanus[19].
+
+[To be continued.]
+
+
+
+
+DILATED ŒSOPHAGUS.
+
+
+_To the Editor of the London Medical Gazette._
+
+  SIR,
+
+Permit me to send the following case to you for insertion in the
+Gazette.
+
+
+Mary Blores, æt. 33, was admitted into the Middlesex Hospital on
+the 16th of November. She was in a state of extreme feebleness and
+emaciation. Those who brought her said that during the preceding
+month she had appeared to swallow nothing: what she took as food
+seemed to her to stop in the gullet, and after a few minutes
+returned. I found, however, that a large œsophagus-bougie passed
+readily into the stomach, meeting with no obstruction beyond a
+spasmodic resistance in the pharynx. A draught of milk and water
+was given her--she swallowed it without much effort, but it quickly
+returned. In the course of the afternoon a pint of beef tea was
+injected through an elastic tube into the stomach--it was thrown up
+directly.
+
+I now learnt from her that she could swallow liquids much more
+readily than solid food; that when she took a small quantity,
+it seemed to her not to reach the stomach, and in three or four
+minutes was invariably thrown up; that on taking a large draught
+she had an impression that it reached the stomach--in this case
+vomiting did not follow so soon, and some part of the draught was
+permanently retained; that she craved food and drink, and was
+literally dying of hunger and thirst; that the vomiting which took
+place was not preceded by nausea, although in its progress it had
+all the appearance of ordinary retching; that the matter vomited
+was not thrown up at once, but by successive efforts; it consisted
+of the food she had last taken, mixed with colourless mucus. The
+belly was so shrunk that the umbilicus was not more than an inch
+distant from the spine, upon which the pulsations of the aorta
+were readily felt: there was no enlargement or hardness about the
+stomach, no particular tenderness on pressing the epigastrium, no
+sensation of pain or heat now or formerly.
+
+The complaint had began ten years ago, during pregnancy, since when
+she had never been free from it, although at times her sufferings
+had been less, and she had been able to retain some portion of her
+meals. She had borne in this period three children; the vomiting
+had lasted during the whole period of her pregnancies, and during
+her confinement. The principal remedies which had been used for her
+relief were a succession of blisters on the pit of the stomach--but
+they had produced no benefit. Latterly her symptoms had been
+greatly aggravated.
+
+This patient was attended by Dr. Watson and myself. But the means
+which we tried to enable her to retain her food, and to support her
+expiring strength, had scarcely a temporary effect. She died on the
+2d Dec. sixteen days after her admission. The body was carefully
+examined, at the expressed wish of her relatives.
+
+The unusual appearances found in the abdomen were--1. the smallness
+of the first part of the duodenum, which was but half the ordinary
+size of the ileum; 2. the capaciousness and fulness of the gall
+bladder,--from which, however, on compressing it, the bile flowed
+readily into the intestine; 3. a contraction of the middle of
+the stomach of the length of two inches, for which extent the
+peritoneal coat was thickened and opaque, and the inner membranes
+folded in deep longitudinal rugæ, the mucous surface of which was
+partially suffused with circular spots of red. The breadth of the
+contracted part of the stomach, as it lay collapsed, was an inch
+and a half.
+
+[Illustration]
+
+[Illustration]
+
+But it was in the chest that the most remarkable circumstance
+presented itself. The œsophagus gradually enlarged from the
+pharynx, which was perhaps rather narrower than usual, to an
+extraordinary degree of dilatation; the greatest breadth which it
+attained was situated about four inches above the cardia: the tube
+then contracted more abruptly, so as to render the termination
+of the œsophagus, like its commencement, of nearly the usual
+dimensions. The structure likewise of the cardiac extremity for
+about an inch, and of the pharyngeal end for about half an inch,
+was healthy. The intermediate part presented, when inverted, the
+following curious appearance:--The inner membrane was thickened
+and opaque, and had _the appearance_ of having partially yielded
+from dilatation; at the upper part the furrows or thinner parts of
+the membrane followed in some degree a longitudinal direction; at
+the lower part the surface was pitted with shallow depressions of
+various figures. I have represented in the adjoined sketches these
+appearances, which on the middle of the œsophagus passed from one
+into the other; at the furrows or depressions the membrane seemed
+of the natural thickness and colour; the intermediate raised and
+thickened part was opaque and whitish. The muscular fibres of the
+œsophagus were of the natural colour and thickness.
+
+  I remain, Mr. Editor,
+  Your obedient servant,
+
+  HERBERT MAYO.
+
+  19, George-street, Hanover-square,
+  Dec. 6, 1828.
+
+
+
+
+HYDROPHOBIA.
+
+
+_To the Editor of the London Medical Gazette._
+
+  SIR,
+
+As the following case may throw some additional light on the
+pathology of hydrophobia, I have sent it you for publication.
+
+  I am, Sir,
+  Your obedient servant,
+
+  F. GODRICH.
+
+  Grove House, Little Chelsea,
+  Nov. 29, 1828.
+
+
+On Thursday morning, the 25th ult. I was called up about seven
+o'clock to see a man who I understood was exceedingly ill, and
+waiting in the surgery very impatiently for my arrival. I found
+my patient (Mr. Barham), a fine looking old man, about 60,
+labouring at intervals of about five minutes under strong spasmodic
+paroxysms, affecting the muscles concerned in breathing and
+deglutition. There was a wildness and an impatience depicted in his
+countenance, totally different from any thing I had ever observed
+in other spasmodic affections. His bowels were open, tongue clean,
+skin moist, pulse full and a little accelerated. I took away
+twenty ounces of blood, and prescribed a mixture containing ʒss.
+of laudanum for a dose every hour until I should see him again.
+He walked home half a mile from my house (Gloucester Road, Old
+Brompton), and left me ruminating on the possible cause of so much
+mischief occurring suddenly in a fine healthy subject. At ten a
+message was sent, saying that he was much worse, and requesting
+me to call as soon as possible. He received me tranquilly, and
+said he was very glad that I had come to see him, for he was very
+ill. His symptoms were now more distressing than when I first saw
+him: he looked wildly and suspiciously at every one entering his
+apartment, and his breathing was accompanied by a short convulsive
+sobbing. On looking at his medicine I perceived he had taken none,
+and expressing my surprise, he assured me it was impossible for
+him to swallow a single drop, as the attempt had been followed
+by violent spasms, and produced so much distress, that he had
+desisted. At this period no one had the slightest idea of the
+origin of his malady. I poured out some medicine into a tea-cup,
+the very act of which produced much excitement and alarm. My first
+impression as to the true nature of his disease arose at this
+period, from the circumstance of his requiring a tea-spoon, with
+which he endeavoured to take some of the medicine. The attempt
+produced much excitement and alarm, and after two or three painful
+efforts at deglutition, with one desperate effort he swallowed a
+tea-spoonful, threw away the spoon, and begged, unless I wished
+to destroy him, that he might have nothing more to swallow. I
+now left his room, and inquired of a bystander whether any thing
+particular had occurred to him within the last few weeks. On
+recollection she said, "About a month since, late at night, a
+strange dog came into the premises and fought with his own dog; he
+got out of bed to separate them, and the strange dog bit him in
+two places, on the left arm and hand; and bit a puppy, which died
+about a fortnight after in a strange way, which was thought to be
+some kind of a fit." To ascertain if this occurrence had produced
+any effect on his mind, while again bleeding him I said, "You have
+been in the wars, Sir, and had your hand and arm torn; how did
+it occur?"--"Oh!" said he, carelessly, "that was done by a dog a
+long time ago, but it healed." The circumstance was never again
+mentioned to him, and he died in total ignorance of the cause of
+his malady. The wounds were perfectly cicatrised, and there was not
+the least action going on indicative of recent absorption. He bore
+the bleeding pretty quietly: 40℥. were removed, which on cooling
+presented strong marks of inflammation.
+
+    Ordered ℳiv. Acid. Hydrocyan. omni horâ, in a little water.
+
+Twelve o'clock.--With much difficulty he has taken two doses of the
+acid; pulse full and hard, 110. 30℥. more blood were removed.
+
+Three o'clock.--Has taken two more doses; complains of a dreadful
+sense of suffocation, and implores that nothing more may be given
+him. Pulse full, and beating at 120 to 130. Continue the acid.
+
+Eight o'clock.--Pulse full and hard. Has taken in all 24ℳ. of the
+acid, but so painfully distressing has the deglutition now become,
+that all attempts at repeating his medicine are discontinued.
+
+    V. S. ad ℥xxx.
+
+During the bleeding he looked wildly at the basin, and begged
+that no more might be spilt (a drop or two had fallen), repeating
+frequently, in great agitation, as the blood was running, "Take
+care! take care!"
+
+Between two and three o'clock next morning my assistant (Mr.
+Davies) visited him. He found him tolerably passive, but observing
+every movement with intense anxiety. Pulse full and hard, face
+flushed, eyes denoting cerebral irritation. He had been at times
+outrageous. On its being intimated that bleeding was again
+necessary, a paroxysm came on more intense than any preceding,--and
+with great effort he submitted. As the blood flowed he became
+more and more alarmed, till at length he got quite unmanageable;
+he raged violently at his nephew, who was holding the basin, and
+ordered it peremptorily to be removed. 30 or 40℥. were taken
+away. It was found necessary to put on the straight waistcoat.
+About four o'clock Mr. Davies wished him to take some more of his
+medicine. He said, "I can take no more," and on reaching the bottle
+to put out a few drops, he became violently agitated, threw himself
+from side to side, and, as well as the incessant spasmodic sobbings
+would allow, he begged that not one more drop of any thing might be
+offered him, and that the bottle might be taken from his sight. He
+did not become tranquillized until its removal. He lingered on till
+ten A.M. in the same state, a few minutes before which he insisted
+on getting up, and walked a short way down his garden, returned,
+laid down on his bed, and died.
+
+Mr. Frederick Salmon, of Old Broad Street, and Mr. Wilson, of
+Chelsea, were kind enough to assist me in conducting the post
+mortem examination. On opening the chest, the heart was free from
+disease, with rather more water in the pericardium than natural;
+the lungs were completely gorged with grumous blood, and the pleura
+adherent on the right side. On removing the cranium, which was
+remarkably thin, and cutting the substance of the brain, numerous
+red spots presented themselves in the medullary portion; about a
+table-spoonful of water in each ventricle; the plexus choroides was
+turgid; the corpora, striata, thalami, and basis of the brain every
+where preternaturally injected; the cerebellum, crura cerebri, and
+cerebelli, in a high state of inflammation. On removing the spinous
+process of the vertebra, the whole cord was considerably inflamed;
+and opposite the two last cervical and dorsal vertebræ the cellular
+substance was studded with dark patches of coagulated blood, the
+theca vertebralis thickened, and the cord in an active state of
+inflammation. The larynx and pharynx bore not the slightest vestige
+of disease. The preparation of the cord is deposited in the museum
+of the London University.
+
+The post mortem examination of this case tends to prove the
+correctness of Professor Thompson's theory of the proximate cause
+and seat of this afflicting malady; and the plate accompanying a
+case recorded by him, in the 13th volume of the Med. Chir. Society,
+gives a faithful delineation of the state in which the spinal cord
+was found in this case.
+
+
+
+
+CASE OF LONG PROTRACTED CONSTIPATION.
+
+
+_To the Editors of the London Medical Gazette._
+
+  GENTLEMEN,
+
+Perhaps the following case may interest some of your readers, and
+if you think so, its insertion in your Journal will oblige
+
+  Your obedient and
+  humble servant,
+
+  S. D. BROUGHTON.
+
+  12, Great Marlborough Street,
+  Dec. 3, 1828.
+
+
+On Tuesday, Nov. 25, I was called upon at the St. George's and St.
+James's Dispensary to advise for an infant at the breast, of five
+months and fourteen days of age, that had not passed any fæces
+during six weeks up to the day before I saw it. After its birth
+it had no passage till the fifth day, and this had apparently
+been effected by the introduction of a bougie, and which was
+subsequently continued at intervals for a short time. The infant
+was otherwise healthy and strong at its birth, and remained so
+until it had gone about three weeks without any evacuation, when it
+was observed to be weak in the lower extremities; and at the period
+of my seeing it the legs were much fallen away in flesh, hanging
+flaccid and inert. Many aperient enemas and medicines had been
+given, and, as a last resource, one drop of the croton oil had been
+prescribed the preceding evening. The infant appeared to suffer
+from distention, and to be disposed to coma, and the croton oil had
+distressed it much some hours after it was given. The fæces could
+be felt blocking up the intestine, but the irritation of the finger
+produced no attempt at evacuation; very small pieces only having
+been brought away. Hot baths also had frequently been used some
+time ago.
+
+Considering the case as one of paralysis in the parts naturally
+employed to relieve the bowels, I recommended the suspension of
+all purgative remedies by the mouth, and a table-spoonful of the
+following injection to be substituted, and to be thrown up with
+three table-spoonfuls of thin gruel occasionally during the day, by
+means of a syringe.
+
+  ℞ Spir. Terebenth. ʒiij.
+  Træ Zinzib. ʒj.
+  Aquæ, ℥iss. M.
+
+The following liniment was also directed to be rubbed in frequently
+along the course of the spine.
+
+  ℞ Linimenti Saponis, ℥iss.
+  Liquor. Ammon. Comp. ℥ss. M.
+
+The result justified my expectations; for, during the night after
+this prescription, two injections having been given, some large
+and hard ash-coloured lumps came away, and these were shortly
+followed by a forcible spouting out of a continued stream of
+feculent dark liquid; a brisk diarrhœa having been kept up till
+the Saturday following. The infant's appetite is become voracious,
+its appearance lively and healthy, and its legs as firm and strong
+as is usual at such an age. Cold water is recommended to be dashed
+upon the loins, the liniment to be continued occasionally, moderate
+doses of magnesia and rhubarb to be given when required, and the
+turpentine injection to be used if any return of the complaint
+should be threatened.
+
+
+
+
+DISLOCATION OF THE PATELLA.
+
+
+_To the Editor of the London Medical Gazette._
+
+  SIR,
+
+Having seen a case of dislocation of the patella, reported by
+Mr. Mayo, in your Journal a few weeks since, in which there was
+experienced some difficulty in the reduction of the bone, I beg
+leave to send you the following, in case you may think it worth
+insertion.
+
+On Saturday last, I was called to a young woman who had dislocated
+the patella of the left knee joint outwards; the inner edge
+rested upon the outer surface of the external condyle, and was
+immoveably fixed, and caused great pain when touched. She says it
+was occasioned by her foot slipping backwards from one stair to
+another, and she immediately fell down.
+
+I commenced the reduction, as stated by Mr. Mayo, but I could only
+produce semiflexion, and that gave her great pain; insomuch that I
+was obliged to desist, and the patella remained in _statu quo_. But
+when the knee was thus semiflexed, I desired my assistant to extend
+the leg suddenly; and having my fingers on the patella at the time,
+and pressing it inwards, it immediately returned to its natural
+position.
+
+I must confess, sir, that I should have been afraid to have
+continued the flexion as described in Mr. Mayo's case, "by bending
+the knee to the utmost," fearing that the remedy might be worse
+than the disease, and the result proved that in this case it was
+not necessary.
+
+  I remain, Sir,
+  Your obedient servant,
+
+  P. M. HOSKINGS.
+
+  168, Fleet-Street,
+  Dec. 3d, 1828.
+
+
+
+
+VACCINATION.
+
+
+_To the Editor of the London Medical Gazette._
+
+  SIR,
+
+The mistake of the printer in substituting the word "every" for
+"even," in the paper on Vaccination (p. 40), so materially affects
+the sense of the passage, that I must request the favour of the
+following insertion:--
+
+"3d. That while the vaccine cicatrix retains even one distinct
+fovea or depression, the individual continues unsusceptible both of
+small pox and of re-vaccination; but that," &c.
+
+  I am, Sir,
+  Your obedient servant,
+
+  THOS. H. BURDER.
+
+  2, Brunswick Square, Dec. 15, 1828.
+
+
+
+
+SINGULAR BICEPS MUSCLE.
+
+
+_To the Editor of the London Medical Gazette._
+
+  SIR,
+
+The valuable paper communicated to your Journal, by Mr. Stanley,
+last week, has brought to my recollection a singular appearance of
+the parts in front of the shoulder-joint which I dissected about
+two years ago. It is a fact worth recording; and perhaps you will
+be kind enough to insert it in your next number.
+
+The circumstance was this--that in the right arm, instead of there
+being a biceps muscle having two origins, the one the shorter from
+the corocoid process, the other the longer from the upper part of
+the glenoid cavity of the scapula, there was simply a one-headed
+muscle arising from the corocoid process. I could find no tendon
+passing through the joint answering to the long head of the
+biceps, neither was there any appearance of a biceptical groove;
+the capsular ligament was, perhaps, thicker than it is found in
+ordinary cases.
+
+I knew nothing of this man during life, and am therefore unable to
+give any account of the use which he made of this arm.
+
+  I am, your obedient servant,
+  C. M. BURNETT.
+
+  House Surgeon's Apartments,
+  St. Bartholomew's Hospital, Dec. 8th.
+
+
+
+
+STETHOSCOPE.
+
+
+_To the Editors of the London Medical Gazette._
+
+  GENTLEMEN,
+
+As you did me the honour, on a former occasion, to publish some
+remarks in defence of _auscultation_, against its enemies and
+detractors, I trust you will permit me to say a few words in
+reference to a communication in a late number, from a gentleman
+who appears to be a friend of that method of diagnosis, but whose
+ignorance of the subject is likely to be more injurious to the
+cause than either open enmity or secret detraction. The case in
+question (page 780, vol. ii.) appears, from the dissection, to
+have been clearly _emphysema of the lungs_, as there stated; but
+I appeal to every one practically acquainted with the physical
+signs of diseases of the lungs, whether the results of the
+exploration with the stethoscope, as narrated in the case, were
+those pathognomonic of that disease? I say they were not only
+not pathognomonic of this affection, but they were actually
+incompatible with its existence. The same ignorance of the subject
+is shewn in relation to the disease of the heart, which, I boldly
+maintain, no one was justified in pronouncing to be _hypertrophy of
+the left ventricle_ from the stethoscopic indications stated in the
+case.
+
+It is just possible that the writer of the case may have made
+further explorations on which his diagnosis was founded; but if he
+had such in his case-book, it is equally unfortunate for the credit
+of the stethoscope and his own, that he suppressed them in his
+printed case.
+
+  I have the honour to be,
+  Gentlemen,
+  Your obedient servant,
+
+  A STETHOSCOPER.
+
+  Nov. 25, 1828.
+
+
+
+
+MECHANISM OF VOMITING.
+
+
+_To the Editor of the London Medical Gazette._
+
+  Glasgow University, Nov. 26, 1828.
+
+  SIR,
+
+Having lately perused, in the 35th Number of the Medical Gazette,
+some observations "on the mechanism of the act of vomiting," by
+Dr. Marshall Hall, in which, after controverting the different
+opinions which have been entertained by physiologists on this
+question, he endeavours to prove that vomiting is an effort, not
+of _inspiration_, but of _expiration_, and advances this opinion
+as having originated in himself, I beg, through the medium of
+your Journal, to refer that gentleman to Richerand's Physiology,
+where, on the subject of vomiting, page 70, he says, "Sometimes the
+action of the muscular fibres of the stomach is quite inverted;
+they contract from the pylorus towards the cardia; and this
+antiperistaltic motion, in which the contractions act with more
+force and rapidity, and in a manner decidedly convulsive, produces
+vomiting. The action of the abdominal muscles then connects itself
+with that of the stomach; the viscera are propelled upwards and
+backwards, by the contraction of the large muscles of the abdomen;
+_the diaphragm ascends towards the chest; if it descended, in
+contracting, the œsophagus that passes between its two crura would
+be compressed, and the expulsion of food through the cardia could
+not be effected_. It is also observed, _that during expiration
+only, any thing can pass from the stomach into the œsophagus_."
+Again, on respiration, page 147--"_In every effort of expiration_,
+as coughing and _vomiting_," &c. Here, then, we see that Dr. Hall's
+views, as far as regards vomiting being an effort of expiration,
+have long since been advanced by Richerand.
+
+The profession are certainly much indebted to Dr. Hall for his
+corroboration of these views; at the same time he should not have
+taken to himself the merit of having first suggested them.
+
+  Sir,
+  Your most obedient servant,
+
+  A SUBSCRIBER.
+
+
+
+
+CHARACTER OF THE LANCET.
+
+
+_To the Editor of the London Medical Gazette._
+
+  Dec. 19, 1828.
+
+  SIR,
+
+The events disclosed during the late trial in the Court of King's
+Bench, must fill every well-disposed mind with astonishment and
+horror. The moral aspect of the case is marked by every feature
+capable of exciting a sense of shame for our profession, and of
+sorrow for our kind. Can it be that a publication conducted in the
+spirit of the extracts produced at the late trial of Cooper against
+Wakley should be fostered and encouraged by a large proportion of
+the medical public? Is it indeed true that no feeling of loathing
+and disgust should have induced the purchasers of the Lancet to
+protest against its glaring injustice, its undisguised ferocity and
+malignity?
+
+I am not a reader of that work myself, and but for the disclosures
+recently made in our courts of justice, together with what I have
+learned from your own pages, I should know little about it. Some
+of its early numbers convinced me that it was a production not
+deserving of support, whatever ability there might be connected
+with it; subsequent events have amply justified this decision, and
+I now address these few hasty lines to you, to express my humble
+hope that all the respectable medical men throughout the kingdom
+will arise, and with one voice oppose this moral pestilence, which
+at once corrupts and degrades their profession.
+
+The _odium medicum_, bitter and vindictive as it unfortunately has
+been, never, I believe, appeared in a form so repulsive. Are we
+living in the nineteenth century? Have arts and sciences, which
+are asserted of old to soften the manners and temper the violence
+of our nature, produced no such fruits amongst us? Is serious, and
+perhaps irremediable injury, to be inflicted on reputation; and is
+the sufferer thereafter to be dared to mortal combat, and this too
+by the wrong-doer? Is it thus that professional justice is to be
+awarded? Is it thus that knowledge is to be advanced, the dignity
+of our profession to be maintained, its benefits enlarged, and
+its usefulness transmitted? Is it thus that the young men are to
+be taught how to acquire an unworthy and discreditable notoriety;
+to disregard all the decencies, charities, and higher virtues
+of life; and to bring into the exercise of our art the insidious
+cunning of the knave, the vulgar dishonesty of the pilferer, and
+the audacious bearing of the bravo?
+
+I know not how others may feel on the present occasion: I am
+entirely unacquainted with the parties who have been at issue in
+the late suit--I have no bias of any kind, but what must arise in
+the mind of every man who has any regard for the profession to
+which he belongs, or who loves truth and fair dealing--I am sure
+that it is not less for the interests of society at large than for
+the advancement of medical science, that just principles should
+regulate all our dealings, both with the public and with each
+other. It is manifest that of late we have signally and woefully
+departed from them; and it is most distressing to know that this
+departure has been sanctioned by so many members of the profession.
+I now entertain a confident hope that all who reflect on the
+character of the late libel will feel that their own _character_ is
+at stake if they do not mark their disapprobation of it in every
+possible way. Sure I am that, if the principles which guide the
+Lancet become generally acceptable, it will mark an æra of moral
+degradation which no surgical dexterity, no medical acquirements,
+however eminent, could possibly redeem.
+
+  VERITAS.
+
+
+
+
+DURATION OF HUMAN LIFE IN RUSSIA.
+
+
+Cases of longevity are not only much more common, but also more
+extraordinary in respect to a greater duration, in Russia than in
+any other part of Europe; thus, from the report of the holy synod,
+published in 1827, it appears that there were living in 1825, among
+those who professed the Greco-Russian religion throughout the
+empire, not fewer than 848 males who were 100 and more years old;
+among whom, 32 had passed the age of 120, 4 were between 125 and
+130, and 4 others between 130 and 135 years of age. Out of 606,881
+males who died in 1826, 2785 had passed the age of 90 years; 1432
+that of 95; and 818 that of 100. Among the latter, 38 were more
+than 115 years of age; 24 more than 120; 7 more than 125; and one
+was 160 years old at his death.
+
+
+
+
+MEDICAL GAZETTE.
+
+_Saturday, December 27, 1828._
+
+    "Licet omnibus, licet etiam mihi, dignitatem _Artis Medicæ_
+    tueri; potestas modo veniendi in publicum sit, dicendi
+    periculum non recuso."--CICERO.
+
+
+
+
+ANALYSIS OF WAKLEY'S DEFENCE ON THE LATE TRIAL.
+
+
+We last week presented our readers with a full[20] and, we trust,
+accurate account of the trial for libel, which has recently excited
+so much interest; and we offered some remarks of a general nature
+upon its result and tendency. We had purposed at the same time to
+subject Mr. Wakley's mode of conducting his cause to a critical
+investigation, but this we were prevented from doing by want of
+time and space. We thought it likely, too, that the Editor of the
+Lancet would have fairly met the question in his next publication,
+and himself put the facts of the case, at least, on record: instead
+of this, however, he has devoted his pages to compliments to
+himself, and scurrilous and absurd abuse of Sir James Scarlett,
+in which he informs us that in his opinion that gentleman is
+"prodigiously overrated even as a lawyer," and says many other
+things, which serve only to shew how dreadfully Wakley himself had
+smarted under his lash.
+
+We find the general opinion to correspond with that which we
+expressed last week--that the defendant had managed his cause in
+a very bungling manner; and the estimation in which he and his
+witnesses were held by Judge and Jury is apparent from the charge
+of the one, and decision of the other. Both, indeed, regarded the
+asseverations of his whole _family party_ as dust in the balance
+against the testimony of one single competent and honourable
+man--Mr. Callaway; for on his evidence the result obviously hinged.
+Our contemporary affects to look upon the verdict as a triumph on
+his part--so he would if the damages had been five hundred or a
+thousand pounds, for in truth he has nothing else for it; and with
+all our hearts we wish him many such victories.
+
+With regard to the amount of damages, we certainly should have been
+better pleased had it been larger; but we did not expect that it
+would--nay a reference to our number which was published while the
+trial was going on, will shew that we were even doubtful of the
+verdict, because we know how extremely difficult it is for a jury
+to comprehend such a complicated question--how easy for a knave to
+impose upon their ignorance by misrepresentation and falsehood. It
+is quite obvious that if the jury had believed one syllable of the
+evidence of Wakley's witnesses, they must have given the verdict
+in his favour. In a case like this, where _one individual only_,
+and he the plaintiff, can be fully aware of the difficulties which
+had to be overcome, it is almost impossible to bring evidence
+into a court of justice capable of satisfying the minds of twelve
+unprofessional men. From this circumstance alone it was that we
+expressed a doubtful opinion of the result. But besides all this,
+it is well known to all--_that one talesman might go determined to
+starve out the rest--that ten special jurymen might wish to give
+500l. and yet that, by the absurd constitution of the English law,
+their verdict might be thus controlled by one individual friendly
+to the defendant_.
+
+Most fortunately for the cause of truth, Wakley had the vanity and
+folly to conduct the defence himself, and, judging of other men's
+estimation of moral character by his own, he did not hesitate to
+place in the box witnesses whom no counsel would have suffered to
+go there, and who, being unable to stand the cross-examination,
+led to what must have been to Wakley a most humiliating exposure.
+Next to this, the most beneficial effect produced was that of
+the defendant's cross-examination of his opponent's witnesses:
+it was amusingly absurd, and shewed a lamentable want of tact,
+always eliciting something which he ought to have avoided. Lastly
+came the reply, of which he tells us he is himself ashamed--"We
+may state most unfeignedly," says he, "that we look back with
+regret to our errors in point of omission." Nor is this the only
+part of it for which he has cause to blush, for any thing more
+miserably deficient we never heard: it was a mass of confusion
+throughout--a repetition of the same ideas and expressions--and a
+most injudicious betrayal of rancorous feeling, at the very moment
+he was profanely invoking heaven to witness that he bore enmity to
+no man. In speaking of his reply in our last number, we declared
+it to be "false in statement--sophistical in argument--coarse
+in language--and diabolical in tendency;" and we now proceed to
+illustrate these several qualifications, in doing which little more
+will be necessary than to select a few passages, and arrange them
+under their appropriate heads.
+
+_False in Statement._--One of Wakley's principal objects was to
+impress upon the Jury a belief that he had not in any way attempted
+to influence his witnesses, nor even spoken to most of them,
+anterior to the trial. "Out of nine witnesses I have placed in the
+box, (says he) I never saw five of them, nor even spoke to five
+of them till yesterday." We appeal to any man of common sense,
+whether it be probable that this is true. It is possible indeed,
+and only just possible, that he was contented with employing
+others to question his witnesses, and ascertain what evidence they
+would give; but even if it were so, the assertion was not the
+less false in a moral point of view, because his intention was
+to convey the belief that he had inquired no farther than merely
+whether or not the witnesses had been present at the operation.
+But incredible and absurd as this was, he ventured a step farther,
+and assigned a reason for the choice made of one witness--(Lee the
+potatoe-merchant.) "I had heard (said Wakley) he was present at the
+operation--an honest man, and that he was a friend of Mr. Bransby
+Cooper, under the highest obligation to the Cooper family. Without
+asking him a single question I put him into the box, as I was most
+anxious you should hear all the evidence that could be adduced, and
+from _unsuspected and untainted quarters_." This lie carried with
+it its own refutation; for Lee swore that he had never even spoken
+to Mr. Cooper; and we are therefore amazed that Wakley should
+have hazarded so gross an assertion, as it could only have been
+effective on the supposition of his addressing a jury of absolute
+simpletons. But again--"Who were my witnesses? not men whom I had
+trained and lectured on models, and sketches, and drawings. Has
+it been shewn to you that I was closeted with any person or set
+of persons?" Yes, Mr. Thomas Wakley, it has been shewn, and by no
+less an authority than that of your _fidus Achates_, Mr. James
+Lambert. "The defendant (says the worthy author of the libel), the
+defendant was there whilst I was explaining the parts to persons
+who were to be witnesses--_the defendant also explained them to
+the same persons_." And again, "I have heard explanations given to
+persons who were to be witnesses in this cause FOUR OR FIVE TIMES
+within the last six weeks." So also that excellent thorough-going
+witness, Mr. Jeffry Pearl: "a _gentleman_ of the name of Lambert
+introduced me to the defendant; THE DEFENDANT _and Mr. Lambert
+endeavoured to shew that the forceps had passed between the bladder
+and the rectum_." So much for placing men in the box because they
+are friends of Mr. Cooper--so much for procuring evidence from
+"untainted quarters!"
+
+This is only to be matched in effrontery by the statement of some
+wise-acre at the radical meeting on Tuesday night. Being asked why
+no notice had been taken in the Lancet of a successful operation of
+lithotomy performed by Mr. B. Cooper, soon after the publication
+of the libel, he assigned as the reason that Mr. Wakley thought it
+might increase the damages, and otherwise injure Mr. Cooper! What a
+noodle the man must be to expect any one to believe him[21]!
+
+Mr. Wakley asserted that the evidence of his witnesses remained
+"untouched--wholly uncontradicted;"--whereas there was scarcely a
+single point in their statements which was not contradicted either
+by Mr. Callaway, who was present at the operation, or Mr. Key and
+Dr. Hodgkin, who examined the parts after death. But what is more
+remarkable, there was scarcely a circumstance on which his own
+witnesses agreed--for example, they differed with regard to the
+nature and direction of the incisions; with regard to the manner
+and frequency of introducing the forceps; with regard to the number
+of instruments used, and the mode of applying them; with regard to
+the size of the wound; with regard to the degree of force employed,
+and with regard to the appearances after death. Yet, in the face
+of all this, Wakley had the impudence to tell the jury that his
+evidence remained "uncontradicted." We have no hesitation in
+asserting that his own witnesses (putting Mr. Cooper's out of the
+question) advanced no charge of which they did not also furnish the
+refutation.
+
+Mr. Wakley asserted that Mr. Cooper was incapable of telling why
+he could not extract the stone, even "while he had his finger in
+the bladder." This is false: neither Mr. Cooper nor Mr. Callaway
+were able to reach the bladder with the finger at all, owing to the
+depth of the perineum.
+
+Mr. Wakley told the jury that the plaintiff did not like the
+bladder to be exposed, "because to surgeons there is indisputable
+proof that Bransby Cooper did not perform that operation as he
+ought," and that "Mr. Key and Mr. Callaway knew it." This is false:
+Mr. Key, Mr. Callaway, and Dr. Hodgkin, who had examined the parts,
+all deposed that there was nothing in them indicative of the
+operation having been improperly performed. Indeed, had it been as
+Wakley asserted, the plaintiff would not have been so foolish as to
+have had the parts preserved at all.
+
+_Sophistical in argument._--One of the pieces of sophistry on
+which Wakley seems chiefly to have depended, inasmuch as he went
+over it _six times_ in the course of his speech, was, that if his
+account of the operation had been incorrect more of those who were
+present would have been brought forward to prove it so. But, as
+we stated in our last Number, to have objected to Wakley bringing
+forward pupils, on the ground of their being incompetent, and then
+to have done the same thing, would have been grossly inconsistent.
+Lord Tenterden, in his charge, said, "he did not see whom he (Mr.
+Cooper) could, with propriety, have called besides Mr. Callaway;
+the others were all young men, only pupils, and probably too young
+and inexperienced to form any judgment on the case that could
+be relied on." There is also another person who has objected to
+these witnesses whom we may mention--not, indeed, one for whose
+authority we have the highest possible respect, but of whom the
+defendant in this case probably thinks more favourably--we mean
+Mr. Thomas Wakley, who, speaking of the Letter formerly published
+by Mr. Cooper's pupils on the subject of this operation, says,
+"their united opinion of the skill, dexterity, and self-possession
+exhibited by Mr. Bransby Cooper on this occasion, is not likely to
+influence the judgment of the profession, whatever it may effect
+with the public."
+
+The use made by Wakley of Sir Astley Cooper's expression, "give
+him time," is another specimen of sophistry. Sir Astley evidently
+meant merely to say that, _ceteris paribus_, a man who had been
+twenty years surgeon to an Hospital would be more experienced than
+one who had held the situation but one-fourth of that period.
+This we believe to have been his sentiment, though nothing was
+ever less happily expressed. Accordingly it was not lost upon the
+defendant, who exclaimed, "Is that the way in which our hospitals
+are to be conducted? Is that the mode in which your poor patients
+are to be treated?--that young and inexperienced men are to be
+placed there to _learn their profession_--not to know it before
+they get there, but are to go there to learn it--and learn it
+upon whom?--upon individuals who are as much entitled to the
+best and most scientific practice of surgery as any nobleman in
+this land." All very fine--but we should be glad to know how or
+where a practical acquaintance with surgery is to be acquired
+but in public hospitals--and if no man is to be appointed till
+after he has gained experience, where are such men to come from?
+Where are ready-made surgeons to be found fit to operate even
+before Lambert, without his being able _to make a hole_ in their
+reputation?
+
+One of the most knavish attempts in the whole speech, to take
+advantage of the jury, was exhibited in his description of the
+operation. How different from the clear, perspicuous, and candid
+narrative of Sir James Scarlett. You are told, says Wakley, that
+the stone was shelved _above_ the pubes and _behind_ the pubes;
+but, continued he, (placing a pelvis in the position in which it is
+during the operation,) a stone cannot be lodged above the pubes,
+because, you see, the pubes is above the bladder! This was, indeed,
+calculated to confuse men unaccustomed to the subject, and who
+did not probably reflect that above and below are merely relative
+terms, which must change with every change of position, and that
+it was not meant that the stone was between the pubes and external
+integuments, which, in the position for lithotomy, would be the
+literal meaning of _above the pubes_, but that it was in such a
+situation as, in the ordinary position of the body, was above the
+pubes. But Wakley assured the jury that it was impossible for any
+stone to be _above_ the pubes, for there was a tendon to prevent it
+which no force could overcome; and he affected to ridicule the idea
+of there being anything unusual, any extraordinary shelf behind the
+pubes, in which the stone could have been lodged. "Had there been
+a shelf here," said he,--"had there been a crooked passage--had
+there been a cavity, or any place for the deposition of the stone,
+do you suppose that shelf would not have been produced? Had there
+been any thing particular in the formation of the pubes, would they
+not have cut out the man's bone as well as the bladder?" It is
+probably impossible for any but medical men to appreciate fully
+the impudent imposition--the fraud of this statement,--this knavish
+artifice to mislead the jury. No attempt was made in any part of
+Mr. Cooper's case to show that there was such malformation, or that
+the stone was in the position which Mr. Wakley demonstrated it
+could not occupy--_thus answering an argument which had never been
+advanced_.
+
+The following is a good specimen of sophistry and stupidity.
+Finding it proved that there was no opening between the bladder
+and rectum, Wakley wanted to make out that he never had said
+otherwise, having stated the cellular membrane to be _lacerable_,
+and therefore not _lacerated_. And then, forgetting the nature of
+his argument, immediately added, "remember this; the gorget is not
+as wide as the finger, and that it is not an uncommon thing for an
+unskilful operator to drive the gorget in between the bladder and
+rectum." Thus insinuating what had been proved to be false, and
+what he had just argued, from the words of the libel, he could not
+have meant.
+
+_Coarse in language._--This scarcely requires illustration. But as
+specimens, on the present occasion, of vulgar slang and miserable
+attempts at wit, we may mention his talking of "hole and corner"
+proceedings,--his comparing Sir James Scarlett to sour milk,
+and which happy thought he has, in hand-bills pasted about the
+town, converted into "Knight and Professor of Sour Milk,"--his
+explanation of the term _bat_ as applied to surgeons, "because
+they live in the dark, they suckle their young, and live in creaks
+and crevices of old walls, hospitals, and dungeons, _thriving and
+fattening on their own species_,"--his address to the "_gang_" of
+hospital surgeons, whom he represented as wading "through blood
+up to the neck,"--and lastly, his exclamations, several times
+repeated, perhaps with _prophetic_ phrenzy, that he "would die in
+a dungeon and expire in a ditch."
+
+_Diabolical in tendency._--The general tendency of Wakley's
+writings, and especially of his address to the Jury on this
+occasion, so far as such ravings can have any influence, is to sow
+distrust between men in every class of society and their medical
+attendants; to poison the sources of public charity, and arrest
+the hand of benevolence; to contract the relief afforded to human
+suffering, leading the poor and uninformed to suppose themselves
+the objects of cruel and wanton experiment, thus encouraging them
+rather to suffer disease to run its course than seek relief in such
+abodes of blood and horror as he most falsely represents our public
+hospitals to be.
+
+One of the first ebullitions of this demoniacal effort consisted
+in representing to the Jury, which he did in two different parts
+of his address, that the patient had been kept _bound_ during the
+operation, as if some unusual degree of coercion had been employed.
+"Yet, in opposition to the patient's cries--in opposition to his
+repeated entreaties to be unbound, still the operator kept him upon
+the table."--"Gentlemen," continued he, "I should like to know
+upon what principle it was that the man was kept _bound_ upon the
+table when he implored to be loosened. Was he not a free agent?"
+And then he goes on to put into Mr. Cooper's mouth not only words,
+but a sentiment he never uttered.--"No, no, (says the operator,)
+my _reputation_ is concerned. You were brought here to have the
+stone extracted, and extracted it shall and must be--_if you were
+to die upon the table_." Unless Wakley was intoxicated we cannot
+in any other manner account for an argument at once so absurd, so
+unprofessional, and so malignant. It evidently excited no feeling
+but that of disgust in the minds either of the Judge or the Jury.
+
+The next paragraph to which we shall allude is a masterpiece
+of hypocrisy--"Let me ask you (said he) what you have heard
+respecting the miseries of the individual on whom the operation was
+performed? Not one word has escaped the lips of the counsel on that
+subject--not one word from the mouth of one of the witnesses. No,
+gentlemen, they are hospital surgeons themselves, and they know too
+well what the practices of our hospitals are, and the sufferings
+_patients are in the habit of enduring at their hands_, to feel
+for this man, or for any other man placed in a similar situation!"
+Canting hypocrite! this from the man who in the very case before
+us published his account of the patient's sufferings in the form
+of a drama, mingled with low and scurrilous gibes. Mark also the
+following--"Give such a verdict as shall satisfy the _poor_--as
+will shew that men are not to go into offices of this sort where
+the _poor are to be killed_, and that they shall not be at liberty
+to wade and ride through blood up to their necks to eminence in
+their profession. Ah! gentlemen, give such a verdict as shall
+satisfy the _poor_!"
+
+There is in the various paragraphs we have quoted, more deep-rooted
+malice--more abandoned violation of the truth--more hypocrisy--and
+more open outrage of common sense, decency, and feeling, than we
+ever remember to have met with, even in the pages of the Lancet.
+It is now quite obvious that Wakley, alarmed at the change which
+has taken place in the estimation of his work within the last few
+months, finds it necessary to adopt a new system; he therefore
+throws off the mask, and openly declares himself the champion of
+the ignorant and illiterate[22]--conjuring up to their imaginations
+evils which do not exist--denouncing the medical profession as
+one of blood and murder--medical men as "thriving and fattening on
+their fellow-creatures"--and calling upon the "humane contributors
+to our hospitals and infirmaries" to support him.
+
+Why really now, if the times of political turbulence were to
+return, and radical reform again to come into vogue, Cobbett
+and Hunt would have a most valuable coadjutor; but as it is, we
+almost think the sphere he has chosen is too limited for such a
+genius. Humbug, to be successful, ought not to be very open to
+detection; alleged abuses ought not to be of a kind which every
+man can satisfy himself are entirely without foundation; and he
+who professes disinterested motives ought not to begin by raising
+a subscription for himself. We offer these few hints to Wakley, in
+hopes they may be of use to him in his new career; above all, we
+advise him to be sparing in protestations: there are some already
+who look upon his sincerity with a suspicious eye; for although
+it is no doubt true, that he would "rather die in a dungeon, and
+expire in a ditch," than injure any man, yet somehow an idea has
+got abroad, that his constant habits of lying and slandering are
+not quite in keeping with these assertions. Nay, we have heard
+of some even of the "humane contributors" to our charitable
+institutions, who have been so unreasonable as to disbelieve all
+Wakley's stories about the _cannibalism_ of hospital surgeons, and
+to look upon the whole system of the Lancet as one of knavery and
+imposition.
+
+
+
+
+WAKLEY'S SUBSCRIPTION MEETING.
+
+
+A most amusing scene took place at the Freemasons' Tavern on
+Tuesday evening, of which we subjoin an account. The object of
+the meeting was, "to present Mr. Wakley with some decided mark of
+their approval of his spirited conduct in his late trial;" or, in
+other words, if possible, to raise a little money, and bolster
+up the Lancet a little longer. The persons present were small in
+number, but great in zeal; and as much noise, hissing, laughter,
+and shouting, took place as would have done credit to a much larger
+assembly. As this is a merry season, and it may amuse our readers,
+we subjoin the speeches of the principal orators on either side:
+it will be perceived that both the Gazette and Lancet had some
+handsome compliments paid them; and that Wakley got thoroughly
+abused even by some of those who went to the meeting as the
+champions of reform. There was not a single individual present of
+any weight in the profession, and the chair was occupied by a young
+man wholly unknown, except as secretary to the meetings held two
+years ago on the subject of surgical reform. Could no one whose
+name might sound familiar in the public ear be prevailed upon to
+go?--could none be found but Pateys, Wallers, Mills, Elliots,
+Childs, and the Lord knows who? Where was he, the idol of the
+Lancet, who on other occasions graced the chair--where he who first
+ycleped that Journal the "invaluable"? Alas! poor Wakley, what an
+exposure of a sinking cause! even thy former friends tremble for
+their reputations, and desert thee.
+
+
+SURGICAL REFORM.
+
+A meeting was held yesterday evening at the Freemasons' Tavern, in
+pursuance of an advertisement calling on the "Friends of Surgical
+Reform, the Supporters of a free Medical Press, and the humane
+Contributors to our Hospitals and Infirmaries," to meet there,
+in order to adopt measures for presenting Mr. Wakley, the Editor
+of the Lancet, with some decided mark of their approval of his
+spirited conduct, in his late trial in the Court of King's Bench,
+at the suit of Mr. Bransby Cooper, and of the principles which he
+so powerfully advocated on that occasion.
+
+[Mr. Patey, who was called to the chair, stated the object of the
+meeting; but as his speech was rather long, and contained nothing
+of the least interest, we omit it.]
+
+_Mr. Waller_, in proposing the first resolution, adverted to the
+terms of the advertisement, and remarked that the question for
+them was not whether they would support Cooper against Wakley, or
+Wakley against Cooper; but whether they would have a free medical
+press or not--(cheers). Every body must admit that there was
+only one medical publication that was entitled to be considered
+free--only one that dared to tell the truth. Another had been
+attempted to be set up against it, but this wretched rival was
+gagged and manacled, and its reports were only a medium which
+distorted truth, and were almost unintelligible. It was not,
+however, to support any particular man, or publication, that he
+came to that meeting, but to support the general cause in which
+they were all interested. He concluded by moving, as the first
+resolution, that "the best interests of the medical profession and
+of the public are identified with the cause of medical and surgical
+reform; and that Mr. Wakley, as Editor of the Lancet, having given
+the first impulse to that cause, and having subsequently advocated
+it with undeviating firmness and fidelity, is entitled to the
+cordial thanks and support of this meeting."
+
+_Mr. Mills_ seconded the resolution.
+
+_Dr. Shiel_ said this was an important meeting, in his opinion;
+for, if this resolution were passed, it would identify the medical
+profession with the Editor of the Lancet. If the principle
+embodied in that resolution went forth to the world, it would be
+attended with consequences deeply injurious to the profession.
+He knew neither Mr. Bransby Cooper nor Sir Astley, and therefore
+he was perfectly impartial. The first question was, how far the
+medical press was conducted with advantage to medical science and
+the members of the profession. Now he contended, but with great
+respect, and disclaiming all personal hostility, that the Lancet
+had nowise contributed to the progress of medical science or the
+improvement of the profession--(loud hissing, and some cheers).
+He trusted that the meeting had not been got up by a few of the
+friends of Mr. Wakley, and he was sure that that gentleman was
+too respectable and too dignified in his proper person to need
+any such attempt--(applause). He trusted that the meeting was
+before the British public to ascertain how far the Lancet was
+useful or advantageous to medical science; and he hoped that,
+however partial the gentlemen present might be to Mr. Wakley, they
+would be governed in what they should do by the real interests of
+science--(hear, hear). The question was one of great interest; for
+it was one that embraced not only the freedom of the press but the
+advancement of medical science. With respect to the freedom of the
+press, they lived in a country where the law always maintained
+that principle. When Mr. Abernethy had applied for an injunction
+against the Lancet, Lord Eldon said that there could be no doubt
+that the Lancet was a most useful publication--(applause). He did
+not know whether that observation had been brought forward at the
+late trial; but taking the case--what was it? It appeared that the
+operation was one of peculiar difficulty, as stated upon oath by
+some of the most experienced surgeons of the day. This operation
+was laid hold of by the Lancet, and published not as a medical but
+as a tragical performance, in which all persons without science
+or knowledge were appealed to, and no opportunity afforded to Mr.
+Cooper to vindicate himself. Here, then, was a low and pitiful
+attempt made through the medium of malice and calumny (loud hisses
+and uproar). Here was a rude and pitiful attempt by malice and
+calumny (renewed signs of disapprobation). And yet it was contended
+that this had advanced the medical profession. The evidence on the
+trial went to shew that the dangers by which the operator had been
+surrounded were not small, and that there was no just reason to
+accuse him of unskilfulness in what he did; and was it then to be
+said, in the face of the British public, that a Meeting had been
+held at the Freemasons' Tavern to offer praise and reward to the
+individual whose conduct had, by the verdict of the Jury, been
+stamped with the accusation of untruth (hear, hear! and hisses)?
+He would not deny that there was a degree of talent displayed in
+the Lancet; but neither could it be denied that it was a public
+depredator by means of reports surreptitiously obtained; and the
+title of "literary raven," which had been applied by Sir James
+Scarlett, appeared to him to truly depict its character (great
+hisses and uproar). Was it to be contended that any one had a right
+to come into a private lecture-room, and catch up all he could
+hear, and then to publish what he had thus surreptitiously and
+fraudulently obtained (immense uproar and hisses)? As far as the
+medical interest was concerned, he looked upon the Lancet as one of
+the most injurious publications that had ever appeared (hisses).
+All the best writers on the subject had dwelt with peculiar
+emphasis on the necessity of secrecy among the members of the
+profession, but the Lancet broke through this good rule, and made
+public whatever came within its notice; and he had no doubt that
+if it could get at the cases that occurred in private practice, it
+would give them without any scruple (uproar).
+
+The _Chairman_ begged to remind the speaker that at all events Mr.
+Wakley had not as yet done so.
+
+_Dr. Shiel._--I am arguing on the principle which appears to
+actuate Mr. Wakley.
+
+_Mr. John Elliot_ rose to order. He could not allow Dr. Shiel to be
+going upon suppositions; the thing that he supposed had never been
+done.
+
+_Dr. Shiel_ was sure that whatever turn might be given to the
+subject in England, that at all events the conclusions that the
+Meeting appeared to be coming to would be resisted abroad. The
+weight of Sir Astley Cooper's name abroad would overpower any
+such attempt, and, in fact, would render it contemptible; so that
+any attempt to prop up so low, pitiful, and mean an attack, must
+inevitably be attended with disgraceful failure (hisses).
+
+A gentleman observed, that he was much surprised at what had fallen
+from Dr. Shiel. He had been induced to suppose that the Lancet
+possessed talent, as he had heard it praised in so many directions,
+and he certainly had never heard till that evening that it was
+only to be found in the hands of the illiterate (hear, hear! and
+a laugh). He had always understood that it was only destined for
+the use of students and other members of the profession, and that
+it was likely to be of great use in reforming the abuses of the
+medical practice (hear, hear! and cries of "So it will!"). For his
+own part, he was glad that medical men were occasionally cut up,
+because when they did what was wrong it was proper that they should
+be told of it; and when they did what was right, it added a fresh
+stimulus to their exertions (applause).
+
+_Mr. Thomas_ observed, that he had not intended to say any thing at
+the present meeting; but as Dr. Shiel, in the course of his speech,
+had thought proper to make some remarks tending to calumniate Mr.
+Wakley's witnesses on the trial, of which he was one, he felt
+called upon to say a few words (hear, hear!). Dr. Shiel seemed to
+consider them all as the mere scum of the earth--as a miserable
+band, collected together to support Mr. Wakley, whatever might
+be the consequence; as though he was desirous of going the whole
+length of the Medical Gazette, which stigmatised them for what it
+called "their deep-laid contrivances--their rankling enmities, and
+their bitter revenge." For himself he could say, that it was not
+till the evening previous to the trial that he had been supœnaed,
+and that he had previous to that time never seen Mr. Wakley.
+
+_Dr. Shiel_ said that he could not have alluded to the gentleman
+who was speaking, as he did not even know his name.
+
+_Mr. Thomas_ then went on to observe, that as Dr. Shiel appeared
+to be the advocate of the opposite party, he also supposed that he
+was a contributor to the aristocratical (Medical) Gazette ("No,
+no!" from Dr. Shiel). If he were not, at all events he had put
+forward ideas that were quite consonant to the sentiments expressed
+in that Journal. In giving his testimony, he had not spoken of the
+instruments employed in the operation, but of his own impression
+on the subject, having been present thirty-five minutes; and that
+impression certainly was, that the operation had been performed in
+a bungling and unscientific manner (loud applause, mingled with
+hisses). Was he then, because he happened to be a witness on the
+occasion, to be put down, pell-mell, by the unfounded imputations
+of any one? The highly-principled, honourable-minded Medical
+Gazette, that had determined never to admit any personalities, had
+loaded Mr. Wakley and Mr. Lambert with all sorts of abuse. Was
+this what they intended to call acting on principle (applause,
+and cries of "No, no!")? He certainly had heard that Mr. B.
+Cooper was an amiable man in private life; but what had that
+to do with the question at issue? What had they to do with the
+private character of a man in a public office (cheers)? Surely the
+witnesses of Mr. Wakley were as competent to speak of the manner
+in which the operation was performed as those who had not been
+present (applause); and as he had seen many operations performed
+he conceived that he was a competent judge of the skill of the
+operator (applause).
+
+A gentleman, who appeared to be a student, thought that the
+introduction of any attack upon the witnesses, or indeed of
+anything that occurred at the trial, was irrelevant (hear,
+hear!). The way to answer a speaker was not by hisses, but by
+disproving his arguments and rebutting his facts (applause). If
+questions were to be settled merely by strength of lungs, he
+was afraid that instead of the right side prevailing, success
+would uniformly attend those whose physical powers probably much
+exceeded their mental (laughter and applause). He could not agree
+with the gentleman who had stated that the law of England was
+the protector of the freedom of the Press; for it was well known
+that the Judges had decided, over and over again, that truth was
+a libel (applause). It was only the vehicle that conveyed public
+sentiment, and not the force that impelled it forward. He was
+convinced that any attempt to connect medical reform with Mr.
+Wakley should be studiously avoided and disclaimed. As a friend of
+free discussion in every case, and anxious to uphold the principle,
+whatever he might think of the instrument, he intended to propose,
+as an Amendment, "That the latter part of the Resolution, relating
+to Mr. Wakley, should be omitted." This would save the cause of
+medical reform from being identified with Mr. Wakley, of whose
+impartiality he would give a specimen. In the last number of the
+Lancet, the report of the late trial was given from the Times, but
+with a remarkable omission. The Lord Chief Justice had rebuked
+one of the defendant's witnesses for not answering the questions
+in a straightforward manner, and this passage was omitted. If Mr.
+Wakley would do this on such an occasion, would he be more candid
+when the public eye was less upon him? He, therefore, wished to
+have the question of medical reform kept separate from Mr. Wakley
+individually. The first part of the Resolution would be carried
+without a dissenting voice, as on that principle they were all
+agreed, whatever they might think of the conduct of individuals.
+
+[One or two persons then made speeches for or against the
+amendment; which was negatived, and the original motion carried.]
+
+_Mr. Hensley_ then, after observing that Mr. Wakley's conduct
+was highly praiseworthy, because it tended in every way to the
+benefit of humanity, moved the second Resolution, which was to the
+following effect:--
+
+"That the purposes for which the Hospitals and Infirmaries of
+the Metropolis were founded, and that the views of the humane
+contributors to their funds, are materially promoted by the
+weekly publication of reports detailing the medical and surgical
+treatment of the unfortunate patients; and that Mr. Wakley having
+originated the practice of publishing Hospital Reports, has
+conferred important benefits on Medical Science, and on the cause
+of humanity."
+
+The resolution was then carried unanimously.
+
+_Mr. John Elliott_, on moving the third resolution, said that he
+did not come there to interfere in the quarrels of Wakley and
+Cooper. They had acknowledged that Mr. Wakley's exertions had been
+very conducive to medical reform, by the last resolution they
+had passed. Indeed, there could be no doubt that he had greatly
+served the cause of humanity, by preventing idleness on the part of
+medical persons, and compelling attention to the poor placed under
+their care. It was his opinion that the editor of the Lancet ought
+to be indemnified for the whole expense entailed on him by the
+late trial, including the damages awarded against him. This would
+not be a private subscription, like Brodie's, but one open to the
+world, and not to be questioned in a court of justice. He would not
+support Mr. Wakley if he had attacked private character; but he
+would, as the editor of the Lancet and the representative of the
+medical free press. He concluded by moving--
+
+"That the independent and impartial principles on which the Lancet
+was first established, have been preserved by Mr. Wakley at all
+risks; and as it was acknowledged at the late trial, that the
+legal expenses of his opponents on another occasion have been
+defrayed by certain hospital physicians and surgeons[23], it is
+farther resolved, that a subscription be opened for the purpose of
+defraying the expenses of the late action."
+
+[Dr. Shiel here spoke very strongly against entering into a
+subscription--while some spoke in its favour.]
+
+A discussion then arose about the question of whether an account
+of a second operation for lithotomy by Mr. Cooper (in which he had
+been successful) had been sent to Mr. Wakley? It was stated that
+such was the case, but as the action for the present libel was then
+commenced, _Mr. Wakley thought that he perceived something in that
+second report that might tend to aggravate the damages, and which,
+at the same time, would be farther injurious to Mr. B. Cooper_.
+
+The third resolution was then carried by an immense majority, only
+five hands being held up against it.
+
+_Mr. Evans_ moved, "That the statement of professional facts in an
+unprofessional form, such as the dramatic instead of the narrative,
+is highly reprehensible in the individual, and detrimental to the
+best interests of science."
+
+This resolution, after some turbulent discussion, was withdrawn.
+
+_Mr. J. L. Stevens_ then moved, as the fourth resolution, that "In
+accordance with the feelings this meeting has expressed, Mr. Wakley
+be invited to attend a Public Dinner, and that a Committee be
+forthwith nominated to arrange the same."
+
+_Mr. Rogers_ seconded the resolution, and it was carried
+unanimously.
+
+The members of the committee were then named, and power given to
+them to add to their number.--The chairman then vacated his office,
+and the meeting separated.--_Morning Chronicle, Wednesday._
+
+
+In the course of the evening, the conduct of one of the speakers
+gave for a short time an amusing turn to the discussion, which for
+a great part had appeared to many extremely dry and tedious. The
+gentleman in question, (not a medical man), in order to show the
+opinion he had entertained of the object of the meeting, proposed
+to read for the audience a letter which he himself had written to
+the chairman of the committee, asking permission to attend. He
+began, but he had scarcely got through a few words when he declared
+he was not able to make out his own writing, and requested the
+chairman to assist him. The chairman made the attempt, but was not
+more successful. Another gentleman then undertook the task, but
+with no better effect. The audience received each unsuccessful
+effort with loud laughter, which so much annoyed the writer that he
+took back the letter, and again tried to go through with it, but
+not being able to make it out, he proposed to read for the meeting
+two letters which he wrote on the same subject to the editor of a
+Sunday paper. (Loud laughter followed this proposition, which was
+increased, when, on an attempt to read one of them, he had no more
+success than before.) The gentleman, after complaining of the want
+of courtesy in the meeting, resumed his seat, declaring that he
+would give the letters to the reporters.--_Times, Wednesday._
+
+
+
+
+HOSPITAL REPORTS.
+
+
+GLASGOW ROYAL INFIRMARY.
+
+_Injuries of the Head._
+
+D. M'Millan, æt. 40, seaman;--while he was employed in the hold
+of a vessel, a heavy iron block, of a round form, fell from the
+rigging, a height of 20 feet, and struck him on the head. He was
+knocked down and stunned, but was able to rise and to walk with
+a little support. He was brought about a mile and a half in a
+hackney-coach to the hospital, and admitted by Mr. Cowan at one
+o'clock P.M., half an hour after the accident. At this time he
+had a stupified look, but was quite collected, and was able to
+walk across the ward; breathing and pupils both natural; pulse 75,
+of moderate strength. There was a wound in the scalp, commencing
+nearly over the centre of the sagittal suture, and running about
+three inches backwards and towards the left; along this a portion
+of skull, corresponding to the wound in size, was felt fractured,
+detached, and irregularly depressed. His right arm was benumbed and
+nearly powerless, but no mark of injury was observed on it.
+
+It was determined to remove the detached piece of bone, and the
+original wound being extended lengthwise in both directions, an
+incision was made through the scalp at right angles to it over the
+left parietal bone, thus bringing the fractured portion into view.
+This was found to be broken down into several fragments, some of
+which were firmly impacted under the surrounding cranium, and one
+spiculum, driven through the dura mater, had penetrated the brain.
+The trephine was applied a little to the left of the fracture, and
+the intermediate part removed with Hey's saw; the detached pieces
+of bone, ten in number, of various sizes and irregular shapes,
+were removed with the forceps, the scalp replaced and retained in
+position by a stripe of adhesive plaister and very light dressings.
+During the operation one artery required ligature, and about ℥v. of
+blood were lost: he had lost perhaps as much before. He remained
+quite sensible, bore it well, and shortly afterwards had half a
+glass of port wine in warm water.
+
+Ten P.M.--Has been tolerably easy; complains of pain of fore-part
+of head; pulse 82, firm.
+
+    Fiat V. S. ad ℥xviii.
+
+    Sumat statim Submur. Hydr. gr. viii. Pulv. Antimon. gr. vi.
+
+    Applic. Capiti Lotio ex Alcohol. et aq. calcis.
+
+Second day.--After bleeding, thought feeling of numbness of right
+arm somewhat lessened, and to-day has rather more power of it.
+Passed a tolerable night; a little head-ache; countenance pretty
+natural; tongue slightly loaded; thirst; no stool.
+
+    Sum. stat. Sulph. Magnesiæ ℥j. et rep. vesp. si opus.
+
+Third day.--From an aversion to use the bed pan, he rose to stool
+last night, and fell forwards on the floor, seemingly from having
+entangled himself in the bed clothes; he got into bed without
+assistance; had a shivering fit shortly after, but has had a pretty
+good night; bowels freely opened; head-ache slight; pulse 84, soft;
+tongue dry in middle. Towards the evening of this day he appeared
+drowsy; and on the fourth day he is reported as seeming confused
+and uneasy; countenance anxious; articulation difficult; the right
+arm was more paralysed, and indeed the whole right side seemed
+now to partake in the paralysis; a small part of the wound had
+adhered, the remaining part was flabby, discharging thin serum.
+In the evening the difficulty of articulation and drowsiness had
+increased. Twelve leeches were applied to each temple, and in a
+short time he seemed a little livelier.
+
+Fifth day.--Much in the same state; took a little beef tea.
+
+Sixth day.--Paralytic symptoms increased; breathing laborious.
+Blister to the neck. It may be worthy of remark, that in the few
+words he now spoke he never made use of the English language, but
+of the Gaelic, which was his native tongue; and even when told that
+he was not understood, he persisted in repeating the Gaelic phrase.
+
+Seventh day.--A small fungus was observed in upper part of wound,
+to which lint dipped in lime water was applied, and moderate
+pressure. The fungus continued to increase.
+
+On the eleventh and twelfth days he had slight bleedings from the
+scalp, which stopped spontaneously. Stupor, &c. greatly increased,
+but he still recognised his friends; took a very little chicken
+soup or beef tea daily, with lemonade, &c. for drink.
+
+On the evening of the thirteenth day bleeding to the extent of
+℥iv. or v. took place from fungus: it was checked by application
+of saturated solution of alum, but he sunk rapidly, and died that
+night.
+
+_Inspection 36 hours after death._--The fungus protruded
+considerably beyond the scalp, and was rather larger than a hen's
+egg, of a dirty brown colour, and a soft spongy consistence; it
+completely filled up the opening made in the skull by the trephine
+and removal of detached bone. The pericranium to the inferior side
+of this opening was found detached from the bone, to the extent
+of a crown piece, and beneath it the bone was rough, and covered
+with thin purulent matter. The dura mater, for two inches around
+the fungus, was covered with pus; this membrane, by sloughing,
+had allowed the fungus to protrude, and its edges adjacent to the
+aperture were thickened. On removing the dura mater, the fungus was
+observed to arise, partly from the middle, but chiefly from the
+posterior lobe of the left cerebral hemisphere: it occupied a space
+about three inches in length, and an inch and a half in breadth,
+extending to within a line or two of the roof of the ventricle;
+at its anterior part was an abscess, containing ℥ss. of pus. The
+fungus seemed to be a degeneration of the cerebral substance;
+sections of it showed the cerebral matter first dotted with an
+unusual number of bloody points, then assuming a greyish colour,
+which gradually passed into a dirty brown. With the exception of
+these bloody points, the brain presented no unusual vascularity:
+it was quite firm, except in the immediate neighbourhood of the
+fungus, where it gradually became softer as the colour of the
+cerebral substance became deeper, till in the centre of the fungus
+it was nearly of a broken down consistence. A quantity of serum was
+found in each ventricle.
+
+
+Another man who had been struck by the piece of iron which
+fractured M'Millan's skull was brought up to the hospital at the
+same time. He had received the blow on the vertex of his head. On
+admission he was in a state of fury, requiring the efforts of
+several men to hold him. His head was bruised out of all shape,
+quite depressed behind, and a fracture also of the frontal bone;
+there were evident symptoms too of fracture of the base of the
+skull. The case was hopeless. Several large depressed and detached
+pieces of bone were removed, but he died a few minutes after the
+operation.
+
+
+During the same week an old woman was brought up to the infirmary,
+who, the day previously, had fallen headlong down a stone
+staircase. She laboured under the severest symptoms of concussion,
+and besides had a comminuted fracture of the humerus into the
+elbow joint, and of the radius into the wrist joint of left arm.
+She was past all treatment, and died on the second day. The case
+is mentioned chiefly to remark, that although no external injury
+of the head could be observed, on inspection a fracture was found
+extending completely across the anterior part of base of cranium.
+
+
+There are no dispensaries in Glasgow, but such of the poor as are
+unable to obtain admission into the Royal Infirmary, and those who
+are not so ill as to submit to the confinement of an hospital,
+or for other reasons prefer remaining in their own houses, are
+prescribed for, and, if necessary, visited at the public expense.
+For this purpose the city is divided into districts, and a surgeon
+appointed to each. The "district shop" thus resembles a dispensary,
+where the surgeon prescribes in the presence of his pupils, who
+indeed, under his superintendance, have the management of many
+of the cases, both among the patients who receive advice at the
+"shop," and those who are visited at home. Although under the care
+of a surgeon, the diseases treated are both medical and surgical,
+for there is little distinction made between the two branches of
+the profession here.
+
+The following case occurred under the care of Mr. Stirling:--
+
+W. M. æt. 28, while returning home during the night in a state
+of intoxication, fell from a height of ten feet, into a court
+paved with stone. He was rendered insensible for some time, but
+on recovering was able to crawl to the nearest door, and was
+conveyed home. Medical assistance was immediately procured. On
+the forehead, about an inch above the nasal process of the frontal
+bone, was a cut an inch and a half in length, extending obliquely
+downwards from the right side; through this a triangular fracture
+was felt, the base of which was in the direction of the external
+wound, and the apex pointing downwards; the fractured portion
+of the bone was slightly depressed; the bones of the nose were
+also fractured, and there was great discharge of blood from the
+nostrils. One third, or nearly, of the upper lip was cut off, and a
+good deal of blood had been lost from the labial artery; the lower
+jaw at the symphysis was fractured and comminuted, and several
+pieces were perceived to be loose. Was quite sensible, remembering
+every thing up to the period of the accident. Pulse 80; has vomited
+frequently. Wound of forehead was dressed with adhesive plaister;
+the loose pieces of bone were removed from the lower jaw, and it
+was afterwards retained in juxta-position by a chin bandage.
+
+Early next morning he was bled to ℥xii. and had a purge of jalap
+and calomel, by which his bowels were freely opened. That night he
+felt considerable pain of head; pulse 90, full, and strong. He was
+bled again to ℥xxv. Blood first drawn had the buffy coat. After
+the bleeding the pain of head diminished, and he continued to do
+well. When the swelling and tenderness of face had subsided, it was
+observed that the fracture communicated with the frontal sinus. On
+holding his nose and attempting to blow it, matter and air escaped
+by the fracture. The man was anxious for a speedy cure, and for
+this purpose an operation to remove the depressed piece of bone was
+at one time thought of; there was no constitutional disturbance,
+however, and the case was left to nature. The discharge gradually
+diminished, and the wound healed up in about a month. The bones
+of the nose retained their position, and the broken ends of the
+jaw, after the swelling had subsided, were kept in their proper
+situation by a pasteboard splint till re-union took place. The lip
+also healed easily, and no deformity is now observable.
+
+
+GUY'S HOSPITAL.
+
+_Inflammation of Hernial Sac._
+
+The previous report of this case (Gazette, No. 51) conducted it to
+Nov. 18th, the tenth day from the operation, and the third on which
+fæces had been discharged from the wound; that discharge continued
+on the 19th, but on the 20th pus only was seen.
+
+Nov. 22.--Yesterday the dresser, Mr. King, observed a portion of
+_solid_ fæces make its escape, and to-day a similar discharge, in
+the fluid form, is manifest.
+
+Nov. 26.--Since the 22d, nothing but healthy pus has been seen; the
+wound is rapidly healing, and the patient's general condition as
+good as can be desired.
+
+Dec. 4.--He has begun to wear a truss, and is to-day allowed to
+leave his bed.
+
+Dec. 8.--As regards his original complaint, the man is perfectly
+convalescent, but he now discloses a small abscess in the scrotum,
+which has been gradually forming, and will detain him in the house
+some time longer.
+
+If it be a sound surgical maxim that, in strangulated hernia,
+the patient's safety depends upon an early operation, it is also
+a maxim no less sound, that where the evidence and symptoms of
+strangulation are imperfect, or dubious, the benefit of the doubt
+should be given to the operation, and it should be performed: for
+it is better that buboes should be laid open, or inflamed sacs cut
+into, twenty, aye, fifty times in succession, than that in one case
+a man should be suffered to die with strangulation of the intestine
+unrelieved.
+
+These remarks apply strikingly to this case of Mr. Key's, in which,
+although no hernia was found, they perfectly justify the operation.
+No case of strangulation could be more distinctly marked, or
+more clearly call for the knife, than did this; and had Mr. Key
+refused to use it, he would have deserved the scoff which, by a
+contemporary, has so preposterously been thrown on the "no hernia
+case." But, more than this, the operation was not only justifiable,
+but beyond a doubt _beneficial_--beneficial inasmuch as it at
+once relieved the distress of the patient, secured him from more
+extensive suppuration, from farther sloughing of intestine, and
+probably from extravasation of fæces into the abdomen; rendering
+also the process of reparation more easy and rapid.
+
+
+_Hereditary Hare-Lip._
+
+Dec. 4th, Mr. Key performed the operation for hare-lip on a child
+a few months old, whose case was remarkable only as it afforded an
+instance of _hereditary_ malformation. The father of the child had
+congenital hare-lip, for which no operation had been performed, and
+of his six children _two_ were born with the same malformation.
+
+_Queries._--1. If the father's lip had, in his infancy, been
+restored to the natural form, would the malformation in that case
+have descended to his children?
+
+2. Is the casualty in these cases to be traced _directly_ from
+the father to the incipient embryo, or _indirectly_, through the
+medium of the mother's imagination--It has been said that paternal
+resemblances are produced in the latter mode.
+
+  G.
+
+
+PARIS HOSPITALS.
+
+_Hôtel Dieu._
+
+_Cases of Gangrene of the Lungs._
+
+Some interesting cases of gangrenous suppuration of the lungs were
+published by Dr. Chambers, about eighteen months ago, in which he
+particularly pointed out the horrible fœtor of the breath as a
+diagnostic mark of the disease. The following cases which recently
+occurred at the Hôtel Dieu are good illustrations of more extensive
+destruction of the lung by a similar disease.
+
+CASE I.--A man, aged 32, of good constitution, laboured under
+bronchitis for some weeks, to which he paid little attention,
+when he was suddenly seized with pain in left side, dyspnœa,
+considerable cough, and a rigor, followed by fever. He was admitted
+into the Hôtel Dieu next day. Crepitation was perceptible over the
+whole extent of the left lung, posteriorly, and reaching to the
+site of the pain in the side, which was increased by percussion;
+great oppression, with frequent cough, and expectoration of
+violet-red colour, mixed with mucus; pulse frequent and small;
+constant chilliness; cheeks flushed.
+
+Next day the symptoms remained unabated, and _fœtor of the breath_
+was observed. Two days after it is stated that the expectoration
+maintained the same appearance, but _was now fœtid_; the breath
+was, however, still more offensive, and during the fits of coughing
+particularly so. In the evening the breath is said to have become
+_gangrenous_.
+
+21.--The cough was small, difficult, and painful, producing an
+expectoration of violet-coloured matter, approaching to chocolate,
+_with a characteristic odour_.
+
+22 to 25.--Expectoration and breath emit an _intolerable stench_.
+On the latter day the patient died.
+
+_Examination._--The body not emaciated. Strong adhesions of the
+left lung to pleura costalis. At its posterior part a large
+gangrenous layer, occupying the two superior thirds of the lung,
+covered at some points by a false membrane. The lower third, and
+the parts round the gangrenous portion, in different degrees of
+inflammation, and hepatised; the putrid mass was in great part
+black or violet-coloured, containing fragments of the pulmonary
+texture; the smell gangrenous, but less so than that of the breath
+during life; pus might be squeezed from the adjacent part of the
+lung.
+
+CASE II.--A man, aged 55, enjoyed good health till the beginning
+of May, at which time he experienced pain in the left side of
+the thorax after exposure to cold. During the next few days the
+cough was frequent, and the expectoration tinged with blood. A
+rigor now came on, followed by a distinct exacerbation of fever,
+and he came to the Hôtel Dieu. At this time he presented symptoms
+of inflammation of the lungs, and was bled with relief; he left
+the hospital in twelve days, being sufficiently well to resume
+his occupation. Scarcely had he done this, however, when he had a
+relapse, accompanied by great lassitude, oppression of breathing,
+and frequent cough. At the end of a week he returned. He was now at
+the twenty-first day of the attack. His skin was yellowish; face
+pale or of leaden hue, and greatly altered; his cough frequent,
+with abundant expectoration of matter like chocolate, with small
+specks resembling pus, and little bodies about the size of peas,
+which appeared to be portions of the lung. This putrid mass exhaled
+a _gangrenous odour_, and the expired air was impregnated in a
+high degree with an equally disgusting smell, which surrounded the
+patient's bed with a contaminated atmosphere. Percussion gave a
+clear sound over the whole extent of the chest; auscultation did
+not discover the pulmonary expansion on the right side. The pulse
+was weak, but not frequent; the patient was in a state of extreme
+prostration. Next day the odour of the breath and expectoration
+was, if possible, more dreadful. He lingered two days longer,
+during which time the fœtid smell somewhat diminished, and the
+proportion of pus in the expectoration increased.
+
+_Examination._--The left lung had contracted firm adhesions,
+particularly above and behind. It was torn in attempting to
+remove it, and there issued from the middle and posterior part a
+large quantity of dark-coloured matter, similar to what had been
+expectorated. An incision was made along the back part of the
+lung, and laid open a large cavity, occupying all the extent of
+the pulmonary organ, and still in part filled with the same kind
+of dark putrid matter. On washing out the cavity it was perceived
+that it was lined with a smooth and white membrane, to which were
+still adherent, at some points, dark filamentous shreds; these
+were removed by the least touch, and left the surface smooth
+beneath. The boundary was formed by a false membrane, about a line
+in thickness, which separated the mortified from the sound parts.
+The lung was reduced to a kind of bag, the parietes of which were
+on an average about an inch thick. In the upper part of the lung,
+which was hepatized, an incision discovered a number of smaller
+tubercles, which in the centre were in a crude state; and at one
+point several had suppurated, forming a cavity large enough to
+contain a nut.
+
+[The Editors of the _Journal Hebdomadaire_, from which these cases
+are abridged, add, in a note, that although the fœtor of the
+expectoration, such as above described, is usually dependent on
+gangrene of the lungs, yet that this is not invariably the case.
+In confirmation of this assertion they refer to three instances
+of fœtid expectoration--in the first, the patient is still alive;
+in the second, there was chronic bronchitis, with considerable
+dilatation of numerous bronchi; and in the third, bronchitis with
+some appearances of chronic pneumonia. Laënnec gives a case of
+dilatation of the bronchi, with remarkably fœtid expectoration.
+The argument derived from the first patient having survived we
+consider to be altogether erroneous, as patients more frequently
+recover from this than other forms of purulent expectoration.--ED.]
+
+
+
+
+PROCEEDINGS OF SOCIETIES.
+
+
+WESTMINSTER MEDICAL SOCIETY.
+
+December 6th, 1828.
+
+JAMES ARNOTT, ESQ. IN THE CHAIR.
+
+Pursuant to announcement, Mr. MacKelcan introduced the subject of
+concussion of the brain. After remarking on the several symptoms,
+and mentioning the other affections of the head with which
+concussion is apt to be confounded, Mr. M. directed the attention
+of the society more particularly to the treatment in the stage of
+collapse, adopted by Professor Andrini of Florence.
+
+Dr. Duffin stated, that having been in Florence, he had witnessed
+the employment of three, four, or six ounce bleedings employed
+by the Professor in the stage above-mentioned. The principle on
+which they were used was that of their acting as a stimulus to the
+brain; and really the plan was not apparently attended with any bad
+effects. When re-action has ensued, the practice of M. Andrini is
+the same as that resorted to in this country.
+
+The discussion then wavered between apoplexy and concussion, and
+ended by some good-humoured sparring between Dr. Addison and Mr.
+Gilbert Burnett, on the capability of the brain containing more
+blood at one time than another.
+
+The President announced from the chair that a special meeting would
+take place on Friday evening, December 12, at 7 P.M.
+
+
+December 20th, 1828.
+
+CÆSAR HAWKINS, ESQ. IN THE CHAIR.
+
+After some business had been dispatched, to which we shall allude
+in another place, Mr. Jewel related the particulars of a case of
+"supposed extra-uterine fœtation." The case, which is one of much
+interest, is as follows:--
+
+Mrs. F. a robust, healthy woman, ætatis 27, had been married one
+year, and aborted once; when, in the month of September 1827,
+she quitted her husband in London, and accepted a situation in
+the country. After the expiration of a few weeks she received
+permission to come to London for a day; and, naturally enough,
+passed that night, (November 8th), with her husband, returning
+again to the country next morning. Soon afterwards, the
+morning-sickness, heart-burn, and other sympathetic affections
+of pregnancy, appeared; but the catamenia still returned at the
+regular periods, though scanty and paler in colour than natural.
+She now quitted her situation, returned to her husband, and
+engaged a midwife to attend her in her expected confinement. The
+circumstance of quickening occurred in the latter part of February,
+and was accompanied by a severe paroxysm of fainting, whilst the
+abdomen gradually enlarged, and the motions of the child (as was
+imagined) could not only be easily detected with the hand, but were
+visible to the eye. On the 9th of August, making a period of 274
+days, she was seized with the usual premonitory symptoms of labour;
+the midwife arrived; found her walking her chamber, and concluded
+that the process had considerably advanced. Three distinct uterine
+contractions took place subsequent to the midwife's arrival, the
+last of which was so severe as to compel the patient to grasp
+firmly the back of a chair, and induce, after its subsidence,
+excessive faintness. From this time no further parturient effort
+was made; no examination per vaginam was instituted; neither was
+there noticed any sanguineous vaginal discharge. When Mr. Jewel saw
+her, examination detected nothing unusual in the os uteri, and the
+symptoms she presents are these. The abdomen is about the size of a
+woman's in the sixth or seventh month of pregnancy, the enlargement
+being general. Her general health is much disturbed: she complains
+of pain in the left hypogastric region, particularly when the
+abdomen is compressed by the hand or stays--and she also complains
+of weight in the abdomen, especially on leaning forwards. The woman
+herself has a strong prepossession that "something is to come
+away," or that she might be relieved by an operation. The woman
+believes that she still feels the motions of the child, though
+feebly.
+
+Having read this case, Mr. Jewel concluded by offering some
+observations on the subject of extra-uterine fœtation. He
+considered this as probably an instance of "graviditus
+abdominalis," and remarked that the uterus not having expelled its
+dezidua, was no conclusive proof to the contrary, Dr. Blundell and
+Mr. Langstaff having examined cases where this was wanting.
+
+Dr. Locock never saw a case where laceration occurred in the
+early months of pregnancy. Dr. L. remembered the particulars
+of a case where the uterus was lacerated in the fourth month,
+and the ovum escaped into the cavity of the abdomen, and the
+symptoms of pregnancy were exceedingly strong. Dr. Locock almost
+doubted whether Mr. Jewel's was an instance of pregnancy at all,
+for frequently women enjoying sexual intercourse have enlarged
+abdomens, and many of the other symptoms of pregnancy, which a few
+doses of purgative medicine will remove.
+
+Two remarkable instances of extra-uterine fœtation were related
+by Mr. Burnett and Mr. Cæsar Hawkins; and towards the conclusion
+of the evening the discussion turned on the powers of the ergot
+of rye. Dr. Locock had frequently tried it in amenorrhœa, and, on
+the whole, without any very good effects. In one remarkable case,
+where the lady particularly wished to have children, Dr. Locock
+having boiled an ounce of the ergot in a pint of water down to half
+a pint, gave an ounce and a half of this decoction three times a
+day. After the young lady had taken about half a pint, the most
+violent convulsions succeeded, which placed her life in imminent
+hazard, and from which it was long before she completely recovered.
+She menstruated twice after that, but then the discharge again was
+arrested, and has never since returned, nor has she become pregnant.
+
+The practice of "bougieing the uterus" in cases of dysmenorrhœa
+was brought upon the tapis, and excited a good deal of laughter,
+the members appearing to consider the proposal ridiculous in the
+extreme.
+
+
+MR. LAMBERT.
+
+At the last meeting of this Society it was proposed, on the
+recommendation of the Committee, that Mr. James Lambert should be
+expelled; and after some discussion it was agreed that the sense
+of the members should be taken by ballot at the next meeting,
+Saturday, January 3, 1829. It was thought that proceeding at
+once to his expulsion might give the appearance of the measure
+originating with a party, and that the delay would enable the
+deliberate judgment of the whole Society to be passed upon his
+conduct.
+
+
+HUNTERIAN SOCIETY.
+
+Dec. 10, 1828.
+
+DR. BILLING, PRESIDENT, IN THE CHAIR.
+
+Mr. Leese, Jun. exhibited to the meeting a specimen of medullary
+sarcoma, taken from the forehead of a man after death, with a
+portion of the os frontis. The man was fifty-eight years of
+age, long asthmatic, and appeared to die of hydrothorax. He
+never suffered any pain in the tumor, but expressed a sense of
+distention. It was immoveable at the base, and there were some
+fissures in the os frontis, from caries. The dura mater at the
+corresponding part adhered firmly to cranium, and on its being
+removed some spiculæ from the carius inner table remained adhered
+to it. There had never been any symptoms of cerebral affection. A
+tumor of the same nature had formed on the scapular extremity of
+the clavicle, and had occasioned anasarca of the limb.
+
+Mr. Key supposed that the tumor had originated from the diplöe,
+and believed that the only chance of relief in such a case
+would be trephining; but he acknowledged that there was little
+encouragement to operate in these cases, owing to the tendency of
+the disease to return in some other part. He related an instance
+of the true medullary fungus taking its origin from the cancellous
+structure of the os femoris. The limb was removed, but the patient
+died. A circle of fungoid glands was observed at the base of the
+heart, and some of the bronchial glands were in the same condition.
+
+Dr. Conquest expressed his belief that carcinoma was always a
+constitutional affection, and stated that at least in nine cases of
+cancer uteri out of ten, there was carcinomatous affection of the
+pylorus, mesenteric glands, or liver.
+
+Mr. Key and Dr. F. Ramsbotham had not observed, in their
+examinations, the coincidence noticed by Dr. Conquest.
+
+The remainder of the evening was occupied by a discussion on the
+different kinds of ulceration that occur about the os and cervix
+uteri, and the circumstances under which the removal of the uterus,
+or the amputation of the cervix, may be warrantable.
+
+Dr. Babington adverted to the occasional existence of a family
+disposition to carcinoma. He had known three sisters successively
+die of cancer in the breast.
+
+
+MEDICAL SOCIETY OF LONDON.
+
+Dec. 13th and 20th, 1828.
+
+DR. HASLAM IN THE CHAIR.
+
+The subject of discussion, at the first of these meetings, was
+stricture of the rectum, when the diagnosis and treatment of
+carcinoma of that part came under consideration. There was a
+remarkable discrepancy in the opinions of Messrs. Lloyd and Salmon
+as to the symptoms and management of carcinomatous affections of
+the rectum. Mr. Lloyd maintained that these affections of the
+intestine were sometimes attended with pain and sometimes not, and
+that the patients were often materially benefited by the use of
+bougies; while Mr. Salmon affirmed, that the disease was always
+painful, and not to be mitigated by the employment of these means.
+
+A variety of subjects came before the society at the next meeting.
+The president read a letter from Mr. Wansborough, of Fulham,
+describing the "original stomach-pump," a specimen of which
+accompanied the letter: the instrument Mr. W. stated to be of 25
+years' standing.
+
+Mr. Shearly exhibited, among other morbid specimens, a uterus,
+on the external surface of which the disease termed the "white
+tubercle" was in progress: there was also a small polypus near the
+os uteri. Mr. Pereira exhibited to the society a fine specimen of
+medullary sarcoma of the liver. The organ was so enlarged as to
+have occupied two-thirds of the abdomen. The other viscera were not
+involved in the disease. The progress of the disease, as far as
+it could be ascertained, was excellently detailed by Mr. Smith, a
+visitor. The symptoms were obscure.
+
+Mr. Armstrong read an extract of a letter from Mr. Morgan, of
+the Bristol Infirmary, a corresponding member of the Society,
+describing a curious conformation of the œsophagus in a child,
+which lived 106 hours only, during which period every attempt to
+swallow food produced considerable distress. The œsophagus was
+found to be divided into two portions; the upper or pharyngæal
+extremity terminating in a _cul de sac_ behind the bifurcation of
+the trachea; and the lower or ventricular extremity arising from
+the trachea at this point, between the bronchi, proceeding down the
+spine, and terminating, as usual, at the cardiac orifice of the
+stomach. Mr. Drysdale mentioned a somewhat similar malformation
+occurring in two children in one family. Mr. Callaway related a
+case of concussion of the brain, which terminated fatally, after
+the restoration of the intellectual functions. The whole of the
+anterior lobes of each hemisphere of the brain was broken down, and
+mixed with effused blood. The remarkable feature of the case was,
+the return of consciousness, and the possession of this power for
+six days, under the disorganization of the brain described; and the
+questions particularly agitated were, Did this extent of mischief
+exist immediately after the concussion? What was the degree of
+laceration of the brain at that period? and, How could the recovery
+of the intellectual faculty be reconciled with so much injury of
+the brain?
+
+The Society then adjourned to the 12th of January, 1829.
+
+
+
+
+COOPER _v._ WAKLEY.
+
+
+Notes of the Cause, Cooper _v._ Wakley--We understand that Mr.
+Cooper is about to publish a verbatim account of the above trial,
+from Mr. Gurney's short-hand notes.
+
+
+
+
+ERRATA.
+
+
+The Advertisement of Mr. B. Cooper's, in our last Number, ought
+to have been dated "_December_ 15," instead of "_Oct._ 15." Also,
+for "_Mr. Elton_," the name of one of Mr. Cooper's witnesses, read
+"_Mr. Hilton_."
+
+In our last leading article, _for_ "can no friend of Wakley be
+named?" _read_ "can the name of no friend of Wakley be mentioned?"
+The alteration is necessary, to connect it with the conclusion of
+the paragraph.
+
+
+W. WILSON, Printer, 57, Skinner-Street, London.
+
+
+FOOTNOTES:
+
+[1] General thickening of all the valvular apparatus on both sides
+of the heart. (St. B. 33.)
+
+[2] Andral, vol. iii. p. 411.
+
+[3] Pl. 1, fig. 5.
+
+[4] Opacity and thickening of the lining membrane on both sides of
+the heart, without unevenness or alteration of form. (St. B. 33).
+
+Opacity and thickening in the valvular apparatus between the left
+auricle and ventricle, with shortening of the chordæ tendinæ, and
+such alteration of structure and form as to produce a considerable
+contraction of the aperture. (St. B. 26).
+
+Such thickening of the whole valvular apparatus as to narrow the
+aperture of communication between the left auricle and ventricle to
+a mere slit. (St. B. 19).
+
+Shrivelled and contracted state of the semilunar valves, in which a
+cartilaginous substance has entirely taken the place of the natural
+structure. (Hodgson, pl. 1, fig. 6).
+
+[5] Osteum aortæ almost closed by ossified valves. (St. B. 15);
+(Hodgson, pl. 1, fig. 2).
+
+[6] Fungus growing from the aortic valves, which are thickened and
+shortened. (St. B. 6, 20).
+
+Fungus form the aortic valves, which are ulcerated. (St. B. 21).
+
+Larger specimens of fungus, growing from the ulcerated edges of two
+of the valves of the aorta. (Hodgson, pl. 1, fig. 7).
+
+[7] Dr. Baillie's plate.
+
+[8] Polypous coagulum in the ventricle. (Coll. of Phys. 4, A. 16).
+
+Coagulum firmly attached to the lining of the left auricle, with
+enlargement of its capacity. (St. B. 19).
+
+[9] (St. B. 13).
+
+[10] It occurs sometimes in the uterus.
+
+[11] Memoir. de l'Acad. des Sciences. Morand, 1732. Morgagni,
+Epist. 27.
+
+[12] Andral, v. 3, 466; Hodgson, plate 1, figure 7; St. B. 14.
+
+[13] Corvisart, cap. 4. sect. 1.
+
+[14] Active dilatation of the left ventricle. (College of Phys. 4,
+c. 10.)
+
+The thickened walls of the left strikingly contrasted with the
+attenuated walls of the right ventricle. (St. B. 9).
+
+Active dilatation of the left ventricle. Its capacity is strikingly
+contrasted with that of the right. (College of Phys. 4, c. 11.)
+
+Passive dilatation of both ventricles, especially of the right.
+(St. B. 10).
+
+[15] Morgagni, Epist. xxvii. 7.
+
+[16] Ibid. 2.
+
+[17] Ibid. 3.
+
+Rupture of the left ventricle, with attenuation of its muscular
+structure. (St. B. 18).
+
+Rupture, without attenuation, but with softening and looseness of
+texture in the muscular substance. (St. B. 22).
+
+[18] Harvey, Exercit. altera.
+
+[19] Rupture of the left ventricle without change in its structure.
+Bone deposited at the commencement of the aorta. (St. B. 27).
+
+In turning over the Memoirs of the Royal Academy of Sciences, I
+find two cases of rupture of the heart, reported by M. Morand. They
+both occurred in the year 1730; and, strange to say, one was that
+of a Duchess of Brunswick, who was of the same family as George II.
+who also died of a ruptured heart. In the one, that of the Duchess,
+there was a manifest ulceration through the walls of the right
+ventricle, its structure being otherwise unimpaired; in the other,
+where the aperture was in the left ventricle, there was probably
+a simple rupture, for the flesh of the heart was so soft that the
+point of a probe would pass through it wherever it was rested.
+(Mem. de l'Acad. Roy. des Sciences, Ann. 1732).
+
+[20] The trial as published in the Lancet occupied less than 21
+pages--in the Gazette it extended, in the same type, to 33 pages
+and a half. In the Lancet, those parts, both of the evidence and
+speeches, which told most against Wakley, were omitted.
+
+[21] See passage in Italics, page 137.
+
+[22] The defendant, on leaving the court, was cheered by the
+populace in Palace Yard.--Lancet, Dec. 20.
+
+[23] This we believe is false; nothing of the kind either occurred,
+or was stated at the trial.--E. G.
+
+
+
+
+  TRANSCRIBER'S NOTE
+
+  Obvious typographical errors and punctuation errors have been
+  corrected after careful comparison with other occurrences within
+  the text and consultation of external sources.
+
+  Except for those changes noted below, all misspellings in the text,
+  and inconsistent or archaic usage, have been retained.
+
+  Pg 116, 'immedate contact' replaced by 'immediate contact'.
+  Pg 119, 'and attennuation in' replaced by 'and attenuation in'.
+  Pg 126, 'Tue valuable paper' replaced by 'The valuable paper'.
+  Pg 132, 'probably impossibly' replaced by 'probably impossible'.
+
+
+
+
+
+End of the Project Gutenberg EBook of The London Medical Gazette; December
+27, 1828, by Various
+
+*** END OF THE PROJECT GUTENBERG EBOOK 53450 ***
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-
-Project Gutenberg's The London Medical Gazette; December 27, 1828, by Various
-
-This eBook is for the use of anyone anywhere in the United States and most
-other parts of the world at no cost and with almost no restrictions
-whatsoever.  You may copy it, give it away or re-use it under the terms of
-the Project Gutenberg License included with this eBook or online at
-www.gutenberg.org.  If you are not located in the United States, you'll have
-to check the laws of the country where you are located before using this ebook.
-
-Title: The London Medical Gazette; December 27, 1828
-       Being a Weekly Journal of Medicine and the Collateral Sciences
-
-Author: Various
-
-Release Date: November 5, 2016 [EBook #53450]
-
-Language: English
-
-Character set encoding: UTF-8
-
-*** START OF THIS PROJECT GUTENBERG EBOOK LONDON MEDICAL GAZETTE, DEC 27, 1828 ***
-
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-Proofreading Team at http://www.pgdp.net (This file was
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-Internet Archive)
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-
-
-
-<div class="transnote">
-<p><strong>TRANSCRIBER'S NOTE</strong></p>
-
-<p class="screenonly">The 'Apothecary System' of measurement was used in the original text.
-The etext uses the following Unicode symbols:<br />
-<span class="pad4">℞ &nbsp;</span><span class="pad4">Prescription symbol</span><br />
-<span class="pad4">ʒ &nbsp;</span><span class="pad4">Dram</span><br />
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-Roman numerals, and 'ss.' for 'half', are retained, so for example
-'℥iss.' indicates 'one and a half ounces'.</p>
-
-<p class="handonly">The 'Apothecary System' of measurement was used in the original text.
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-<span class="pad4"><img class="glyph" src="images/rx.jpg" alt="" /></span> <span class="pad4">Prescription symbol</span><br />
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-Roman numerals, and 'ss.' for 'half', are retained, so for example
-'<img class="glyph" src="images/ounce.jpg" alt="" />iss.' indicates 'one and a half ounces'.</p>
-
-<p>Obvious typographical errors and punctuation errors have been
-corrected after careful comparison with other occurrences within
-the text and consultation of external sources.</p>
-
-<p>More detail can be found at <a href="#TN">the end of the book</a>.</p>
-</div>
-
-<hr class="chap pg-brk" />
-<p><span class="pagenum"><a name="Page_113" id="Page_113">[Pg 113]</a></span></p>
-
-
-<h1>
-<span class="small">THE</span><br />
-<span class="xl">LONDON MEDICAL GAZETTE,</span></h1>
-
-<p class="center lht">
-<span class="xxs">BEING A</span><br />
-<span class="large">WEEKLY JOURNAL</span><br />
-<span class="xxs">OF</span><br />
-<span class="large lsp antiqua">Medicine and the Collateral Sciences.</span></p>
-
-<p class="p1" />
-<hr class="fulla" />
-<p class="center large">SATURDAY, DECEMBER 27, 1828.</p>
-<hr class="fulla" />
-
-
-<h2>
-<span class="xs">PATHOLOGICAL ESSAYS</span><br />
-<span class="xxs">ON SOME</span><br />
-<span class="small">DISEASES OF THE HEART;</span></h2>
-
-<p class="pfs100"><em>Being the Substance of Lectures delivered before
-the College of Physicians</em>,</p>
-
-<p class="pfs100"><span class="smcap">By P. Mere Latham</span>, M.D.</p>
-
-<p class="pfs90">Physician to St. Bartholomew's Hospital.</p>
-
-<p class="pfs80">[Continued from p. 7.]</p>
-
-<hr class="r10a" />
-<h3>ESSAY II.</h3>
-
-<p class="pfs100"><em>Morbid Anatomy of the Internal Lining
-Membrane of the Heart.</em></p>
-
-<p class="noindent">The membrane which lines the cavities
-of the heart is very liable to disease,
-but not equally so in every part. Where
-it is thin and transparent, and admits
-the colour and character of the muscular
-structure upon which it is spread
-to be seen through it, it is seldom found
-diseased; but where it is of a denser
-texture, either in itself or from an admixture
-of other structures, whether
-cellular or fibrous, with its own, it is
-frequently, and often exclusively diseased.
-This latter character of a denser
-texture belongs to it where it forms
-the tough white circles which surround
-the apertures of communication between
-the auricles and ventricles; also
-where it is reflected upon itself, and
-forms the loose duplicatures of membrane,
-which are given off, as it were,
-from the internal surface of the heart,
-either at the fibrous circles intermediate
-between the auricles and ventricles,
-constituting the tricuspid and the mitral
-valves, or at the commencement of the
-pulmonary artery and aorta, constituting
-the semilunar valves.</p>
-
-<p>It is remarkable how curiously disease
-is apt to limit itself to the spaces
-just pointed out. Of the fibrous circle
-between the auricle and ventricle, of
-the valves which originate from it, and
-of the tendinous cords which connect
-the valves with the carneæ columnæ,
-there will not be the smallest space free
-from disease; but the disease will
-abruptly stop where the tendinous
-cords cease and the carneæ columnæ
-begin<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a>.</p>
-
-<p>The membrane, however, where it
-covers the fleshy columns of the heart,
-is not exempt from the possibility of
-disease: but when disease actually
-affects it, it has seldom originated there,
-but has generally spread from other
-parts of the same membrane, although
-(as we have just remarked) it is apt to
-stop short before it reaches this.</p>
-
-<p>Of the two sides of the heart, the
-membrane which lines the left is unquestionably
-the more liable to disease.
-But my own observation would never
-have led me to conclude that the membrane
-of the right side was so far exempt
-as it is commonly thought to be.
-Speaking from the best recollection I
-have of the specimens which have fallen
-under my examination, I should say
-that, in one-third of the cases where
-disease has been found on the left side,
-it has existed on the right side also,
-and been essentially of the same character.
-But there has been a remarkable
-difference in the extent to which it
-has proceeded on each side respectively:
-while on the left it has gone so far as to
-be the undoubted cause of death, on
-the right, although essentially of the
-same character, it has been only just
-beginning.</p>
-
-<p><span class="pagenum"><a name="Page_114" id="Page_114">[114]</a></span></p>
-
-<p>It very seldom happens that disease
-appertains to the lining of the right cavities
-of the heart exclusively; and,
-where it affects both, the disease in the
-right cavities is very seldom found in
-advance of that in the left.</p>
-
-<p>It should seem, indeed, according to
-the ordinary course of things, that disease
-does not begin in the lining of the
-right cavities of the heart, until it has
-already advanced to an extreme degree
-in the left.</p>
-
-<p>The internal lining of the heart, as well
-as of the arteries, is often found to have
-become of a red colour. This redness,
-so well known to all who are accustomed
-to examine dead bodies, used to be
-regarded as a mere stain imparted to it
-by the colouring matter of the blood
-after death. Yet a due consideration of
-various circumstances connected with
-it will hardly warrant this conclusion.</p>
-
-<p>It has been found whether the heart
-or artery be full or empty of blood;
-and if blood be present it has been
-found, whether it is liquid or clotted;
-and if it be clotted, whether it does or
-does not retain its colouring matter.
-External temperature, and length of
-time between the death of the patient
-and the dissection of his body, have not
-made any difference in the frequency
-with which this peculiar appearance occurs.
-Lastly, no artificial methods,
-such as washing of any kind, can get
-rid of it; nor will inclosing blood within
-an artery for any period produce it<a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a>.
-This simple redness is sometimes seen
-universally in both sides of the heart
-and throughout the whole arterial system,
-and sometimes in patches only, of
-greater or less extent, whether in the
-arteries or in the heart.</p>
-
-<p>Now, when all these circumstances
-are considered, although in some instances
-it may be a mere stain imparted
-by the colouring matter of the blood
-after death, it is plainly impossible that
-it should be of that nature in any large
-proportion of the numerous instances
-in which it is found.</p>
-
-<p>But if the appearance in question implies
-(as I believe it generally does) a
-morbid condition, of what kind is that
-condition? There are the same objections
-to considering mere redness as
-equivalent to inflammation here as in
-the pericardium, or in any other part of
-the body: here, as elsewhere, in one
-case it may be the condition out of
-which inflammation is to spring;
-while in another it may not be destined
-to give origin to any change in the
-structure of the part beyond itself, and
-may itself constitute the whole disease.</p>
-
-<p>It appears to me, that this mere redness
-of the internal lining of the heart
-and arteries has become a matter of
-undue perplexity to pathologists, because
-they have laboured to infer from
-it more than the simple fact itself will
-authorize. All I wish to establish concerning
-it is, first, that it is not always
-(probably very seldom) a mere stain
-imparted by the colouring matter of the
-blood after death; secondly, that it
-alone does not constitute inflammation.</p>
-
-<p>It may not be improper to mention
-the circumstances under which it has
-occurred to myself to find it. I have
-met with it most frequently, and to
-the largest extent, in subjects whose
-previous disease has produced a constant
-and habitual impediment to the transmission
-of blood through the heart and
-through the lungs, and that impediment
-has gone on increasing to the hour of
-their death; also in those, whatever
-might have been the nature of their disease,
-whose dissolution (I mean the actual
-process of dying) has been tardy and
-agonizing, and marked by great labour
-of respiration; in the apoplectic, for
-example, in whom, after sense and
-consciousness were extinct, life had
-been protracted, with stertorous breathing,
-for many days.</p>
-
-<p>In such subjects the countenance,
-the lips, and the whole skin, give
-evidence during life of blood pushed
-beyond the natural sphere of the circulation,
-and detained in the extreme
-blood-vessels. Hence it is obvious
-that the causes which have loaded and
-distended the capillaries in every part
-of the body have had a like influence
-upon the vasa vasorum.</p>
-
-<p>I do not mean to say that I never met
-with this peculiar condition of the heart
-and arteries under other circumstances,
-or that other causes may not produce it;
-but that I am not acquainted with it
-under any other with which, from frequent
-coincidence, it has seemed to have
-a natural connexion, or which have
-afforded a reasonable explanation of the
-phenomenon.</p>
-
-<p>This condition of the heart and arteries,
-considered as inflammation, has
-been assigned by some as the cause of
-<span class="pagenum"><a name="Page_115" id="Page_115">[115]</a></span>
-fevers of the more malignant kind.
-The frequency with which it has been
-found in some particular epidemic,
-must have led to the conclusion. But,
-however this may be, from my own observation,
-not restricting myself to the
-fever of any particular season, but taking
-into account all complaints called
-febrile, and belonging to all seasons,
-also from the result of inquiry among
-medical men who have had large acquaintance
-with morbid dissections,
-and from the experience of those who
-have made this particular point a subject
-of investigation (Laënnec and Andral)
-I venture to conclude that it has
-no essential connexion with fevers of
-any kind, either as cause or as effect.</p>
-
-<p>On some occasions the internal membrane
-of the heart and arteries, wherever
-it exhibits the appearance described,
-will allow itself to be peeled off from
-the subjacent structure with the least
-possible force; this facility of separation
-ceasing entirely beyond the boundary
-of the red tinge.</p>
-
-<p>Here unquestionably is further evidence
-of a diseased condition: but of
-what nature? Most pathologists would
-consider this to be of the nature of inflammation&mdash;and
-I believe justly.</p>
-
-<p>There is indeed much difficulty in pronouncing
-upon the nature of minuter
-changes of structure detected in the internal
-parts of the body after death. We
-are obliged to arrive at conclusions by
-help of analogies drawn from morbid
-processes, which we have watched in
-their progress during life, upon the external
-surfaces; for during life we have
-the functions and sensibilities of the part
-to aid us in forming a right judgment
-concerning its disease. When, during
-life, one tissue is separated from another,
-as the periosteum from the bone,
-or the cuticle from the skin, or the mutual
-cohesion between different tissues
-is sensibly weakened, we find it to be
-owing to the intervention of serous fluid
-which does not belong to their healthy
-state; and this, together with increased
-vascularity, or redness and heat, and
-pain, is enough to bespeak the presence
-of inflammation. All these conditions
-cannot remain after death. Hence, if
-we desire to form positive opinions concerning
-much which is unfolded by dissection,
-we must supply the defect by
-analogy. Thus, whenever, in any part
-of the heart or arteries, the cohesion between
-the internal membrane and the
-subjacent structure is manifestly lessened,
-and the membrane is unusually red
-at that part, we may regard these appearances
-as the vestiges of inflammation,
-without thinking that we go too far
-in so regarding them.</p>
-
-<p>The internal lining of the heart and
-arteries is often found red solely in the
-neighbourhood of ulcerated spaces,
-when there can be no doubt concerning
-the existence of inflammatory action.</p>
-
-<p>But the internal lining of the heart
-and arteries gives the most unequivocal
-evidence of its inflammation when it is
-found of a deep red colour, with coagulable
-lymph adhering to its surface.
-This condition is represented, as it was
-found in the aorta, in one of the beautiful
-plates, illustrative of the diseases of
-arteries, by Mr. Hodgson<a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a>. And the
-same condition, in the heart, I
-have seen in a preparation of Dr.
-Farre's, where lymph is deposited,
-upon the circular zone, which forms the
-aperture of communication between the
-left auricle and ventricle. These appearances
-denote the most acute inflammation:
-they are, I suspect, very rarely
-met with. In the few instances in which
-I have heard of them, they have been
-found where death has taken place
-after short and severe suffering, and with
-symptoms which characterize inflammation.</p>
-
-<p>But the specimens of disease most
-frequently met with in the internal lining
-of the heart, consist in an entire
-change of its natural structure, and in
-the formation of new products upon it
-or within it. Many of these, from the
-analogy of morbid actions in other parts
-of the body, must be considered to result
-from chronic inflammation.</p>
-
-<p>In any of those situations which have
-been stated as especially liable to disease,
-the membrane will become thick,
-tough, inelastic, puckered and shrivelled;
-and cartilage or gristle, and bone, will
-enter into its structure; excrescences
-will sprout out from it, resembling warts
-and fungus; and it will become ruptured
-and ulcerated.</p>
-
-<p>Cartilaginous depositions are often
-found beneath the membrane where it is
-single; or between its folds where it is
-double, in the situation of the valves;
-and thus they seem rather to belong to
-some structure contiguous to the membrane
-than to the membrane itself.
-<span class="pagenum"><a name="Page_116" id="Page_116">[116]</a></span>
-Such depositions will proceed to a considerable
-extent, while the membrane
-still remains free from disease. From
-a valve, which has been thick, opaque,
-and cartilaginous, I have seen the membrane
-separated on both sides, and
-transparent; the opaque and cartilaginous
-matter being left behind. Where, in
-cartilaginous depositions, the lining of the
-heart has become puckered and uneven
-on its surface, and the valves shortened
-and altered in their shape, the membrane
-itself participates in the disease,
-and is generally incapable of being separated
-from the subjacent structure.
-But great thickening may take place in
-the situation of the valves, from deposition
-of cartilage, without any unevenness
-of their surface or alteration of their
-shape; and under these circumstances
-the membrane itself you may expect to
-find hitherto exempt from disease<a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">[4]</a>.</p>
-
-<p>Osseous depositions are always, I
-believe, originally formed beneath, or
-exterior to, the membrane, both in the
-heart and in the arteries. There are two
-circumstances especially worthy of remark
-in this process of ossification:
-sometimes it is a pure and unmixed process:
-bone is formed, and nothing else.
-It is deposited in minute granules, or
-little brittle scales, or in plates of a
-larger size; and the intermediate spaces,
-whether in the heart or arteries, preserve
-their natural and healthy appearance.
-At first, these granules or scales,
-or plates of pure bone, are covered by a
-delicate pellicle, which is in fact the internal
-membrane of the heart or artery,
-separating them from the immediate
-contact of the circulating blood. But
-in process of time, as they increase in
-size, and become rough and unequal on
-their surface, they cause a rupture of the
-internal membrane, and have now nothing
-to separate them from the <ins class="corr" title="Transcriber's Note&mdash;Original text: 'immedate contact'">immediate
-contact</ins> of the blood<a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">[5]</a>.</p>
-
-<p>Sometimes ossification is a mixed
-process, or rather, I suspect, the result
-of another morbid process preceding it.
-With the cartilaginous depositions already
-described there is an admixture of
-bone. The quantity of bone generally
-bears a very small proportion to the cartilage
-when they both occur together, as
-if the bone proceeded from the cartilage,
-and not the cartilage from the bone. It
-is sometimes seen growing from the surface
-of the cartilage, and is sometimes
-deposited in its substance, and only detected
-by the knife.</p>
-
-<p>Simple ossification, as it occurs
-in the heart and arteries, has been
-classed among the natural changes
-which the parts in question are liable to
-undergo after a certain period of life.
-Of persons above the age of sixty years
-the proportion is that of seven in ten
-according to Bichât, in which ossification
-is discovered in some part of the
-arterial system. It very rarely happens
-that simple ossification is found before
-the period of old age: still it is difficult
-not to regard it as a morbid process.</p>
-
-<p>But ossification, when it is a mixed
-process, is unquestionably the result of
-disease. It is met with at all periods of
-life; and probably constitutes one of
-the terminations of inflammation. The
-kind of morbid structures with which
-the bone is united leads to this belief.</p>
-
-<p>Fungous, and wart-like excrescences,
-are found in all those parts of the internal
-lining of the heart, which have been
-already mentioned as most subject
-to disease. They seem to be the result
-of a new morbid action set up in parts
-already disorganized; for I have not
-met with them where the membrane has
-been otherwise healthy, but only where
-it has been thickened or cartilaginous,
-or ossified, ruptured, or ulcerated.
-They grow either from the surface of the
-membrane, or from its ruptured or ulcerated
-edges, and are always in immediate
-contact with the circulating
-blood<a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">[6]</a>.</p>
-
-<p>According to my observation, when a
-fungous or warty excrescence has
-grown from the ruptured edges of the
-membrane, it has been from them exclusively,
-<span class="pagenum"><a name="Page_117" id="Page_117">[117]</a></span>
-and from no other part of the
-lining of the same heart. And as rupture
-of the membrane seldom occurs in
-more than one situation at a time, the
-heart of the same individual seldom presents
-more than one excrescence of this
-kind: and as the aortic valves are the
-parts most liable to rupture, it is there
-that this single excrescence is most frequently
-found; not that rupture may
-not take place elsewhere. I once saw a
-single <i lang="la" xml:lang="la">chorda tendinea</i> ruptured; and a
-single fungous excrescence of considerable
-size hanging from it into the cavity
-of the left ventricle.</p>
-
-<p>Now, this morbid growth is evidently
-connected with the lacerated state of the
-membrane in the conditions of its production,
-whereby it is limited to a small
-space.</p>
-
-<p>It is probable that the membrane is
-first ruptured; that its lacerated edges
-inflame, and then throw out unhealthy
-lymph, or unhealthy granulations, in the
-shape of these fungous or wart-like excrescences.
-When they have sprung
-from a ruptured membrane, they
-have, in the specimens which I have
-examined, been larger than when
-they have arisen under other conditions.</p>
-
-<p>But when such excrescences grow
-from the surface of the membrane which
-is thickened and cartilaginous only, but
-not lacerated, they are more apt to
-occur in many parts of it at the same
-time. I have seen the valvular apparatus
-between the auricles and ventricles
-on both sides, as well as the aortic
-valves of the same heart, studded with
-them. They were all about the size of
-hemp seeds: they adhered to the membrane
-with different degrees of tenacity,
-and wherever they were capable of
-being detached, they left a rough surface.
-The lining of the arteries has
-been known to give origin to morbid
-growths of the same kind, which have
-obstructed the passage of blood, and
-given occasion to the formation of a
-coagulum, which has obliterated the
-pulse.</p>
-
-<p>The internal lining of the heart is
-liable to ulceration, not as a common
-consequence of simple inflammation,
-but as an occasional consequence of
-some of those diseased conditions which
-have been described.</p>
-
-<p>It is most commonly found around
-scales and spiculæ of bone, and under
-such circumstances as to leave no doubt
-that the bone itself has furnished the
-source of irritation from which it springs.
-The ulceration commences from the
-very border of the bony scale, as if it
-was a process of nature for detaching it,
-and to a considerable distance around
-the ulceration the membrane is reddened,
-and easily detached from the subjacent
-structure. Where there are several
-distinct scales of bone, it is not uncommon
-to find a circle of ulceration
-around each of them.</p>
-
-<p>Ulceration is also met with where
-there is a thickened and cartilaginous
-state of the membrane without ossification.
-Under these circumstances, as
-far as I know, it affects no definite form.
-It is often a very destructive process of
-disease, obliterating large portions of
-the valvular structure, and penetrating
-deep into the muscular substance of the
-heart.</p>
-
-<p>Rupture of the internal lining of the
-heart is not easily distinguished from
-ulceration. In collections of morbid
-anatomy, many unquestionable specimens
-of ulceration are described as specimens
-of rupture. Rupture must
-always be looked for in the valvular
-apparatus of the heart, <em>i. e.</em> in the
-valves themselves, or in the chordæ
-tendineæ which are their appendages.
-It is probably incapable of taking place
-elsewhere, except as a part of a rupture,
-which involves the whole organ.</p>
-
-<p>That solution of continuity which is
-evidently without loss of substance;
-that of which the separated edges when
-they are brought together are completely
-adapted to each other; also that
-which is unaccompanied by any thickening
-or other morbid condition of the
-valve; the solution of continuity which
-is found under these circumstances, may
-safely be considered to proceed from
-rupture, and not from ulceration<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">[7]</a>.</p>
-
-<p>But it is probable that these characteristic
-conditions do not long remain
-after the occurrence of the rupture.
-Complete specimens of them are very
-rare; but specimens are numerous
-where the solution of continuity, by its
-form and direction, bespeaks rupture,
-while its rounded edges and the general
-thickening of the valve denote ulceration.
-These, it may be fairly conjectured,
-do in fact exhibit a compound of
-both. The membrane was originally
-ruptured, but disease has subsequently
-arisen and obscured the character of
-the mechanical injury.</p>
-
-<p>The greater number of those concretions,
-<span class="pagenum"><a name="Page_118" id="Page_118">[118]</a></span>
-which were regarded by the
-older anatomists as polypi of the heart,
-were unquestionably portions of mere
-blood, which had undergone coagulation
-after death. The blood remaining
-in the heart after death discharges itself
-of its colouring matter as it coagulates,
-and, giving off processes between
-the muscular fasciculi, assumes a shape
-which has suggested the name of
-polypus<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">[8]</a>.</p>
-
-<p>I have often found (I presume, therefore,
-that it is not an uncommon occurrence)
-coagula of an irregularly
-laminated texture having their colouring
-matter not entirely discharged,
-but unequally distributed through
-them, which have been most intimately
-adherent to some part of the lining
-of the heart. Of these some have admitted
-of separation, while the surface
-of the membrane and the surface of the
-clot were left rough at the place of contact,
-and others were incapable of being
-detached without the membrane being
-detached along with them. The appendix
-of the left auricle is a situation in
-which they are apt to occur, and they
-are generally accompanied by an extensively
-diseased condition of the lining
-membrane. These coagula, from their
-laminated texture, and from the intimacy
-of their union with the internal
-lining, seem to be essentially different
-from polypi of the heart. They appear
-to be connected with a process
-of disease in the membrane, and to
-have obtained their union with it long
-before the death of the patient.</p>
-
-<p>I once saw two separate tumors, entirely
-resembling what are called polypi, between
-the carneæ columnæ of the left
-ventricle, and firmly adherent to the
-heart; and in the centre of each a distinct
-formation of pus. The heart was
-otherwise healthy<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">[9]</a>.</p>
-
-<p>There are three preparations in the
-museum of the College of Surgeons,
-put up by Mr. Hunter himself, and
-noted by him as exhibiting "Tumors
-on the inner surface of the right
-ventricle, seemingly composed of layers
-of coagulable lymph one upon another,
-the central part having the appearance
-of glary mucus." This last appearance
-(the mucus) no longer remains
-in any of the three, but in its stead
-there is a cavity. The tumors
-which I have mentioned as originally
-containing in their centre a distinct
-formation of pus, also now present
-in its stead a cavity. The preparation
-preserved at St. Bartholomew's,
-and those at the College of Surgeons,
-are probably specimens of the same
-disease.</p>
-
-<p>Here what in the recent parts seemed
-to be pus or glary mucus, and the cavities
-still remaining in the preparations,
-must suggest the suspicion, that these
-tumors, whether they grew from the
-surface or were deposited from the
-blood, had become organized, and afterwards
-inflamed; and that the inflammation
-had terminated in the formation of
-an abscess.</p>
-
-
-<h3>ESSAY III.</h3>
-
-<p class="center"><em>Morbid Anatomy of the Muscular Substance
-of the Heart.</em></p>
-
-<p class="noindent">Dr. Baillie, speaking of inflammation
-of the substance of the heart,
-says, "When the pericardium covering
-its surface is inflamed, the inflammation
-sometimes passes a little way into
-the substance of the heart:" and then
-he gives these as the characteristic
-marks of such inflammation&mdash;that "it
-(the substance of the heart) becomes
-much more crowded with small vessels
-than in its natural state, and there are
-sometimes to be seen a few spots of
-extravasated blood." Now, this undue
-vascularity, and these few extravasated
-spots, where inflammation unquestionably
-belongs to a contiguous structure,
-may be deemed sufficient evidence of
-the muscular substance of the heart
-participating, or beginning to participate,
-in the same disease; but, absolutely
-and exclusively, it may be doubted
-whether more is not required to give
-a certain assurance of its inflammation.
-Here, as elsewhere, we must look for
-some of the proper products of inflammation;
-or for some of the permanent
-changes of texture which naturally result
-from it, according to its several
-modes of disorganizing.</p>
-
-<p>It is a very rare event to find pus
-among the products of inflammation
-of the substance of the heart: yet this
-event has occurred twice to my observation.
-In one instance the whole
-heart was deeply tinged with dark-coloured
-<span class="pagenum"><a name="Page_119" id="Page_119">[119]</a></span>
-blood, and its substance
-softened; and here and there, upon the
-section of both ventricles, innumerable
-small points of pus oozed from among
-the muscular fibres. This was the result
-of a most rapid and acute inflammation,
-in which death took place after
-an illness of only two days. In another
-instance, after death, which terminated
-an illness of long duration and
-characterized by symptoms referable to
-the heart, a distinct abscess was found
-in the substance of the left ventricle,
-closed externally by a portion of adherent
-pericardium, and connected internally
-with an ossified portion of the
-lining membrane.</p>
-
-<p>This diffusion of pus, or rather its
-formation in innumerable separate
-points, throughout the muscular structure
-of the heart, by a rapid and acute
-inflammation, is a singular occurrence.
-No such case has ever fallen within the
-knowledge of the most experienced in
-morbid anatomy, of whom I have made
-inquiry; neither has any such (as far
-as I can learn) been recorded in books<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">[10]</a>.</p>
-
-<p>A single collection of pus<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">[11]</a>, constituting
-an ulcer or abscess of the heart,
-and resulting from chronic inflammation,
-is also a rare occurrence, yet not
-so rare but that a specimen of it may
-be found in most collections of morbid
-anatomy<a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">[12]</a>.</p>
-
-<p>But independent of the formation of
-pus, softening and attenuation, as well
-as induration and thickening of the
-muscular substance of the heart, do,
-in different cases, according to the circumstances
-under which they are found,
-both bespeak inflammation.</p>
-
-<p>Together with the unequivocal evidence
-of inflammation in other parts of
-the heart, the muscular fibres have at
-the same time been found very soft and
-loose, and easily torn; and with this
-looseness of texture the heart has sometimes
-presented a dark and almost black
-appearance, and sometimes it has been
-almost blanched and colourless. The
-deep dark tinge shews that the muscular
-substance is unnaturally loaded with
-blood; whereas the absence of colour
-shews that it is destitute of its natural
-quantity. These different appearances
-do, in fact, belong to different stages of
-the same disease. The first indicates
-inflammation of the muscular substance
-in its present state of activity; the
-second, an irreparable disorganization
-of the muscular substance left by inflammation,
-when it has been unarrested
-in its earliest stages. The first is
-found when death takes place <em>in a
-few days after</em> the accession of the disease;
-the second, when the patient survives
-the first attack, and dies at a remoter
-period.</p>
-
-<p>The inflammation, which produces
-softening and attenuation of the muscular
-structure, is, I believe, always of
-an acute kind.</p>
-
-<p>But induration and thickening of
-the muscular substance of the heart is
-also the result of inflammation. This
-must be distinguished from hypertrophy,
-or mere augmentation of bulk, of
-which we shall speak hereafter. In this
-induration, which proceeds from inflammation,
-there is, besides increase
-of bulk and firmness, a manifest alteration
-of texture. A substance<a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">[13]</a> is produced
-offering a peculiar resistance to
-the knife. This condition unquestionably
-must result from an interstitial deposition
-of new matter among the muscular
-fibres. From concomitant circumstances,
-as well as from its own
-character, I presume that it proceeds
-from chronic, not from acute inflammation.
-I confess that I never saw a
-specimen of what I now allude to. It
-is described with some minuteness by
-Corvisart; but it may be presumed to
-be very rare, since Laënnec admits that
-it never fell under his observation.</p>
-
-<p>These opposite states of softening
-<ins class="corr" title="Transcriber's Note&mdash;Original text: 'and attennuation in'">and attenuation in</ins> one case, and induration
-and thickening in another, are
-known to those conversant with morbid
-dissection as the evidences of inflammation
-in other parts of the body besides
-the muscular substance of the heart.</p>
-
-<p>But there are changes of structure
-incident to the muscular substance of
-the heart which are independent upon
-inflammation, or, perhaps, upon
-any process which can properly be
-called morbid. They consist of simple
-augmentation and simple diminution of
-bulk and consistence. This simple
-augmentation of bulk and consistence is
-owing exclusively to a more ample development
-of natural structure. The
-muscular substance is more red than
-<span class="pagenum"><a name="Page_120" id="Page_120">[120]</a></span>
-natural, its carneæ columnæ are increased
-in thickness, and its proper fibrous
-texture is every where more strikingly
-manifest; but there is no interstitial
-deposition of matter new in its
-kind. It has been called hypertrophia
-of the heart, and the name conveys a
-tolerably just idea of its actual condition.</p>
-
-<p>The simple diminution of bulk and
-consistence is a condition the exact opposite
-of the former. The muscular
-substance is less red than natural; its
-proper fibrous texture less distinguishable;
-but there is still the appearance
-of muscle shrunk and withered, as if
-from an insufficient supply of nourishment.
-It may be called atrophia of
-the heart.</p>
-
-<p>Conjoined with augmentation, as well
-as with diminution of strength and bulk
-in the walls of the heart, there is almost
-always an increase in the capacity of its
-cavities; and in whichsoever part of
-the heart the walls are thus augmented
-or diminished, it is the cavity appertaining
-to the same part which undergoes
-the increase of capacity. Hence
-it appears either that one of these conditions
-is the immediate and necessary
-consequence of the other, or that both
-are the simultaneous effects of the
-same causes.</p>
-
-<p>Dilatation of any cavity of the heart,
-with thickening of its walls, is called
-<em>active dilatation</em>; and dilatation of any
-cavity, with attenuation, is called <em>passive</em><a name="FNanchor_14_14" id="FNanchor_14_14"></a><a href="#Footnote_14_14" class="fnanchor">[14]</a>.</p>
-
-<p>Active dilatation may appertain to
-every cavity of the heart simultaneously;
-and so may passive dilatation. But
-such occurrences are very rare: for
-one cavity being naturally more liable
-to this species of dilatation, and another
-to that, it most frequently happens that
-specimens of both conditions are found
-in the different cavities of the same
-heart.</p>
-
-<p>The left ventricle is much more
-liable to active dilatation than the
-right; and the right ventricle more so
-than either of the auricles; and of the
-auricles unquestionably the left. Upon
-the whole, perhaps, the fact may be
-truly stated thus&mdash;that the left ventricle
-commonly gains an increase of bulk
-and strength, with an increase of capacity;
-and that all the other cavities, at
-the time that they expand, are rather
-apt to become attenuated.</p>
-
-<p>It sometimes (though rarely) happens,
-that, with an increase of strength
-and bulk in its muscular structure, the
-left ventricle suffers a diminution of
-capacity in its cavity. In a case reported
-by Laënnec, the left ventricle
-was an inch and a half thick at its
-broadest, and an inch thick at its
-thinnest part; and yet its cavity was
-only capable of containing an unblanched
-almond. I have seen the same condition
-in a less degree.&mdash;(<cite>Laënnec</cite>,
-vol. ii. 698.)</p>
-
-<p>The circumstances under which these
-opposite conditions, this hypertrophy
-and atrophy of the heart, with the enlargement
-or diminution of its cavities,
-arise, must be explained hereafter.
-At present I would only remark that
-they are often found conjoined with
-actual disease in other structures of the
-heart, such as osseous or cartilaginous
-thickening of internal lining, adhesion
-of the pericardium, and ossification
-of the coronary arteries, to which they
-owe their origin; and, moreover, that
-they are often found where the heart is
-otherwise perfectly sound in texture,
-and where their cause must be sought
-in other parts of the body.</p>
-
-<p>The heart is liable to undergo a simple
-dilatation of its cavities without either
-thickening or attenuation of its muscular
-substance. This simple dilatation
-is sometimes of the whole organ, sometimes
-of one side, and sometimes only
-of one auricle or ventricle. When it is
-of one cavity only, it may be complicated
-with active or passive dilatation of
-another, or of all the rest.</p>
-
-<p>There is reason to believe that the
-heart sometimes undergoes a temporary
-dilatation, and again returns to its natural
-capacity; but that the dilatation
-can only subsist for a short time without
-becoming permanent.</p>
-
-<p>The power of thus enlarging its cavities,
-and restoring them to their natural
-condition, belongs more especially to
-the right side of the heart.</p>
-
-<p>A large accumulation of fat is sometimes
-met with about the heart.</p>
-
-<p>The healthy heart is always more or
-<span class="pagenum"><a name="Page_121" id="Page_121">[121]</a></span>
-less marked upon its external surface
-with streaks of white, and this appearance
-results from the deposition of fat in
-the cellular texture, which unites the
-serous covering with the subjacent muscular
-structure. It is found principally
-where the venæ cavæ unite to form the
-right auricle; also at the base of the
-ventricles, and along the line which
-marks the boundary between the two,
-and around the origin of the great blood-vessels
-as they emerge from the heart.
-But when fat is deposited in more than
-these situations, and in more than the
-natural quantity, it is not so much
-added to the healthy substance of the
-heart, as existing at its expense and detriment,
-and the muscular structure is
-that which especially suffers. The fibre
-of the fat heart is pale and wasted,
-like that of a paralytic limb.&mdash;<cite>Mus. of
-the Coll. of Surg.</cite> 327.</p>
-
-<p>A rupture of the heart is sometimes
-met with; but all the cases of reputed
-rupture are not such in reality. An
-aperture in the walls of the heart,
-through which blood escapes into the
-cavity of the pericardium, may result
-from ulceration as well as from rupture,
-or from a mixed process of one and
-the other; but whatever be the precise
-nature of the process by which this
-perforation of the heart is effected, it is
-undoubtedly of rare occurrence.</p>
-
-<p>Where it has been found, there has
-generally been at the same time some
-peculiar condition of the organ, which
-might be presumed favourable to its
-production. Its muscular substance
-has been so soft and loose of texture,
-that it could be pierced through by the
-weight of a probe<a name="FNanchor_15_15" id="FNanchor_15_15"></a><a href="#Footnote_15_15" class="fnanchor">[15]</a>; or it has been converted
-into, or greatly intermixed with
-fat<a name="FNanchor_16_16" id="FNanchor_16_16"></a><a href="#Footnote_16_16" class="fnanchor">[16]</a>; or its muscular fibres have been
-absolutely defective, leaving a certain
-transparent space, where the internal
-lining and the pericardium have been
-in contact, and served to maintain the
-completeness of the cavity, until the
-rupture has taken place<a name="FNanchor_17_17" id="FNanchor_17_17"></a><a href="#Footnote_17_17" class="fnanchor">[17]</a>.</p>
-
-<p>Not that a rupture has not been
-found where the texture of the parts has
-seemed to offer no natural facilities to
-its occurrence&mdash;as in the case related
-by Harvey himself, who found a lacerated
-aperture in the left ventricle, capable
-of admitting his finger, through
-which blood had escaped into the pericardium,
-the walls of the ventricle being
-increased in thickness and strength,
-while an obstacle existed at the entrance
-of the aorta<a name="FNanchor_18_18" id="FNanchor_18_18"></a><a href="#Footnote_18_18" class="fnanchor">[18]</a>. Here the heart must
-have torn itself asunder by the simple
-violence of its contraction, in contending
-against the impediment to the egress
-of blood from its cavity. This is an
-effect which would hardly be thought
-capable of being thus produced; but
-I can well believe it possible after having
-seen one of the recti muscles of the
-abdomen literally torn in twain, in a
-man who died of tetanus<a name="FNanchor_19_19" id="FNanchor_19_19"></a><a href="#Footnote_19_19" class="fnanchor">[19]</a>.</p>
-
-<p class="pfs80">[To be continued.]</p>
-
-
-<hr class="fulla" />
-<h2>DILATED ŒSOPHAGUS.</h2>
-<hr class="r10a" />
-
-<p class="center"><em>To the Editor of the London Medical
-Gazette.</em></p>
-
-<p><span class="pad1 smcap">Sir,</span><br />
-
-Permit me to send the following case
-to you for insertion in the Gazette.</p>
-
-<p>Mary Blores, æt. 33, was admitted
-into the Middlesex Hospital on the 16th
-of November. She was in a state of
-extreme feebleness and emaciation.
-Those who brought her said that during
-the preceding month she had appeared
-to swallow nothing: what she took
-as food seemed to her to stop in the
-gullet, and after a few minutes returned.
-I found, however, that a
-large œsophagus-bougie passed readily
-into the stomach, meeting with no obstruction
-beyond a spasmodic resistance
-in the pharynx. A draught of
-milk and water was given her&mdash;she
-swallowed it without much effort, but
-it quickly returned. In the course of the
-<span class="pagenum"><a name="Page_122" id="Page_122">[122]</a></span>
-afternoon a pint of beef tea was injected
-through an elastic tube into the stomach&mdash;it
-was thrown up directly.</p>
-
-<p>I now learnt from her that she could
-swallow liquids much more readily than
-solid food; that when she took a small
-quantity, it seemed to her not to reach
-the stomach, and in three or four
-minutes was invariably thrown up; that
-on taking a large draught she had an
-impression that it reached the stomach&mdash;in
-this case vomiting did not follow so
-soon, and some part of the draught was
-permanently retained; that she craved
-food and drink, and was literally dying
-of hunger and thirst; that the vomiting
-which took place was not preceded by
-nausea, although in its progress it had
-all the appearance of ordinary retching;
-that the matter vomited was not
-thrown up at once, but by successive
-efforts; it consisted of the food she had
-last taken, mixed with colourless
-mucus. The belly was so shrunk that
-the umbilicus was not more than an
-inch distant from the spine, upon
-which the pulsations of the aorta were
-readily felt: there was no enlargement
-or hardness about the stomach,
-no particular tenderness on pressing
-the epigastrium, no sensation of pain or
-heat now or formerly.</p>
-
-<p>The complaint had began ten years
-ago, during pregnancy, since when she
-had never been free from it, although
-at times her sufferings had been less,
-and she had been able to retain some
-portion of her meals. She had borne
-in this period three children; the vomiting
-had lasted during the whole
-period of her pregnancies, and during
-her confinement. The principal remedies
-which had been used for her relief
-were a succession of blisters on the pit
-of the stomach&mdash;but they had produced
-no benefit. Latterly her symptoms had
-been greatly aggravated.</p>
-
-<p>This patient was attended by Dr.
-Watson and myself. But the means
-which we tried to enable her to retain
-her food, and to support her expiring
-strength, had scarcely a temporary
-effect. She died on the 2d Dec. sixteen
-days after her admission. The body
-was carefully examined, at the expressed
-wish of her relatives.</p>
-
-<p>The unusual appearances found in the
-abdomen were&mdash;1. the smallness of
-the first part of the duodenum, which
-was but half the ordinary size of
-the ileum; 2. the capaciousness and
-fulness of the gall bladder,&mdash;from
-which, however, on compressing it,
-the bile flowed readily into the intestine;
-3. a contraction of the middle of the
-stomach of the length of two inches,
-for which extent the peritoneal coat
-was thickened and opaque, and the inner
-membranes folded in deep longitudinal
-rugæ, the mucous surface of which was
-partially suffused with circular spots of
-red. The breadth of the contracted
-part of the stomach, as it lay collapsed,
-was an inch and a half.</p>
-
-<div class="figcenter">
-<img src="images/i019g.jpg" width="250" alt="" />
-</div>
-
-<div class="figcenter">
-<img src="images/i020g.jpg" width="250" alt="" />
-</div>
-
-<p>But it was in the chest that the most
-remarkable circumstance presented itself.
-The œsophagus gradually enlarged
-from the pharynx, which was
-perhaps rather narrower than usual,
-to an extraordinary degree of dilatation;
-the greatest breadth which it
-attained was situated about four inches
-above the cardia: the tube then contracted
-more abruptly, so as to render
-the termination of the œsophagus, like
-its commencement, of nearly the usual
-dimensions. The structure likewise of
-the cardiac extremity for about an
-inch, and of the pharyngeal end for
-about half an inch, was healthy. The
-intermediate part presented, when inverted,
-the following curious appearance:&mdash;The
-inner membrane was thickened
-and opaque, and had <em>the appearance</em>
-of having partially yielded from dilatation;
-at the upper part the furrows or
-thinner parts of the membrane followed
-in some degree a longitudinal direction;
-at the lower part the surface was pitted
-with shallow depressions of various
-figures. I have represented in the adjoined
-sketches these appearances, which on
-the middle of the œsophagus passed
-from one into the other; at the furrows
-<span class="pagenum"><a name="Page_123" id="Page_123">[123]</a></span>
-or depressions the membrane seemed of
-the natural thickness and colour; the
-intermediate raised and thickened part
-was opaque and whitish. The muscular
-fibres of the œsophagus were of the
-natural colour and thickness.</p>
-
-<p>
-<span class="pad2">I remain, Mr. Editor,</span><br />
-<span class="pad6">Your obedient servant,</span><br />
-<span class="pad10 smcap">Herbert Mayo</span>.</p>
-
-<p class="noindent fs80">19, George-street, Hanover-square,<br />
-<span class="pad4">Dec. 6, 1828.</span></p>
-
-
-<hr class="fulla" />
-<h2>HYDROPHOBIA.</h2>
-<hr class="r10a" />
-
-<p class="center"><em>To the Editor of the London Medical Gazette.</em></p>
-
-<p><span class="pad1 smcap">Sir</span>,<br />
-
-As the following case may throw some
-additional light on the pathology of
-hydrophobia, I have sent it you for
-publication.</p>
-
-<p>
-<span class="pad2">I am, Sir,</span><br />
-<span class="pad6">Your obedient servant,</span><br />
-<span class="pad10 smcap">F. Godrich</span>.</p>
-
-<p class="fs80">Grove House, Little Chelsea,<br />
-<span class="pad4">Nov. 29, 1828.</span></p>
-
-<p class="p1" />
-<p>On Thursday morning, the 25th ult.
-I was called up about seven o'clock to
-see a man who I understood was exceedingly
-ill, and waiting in the surgery
-very impatiently for my arrival. I
-found my patient (Mr. Barham), a fine
-looking old man, about 60, labouring
-at intervals of about five minutes under
-strong spasmodic paroxysms, affecting
-the muscles concerned in breathing
-and deglutition. There was a wildness
-and an impatience depicted in his
-countenance, totally different from any
-thing I had ever observed in other spasmodic
-affections. His bowels were open,
-tongue clean, skin moist, pulse full and
-a little accelerated. I took away twenty
-ounces of blood, and prescribed a mixture
-containing
-<span class="screenonly">ʒss.</span><span class="handonly"><img class="glyph" src="images/dram.jpg" alt="" />ss.</span>
-of laudanum for a
-dose every hour until I should see him
-again. He walked home half a mile
-from my house (Gloucester Road, Old
-Brompton), and left me ruminating on
-the possible cause of so much mischief
-occurring suddenly in a fine healthy
-subject. At ten a message was sent,
-saying that he was much worse, and
-requesting me to call as soon as possible.
-He received me tranquilly, and
-said he was very glad that I had come
-to see him, for he was very ill. His
-symptoms were now more distressing
-than when I first saw him: he looked
-wildly and suspiciously at every one entering
-his apartment, and his breathing
-was accompanied by a short convulsive
-sobbing. On looking at his medicine
-I perceived he had taken none, and expressing
-my surprise, he assured me it
-was impossible for him to swallow a
-single drop, as the attempt had been
-followed by violent spasms, and produced
-so much distress, that he had desisted.
-At this period no one had the
-slightest idea of the origin of his
-malady. I poured out some medicine
-into a tea-cup, the very act of which
-produced much excitement and alarm.
-My first impression as to the true nature
-of his disease arose at this period, from
-the circumstance of his requiring a tea-spoon,
-with which he endeavoured to
-take some of the medicine. The attempt
-produced much excitement and
-alarm, and after two or three painful
-efforts at deglutition, with one desperate
-effort he swallowed a tea-spoonful, threw
-away the spoon, and begged, unless I
-wished to destroy him, that he might
-have nothing more to swallow. I now
-left his room, and inquired of a bystander
-whether any thing particular
-had occurred to him within the last
-few weeks. On recollection she said,
-"About a month since, late at night, a
-strange dog came into the premises and
-fought with his own dog; he got out of
-bed to separate them, and the strange
-dog bit him in two places, on the left
-arm and hand; and bit a puppy, which
-died about a fortnight after in a strange
-<span class="pagenum"><a name="Page_124" id="Page_124">[124]</a></span>
-way, which was thought to be some
-kind of a fit." To ascertain if this occurrence
-had produced any effect on his
-mind, while again bleeding him I said,
-"You have been in the wars, Sir, and
-had your hand and arm torn; how did
-it occur?"&mdash;"Oh!" said he, carelessly,
-"that was done by a dog a long time
-ago, but it healed." The circumstance
-was never again mentioned to him, and
-he died in total ignorance of the cause
-of his malady. The wounds were perfectly
-cicatrised, and there was not the
-least action going on indicative of recent
-absorption. He bore the bleeding
-pretty quietly:
-<span class="screenonly">40℥.</span><span class="handonly">40<img class="glyph" src="images/ounce.jpg" alt="" />.</span>
-were removed,
-which on cooling presented strong
-marks of inflammation.</p>
-
-<p class="pad2 fs80">Ordered
-<span class="screenonly">ℳiv.</span><span class="handonly"><img class="glyph" src="images/scruple.jpg" alt="" />iv.</span>
-Acid. Hydrocyan. omni horâ, in a little water.</p>
-
-<p>Twelve o'clock.&mdash;With much difficulty
-he has taken two doses of the
-acid; pulse full and hard, 110.
-<span class="screenonly">30℥.</span><span class="handonly">30<img class="glyph" src="images/ounce.jpg" alt="" />.</span>
-more blood were removed.</p>
-
-<p>Three o'clock.&mdash;Has taken two more
-doses; complains of a dreadful sense
-of suffocation, and implores that nothing
-more may be given him. Pulse full, and
-beating at 120 to 130. Continue the
-acid.</p>
-
-<p>Eight o'clock.&mdash;Pulse full and hard.
-Has taken in all
-<span class="screenonly">24ℳ.</span><span class="handonly">24<img class="glyph" src="images/scruple.jpg" alt="" />.</span>
-of the acid, but
-so painfully distressing has the deglutition
-now become, that all attempts at
-repeating his medicine are discontinued.</p>
-
-<p class="pad8 fs80">V. S. ad
-<span class="screenonly">℥xxx.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />xxx.</span></p>
-
-<p>During the bleeding he looked wildly
-at the basin, and begged that no more
-might be spilt (a drop or two had fallen),
-repeating frequently, in great
-agitation, as the blood was running,
-"Take care! take care!"</p>
-
-<p>Between two and three o'clock next
-morning my assistant (Mr. Davies) visited
-him. He found him tolerably
-passive, but observing every movement
-with intense anxiety. Pulse full and
-hard, face flushed, eyes denoting cerebral
-irritation. He had been at times
-outrageous. On its being intimated
-that bleeding was again necessary, a
-paroxysm came on more intense than
-any preceding,&mdash;and with great effort he
-submitted. As the blood flowed he became
-more and more alarmed, till at
-length he got quite unmanageable; he
-raged violently at his nephew, who was
-holding the basin, and ordered it peremptorily
-to be removed. 30 or
-<span class="screenonly">40℥.</span><span class="handonly">40<img class="glyph" src="images/ounce.jpg" alt="" />.</span>
-were taken away. It was found necessary
-to put on the straight waistcoat.
-About four o'clock Mr. Davies wished
-him to take some more of his medicine.
-He said, "I can take no more," and on
-reaching the bottle to put out a few drops,
-he became violently agitated, threw himself
-from side to side, and, as well as
-the incessant spasmodic sobbings would
-allow, he begged that not one more drop
-of any thing might be offered him, and
-that the bottle might be taken from his
-sight. He did not become tranquillized
-until its removal. He lingered on till
-ten <span class="fs70">A.M.</span> in the same state, a few minutes
-before which he insisted on getting
-up, and walked a short way down
-his garden, returned, laid down on his
-bed, and died.</p>
-
-<p>Mr. Frederick Salmon, of Old Broad
-Street, and Mr. Wilson, of Chelsea,
-were kind enough to assist me in conducting
-the post mortem examination.
-On opening the chest, the heart was free
-from disease, with rather more water in
-the pericardium than natural; the lungs
-were completely gorged with grumous
-blood, and the pleura adherent on the
-right side. On removing the cranium,
-which was remarkably thin, and cutting
-the substance of the brain, numerous
-red spots presented themselves in the
-medullary portion; about a table-spoonful
-of water in each ventricle; the
-plexus choroides was turgid; the corpora,
-striata, thalami, and basis of the
-brain every where preternaturally injected;
-the cerebellum, crura cerebri,
-and cerebelli, in a high state of inflammation.
-On removing the spinous process
-of the vertebra, the whole cord
-was considerably inflamed; and opposite
-the two last cervical and dorsal
-vertebræ the cellular substance was
-studded with dark patches of coagulated
-blood, the theca vertebralis thickened,
-and the cord in an active state of inflammation.
-The larynx and pharynx
-bore not the slightest vestige of disease.
-The preparation of the cord is deposited
-in the museum of the London
-University.</p>
-
-<p>The post mortem examination of this
-case tends to prove the correctness of
-Professor Thompson's theory of the
-proximate cause and seat of this afflicting
-malady; and the plate accompanying
-a case recorded by him, in the
-13th volume of the Med. Chir. Society,
-gives a faithful delineation of the state
-in which the spinal cord was found in
-this case.</p>
-
-
-<p><span class="pagenum"><a name="Page_125" id="Page_125">[125]</a></span></p>
-
-<hr class="fulla" />
-<h2>CASE OF LONG PROTRACTED CONSTIPATION.</h2>
-<hr class="r10a" />
-
-<p class="center"><em>To the Editors of the London Medical
-Gazette.</em></p>
-
-<p><span class="pad1 smcap">Gentlemen</span>,<br />
-
-Perhaps the following case may interest
-some of your readers, and if you
-think so, its insertion in your Journal
-will oblige</p>
-
-<p>
-<span class="pad2">Your obedient and</span><br />
-<span class="pad6">humble servant,</span><br />
-<span class="pad10 smcap">S. D. Broughton</span>.</p>
-
-<p class="fs80">12, Great Marlborough Street,<br />
-<span class="pad4">Dec. 3, 1828.</span></p>
-
-<p class="p1" />
-<p>On Tuesday, Nov. 25, I was called
-upon at the St. George's and St. James's
-Dispensary to advise for an infant at
-the breast, of five months and fourteen
-days of age, that had not passed
-any fæces during six weeks up to the
-day before I saw it. After its birth it
-had no passage till the fifth day, and
-this had apparently been effected by the
-introduction of a bougie, and which
-was subsequently continued at intervals
-for a short time. The infant was otherwise
-healthy and strong at its birth, and remained
-so until it had gone about three
-weeks without any evacuation, when it
-was observed to be weak in the lower
-extremities; and at the period of my
-seeing it the legs were much fallen
-away in flesh, hanging flaccid and inert.
-Many aperient enemas and medicines
-had been given, and, as a last resource,
-one drop of the croton oil had been
-prescribed the preceding evening. The
-infant appeared to suffer from distention,
-and to be disposed to coma, and
-the croton oil had distressed it much
-some hours after it was given. The
-fæces could be felt blocking up the intestine,
-but the irritation of the finger
-produced no attempt at evacuation;
-very small pieces only having been
-brought away. Hot baths also had
-frequently been used some time ago.</p>
-
-<p>Considering the case as one of paralysis
-in the parts naturally employed to
-relieve the bowels, I recommended
-the suspension of all purgative remedies
-by the mouth, and a table-spoonful
-of the following injection to be substituted,
-and to be thrown up with three
-table-spoonfuls of thin gruel occasionally
-during the day, by means of a
-syringe.</p>
-
-<p class="neg5 screenonly">
-℞ Spir. Terebenth. ʒiij.<br />
-Træ Zinzib. ʒj.<br />
-Aquæ, ℥iss. M.
-</p>
-
-<p class="neg5 handonly">
-<img class="glyph" src="images/rx.jpg" alt="" />Spir. Terebenth.
-<img class="glyph" src="images/dram.jpg" alt="" />iij.<br />
-Træ Zinzib. <img class="glyph" src="images/dram.jpg" alt="" />j.<br />
-Aquæ, <img class="glyph" src="images/ounce.jpg" alt="" />iss. M.
-</p>
-
-<p>The following liniment was also directed
-to be rubbed in frequently along
-the course of the spine.</p>
-
-<p class="neg3 screenonly">
-℞ Linimenti Saponis, ℥iss.<br />
-Liquor. Ammon. Comp. ℥ss. M.
-</p>
-
-<p class="neg3 handonly">
-<img class="glyph" src="images/rx.jpg" alt="" /> Linimenti Saponis,
-<img class="glyph" src="images/ounce.jpg" alt="" />iss.<br />
-Liquor. Ammon. Comp. <img class="glyph" src="images/ounce.jpg" alt="" />ss. M.
-</p>
-
-<p>The result justified my expectations;
-for, during the night after this prescription,
-two injections having been
-given, some large and hard ash-coloured
-lumps came away, and these were
-shortly followed by a forcible spouting
-out of a continued stream of feculent
-dark liquid; a brisk diarrhœa having
-been kept up till the Saturday following.
-The infant's appetite is become
-voracious, its appearance lively and
-healthy, and its legs as firm and strong
-as is usual at such an age. Cold water
-is recommended to be dashed upon the
-loins, the liniment to be continued
-occasionally, moderate doses of magnesia
-and rhubarb to be given when
-required, and the turpentine injection
-to be used if any return of the complaint
-should be threatened.</p>
-
-
-<hr class="fulla" />
-<h2>DISLOCATION OF THE PATELLA.</h2>
-<hr class="r10a" />
-
-<p class="center"><em>To the Editor of the London Medical
-Gazette.</em></p>
-
-<p><span class="pad1 smcap">Sir</span>,<br />
-
-Having seen a case of dislocation of the
-patella, reported by Mr. Mayo, in your
-Journal a few weeks since, in which
-there was experienced some difficulty in
-the reduction of the bone, I beg leave
-to send you the following, in case you
-may think it worth insertion.</p>
-
-<p>On Saturday last, I was called to a
-young woman who had dislocated the
-patella of the left knee joint outwards;
-the inner edge rested upon the outer
-surface of the external condyle, and was
-immoveably fixed, and caused great pain
-when touched. She says it was occasioned
-by her foot slipping backwards
-from one stair to another, and she immediately
-fell down.</p>
-
-<p>I commenced the reduction, as stated
-by Mr. Mayo, but I could only produce
-semiflexion, and that gave her great
-pain; insomuch that I was obliged to
-desist, and the patella remained in <i lang="la" xml:lang="la">statu
-quo</i>. But when the knee was thus semiflexed,
-I desired my assistant to extend
-the leg suddenly; and having my fingers
-on the patella at the time, and pressing
-<span class="pagenum"><a name="Page_126" id="Page_126">[126]</a></span>
-it inwards, it immediately returned to
-its natural position.</p>
-
-<p>I must confess, sir, that I should
-have been afraid to have continued the
-flexion as described in Mr. Mayo's case,
-"by bending the knee to the utmost,"
-fearing that the remedy might be worse
-than the disease, and the result proved
-that in this case it was not necessary.</p>
-
-<p>
-<span class="pad2">I remain, Sir,</span><br />
-<span class="pad6">Your obedient servant,</span><br />
-<span class="pad10 fs70">P. M. Hoskings</span>.</p>
-
-<p class="fs80">168, Fleet-Street,<br />
-<span class="pad2">Dec. 3d, 1828.</span></p>
-
-
-<hr class="fulla" />
-<h2>VACCINATION.</h2>
-<hr class="r10a" />
-
-<p class="center"><em>To the Editor of the London Medical
-Gazette.</em></p>
-
-<p><span class="smcap">Sir</span>,<br />
-
-The mistake of the printer in substituting
-the word "every" for "even,"
-in the paper on Vaccination (p. 40), so
-materially affects the sense of the passage,
-that I must request the favour of
-the following insertion:&mdash;</p>
-
-<p>"3d. That while the vaccine cicatrix
-retains even one distinct fovea or depression,
-the individual continues unsusceptible
-both of small pox and of re-vaccination;
-but that," &amp;c.</p>
-
-<p>
-<span class="pad2">I am, Sir,</span><br />
-<span class="pad6">Your obedient servant,</span><br />
-<span class="pad10 smcap">Thos. H. Burder</span>.</p>
-
-<p class="fs80">2, Brunswick Square, Dec. 15, 1828.</p>
-
-
-<hr class="fulla" />
-<h2>SINGULAR BICEPS MUSCLE.</h2>
-
-<p class="center"><em>To the Editor of the London Medical
-Gazette.</em></p>
-
-<p><span class="smcap">Sir</span>,<br />
-
-<ins class="corr" title="Transcriber's Note&mdash;Original text: 'Tue valuable paper'">The valuable paper</ins> communicated to
-your Journal, by Mr. Stanley, last
-week, has brought to my recollection a
-singular appearance of the parts in front
-of the shoulder-joint which I dissected
-about two years ago. It is a fact
-worth recording; and perhaps you will
-be kind enough to insert it in your next
-number.</p>
-
-<p>The circumstance was this&mdash;that in
-the right arm, instead of there being
-a biceps muscle having two origins, the
-one the shorter from the corocoid process,
-the other the longer from the
-upper part of the glenoid cavity of the
-scapula, there was simply a one-headed
-muscle arising from the corocoid process.
-I could find no tendon passing
-through the joint answering to the long
-head of the biceps, neither was there
-any appearance of a biceptical groove;
-the capsular ligament was, perhaps,
-thicker than it is found in ordinary
-cases.</p>
-
-<p>I knew nothing of this man during
-life, and am therefore unable to give
-any account of the use which he made
-of this arm.</p>
-
-<p>
-<span class="pad2">I am, your obedient servant,</span><br />
-<span class="pad10 smcap">C. M. Burnett</span>.</p>
-
-<p class="fs80">House Surgeon's Apartments,<br />
-St. Bartholomew's Hospital, Dec. 8th.</p>
-
-
-<hr class="fulla" />
-<h2>STETHOSCOPE.</h2>
-<hr class="r10a" />
-
-<p class="center"><em>To the Editors of the London Medical
-Gazette.</em></p>
-
-<p><span class="smcap">Gentlemen</span>,<br />
-
-As you did me the honour, on a former
-occasion, to publish some remarks in
-defence of <em>auscultation</em>, against its
-enemies and detractors, I trust you will
-permit me to say a few words in reference
-to a communication in a late
-number, from a gentleman who appears
-to be a friend of that method of diagnosis,
-but whose ignorance of the subject
-is likely to be more injurious to the
-cause than either open enmity or secret
-detraction. The case in question (page
-780, vol. ii.) appears, from the dissection,
-to have been clearly <em>emphysema of the
-lungs</em>, as there stated; but I appeal to
-every one practically acquainted with
-the physical signs of diseases of the
-lungs, whether the results of the exploration
-with the stethoscope, as narrated
-in the case, were those pathognomonic
-of that disease? I say they were
-not only not pathognomonic of this
-affection, but they were actually incompatible
-with its existence. The same
-ignorance of the subject is shewn in relation
-to the disease of the heart, which,
-I boldly maintain, no one was justified
-in pronouncing to be <em>hypertrophy of the
-left ventricle</em> from the stethoscopic indications
-stated in the case.</p>
-
-<p>It is just possible that the writer of
-the case may have made further explorations
-on which his diagnosis was founded;
-but if he had such in his case-book,
-it is equally unfortunate for the credit
-of the stethoscope and his own, that he
-suppressed them in his printed case.</p>
-
-<p>
-<span class="pad2">I have the honour to be,</span><br />
-<span class="pad8">Gentlemen,</span><br />
-<span class="pad6">Your obedient servant,</span><br />
-<span class="pad10 smcap">A Stethoscoper</span>.</p>
-
-<p class="pad1 fs80">Nov. 25, 1828.</p>
-
-
-<p><span class="pagenum"><a name="Page_127" id="Page_127">[127]</a></span></p>
-
-<hr class="fulla" />
-<h2>MECHANISM OF VOMITING.</h2>
-<hr class="r10a" />
-
-<p class="center"><em>To the Editor of the London Medical
-Gazette.</em></p>
-
-<p class="center fs80">Glasgow University, Nov. 26, 1828.</p>
-
-<p><span class="smcap">Sir</span>,<br />
-
-Having lately perused, in the 35th
-Number of the Medical Gazette, some
-observations "on the mechanism of
-the act of vomiting," by Dr. Marshall
-Hall, in which, after controverting the
-different opinions which have been entertained
-by physiologists on this
-question, he endeavours to prove that
-vomiting is an effort, not of <em>inspiration</em>,
-but of <em>expiration</em>, and advances this
-opinion as having originated in himself,
-I beg, through the medium of your
-Journal, to refer that gentleman to
-Richerand's Physiology, where, on the
-subject of vomiting, page 70, he says,
-"Sometimes the action of the muscular
-fibres of the stomach is quite inverted;
-they contract from the pylorus towards
-the cardia; and this antiperistaltic motion,
-in which the contractions act
-with more force and rapidity, and in a
-manner decidedly convulsive, produces
-vomiting. The action of the abdominal
-muscles then connects itself with that
-of the stomach; the viscera are propelled
-upwards and backwards, by the
-contraction of the large muscles of the
-abdomen; <em>the diaphragm ascends towards
-the chest; if it descended, in contracting,
-the œsophagus that passes between
-its two crura would be compressed,
-and the expulsion of food
-through the cardia could not be effected</em>.
-It is also observed, <em>that during expiration
-only, any thing can pass from the
-stomach into the œsophagus</em>." Again, on
-respiration, page 147&mdash;"<em>In every effort
-of expiration</em>, as coughing and <em>vomiting</em>,"
-&amp;c. Here, then, we see that Dr.
-Hall's views, as far as regards vomiting
-being an effort of expiration, have
-long since been advanced by Richerand.</p>
-
-<p>The profession are certainly much
-indebted to Dr. Hall for his corroboration
-of these views; at the same time
-he should not have taken to himself the
-merit of having first suggested them.</p>
-
-<p>
-<span class="pad6">Sir,</span><br />
-<span class="pad4">Your most obedient servant,</span><br />
-<span class="pad10 smcap">A Subscriber</span>.</p>
-
-
-<hr class="fulla" />
-<h2>CHARACTER OF THE LANCET.</h2>
-
-<p class="center"><em>To the Editor of the London Medical
-Gazette.</em></p>
-
-<p class="right fs80">Dec. 19, 1828.</p>
-
-<p><span class="smcap">Sir</span>,</p>
-
-<p class="noindent">The events disclosed during the late
-trial in the Court of King's Bench, must
-fill every well-disposed mind with astonishment
-and horror. The moral aspect
-of the case is marked by every feature
-capable of exciting a sense of shame
-for our profession, and of sorrow for
-our kind. Can it be that a publication
-conducted in the spirit of the extracts
-produced at the late trial of Cooper
-against Wakley should be fostered and
-encouraged by a large proportion of the
-medical public? Is it indeed true that
-no feeling of loathing and disgust
-should have induced the purchasers of
-the Lancet to protest against its glaring
-injustice, its undisguised ferocity and
-malignity?</p>
-
-<p>I am not a reader of that work myself,
-and but for the disclosures recently
-made in our courts of justice, together
-with what I have learned from your
-own pages, I should know little about
-it. Some of its early numbers convinced
-me that it was a production not
-deserving of support, whatever ability
-there might be connected with it; subsequent
-events have amply justified this
-decision, and I now address these few
-hasty lines to you, to express my humble
-hope that all the respectable medical
-men throughout the kingdom will arise,
-and with one voice oppose this moral
-pestilence, which at once corrupts and
-degrades their profession.</p>
-
-<p>The <i lang="la" xml:lang="la">odium medicum</i>, bitter and vindictive
-as it unfortunately has been,
-never, I believe, appeared in a form so
-repulsive. Are we living in the nineteenth
-century? Have arts and sciences,
-which are asserted of old to soften the
-manners and temper the violence of our
-nature, produced no such fruits amongst
-us? Is serious, and perhaps irremediable
-injury, to be inflicted on reputation;
-and is the sufferer thereafter to be
-dared to mortal combat, and this too by
-the wrong-doer? Is it thus that professional
-justice is to be awarded? Is
-it thus that knowledge is to be advanced,
-the dignity of our profession
-to be maintained, its benefits enlarged,
-and its usefulness transmitted? Is it
-thus that the young men are to be
-taught how to acquire an unworthy and
-discreditable notoriety; to disregard all
-<span class="pagenum"><a name="Page_128" id="Page_128">[128]</a></span>
-the decencies, charities, and higher
-virtues of life; and to bring into the
-exercise of our art the insidious cunning
-of the knave, the vulgar dishonesty of
-the pilferer, and the audacious bearing
-of the bravo?</p>
-
-<p>I know not how others may feel on
-the present occasion: I am entirely unacquainted
-with the parties who have
-been at issue in the late suit&mdash;I have no
-bias of any kind, but what must arise in
-the mind of every man who has any regard
-for the profession to which he
-belongs, or who loves truth and fair
-dealing&mdash;I am sure that it is not less for
-the interests of society at large than for
-the advancement of medical science,
-that just principles should regulate all
-our dealings, both with the public and
-with each other. It is manifest that of
-late we have signally and woefully departed
-from them; and it is most distressing
-to know that this departure has
-been sanctioned by so many members of
-the profession. I now entertain a confident
-hope that all who reflect on the
-character of the late libel will feel that
-their own <em>character</em> is at stake if they
-do not mark their disapprobation of it
-in every possible way. Sure I am that,
-if the principles which guide the Lancet
-become generally acceptable, it will
-mark an æra of moral degradation
-which no surgical dexterity, no medical
-acquirements, however eminent, could
-possibly redeem.</p>
-
-<p class="right smcap">Veritas.</p>
-
-
-<hr class="fulla" />
-<h2>DURATION OF HUMAN LIFE IN RUSSIA.</h2>
-<hr class="r10a" />
-
-<p class="noindent">Cases of longevity are not only
-much more common, but also more extraordinary
-in respect to a greater duration,
-in Russia than in any other part of
-Europe; thus, from the report of the
-holy synod, published in 1827, it appears
-that there were living in 1825,
-among those who professed the Greco-Russian
-religion throughout the empire,
-not fewer than 848 males who
-were 100 and more years old; among
-whom, 32 had passed the age of 120, 4
-were between 125 and 130, and 4 others
-between 130 and 135 years of age. Out
-of 606,881 males who died in 1826,
-2785 had passed the age of 90 years;
-1432 that of 95; and 818 that of 100.
-Among the latter, 38 were more than
-115 years of age; 24 more than 120;
-7 more than 125; and one was 160
-years old at his death.</p>
-
-
-    <div class="chapter"></div>
-
-
-<hr class="fulla" />
-
-<p class="p1 pfs120 pg-brk">MEDICAL GAZETTE.</p>
-
-<p class="center"><em>Saturday, December 27, 1828.</em></p>
-
-<hr class="r10a" />
-
-<p class="fs70" lang="la" xml:lang="la">"Licet omnibus, licet etiam mihi, dignitatem <em>Artis
-Medicæ</em> tueri; potestas modo veniendi in publicum
-sit, dicendi periculum non recuso."&mdash;<span class="smcap">Cicero.</span></p>
-
-<hr class="r10a" />
-
-<h2 class="no-brk">ANALYSIS OF WAKLEY'S DEFENCE ON THE LATE TRIAL.</h2>
-
-
-<p class="noindent">We last week presented our readers
-with a full<a name="FNanchor_20_20" id="FNanchor_20_20"></a><a href="#Footnote_20_20" class="fnanchor">[20]</a> and, we trust, accurate
-account of the trial for libel, which
-has recently excited so much interest;
-and we offered some remarks of a general
-nature upon its result and tendency.
-We had purposed at the same time to
-subject Mr. Wakley's mode of conducting
-his cause to a critical investigation,
-but this we were prevented from doing
-by want of time and space. We thought
-it likely, too, that the Editor of the
-Lancet would have fairly met the question
-in his next publication, and himself
-put the facts of the case, at least,
-on record: instead of this, however,
-he has devoted his pages to compliments
-to himself, and scurrilous and
-absurd abuse of Sir James Scarlett, in
-which he informs us that in his opinion
-that gentleman is "prodigiously overrated
-even as a lawyer," and says many
-other things, which serve only to shew
-how dreadfully Wakley himself had
-smarted under his lash.</p>
-
-<p>We find the general opinion to correspond
-with that which we expressed
-last week&mdash;that the defendant had managed
-his cause in a very bungling
-manner; and the estimation in which
-he and his witnesses were held by Judge
-and Jury is apparent from the charge
-of the one, and decision of the other.
-<span class="pagenum"><a name="Page_129" id="Page_129">[129]</a></span>
-Both, indeed, regarded the asseverations
-of his whole <em>family party</em> as dust in the
-balance against the testimony of one
-single competent and honourable man&mdash;Mr.
-Callaway; for on his evidence the
-result obviously hinged. Our contemporary
-affects to look upon the verdict
-as a triumph on his part&mdash;so he would
-if the damages had been five hundred
-or a thousand pounds, for in truth he
-has nothing else for it; and with all
-our hearts we wish him many such
-victories.</p>
-
-<p>With regard to the amount of damages,
-we certainly should have been
-better pleased had it been larger; but
-we did not expect that it would&mdash;nay a
-reference to our number which was
-published while the trial was going on,
-will shew that we were even doubtful of
-the verdict, because we know how extremely
-difficult it is for a jury to comprehend
-such a complicated question&mdash;how
-easy for a knave to impose upon
-their ignorance by misrepresentation
-and falsehood. It is quite obvious
-that if the jury had believed one syllable
-of the evidence of Wakley's witnesses,
-they must have given the verdict
-in his favour. In a case like this,
-where <em>one individual only</em>, and he the
-plaintiff, can be fully aware of the difficulties
-which had to be overcome, it is
-almost impossible to bring evidence
-into a court of justice capable of satisfying
-the minds of twelve unprofessional
-men. From this circumstance alone it
-was that we expressed a doubtful
-opinion of the result. But besides all
-this, it is well known to all&mdash;<em>that one
-talesman might go determined to starve
-out the rest&mdash;that ten special jurymen
-might wish to give 500l. and yet that, by
-the absurd constitution of the English
-law, their verdict might be thus controlled
-by one individual friendly to the
-defendant</em>.</p>
-
-<p>Most fortunately for the cause of truth,
-Wakley had the vanity and folly to conduct
-the defence himself, and, judging of
-other men's estimation of moral character
-by his own, he did not hesitate
-to place in the box witnesses whom no
-counsel would have suffered to go there,
-and who, being unable to stand the cross-examination,
-led to what must have
-been to Wakley a most humiliating
-exposure. Next to this, the most
-beneficial effect produced was that of
-the defendant's cross-examination of
-his opponent's witnesses: it was
-amusingly absurd, and shewed a lamentable
-want of tact, always eliciting
-something which he ought to have
-avoided. Lastly came the reply, of
-which he tells us he is himself ashamed&mdash;"We
-may state most unfeignedly,"
-says he, "that we look back with regret
-to our errors in point of omission."
-Nor is this the only part of it for which
-he has cause to blush, for any thing more
-miserably deficient we never heard: it
-was a mass of confusion throughout&mdash;a
-repetition of the same ideas and expressions&mdash;and
-a most injudicious betrayal of
-rancorous feeling, at the very moment
-he was profanely invoking heaven to
-witness that he bore enmity to no man.
-In speaking of his reply in our last
-number, we declared it to be "false
-in statement&mdash;sophistical in argument&mdash;coarse
-in language&mdash;and diabolical in
-tendency;" and we now proceed to
-illustrate these several qualifications, in
-doing which little more will be necessary
-than to select a few passages, and
-arrange them under their appropriate
-heads.</p>
-
-<p><em>False in Statement.</em>&mdash;One of Wakley's
-principal objects was to impress
-upon the Jury a belief that he had
-not in any way attempted to influence
-his witnesses, nor even spoken to most
-of them, anterior to the trial. "Out
-of nine witnesses I have placed in the
-box, (says he) I never saw five of them,
-nor even spoke to five of them till yesterday."
-We appeal to any man of
-<span class="pagenum"><a name="Page_130" id="Page_130">[130]</a></span>
-common sense, whether it be probable
-that this is true. It is possible indeed,
-and only just possible, that he was contented
-with employing others to question
-his witnesses, and ascertain what
-evidence they would give; but even if it
-were so, the assertion was not the less
-false in a moral point of view, because
-his intention was to convey the belief that
-he had inquired no farther than merely
-whether or not the witnesses had been
-present at the operation. But incredible
-and absurd as this was, he ventured a
-step farther, and assigned a reason for the
-choice made of one witness&mdash;(Lee the
-potatoe-merchant.) "I had heard
-(said Wakley) he was present at the
-operation&mdash;an honest man, and that he
-was a friend of Mr. Bransby Cooper,
-under the highest obligation to the
-Cooper family. Without asking him a
-single question I put him into the box,
-as I was most anxious you should hear
-all the evidence that could be adduced,
-and from <em>unsuspected and untainted
-quarters</em>." This lie carried with it its
-own refutation; for Lee swore that he
-had never even spoken to Mr. Cooper;
-and we are therefore amazed that Wakley
-should have hazarded so gross an assertion,
-as it could only have been effective
-on the supposition of his addressing
-a jury of absolute simpletons. But
-again&mdash;"Who were my witnesses? not
-men whom I had trained and lectured
-on models, and sketches, and drawings.
-Has it been shewn to you that I
-was closeted with any person or set of
-persons?" Yes, Mr. Thomas Wakley,
-it has been shewn, and by no less an
-authority than that of your <i lang="la" xml:lang="la">fidus Achates</i>,
-Mr. James Lambert. "The defendant
-(says the worthy author of the libel), the
-defendant was there whilst I was explaining
-the parts to persons who were
-to be witnesses&mdash;<em>the defendant also explained
-them to the same persons</em>." And
-again, "I have heard explanations given
-to persons who were to be witnesses in
-this cause <span class="fs70">FOUR OR FIVE TIMES</span> within
-the last six weeks." So also that excellent
-thorough-going witness, Mr. Jeffry
-Pearl: "a <em>gentleman</em> of the name of
-Lambert introduced me to the defendant;
-<span class="fs70">THE DEFENDANT</span> <em>and Mr. Lambert
-endeavoured to shew that the forceps
-had passed between the bladder and the
-rectum</em>." So much for placing men in
-the box because they are friends of Mr.
-Cooper&mdash;so much for procuring evidence
-from "untainted quarters!"</p>
-
-<p>This is only to be matched in effrontery
-by the statement of some wise-acre
-at the radical meeting on Tuesday
-night. Being asked why no notice had
-been taken in the Lancet of a successful
-operation of lithotomy performed by
-Mr. B. Cooper, soon after the publication
-of the libel, he assigned as the
-reason that Mr. Wakley thought it
-might increase the damages, and otherwise
-injure Mr. Cooper! What a
-noodle the man must be to expect any
-one to believe him<a name="FNanchor_21_21" id="FNanchor_21_21"></a><a href="#Footnote_21_21" class="fnanchor">[21]</a>!</p>
-
-<p>Mr. Wakley asserted that the evidence
-of his witnesses remained "untouched&mdash;wholly
-uncontradicted;"&mdash;whereas
-there was scarcely a single
-point in their statements which was not
-contradicted either by Mr. Callaway,
-who was present at the operation, or
-Mr. Key and Dr. Hodgkin, who examined
-the parts after death. But what
-is more remarkable, there was scarcely
-a circumstance on which his own witnesses
-agreed&mdash;for example, they differed
-with regard to the nature and direction
-of the incisions; with regard
-to the manner and frequency of introducing
-the forceps; with regard to the
-number of instruments used, and the
-mode of applying them; with regard
-to the size of the wound; with regard
-to the degree of force employed, and
-with regard to the appearances after
-death. Yet, in the face of all this, Wakley
-<span class="pagenum"><a name="Page_131" id="Page_131">[131]</a></span>
-had the impudence to tell the jury
-that his evidence remained "uncontradicted."
-We have no hesitation in asserting
-that his own witnesses (putting
-Mr. Cooper's out of the question) advanced
-no charge of which they did not
-also furnish the refutation.</p>
-
-<p>Mr. Wakley asserted that Mr. Cooper
-was incapable of telling why he could
-not extract the stone, even "while he
-had his finger in the bladder." This is
-false: neither Mr. Cooper nor Mr.
-Callaway were able to reach the bladder
-with the finger at all, owing to the
-depth of the perineum.</p>
-
-<p>Mr. Wakley told the jury that the
-plaintiff did not like the bladder to be
-exposed, "because to surgeons there is
-indisputable proof that Bransby Cooper
-did not perform that operation as he
-ought," and that "Mr. Key and Mr. Callaway
-knew it." This is false: Mr. Key,
-Mr. Callaway, and Dr. Hodgkin, who
-had examined the parts, all deposed that
-there was nothing in them indicative of
-the operation having been improperly
-performed. Indeed, had it been as
-Wakley asserted, the plaintiff would
-not have been so foolish as to have had
-the parts preserved at all.</p>
-
-<p><em>Sophistical in argument.</em>&mdash;One of the
-pieces of sophistry on which Wakley
-seems chiefly to have depended, inasmuch
-as he went over it <em>six times</em> in the
-course of his speech, was, that if his
-account of the operation had been incorrect
-more of those who were present
-would have been brought forward
-to prove it so. But, as we stated in
-our last Number, to have objected to
-Wakley bringing forward pupils, on the
-ground of their being incompetent, and
-then to have done the same thing, would
-have been grossly inconsistent. Lord
-Tenterden, in his charge, said, "he did
-not see whom he (Mr. Cooper) could,
-with propriety, have called besides Mr.
-Callaway; the others were all young
-men, only pupils, and probably too
-young and inexperienced to form any
-judgment on the case that could be relied
-on." There is also another person
-who has objected to these witnesses
-whom we may mention&mdash;not, indeed,
-one for whose authority we have the
-highest possible respect, but of whom
-the defendant in this case probably
-thinks more favourably&mdash;we mean Mr.
-Thomas Wakley, who, speaking of the
-Letter formerly published by Mr.
-Cooper's pupils on the subject of this
-operation, says, "their united opinion of
-the skill, dexterity, and self-possession
-exhibited by Mr. Bransby Cooper on
-this occasion, is not likely to influence
-the judgment of the profession, whatever
-it may effect with the public."</p>
-
-<p>The use made by Wakley of Sir Astley
-Cooper's expression, "give him
-time," is another specimen of sophistry.
-Sir Astley evidently meant merely to
-say that, <i lang="la" xml:lang="la">ceteris paribus</i>, a man who had
-been twenty years surgeon to an Hospital
-would be more experienced than
-one who had held the situation but one-fourth
-of that period. This we believe
-to have been his sentiment, though nothing
-was ever less happily expressed.
-Accordingly it was not lost upon the
-defendant, who exclaimed, "Is that the
-way in which our hospitals are to be conducted?
-Is that the mode in which your
-poor patients are to be treated?&mdash;that
-young and inexperienced men are to be
-placed there to <em>learn their profession</em>&mdash;not
-to know it before they get there, but
-are to go there to learn it&mdash;and learn it
-upon whom?&mdash;upon individuals who
-are as much entitled to the best and
-most scientific practice of surgery as
-any nobleman in this land." All very
-fine&mdash;but we should be glad to know
-how or where a practical acquaintance
-with surgery is to be acquired but
-in public hospitals&mdash;and if no man
-is to be appointed till after he has
-gained experience, where are such
-men to come from? Where are ready-made
-<span class="pagenum"><a name="Page_132" id="Page_132">[132]</a></span>
-surgeons to be found fit to
-operate even before Lambert, without
-his being able <em>to make a hole</em> in their
-reputation?</p>
-
-<p>One of the most knavish attempts in
-the whole speech, to take advantage of
-the jury, was exhibited in his description
-of the operation. How different
-from the clear, perspicuous, and candid
-narrative of Sir James Scarlett. You
-are told, says Wakley, that the stone
-was shelved <em>above</em> the pubes and <em>behind</em>
-the pubes; but, continued he, (placing
-a pelvis in the position in which it is
-during the operation,) a stone cannot
-be lodged above the pubes, because,
-you see, the pubes is above the bladder!
-This was, indeed, calculated to
-confuse men unaccustomed to the subject,
-and who did not probably reflect
-that above and below are merely relative
-terms, which must change with
-every change of position, and that it
-was not meant that the stone was between
-the pubes and external integuments,
-which, in the position for lithotomy,
-would be the literal meaning of
-<em>above the pubes</em>, but that it was in such
-a situation as, in the ordinary position
-of the body, was above the pubes.
-But Wakley assured the jury that it was
-impossible for any stone to be <em>above</em>
-the pubes, for there was a tendon to
-prevent it which no force could overcome;
-and he affected to ridicule the
-idea of there being anything unusual,
-any extraordinary shelf behind the
-pubes, in which the stone could have
-been lodged. "Had there been
-a shelf here," said he,&mdash;"had
-there been a crooked passage&mdash;had
-there been a cavity, or any place for
-the deposition of the stone, do you
-suppose that shelf would not have been
-produced? Had there been any thing
-particular in the formation of the
-pubes, would they not have cut out
-the man's bone as well as the bladder?"
-It is <ins class="corr" title="Transcriber's Note&mdash;Original text: 'probably impossibly'">probably impossible</ins> for any but
-medical men to appreciate fully the impudent
-imposition&mdash;the fraud of this
-statement,&mdash;this knavish artifice to mislead
-the jury. No attempt was made
-in any part of Mr. Cooper's case to
-show that there was such malformation,
-or that the stone was in the position
-which Mr. Wakley demonstrated
-it could not occupy&mdash;<em>thus answering
-an argument which had never been advanced</em>.</p>
-
-<p>The following is a good specimen of
-sophistry and stupidity. Finding it
-proved that there was no opening between
-the bladder and rectum, Wakley
-wanted to make out that he never had
-said otherwise, having stated the cellular
-membrane to be <em>lacerable</em>, and therefore
-not <em>lacerated</em>. And then, forgetting
-the nature of his argument, immediately
-added, "remember this; the
-gorget is not as wide as the finger, and
-that it is not an uncommon thing for
-an unskilful operator to drive the gorget
-in between the bladder and rectum."
-Thus insinuating what had been
-proved to be false, and what he had
-just argued, from the words of the libel,
-he could not have meant.</p>
-
-<p><em>Coarse in language.</em>&mdash;This scarcely
-requires illustration. But as specimens,
-on the present occasion, of vulgar slang
-and miserable attempts at wit, we may
-mention his talking of "hole and corner"
-proceedings,&mdash;his comparing Sir
-James Scarlett to sour milk, and which
-happy thought he has, in hand-bills pasted
-about the town, converted into
-"Knight and Professor of Sour Milk,"&mdash;his
-explanation of the term <em>bat</em> as applied
-to surgeons, "because they live in
-the dark, they suckle their young, and
-live in creaks and crevices of old walls,
-hospitals, and dungeons, <em>thriving and fattening
-on their own species</em>,"&mdash;his address
-to the "<em>gang</em>" of hospital surgeons,
-whom he represented as wading "through
-blood up to the neck,"&mdash;and lastly, his
-exclamations, several times repeated,
-<span class="pagenum"><a name="Page_133" id="Page_133">[133]</a></span>
-perhaps with <em>prophetic</em> phrenzy, that he
-"would die in a dungeon and expire in
-a ditch."</p>
-
-<p><em>Diabolical in tendency.</em>&mdash;The general
-tendency of Wakley's writings, and especially
-of his address to the Jury on this
-occasion, so far as such ravings can
-have any influence, is to sow distrust
-between men in every class of society
-and their medical attendants; to poison
-the sources of public charity, and arrest
-the hand of benevolence; to contract
-the relief afforded to human suffering,
-leading the poor and uninformed to
-suppose themselves the objects of cruel
-and wanton experiment, thus encouraging
-them rather to suffer disease
-to run its course than seek relief in such
-abodes of blood and horror as he most
-falsely represents our public hospitals
-to be.</p>
-
-<p>One of the first ebullitions of this demoniacal
-effort consisted in representing
-to the Jury, which he did in two different
-parts of his address, that the patient had
-been kept <em>bound</em> during the operation,
-as if some unusual degree of coercion
-had been employed. "Yet, in opposition
-to the patient's cries&mdash;in opposition
-to his repeated entreaties to be
-unbound, still the operator kept him
-upon the table."&mdash;"Gentlemen," continued
-he, "I should like to know
-upon what principle it was that the
-man was kept <em>bound</em> upon the table
-when he implored to be loosened. Was
-he not a free agent?" And then he
-goes on to put into Mr. Cooper's mouth
-not only words, but a sentiment he never
-uttered.&mdash;"No, no, (says the operator,)
-my <em>reputation</em> is concerned. You were
-brought here to have the stone extracted,
-and extracted it shall and must be&mdash;<em>if
-you were to die upon the table</em>." Unless
-Wakley was intoxicated we cannot in
-any other manner account for an argument
-at once so absurd, so unprofessional,
-and so malignant. It evidently
-excited no feeling but that of disgust in
-the minds either of the Judge or the Jury.</p>
-
-<p>The next paragraph to which we
-shall allude is a masterpiece of hypocrisy&mdash;"Let
-me ask you (said he) what
-you have heard respecting the miseries
-of the individual on whom the operation
-was performed? Not one word
-has escaped the lips of the counsel on
-that subject&mdash;not one word from the
-mouth of one of the witnesses. No,
-gentlemen, they are hospital surgeons
-themselves, and they know too well
-what the practices of our hospitals are,
-and the sufferings <em>patients are in the
-habit of enduring at their hands</em>, to
-feel for this man, or for any other man
-placed in a similar situation!" Canting
-hypocrite! this from the man who
-in the very case before us published his
-account of the patient's sufferings in the
-form of a drama, mingled with low and
-scurrilous gibes. Mark also the following&mdash;"Give
-such a verdict as shall
-satisfy the <em>poor</em>&mdash;as will shew that men
-are not to go into offices of this sort
-where the <em>poor are to be killed</em>, and
-that they shall not be at liberty to wade
-and ride through blood up to their
-necks to eminence in their profession.
-Ah! gentlemen, give such a verdict as
-shall satisfy the <em>poor</em>!"</p>
-
-<p>There is in the various paragraphs
-we have quoted, more deep-rooted
-malice&mdash;more abandoned violation of
-the truth&mdash;more hypocrisy&mdash;and more
-open outrage of common sense, decency,
-and feeling, than we ever remember
-to have met with, even in the
-pages of the Lancet. It is now quite
-obvious that Wakley, alarmed at the
-change which has taken place in the
-estimation of his work within the last
-few months, finds it necessary to adopt
-a new system; he therefore throws off
-the mask, and openly declares himself
-the champion of the ignorant and
-illiterate<a name="FNanchor_22_22" id="FNanchor_22_22"></a><a href="#Footnote_22_22" class="fnanchor">[22]</a>&mdash;conjuring up to their imaginations
-evils which do not exist&mdash;denouncing
-<span class="pagenum"><a name="Page_134" id="Page_134">[134]</a></span>
-the medical profession as
-one of blood and murder&mdash;medical
-men as "thriving and fattening on
-their fellow-creatures"&mdash;and calling
-upon the "humane contributors to our
-hospitals and infirmaries" to support
-him.</p>
-
-<p>Why really now, if the times of political
-turbulence were to return, and
-radical reform again to come into vogue,
-Cobbett and Hunt would have a most
-valuable coadjutor; but as it is, we almost
-think the sphere he has chosen is
-too limited for such a genius. Humbug,
-to be successful, ought not to be
-very open to detection; alleged abuses
-ought not to be of a kind which every
-man can satisfy himself are entirely
-without foundation; and he who professes
-disinterested motives ought not
-to begin by raising a subscription for
-himself. We offer these few hints to
-Wakley, in hopes they may be of use to
-him in his new career; above all, we
-advise him to be sparing in protestations:
-there are some already who look
-upon his sincerity with a suspicious
-eye; for although it is no doubt true,
-that he would "rather die in a dungeon,
-and expire in a ditch," than injure
-any man, yet somehow an idea has got
-abroad, that his constant habits of lying
-and slandering are not quite in keeping
-with these assertions. Nay, we have
-heard of some even of the "humane
-contributors" to our charitable institutions,
-who have been so unreasonable
-as to disbelieve all Wakley's stories
-about the <em>cannibalism</em> of hospital surgeons,
-and to look upon the whole system
-of the Lancet as one of knavery
-and imposition.</p>
-
-
-<hr class="fulla" />
-<h2>WAKLEY'S SUBSCRIPTION MEETING.</h2>
-<hr class="r10a" />
-
-<p class="noindent">A most amusing scene took place at the
-Freemasons' Tavern on Tuesday evening,
-of which we subjoin an account. The
-object of the meeting was, "to present
-Mr. Wakley with some decided mark of
-their approval of his spirited conduct in
-his late trial;" or, in other words, if
-possible, to raise a little money, and bolster
-up the Lancet a little longer. The
-persons present were small in number,
-but great in zeal; and as much noise, hissing,
-laughter, and shouting, took place
-as would have done credit to a much
-larger assembly. As this is a merry
-season, and it may amuse our readers,
-we subjoin the speeches of the principal
-orators on either side: it will be perceived
-that both the Gazette and Lancet
-had some handsome compliments paid
-them; and that Wakley got thoroughly
-abused even by some of those who went to
-the meeting as the champions of reform.
-There was not a single individual present
-of any weight in the profession,
-and the chair was occupied by a young
-man wholly unknown, except as secretary
-to the meetings held two years ago
-on the subject of surgical reform.
-Could no one whose name might sound
-familiar in the public ear be prevailed
-upon to go?&mdash;could none be found but
-Pateys, Wallers, Mills, Elliots, Childs,
-and the Lord knows who? Where was
-he, the idol of the Lancet, who on
-other occasions graced the chair&mdash;where
-he who first ycleped that Journal the
-"invaluable"? Alas! poor Wakley,
-what an exposure of a sinking cause!
-even thy former friends tremble for
-their reputations, and desert thee.</p>
-
-
-<hr class="fulla" />
-<h2>SURGICAL REFORM.</h2>
-
-    <div class="fs90">
-
-<p class="noindent">A meeting was held yesterday evening at
-the Freemasons' Tavern, in pursuance of an
-advertisement calling on the "Friends of
-Surgical Reform, the Supporters of a free
-Medical Press, and the humane Contributors
-to our Hospitals and Infirmaries," to
-meet there, in order to adopt measures for
-presenting Mr. Wakley, the Editor of the
-Lancet, with some decided mark of their
-approval of his spirited conduct, in his late
-trial in the Court of King's Bench, at the
-suit of Mr. Bransby Cooper, and of the
-principles which he so powerfully advocated
-on that occasion.</p>
-
-<p>[Mr. Patey, who was called to the chair,
-stated the object of the meeting; but as his
-speech was rather long, and contained
-nothing of the least interest, we omit it.]</p>
-
-<p><em>Mr. Waller</em>, in proposing the first resolution,
-adverted to the terms of the advertisement,
-and remarked that the question
-for them was not whether they would support
-<span class="pagenum"><a name="Page_135" id="Page_135">[135]</a></span>
-Cooper against Wakley, or Wakley
-against Cooper; but whether they would
-have a free medical press or not&mdash;(cheers).
-Every body must admit that there was only
-one medical publication that was entitled to
-be considered free&mdash;only one that dared to
-tell the truth. Another had been attempted
-to be set up against it, but this wretched rival
-was gagged and manacled, and its reports
-were only a medium which distorted truth,
-and were almost unintelligible. It was not,
-however, to support any particular man, or
-publication, that he came to that meeting,
-but to support the general cause in which
-they were all interested. He concluded by
-moving, as the first resolution, that "the
-best interests of the medical profession and
-of the public are identified with the cause
-of medical and surgical reform; and that
-Mr. Wakley, as Editor of the Lancet, having
-given the first impulse to that cause, and
-having subsequently advocated it with undeviating
-firmness and fidelity, is entitled to
-the cordial thanks and support of this meeting."</p>
-
-<p><em>Mr. Mills</em> seconded the resolution.</p>
-
-<p><em>Dr. Shiel</em> said this was an important meeting,
-in his opinion; for, if this resolution
-were passed, it would identify the medical
-profession with the Editor of the Lancet.
-If the principle embodied in that resolution
-went forth to the world, it would be attended
-with consequences deeply injurious to the
-profession. He knew neither Mr. Bransby
-Cooper nor Sir Astley, and therefore he was
-perfectly impartial. The first question was,
-how far the medical press was conducted
-with advantage to medical science and the
-members of the profession. Now he contended,
-but with great respect, and disclaiming
-all personal hostility, that the
-Lancet had nowise contributed to the progress
-of medical science or the improvement
-of the profession&mdash;(loud hissing, and some
-cheers). He trusted that the meeting had
-not been got up by a few of the friends of
-Mr. Wakley, and he was sure that that
-gentleman was too respectable and too dignified
-in his proper person to need any such
-attempt&mdash;(applause). He trusted that the
-meeting was before the British public to ascertain
-how far the Lancet was useful or advantageous
-to medical science; and he hoped
-that, however partial the gentlemen present
-might be to Mr. Wakley, they would be
-governed in what they should do by the
-real interests of science&mdash;(hear, hear). The
-question was one of great interest; for it
-was one that embraced not only the freedom
-of the press but the advancement of medical
-science. With respect to the freedom
-of the press, they lived in a country where
-the law always maintained that principle.
-When Mr. Abernethy had applied for an injunction
-against the Lancet, Lord Eldon
-said that there could be no doubt that the
-Lancet was a most useful publication&mdash;(applause).
-He did not know whether that observation
-had been brought forward at the late
-trial; but taking the case&mdash;what was it? It
-appeared that the operation was one of
-peculiar difficulty, as stated upon oath by
-some of the most experienced surgeons of
-the day. This operation was laid hold of by
-the Lancet, and published not as a medical
-but as a tragical performance, in which all
-persons without science or knowledge were
-appealed to, and no opportunity afforded to
-Mr. Cooper to vindicate himself. Here,
-then, was a low and pitiful attempt made
-through the medium of malice and calumny
-(loud hisses and uproar). Here was a rude
-and pitiful attempt by malice and calumny
-(renewed signs of disapprobation). And yet
-it was contended that this had advanced the
-medical profession. The evidence on the
-trial went to shew that the dangers by which
-the operator had been surrounded were not
-small, and that there was no just reason to
-accuse him of unskilfulness in what he did;
-and was it then to be said, in the face of the
-British public, that a Meeting had been held
-at the Freemasons' Tavern to offer praise
-and reward to the individual whose conduct
-had, by the verdict of the Jury, been stamped
-with the accusation of untruth (hear, hear!
-and hisses)? He would not deny that there
-was a degree of talent displayed in the Lancet;
-but neither could it be denied that it
-was a public depredator by means of reports
-surreptitiously obtained; and the title of
-"literary raven," which had been applied by
-Sir James Scarlett, appeared to him to truly
-depict its character (great hisses and uproar).
-Was it to be contended that any one
-had a right to come into a private lecture-room,
-and catch up all he could hear, and
-then to publish what he had thus surreptitiously
-and fraudulently obtained (immense uproar
-and hisses)? As far as the medical interest
-was concerned, he looked upon the Lancet
-as one of the most injurious publications that
-had ever appeared (hisses). All the best
-writers on the subject had dwelt with peculiar
-emphasis on the necessity of secrecy
-among the members of the profession, but
-the Lancet broke through this good rule, and
-made public whatever came within its notice;
-and he had no doubt that if it could get at the
-cases that occurred in private practice, it
-would give them without any scruple (uproar).</p>
-
-<p>The <em>Chairman</em> begged to remind the
-speaker that at all events Mr. Wakley had
-not as yet done so.</p>
-
-<p><em>Dr. Shiel.</em>&mdash;I am arguing on the principle
-which appears to actuate Mr. Wakley.</p>
-
-<p><em>Mr. John Elliot</em> rose to order. He could
-not allow Dr. Shiel to be going upon suppositions;
-the thing that he supposed had never
-been done.</p>
-
-<p><em>Dr. Shiel</em> was sure that whatever turn might
-<span class="pagenum"><a name="Page_136" id="Page_136">[136]</a></span>
-be given to the subject in England, that at all
-events the conclusions that the Meeting appeared
-to be coming to would be resisted
-abroad. The weight of Sir Astley Cooper's
-name abroad would overpower any such attempt,
-and, in fact, would render it contemptible;
-so that any attempt to prop up
-so low, pitiful, and mean an attack, must inevitably
-be attended with disgraceful failure
-(hisses).</p>
-
-<p>A gentleman observed, that he was much
-surprised at what had fallen from Dr. Shiel.
-He had been induced to suppose that the
-Lancet possessed talent, as he had heard it
-praised in so many directions, and he certainly
-had never heard till that evening that
-it was only to be found in the hands of the
-illiterate (hear, hear! and a laugh). He
-had always understood that it was only destined
-for the use of students and other members
-of the profession, and that it was likely
-to be of great use in reforming the abuses of
-the medical practice (hear, hear! and cries
-of "So it will!"). For his own part, he
-was glad that medical men were occasionally
-cut up, because when they did what was
-wrong it was proper that they should be
-told of it; and when they did what was right,
-it added a fresh stimulus to their exertions
-(applause).</p>
-
-<p><em>Mr. Thomas</em> observed, that he had not intended
-to say any thing at the present meeting;
-but as Dr. Shiel, in the course of his
-speech, had thought proper to make some
-remarks tending to calumniate Mr. Wakley's
-witnesses on the trial, of which he was one,
-he felt called upon to say a few words (hear,
-hear!). Dr. Shiel seemed to consider them
-all as the mere scum of the earth&mdash;as a miserable
-band, collected together to support
-Mr. Wakley, whatever might be the consequence;
-as though he was desirous of going
-the whole length of the Medical Gazette,
-which stigmatised them for what it called
-"their deep-laid contrivances&mdash;their rankling
-enmities, and their bitter revenge."
-For himself he could say, that it was not till
-the evening previous to the trial that he had
-been supœnaed, and that he had previous to
-that time never seen Mr. Wakley.</p>
-
-<p><em>Dr. Shiel</em> said that he could not have alluded
-to the gentleman who was speaking,
-as he did not even know his name.</p>
-
-<p><em>Mr. Thomas</em> then went on to observe, that
-as Dr. Shiel appeared to be the advocate of
-the opposite party, he also supposed that he
-was a contributor to the aristocratical (Medical)
-Gazette ("No, no!" from Dr. Shiel).
-If he were not, at all events he had put forward
-ideas that were quite consonant to the
-sentiments expressed in that Journal. In
-giving his testimony, he had not spoken of
-the instruments employed in the operation,
-but of his own impression on the subject,
-having been present thirty-five minutes; and
-that impression certainly was, that the operation
-had been performed in a bungling and
-unscientific manner (loud applause, mingled
-with hisses). Was he then, because he happened
-to be a witness on the occasion, to be
-put down, pell-mell, by the unfounded imputations
-of any one? The highly-principled,
-honourable-minded Medical Gazette, that
-had determined never to admit any personalities,
-had loaded Mr. Wakley and Mr.
-Lambert with all sorts of abuse. Was this
-what they intended to call acting on principle
-(applause, and cries of "No, no!")?
-He certainly had heard that Mr. B. Cooper
-was an amiable man in private life; but
-what had that to do with the question at
-issue? What had they to do with the private
-character of a man in a public office
-(cheers)? Surely the witnesses of Mr.
-Wakley were as competent to speak of the
-manner in which the operation was performed
-as those who had not been present
-(applause); and as he had seen many operations
-performed he conceived that he was a
-competent judge of the skill of the operator
-(applause).</p>
-
-<p>A gentleman, who appeared to be a student,
-thought that the introduction of any attack
-upon the witnesses, or indeed of anything
-that occurred at the trial, was irrelevant
-(hear, hear!). The way to answer a
-speaker was not by hisses, but by disproving
-his arguments and rebutting his facts
-(applause). If questions were to be settled
-merely by strength of lungs, he was afraid
-that instead of the right side prevailing, success
-would uniformly attend those whose physical
-powers probably much exceeded their mental
-(laughter and applause). He could not agree
-with the gentleman who had stated that the
-law of England was the protector of the freedom
-of the Press; for it was well known
-that the Judges had decided, over and over
-again, that truth was a libel (applause). It
-was only the vehicle that conveyed public
-sentiment, and not the force that impelled it
-forward. He was convinced that any attempt
-to connect medical reform with Mr.
-Wakley should be studiously avoided and
-disclaimed. As a friend of free discussion
-in every case, and anxious to uphold the
-principle, whatever he might think of the
-instrument, he intended to propose, as an
-Amendment, "That the latter part of the
-Resolution, relating to Mr. Wakley, should
-be omitted." This would save the cause of
-medical reform from being identified with
-Mr. Wakley, of whose impartiality he would
-give a specimen. In the last number of the
-Lancet, the report of the late trial was given
-from the Times, but with a remarkable omission.
-The Lord Chief Justice had rebuked
-one of the defendant's witnesses for not answering
-the questions in a straightforward
-manner, and this passage was omitted. If
-Mr. Wakley would do this on such an occasion,
-would he be more candid when the public
-eye was less upon him? He, therefore,
-wished to have the question of medical reform
-<span class="pagenum"><a name="Page_137" id="Page_137">[137]</a></span>
-kept separate from Mr. Wakley individually.
-The first part of the Resolution
-would be carried without a dissenting voice,
-as on that principle they were all agreed,
-whatever they might think of the conduct of
-individuals.</p>
-
-<p>[One or two persons then made speeches
-for or against the amendment; which was
-negatived, and the original motion carried.]</p>
-
-<p><em>Mr. Hensley</em> then, after observing that Mr.
-Wakley's conduct was highly praiseworthy,
-because it tended in every way to the benefit
-of humanity, moved the second Resolution,
-which was to the following effect:&mdash;</p>
-
-<p>"That the purposes for which the Hospitals
-and Infirmaries of the Metropolis were
-founded, and that the views of the humane
-contributors to their funds, are materially
-promoted by the weekly publication of reports
-detailing the medical and surgical
-treatment of the unfortunate patients; and
-that Mr. Wakley having originated the practice
-of publishing Hospital Reports, has conferred
-important benefits on Medical Science,
-and on the cause of humanity."</p>
-
-<p>The resolution was then carried unanimously.</p>
-
-<p><em>Mr. John Elliott</em>, on moving the third resolution,
-said that he did not come there to
-interfere in the quarrels of Wakley and
-Cooper. They had acknowledged that Mr.
-Wakley's exertions had been very conducive
-to medical reform, by the last resolution
-they had passed. Indeed, there could be
-no doubt that he had greatly served the
-cause of humanity, by preventing idleness on
-the part of medical persons, and compelling
-attention to the poor placed under their care.
-It was his opinion that the editor of the
-Lancet ought to be indemnified for the whole
-expense entailed on him by the late trial,
-including the damages awarded against him.
-This would not be a private subscription,
-like Brodie's, but one open to the world,
-and not to be questioned in a court of justice.
-He would not support Mr. Wakley
-if he had attacked private character; but he
-would, as the editor of the Lancet and the
-representative of the medical free press.
-He concluded by moving&mdash;</p>
-
-<p>"That the independent and impartial
-principles on which the Lancet was first
-established, have been preserved by Mr.
-Wakley at all risks; and as it was acknowledged
-at the late trial, that the legal expenses
-of his opponents on another occasion
-have been defrayed by certain hospital physicians
-and surgeons<a name="FNanchor_23_23" id="FNanchor_23_23"></a><a href="#Footnote_23_23" class="fnanchor">[23]</a>, it is farther resolved,
-that a subscription be opened for the purpose
-of defraying the expenses of the late
-action."</p>
-
-<p>[Dr. Shiel here spoke very strongly
-against entering into a subscription&mdash;while
-some spoke in its favour.]</p>
-
-<a name="P137" id="P137"></a>
-<p>A discussion then arose about the question
-of whether an account of a second operation
-for lithotomy by Mr. Cooper (in which he
-had been successful) had been sent to Mr.
-Wakley? It was stated that such was the
-case, but as the action for the present libel
-was then commenced, <em>Mr. Wakley thought
-that he perceived something in that second report
-that might tend to aggravate the damages, and
-which, at the same time, would be farther injurious
-to Mr. B. Cooper</em>.</p>
-
-<p>The third resolution was then carried by
-an immense majority, only five hands being
-held up against it.</p>
-
-<p><em>Mr. Evans</em> moved, "That the statement of
-professional facts in an unprofessional form,
-such as the dramatic instead of the narrative,
-is highly reprehensible in the individual,
-and detrimental to the best interests of
-science."</p>
-
-<p>This resolution, after some turbulent discussion,
-was withdrawn.</p>
-
-<p><em>Mr. J. L. Stevens</em> then moved, as the fourth
-resolution, that "In accordance with the
-feelings this meeting has expressed, Mr.
-Wakley be invited to attend a Public Dinner,
-and that a Committee be forthwith nominated
-to arrange the same."</p>
-
-<p><em>Mr. Rogers</em> seconded the resolution, and
-it was carried unanimously.</p>
-
-<p>The members of the committee were then
-named, and power given to them to add to
-their number.&mdash;The chairman then vacated
-his office, and the meeting separated.&mdash;<cite>Morning
-Chronicle, Wednesday.</cite></p>
-
-<hr class="r10a" />
-
-<p>In the course of the evening, the conduct
-of one of the speakers gave for a short time
-an amusing turn to the discussion, which for
-a great part had appeared to many extremely
-dry and tedious. The gentleman in question,
-(not a medical man), in order to show
-the opinion he had entertained of the object
-of the meeting, proposed to read for the
-audience a letter which he himself had
-written to the chairman of the committee,
-asking permission to attend. He began, but
-he had scarcely got through a few words
-when he declared he was not able to make
-out his own writing, and requested the chairman
-to assist him. The chairman made the
-attempt, but was not more successful. Another
-gentleman then undertook the task, but
-with no better effect. The audience received
-each unsuccessful effort with loud laughter,
-which so much annoyed the writer that
-he took back the letter, and again tried to
-go through with it, but not being able to
-make it out, he proposed to read for the
-meeting two letters which he wrote on the
-same subject to the editor of a Sunday
-paper. (Loud laughter followed this proposition,
-which was increased, when, on an attempt
-to read one of them, he had no more
-success than before.) The gentleman, after
-complaining of the want of courtesy in the
-meeting, resumed his seat, declaring that he
-would give the letters to the reporters.&mdash;<cite>Times,
-Wednesday.</cite></p>
-
-    </div>
-
-
-<hr class="fulla" />
-<p><span class="pagenum"><a name="Page_138" id="Page_138">[138]</a></span></p>
-<h2>HOSPITAL REPORTS.</h2>
-
-<hr class="r10a" />
-<h3>GLASGOW ROYAL INFIRMARY.</h3>
-
-<p class="center"><em>Injuries of the Head.</em></p>
-
-<p class="noindent">D. M'Millan, æt. 40, seaman;&mdash;while
-he was employed in the hold of a vessel,
-a heavy iron block, of a round form, fell
-from the rigging, a height of 20
-feet, and struck him on the head.
-He was knocked down and stunned,
-but was able to rise and to walk with
-a little support. He was brought about
-a mile and a half in a hackney-coach to
-the hospital, and admitted by Mr.
-Cowan at one o'clock <span class="fs70">P.M.</span>, half an hour
-after the accident. At this time he had
-a stupified look, but was quite collected,
-and was able to walk across the
-ward; breathing and pupils both natural;
-pulse 75, of moderate strength.
-There was a wound in the scalp, commencing
-nearly over the centre of the
-sagittal suture, and running about
-three inches backwards and towards the
-left; along this a portion of skull, corresponding
-to the wound in size, was
-felt fractured, detached, and irregularly
-depressed. His right arm was benumbed
-and nearly powerless, but no
-mark of injury was observed on it.</p>
-
-<p>It was determined to remove the detached
-piece of bone, and the original
-wound being extended lengthwise in
-both directions, an incision was made
-through the scalp at right angles to it
-over the left parietal bone, thus bringing
-the fractured portion into view. This
-was found to be broken down into several
-fragments, some of which were
-firmly impacted under the surrounding
-cranium, and one spiculum, driven
-through the dura mater, had penetrated
-the brain. The trephine was applied a
-little to the left of the fracture, and
-the intermediate part removed with
-Hey's saw; the detached pieces of
-bone, ten in number, of various sizes
-and irregular shapes, were removed
-with the forceps, the scalp replaced
-and retained in position by a stripe of
-adhesive plaister and very light dressings.
-During the operation one artery
-required ligature, and about
-<span class="screenonly">℥v.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />v.</span>
-of blood were lost: he had lost perhaps as
-much before. He remained quite sensible,
-bore it well, and shortly afterwards
-had half a glass of port wine in
-warm water.</p>
-
-<p>Ten <span class="fs70">P.M.</span>&mdash;Has been tolerably easy;
-complains of pain of fore-part of head;
-pulse 82, firm.</p>
-
-<p class="pad1 fs80">Fiat V. S. ad
-<span class="screenonly">℥xviii.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />xviii.</span></p>
-
-<p class="neg3">Sumat statim Submur. Hydr. gr. viii.
-Pulv. Antimon. gr. vi.</p>
-
-<p class="neg3">Applic. Capiti Lotio ex Alcohol. et aq.
-calcis.</p>
-
-<p>Second day.&mdash;After bleeding, thought
-feeling of numbness of right arm somewhat
-lessened, and to-day has rather
-more power of it. Passed a tolerable
-night; a little head-ache; countenance
-pretty natural; tongue slightly loaded;
-thirst; no stool.</p>
-
-<p class="pad2 fs80">Sum. stat. Sulph. Magnesiæ
-<span class="screenonly">℥j.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />j.</span>
-et rep. vesp. si opus.</p>
-
-<p>Third day.&mdash;From an aversion to use
-the bed pan, he rose to stool last night,
-and fell forwards on the floor, seemingly
-from having entangled himself in
-the bed clothes; he got into bed without
-assistance; had a shivering fit
-shortly after, but has had a pretty good
-night; bowels freely opened; head-ache
-slight; pulse 84, soft; tongue
-dry in middle. Towards the evening of
-this day he appeared drowsy; and on
-the fourth day he is reported as seeming
-confused and uneasy; countenance
-anxious; articulation difficult; the
-right arm was more paralysed, and indeed
-the whole right side seemed now
-to partake in the paralysis; a small
-part of the wound had adhered, the remaining
-part was flabby, discharging
-thin serum. In the evening the difficulty
-of articulation and drowsiness
-had increased. Twelve leeches were
-applied to each temple, and in a short
-time he seemed a little livelier.</p>
-
-<p>Fifth day.&mdash;Much in the same state;
-took a little beef tea.</p>
-
-<p>Sixth day.&mdash;Paralytic symptoms increased;
-breathing laborious. Blister
-to the neck. It may be worthy of remark,
-that in the few words he now
-spoke he never made use of the English
-language, but of the Gaelic, which was
-his native tongue; and even when told
-that he was not understood, he persisted
-in repeating the Gaelic phrase.</p>
-
-<p>Seventh day.&mdash;A small fungus was
-observed in upper part of wound, to
-which lint dipped in lime water was
-applied, and moderate pressure. The
-fungus continued to increase.</p>
-
-<p>On the eleventh and twelfth days he
-had slight bleedings from the scalp,
-<span class="pagenum"><a name="Page_139" id="Page_139">[139]</a></span>
-which stopped spontaneously. Stupor,
-&amp;c. greatly increased, but he still recognised
-his friends; took a very little
-chicken soup or beef tea daily, with
-lemonade, &amp;c. for drink.</p>
-
-<p>On the evening of the thirteenth day
-bleeding to the extent of
-<span class="screenonly">℥iv.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />iv.</span>
-or v. took place from fungus: it was checked by
-application of saturated solution of
-alum, but he sunk rapidly, and died
-that night.</p>
-
-<p><em>Inspection 36 hours after death.</em>&mdash;The
-fungus protruded considerably beyond
-the scalp, and was rather larger
-than a hen's egg, of a dirty brown
-colour, and a soft spongy consistence;
-it completely filled up the opening
-made in the skull by the trephine and
-removal of detached bone. The pericranium
-to the inferior side of this
-opening was found detached from the
-bone, to the extent of a crown piece,
-and beneath it the bone was rough, and
-covered with thin purulent matter.
-The dura mater, for two inches around
-the fungus, was covered with pus; this
-membrane, by sloughing, had allowed
-the fungus to protrude, and its edges
-adjacent to the aperture were thickened.
-On removing the dura mater, the
-fungus was observed to arise, partly
-from the middle, but chiefly from the
-posterior lobe of the left cerebral hemisphere:
-it occupied a space about
-three inches in length, and an inch and
-a half in breadth, extending to within
-a line or two of the roof of the ventricle;
-at its anterior part was an abscess,
-containing
-<span class="screenonly">℥ss.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />ss.</span>
-of pus. The fungus
-seemed to be a degeneration of the
-cerebral substance; sections of it showed
-the cerebral matter first dotted with
-an unusual number of bloody points,
-then assuming a greyish colour, which
-gradually passed into a dirty brown.
-With the exception of these bloody
-points, the brain presented no unusual
-vascularity: it was quite firm, except
-in the immediate neighbourhood of the
-fungus, where it gradually became
-softer as the colour of the cerebral substance
-became deeper, till in the centre
-of the fungus it was nearly of a broken
-down consistence. A quantity of serum
-was found in each ventricle.</p>
-
-<p class="p1" />
-<p>Another man who had been struck by
-the piece of iron which fractured M'Millan's
-skull was brought up to the hospital
-at the same time. He had received the
-blow on the vertex of his head. On admission
-he was in a state of fury, requiring
-the efforts of several men to hold him.
-His head was bruised out of all shape,
-quite depressed behind, and a fracture
-also of the frontal bone; there were
-evident symptoms too of fracture of the
-base of the skull. The case was hopeless.
-Several large depressed and detached
-pieces of bone were removed,
-but he died a few minutes after the
-operation.</p>
-
-<p class="p1" />
-<p>During the same week an old woman
-was brought up to the infirmary, who,
-the day previously, had fallen headlong
-down a stone staircase. She laboured
-under the severest symptoms of concussion,
-and besides had a comminuted
-fracture of the humerus into the elbow
-joint, and of the radius into the wrist
-joint of left arm. She was past all treatment,
-and died on the second day. The
-case is mentioned chiefly to remark,
-that although no external injury of the
-head could be observed, on inspection a
-fracture was found extending completely
-across the anterior part of base of
-cranium.</p>
-
-<p class="p1" />
-<p>There are no dispensaries in Glasgow,
-but such of the poor as are unable to
-obtain admission into the Royal Infirmary,
-and those who are not so ill as to
-submit to the confinement of an hospital,
-or for other reasons prefer remaining
-in their own houses, are prescribed
-for, and, if necessary, visited at the
-public expense. For this purpose the
-city is divided into districts, and a surgeon
-appointed to each. The "district
-shop" thus resembles a dispensary,
-where the surgeon prescribes in the presence
-of his pupils, who indeed, under
-his superintendance, have the management
-of many of the cases, both among
-the patients who receive advice at the
-"shop," and those who are visited at
-home. Although under the care of a
-surgeon, the diseases treated are both
-medical and surgical, for there is little
-distinction made between the two
-branches of the profession here.</p>
-
-<p>The following case occurred under
-the care of Mr. Stirling:&mdash;</p>
-
-<p>W. M. æt. 28, while returning home
-during the night in a state of intoxication,
-fell from a height of ten feet, into
-a court paved with stone. He was rendered
-insensible for some time, but on recovering
-was able to crawl to the nearest
-door, and was conveyed home. Medical
-assistance was immediately procured.
-<span class="pagenum"><a name="Page_140" id="Page_140">[140]</a></span>
-On the forehead, about an inch above
-the nasal process of the frontal bone, was
-a cut an inch and a half in length, extending
-obliquely downwards from the
-right side; through this a triangular
-fracture was felt, the base of which was
-in the direction of the external wound,
-and the apex pointing downwards; the
-fractured portion of the bone was slightly
-depressed; the bones of the nose were
-also fractured, and there was great discharge
-of blood from the nostrils. One
-third, or nearly, of the upper lip was
-cut off, and a good deal of blood had
-been lost from the labial artery; the
-lower jaw at the symphysis was fractured
-and comminuted, and several
-pieces were perceived to be loose. Was
-quite sensible, remembering every thing
-up to the period of the accident. Pulse
-80; has vomited frequently. Wound of
-forehead was dressed with adhesive
-plaister; the loose pieces of bone were
-removed from the lower jaw, and it was
-afterwards retained in juxta-position by
-a chin bandage.</p>
-
-<p>Early next morning he was bled to
-<span class="screenonly">℥xii.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />xii.</span>
-and had a purge of jalap and calomel,
-by which his bowels were freely
-opened. That night he felt considerable
-pain of head; pulse 90, full, and
-strong. He was bled again to
-<span class="screenonly">℥xxv.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />xxv.</span>
-Blood first drawn had the buffy coat.
-After the bleeding the pain of head
-diminished, and he continued to do
-well. When the swelling and tenderness
-of face had subsided, it was observed
-that the fracture communicated
-with the frontal sinus. On holding his
-nose and attempting to blow it, matter
-and air escaped by the fracture. The
-man was anxious for a speedy cure, and
-for this purpose an operation to remove
-the depressed piece of bone was at one
-time thought of; there was no constitutional
-disturbance, however, and the
-case was left to nature. The discharge
-gradually diminished, and the wound
-healed up in about a month. The bones
-of the nose retained their position, and
-the broken ends of the jaw, after the
-swelling had subsided, were kept in
-their proper situation by a pasteboard
-splint till re-union took place. The lip
-also healed easily, and no deformity is
-now observable.</p>
-
-
-<hr class="r10a" />
-<h3>GUY'S HOSPITAL.</h3>
-
-<p class="center"><em>Inflammation of Hernial Sac.</em></p>
-
-<p class="noindent">The previous report of this case (Gazette,
-No. 51) conducted it to Nov.
-18th, the tenth day from the operation,
-and the third on which fæces had been
-discharged from the wound; that discharge
-continued on the 19th, but on
-the 20th pus only was seen.</p>
-
-<p>Nov. 22.&mdash;Yesterday the dresser, Mr.
-King, observed a portion of <em>solid</em> fæces
-make its escape, and to-day a similar
-discharge, in the fluid form, is manifest.</p>
-
-<p>Nov. 26.&mdash;Since the 22d, nothing
-but healthy pus has been seen; the
-wound is rapidly healing, and the patient's
-general condition as good as can
-be desired.</p>
-
-<p>Dec. 4.&mdash;He has begun to wear a
-truss, and is to-day allowed to leave
-his bed.</p>
-
-<p>Dec. 8.&mdash;As regards his original complaint,
-the man is perfectly convalescent,
-but he now discloses a small abscess in
-the scrotum, which has been gradually
-forming, and will detain him in the
-house some time longer.</p>
-
-<p>If it be a sound surgical maxim that,
-in strangulated hernia, the patient's
-safety depends upon an early operation,
-it is also a maxim no less sound, that
-where the evidence and symptoms of
-strangulation are imperfect, or dubious,
-the benefit of the doubt should be
-given to the operation, and it should
-be performed: for it is better that buboes
-should be laid open, or inflamed
-sacs cut into, twenty, aye, fifty times
-in succession, than that in one case a
-man should be suffered to die with
-strangulation of the intestine unrelieved.</p>
-
-<p>These remarks apply strikingly to
-this case of Mr. Key's, in which, although
-no hernia was found, they perfectly
-justify the operation. No case of
-strangulation could be more distinctly
-marked, or more clearly call for the
-knife, than did this; and had Mr. Key
-refused to use it, he would have deserved
-the scoff which, by a contemporary,
-has so preposterously been
-thrown on the "no hernia case." But,
-more than this, the operation was not
-only justifiable, but beyond a doubt
-<em>beneficial</em>&mdash;beneficial inasmuch as it at
-once relieved the distress of the patient,
-secured him from more extensive suppuration,
-from farther sloughing of intestine,
-and probably from extravasation
-of fæces into the abdomen; rendering
-also the process of reparation
-more easy and rapid.</p>
-
-<p><span class="pagenum"><a name="Page_141" id="Page_141">[141]</a></span></p>
-
-<p class="center"><em>Hereditary Hare-Lip.</em></p>
-
-<p>Dec. 4th, Mr. Key performed the
-operation for hare-lip on a child a few
-months old, whose case was remarkable
-only as it afforded an instance of <em>hereditary</em>
-malformation. The father of
-the child had congenital hare-lip, for
-which no operation had been performed,
-and of his six children <em>two</em> were born
-with the same malformation.</p>
-
-<p><em>Queries.</em>&mdash;1. If the father's lip had,
-in his infancy, been restored to the natural
-form, would the malformation
-in that case have descended to his children?</p>
-
-<p>2. Is the casualty in these cases to
-be traced <em>directly</em> from the father to the
-incipient embryo, or <em>indirectly</em>, through
-the medium of the mother's imagination&mdash;It
-has been said that paternal resemblances
-are produced in the latter
-mode.</p>
-
-<p class="rt">G.</p>
-
-
-<hr class="r10a" />
-<h3>PARIS HOSPITALS.</h3>
-
-<p class="center"><em>Hôtel Dieu.</em></p>
-
-<p class="center"><em>Cases of Gangrene of the Lungs.</em></p>
-
-<p class="noindent">Some interesting cases of gangrenous
-suppuration of the lungs were published
-by Dr. Chambers, about eighteen
-months ago, in which he particularly
-pointed out the horrible fœtor
-of the breath as a diagnostic mark
-of the disease. The following cases
-which recently occurred at the Hôtel
-Dieu are good illustrations of more
-extensive destruction of the lung by a
-similar disease.</p>
-
-<p><span class="smcap">Case I.</span>&mdash;A man, aged 32, of good
-constitution, laboured under bronchitis
-for some weeks, to which he paid little
-attention, when he was suddenly seized
-with pain in left side, dyspnœa, considerable
-cough, and a rigor, followed
-by fever. He was admitted into the
-Hôtel Dieu next day. Crepitation was
-perceptible over the whole extent of the
-left lung, posteriorly, and reaching to
-the site of the pain in the side, which
-was increased by percussion; great oppression,
-with frequent cough, and expectoration
-of violet-red colour, mixed
-with mucus; pulse frequent and small;
-constant chilliness; cheeks flushed.</p>
-
-<p>Next day the symptoms remained unabated,
-and <em>fœtor of the breath</em> was
-observed. Two days after it is stated
-that the expectoration maintained the
-same appearance, but <em>was now fœtid</em>;
-the breath was, however, still more
-offensive, and during the fits of coughing
-particularly so. In the evening the
-breath is said to have become <em>gangrenous</em>.</p>
-
-<p>21.&mdash;The cough was small, difficult,
-and painful, producing an expectoration
-of violet-coloured matter, approaching
-to chocolate, <em>with a characteristic
-odour</em>.</p>
-
-<p>22 to 25.&mdash;Expectoration and breath
-emit an <em>intolerable stench</em>. On the latter
-day the patient died.</p>
-
-<p><em>Examination.</em>&mdash;The body not emaciated.
-Strong adhesions of the left
-lung to pleura costalis. At its posterior
-part a large gangrenous layer, occupying
-the two superior thirds of the
-lung, covered at some points by a false
-membrane. The lower third, and the
-parts round the gangrenous portion, in
-different degrees of inflammation, and
-hepatised; the putrid mass was in great
-part black or violet-coloured, containing
-fragments of the pulmonary texture;
-the smell gangrenous, but less
-so than that of the breath during life;
-pus might be squeezed from the adjacent
-part of the lung.</p>
-
-<p><span class="smcap">Case II.</span>&mdash;A man, aged 55, enjoyed
-good health till the beginning of May,
-at which time he experienced pain in
-the left side of the thorax after exposure
-to cold. During the next few
-days the cough was frequent, and the
-expectoration tinged with blood. A
-rigor now came on, followed by a distinct
-exacerbation of fever, and he
-came to the Hôtel Dieu. At this time
-he presented symptoms of inflammation
-of the lungs, and was bled with
-relief; he left the hospital in twelve
-days, being sufficiently well to resume
-his occupation. Scarcely had he done
-this, however, when he had a relapse,
-accompanied by great lassitude, oppression
-of breathing, and frequent cough.
-At the end of a week he returned. He
-was now at the twenty-first day of the
-attack. His skin was yellowish; face
-pale or of leaden hue, and greatly altered;
-his cough frequent, with abundant
-expectoration of matter like chocolate,
-with small specks resembling
-pus, and little bodies about the size of
-peas, which appeared to be portions of
-the lung. This putrid mass exhaled a
-<em>gangrenous odour</em>, and the expired air
-was impregnated in a high degree with
-an equally disgusting smell, which surrounded
-the patient's bed with a contaminated
-<span class="pagenum"><a name="Page_142" id="Page_142">[142]</a></span>
-atmosphere. Percussion gave
-a clear sound over the whole extent of
-the chest; auscultation did not discover
-the pulmonary expansion on the right
-side. The pulse was weak, but not
-frequent; the patient was in a state of
-extreme prostration. Next day the
-odour of the breath and expectoration
-was, if possible, more dreadful. He lingered
-two days longer, during which time
-the fœtid smell somewhat diminished,
-and the proportion of pus in the expectoration
-increased.</p>
-
-<p><em>Examination.</em>&mdash;The left lung had
-contracted firm adhesions, particularly
-above and behind. It was torn in attempting
-to remove it, and there issued
-from the middle and posterior part a
-large quantity of dark-coloured matter,
-similar to what had been expectorated.
-An incision was made along the back
-part of the lung, and laid open a large
-cavity, occupying all the extent of the
-pulmonary organ, and still in part filled
-with the same kind of dark putrid matter.
-On washing out the cavity it was
-perceived that it was lined with a
-smooth and white membrane, to which
-were still adherent, at some points, dark
-filamentous shreds; these were removed
-by the least touch, and left the surface
-smooth beneath. The boundary was
-formed by a false membrane, about a
-line in thickness, which separated the
-mortified from the sound parts. The
-lung was reduced to a kind of bag, the
-parietes of which were on an average
-about an inch thick. In the upper part
-of the lung, which was hepatized, an
-incision discovered a number of smaller
-tubercles, which in the centre were in
-a crude state; and at one point several
-had suppurated, forming a cavity large
-enough to contain a nut.</p>
-
-<p>[The Editors of the <cite>Journal Hebdomadaire</cite>,
-from which these cases are abridged,
-add, in a note, that although the fœtor
-of the expectoration, such as above
-described, is usually dependent on gangrene
-of the lungs, yet that this is not
-invariably the case. In confirmation of
-this assertion they refer to three instances
-of fœtid expectoration&mdash;in the
-first, the patient is still alive; in the
-second, there was chronic bronchitis,
-with considerable dilatation of numerous
-bronchi; and in the third, bronchitis
-with some appearances of chronic
-pneumonia. Laënnec gives a case of
-dilatation of the bronchi, with remarkably
-fœtid expectoration. The argument
-derived from the first patient
-having survived we consider to be altogether
-erroneous, as patients more
-frequently recover from this than other
-forms of purulent expectoration.&mdash;<span class="smcap">Ed.</span>]</p>
-
-
-<hr class="fulla" />
-<h2>PROCEEDINGS OF SOCIETIES.</h2>
-<hr class="r10a" />
-
-<h3>WESTMINSTER MEDICAL SOCIETY.</h3>
-
-<p class="center fs80">December 6th, 1828.</p>
-
-<p class="center smcap">James Arnott, Esq. in the Chair.</p>
-
-<p class="noindent">Pursuant to announcement, Mr. MacKelcan
-introduced the subject of concussion of the
-brain. After remarking on the several
-symptoms, and mentioning the other affections
-of the head with which concussion is
-apt to be confounded, Mr. M. directed the
-attention of the society more particularly to
-the treatment in the stage of collapse, adopted
-by Professor Andrini of Florence.</p>
-
-<p>Dr. Duffin stated, that having been in
-Florence, he had witnessed the employment
-of three, four, or six ounce bleedings employed
-by the Professor in the stage above-mentioned.
-The principle on which they
-were used was that of their acting as a
-stimulus to the brain; and really the plan
-was not apparently attended with any bad
-effects. When re-action has ensued, the
-practice of M. Andrini is the same as that
-resorted to in this country.</p>
-
-<p>The discussion then wavered between
-apoplexy and concussion, and ended by some
-good-humoured sparring between Dr. Addison
-and Mr. Gilbert Burnett, on the capability
-of the brain containing more blood at
-one time than another.</p>
-
-<p>The President announced from the chair
-that a special meeting would take place on
-Friday evening, December 12, at 7 <span class="fs70">P.M.</span></p>
-
-
-<p class="p1 center fs80">December 20th, 1828.</p>
-
-<p class="center smcap">Cæsar Hawkins, Esq. in the Chair.</p>
-
-<p>After some business had been dispatched,
-to which we shall allude in another place,
-Mr. Jewel related the particulars of a case of
-"supposed extra-uterine fœtation." The
-case, which is one of much interest, is as
-follows:&mdash;</p>
-
-<p>Mrs. F. a robust, healthy woman, ætatis
-27, had been married one year, and aborted
-once; when, in the month of September
-1827, she quitted her husband in London,
-and accepted a situation in the country.
-After the expiration of a few weeks she
-received permission to come to London for
-a day; and, naturally enough, passed that
-night, (November 8th), with her husband,
-returning again to the country next morning.
-Soon afterwards, the morning-sickness,
-heart-burn, and other sympathetic affections
-<span class="pagenum"><a name="Page_143" id="Page_143">[143]</a></span>
-of pregnancy, appeared; but the catamenia
-still returned at the regular periods, though
-scanty and paler in colour than natural.
-She now quitted her situation, returned to
-her husband, and engaged a midwife to attend
-her in her expected confinement. The
-circumstance of quickening occurred in the
-latter part of February, and was accompanied
-by a severe paroxysm of fainting, whilst the
-abdomen gradually enlarged, and the motions
-of the child (as was imagined) could
-not only be easily detected with the hand,
-but were visible to the eye. On the 9th of
-August, making a period of 274 days, she
-was seized with the usual premonitory symptoms
-of labour; the midwife arrived; found
-her walking her chamber, and concluded that
-the process had considerably advanced.
-Three distinct uterine contractions took
-place subsequent to the midwife's arrival,
-the last of which was so severe as to compel
-the patient to grasp firmly the back of a
-chair, and induce, after its subsidence, excessive
-faintness. From this time no further
-parturient effort was made; no examination
-per vaginam was instituted; neither was
-there noticed any sanguineous vaginal discharge.
-When Mr. Jewel saw her, examination
-detected nothing unusual in the os
-uteri, and the symptoms she presents are
-these. The abdomen is about the size of a
-woman's in the sixth or seventh month of
-pregnancy, the enlargement being general.
-Her general health is much disturbed: she
-complains of pain in the left hypogastric
-region, particularly when the abdomen is
-compressed by the hand or stays&mdash;and she
-also complains of weight in the abdomen,
-especially on leaning forwards. The woman
-herself has a strong prepossession that
-"something is to come away," or that she
-might be relieved by an operation. The
-woman believes that she still feels the motions
-of the child, though feebly.</p>
-
-<p>Having read this case, Mr. Jewel concluded
-by offering some observations on the
-subject of extra-uterine fœtation. He considered
-this as probably an instance of "graviditus
-abdominalis," and remarked that the
-uterus not having expelled its dezidua, was
-no conclusive proof to the contrary, Dr.
-Blundell and Mr. Langstaff having examined
-cases where this was wanting.</p>
-
-<p>Dr. Locock never saw a case where laceration
-occurred in the early months of pregnancy.
-Dr. L. remembered the particulars
-of a case where the uterus was lacerated in
-the fourth month, and the ovum escaped into
-the cavity of the abdomen, and the symptoms
-of pregnancy were exceedingly strong.
-Dr. Locock almost doubted whether Mr.
-Jewel's was an instance of pregnancy at all,
-for frequently women enjoying sexual intercourse
-have enlarged abdomens, and many
-of the other symptoms of pregnancy, which
-a few doses of purgative medicine will
-remove.</p>
-
-<p>Two remarkable instances of extra-uterine
-fœtation were related by Mr. Burnett and
-Mr. Cæsar Hawkins; and towards the conclusion
-of the evening the discussion turned
-on the powers of the ergot of rye. Dr.
-Locock had frequently tried it in amenorrhœa,
-and, on the whole, without any very good
-effects. In one remarkable case, where the
-lady particularly wished to have children,
-Dr. Locock having boiled an ounce of the
-ergot in a pint of water down to half a pint,
-gave an ounce and a half of this decoction
-three times a day. After the young lady
-had taken about half a pint, the most violent
-convulsions succeeded, which placed her life
-in imminent hazard, and from which it was
-long before she completely recovered. She
-menstruated twice after that, but then the
-discharge again was arrested, and has never
-since returned, nor has she become pregnant.</p>
-
-<p>The practice of "bougieing the uterus"
-in cases of dysmenorrhœa was brought upon
-the tapis, and excited a good deal of laughter,
-the members appearing to consider the
-proposal ridiculous in the extreme.</p>
-
-
-<p class="center fs90">MR. LAMBERT.</p>
-
-<p>At the last meeting of this Society it
-was proposed, on the recommendation of the
-Committee, that Mr. James Lambert should
-be expelled; and after some discussion it
-was agreed that the sense of the members
-should be taken by ballot at the next
-meeting, Saturday, January 3, 1829. It
-was thought that proceeding at once to his
-expulsion might give the appearance of the
-measure originating with a party, and that
-the delay would enable the deliberate judgment
-of the whole Society to be passed upon
-his conduct.</p>
-
-
-<hr class="r10a" />
-<h3>HUNTERIAN SOCIETY.</h3>
-
-<p class="center fs80">Dec. 10, 1828.</p>
-
-<p class="center smcap">Dr. Billing, President, in the Chair.</p>
-
-<p class="noindent">Mr. Leese, Jun. exhibited to the meeting a
-specimen of medullary sarcoma, taken from
-the forehead of a man after death, with a
-portion of the os frontis. The man was
-fifty-eight years of age, long asthmatic, and
-appeared to die of hydrothorax. He never
-suffered any pain in the tumor, but expressed
-a sense of distention. It was immoveable
-at the base, and there were some fissures in
-the os frontis, from caries. The dura mater
-at the corresponding part adhered firmly to
-cranium, and on its being removed some
-spiculæ from the carius inner table remained
-adhered to it. There had never
-been any symptoms of cerebral affection.
-A tumor of the same nature had formed on
-the scapular extremity of the clavicle, and
-had occasioned anasarca of the limb.</p>
-
-<p>Mr. Key supposed that the tumor had
-originated from the diplöe, and believed
-that the only chance of relief in such a case
-would be trephining; but he acknowledged
-<span class="pagenum"><a name="Page_144" id="Page_144">[144]</a></span>
-that there was little encouragement to operate
-in these cases, owing to the tendency
-of the disease to return in some other part.
-He related an instance of the true medullary
-fungus taking its origin from the cancellous
-structure of the os femoris. The limb was
-removed, but the patient died. A circle of
-fungoid glands was observed at the base of
-the heart, and some of the bronchial glands
-were in the same condition.</p>
-
-<p>Dr. Conquest expressed his belief that
-carcinoma was always a constitutional affection,
-and stated that at least in nine cases
-of cancer uteri out of ten, there was carcinomatous
-affection of the pylorus, mesenteric
-glands, or liver.</p>
-
-<p>Mr. Key and Dr. F. Ramsbotham had
-not observed, in their examinations, the
-coincidence noticed by Dr. Conquest.</p>
-
-<p>The remainder of the evening was occupied
-by a discussion on the different kinds
-of ulceration that occur about the os and
-cervix uteri, and the circumstances under
-which the removal of the uterus, or the amputation
-of the cervix, may be warrantable.</p>
-
-<p>Dr. Babington adverted to the occasional
-existence of a family disposition to carcinoma.
-He had known three sisters successively
-die of cancer in the breast.</p>
-
-
-<hr class="r10a" />
-
-<h3>MEDICAL SOCIETY OF LONDON.</h3>
-
-<p class="center fs80">Dec. 13th and 20th, 1828.</p>
-
-<p class="center smcap">Dr. Haslam in the Chair.</p>
-
-<p class="noindent">The subject of discussion, at the first of
-these meetings, was stricture of the rectum,
-when the diagnosis and treatment of carcinoma
-of that part came under consideration.
-There was a remarkable discrepancy in the
-opinions of Messrs. Lloyd and Salmon as to
-the symptoms and management of carcinomatous
-affections of the rectum. Mr. Lloyd
-maintained that these affections of the intestine
-were sometimes attended with pain
-and sometimes not, and that the patients
-were often materially benefited by the use
-of bougies; while Mr. Salmon affirmed,
-that the disease was always painful, and not
-to be mitigated by the employment of these
-means.</p>
-
-<p>A variety of subjects came before the
-society at the next meeting. The president
-read a letter from Mr. Wansborough, of
-Fulham, describing the "original stomach-pump,"
-a specimen of which accompanied
-the letter: the instrument Mr. W. stated to
-be of 25 years' standing.</p>
-
-<p>Mr. Shearly exhibited, among other morbid
-specimens, a uterus, on the external
-surface of which the disease termed the
-"white tubercle" was in progress: there
-was also a small polypus near the os uteri.
-Mr. Pereira exhibited to the society a fine
-specimen of medullary sarcoma of the liver.
-The organ was so enlarged as to have occupied
-two-thirds of the abdomen. The other
-viscera were not involved in the disease.
-The progress of the disease, as far as it
-could be ascertained, was excellently detailed
-by Mr. Smith, a visitor. The symptoms
-were obscure.</p>
-
-<p>Mr. Armstrong read an extract of a letter
-from Mr. Morgan, of the Bristol Infirmary, a
-corresponding member of the Society, describing
-a curious conformation of the œsophagus
-in a child, which lived 106 hours
-only, during which period every attempt to
-swallow food produced considerable distress.
-The œsophagus was found to be divided into
-two portions; the upper or pharyngæal extremity
-terminating in a <i lang="fr" xml:lang="fr">cul de sac</i> behind
-the bifurcation of the trachea; and the lower
-or ventricular extremity arising from the
-trachea at this point, between the bronchi,
-proceeding down the spine, and terminating,
-as usual, at the cardiac orifice of the stomach.
-Mr. Drysdale mentioned a somewhat
-similar malformation occurring in two
-children in one family. Mr. Callaway related
-a case of concussion of the brain, which terminated
-fatally, after the restoration of the
-intellectual functions. The whole of the anterior
-lobes of each hemisphere of the brain
-was broken down, and mixed with effused
-blood. The remarkable feature of the case
-was, the return of consciousness, and the
-possession of this power for six days, under
-the disorganization of the brain described;
-and the questions particularly agitated were,
-Did this extent of mischief exist immediately
-after the concussion? What was the
-degree of laceration of the brain at that period?
-and, How could the recovery of the
-intellectual faculty be reconciled with so
-much injury of the brain?</p>
-
-<p>The Society then adjourned to the 12th of
-January, 1829.</p>
-
-
-<hr class="fulla" />
-<h2>COOPER <em>v.</em> WAKLEY.</h2>
-
-<p>Notes of the Cause, Cooper <em>v.</em> Wakley&mdash;We
-understand that Mr. Cooper is about to
-publish a verbatim account of the above
-trial, from Mr. Gurney's short-hand notes.</p>
-
-
-<hr class="fulla" />
-<h2>ERRATA.</h2>
-
-<p>The Advertisement of Mr. B. Cooper's,
-in our last Number, ought to have been
-dated "<em>December</em> 15," instead of "<em>Oct.</em> 15."
-Also, for "<em>Mr. Elton</em>," the name of one of
-Mr. Cooper's witnesses, read "<em>Mr. Hilton</em>."</p>
-
-<p>In our last leading article, <em>for</em> "can no
-friend of Wakley be named?" <em>read</em> "can
-the name of no friend of Wakley be mentioned?"
-The alteration is necessary, to connect
-it with the conclusion of the paragraph.</p>
-
-<hr class="fulla" />
-<p class="center fs80"><span class="smcap">W. Wilson</span>, Printer, 57, Skinner-Street, London.</p>
-
-
-<div class="footnotes"><h2>FOOTNOTES:</h2>
-
-<div class="footnote">
-
-<p><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">[1]</span></a> General thickening of all the valvular apparatus
-on both sides of the heart. (St. B. 33.)</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">[2]</span></a> Andral, vol. iii. p. 411.</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3"><span class="label">[3]</span></a> Pl. 1, fig. 5.</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_4_4" id="Footnote_4_4"></a><a href="#FNanchor_4_4"><span class="label">[4]</span></a> Opacity and thickening of the lining membrane
-on both sides of the heart, without unevenness
-or alteration of form. (St. B. 33).</p>
-
-<p>
-Opacity and thickening in the valvular apparatus
-between the left auricle and ventricle, with
-shortening of the chordæ tendinæ, and such alteration
-of structure and form as to produce a considerable
-contraction of the aperture. (St. B. 26).</p>
-
-<p>
-Such thickening of the whole valvular apparatus
-as to narrow the aperture of communication
-between the left auricle and ventricle to a mere
-slit. (St. B. 19).</p>
-
-<p>
-Shrivelled and contracted state of the semilunar
-valves, in which a cartilaginous substance has entirely
-taken the place of the natural structure.
-(Hodgson, pl. 1, fig. 6).</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_5_5" id="Footnote_5_5"></a><a href="#FNanchor_5_5"><span class="label">[5]</span></a> Osteum aortæ almost closed by ossified valves.
-(St. B. 15); (Hodgson, pl. 1, fig. 2).</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_6_6" id="Footnote_6_6"></a><a href="#FNanchor_6_6"><span class="label">[6]</span></a> Fungus growing from the aortic valves, which
-are thickened and shortened. (St. B. 6, 20).</p>
-
-<p>
-Fungus form the aortic valves, which are ulcerated.
-(St. B. 21).</p>
-
-<p>
-Larger specimens of fungus, growing from the
-ulcerated edges of two of the valves of the aorta.
-(Hodgson, pl. 1, fig. 7).</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_7_7" id="Footnote_7_7"></a><a href="#FNanchor_7_7"><span class="label">[7]</span></a> Dr. Baillie's plate.</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_8_8" id="Footnote_8_8"></a><a href="#FNanchor_8_8"><span class="label">[8]</span></a> Polypous coagulum in the ventricle. (Coll. of
-Phys. 4, A. 16).</p>
-
-<p>
-Coagulum firmly attached to the lining of the
-left auricle, with enlargement of its capacity. (St.
-B. 19).</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_9_9" id="Footnote_9_9"></a><a href="#FNanchor_9_9"><span class="label">[9]</span></a> (St. B. 13).</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_10_10" id="Footnote_10_10"></a><a href="#FNanchor_10_10"><span class="label">[10]</span></a> It occurs sometimes in the uterus.</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">[11]</span></a> Memoir. de l'Acad. des Sciences. Morand,
-1732. Morgagni, Epist. 27.</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_12_12" id="Footnote_12_12"></a><a href="#FNanchor_12_12"><span class="label">[12]</span></a> Andral, v. 3, 466; Hodgson, plate 1, figure 7;
-St. B. 14.</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_13_13" id="Footnote_13_13"></a><a href="#FNanchor_13_13"><span class="label">[13]</span></a> Corvisart, cap. 4. sect. 1.</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_14_14" id="Footnote_14_14"></a><a href="#FNanchor_14_14"><span class="label">[14]</span></a> Active dilatation of the left ventricle. (College
-of Phys. 4, c. 10.)</p>
-
-<p>
-The thickened walls of the left strikingly contrasted
-with the attenuated walls of the right ventricle.
-(St. B. 9).</p>
-
-<p>
-Active dilatation of the left ventricle. Its
-capacity is strikingly contrasted with that of the
-right. (College of Phys. 4, c. 11.)</p>
-
-<p>
-Passive dilatation of both ventricles, especially
-of the right. (St. B. 10).</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_15_15" id="Footnote_15_15"></a><a href="#FNanchor_15_15"><span class="label">[15]</span></a> Morgagni, Epist. xxvii. 7.</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_16_16" id="Footnote_16_16"></a><a href="#FNanchor_16_16"><span class="label">[16]</span></a> Ibid. 2.</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_17_17" id="Footnote_17_17"></a><a href="#FNanchor_17_17"><span class="label">[17]</span></a> Ibid. 3.</p>
-
-<p>
-Rupture of the left ventricle, with attenuation
-of its muscular structure. (St. B. 18).</p>
-
-<p>
-Rupture, without attenuation, but with softening
-and looseness of texture in the muscular substance.
-(St. B. 22).</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_18_18" id="Footnote_18_18"></a><a href="#FNanchor_18_18"><span class="label">[18]</span></a> Harvey, Exercit. altera.</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_19_19" id="Footnote_19_19"></a><a href="#FNanchor_19_19"><span class="label">[19]</span></a> Rupture of the left ventricle without change
-in its structure. Bone deposited at the commencement
-of the aorta. (St. B. 27).</p>
-
-<p>
-In turning over the Memoirs of the Royal
-Academy of Sciences, I find two cases of rupture
-of the heart, reported by M. Morand. They both
-occurred in the year 1730; and, strange to say,
-one was that of a Duchess of Brunswick,
-who was of the same family as George II.
-who also died of a ruptured heart. In the one,
-that of the Duchess, there was a manifest ulceration
-through the walls of the right ventricle, its
-structure being otherwise unimpaired; in the
-other, where the aperture was in the left ventricle,
-there was probably a simple rupture, for the flesh
-of the heart was so soft that the point of a probe
-would pass through it wherever it was rested.
-(Mem. de l'Acad. Roy. des Sciences, Ann. 1732).</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_20_20" id="Footnote_20_20"></a><a href="#FNanchor_20_20"><span class="label">[20]</span></a> The trial as published in the Lancet occupied
-less than 21 pages&mdash;in the Gazette it extended, in
-the same type, to 33 pages and a half. In the
-Lancet, those parts, both of the evidence and
-speeches, which told most against Wakley, were
-omitted.</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_21_21" id="Footnote_21_21"></a><a href="#FNanchor_21_21"><span class="label">[21]</span></a> <a href="#P137">See passage in Italics, page 137.</a></p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_22_22" id="Footnote_22_22"></a><a href="#FNanchor_22_22"><span class="label">[22]</span></a> The defendant, on leaving the court, was
-cheered by the populace in Palace Yard.&mdash;Lancet,
-Dec. 20.</p></div>
-
-<div class="footnote">
-
-<p><a name="Footnote_23_23" id="Footnote_23_23"></a><a href="#FNanchor_23_23"><span class="label">[23]</span></a> This we believe is false; nothing of the kind
-either occurred, or was stated at the trial.&mdash;E. G.</p></div></div>
-
-
-<div class="transnote pg-brk">
-<a name="TN" id="TN"></a>
-<p><strong>TRANSCRIBER'S NOTE</strong></p>
-
-<p>Obvious typographical errors and punctuation errors have been
-corrected after careful comparison with other occurrences within
-the text and consultation of external sources.</p>
-
-<p>Except for those changes noted below, all misspellings in the text,
-and inconsistent or archaic usage, have been retained.</p>
-
-<p>
-<a href="#Page_116">Pg 116</a>, 'immedate contact' replaced by 'immediate contact'.<br />
-<a href="#Page_119">Pg 119</a>, 'and attennuation in' replaced by 'and attenuation in'.<br />
-<a href="#Page_126">Pg 126</a>, 'Tue valuable paper' replaced by 'The valuable paper'.<br />
-<a href="#Page_132">Pg 132</a>, 'probably impossibly' replaced by 'probably impossible'.<br />
-</p>
-</div>
-
-
-
-
-
-
-
-
-<pre>
-
-
-
-
-
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+<body>
+<div>*** START OF THE PROJECT GUTENBERG EBOOK 53450 ***</div>
+
+<div class="transnote">
+<p><strong>TRANSCRIBER'S NOTE</strong></p>
+
+<p class="screenonly">The 'Apothecary System' of measurement was used in the original text.
+The etext uses the following Unicode symbols:<br />
+<span class="pad4">℞ &nbsp;</span><span class="pad4">Prescription symbol</span><br />
+<span class="pad4">ʒ &nbsp;</span><span class="pad4">Dram</span><br />
+<span class="pad4">℥ &nbsp;</span><span class="pad4">Ounce</span><br />
+<span class="pad4">ℳ</span><span class="pad4">Scruple</span><br />
+Roman numerals, and 'ss.' for 'half', are retained, so for example
+'℥iss.' indicates 'one and a half ounces'.</p>
+
+<p class="handonly">The 'Apothecary System' of measurement was used in the original text.
+The etext uses the following glyphs taken from the text images:<br />
+<span class="pad4"><img class="glyph" src="images/rx.jpg" alt="" /></span> <span class="pad4">Prescription symbol</span><br />
+<span class="pad4"><img class="glyph" src="images/dram.jpg" alt="" /></span> <span class="pad4">Dram</span><br />
+<span class="pad4"><img class="glyph" src="images/ounce.jpg" alt="" /></span> <span class="pad4">Ounce</span><br />
+<span class="pad4"><img class="glyph" src="images/scruple.jpg" alt="" /></span><span class="pad4">Scruple</span><br />
+Roman numerals, and 'ss.' for 'half', are retained, so for example
+'<img class="glyph" src="images/ounce.jpg" alt="" />iss.' indicates 'one and a half ounces'.</p>
+
+<p>Obvious typographical errors and punctuation errors have been
+corrected after careful comparison with other occurrences within
+the text and consultation of external sources.</p>
+
+<p>More detail can be found at <a href="#TN">the end of the book</a>.</p>
+</div>
+
+<hr class="chap pg-brk" />
+<p><span class="pagenum"><a name="Page_113" id="Page_113">[Pg 113]</a></span></p>
+
+
+<h1>
+<span class="small">THE</span><br />
+<span class="xl">LONDON MEDICAL GAZETTE,</span></h1>
+
+<p class="center lht">
+<span class="xxs">BEING A</span><br />
+<span class="large">WEEKLY JOURNAL</span><br />
+<span class="xxs">OF</span><br />
+<span class="large lsp antiqua">Medicine and the Collateral Sciences.</span></p>
+
+<p class="p1" />
+<hr class="fulla" />
+<p class="center large">SATURDAY, DECEMBER 27, 1828.</p>
+<hr class="fulla" />
+
+
+<h2>
+<span class="xs">PATHOLOGICAL ESSAYS</span><br />
+<span class="xxs">ON SOME</span><br />
+<span class="small">DISEASES OF THE HEART;</span></h2>
+
+<p class="pfs100"><em>Being the Substance of Lectures delivered before
+the College of Physicians</em>,</p>
+
+<p class="pfs100"><span class="smcap">By P. Mere Latham</span>, M.D.</p>
+
+<p class="pfs90">Physician to St. Bartholomew's Hospital.</p>
+
+<p class="pfs80">[Continued from p. 7.]</p>
+
+<hr class="r10a" />
+<h3>ESSAY II.</h3>
+
+<p class="pfs100"><em>Morbid Anatomy of the Internal Lining
+Membrane of the Heart.</em></p>
+
+<p class="noindent">The membrane which lines the cavities
+of the heart is very liable to disease,
+but not equally so in every part. Where
+it is thin and transparent, and admits
+the colour and character of the muscular
+structure upon which it is spread
+to be seen through it, it is seldom found
+diseased; but where it is of a denser
+texture, either in itself or from an admixture
+of other structures, whether
+cellular or fibrous, with its own, it is
+frequently, and often exclusively diseased.
+This latter character of a denser
+texture belongs to it where it forms
+the tough white circles which surround
+the apertures of communication between
+the auricles and ventricles; also
+where it is reflected upon itself, and
+forms the loose duplicatures of membrane,
+which are given off, as it were,
+from the internal surface of the heart,
+either at the fibrous circles intermediate
+between the auricles and ventricles,
+constituting the tricuspid and the mitral
+valves, or at the commencement of the
+pulmonary artery and aorta, constituting
+the semilunar valves.</p>
+
+<p>It is remarkable how curiously disease
+is apt to limit itself to the spaces
+just pointed out. Of the fibrous circle
+between the auricle and ventricle, of
+the valves which originate from it, and
+of the tendinous cords which connect
+the valves with the carneæ columnæ,
+there will not be the smallest space free
+from disease; but the disease will
+abruptly stop where the tendinous
+cords cease and the carneæ columnæ
+begin<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a>.</p>
+
+<p>The membrane, however, where it
+covers the fleshy columns of the heart,
+is not exempt from the possibility of
+disease: but when disease actually
+affects it, it has seldom originated there,
+but has generally spread from other
+parts of the same membrane, although
+(as we have just remarked) it is apt to
+stop short before it reaches this.</p>
+
+<p>Of the two sides of the heart, the
+membrane which lines the left is unquestionably
+the more liable to disease.
+But my own observation would never
+have led me to conclude that the membrane
+of the right side was so far exempt
+as it is commonly thought to be.
+Speaking from the best recollection I
+have of the specimens which have fallen
+under my examination, I should say
+that, in one-third of the cases where
+disease has been found on the left side,
+it has existed on the right side also,
+and been essentially of the same character.
+But there has been a remarkable
+difference in the extent to which it
+has proceeded on each side respectively:
+while on the left it has gone so far as to
+be the undoubted cause of death, on
+the right, although essentially of the
+same character, it has been only just
+beginning.</p>
+
+<p><span class="pagenum"><a name="Page_114" id="Page_114">[114]</a></span></p>
+
+<p>It very seldom happens that disease
+appertains to the lining of the right cavities
+of the heart exclusively; and,
+where it affects both, the disease in the
+right cavities is very seldom found in
+advance of that in the left.</p>
+
+<p>It should seem, indeed, according to
+the ordinary course of things, that disease
+does not begin in the lining of the
+right cavities of the heart, until it has
+already advanced to an extreme degree
+in the left.</p>
+
+<p>The internal lining of the heart, as well
+as of the arteries, is often found to have
+become of a red colour. This redness,
+so well known to all who are accustomed
+to examine dead bodies, used to be
+regarded as a mere stain imparted to it
+by the colouring matter of the blood
+after death. Yet a due consideration of
+various circumstances connected with
+it will hardly warrant this conclusion.</p>
+
+<p>It has been found whether the heart
+or artery be full or empty of blood;
+and if blood be present it has been
+found, whether it is liquid or clotted;
+and if it be clotted, whether it does or
+does not retain its colouring matter.
+External temperature, and length of
+time between the death of the patient
+and the dissection of his body, have not
+made any difference in the frequency
+with which this peculiar appearance occurs.
+Lastly, no artificial methods,
+such as washing of any kind, can get
+rid of it; nor will inclosing blood within
+an artery for any period produce it<a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a>.
+This simple redness is sometimes seen
+universally in both sides of the heart
+and throughout the whole arterial system,
+and sometimes in patches only, of
+greater or less extent, whether in the
+arteries or in the heart.</p>
+
+<p>Now, when all these circumstances
+are considered, although in some instances
+it may be a mere stain imparted
+by the colouring matter of the blood
+after death, it is plainly impossible that
+it should be of that nature in any large
+proportion of the numerous instances
+in which it is found.</p>
+
+<p>But if the appearance in question implies
+(as I believe it generally does) a
+morbid condition, of what kind is that
+condition? There are the same objections
+to considering mere redness as
+equivalent to inflammation here as in
+the pericardium, or in any other part of
+the body: here, as elsewhere, in one
+case it may be the condition out of
+which inflammation is to spring;
+while in another it may not be destined
+to give origin to any change in the
+structure of the part beyond itself, and
+may itself constitute the whole disease.</p>
+
+<p>It appears to me, that this mere redness
+of the internal lining of the heart
+and arteries has become a matter of
+undue perplexity to pathologists, because
+they have laboured to infer from
+it more than the simple fact itself will
+authorize. All I wish to establish concerning
+it is, first, that it is not always
+(probably very seldom) a mere stain
+imparted by the colouring matter of the
+blood after death; secondly, that it
+alone does not constitute inflammation.</p>
+
+<p>It may not be improper to mention
+the circumstances under which it has
+occurred to myself to find it. I have
+met with it most frequently, and to
+the largest extent, in subjects whose
+previous disease has produced a constant
+and habitual impediment to the transmission
+of blood through the heart and
+through the lungs, and that impediment
+has gone on increasing to the hour of
+their death; also in those, whatever
+might have been the nature of their disease,
+whose dissolution (I mean the actual
+process of dying) has been tardy and
+agonizing, and marked by great labour
+of respiration; in the apoplectic, for
+example, in whom, after sense and
+consciousness were extinct, life had
+been protracted, with stertorous breathing,
+for many days.</p>
+
+<p>In such subjects the countenance,
+the lips, and the whole skin, give
+evidence during life of blood pushed
+beyond the natural sphere of the circulation,
+and detained in the extreme
+blood-vessels. Hence it is obvious
+that the causes which have loaded and
+distended the capillaries in every part
+of the body have had a like influence
+upon the vasa vasorum.</p>
+
+<p>I do not mean to say that I never met
+with this peculiar condition of the heart
+and arteries under other circumstances,
+or that other causes may not produce it;
+but that I am not acquainted with it
+under any other with which, from frequent
+coincidence, it has seemed to have
+a natural connexion, or which have
+afforded a reasonable explanation of the
+phenomenon.</p>
+
+<p>This condition of the heart and arteries,
+considered as inflammation, has
+been assigned by some as the cause of
+<span class="pagenum"><a name="Page_115" id="Page_115">[115]</a></span>
+fevers of the more malignant kind.
+The frequency with which it has been
+found in some particular epidemic,
+must have led to the conclusion. But,
+however this may be, from my own observation,
+not restricting myself to the
+fever of any particular season, but taking
+into account all complaints called
+febrile, and belonging to all seasons,
+also from the result of inquiry among
+medical men who have had large acquaintance
+with morbid dissections,
+and from the experience of those who
+have made this particular point a subject
+of investigation (Laënnec and Andral)
+I venture to conclude that it has
+no essential connexion with fevers of
+any kind, either as cause or as effect.</p>
+
+<p>On some occasions the internal membrane
+of the heart and arteries, wherever
+it exhibits the appearance described,
+will allow itself to be peeled off from
+the subjacent structure with the least
+possible force; this facility of separation
+ceasing entirely beyond the boundary
+of the red tinge.</p>
+
+<p>Here unquestionably is further evidence
+of a diseased condition: but of
+what nature? Most pathologists would
+consider this to be of the nature of inflammation&mdash;and
+I believe justly.</p>
+
+<p>There is indeed much difficulty in pronouncing
+upon the nature of minuter
+changes of structure detected in the internal
+parts of the body after death. We
+are obliged to arrive at conclusions by
+help of analogies drawn from morbid
+processes, which we have watched in
+their progress during life, upon the external
+surfaces; for during life we have
+the functions and sensibilities of the part
+to aid us in forming a right judgment
+concerning its disease. When, during
+life, one tissue is separated from another,
+as the periosteum from the bone,
+or the cuticle from the skin, or the mutual
+cohesion between different tissues
+is sensibly weakened, we find it to be
+owing to the intervention of serous fluid
+which does not belong to their healthy
+state; and this, together with increased
+vascularity, or redness and heat, and
+pain, is enough to bespeak the presence
+of inflammation. All these conditions
+cannot remain after death. Hence, if
+we desire to form positive opinions concerning
+much which is unfolded by dissection,
+we must supply the defect by
+analogy. Thus, whenever, in any part
+of the heart or arteries, the cohesion between
+the internal membrane and the
+subjacent structure is manifestly lessened,
+and the membrane is unusually red
+at that part, we may regard these appearances
+as the vestiges of inflammation,
+without thinking that we go too far
+in so regarding them.</p>
+
+<p>The internal lining of the heart and
+arteries is often found red solely in the
+neighbourhood of ulcerated spaces,
+when there can be no doubt concerning
+the existence of inflammatory action.</p>
+
+<p>But the internal lining of the heart
+and arteries gives the most unequivocal
+evidence of its inflammation when it is
+found of a deep red colour, with coagulable
+lymph adhering to its surface.
+This condition is represented, as it was
+found in the aorta, in one of the beautiful
+plates, illustrative of the diseases of
+arteries, by Mr. Hodgson<a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a>. And the
+same condition, in the heart, I
+have seen in a preparation of Dr.
+Farre's, where lymph is deposited,
+upon the circular zone, which forms the
+aperture of communication between the
+left auricle and ventricle. These appearances
+denote the most acute inflammation:
+they are, I suspect, very rarely
+met with. In the few instances in which
+I have heard of them, they have been
+found where death has taken place
+after short and severe suffering, and with
+symptoms which characterize inflammation.</p>
+
+<p>But the specimens of disease most
+frequently met with in the internal lining
+of the heart, consist in an entire
+change of its natural structure, and in
+the formation of new products upon it
+or within it. Many of these, from the
+analogy of morbid actions in other parts
+of the body, must be considered to result
+from chronic inflammation.</p>
+
+<p>In any of those situations which have
+been stated as especially liable to disease,
+the membrane will become thick,
+tough, inelastic, puckered and shrivelled;
+and cartilage or gristle, and bone, will
+enter into its structure; excrescences
+will sprout out from it, resembling warts
+and fungus; and it will become ruptured
+and ulcerated.</p>
+
+<p>Cartilaginous depositions are often
+found beneath the membrane where it is
+single; or between its folds where it is
+double, in the situation of the valves;
+and thus they seem rather to belong to
+some structure contiguous to the membrane
+than to the membrane itself.
+<span class="pagenum"><a name="Page_116" id="Page_116">[116]</a></span>
+Such depositions will proceed to a considerable
+extent, while the membrane
+still remains free from disease. From
+a valve, which has been thick, opaque,
+and cartilaginous, I have seen the membrane
+separated on both sides, and
+transparent; the opaque and cartilaginous
+matter being left behind. Where, in
+cartilaginous depositions, the lining of the
+heart has become puckered and uneven
+on its surface, and the valves shortened
+and altered in their shape, the membrane
+itself participates in the disease,
+and is generally incapable of being separated
+from the subjacent structure.
+But great thickening may take place in
+the situation of the valves, from deposition
+of cartilage, without any unevenness
+of their surface or alteration of their
+shape; and under these circumstances
+the membrane itself you may expect to
+find hitherto exempt from disease<a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">[4]</a>.</p>
+
+<p>Osseous depositions are always, I
+believe, originally formed beneath, or
+exterior to, the membrane, both in the
+heart and in the arteries. There are two
+circumstances especially worthy of remark
+in this process of ossification:
+sometimes it is a pure and unmixed process:
+bone is formed, and nothing else.
+It is deposited in minute granules, or
+little brittle scales, or in plates of a
+larger size; and the intermediate spaces,
+whether in the heart or arteries, preserve
+their natural and healthy appearance.
+At first, these granules or scales,
+or plates of pure bone, are covered by a
+delicate pellicle, which is in fact the internal
+membrane of the heart or artery,
+separating them from the immediate
+contact of the circulating blood. But
+in process of time, as they increase in
+size, and become rough and unequal on
+their surface, they cause a rupture of the
+internal membrane, and have now nothing
+to separate them from the <ins class="corr" title="Transcriber's Note&mdash;Original text: 'immedate contact'">immediate
+contact</ins> of the blood<a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">[5]</a>.</p>
+
+<p>Sometimes ossification is a mixed
+process, or rather, I suspect, the result
+of another morbid process preceding it.
+With the cartilaginous depositions already
+described there is an admixture of
+bone. The quantity of bone generally
+bears a very small proportion to the cartilage
+when they both occur together, as
+if the bone proceeded from the cartilage,
+and not the cartilage from the bone. It
+is sometimes seen growing from the surface
+of the cartilage, and is sometimes
+deposited in its substance, and only detected
+by the knife.</p>
+
+<p>Simple ossification, as it occurs
+in the heart and arteries, has been
+classed among the natural changes
+which the parts in question are liable to
+undergo after a certain period of life.
+Of persons above the age of sixty years
+the proportion is that of seven in ten
+according to Bichât, in which ossification
+is discovered in some part of the
+arterial system. It very rarely happens
+that simple ossification is found before
+the period of old age: still it is difficult
+not to regard it as a morbid process.</p>
+
+<p>But ossification, when it is a mixed
+process, is unquestionably the result of
+disease. It is met with at all periods of
+life; and probably constitutes one of
+the terminations of inflammation. The
+kind of morbid structures with which
+the bone is united leads to this belief.</p>
+
+<p>Fungous, and wart-like excrescences,
+are found in all those parts of the internal
+lining of the heart, which have been
+already mentioned as most subject
+to disease. They seem to be the result
+of a new morbid action set up in parts
+already disorganized; for I have not
+met with them where the membrane has
+been otherwise healthy, but only where
+it has been thickened or cartilaginous,
+or ossified, ruptured, or ulcerated.
+They grow either from the surface of the
+membrane, or from its ruptured or ulcerated
+edges, and are always in immediate
+contact with the circulating
+blood<a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">[6]</a>.</p>
+
+<p>According to my observation, when a
+fungous or warty excrescence has
+grown from the ruptured edges of the
+membrane, it has been from them exclusively,
+<span class="pagenum"><a name="Page_117" id="Page_117">[117]</a></span>
+and from no other part of the
+lining of the same heart. And as rupture
+of the membrane seldom occurs in
+more than one situation at a time, the
+heart of the same individual seldom presents
+more than one excrescence of this
+kind: and as the aortic valves are the
+parts most liable to rupture, it is there
+that this single excrescence is most frequently
+found; not that rupture may
+not take place elsewhere. I once saw a
+single <i lang="la" xml:lang="la">chorda tendinea</i> ruptured; and a
+single fungous excrescence of considerable
+size hanging from it into the cavity
+of the left ventricle.</p>
+
+<p>Now, this morbid growth is evidently
+connected with the lacerated state of the
+membrane in the conditions of its production,
+whereby it is limited to a small
+space.</p>
+
+<p>It is probable that the membrane is
+first ruptured; that its lacerated edges
+inflame, and then throw out unhealthy
+lymph, or unhealthy granulations, in the
+shape of these fungous or wart-like excrescences.
+When they have sprung
+from a ruptured membrane, they
+have, in the specimens which I have
+examined, been larger than when
+they have arisen under other conditions.</p>
+
+<p>But when such excrescences grow
+from the surface of the membrane which
+is thickened and cartilaginous only, but
+not lacerated, they are more apt to
+occur in many parts of it at the same
+time. I have seen the valvular apparatus
+between the auricles and ventricles
+on both sides, as well as the aortic
+valves of the same heart, studded with
+them. They were all about the size of
+hemp seeds: they adhered to the membrane
+with different degrees of tenacity,
+and wherever they were capable of
+being detached, they left a rough surface.
+The lining of the arteries has
+been known to give origin to morbid
+growths of the same kind, which have
+obstructed the passage of blood, and
+given occasion to the formation of a
+coagulum, which has obliterated the
+pulse.</p>
+
+<p>The internal lining of the heart is
+liable to ulceration, not as a common
+consequence of simple inflammation,
+but as an occasional consequence of
+some of those diseased conditions which
+have been described.</p>
+
+<p>It is most commonly found around
+scales and spiculæ of bone, and under
+such circumstances as to leave no doubt
+that the bone itself has furnished the
+source of irritation from which it springs.
+The ulceration commences from the
+very border of the bony scale, as if it
+was a process of nature for detaching it,
+and to a considerable distance around
+the ulceration the membrane is reddened,
+and easily detached from the subjacent
+structure. Where there are several
+distinct scales of bone, it is not uncommon
+to find a circle of ulceration
+around each of them.</p>
+
+<p>Ulceration is also met with where
+there is a thickened and cartilaginous
+state of the membrane without ossification.
+Under these circumstances, as
+far as I know, it affects no definite form.
+It is often a very destructive process of
+disease, obliterating large portions of
+the valvular structure, and penetrating
+deep into the muscular substance of the
+heart.</p>
+
+<p>Rupture of the internal lining of the
+heart is not easily distinguished from
+ulceration. In collections of morbid
+anatomy, many unquestionable specimens
+of ulceration are described as specimens
+of rupture. Rupture must
+always be looked for in the valvular
+apparatus of the heart, <em>i. e.</em> in the
+valves themselves, or in the chordæ
+tendineæ which are their appendages.
+It is probably incapable of taking place
+elsewhere, except as a part of a rupture,
+which involves the whole organ.</p>
+
+<p>That solution of continuity which is
+evidently without loss of substance;
+that of which the separated edges when
+they are brought together are completely
+adapted to each other; also that
+which is unaccompanied by any thickening
+or other morbid condition of the
+valve; the solution of continuity which
+is found under these circumstances, may
+safely be considered to proceed from
+rupture, and not from ulceration<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">[7]</a>.</p>
+
+<p>But it is probable that these characteristic
+conditions do not long remain
+after the occurrence of the rupture.
+Complete specimens of them are very
+rare; but specimens are numerous
+where the solution of continuity, by its
+form and direction, bespeaks rupture,
+while its rounded edges and the general
+thickening of the valve denote ulceration.
+These, it may be fairly conjectured,
+do in fact exhibit a compound of
+both. The membrane was originally
+ruptured, but disease has subsequently
+arisen and obscured the character of
+the mechanical injury.</p>
+
+<p>The greater number of those concretions,
+<span class="pagenum"><a name="Page_118" id="Page_118">[118]</a></span>
+which were regarded by the
+older anatomists as polypi of the heart,
+were unquestionably portions of mere
+blood, which had undergone coagulation
+after death. The blood remaining
+in the heart after death discharges itself
+of its colouring matter as it coagulates,
+and, giving off processes between
+the muscular fasciculi, assumes a shape
+which has suggested the name of
+polypus<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">[8]</a>.</p>
+
+<p>I have often found (I presume, therefore,
+that it is not an uncommon occurrence)
+coagula of an irregularly
+laminated texture having their colouring
+matter not entirely discharged,
+but unequally distributed through
+them, which have been most intimately
+adherent to some part of the lining
+of the heart. Of these some have admitted
+of separation, while the surface
+of the membrane and the surface of the
+clot were left rough at the place of contact,
+and others were incapable of being
+detached without the membrane being
+detached along with them. The appendix
+of the left auricle is a situation in
+which they are apt to occur, and they
+are generally accompanied by an extensively
+diseased condition of the lining
+membrane. These coagula, from their
+laminated texture, and from the intimacy
+of their union with the internal
+lining, seem to be essentially different
+from polypi of the heart. They appear
+to be connected with a process
+of disease in the membrane, and to
+have obtained their union with it long
+before the death of the patient.</p>
+
+<p>I once saw two separate tumors, entirely
+resembling what are called polypi, between
+the carneæ columnæ of the left
+ventricle, and firmly adherent to the
+heart; and in the centre of each a distinct
+formation of pus. The heart was
+otherwise healthy<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">[9]</a>.</p>
+
+<p>There are three preparations in the
+museum of the College of Surgeons,
+put up by Mr. Hunter himself, and
+noted by him as exhibiting "Tumors
+on the inner surface of the right
+ventricle, seemingly composed of layers
+of coagulable lymph one upon another,
+the central part having the appearance
+of glary mucus." This last appearance
+(the mucus) no longer remains
+in any of the three, but in its stead
+there is a cavity. The tumors
+which I have mentioned as originally
+containing in their centre a distinct
+formation of pus, also now present
+in its stead a cavity. The preparation
+preserved at St. Bartholomew's,
+and those at the College of Surgeons,
+are probably specimens of the same
+disease.</p>
+
+<p>Here what in the recent parts seemed
+to be pus or glary mucus, and the cavities
+still remaining in the preparations,
+must suggest the suspicion, that these
+tumors, whether they grew from the
+surface or were deposited from the
+blood, had become organized, and afterwards
+inflamed; and that the inflammation
+had terminated in the formation of
+an abscess.</p>
+
+
+<h3>ESSAY III.</h3>
+
+<p class="center"><em>Morbid Anatomy of the Muscular Substance
+of the Heart.</em></p>
+
+<p class="noindent">Dr. Baillie, speaking of inflammation
+of the substance of the heart,
+says, "When the pericardium covering
+its surface is inflamed, the inflammation
+sometimes passes a little way into
+the substance of the heart:" and then
+he gives these as the characteristic
+marks of such inflammation&mdash;that "it
+(the substance of the heart) becomes
+much more crowded with small vessels
+than in its natural state, and there are
+sometimes to be seen a few spots of
+extravasated blood." Now, this undue
+vascularity, and these few extravasated
+spots, where inflammation unquestionably
+belongs to a contiguous structure,
+may be deemed sufficient evidence of
+the muscular substance of the heart
+participating, or beginning to participate,
+in the same disease; but, absolutely
+and exclusively, it may be doubted
+whether more is not required to give
+a certain assurance of its inflammation.
+Here, as elsewhere, we must look for
+some of the proper products of inflammation;
+or for some of the permanent
+changes of texture which naturally result
+from it, according to its several
+modes of disorganizing.</p>
+
+<p>It is a very rare event to find pus
+among the products of inflammation
+of the substance of the heart: yet this
+event has occurred twice to my observation.
+In one instance the whole
+heart was deeply tinged with dark-coloured
+<span class="pagenum"><a name="Page_119" id="Page_119">[119]</a></span>
+blood, and its substance
+softened; and here and there, upon the
+section of both ventricles, innumerable
+small points of pus oozed from among
+the muscular fibres. This was the result
+of a most rapid and acute inflammation,
+in which death took place after
+an illness of only two days. In another
+instance, after death, which terminated
+an illness of long duration and
+characterized by symptoms referable to
+the heart, a distinct abscess was found
+in the substance of the left ventricle,
+closed externally by a portion of adherent
+pericardium, and connected internally
+with an ossified portion of the
+lining membrane.</p>
+
+<p>This diffusion of pus, or rather its
+formation in innumerable separate
+points, throughout the muscular structure
+of the heart, by a rapid and acute
+inflammation, is a singular occurrence.
+No such case has ever fallen within the
+knowledge of the most experienced in
+morbid anatomy, of whom I have made
+inquiry; neither has any such (as far
+as I can learn) been recorded in books<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">[10]</a>.</p>
+
+<p>A single collection of pus<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">[11]</a>, constituting
+an ulcer or abscess of the heart,
+and resulting from chronic inflammation,
+is also a rare occurrence, yet not
+so rare but that a specimen of it may
+be found in most collections of morbid
+anatomy<a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">[12]</a>.</p>
+
+<p>But independent of the formation of
+pus, softening and attenuation, as well
+as induration and thickening of the
+muscular substance of the heart, do,
+in different cases, according to the circumstances
+under which they are found,
+both bespeak inflammation.</p>
+
+<p>Together with the unequivocal evidence
+of inflammation in other parts of
+the heart, the muscular fibres have at
+the same time been found very soft and
+loose, and easily torn; and with this
+looseness of texture the heart has sometimes
+presented a dark and almost black
+appearance, and sometimes it has been
+almost blanched and colourless. The
+deep dark tinge shews that the muscular
+substance is unnaturally loaded with
+blood; whereas the absence of colour
+shews that it is destitute of its natural
+quantity. These different appearances
+do, in fact, belong to different stages of
+the same disease. The first indicates
+inflammation of the muscular substance
+in its present state of activity; the
+second, an irreparable disorganization
+of the muscular substance left by inflammation,
+when it has been unarrested
+in its earliest stages. The first is
+found when death takes place <em>in a
+few days after</em> the accession of the disease;
+the second, when the patient survives
+the first attack, and dies at a remoter
+period.</p>
+
+<p>The inflammation, which produces
+softening and attenuation of the muscular
+structure, is, I believe, always of
+an acute kind.</p>
+
+<p>But induration and thickening of
+the muscular substance of the heart is
+also the result of inflammation. This
+must be distinguished from hypertrophy,
+or mere augmentation of bulk, of
+which we shall speak hereafter. In this
+induration, which proceeds from inflammation,
+there is, besides increase
+of bulk and firmness, a manifest alteration
+of texture. A substance<a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">[13]</a> is produced
+offering a peculiar resistance to
+the knife. This condition unquestionably
+must result from an interstitial deposition
+of new matter among the muscular
+fibres. From concomitant circumstances,
+as well as from its own
+character, I presume that it proceeds
+from chronic, not from acute inflammation.
+I confess that I never saw a
+specimen of what I now allude to. It
+is described with some minuteness by
+Corvisart; but it may be presumed to
+be very rare, since Laënnec admits that
+it never fell under his observation.</p>
+
+<p>These opposite states of softening
+<ins class="corr" title="Transcriber's Note&mdash;Original text: 'and attennuation in'">and attenuation in</ins> one case, and induration
+and thickening in another, are
+known to those conversant with morbid
+dissection as the evidences of inflammation
+in other parts of the body besides
+the muscular substance of the heart.</p>
+
+<p>But there are changes of structure
+incident to the muscular substance of
+the heart which are independent upon
+inflammation, or, perhaps, upon
+any process which can properly be
+called morbid. They consist of simple
+augmentation and simple diminution of
+bulk and consistence. This simple
+augmentation of bulk and consistence is
+owing exclusively to a more ample development
+of natural structure. The
+muscular substance is more red than
+<span class="pagenum"><a name="Page_120" id="Page_120">[120]</a></span>
+natural, its carneæ columnæ are increased
+in thickness, and its proper fibrous
+texture is every where more strikingly
+manifest; but there is no interstitial
+deposition of matter new in its
+kind. It has been called hypertrophia
+of the heart, and the name conveys a
+tolerably just idea of its actual condition.</p>
+
+<p>The simple diminution of bulk and
+consistence is a condition the exact opposite
+of the former. The muscular
+substance is less red than natural; its
+proper fibrous texture less distinguishable;
+but there is still the appearance
+of muscle shrunk and withered, as if
+from an insufficient supply of nourishment.
+It may be called atrophia of
+the heart.</p>
+
+<p>Conjoined with augmentation, as well
+as with diminution of strength and bulk
+in the walls of the heart, there is almost
+always an increase in the capacity of its
+cavities; and in whichsoever part of
+the heart the walls are thus augmented
+or diminished, it is the cavity appertaining
+to the same part which undergoes
+the increase of capacity. Hence
+it appears either that one of these conditions
+is the immediate and necessary
+consequence of the other, or that both
+are the simultaneous effects of the
+same causes.</p>
+
+<p>Dilatation of any cavity of the heart,
+with thickening of its walls, is called
+<em>active dilatation</em>; and dilatation of any
+cavity, with attenuation, is called <em>passive</em><a name="FNanchor_14_14" id="FNanchor_14_14"></a><a href="#Footnote_14_14" class="fnanchor">[14]</a>.</p>
+
+<p>Active dilatation may appertain to
+every cavity of the heart simultaneously;
+and so may passive dilatation. But
+such occurrences are very rare: for
+one cavity being naturally more liable
+to this species of dilatation, and another
+to that, it most frequently happens that
+specimens of both conditions are found
+in the different cavities of the same
+heart.</p>
+
+<p>The left ventricle is much more
+liable to active dilatation than the
+right; and the right ventricle more so
+than either of the auricles; and of the
+auricles unquestionably the left. Upon
+the whole, perhaps, the fact may be
+truly stated thus&mdash;that the left ventricle
+commonly gains an increase of bulk
+and strength, with an increase of capacity;
+and that all the other cavities, at
+the time that they expand, are rather
+apt to become attenuated.</p>
+
+<p>It sometimes (though rarely) happens,
+that, with an increase of strength
+and bulk in its muscular structure, the
+left ventricle suffers a diminution of
+capacity in its cavity. In a case reported
+by Laënnec, the left ventricle
+was an inch and a half thick at its
+broadest, and an inch thick at its
+thinnest part; and yet its cavity was
+only capable of containing an unblanched
+almond. I have seen the same condition
+in a less degree.&mdash;(<cite>Laënnec</cite>,
+vol. ii. 698.)</p>
+
+<p>The circumstances under which these
+opposite conditions, this hypertrophy
+and atrophy of the heart, with the enlargement
+or diminution of its cavities,
+arise, must be explained hereafter.
+At present I would only remark that
+they are often found conjoined with
+actual disease in other structures of the
+heart, such as osseous or cartilaginous
+thickening of internal lining, adhesion
+of the pericardium, and ossification
+of the coronary arteries, to which they
+owe their origin; and, moreover, that
+they are often found where the heart is
+otherwise perfectly sound in texture,
+and where their cause must be sought
+in other parts of the body.</p>
+
+<p>The heart is liable to undergo a simple
+dilatation of its cavities without either
+thickening or attenuation of its muscular
+substance. This simple dilatation
+is sometimes of the whole organ, sometimes
+of one side, and sometimes only
+of one auricle or ventricle. When it is
+of one cavity only, it may be complicated
+with active or passive dilatation of
+another, or of all the rest.</p>
+
+<p>There is reason to believe that the
+heart sometimes undergoes a temporary
+dilatation, and again returns to its natural
+capacity; but that the dilatation
+can only subsist for a short time without
+becoming permanent.</p>
+
+<p>The power of thus enlarging its cavities,
+and restoring them to their natural
+condition, belongs more especially to
+the right side of the heart.</p>
+
+<p>A large accumulation of fat is sometimes
+met with about the heart.</p>
+
+<p>The healthy heart is always more or
+<span class="pagenum"><a name="Page_121" id="Page_121">[121]</a></span>
+less marked upon its external surface
+with streaks of white, and this appearance
+results from the deposition of fat in
+the cellular texture, which unites the
+serous covering with the subjacent muscular
+structure. It is found principally
+where the venæ cavæ unite to form the
+right auricle; also at the base of the
+ventricles, and along the line which
+marks the boundary between the two,
+and around the origin of the great blood-vessels
+as they emerge from the heart.
+But when fat is deposited in more than
+these situations, and in more than the
+natural quantity, it is not so much
+added to the healthy substance of the
+heart, as existing at its expense and detriment,
+and the muscular structure is
+that which especially suffers. The fibre
+of the fat heart is pale and wasted,
+like that of a paralytic limb.&mdash;<cite>Mus. of
+the Coll. of Surg.</cite> 327.</p>
+
+<p>A rupture of the heart is sometimes
+met with; but all the cases of reputed
+rupture are not such in reality. An
+aperture in the walls of the heart,
+through which blood escapes into the
+cavity of the pericardium, may result
+from ulceration as well as from rupture,
+or from a mixed process of one and
+the other; but whatever be the precise
+nature of the process by which this
+perforation of the heart is effected, it is
+undoubtedly of rare occurrence.</p>
+
+<p>Where it has been found, there has
+generally been at the same time some
+peculiar condition of the organ, which
+might be presumed favourable to its
+production. Its muscular substance
+has been so soft and loose of texture,
+that it could be pierced through by the
+weight of a probe<a name="FNanchor_15_15" id="FNanchor_15_15"></a><a href="#Footnote_15_15" class="fnanchor">[15]</a>; or it has been converted
+into, or greatly intermixed with
+fat<a name="FNanchor_16_16" id="FNanchor_16_16"></a><a href="#Footnote_16_16" class="fnanchor">[16]</a>; or its muscular fibres have been
+absolutely defective, leaving a certain
+transparent space, where the internal
+lining and the pericardium have been
+in contact, and served to maintain the
+completeness of the cavity, until the
+rupture has taken place<a name="FNanchor_17_17" id="FNanchor_17_17"></a><a href="#Footnote_17_17" class="fnanchor">[17]</a>.</p>
+
+<p>Not that a rupture has not been
+found where the texture of the parts has
+seemed to offer no natural facilities to
+its occurrence&mdash;as in the case related
+by Harvey himself, who found a lacerated
+aperture in the left ventricle, capable
+of admitting his finger, through
+which blood had escaped into the pericardium,
+the walls of the ventricle being
+increased in thickness and strength,
+while an obstacle existed at the entrance
+of the aorta<a name="FNanchor_18_18" id="FNanchor_18_18"></a><a href="#Footnote_18_18" class="fnanchor">[18]</a>. Here the heart must
+have torn itself asunder by the simple
+violence of its contraction, in contending
+against the impediment to the egress
+of blood from its cavity. This is an
+effect which would hardly be thought
+capable of being thus produced; but
+I can well believe it possible after having
+seen one of the recti muscles of the
+abdomen literally torn in twain, in a
+man who died of tetanus<a name="FNanchor_19_19" id="FNanchor_19_19"></a><a href="#Footnote_19_19" class="fnanchor">[19]</a>.</p>
+
+<p class="pfs80">[To be continued.]</p>
+
+
+<hr class="fulla" />
+<h2>DILATED ŒSOPHAGUS.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editor of the London Medical
+Gazette.</em></p>
+
+<p><span class="pad1 smcap">Sir,</span><br />
+
+Permit me to send the following case
+to you for insertion in the Gazette.</p>
+
+<p>Mary Blores, æt. 33, was admitted
+into the Middlesex Hospital on the 16th
+of November. She was in a state of
+extreme feebleness and emaciation.
+Those who brought her said that during
+the preceding month she had appeared
+to swallow nothing: what she took
+as food seemed to her to stop in the
+gullet, and after a few minutes returned.
+I found, however, that a
+large œsophagus-bougie passed readily
+into the stomach, meeting with no obstruction
+beyond a spasmodic resistance
+in the pharynx. A draught of
+milk and water was given her&mdash;she
+swallowed it without much effort, but
+it quickly returned. In the course of the
+<span class="pagenum"><a name="Page_122" id="Page_122">[122]</a></span>
+afternoon a pint of beef tea was injected
+through an elastic tube into the stomach&mdash;it
+was thrown up directly.</p>
+
+<p>I now learnt from her that she could
+swallow liquids much more readily than
+solid food; that when she took a small
+quantity, it seemed to her not to reach
+the stomach, and in three or four
+minutes was invariably thrown up; that
+on taking a large draught she had an
+impression that it reached the stomach&mdash;in
+this case vomiting did not follow so
+soon, and some part of the draught was
+permanently retained; that she craved
+food and drink, and was literally dying
+of hunger and thirst; that the vomiting
+which took place was not preceded by
+nausea, although in its progress it had
+all the appearance of ordinary retching;
+that the matter vomited was not
+thrown up at once, but by successive
+efforts; it consisted of the food she had
+last taken, mixed with colourless
+mucus. The belly was so shrunk that
+the umbilicus was not more than an
+inch distant from the spine, upon
+which the pulsations of the aorta were
+readily felt: there was no enlargement
+or hardness about the stomach,
+no particular tenderness on pressing
+the epigastrium, no sensation of pain or
+heat now or formerly.</p>
+
+<p>The complaint had began ten years
+ago, during pregnancy, since when she
+had never been free from it, although
+at times her sufferings had been less,
+and she had been able to retain some
+portion of her meals. She had borne
+in this period three children; the vomiting
+had lasted during the whole
+period of her pregnancies, and during
+her confinement. The principal remedies
+which had been used for her relief
+were a succession of blisters on the pit
+of the stomach&mdash;but they had produced
+no benefit. Latterly her symptoms had
+been greatly aggravated.</p>
+
+<p>This patient was attended by Dr.
+Watson and myself. But the means
+which we tried to enable her to retain
+her food, and to support her expiring
+strength, had scarcely a temporary
+effect. She died on the 2d Dec. sixteen
+days after her admission. The body
+was carefully examined, at the expressed
+wish of her relatives.</p>
+
+<p>The unusual appearances found in the
+abdomen were&mdash;1. the smallness of
+the first part of the duodenum, which
+was but half the ordinary size of
+the ileum; 2. the capaciousness and
+fulness of the gall bladder,&mdash;from
+which, however, on compressing it,
+the bile flowed readily into the intestine;
+3. a contraction of the middle of the
+stomach of the length of two inches,
+for which extent the peritoneal coat
+was thickened and opaque, and the inner
+membranes folded in deep longitudinal
+rugæ, the mucous surface of which was
+partially suffused with circular spots of
+red. The breadth of the contracted
+part of the stomach, as it lay collapsed,
+was an inch and a half.</p>
+
+<div class="figcenter">
+<img src="images/i019g.jpg" width="250" alt="" />
+</div>
+
+<div class="figcenter">
+<img src="images/i020g.jpg" width="250" alt="" />
+</div>
+
+<p>But it was in the chest that the most
+remarkable circumstance presented itself.
+The œsophagus gradually enlarged
+from the pharynx, which was
+perhaps rather narrower than usual,
+to an extraordinary degree of dilatation;
+the greatest breadth which it
+attained was situated about four inches
+above the cardia: the tube then contracted
+more abruptly, so as to render
+the termination of the œsophagus, like
+its commencement, of nearly the usual
+dimensions. The structure likewise of
+the cardiac extremity for about an
+inch, and of the pharyngeal end for
+about half an inch, was healthy. The
+intermediate part presented, when inverted,
+the following curious appearance:&mdash;The
+inner membrane was thickened
+and opaque, and had <em>the appearance</em>
+of having partially yielded from dilatation;
+at the upper part the furrows or
+thinner parts of the membrane followed
+in some degree a longitudinal direction;
+at the lower part the surface was pitted
+with shallow depressions of various
+figures. I have represented in the adjoined
+sketches these appearances, which on
+the middle of the œsophagus passed
+from one into the other; at the furrows
+<span class="pagenum"><a name="Page_123" id="Page_123">[123]</a></span>
+or depressions the membrane seemed of
+the natural thickness and colour; the
+intermediate raised and thickened part
+was opaque and whitish. The muscular
+fibres of the œsophagus were of the
+natural colour and thickness.</p>
+
+<p>
+<span class="pad2">I remain, Mr. Editor,</span><br />
+<span class="pad6">Your obedient servant,</span><br />
+<span class="pad10 smcap">Herbert Mayo</span>.</p>
+
+<p class="noindent fs80">19, George-street, Hanover-square,<br />
+<span class="pad4">Dec. 6, 1828.</span></p>
+
+
+<hr class="fulla" />
+<h2>HYDROPHOBIA.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editor of the London Medical Gazette.</em></p>
+
+<p><span class="pad1 smcap">Sir</span>,<br />
+
+As the following case may throw some
+additional light on the pathology of
+hydrophobia, I have sent it you for
+publication.</p>
+
+<p>
+<span class="pad2">I am, Sir,</span><br />
+<span class="pad6">Your obedient servant,</span><br />
+<span class="pad10 smcap">F. Godrich</span>.</p>
+
+<p class="fs80">Grove House, Little Chelsea,<br />
+<span class="pad4">Nov. 29, 1828.</span></p>
+
+<p class="p1" />
+<p>On Thursday morning, the 25th ult.
+I was called up about seven o'clock to
+see a man who I understood was exceedingly
+ill, and waiting in the surgery
+very impatiently for my arrival. I
+found my patient (Mr. Barham), a fine
+looking old man, about 60, labouring
+at intervals of about five minutes under
+strong spasmodic paroxysms, affecting
+the muscles concerned in breathing
+and deglutition. There was a wildness
+and an impatience depicted in his
+countenance, totally different from any
+thing I had ever observed in other spasmodic
+affections. His bowels were open,
+tongue clean, skin moist, pulse full and
+a little accelerated. I took away twenty
+ounces of blood, and prescribed a mixture
+containing
+<span class="screenonly">ʒss.</span><span class="handonly"><img class="glyph" src="images/dram.jpg" alt="" />ss.</span>
+of laudanum for a
+dose every hour until I should see him
+again. He walked home half a mile
+from my house (Gloucester Road, Old
+Brompton), and left me ruminating on
+the possible cause of so much mischief
+occurring suddenly in a fine healthy
+subject. At ten a message was sent,
+saying that he was much worse, and
+requesting me to call as soon as possible.
+He received me tranquilly, and
+said he was very glad that I had come
+to see him, for he was very ill. His
+symptoms were now more distressing
+than when I first saw him: he looked
+wildly and suspiciously at every one entering
+his apartment, and his breathing
+was accompanied by a short convulsive
+sobbing. On looking at his medicine
+I perceived he had taken none, and expressing
+my surprise, he assured me it
+was impossible for him to swallow a
+single drop, as the attempt had been
+followed by violent spasms, and produced
+so much distress, that he had desisted.
+At this period no one had the
+slightest idea of the origin of his
+malady. I poured out some medicine
+into a tea-cup, the very act of which
+produced much excitement and alarm.
+My first impression as to the true nature
+of his disease arose at this period, from
+the circumstance of his requiring a tea-spoon,
+with which he endeavoured to
+take some of the medicine. The attempt
+produced much excitement and
+alarm, and after two or three painful
+efforts at deglutition, with one desperate
+effort he swallowed a tea-spoonful, threw
+away the spoon, and begged, unless I
+wished to destroy him, that he might
+have nothing more to swallow. I now
+left his room, and inquired of a bystander
+whether any thing particular
+had occurred to him within the last
+few weeks. On recollection she said,
+"About a month since, late at night, a
+strange dog came into the premises and
+fought with his own dog; he got out of
+bed to separate them, and the strange
+dog bit him in two places, on the left
+arm and hand; and bit a puppy, which
+died about a fortnight after in a strange
+<span class="pagenum"><a name="Page_124" id="Page_124">[124]</a></span>
+way, which was thought to be some
+kind of a fit." To ascertain if this occurrence
+had produced any effect on his
+mind, while again bleeding him I said,
+"You have been in the wars, Sir, and
+had your hand and arm torn; how did
+it occur?"&mdash;"Oh!" said he, carelessly,
+"that was done by a dog a long time
+ago, but it healed." The circumstance
+was never again mentioned to him, and
+he died in total ignorance of the cause
+of his malady. The wounds were perfectly
+cicatrised, and there was not the
+least action going on indicative of recent
+absorption. He bore the bleeding
+pretty quietly:
+<span class="screenonly">40℥.</span><span class="handonly">40<img class="glyph" src="images/ounce.jpg" alt="" />.</span>
+were removed,
+which on cooling presented strong
+marks of inflammation.</p>
+
+<p class="pad2 fs80">Ordered
+<span class="screenonly">ℳiv.</span><span class="handonly"><img class="glyph" src="images/scruple.jpg" alt="" />iv.</span>
+Acid. Hydrocyan. omni horâ, in a little water.</p>
+
+<p>Twelve o'clock.&mdash;With much difficulty
+he has taken two doses of the
+acid; pulse full and hard, 110.
+<span class="screenonly">30℥.</span><span class="handonly">30<img class="glyph" src="images/ounce.jpg" alt="" />.</span>
+more blood were removed.</p>
+
+<p>Three o'clock.&mdash;Has taken two more
+doses; complains of a dreadful sense
+of suffocation, and implores that nothing
+more may be given him. Pulse full, and
+beating at 120 to 130. Continue the
+acid.</p>
+
+<p>Eight o'clock.&mdash;Pulse full and hard.
+Has taken in all
+<span class="screenonly">24ℳ.</span><span class="handonly">24<img class="glyph" src="images/scruple.jpg" alt="" />.</span>
+of the acid, but
+so painfully distressing has the deglutition
+now become, that all attempts at
+repeating his medicine are discontinued.</p>
+
+<p class="pad8 fs80">V. S. ad
+<span class="screenonly">℥xxx.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />xxx.</span></p>
+
+<p>During the bleeding he looked wildly
+at the basin, and begged that no more
+might be spilt (a drop or two had fallen),
+repeating frequently, in great
+agitation, as the blood was running,
+"Take care! take care!"</p>
+
+<p>Between two and three o'clock next
+morning my assistant (Mr. Davies) visited
+him. He found him tolerably
+passive, but observing every movement
+with intense anxiety. Pulse full and
+hard, face flushed, eyes denoting cerebral
+irritation. He had been at times
+outrageous. On its being intimated
+that bleeding was again necessary, a
+paroxysm came on more intense than
+any preceding,&mdash;and with great effort he
+submitted. As the blood flowed he became
+more and more alarmed, till at
+length he got quite unmanageable; he
+raged violently at his nephew, who was
+holding the basin, and ordered it peremptorily
+to be removed. 30 or
+<span class="screenonly">40℥.</span><span class="handonly">40<img class="glyph" src="images/ounce.jpg" alt="" />.</span>
+were taken away. It was found necessary
+to put on the straight waistcoat.
+About four o'clock Mr. Davies wished
+him to take some more of his medicine.
+He said, "I can take no more," and on
+reaching the bottle to put out a few drops,
+he became violently agitated, threw himself
+from side to side, and, as well as
+the incessant spasmodic sobbings would
+allow, he begged that not one more drop
+of any thing might be offered him, and
+that the bottle might be taken from his
+sight. He did not become tranquillized
+until its removal. He lingered on till
+ten <span class="fs70">A.M.</span> in the same state, a few minutes
+before which he insisted on getting
+up, and walked a short way down
+his garden, returned, laid down on his
+bed, and died.</p>
+
+<p>Mr. Frederick Salmon, of Old Broad
+Street, and Mr. Wilson, of Chelsea,
+were kind enough to assist me in conducting
+the post mortem examination.
+On opening the chest, the heart was free
+from disease, with rather more water in
+the pericardium than natural; the lungs
+were completely gorged with grumous
+blood, and the pleura adherent on the
+right side. On removing the cranium,
+which was remarkably thin, and cutting
+the substance of the brain, numerous
+red spots presented themselves in the
+medullary portion; about a table-spoonful
+of water in each ventricle; the
+plexus choroides was turgid; the corpora,
+striata, thalami, and basis of the
+brain every where preternaturally injected;
+the cerebellum, crura cerebri,
+and cerebelli, in a high state of inflammation.
+On removing the spinous process
+of the vertebra, the whole cord
+was considerably inflamed; and opposite
+the two last cervical and dorsal
+vertebræ the cellular substance was
+studded with dark patches of coagulated
+blood, the theca vertebralis thickened,
+and the cord in an active state of inflammation.
+The larynx and pharynx
+bore not the slightest vestige of disease.
+The preparation of the cord is deposited
+in the museum of the London
+University.</p>
+
+<p>The post mortem examination of this
+case tends to prove the correctness of
+Professor Thompson's theory of the
+proximate cause and seat of this afflicting
+malady; and the plate accompanying
+a case recorded by him, in the
+13th volume of the Med. Chir. Society,
+gives a faithful delineation of the state
+in which the spinal cord was found in
+this case.</p>
+
+
+<p><span class="pagenum"><a name="Page_125" id="Page_125">[125]</a></span></p>
+
+<hr class="fulla" />
+<h2>CASE OF LONG PROTRACTED CONSTIPATION.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editors of the London Medical
+Gazette.</em></p>
+
+<p><span class="pad1 smcap">Gentlemen</span>,<br />
+
+Perhaps the following case may interest
+some of your readers, and if you
+think so, its insertion in your Journal
+will oblige</p>
+
+<p>
+<span class="pad2">Your obedient and</span><br />
+<span class="pad6">humble servant,</span><br />
+<span class="pad10 smcap">S. D. Broughton</span>.</p>
+
+<p class="fs80">12, Great Marlborough Street,<br />
+<span class="pad4">Dec. 3, 1828.</span></p>
+
+<p class="p1" />
+<p>On Tuesday, Nov. 25, I was called
+upon at the St. George's and St. James's
+Dispensary to advise for an infant at
+the breast, of five months and fourteen
+days of age, that had not passed
+any fæces during six weeks up to the
+day before I saw it. After its birth it
+had no passage till the fifth day, and
+this had apparently been effected by the
+introduction of a bougie, and which
+was subsequently continued at intervals
+for a short time. The infant was otherwise
+healthy and strong at its birth, and remained
+so until it had gone about three
+weeks without any evacuation, when it
+was observed to be weak in the lower
+extremities; and at the period of my
+seeing it the legs were much fallen
+away in flesh, hanging flaccid and inert.
+Many aperient enemas and medicines
+had been given, and, as a last resource,
+one drop of the croton oil had been
+prescribed the preceding evening. The
+infant appeared to suffer from distention,
+and to be disposed to coma, and
+the croton oil had distressed it much
+some hours after it was given. The
+fæces could be felt blocking up the intestine,
+but the irritation of the finger
+produced no attempt at evacuation;
+very small pieces only having been
+brought away. Hot baths also had
+frequently been used some time ago.</p>
+
+<p>Considering the case as one of paralysis
+in the parts naturally employed to
+relieve the bowels, I recommended
+the suspension of all purgative remedies
+by the mouth, and a table-spoonful
+of the following injection to be substituted,
+and to be thrown up with three
+table-spoonfuls of thin gruel occasionally
+during the day, by means of a
+syringe.</p>
+
+<p class="neg5 screenonly">
+℞ Spir. Terebenth. ʒiij.<br />
+Træ Zinzib. ʒj.<br />
+Aquæ, ℥iss. M.
+</p>
+
+<p class="neg5 handonly">
+<img class="glyph" src="images/rx.jpg" alt="" />Spir. Terebenth.
+<img class="glyph" src="images/dram.jpg" alt="" />iij.<br />
+Træ Zinzib. <img class="glyph" src="images/dram.jpg" alt="" />j.<br />
+Aquæ, <img class="glyph" src="images/ounce.jpg" alt="" />iss. M.
+</p>
+
+<p>The following liniment was also directed
+to be rubbed in frequently along
+the course of the spine.</p>
+
+<p class="neg3 screenonly">
+℞ Linimenti Saponis, ℥iss.<br />
+Liquor. Ammon. Comp. ℥ss. M.
+</p>
+
+<p class="neg3 handonly">
+<img class="glyph" src="images/rx.jpg" alt="" /> Linimenti Saponis,
+<img class="glyph" src="images/ounce.jpg" alt="" />iss.<br />
+Liquor. Ammon. Comp. <img class="glyph" src="images/ounce.jpg" alt="" />ss. M.
+</p>
+
+<p>The result justified my expectations;
+for, during the night after this prescription,
+two injections having been
+given, some large and hard ash-coloured
+lumps came away, and these were
+shortly followed by a forcible spouting
+out of a continued stream of feculent
+dark liquid; a brisk diarrhœa having
+been kept up till the Saturday following.
+The infant's appetite is become
+voracious, its appearance lively and
+healthy, and its legs as firm and strong
+as is usual at such an age. Cold water
+is recommended to be dashed upon the
+loins, the liniment to be continued
+occasionally, moderate doses of magnesia
+and rhubarb to be given when
+required, and the turpentine injection
+to be used if any return of the complaint
+should be threatened.</p>
+
+
+<hr class="fulla" />
+<h2>DISLOCATION OF THE PATELLA.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editor of the London Medical
+Gazette.</em></p>
+
+<p><span class="pad1 smcap">Sir</span>,<br />
+
+Having seen a case of dislocation of the
+patella, reported by Mr. Mayo, in your
+Journal a few weeks since, in which
+there was experienced some difficulty in
+the reduction of the bone, I beg leave
+to send you the following, in case you
+may think it worth insertion.</p>
+
+<p>On Saturday last, I was called to a
+young woman who had dislocated the
+patella of the left knee joint outwards;
+the inner edge rested upon the outer
+surface of the external condyle, and was
+immoveably fixed, and caused great pain
+when touched. She says it was occasioned
+by her foot slipping backwards
+from one stair to another, and she immediately
+fell down.</p>
+
+<p>I commenced the reduction, as stated
+by Mr. Mayo, but I could only produce
+semiflexion, and that gave her great
+pain; insomuch that I was obliged to
+desist, and the patella remained in <i lang="la" xml:lang="la">statu
+quo</i>. But when the knee was thus semiflexed,
+I desired my assistant to extend
+the leg suddenly; and having my fingers
+on the patella at the time, and pressing
+<span class="pagenum"><a name="Page_126" id="Page_126">[126]</a></span>
+it inwards, it immediately returned to
+its natural position.</p>
+
+<p>I must confess, sir, that I should
+have been afraid to have continued the
+flexion as described in Mr. Mayo's case,
+"by bending the knee to the utmost,"
+fearing that the remedy might be worse
+than the disease, and the result proved
+that in this case it was not necessary.</p>
+
+<p>
+<span class="pad2">I remain, Sir,</span><br />
+<span class="pad6">Your obedient servant,</span><br />
+<span class="pad10 fs70">P. M. Hoskings</span>.</p>
+
+<p class="fs80">168, Fleet-Street,<br />
+<span class="pad2">Dec. 3d, 1828.</span></p>
+
+
+<hr class="fulla" />
+<h2>VACCINATION.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editor of the London Medical
+Gazette.</em></p>
+
+<p><span class="smcap">Sir</span>,<br />
+
+The mistake of the printer in substituting
+the word "every" for "even,"
+in the paper on Vaccination (p. 40), so
+materially affects the sense of the passage,
+that I must request the favour of
+the following insertion:&mdash;</p>
+
+<p>"3d. That while the vaccine cicatrix
+retains even one distinct fovea or depression,
+the individual continues unsusceptible
+both of small pox and of re-vaccination;
+but that," &amp;c.</p>
+
+<p>
+<span class="pad2">I am, Sir,</span><br />
+<span class="pad6">Your obedient servant,</span><br />
+<span class="pad10 smcap">Thos. H. Burder</span>.</p>
+
+<p class="fs80">2, Brunswick Square, Dec. 15, 1828.</p>
+
+
+<hr class="fulla" />
+<h2>SINGULAR BICEPS MUSCLE.</h2>
+
+<p class="center"><em>To the Editor of the London Medical
+Gazette.</em></p>
+
+<p><span class="smcap">Sir</span>,<br />
+
+<ins class="corr" title="Transcriber's Note&mdash;Original text: 'Tue valuable paper'">The valuable paper</ins> communicated to
+your Journal, by Mr. Stanley, last
+week, has brought to my recollection a
+singular appearance of the parts in front
+of the shoulder-joint which I dissected
+about two years ago. It is a fact
+worth recording; and perhaps you will
+be kind enough to insert it in your next
+number.</p>
+
+<p>The circumstance was this&mdash;that in
+the right arm, instead of there being
+a biceps muscle having two origins, the
+one the shorter from the corocoid process,
+the other the longer from the
+upper part of the glenoid cavity of the
+scapula, there was simply a one-headed
+muscle arising from the corocoid process.
+I could find no tendon passing
+through the joint answering to the long
+head of the biceps, neither was there
+any appearance of a biceptical groove;
+the capsular ligament was, perhaps,
+thicker than it is found in ordinary
+cases.</p>
+
+<p>I knew nothing of this man during
+life, and am therefore unable to give
+any account of the use which he made
+of this arm.</p>
+
+<p>
+<span class="pad2">I am, your obedient servant,</span><br />
+<span class="pad10 smcap">C. M. Burnett</span>.</p>
+
+<p class="fs80">House Surgeon's Apartments,<br />
+St. Bartholomew's Hospital, Dec. 8th.</p>
+
+
+<hr class="fulla" />
+<h2>STETHOSCOPE.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editors of the London Medical
+Gazette.</em></p>
+
+<p><span class="smcap">Gentlemen</span>,<br />
+
+As you did me the honour, on a former
+occasion, to publish some remarks in
+defence of <em>auscultation</em>, against its
+enemies and detractors, I trust you will
+permit me to say a few words in reference
+to a communication in a late
+number, from a gentleman who appears
+to be a friend of that method of diagnosis,
+but whose ignorance of the subject
+is likely to be more injurious to the
+cause than either open enmity or secret
+detraction. The case in question (page
+780, vol. ii.) appears, from the dissection,
+to have been clearly <em>emphysema of the
+lungs</em>, as there stated; but I appeal to
+every one practically acquainted with
+the physical signs of diseases of the
+lungs, whether the results of the exploration
+with the stethoscope, as narrated
+in the case, were those pathognomonic
+of that disease? I say they were
+not only not pathognomonic of this
+affection, but they were actually incompatible
+with its existence. The same
+ignorance of the subject is shewn in relation
+to the disease of the heart, which,
+I boldly maintain, no one was justified
+in pronouncing to be <em>hypertrophy of the
+left ventricle</em> from the stethoscopic indications
+stated in the case.</p>
+
+<p>It is just possible that the writer of
+the case may have made further explorations
+on which his diagnosis was founded;
+but if he had such in his case-book,
+it is equally unfortunate for the credit
+of the stethoscope and his own, that he
+suppressed them in his printed case.</p>
+
+<p>
+<span class="pad2">I have the honour to be,</span><br />
+<span class="pad8">Gentlemen,</span><br />
+<span class="pad6">Your obedient servant,</span><br />
+<span class="pad10 smcap">A Stethoscoper</span>.</p>
+
+<p class="pad1 fs80">Nov. 25, 1828.</p>
+
+
+<p><span class="pagenum"><a name="Page_127" id="Page_127">[127]</a></span></p>
+
+<hr class="fulla" />
+<h2>MECHANISM OF VOMITING.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editor of the London Medical
+Gazette.</em></p>
+
+<p class="center fs80">Glasgow University, Nov. 26, 1828.</p>
+
+<p><span class="smcap">Sir</span>,<br />
+
+Having lately perused, in the 35th
+Number of the Medical Gazette, some
+observations "on the mechanism of
+the act of vomiting," by Dr. Marshall
+Hall, in which, after controverting the
+different opinions which have been entertained
+by physiologists on this
+question, he endeavours to prove that
+vomiting is an effort, not of <em>inspiration</em>,
+but of <em>expiration</em>, and advances this
+opinion as having originated in himself,
+I beg, through the medium of your
+Journal, to refer that gentleman to
+Richerand's Physiology, where, on the
+subject of vomiting, page 70, he says,
+"Sometimes the action of the muscular
+fibres of the stomach is quite inverted;
+they contract from the pylorus towards
+the cardia; and this antiperistaltic motion,
+in which the contractions act
+with more force and rapidity, and in a
+manner decidedly convulsive, produces
+vomiting. The action of the abdominal
+muscles then connects itself with that
+of the stomach; the viscera are propelled
+upwards and backwards, by the
+contraction of the large muscles of the
+abdomen; <em>the diaphragm ascends towards
+the chest; if it descended, in contracting,
+the œsophagus that passes between
+its two crura would be compressed,
+and the expulsion of food
+through the cardia could not be effected</em>.
+It is also observed, <em>that during expiration
+only, any thing can pass from the
+stomach into the œsophagus</em>." Again, on
+respiration, page 147&mdash;"<em>In every effort
+of expiration</em>, as coughing and <em>vomiting</em>,"
+&amp;c. Here, then, we see that Dr.
+Hall's views, as far as regards vomiting
+being an effort of expiration, have
+long since been advanced by Richerand.</p>
+
+<p>The profession are certainly much
+indebted to Dr. Hall for his corroboration
+of these views; at the same time
+he should not have taken to himself the
+merit of having first suggested them.</p>
+
+<p>
+<span class="pad6">Sir,</span><br />
+<span class="pad4">Your most obedient servant,</span><br />
+<span class="pad10 smcap">A Subscriber</span>.</p>
+
+
+<hr class="fulla" />
+<h2>CHARACTER OF THE LANCET.</h2>
+
+<p class="center"><em>To the Editor of the London Medical
+Gazette.</em></p>
+
+<p class="right fs80">Dec. 19, 1828.</p>
+
+<p><span class="smcap">Sir</span>,</p>
+
+<p class="noindent">The events disclosed during the late
+trial in the Court of King's Bench, must
+fill every well-disposed mind with astonishment
+and horror. The moral aspect
+of the case is marked by every feature
+capable of exciting a sense of shame
+for our profession, and of sorrow for
+our kind. Can it be that a publication
+conducted in the spirit of the extracts
+produced at the late trial of Cooper
+against Wakley should be fostered and
+encouraged by a large proportion of the
+medical public? Is it indeed true that
+no feeling of loathing and disgust
+should have induced the purchasers of
+the Lancet to protest against its glaring
+injustice, its undisguised ferocity and
+malignity?</p>
+
+<p>I am not a reader of that work myself,
+and but for the disclosures recently
+made in our courts of justice, together
+with what I have learned from your
+own pages, I should know little about
+it. Some of its early numbers convinced
+me that it was a production not
+deserving of support, whatever ability
+there might be connected with it; subsequent
+events have amply justified this
+decision, and I now address these few
+hasty lines to you, to express my humble
+hope that all the respectable medical
+men throughout the kingdom will arise,
+and with one voice oppose this moral
+pestilence, which at once corrupts and
+degrades their profession.</p>
+
+<p>The <i lang="la" xml:lang="la">odium medicum</i>, bitter and vindictive
+as it unfortunately has been,
+never, I believe, appeared in a form so
+repulsive. Are we living in the nineteenth
+century? Have arts and sciences,
+which are asserted of old to soften the
+manners and temper the violence of our
+nature, produced no such fruits amongst
+us? Is serious, and perhaps irremediable
+injury, to be inflicted on reputation;
+and is the sufferer thereafter to be
+dared to mortal combat, and this too by
+the wrong-doer? Is it thus that professional
+justice is to be awarded? Is
+it thus that knowledge is to be advanced,
+the dignity of our profession
+to be maintained, its benefits enlarged,
+and its usefulness transmitted? Is it
+thus that the young men are to be
+taught how to acquire an unworthy and
+discreditable notoriety; to disregard all
+<span class="pagenum"><a name="Page_128" id="Page_128">[128]</a></span>
+the decencies, charities, and higher
+virtues of life; and to bring into the
+exercise of our art the insidious cunning
+of the knave, the vulgar dishonesty of
+the pilferer, and the audacious bearing
+of the bravo?</p>
+
+<p>I know not how others may feel on
+the present occasion: I am entirely unacquainted
+with the parties who have
+been at issue in the late suit&mdash;I have no
+bias of any kind, but what must arise in
+the mind of every man who has any regard
+for the profession to which he
+belongs, or who loves truth and fair
+dealing&mdash;I am sure that it is not less for
+the interests of society at large than for
+the advancement of medical science,
+that just principles should regulate all
+our dealings, both with the public and
+with each other. It is manifest that of
+late we have signally and woefully departed
+from them; and it is most distressing
+to know that this departure has
+been sanctioned by so many members of
+the profession. I now entertain a confident
+hope that all who reflect on the
+character of the late libel will feel that
+their own <em>character</em> is at stake if they
+do not mark their disapprobation of it
+in every possible way. Sure I am that,
+if the principles which guide the Lancet
+become generally acceptable, it will
+mark an æra of moral degradation
+which no surgical dexterity, no medical
+acquirements, however eminent, could
+possibly redeem.</p>
+
+<p class="right smcap">Veritas.</p>
+
+
+<hr class="fulla" />
+<h2>DURATION OF HUMAN LIFE IN RUSSIA.</h2>
+<hr class="r10a" />
+
+<p class="noindent">Cases of longevity are not only
+much more common, but also more extraordinary
+in respect to a greater duration,
+in Russia than in any other part of
+Europe; thus, from the report of the
+holy synod, published in 1827, it appears
+that there were living in 1825,
+among those who professed the Greco-Russian
+religion throughout the empire,
+not fewer than 848 males who
+were 100 and more years old; among
+whom, 32 had passed the age of 120, 4
+were between 125 and 130, and 4 others
+between 130 and 135 years of age. Out
+of 606,881 males who died in 1826,
+2785 had passed the age of 90 years;
+1432 that of 95; and 818 that of 100.
+Among the latter, 38 were more than
+115 years of age; 24 more than 120;
+7 more than 125; and one was 160
+years old at his death.</p>
+
+
+    <div class="chapter"></div>
+
+
+<hr class="fulla" />
+
+<p class="p1 pfs120 pg-brk">MEDICAL GAZETTE.</p>
+
+<p class="center"><em>Saturday, December 27, 1828.</em></p>
+
+<hr class="r10a" />
+
+<p class="fs70" lang="la" xml:lang="la">"Licet omnibus, licet etiam mihi, dignitatem <em>Artis
+Medicæ</em> tueri; potestas modo veniendi in publicum
+sit, dicendi periculum non recuso."&mdash;<span class="smcap">Cicero.</span></p>
+
+<hr class="r10a" />
+
+<h2 class="no-brk">ANALYSIS OF WAKLEY'S DEFENCE ON THE LATE TRIAL.</h2>
+
+
+<p class="noindent">We last week presented our readers
+with a full<a name="FNanchor_20_20" id="FNanchor_20_20"></a><a href="#Footnote_20_20" class="fnanchor">[20]</a> and, we trust, accurate
+account of the trial for libel, which
+has recently excited so much interest;
+and we offered some remarks of a general
+nature upon its result and tendency.
+We had purposed at the same time to
+subject Mr. Wakley's mode of conducting
+his cause to a critical investigation,
+but this we were prevented from doing
+by want of time and space. We thought
+it likely, too, that the Editor of the
+Lancet would have fairly met the question
+in his next publication, and himself
+put the facts of the case, at least,
+on record: instead of this, however,
+he has devoted his pages to compliments
+to himself, and scurrilous and
+absurd abuse of Sir James Scarlett, in
+which he informs us that in his opinion
+that gentleman is "prodigiously overrated
+even as a lawyer," and says many
+other things, which serve only to shew
+how dreadfully Wakley himself had
+smarted under his lash.</p>
+
+<p>We find the general opinion to correspond
+with that which we expressed
+last week&mdash;that the defendant had managed
+his cause in a very bungling
+manner; and the estimation in which
+he and his witnesses were held by Judge
+and Jury is apparent from the charge
+of the one, and decision of the other.
+<span class="pagenum"><a name="Page_129" id="Page_129">[129]</a></span>
+Both, indeed, regarded the asseverations
+of his whole <em>family party</em> as dust in the
+balance against the testimony of one
+single competent and honourable man&mdash;Mr.
+Callaway; for on his evidence the
+result obviously hinged. Our contemporary
+affects to look upon the verdict
+as a triumph on his part&mdash;so he would
+if the damages had been five hundred
+or a thousand pounds, for in truth he
+has nothing else for it; and with all
+our hearts we wish him many such
+victories.</p>
+
+<p>With regard to the amount of damages,
+we certainly should have been
+better pleased had it been larger; but
+we did not expect that it would&mdash;nay a
+reference to our number which was
+published while the trial was going on,
+will shew that we were even doubtful of
+the verdict, because we know how extremely
+difficult it is for a jury to comprehend
+such a complicated question&mdash;how
+easy for a knave to impose upon
+their ignorance by misrepresentation
+and falsehood. It is quite obvious
+that if the jury had believed one syllable
+of the evidence of Wakley's witnesses,
+they must have given the verdict
+in his favour. In a case like this,
+where <em>one individual only</em>, and he the
+plaintiff, can be fully aware of the difficulties
+which had to be overcome, it is
+almost impossible to bring evidence
+into a court of justice capable of satisfying
+the minds of twelve unprofessional
+men. From this circumstance alone it
+was that we expressed a doubtful
+opinion of the result. But besides all
+this, it is well known to all&mdash;<em>that one
+talesman might go determined to starve
+out the rest&mdash;that ten special jurymen
+might wish to give 500l. and yet that, by
+the absurd constitution of the English
+law, their verdict might be thus controlled
+by one individual friendly to the
+defendant</em>.</p>
+
+<p>Most fortunately for the cause of truth,
+Wakley had the vanity and folly to conduct
+the defence himself, and, judging of
+other men's estimation of moral character
+by his own, he did not hesitate
+to place in the box witnesses whom no
+counsel would have suffered to go there,
+and who, being unable to stand the cross-examination,
+led to what must have
+been to Wakley a most humiliating
+exposure. Next to this, the most
+beneficial effect produced was that of
+the defendant's cross-examination of
+his opponent's witnesses: it was
+amusingly absurd, and shewed a lamentable
+want of tact, always eliciting
+something which he ought to have
+avoided. Lastly came the reply, of
+which he tells us he is himself ashamed&mdash;"We
+may state most unfeignedly,"
+says he, "that we look back with regret
+to our errors in point of omission."
+Nor is this the only part of it for which
+he has cause to blush, for any thing more
+miserably deficient we never heard: it
+was a mass of confusion throughout&mdash;a
+repetition of the same ideas and expressions&mdash;and
+a most injudicious betrayal of
+rancorous feeling, at the very moment
+he was profanely invoking heaven to
+witness that he bore enmity to no man.
+In speaking of his reply in our last
+number, we declared it to be "false
+in statement&mdash;sophistical in argument&mdash;coarse
+in language&mdash;and diabolical in
+tendency;" and we now proceed to
+illustrate these several qualifications, in
+doing which little more will be necessary
+than to select a few passages, and
+arrange them under their appropriate
+heads.</p>
+
+<p><em>False in Statement.</em>&mdash;One of Wakley's
+principal objects was to impress
+upon the Jury a belief that he had
+not in any way attempted to influence
+his witnesses, nor even spoken to most
+of them, anterior to the trial. "Out
+of nine witnesses I have placed in the
+box, (says he) I never saw five of them,
+nor even spoke to five of them till yesterday."
+We appeal to any man of
+<span class="pagenum"><a name="Page_130" id="Page_130">[130]</a></span>
+common sense, whether it be probable
+that this is true. It is possible indeed,
+and only just possible, that he was contented
+with employing others to question
+his witnesses, and ascertain what
+evidence they would give; but even if it
+were so, the assertion was not the less
+false in a moral point of view, because
+his intention was to convey the belief that
+he had inquired no farther than merely
+whether or not the witnesses had been
+present at the operation. But incredible
+and absurd as this was, he ventured a
+step farther, and assigned a reason for the
+choice made of one witness&mdash;(Lee the
+potatoe-merchant.) "I had heard
+(said Wakley) he was present at the
+operation&mdash;an honest man, and that he
+was a friend of Mr. Bransby Cooper,
+under the highest obligation to the
+Cooper family. Without asking him a
+single question I put him into the box,
+as I was most anxious you should hear
+all the evidence that could be adduced,
+and from <em>unsuspected and untainted
+quarters</em>." This lie carried with it its
+own refutation; for Lee swore that he
+had never even spoken to Mr. Cooper;
+and we are therefore amazed that Wakley
+should have hazarded so gross an assertion,
+as it could only have been effective
+on the supposition of his addressing
+a jury of absolute simpletons. But
+again&mdash;"Who were my witnesses? not
+men whom I had trained and lectured
+on models, and sketches, and drawings.
+Has it been shewn to you that I
+was closeted with any person or set of
+persons?" Yes, Mr. Thomas Wakley,
+it has been shewn, and by no less an
+authority than that of your <i lang="la" xml:lang="la">fidus Achates</i>,
+Mr. James Lambert. "The defendant
+(says the worthy author of the libel), the
+defendant was there whilst I was explaining
+the parts to persons who were
+to be witnesses&mdash;<em>the defendant also explained
+them to the same persons</em>." And
+again, "I have heard explanations given
+to persons who were to be witnesses in
+this cause <span class="fs70">FOUR OR FIVE TIMES</span> within
+the last six weeks." So also that excellent
+thorough-going witness, Mr. Jeffry
+Pearl: "a <em>gentleman</em> of the name of
+Lambert introduced me to the defendant;
+<span class="fs70">THE DEFENDANT</span> <em>and Mr. Lambert
+endeavoured to shew that the forceps
+had passed between the bladder and the
+rectum</em>." So much for placing men in
+the box because they are friends of Mr.
+Cooper&mdash;so much for procuring evidence
+from "untainted quarters!"</p>
+
+<p>This is only to be matched in effrontery
+by the statement of some wise-acre
+at the radical meeting on Tuesday
+night. Being asked why no notice had
+been taken in the Lancet of a successful
+operation of lithotomy performed by
+Mr. B. Cooper, soon after the publication
+of the libel, he assigned as the
+reason that Mr. Wakley thought it
+might increase the damages, and otherwise
+injure Mr. Cooper! What a
+noodle the man must be to expect any
+one to believe him<a name="FNanchor_21_21" id="FNanchor_21_21"></a><a href="#Footnote_21_21" class="fnanchor">[21]</a>!</p>
+
+<p>Mr. Wakley asserted that the evidence
+of his witnesses remained "untouched&mdash;wholly
+uncontradicted;"&mdash;whereas
+there was scarcely a single
+point in their statements which was not
+contradicted either by Mr. Callaway,
+who was present at the operation, or
+Mr. Key and Dr. Hodgkin, who examined
+the parts after death. But what
+is more remarkable, there was scarcely
+a circumstance on which his own witnesses
+agreed&mdash;for example, they differed
+with regard to the nature and direction
+of the incisions; with regard
+to the manner and frequency of introducing
+the forceps; with regard to the
+number of instruments used, and the
+mode of applying them; with regard
+to the size of the wound; with regard
+to the degree of force employed, and
+with regard to the appearances after
+death. Yet, in the face of all this, Wakley
+<span class="pagenum"><a name="Page_131" id="Page_131">[131]</a></span>
+had the impudence to tell the jury
+that his evidence remained "uncontradicted."
+We have no hesitation in asserting
+that his own witnesses (putting
+Mr. Cooper's out of the question) advanced
+no charge of which they did not
+also furnish the refutation.</p>
+
+<p>Mr. Wakley asserted that Mr. Cooper
+was incapable of telling why he could
+not extract the stone, even "while he
+had his finger in the bladder." This is
+false: neither Mr. Cooper nor Mr.
+Callaway were able to reach the bladder
+with the finger at all, owing to the
+depth of the perineum.</p>
+
+<p>Mr. Wakley told the jury that the
+plaintiff did not like the bladder to be
+exposed, "because to surgeons there is
+indisputable proof that Bransby Cooper
+did not perform that operation as he
+ought," and that "Mr. Key and Mr. Callaway
+knew it." This is false: Mr. Key,
+Mr. Callaway, and Dr. Hodgkin, who
+had examined the parts, all deposed that
+there was nothing in them indicative of
+the operation having been improperly
+performed. Indeed, had it been as
+Wakley asserted, the plaintiff would
+not have been so foolish as to have had
+the parts preserved at all.</p>
+
+<p><em>Sophistical in argument.</em>&mdash;One of the
+pieces of sophistry on which Wakley
+seems chiefly to have depended, inasmuch
+as he went over it <em>six times</em> in the
+course of his speech, was, that if his
+account of the operation had been incorrect
+more of those who were present
+would have been brought forward
+to prove it so. But, as we stated in
+our last Number, to have objected to
+Wakley bringing forward pupils, on the
+ground of their being incompetent, and
+then to have done the same thing, would
+have been grossly inconsistent. Lord
+Tenterden, in his charge, said, "he did
+not see whom he (Mr. Cooper) could,
+with propriety, have called besides Mr.
+Callaway; the others were all young
+men, only pupils, and probably too
+young and inexperienced to form any
+judgment on the case that could be relied
+on." There is also another person
+who has objected to these witnesses
+whom we may mention&mdash;not, indeed,
+one for whose authority we have the
+highest possible respect, but of whom
+the defendant in this case probably
+thinks more favourably&mdash;we mean Mr.
+Thomas Wakley, who, speaking of the
+Letter formerly published by Mr.
+Cooper's pupils on the subject of this
+operation, says, "their united opinion of
+the skill, dexterity, and self-possession
+exhibited by Mr. Bransby Cooper on
+this occasion, is not likely to influence
+the judgment of the profession, whatever
+it may effect with the public."</p>
+
+<p>The use made by Wakley of Sir Astley
+Cooper's expression, "give him
+time," is another specimen of sophistry.
+Sir Astley evidently meant merely to
+say that, <i lang="la" xml:lang="la">ceteris paribus</i>, a man who had
+been twenty years surgeon to an Hospital
+would be more experienced than
+one who had held the situation but one-fourth
+of that period. This we believe
+to have been his sentiment, though nothing
+was ever less happily expressed.
+Accordingly it was not lost upon the
+defendant, who exclaimed, "Is that the
+way in which our hospitals are to be conducted?
+Is that the mode in which your
+poor patients are to be treated?&mdash;that
+young and inexperienced men are to be
+placed there to <em>learn their profession</em>&mdash;not
+to know it before they get there, but
+are to go there to learn it&mdash;and learn it
+upon whom?&mdash;upon individuals who
+are as much entitled to the best and
+most scientific practice of surgery as
+any nobleman in this land." All very
+fine&mdash;but we should be glad to know
+how or where a practical acquaintance
+with surgery is to be acquired but
+in public hospitals&mdash;and if no man
+is to be appointed till after he has
+gained experience, where are such
+men to come from? Where are ready-made
+<span class="pagenum"><a name="Page_132" id="Page_132">[132]</a></span>
+surgeons to be found fit to
+operate even before Lambert, without
+his being able <em>to make a hole</em> in their
+reputation?</p>
+
+<p>One of the most knavish attempts in
+the whole speech, to take advantage of
+the jury, was exhibited in his description
+of the operation. How different
+from the clear, perspicuous, and candid
+narrative of Sir James Scarlett. You
+are told, says Wakley, that the stone
+was shelved <em>above</em> the pubes and <em>behind</em>
+the pubes; but, continued he, (placing
+a pelvis in the position in which it is
+during the operation,) a stone cannot
+be lodged above the pubes, because,
+you see, the pubes is above the bladder!
+This was, indeed, calculated to
+confuse men unaccustomed to the subject,
+and who did not probably reflect
+that above and below are merely relative
+terms, which must change with
+every change of position, and that it
+was not meant that the stone was between
+the pubes and external integuments,
+which, in the position for lithotomy,
+would be the literal meaning of
+<em>above the pubes</em>, but that it was in such
+a situation as, in the ordinary position
+of the body, was above the pubes.
+But Wakley assured the jury that it was
+impossible for any stone to be <em>above</em>
+the pubes, for there was a tendon to
+prevent it which no force could overcome;
+and he affected to ridicule the
+idea of there being anything unusual,
+any extraordinary shelf behind the
+pubes, in which the stone could have
+been lodged. "Had there been
+a shelf here," said he,&mdash;"had
+there been a crooked passage&mdash;had
+there been a cavity, or any place for
+the deposition of the stone, do you
+suppose that shelf would not have been
+produced? Had there been any thing
+particular in the formation of the
+pubes, would they not have cut out
+the man's bone as well as the bladder?"
+It is <ins class="corr" title="Transcriber's Note&mdash;Original text: 'probably impossibly'">probably impossible</ins> for any but
+medical men to appreciate fully the impudent
+imposition&mdash;the fraud of this
+statement,&mdash;this knavish artifice to mislead
+the jury. No attempt was made
+in any part of Mr. Cooper's case to
+show that there was such malformation,
+or that the stone was in the position
+which Mr. Wakley demonstrated
+it could not occupy&mdash;<em>thus answering
+an argument which had never been advanced</em>.</p>
+
+<p>The following is a good specimen of
+sophistry and stupidity. Finding it
+proved that there was no opening between
+the bladder and rectum, Wakley
+wanted to make out that he never had
+said otherwise, having stated the cellular
+membrane to be <em>lacerable</em>, and therefore
+not <em>lacerated</em>. And then, forgetting
+the nature of his argument, immediately
+added, "remember this; the
+gorget is not as wide as the finger, and
+that it is not an uncommon thing for
+an unskilful operator to drive the gorget
+in between the bladder and rectum."
+Thus insinuating what had been
+proved to be false, and what he had
+just argued, from the words of the libel,
+he could not have meant.</p>
+
+<p><em>Coarse in language.</em>&mdash;This scarcely
+requires illustration. But as specimens,
+on the present occasion, of vulgar slang
+and miserable attempts at wit, we may
+mention his talking of "hole and corner"
+proceedings,&mdash;his comparing Sir
+James Scarlett to sour milk, and which
+happy thought he has, in hand-bills pasted
+about the town, converted into
+"Knight and Professor of Sour Milk,"&mdash;his
+explanation of the term <em>bat</em> as applied
+to surgeons, "because they live in
+the dark, they suckle their young, and
+live in creaks and crevices of old walls,
+hospitals, and dungeons, <em>thriving and fattening
+on their own species</em>,"&mdash;his address
+to the "<em>gang</em>" of hospital surgeons,
+whom he represented as wading "through
+blood up to the neck,"&mdash;and lastly, his
+exclamations, several times repeated,
+<span class="pagenum"><a name="Page_133" id="Page_133">[133]</a></span>
+perhaps with <em>prophetic</em> phrenzy, that he
+"would die in a dungeon and expire in
+a ditch."</p>
+
+<p><em>Diabolical in tendency.</em>&mdash;The general
+tendency of Wakley's writings, and especially
+of his address to the Jury on this
+occasion, so far as such ravings can
+have any influence, is to sow distrust
+between men in every class of society
+and their medical attendants; to poison
+the sources of public charity, and arrest
+the hand of benevolence; to contract
+the relief afforded to human suffering,
+leading the poor and uninformed to
+suppose themselves the objects of cruel
+and wanton experiment, thus encouraging
+them rather to suffer disease
+to run its course than seek relief in such
+abodes of blood and horror as he most
+falsely represents our public hospitals
+to be.</p>
+
+<p>One of the first ebullitions of this demoniacal
+effort consisted in representing
+to the Jury, which he did in two different
+parts of his address, that the patient had
+been kept <em>bound</em> during the operation,
+as if some unusual degree of coercion
+had been employed. "Yet, in opposition
+to the patient's cries&mdash;in opposition
+to his repeated entreaties to be
+unbound, still the operator kept him
+upon the table."&mdash;"Gentlemen," continued
+he, "I should like to know
+upon what principle it was that the
+man was kept <em>bound</em> upon the table
+when he implored to be loosened. Was
+he not a free agent?" And then he
+goes on to put into Mr. Cooper's mouth
+not only words, but a sentiment he never
+uttered.&mdash;"No, no, (says the operator,)
+my <em>reputation</em> is concerned. You were
+brought here to have the stone extracted,
+and extracted it shall and must be&mdash;<em>if
+you were to die upon the table</em>." Unless
+Wakley was intoxicated we cannot in
+any other manner account for an argument
+at once so absurd, so unprofessional,
+and so malignant. It evidently
+excited no feeling but that of disgust in
+the minds either of the Judge or the Jury.</p>
+
+<p>The next paragraph to which we
+shall allude is a masterpiece of hypocrisy&mdash;"Let
+me ask you (said he) what
+you have heard respecting the miseries
+of the individual on whom the operation
+was performed? Not one word
+has escaped the lips of the counsel on
+that subject&mdash;not one word from the
+mouth of one of the witnesses. No,
+gentlemen, they are hospital surgeons
+themselves, and they know too well
+what the practices of our hospitals are,
+and the sufferings <em>patients are in the
+habit of enduring at their hands</em>, to
+feel for this man, or for any other man
+placed in a similar situation!" Canting
+hypocrite! this from the man who
+in the very case before us published his
+account of the patient's sufferings in the
+form of a drama, mingled with low and
+scurrilous gibes. Mark also the following&mdash;"Give
+such a verdict as shall
+satisfy the <em>poor</em>&mdash;as will shew that men
+are not to go into offices of this sort
+where the <em>poor are to be killed</em>, and
+that they shall not be at liberty to wade
+and ride through blood up to their
+necks to eminence in their profession.
+Ah! gentlemen, give such a verdict as
+shall satisfy the <em>poor</em>!"</p>
+
+<p>There is in the various paragraphs
+we have quoted, more deep-rooted
+malice&mdash;more abandoned violation of
+the truth&mdash;more hypocrisy&mdash;and more
+open outrage of common sense, decency,
+and feeling, than we ever remember
+to have met with, even in the
+pages of the Lancet. It is now quite
+obvious that Wakley, alarmed at the
+change which has taken place in the
+estimation of his work within the last
+few months, finds it necessary to adopt
+a new system; he therefore throws off
+the mask, and openly declares himself
+the champion of the ignorant and
+illiterate<a name="FNanchor_22_22" id="FNanchor_22_22"></a><a href="#Footnote_22_22" class="fnanchor">[22]</a>&mdash;conjuring up to their imaginations
+evils which do not exist&mdash;denouncing
+<span class="pagenum"><a name="Page_134" id="Page_134">[134]</a></span>
+the medical profession as
+one of blood and murder&mdash;medical
+men as "thriving and fattening on
+their fellow-creatures"&mdash;and calling
+upon the "humane contributors to our
+hospitals and infirmaries" to support
+him.</p>
+
+<p>Why really now, if the times of political
+turbulence were to return, and
+radical reform again to come into vogue,
+Cobbett and Hunt would have a most
+valuable coadjutor; but as it is, we almost
+think the sphere he has chosen is
+too limited for such a genius. Humbug,
+to be successful, ought not to be
+very open to detection; alleged abuses
+ought not to be of a kind which every
+man can satisfy himself are entirely
+without foundation; and he who professes
+disinterested motives ought not
+to begin by raising a subscription for
+himself. We offer these few hints to
+Wakley, in hopes they may be of use to
+him in his new career; above all, we
+advise him to be sparing in protestations:
+there are some already who look
+upon his sincerity with a suspicious
+eye; for although it is no doubt true,
+that he would "rather die in a dungeon,
+and expire in a ditch," than injure
+any man, yet somehow an idea has got
+abroad, that his constant habits of lying
+and slandering are not quite in keeping
+with these assertions. Nay, we have
+heard of some even of the "humane
+contributors" to our charitable institutions,
+who have been so unreasonable
+as to disbelieve all Wakley's stories
+about the <em>cannibalism</em> of hospital surgeons,
+and to look upon the whole system
+of the Lancet as one of knavery
+and imposition.</p>
+
+
+<hr class="fulla" />
+<h2>WAKLEY'S SUBSCRIPTION MEETING.</h2>
+<hr class="r10a" />
+
+<p class="noindent">A most amusing scene took place at the
+Freemasons' Tavern on Tuesday evening,
+of which we subjoin an account. The
+object of the meeting was, "to present
+Mr. Wakley with some decided mark of
+their approval of his spirited conduct in
+his late trial;" or, in other words, if
+possible, to raise a little money, and bolster
+up the Lancet a little longer. The
+persons present were small in number,
+but great in zeal; and as much noise, hissing,
+laughter, and shouting, took place
+as would have done credit to a much
+larger assembly. As this is a merry
+season, and it may amuse our readers,
+we subjoin the speeches of the principal
+orators on either side: it will be perceived
+that both the Gazette and Lancet
+had some handsome compliments paid
+them; and that Wakley got thoroughly
+abused even by some of those who went to
+the meeting as the champions of reform.
+There was not a single individual present
+of any weight in the profession,
+and the chair was occupied by a young
+man wholly unknown, except as secretary
+to the meetings held two years ago
+on the subject of surgical reform.
+Could no one whose name might sound
+familiar in the public ear be prevailed
+upon to go?&mdash;could none be found but
+Pateys, Wallers, Mills, Elliots, Childs,
+and the Lord knows who? Where was
+he, the idol of the Lancet, who on
+other occasions graced the chair&mdash;where
+he who first ycleped that Journal the
+"invaluable"? Alas! poor Wakley,
+what an exposure of a sinking cause!
+even thy former friends tremble for
+their reputations, and desert thee.</p>
+
+
+<hr class="fulla" />
+<h2>SURGICAL REFORM.</h2>
+
+    <div class="fs90">
+
+<p class="noindent">A meeting was held yesterday evening at
+the Freemasons' Tavern, in pursuance of an
+advertisement calling on the "Friends of
+Surgical Reform, the Supporters of a free
+Medical Press, and the humane Contributors
+to our Hospitals and Infirmaries," to
+meet there, in order to adopt measures for
+presenting Mr. Wakley, the Editor of the
+Lancet, with some decided mark of their
+approval of his spirited conduct, in his late
+trial in the Court of King's Bench, at the
+suit of Mr. Bransby Cooper, and of the
+principles which he so powerfully advocated
+on that occasion.</p>
+
+<p>[Mr. Patey, who was called to the chair,
+stated the object of the meeting; but as his
+speech was rather long, and contained
+nothing of the least interest, we omit it.]</p>
+
+<p><em>Mr. Waller</em>, in proposing the first resolution,
+adverted to the terms of the advertisement,
+and remarked that the question
+for them was not whether they would support
+<span class="pagenum"><a name="Page_135" id="Page_135">[135]</a></span>
+Cooper against Wakley, or Wakley
+against Cooper; but whether they would
+have a free medical press or not&mdash;(cheers).
+Every body must admit that there was only
+one medical publication that was entitled to
+be considered free&mdash;only one that dared to
+tell the truth. Another had been attempted
+to be set up against it, but this wretched rival
+was gagged and manacled, and its reports
+were only a medium which distorted truth,
+and were almost unintelligible. It was not,
+however, to support any particular man, or
+publication, that he came to that meeting,
+but to support the general cause in which
+they were all interested. He concluded by
+moving, as the first resolution, that "the
+best interests of the medical profession and
+of the public are identified with the cause
+of medical and surgical reform; and that
+Mr. Wakley, as Editor of the Lancet, having
+given the first impulse to that cause, and
+having subsequently advocated it with undeviating
+firmness and fidelity, is entitled to
+the cordial thanks and support of this meeting."</p>
+
+<p><em>Mr. Mills</em> seconded the resolution.</p>
+
+<p><em>Dr. Shiel</em> said this was an important meeting,
+in his opinion; for, if this resolution
+were passed, it would identify the medical
+profession with the Editor of the Lancet.
+If the principle embodied in that resolution
+went forth to the world, it would be attended
+with consequences deeply injurious to the
+profession. He knew neither Mr. Bransby
+Cooper nor Sir Astley, and therefore he was
+perfectly impartial. The first question was,
+how far the medical press was conducted
+with advantage to medical science and the
+members of the profession. Now he contended,
+but with great respect, and disclaiming
+all personal hostility, that the
+Lancet had nowise contributed to the progress
+of medical science or the improvement
+of the profession&mdash;(loud hissing, and some
+cheers). He trusted that the meeting had
+not been got up by a few of the friends of
+Mr. Wakley, and he was sure that that
+gentleman was too respectable and too dignified
+in his proper person to need any such
+attempt&mdash;(applause). He trusted that the
+meeting was before the British public to ascertain
+how far the Lancet was useful or advantageous
+to medical science; and he hoped
+that, however partial the gentlemen present
+might be to Mr. Wakley, they would be
+governed in what they should do by the
+real interests of science&mdash;(hear, hear). The
+question was one of great interest; for it
+was one that embraced not only the freedom
+of the press but the advancement of medical
+science. With respect to the freedom
+of the press, they lived in a country where
+the law always maintained that principle.
+When Mr. Abernethy had applied for an injunction
+against the Lancet, Lord Eldon
+said that there could be no doubt that the
+Lancet was a most useful publication&mdash;(applause).
+He did not know whether that observation
+had been brought forward at the late
+trial; but taking the case&mdash;what was it? It
+appeared that the operation was one of
+peculiar difficulty, as stated upon oath by
+some of the most experienced surgeons of
+the day. This operation was laid hold of by
+the Lancet, and published not as a medical
+but as a tragical performance, in which all
+persons without science or knowledge were
+appealed to, and no opportunity afforded to
+Mr. Cooper to vindicate himself. Here,
+then, was a low and pitiful attempt made
+through the medium of malice and calumny
+(loud hisses and uproar). Here was a rude
+and pitiful attempt by malice and calumny
+(renewed signs of disapprobation). And yet
+it was contended that this had advanced the
+medical profession. The evidence on the
+trial went to shew that the dangers by which
+the operator had been surrounded were not
+small, and that there was no just reason to
+accuse him of unskilfulness in what he did;
+and was it then to be said, in the face of the
+British public, that a Meeting had been held
+at the Freemasons' Tavern to offer praise
+and reward to the individual whose conduct
+had, by the verdict of the Jury, been stamped
+with the accusation of untruth (hear, hear!
+and hisses)? He would not deny that there
+was a degree of talent displayed in the Lancet;
+but neither could it be denied that it
+was a public depredator by means of reports
+surreptitiously obtained; and the title of
+"literary raven," which had been applied by
+Sir James Scarlett, appeared to him to truly
+depict its character (great hisses and uproar).
+Was it to be contended that any one
+had a right to come into a private lecture-room,
+and catch up all he could hear, and
+then to publish what he had thus surreptitiously
+and fraudulently obtained (immense uproar
+and hisses)? As far as the medical interest
+was concerned, he looked upon the Lancet
+as one of the most injurious publications that
+had ever appeared (hisses). All the best
+writers on the subject had dwelt with peculiar
+emphasis on the necessity of secrecy
+among the members of the profession, but
+the Lancet broke through this good rule, and
+made public whatever came within its notice;
+and he had no doubt that if it could get at the
+cases that occurred in private practice, it
+would give them without any scruple (uproar).</p>
+
+<p>The <em>Chairman</em> begged to remind the
+speaker that at all events Mr. Wakley had
+not as yet done so.</p>
+
+<p><em>Dr. Shiel.</em>&mdash;I am arguing on the principle
+which appears to actuate Mr. Wakley.</p>
+
+<p><em>Mr. John Elliot</em> rose to order. He could
+not allow Dr. Shiel to be going upon suppositions;
+the thing that he supposed had never
+been done.</p>
+
+<p><em>Dr. Shiel</em> was sure that whatever turn might
+<span class="pagenum"><a name="Page_136" id="Page_136">[136]</a></span>
+be given to the subject in England, that at all
+events the conclusions that the Meeting appeared
+to be coming to would be resisted
+abroad. The weight of Sir Astley Cooper's
+name abroad would overpower any such attempt,
+and, in fact, would render it contemptible;
+so that any attempt to prop up
+so low, pitiful, and mean an attack, must inevitably
+be attended with disgraceful failure
+(hisses).</p>
+
+<p>A gentleman observed, that he was much
+surprised at what had fallen from Dr. Shiel.
+He had been induced to suppose that the
+Lancet possessed talent, as he had heard it
+praised in so many directions, and he certainly
+had never heard till that evening that
+it was only to be found in the hands of the
+illiterate (hear, hear! and a laugh). He
+had always understood that it was only destined
+for the use of students and other members
+of the profession, and that it was likely
+to be of great use in reforming the abuses of
+the medical practice (hear, hear! and cries
+of "So it will!"). For his own part, he
+was glad that medical men were occasionally
+cut up, because when they did what was
+wrong it was proper that they should be
+told of it; and when they did what was right,
+it added a fresh stimulus to their exertions
+(applause).</p>
+
+<p><em>Mr. Thomas</em> observed, that he had not intended
+to say any thing at the present meeting;
+but as Dr. Shiel, in the course of his
+speech, had thought proper to make some
+remarks tending to calumniate Mr. Wakley's
+witnesses on the trial, of which he was one,
+he felt called upon to say a few words (hear,
+hear!). Dr. Shiel seemed to consider them
+all as the mere scum of the earth&mdash;as a miserable
+band, collected together to support
+Mr. Wakley, whatever might be the consequence;
+as though he was desirous of going
+the whole length of the Medical Gazette,
+which stigmatised them for what it called
+"their deep-laid contrivances&mdash;their rankling
+enmities, and their bitter revenge."
+For himself he could say, that it was not till
+the evening previous to the trial that he had
+been supœnaed, and that he had previous to
+that time never seen Mr. Wakley.</p>
+
+<p><em>Dr. Shiel</em> said that he could not have alluded
+to the gentleman who was speaking,
+as he did not even know his name.</p>
+
+<p><em>Mr. Thomas</em> then went on to observe, that
+as Dr. Shiel appeared to be the advocate of
+the opposite party, he also supposed that he
+was a contributor to the aristocratical (Medical)
+Gazette ("No, no!" from Dr. Shiel).
+If he were not, at all events he had put forward
+ideas that were quite consonant to the
+sentiments expressed in that Journal. In
+giving his testimony, he had not spoken of
+the instruments employed in the operation,
+but of his own impression on the subject,
+having been present thirty-five minutes; and
+that impression certainly was, that the operation
+had been performed in a bungling and
+unscientific manner (loud applause, mingled
+with hisses). Was he then, because he happened
+to be a witness on the occasion, to be
+put down, pell-mell, by the unfounded imputations
+of any one? The highly-principled,
+honourable-minded Medical Gazette, that
+had determined never to admit any personalities,
+had loaded Mr. Wakley and Mr.
+Lambert with all sorts of abuse. Was this
+what they intended to call acting on principle
+(applause, and cries of "No, no!")?
+He certainly had heard that Mr. B. Cooper
+was an amiable man in private life; but
+what had that to do with the question at
+issue? What had they to do with the private
+character of a man in a public office
+(cheers)? Surely the witnesses of Mr.
+Wakley were as competent to speak of the
+manner in which the operation was performed
+as those who had not been present
+(applause); and as he had seen many operations
+performed he conceived that he was a
+competent judge of the skill of the operator
+(applause).</p>
+
+<p>A gentleman, who appeared to be a student,
+thought that the introduction of any attack
+upon the witnesses, or indeed of anything
+that occurred at the trial, was irrelevant
+(hear, hear!). The way to answer a
+speaker was not by hisses, but by disproving
+his arguments and rebutting his facts
+(applause). If questions were to be settled
+merely by strength of lungs, he was afraid
+that instead of the right side prevailing, success
+would uniformly attend those whose physical
+powers probably much exceeded their mental
+(laughter and applause). He could not agree
+with the gentleman who had stated that the
+law of England was the protector of the freedom
+of the Press; for it was well known
+that the Judges had decided, over and over
+again, that truth was a libel (applause). It
+was only the vehicle that conveyed public
+sentiment, and not the force that impelled it
+forward. He was convinced that any attempt
+to connect medical reform with Mr.
+Wakley should be studiously avoided and
+disclaimed. As a friend of free discussion
+in every case, and anxious to uphold the
+principle, whatever he might think of the
+instrument, he intended to propose, as an
+Amendment, "That the latter part of the
+Resolution, relating to Mr. Wakley, should
+be omitted." This would save the cause of
+medical reform from being identified with
+Mr. Wakley, of whose impartiality he would
+give a specimen. In the last number of the
+Lancet, the report of the late trial was given
+from the Times, but with a remarkable omission.
+The Lord Chief Justice had rebuked
+one of the defendant's witnesses for not answering
+the questions in a straightforward
+manner, and this passage was omitted. If
+Mr. Wakley would do this on such an occasion,
+would he be more candid when the public
+eye was less upon him? He, therefore,
+wished to have the question of medical reform
+<span class="pagenum"><a name="Page_137" id="Page_137">[137]</a></span>
+kept separate from Mr. Wakley individually.
+The first part of the Resolution
+would be carried without a dissenting voice,
+as on that principle they were all agreed,
+whatever they might think of the conduct of
+individuals.</p>
+
+<p>[One or two persons then made speeches
+for or against the amendment; which was
+negatived, and the original motion carried.]</p>
+
+<p><em>Mr. Hensley</em> then, after observing that Mr.
+Wakley's conduct was highly praiseworthy,
+because it tended in every way to the benefit
+of humanity, moved the second Resolution,
+which was to the following effect:&mdash;</p>
+
+<p>"That the purposes for which the Hospitals
+and Infirmaries of the Metropolis were
+founded, and that the views of the humane
+contributors to their funds, are materially
+promoted by the weekly publication of reports
+detailing the medical and surgical
+treatment of the unfortunate patients; and
+that Mr. Wakley having originated the practice
+of publishing Hospital Reports, has conferred
+important benefits on Medical Science,
+and on the cause of humanity."</p>
+
+<p>The resolution was then carried unanimously.</p>
+
+<p><em>Mr. John Elliott</em>, on moving the third resolution,
+said that he did not come there to
+interfere in the quarrels of Wakley and
+Cooper. They had acknowledged that Mr.
+Wakley's exertions had been very conducive
+to medical reform, by the last resolution
+they had passed. Indeed, there could be
+no doubt that he had greatly served the
+cause of humanity, by preventing idleness on
+the part of medical persons, and compelling
+attention to the poor placed under their care.
+It was his opinion that the editor of the
+Lancet ought to be indemnified for the whole
+expense entailed on him by the late trial,
+including the damages awarded against him.
+This would not be a private subscription,
+like Brodie's, but one open to the world,
+and not to be questioned in a court of justice.
+He would not support Mr. Wakley
+if he had attacked private character; but he
+would, as the editor of the Lancet and the
+representative of the medical free press.
+He concluded by moving&mdash;</p>
+
+<p>"That the independent and impartial
+principles on which the Lancet was first
+established, have been preserved by Mr.
+Wakley at all risks; and as it was acknowledged
+at the late trial, that the legal expenses
+of his opponents on another occasion
+have been defrayed by certain hospital physicians
+and surgeons<a name="FNanchor_23_23" id="FNanchor_23_23"></a><a href="#Footnote_23_23" class="fnanchor">[23]</a>, it is farther resolved,
+that a subscription be opened for the purpose
+of defraying the expenses of the late
+action."</p>
+
+<p>[Dr. Shiel here spoke very strongly
+against entering into a subscription&mdash;while
+some spoke in its favour.]</p>
+
+<a name="P137" id="P137"></a>
+<p>A discussion then arose about the question
+of whether an account of a second operation
+for lithotomy by Mr. Cooper (in which he
+had been successful) had been sent to Mr.
+Wakley? It was stated that such was the
+case, but as the action for the present libel
+was then commenced, <em>Mr. Wakley thought
+that he perceived something in that second report
+that might tend to aggravate the damages, and
+which, at the same time, would be farther injurious
+to Mr. B. Cooper</em>.</p>
+
+<p>The third resolution was then carried by
+an immense majority, only five hands being
+held up against it.</p>
+
+<p><em>Mr. Evans</em> moved, "That the statement of
+professional facts in an unprofessional form,
+such as the dramatic instead of the narrative,
+is highly reprehensible in the individual,
+and detrimental to the best interests of
+science."</p>
+
+<p>This resolution, after some turbulent discussion,
+was withdrawn.</p>
+
+<p><em>Mr. J. L. Stevens</em> then moved, as the fourth
+resolution, that "In accordance with the
+feelings this meeting has expressed, Mr.
+Wakley be invited to attend a Public Dinner,
+and that a Committee be forthwith nominated
+to arrange the same."</p>
+
+<p><em>Mr. Rogers</em> seconded the resolution, and
+it was carried unanimously.</p>
+
+<p>The members of the committee were then
+named, and power given to them to add to
+their number.&mdash;The chairman then vacated
+his office, and the meeting separated.&mdash;<cite>Morning
+Chronicle, Wednesday.</cite></p>
+
+<hr class="r10a" />
+
+<p>In the course of the evening, the conduct
+of one of the speakers gave for a short time
+an amusing turn to the discussion, which for
+a great part had appeared to many extremely
+dry and tedious. The gentleman in question,
+(not a medical man), in order to show
+the opinion he had entertained of the object
+of the meeting, proposed to read for the
+audience a letter which he himself had
+written to the chairman of the committee,
+asking permission to attend. He began, but
+he had scarcely got through a few words
+when he declared he was not able to make
+out his own writing, and requested the chairman
+to assist him. The chairman made the
+attempt, but was not more successful. Another
+gentleman then undertook the task, but
+with no better effect. The audience received
+each unsuccessful effort with loud laughter,
+which so much annoyed the writer that
+he took back the letter, and again tried to
+go through with it, but not being able to
+make it out, he proposed to read for the
+meeting two letters which he wrote on the
+same subject to the editor of a Sunday
+paper. (Loud laughter followed this proposition,
+which was increased, when, on an attempt
+to read one of them, he had no more
+success than before.) The gentleman, after
+complaining of the want of courtesy in the
+meeting, resumed his seat, declaring that he
+would give the letters to the reporters.&mdash;<cite>Times,
+Wednesday.</cite></p>
+
+    </div>
+
+
+<hr class="fulla" />
+<p><span class="pagenum"><a name="Page_138" id="Page_138">[138]</a></span></p>
+<h2>HOSPITAL REPORTS.</h2>
+
+<hr class="r10a" />
+<h3>GLASGOW ROYAL INFIRMARY.</h3>
+
+<p class="center"><em>Injuries of the Head.</em></p>
+
+<p class="noindent">D. M'Millan, æt. 40, seaman;&mdash;while
+he was employed in the hold of a vessel,
+a heavy iron block, of a round form, fell
+from the rigging, a height of 20
+feet, and struck him on the head.
+He was knocked down and stunned,
+but was able to rise and to walk with
+a little support. He was brought about
+a mile and a half in a hackney-coach to
+the hospital, and admitted by Mr.
+Cowan at one o'clock <span class="fs70">P.M.</span>, half an hour
+after the accident. At this time he had
+a stupified look, but was quite collected,
+and was able to walk across the
+ward; breathing and pupils both natural;
+pulse 75, of moderate strength.
+There was a wound in the scalp, commencing
+nearly over the centre of the
+sagittal suture, and running about
+three inches backwards and towards the
+left; along this a portion of skull, corresponding
+to the wound in size, was
+felt fractured, detached, and irregularly
+depressed. His right arm was benumbed
+and nearly powerless, but no
+mark of injury was observed on it.</p>
+
+<p>It was determined to remove the detached
+piece of bone, and the original
+wound being extended lengthwise in
+both directions, an incision was made
+through the scalp at right angles to it
+over the left parietal bone, thus bringing
+the fractured portion into view. This
+was found to be broken down into several
+fragments, some of which were
+firmly impacted under the surrounding
+cranium, and one spiculum, driven
+through the dura mater, had penetrated
+the brain. The trephine was applied a
+little to the left of the fracture, and
+the intermediate part removed with
+Hey's saw; the detached pieces of
+bone, ten in number, of various sizes
+and irregular shapes, were removed
+with the forceps, the scalp replaced
+and retained in position by a stripe of
+adhesive plaister and very light dressings.
+During the operation one artery
+required ligature, and about
+<span class="screenonly">℥v.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />v.</span>
+of blood were lost: he had lost perhaps as
+much before. He remained quite sensible,
+bore it well, and shortly afterwards
+had half a glass of port wine in
+warm water.</p>
+
+<p>Ten <span class="fs70">P.M.</span>&mdash;Has been tolerably easy;
+complains of pain of fore-part of head;
+pulse 82, firm.</p>
+
+<p class="pad1 fs80">Fiat V. S. ad
+<span class="screenonly">℥xviii.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />xviii.</span></p>
+
+<p class="neg3">Sumat statim Submur. Hydr. gr. viii.
+Pulv. Antimon. gr. vi.</p>
+
+<p class="neg3">Applic. Capiti Lotio ex Alcohol. et aq.
+calcis.</p>
+
+<p>Second day.&mdash;After bleeding, thought
+feeling of numbness of right arm somewhat
+lessened, and to-day has rather
+more power of it. Passed a tolerable
+night; a little head-ache; countenance
+pretty natural; tongue slightly loaded;
+thirst; no stool.</p>
+
+<p class="pad2 fs80">Sum. stat. Sulph. Magnesiæ
+<span class="screenonly">℥j.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />j.</span>
+et rep. vesp. si opus.</p>
+
+<p>Third day.&mdash;From an aversion to use
+the bed pan, he rose to stool last night,
+and fell forwards on the floor, seemingly
+from having entangled himself in
+the bed clothes; he got into bed without
+assistance; had a shivering fit
+shortly after, but has had a pretty good
+night; bowels freely opened; head-ache
+slight; pulse 84, soft; tongue
+dry in middle. Towards the evening of
+this day he appeared drowsy; and on
+the fourth day he is reported as seeming
+confused and uneasy; countenance
+anxious; articulation difficult; the
+right arm was more paralysed, and indeed
+the whole right side seemed now
+to partake in the paralysis; a small
+part of the wound had adhered, the remaining
+part was flabby, discharging
+thin serum. In the evening the difficulty
+of articulation and drowsiness
+had increased. Twelve leeches were
+applied to each temple, and in a short
+time he seemed a little livelier.</p>
+
+<p>Fifth day.&mdash;Much in the same state;
+took a little beef tea.</p>
+
+<p>Sixth day.&mdash;Paralytic symptoms increased;
+breathing laborious. Blister
+to the neck. It may be worthy of remark,
+that in the few words he now
+spoke he never made use of the English
+language, but of the Gaelic, which was
+his native tongue; and even when told
+that he was not understood, he persisted
+in repeating the Gaelic phrase.</p>
+
+<p>Seventh day.&mdash;A small fungus was
+observed in upper part of wound, to
+which lint dipped in lime water was
+applied, and moderate pressure. The
+fungus continued to increase.</p>
+
+<p>On the eleventh and twelfth days he
+had slight bleedings from the scalp,
+<span class="pagenum"><a name="Page_139" id="Page_139">[139]</a></span>
+which stopped spontaneously. Stupor,
+&amp;c. greatly increased, but he still recognised
+his friends; took a very little
+chicken soup or beef tea daily, with
+lemonade, &amp;c. for drink.</p>
+
+<p>On the evening of the thirteenth day
+bleeding to the extent of
+<span class="screenonly">℥iv.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />iv.</span>
+or v. took place from fungus: it was checked by
+application of saturated solution of
+alum, but he sunk rapidly, and died
+that night.</p>
+
+<p><em>Inspection 36 hours after death.</em>&mdash;The
+fungus protruded considerably beyond
+the scalp, and was rather larger
+than a hen's egg, of a dirty brown
+colour, and a soft spongy consistence;
+it completely filled up the opening
+made in the skull by the trephine and
+removal of detached bone. The pericranium
+to the inferior side of this
+opening was found detached from the
+bone, to the extent of a crown piece,
+and beneath it the bone was rough, and
+covered with thin purulent matter.
+The dura mater, for two inches around
+the fungus, was covered with pus; this
+membrane, by sloughing, had allowed
+the fungus to protrude, and its edges
+adjacent to the aperture were thickened.
+On removing the dura mater, the
+fungus was observed to arise, partly
+from the middle, but chiefly from the
+posterior lobe of the left cerebral hemisphere:
+it occupied a space about
+three inches in length, and an inch and
+a half in breadth, extending to within
+a line or two of the roof of the ventricle;
+at its anterior part was an abscess,
+containing
+<span class="screenonly">℥ss.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />ss.</span>
+of pus. The fungus
+seemed to be a degeneration of the
+cerebral substance; sections of it showed
+the cerebral matter first dotted with
+an unusual number of bloody points,
+then assuming a greyish colour, which
+gradually passed into a dirty brown.
+With the exception of these bloody
+points, the brain presented no unusual
+vascularity: it was quite firm, except
+in the immediate neighbourhood of the
+fungus, where it gradually became
+softer as the colour of the cerebral substance
+became deeper, till in the centre
+of the fungus it was nearly of a broken
+down consistence. A quantity of serum
+was found in each ventricle.</p>
+
+<p class="p1" />
+<p>Another man who had been struck by
+the piece of iron which fractured M'Millan's
+skull was brought up to the hospital
+at the same time. He had received the
+blow on the vertex of his head. On admission
+he was in a state of fury, requiring
+the efforts of several men to hold him.
+His head was bruised out of all shape,
+quite depressed behind, and a fracture
+also of the frontal bone; there were
+evident symptoms too of fracture of the
+base of the skull. The case was hopeless.
+Several large depressed and detached
+pieces of bone were removed,
+but he died a few minutes after the
+operation.</p>
+
+<p class="p1" />
+<p>During the same week an old woman
+was brought up to the infirmary, who,
+the day previously, had fallen headlong
+down a stone staircase. She laboured
+under the severest symptoms of concussion,
+and besides had a comminuted
+fracture of the humerus into the elbow
+joint, and of the radius into the wrist
+joint of left arm. She was past all treatment,
+and died on the second day. The
+case is mentioned chiefly to remark,
+that although no external injury of the
+head could be observed, on inspection a
+fracture was found extending completely
+across the anterior part of base of
+cranium.</p>
+
+<p class="p1" />
+<p>There are no dispensaries in Glasgow,
+but such of the poor as are unable to
+obtain admission into the Royal Infirmary,
+and those who are not so ill as to
+submit to the confinement of an hospital,
+or for other reasons prefer remaining
+in their own houses, are prescribed
+for, and, if necessary, visited at the
+public expense. For this purpose the
+city is divided into districts, and a surgeon
+appointed to each. The "district
+shop" thus resembles a dispensary,
+where the surgeon prescribes in the presence
+of his pupils, who indeed, under
+his superintendance, have the management
+of many of the cases, both among
+the patients who receive advice at the
+"shop," and those who are visited at
+home. Although under the care of a
+surgeon, the diseases treated are both
+medical and surgical, for there is little
+distinction made between the two
+branches of the profession here.</p>
+
+<p>The following case occurred under
+the care of Mr. Stirling:&mdash;</p>
+
+<p>W. M. æt. 28, while returning home
+during the night in a state of intoxication,
+fell from a height of ten feet, into
+a court paved with stone. He was rendered
+insensible for some time, but on recovering
+was able to crawl to the nearest
+door, and was conveyed home. Medical
+assistance was immediately procured.
+<span class="pagenum"><a name="Page_140" id="Page_140">[140]</a></span>
+On the forehead, about an inch above
+the nasal process of the frontal bone, was
+a cut an inch and a half in length, extending
+obliquely downwards from the
+right side; through this a triangular
+fracture was felt, the base of which was
+in the direction of the external wound,
+and the apex pointing downwards; the
+fractured portion of the bone was slightly
+depressed; the bones of the nose were
+also fractured, and there was great discharge
+of blood from the nostrils. One
+third, or nearly, of the upper lip was
+cut off, and a good deal of blood had
+been lost from the labial artery; the
+lower jaw at the symphysis was fractured
+and comminuted, and several
+pieces were perceived to be loose. Was
+quite sensible, remembering every thing
+up to the period of the accident. Pulse
+80; has vomited frequently. Wound of
+forehead was dressed with adhesive
+plaister; the loose pieces of bone were
+removed from the lower jaw, and it was
+afterwards retained in juxta-position by
+a chin bandage.</p>
+
+<p>Early next morning he was bled to
+<span class="screenonly">℥xii.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />xii.</span>
+and had a purge of jalap and calomel,
+by which his bowels were freely
+opened. That night he felt considerable
+pain of head; pulse 90, full, and
+strong. He was bled again to
+<span class="screenonly">℥xxv.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />xxv.</span>
+Blood first drawn had the buffy coat.
+After the bleeding the pain of head
+diminished, and he continued to do
+well. When the swelling and tenderness
+of face had subsided, it was observed
+that the fracture communicated
+with the frontal sinus. On holding his
+nose and attempting to blow it, matter
+and air escaped by the fracture. The
+man was anxious for a speedy cure, and
+for this purpose an operation to remove
+the depressed piece of bone was at one
+time thought of; there was no constitutional
+disturbance, however, and the
+case was left to nature. The discharge
+gradually diminished, and the wound
+healed up in about a month. The bones
+of the nose retained their position, and
+the broken ends of the jaw, after the
+swelling had subsided, were kept in
+their proper situation by a pasteboard
+splint till re-union took place. The lip
+also healed easily, and no deformity is
+now observable.</p>
+
+
+<hr class="r10a" />
+<h3>GUY'S HOSPITAL.</h3>
+
+<p class="center"><em>Inflammation of Hernial Sac.</em></p>
+
+<p class="noindent">The previous report of this case (Gazette,
+No. 51) conducted it to Nov.
+18th, the tenth day from the operation,
+and the third on which fæces had been
+discharged from the wound; that discharge
+continued on the 19th, but on
+the 20th pus only was seen.</p>
+
+<p>Nov. 22.&mdash;Yesterday the dresser, Mr.
+King, observed a portion of <em>solid</em> fæces
+make its escape, and to-day a similar
+discharge, in the fluid form, is manifest.</p>
+
+<p>Nov. 26.&mdash;Since the 22d, nothing
+but healthy pus has been seen; the
+wound is rapidly healing, and the patient's
+general condition as good as can
+be desired.</p>
+
+<p>Dec. 4.&mdash;He has begun to wear a
+truss, and is to-day allowed to leave
+his bed.</p>
+
+<p>Dec. 8.&mdash;As regards his original complaint,
+the man is perfectly convalescent,
+but he now discloses a small abscess in
+the scrotum, which has been gradually
+forming, and will detain him in the
+house some time longer.</p>
+
+<p>If it be a sound surgical maxim that,
+in strangulated hernia, the patient's
+safety depends upon an early operation,
+it is also a maxim no less sound, that
+where the evidence and symptoms of
+strangulation are imperfect, or dubious,
+the benefit of the doubt should be
+given to the operation, and it should
+be performed: for it is better that buboes
+should be laid open, or inflamed
+sacs cut into, twenty, aye, fifty times
+in succession, than that in one case a
+man should be suffered to die with
+strangulation of the intestine unrelieved.</p>
+
+<p>These remarks apply strikingly to
+this case of Mr. Key's, in which, although
+no hernia was found, they perfectly
+justify the operation. No case of
+strangulation could be more distinctly
+marked, or more clearly call for the
+knife, than did this; and had Mr. Key
+refused to use it, he would have deserved
+the scoff which, by a contemporary,
+has so preposterously been
+thrown on the "no hernia case." But,
+more than this, the operation was not
+only justifiable, but beyond a doubt
+<em>beneficial</em>&mdash;beneficial inasmuch as it at
+once relieved the distress of the patient,
+secured him from more extensive suppuration,
+from farther sloughing of intestine,
+and probably from extravasation
+of fæces into the abdomen; rendering
+also the process of reparation
+more easy and rapid.</p>
+
+<p><span class="pagenum"><a name="Page_141" id="Page_141">[141]</a></span></p>
+
+<p class="center"><em>Hereditary Hare-Lip.</em></p>
+
+<p>Dec. 4th, Mr. Key performed the
+operation for hare-lip on a child a few
+months old, whose case was remarkable
+only as it afforded an instance of <em>hereditary</em>
+malformation. The father of
+the child had congenital hare-lip, for
+which no operation had been performed,
+and of his six children <em>two</em> were born
+with the same malformation.</p>
+
+<p><em>Queries.</em>&mdash;1. If the father's lip had,
+in his infancy, been restored to the natural
+form, would the malformation
+in that case have descended to his children?</p>
+
+<p>2. Is the casualty in these cases to
+be traced <em>directly</em> from the father to the
+incipient embryo, or <em>indirectly</em>, through
+the medium of the mother's imagination&mdash;It
+has been said that paternal resemblances
+are produced in the latter
+mode.</p>
+
+<p class="rt">G.</p>
+
+
+<hr class="r10a" />
+<h3>PARIS HOSPITALS.</h3>
+
+<p class="center"><em>Hôtel Dieu.</em></p>
+
+<p class="center"><em>Cases of Gangrene of the Lungs.</em></p>
+
+<p class="noindent">Some interesting cases of gangrenous
+suppuration of the lungs were published
+by Dr. Chambers, about eighteen
+months ago, in which he particularly
+pointed out the horrible fœtor
+of the breath as a diagnostic mark
+of the disease. The following cases
+which recently occurred at the Hôtel
+Dieu are good illustrations of more
+extensive destruction of the lung by a
+similar disease.</p>
+
+<p><span class="smcap">Case I.</span>&mdash;A man, aged 32, of good
+constitution, laboured under bronchitis
+for some weeks, to which he paid little
+attention, when he was suddenly seized
+with pain in left side, dyspnœa, considerable
+cough, and a rigor, followed
+by fever. He was admitted into the
+Hôtel Dieu next day. Crepitation was
+perceptible over the whole extent of the
+left lung, posteriorly, and reaching to
+the site of the pain in the side, which
+was increased by percussion; great oppression,
+with frequent cough, and expectoration
+of violet-red colour, mixed
+with mucus; pulse frequent and small;
+constant chilliness; cheeks flushed.</p>
+
+<p>Next day the symptoms remained unabated,
+and <em>fœtor of the breath</em> was
+observed. Two days after it is stated
+that the expectoration maintained the
+same appearance, but <em>was now fœtid</em>;
+the breath was, however, still more
+offensive, and during the fits of coughing
+particularly so. In the evening the
+breath is said to have become <em>gangrenous</em>.</p>
+
+<p>21.&mdash;The cough was small, difficult,
+and painful, producing an expectoration
+of violet-coloured matter, approaching
+to chocolate, <em>with a characteristic
+odour</em>.</p>
+
+<p>22 to 25.&mdash;Expectoration and breath
+emit an <em>intolerable stench</em>. On the latter
+day the patient died.</p>
+
+<p><em>Examination.</em>&mdash;The body not emaciated.
+Strong adhesions of the left
+lung to pleura costalis. At its posterior
+part a large gangrenous layer, occupying
+the two superior thirds of the
+lung, covered at some points by a false
+membrane. The lower third, and the
+parts round the gangrenous portion, in
+different degrees of inflammation, and
+hepatised; the putrid mass was in great
+part black or violet-coloured, containing
+fragments of the pulmonary texture;
+the smell gangrenous, but less
+so than that of the breath during life;
+pus might be squeezed from the adjacent
+part of the lung.</p>
+
+<p><span class="smcap">Case II.</span>&mdash;A man, aged 55, enjoyed
+good health till the beginning of May,
+at which time he experienced pain in
+the left side of the thorax after exposure
+to cold. During the next few
+days the cough was frequent, and the
+expectoration tinged with blood. A
+rigor now came on, followed by a distinct
+exacerbation of fever, and he
+came to the Hôtel Dieu. At this time
+he presented symptoms of inflammation
+of the lungs, and was bled with
+relief; he left the hospital in twelve
+days, being sufficiently well to resume
+his occupation. Scarcely had he done
+this, however, when he had a relapse,
+accompanied by great lassitude, oppression
+of breathing, and frequent cough.
+At the end of a week he returned. He
+was now at the twenty-first day of the
+attack. His skin was yellowish; face
+pale or of leaden hue, and greatly altered;
+his cough frequent, with abundant
+expectoration of matter like chocolate,
+with small specks resembling
+pus, and little bodies about the size of
+peas, which appeared to be portions of
+the lung. This putrid mass exhaled a
+<em>gangrenous odour</em>, and the expired air
+was impregnated in a high degree with
+an equally disgusting smell, which surrounded
+the patient's bed with a contaminated
+<span class="pagenum"><a name="Page_142" id="Page_142">[142]</a></span>
+atmosphere. Percussion gave
+a clear sound over the whole extent of
+the chest; auscultation did not discover
+the pulmonary expansion on the right
+side. The pulse was weak, but not
+frequent; the patient was in a state of
+extreme prostration. Next day the
+odour of the breath and expectoration
+was, if possible, more dreadful. He lingered
+two days longer, during which time
+the fœtid smell somewhat diminished,
+and the proportion of pus in the expectoration
+increased.</p>
+
+<p><em>Examination.</em>&mdash;The left lung had
+contracted firm adhesions, particularly
+above and behind. It was torn in attempting
+to remove it, and there issued
+from the middle and posterior part a
+large quantity of dark-coloured matter,
+similar to what had been expectorated.
+An incision was made along the back
+part of the lung, and laid open a large
+cavity, occupying all the extent of the
+pulmonary organ, and still in part filled
+with the same kind of dark putrid matter.
+On washing out the cavity it was
+perceived that it was lined with a
+smooth and white membrane, to which
+were still adherent, at some points, dark
+filamentous shreds; these were removed
+by the least touch, and left the surface
+smooth beneath. The boundary was
+formed by a false membrane, about a
+line in thickness, which separated the
+mortified from the sound parts. The
+lung was reduced to a kind of bag, the
+parietes of which were on an average
+about an inch thick. In the upper part
+of the lung, which was hepatized, an
+incision discovered a number of smaller
+tubercles, which in the centre were in
+a crude state; and at one point several
+had suppurated, forming a cavity large
+enough to contain a nut.</p>
+
+<p>[The Editors of the <cite>Journal Hebdomadaire</cite>,
+from which these cases are abridged,
+add, in a note, that although the fœtor
+of the expectoration, such as above
+described, is usually dependent on gangrene
+of the lungs, yet that this is not
+invariably the case. In confirmation of
+this assertion they refer to three instances
+of fœtid expectoration&mdash;in the
+first, the patient is still alive; in the
+second, there was chronic bronchitis,
+with considerable dilatation of numerous
+bronchi; and in the third, bronchitis
+with some appearances of chronic
+pneumonia. Laënnec gives a case of
+dilatation of the bronchi, with remarkably
+fœtid expectoration. The argument
+derived from the first patient
+having survived we consider to be altogether
+erroneous, as patients more
+frequently recover from this than other
+forms of purulent expectoration.&mdash;<span class="smcap">Ed.</span>]</p>
+
+
+<hr class="fulla" />
+<h2>PROCEEDINGS OF SOCIETIES.</h2>
+<hr class="r10a" />
+
+<h3>WESTMINSTER MEDICAL SOCIETY.</h3>
+
+<p class="center fs80">December 6th, 1828.</p>
+
+<p class="center smcap">James Arnott, Esq. in the Chair.</p>
+
+<p class="noindent">Pursuant to announcement, Mr. MacKelcan
+introduced the subject of concussion of the
+brain. After remarking on the several
+symptoms, and mentioning the other affections
+of the head with which concussion is
+apt to be confounded, Mr. M. directed the
+attention of the society more particularly to
+the treatment in the stage of collapse, adopted
+by Professor Andrini of Florence.</p>
+
+<p>Dr. Duffin stated, that having been in
+Florence, he had witnessed the employment
+of three, four, or six ounce bleedings employed
+by the Professor in the stage above-mentioned.
+The principle on which they
+were used was that of their acting as a
+stimulus to the brain; and really the plan
+was not apparently attended with any bad
+effects. When re-action has ensued, the
+practice of M. Andrini is the same as that
+resorted to in this country.</p>
+
+<p>The discussion then wavered between
+apoplexy and concussion, and ended by some
+good-humoured sparring between Dr. Addison
+and Mr. Gilbert Burnett, on the capability
+of the brain containing more blood at
+one time than another.</p>
+
+<p>The President announced from the chair
+that a special meeting would take place on
+Friday evening, December 12, at 7 <span class="fs70">P.M.</span></p>
+
+
+<p class="p1 center fs80">December 20th, 1828.</p>
+
+<p class="center smcap">Cæsar Hawkins, Esq. in the Chair.</p>
+
+<p>After some business had been dispatched,
+to which we shall allude in another place,
+Mr. Jewel related the particulars of a case of
+"supposed extra-uterine fœtation." The
+case, which is one of much interest, is as
+follows:&mdash;</p>
+
+<p>Mrs. F. a robust, healthy woman, ætatis
+27, had been married one year, and aborted
+once; when, in the month of September
+1827, she quitted her husband in London,
+and accepted a situation in the country.
+After the expiration of a few weeks she
+received permission to come to London for
+a day; and, naturally enough, passed that
+night, (November 8th), with her husband,
+returning again to the country next morning.
+Soon afterwards, the morning-sickness,
+heart-burn, and other sympathetic affections
+<span class="pagenum"><a name="Page_143" id="Page_143">[143]</a></span>
+of pregnancy, appeared; but the catamenia
+still returned at the regular periods, though
+scanty and paler in colour than natural.
+She now quitted her situation, returned to
+her husband, and engaged a midwife to attend
+her in her expected confinement. The
+circumstance of quickening occurred in the
+latter part of February, and was accompanied
+by a severe paroxysm of fainting, whilst the
+abdomen gradually enlarged, and the motions
+of the child (as was imagined) could
+not only be easily detected with the hand,
+but were visible to the eye. On the 9th of
+August, making a period of 274 days, she
+was seized with the usual premonitory symptoms
+of labour; the midwife arrived; found
+her walking her chamber, and concluded that
+the process had considerably advanced.
+Three distinct uterine contractions took
+place subsequent to the midwife's arrival,
+the last of which was so severe as to compel
+the patient to grasp firmly the back of a
+chair, and induce, after its subsidence, excessive
+faintness. From this time no further
+parturient effort was made; no examination
+per vaginam was instituted; neither was
+there noticed any sanguineous vaginal discharge.
+When Mr. Jewel saw her, examination
+detected nothing unusual in the os
+uteri, and the symptoms she presents are
+these. The abdomen is about the size of a
+woman's in the sixth or seventh month of
+pregnancy, the enlargement being general.
+Her general health is much disturbed: she
+complains of pain in the left hypogastric
+region, particularly when the abdomen is
+compressed by the hand or stays&mdash;and she
+also complains of weight in the abdomen,
+especially on leaning forwards. The woman
+herself has a strong prepossession that
+"something is to come away," or that she
+might be relieved by an operation. The
+woman believes that she still feels the motions
+of the child, though feebly.</p>
+
+<p>Having read this case, Mr. Jewel concluded
+by offering some observations on the
+subject of extra-uterine fœtation. He considered
+this as probably an instance of "graviditus
+abdominalis," and remarked that the
+uterus not having expelled its dezidua, was
+no conclusive proof to the contrary, Dr.
+Blundell and Mr. Langstaff having examined
+cases where this was wanting.</p>
+
+<p>Dr. Locock never saw a case where laceration
+occurred in the early months of pregnancy.
+Dr. L. remembered the particulars
+of a case where the uterus was lacerated in
+the fourth month, and the ovum escaped into
+the cavity of the abdomen, and the symptoms
+of pregnancy were exceedingly strong.
+Dr. Locock almost doubted whether Mr.
+Jewel's was an instance of pregnancy at all,
+for frequently women enjoying sexual intercourse
+have enlarged abdomens, and many
+of the other symptoms of pregnancy, which
+a few doses of purgative medicine will
+remove.</p>
+
+<p>Two remarkable instances of extra-uterine
+fœtation were related by Mr. Burnett and
+Mr. Cæsar Hawkins; and towards the conclusion
+of the evening the discussion turned
+on the powers of the ergot of rye. Dr.
+Locock had frequently tried it in amenorrhœa,
+and, on the whole, without any very good
+effects. In one remarkable case, where the
+lady particularly wished to have children,
+Dr. Locock having boiled an ounce of the
+ergot in a pint of water down to half a pint,
+gave an ounce and a half of this decoction
+three times a day. After the young lady
+had taken about half a pint, the most violent
+convulsions succeeded, which placed her life
+in imminent hazard, and from which it was
+long before she completely recovered. She
+menstruated twice after that, but then the
+discharge again was arrested, and has never
+since returned, nor has she become pregnant.</p>
+
+<p>The practice of "bougieing the uterus"
+in cases of dysmenorrhœa was brought upon
+the tapis, and excited a good deal of laughter,
+the members appearing to consider the
+proposal ridiculous in the extreme.</p>
+
+
+<p class="center fs90">MR. LAMBERT.</p>
+
+<p>At the last meeting of this Society it
+was proposed, on the recommendation of the
+Committee, that Mr. James Lambert should
+be expelled; and after some discussion it
+was agreed that the sense of the members
+should be taken by ballot at the next
+meeting, Saturday, January 3, 1829. It
+was thought that proceeding at once to his
+expulsion might give the appearance of the
+measure originating with a party, and that
+the delay would enable the deliberate judgment
+of the whole Society to be passed upon
+his conduct.</p>
+
+
+<hr class="r10a" />
+<h3>HUNTERIAN SOCIETY.</h3>
+
+<p class="center fs80">Dec. 10, 1828.</p>
+
+<p class="center smcap">Dr. Billing, President, in the Chair.</p>
+
+<p class="noindent">Mr. Leese, Jun. exhibited to the meeting a
+specimen of medullary sarcoma, taken from
+the forehead of a man after death, with a
+portion of the os frontis. The man was
+fifty-eight years of age, long asthmatic, and
+appeared to die of hydrothorax. He never
+suffered any pain in the tumor, but expressed
+a sense of distention. It was immoveable
+at the base, and there were some fissures in
+the os frontis, from caries. The dura mater
+at the corresponding part adhered firmly to
+cranium, and on its being removed some
+spiculæ from the carius inner table remained
+adhered to it. There had never
+been any symptoms of cerebral affection.
+A tumor of the same nature had formed on
+the scapular extremity of the clavicle, and
+had occasioned anasarca of the limb.</p>
+
+<p>Mr. Key supposed that the tumor had
+originated from the diplöe, and believed
+that the only chance of relief in such a case
+would be trephining; but he acknowledged
+<span class="pagenum"><a name="Page_144" id="Page_144">[144]</a></span>
+that there was little encouragement to operate
+in these cases, owing to the tendency
+of the disease to return in some other part.
+He related an instance of the true medullary
+fungus taking its origin from the cancellous
+structure of the os femoris. The limb was
+removed, but the patient died. A circle of
+fungoid glands was observed at the base of
+the heart, and some of the bronchial glands
+were in the same condition.</p>
+
+<p>Dr. Conquest expressed his belief that
+carcinoma was always a constitutional affection,
+and stated that at least in nine cases
+of cancer uteri out of ten, there was carcinomatous
+affection of the pylorus, mesenteric
+glands, or liver.</p>
+
+<p>Mr. Key and Dr. F. Ramsbotham had
+not observed, in their examinations, the
+coincidence noticed by Dr. Conquest.</p>
+
+<p>The remainder of the evening was occupied
+by a discussion on the different kinds
+of ulceration that occur about the os and
+cervix uteri, and the circumstances under
+which the removal of the uterus, or the amputation
+of the cervix, may be warrantable.</p>
+
+<p>Dr. Babington adverted to the occasional
+existence of a family disposition to carcinoma.
+He had known three sisters successively
+die of cancer in the breast.</p>
+
+
+<hr class="r10a" />
+
+<h3>MEDICAL SOCIETY OF LONDON.</h3>
+
+<p class="center fs80">Dec. 13th and 20th, 1828.</p>
+
+<p class="center smcap">Dr. Haslam in the Chair.</p>
+
+<p class="noindent">The subject of discussion, at the first of
+these meetings, was stricture of the rectum,
+when the diagnosis and treatment of carcinoma
+of that part came under consideration.
+There was a remarkable discrepancy in the
+opinions of Messrs. Lloyd and Salmon as to
+the symptoms and management of carcinomatous
+affections of the rectum. Mr. Lloyd
+maintained that these affections of the intestine
+were sometimes attended with pain
+and sometimes not, and that the patients
+were often materially benefited by the use
+of bougies; while Mr. Salmon affirmed,
+that the disease was always painful, and not
+to be mitigated by the employment of these
+means.</p>
+
+<p>A variety of subjects came before the
+society at the next meeting. The president
+read a letter from Mr. Wansborough, of
+Fulham, describing the "original stomach-pump,"
+a specimen of which accompanied
+the letter: the instrument Mr. W. stated to
+be of 25 years' standing.</p>
+
+<p>Mr. Shearly exhibited, among other morbid
+specimens, a uterus, on the external
+surface of which the disease termed the
+"white tubercle" was in progress: there
+was also a small polypus near the os uteri.
+Mr. Pereira exhibited to the society a fine
+specimen of medullary sarcoma of the liver.
+The organ was so enlarged as to have occupied
+two-thirds of the abdomen. The other
+viscera were not involved in the disease.
+The progress of the disease, as far as it
+could be ascertained, was excellently detailed
+by Mr. Smith, a visitor. The symptoms
+were obscure.</p>
+
+<p>Mr. Armstrong read an extract of a letter
+from Mr. Morgan, of the Bristol Infirmary, a
+corresponding member of the Society, describing
+a curious conformation of the œsophagus
+in a child, which lived 106 hours
+only, during which period every attempt to
+swallow food produced considerable distress.
+The œsophagus was found to be divided into
+two portions; the upper or pharyngæal extremity
+terminating in a <i lang="fr" xml:lang="fr">cul de sac</i> behind
+the bifurcation of the trachea; and the lower
+or ventricular extremity arising from the
+trachea at this point, between the bronchi,
+proceeding down the spine, and terminating,
+as usual, at the cardiac orifice of the stomach.
+Mr. Drysdale mentioned a somewhat
+similar malformation occurring in two
+children in one family. Mr. Callaway related
+a case of concussion of the brain, which terminated
+fatally, after the restoration of the
+intellectual functions. The whole of the anterior
+lobes of each hemisphere of the brain
+was broken down, and mixed with effused
+blood. The remarkable feature of the case
+was, the return of consciousness, and the
+possession of this power for six days, under
+the disorganization of the brain described;
+and the questions particularly agitated were,
+Did this extent of mischief exist immediately
+after the concussion? What was the
+degree of laceration of the brain at that period?
+and, How could the recovery of the
+intellectual faculty be reconciled with so
+much injury of the brain?</p>
+
+<p>The Society then adjourned to the 12th of
+January, 1829.</p>
+
+
+<hr class="fulla" />
+<h2>COOPER <em>v.</em> WAKLEY.</h2>
+
+<p>Notes of the Cause, Cooper <em>v.</em> Wakley&mdash;We
+understand that Mr. Cooper is about to
+publish a verbatim account of the above
+trial, from Mr. Gurney's short-hand notes.</p>
+
+
+<hr class="fulla" />
+<h2>ERRATA.</h2>
+
+<p>The Advertisement of Mr. B. Cooper's,
+in our last Number, ought to have been
+dated "<em>December</em> 15," instead of "<em>Oct.</em> 15."
+Also, for "<em>Mr. Elton</em>," the name of one of
+Mr. Cooper's witnesses, read "<em>Mr. Hilton</em>."</p>
+
+<p>In our last leading article, <em>for</em> "can no
+friend of Wakley be named?" <em>read</em> "can
+the name of no friend of Wakley be mentioned?"
+The alteration is necessary, to connect
+it with the conclusion of the paragraph.</p>
+
+<hr class="fulla" />
+<p class="center fs80"><span class="smcap">W. Wilson</span>, Printer, 57, Skinner-Street, London.</p>
+
+
+<div class="footnotes"><h2>FOOTNOTES:</h2>
+
+<div class="footnote">
+
+<p><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">[1]</span></a> General thickening of all the valvular apparatus
+on both sides of the heart. (St. B. 33.)</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">[2]</span></a> Andral, vol. iii. p. 411.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3"><span class="label">[3]</span></a> Pl. 1, fig. 5.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_4_4" id="Footnote_4_4"></a><a href="#FNanchor_4_4"><span class="label">[4]</span></a> Opacity and thickening of the lining membrane
+on both sides of the heart, without unevenness
+or alteration of form. (St. B. 33).</p>
+
+<p>
+Opacity and thickening in the valvular apparatus
+between the left auricle and ventricle, with
+shortening of the chordæ tendinæ, and such alteration
+of structure and form as to produce a considerable
+contraction of the aperture. (St. B. 26).</p>
+
+<p>
+Such thickening of the whole valvular apparatus
+as to narrow the aperture of communication
+between the left auricle and ventricle to a mere
+slit. (St. B. 19).</p>
+
+<p>
+Shrivelled and contracted state of the semilunar
+valves, in which a cartilaginous substance has entirely
+taken the place of the natural structure.
+(Hodgson, pl. 1, fig. 6).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_5_5" id="Footnote_5_5"></a><a href="#FNanchor_5_5"><span class="label">[5]</span></a> Osteum aortæ almost closed by ossified valves.
+(St. B. 15); (Hodgson, pl. 1, fig. 2).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_6_6" id="Footnote_6_6"></a><a href="#FNanchor_6_6"><span class="label">[6]</span></a> Fungus growing from the aortic valves, which
+are thickened and shortened. (St. B. 6, 20).</p>
+
+<p>
+Fungus form the aortic valves, which are ulcerated.
+(St. B. 21).</p>
+
+<p>
+Larger specimens of fungus, growing from the
+ulcerated edges of two of the valves of the aorta.
+(Hodgson, pl. 1, fig. 7).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_7_7" id="Footnote_7_7"></a><a href="#FNanchor_7_7"><span class="label">[7]</span></a> Dr. Baillie's plate.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_8_8" id="Footnote_8_8"></a><a href="#FNanchor_8_8"><span class="label">[8]</span></a> Polypous coagulum in the ventricle. (Coll. of
+Phys. 4, A. 16).</p>
+
+<p>
+Coagulum firmly attached to the lining of the
+left auricle, with enlargement of its capacity. (St.
+B. 19).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_9_9" id="Footnote_9_9"></a><a href="#FNanchor_9_9"><span class="label">[9]</span></a> (St. B. 13).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_10_10" id="Footnote_10_10"></a><a href="#FNanchor_10_10"><span class="label">[10]</span></a> It occurs sometimes in the uterus.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">[11]</span></a> Memoir. de l'Acad. des Sciences. Morand,
+1732. Morgagni, Epist. 27.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_12_12" id="Footnote_12_12"></a><a href="#FNanchor_12_12"><span class="label">[12]</span></a> Andral, v. 3, 466; Hodgson, plate 1, figure 7;
+St. B. 14.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_13_13" id="Footnote_13_13"></a><a href="#FNanchor_13_13"><span class="label">[13]</span></a> Corvisart, cap. 4. sect. 1.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_14_14" id="Footnote_14_14"></a><a href="#FNanchor_14_14"><span class="label">[14]</span></a> Active dilatation of the left ventricle. (College
+of Phys. 4, c. 10.)</p>
+
+<p>
+The thickened walls of the left strikingly contrasted
+with the attenuated walls of the right ventricle.
+(St. B. 9).</p>
+
+<p>
+Active dilatation of the left ventricle. Its
+capacity is strikingly contrasted with that of the
+right. (College of Phys. 4, c. 11.)</p>
+
+<p>
+Passive dilatation of both ventricles, especially
+of the right. (St. B. 10).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_15_15" id="Footnote_15_15"></a><a href="#FNanchor_15_15"><span class="label">[15]</span></a> Morgagni, Epist. xxvii. 7.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_16_16" id="Footnote_16_16"></a><a href="#FNanchor_16_16"><span class="label">[16]</span></a> Ibid. 2.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_17_17" id="Footnote_17_17"></a><a href="#FNanchor_17_17"><span class="label">[17]</span></a> Ibid. 3.</p>
+
+<p>
+Rupture of the left ventricle, with attenuation
+of its muscular structure. (St. B. 18).</p>
+
+<p>
+Rupture, without attenuation, but with softening
+and looseness of texture in the muscular substance.
+(St. B. 22).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_18_18" id="Footnote_18_18"></a><a href="#FNanchor_18_18"><span class="label">[18]</span></a> Harvey, Exercit. altera.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_19_19" id="Footnote_19_19"></a><a href="#FNanchor_19_19"><span class="label">[19]</span></a> Rupture of the left ventricle without change
+in its structure. Bone deposited at the commencement
+of the aorta. (St. B. 27).</p>
+
+<p>
+In turning over the Memoirs of the Royal
+Academy of Sciences, I find two cases of rupture
+of the heart, reported by M. Morand. They both
+occurred in the year 1730; and, strange to say,
+one was that of a Duchess of Brunswick,
+who was of the same family as George II.
+who also died of a ruptured heart. In the one,
+that of the Duchess, there was a manifest ulceration
+through the walls of the right ventricle, its
+structure being otherwise unimpaired; in the
+other, where the aperture was in the left ventricle,
+there was probably a simple rupture, for the flesh
+of the heart was so soft that the point of a probe
+would pass through it wherever it was rested.
+(Mem. de l'Acad. Roy. des Sciences, Ann. 1732).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_20_20" id="Footnote_20_20"></a><a href="#FNanchor_20_20"><span class="label">[20]</span></a> The trial as published in the Lancet occupied
+less than 21 pages&mdash;in the Gazette it extended, in
+the same type, to 33 pages and a half. In the
+Lancet, those parts, both of the evidence and
+speeches, which told most against Wakley, were
+omitted.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_21_21" id="Footnote_21_21"></a><a href="#FNanchor_21_21"><span class="label">[21]</span></a> <a href="#P137">See passage in Italics, page 137.</a></p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_22_22" id="Footnote_22_22"></a><a href="#FNanchor_22_22"><span class="label">[22]</span></a> The defendant, on leaving the court, was
+cheered by the populace in Palace Yard.&mdash;Lancet,
+Dec. 20.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_23_23" id="Footnote_23_23"></a><a href="#FNanchor_23_23"><span class="label">[23]</span></a> This we believe is false; nothing of the kind
+either occurred, or was stated at the trial.&mdash;E. G.</p></div></div>
+
+
+<div class="transnote pg-brk">
+<a name="TN" id="TN"></a>
+<p><strong>TRANSCRIBER'S NOTE</strong></p>
+
+<p>Obvious typographical errors and punctuation errors have been
+corrected after careful comparison with other occurrences within
+the text and consultation of external sources.</p>
+
+<p>Except for those changes noted below, all misspellings in the text,
+and inconsistent or archaic usage, have been retained.</p>
+
+<p>
+<a href="#Page_116">Pg 116</a>, 'immedate contact' replaced by 'immediate contact'.<br />
+<a href="#Page_119">Pg 119</a>, 'and attennuation in' replaced by 'and attenuation in'.<br />
+<a href="#Page_126">Pg 126</a>, 'Tue valuable paper' replaced by 'The valuable paper'.<br />
+<a href="#Page_132">Pg 132</a>, 'probably impossibly' replaced by 'probably impossible'.<br />
+</p>
+</div>
+
+<div>*** END OF THE PROJECT GUTENBERG EBOOK 53450 ***</div>
+</body>
+</html>
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+Project Gutenberg's The London Medical Gazette; December 27, 1828, by Various
+
+This eBook is for the use of anyone anywhere in the United States and most
+other parts of the world at no cost and with almost no restrictions
+whatsoever.  You may copy it, give it away or re-use it under the terms of
+the Project Gutenberg License included with this eBook or online at
+www.gutenberg.org.  If you are not located in the United States, you'll have
+to check the laws of the country where you are located before using this ebook.
+
+Title: The London Medical Gazette; December 27, 1828
+       Being a Weekly Journal of Medicine and the Collateral Sciences
+
+Author: Various
+
+Release Date: November 5, 2016 [EBook #53450]
+
+Language: English
+
+Character set encoding: UTF-8
+
+*** START OF THIS PROJECT GUTENBERG EBOOK LONDON MEDICAL GAZETTE, DEC 27, 1828 ***
+
+
+
+
+Produced by John Campbell and the Online Distributed
+Proofreading Team at http://www.pgdp.net (This file was
+produced from images generously made available by The
+Internet Archive)
+
+
+
+
+
+
+
+
+
+  TRANSCRIBER'S NOTE
+
+  Italic text is denoted by _underscores_.
+
+  The 'Apothecary System' of measurement was used in the original text.
+  The etext uses the following Unicode symbols:
+      ℞      Prescription symbol
+      ʒ      Dram
+      ℥      Ounce
+      ℳ      Scruple
+  Roman numerals, and 'ss.' for 'half', are retained, so for example
+  '℥iss.' indicates 'one and a half ounces'.
+
+  Obvious typographical errors and punctuation errors have been
+  corrected after careful comparison with other occurrences within
+  the text and consultation of external sources.
+
+  More detail can be found at the end of the book.
+
+
+
+
+  THE
+  LONDON MEDICAL GAZETTE,
+
+  BEING A
+  WEEKLY JOURNAL
+  OF
+  Medicine and the Collateral Sciences.
+
+  SATURDAY, DECEMBER 27, 1828.
+
+
+
+
+PATHOLOGICAL ESSAYS
+
+ON SOME
+
+DISEASES OF THE HEART;
+
+_Being the Substance of Lectures delivered before the College of
+Physicians_,
+
+BY P. MERE LATHAM, M.D.
+
+Physician to St. Bartholomew's Hospital.
+
+[Continued from p. 7.]
+
+
+ESSAY II.
+
+_Morbid Anatomy of the Internal Lining Membrane of the Heart._
+
+The membrane which lines the cavities of the heart is very liable
+to disease, but not equally so in every part. Where it is thin
+and transparent, and admits the colour and character of the
+muscular structure upon which it is spread to be seen through it,
+it is seldom found diseased; but where it is of a denser texture,
+either in itself or from an admixture of other structures, whether
+cellular or fibrous, with its own, it is frequently, and often
+exclusively diseased. This latter character of a denser texture
+belongs to it where it forms the tough white circles which surround
+the apertures of communication between the auricles and ventricles;
+also where it is reflected upon itself, and forms the loose
+duplicatures of membrane, which are given off, as it were, from
+the internal surface of the heart, either at the fibrous circles
+intermediate between the auricles and ventricles, constituting the
+tricuspid and the mitral valves, or at the commencement of the
+pulmonary artery and aorta, constituting the semilunar valves.
+
+It is remarkable how curiously disease is apt to limit itself to
+the spaces just pointed out. Of the fibrous circle between the
+auricle and ventricle, of the valves which originate from it, and
+of the tendinous cords which connect the valves with the carneæ
+columnæ, there will not be the smallest space free from disease;
+but the disease will abruptly stop where the tendinous cords cease
+and the carneæ columnæ begin[1].
+
+The membrane, however, where it covers the fleshy columns of the
+heart, is not exempt from the possibility of disease: but when
+disease actually affects it, it has seldom originated there,
+but has generally spread from other parts of the same membrane,
+although (as we have just remarked) it is apt to stop short before
+it reaches this.
+
+Of the two sides of the heart, the membrane which lines the left is
+unquestionably the more liable to disease. But my own observation
+would never have led me to conclude that the membrane of the right
+side was so far exempt as it is commonly thought to be. Speaking
+from the best recollection I have of the specimens which have
+fallen under my examination, I should say that, in one-third of the
+cases where disease has been found on the left side, it has existed
+on the right side also, and been essentially of the same character.
+But there has been a remarkable difference in the extent to which
+it has proceeded on each side respectively: while on the left it
+has gone so far as to be the undoubted cause of death, on the
+right, although essentially of the same character, it has been only
+just beginning.
+
+It very seldom happens that disease appertains to the lining of
+the right cavities of the heart exclusively; and, where it affects
+both, the disease in the right cavities is very seldom found in
+advance of that in the left.
+
+It should seem, indeed, according to the ordinary course of things,
+that disease does not begin in the lining of the right cavities of
+the heart, until it has already advanced to an extreme degree in
+the left.
+
+The internal lining of the heart, as well as of the arteries, is
+often found to have become of a red colour. This redness, so well
+known to all who are accustomed to examine dead bodies, used to be
+regarded as a mere stain imparted to it by the colouring matter
+of the blood after death. Yet a due consideration of various
+circumstances connected with it will hardly warrant this conclusion.
+
+It has been found whether the heart or artery be full or empty of
+blood; and if blood be present it has been found, whether it is
+liquid or clotted; and if it be clotted, whether it does or does
+not retain its colouring matter. External temperature, and length
+of time between the death of the patient and the dissection of his
+body, have not made any difference in the frequency with which
+this peculiar appearance occurs. Lastly, no artificial methods,
+such as washing of any kind, can get rid of it; nor will inclosing
+blood within an artery for any period produce it[2]. This simple
+redness is sometimes seen universally in both sides of the heart
+and throughout the whole arterial system, and sometimes in patches
+only, of greater or less extent, whether in the arteries or in the
+heart.
+
+Now, when all these circumstances are considered, although in some
+instances it may be a mere stain imparted by the colouring matter
+of the blood after death, it is plainly impossible that it should
+be of that nature in any large proportion of the numerous instances
+in which it is found.
+
+But if the appearance in question implies (as I believe it
+generally does) a morbid condition, of what kind is that condition?
+There are the same objections to considering mere redness as
+equivalent to inflammation here as in the pericardium, or in any
+other part of the body: here, as elsewhere, in one case it may
+be the condition out of which inflammation is to spring; while in
+another it may not be destined to give origin to any change in the
+structure of the part beyond itself, and may itself constitute the
+whole disease.
+
+It appears to me, that this mere redness of the internal lining
+of the heart and arteries has become a matter of undue perplexity
+to pathologists, because they have laboured to infer from it
+more than the simple fact itself will authorize. All I wish to
+establish concerning it is, first, that it is not always (probably
+very seldom) a mere stain imparted by the colouring matter of the
+blood after death; secondly, that it alone does not constitute
+inflammation.
+
+It may not be improper to mention the circumstances under which
+it has occurred to myself to find it. I have met with it most
+frequently, and to the largest extent, in subjects whose previous
+disease has produced a constant and habitual impediment to the
+transmission of blood through the heart and through the lungs,
+and that impediment has gone on increasing to the hour of their
+death; also in those, whatever might have been the nature of
+their disease, whose dissolution (I mean the actual process of
+dying) has been tardy and agonizing, and marked by great labour of
+respiration; in the apoplectic, for example, in whom, after sense
+and consciousness were extinct, life had been protracted, with
+stertorous breathing, for many days.
+
+In such subjects the countenance, the lips, and the whole skin,
+give evidence during life of blood pushed beyond the natural sphere
+of the circulation, and detained in the extreme blood-vessels.
+Hence it is obvious that the causes which have loaded and distended
+the capillaries in every part of the body have had a like influence
+upon the vasa vasorum.
+
+I do not mean to say that I never met with this peculiar condition
+of the heart and arteries under other circumstances, or that
+other causes may not produce it; but that I am not acquainted
+with it under any other with which, from frequent coincidence, it
+has seemed to have a natural connexion, or which have afforded a
+reasonable explanation of the phenomenon.
+
+This condition of the heart and arteries, considered as
+inflammation, has been assigned by some as the cause of fevers
+of the more malignant kind. The frequency with which it has been
+found in some particular epidemic, must have led to the conclusion.
+But, however this may be, from my own observation, not restricting
+myself to the fever of any particular season, but taking into
+account all complaints called febrile, and belonging to all
+seasons, also from the result of inquiry among medical men who
+have had large acquaintance with morbid dissections, and from the
+experience of those who have made this particular point a subject
+of investigation (Laënnec and Andral) I venture to conclude that it
+has no essential connexion with fevers of any kind, either as cause
+or as effect.
+
+On some occasions the internal membrane of the heart and arteries,
+wherever it exhibits the appearance described, will allow itself to
+be peeled off from the subjacent structure with the least possible
+force; this facility of separation ceasing entirely beyond the
+boundary of the red tinge.
+
+Here unquestionably is further evidence of a diseased condition:
+but of what nature? Most pathologists would consider this to be of
+the nature of inflammation--and I believe justly.
+
+There is indeed much difficulty in pronouncing upon the nature of
+minuter changes of structure detected in the internal parts of the
+body after death. We are obliged to arrive at conclusions by help
+of analogies drawn from morbid processes, which we have watched in
+their progress during life, upon the external surfaces; for during
+life we have the functions and sensibilities of the part to aid us
+in forming a right judgment concerning its disease. When, during
+life, one tissue is separated from another, as the periosteum from
+the bone, or the cuticle from the skin, or the mutual cohesion
+between different tissues is sensibly weakened, we find it to be
+owing to the intervention of serous fluid which does not belong to
+their healthy state; and this, together with increased vascularity,
+or redness and heat, and pain, is enough to bespeak the presence
+of inflammation. All these conditions cannot remain after death.
+Hence, if we desire to form positive opinions concerning much
+which is unfolded by dissection, we must supply the defect by
+analogy. Thus, whenever, in any part of the heart or arteries,
+the cohesion between the internal membrane and the subjacent
+structure is manifestly lessened, and the membrane is unusually red
+at that part, we may regard these appearances as the vestiges of
+inflammation, without thinking that we go too far in so regarding
+them.
+
+The internal lining of the heart and arteries is often found red
+solely in the neighbourhood of ulcerated spaces, when there can be
+no doubt concerning the existence of inflammatory action.
+
+But the internal lining of the heart and arteries gives the most
+unequivocal evidence of its inflammation when it is found of a deep
+red colour, with coagulable lymph adhering to its surface. This
+condition is represented, as it was found in the aorta, in one of
+the beautiful plates, illustrative of the diseases of arteries, by
+Mr. Hodgson[3]. And the same condition, in the heart, I have seen
+in a preparation of Dr. Farre's, where lymph is deposited, upon the
+circular zone, which forms the aperture of communication between
+the left auricle and ventricle. These appearances denote the most
+acute inflammation: they are, I suspect, very rarely met with. In
+the few instances in which I have heard of them, they have been
+found where death has taken place after short and severe suffering,
+and with symptoms which characterize inflammation.
+
+But the specimens of disease most frequently met with in the
+internal lining of the heart, consist in an entire change of its
+natural structure, and in the formation of new products upon it or
+within it. Many of these, from the analogy of morbid actions in
+other parts of the body, must be considered to result from chronic
+inflammation.
+
+In any of those situations which have been stated as especially
+liable to disease, the membrane will become thick, tough,
+inelastic, puckered and shrivelled; and cartilage or gristle, and
+bone, will enter into its structure; excrescences will sprout out
+from it, resembling warts and fungus; and it will become ruptured
+and ulcerated.
+
+Cartilaginous depositions are often found beneath the membrane
+where it is single; or between its folds where it is double, in
+the situation of the valves; and thus they seem rather to belong
+to some structure contiguous to the membrane than to the membrane
+itself. Such depositions will proceed to a considerable extent,
+while the membrane still remains free from disease. From a valve,
+which has been thick, opaque, and cartilaginous, I have seen the
+membrane separated on both sides, and transparent; the opaque and
+cartilaginous matter being left behind. Where, in cartilaginous
+depositions, the lining of the heart has become puckered and
+uneven on its surface, and the valves shortened and altered in
+their shape, the membrane itself participates in the disease,
+and is generally incapable of being separated from the subjacent
+structure. But great thickening may take place in the situation of
+the valves, from deposition of cartilage, without any unevenness
+of their surface or alteration of their shape; and under these
+circumstances the membrane itself you may expect to find hitherto
+exempt from disease[4].
+
+Osseous depositions are always, I believe, originally formed
+beneath, or exterior to, the membrane, both in the heart and in
+the arteries. There are two circumstances especially worthy of
+remark in this process of ossification: sometimes it is a pure and
+unmixed process: bone is formed, and nothing else. It is deposited
+in minute granules, or little brittle scales, or in plates of a
+larger size; and the intermediate spaces, whether in the heart or
+arteries, preserve their natural and healthy appearance. At first,
+these granules or scales, or plates of pure bone, are covered by a
+delicate pellicle, which is in fact the internal membrane of the
+heart or artery, separating them from the immediate contact of the
+circulating blood. But in process of time, as they increase in
+size, and become rough and unequal on their surface, they cause a
+rupture of the internal membrane, and have now nothing to separate
+them from the immediate contact of the blood[5].
+
+Sometimes ossification is a mixed process, or rather, I suspect,
+the result of another morbid process preceding it. With the
+cartilaginous depositions already described there is an admixture
+of bone. The quantity of bone generally bears a very small
+proportion to the cartilage when they both occur together, as if
+the bone proceeded from the cartilage, and not the cartilage from
+the bone. It is sometimes seen growing from the surface of the
+cartilage, and is sometimes deposited in its substance, and only
+detected by the knife.
+
+Simple ossification, as it occurs in the heart and arteries, has
+been classed among the natural changes which the parts in question
+are liable to undergo after a certain period of life. Of persons
+above the age of sixty years the proportion is that of seven in ten
+according to Bichât, in which ossification is discovered in some
+part of the arterial system. It very rarely happens that simple
+ossification is found before the period of old age: still it is
+difficult not to regard it as a morbid process.
+
+But ossification, when it is a mixed process, is unquestionably
+the result of disease. It is met with at all periods of life; and
+probably constitutes one of the terminations of inflammation. The
+kind of morbid structures with which the bone is united leads to
+this belief.
+
+Fungous, and wart-like excrescences, are found in all those parts
+of the internal lining of the heart, which have been already
+mentioned as most subject to disease. They seem to be the result
+of a new morbid action set up in parts already disorganized; for
+I have not met with them where the membrane has been otherwise
+healthy, but only where it has been thickened or cartilaginous, or
+ossified, ruptured, or ulcerated. They grow either from the surface
+of the membrane, or from its ruptured or ulcerated edges, and are
+always in immediate contact with the circulating blood[6].
+
+According to my observation, when a fungous or warty excrescence
+has grown from the ruptured edges of the membrane, it has been from
+them exclusively, and from no other part of the lining of the same
+heart. And as rupture of the membrane seldom occurs in more than
+one situation at a time, the heart of the same individual seldom
+presents more than one excrescence of this kind: and as the aortic
+valves are the parts most liable to rupture, it is there that this
+single excrescence is most frequently found; not that rupture may
+not take place elsewhere. I once saw a single _chorda tendinea_
+ruptured; and a single fungous excrescence of considerable size
+hanging from it into the cavity of the left ventricle.
+
+Now, this morbid growth is evidently connected with the lacerated
+state of the membrane in the conditions of its production, whereby
+it is limited to a small space.
+
+It is probable that the membrane is first ruptured; that its
+lacerated edges inflame, and then throw out unhealthy lymph, or
+unhealthy granulations, in the shape of these fungous or wart-like
+excrescences. When they have sprung from a ruptured membrane, they
+have, in the specimens which I have examined, been larger than when
+they have arisen under other conditions.
+
+But when such excrescences grow from the surface of the membrane
+which is thickened and cartilaginous only, but not lacerated, they
+are more apt to occur in many parts of it at the same time. I have
+seen the valvular apparatus between the auricles and ventricles on
+both sides, as well as the aortic valves of the same heart, studded
+with them. They were all about the size of hemp seeds: they adhered
+to the membrane with different degrees of tenacity, and wherever
+they were capable of being detached, they left a rough surface.
+The lining of the arteries has been known to give origin to morbid
+growths of the same kind, which have obstructed the passage of
+blood, and given occasion to the formation of a coagulum, which has
+obliterated the pulse.
+
+The internal lining of the heart is liable to ulceration, not as
+a common consequence of simple inflammation, but as an occasional
+consequence of some of those diseased conditions which have been
+described.
+
+It is most commonly found around scales and spiculæ of bone, and
+under such circumstances as to leave no doubt that the bone itself
+has furnished the source of irritation from which it springs. The
+ulceration commences from the very border of the bony scale, as if
+it was a process of nature for detaching it, and to a considerable
+distance around the ulceration the membrane is reddened, and easily
+detached from the subjacent structure. Where there are several
+distinct scales of bone, it is not uncommon to find a circle of
+ulceration around each of them.
+
+Ulceration is also met with where there is a thickened and
+cartilaginous state of the membrane without ossification. Under
+these circumstances, as far as I know, it affects no definite form.
+It is often a very destructive process of disease, obliterating
+large portions of the valvular structure, and penetrating deep into
+the muscular substance of the heart.
+
+Rupture of the internal lining of the heart is not easily
+distinguished from ulceration. In collections of morbid anatomy,
+many unquestionable specimens of ulceration are described as
+specimens of rupture. Rupture must always be looked for in the
+valvular apparatus of the heart, _i. e._ in the valves themselves,
+or in the chordæ tendineæ which are their appendages. It is
+probably incapable of taking place elsewhere, except as a part of a
+rupture, which involves the whole organ.
+
+That solution of continuity which is evidently without loss of
+substance; that of which the separated edges when they are brought
+together are completely adapted to each other; also that which
+is unaccompanied by any thickening or other morbid condition of
+the valve; the solution of continuity which is found under these
+circumstances, may safely be considered to proceed from rupture,
+and not from ulceration[7].
+
+But it is probable that these characteristic conditions do not long
+remain after the occurrence of the rupture. Complete specimens of
+them are very rare; but specimens are numerous where the solution
+of continuity, by its form and direction, bespeaks rupture, while
+its rounded edges and the general thickening of the valve denote
+ulceration. These, it may be fairly conjectured, do in fact exhibit
+a compound of both. The membrane was originally ruptured, but
+disease has subsequently arisen and obscured the character of the
+mechanical injury.
+
+The greater number of those concretions, which were regarded by
+the older anatomists as polypi of the heart, were unquestionably
+portions of mere blood, which had undergone coagulation after
+death. The blood remaining in the heart after death discharges
+itself of its colouring matter as it coagulates, and, giving off
+processes between the muscular fasciculi, assumes a shape which has
+suggested the name of polypus[8].
+
+I have often found (I presume, therefore, that it is not an
+uncommon occurrence) coagula of an irregularly laminated texture
+having their colouring matter not entirely discharged, but
+unequally distributed through them, which have been most intimately
+adherent to some part of the lining of the heart. Of these some
+have admitted of separation, while the surface of the membrane and
+the surface of the clot were left rough at the place of contact,
+and others were incapable of being detached without the membrane
+being detached along with them. The appendix of the left auricle is
+a situation in which they are apt to occur, and they are generally
+accompanied by an extensively diseased condition of the lining
+membrane. These coagula, from their laminated texture, and from
+the intimacy of their union with the internal lining, seem to be
+essentially different from polypi of the heart. They appear to be
+connected with a process of disease in the membrane, and to have
+obtained their union with it long before the death of the patient.
+
+I once saw two separate tumors, entirely resembling what are called
+polypi, between the carneæ columnæ of the left ventricle, and
+firmly adherent to the heart; and in the centre of each a distinct
+formation of pus. The heart was otherwise healthy[9].
+
+There are three preparations in the museum of the College of
+Surgeons, put up by Mr. Hunter himself, and noted by him as
+exhibiting "Tumors on the inner surface of the right ventricle,
+seemingly composed of layers of coagulable lymph one upon another,
+the central part having the appearance of glary mucus." This last
+appearance (the mucus) no longer remains in any of the three, but
+in its stead there is a cavity. The tumors which I have mentioned
+as originally containing in their centre a distinct formation
+of pus, also now present in its stead a cavity. The preparation
+preserved at St. Bartholomew's, and those at the College of
+Surgeons, are probably specimens of the same disease.
+
+Here what in the recent parts seemed to be pus or glary mucus, and
+the cavities still remaining in the preparations, must suggest the
+suspicion, that these tumors, whether they grew from the surface or
+were deposited from the blood, had become organized, and afterwards
+inflamed; and that the inflammation had terminated in the formation
+of an abscess.
+
+
+
+
+ESSAY III.
+
+_Morbid Anatomy of the Muscular Substance of the Heart._
+
+Dr. Baillie, speaking of inflammation of the substance of the
+heart, says, "When the pericardium covering its surface is
+inflamed, the inflammation sometimes passes a little way into
+the substance of the heart:" and then he gives these as the
+characteristic marks of such inflammation--that "it (the substance
+of the heart) becomes much more crowded with small vessels than in
+its natural state, and there are sometimes to be seen a few spots
+of extravasated blood." Now, this undue vascularity, and these few
+extravasated spots, where inflammation unquestionably belongs to
+a contiguous structure, may be deemed sufficient evidence of the
+muscular substance of the heart participating, or beginning to
+participate, in the same disease; but, absolutely and exclusively,
+it may be doubted whether more is not required to give a certain
+assurance of its inflammation. Here, as elsewhere, we must look
+for some of the proper products of inflammation; or for some of
+the permanent changes of texture which naturally result from it,
+according to its several modes of disorganizing.
+
+It is a very rare event to find pus among the products of
+inflammation of the substance of the heart: yet this event has
+occurred twice to my observation. In one instance the whole heart
+was deeply tinged with dark-coloured blood, and its substance
+softened; and here and there, upon the section of both ventricles,
+innumerable small points of pus oozed from among the muscular
+fibres. This was the result of a most rapid and acute inflammation,
+in which death took place after an illness of only two days. In
+another instance, after death, which terminated an illness of
+long duration and characterized by symptoms referable to the
+heart, a distinct abscess was found in the substance of the left
+ventricle, closed externally by a portion of adherent pericardium,
+and connected internally with an ossified portion of the lining
+membrane.
+
+This diffusion of pus, or rather its formation in innumerable
+separate points, throughout the muscular structure of the heart, by
+a rapid and acute inflammation, is a singular occurrence. No such
+case has ever fallen within the knowledge of the most experienced
+in morbid anatomy, of whom I have made inquiry; neither has any
+such (as far as I can learn) been recorded in books[10].
+
+A single collection of pus[11], constituting an ulcer or abscess of
+the heart, and resulting from chronic inflammation, is also a rare
+occurrence, yet not so rare but that a specimen of it may be found
+in most collections of morbid anatomy[12].
+
+But independent of the formation of pus, softening and attenuation,
+as well as induration and thickening of the muscular substance of
+the heart, do, in different cases, according to the circumstances
+under which they are found, both bespeak inflammation.
+
+Together with the unequivocal evidence of inflammation in other
+parts of the heart, the muscular fibres have at the same time been
+found very soft and loose, and easily torn; and with this looseness
+of texture the heart has sometimes presented a dark and almost
+black appearance, and sometimes it has been almost blanched and
+colourless. The deep dark tinge shews that the muscular substance
+is unnaturally loaded with blood; whereas the absence of colour
+shews that it is destitute of its natural quantity. These different
+appearances do, in fact, belong to different stages of the same
+disease. The first indicates inflammation of the muscular substance
+in its present state of activity; the second, an irreparable
+disorganization of the muscular substance left by inflammation,
+when it has been unarrested in its earliest stages. The first is
+found when death takes place _in a few days after_ the accession
+of the disease; the second, when the patient survives the first
+attack, and dies at a remoter period.
+
+The inflammation, which produces softening and attenuation of the
+muscular structure, is, I believe, always of an acute kind.
+
+But induration and thickening of the muscular substance of
+the heart is also the result of inflammation. This must be
+distinguished from hypertrophy, or mere augmentation of bulk, of
+which we shall speak hereafter. In this induration, which proceeds
+from inflammation, there is, besides increase of bulk and firmness,
+a manifest alteration of texture. A substance[13] is produced
+offering a peculiar resistance to the knife. This condition
+unquestionably must result from an interstitial deposition of new
+matter among the muscular fibres. From concomitant circumstances,
+as well as from its own character, I presume that it proceeds
+from chronic, not from acute inflammation. I confess that I never
+saw a specimen of what I now allude to. It is described with some
+minuteness by Corvisart; but it may be presumed to be very rare,
+since Laënnec admits that it never fell under his observation.
+
+These opposite states of softening and attenuation in one case, and
+induration and thickening in another, are known to those conversant
+with morbid dissection as the evidences of inflammation in other
+parts of the body besides the muscular substance of the heart.
+
+But there are changes of structure incident to the muscular
+substance of the heart which are independent upon inflammation,
+or, perhaps, upon any process which can properly be called morbid.
+They consist of simple augmentation and simple diminution of bulk
+and consistence. This simple augmentation of bulk and consistence
+is owing exclusively to a more ample development of natural
+structure. The muscular substance is more red than natural, its
+carneæ columnæ are increased in thickness, and its proper fibrous
+texture is every where more strikingly manifest; but there is no
+interstitial deposition of matter new in its kind. It has been
+called hypertrophia of the heart, and the name conveys a tolerably
+just idea of its actual condition.
+
+The simple diminution of bulk and consistence is a condition the
+exact opposite of the former. The muscular substance is less red
+than natural; its proper fibrous texture less distinguishable; but
+there is still the appearance of muscle shrunk and withered, as
+if from an insufficient supply of nourishment. It may be called
+atrophia of the heart.
+
+Conjoined with augmentation, as well as with diminution of strength
+and bulk in the walls of the heart, there is almost always an
+increase in the capacity of its cavities; and in whichsoever part
+of the heart the walls are thus augmented or diminished, it is the
+cavity appertaining to the same part which undergoes the increase
+of capacity. Hence it appears either that one of these conditions
+is the immediate and necessary consequence of the other, or that
+both are the simultaneous effects of the same causes.
+
+Dilatation of any cavity of the heart, with thickening of its
+walls, is called _active dilatation_; and dilatation of any cavity,
+with attenuation, is called _passive_[14].
+
+Active dilatation may appertain to every cavity of the heart
+simultaneously; and so may passive dilatation. But such occurrences
+are very rare: for one cavity being naturally more liable to this
+species of dilatation, and another to that, it most frequently
+happens that specimens of both conditions are found in the
+different cavities of the same heart.
+
+The left ventricle is much more liable to active dilatation than
+the right; and the right ventricle more so than either of the
+auricles; and of the auricles unquestionably the left. Upon the
+whole, perhaps, the fact may be truly stated thus--that the left
+ventricle commonly gains an increase of bulk and strength, with an
+increase of capacity; and that all the other cavities, at the time
+that they expand, are rather apt to become attenuated.
+
+It sometimes (though rarely) happens, that, with an increase of
+strength and bulk in its muscular structure, the left ventricle
+suffers a diminution of capacity in its cavity. In a case reported
+by Laënnec, the left ventricle was an inch and a half thick at
+its broadest, and an inch thick at its thinnest part; and yet its
+cavity was only capable of containing an unblanched almond. I have
+seen the same condition in a less degree.--(_Laënnec_, vol. ii.
+698.)
+
+The circumstances under which these opposite conditions, this
+hypertrophy and atrophy of the heart, with the enlargement or
+diminution of its cavities, arise, must be explained hereafter. At
+present I would only remark that they are often found conjoined
+with actual disease in other structures of the heart, such as
+osseous or cartilaginous thickening of internal lining, adhesion
+of the pericardium, and ossification of the coronary arteries, to
+which they owe their origin; and, moreover, that they are often
+found where the heart is otherwise perfectly sound in texture, and
+where their cause must be sought in other parts of the body.
+
+The heart is liable to undergo a simple dilatation of its cavities
+without either thickening or attenuation of its muscular substance.
+This simple dilatation is sometimes of the whole organ, sometimes
+of one side, and sometimes only of one auricle or ventricle. When
+it is of one cavity only, it may be complicated with active or
+passive dilatation of another, or of all the rest.
+
+There is reason to believe that the heart sometimes undergoes a
+temporary dilatation, and again returns to its natural capacity;
+but that the dilatation can only subsist for a short time without
+becoming permanent.
+
+The power of thus enlarging its cavities, and restoring them to
+their natural condition, belongs more especially to the right side
+of the heart.
+
+A large accumulation of fat is sometimes met with about the heart.
+
+The healthy heart is always more or less marked upon its external
+surface with streaks of white, and this appearance results from
+the deposition of fat in the cellular texture, which unites the
+serous covering with the subjacent muscular structure. It is found
+principally where the venæ cavæ unite to form the right auricle;
+also at the base of the ventricles, and along the line which
+marks the boundary between the two, and around the origin of the
+great blood-vessels as they emerge from the heart. But when fat
+is deposited in more than these situations, and in more than the
+natural quantity, it is not so much added to the healthy substance
+of the heart, as existing at its expense and detriment, and the
+muscular structure is that which especially suffers. The fibre
+of the fat heart is pale and wasted, like that of a paralytic
+limb.--_Mus. of the Coll. of Surg._ 327.
+
+A rupture of the heart is sometimes met with; but all the cases of
+reputed rupture are not such in reality. An aperture in the walls
+of the heart, through which blood escapes into the cavity of the
+pericardium, may result from ulceration as well as from rupture,
+or from a mixed process of one and the other; but whatever be the
+precise nature of the process by which this perforation of the
+heart is effected, it is undoubtedly of rare occurrence.
+
+Where it has been found, there has generally been at the same time
+some peculiar condition of the organ, which might be presumed
+favourable to its production. Its muscular substance has been
+so soft and loose of texture, that it could be pierced through
+by the weight of a probe[15]; or it has been converted into, or
+greatly intermixed with fat[16]; or its muscular fibres have been
+absolutely defective, leaving a certain transparent space, where
+the internal lining and the pericardium have been in contact,
+and served to maintain the completeness of the cavity, until the
+rupture has taken place[17].
+
+Not that a rupture has not been found where the texture of
+the parts has seemed to offer no natural facilities to its
+occurrence--as in the case related by Harvey himself, who found a
+lacerated aperture in the left ventricle, capable of admitting his
+finger, through which blood had escaped into the pericardium, the
+walls of the ventricle being increased in thickness and strength,
+while an obstacle existed at the entrance of the aorta[18]. Here
+the heart must have torn itself asunder by the simple violence of
+its contraction, in contending against the impediment to the egress
+of blood from its cavity. This is an effect which would hardly be
+thought capable of being thus produced; but I can well believe it
+possible after having seen one of the recti muscles of the abdomen
+literally torn in twain, in a man who died of tetanus[19].
+
+[To be continued.]
+
+
+
+
+DILATED ŒSOPHAGUS.
+
+
+_To the Editor of the London Medical Gazette._
+
+  SIR,
+
+Permit me to send the following case to you for insertion in the
+Gazette.
+
+
+Mary Blores, æt. 33, was admitted into the Middlesex Hospital on
+the 16th of November. She was in a state of extreme feebleness and
+emaciation. Those who brought her said that during the preceding
+month she had appeared to swallow nothing: what she took as food
+seemed to her to stop in the gullet, and after a few minutes
+returned. I found, however, that a large œsophagus-bougie passed
+readily into the stomach, meeting with no obstruction beyond a
+spasmodic resistance in the pharynx. A draught of milk and water
+was given her--she swallowed it without much effort, but it quickly
+returned. In the course of the afternoon a pint of beef tea was
+injected through an elastic tube into the stomach--it was thrown up
+directly.
+
+I now learnt from her that she could swallow liquids much more
+readily than solid food; that when she took a small quantity,
+it seemed to her not to reach the stomach, and in three or four
+minutes was invariably thrown up; that on taking a large draught
+she had an impression that it reached the stomach--in this case
+vomiting did not follow so soon, and some part of the draught was
+permanently retained; that she craved food and drink, and was
+literally dying of hunger and thirst; that the vomiting which took
+place was not preceded by nausea, although in its progress it had
+all the appearance of ordinary retching; that the matter vomited
+was not thrown up at once, but by successive efforts; it consisted
+of the food she had last taken, mixed with colourless mucus. The
+belly was so shrunk that the umbilicus was not more than an inch
+distant from the spine, upon which the pulsations of the aorta
+were readily felt: there was no enlargement or hardness about the
+stomach, no particular tenderness on pressing the epigastrium, no
+sensation of pain or heat now or formerly.
+
+The complaint had began ten years ago, during pregnancy, since when
+she had never been free from it, although at times her sufferings
+had been less, and she had been able to retain some portion of her
+meals. She had borne in this period three children; the vomiting
+had lasted during the whole period of her pregnancies, and during
+her confinement. The principal remedies which had been used for her
+relief were a succession of blisters on the pit of the stomach--but
+they had produced no benefit. Latterly her symptoms had been
+greatly aggravated.
+
+This patient was attended by Dr. Watson and myself. But the means
+which we tried to enable her to retain her food, and to support her
+expiring strength, had scarcely a temporary effect. She died on the
+2d Dec. sixteen days after her admission. The body was carefully
+examined, at the expressed wish of her relatives.
+
+The unusual appearances found in the abdomen were--1. the smallness
+of the first part of the duodenum, which was but half the ordinary
+size of the ileum; 2. the capaciousness and fulness of the gall
+bladder,--from which, however, on compressing it, the bile flowed
+readily into the intestine; 3. a contraction of the middle of
+the stomach of the length of two inches, for which extent the
+peritoneal coat was thickened and opaque, and the inner membranes
+folded in deep longitudinal rugæ, the mucous surface of which was
+partially suffused with circular spots of red. The breadth of the
+contracted part of the stomach, as it lay collapsed, was an inch
+and a half.
+
+[Illustration]
+
+[Illustration]
+
+But it was in the chest that the most remarkable circumstance
+presented itself. The œsophagus gradually enlarged from the
+pharynx, which was perhaps rather narrower than usual, to an
+extraordinary degree of dilatation; the greatest breadth which it
+attained was situated about four inches above the cardia: the tube
+then contracted more abruptly, so as to render the termination
+of the œsophagus, like its commencement, of nearly the usual
+dimensions. The structure likewise of the cardiac extremity for
+about an inch, and of the pharyngeal end for about half an inch,
+was healthy. The intermediate part presented, when inverted, the
+following curious appearance:--The inner membrane was thickened
+and opaque, and had _the appearance_ of having partially yielded
+from dilatation; at the upper part the furrows or thinner parts of
+the membrane followed in some degree a longitudinal direction; at
+the lower part the surface was pitted with shallow depressions of
+various figures. I have represented in the adjoined sketches these
+appearances, which on the middle of the œsophagus passed from one
+into the other; at the furrows or depressions the membrane seemed
+of the natural thickness and colour; the intermediate raised and
+thickened part was opaque and whitish. The muscular fibres of the
+œsophagus were of the natural colour and thickness.
+
+  I remain, Mr. Editor,
+  Your obedient servant,
+
+  HERBERT MAYO.
+
+  19, George-street, Hanover-square,
+  Dec. 6, 1828.
+
+
+
+
+HYDROPHOBIA.
+
+
+_To the Editor of the London Medical Gazette._
+
+  SIR,
+
+As the following case may throw some additional light on the
+pathology of hydrophobia, I have sent it you for publication.
+
+  I am, Sir,
+  Your obedient servant,
+
+  F. GODRICH.
+
+  Grove House, Little Chelsea,
+  Nov. 29, 1828.
+
+
+On Thursday morning, the 25th ult. I was called up about seven
+o'clock to see a man who I understood was exceedingly ill, and
+waiting in the surgery very impatiently for my arrival. I found
+my patient (Mr. Barham), a fine looking old man, about 60,
+labouring at intervals of about five minutes under strong spasmodic
+paroxysms, affecting the muscles concerned in breathing and
+deglutition. There was a wildness and an impatience depicted in his
+countenance, totally different from any thing I had ever observed
+in other spasmodic affections. His bowels were open, tongue clean,
+skin moist, pulse full and a little accelerated. I took away
+twenty ounces of blood, and prescribed a mixture containing ʒss.
+of laudanum for a dose every hour until I should see him again.
+He walked home half a mile from my house (Gloucester Road, Old
+Brompton), and left me ruminating on the possible cause of so much
+mischief occurring suddenly in a fine healthy subject. At ten a
+message was sent, saying that he was much worse, and requesting
+me to call as soon as possible. He received me tranquilly, and
+said he was very glad that I had come to see him, for he was very
+ill. His symptoms were now more distressing than when I first saw
+him: he looked wildly and suspiciously at every one entering his
+apartment, and his breathing was accompanied by a short convulsive
+sobbing. On looking at his medicine I perceived he had taken none,
+and expressing my surprise, he assured me it was impossible for
+him to swallow a single drop, as the attempt had been followed
+by violent spasms, and produced so much distress, that he had
+desisted. At this period no one had the slightest idea of the
+origin of his malady. I poured out some medicine into a tea-cup,
+the very act of which produced much excitement and alarm. My first
+impression as to the true nature of his disease arose at this
+period, from the circumstance of his requiring a tea-spoon, with
+which he endeavoured to take some of the medicine. The attempt
+produced much excitement and alarm, and after two or three painful
+efforts at deglutition, with one desperate effort he swallowed a
+tea-spoonful, threw away the spoon, and begged, unless I wished
+to destroy him, that he might have nothing more to swallow. I
+now left his room, and inquired of a bystander whether any thing
+particular had occurred to him within the last few weeks. On
+recollection she said, "About a month since, late at night, a
+strange dog came into the premises and fought with his own dog; he
+got out of bed to separate them, and the strange dog bit him in
+two places, on the left arm and hand; and bit a puppy, which died
+about a fortnight after in a strange way, which was thought to be
+some kind of a fit." To ascertain if this occurrence had produced
+any effect on his mind, while again bleeding him I said, "You have
+been in the wars, Sir, and had your hand and arm torn; how did
+it occur?"--"Oh!" said he, carelessly, "that was done by a dog a
+long time ago, but it healed." The circumstance was never again
+mentioned to him, and he died in total ignorance of the cause of
+his malady. The wounds were perfectly cicatrised, and there was not
+the least action going on indicative of recent absorption. He bore
+the bleeding pretty quietly: 40℥. were removed, which on cooling
+presented strong marks of inflammation.
+
+    Ordered ℳiv. Acid. Hydrocyan. omni horâ, in a little water.
+
+Twelve o'clock.--With much difficulty he has taken two doses of the
+acid; pulse full and hard, 110. 30℥. more blood were removed.
+
+Three o'clock.--Has taken two more doses; complains of a dreadful
+sense of suffocation, and implores that nothing more may be given
+him. Pulse full, and beating at 120 to 130. Continue the acid.
+
+Eight o'clock.--Pulse full and hard. Has taken in all 24ℳ. of the
+acid, but so painfully distressing has the deglutition now become,
+that all attempts at repeating his medicine are discontinued.
+
+    V. S. ad ℥xxx.
+
+During the bleeding he looked wildly at the basin, and begged
+that no more might be spilt (a drop or two had fallen), repeating
+frequently, in great agitation, as the blood was running, "Take
+care! take care!"
+
+Between two and three o'clock next morning my assistant (Mr.
+Davies) visited him. He found him tolerably passive, but observing
+every movement with intense anxiety. Pulse full and hard, face
+flushed, eyes denoting cerebral irritation. He had been at times
+outrageous. On its being intimated that bleeding was again
+necessary, a paroxysm came on more intense than any preceding,--and
+with great effort he submitted. As the blood flowed he became
+more and more alarmed, till at length he got quite unmanageable;
+he raged violently at his nephew, who was holding the basin, and
+ordered it peremptorily to be removed. 30 or 40℥. were taken
+away. It was found necessary to put on the straight waistcoat.
+About four o'clock Mr. Davies wished him to take some more of his
+medicine. He said, "I can take no more," and on reaching the bottle
+to put out a few drops, he became violently agitated, threw himself
+from side to side, and, as well as the incessant spasmodic sobbings
+would allow, he begged that not one more drop of any thing might be
+offered him, and that the bottle might be taken from his sight. He
+did not become tranquillized until its removal. He lingered on till
+ten A.M. in the same state, a few minutes before which he insisted
+on getting up, and walked a short way down his garden, returned,
+laid down on his bed, and died.
+
+Mr. Frederick Salmon, of Old Broad Street, and Mr. Wilson, of
+Chelsea, were kind enough to assist me in conducting the post
+mortem examination. On opening the chest, the heart was free from
+disease, with rather more water in the pericardium than natural;
+the lungs were completely gorged with grumous blood, and the pleura
+adherent on the right side. On removing the cranium, which was
+remarkably thin, and cutting the substance of the brain, numerous
+red spots presented themselves in the medullary portion; about a
+table-spoonful of water in each ventricle; the plexus choroides was
+turgid; the corpora, striata, thalami, and basis of the brain every
+where preternaturally injected; the cerebellum, crura cerebri, and
+cerebelli, in a high state of inflammation. On removing the spinous
+process of the vertebra, the whole cord was considerably inflamed;
+and opposite the two last cervical and dorsal vertebræ the cellular
+substance was studded with dark patches of coagulated blood, the
+theca vertebralis thickened, and the cord in an active state of
+inflammation. The larynx and pharynx bore not the slightest vestige
+of disease. The preparation of the cord is deposited in the museum
+of the London University.
+
+The post mortem examination of this case tends to prove the
+correctness of Professor Thompson's theory of the proximate cause
+and seat of this afflicting malady; and the plate accompanying a
+case recorded by him, in the 13th volume of the Med. Chir. Society,
+gives a faithful delineation of the state in which the spinal cord
+was found in this case.
+
+
+
+
+CASE OF LONG PROTRACTED CONSTIPATION.
+
+
+_To the Editors of the London Medical Gazette._
+
+  GENTLEMEN,
+
+Perhaps the following case may interest some of your readers, and
+if you think so, its insertion in your Journal will oblige
+
+  Your obedient and
+  humble servant,
+
+  S. D. BROUGHTON.
+
+  12, Great Marlborough Street,
+  Dec. 3, 1828.
+
+
+On Tuesday, Nov. 25, I was called upon at the St. George's and St.
+James's Dispensary to advise for an infant at the breast, of five
+months and fourteen days of age, that had not passed any fæces
+during six weeks up to the day before I saw it. After its birth
+it had no passage till the fifth day, and this had apparently
+been effected by the introduction of a bougie, and which was
+subsequently continued at intervals for a short time. The infant
+was otherwise healthy and strong at its birth, and remained so
+until it had gone about three weeks without any evacuation, when it
+was observed to be weak in the lower extremities; and at the period
+of my seeing it the legs were much fallen away in flesh, hanging
+flaccid and inert. Many aperient enemas and medicines had been
+given, and, as a last resource, one drop of the croton oil had been
+prescribed the preceding evening. The infant appeared to suffer
+from distention, and to be disposed to coma, and the croton oil had
+distressed it much some hours after it was given. The fæces could
+be felt blocking up the intestine, but the irritation of the finger
+produced no attempt at evacuation; very small pieces only having
+been brought away. Hot baths also had frequently been used some
+time ago.
+
+Considering the case as one of paralysis in the parts naturally
+employed to relieve the bowels, I recommended the suspension of
+all purgative remedies by the mouth, and a table-spoonful of the
+following injection to be substituted, and to be thrown up with
+three table-spoonfuls of thin gruel occasionally during the day, by
+means of a syringe.
+
+  ℞ Spir. Terebenth. ʒiij.
+  Træ Zinzib. ʒj.
+  Aquæ, ℥iss. M.
+
+The following liniment was also directed to be rubbed in frequently
+along the course of the spine.
+
+  ℞ Linimenti Saponis, ℥iss.
+  Liquor. Ammon. Comp. ℥ss. M.
+
+The result justified my expectations; for, during the night after
+this prescription, two injections having been given, some large
+and hard ash-coloured lumps came away, and these were shortly
+followed by a forcible spouting out of a continued stream of
+feculent dark liquid; a brisk diarrhœa having been kept up till
+the Saturday following. The infant's appetite is become voracious,
+its appearance lively and healthy, and its legs as firm and strong
+as is usual at such an age. Cold water is recommended to be dashed
+upon the loins, the liniment to be continued occasionally, moderate
+doses of magnesia and rhubarb to be given when required, and the
+turpentine injection to be used if any return of the complaint
+should be threatened.
+
+
+
+
+DISLOCATION OF THE PATELLA.
+
+
+_To the Editor of the London Medical Gazette._
+
+  SIR,
+
+Having seen a case of dislocation of the patella, reported by
+Mr. Mayo, in your Journal a few weeks since, in which there was
+experienced some difficulty in the reduction of the bone, I beg
+leave to send you the following, in case you may think it worth
+insertion.
+
+On Saturday last, I was called to a young woman who had dislocated
+the patella of the left knee joint outwards; the inner edge
+rested upon the outer surface of the external condyle, and was
+immoveably fixed, and caused great pain when touched. She says it
+was occasioned by her foot slipping backwards from one stair to
+another, and she immediately fell down.
+
+I commenced the reduction, as stated by Mr. Mayo, but I could only
+produce semiflexion, and that gave her great pain; insomuch that I
+was obliged to desist, and the patella remained in _statu quo_. But
+when the knee was thus semiflexed, I desired my assistant to extend
+the leg suddenly; and having my fingers on the patella at the time,
+and pressing it inwards, it immediately returned to its natural
+position.
+
+I must confess, sir, that I should have been afraid to have
+continued the flexion as described in Mr. Mayo's case, "by bending
+the knee to the utmost," fearing that the remedy might be worse
+than the disease, and the result proved that in this case it was
+not necessary.
+
+  I remain, Sir,
+  Your obedient servant,
+
+  P. M. HOSKINGS.
+
+  168, Fleet-Street,
+  Dec. 3d, 1828.
+
+
+
+
+VACCINATION.
+
+
+_To the Editor of the London Medical Gazette._
+
+  SIR,
+
+The mistake of the printer in substituting the word "every" for
+"even," in the paper on Vaccination (p. 40), so materially affects
+the sense of the passage, that I must request the favour of the
+following insertion:--
+
+"3d. That while the vaccine cicatrix retains even one distinct
+fovea or depression, the individual continues unsusceptible both of
+small pox and of re-vaccination; but that," &c.
+
+  I am, Sir,
+  Your obedient servant,
+
+  THOS. H. BURDER.
+
+  2, Brunswick Square, Dec. 15, 1828.
+
+
+
+
+SINGULAR BICEPS MUSCLE.
+
+
+_To the Editor of the London Medical Gazette._
+
+  SIR,
+
+The valuable paper communicated to your Journal, by Mr. Stanley,
+last week, has brought to my recollection a singular appearance of
+the parts in front of the shoulder-joint which I dissected about
+two years ago. It is a fact worth recording; and perhaps you will
+be kind enough to insert it in your next number.
+
+The circumstance was this--that in the right arm, instead of there
+being a biceps muscle having two origins, the one the shorter from
+the corocoid process, the other the longer from the upper part of
+the glenoid cavity of the scapula, there was simply a one-headed
+muscle arising from the corocoid process. I could find no tendon
+passing through the joint answering to the long head of the
+biceps, neither was there any appearance of a biceptical groove;
+the capsular ligament was, perhaps, thicker than it is found in
+ordinary cases.
+
+I knew nothing of this man during life, and am therefore unable to
+give any account of the use which he made of this arm.
+
+  I am, your obedient servant,
+  C. M. BURNETT.
+
+  House Surgeon's Apartments,
+  St. Bartholomew's Hospital, Dec. 8th.
+
+
+
+
+STETHOSCOPE.
+
+
+_To the Editors of the London Medical Gazette._
+
+  GENTLEMEN,
+
+As you did me the honour, on a former occasion, to publish some
+remarks in defence of _auscultation_, against its enemies and
+detractors, I trust you will permit me to say a few words in
+reference to a communication in a late number, from a gentleman
+who appears to be a friend of that method of diagnosis, but whose
+ignorance of the subject is likely to be more injurious to the
+cause than either open enmity or secret detraction. The case in
+question (page 780, vol. ii.) appears, from the dissection, to
+have been clearly _emphysema of the lungs_, as there stated; but
+I appeal to every one practically acquainted with the physical
+signs of diseases of the lungs, whether the results of the
+exploration with the stethoscope, as narrated in the case, were
+those pathognomonic of that disease? I say they were not only
+not pathognomonic of this affection, but they were actually
+incompatible with its existence. The same ignorance of the subject
+is shewn in relation to the disease of the heart, which, I boldly
+maintain, no one was justified in pronouncing to be _hypertrophy of
+the left ventricle_ from the stethoscopic indications stated in the
+case.
+
+It is just possible that the writer of the case may have made
+further explorations on which his diagnosis was founded; but if he
+had such in his case-book, it is equally unfortunate for the credit
+of the stethoscope and his own, that he suppressed them in his
+printed case.
+
+  I have the honour to be,
+  Gentlemen,
+  Your obedient servant,
+
+  A STETHOSCOPER.
+
+  Nov. 25, 1828.
+
+
+
+
+MECHANISM OF VOMITING.
+
+
+_To the Editor of the London Medical Gazette._
+
+  Glasgow University, Nov. 26, 1828.
+
+  SIR,
+
+Having lately perused, in the 35th Number of the Medical Gazette,
+some observations "on the mechanism of the act of vomiting," by
+Dr. Marshall Hall, in which, after controverting the different
+opinions which have been entertained by physiologists on this
+question, he endeavours to prove that vomiting is an effort, not
+of _inspiration_, but of _expiration_, and advances this opinion
+as having originated in himself, I beg, through the medium of
+your Journal, to refer that gentleman to Richerand's Physiology,
+where, on the subject of vomiting, page 70, he says, "Sometimes the
+action of the muscular fibres of the stomach is quite inverted;
+they contract from the pylorus towards the cardia; and this
+antiperistaltic motion, in which the contractions act with more
+force and rapidity, and in a manner decidedly convulsive, produces
+vomiting. The action of the abdominal muscles then connects itself
+with that of the stomach; the viscera are propelled upwards and
+backwards, by the contraction of the large muscles of the abdomen;
+_the diaphragm ascends towards the chest; if it descended, in
+contracting, the œsophagus that passes between its two crura would
+be compressed, and the expulsion of food through the cardia could
+not be effected_. It is also observed, _that during expiration
+only, any thing can pass from the stomach into the œsophagus_."
+Again, on respiration, page 147--"_In every effort of expiration_,
+as coughing and _vomiting_," &c. Here, then, we see that Dr. Hall's
+views, as far as regards vomiting being an effort of expiration,
+have long since been advanced by Richerand.
+
+The profession are certainly much indebted to Dr. Hall for his
+corroboration of these views; at the same time he should not have
+taken to himself the merit of having first suggested them.
+
+  Sir,
+  Your most obedient servant,
+
+  A SUBSCRIBER.
+
+
+
+
+CHARACTER OF THE LANCET.
+
+
+_To the Editor of the London Medical Gazette._
+
+  Dec. 19, 1828.
+
+  SIR,
+
+The events disclosed during the late trial in the Court of King's
+Bench, must fill every well-disposed mind with astonishment and
+horror. The moral aspect of the case is marked by every feature
+capable of exciting a sense of shame for our profession, and of
+sorrow for our kind. Can it be that a publication conducted in the
+spirit of the extracts produced at the late trial of Cooper against
+Wakley should be fostered and encouraged by a large proportion of
+the medical public? Is it indeed true that no feeling of loathing
+and disgust should have induced the purchasers of the Lancet to
+protest against its glaring injustice, its undisguised ferocity and
+malignity?
+
+I am not a reader of that work myself, and but for the disclosures
+recently made in our courts of justice, together with what I have
+learned from your own pages, I should know little about it. Some
+of its early numbers convinced me that it was a production not
+deserving of support, whatever ability there might be connected
+with it; subsequent events have amply justified this decision, and
+I now address these few hasty lines to you, to express my humble
+hope that all the respectable medical men throughout the kingdom
+will arise, and with one voice oppose this moral pestilence, which
+at once corrupts and degrades their profession.
+
+The _odium medicum_, bitter and vindictive as it unfortunately has
+been, never, I believe, appeared in a form so repulsive. Are we
+living in the nineteenth century? Have arts and sciences, which
+are asserted of old to soften the manners and temper the violence
+of our nature, produced no such fruits amongst us? Is serious, and
+perhaps irremediable injury, to be inflicted on reputation; and is
+the sufferer thereafter to be dared to mortal combat, and this too
+by the wrong-doer? Is it thus that professional justice is to be
+awarded? Is it thus that knowledge is to be advanced, the dignity
+of our profession to be maintained, its benefits enlarged, and
+its usefulness transmitted? Is it thus that the young men are to
+be taught how to acquire an unworthy and discreditable notoriety;
+to disregard all the decencies, charities, and higher virtues
+of life; and to bring into the exercise of our art the insidious
+cunning of the knave, the vulgar dishonesty of the pilferer, and
+the audacious bearing of the bravo?
+
+I know not how others may feel on the present occasion: I am
+entirely unacquainted with the parties who have been at issue in
+the late suit--I have no bias of any kind, but what must arise in
+the mind of every man who has any regard for the profession to
+which he belongs, or who loves truth and fair dealing--I am sure
+that it is not less for the interests of society at large than for
+the advancement of medical science, that just principles should
+regulate all our dealings, both with the public and with each
+other. It is manifest that of late we have signally and woefully
+departed from them; and it is most distressing to know that this
+departure has been sanctioned by so many members of the profession.
+I now entertain a confident hope that all who reflect on the
+character of the late libel will feel that their own _character_ is
+at stake if they do not mark their disapprobation of it in every
+possible way. Sure I am that, if the principles which guide the
+Lancet become generally acceptable, it will mark an æra of moral
+degradation which no surgical dexterity, no medical acquirements,
+however eminent, could possibly redeem.
+
+  VERITAS.
+
+
+
+
+DURATION OF HUMAN LIFE IN RUSSIA.
+
+
+Cases of longevity are not only much more common, but also more
+extraordinary in respect to a greater duration, in Russia than in
+any other part of Europe; thus, from the report of the holy synod,
+published in 1827, it appears that there were living in 1825, among
+those who professed the Greco-Russian religion throughout the
+empire, not fewer than 848 males who were 100 and more years old;
+among whom, 32 had passed the age of 120, 4 were between 125 and
+130, and 4 others between 130 and 135 years of age. Out of 606,881
+males who died in 1826, 2785 had passed the age of 90 years; 1432
+that of 95; and 818 that of 100. Among the latter, 38 were more
+than 115 years of age; 24 more than 120; 7 more than 125; and one
+was 160 years old at his death.
+
+
+
+
+MEDICAL GAZETTE.
+
+_Saturday, December 27, 1828._
+
+    "Licet omnibus, licet etiam mihi, dignitatem _Artis Medicæ_
+    tueri; potestas modo veniendi in publicum sit, dicendi
+    periculum non recuso."--CICERO.
+
+
+
+
+ANALYSIS OF WAKLEY'S DEFENCE ON THE LATE TRIAL.
+
+
+We last week presented our readers with a full[20] and, we trust,
+accurate account of the trial for libel, which has recently excited
+so much interest; and we offered some remarks of a general nature
+upon its result and tendency. We had purposed at the same time to
+subject Mr. Wakley's mode of conducting his cause to a critical
+investigation, but this we were prevented from doing by want of
+time and space. We thought it likely, too, that the Editor of the
+Lancet would have fairly met the question in his next publication,
+and himself put the facts of the case, at least, on record: instead
+of this, however, he has devoted his pages to compliments to
+himself, and scurrilous and absurd abuse of Sir James Scarlett,
+in which he informs us that in his opinion that gentleman is
+"prodigiously overrated even as a lawyer," and says many other
+things, which serve only to shew how dreadfully Wakley himself had
+smarted under his lash.
+
+We find the general opinion to correspond with that which we
+expressed last week--that the defendant had managed his cause in
+a very bungling manner; and the estimation in which he and his
+witnesses were held by Judge and Jury is apparent from the charge
+of the one, and decision of the other. Both, indeed, regarded the
+asseverations of his whole _family party_ as dust in the balance
+against the testimony of one single competent and honourable
+man--Mr. Callaway; for on his evidence the result obviously hinged.
+Our contemporary affects to look upon the verdict as a triumph on
+his part--so he would if the damages had been five hundred or a
+thousand pounds, for in truth he has nothing else for it; and with
+all our hearts we wish him many such victories.
+
+With regard to the amount of damages, we certainly should have been
+better pleased had it been larger; but we did not expect that it
+would--nay a reference to our number which was published while the
+trial was going on, will shew that we were even doubtful of the
+verdict, because we know how extremely difficult it is for a jury
+to comprehend such a complicated question--how easy for a knave to
+impose upon their ignorance by misrepresentation and falsehood. It
+is quite obvious that if the jury had believed one syllable of the
+evidence of Wakley's witnesses, they must have given the verdict
+in his favour. In a case like this, where _one individual only_,
+and he the plaintiff, can be fully aware of the difficulties which
+had to be overcome, it is almost impossible to bring evidence
+into a court of justice capable of satisfying the minds of twelve
+unprofessional men. From this circumstance alone it was that we
+expressed a doubtful opinion of the result. But besides all this,
+it is well known to all--_that one talesman might go determined to
+starve out the rest--that ten special jurymen might wish to give
+500l. and yet that, by the absurd constitution of the English law,
+their verdict might be thus controlled by one individual friendly
+to the defendant_.
+
+Most fortunately for the cause of truth, Wakley had the vanity and
+folly to conduct the defence himself, and, judging of other men's
+estimation of moral character by his own, he did not hesitate to
+place in the box witnesses whom no counsel would have suffered to
+go there, and who, being unable to stand the cross-examination,
+led to what must have been to Wakley a most humiliating exposure.
+Next to this, the most beneficial effect produced was that of
+the defendant's cross-examination of his opponent's witnesses:
+it was amusingly absurd, and shewed a lamentable want of tact,
+always eliciting something which he ought to have avoided. Lastly
+came the reply, of which he tells us he is himself ashamed--"We
+may state most unfeignedly," says he, "that we look back with
+regret to our errors in point of omission." Nor is this the only
+part of it for which he has cause to blush, for any thing more
+miserably deficient we never heard: it was a mass of confusion
+throughout--a repetition of the same ideas and expressions--and a
+most injudicious betrayal of rancorous feeling, at the very moment
+he was profanely invoking heaven to witness that he bore enmity to
+no man. In speaking of his reply in our last number, we declared
+it to be "false in statement--sophistical in argument--coarse
+in language--and diabolical in tendency;" and we now proceed to
+illustrate these several qualifications, in doing which little more
+will be necessary than to select a few passages, and arrange them
+under their appropriate heads.
+
+_False in Statement._--One of Wakley's principal objects was to
+impress upon the Jury a belief that he had not in any way attempted
+to influence his witnesses, nor even spoken to most of them,
+anterior to the trial. "Out of nine witnesses I have placed in the
+box, (says he) I never saw five of them, nor even spoke to five
+of them till yesterday." We appeal to any man of common sense,
+whether it be probable that this is true. It is possible indeed,
+and only just possible, that he was contented with employing
+others to question his witnesses, and ascertain what evidence they
+would give; but even if it were so, the assertion was not the
+less false in a moral point of view, because his intention was
+to convey the belief that he had inquired no farther than merely
+whether or not the witnesses had been present at the operation.
+But incredible and absurd as this was, he ventured a step farther,
+and assigned a reason for the choice made of one witness--(Lee the
+potatoe-merchant.) "I had heard (said Wakley) he was present at the
+operation--an honest man, and that he was a friend of Mr. Bransby
+Cooper, under the highest obligation to the Cooper family. Without
+asking him a single question I put him into the box, as I was most
+anxious you should hear all the evidence that could be adduced, and
+from _unsuspected and untainted quarters_." This lie carried with
+it its own refutation; for Lee swore that he had never even spoken
+to Mr. Cooper; and we are therefore amazed that Wakley should
+have hazarded so gross an assertion, as it could only have been
+effective on the supposition of his addressing a jury of absolute
+simpletons. But again--"Who were my witnesses? not men whom I had
+trained and lectured on models, and sketches, and drawings. Has
+it been shewn to you that I was closeted with any person or set
+of persons?" Yes, Mr. Thomas Wakley, it has been shewn, and by no
+less an authority than that of your _fidus Achates_, Mr. James
+Lambert. "The defendant (says the worthy author of the libel), the
+defendant was there whilst I was explaining the parts to persons
+who were to be witnesses--_the defendant also explained them to
+the same persons_." And again, "I have heard explanations given to
+persons who were to be witnesses in this cause FOUR OR FIVE TIMES
+within the last six weeks." So also that excellent thorough-going
+witness, Mr. Jeffry Pearl: "a _gentleman_ of the name of Lambert
+introduced me to the defendant; THE DEFENDANT _and Mr. Lambert
+endeavoured to shew that the forceps had passed between the bladder
+and the rectum_." So much for placing men in the box because they
+are friends of Mr. Cooper--so much for procuring evidence from
+"untainted quarters!"
+
+This is only to be matched in effrontery by the statement of some
+wise-acre at the radical meeting on Tuesday night. Being asked why
+no notice had been taken in the Lancet of a successful operation of
+lithotomy performed by Mr. B. Cooper, soon after the publication
+of the libel, he assigned as the reason that Mr. Wakley thought it
+might increase the damages, and otherwise injure Mr. Cooper! What a
+noodle the man must be to expect any one to believe him[21]!
+
+Mr. Wakley asserted that the evidence of his witnesses remained
+"untouched--wholly uncontradicted;"--whereas there was scarcely a
+single point in their statements which was not contradicted either
+by Mr. Callaway, who was present at the operation, or Mr. Key and
+Dr. Hodgkin, who examined the parts after death. But what is more
+remarkable, there was scarcely a circumstance on which his own
+witnesses agreed--for example, they differed with regard to the
+nature and direction of the incisions; with regard to the manner
+and frequency of introducing the forceps; with regard to the number
+of instruments used, and the mode of applying them; with regard to
+the size of the wound; with regard to the degree of force employed,
+and with regard to the appearances after death. Yet, in the face
+of all this, Wakley had the impudence to tell the jury that his
+evidence remained "uncontradicted." We have no hesitation in
+asserting that his own witnesses (putting Mr. Cooper's out of the
+question) advanced no charge of which they did not also furnish the
+refutation.
+
+Mr. Wakley asserted that Mr. Cooper was incapable of telling why
+he could not extract the stone, even "while he had his finger in
+the bladder." This is false: neither Mr. Cooper nor Mr. Callaway
+were able to reach the bladder with the finger at all, owing to the
+depth of the perineum.
+
+Mr. Wakley told the jury that the plaintiff did not like the
+bladder to be exposed, "because to surgeons there is indisputable
+proof that Bransby Cooper did not perform that operation as he
+ought," and that "Mr. Key and Mr. Callaway knew it." This is false:
+Mr. Key, Mr. Callaway, and Dr. Hodgkin, who had examined the parts,
+all deposed that there was nothing in them indicative of the
+operation having been improperly performed. Indeed, had it been as
+Wakley asserted, the plaintiff would not have been so foolish as to
+have had the parts preserved at all.
+
+_Sophistical in argument._--One of the pieces of sophistry on
+which Wakley seems chiefly to have depended, inasmuch as he went
+over it _six times_ in the course of his speech, was, that if his
+account of the operation had been incorrect more of those who were
+present would have been brought forward to prove it so. But, as
+we stated in our last Number, to have objected to Wakley bringing
+forward pupils, on the ground of their being incompetent, and then
+to have done the same thing, would have been grossly inconsistent.
+Lord Tenterden, in his charge, said, "he did not see whom he (Mr.
+Cooper) could, with propriety, have called besides Mr. Callaway;
+the others were all young men, only pupils, and probably too young
+and inexperienced to form any judgment on the case that could
+be relied on." There is also another person who has objected to
+these witnesses whom we may mention--not, indeed, one for whose
+authority we have the highest possible respect, but of whom the
+defendant in this case probably thinks more favourably--we mean
+Mr. Thomas Wakley, who, speaking of the Letter formerly published
+by Mr. Cooper's pupils on the subject of this operation, says,
+"their united opinion of the skill, dexterity, and self-possession
+exhibited by Mr. Bransby Cooper on this occasion, is not likely to
+influence the judgment of the profession, whatever it may effect
+with the public."
+
+The use made by Wakley of Sir Astley Cooper's expression, "give
+him time," is another specimen of sophistry. Sir Astley evidently
+meant merely to say that, _ceteris paribus_, a man who had been
+twenty years surgeon to an Hospital would be more experienced than
+one who had held the situation but one-fourth of that period.
+This we believe to have been his sentiment, though nothing was
+ever less happily expressed. Accordingly it was not lost upon the
+defendant, who exclaimed, "Is that the way in which our hospitals
+are to be conducted? Is that the mode in which your poor patients
+are to be treated?--that young and inexperienced men are to be
+placed there to _learn their profession_--not to know it before
+they get there, but are to go there to learn it--and learn it
+upon whom?--upon individuals who are as much entitled to the
+best and most scientific practice of surgery as any nobleman in
+this land." All very fine--but we should be glad to know how or
+where a practical acquaintance with surgery is to be acquired
+but in public hospitals--and if no man is to be appointed till
+after he has gained experience, where are such men to come from?
+Where are ready-made surgeons to be found fit to operate even
+before Lambert, without his being able _to make a hole_ in their
+reputation?
+
+One of the most knavish attempts in the whole speech, to take
+advantage of the jury, was exhibited in his description of the
+operation. How different from the clear, perspicuous, and candid
+narrative of Sir James Scarlett. You are told, says Wakley, that
+the stone was shelved _above_ the pubes and _behind_ the pubes;
+but, continued he, (placing a pelvis in the position in which it is
+during the operation,) a stone cannot be lodged above the pubes,
+because, you see, the pubes is above the bladder! This was, indeed,
+calculated to confuse men unaccustomed to the subject, and who
+did not probably reflect that above and below are merely relative
+terms, which must change with every change of position, and that
+it was not meant that the stone was between the pubes and external
+integuments, which, in the position for lithotomy, would be the
+literal meaning of _above the pubes_, but that it was in such a
+situation as, in the ordinary position of the body, was above the
+pubes. But Wakley assured the jury that it was impossible for any
+stone to be _above_ the pubes, for there was a tendon to prevent it
+which no force could overcome; and he affected to ridicule the idea
+of there being anything unusual, any extraordinary shelf behind the
+pubes, in which the stone could have been lodged. "Had there been
+a shelf here," said he,--"had there been a crooked passage--had
+there been a cavity, or any place for the deposition of the stone,
+do you suppose that shelf would not have been produced? Had there
+been any thing particular in the formation of the pubes, would they
+not have cut out the man's bone as well as the bladder?" It is
+probably impossible for any but medical men to appreciate fully
+the impudent imposition--the fraud of this statement,--this knavish
+artifice to mislead the jury. No attempt was made in any part of
+Mr. Cooper's case to show that there was such malformation, or that
+the stone was in the position which Mr. Wakley demonstrated it
+could not occupy--_thus answering an argument which had never been
+advanced_.
+
+The following is a good specimen of sophistry and stupidity.
+Finding it proved that there was no opening between the bladder
+and rectum, Wakley wanted to make out that he never had said
+otherwise, having stated the cellular membrane to be _lacerable_,
+and therefore not _lacerated_. And then, forgetting the nature of
+his argument, immediately added, "remember this; the gorget is not
+as wide as the finger, and that it is not an uncommon thing for an
+unskilful operator to drive the gorget in between the bladder and
+rectum." Thus insinuating what had been proved to be false, and
+what he had just argued, from the words of the libel, he could not
+have meant.
+
+_Coarse in language._--This scarcely requires illustration. But as
+specimens, on the present occasion, of vulgar slang and miserable
+attempts at wit, we may mention his talking of "hole and corner"
+proceedings,--his comparing Sir James Scarlett to sour milk,
+and which happy thought he has, in hand-bills pasted about the
+town, converted into "Knight and Professor of Sour Milk,"--his
+explanation of the term _bat_ as applied to surgeons, "because
+they live in the dark, they suckle their young, and live in creaks
+and crevices of old walls, hospitals, and dungeons, _thriving and
+fattening on their own species_,"--his address to the "_gang_" of
+hospital surgeons, whom he represented as wading "through blood
+up to the neck,"--and lastly, his exclamations, several times
+repeated, perhaps with _prophetic_ phrenzy, that he "would die in
+a dungeon and expire in a ditch."
+
+_Diabolical in tendency._--The general tendency of Wakley's
+writings, and especially of his address to the Jury on this
+occasion, so far as such ravings can have any influence, is to sow
+distrust between men in every class of society and their medical
+attendants; to poison the sources of public charity, and arrest
+the hand of benevolence; to contract the relief afforded to human
+suffering, leading the poor and uninformed to suppose themselves
+the objects of cruel and wanton experiment, thus encouraging them
+rather to suffer disease to run its course than seek relief in such
+abodes of blood and horror as he most falsely represents our public
+hospitals to be.
+
+One of the first ebullitions of this demoniacal effort consisted
+in representing to the Jury, which he did in two different parts
+of his address, that the patient had been kept _bound_ during the
+operation, as if some unusual degree of coercion had been employed.
+"Yet, in opposition to the patient's cries--in opposition to his
+repeated entreaties to be unbound, still the operator kept him upon
+the table."--"Gentlemen," continued he, "I should like to know
+upon what principle it was that the man was kept _bound_ upon the
+table when he implored to be loosened. Was he not a free agent?"
+And then he goes on to put into Mr. Cooper's mouth not only words,
+but a sentiment he never uttered.--"No, no, (says the operator,)
+my _reputation_ is concerned. You were brought here to have the
+stone extracted, and extracted it shall and must be--_if you were
+to die upon the table_." Unless Wakley was intoxicated we cannot
+in any other manner account for an argument at once so absurd, so
+unprofessional, and so malignant. It evidently excited no feeling
+but that of disgust in the minds either of the Judge or the Jury.
+
+The next paragraph to which we shall allude is a masterpiece
+of hypocrisy--"Let me ask you (said he) what you have heard
+respecting the miseries of the individual on whom the operation was
+performed? Not one word has escaped the lips of the counsel on that
+subject--not one word from the mouth of one of the witnesses. No,
+gentlemen, they are hospital surgeons themselves, and they know too
+well what the practices of our hospitals are, and the sufferings
+_patients are in the habit of enduring at their hands_, to feel
+for this man, or for any other man placed in a similar situation!"
+Canting hypocrite! this from the man who in the very case before
+us published his account of the patient's sufferings in the form
+of a drama, mingled with low and scurrilous gibes. Mark also the
+following--"Give such a verdict as shall satisfy the _poor_--as
+will shew that men are not to go into offices of this sort where
+the _poor are to be killed_, and that they shall not be at liberty
+to wade and ride through blood up to their necks to eminence in
+their profession. Ah! gentlemen, give such a verdict as shall
+satisfy the _poor_!"
+
+There is in the various paragraphs we have quoted, more deep-rooted
+malice--more abandoned violation of the truth--more hypocrisy--and
+more open outrage of common sense, decency, and feeling, than we
+ever remember to have met with, even in the pages of the Lancet.
+It is now quite obvious that Wakley, alarmed at the change which
+has taken place in the estimation of his work within the last few
+months, finds it necessary to adopt a new system; he therefore
+throws off the mask, and openly declares himself the champion of
+the ignorant and illiterate[22]--conjuring up to their imaginations
+evils which do not exist--denouncing the medical profession as
+one of blood and murder--medical men as "thriving and fattening on
+their fellow-creatures"--and calling upon the "humane contributors
+to our hospitals and infirmaries" to support him.
+
+Why really now, if the times of political turbulence were to
+return, and radical reform again to come into vogue, Cobbett
+and Hunt would have a most valuable coadjutor; but as it is, we
+almost think the sphere he has chosen is too limited for such a
+genius. Humbug, to be successful, ought not to be very open to
+detection; alleged abuses ought not to be of a kind which every
+man can satisfy himself are entirely without foundation; and he
+who professes disinterested motives ought not to begin by raising
+a subscription for himself. We offer these few hints to Wakley, in
+hopes they may be of use to him in his new career; above all, we
+advise him to be sparing in protestations: there are some already
+who look upon his sincerity with a suspicious eye; for although
+it is no doubt true, that he would "rather die in a dungeon, and
+expire in a ditch," than injure any man, yet somehow an idea has
+got abroad, that his constant habits of lying and slandering are
+not quite in keeping with these assertions. Nay, we have heard
+of some even of the "humane contributors" to our charitable
+institutions, who have been so unreasonable as to disbelieve all
+Wakley's stories about the _cannibalism_ of hospital surgeons, and
+to look upon the whole system of the Lancet as one of knavery and
+imposition.
+
+
+
+
+WAKLEY'S SUBSCRIPTION MEETING.
+
+
+A most amusing scene took place at the Freemasons' Tavern on
+Tuesday evening, of which we subjoin an account. The object of
+the meeting was, "to present Mr. Wakley with some decided mark of
+their approval of his spirited conduct in his late trial;" or, in
+other words, if possible, to raise a little money, and bolster
+up the Lancet a little longer. The persons present were small in
+number, but great in zeal; and as much noise, hissing, laughter,
+and shouting, took place as would have done credit to a much larger
+assembly. As this is a merry season, and it may amuse our readers,
+we subjoin the speeches of the principal orators on either side:
+it will be perceived that both the Gazette and Lancet had some
+handsome compliments paid them; and that Wakley got thoroughly
+abused even by some of those who went to the meeting as the
+champions of reform. There was not a single individual present of
+any weight in the profession, and the chair was occupied by a young
+man wholly unknown, except as secretary to the meetings held two
+years ago on the subject of surgical reform. Could no one whose
+name might sound familiar in the public ear be prevailed upon to
+go?--could none be found but Pateys, Wallers, Mills, Elliots,
+Childs, and the Lord knows who? Where was he, the idol of the
+Lancet, who on other occasions graced the chair--where he who first
+ycleped that Journal the "invaluable"? Alas! poor Wakley, what an
+exposure of a sinking cause! even thy former friends tremble for
+their reputations, and desert thee.
+
+
+SURGICAL REFORM.
+
+A meeting was held yesterday evening at the Freemasons' Tavern, in
+pursuance of an advertisement calling on the "Friends of Surgical
+Reform, the Supporters of a free Medical Press, and the humane
+Contributors to our Hospitals and Infirmaries," to meet there,
+in order to adopt measures for presenting Mr. Wakley, the Editor
+of the Lancet, with some decided mark of their approval of his
+spirited conduct, in his late trial in the Court of King's Bench,
+at the suit of Mr. Bransby Cooper, and of the principles which he
+so powerfully advocated on that occasion.
+
+[Mr. Patey, who was called to the chair, stated the object of the
+meeting; but as his speech was rather long, and contained nothing
+of the least interest, we omit it.]
+
+_Mr. Waller_, in proposing the first resolution, adverted to the
+terms of the advertisement, and remarked that the question for
+them was not whether they would support Cooper against Wakley, or
+Wakley against Cooper; but whether they would have a free medical
+press or not--(cheers). Every body must admit that there was
+only one medical publication that was entitled to be considered
+free--only one that dared to tell the truth. Another had been
+attempted to be set up against it, but this wretched rival was
+gagged and manacled, and its reports were only a medium which
+distorted truth, and were almost unintelligible. It was not,
+however, to support any particular man, or publication, that he
+came to that meeting, but to support the general cause in which
+they were all interested. He concluded by moving, as the first
+resolution, that "the best interests of the medical profession and
+of the public are identified with the cause of medical and surgical
+reform; and that Mr. Wakley, as Editor of the Lancet, having given
+the first impulse to that cause, and having subsequently advocated
+it with undeviating firmness and fidelity, is entitled to the
+cordial thanks and support of this meeting."
+
+_Mr. Mills_ seconded the resolution.
+
+_Dr. Shiel_ said this was an important meeting, in his opinion;
+for, if this resolution were passed, it would identify the medical
+profession with the Editor of the Lancet. If the principle
+embodied in that resolution went forth to the world, it would be
+attended with consequences deeply injurious to the profession.
+He knew neither Mr. Bransby Cooper nor Sir Astley, and therefore
+he was perfectly impartial. The first question was, how far the
+medical press was conducted with advantage to medical science and
+the members of the profession. Now he contended, but with great
+respect, and disclaiming all personal hostility, that the Lancet
+had nowise contributed to the progress of medical science or the
+improvement of the profession--(loud hissing, and some cheers).
+He trusted that the meeting had not been got up by a few of the
+friends of Mr. Wakley, and he was sure that that gentleman was
+too respectable and too dignified in his proper person to need
+any such attempt--(applause). He trusted that the meeting was
+before the British public to ascertain how far the Lancet was
+useful or advantageous to medical science; and he hoped that,
+however partial the gentlemen present might be to Mr. Wakley, they
+would be governed in what they should do by the real interests of
+science--(hear, hear). The question was one of great interest; for
+it was one that embraced not only the freedom of the press but the
+advancement of medical science. With respect to the freedom of the
+press, they lived in a country where the law always maintained
+that principle. When Mr. Abernethy had applied for an injunction
+against the Lancet, Lord Eldon said that there could be no doubt
+that the Lancet was a most useful publication--(applause). He did
+not know whether that observation had been brought forward at the
+late trial; but taking the case--what was it? It appeared that the
+operation was one of peculiar difficulty, as stated upon oath by
+some of the most experienced surgeons of the day. This operation
+was laid hold of by the Lancet, and published not as a medical but
+as a tragical performance, in which all persons without science
+or knowledge were appealed to, and no opportunity afforded to Mr.
+Cooper to vindicate himself. Here, then, was a low and pitiful
+attempt made through the medium of malice and calumny (loud hisses
+and uproar). Here was a rude and pitiful attempt by malice and
+calumny (renewed signs of disapprobation). And yet it was contended
+that this had advanced the medical profession. The evidence on the
+trial went to shew that the dangers by which the operator had been
+surrounded were not small, and that there was no just reason to
+accuse him of unskilfulness in what he did; and was it then to be
+said, in the face of the British public, that a Meeting had been
+held at the Freemasons' Tavern to offer praise and reward to the
+individual whose conduct had, by the verdict of the Jury, been
+stamped with the accusation of untruth (hear, hear! and hisses)?
+He would not deny that there was a degree of talent displayed in
+the Lancet; but neither could it be denied that it was a public
+depredator by means of reports surreptitiously obtained; and the
+title of "literary raven," which had been applied by Sir James
+Scarlett, appeared to him to truly depict its character (great
+hisses and uproar). Was it to be contended that any one had a right
+to come into a private lecture-room, and catch up all he could
+hear, and then to publish what he had thus surreptitiously and
+fraudulently obtained (immense uproar and hisses)? As far as the
+medical interest was concerned, he looked upon the Lancet as one of
+the most injurious publications that had ever appeared (hisses).
+All the best writers on the subject had dwelt with peculiar
+emphasis on the necessity of secrecy among the members of the
+profession, but the Lancet broke through this good rule, and made
+public whatever came within its notice; and he had no doubt that
+if it could get at the cases that occurred in private practice, it
+would give them without any scruple (uproar).
+
+The _Chairman_ begged to remind the speaker that at all events Mr.
+Wakley had not as yet done so.
+
+_Dr. Shiel._--I am arguing on the principle which appears to
+actuate Mr. Wakley.
+
+_Mr. John Elliot_ rose to order. He could not allow Dr. Shiel to be
+going upon suppositions; the thing that he supposed had never been
+done.
+
+_Dr. Shiel_ was sure that whatever turn might be given to the
+subject in England, that at all events the conclusions that the
+Meeting appeared to be coming to would be resisted abroad. The
+weight of Sir Astley Cooper's name abroad would overpower any
+such attempt, and, in fact, would render it contemptible; so that
+any attempt to prop up so low, pitiful, and mean an attack, must
+inevitably be attended with disgraceful failure (hisses).
+
+A gentleman observed, that he was much surprised at what had fallen
+from Dr. Shiel. He had been induced to suppose that the Lancet
+possessed talent, as he had heard it praised in so many directions,
+and he certainly had never heard till that evening that it was
+only to be found in the hands of the illiterate (hear, hear! and
+a laugh). He had always understood that it was only destined for
+the use of students and other members of the profession, and that
+it was likely to be of great use in reforming the abuses of the
+medical practice (hear, hear! and cries of "So it will!"). For his
+own part, he was glad that medical men were occasionally cut up,
+because when they did what was wrong it was proper that they should
+be told of it; and when they did what was right, it added a fresh
+stimulus to their exertions (applause).
+
+_Mr. Thomas_ observed, that he had not intended to say any thing at
+the present meeting; but as Dr. Shiel, in the course of his speech,
+had thought proper to make some remarks tending to calumniate Mr.
+Wakley's witnesses on the trial, of which he was one, he felt
+called upon to say a few words (hear, hear!). Dr. Shiel seemed to
+consider them all as the mere scum of the earth--as a miserable
+band, collected together to support Mr. Wakley, whatever might
+be the consequence; as though he was desirous of going the whole
+length of the Medical Gazette, which stigmatised them for what it
+called "their deep-laid contrivances--their rankling enmities, and
+their bitter revenge." For himself he could say, that it was not
+till the evening previous to the trial that he had been supœnaed,
+and that he had previous to that time never seen Mr. Wakley.
+
+_Dr. Shiel_ said that he could not have alluded to the gentleman
+who was speaking, as he did not even know his name.
+
+_Mr. Thomas_ then went on to observe, that as Dr. Shiel appeared
+to be the advocate of the opposite party, he also supposed that he
+was a contributor to the aristocratical (Medical) Gazette ("No,
+no!" from Dr. Shiel). If he were not, at all events he had put
+forward ideas that were quite consonant to the sentiments expressed
+in that Journal. In giving his testimony, he had not spoken of the
+instruments employed in the operation, but of his own impression
+on the subject, having been present thirty-five minutes; and that
+impression certainly was, that the operation had been performed in
+a bungling and unscientific manner (loud applause, mingled with
+hisses). Was he then, because he happened to be a witness on the
+occasion, to be put down, pell-mell, by the unfounded imputations
+of any one? The highly-principled, honourable-minded Medical
+Gazette, that had determined never to admit any personalities, had
+loaded Mr. Wakley and Mr. Lambert with all sorts of abuse. Was
+this what they intended to call acting on principle (applause,
+and cries of "No, no!")? He certainly had heard that Mr. B.
+Cooper was an amiable man in private life; but what had that
+to do with the question at issue? What had they to do with the
+private character of a man in a public office (cheers)? Surely the
+witnesses of Mr. Wakley were as competent to speak of the manner
+in which the operation was performed as those who had not been
+present (applause); and as he had seen many operations performed
+he conceived that he was a competent judge of the skill of the
+operator (applause).
+
+A gentleman, who appeared to be a student, thought that the
+introduction of any attack upon the witnesses, or indeed of
+anything that occurred at the trial, was irrelevant (hear,
+hear!). The way to answer a speaker was not by hisses, but by
+disproving his arguments and rebutting his facts (applause). If
+questions were to be settled merely by strength of lungs, he
+was afraid that instead of the right side prevailing, success
+would uniformly attend those whose physical powers probably much
+exceeded their mental (laughter and applause). He could not agree
+with the gentleman who had stated that the law of England was
+the protector of the freedom of the Press; for it was well known
+that the Judges had decided, over and over again, that truth was
+a libel (applause). It was only the vehicle that conveyed public
+sentiment, and not the force that impelled it forward. He was
+convinced that any attempt to connect medical reform with Mr.
+Wakley should be studiously avoided and disclaimed. As a friend of
+free discussion in every case, and anxious to uphold the principle,
+whatever he might think of the instrument, he intended to propose,
+as an Amendment, "That the latter part of the Resolution, relating
+to Mr. Wakley, should be omitted." This would save the cause of
+medical reform from being identified with Mr. Wakley, of whose
+impartiality he would give a specimen. In the last number of the
+Lancet, the report of the late trial was given from the Times, but
+with a remarkable omission. The Lord Chief Justice had rebuked
+one of the defendant's witnesses for not answering the questions
+in a straightforward manner, and this passage was omitted. If Mr.
+Wakley would do this on such an occasion, would he be more candid
+when the public eye was less upon him? He, therefore, wished to
+have the question of medical reform kept separate from Mr. Wakley
+individually. The first part of the Resolution would be carried
+without a dissenting voice, as on that principle they were all
+agreed, whatever they might think of the conduct of individuals.
+
+[One or two persons then made speeches for or against the
+amendment; which was negatived, and the original motion carried.]
+
+_Mr. Hensley_ then, after observing that Mr. Wakley's conduct
+was highly praiseworthy, because it tended in every way to the
+benefit of humanity, moved the second Resolution, which was to the
+following effect:--
+
+"That the purposes for which the Hospitals and Infirmaries of
+the Metropolis were founded, and that the views of the humane
+contributors to their funds, are materially promoted by the
+weekly publication of reports detailing the medical and surgical
+treatment of the unfortunate patients; and that Mr. Wakley having
+originated the practice of publishing Hospital Reports, has
+conferred important benefits on Medical Science, and on the cause
+of humanity."
+
+The resolution was then carried unanimously.
+
+_Mr. John Elliott_, on moving the third resolution, said that he
+did not come there to interfere in the quarrels of Wakley and
+Cooper. They had acknowledged that Mr. Wakley's exertions had been
+very conducive to medical reform, by the last resolution they
+had passed. Indeed, there could be no doubt that he had greatly
+served the cause of humanity, by preventing idleness on the part of
+medical persons, and compelling attention to the poor placed under
+their care. It was his opinion that the editor of the Lancet ought
+to be indemnified for the whole expense entailed on him by the
+late trial, including the damages awarded against him. This would
+not be a private subscription, like Brodie's, but one open to the
+world, and not to be questioned in a court of justice. He would not
+support Mr. Wakley if he had attacked private character; but he
+would, as the editor of the Lancet and the representative of the
+medical free press. He concluded by moving--
+
+"That the independent and impartial principles on which the Lancet
+was first established, have been preserved by Mr. Wakley at all
+risks; and as it was acknowledged at the late trial, that the
+legal expenses of his opponents on another occasion have been
+defrayed by certain hospital physicians and surgeons[23], it is
+farther resolved, that a subscription be opened for the purpose of
+defraying the expenses of the late action."
+
+[Dr. Shiel here spoke very strongly against entering into a
+subscription--while some spoke in its favour.]
+
+A discussion then arose about the question of whether an account
+of a second operation for lithotomy by Mr. Cooper (in which he had
+been successful) had been sent to Mr. Wakley? It was stated that
+such was the case, but as the action for the present libel was then
+commenced, _Mr. Wakley thought that he perceived something in that
+second report that might tend to aggravate the damages, and which,
+at the same time, would be farther injurious to Mr. B. Cooper_.
+
+The third resolution was then carried by an immense majority, only
+five hands being held up against it.
+
+_Mr. Evans_ moved, "That the statement of professional facts in an
+unprofessional form, such as the dramatic instead of the narrative,
+is highly reprehensible in the individual, and detrimental to the
+best interests of science."
+
+This resolution, after some turbulent discussion, was withdrawn.
+
+_Mr. J. L. Stevens_ then moved, as the fourth resolution, that "In
+accordance with the feelings this meeting has expressed, Mr. Wakley
+be invited to attend a Public Dinner, and that a Committee be
+forthwith nominated to arrange the same."
+
+_Mr. Rogers_ seconded the resolution, and it was carried
+unanimously.
+
+The members of the committee were then named, and power given to
+them to add to their number.--The chairman then vacated his office,
+and the meeting separated.--_Morning Chronicle, Wednesday._
+
+
+In the course of the evening, the conduct of one of the speakers
+gave for a short time an amusing turn to the discussion, which for
+a great part had appeared to many extremely dry and tedious. The
+gentleman in question, (not a medical man), in order to show the
+opinion he had entertained of the object of the meeting, proposed
+to read for the audience a letter which he himself had written to
+the chairman of the committee, asking permission to attend. He
+began, but he had scarcely got through a few words when he declared
+he was not able to make out his own writing, and requested the
+chairman to assist him. The chairman made the attempt, but was not
+more successful. Another gentleman then undertook the task, but
+with no better effect. The audience received each unsuccessful
+effort with loud laughter, which so much annoyed the writer that he
+took back the letter, and again tried to go through with it, but
+not being able to make it out, he proposed to read for the meeting
+two letters which he wrote on the same subject to the editor of a
+Sunday paper. (Loud laughter followed this proposition, which was
+increased, when, on an attempt to read one of them, he had no more
+success than before.) The gentleman, after complaining of the want
+of courtesy in the meeting, resumed his seat, declaring that he
+would give the letters to the reporters.--_Times, Wednesday._
+
+
+
+
+HOSPITAL REPORTS.
+
+
+GLASGOW ROYAL INFIRMARY.
+
+_Injuries of the Head._
+
+D. M'Millan, æt. 40, seaman;--while he was employed in the hold
+of a vessel, a heavy iron block, of a round form, fell from the
+rigging, a height of 20 feet, and struck him on the head. He was
+knocked down and stunned, but was able to rise and to walk with
+a little support. He was brought about a mile and a half in a
+hackney-coach to the hospital, and admitted by Mr. Cowan at one
+o'clock P.M., half an hour after the accident. At this time he
+had a stupified look, but was quite collected, and was able to
+walk across the ward; breathing and pupils both natural; pulse 75,
+of moderate strength. There was a wound in the scalp, commencing
+nearly over the centre of the sagittal suture, and running about
+three inches backwards and towards the left; along this a portion
+of skull, corresponding to the wound in size, was felt fractured,
+detached, and irregularly depressed. His right arm was benumbed and
+nearly powerless, but no mark of injury was observed on it.
+
+It was determined to remove the detached piece of bone, and the
+original wound being extended lengthwise in both directions, an
+incision was made through the scalp at right angles to it over the
+left parietal bone, thus bringing the fractured portion into view.
+This was found to be broken down into several fragments, some of
+which were firmly impacted under the surrounding cranium, and one
+spiculum, driven through the dura mater, had penetrated the brain.
+The trephine was applied a little to the left of the fracture, and
+the intermediate part removed with Hey's saw; the detached pieces
+of bone, ten in number, of various sizes and irregular shapes,
+were removed with the forceps, the scalp replaced and retained in
+position by a stripe of adhesive plaister and very light dressings.
+During the operation one artery required ligature, and about ℥v. of
+blood were lost: he had lost perhaps as much before. He remained
+quite sensible, bore it well, and shortly afterwards had half a
+glass of port wine in warm water.
+
+Ten P.M.--Has been tolerably easy; complains of pain of fore-part
+of head; pulse 82, firm.
+
+    Fiat V. S. ad ℥xviii.
+
+    Sumat statim Submur. Hydr. gr. viii. Pulv. Antimon. gr. vi.
+
+    Applic. Capiti Lotio ex Alcohol. et aq. calcis.
+
+Second day.--After bleeding, thought feeling of numbness of right
+arm somewhat lessened, and to-day has rather more power of it.
+Passed a tolerable night; a little head-ache; countenance pretty
+natural; tongue slightly loaded; thirst; no stool.
+
+    Sum. stat. Sulph. Magnesiæ ℥j. et rep. vesp. si opus.
+
+Third day.--From an aversion to use the bed pan, he rose to stool
+last night, and fell forwards on the floor, seemingly from having
+entangled himself in the bed clothes; he got into bed without
+assistance; had a shivering fit shortly after, but has had a pretty
+good night; bowels freely opened; head-ache slight; pulse 84, soft;
+tongue dry in middle. Towards the evening of this day he appeared
+drowsy; and on the fourth day he is reported as seeming confused
+and uneasy; countenance anxious; articulation difficult; the right
+arm was more paralysed, and indeed the whole right side seemed
+now to partake in the paralysis; a small part of the wound had
+adhered, the remaining part was flabby, discharging thin serum.
+In the evening the difficulty of articulation and drowsiness had
+increased. Twelve leeches were applied to each temple, and in a
+short time he seemed a little livelier.
+
+Fifth day.--Much in the same state; took a little beef tea.
+
+Sixth day.--Paralytic symptoms increased; breathing laborious.
+Blister to the neck. It may be worthy of remark, that in the few
+words he now spoke he never made use of the English language, but
+of the Gaelic, which was his native tongue; and even when told that
+he was not understood, he persisted in repeating the Gaelic phrase.
+
+Seventh day.--A small fungus was observed in upper part of wound,
+to which lint dipped in lime water was applied, and moderate
+pressure. The fungus continued to increase.
+
+On the eleventh and twelfth days he had slight bleedings from the
+scalp, which stopped spontaneously. Stupor, &c. greatly increased,
+but he still recognised his friends; took a very little chicken
+soup or beef tea daily, with lemonade, &c. for drink.
+
+On the evening of the thirteenth day bleeding to the extent of
+℥iv. or v. took place from fungus: it was checked by application
+of saturated solution of alum, but he sunk rapidly, and died that
+night.
+
+_Inspection 36 hours after death._--The fungus protruded
+considerably beyond the scalp, and was rather larger than a hen's
+egg, of a dirty brown colour, and a soft spongy consistence; it
+completely filled up the opening made in the skull by the trephine
+and removal of detached bone. The pericranium to the inferior side
+of this opening was found detached from the bone, to the extent
+of a crown piece, and beneath it the bone was rough, and covered
+with thin purulent matter. The dura mater, for two inches around
+the fungus, was covered with pus; this membrane, by sloughing,
+had allowed the fungus to protrude, and its edges adjacent to the
+aperture were thickened. On removing the dura mater, the fungus was
+observed to arise, partly from the middle, but chiefly from the
+posterior lobe of the left cerebral hemisphere: it occupied a space
+about three inches in length, and an inch and a half in breadth,
+extending to within a line or two of the roof of the ventricle;
+at its anterior part was an abscess, containing ℥ss. of pus. The
+fungus seemed to be a degeneration of the cerebral substance;
+sections of it showed the cerebral matter first dotted with an
+unusual number of bloody points, then assuming a greyish colour,
+which gradually passed into a dirty brown. With the exception of
+these bloody points, the brain presented no unusual vascularity:
+it was quite firm, except in the immediate neighbourhood of the
+fungus, where it gradually became softer as the colour of the
+cerebral substance became deeper, till in the centre of the fungus
+it was nearly of a broken down consistence. A quantity of serum was
+found in each ventricle.
+
+
+Another man who had been struck by the piece of iron which
+fractured M'Millan's skull was brought up to the hospital at the
+same time. He had received the blow on the vertex of his head. On
+admission he was in a state of fury, requiring the efforts of
+several men to hold him. His head was bruised out of all shape,
+quite depressed behind, and a fracture also of the frontal bone;
+there were evident symptoms too of fracture of the base of the
+skull. The case was hopeless. Several large depressed and detached
+pieces of bone were removed, but he died a few minutes after the
+operation.
+
+
+During the same week an old woman was brought up to the infirmary,
+who, the day previously, had fallen headlong down a stone
+staircase. She laboured under the severest symptoms of concussion,
+and besides had a comminuted fracture of the humerus into the
+elbow joint, and of the radius into the wrist joint of left arm.
+She was past all treatment, and died on the second day. The case
+is mentioned chiefly to remark, that although no external injury
+of the head could be observed, on inspection a fracture was found
+extending completely across the anterior part of base of cranium.
+
+
+There are no dispensaries in Glasgow, but such of the poor as are
+unable to obtain admission into the Royal Infirmary, and those who
+are not so ill as to submit to the confinement of an hospital,
+or for other reasons prefer remaining in their own houses, are
+prescribed for, and, if necessary, visited at the public expense.
+For this purpose the city is divided into districts, and a surgeon
+appointed to each. The "district shop" thus resembles a dispensary,
+where the surgeon prescribes in the presence of his pupils, who
+indeed, under his superintendance, have the management of many
+of the cases, both among the patients who receive advice at the
+"shop," and those who are visited at home. Although under the care
+of a surgeon, the diseases treated are both medical and surgical,
+for there is little distinction made between the two branches of
+the profession here.
+
+The following case occurred under the care of Mr. Stirling:--
+
+W. M. æt. 28, while returning home during the night in a state
+of intoxication, fell from a height of ten feet, into a court
+paved with stone. He was rendered insensible for some time, but
+on recovering was able to crawl to the nearest door, and was
+conveyed home. Medical assistance was immediately procured. On
+the forehead, about an inch above the nasal process of the frontal
+bone, was a cut an inch and a half in length, extending obliquely
+downwards from the right side; through this a triangular fracture
+was felt, the base of which was in the direction of the external
+wound, and the apex pointing downwards; the fractured portion
+of the bone was slightly depressed; the bones of the nose were
+also fractured, and there was great discharge of blood from the
+nostrils. One third, or nearly, of the upper lip was cut off, and a
+good deal of blood had been lost from the labial artery; the lower
+jaw at the symphysis was fractured and comminuted, and several
+pieces were perceived to be loose. Was quite sensible, remembering
+every thing up to the period of the accident. Pulse 80; has vomited
+frequently. Wound of forehead was dressed with adhesive plaister;
+the loose pieces of bone were removed from the lower jaw, and it
+was afterwards retained in juxta-position by a chin bandage.
+
+Early next morning he was bled to ℥xii. and had a purge of jalap
+and calomel, by which his bowels were freely opened. That night he
+felt considerable pain of head; pulse 90, full, and strong. He was
+bled again to ℥xxv. Blood first drawn had the buffy coat. After
+the bleeding the pain of head diminished, and he continued to do
+well. When the swelling and tenderness of face had subsided, it was
+observed that the fracture communicated with the frontal sinus. On
+holding his nose and attempting to blow it, matter and air escaped
+by the fracture. The man was anxious for a speedy cure, and for
+this purpose an operation to remove the depressed piece of bone was
+at one time thought of; there was no constitutional disturbance,
+however, and the case was left to nature. The discharge gradually
+diminished, and the wound healed up in about a month. The bones
+of the nose retained their position, and the broken ends of the
+jaw, after the swelling had subsided, were kept in their proper
+situation by a pasteboard splint till re-union took place. The lip
+also healed easily, and no deformity is now observable.
+
+
+GUY'S HOSPITAL.
+
+_Inflammation of Hernial Sac._
+
+The previous report of this case (Gazette, No. 51) conducted it to
+Nov. 18th, the tenth day from the operation, and the third on which
+fæces had been discharged from the wound; that discharge continued
+on the 19th, but on the 20th pus only was seen.
+
+Nov. 22.--Yesterday the dresser, Mr. King, observed a portion of
+_solid_ fæces make its escape, and to-day a similar discharge, in
+the fluid form, is manifest.
+
+Nov. 26.--Since the 22d, nothing but healthy pus has been seen; the
+wound is rapidly healing, and the patient's general condition as
+good as can be desired.
+
+Dec. 4.--He has begun to wear a truss, and is to-day allowed to
+leave his bed.
+
+Dec. 8.--As regards his original complaint, the man is perfectly
+convalescent, but he now discloses a small abscess in the scrotum,
+which has been gradually forming, and will detain him in the house
+some time longer.
+
+If it be a sound surgical maxim that, in strangulated hernia,
+the patient's safety depends upon an early operation, it is also
+a maxim no less sound, that where the evidence and symptoms of
+strangulation are imperfect, or dubious, the benefit of the doubt
+should be given to the operation, and it should be performed: for
+it is better that buboes should be laid open, or inflamed sacs cut
+into, twenty, aye, fifty times in succession, than that in one case
+a man should be suffered to die with strangulation of the intestine
+unrelieved.
+
+These remarks apply strikingly to this case of Mr. Key's, in which,
+although no hernia was found, they perfectly justify the operation.
+No case of strangulation could be more distinctly marked, or
+more clearly call for the knife, than did this; and had Mr. Key
+refused to use it, he would have deserved the scoff which, by a
+contemporary, has so preposterously been thrown on the "no hernia
+case." But, more than this, the operation was not only justifiable,
+but beyond a doubt _beneficial_--beneficial inasmuch as it at
+once relieved the distress of the patient, secured him from more
+extensive suppuration, from farther sloughing of intestine, and
+probably from extravasation of fæces into the abdomen; rendering
+also the process of reparation more easy and rapid.
+
+
+_Hereditary Hare-Lip._
+
+Dec. 4th, Mr. Key performed the operation for hare-lip on a child
+a few months old, whose case was remarkable only as it afforded an
+instance of _hereditary_ malformation. The father of the child had
+congenital hare-lip, for which no operation had been performed, and
+of his six children _two_ were born with the same malformation.
+
+_Queries._--1. If the father's lip had, in his infancy, been
+restored to the natural form, would the malformation in that case
+have descended to his children?
+
+2. Is the casualty in these cases to be traced _directly_ from
+the father to the incipient embryo, or _indirectly_, through the
+medium of the mother's imagination--It has been said that paternal
+resemblances are produced in the latter mode.
+
+  G.
+
+
+PARIS HOSPITALS.
+
+_Hôtel Dieu._
+
+_Cases of Gangrene of the Lungs._
+
+Some interesting cases of gangrenous suppuration of the lungs were
+published by Dr. Chambers, about eighteen months ago, in which he
+particularly pointed out the horrible fœtor of the breath as a
+diagnostic mark of the disease. The following cases which recently
+occurred at the Hôtel Dieu are good illustrations of more extensive
+destruction of the lung by a similar disease.
+
+CASE I.--A man, aged 32, of good constitution, laboured under
+bronchitis for some weeks, to which he paid little attention,
+when he was suddenly seized with pain in left side, dyspnœa,
+considerable cough, and a rigor, followed by fever. He was admitted
+into the Hôtel Dieu next day. Crepitation was perceptible over the
+whole extent of the left lung, posteriorly, and reaching to the
+site of the pain in the side, which was increased by percussion;
+great oppression, with frequent cough, and expectoration of
+violet-red colour, mixed with mucus; pulse frequent and small;
+constant chilliness; cheeks flushed.
+
+Next day the symptoms remained unabated, and _fœtor of the breath_
+was observed. Two days after it is stated that the expectoration
+maintained the same appearance, but _was now fœtid_; the breath
+was, however, still more offensive, and during the fits of coughing
+particularly so. In the evening the breath is said to have become
+_gangrenous_.
+
+21.--The cough was small, difficult, and painful, producing an
+expectoration of violet-coloured matter, approaching to chocolate,
+_with a characteristic odour_.
+
+22 to 25.--Expectoration and breath emit an _intolerable stench_.
+On the latter day the patient died.
+
+_Examination._--The body not emaciated. Strong adhesions of the
+left lung to pleura costalis. At its posterior part a large
+gangrenous layer, occupying the two superior thirds of the lung,
+covered at some points by a false membrane. The lower third, and
+the parts round the gangrenous portion, in different degrees of
+inflammation, and hepatised; the putrid mass was in great part
+black or violet-coloured, containing fragments of the pulmonary
+texture; the smell gangrenous, but less so than that of the breath
+during life; pus might be squeezed from the adjacent part of the
+lung.
+
+CASE II.--A man, aged 55, enjoyed good health till the beginning
+of May, at which time he experienced pain in the left side of
+the thorax after exposure to cold. During the next few days the
+cough was frequent, and the expectoration tinged with blood. A
+rigor now came on, followed by a distinct exacerbation of fever,
+and he came to the Hôtel Dieu. At this time he presented symptoms
+of inflammation of the lungs, and was bled with relief; he left
+the hospital in twelve days, being sufficiently well to resume
+his occupation. Scarcely had he done this, however, when he had a
+relapse, accompanied by great lassitude, oppression of breathing,
+and frequent cough. At the end of a week he returned. He was now at
+the twenty-first day of the attack. His skin was yellowish; face
+pale or of leaden hue, and greatly altered; his cough frequent,
+with abundant expectoration of matter like chocolate, with small
+specks resembling pus, and little bodies about the size of peas,
+which appeared to be portions of the lung. This putrid mass exhaled
+a _gangrenous odour_, and the expired air was impregnated in a
+high degree with an equally disgusting smell, which surrounded the
+patient's bed with a contaminated atmosphere. Percussion gave a
+clear sound over the whole extent of the chest; auscultation did
+not discover the pulmonary expansion on the right side. The pulse
+was weak, but not frequent; the patient was in a state of extreme
+prostration. Next day the odour of the breath and expectoration
+was, if possible, more dreadful. He lingered two days longer,
+during which time the fœtid smell somewhat diminished, and the
+proportion of pus in the expectoration increased.
+
+_Examination._--The left lung had contracted firm adhesions,
+particularly above and behind. It was torn in attempting to
+remove it, and there issued from the middle and posterior part a
+large quantity of dark-coloured matter, similar to what had been
+expectorated. An incision was made along the back part of the
+lung, and laid open a large cavity, occupying all the extent of
+the pulmonary organ, and still in part filled with the same kind
+of dark putrid matter. On washing out the cavity it was perceived
+that it was lined with a smooth and white membrane, to which were
+still adherent, at some points, dark filamentous shreds; these
+were removed by the least touch, and left the surface smooth
+beneath. The boundary was formed by a false membrane, about a line
+in thickness, which separated the mortified from the sound parts.
+The lung was reduced to a kind of bag, the parietes of which were
+on an average about an inch thick. In the upper part of the lung,
+which was hepatized, an incision discovered a number of smaller
+tubercles, which in the centre were in a crude state; and at one
+point several had suppurated, forming a cavity large enough to
+contain a nut.
+
+[The Editors of the _Journal Hebdomadaire_, from which these cases
+are abridged, add, in a note, that although the fœtor of the
+expectoration, such as above described, is usually dependent on
+gangrene of the lungs, yet that this is not invariably the case.
+In confirmation of this assertion they refer to three instances
+of fœtid expectoration--in the first, the patient is still alive;
+in the second, there was chronic bronchitis, with considerable
+dilatation of numerous bronchi; and in the third, bronchitis with
+some appearances of chronic pneumonia. Laënnec gives a case of
+dilatation of the bronchi, with remarkably fœtid expectoration.
+The argument derived from the first patient having survived we
+consider to be altogether erroneous, as patients more frequently
+recover from this than other forms of purulent expectoration.--ED.]
+
+
+
+
+PROCEEDINGS OF SOCIETIES.
+
+
+WESTMINSTER MEDICAL SOCIETY.
+
+December 6th, 1828.
+
+JAMES ARNOTT, ESQ. IN THE CHAIR.
+
+Pursuant to announcement, Mr. MacKelcan introduced the subject of
+concussion of the brain. After remarking on the several symptoms,
+and mentioning the other affections of the head with which
+concussion is apt to be confounded, Mr. M. directed the attention
+of the society more particularly to the treatment in the stage of
+collapse, adopted by Professor Andrini of Florence.
+
+Dr. Duffin stated, that having been in Florence, he had witnessed
+the employment of three, four, or six ounce bleedings employed
+by the Professor in the stage above-mentioned. The principle on
+which they were used was that of their acting as a stimulus to the
+brain; and really the plan was not apparently attended with any bad
+effects. When re-action has ensued, the practice of M. Andrini is
+the same as that resorted to in this country.
+
+The discussion then wavered between apoplexy and concussion, and
+ended by some good-humoured sparring between Dr. Addison and Mr.
+Gilbert Burnett, on the capability of the brain containing more
+blood at one time than another.
+
+The President announced from the chair that a special meeting would
+take place on Friday evening, December 12, at 7 P.M.
+
+
+December 20th, 1828.
+
+CÆSAR HAWKINS, ESQ. IN THE CHAIR.
+
+After some business had been dispatched, to which we shall allude
+in another place, Mr. Jewel related the particulars of a case of
+"supposed extra-uterine fœtation." The case, which is one of much
+interest, is as follows:--
+
+Mrs. F. a robust, healthy woman, ætatis 27, had been married one
+year, and aborted once; when, in the month of September 1827,
+she quitted her husband in London, and accepted a situation in
+the country. After the expiration of a few weeks she received
+permission to come to London for a day; and, naturally enough,
+passed that night, (November 8th), with her husband, returning
+again to the country next morning. Soon afterwards, the
+morning-sickness, heart-burn, and other sympathetic affections
+of pregnancy, appeared; but the catamenia still returned at the
+regular periods, though scanty and paler in colour than natural.
+She now quitted her situation, returned to her husband, and
+engaged a midwife to attend her in her expected confinement. The
+circumstance of quickening occurred in the latter part of February,
+and was accompanied by a severe paroxysm of fainting, whilst the
+abdomen gradually enlarged, and the motions of the child (as was
+imagined) could not only be easily detected with the hand, but were
+visible to the eye. On the 9th of August, making a period of 274
+days, she was seized with the usual premonitory symptoms of labour;
+the midwife arrived; found her walking her chamber, and concluded
+that the process had considerably advanced. Three distinct uterine
+contractions took place subsequent to the midwife's arrival, the
+last of which was so severe as to compel the patient to grasp
+firmly the back of a chair, and induce, after its subsidence,
+excessive faintness. From this time no further parturient effort
+was made; no examination per vaginam was instituted; neither was
+there noticed any sanguineous vaginal discharge. When Mr. Jewel saw
+her, examination detected nothing unusual in the os uteri, and the
+symptoms she presents are these. The abdomen is about the size of a
+woman's in the sixth or seventh month of pregnancy, the enlargement
+being general. Her general health is much disturbed: she complains
+of pain in the left hypogastric region, particularly when the
+abdomen is compressed by the hand or stays--and she also complains
+of weight in the abdomen, especially on leaning forwards. The woman
+herself has a strong prepossession that "something is to come
+away," or that she might be relieved by an operation. The woman
+believes that she still feels the motions of the child, though
+feebly.
+
+Having read this case, Mr. Jewel concluded by offering some
+observations on the subject of extra-uterine fœtation. He
+considered this as probably an instance of "graviditus
+abdominalis," and remarked that the uterus not having expelled its
+dezidua, was no conclusive proof to the contrary, Dr. Blundell and
+Mr. Langstaff having examined cases where this was wanting.
+
+Dr. Locock never saw a case where laceration occurred in the
+early months of pregnancy. Dr. L. remembered the particulars
+of a case where the uterus was lacerated in the fourth month,
+and the ovum escaped into the cavity of the abdomen, and the
+symptoms of pregnancy were exceedingly strong. Dr. Locock almost
+doubted whether Mr. Jewel's was an instance of pregnancy at all,
+for frequently women enjoying sexual intercourse have enlarged
+abdomens, and many of the other symptoms of pregnancy, which a few
+doses of purgative medicine will remove.
+
+Two remarkable instances of extra-uterine fœtation were related
+by Mr. Burnett and Mr. Cæsar Hawkins; and towards the conclusion
+of the evening the discussion turned on the powers of the ergot
+of rye. Dr. Locock had frequently tried it in amenorrhœa, and, on
+the whole, without any very good effects. In one remarkable case,
+where the lady particularly wished to have children, Dr. Locock
+having boiled an ounce of the ergot in a pint of water down to half
+a pint, gave an ounce and a half of this decoction three times a
+day. After the young lady had taken about half a pint, the most
+violent convulsions succeeded, which placed her life in imminent
+hazard, and from which it was long before she completely recovered.
+She menstruated twice after that, but then the discharge again was
+arrested, and has never since returned, nor has she become pregnant.
+
+The practice of "bougieing the uterus" in cases of dysmenorrhœa
+was brought upon the tapis, and excited a good deal of laughter,
+the members appearing to consider the proposal ridiculous in the
+extreme.
+
+
+MR. LAMBERT.
+
+At the last meeting of this Society it was proposed, on the
+recommendation of the Committee, that Mr. James Lambert should be
+expelled; and after some discussion it was agreed that the sense
+of the members should be taken by ballot at the next meeting,
+Saturday, January 3, 1829. It was thought that proceeding at
+once to his expulsion might give the appearance of the measure
+originating with a party, and that the delay would enable the
+deliberate judgment of the whole Society to be passed upon his
+conduct.
+
+
+HUNTERIAN SOCIETY.
+
+Dec. 10, 1828.
+
+DR. BILLING, PRESIDENT, IN THE CHAIR.
+
+Mr. Leese, Jun. exhibited to the meeting a specimen of medullary
+sarcoma, taken from the forehead of a man after death, with a
+portion of the os frontis. The man was fifty-eight years of
+age, long asthmatic, and appeared to die of hydrothorax. He
+never suffered any pain in the tumor, but expressed a sense of
+distention. It was immoveable at the base, and there were some
+fissures in the os frontis, from caries. The dura mater at the
+corresponding part adhered firmly to cranium, and on its being
+removed some spiculæ from the carius inner table remained adhered
+to it. There had never been any symptoms of cerebral affection. A
+tumor of the same nature had formed on the scapular extremity of
+the clavicle, and had occasioned anasarca of the limb.
+
+Mr. Key supposed that the tumor had originated from the diplöe,
+and believed that the only chance of relief in such a case
+would be trephining; but he acknowledged that there was little
+encouragement to operate in these cases, owing to the tendency of
+the disease to return in some other part. He related an instance
+of the true medullary fungus taking its origin from the cancellous
+structure of the os femoris. The limb was removed, but the patient
+died. A circle of fungoid glands was observed at the base of the
+heart, and some of the bronchial glands were in the same condition.
+
+Dr. Conquest expressed his belief that carcinoma was always a
+constitutional affection, and stated that at least in nine cases of
+cancer uteri out of ten, there was carcinomatous affection of the
+pylorus, mesenteric glands, or liver.
+
+Mr. Key and Dr. F. Ramsbotham had not observed, in their
+examinations, the coincidence noticed by Dr. Conquest.
+
+The remainder of the evening was occupied by a discussion on the
+different kinds of ulceration that occur about the os and cervix
+uteri, and the circumstances under which the removal of the uterus,
+or the amputation of the cervix, may be warrantable.
+
+Dr. Babington adverted to the occasional existence of a family
+disposition to carcinoma. He had known three sisters successively
+die of cancer in the breast.
+
+
+MEDICAL SOCIETY OF LONDON.
+
+Dec. 13th and 20th, 1828.
+
+DR. HASLAM IN THE CHAIR.
+
+The subject of discussion, at the first of these meetings, was
+stricture of the rectum, when the diagnosis and treatment of
+carcinoma of that part came under consideration. There was a
+remarkable discrepancy in the opinions of Messrs. Lloyd and Salmon
+as to the symptoms and management of carcinomatous affections of
+the rectum. Mr. Lloyd maintained that these affections of the
+intestine were sometimes attended with pain and sometimes not, and
+that the patients were often materially benefited by the use of
+bougies; while Mr. Salmon affirmed, that the disease was always
+painful, and not to be mitigated by the employment of these means.
+
+A variety of subjects came before the society at the next meeting.
+The president read a letter from Mr. Wansborough, of Fulham,
+describing the "original stomach-pump," a specimen of which
+accompanied the letter: the instrument Mr. W. stated to be of 25
+years' standing.
+
+Mr. Shearly exhibited, among other morbid specimens, a uterus,
+on the external surface of which the disease termed the "white
+tubercle" was in progress: there was also a small polypus near the
+os uteri. Mr. Pereira exhibited to the society a fine specimen of
+medullary sarcoma of the liver. The organ was so enlarged as to
+have occupied two-thirds of the abdomen. The other viscera were not
+involved in the disease. The progress of the disease, as far as
+it could be ascertained, was excellently detailed by Mr. Smith, a
+visitor. The symptoms were obscure.
+
+Mr. Armstrong read an extract of a letter from Mr. Morgan, of
+the Bristol Infirmary, a corresponding member of the Society,
+describing a curious conformation of the œsophagus in a child,
+which lived 106 hours only, during which period every attempt to
+swallow food produced considerable distress. The œsophagus was
+found to be divided into two portions; the upper or pharyngæal
+extremity terminating in a _cul de sac_ behind the bifurcation of
+the trachea; and the lower or ventricular extremity arising from
+the trachea at this point, between the bronchi, proceeding down the
+spine, and terminating, as usual, at the cardiac orifice of the
+stomach. Mr. Drysdale mentioned a somewhat similar malformation
+occurring in two children in one family. Mr. Callaway related a
+case of concussion of the brain, which terminated fatally, after
+the restoration of the intellectual functions. The whole of the
+anterior lobes of each hemisphere of the brain was broken down, and
+mixed with effused blood. The remarkable feature of the case was,
+the return of consciousness, and the possession of this power for
+six days, under the disorganization of the brain described; and the
+questions particularly agitated were, Did this extent of mischief
+exist immediately after the concussion? What was the degree of
+laceration of the brain at that period? and, How could the recovery
+of the intellectual faculty be reconciled with so much injury of
+the brain?
+
+The Society then adjourned to the 12th of January, 1829.
+
+
+
+
+COOPER _v._ WAKLEY.
+
+
+Notes of the Cause, Cooper _v._ Wakley--We understand that Mr.
+Cooper is about to publish a verbatim account of the above trial,
+from Mr. Gurney's short-hand notes.
+
+
+
+
+ERRATA.
+
+
+The Advertisement of Mr. B. Cooper's, in our last Number, ought
+to have been dated "_December_ 15," instead of "_Oct._ 15." Also,
+for "_Mr. Elton_," the name of one of Mr. Cooper's witnesses, read
+"_Mr. Hilton_."
+
+In our last leading article, _for_ "can no friend of Wakley be
+named?" _read_ "can the name of no friend of Wakley be mentioned?"
+The alteration is necessary, to connect it with the conclusion of
+the paragraph.
+
+
+W. WILSON, Printer, 57, Skinner-Street, London.
+
+
+FOOTNOTES:
+
+[1] General thickening of all the valvular apparatus on both sides
+of the heart. (St. B. 33.)
+
+[2] Andral, vol. iii. p. 411.
+
+[3] Pl. 1, fig. 5.
+
+[4] Opacity and thickening of the lining membrane on both sides of
+the heart, without unevenness or alteration of form. (St. B. 33).
+
+Opacity and thickening in the valvular apparatus between the left
+auricle and ventricle, with shortening of the chordæ tendinæ, and
+such alteration of structure and form as to produce a considerable
+contraction of the aperture. (St. B. 26).
+
+Such thickening of the whole valvular apparatus as to narrow the
+aperture of communication between the left auricle and ventricle to
+a mere slit. (St. B. 19).
+
+Shrivelled and contracted state of the semilunar valves, in which a
+cartilaginous substance has entirely taken the place of the natural
+structure. (Hodgson, pl. 1, fig. 6).
+
+[5] Osteum aortæ almost closed by ossified valves. (St. B. 15);
+(Hodgson, pl. 1, fig. 2).
+
+[6] Fungus growing from the aortic valves, which are thickened and
+shortened. (St. B. 6, 20).
+
+Fungus form the aortic valves, which are ulcerated. (St. B. 21).
+
+Larger specimens of fungus, growing from the ulcerated edges of two
+of the valves of the aorta. (Hodgson, pl. 1, fig. 7).
+
+[7] Dr. Baillie's plate.
+
+[8] Polypous coagulum in the ventricle. (Coll. of Phys. 4, A. 16).
+
+Coagulum firmly attached to the lining of the left auricle, with
+enlargement of its capacity. (St. B. 19).
+
+[9] (St. B. 13).
+
+[10] It occurs sometimes in the uterus.
+
+[11] Memoir. de l'Acad. des Sciences. Morand, 1732. Morgagni,
+Epist. 27.
+
+[12] Andral, v. 3, 466; Hodgson, plate 1, figure 7; St. B. 14.
+
+[13] Corvisart, cap. 4. sect. 1.
+
+[14] Active dilatation of the left ventricle. (College of Phys. 4,
+c. 10.)
+
+The thickened walls of the left strikingly contrasted with the
+attenuated walls of the right ventricle. (St. B. 9).
+
+Active dilatation of the left ventricle. Its capacity is strikingly
+contrasted with that of the right. (College of Phys. 4, c. 11.)
+
+Passive dilatation of both ventricles, especially of the right.
+(St. B. 10).
+
+[15] Morgagni, Epist. xxvii. 7.
+
+[16] Ibid. 2.
+
+[17] Ibid. 3.
+
+Rupture of the left ventricle, with attenuation of its muscular
+structure. (St. B. 18).
+
+Rupture, without attenuation, but with softening and looseness of
+texture in the muscular substance. (St. B. 22).
+
+[18] Harvey, Exercit. altera.
+
+[19] Rupture of the left ventricle without change in its structure.
+Bone deposited at the commencement of the aorta. (St. B. 27).
+
+In turning over the Memoirs of the Royal Academy of Sciences, I
+find two cases of rupture of the heart, reported by M. Morand. They
+both occurred in the year 1730; and, strange to say, one was that
+of a Duchess of Brunswick, who was of the same family as George II.
+who also died of a ruptured heart. In the one, that of the Duchess,
+there was a manifest ulceration through the walls of the right
+ventricle, its structure being otherwise unimpaired; in the other,
+where the aperture was in the left ventricle, there was probably
+a simple rupture, for the flesh of the heart was so soft that the
+point of a probe would pass through it wherever it was rested.
+(Mem. de l'Acad. Roy. des Sciences, Ann. 1732).
+
+[20] The trial as published in the Lancet occupied less than 21
+pages--in the Gazette it extended, in the same type, to 33 pages
+and a half. In the Lancet, those parts, both of the evidence and
+speeches, which told most against Wakley, were omitted.
+
+[21] See passage in Italics, page 137.
+
+[22] The defendant, on leaving the court, was cheered by the
+populace in Palace Yard.--Lancet, Dec. 20.
+
+[23] This we believe is false; nothing of the kind either occurred,
+or was stated at the trial.--E. G.
+
+
+
+
+  TRANSCRIBER'S NOTE
+
+  Obvious typographical errors and punctuation errors have been
+  corrected after careful comparison with other occurrences within
+  the text and consultation of external sources.
+
+  Except for those changes noted below, all misspellings in the text,
+  and inconsistent or archaic usage, have been retained.
+
+  Pg 116, 'immedate contact' replaced by 'immediate contact'.
+  Pg 119, 'and attennuation in' replaced by 'and attenuation in'.
+  Pg 126, 'Tue valuable paper' replaced by 'The valuable paper'.
+  Pg 132, 'probably impossibly' replaced by 'probably impossible'.
+
+
+
+
+
+End of the Project Gutenberg EBook of The London Medical Gazette; December
+27, 1828, by Various
+
+*** END OF THIS PROJECT GUTENBERG EBOOK LONDON MEDICAL GAZETTE, DEC 27, 1828 ***
+
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+
+Project Gutenberg's The London Medical Gazette; December 27, 1828, by Various
+
+This eBook is for the use of anyone anywhere in the United States and most
+other parts of the world at no cost and with almost no restrictions
+whatsoever.  You may copy it, give it away or re-use it under the terms of
+the Project Gutenberg License included with this eBook or online at
+www.gutenberg.org.  If you are not located in the United States, you'll have
+to check the laws of the country where you are located before using this ebook.
+
+Title: The London Medical Gazette; December 27, 1828
+       Being a Weekly Journal of Medicine and the Collateral Sciences
+
+Author: Various
+
+Release Date: November 5, 2016 [EBook #53450]
+
+Language: English
+
+Character set encoding: UTF-8
+
+*** START OF THIS PROJECT GUTENBERG EBOOK LONDON MEDICAL GAZETTE, DEC 27, 1828 ***
+
+
+
+
+Produced by John Campbell and the Online Distributed
+Proofreading Team at http://www.pgdp.net (This file was
+produced from images generously made available by The
+Internet Archive)
+
+
+
+
+
+
+</pre>
+
+
+
+<div class="transnote">
+<p><strong>TRANSCRIBER'S NOTE</strong></p>
+
+<p class="screenonly">The 'Apothecary System' of measurement was used in the original text.
+The etext uses the following Unicode symbols:<br />
+<span class="pad4">℞ &nbsp;</span><span class="pad4">Prescription symbol</span><br />
+<span class="pad4">ʒ &nbsp;</span><span class="pad4">Dram</span><br />
+<span class="pad4">℥ &nbsp;</span><span class="pad4">Ounce</span><br />
+<span class="pad4">ℳ</span><span class="pad4">Scruple</span><br />
+Roman numerals, and 'ss.' for 'half', are retained, so for example
+'℥iss.' indicates 'one and a half ounces'.</p>
+
+<p class="handonly">The 'Apothecary System' of measurement was used in the original text.
+The etext uses the following glyphs taken from the text images:<br />
+<span class="pad4"><img class="glyph" src="images/rx.jpg" alt="" /></span> <span class="pad4">Prescription symbol</span><br />
+<span class="pad4"><img class="glyph" src="images/dram.jpg" alt="" /></span> <span class="pad4">Dram</span><br />
+<span class="pad4"><img class="glyph" src="images/ounce.jpg" alt="" /></span> <span class="pad4">Ounce</span><br />
+<span class="pad4"><img class="glyph" src="images/scruple.jpg" alt="" /></span><span class="pad4">Scruple</span><br />
+Roman numerals, and 'ss.' for 'half', are retained, so for example
+'<img class="glyph" src="images/ounce.jpg" alt="" />iss.' indicates 'one and a half ounces'.</p>
+
+<p>Obvious typographical errors and punctuation errors have been
+corrected after careful comparison with other occurrences within
+the text and consultation of external sources.</p>
+
+<p>More detail can be found at <a href="#TN">the end of the book</a>.</p>
+</div>
+
+<hr class="chap pg-brk" />
+<p><span class="pagenum"><a name="Page_113" id="Page_113">[Pg 113]</a></span></p>
+
+
+<h1>
+<span class="small">THE</span><br />
+<span class="xl">LONDON MEDICAL GAZETTE,</span></h1>
+
+<p class="center lht">
+<span class="xxs">BEING A</span><br />
+<span class="large">WEEKLY JOURNAL</span><br />
+<span class="xxs">OF</span><br />
+<span class="large lsp antiqua">Medicine and the Collateral Sciences.</span></p>
+
+<p class="p1" />
+<hr class="fulla" />
+<p class="center large">SATURDAY, DECEMBER 27, 1828.</p>
+<hr class="fulla" />
+
+
+<h2>
+<span class="xs">PATHOLOGICAL ESSAYS</span><br />
+<span class="xxs">ON SOME</span><br />
+<span class="small">DISEASES OF THE HEART;</span></h2>
+
+<p class="pfs100"><em>Being the Substance of Lectures delivered before
+the College of Physicians</em>,</p>
+
+<p class="pfs100"><span class="smcap">By P. Mere Latham</span>, M.D.</p>
+
+<p class="pfs90">Physician to St. Bartholomew's Hospital.</p>
+
+<p class="pfs80">[Continued from p. 7.]</p>
+
+<hr class="r10a" />
+<h3>ESSAY II.</h3>
+
+<p class="pfs100"><em>Morbid Anatomy of the Internal Lining
+Membrane of the Heart.</em></p>
+
+<p class="noindent">The membrane which lines the cavities
+of the heart is very liable to disease,
+but not equally so in every part. Where
+it is thin and transparent, and admits
+the colour and character of the muscular
+structure upon which it is spread
+to be seen through it, it is seldom found
+diseased; but where it is of a denser
+texture, either in itself or from an admixture
+of other structures, whether
+cellular or fibrous, with its own, it is
+frequently, and often exclusively diseased.
+This latter character of a denser
+texture belongs to it where it forms
+the tough white circles which surround
+the apertures of communication between
+the auricles and ventricles; also
+where it is reflected upon itself, and
+forms the loose duplicatures of membrane,
+which are given off, as it were,
+from the internal surface of the heart,
+either at the fibrous circles intermediate
+between the auricles and ventricles,
+constituting the tricuspid and the mitral
+valves, or at the commencement of the
+pulmonary artery and aorta, constituting
+the semilunar valves.</p>
+
+<p>It is remarkable how curiously disease
+is apt to limit itself to the spaces
+just pointed out. Of the fibrous circle
+between the auricle and ventricle, of
+the valves which originate from it, and
+of the tendinous cords which connect
+the valves with the carneæ columnæ,
+there will not be the smallest space free
+from disease; but the disease will
+abruptly stop where the tendinous
+cords cease and the carneæ columnæ
+begin<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a>.</p>
+
+<p>The membrane, however, where it
+covers the fleshy columns of the heart,
+is not exempt from the possibility of
+disease: but when disease actually
+affects it, it has seldom originated there,
+but has generally spread from other
+parts of the same membrane, although
+(as we have just remarked) it is apt to
+stop short before it reaches this.</p>
+
+<p>Of the two sides of the heart, the
+membrane which lines the left is unquestionably
+the more liable to disease.
+But my own observation would never
+have led me to conclude that the membrane
+of the right side was so far exempt
+as it is commonly thought to be.
+Speaking from the best recollection I
+have of the specimens which have fallen
+under my examination, I should say
+that, in one-third of the cases where
+disease has been found on the left side,
+it has existed on the right side also,
+and been essentially of the same character.
+But there has been a remarkable
+difference in the extent to which it
+has proceeded on each side respectively:
+while on the left it has gone so far as to
+be the undoubted cause of death, on
+the right, although essentially of the
+same character, it has been only just
+beginning.</p>
+
+<p><span class="pagenum"><a name="Page_114" id="Page_114">[114]</a></span></p>
+
+<p>It very seldom happens that disease
+appertains to the lining of the right cavities
+of the heart exclusively; and,
+where it affects both, the disease in the
+right cavities is very seldom found in
+advance of that in the left.</p>
+
+<p>It should seem, indeed, according to
+the ordinary course of things, that disease
+does not begin in the lining of the
+right cavities of the heart, until it has
+already advanced to an extreme degree
+in the left.</p>
+
+<p>The internal lining of the heart, as well
+as of the arteries, is often found to have
+become of a red colour. This redness,
+so well known to all who are accustomed
+to examine dead bodies, used to be
+regarded as a mere stain imparted to it
+by the colouring matter of the blood
+after death. Yet a due consideration of
+various circumstances connected with
+it will hardly warrant this conclusion.</p>
+
+<p>It has been found whether the heart
+or artery be full or empty of blood;
+and if blood be present it has been
+found, whether it is liquid or clotted;
+and if it be clotted, whether it does or
+does not retain its colouring matter.
+External temperature, and length of
+time between the death of the patient
+and the dissection of his body, have not
+made any difference in the frequency
+with which this peculiar appearance occurs.
+Lastly, no artificial methods,
+such as washing of any kind, can get
+rid of it; nor will inclosing blood within
+an artery for any period produce it<a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a>.
+This simple redness is sometimes seen
+universally in both sides of the heart
+and throughout the whole arterial system,
+and sometimes in patches only, of
+greater or less extent, whether in the
+arteries or in the heart.</p>
+
+<p>Now, when all these circumstances
+are considered, although in some instances
+it may be a mere stain imparted
+by the colouring matter of the blood
+after death, it is plainly impossible that
+it should be of that nature in any large
+proportion of the numerous instances
+in which it is found.</p>
+
+<p>But if the appearance in question implies
+(as I believe it generally does) a
+morbid condition, of what kind is that
+condition? There are the same objections
+to considering mere redness as
+equivalent to inflammation here as in
+the pericardium, or in any other part of
+the body: here, as elsewhere, in one
+case it may be the condition out of
+which inflammation is to spring;
+while in another it may not be destined
+to give origin to any change in the
+structure of the part beyond itself, and
+may itself constitute the whole disease.</p>
+
+<p>It appears to me, that this mere redness
+of the internal lining of the heart
+and arteries has become a matter of
+undue perplexity to pathologists, because
+they have laboured to infer from
+it more than the simple fact itself will
+authorize. All I wish to establish concerning
+it is, first, that it is not always
+(probably very seldom) a mere stain
+imparted by the colouring matter of the
+blood after death; secondly, that it
+alone does not constitute inflammation.</p>
+
+<p>It may not be improper to mention
+the circumstances under which it has
+occurred to myself to find it. I have
+met with it most frequently, and to
+the largest extent, in subjects whose
+previous disease has produced a constant
+and habitual impediment to the transmission
+of blood through the heart and
+through the lungs, and that impediment
+has gone on increasing to the hour of
+their death; also in those, whatever
+might have been the nature of their disease,
+whose dissolution (I mean the actual
+process of dying) has been tardy and
+agonizing, and marked by great labour
+of respiration; in the apoplectic, for
+example, in whom, after sense and
+consciousness were extinct, life had
+been protracted, with stertorous breathing,
+for many days.</p>
+
+<p>In such subjects the countenance,
+the lips, and the whole skin, give
+evidence during life of blood pushed
+beyond the natural sphere of the circulation,
+and detained in the extreme
+blood-vessels. Hence it is obvious
+that the causes which have loaded and
+distended the capillaries in every part
+of the body have had a like influence
+upon the vasa vasorum.</p>
+
+<p>I do not mean to say that I never met
+with this peculiar condition of the heart
+and arteries under other circumstances,
+or that other causes may not produce it;
+but that I am not acquainted with it
+under any other with which, from frequent
+coincidence, it has seemed to have
+a natural connexion, or which have
+afforded a reasonable explanation of the
+phenomenon.</p>
+
+<p>This condition of the heart and arteries,
+considered as inflammation, has
+been assigned by some as the cause of
+<span class="pagenum"><a name="Page_115" id="Page_115">[115]</a></span>
+fevers of the more malignant kind.
+The frequency with which it has been
+found in some particular epidemic,
+must have led to the conclusion. But,
+however this may be, from my own observation,
+not restricting myself to the
+fever of any particular season, but taking
+into account all complaints called
+febrile, and belonging to all seasons,
+also from the result of inquiry among
+medical men who have had large acquaintance
+with morbid dissections,
+and from the experience of those who
+have made this particular point a subject
+of investigation (Laënnec and Andral)
+I venture to conclude that it has
+no essential connexion with fevers of
+any kind, either as cause or as effect.</p>
+
+<p>On some occasions the internal membrane
+of the heart and arteries, wherever
+it exhibits the appearance described,
+will allow itself to be peeled off from
+the subjacent structure with the least
+possible force; this facility of separation
+ceasing entirely beyond the boundary
+of the red tinge.</p>
+
+<p>Here unquestionably is further evidence
+of a diseased condition: but of
+what nature? Most pathologists would
+consider this to be of the nature of inflammation&mdash;and
+I believe justly.</p>
+
+<p>There is indeed much difficulty in pronouncing
+upon the nature of minuter
+changes of structure detected in the internal
+parts of the body after death. We
+are obliged to arrive at conclusions by
+help of analogies drawn from morbid
+processes, which we have watched in
+their progress during life, upon the external
+surfaces; for during life we have
+the functions and sensibilities of the part
+to aid us in forming a right judgment
+concerning its disease. When, during
+life, one tissue is separated from another,
+as the periosteum from the bone,
+or the cuticle from the skin, or the mutual
+cohesion between different tissues
+is sensibly weakened, we find it to be
+owing to the intervention of serous fluid
+which does not belong to their healthy
+state; and this, together with increased
+vascularity, or redness and heat, and
+pain, is enough to bespeak the presence
+of inflammation. All these conditions
+cannot remain after death. Hence, if
+we desire to form positive opinions concerning
+much which is unfolded by dissection,
+we must supply the defect by
+analogy. Thus, whenever, in any part
+of the heart or arteries, the cohesion between
+the internal membrane and the
+subjacent structure is manifestly lessened,
+and the membrane is unusually red
+at that part, we may regard these appearances
+as the vestiges of inflammation,
+without thinking that we go too far
+in so regarding them.</p>
+
+<p>The internal lining of the heart and
+arteries is often found red solely in the
+neighbourhood of ulcerated spaces,
+when there can be no doubt concerning
+the existence of inflammatory action.</p>
+
+<p>But the internal lining of the heart
+and arteries gives the most unequivocal
+evidence of its inflammation when it is
+found of a deep red colour, with coagulable
+lymph adhering to its surface.
+This condition is represented, as it was
+found in the aorta, in one of the beautiful
+plates, illustrative of the diseases of
+arteries, by Mr. Hodgson<a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a>. And the
+same condition, in the heart, I
+have seen in a preparation of Dr.
+Farre's, where lymph is deposited,
+upon the circular zone, which forms the
+aperture of communication between the
+left auricle and ventricle. These appearances
+denote the most acute inflammation:
+they are, I suspect, very rarely
+met with. In the few instances in which
+I have heard of them, they have been
+found where death has taken place
+after short and severe suffering, and with
+symptoms which characterize inflammation.</p>
+
+<p>But the specimens of disease most
+frequently met with in the internal lining
+of the heart, consist in an entire
+change of its natural structure, and in
+the formation of new products upon it
+or within it. Many of these, from the
+analogy of morbid actions in other parts
+of the body, must be considered to result
+from chronic inflammation.</p>
+
+<p>In any of those situations which have
+been stated as especially liable to disease,
+the membrane will become thick,
+tough, inelastic, puckered and shrivelled;
+and cartilage or gristle, and bone, will
+enter into its structure; excrescences
+will sprout out from it, resembling warts
+and fungus; and it will become ruptured
+and ulcerated.</p>
+
+<p>Cartilaginous depositions are often
+found beneath the membrane where it is
+single; or between its folds where it is
+double, in the situation of the valves;
+and thus they seem rather to belong to
+some structure contiguous to the membrane
+than to the membrane itself.
+<span class="pagenum"><a name="Page_116" id="Page_116">[116]</a></span>
+Such depositions will proceed to a considerable
+extent, while the membrane
+still remains free from disease. From
+a valve, which has been thick, opaque,
+and cartilaginous, I have seen the membrane
+separated on both sides, and
+transparent; the opaque and cartilaginous
+matter being left behind. Where, in
+cartilaginous depositions, the lining of the
+heart has become puckered and uneven
+on its surface, and the valves shortened
+and altered in their shape, the membrane
+itself participates in the disease,
+and is generally incapable of being separated
+from the subjacent structure.
+But great thickening may take place in
+the situation of the valves, from deposition
+of cartilage, without any unevenness
+of their surface or alteration of their
+shape; and under these circumstances
+the membrane itself you may expect to
+find hitherto exempt from disease<a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">[4]</a>.</p>
+
+<p>Osseous depositions are always, I
+believe, originally formed beneath, or
+exterior to, the membrane, both in the
+heart and in the arteries. There are two
+circumstances especially worthy of remark
+in this process of ossification:
+sometimes it is a pure and unmixed process:
+bone is formed, and nothing else.
+It is deposited in minute granules, or
+little brittle scales, or in plates of a
+larger size; and the intermediate spaces,
+whether in the heart or arteries, preserve
+their natural and healthy appearance.
+At first, these granules or scales,
+or plates of pure bone, are covered by a
+delicate pellicle, which is in fact the internal
+membrane of the heart or artery,
+separating them from the immediate
+contact of the circulating blood. But
+in process of time, as they increase in
+size, and become rough and unequal on
+their surface, they cause a rupture of the
+internal membrane, and have now nothing
+to separate them from the <ins class="corr" title="Transcriber's Note&mdash;Original text: 'immedate contact'">immediate
+contact</ins> of the blood<a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">[5]</a>.</p>
+
+<p>Sometimes ossification is a mixed
+process, or rather, I suspect, the result
+of another morbid process preceding it.
+With the cartilaginous depositions already
+described there is an admixture of
+bone. The quantity of bone generally
+bears a very small proportion to the cartilage
+when they both occur together, as
+if the bone proceeded from the cartilage,
+and not the cartilage from the bone. It
+is sometimes seen growing from the surface
+of the cartilage, and is sometimes
+deposited in its substance, and only detected
+by the knife.</p>
+
+<p>Simple ossification, as it occurs
+in the heart and arteries, has been
+classed among the natural changes
+which the parts in question are liable to
+undergo after a certain period of life.
+Of persons above the age of sixty years
+the proportion is that of seven in ten
+according to Bichât, in which ossification
+is discovered in some part of the
+arterial system. It very rarely happens
+that simple ossification is found before
+the period of old age: still it is difficult
+not to regard it as a morbid process.</p>
+
+<p>But ossification, when it is a mixed
+process, is unquestionably the result of
+disease. It is met with at all periods of
+life; and probably constitutes one of
+the terminations of inflammation. The
+kind of morbid structures with which
+the bone is united leads to this belief.</p>
+
+<p>Fungous, and wart-like excrescences,
+are found in all those parts of the internal
+lining of the heart, which have been
+already mentioned as most subject
+to disease. They seem to be the result
+of a new morbid action set up in parts
+already disorganized; for I have not
+met with them where the membrane has
+been otherwise healthy, but only where
+it has been thickened or cartilaginous,
+or ossified, ruptured, or ulcerated.
+They grow either from the surface of the
+membrane, or from its ruptured or ulcerated
+edges, and are always in immediate
+contact with the circulating
+blood<a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">[6]</a>.</p>
+
+<p>According to my observation, when a
+fungous or warty excrescence has
+grown from the ruptured edges of the
+membrane, it has been from them exclusively,
+<span class="pagenum"><a name="Page_117" id="Page_117">[117]</a></span>
+and from no other part of the
+lining of the same heart. And as rupture
+of the membrane seldom occurs in
+more than one situation at a time, the
+heart of the same individual seldom presents
+more than one excrescence of this
+kind: and as the aortic valves are the
+parts most liable to rupture, it is there
+that this single excrescence is most frequently
+found; not that rupture may
+not take place elsewhere. I once saw a
+single <i lang="la" xml:lang="la">chorda tendinea</i> ruptured; and a
+single fungous excrescence of considerable
+size hanging from it into the cavity
+of the left ventricle.</p>
+
+<p>Now, this morbid growth is evidently
+connected with the lacerated state of the
+membrane in the conditions of its production,
+whereby it is limited to a small
+space.</p>
+
+<p>It is probable that the membrane is
+first ruptured; that its lacerated edges
+inflame, and then throw out unhealthy
+lymph, or unhealthy granulations, in the
+shape of these fungous or wart-like excrescences.
+When they have sprung
+from a ruptured membrane, they
+have, in the specimens which I have
+examined, been larger than when
+they have arisen under other conditions.</p>
+
+<p>But when such excrescences grow
+from the surface of the membrane which
+is thickened and cartilaginous only, but
+not lacerated, they are more apt to
+occur in many parts of it at the same
+time. I have seen the valvular apparatus
+between the auricles and ventricles
+on both sides, as well as the aortic
+valves of the same heart, studded with
+them. They were all about the size of
+hemp seeds: they adhered to the membrane
+with different degrees of tenacity,
+and wherever they were capable of
+being detached, they left a rough surface.
+The lining of the arteries has
+been known to give origin to morbid
+growths of the same kind, which have
+obstructed the passage of blood, and
+given occasion to the formation of a
+coagulum, which has obliterated the
+pulse.</p>
+
+<p>The internal lining of the heart is
+liable to ulceration, not as a common
+consequence of simple inflammation,
+but as an occasional consequence of
+some of those diseased conditions which
+have been described.</p>
+
+<p>It is most commonly found around
+scales and spiculæ of bone, and under
+such circumstances as to leave no doubt
+that the bone itself has furnished the
+source of irritation from which it springs.
+The ulceration commences from the
+very border of the bony scale, as if it
+was a process of nature for detaching it,
+and to a considerable distance around
+the ulceration the membrane is reddened,
+and easily detached from the subjacent
+structure. Where there are several
+distinct scales of bone, it is not uncommon
+to find a circle of ulceration
+around each of them.</p>
+
+<p>Ulceration is also met with where
+there is a thickened and cartilaginous
+state of the membrane without ossification.
+Under these circumstances, as
+far as I know, it affects no definite form.
+It is often a very destructive process of
+disease, obliterating large portions of
+the valvular structure, and penetrating
+deep into the muscular substance of the
+heart.</p>
+
+<p>Rupture of the internal lining of the
+heart is not easily distinguished from
+ulceration. In collections of morbid
+anatomy, many unquestionable specimens
+of ulceration are described as specimens
+of rupture. Rupture must
+always be looked for in the valvular
+apparatus of the heart, <em>i. e.</em> in the
+valves themselves, or in the chordæ
+tendineæ which are their appendages.
+It is probably incapable of taking place
+elsewhere, except as a part of a rupture,
+which involves the whole organ.</p>
+
+<p>That solution of continuity which is
+evidently without loss of substance;
+that of which the separated edges when
+they are brought together are completely
+adapted to each other; also that
+which is unaccompanied by any thickening
+or other morbid condition of the
+valve; the solution of continuity which
+is found under these circumstances, may
+safely be considered to proceed from
+rupture, and not from ulceration<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">[7]</a>.</p>
+
+<p>But it is probable that these characteristic
+conditions do not long remain
+after the occurrence of the rupture.
+Complete specimens of them are very
+rare; but specimens are numerous
+where the solution of continuity, by its
+form and direction, bespeaks rupture,
+while its rounded edges and the general
+thickening of the valve denote ulceration.
+These, it may be fairly conjectured,
+do in fact exhibit a compound of
+both. The membrane was originally
+ruptured, but disease has subsequently
+arisen and obscured the character of
+the mechanical injury.</p>
+
+<p>The greater number of those concretions,
+<span class="pagenum"><a name="Page_118" id="Page_118">[118]</a></span>
+which were regarded by the
+older anatomists as polypi of the heart,
+were unquestionably portions of mere
+blood, which had undergone coagulation
+after death. The blood remaining
+in the heart after death discharges itself
+of its colouring matter as it coagulates,
+and, giving off processes between
+the muscular fasciculi, assumes a shape
+which has suggested the name of
+polypus<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">[8]</a>.</p>
+
+<p>I have often found (I presume, therefore,
+that it is not an uncommon occurrence)
+coagula of an irregularly
+laminated texture having their colouring
+matter not entirely discharged,
+but unequally distributed through
+them, which have been most intimately
+adherent to some part of the lining
+of the heart. Of these some have admitted
+of separation, while the surface
+of the membrane and the surface of the
+clot were left rough at the place of contact,
+and others were incapable of being
+detached without the membrane being
+detached along with them. The appendix
+of the left auricle is a situation in
+which they are apt to occur, and they
+are generally accompanied by an extensively
+diseased condition of the lining
+membrane. These coagula, from their
+laminated texture, and from the intimacy
+of their union with the internal
+lining, seem to be essentially different
+from polypi of the heart. They appear
+to be connected with a process
+of disease in the membrane, and to
+have obtained their union with it long
+before the death of the patient.</p>
+
+<p>I once saw two separate tumors, entirely
+resembling what are called polypi, between
+the carneæ columnæ of the left
+ventricle, and firmly adherent to the
+heart; and in the centre of each a distinct
+formation of pus. The heart was
+otherwise healthy<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">[9]</a>.</p>
+
+<p>There are three preparations in the
+museum of the College of Surgeons,
+put up by Mr. Hunter himself, and
+noted by him as exhibiting "Tumors
+on the inner surface of the right
+ventricle, seemingly composed of layers
+of coagulable lymph one upon another,
+the central part having the appearance
+of glary mucus." This last appearance
+(the mucus) no longer remains
+in any of the three, but in its stead
+there is a cavity. The tumors
+which I have mentioned as originally
+containing in their centre a distinct
+formation of pus, also now present
+in its stead a cavity. The preparation
+preserved at St. Bartholomew's,
+and those at the College of Surgeons,
+are probably specimens of the same
+disease.</p>
+
+<p>Here what in the recent parts seemed
+to be pus or glary mucus, and the cavities
+still remaining in the preparations,
+must suggest the suspicion, that these
+tumors, whether they grew from the
+surface or were deposited from the
+blood, had become organized, and afterwards
+inflamed; and that the inflammation
+had terminated in the formation of
+an abscess.</p>
+
+
+<h3>ESSAY III.</h3>
+
+<p class="center"><em>Morbid Anatomy of the Muscular Substance
+of the Heart.</em></p>
+
+<p class="noindent">Dr. Baillie, speaking of inflammation
+of the substance of the heart,
+says, "When the pericardium covering
+its surface is inflamed, the inflammation
+sometimes passes a little way into
+the substance of the heart:" and then
+he gives these as the characteristic
+marks of such inflammation&mdash;that "it
+(the substance of the heart) becomes
+much more crowded with small vessels
+than in its natural state, and there are
+sometimes to be seen a few spots of
+extravasated blood." Now, this undue
+vascularity, and these few extravasated
+spots, where inflammation unquestionably
+belongs to a contiguous structure,
+may be deemed sufficient evidence of
+the muscular substance of the heart
+participating, or beginning to participate,
+in the same disease; but, absolutely
+and exclusively, it may be doubted
+whether more is not required to give
+a certain assurance of its inflammation.
+Here, as elsewhere, we must look for
+some of the proper products of inflammation;
+or for some of the permanent
+changes of texture which naturally result
+from it, according to its several
+modes of disorganizing.</p>
+
+<p>It is a very rare event to find pus
+among the products of inflammation
+of the substance of the heart: yet this
+event has occurred twice to my observation.
+In one instance the whole
+heart was deeply tinged with dark-coloured
+<span class="pagenum"><a name="Page_119" id="Page_119">[119]</a></span>
+blood, and its substance
+softened; and here and there, upon the
+section of both ventricles, innumerable
+small points of pus oozed from among
+the muscular fibres. This was the result
+of a most rapid and acute inflammation,
+in which death took place after
+an illness of only two days. In another
+instance, after death, which terminated
+an illness of long duration and
+characterized by symptoms referable to
+the heart, a distinct abscess was found
+in the substance of the left ventricle,
+closed externally by a portion of adherent
+pericardium, and connected internally
+with an ossified portion of the
+lining membrane.</p>
+
+<p>This diffusion of pus, or rather its
+formation in innumerable separate
+points, throughout the muscular structure
+of the heart, by a rapid and acute
+inflammation, is a singular occurrence.
+No such case has ever fallen within the
+knowledge of the most experienced in
+morbid anatomy, of whom I have made
+inquiry; neither has any such (as far
+as I can learn) been recorded in books<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">[10]</a>.</p>
+
+<p>A single collection of pus<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">[11]</a>, constituting
+an ulcer or abscess of the heart,
+and resulting from chronic inflammation,
+is also a rare occurrence, yet not
+so rare but that a specimen of it may
+be found in most collections of morbid
+anatomy<a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">[12]</a>.</p>
+
+<p>But independent of the formation of
+pus, softening and attenuation, as well
+as induration and thickening of the
+muscular substance of the heart, do,
+in different cases, according to the circumstances
+under which they are found,
+both bespeak inflammation.</p>
+
+<p>Together with the unequivocal evidence
+of inflammation in other parts of
+the heart, the muscular fibres have at
+the same time been found very soft and
+loose, and easily torn; and with this
+looseness of texture the heart has sometimes
+presented a dark and almost black
+appearance, and sometimes it has been
+almost blanched and colourless. The
+deep dark tinge shews that the muscular
+substance is unnaturally loaded with
+blood; whereas the absence of colour
+shews that it is destitute of its natural
+quantity. These different appearances
+do, in fact, belong to different stages of
+the same disease. The first indicates
+inflammation of the muscular substance
+in its present state of activity; the
+second, an irreparable disorganization
+of the muscular substance left by inflammation,
+when it has been unarrested
+in its earliest stages. The first is
+found when death takes place <em>in a
+few days after</em> the accession of the disease;
+the second, when the patient survives
+the first attack, and dies at a remoter
+period.</p>
+
+<p>The inflammation, which produces
+softening and attenuation of the muscular
+structure, is, I believe, always of
+an acute kind.</p>
+
+<p>But induration and thickening of
+the muscular substance of the heart is
+also the result of inflammation. This
+must be distinguished from hypertrophy,
+or mere augmentation of bulk, of
+which we shall speak hereafter. In this
+induration, which proceeds from inflammation,
+there is, besides increase
+of bulk and firmness, a manifest alteration
+of texture. A substance<a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">[13]</a> is produced
+offering a peculiar resistance to
+the knife. This condition unquestionably
+must result from an interstitial deposition
+of new matter among the muscular
+fibres. From concomitant circumstances,
+as well as from its own
+character, I presume that it proceeds
+from chronic, not from acute inflammation.
+I confess that I never saw a
+specimen of what I now allude to. It
+is described with some minuteness by
+Corvisart; but it may be presumed to
+be very rare, since Laënnec admits that
+it never fell under his observation.</p>
+
+<p>These opposite states of softening
+<ins class="corr" title="Transcriber's Note&mdash;Original text: 'and attennuation in'">and attenuation in</ins> one case, and induration
+and thickening in another, are
+known to those conversant with morbid
+dissection as the evidences of inflammation
+in other parts of the body besides
+the muscular substance of the heart.</p>
+
+<p>But there are changes of structure
+incident to the muscular substance of
+the heart which are independent upon
+inflammation, or, perhaps, upon
+any process which can properly be
+called morbid. They consist of simple
+augmentation and simple diminution of
+bulk and consistence. This simple
+augmentation of bulk and consistence is
+owing exclusively to a more ample development
+of natural structure. The
+muscular substance is more red than
+<span class="pagenum"><a name="Page_120" id="Page_120">[120]</a></span>
+natural, its carneæ columnæ are increased
+in thickness, and its proper fibrous
+texture is every where more strikingly
+manifest; but there is no interstitial
+deposition of matter new in its
+kind. It has been called hypertrophia
+of the heart, and the name conveys a
+tolerably just idea of its actual condition.</p>
+
+<p>The simple diminution of bulk and
+consistence is a condition the exact opposite
+of the former. The muscular
+substance is less red than natural; its
+proper fibrous texture less distinguishable;
+but there is still the appearance
+of muscle shrunk and withered, as if
+from an insufficient supply of nourishment.
+It may be called atrophia of
+the heart.</p>
+
+<p>Conjoined with augmentation, as well
+as with diminution of strength and bulk
+in the walls of the heart, there is almost
+always an increase in the capacity of its
+cavities; and in whichsoever part of
+the heart the walls are thus augmented
+or diminished, it is the cavity appertaining
+to the same part which undergoes
+the increase of capacity. Hence
+it appears either that one of these conditions
+is the immediate and necessary
+consequence of the other, or that both
+are the simultaneous effects of the
+same causes.</p>
+
+<p>Dilatation of any cavity of the heart,
+with thickening of its walls, is called
+<em>active dilatation</em>; and dilatation of any
+cavity, with attenuation, is called <em>passive</em><a name="FNanchor_14_14" id="FNanchor_14_14"></a><a href="#Footnote_14_14" class="fnanchor">[14]</a>.</p>
+
+<p>Active dilatation may appertain to
+every cavity of the heart simultaneously;
+and so may passive dilatation. But
+such occurrences are very rare: for
+one cavity being naturally more liable
+to this species of dilatation, and another
+to that, it most frequently happens that
+specimens of both conditions are found
+in the different cavities of the same
+heart.</p>
+
+<p>The left ventricle is much more
+liable to active dilatation than the
+right; and the right ventricle more so
+than either of the auricles; and of the
+auricles unquestionably the left. Upon
+the whole, perhaps, the fact may be
+truly stated thus&mdash;that the left ventricle
+commonly gains an increase of bulk
+and strength, with an increase of capacity;
+and that all the other cavities, at
+the time that they expand, are rather
+apt to become attenuated.</p>
+
+<p>It sometimes (though rarely) happens,
+that, with an increase of strength
+and bulk in its muscular structure, the
+left ventricle suffers a diminution of
+capacity in its cavity. In a case reported
+by Laënnec, the left ventricle
+was an inch and a half thick at its
+broadest, and an inch thick at its
+thinnest part; and yet its cavity was
+only capable of containing an unblanched
+almond. I have seen the same condition
+in a less degree.&mdash;(<cite>Laënnec</cite>,
+vol. ii. 698.)</p>
+
+<p>The circumstances under which these
+opposite conditions, this hypertrophy
+and atrophy of the heart, with the enlargement
+or diminution of its cavities,
+arise, must be explained hereafter.
+At present I would only remark that
+they are often found conjoined with
+actual disease in other structures of the
+heart, such as osseous or cartilaginous
+thickening of internal lining, adhesion
+of the pericardium, and ossification
+of the coronary arteries, to which they
+owe their origin; and, moreover, that
+they are often found where the heart is
+otherwise perfectly sound in texture,
+and where their cause must be sought
+in other parts of the body.</p>
+
+<p>The heart is liable to undergo a simple
+dilatation of its cavities without either
+thickening or attenuation of its muscular
+substance. This simple dilatation
+is sometimes of the whole organ, sometimes
+of one side, and sometimes only
+of one auricle or ventricle. When it is
+of one cavity only, it may be complicated
+with active or passive dilatation of
+another, or of all the rest.</p>
+
+<p>There is reason to believe that the
+heart sometimes undergoes a temporary
+dilatation, and again returns to its natural
+capacity; but that the dilatation
+can only subsist for a short time without
+becoming permanent.</p>
+
+<p>The power of thus enlarging its cavities,
+and restoring them to their natural
+condition, belongs more especially to
+the right side of the heart.</p>
+
+<p>A large accumulation of fat is sometimes
+met with about the heart.</p>
+
+<p>The healthy heart is always more or
+<span class="pagenum"><a name="Page_121" id="Page_121">[121]</a></span>
+less marked upon its external surface
+with streaks of white, and this appearance
+results from the deposition of fat in
+the cellular texture, which unites the
+serous covering with the subjacent muscular
+structure. It is found principally
+where the venæ cavæ unite to form the
+right auricle; also at the base of the
+ventricles, and along the line which
+marks the boundary between the two,
+and around the origin of the great blood-vessels
+as they emerge from the heart.
+But when fat is deposited in more than
+these situations, and in more than the
+natural quantity, it is not so much
+added to the healthy substance of the
+heart, as existing at its expense and detriment,
+and the muscular structure is
+that which especially suffers. The fibre
+of the fat heart is pale and wasted,
+like that of a paralytic limb.&mdash;<cite>Mus. of
+the Coll. of Surg.</cite> 327.</p>
+
+<p>A rupture of the heart is sometimes
+met with; but all the cases of reputed
+rupture are not such in reality. An
+aperture in the walls of the heart,
+through which blood escapes into the
+cavity of the pericardium, may result
+from ulceration as well as from rupture,
+or from a mixed process of one and
+the other; but whatever be the precise
+nature of the process by which this
+perforation of the heart is effected, it is
+undoubtedly of rare occurrence.</p>
+
+<p>Where it has been found, there has
+generally been at the same time some
+peculiar condition of the organ, which
+might be presumed favourable to its
+production. Its muscular substance
+has been so soft and loose of texture,
+that it could be pierced through by the
+weight of a probe<a name="FNanchor_15_15" id="FNanchor_15_15"></a><a href="#Footnote_15_15" class="fnanchor">[15]</a>; or it has been converted
+into, or greatly intermixed with
+fat<a name="FNanchor_16_16" id="FNanchor_16_16"></a><a href="#Footnote_16_16" class="fnanchor">[16]</a>; or its muscular fibres have been
+absolutely defective, leaving a certain
+transparent space, where the internal
+lining and the pericardium have been
+in contact, and served to maintain the
+completeness of the cavity, until the
+rupture has taken place<a name="FNanchor_17_17" id="FNanchor_17_17"></a><a href="#Footnote_17_17" class="fnanchor">[17]</a>.</p>
+
+<p>Not that a rupture has not been
+found where the texture of the parts has
+seemed to offer no natural facilities to
+its occurrence&mdash;as in the case related
+by Harvey himself, who found a lacerated
+aperture in the left ventricle, capable
+of admitting his finger, through
+which blood had escaped into the pericardium,
+the walls of the ventricle being
+increased in thickness and strength,
+while an obstacle existed at the entrance
+of the aorta<a name="FNanchor_18_18" id="FNanchor_18_18"></a><a href="#Footnote_18_18" class="fnanchor">[18]</a>. Here the heart must
+have torn itself asunder by the simple
+violence of its contraction, in contending
+against the impediment to the egress
+of blood from its cavity. This is an
+effect which would hardly be thought
+capable of being thus produced; but
+I can well believe it possible after having
+seen one of the recti muscles of the
+abdomen literally torn in twain, in a
+man who died of tetanus<a name="FNanchor_19_19" id="FNanchor_19_19"></a><a href="#Footnote_19_19" class="fnanchor">[19]</a>.</p>
+
+<p class="pfs80">[To be continued.]</p>
+
+
+<hr class="fulla" />
+<h2>DILATED ŒSOPHAGUS.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editor of the London Medical
+Gazette.</em></p>
+
+<p><span class="pad1 smcap">Sir,</span><br />
+
+Permit me to send the following case
+to you for insertion in the Gazette.</p>
+
+<p>Mary Blores, æt. 33, was admitted
+into the Middlesex Hospital on the 16th
+of November. She was in a state of
+extreme feebleness and emaciation.
+Those who brought her said that during
+the preceding month she had appeared
+to swallow nothing: what she took
+as food seemed to her to stop in the
+gullet, and after a few minutes returned.
+I found, however, that a
+large œsophagus-bougie passed readily
+into the stomach, meeting with no obstruction
+beyond a spasmodic resistance
+in the pharynx. A draught of
+milk and water was given her&mdash;she
+swallowed it without much effort, but
+it quickly returned. In the course of the
+<span class="pagenum"><a name="Page_122" id="Page_122">[122]</a></span>
+afternoon a pint of beef tea was injected
+through an elastic tube into the stomach&mdash;it
+was thrown up directly.</p>
+
+<p>I now learnt from her that she could
+swallow liquids much more readily than
+solid food; that when she took a small
+quantity, it seemed to her not to reach
+the stomach, and in three or four
+minutes was invariably thrown up; that
+on taking a large draught she had an
+impression that it reached the stomach&mdash;in
+this case vomiting did not follow so
+soon, and some part of the draught was
+permanently retained; that she craved
+food and drink, and was literally dying
+of hunger and thirst; that the vomiting
+which took place was not preceded by
+nausea, although in its progress it had
+all the appearance of ordinary retching;
+that the matter vomited was not
+thrown up at once, but by successive
+efforts; it consisted of the food she had
+last taken, mixed with colourless
+mucus. The belly was so shrunk that
+the umbilicus was not more than an
+inch distant from the spine, upon
+which the pulsations of the aorta were
+readily felt: there was no enlargement
+or hardness about the stomach,
+no particular tenderness on pressing
+the epigastrium, no sensation of pain or
+heat now or formerly.</p>
+
+<p>The complaint had began ten years
+ago, during pregnancy, since when she
+had never been free from it, although
+at times her sufferings had been less,
+and she had been able to retain some
+portion of her meals. She had borne
+in this period three children; the vomiting
+had lasted during the whole
+period of her pregnancies, and during
+her confinement. The principal remedies
+which had been used for her relief
+were a succession of blisters on the pit
+of the stomach&mdash;but they had produced
+no benefit. Latterly her symptoms had
+been greatly aggravated.</p>
+
+<p>This patient was attended by Dr.
+Watson and myself. But the means
+which we tried to enable her to retain
+her food, and to support her expiring
+strength, had scarcely a temporary
+effect. She died on the 2d Dec. sixteen
+days after her admission. The body
+was carefully examined, at the expressed
+wish of her relatives.</p>
+
+<p>The unusual appearances found in the
+abdomen were&mdash;1. the smallness of
+the first part of the duodenum, which
+was but half the ordinary size of
+the ileum; 2. the capaciousness and
+fulness of the gall bladder,&mdash;from
+which, however, on compressing it,
+the bile flowed readily into the intestine;
+3. a contraction of the middle of the
+stomach of the length of two inches,
+for which extent the peritoneal coat
+was thickened and opaque, and the inner
+membranes folded in deep longitudinal
+rugæ, the mucous surface of which was
+partially suffused with circular spots of
+red. The breadth of the contracted
+part of the stomach, as it lay collapsed,
+was an inch and a half.</p>
+
+<div class="figcenter">
+<img src="images/i019g.jpg" width="250" alt="" />
+</div>
+
+<div class="figcenter">
+<img src="images/i020g.jpg" width="250" alt="" />
+</div>
+
+<p>But it was in the chest that the most
+remarkable circumstance presented itself.
+The œsophagus gradually enlarged
+from the pharynx, which was
+perhaps rather narrower than usual,
+to an extraordinary degree of dilatation;
+the greatest breadth which it
+attained was situated about four inches
+above the cardia: the tube then contracted
+more abruptly, so as to render
+the termination of the œsophagus, like
+its commencement, of nearly the usual
+dimensions. The structure likewise of
+the cardiac extremity for about an
+inch, and of the pharyngeal end for
+about half an inch, was healthy. The
+intermediate part presented, when inverted,
+the following curious appearance:&mdash;The
+inner membrane was thickened
+and opaque, and had <em>the appearance</em>
+of having partially yielded from dilatation;
+at the upper part the furrows or
+thinner parts of the membrane followed
+in some degree a longitudinal direction;
+at the lower part the surface was pitted
+with shallow depressions of various
+figures. I have represented in the adjoined
+sketches these appearances, which on
+the middle of the œsophagus passed
+from one into the other; at the furrows
+<span class="pagenum"><a name="Page_123" id="Page_123">[123]</a></span>
+or depressions the membrane seemed of
+the natural thickness and colour; the
+intermediate raised and thickened part
+was opaque and whitish. The muscular
+fibres of the œsophagus were of the
+natural colour and thickness.</p>
+
+<p>
+<span class="pad2">I remain, Mr. Editor,</span><br />
+<span class="pad6">Your obedient servant,</span><br />
+<span class="pad10 smcap">Herbert Mayo</span>.</p>
+
+<p class="noindent fs80">19, George-street, Hanover-square,<br />
+<span class="pad4">Dec. 6, 1828.</span></p>
+
+
+<hr class="fulla" />
+<h2>HYDROPHOBIA.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editor of the London Medical Gazette.</em></p>
+
+<p><span class="pad1 smcap">Sir</span>,<br />
+
+As the following case may throw some
+additional light on the pathology of
+hydrophobia, I have sent it you for
+publication.</p>
+
+<p>
+<span class="pad2">I am, Sir,</span><br />
+<span class="pad6">Your obedient servant,</span><br />
+<span class="pad10 smcap">F. Godrich</span>.</p>
+
+<p class="fs80">Grove House, Little Chelsea,<br />
+<span class="pad4">Nov. 29, 1828.</span></p>
+
+<p class="p1" />
+<p>On Thursday morning, the 25th ult.
+I was called up about seven o'clock to
+see a man who I understood was exceedingly
+ill, and waiting in the surgery
+very impatiently for my arrival. I
+found my patient (Mr. Barham), a fine
+looking old man, about 60, labouring
+at intervals of about five minutes under
+strong spasmodic paroxysms, affecting
+the muscles concerned in breathing
+and deglutition. There was a wildness
+and an impatience depicted in his
+countenance, totally different from any
+thing I had ever observed in other spasmodic
+affections. His bowels were open,
+tongue clean, skin moist, pulse full and
+a little accelerated. I took away twenty
+ounces of blood, and prescribed a mixture
+containing
+<span class="screenonly">ʒss.</span><span class="handonly"><img class="glyph" src="images/dram.jpg" alt="" />ss.</span>
+of laudanum for a
+dose every hour until I should see him
+again. He walked home half a mile
+from my house (Gloucester Road, Old
+Brompton), and left me ruminating on
+the possible cause of so much mischief
+occurring suddenly in a fine healthy
+subject. At ten a message was sent,
+saying that he was much worse, and
+requesting me to call as soon as possible.
+He received me tranquilly, and
+said he was very glad that I had come
+to see him, for he was very ill. His
+symptoms were now more distressing
+than when I first saw him: he looked
+wildly and suspiciously at every one entering
+his apartment, and his breathing
+was accompanied by a short convulsive
+sobbing. On looking at his medicine
+I perceived he had taken none, and expressing
+my surprise, he assured me it
+was impossible for him to swallow a
+single drop, as the attempt had been
+followed by violent spasms, and produced
+so much distress, that he had desisted.
+At this period no one had the
+slightest idea of the origin of his
+malady. I poured out some medicine
+into a tea-cup, the very act of which
+produced much excitement and alarm.
+My first impression as to the true nature
+of his disease arose at this period, from
+the circumstance of his requiring a tea-spoon,
+with which he endeavoured to
+take some of the medicine. The attempt
+produced much excitement and
+alarm, and after two or three painful
+efforts at deglutition, with one desperate
+effort he swallowed a tea-spoonful, threw
+away the spoon, and begged, unless I
+wished to destroy him, that he might
+have nothing more to swallow. I now
+left his room, and inquired of a bystander
+whether any thing particular
+had occurred to him within the last
+few weeks. On recollection she said,
+"About a month since, late at night, a
+strange dog came into the premises and
+fought with his own dog; he got out of
+bed to separate them, and the strange
+dog bit him in two places, on the left
+arm and hand; and bit a puppy, which
+died about a fortnight after in a strange
+<span class="pagenum"><a name="Page_124" id="Page_124">[124]</a></span>
+way, which was thought to be some
+kind of a fit." To ascertain if this occurrence
+had produced any effect on his
+mind, while again bleeding him I said,
+"You have been in the wars, Sir, and
+had your hand and arm torn; how did
+it occur?"&mdash;"Oh!" said he, carelessly,
+"that was done by a dog a long time
+ago, but it healed." The circumstance
+was never again mentioned to him, and
+he died in total ignorance of the cause
+of his malady. The wounds were perfectly
+cicatrised, and there was not the
+least action going on indicative of recent
+absorption. He bore the bleeding
+pretty quietly:
+<span class="screenonly">40℥.</span><span class="handonly">40<img class="glyph" src="images/ounce.jpg" alt="" />.</span>
+were removed,
+which on cooling presented strong
+marks of inflammation.</p>
+
+<p class="pad2 fs80">Ordered
+<span class="screenonly">ℳiv.</span><span class="handonly"><img class="glyph" src="images/scruple.jpg" alt="" />iv.</span>
+Acid. Hydrocyan. omni horâ, in a little water.</p>
+
+<p>Twelve o'clock.&mdash;With much difficulty
+he has taken two doses of the
+acid; pulse full and hard, 110.
+<span class="screenonly">30℥.</span><span class="handonly">30<img class="glyph" src="images/ounce.jpg" alt="" />.</span>
+more blood were removed.</p>
+
+<p>Three o'clock.&mdash;Has taken two more
+doses; complains of a dreadful sense
+of suffocation, and implores that nothing
+more may be given him. Pulse full, and
+beating at 120 to 130. Continue the
+acid.</p>
+
+<p>Eight o'clock.&mdash;Pulse full and hard.
+Has taken in all
+<span class="screenonly">24ℳ.</span><span class="handonly">24<img class="glyph" src="images/scruple.jpg" alt="" />.</span>
+of the acid, but
+so painfully distressing has the deglutition
+now become, that all attempts at
+repeating his medicine are discontinued.</p>
+
+<p class="pad8 fs80">V. S. ad
+<span class="screenonly">℥xxx.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />xxx.</span></p>
+
+<p>During the bleeding he looked wildly
+at the basin, and begged that no more
+might be spilt (a drop or two had fallen),
+repeating frequently, in great
+agitation, as the blood was running,
+"Take care! take care!"</p>
+
+<p>Between two and three o'clock next
+morning my assistant (Mr. Davies) visited
+him. He found him tolerably
+passive, but observing every movement
+with intense anxiety. Pulse full and
+hard, face flushed, eyes denoting cerebral
+irritation. He had been at times
+outrageous. On its being intimated
+that bleeding was again necessary, a
+paroxysm came on more intense than
+any preceding,&mdash;and with great effort he
+submitted. As the blood flowed he became
+more and more alarmed, till at
+length he got quite unmanageable; he
+raged violently at his nephew, who was
+holding the basin, and ordered it peremptorily
+to be removed. 30 or
+<span class="screenonly">40℥.</span><span class="handonly">40<img class="glyph" src="images/ounce.jpg" alt="" />.</span>
+were taken away. It was found necessary
+to put on the straight waistcoat.
+About four o'clock Mr. Davies wished
+him to take some more of his medicine.
+He said, "I can take no more," and on
+reaching the bottle to put out a few drops,
+he became violently agitated, threw himself
+from side to side, and, as well as
+the incessant spasmodic sobbings would
+allow, he begged that not one more drop
+of any thing might be offered him, and
+that the bottle might be taken from his
+sight. He did not become tranquillized
+until its removal. He lingered on till
+ten <span class="fs70">A.M.</span> in the same state, a few minutes
+before which he insisted on getting
+up, and walked a short way down
+his garden, returned, laid down on his
+bed, and died.</p>
+
+<p>Mr. Frederick Salmon, of Old Broad
+Street, and Mr. Wilson, of Chelsea,
+were kind enough to assist me in conducting
+the post mortem examination.
+On opening the chest, the heart was free
+from disease, with rather more water in
+the pericardium than natural; the lungs
+were completely gorged with grumous
+blood, and the pleura adherent on the
+right side. On removing the cranium,
+which was remarkably thin, and cutting
+the substance of the brain, numerous
+red spots presented themselves in the
+medullary portion; about a table-spoonful
+of water in each ventricle; the
+plexus choroides was turgid; the corpora,
+striata, thalami, and basis of the
+brain every where preternaturally injected;
+the cerebellum, crura cerebri,
+and cerebelli, in a high state of inflammation.
+On removing the spinous process
+of the vertebra, the whole cord
+was considerably inflamed; and opposite
+the two last cervical and dorsal
+vertebræ the cellular substance was
+studded with dark patches of coagulated
+blood, the theca vertebralis thickened,
+and the cord in an active state of inflammation.
+The larynx and pharynx
+bore not the slightest vestige of disease.
+The preparation of the cord is deposited
+in the museum of the London
+University.</p>
+
+<p>The post mortem examination of this
+case tends to prove the correctness of
+Professor Thompson's theory of the
+proximate cause and seat of this afflicting
+malady; and the plate accompanying
+a case recorded by him, in the
+13th volume of the Med. Chir. Society,
+gives a faithful delineation of the state
+in which the spinal cord was found in
+this case.</p>
+
+
+<p><span class="pagenum"><a name="Page_125" id="Page_125">[125]</a></span></p>
+
+<hr class="fulla" />
+<h2>CASE OF LONG PROTRACTED CONSTIPATION.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editors of the London Medical
+Gazette.</em></p>
+
+<p><span class="pad1 smcap">Gentlemen</span>,<br />
+
+Perhaps the following case may interest
+some of your readers, and if you
+think so, its insertion in your Journal
+will oblige</p>
+
+<p>
+<span class="pad2">Your obedient and</span><br />
+<span class="pad6">humble servant,</span><br />
+<span class="pad10 smcap">S. D. Broughton</span>.</p>
+
+<p class="fs80">12, Great Marlborough Street,<br />
+<span class="pad4">Dec. 3, 1828.</span></p>
+
+<p class="p1" />
+<p>On Tuesday, Nov. 25, I was called
+upon at the St. George's and St. James's
+Dispensary to advise for an infant at
+the breast, of five months and fourteen
+days of age, that had not passed
+any fæces during six weeks up to the
+day before I saw it. After its birth it
+had no passage till the fifth day, and
+this had apparently been effected by the
+introduction of a bougie, and which
+was subsequently continued at intervals
+for a short time. The infant was otherwise
+healthy and strong at its birth, and remained
+so until it had gone about three
+weeks without any evacuation, when it
+was observed to be weak in the lower
+extremities; and at the period of my
+seeing it the legs were much fallen
+away in flesh, hanging flaccid and inert.
+Many aperient enemas and medicines
+had been given, and, as a last resource,
+one drop of the croton oil had been
+prescribed the preceding evening. The
+infant appeared to suffer from distention,
+and to be disposed to coma, and
+the croton oil had distressed it much
+some hours after it was given. The
+fæces could be felt blocking up the intestine,
+but the irritation of the finger
+produced no attempt at evacuation;
+very small pieces only having been
+brought away. Hot baths also had
+frequently been used some time ago.</p>
+
+<p>Considering the case as one of paralysis
+in the parts naturally employed to
+relieve the bowels, I recommended
+the suspension of all purgative remedies
+by the mouth, and a table-spoonful
+of the following injection to be substituted,
+and to be thrown up with three
+table-spoonfuls of thin gruel occasionally
+during the day, by means of a
+syringe.</p>
+
+<p class="neg5 screenonly">
+℞ Spir. Terebenth. ʒiij.<br />
+Træ Zinzib. ʒj.<br />
+Aquæ, ℥iss. M.
+</p>
+
+<p class="neg5 handonly">
+<img class="glyph" src="images/rx.jpg" alt="" />Spir. Terebenth.
+<img class="glyph" src="images/dram.jpg" alt="" />iij.<br />
+Træ Zinzib. <img class="glyph" src="images/dram.jpg" alt="" />j.<br />
+Aquæ, <img class="glyph" src="images/ounce.jpg" alt="" />iss. M.
+</p>
+
+<p>The following liniment was also directed
+to be rubbed in frequently along
+the course of the spine.</p>
+
+<p class="neg3 screenonly">
+℞ Linimenti Saponis, ℥iss.<br />
+Liquor. Ammon. Comp. ℥ss. M.
+</p>
+
+<p class="neg3 handonly">
+<img class="glyph" src="images/rx.jpg" alt="" /> Linimenti Saponis,
+<img class="glyph" src="images/ounce.jpg" alt="" />iss.<br />
+Liquor. Ammon. Comp. <img class="glyph" src="images/ounce.jpg" alt="" />ss. M.
+</p>
+
+<p>The result justified my expectations;
+for, during the night after this prescription,
+two injections having been
+given, some large and hard ash-coloured
+lumps came away, and these were
+shortly followed by a forcible spouting
+out of a continued stream of feculent
+dark liquid; a brisk diarrhœa having
+been kept up till the Saturday following.
+The infant's appetite is become
+voracious, its appearance lively and
+healthy, and its legs as firm and strong
+as is usual at such an age. Cold water
+is recommended to be dashed upon the
+loins, the liniment to be continued
+occasionally, moderate doses of magnesia
+and rhubarb to be given when
+required, and the turpentine injection
+to be used if any return of the complaint
+should be threatened.</p>
+
+
+<hr class="fulla" />
+<h2>DISLOCATION OF THE PATELLA.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editor of the London Medical
+Gazette.</em></p>
+
+<p><span class="pad1 smcap">Sir</span>,<br />
+
+Having seen a case of dislocation of the
+patella, reported by Mr. Mayo, in your
+Journal a few weeks since, in which
+there was experienced some difficulty in
+the reduction of the bone, I beg leave
+to send you the following, in case you
+may think it worth insertion.</p>
+
+<p>On Saturday last, I was called to a
+young woman who had dislocated the
+patella of the left knee joint outwards;
+the inner edge rested upon the outer
+surface of the external condyle, and was
+immoveably fixed, and caused great pain
+when touched. She says it was occasioned
+by her foot slipping backwards
+from one stair to another, and she immediately
+fell down.</p>
+
+<p>I commenced the reduction, as stated
+by Mr. Mayo, but I could only produce
+semiflexion, and that gave her great
+pain; insomuch that I was obliged to
+desist, and the patella remained in <i lang="la" xml:lang="la">statu
+quo</i>. But when the knee was thus semiflexed,
+I desired my assistant to extend
+the leg suddenly; and having my fingers
+on the patella at the time, and pressing
+<span class="pagenum"><a name="Page_126" id="Page_126">[126]</a></span>
+it inwards, it immediately returned to
+its natural position.</p>
+
+<p>I must confess, sir, that I should
+have been afraid to have continued the
+flexion as described in Mr. Mayo's case,
+"by bending the knee to the utmost,"
+fearing that the remedy might be worse
+than the disease, and the result proved
+that in this case it was not necessary.</p>
+
+<p>
+<span class="pad2">I remain, Sir,</span><br />
+<span class="pad6">Your obedient servant,</span><br />
+<span class="pad10 fs70">P. M. Hoskings</span>.</p>
+
+<p class="fs80">168, Fleet-Street,<br />
+<span class="pad2">Dec. 3d, 1828.</span></p>
+
+
+<hr class="fulla" />
+<h2>VACCINATION.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editor of the London Medical
+Gazette.</em></p>
+
+<p><span class="smcap">Sir</span>,<br />
+
+The mistake of the printer in substituting
+the word "every" for "even,"
+in the paper on Vaccination (p. 40), so
+materially affects the sense of the passage,
+that I must request the favour of
+the following insertion:&mdash;</p>
+
+<p>"3d. That while the vaccine cicatrix
+retains even one distinct fovea or depression,
+the individual continues unsusceptible
+both of small pox and of re-vaccination;
+but that," &amp;c.</p>
+
+<p>
+<span class="pad2">I am, Sir,</span><br />
+<span class="pad6">Your obedient servant,</span><br />
+<span class="pad10 smcap">Thos. H. Burder</span>.</p>
+
+<p class="fs80">2, Brunswick Square, Dec. 15, 1828.</p>
+
+
+<hr class="fulla" />
+<h2>SINGULAR BICEPS MUSCLE.</h2>
+
+<p class="center"><em>To the Editor of the London Medical
+Gazette.</em></p>
+
+<p><span class="smcap">Sir</span>,<br />
+
+<ins class="corr" title="Transcriber's Note&mdash;Original text: 'Tue valuable paper'">The valuable paper</ins> communicated to
+your Journal, by Mr. Stanley, last
+week, has brought to my recollection a
+singular appearance of the parts in front
+of the shoulder-joint which I dissected
+about two years ago. It is a fact
+worth recording; and perhaps you will
+be kind enough to insert it in your next
+number.</p>
+
+<p>The circumstance was this&mdash;that in
+the right arm, instead of there being
+a biceps muscle having two origins, the
+one the shorter from the corocoid process,
+the other the longer from the
+upper part of the glenoid cavity of the
+scapula, there was simply a one-headed
+muscle arising from the corocoid process.
+I could find no tendon passing
+through the joint answering to the long
+head of the biceps, neither was there
+any appearance of a biceptical groove;
+the capsular ligament was, perhaps,
+thicker than it is found in ordinary
+cases.</p>
+
+<p>I knew nothing of this man during
+life, and am therefore unable to give
+any account of the use which he made
+of this arm.</p>
+
+<p>
+<span class="pad2">I am, your obedient servant,</span><br />
+<span class="pad10 smcap">C. M. Burnett</span>.</p>
+
+<p class="fs80">House Surgeon's Apartments,<br />
+St. Bartholomew's Hospital, Dec. 8th.</p>
+
+
+<hr class="fulla" />
+<h2>STETHOSCOPE.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editors of the London Medical
+Gazette.</em></p>
+
+<p><span class="smcap">Gentlemen</span>,<br />
+
+As you did me the honour, on a former
+occasion, to publish some remarks in
+defence of <em>auscultation</em>, against its
+enemies and detractors, I trust you will
+permit me to say a few words in reference
+to a communication in a late
+number, from a gentleman who appears
+to be a friend of that method of diagnosis,
+but whose ignorance of the subject
+is likely to be more injurious to the
+cause than either open enmity or secret
+detraction. The case in question (page
+780, vol. ii.) appears, from the dissection,
+to have been clearly <em>emphysema of the
+lungs</em>, as there stated; but I appeal to
+every one practically acquainted with
+the physical signs of diseases of the
+lungs, whether the results of the exploration
+with the stethoscope, as narrated
+in the case, were those pathognomonic
+of that disease? I say they were
+not only not pathognomonic of this
+affection, but they were actually incompatible
+with its existence. The same
+ignorance of the subject is shewn in relation
+to the disease of the heart, which,
+I boldly maintain, no one was justified
+in pronouncing to be <em>hypertrophy of the
+left ventricle</em> from the stethoscopic indications
+stated in the case.</p>
+
+<p>It is just possible that the writer of
+the case may have made further explorations
+on which his diagnosis was founded;
+but if he had such in his case-book,
+it is equally unfortunate for the credit
+of the stethoscope and his own, that he
+suppressed them in his printed case.</p>
+
+<p>
+<span class="pad2">I have the honour to be,</span><br />
+<span class="pad8">Gentlemen,</span><br />
+<span class="pad6">Your obedient servant,</span><br />
+<span class="pad10 smcap">A Stethoscoper</span>.</p>
+
+<p class="pad1 fs80">Nov. 25, 1828.</p>
+
+
+<p><span class="pagenum"><a name="Page_127" id="Page_127">[127]</a></span></p>
+
+<hr class="fulla" />
+<h2>MECHANISM OF VOMITING.</h2>
+<hr class="r10a" />
+
+<p class="center"><em>To the Editor of the London Medical
+Gazette.</em></p>
+
+<p class="center fs80">Glasgow University, Nov. 26, 1828.</p>
+
+<p><span class="smcap">Sir</span>,<br />
+
+Having lately perused, in the 35th
+Number of the Medical Gazette, some
+observations "on the mechanism of
+the act of vomiting," by Dr. Marshall
+Hall, in which, after controverting the
+different opinions which have been entertained
+by physiologists on this
+question, he endeavours to prove that
+vomiting is an effort, not of <em>inspiration</em>,
+but of <em>expiration</em>, and advances this
+opinion as having originated in himself,
+I beg, through the medium of your
+Journal, to refer that gentleman to
+Richerand's Physiology, where, on the
+subject of vomiting, page 70, he says,
+"Sometimes the action of the muscular
+fibres of the stomach is quite inverted;
+they contract from the pylorus towards
+the cardia; and this antiperistaltic motion,
+in which the contractions act
+with more force and rapidity, and in a
+manner decidedly convulsive, produces
+vomiting. The action of the abdominal
+muscles then connects itself with that
+of the stomach; the viscera are propelled
+upwards and backwards, by the
+contraction of the large muscles of the
+abdomen; <em>the diaphragm ascends towards
+the chest; if it descended, in contracting,
+the œsophagus that passes between
+its two crura would be compressed,
+and the expulsion of food
+through the cardia could not be effected</em>.
+It is also observed, <em>that during expiration
+only, any thing can pass from the
+stomach into the œsophagus</em>." Again, on
+respiration, page 147&mdash;"<em>In every effort
+of expiration</em>, as coughing and <em>vomiting</em>,"
+&amp;c. Here, then, we see that Dr.
+Hall's views, as far as regards vomiting
+being an effort of expiration, have
+long since been advanced by Richerand.</p>
+
+<p>The profession are certainly much
+indebted to Dr. Hall for his corroboration
+of these views; at the same time
+he should not have taken to himself the
+merit of having first suggested them.</p>
+
+<p>
+<span class="pad6">Sir,</span><br />
+<span class="pad4">Your most obedient servant,</span><br />
+<span class="pad10 smcap">A Subscriber</span>.</p>
+
+
+<hr class="fulla" />
+<h2>CHARACTER OF THE LANCET.</h2>
+
+<p class="center"><em>To the Editor of the London Medical
+Gazette.</em></p>
+
+<p class="right fs80">Dec. 19, 1828.</p>
+
+<p><span class="smcap">Sir</span>,</p>
+
+<p class="noindent">The events disclosed during the late
+trial in the Court of King's Bench, must
+fill every well-disposed mind with astonishment
+and horror. The moral aspect
+of the case is marked by every feature
+capable of exciting a sense of shame
+for our profession, and of sorrow for
+our kind. Can it be that a publication
+conducted in the spirit of the extracts
+produced at the late trial of Cooper
+against Wakley should be fostered and
+encouraged by a large proportion of the
+medical public? Is it indeed true that
+no feeling of loathing and disgust
+should have induced the purchasers of
+the Lancet to protest against its glaring
+injustice, its undisguised ferocity and
+malignity?</p>
+
+<p>I am not a reader of that work myself,
+and but for the disclosures recently
+made in our courts of justice, together
+with what I have learned from your
+own pages, I should know little about
+it. Some of its early numbers convinced
+me that it was a production not
+deserving of support, whatever ability
+there might be connected with it; subsequent
+events have amply justified this
+decision, and I now address these few
+hasty lines to you, to express my humble
+hope that all the respectable medical
+men throughout the kingdom will arise,
+and with one voice oppose this moral
+pestilence, which at once corrupts and
+degrades their profession.</p>
+
+<p>The <i lang="la" xml:lang="la">odium medicum</i>, bitter and vindictive
+as it unfortunately has been,
+never, I believe, appeared in a form so
+repulsive. Are we living in the nineteenth
+century? Have arts and sciences,
+which are asserted of old to soften the
+manners and temper the violence of our
+nature, produced no such fruits amongst
+us? Is serious, and perhaps irremediable
+injury, to be inflicted on reputation;
+and is the sufferer thereafter to be
+dared to mortal combat, and this too by
+the wrong-doer? Is it thus that professional
+justice is to be awarded? Is
+it thus that knowledge is to be advanced,
+the dignity of our profession
+to be maintained, its benefits enlarged,
+and its usefulness transmitted? Is it
+thus that the young men are to be
+taught how to acquire an unworthy and
+discreditable notoriety; to disregard all
+<span class="pagenum"><a name="Page_128" id="Page_128">[128]</a></span>
+the decencies, charities, and higher
+virtues of life; and to bring into the
+exercise of our art the insidious cunning
+of the knave, the vulgar dishonesty of
+the pilferer, and the audacious bearing
+of the bravo?</p>
+
+<p>I know not how others may feel on
+the present occasion: I am entirely unacquainted
+with the parties who have
+been at issue in the late suit&mdash;I have no
+bias of any kind, but what must arise in
+the mind of every man who has any regard
+for the profession to which he
+belongs, or who loves truth and fair
+dealing&mdash;I am sure that it is not less for
+the interests of society at large than for
+the advancement of medical science,
+that just principles should regulate all
+our dealings, both with the public and
+with each other. It is manifest that of
+late we have signally and woefully departed
+from them; and it is most distressing
+to know that this departure has
+been sanctioned by so many members of
+the profession. I now entertain a confident
+hope that all who reflect on the
+character of the late libel will feel that
+their own <em>character</em> is at stake if they
+do not mark their disapprobation of it
+in every possible way. Sure I am that,
+if the principles which guide the Lancet
+become generally acceptable, it will
+mark an æra of moral degradation
+which no surgical dexterity, no medical
+acquirements, however eminent, could
+possibly redeem.</p>
+
+<p class="right smcap">Veritas.</p>
+
+
+<hr class="fulla" />
+<h2>DURATION OF HUMAN LIFE IN RUSSIA.</h2>
+<hr class="r10a" />
+
+<p class="noindent">Cases of longevity are not only
+much more common, but also more extraordinary
+in respect to a greater duration,
+in Russia than in any other part of
+Europe; thus, from the report of the
+holy synod, published in 1827, it appears
+that there were living in 1825,
+among those who professed the Greco-Russian
+religion throughout the empire,
+not fewer than 848 males who
+were 100 and more years old; among
+whom, 32 had passed the age of 120, 4
+were between 125 and 130, and 4 others
+between 130 and 135 years of age. Out
+of 606,881 males who died in 1826,
+2785 had passed the age of 90 years;
+1432 that of 95; and 818 that of 100.
+Among the latter, 38 were more than
+115 years of age; 24 more than 120;
+7 more than 125; and one was 160
+years old at his death.</p>
+
+
+    <div class="chapter"></div>
+
+
+<hr class="fulla" />
+
+<p class="p1 pfs120 pg-brk">MEDICAL GAZETTE.</p>
+
+<p class="center"><em>Saturday, December 27, 1828.</em></p>
+
+<hr class="r10a" />
+
+<p class="fs70" lang="la" xml:lang="la">"Licet omnibus, licet etiam mihi, dignitatem <em>Artis
+Medicæ</em> tueri; potestas modo veniendi in publicum
+sit, dicendi periculum non recuso."&mdash;<span class="smcap">Cicero.</span></p>
+
+<hr class="r10a" />
+
+<h2 class="no-brk">ANALYSIS OF WAKLEY'S DEFENCE ON THE LATE TRIAL.</h2>
+
+
+<p class="noindent">We last week presented our readers
+with a full<a name="FNanchor_20_20" id="FNanchor_20_20"></a><a href="#Footnote_20_20" class="fnanchor">[20]</a> and, we trust, accurate
+account of the trial for libel, which
+has recently excited so much interest;
+and we offered some remarks of a general
+nature upon its result and tendency.
+We had purposed at the same time to
+subject Mr. Wakley's mode of conducting
+his cause to a critical investigation,
+but this we were prevented from doing
+by want of time and space. We thought
+it likely, too, that the Editor of the
+Lancet would have fairly met the question
+in his next publication, and himself
+put the facts of the case, at least,
+on record: instead of this, however,
+he has devoted his pages to compliments
+to himself, and scurrilous and
+absurd abuse of Sir James Scarlett, in
+which he informs us that in his opinion
+that gentleman is "prodigiously overrated
+even as a lawyer," and says many
+other things, which serve only to shew
+how dreadfully Wakley himself had
+smarted under his lash.</p>
+
+<p>We find the general opinion to correspond
+with that which we expressed
+last week&mdash;that the defendant had managed
+his cause in a very bungling
+manner; and the estimation in which
+he and his witnesses were held by Judge
+and Jury is apparent from the charge
+of the one, and decision of the other.
+<span class="pagenum"><a name="Page_129" id="Page_129">[129]</a></span>
+Both, indeed, regarded the asseverations
+of his whole <em>family party</em> as dust in the
+balance against the testimony of one
+single competent and honourable man&mdash;Mr.
+Callaway; for on his evidence the
+result obviously hinged. Our contemporary
+affects to look upon the verdict
+as a triumph on his part&mdash;so he would
+if the damages had been five hundred
+or a thousand pounds, for in truth he
+has nothing else for it; and with all
+our hearts we wish him many such
+victories.</p>
+
+<p>With regard to the amount of damages,
+we certainly should have been
+better pleased had it been larger; but
+we did not expect that it would&mdash;nay a
+reference to our number which was
+published while the trial was going on,
+will shew that we were even doubtful of
+the verdict, because we know how extremely
+difficult it is for a jury to comprehend
+such a complicated question&mdash;how
+easy for a knave to impose upon
+their ignorance by misrepresentation
+and falsehood. It is quite obvious
+that if the jury had believed one syllable
+of the evidence of Wakley's witnesses,
+they must have given the verdict
+in his favour. In a case like this,
+where <em>one individual only</em>, and he the
+plaintiff, can be fully aware of the difficulties
+which had to be overcome, it is
+almost impossible to bring evidence
+into a court of justice capable of satisfying
+the minds of twelve unprofessional
+men. From this circumstance alone it
+was that we expressed a doubtful
+opinion of the result. But besides all
+this, it is well known to all&mdash;<em>that one
+talesman might go determined to starve
+out the rest&mdash;that ten special jurymen
+might wish to give 500l. and yet that, by
+the absurd constitution of the English
+law, their verdict might be thus controlled
+by one individual friendly to the
+defendant</em>.</p>
+
+<p>Most fortunately for the cause of truth,
+Wakley had the vanity and folly to conduct
+the defence himself, and, judging of
+other men's estimation of moral character
+by his own, he did not hesitate
+to place in the box witnesses whom no
+counsel would have suffered to go there,
+and who, being unable to stand the cross-examination,
+led to what must have
+been to Wakley a most humiliating
+exposure. Next to this, the most
+beneficial effect produced was that of
+the defendant's cross-examination of
+his opponent's witnesses: it was
+amusingly absurd, and shewed a lamentable
+want of tact, always eliciting
+something which he ought to have
+avoided. Lastly came the reply, of
+which he tells us he is himself ashamed&mdash;"We
+may state most unfeignedly,"
+says he, "that we look back with regret
+to our errors in point of omission."
+Nor is this the only part of it for which
+he has cause to blush, for any thing more
+miserably deficient we never heard: it
+was a mass of confusion throughout&mdash;a
+repetition of the same ideas and expressions&mdash;and
+a most injudicious betrayal of
+rancorous feeling, at the very moment
+he was profanely invoking heaven to
+witness that he bore enmity to no man.
+In speaking of his reply in our last
+number, we declared it to be "false
+in statement&mdash;sophistical in argument&mdash;coarse
+in language&mdash;and diabolical in
+tendency;" and we now proceed to
+illustrate these several qualifications, in
+doing which little more will be necessary
+than to select a few passages, and
+arrange them under their appropriate
+heads.</p>
+
+<p><em>False in Statement.</em>&mdash;One of Wakley's
+principal objects was to impress
+upon the Jury a belief that he had
+not in any way attempted to influence
+his witnesses, nor even spoken to most
+of them, anterior to the trial. "Out
+of nine witnesses I have placed in the
+box, (says he) I never saw five of them,
+nor even spoke to five of them till yesterday."
+We appeal to any man of
+<span class="pagenum"><a name="Page_130" id="Page_130">[130]</a></span>
+common sense, whether it be probable
+that this is true. It is possible indeed,
+and only just possible, that he was contented
+with employing others to question
+his witnesses, and ascertain what
+evidence they would give; but even if it
+were so, the assertion was not the less
+false in a moral point of view, because
+his intention was to convey the belief that
+he had inquired no farther than merely
+whether or not the witnesses had been
+present at the operation. But incredible
+and absurd as this was, he ventured a
+step farther, and assigned a reason for the
+choice made of one witness&mdash;(Lee the
+potatoe-merchant.) "I had heard
+(said Wakley) he was present at the
+operation&mdash;an honest man, and that he
+was a friend of Mr. Bransby Cooper,
+under the highest obligation to the
+Cooper family. Without asking him a
+single question I put him into the box,
+as I was most anxious you should hear
+all the evidence that could be adduced,
+and from <em>unsuspected and untainted
+quarters</em>." This lie carried with it its
+own refutation; for Lee swore that he
+had never even spoken to Mr. Cooper;
+and we are therefore amazed that Wakley
+should have hazarded so gross an assertion,
+as it could only have been effective
+on the supposition of his addressing
+a jury of absolute simpletons. But
+again&mdash;"Who were my witnesses? not
+men whom I had trained and lectured
+on models, and sketches, and drawings.
+Has it been shewn to you that I
+was closeted with any person or set of
+persons?" Yes, Mr. Thomas Wakley,
+it has been shewn, and by no less an
+authority than that of your <i lang="la" xml:lang="la">fidus Achates</i>,
+Mr. James Lambert. "The defendant
+(says the worthy author of the libel), the
+defendant was there whilst I was explaining
+the parts to persons who were
+to be witnesses&mdash;<em>the defendant also explained
+them to the same persons</em>." And
+again, "I have heard explanations given
+to persons who were to be witnesses in
+this cause <span class="fs70">FOUR OR FIVE TIMES</span> within
+the last six weeks." So also that excellent
+thorough-going witness, Mr. Jeffry
+Pearl: "a <em>gentleman</em> of the name of
+Lambert introduced me to the defendant;
+<span class="fs70">THE DEFENDANT</span> <em>and Mr. Lambert
+endeavoured to shew that the forceps
+had passed between the bladder and the
+rectum</em>." So much for placing men in
+the box because they are friends of Mr.
+Cooper&mdash;so much for procuring evidence
+from "untainted quarters!"</p>
+
+<p>This is only to be matched in effrontery
+by the statement of some wise-acre
+at the radical meeting on Tuesday
+night. Being asked why no notice had
+been taken in the Lancet of a successful
+operation of lithotomy performed by
+Mr. B. Cooper, soon after the publication
+of the libel, he assigned as the
+reason that Mr. Wakley thought it
+might increase the damages, and otherwise
+injure Mr. Cooper! What a
+noodle the man must be to expect any
+one to believe him<a name="FNanchor_21_21" id="FNanchor_21_21"></a><a href="#Footnote_21_21" class="fnanchor">[21]</a>!</p>
+
+<p>Mr. Wakley asserted that the evidence
+of his witnesses remained "untouched&mdash;wholly
+uncontradicted;"&mdash;whereas
+there was scarcely a single
+point in their statements which was not
+contradicted either by Mr. Callaway,
+who was present at the operation, or
+Mr. Key and Dr. Hodgkin, who examined
+the parts after death. But what
+is more remarkable, there was scarcely
+a circumstance on which his own witnesses
+agreed&mdash;for example, they differed
+with regard to the nature and direction
+of the incisions; with regard
+to the manner and frequency of introducing
+the forceps; with regard to the
+number of instruments used, and the
+mode of applying them; with regard
+to the size of the wound; with regard
+to the degree of force employed, and
+with regard to the appearances after
+death. Yet, in the face of all this, Wakley
+<span class="pagenum"><a name="Page_131" id="Page_131">[131]</a></span>
+had the impudence to tell the jury
+that his evidence remained "uncontradicted."
+We have no hesitation in asserting
+that his own witnesses (putting
+Mr. Cooper's out of the question) advanced
+no charge of which they did not
+also furnish the refutation.</p>
+
+<p>Mr. Wakley asserted that Mr. Cooper
+was incapable of telling why he could
+not extract the stone, even "while he
+had his finger in the bladder." This is
+false: neither Mr. Cooper nor Mr.
+Callaway were able to reach the bladder
+with the finger at all, owing to the
+depth of the perineum.</p>
+
+<p>Mr. Wakley told the jury that the
+plaintiff did not like the bladder to be
+exposed, "because to surgeons there is
+indisputable proof that Bransby Cooper
+did not perform that operation as he
+ought," and that "Mr. Key and Mr. Callaway
+knew it." This is false: Mr. Key,
+Mr. Callaway, and Dr. Hodgkin, who
+had examined the parts, all deposed that
+there was nothing in them indicative of
+the operation having been improperly
+performed. Indeed, had it been as
+Wakley asserted, the plaintiff would
+not have been so foolish as to have had
+the parts preserved at all.</p>
+
+<p><em>Sophistical in argument.</em>&mdash;One of the
+pieces of sophistry on which Wakley
+seems chiefly to have depended, inasmuch
+as he went over it <em>six times</em> in the
+course of his speech, was, that if his
+account of the operation had been incorrect
+more of those who were present
+would have been brought forward
+to prove it so. But, as we stated in
+our last Number, to have objected to
+Wakley bringing forward pupils, on the
+ground of their being incompetent, and
+then to have done the same thing, would
+have been grossly inconsistent. Lord
+Tenterden, in his charge, said, "he did
+not see whom he (Mr. Cooper) could,
+with propriety, have called besides Mr.
+Callaway; the others were all young
+men, only pupils, and probably too
+young and inexperienced to form any
+judgment on the case that could be relied
+on." There is also another person
+who has objected to these witnesses
+whom we may mention&mdash;not, indeed,
+one for whose authority we have the
+highest possible respect, but of whom
+the defendant in this case probably
+thinks more favourably&mdash;we mean Mr.
+Thomas Wakley, who, speaking of the
+Letter formerly published by Mr.
+Cooper's pupils on the subject of this
+operation, says, "their united opinion of
+the skill, dexterity, and self-possession
+exhibited by Mr. Bransby Cooper on
+this occasion, is not likely to influence
+the judgment of the profession, whatever
+it may effect with the public."</p>
+
+<p>The use made by Wakley of Sir Astley
+Cooper's expression, "give him
+time," is another specimen of sophistry.
+Sir Astley evidently meant merely to
+say that, <i lang="la" xml:lang="la">ceteris paribus</i>, a man who had
+been twenty years surgeon to an Hospital
+would be more experienced than
+one who had held the situation but one-fourth
+of that period. This we believe
+to have been his sentiment, though nothing
+was ever less happily expressed.
+Accordingly it was not lost upon the
+defendant, who exclaimed, "Is that the
+way in which our hospitals are to be conducted?
+Is that the mode in which your
+poor patients are to be treated?&mdash;that
+young and inexperienced men are to be
+placed there to <em>learn their profession</em>&mdash;not
+to know it before they get there, but
+are to go there to learn it&mdash;and learn it
+upon whom?&mdash;upon individuals who
+are as much entitled to the best and
+most scientific practice of surgery as
+any nobleman in this land." All very
+fine&mdash;but we should be glad to know
+how or where a practical acquaintance
+with surgery is to be acquired but
+in public hospitals&mdash;and if no man
+is to be appointed till after he has
+gained experience, where are such
+men to come from? Where are ready-made
+<span class="pagenum"><a name="Page_132" id="Page_132">[132]</a></span>
+surgeons to be found fit to
+operate even before Lambert, without
+his being able <em>to make a hole</em> in their
+reputation?</p>
+
+<p>One of the most knavish attempts in
+the whole speech, to take advantage of
+the jury, was exhibited in his description
+of the operation. How different
+from the clear, perspicuous, and candid
+narrative of Sir James Scarlett. You
+are told, says Wakley, that the stone
+was shelved <em>above</em> the pubes and <em>behind</em>
+the pubes; but, continued he, (placing
+a pelvis in the position in which it is
+during the operation,) a stone cannot
+be lodged above the pubes, because,
+you see, the pubes is above the bladder!
+This was, indeed, calculated to
+confuse men unaccustomed to the subject,
+and who did not probably reflect
+that above and below are merely relative
+terms, which must change with
+every change of position, and that it
+was not meant that the stone was between
+the pubes and external integuments,
+which, in the position for lithotomy,
+would be the literal meaning of
+<em>above the pubes</em>, but that it was in such
+a situation as, in the ordinary position
+of the body, was above the pubes.
+But Wakley assured the jury that it was
+impossible for any stone to be <em>above</em>
+the pubes, for there was a tendon to
+prevent it which no force could overcome;
+and he affected to ridicule the
+idea of there being anything unusual,
+any extraordinary shelf behind the
+pubes, in which the stone could have
+been lodged. "Had there been
+a shelf here," said he,&mdash;"had
+there been a crooked passage&mdash;had
+there been a cavity, or any place for
+the deposition of the stone, do you
+suppose that shelf would not have been
+produced? Had there been any thing
+particular in the formation of the
+pubes, would they not have cut out
+the man's bone as well as the bladder?"
+It is <ins class="corr" title="Transcriber's Note&mdash;Original text: 'probably impossibly'">probably impossible</ins> for any but
+medical men to appreciate fully the impudent
+imposition&mdash;the fraud of this
+statement,&mdash;this knavish artifice to mislead
+the jury. No attempt was made
+in any part of Mr. Cooper's case to
+show that there was such malformation,
+or that the stone was in the position
+which Mr. Wakley demonstrated
+it could not occupy&mdash;<em>thus answering
+an argument which had never been advanced</em>.</p>
+
+<p>The following is a good specimen of
+sophistry and stupidity. Finding it
+proved that there was no opening between
+the bladder and rectum, Wakley
+wanted to make out that he never had
+said otherwise, having stated the cellular
+membrane to be <em>lacerable</em>, and therefore
+not <em>lacerated</em>. And then, forgetting
+the nature of his argument, immediately
+added, "remember this; the
+gorget is not as wide as the finger, and
+that it is not an uncommon thing for
+an unskilful operator to drive the gorget
+in between the bladder and rectum."
+Thus insinuating what had been
+proved to be false, and what he had
+just argued, from the words of the libel,
+he could not have meant.</p>
+
+<p><em>Coarse in language.</em>&mdash;This scarcely
+requires illustration. But as specimens,
+on the present occasion, of vulgar slang
+and miserable attempts at wit, we may
+mention his talking of "hole and corner"
+proceedings,&mdash;his comparing Sir
+James Scarlett to sour milk, and which
+happy thought he has, in hand-bills pasted
+about the town, converted into
+"Knight and Professor of Sour Milk,"&mdash;his
+explanation of the term <em>bat</em> as applied
+to surgeons, "because they live in
+the dark, they suckle their young, and
+live in creaks and crevices of old walls,
+hospitals, and dungeons, <em>thriving and fattening
+on their own species</em>,"&mdash;his address
+to the "<em>gang</em>" of hospital surgeons,
+whom he represented as wading "through
+blood up to the neck,"&mdash;and lastly, his
+exclamations, several times repeated,
+<span class="pagenum"><a name="Page_133" id="Page_133">[133]</a></span>
+perhaps with <em>prophetic</em> phrenzy, that he
+"would die in a dungeon and expire in
+a ditch."</p>
+
+<p><em>Diabolical in tendency.</em>&mdash;The general
+tendency of Wakley's writings, and especially
+of his address to the Jury on this
+occasion, so far as such ravings can
+have any influence, is to sow distrust
+between men in every class of society
+and their medical attendants; to poison
+the sources of public charity, and arrest
+the hand of benevolence; to contract
+the relief afforded to human suffering,
+leading the poor and uninformed to
+suppose themselves the objects of cruel
+and wanton experiment, thus encouraging
+them rather to suffer disease
+to run its course than seek relief in such
+abodes of blood and horror as he most
+falsely represents our public hospitals
+to be.</p>
+
+<p>One of the first ebullitions of this demoniacal
+effort consisted in representing
+to the Jury, which he did in two different
+parts of his address, that the patient had
+been kept <em>bound</em> during the operation,
+as if some unusual degree of coercion
+had been employed. "Yet, in opposition
+to the patient's cries&mdash;in opposition
+to his repeated entreaties to be
+unbound, still the operator kept him
+upon the table."&mdash;"Gentlemen," continued
+he, "I should like to know
+upon what principle it was that the
+man was kept <em>bound</em> upon the table
+when he implored to be loosened. Was
+he not a free agent?" And then he
+goes on to put into Mr. Cooper's mouth
+not only words, but a sentiment he never
+uttered.&mdash;"No, no, (says the operator,)
+my <em>reputation</em> is concerned. You were
+brought here to have the stone extracted,
+and extracted it shall and must be&mdash;<em>if
+you were to die upon the table</em>." Unless
+Wakley was intoxicated we cannot in
+any other manner account for an argument
+at once so absurd, so unprofessional,
+and so malignant. It evidently
+excited no feeling but that of disgust in
+the minds either of the Judge or the Jury.</p>
+
+<p>The next paragraph to which we
+shall allude is a masterpiece of hypocrisy&mdash;"Let
+me ask you (said he) what
+you have heard respecting the miseries
+of the individual on whom the operation
+was performed? Not one word
+has escaped the lips of the counsel on
+that subject&mdash;not one word from the
+mouth of one of the witnesses. No,
+gentlemen, they are hospital surgeons
+themselves, and they know too well
+what the practices of our hospitals are,
+and the sufferings <em>patients are in the
+habit of enduring at their hands</em>, to
+feel for this man, or for any other man
+placed in a similar situation!" Canting
+hypocrite! this from the man who
+in the very case before us published his
+account of the patient's sufferings in the
+form of a drama, mingled with low and
+scurrilous gibes. Mark also the following&mdash;"Give
+such a verdict as shall
+satisfy the <em>poor</em>&mdash;as will shew that men
+are not to go into offices of this sort
+where the <em>poor are to be killed</em>, and
+that they shall not be at liberty to wade
+and ride through blood up to their
+necks to eminence in their profession.
+Ah! gentlemen, give such a verdict as
+shall satisfy the <em>poor</em>!"</p>
+
+<p>There is in the various paragraphs
+we have quoted, more deep-rooted
+malice&mdash;more abandoned violation of
+the truth&mdash;more hypocrisy&mdash;and more
+open outrage of common sense, decency,
+and feeling, than we ever remember
+to have met with, even in the
+pages of the Lancet. It is now quite
+obvious that Wakley, alarmed at the
+change which has taken place in the
+estimation of his work within the last
+few months, finds it necessary to adopt
+a new system; he therefore throws off
+the mask, and openly declares himself
+the champion of the ignorant and
+illiterate<a name="FNanchor_22_22" id="FNanchor_22_22"></a><a href="#Footnote_22_22" class="fnanchor">[22]</a>&mdash;conjuring up to their imaginations
+evils which do not exist&mdash;denouncing
+<span class="pagenum"><a name="Page_134" id="Page_134">[134]</a></span>
+the medical profession as
+one of blood and murder&mdash;medical
+men as "thriving and fattening on
+their fellow-creatures"&mdash;and calling
+upon the "humane contributors to our
+hospitals and infirmaries" to support
+him.</p>
+
+<p>Why really now, if the times of political
+turbulence were to return, and
+radical reform again to come into vogue,
+Cobbett and Hunt would have a most
+valuable coadjutor; but as it is, we almost
+think the sphere he has chosen is
+too limited for such a genius. Humbug,
+to be successful, ought not to be
+very open to detection; alleged abuses
+ought not to be of a kind which every
+man can satisfy himself are entirely
+without foundation; and he who professes
+disinterested motives ought not
+to begin by raising a subscription for
+himself. We offer these few hints to
+Wakley, in hopes they may be of use to
+him in his new career; above all, we
+advise him to be sparing in protestations:
+there are some already who look
+upon his sincerity with a suspicious
+eye; for although it is no doubt true,
+that he would "rather die in a dungeon,
+and expire in a ditch," than injure
+any man, yet somehow an idea has got
+abroad, that his constant habits of lying
+and slandering are not quite in keeping
+with these assertions. Nay, we have
+heard of some even of the "humane
+contributors" to our charitable institutions,
+who have been so unreasonable
+as to disbelieve all Wakley's stories
+about the <em>cannibalism</em> of hospital surgeons,
+and to look upon the whole system
+of the Lancet as one of knavery
+and imposition.</p>
+
+
+<hr class="fulla" />
+<h2>WAKLEY'S SUBSCRIPTION MEETING.</h2>
+<hr class="r10a" />
+
+<p class="noindent">A most amusing scene took place at the
+Freemasons' Tavern on Tuesday evening,
+of which we subjoin an account. The
+object of the meeting was, "to present
+Mr. Wakley with some decided mark of
+their approval of his spirited conduct in
+his late trial;" or, in other words, if
+possible, to raise a little money, and bolster
+up the Lancet a little longer. The
+persons present were small in number,
+but great in zeal; and as much noise, hissing,
+laughter, and shouting, took place
+as would have done credit to a much
+larger assembly. As this is a merry
+season, and it may amuse our readers,
+we subjoin the speeches of the principal
+orators on either side: it will be perceived
+that both the Gazette and Lancet
+had some handsome compliments paid
+them; and that Wakley got thoroughly
+abused even by some of those who went to
+the meeting as the champions of reform.
+There was not a single individual present
+of any weight in the profession,
+and the chair was occupied by a young
+man wholly unknown, except as secretary
+to the meetings held two years ago
+on the subject of surgical reform.
+Could no one whose name might sound
+familiar in the public ear be prevailed
+upon to go?&mdash;could none be found but
+Pateys, Wallers, Mills, Elliots, Childs,
+and the Lord knows who? Where was
+he, the idol of the Lancet, who on
+other occasions graced the chair&mdash;where
+he who first ycleped that Journal the
+"invaluable"? Alas! poor Wakley,
+what an exposure of a sinking cause!
+even thy former friends tremble for
+their reputations, and desert thee.</p>
+
+
+<hr class="fulla" />
+<h2>SURGICAL REFORM.</h2>
+
+    <div class="fs90">
+
+<p class="noindent">A meeting was held yesterday evening at
+the Freemasons' Tavern, in pursuance of an
+advertisement calling on the "Friends of
+Surgical Reform, the Supporters of a free
+Medical Press, and the humane Contributors
+to our Hospitals and Infirmaries," to
+meet there, in order to adopt measures for
+presenting Mr. Wakley, the Editor of the
+Lancet, with some decided mark of their
+approval of his spirited conduct, in his late
+trial in the Court of King's Bench, at the
+suit of Mr. Bransby Cooper, and of the
+principles which he so powerfully advocated
+on that occasion.</p>
+
+<p>[Mr. Patey, who was called to the chair,
+stated the object of the meeting; but as his
+speech was rather long, and contained
+nothing of the least interest, we omit it.]</p>
+
+<p><em>Mr. Waller</em>, in proposing the first resolution,
+adverted to the terms of the advertisement,
+and remarked that the question
+for them was not whether they would support
+<span class="pagenum"><a name="Page_135" id="Page_135">[135]</a></span>
+Cooper against Wakley, or Wakley
+against Cooper; but whether they would
+have a free medical press or not&mdash;(cheers).
+Every body must admit that there was only
+one medical publication that was entitled to
+be considered free&mdash;only one that dared to
+tell the truth. Another had been attempted
+to be set up against it, but this wretched rival
+was gagged and manacled, and its reports
+were only a medium which distorted truth,
+and were almost unintelligible. It was not,
+however, to support any particular man, or
+publication, that he came to that meeting,
+but to support the general cause in which
+they were all interested. He concluded by
+moving, as the first resolution, that "the
+best interests of the medical profession and
+of the public are identified with the cause
+of medical and surgical reform; and that
+Mr. Wakley, as Editor of the Lancet, having
+given the first impulse to that cause, and
+having subsequently advocated it with undeviating
+firmness and fidelity, is entitled to
+the cordial thanks and support of this meeting."</p>
+
+<p><em>Mr. Mills</em> seconded the resolution.</p>
+
+<p><em>Dr. Shiel</em> said this was an important meeting,
+in his opinion; for, if this resolution
+were passed, it would identify the medical
+profession with the Editor of the Lancet.
+If the principle embodied in that resolution
+went forth to the world, it would be attended
+with consequences deeply injurious to the
+profession. He knew neither Mr. Bransby
+Cooper nor Sir Astley, and therefore he was
+perfectly impartial. The first question was,
+how far the medical press was conducted
+with advantage to medical science and the
+members of the profession. Now he contended,
+but with great respect, and disclaiming
+all personal hostility, that the
+Lancet had nowise contributed to the progress
+of medical science or the improvement
+of the profession&mdash;(loud hissing, and some
+cheers). He trusted that the meeting had
+not been got up by a few of the friends of
+Mr. Wakley, and he was sure that that
+gentleman was too respectable and too dignified
+in his proper person to need any such
+attempt&mdash;(applause). He trusted that the
+meeting was before the British public to ascertain
+how far the Lancet was useful or advantageous
+to medical science; and he hoped
+that, however partial the gentlemen present
+might be to Mr. Wakley, they would be
+governed in what they should do by the
+real interests of science&mdash;(hear, hear). The
+question was one of great interest; for it
+was one that embraced not only the freedom
+of the press but the advancement of medical
+science. With respect to the freedom
+of the press, they lived in a country where
+the law always maintained that principle.
+When Mr. Abernethy had applied for an injunction
+against the Lancet, Lord Eldon
+said that there could be no doubt that the
+Lancet was a most useful publication&mdash;(applause).
+He did not know whether that observation
+had been brought forward at the late
+trial; but taking the case&mdash;what was it? It
+appeared that the operation was one of
+peculiar difficulty, as stated upon oath by
+some of the most experienced surgeons of
+the day. This operation was laid hold of by
+the Lancet, and published not as a medical
+but as a tragical performance, in which all
+persons without science or knowledge were
+appealed to, and no opportunity afforded to
+Mr. Cooper to vindicate himself. Here,
+then, was a low and pitiful attempt made
+through the medium of malice and calumny
+(loud hisses and uproar). Here was a rude
+and pitiful attempt by malice and calumny
+(renewed signs of disapprobation). And yet
+it was contended that this had advanced the
+medical profession. The evidence on the
+trial went to shew that the dangers by which
+the operator had been surrounded were not
+small, and that there was no just reason to
+accuse him of unskilfulness in what he did;
+and was it then to be said, in the face of the
+British public, that a Meeting had been held
+at the Freemasons' Tavern to offer praise
+and reward to the individual whose conduct
+had, by the verdict of the Jury, been stamped
+with the accusation of untruth (hear, hear!
+and hisses)? He would not deny that there
+was a degree of talent displayed in the Lancet;
+but neither could it be denied that it
+was a public depredator by means of reports
+surreptitiously obtained; and the title of
+"literary raven," which had been applied by
+Sir James Scarlett, appeared to him to truly
+depict its character (great hisses and uproar).
+Was it to be contended that any one
+had a right to come into a private lecture-room,
+and catch up all he could hear, and
+then to publish what he had thus surreptitiously
+and fraudulently obtained (immense uproar
+and hisses)? As far as the medical interest
+was concerned, he looked upon the Lancet
+as one of the most injurious publications that
+had ever appeared (hisses). All the best
+writers on the subject had dwelt with peculiar
+emphasis on the necessity of secrecy
+among the members of the profession, but
+the Lancet broke through this good rule, and
+made public whatever came within its notice;
+and he had no doubt that if it could get at the
+cases that occurred in private practice, it
+would give them without any scruple (uproar).</p>
+
+<p>The <em>Chairman</em> begged to remind the
+speaker that at all events Mr. Wakley had
+not as yet done so.</p>
+
+<p><em>Dr. Shiel.</em>&mdash;I am arguing on the principle
+which appears to actuate Mr. Wakley.</p>
+
+<p><em>Mr. John Elliot</em> rose to order. He could
+not allow Dr. Shiel to be going upon suppositions;
+the thing that he supposed had never
+been done.</p>
+
+<p><em>Dr. Shiel</em> was sure that whatever turn might
+<span class="pagenum"><a name="Page_136" id="Page_136">[136]</a></span>
+be given to the subject in England, that at all
+events the conclusions that the Meeting appeared
+to be coming to would be resisted
+abroad. The weight of Sir Astley Cooper's
+name abroad would overpower any such attempt,
+and, in fact, would render it contemptible;
+so that any attempt to prop up
+so low, pitiful, and mean an attack, must inevitably
+be attended with disgraceful failure
+(hisses).</p>
+
+<p>A gentleman observed, that he was much
+surprised at what had fallen from Dr. Shiel.
+He had been induced to suppose that the
+Lancet possessed talent, as he had heard it
+praised in so many directions, and he certainly
+had never heard till that evening that
+it was only to be found in the hands of the
+illiterate (hear, hear! and a laugh). He
+had always understood that it was only destined
+for the use of students and other members
+of the profession, and that it was likely
+to be of great use in reforming the abuses of
+the medical practice (hear, hear! and cries
+of "So it will!"). For his own part, he
+was glad that medical men were occasionally
+cut up, because when they did what was
+wrong it was proper that they should be
+told of it; and when they did what was right,
+it added a fresh stimulus to their exertions
+(applause).</p>
+
+<p><em>Mr. Thomas</em> observed, that he had not intended
+to say any thing at the present meeting;
+but as Dr. Shiel, in the course of his
+speech, had thought proper to make some
+remarks tending to calumniate Mr. Wakley's
+witnesses on the trial, of which he was one,
+he felt called upon to say a few words (hear,
+hear!). Dr. Shiel seemed to consider them
+all as the mere scum of the earth&mdash;as a miserable
+band, collected together to support
+Mr. Wakley, whatever might be the consequence;
+as though he was desirous of going
+the whole length of the Medical Gazette,
+which stigmatised them for what it called
+"their deep-laid contrivances&mdash;their rankling
+enmities, and their bitter revenge."
+For himself he could say, that it was not till
+the evening previous to the trial that he had
+been supœnaed, and that he had previous to
+that time never seen Mr. Wakley.</p>
+
+<p><em>Dr. Shiel</em> said that he could not have alluded
+to the gentleman who was speaking,
+as he did not even know his name.</p>
+
+<p><em>Mr. Thomas</em> then went on to observe, that
+as Dr. Shiel appeared to be the advocate of
+the opposite party, he also supposed that he
+was a contributor to the aristocratical (Medical)
+Gazette ("No, no!" from Dr. Shiel).
+If he were not, at all events he had put forward
+ideas that were quite consonant to the
+sentiments expressed in that Journal. In
+giving his testimony, he had not spoken of
+the instruments employed in the operation,
+but of his own impression on the subject,
+having been present thirty-five minutes; and
+that impression certainly was, that the operation
+had been performed in a bungling and
+unscientific manner (loud applause, mingled
+with hisses). Was he then, because he happened
+to be a witness on the occasion, to be
+put down, pell-mell, by the unfounded imputations
+of any one? The highly-principled,
+honourable-minded Medical Gazette, that
+had determined never to admit any personalities,
+had loaded Mr. Wakley and Mr.
+Lambert with all sorts of abuse. Was this
+what they intended to call acting on principle
+(applause, and cries of "No, no!")?
+He certainly had heard that Mr. B. Cooper
+was an amiable man in private life; but
+what had that to do with the question at
+issue? What had they to do with the private
+character of a man in a public office
+(cheers)? Surely the witnesses of Mr.
+Wakley were as competent to speak of the
+manner in which the operation was performed
+as those who had not been present
+(applause); and as he had seen many operations
+performed he conceived that he was a
+competent judge of the skill of the operator
+(applause).</p>
+
+<p>A gentleman, who appeared to be a student,
+thought that the introduction of any attack
+upon the witnesses, or indeed of anything
+that occurred at the trial, was irrelevant
+(hear, hear!). The way to answer a
+speaker was not by hisses, but by disproving
+his arguments and rebutting his facts
+(applause). If questions were to be settled
+merely by strength of lungs, he was afraid
+that instead of the right side prevailing, success
+would uniformly attend those whose physical
+powers probably much exceeded their mental
+(laughter and applause). He could not agree
+with the gentleman who had stated that the
+law of England was the protector of the freedom
+of the Press; for it was well known
+that the Judges had decided, over and over
+again, that truth was a libel (applause). It
+was only the vehicle that conveyed public
+sentiment, and not the force that impelled it
+forward. He was convinced that any attempt
+to connect medical reform with Mr.
+Wakley should be studiously avoided and
+disclaimed. As a friend of free discussion
+in every case, and anxious to uphold the
+principle, whatever he might think of the
+instrument, he intended to propose, as an
+Amendment, "That the latter part of the
+Resolution, relating to Mr. Wakley, should
+be omitted." This would save the cause of
+medical reform from being identified with
+Mr. Wakley, of whose impartiality he would
+give a specimen. In the last number of the
+Lancet, the report of the late trial was given
+from the Times, but with a remarkable omission.
+The Lord Chief Justice had rebuked
+one of the defendant's witnesses for not answering
+the questions in a straightforward
+manner, and this passage was omitted. If
+Mr. Wakley would do this on such an occasion,
+would he be more candid when the public
+eye was less upon him? He, therefore,
+wished to have the question of medical reform
+<span class="pagenum"><a name="Page_137" id="Page_137">[137]</a></span>
+kept separate from Mr. Wakley individually.
+The first part of the Resolution
+would be carried without a dissenting voice,
+as on that principle they were all agreed,
+whatever they might think of the conduct of
+individuals.</p>
+
+<p>[One or two persons then made speeches
+for or against the amendment; which was
+negatived, and the original motion carried.]</p>
+
+<p><em>Mr. Hensley</em> then, after observing that Mr.
+Wakley's conduct was highly praiseworthy,
+because it tended in every way to the benefit
+of humanity, moved the second Resolution,
+which was to the following effect:&mdash;</p>
+
+<p>"That the purposes for which the Hospitals
+and Infirmaries of the Metropolis were
+founded, and that the views of the humane
+contributors to their funds, are materially
+promoted by the weekly publication of reports
+detailing the medical and surgical
+treatment of the unfortunate patients; and
+that Mr. Wakley having originated the practice
+of publishing Hospital Reports, has conferred
+important benefits on Medical Science,
+and on the cause of humanity."</p>
+
+<p>The resolution was then carried unanimously.</p>
+
+<p><em>Mr. John Elliott</em>, on moving the third resolution,
+said that he did not come there to
+interfere in the quarrels of Wakley and
+Cooper. They had acknowledged that Mr.
+Wakley's exertions had been very conducive
+to medical reform, by the last resolution
+they had passed. Indeed, there could be
+no doubt that he had greatly served the
+cause of humanity, by preventing idleness on
+the part of medical persons, and compelling
+attention to the poor placed under their care.
+It was his opinion that the editor of the
+Lancet ought to be indemnified for the whole
+expense entailed on him by the late trial,
+including the damages awarded against him.
+This would not be a private subscription,
+like Brodie's, but one open to the world,
+and not to be questioned in a court of justice.
+He would not support Mr. Wakley
+if he had attacked private character; but he
+would, as the editor of the Lancet and the
+representative of the medical free press.
+He concluded by moving&mdash;</p>
+
+<p>"That the independent and impartial
+principles on which the Lancet was first
+established, have been preserved by Mr.
+Wakley at all risks; and as it was acknowledged
+at the late trial, that the legal expenses
+of his opponents on another occasion
+have been defrayed by certain hospital physicians
+and surgeons<a name="FNanchor_23_23" id="FNanchor_23_23"></a><a href="#Footnote_23_23" class="fnanchor">[23]</a>, it is farther resolved,
+that a subscription be opened for the purpose
+of defraying the expenses of the late
+action."</p>
+
+<p>[Dr. Shiel here spoke very strongly
+against entering into a subscription&mdash;while
+some spoke in its favour.]</p>
+
+<a name="P137" id="P137"></a>
+<p>A discussion then arose about the question
+of whether an account of a second operation
+for lithotomy by Mr. Cooper (in which he
+had been successful) had been sent to Mr.
+Wakley? It was stated that such was the
+case, but as the action for the present libel
+was then commenced, <em>Mr. Wakley thought
+that he perceived something in that second report
+that might tend to aggravate the damages, and
+which, at the same time, would be farther injurious
+to Mr. B. Cooper</em>.</p>
+
+<p>The third resolution was then carried by
+an immense majority, only five hands being
+held up against it.</p>
+
+<p><em>Mr. Evans</em> moved, "That the statement of
+professional facts in an unprofessional form,
+such as the dramatic instead of the narrative,
+is highly reprehensible in the individual,
+and detrimental to the best interests of
+science."</p>
+
+<p>This resolution, after some turbulent discussion,
+was withdrawn.</p>
+
+<p><em>Mr. J. L. Stevens</em> then moved, as the fourth
+resolution, that "In accordance with the
+feelings this meeting has expressed, Mr.
+Wakley be invited to attend a Public Dinner,
+and that a Committee be forthwith nominated
+to arrange the same."</p>
+
+<p><em>Mr. Rogers</em> seconded the resolution, and
+it was carried unanimously.</p>
+
+<p>The members of the committee were then
+named, and power given to them to add to
+their number.&mdash;The chairman then vacated
+his office, and the meeting separated.&mdash;<cite>Morning
+Chronicle, Wednesday.</cite></p>
+
+<hr class="r10a" />
+
+<p>In the course of the evening, the conduct
+of one of the speakers gave for a short time
+an amusing turn to the discussion, which for
+a great part had appeared to many extremely
+dry and tedious. The gentleman in question,
+(not a medical man), in order to show
+the opinion he had entertained of the object
+of the meeting, proposed to read for the
+audience a letter which he himself had
+written to the chairman of the committee,
+asking permission to attend. He began, but
+he had scarcely got through a few words
+when he declared he was not able to make
+out his own writing, and requested the chairman
+to assist him. The chairman made the
+attempt, but was not more successful. Another
+gentleman then undertook the task, but
+with no better effect. The audience received
+each unsuccessful effort with loud laughter,
+which so much annoyed the writer that
+he took back the letter, and again tried to
+go through with it, but not being able to
+make it out, he proposed to read for the
+meeting two letters which he wrote on the
+same subject to the editor of a Sunday
+paper. (Loud laughter followed this proposition,
+which was increased, when, on an attempt
+to read one of them, he had no more
+success than before.) The gentleman, after
+complaining of the want of courtesy in the
+meeting, resumed his seat, declaring that he
+would give the letters to the reporters.&mdash;<cite>Times,
+Wednesday.</cite></p>
+
+    </div>
+
+
+<hr class="fulla" />
+<p><span class="pagenum"><a name="Page_138" id="Page_138">[138]</a></span></p>
+<h2>HOSPITAL REPORTS.</h2>
+
+<hr class="r10a" />
+<h3>GLASGOW ROYAL INFIRMARY.</h3>
+
+<p class="center"><em>Injuries of the Head.</em></p>
+
+<p class="noindent">D. M'Millan, æt. 40, seaman;&mdash;while
+he was employed in the hold of a vessel,
+a heavy iron block, of a round form, fell
+from the rigging, a height of 20
+feet, and struck him on the head.
+He was knocked down and stunned,
+but was able to rise and to walk with
+a little support. He was brought about
+a mile and a half in a hackney-coach to
+the hospital, and admitted by Mr.
+Cowan at one o'clock <span class="fs70">P.M.</span>, half an hour
+after the accident. At this time he had
+a stupified look, but was quite collected,
+and was able to walk across the
+ward; breathing and pupils both natural;
+pulse 75, of moderate strength.
+There was a wound in the scalp, commencing
+nearly over the centre of the
+sagittal suture, and running about
+three inches backwards and towards the
+left; along this a portion of skull, corresponding
+to the wound in size, was
+felt fractured, detached, and irregularly
+depressed. His right arm was benumbed
+and nearly powerless, but no
+mark of injury was observed on it.</p>
+
+<p>It was determined to remove the detached
+piece of bone, and the original
+wound being extended lengthwise in
+both directions, an incision was made
+through the scalp at right angles to it
+over the left parietal bone, thus bringing
+the fractured portion into view. This
+was found to be broken down into several
+fragments, some of which were
+firmly impacted under the surrounding
+cranium, and one spiculum, driven
+through the dura mater, had penetrated
+the brain. The trephine was applied a
+little to the left of the fracture, and
+the intermediate part removed with
+Hey's saw; the detached pieces of
+bone, ten in number, of various sizes
+and irregular shapes, were removed
+with the forceps, the scalp replaced
+and retained in position by a stripe of
+adhesive plaister and very light dressings.
+During the operation one artery
+required ligature, and about
+<span class="screenonly">℥v.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />v.</span>
+of blood were lost: he had lost perhaps as
+much before. He remained quite sensible,
+bore it well, and shortly afterwards
+had half a glass of port wine in
+warm water.</p>
+
+<p>Ten <span class="fs70">P.M.</span>&mdash;Has been tolerably easy;
+complains of pain of fore-part of head;
+pulse 82, firm.</p>
+
+<p class="pad1 fs80">Fiat V. S. ad
+<span class="screenonly">℥xviii.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />xviii.</span></p>
+
+<p class="neg3">Sumat statim Submur. Hydr. gr. viii.
+Pulv. Antimon. gr. vi.</p>
+
+<p class="neg3">Applic. Capiti Lotio ex Alcohol. et aq.
+calcis.</p>
+
+<p>Second day.&mdash;After bleeding, thought
+feeling of numbness of right arm somewhat
+lessened, and to-day has rather
+more power of it. Passed a tolerable
+night; a little head-ache; countenance
+pretty natural; tongue slightly loaded;
+thirst; no stool.</p>
+
+<p class="pad2 fs80">Sum. stat. Sulph. Magnesiæ
+<span class="screenonly">℥j.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />j.</span>
+et rep. vesp. si opus.</p>
+
+<p>Third day.&mdash;From an aversion to use
+the bed pan, he rose to stool last night,
+and fell forwards on the floor, seemingly
+from having entangled himself in
+the bed clothes; he got into bed without
+assistance; had a shivering fit
+shortly after, but has had a pretty good
+night; bowels freely opened; head-ache
+slight; pulse 84, soft; tongue
+dry in middle. Towards the evening of
+this day he appeared drowsy; and on
+the fourth day he is reported as seeming
+confused and uneasy; countenance
+anxious; articulation difficult; the
+right arm was more paralysed, and indeed
+the whole right side seemed now
+to partake in the paralysis; a small
+part of the wound had adhered, the remaining
+part was flabby, discharging
+thin serum. In the evening the difficulty
+of articulation and drowsiness
+had increased. Twelve leeches were
+applied to each temple, and in a short
+time he seemed a little livelier.</p>
+
+<p>Fifth day.&mdash;Much in the same state;
+took a little beef tea.</p>
+
+<p>Sixth day.&mdash;Paralytic symptoms increased;
+breathing laborious. Blister
+to the neck. It may be worthy of remark,
+that in the few words he now
+spoke he never made use of the English
+language, but of the Gaelic, which was
+his native tongue; and even when told
+that he was not understood, he persisted
+in repeating the Gaelic phrase.</p>
+
+<p>Seventh day.&mdash;A small fungus was
+observed in upper part of wound, to
+which lint dipped in lime water was
+applied, and moderate pressure. The
+fungus continued to increase.</p>
+
+<p>On the eleventh and twelfth days he
+had slight bleedings from the scalp,
+<span class="pagenum"><a name="Page_139" id="Page_139">[139]</a></span>
+which stopped spontaneously. Stupor,
+&amp;c. greatly increased, but he still recognised
+his friends; took a very little
+chicken soup or beef tea daily, with
+lemonade, &amp;c. for drink.</p>
+
+<p>On the evening of the thirteenth day
+bleeding to the extent of
+<span class="screenonly">℥iv.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />iv.</span>
+or v. took place from fungus: it was checked by
+application of saturated solution of
+alum, but he sunk rapidly, and died
+that night.</p>
+
+<p><em>Inspection 36 hours after death.</em>&mdash;The
+fungus protruded considerably beyond
+the scalp, and was rather larger
+than a hen's egg, of a dirty brown
+colour, and a soft spongy consistence;
+it completely filled up the opening
+made in the skull by the trephine and
+removal of detached bone. The pericranium
+to the inferior side of this
+opening was found detached from the
+bone, to the extent of a crown piece,
+and beneath it the bone was rough, and
+covered with thin purulent matter.
+The dura mater, for two inches around
+the fungus, was covered with pus; this
+membrane, by sloughing, had allowed
+the fungus to protrude, and its edges
+adjacent to the aperture were thickened.
+On removing the dura mater, the
+fungus was observed to arise, partly
+from the middle, but chiefly from the
+posterior lobe of the left cerebral hemisphere:
+it occupied a space about
+three inches in length, and an inch and
+a half in breadth, extending to within
+a line or two of the roof of the ventricle;
+at its anterior part was an abscess,
+containing
+<span class="screenonly">℥ss.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />ss.</span>
+of pus. The fungus
+seemed to be a degeneration of the
+cerebral substance; sections of it showed
+the cerebral matter first dotted with
+an unusual number of bloody points,
+then assuming a greyish colour, which
+gradually passed into a dirty brown.
+With the exception of these bloody
+points, the brain presented no unusual
+vascularity: it was quite firm, except
+in the immediate neighbourhood of the
+fungus, where it gradually became
+softer as the colour of the cerebral substance
+became deeper, till in the centre
+of the fungus it was nearly of a broken
+down consistence. A quantity of serum
+was found in each ventricle.</p>
+
+<p class="p1" />
+<p>Another man who had been struck by
+the piece of iron which fractured M'Millan's
+skull was brought up to the hospital
+at the same time. He had received the
+blow on the vertex of his head. On admission
+he was in a state of fury, requiring
+the efforts of several men to hold him.
+His head was bruised out of all shape,
+quite depressed behind, and a fracture
+also of the frontal bone; there were
+evident symptoms too of fracture of the
+base of the skull. The case was hopeless.
+Several large depressed and detached
+pieces of bone were removed,
+but he died a few minutes after the
+operation.</p>
+
+<p class="p1" />
+<p>During the same week an old woman
+was brought up to the infirmary, who,
+the day previously, had fallen headlong
+down a stone staircase. She laboured
+under the severest symptoms of concussion,
+and besides had a comminuted
+fracture of the humerus into the elbow
+joint, and of the radius into the wrist
+joint of left arm. She was past all treatment,
+and died on the second day. The
+case is mentioned chiefly to remark,
+that although no external injury of the
+head could be observed, on inspection a
+fracture was found extending completely
+across the anterior part of base of
+cranium.</p>
+
+<p class="p1" />
+<p>There are no dispensaries in Glasgow,
+but such of the poor as are unable to
+obtain admission into the Royal Infirmary,
+and those who are not so ill as to
+submit to the confinement of an hospital,
+or for other reasons prefer remaining
+in their own houses, are prescribed
+for, and, if necessary, visited at the
+public expense. For this purpose the
+city is divided into districts, and a surgeon
+appointed to each. The "district
+shop" thus resembles a dispensary,
+where the surgeon prescribes in the presence
+of his pupils, who indeed, under
+his superintendance, have the management
+of many of the cases, both among
+the patients who receive advice at the
+"shop," and those who are visited at
+home. Although under the care of a
+surgeon, the diseases treated are both
+medical and surgical, for there is little
+distinction made between the two
+branches of the profession here.</p>
+
+<p>The following case occurred under
+the care of Mr. Stirling:&mdash;</p>
+
+<p>W. M. æt. 28, while returning home
+during the night in a state of intoxication,
+fell from a height of ten feet, into
+a court paved with stone. He was rendered
+insensible for some time, but on recovering
+was able to crawl to the nearest
+door, and was conveyed home. Medical
+assistance was immediately procured.
+<span class="pagenum"><a name="Page_140" id="Page_140">[140]</a></span>
+On the forehead, about an inch above
+the nasal process of the frontal bone, was
+a cut an inch and a half in length, extending
+obliquely downwards from the
+right side; through this a triangular
+fracture was felt, the base of which was
+in the direction of the external wound,
+and the apex pointing downwards; the
+fractured portion of the bone was slightly
+depressed; the bones of the nose were
+also fractured, and there was great discharge
+of blood from the nostrils. One
+third, or nearly, of the upper lip was
+cut off, and a good deal of blood had
+been lost from the labial artery; the
+lower jaw at the symphysis was fractured
+and comminuted, and several
+pieces were perceived to be loose. Was
+quite sensible, remembering every thing
+up to the period of the accident. Pulse
+80; has vomited frequently. Wound of
+forehead was dressed with adhesive
+plaister; the loose pieces of bone were
+removed from the lower jaw, and it was
+afterwards retained in juxta-position by
+a chin bandage.</p>
+
+<p>Early next morning he was bled to
+<span class="screenonly">℥xii.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />xii.</span>
+and had a purge of jalap and calomel,
+by which his bowels were freely
+opened. That night he felt considerable
+pain of head; pulse 90, full, and
+strong. He was bled again to
+<span class="screenonly">℥xxv.</span><span class="handonly"><img class="glyph" src="images/ounce.jpg" alt="" />xxv.</span>
+Blood first drawn had the buffy coat.
+After the bleeding the pain of head
+diminished, and he continued to do
+well. When the swelling and tenderness
+of face had subsided, it was observed
+that the fracture communicated
+with the frontal sinus. On holding his
+nose and attempting to blow it, matter
+and air escaped by the fracture. The
+man was anxious for a speedy cure, and
+for this purpose an operation to remove
+the depressed piece of bone was at one
+time thought of; there was no constitutional
+disturbance, however, and the
+case was left to nature. The discharge
+gradually diminished, and the wound
+healed up in about a month. The bones
+of the nose retained their position, and
+the broken ends of the jaw, after the
+swelling had subsided, were kept in
+their proper situation by a pasteboard
+splint till re-union took place. The lip
+also healed easily, and no deformity is
+now observable.</p>
+
+
+<hr class="r10a" />
+<h3>GUY'S HOSPITAL.</h3>
+
+<p class="center"><em>Inflammation of Hernial Sac.</em></p>
+
+<p class="noindent">The previous report of this case (Gazette,
+No. 51) conducted it to Nov.
+18th, the tenth day from the operation,
+and the third on which fæces had been
+discharged from the wound; that discharge
+continued on the 19th, but on
+the 20th pus only was seen.</p>
+
+<p>Nov. 22.&mdash;Yesterday the dresser, Mr.
+King, observed a portion of <em>solid</em> fæces
+make its escape, and to-day a similar
+discharge, in the fluid form, is manifest.</p>
+
+<p>Nov. 26.&mdash;Since the 22d, nothing
+but healthy pus has been seen; the
+wound is rapidly healing, and the patient's
+general condition as good as can
+be desired.</p>
+
+<p>Dec. 4.&mdash;He has begun to wear a
+truss, and is to-day allowed to leave
+his bed.</p>
+
+<p>Dec. 8.&mdash;As regards his original complaint,
+the man is perfectly convalescent,
+but he now discloses a small abscess in
+the scrotum, which has been gradually
+forming, and will detain him in the
+house some time longer.</p>
+
+<p>If it be a sound surgical maxim that,
+in strangulated hernia, the patient's
+safety depends upon an early operation,
+it is also a maxim no less sound, that
+where the evidence and symptoms of
+strangulation are imperfect, or dubious,
+the benefit of the doubt should be
+given to the operation, and it should
+be performed: for it is better that buboes
+should be laid open, or inflamed
+sacs cut into, twenty, aye, fifty times
+in succession, than that in one case a
+man should be suffered to die with
+strangulation of the intestine unrelieved.</p>
+
+<p>These remarks apply strikingly to
+this case of Mr. Key's, in which, although
+no hernia was found, they perfectly
+justify the operation. No case of
+strangulation could be more distinctly
+marked, or more clearly call for the
+knife, than did this; and had Mr. Key
+refused to use it, he would have deserved
+the scoff which, by a contemporary,
+has so preposterously been
+thrown on the "no hernia case." But,
+more than this, the operation was not
+only justifiable, but beyond a doubt
+<em>beneficial</em>&mdash;beneficial inasmuch as it at
+once relieved the distress of the patient,
+secured him from more extensive suppuration,
+from farther sloughing of intestine,
+and probably from extravasation
+of fæces into the abdomen; rendering
+also the process of reparation
+more easy and rapid.</p>
+
+<p><span class="pagenum"><a name="Page_141" id="Page_141">[141]</a></span></p>
+
+<p class="center"><em>Hereditary Hare-Lip.</em></p>
+
+<p>Dec. 4th, Mr. Key performed the
+operation for hare-lip on a child a few
+months old, whose case was remarkable
+only as it afforded an instance of <em>hereditary</em>
+malformation. The father of
+the child had congenital hare-lip, for
+which no operation had been performed,
+and of his six children <em>two</em> were born
+with the same malformation.</p>
+
+<p><em>Queries.</em>&mdash;1. If the father's lip had,
+in his infancy, been restored to the natural
+form, would the malformation
+in that case have descended to his children?</p>
+
+<p>2. Is the casualty in these cases to
+be traced <em>directly</em> from the father to the
+incipient embryo, or <em>indirectly</em>, through
+the medium of the mother's imagination&mdash;It
+has been said that paternal resemblances
+are produced in the latter
+mode.</p>
+
+<p class="rt">G.</p>
+
+
+<hr class="r10a" />
+<h3>PARIS HOSPITALS.</h3>
+
+<p class="center"><em>Hôtel Dieu.</em></p>
+
+<p class="center"><em>Cases of Gangrene of the Lungs.</em></p>
+
+<p class="noindent">Some interesting cases of gangrenous
+suppuration of the lungs were published
+by Dr. Chambers, about eighteen
+months ago, in which he particularly
+pointed out the horrible fœtor
+of the breath as a diagnostic mark
+of the disease. The following cases
+which recently occurred at the Hôtel
+Dieu are good illustrations of more
+extensive destruction of the lung by a
+similar disease.</p>
+
+<p><span class="smcap">Case I.</span>&mdash;A man, aged 32, of good
+constitution, laboured under bronchitis
+for some weeks, to which he paid little
+attention, when he was suddenly seized
+with pain in left side, dyspnœa, considerable
+cough, and a rigor, followed
+by fever. He was admitted into the
+Hôtel Dieu next day. Crepitation was
+perceptible over the whole extent of the
+left lung, posteriorly, and reaching to
+the site of the pain in the side, which
+was increased by percussion; great oppression,
+with frequent cough, and expectoration
+of violet-red colour, mixed
+with mucus; pulse frequent and small;
+constant chilliness; cheeks flushed.</p>
+
+<p>Next day the symptoms remained unabated,
+and <em>fœtor of the breath</em> was
+observed. Two days after it is stated
+that the expectoration maintained the
+same appearance, but <em>was now fœtid</em>;
+the breath was, however, still more
+offensive, and during the fits of coughing
+particularly so. In the evening the
+breath is said to have become <em>gangrenous</em>.</p>
+
+<p>21.&mdash;The cough was small, difficult,
+and painful, producing an expectoration
+of violet-coloured matter, approaching
+to chocolate, <em>with a characteristic
+odour</em>.</p>
+
+<p>22 to 25.&mdash;Expectoration and breath
+emit an <em>intolerable stench</em>. On the latter
+day the patient died.</p>
+
+<p><em>Examination.</em>&mdash;The body not emaciated.
+Strong adhesions of the left
+lung to pleura costalis. At its posterior
+part a large gangrenous layer, occupying
+the two superior thirds of the
+lung, covered at some points by a false
+membrane. The lower third, and the
+parts round the gangrenous portion, in
+different degrees of inflammation, and
+hepatised; the putrid mass was in great
+part black or violet-coloured, containing
+fragments of the pulmonary texture;
+the smell gangrenous, but less
+so than that of the breath during life;
+pus might be squeezed from the adjacent
+part of the lung.</p>
+
+<p><span class="smcap">Case II.</span>&mdash;A man, aged 55, enjoyed
+good health till the beginning of May,
+at which time he experienced pain in
+the left side of the thorax after exposure
+to cold. During the next few
+days the cough was frequent, and the
+expectoration tinged with blood. A
+rigor now came on, followed by a distinct
+exacerbation of fever, and he
+came to the Hôtel Dieu. At this time
+he presented symptoms of inflammation
+of the lungs, and was bled with
+relief; he left the hospital in twelve
+days, being sufficiently well to resume
+his occupation. Scarcely had he done
+this, however, when he had a relapse,
+accompanied by great lassitude, oppression
+of breathing, and frequent cough.
+At the end of a week he returned. He
+was now at the twenty-first day of the
+attack. His skin was yellowish; face
+pale or of leaden hue, and greatly altered;
+his cough frequent, with abundant
+expectoration of matter like chocolate,
+with small specks resembling
+pus, and little bodies about the size of
+peas, which appeared to be portions of
+the lung. This putrid mass exhaled a
+<em>gangrenous odour</em>, and the expired air
+was impregnated in a high degree with
+an equally disgusting smell, which surrounded
+the patient's bed with a contaminated
+<span class="pagenum"><a name="Page_142" id="Page_142">[142]</a></span>
+atmosphere. Percussion gave
+a clear sound over the whole extent of
+the chest; auscultation did not discover
+the pulmonary expansion on the right
+side. The pulse was weak, but not
+frequent; the patient was in a state of
+extreme prostration. Next day the
+odour of the breath and expectoration
+was, if possible, more dreadful. He lingered
+two days longer, during which time
+the fœtid smell somewhat diminished,
+and the proportion of pus in the expectoration
+increased.</p>
+
+<p><em>Examination.</em>&mdash;The left lung had
+contracted firm adhesions, particularly
+above and behind. It was torn in attempting
+to remove it, and there issued
+from the middle and posterior part a
+large quantity of dark-coloured matter,
+similar to what had been expectorated.
+An incision was made along the back
+part of the lung, and laid open a large
+cavity, occupying all the extent of the
+pulmonary organ, and still in part filled
+with the same kind of dark putrid matter.
+On washing out the cavity it was
+perceived that it was lined with a
+smooth and white membrane, to which
+were still adherent, at some points, dark
+filamentous shreds; these were removed
+by the least touch, and left the surface
+smooth beneath. The boundary was
+formed by a false membrane, about a
+line in thickness, which separated the
+mortified from the sound parts. The
+lung was reduced to a kind of bag, the
+parietes of which were on an average
+about an inch thick. In the upper part
+of the lung, which was hepatized, an
+incision discovered a number of smaller
+tubercles, which in the centre were in
+a crude state; and at one point several
+had suppurated, forming a cavity large
+enough to contain a nut.</p>
+
+<p>[The Editors of the <cite>Journal Hebdomadaire</cite>,
+from which these cases are abridged,
+add, in a note, that although the fœtor
+of the expectoration, such as above
+described, is usually dependent on gangrene
+of the lungs, yet that this is not
+invariably the case. In confirmation of
+this assertion they refer to three instances
+of fœtid expectoration&mdash;in the
+first, the patient is still alive; in the
+second, there was chronic bronchitis,
+with considerable dilatation of numerous
+bronchi; and in the third, bronchitis
+with some appearances of chronic
+pneumonia. Laënnec gives a case of
+dilatation of the bronchi, with remarkably
+fœtid expectoration. The argument
+derived from the first patient
+having survived we consider to be altogether
+erroneous, as patients more
+frequently recover from this than other
+forms of purulent expectoration.&mdash;<span class="smcap">Ed.</span>]</p>
+
+
+<hr class="fulla" />
+<h2>PROCEEDINGS OF SOCIETIES.</h2>
+<hr class="r10a" />
+
+<h3>WESTMINSTER MEDICAL SOCIETY.</h3>
+
+<p class="center fs80">December 6th, 1828.</p>
+
+<p class="center smcap">James Arnott, Esq. in the Chair.</p>
+
+<p class="noindent">Pursuant to announcement, Mr. MacKelcan
+introduced the subject of concussion of the
+brain. After remarking on the several
+symptoms, and mentioning the other affections
+of the head with which concussion is
+apt to be confounded, Mr. M. directed the
+attention of the society more particularly to
+the treatment in the stage of collapse, adopted
+by Professor Andrini of Florence.</p>
+
+<p>Dr. Duffin stated, that having been in
+Florence, he had witnessed the employment
+of three, four, or six ounce bleedings employed
+by the Professor in the stage above-mentioned.
+The principle on which they
+were used was that of their acting as a
+stimulus to the brain; and really the plan
+was not apparently attended with any bad
+effects. When re-action has ensued, the
+practice of M. Andrini is the same as that
+resorted to in this country.</p>
+
+<p>The discussion then wavered between
+apoplexy and concussion, and ended by some
+good-humoured sparring between Dr. Addison
+and Mr. Gilbert Burnett, on the capability
+of the brain containing more blood at
+one time than another.</p>
+
+<p>The President announced from the chair
+that a special meeting would take place on
+Friday evening, December 12, at 7 <span class="fs70">P.M.</span></p>
+
+
+<p class="p1 center fs80">December 20th, 1828.</p>
+
+<p class="center smcap">Cæsar Hawkins, Esq. in the Chair.</p>
+
+<p>After some business had been dispatched,
+to which we shall allude in another place,
+Mr. Jewel related the particulars of a case of
+"supposed extra-uterine fœtation." The
+case, which is one of much interest, is as
+follows:&mdash;</p>
+
+<p>Mrs. F. a robust, healthy woman, ætatis
+27, had been married one year, and aborted
+once; when, in the month of September
+1827, she quitted her husband in London,
+and accepted a situation in the country.
+After the expiration of a few weeks she
+received permission to come to London for
+a day; and, naturally enough, passed that
+night, (November 8th), with her husband,
+returning again to the country next morning.
+Soon afterwards, the morning-sickness,
+heart-burn, and other sympathetic affections
+<span class="pagenum"><a name="Page_143" id="Page_143">[143]</a></span>
+of pregnancy, appeared; but the catamenia
+still returned at the regular periods, though
+scanty and paler in colour than natural.
+She now quitted her situation, returned to
+her husband, and engaged a midwife to attend
+her in her expected confinement. The
+circumstance of quickening occurred in the
+latter part of February, and was accompanied
+by a severe paroxysm of fainting, whilst the
+abdomen gradually enlarged, and the motions
+of the child (as was imagined) could
+not only be easily detected with the hand,
+but were visible to the eye. On the 9th of
+August, making a period of 274 days, she
+was seized with the usual premonitory symptoms
+of labour; the midwife arrived; found
+her walking her chamber, and concluded that
+the process had considerably advanced.
+Three distinct uterine contractions took
+place subsequent to the midwife's arrival,
+the last of which was so severe as to compel
+the patient to grasp firmly the back of a
+chair, and induce, after its subsidence, excessive
+faintness. From this time no further
+parturient effort was made; no examination
+per vaginam was instituted; neither was
+there noticed any sanguineous vaginal discharge.
+When Mr. Jewel saw her, examination
+detected nothing unusual in the os
+uteri, and the symptoms she presents are
+these. The abdomen is about the size of a
+woman's in the sixth or seventh month of
+pregnancy, the enlargement being general.
+Her general health is much disturbed: she
+complains of pain in the left hypogastric
+region, particularly when the abdomen is
+compressed by the hand or stays&mdash;and she
+also complains of weight in the abdomen,
+especially on leaning forwards. The woman
+herself has a strong prepossession that
+"something is to come away," or that she
+might be relieved by an operation. The
+woman believes that she still feels the motions
+of the child, though feebly.</p>
+
+<p>Having read this case, Mr. Jewel concluded
+by offering some observations on the
+subject of extra-uterine fœtation. He considered
+this as probably an instance of "graviditus
+abdominalis," and remarked that the
+uterus not having expelled its dezidua, was
+no conclusive proof to the contrary, Dr.
+Blundell and Mr. Langstaff having examined
+cases where this was wanting.</p>
+
+<p>Dr. Locock never saw a case where laceration
+occurred in the early months of pregnancy.
+Dr. L. remembered the particulars
+of a case where the uterus was lacerated in
+the fourth month, and the ovum escaped into
+the cavity of the abdomen, and the symptoms
+of pregnancy were exceedingly strong.
+Dr. Locock almost doubted whether Mr.
+Jewel's was an instance of pregnancy at all,
+for frequently women enjoying sexual intercourse
+have enlarged abdomens, and many
+of the other symptoms of pregnancy, which
+a few doses of purgative medicine will
+remove.</p>
+
+<p>Two remarkable instances of extra-uterine
+fœtation were related by Mr. Burnett and
+Mr. Cæsar Hawkins; and towards the conclusion
+of the evening the discussion turned
+on the powers of the ergot of rye. Dr.
+Locock had frequently tried it in amenorrhœa,
+and, on the whole, without any very good
+effects. In one remarkable case, where the
+lady particularly wished to have children,
+Dr. Locock having boiled an ounce of the
+ergot in a pint of water down to half a pint,
+gave an ounce and a half of this decoction
+three times a day. After the young lady
+had taken about half a pint, the most violent
+convulsions succeeded, which placed her life
+in imminent hazard, and from which it was
+long before she completely recovered. She
+menstruated twice after that, but then the
+discharge again was arrested, and has never
+since returned, nor has she become pregnant.</p>
+
+<p>The practice of "bougieing the uterus"
+in cases of dysmenorrhœa was brought upon
+the tapis, and excited a good deal of laughter,
+the members appearing to consider the
+proposal ridiculous in the extreme.</p>
+
+
+<p class="center fs90">MR. LAMBERT.</p>
+
+<p>At the last meeting of this Society it
+was proposed, on the recommendation of the
+Committee, that Mr. James Lambert should
+be expelled; and after some discussion it
+was agreed that the sense of the members
+should be taken by ballot at the next
+meeting, Saturday, January 3, 1829. It
+was thought that proceeding at once to his
+expulsion might give the appearance of the
+measure originating with a party, and that
+the delay would enable the deliberate judgment
+of the whole Society to be passed upon
+his conduct.</p>
+
+
+<hr class="r10a" />
+<h3>HUNTERIAN SOCIETY.</h3>
+
+<p class="center fs80">Dec. 10, 1828.</p>
+
+<p class="center smcap">Dr. Billing, President, in the Chair.</p>
+
+<p class="noindent">Mr. Leese, Jun. exhibited to the meeting a
+specimen of medullary sarcoma, taken from
+the forehead of a man after death, with a
+portion of the os frontis. The man was
+fifty-eight years of age, long asthmatic, and
+appeared to die of hydrothorax. He never
+suffered any pain in the tumor, but expressed
+a sense of distention. It was immoveable
+at the base, and there were some fissures in
+the os frontis, from caries. The dura mater
+at the corresponding part adhered firmly to
+cranium, and on its being removed some
+spiculæ from the carius inner table remained
+adhered to it. There had never
+been any symptoms of cerebral affection.
+A tumor of the same nature had formed on
+the scapular extremity of the clavicle, and
+had occasioned anasarca of the limb.</p>
+
+<p>Mr. Key supposed that the tumor had
+originated from the diplöe, and believed
+that the only chance of relief in such a case
+would be trephining; but he acknowledged
+<span class="pagenum"><a name="Page_144" id="Page_144">[144]</a></span>
+that there was little encouragement to operate
+in these cases, owing to the tendency
+of the disease to return in some other part.
+He related an instance of the true medullary
+fungus taking its origin from the cancellous
+structure of the os femoris. The limb was
+removed, but the patient died. A circle of
+fungoid glands was observed at the base of
+the heart, and some of the bronchial glands
+were in the same condition.</p>
+
+<p>Dr. Conquest expressed his belief that
+carcinoma was always a constitutional affection,
+and stated that at least in nine cases
+of cancer uteri out of ten, there was carcinomatous
+affection of the pylorus, mesenteric
+glands, or liver.</p>
+
+<p>Mr. Key and Dr. F. Ramsbotham had
+not observed, in their examinations, the
+coincidence noticed by Dr. Conquest.</p>
+
+<p>The remainder of the evening was occupied
+by a discussion on the different kinds
+of ulceration that occur about the os and
+cervix uteri, and the circumstances under
+which the removal of the uterus, or the amputation
+of the cervix, may be warrantable.</p>
+
+<p>Dr. Babington adverted to the occasional
+existence of a family disposition to carcinoma.
+He had known three sisters successively
+die of cancer in the breast.</p>
+
+
+<hr class="r10a" />
+
+<h3>MEDICAL SOCIETY OF LONDON.</h3>
+
+<p class="center fs80">Dec. 13th and 20th, 1828.</p>
+
+<p class="center smcap">Dr. Haslam in the Chair.</p>
+
+<p class="noindent">The subject of discussion, at the first of
+these meetings, was stricture of the rectum,
+when the diagnosis and treatment of carcinoma
+of that part came under consideration.
+There was a remarkable discrepancy in the
+opinions of Messrs. Lloyd and Salmon as to
+the symptoms and management of carcinomatous
+affections of the rectum. Mr. Lloyd
+maintained that these affections of the intestine
+were sometimes attended with pain
+and sometimes not, and that the patients
+were often materially benefited by the use
+of bougies; while Mr. Salmon affirmed,
+that the disease was always painful, and not
+to be mitigated by the employment of these
+means.</p>
+
+<p>A variety of subjects came before the
+society at the next meeting. The president
+read a letter from Mr. Wansborough, of
+Fulham, describing the "original stomach-pump,"
+a specimen of which accompanied
+the letter: the instrument Mr. W. stated to
+be of 25 years' standing.</p>
+
+<p>Mr. Shearly exhibited, among other morbid
+specimens, a uterus, on the external
+surface of which the disease termed the
+"white tubercle" was in progress: there
+was also a small polypus near the os uteri.
+Mr. Pereira exhibited to the society a fine
+specimen of medullary sarcoma of the liver.
+The organ was so enlarged as to have occupied
+two-thirds of the abdomen. The other
+viscera were not involved in the disease.
+The progress of the disease, as far as it
+could be ascertained, was excellently detailed
+by Mr. Smith, a visitor. The symptoms
+were obscure.</p>
+
+<p>Mr. Armstrong read an extract of a letter
+from Mr. Morgan, of the Bristol Infirmary, a
+corresponding member of the Society, describing
+a curious conformation of the œsophagus
+in a child, which lived 106 hours
+only, during which period every attempt to
+swallow food produced considerable distress.
+The œsophagus was found to be divided into
+two portions; the upper or pharyngæal extremity
+terminating in a <i lang="fr" xml:lang="fr">cul de sac</i> behind
+the bifurcation of the trachea; and the lower
+or ventricular extremity arising from the
+trachea at this point, between the bronchi,
+proceeding down the spine, and terminating,
+as usual, at the cardiac orifice of the stomach.
+Mr. Drysdale mentioned a somewhat
+similar malformation occurring in two
+children in one family. Mr. Callaway related
+a case of concussion of the brain, which terminated
+fatally, after the restoration of the
+intellectual functions. The whole of the anterior
+lobes of each hemisphere of the brain
+was broken down, and mixed with effused
+blood. The remarkable feature of the case
+was, the return of consciousness, and the
+possession of this power for six days, under
+the disorganization of the brain described;
+and the questions particularly agitated were,
+Did this extent of mischief exist immediately
+after the concussion? What was the
+degree of laceration of the brain at that period?
+and, How could the recovery of the
+intellectual faculty be reconciled with so
+much injury of the brain?</p>
+
+<p>The Society then adjourned to the 12th of
+January, 1829.</p>
+
+
+<hr class="fulla" />
+<h2>COOPER <em>v.</em> WAKLEY.</h2>
+
+<p>Notes of the Cause, Cooper <em>v.</em> Wakley&mdash;We
+understand that Mr. Cooper is about to
+publish a verbatim account of the above
+trial, from Mr. Gurney's short-hand notes.</p>
+
+
+<hr class="fulla" />
+<h2>ERRATA.</h2>
+
+<p>The Advertisement of Mr. B. Cooper's,
+in our last Number, ought to have been
+dated "<em>December</em> 15," instead of "<em>Oct.</em> 15."
+Also, for "<em>Mr. Elton</em>," the name of one of
+Mr. Cooper's witnesses, read "<em>Mr. Hilton</em>."</p>
+
+<p>In our last leading article, <em>for</em> "can no
+friend of Wakley be named?" <em>read</em> "can
+the name of no friend of Wakley be mentioned?"
+The alteration is necessary, to connect
+it with the conclusion of the paragraph.</p>
+
+<hr class="fulla" />
+<p class="center fs80"><span class="smcap">W. Wilson</span>, Printer, 57, Skinner-Street, London.</p>
+
+
+<div class="footnotes"><h2>FOOTNOTES:</h2>
+
+<div class="footnote">
+
+<p><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">[1]</span></a> General thickening of all the valvular apparatus
+on both sides of the heart. (St. B. 33.)</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">[2]</span></a> Andral, vol. iii. p. 411.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3"><span class="label">[3]</span></a> Pl. 1, fig. 5.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_4_4" id="Footnote_4_4"></a><a href="#FNanchor_4_4"><span class="label">[4]</span></a> Opacity and thickening of the lining membrane
+on both sides of the heart, without unevenness
+or alteration of form. (St. B. 33).</p>
+
+<p>
+Opacity and thickening in the valvular apparatus
+between the left auricle and ventricle, with
+shortening of the chordæ tendinæ, and such alteration
+of structure and form as to produce a considerable
+contraction of the aperture. (St. B. 26).</p>
+
+<p>
+Such thickening of the whole valvular apparatus
+as to narrow the aperture of communication
+between the left auricle and ventricle to a mere
+slit. (St. B. 19).</p>
+
+<p>
+Shrivelled and contracted state of the semilunar
+valves, in which a cartilaginous substance has entirely
+taken the place of the natural structure.
+(Hodgson, pl. 1, fig. 6).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_5_5" id="Footnote_5_5"></a><a href="#FNanchor_5_5"><span class="label">[5]</span></a> Osteum aortæ almost closed by ossified valves.
+(St. B. 15); (Hodgson, pl. 1, fig. 2).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_6_6" id="Footnote_6_6"></a><a href="#FNanchor_6_6"><span class="label">[6]</span></a> Fungus growing from the aortic valves, which
+are thickened and shortened. (St. B. 6, 20).</p>
+
+<p>
+Fungus form the aortic valves, which are ulcerated.
+(St. B. 21).</p>
+
+<p>
+Larger specimens of fungus, growing from the
+ulcerated edges of two of the valves of the aorta.
+(Hodgson, pl. 1, fig. 7).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_7_7" id="Footnote_7_7"></a><a href="#FNanchor_7_7"><span class="label">[7]</span></a> Dr. Baillie's plate.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_8_8" id="Footnote_8_8"></a><a href="#FNanchor_8_8"><span class="label">[8]</span></a> Polypous coagulum in the ventricle. (Coll. of
+Phys. 4, A. 16).</p>
+
+<p>
+Coagulum firmly attached to the lining of the
+left auricle, with enlargement of its capacity. (St.
+B. 19).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_9_9" id="Footnote_9_9"></a><a href="#FNanchor_9_9"><span class="label">[9]</span></a> (St. B. 13).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_10_10" id="Footnote_10_10"></a><a href="#FNanchor_10_10"><span class="label">[10]</span></a> It occurs sometimes in the uterus.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">[11]</span></a> Memoir. de l'Acad. des Sciences. Morand,
+1732. Morgagni, Epist. 27.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_12_12" id="Footnote_12_12"></a><a href="#FNanchor_12_12"><span class="label">[12]</span></a> Andral, v. 3, 466; Hodgson, plate 1, figure 7;
+St. B. 14.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_13_13" id="Footnote_13_13"></a><a href="#FNanchor_13_13"><span class="label">[13]</span></a> Corvisart, cap. 4. sect. 1.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_14_14" id="Footnote_14_14"></a><a href="#FNanchor_14_14"><span class="label">[14]</span></a> Active dilatation of the left ventricle. (College
+of Phys. 4, c. 10.)</p>
+
+<p>
+The thickened walls of the left strikingly contrasted
+with the attenuated walls of the right ventricle.
+(St. B. 9).</p>
+
+<p>
+Active dilatation of the left ventricle. Its
+capacity is strikingly contrasted with that of the
+right. (College of Phys. 4, c. 11.)</p>
+
+<p>
+Passive dilatation of both ventricles, especially
+of the right. (St. B. 10).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_15_15" id="Footnote_15_15"></a><a href="#FNanchor_15_15"><span class="label">[15]</span></a> Morgagni, Epist. xxvii. 7.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_16_16" id="Footnote_16_16"></a><a href="#FNanchor_16_16"><span class="label">[16]</span></a> Ibid. 2.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_17_17" id="Footnote_17_17"></a><a href="#FNanchor_17_17"><span class="label">[17]</span></a> Ibid. 3.</p>
+
+<p>
+Rupture of the left ventricle, with attenuation
+of its muscular structure. (St. B. 18).</p>
+
+<p>
+Rupture, without attenuation, but with softening
+and looseness of texture in the muscular substance.
+(St. B. 22).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_18_18" id="Footnote_18_18"></a><a href="#FNanchor_18_18"><span class="label">[18]</span></a> Harvey, Exercit. altera.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_19_19" id="Footnote_19_19"></a><a href="#FNanchor_19_19"><span class="label">[19]</span></a> Rupture of the left ventricle without change
+in its structure. Bone deposited at the commencement
+of the aorta. (St. B. 27).</p>
+
+<p>
+In turning over the Memoirs of the Royal
+Academy of Sciences, I find two cases of rupture
+of the heart, reported by M. Morand. They both
+occurred in the year 1730; and, strange to say,
+one was that of a Duchess of Brunswick,
+who was of the same family as George II.
+who also died of a ruptured heart. In the one,
+that of the Duchess, there was a manifest ulceration
+through the walls of the right ventricle, its
+structure being otherwise unimpaired; in the
+other, where the aperture was in the left ventricle,
+there was probably a simple rupture, for the flesh
+of the heart was so soft that the point of a probe
+would pass through it wherever it was rested.
+(Mem. de l'Acad. Roy. des Sciences, Ann. 1732).</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_20_20" id="Footnote_20_20"></a><a href="#FNanchor_20_20"><span class="label">[20]</span></a> The trial as published in the Lancet occupied
+less than 21 pages&mdash;in the Gazette it extended, in
+the same type, to 33 pages and a half. In the
+Lancet, those parts, both of the evidence and
+speeches, which told most against Wakley, were
+omitted.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_21_21" id="Footnote_21_21"></a><a href="#FNanchor_21_21"><span class="label">[21]</span></a> <a href="#P137">See passage in Italics, page 137.</a></p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_22_22" id="Footnote_22_22"></a><a href="#FNanchor_22_22"><span class="label">[22]</span></a> The defendant, on leaving the court, was
+cheered by the populace in Palace Yard.&mdash;Lancet,
+Dec. 20.</p></div>
+
+<div class="footnote">
+
+<p><a name="Footnote_23_23" id="Footnote_23_23"></a><a href="#FNanchor_23_23"><span class="label">[23]</span></a> This we believe is false; nothing of the kind
+either occurred, or was stated at the trial.&mdash;E. G.</p></div></div>
+
+
+<div class="transnote pg-brk">
+<a name="TN" id="TN"></a>
+<p><strong>TRANSCRIBER'S NOTE</strong></p>
+
+<p>Obvious typographical errors and punctuation errors have been
+corrected after careful comparison with other occurrences within
+the text and consultation of external sources.</p>
+
+<p>Except for those changes noted below, all misspellings in the text,
+and inconsistent or archaic usage, have been retained.</p>
+
+<p>
+<a href="#Page_116">Pg 116</a>, 'immedate contact' replaced by 'immediate contact'.<br />
+<a href="#Page_119">Pg 119</a>, 'and attennuation in' replaced by 'and attenuation in'.<br />
+<a href="#Page_126">Pg 126</a>, 'Tue valuable paper' replaced by 'The valuable paper'.<br />
+<a href="#Page_132">Pg 132</a>, 'probably impossibly' replaced by 'probably impossible'.<br />
+</p>
+</div>
+
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
+End of the Project Gutenberg EBook of The London Medical Gazette; December
+27, 1828, by Various
+
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+</pre>
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+</body>
+</html>
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author	nfenwick <nfenwick@pglaf.org>	2025-02-06 16:44:17 -0800
committer	nfenwick <nfenwick@pglaf.org>	2025-02-06 16:44:17 -0800
commit	deb32ce4296fd61248fae089f9183505fae1e3b4 (patch)
tree	3673f03be4f0d2a46d1c6fef0063a6f4a0ad4092
parent	34b01c644dd8524fdb9b24267fe662a29569f674 (diff)