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diff --git a/old/53450-0.txt b/old/53450-0.txt deleted file mode 100644 index bea2449..0000000 --- a/old/53450-0.txt +++ /dev/null @@ -1,3207 +0,0 @@ -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 *** - -***** This file should be named 53450-0.txt or 53450-0.zip ***** -This and all associated files of various formats will be found in: - http://www.gutenberg.org/5/3/4/5/53450/ - -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) - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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