LONDON MEDICAL GAZETTE. YOL. XIX. (VOL. I. FOR THE SESSION 1836-37.) - - - WILSON AN1) SON, PRINTERS, 57, SKINNER-STREET, LONDON. < THE HOtttlOtY MEDICAL GAZETTE; BEING A OTee&lp Sournal OF MEDICINE AND THE COLLATERAL SCIENCES. VOL. XIX. (VOL. I. FOR THE SESSION 1836-37.) LONDON : PRINTED FOR LONGMAN, REES, ORME, BROWN, GREEN, <$f LONGMAN, PATERNOSTER-ROW. 1837. Digitized by the Internet Archive in 2019 with funding from Wellcome Library I H ISTOR iCAL ] \ MEDICAL J <'/£3r https://archive.org/details/s2id13404530 THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOyRINM. OF i¥irttrtnc attJj ffie Collateral Emitted. SATURDAY, OCTOBER 1, 1836. LECTURE S ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine , By William Cummin, M.D. INTRODUCTORY LECTURE. Gentlemen, — The subject of the course of lectures on which we are about to en¬ ter, is one which, for variety, interest, and importance, is second to none other taught in the schools. An assertion of this kind in the outset, may possibly risk the raising of expectations which it may not be so easy in the sequel to realize: but it is pro¬ per, at all hazards, that the fact should be fairly stated. Definition. — Forensic medicine, in its literal sense, signifies medicine, or medical science, adapted to the forum or court of jus¬ tice; but its actual import may be more largely described. As at present generally understood, it comprehends all that medi¬ cal knowledge which is available for the ascertainment of facts required in the ad¬ ministration of justice, and that informa¬ tion which is requisite for the construction of certain laws. An unexceptionable defi¬ nition cannot readily be given. I might quote to you the various forms in which the best authorities, both at home and abroad, have endeavoured to describe and to define the object of this study; but it would not be a very profitable mode of spending our time ; the terms already em¬ ployed may perhaps be deemed sufficiently clear and adequate for every purpose. As an art, forensic medicine assists in law¬ making as well as in the administration of the laws ; it comes in aid of the legis¬ lator as well as of the judge; its mission, accordingly, must be considered as of no mean importance. 461. — xix. Other appellations. — The distinctive ap¬ pellation of Forensic medicine — medicina forensis — has been sanctioned by Latin writers for more than a century, and has been freely adopted in various countries ; particularly in Italy and Spain. As a synonym, Legal medicine — medicina legalis, medecme legale — is used principally by our French contemporaries, and is, perhaps, in some degree, a preferable term to that used among us, as more obviously imply¬ ing an immediate relation to law. The Juridical or Judicial medicine of some au¬ thors, though it approach in signification to the Gerichtl'che Medicin, G. Arzneikunde , G. Arzneiwissenchaft, of the Germans, can¬ not be considered as a very correct title ; for medical men are never called on to de¬ clare what is or is not the law ; their busi¬ ness in courts of justice is simply to ascer¬ tain facts whereby the law, as interpreted by the proper authorities, may be duly administered. But what shall we say of Medical jurisprudence? — an unfortunate misnomer, which has obtained a footing in this country, and which began to be employed before the subject it was intended to denote was rightly understood. Medical juris¬ prudence is synonymous, or identical, with medical law; using the term law in its ordinary sense of legal science. Now who shall say that medical law and legal medi¬ cine mean the same thing? Might we not as well assert that the chestnut- horse and the horse-chestnut are equivalent ? But whatever be the appellation we give this study — whether forensic, legal, or juridical medicine — its nature and objects are easy to be recognized. It ministers to certain necessities of man as a member of society, just as clinical medicine does to his wants as an individual. That the duty of the medical practitioner is not confined to the sick chamber has long been known ; the medical man has also to attend the court of justice; and though the period is not far distant when medicine used to be de¬ fined simply and exclusively as the art of B 2 DR. CUMMIN ON FORENSIC MEDICINE. curing or preventing disease, such a defi¬ nition is now generally admitted to be incomplete, for it does not embrace the practitioner’s duties in aid of the construc¬ tion and administration of the laws. History. — This, gentlemen, is no mere modern or new-fangled application of medical science ; it is nearly as old as clinical medicine itself. It is not unrea¬ sonable to suppose that mankind possessed some degree of medical knowledge even before they were collected into communi¬ ties : but it is not possible to believe that this event took place, and that laws were instituted for the governance of society, without the aid of some degree of medical skill in their formation, and some also in having them properly executed. A rapid glance at the history of forensic medicine will not here be out of place : it will show at how early a period medico-legal questions began to be entertained, also what sort of questions have principally occupied the attention of legislators and jurists, from the most ancient date up to the present time. But it were not pos¬ sible (nor perhaps desirable, if possible) to enter largely into historical detail within the limits of an opening lecture : so that I shall have to refer you, for the principal facts and dates, to the Tabular View of the History and Literature of Forensic Medicine here drawn up for your inspec¬ tion [see the Table subjoined to the lec¬ ture]. I have divided the whole series of events into two periods ; in the first of which, the principles of the art may be recog¬ nized as existing, though not practised by a separate order of practitioners, or, in¬ deed, by medical men at all, as was the case with clinical medicine itself in the beginning : the second period commences about the early part of the sixteenth cen¬ tury, when, by a special ordinance of the German Emperor, the intervention and assistance of medical witnesses, in certain specified cases occurring in courts of jus¬ tice, were provided. Period 1. — In relation to the first period I shall be very brief. We find, in the sacred books of Moses, the first written rudiments of forensic medicine. There are there stated certain distinctions to be observed with regard to wounds — homicide — violation — criminal abortion — diseases and disqualifi¬ cations — the proofs of virginity, &c. found¬ ed on medical principles, and to be ascer¬ tained by the inquiries of persons compe¬ tently skilled. But the earliest special tract extant on a medico-legal subject is that of Galen, on the detection of persons who feign disease : this was produced in the second century of our sera *. In the laws of the ancient Greeks and Romans there are many medico legal provisions to be detected; yet, passing over several centuries, when we come to the great wmrk of Justinian, the Corpus Juris Civilis , we are surprised to find in it no ordinance expressly requiring reference to be made to medical practi¬ tioners, and that, although the medici of the period were not an obscure nor an unprivi¬ leged class. The presence of midwives, indeed, was distinctly enjoined in exe¬ cuting the law de ventre inspiciendo ; but there are several of the enactments which could not possibly be put in force with any regard to justice without the inter¬ vention of medical witnesses, — the lex Aquilia , for example, which ordered that damages should be paid for personal injuries, — and the Lex Cornelia de sicariis et venejicis, which took cognizance of homi¬ cide by weapons or poison. It is a curious fact in the history of legislation, that at the very time Justinian in the East was intent on giving the world a body of laws that should concen¬ trate all the civil wisdom of the age, the warlike nations in the north-western parts of Europe were engaged in a similar, but, of course, a far more rude, design. Before the election of the Merovingian kings, the most powerful tribe, that of the Franks, appointed four venerable chieftains to compose the Salic laws, and their labours were approved in three successive assem¬ blies of the people. Somewhat later, the customs of the Ripuarians were tran¬ scribed and published; and the Visigoths were among the latest to secure for them¬ selves one of the principal benefits of civilized society. The institutions of these untutored tribes have come down to us, and are found to contain several ordinances which must have given considerable lati¬ tude to medical authority in courts of justice. The capitularies also of Charle¬ magne, founded on the Salic and Ripua- rian laws, are understood to go still further, and to render the evidence of medical men, in certain cases, indispensa¬ ble. But the decretals of the Popes sanc¬ tioned a superior and more express discre¬ tion : in one of them, an ordinance of Innocent the Third, of the date 1209, it is distinctly provided that in a case of homi¬ cide by alleged wounds, there should be procured the testimony, or the judgment, rather, of experienced practitioners — ut peritorum judicio medicorum talis percussio assereretur, fyc., an expression , by the way, which corresponds with that of Baldus, the celebrated jurisconsult of Perugia, who, in his commentary on the Pandects has said, that medical men were no common witnesses — they had rather a judgment to deliver, than their simple testimony. * See Medical Gazette, vol, xYii. p. 980. INTRODUCTORY LECTURE. ’ 3 Period 2.— But I must hasten to the second period of our medico-legal history, marked by the famous ordinance of the Emperor Charles the Fifth. Various circumstances conspired to this important enactment : anatomy had now for some time been freely practised, and the superior value of medico-legal testimony, founded on the necroscopic appearances, had be¬ gun to be understood. Criminal codes had been drawn up by the bishops of Wurtzburg and Bamberg, in which the importance of medical evidence was not overlooked. With such aids to its com¬ pletion and success was the Halsgerichtsord- nung, or grand criminal constitution of the empire, composed, and first published in the year 1533. I refer you to the historical table for the heads of the particular clauses which are of a medico legal nature, only taking occasion here to observe, that by this ordinance, the presence of medical practitioners, in their respective grades, was secured in courts of justice, whenever their evidence was required for judicial purposes. Legal medicine in France. — France fol¬ lowed the example of Germany : the reports and opinions of medical men were held to be indispensable in criminal pro¬ cesses relating to personal injuries, suspi¬ cious deaths, questionable suicides, &c. ; and several French documents are extant, which were drawn up at a very early date in such circumstances. Ambrose Pare, that illustrious old surgeon, was decidedly the earliest writer of a treatise for the guidance of medico-legal practitioners. His book of Reports, some portions of which seem to have appeared as early as 1575, contains a variety of precepts and maxims relating to some of the most important questions in legal medicine. On wounds, as inflicted before or after death — on the signs of suf¬ focation, particularly in infant children — on the proofs of virginity, with reference to defloration— on impotence — on lesions of the viscera, and on various kinds of death, there are many sound rules pre¬ scribed. But it was not in this hook alone that Pare treated of medico-legal subjects: in several other parts of his works we find notices of a smilar description. In his 24th book he mentions the signs of preg¬ nancy ; in the 25th he gives some curious instances of feigned disorders, and of the methods by which they were detected ; and in his 21st book he lays down certain principles relating to poisons, in order, as he says expressly, that the surgeon might be enabled to distinguish by cer¬ tain signs the proofs of poisoning, and to give a faithful report thereof to the judges when required so to do. The ardour with which Forensic medi¬ cine has been pursued in France in later times, and the advanced state to which the study has been brought in connexion with the names of Louis, Chaussier, Fodere, Orfila, and others, are facts too well known to require dwelling on in this rapid sketch. In Italy. — Ttaly may boast of having pro¬ duced some of the earliestsystematiewriters on forensic medicine; and BaptistaCodron- chi, of Tmola, is probably entitled in great measure to that precedence which has generally been awarded to bis countryman Fedeli. Codronchi, in 1597, published at the Frankfort press, his tract entitled Methodus testificandi, in which, as he says himself, some very difficult but most in¬ teresting questions are treated : among these are feigned diseases, real maladies or injuries forming grounds of excuse or disqualification, suspected poisoning, wilful abortion, legitimacy, virginity, im¬ potence, pregnancy, &c. ; in short, his little book is a collection of medico-legal topics very remarkable for their date, though not discussed in any regular order. In his preface he speaks confidently, and, to all appearance, correctly, of his being the first to proceed in this track, and to set the example of a better kind of testimony than had been in use theretofore. Five years later appeared the well- known work of Fortunato Fedeli, De Relationibus Medicorum, Palermo 1602, in which there is certainly a wider range of subjects than is found in Codronchi’s treatise. But the author seems to have had no idea of having been anticipated by any one. With conscious pride he says id equidem profited possum, similis arguments opus nusquam untea quod sciam in lucent venisse. Fedeli obtained quite as much reputation as he merited by this book, a book remarkable, no doubt, for the period in which it appeared ; but con¬ sidering the crude nature of its contents, the Aristotelic formality with which it is composed, and the superstitious errors with which it abounds, one cannot readily assign a reason for its continuing to be so long looked upon as an authority. It went through three or four editions, and seventy years after its first appearance was thought worthy of being re-produced by a learned professor of Leipsic. But the great medico legal luminary of the Italians was Paulo Zacchia, a man of great learning, singular talent, and sound judgment. He was the great authority of his day; and there has scarcely been a writer since on Forensic medicine, who has not, more or less, availed himself of the rich treasures of that amazing performance, the Quastiones Medico - legates (1621 — 1651). As may rea- dily be imagined, however, from the date at which it was produced — when the cir¬ culation of the blood had only recently been 4 DR. CUMMIN ON FORENSIC MEDICINE. announced tb the world, this voluminous work abounds with matter which at pre¬ sent is of very little practical utility : ana¬ tomy, surgery, physiology, chemistry, and therapeutics, have all been greatly altered and reformed since it wras written ; and the digressions, poetical passages, quota¬ tions from old histories, samples of the Aristotelian philosophy and Galenism, which prevailed at that period, have ren¬ dered it now rather a source of recreation than of profitable research. In Germany. — Germany, though the source and birth-place of Forensic medi¬ cine, and in later times so productive of great names in connexion with the study, yet seems to have done little or nothing in a systematic way till nearly a century after Italy. It was not totally idle, how¬ ever, in cultivating particular branches of the subject. The hydrostatic test, for ex¬ ample, by which the question of the re¬ spiration of the new-born child, in refe¬ rence to the charge of infanticide, is sought to be determined, was contrived in Germany towards the latter part of the seventeenth century. Carl Rayger suggested, and John Schreyer employed it for forensic purposes. Other perform¬ ances likewise of the Germans, about this time, were fraught with utility : on wounds — on the proofs of homicide — on deflora¬ tion — and on alleged sorcery, writings of considerable value were produced. But it was in the subsequent century that bril¬ liant progress was made among the Ger¬ mans in Forensic medicine : then it was that they attained that mastery which they still continue to hold. It would occupy more time than we can at present afford even to enumerate the labours of Bohn, Teichmeyer, Hebenstreit, Haller (for Hal¬ ler taught Forensic medicine), Ploucquet, Daniel, Metzger, Platner, and a host of others, who contributed to raise the science to a degree of importance previously little to be anticipated. But we shall have ample opportunities of adverting to the peculiar services and merits of the German jurists hereafter. In England. — When from this review of the progress of Forensic medicine on the continent, wre turn our eyes to what has taken plaee in England at an early date, we find almost a complete blank — scarcely a trace of the least at¬ tention having been paid to it ; and morbid anatomy itself in a deplorable degree of backwardness. When the young Prince Henry, the hope of the nation, died in 1607, and it was popularly be¬ lieved for a time that he had been poi¬ soned through the contrivances of the favourite Somerset, it became, of course, an object with the physicians who attend¬ ed the Prince in his last illness to give a sufficient account of the appearances no¬ ticed after death. The pains taken to do this may be estimated from the steps adopt¬ ed by Sir Theodore Mayerne, the first phy¬ sician in ordinary to his Majesty, and in his time reckoned to be at the head of the profession. We find in his works a mi¬ nute account of the last illness and death of Henry, drawn up both in French and Latin; to which is appended the certifi¬ cate of the King and Lords in Council, attesting the satisfactory nature of the narrative, and acquitting Sir Theodore of all blame in the transaction. But the de¬ tails of the post-mortem report are miserably meagre, and utterly unsatisfactory in a medico-legal point of view. It should be recollected that, at the time referred to, Harvey was pursuing those investigations wdiich have since immortalized him, and shed so much glory on his country. I must be permitted to dwell for a mo¬ ment on the name of Harvey, which it is gratifying to be able to connect with the history of Forensic medicine in England. That illustrious man, however little motive there was in his time for attending to such observations, did not allow at least one phy¬ siological fact, bearing on a vitally impor¬ tant question of Forensic medicine, to escape him. It w7as known to Galen that the lungs of the foetus w7ere red, heavy, and dense, and that they afterwards became white, light, and of more deli¬ cate texture. Harvey, however, went much farther. The physician of Per- gamus made no inference of medico¬ legal diagnosis ; he did not even say that the change was produced by respiration; nay, he gives us to understand that the change in colour and texture is a sort of vital process that spontaneously takes place preparatory to the process of respi¬ ration. Now our great physiologist not only noticed the fact of change of colour in the foetal lungs, but stated the true cause of the change, and suggested that this phenomenon might serve to distin¬ guish whether the mother had brought forth stillborn offspring, or issue that had breathed after birth. The passage in which this remark oc¬ curs should be highly prized by English medical jurists. It will be found in the 70th Exercitation, De Generatione Animalium : — “ In embryone hoc tem¬ pore dissecto,” says Harvey, speaking of the foetus that has completed the fifth month of intra-uterine life, “ interiora omnia distincta et perfecta conspiciuntur : pimsertim ventriculus, intestina, cor,renes, pulmones ; qui etiam in lobos divisi san- guinolenti apparent, formamque debitam nacti sunt. Color autem his rubicundior est, quam iis qui aerem aliquando inspira- runt ; quod pulmones, ab eo dilatati, al- INTRODUCTORY LECTURE. 5 bedinera induant. Eoque indicio facile inter- noveris , materne vivum , ati mortuum fcetum pepererit : illico enim ab inspirato aere, mutatur pulmonum color; qui, etiam post repentina fata, idem permanet.” The work from which this passage is taken was first published in 1651, and the fact which it announces was probably observed several years previously. Now the tests for infanticide did not begin to be inquired into, even in Germany, until nearly thirty years after the date just mentioned. I must pass over a whole century from this time before I can find any thing else particularly deserving .of notice in the proceedings of practitioners and writers in Great Britain. The two Hunters at length contribute indirectly to the study : John Hunter, by his researches relative to the treatment of the drowned; and Wil¬ liam, by his embryology, and his remarks on the signs of child-murder; in which latter, however, he shews himself to be very imperfectly acquainted with the in¬ vestigations of his predecessors and con¬ temporaries. At the time that William Hunter stated his objections to the hy¬ drostatic test, Haller and Morgagni had already pronounced their opinions upon it, had discussed the arguments pro and con , in respect to its value, and decided in its favour provided it were discreetly applied. Ploucquet, also, and Daniel, had publish¬ ed their remarks on that test, and sug¬ gested others of their own in emendation of it ; but Hunter seemed to know nothing of these things. In fact, though his tract on Child-murder is still referred to as an authority, particularly by members of the legal profession, its author, when it was produced, was nearly a century behind his time, for he stated not one medico-legal objection that had not been proposed and canvassed above at least 80 years before. It was subsequent to the publication of Hunter’s tract that the first systematic treatise on legal medicine was produced in this country. This was an abridged translation of Faselius’s Elements, by Dr. Samuel Farr, which appeared in 1788, — the original work of Faselius being at that time above tw’enty years old! Yet such was the compendium which sufficed in England up to the present century, when a few elementary works began to make their appearance at intervals. Of late, indeed, there is not so much room to complain : we can even boast of having some very respectable treatises on Forensic medicine in our language. The late Dr. Gordon Smith produced works of considerable value, in his Principles, and his Analysis of Medical Evidence. Paris and Fonblanque contributed much to the advancement of the study, by their popular and interesting volumes ; anct Dr. Beck sent us from beyond the Atlantic a most important production, which has become naturalized amongst us — constituting, in¬ deed, at present our best book of Elements, and one that is eminently serviceable to the medico-legal practitioner. It is now more than thirty years since an event occurred which ought to have had, as, indeed, it has had, a considerable influence in the promotion of Forensic medicine in this country. Through a strong recommendation to Government, a professorship of Medical Jurisprudence and Police was founded in the University of Edinburgh, in 180J: but for several years after, though the chair was occupied by a very able professor (the late Dr. Duncan), little attention w as paid to the sub¬ ject : nor did the emoluments of the appoint¬ ment much exceed the salary allowed by the crown. Of late, however, the study has been more successfully pursued, because patronized by authority; it has been enjoin¬ ed in the curricula of several of our medical corporations: first in Edinburgh University partially; then, in 1829, in the College of Surgeons in Ireland; in 1830, by the So¬ ciety of Apothecaries in London; and in 1831, by the College of Surgeons in Edin¬ burgh. The London College of Physi¬ cians also, in their new curriculum, have adopted Forensic medicine; though, strangely enough, the London College of Surgeons have not yet thought proper to admit it, notwithstanding that it has be¬ come almost popularly and familiarly re¬ cognized as a department of the highest importance to the practitioner. Itidispensable to British practitioners. — The peculiar position in which medical prac¬ titioners in this country are placed, in respect to the legal tribunals, must neces¬ sarily lead to such a recognition ; for there are not here — as there are in France, Italy, Germany, and other countries — persons specially appointed to the discharge of medico-legal functions ; consequently, in the event of medical evidence being required amongst us, any practitioner in any manner connected with the case, or perhaps having no anterior cognizance of it whatever, may be called upon to act in the capacity of a medical jurist. But our laws, perhaps it may be sup¬ posed, areof a different character from those of other countries : we do not here take cognizance of those minutiae on w hich the decision of cases in the foreign courts de- pends. In other words, it may be at¬ tempted to be alleged that medical aid is not essentially necessary for the adminis¬ tration or composition of British law. If such an assertion be seriously made, it can easily be shown to be inconsis¬ tent both with truth and fact. We have G DR. CUMMIN ON FORENSIC MEDICINE- only to appeal to the history of our laws — criminal, ecclesiastical, and civil — to see how the matter really stands. The laws of England, like our lan¬ guage, may be traced to various sources ; they are the concentrated wisdom, not only of our own ancestors, but of those of other and more ancient nations. Our civil and canon law, which prevails in the ecclesias¬ tical and certain other courts, is almost wholly borrowed from the codes of Justi¬ nian and Theodosith, and from the Decre¬ tals of the Popes ; while our common law, based on the enactments of our Ethelberts, our Alfreds, and our Edwards, has been en¬ riched by the experience of ages, and may fairly lay claim to the designation which has by some been accorded to it — namely, that of being the perfection of human reason. Now the civil law, already noticed in speaking of the Corpus Juris and the Decretals, contains many provisions of a medico-legal nature : these provisions have, many of them, been transmit¬ ted to us in their original integrity ; and I can give you, as an example, the practice followed when it is necessary to ascertain pregnancy, in the conduct of civil suits. The writ called, after the Roman law, de ventre inspiciendo, is issued, and a jury of discreet and experienced persons is called upon to execute it. In criminal cases, when pregnancy is pleaded in bar of execution, a jury of matrons must give a verdict on the plea : but the usual practice has for some time been to sub¬ stitute certain professional examiners in¬ stead. I might refer to many of our ancient statutes in like manner, to show that they c ntain clauses, the administration of which can only be, as it commonly has been, properly effected by medico legal assistance. Take the statute 25th of Ed¬ ward ILL c 2, concerning the crime of high treason, in compassing or imagining the death of the king — violating certain females of the royal family — slaying the judges, &c. The application of this sta¬ tute has rarely taken place, nor could it well be conducted, without medical evidence being tendered. Or take the laws of May¬ hem, or maiming, which were very an¬ cient, or the Coventry act, according to which the guilt of the accused depended on his having, with a certain intent, inflicted peculiar wounds — such as slitting the nose, cutting out or disabling the tongue or any member: medical evidence was here also absolutely necessary. It is certainly true, that in these, or any other of our laws, there has rarely, if ever, been any mention of medical referees. But this is only consis¬ tent with the cautious reserve so remarka¬ ble in ourlegislation, which always chooses to leave as much as possible to the discre¬ tionary management of its functionaries; nor is the necessity for medico-legal aid by any means lessened owing to that circum¬ stance. A better example of the cautious policy to which I allude cannot be afforded, than that which we find in the statute which I hold in my hands. It is the 9 Geo. IV. chap. 31, commonly called Lord Lansdowne’s Act. Itconsists of thirty-eight sections, consolidating our statute law rela¬ tive to offences against the person ; and though full five-and-twenty of those sec¬ tions are of a medico-legal nature, or re¬ quiring the evidence of medical witnesses, in order that the provisions of each should be duly satisfied, several of them requiring the substantiation of facts only to be ascertained by the examination of competent medical men, there is not one word, from beginning to end, explicitly referring to professional testimony : the nature of the proofs required, however, can leave no doubt as to the persons by whom those proofs are to be ascertained. But the practice of our courts puts the matter beyond a question. Though there are among us no recognized medical jurists — no special class of medical referees — we find few trials in which persons discharg¬ ing such functions are not specially re¬ quired to be present, and called upon to elucidate, by their opinions, the difficul¬ ties that may arise. Observe the busi¬ ness on circuit : in almost all the cases occurring at the spring and summer as¬ sizes, the testimony of members of the pro¬ fession is deemed of vital importance ; the medical man seems to be the very hinge on which each case turns, the arbiter by whose decision the matter (frequently matter of life and death) is determined. Look, again, to that more ordinary and familiar court, the Coroner’s — the impor¬ tant originator of further proceedings — where almost the entire business (with the exception, indeed, only of treasure trove, and wreck cases) consists of matter of medico-legal investigation. In few and rare instances can a Coroner’s inquest be properly conducted without medical tes¬ timony; yet — and it is a good illustration of the non-intervention principle of our laws — though there are probably not less than five or six thousand inquests held by coroners annually, throughout the coun¬ try, in almost every one of which medical evidence is indispensably required — it has been left entirely to the discretion of the co¬ roner to procure that evidence ; there is no medical man on whom he is specially au¬ thorized to call ; he must exercise his inge¬ nuity to obtain what hedeemssufficienttes- timonv, and has been frequently reduced to great difficulties in this respect, having had (until the passing of the new Medi¬ cal Witnesses’ Act) no remuneration to INTRODUCTORY LECTURE. 7 offer to the professional man for the trouble of attending. We thus see how, both by the construc¬ tion of our law and the practice of its functionaries, we are all involved largely in the duty of aiding the furtherance of justice. There can be no evasion. The law requires the ai dance of medical skill, that it may be duly administered, and that skill it may require at the hands of any practitioner in the kingdom. The legislature presumes every practitioner competent to act in a medico-legal capa¬ city; nor may any medical man, however conscientious or scrupulous, excuse him¬ self on the ground of his not being a me¬ dical jurist; when summoned, he must only make the best figure he can in ex¬ ercise of the important functions de¬ manded of him, or otherwise plead igno¬ rance, and suffer accordingly in the public estimation. Duties of medical jurists. — It is on most occasions a critical office to discharge well the duties of a medical jurist. Let us take a view of what is usually imposed on the practitioner, when called upon in this capacity. Suppose a case of alleged •poisoning to be investigated, and that there is a party accused of that crime. The referee must in such a case bring to the investigation several requisites of a special sort. He must have a general knowledge of the effects of poi¬ sons : he must be able to distinguish the effects of poison from those of natural disease; he must be familiar with the morbid appearances produced by poison, and in nowise confound them with those resulting from other causes. By com¬ petent chemical skill he must be able to give convincing evidence of the particular deleterious substance wherewith the mis¬ chief has been done ; and finally, he must be prepared to have his opinions and his processes strictly scrutinized, and to give a clear account of them viva voce before a legal tribunal. Or, suppose another common case. The body of a new-born infant is found under suspicious circumstances. It will rest on the evidence of the professional examiner whether or not an indictment for murder shall be preferred against a suspected party. The competent medical jurist will in such a case proceed most cautiously and deliberately : he will examine the body, both externally and internally, with reference to several tests Whereby the fact of live or still birth may be ascertained ; and supposing the former to be made out, he will then endeavour to determine the cause of death. All the apparent lesions will have to be narrowly noticed ; the ap¬ pearances of disease or of wilful injury must be distinctly appreciated; the phe¬ nomena of asphyxia by drowning, strang¬ ling, and so forth, must be carefully dis¬ criminated ; and any suspicious-looking fluids in the stomach or bowels must be chemically analyzed. In most cases of alleged unsoundness of mind,— a subject of so much interest and importance both in our civil and criminal courts of justice, — the medical referee has the arduous task imposed upon him of stating publicly his deliberate opinions respecting the existence or non-existence of such a state of mind as is consistent with responsibility for imputed crime, or competency to the management of pro¬ perty. He must be able to distinguish the merely eccentric individual from the per¬ son of positively unsound mind: he must define, describe, and show himself ac¬ quainted with the peculiarities consti¬ tuting the various kinds of mental aliena¬ tion : and here again I need not add the perils that lie in wrait for the professional witness who is not perfectly prepared for the task, — the misadventures that have oc¬ curred are matter of common notoriety. So again with respect to wounds or other personal injuries, the skill of the medical jurist will often be exercised. The question may be as to the consequence of the alleged injury — whether, in case death has followed, such a result was to be con¬ sidered as inevitable or accidental; and cases of this kind sometimes involve some of the most complicated inquiries. Special education and discipline necessary. — Without a previous and an especial disci¬ pline in the inquiries relative to which he may have to appear in a court of justice, the medical.witness must not be surprised to find himself in an awkward, if not a very dangerous, situation. Even the ablest practitioners, -—men the most distinguish¬ ed in particular departments of medical science, — have been foiled and humiliated when they have ventured unprepared to give medical evidence. The case of John Hunter will serve as an illustration. On the trial of Donellan, in 1781, for poison¬ ing the young baronet, his brother-in-law, the great physiologist wras summoned as a witness, being presumed to be well acquainted with the action of poisons on the animal economy. I shall not trouble you with the examination and cross-examina¬ tion of Mr. Hunter, but the judge’s re¬ marks must not be omitted: — “For the prisoner,” said his Lordship, “you have had one gentleman called, W'ho is likewise of the faculty, and a very able man. I can hardly say what his opinion is, for he does not seem to have formed any opinion at all of the matter. He at first said he could not form an opinion whether the death was or was not occasioned by the poison, because he could conceive that it might be DR. CUMMIN ON FORENSIC MEDICINE. ascribed to other causes. I wished very much to have got a direct answer from Mr. Hunter, if I could, what upon the whole was the result of his attention and application to the subject, and what was his present opinion, but he says he can say nothing decisive.” I am aware that attempts have been made by some of the ardent admirers of John Hunter to defend the evidence he gave on this trial; but there, is reason to believe that this is more than that eminent man himself ever ventured to do. On the contrary, he seems to have ever retained an unpleasant consciousness of the un credita¬ ble iigure he made on the occasion, and to have regretted that he had not previously taken the trouble to make himself better acquainted with the points on which he was examined. The candour, indeed, which he displayed subsequently, ought to go far towards disarming censure, wffiile it conveys to us a lesson not to be lightly prized. He used ever to lament, as wTe are inform¬ ed by Sir Astley Cooper, that he had not made more preparation for this trial : “ he found himself a good deal embarrassed on the occasion ; the lawyers took advantage of his embarrassment, and he used to ex¬ press his regret publicly in his lectures, that he had not given more attention to the subject, before he ventured to give an opinion in a court of justice.” This re¬ gret on the part of Mr. Hunter must have been purely for having so perilously risked his reputation, and at the same time so little served the cause of truth; for if he had given the requisite attention to the subject, he could only have come to the same conclusion as the other witnesses. Let me be permitted to give one other example. If the most distinguished ability as a teacher of anatomy could constitute all that was requisite for a medical jurist, this was to be found in the late Mr. Joshua Brookes. Yet some circumstances which occurred in the spring of the year 1829, put his qualifi¬ cations in this respect to the test. An el¬ derly gentleman, a Mr. Neale, was found dead on the floor of his chamber; and a soldier, who had been with him the even¬ ing before, and who, there was reason to believe, had robbed him, was suspected to have been the cause of his death. The question was, whether the deceased had died a natural death, — as by apoplexy, for instance, — or had been murdered. The body was examined by Mr. Brookes, and an account of the appearances, signed by him and two other medical gentle¬ men, submitted to the coroner and his jury. A more unsatisfactory document cannot well be conceived issuing from men of medical education : it was, how¬ ever, sufficient to lead to a verdict of wilful murder against the soldier. But the transaction had caught the atten¬ tion of the public, and luckily, also, of some well-informed members of our profession. The matter was taken up by the medical societies of the metropolis, and discussed in the journals, promptly and impartially*. Mr. Brookes had time to reconsider the circumstances of the case: he was examined again, a week after, at the Old Bailey, when the evidence he gave was directly the reverse of what he had previously given, and in con¬ sequence the prisoner was acquitted. It was creditable, no doubt, to Mr. Brookes to unsay what he had said before, when he became convinced of bis error : but consider the appearance of all this before the public, — consider the jeopardy in which truth and justice were placed, — and what might not have been the result had there been no opportunity of retracting the original statement ! We see, then, that however the magis¬ trate or the judge may presume medical men in general, and the more eminent among them in particular, competent to the business of forensic medicine, practi¬ tioners themselves may not so safely form the same opinion, unless they be fully con¬ scious of sufficient preparation. Necessity for a distinct course. — But how is that preparation to be effected ? May it be attained in the course of the ordinary education for clinical prac¬ tice ? It is not very possible nor probable that it should. In the departments of practical medicine, surgery, midwifery, chemistry, anatomy, and materia medica, much information may undoubtedly be gathered which shall afterwards serve in the investigation of wounds, pregnancy, poisoning, and other subjects of Forensic medicine ; but the special application of those branches can scarcely be expected to be entered upon by their teachers, who have already quite enough on their hands. Or if one or two of them should find time for such application, the others certainly cannot: while at all events the student is sent about gathering his medico-legal prin¬ ciples. There is no other feasible means save making this department of knowledge a special study, — a study which is to suc¬ ceed to the student’s attendance on the other branches of medical education, making this the complement and the completion of them all. There is even a positive necessity for such a course, because many of the subjects comprehended within the range of Foren¬ sic medicine are not treated of elsewhere. Extent and variety of Forensic medicine. — If we advert to the extent and variety of topics which come within the province of * See Medical Gazette, vol. iii. p. 578. INTRODUCTORY LECTURE. 9 legal medicine, it is impossible not to be struck with the changes which some of these have undergone in course of time, some having become immeasureably low¬ ered in the scale of relative importance, and others absolutely extinct. To give one instance : time was when Demo - noiogy and Witch ruft were prime ob¬ jects of attention to the bar, the bench, and the medical profession, in this coun¬ try. Some of our ablest judges were per¬ suaded that supernatural powers of mis¬ chief were possessed by certain persons in the lower classes of society, and that they were often exercised with malicious inten¬ tions and fatal effect. The character of Sir Matthew Hale is stained by such a weakness: this great man tried prisoners who were arraigned on the charge of witch¬ craft ; and on one occasion fortified his impressions of their guilt by appealing to one of the most learned physicians of the day, Sir Thomas Browne, wdio happened to be in court. It is lamentable to add, that the infatuated opinion then uttered, cost two unfortunate women their lives. In Catholic countries, and where reli¬ gious fanaticism much prevails, questions of alleged miracles often come before the authorities. Hence the consideration of miracles is still entertained by certain foreign medico-legal waiters. In the work of Zaccliia, we find that the first con¬ sultation in which that distinguished ju¬ rist was engaged before the Rota, was to determine whether or not the re¬ moval of epilepsy, in a certain case, was to be attributed as an instance of miracu¬ lous power to a reputed saint, whom it was intended to canonize ? Tortosa, who belongs to the present century, devotes special chapters to miracles, magic, and the possessed ; and Martini, one of the most eminent Italian professors of the present day, does much the same. In his Medicina Forensis, published so late as 1832, he treats of miracles, demoniacs, sorcerers, witches, and the bewitched. On the debt- turn conjugate, also, Martini gravely devotes a chapter to an enumeration of the cir¬ cumstances under which the debtor may be occasionally excused. If froni these and similar inquiries the present advanced state of civilization in this country has wholly delivered us, it may still be doubted w hether, upon that account, the circle of our medico-legal re¬ search is much contracted : the progress of knowledge, keeping pace with social im¬ provement, has given rise to several other subjects of investigation, not less curious, perhaps, wThile they have far more serious claims on our attention. Toxicology may be cited as an example — a department of medical science which can scarcely be said to have originated anterior to the present century: the subtlety of research, how¬ ever, and the accuracy of the conclusions w hich Forensic Medicine can boast of, in connexion with this department, have al¬ ready attained a perfection, which it would have been deemed by the medical jurists of the generation gone by, chimerical, if not preposterous, to hope for. Conciuijon. — I find that I must here con¬ clude, though a number of interesting- points would still deserve to be no¬ ticed. But perhaps all has been said that was absolutely essential for an opening lecture. It was my purpose to give a succinct account of the nature and the im¬ portance of Forensic medicine; and I have done this, or attempted to do it, chiefly by tracing the art from its origin. In the rapid and necessarily superficial sketch presented to you, it may be discerned at how very early a date of human society this application of medical know¬ ledge was found requisite, and from its progress, it may be inferred howr much the widely extending relations of society will in future render its assistance still more and more needed. On the actual prowess — the triumphs — of legal medicine, I have dwrelt but little, partly because the details can be better appreciated as we proceed in the course, and partly because, to say the truth, though there are bright and beautiful tints in the picture, there are also dark spots — deplorable blemishes. I might bring be¬ fore you instances in which medical men, by the conscientious and able discharge of their duty as professional witnesses, have vindicated the purity and honour of per¬ sons unjustly charged with crime, have rescued the innocent from impending ruin, and by detecting guilt in its most secret recesses, have brought the criminal to de¬ served punishment. But it would be to abuse your good faith, were I, at the same time, to withhold examples of quite an opposite description, and to omit to mention in how many instances great opportunities have been lost, positive and irretrievable mischief has been done, by incompetent or reckless medical referees. That upon weighing the good against the bad, the former should be found considera¬ bly to preponderate, is gratifying as it is certain ; but it wrouldbe unjustifiable hence to insinuate that the bad instances are weightless, or only as a feather in the scale. It is but too true, nor can it be too early impressed on those entering upon the study, that the practice of legal medicine involves a heavy responsibility, and that it is attend¬ ed with anxieties and difficulties w'hich do not usually fall to the lot of the ordinary praetitioner. The consolation, however, is, that if the danger be great, the glory is not incommensurate, and that, in the very endeavour to achieve success, we may hope to obtain that most enviable of all prizes — therespect and approbation of our fellow citizens. [ Tabular View , fyc. 10 DR. CUMMIN ON FORENSIC MEDICINE TABULAR VIEW OF THE HISTORY AND LITERATURE of FORENSIC MEDICINE. PERIOD I. In which the Principles existed and were recognized without a distinct order of Practitioners. From the earliest Date to the Sixteenth Century. B. C. (2000) ASSYRIANS and EGYPTIANS. The custom of exposing the sick publicly {Herod, i. 197, and Strabo,) must have led to many observations of a medico-legal kind. In Egypt, the kings themselves practised dissection, in order to discover the cause of death ( Plin . xix. 26.) Pregnant women were respited from punishment. 1722 1604 1451 884 536 430 400 S25 300 330 60 44 A. D. 19 54 75 180 438 450 HEBREWS. The midwife who attended Tamar {Gen. xxxviii. 28) exercised a proper medico-legal discretion. Shiphrah and Puah consulted by the king of Egypt respecting infanticide, as a measure of state policy ( Exod . i. 15.) Moses issues several medico- legal ordinances for investigating questions of homicide, the nature of wounds, violation, virginity, personal disqualifications, &c. : in fact, the chapters in the Pen¬ tateuch, on these subjects, contain the first written rudiments of forensic medicine. GREEKS. Lycurgus ordains that the destruction of infants be regulated by certain persons, appointed to determine the question of weakliness or deformity. Pythagoras ; embryology — climacteric years. Democritus ; signs of defloration — signs of death. Hippocrates, in various parts of his writ¬ ings, touches on medico -legal subjects, parti¬ cularly on seven and eight months’ births, on superfetation, &c. Aristotle, in his Hist. Animal, (vii. 4, &e.) states the doctrine of uncertain length of ges¬ tation in the human female; signs of preg¬ nancy, &c. Theophrastus, on poisons: author of the cele¬ brated work on Characters. B. C. 680 451 (350) ROMANS. Numa ordains that the csesarean opera¬ tion be performed on women who have died pregnant of a living foetus. The lex talionis, one of the laws of the Twelve Tables, implies a certain kind of medical knowledge for its due adminis¬ tration. The jus honorarium gave a discretion¬ ary power ( medico-legal ?) of levying damages in proportion to the injury. Case of extensive poisoning by Roman matrons ; above 150 of them punished. Cicero {pro A. Cluentio, and ad Herenn .) alludes to the signs of poisoning commonly noticed on the dead body. Julius Ceesar assassinated; medico-legal opinion of Antistius, that one wound alone, of the three-and-twenty, was mortal. Germanicus dies, as it is supposed, from poison : the appearances about the body favour the popular supposition.— (Sueton. Calig. 1.) Agrippina, with Locusta’s assistance, procures several deaths by poison. — (Tacit. Ann.) Quintilian mentions the necessary proofs of poisoning {Declam, xv.) Pliny the elder, also, and Seneca, touch on the same subject. Galen — the first who wrote expressly on a medico-legal subject — on Feigned Diseases, and the means of detecting them. He also noticed the change produced in the fetal lungs at birth — the vitality of seven months’ and the mortality of eight months’ births— the signs of poisoning, and some circumstances connected with legitimacy. WESTERN EMPIRE. The Theodosian Code compiled : its en¬ actments remain in force for a time. FRANKS and VISIGOTHS. The Salic and Ripuarian laws (enacted between a.d. 422 and 490) contain several provisions, requiring medico-legal assist¬ ance for putting them in practice : thus, in cases of wounds, homicide, poisoning, and the like, punishment was inflicted, or pecuniary penalties assessed, according to EASTERN EMPIRE. Justinian’s great work, the Corpus Juris Civilis, completed. It contains many laws based on medical principles, some of them expressly “on the authority of Hippocrates.” The lex Aquilia, and lex Cornelia de sica- riis et venejxcis, also the principles laid down respecting retarded births and super- fetation, and more especially the enactment de ventre inspiciendo, et de custodiendo partu, require medical aid for their adminis¬ tration ; in the latter enactment, the presence of midwives is enjoined, if necessary. the amount of crime in the guilty party, which was ascertained in some instances by a sectio vulnerum. at Amalfi in the year 1 137 : upon this event, ; tance throughout Europe, and commentators The Corpus Juris , however, in the course of a few centuries, became obsolete, and had fallen into total oblivion in the West, when a copy of the Digest was accidentally found at once the Civil Law met with universal accep* gan to abound. INTRODUCTORY LECTURE 11 A. D. 790 GERMAN EMPIRE. Charlemagne, improving on the laws of the Franks, enacts his Capitularies, several of which virtually require the intervention of medical assessors. JURISDICTION of THE CHURCH. 1151 1209 The Decretals, or body of Canon Law, reduced to order by Gratian the Monk. They receive successive additions for some centuries. Among them are many enact¬ ments, in which the necessity of medico¬ legal interference is plainly implied. Innocent III. decrees that in a case of homicide by wounds, medical evidence, or, as it is expressed, judicium peritorum medicorum, shall be obtained, for the better administration of justice. A.D. 932 1036 1140 1206 ARABIANS. Rhases (Arrhasi) of Bagdad— the most original of the Arabian writers — treats of medical impostors, and the means of detect¬ ing them ; on poisons also. His chief work, Elchavi, or the Continent. Avicenna (Ebn Sina) ; the most famous of the physicians of the East, accounted ano¬ ther Galen, and celebrated for his sagacity. Avenzoar (Ebn Zohr) of Seville 3 touches on the subject of impotence, &c. Averrhoes (Ebn Itoschd) of Cordova. 1238 1315 1370 1492 1503 1502 1507 GERMANY and ITALY. The Emperor Frederic II. issues some ordinances of a medico-legal characters patronizes the schools of Italy 3 and sanctions the occasional practice of human anatomy. Mondini de Luzzi dissects publicly the bodies of two women at Bologna. This may be considered as the era of the commencement of practical forensic medicine. Mondini publishes a treatise on descriptive anatomy, illustrated with woodcuts. Baldus de Ubaldis, in his Commentary 011 the Pandects, points out the superiority of medical evidence. Medical men, he says, are no common witnesses— proprie-non sunt ttstes, sed estmagis judicium quam testimonium . — ( Digest . ii. Tit. 12.) Santes Ardoyni, and Cardinal PonzeUi, write on poisons : the work of the former is very complete for the time in which it was composed r the morbid appearances produced by poisons are said to be described in it from actual observation. Death of Pope Alexander VI. by poison 5 his son, Caesar Borgia, escapes. The Bishop of Wiirtzburg’s Ordinances. The Bishop of Bamberg’s Criminal Con¬ stitutions. Both these codes were revised, and incorporated in the Const. Crirn. Caro¬ lina, presently to be noticed. A.D. 1374 1418 FRANCE. The University of Montpellier procures leave to dissect human bodies, for instruction in anatomy. Valescus de Tharanta treats of poisons. 1533 1564 1594 1638 1663 1667 1677 1682 1691 1701 PERIOD II. In which Forensic Medicine becomes a distinct Profession, practised in several countries by a special order of Medical Men. From the year 1533 to the present time. GERMANY. The Emperor Charles V. promulgates the great Criminal Code of the Empire— the Constitutio Criminalis Carolina, — certain articles of which expressly enjoin the magistrates to call in medical persons to give their evidence touching questions at issue. Thus, Arts. 35 and 36 relate to con¬ cealed delivery and child-murder, and ordain that the evidence of midwives and physicians shall be procured in such cases ; Art. 147 is on wounds proving mortal, regarding which surgeons and other skilful persons are to decide whether death eusued in consequence of the injury 3 Art. 33 relates to assassination; Art.'Al restricts and regulates the sale of poisons 5 Art. 44 relates to witchcraft; Art. 59 provides a mitigation of the torture in the case of feeble persons 5 Art. 119, on the crime of violation 3 Art. 109, on magic 5 Art. 130, on poisoning, and its punishment; Art. 131, the question of live or still birth, with reference to concealed delivery ; Art. 133, on criminal abortion, making a distinction in the crime, according as the foetus is quick or not 5 Art. 135 relates to suicide, whether effected with design of escaping punishment, or in insanity 5 Art. 134, the responsibility of physicianskilling their patients ; Arts. 149 and 164 authorize medico¬ legal inspection of the dead body before burial, in cases of suspected homicide; and Arts. 179 and 219 point out how the proofs of unsound mind are to be ascertained in questionable cases. The chief parts of this celebrated Code have been adopted by most of the Continental states in reform¬ ing or revising their Statute-books. It now only remains to give a list of the principal persons who have distinguished themselves in connexion with Forensic Medicine. Wier ; witchcraft, hymen, &c. Libavius ; bleeding of the corpse in pre¬ sence of the murderer. Sebiz ; wounds, virginity. Bartholin ; observes the phenomenon of the lungs of the still-born sinking, while other lungs float in water. Swammerdam explains why this is so. Rayger proposes the hydrostatic test. Schreyer actually practises the test for judi¬ cial purposes. Zeller writes against the test; and some of the faculties declare against it, — some, however, for it. Ammann; Praxis vuln. lethal. I 1701 1704 1704 1706 1720 1722 1723 1725 1731 1733 1736 1746 1753 Valentin ; Pandectm medico-legales. Bohn; De officio me did, clin. et foretisis ; on wounds, the test of infanticide, &c. Becker 3 on death by drowning — sine pota aqua. Zittman ; Med. forensis, h. e. responsa , tyc, Schurig ; Spermatologia, Cynacol. S>-c. Teichmeyer; Instit. med. legalis vel for. Goelicke; Medicina forensis. Alberti; Systema jurisy. medicos. Richter 3 Digesta tried, s. decisiones. Troppaneger ; Decisiones med. for. Hoffman ; on poisons, wounds, &e. Eschenbach; Med. legalis brev. thesibus. Hebenstreit 3 Anthropologia forensis. 12 DR. CUMMIN ON FORENSIC MEDICINE. 1756 Boerner ; Instit. med. leg. 1804 1767 Faselius ; Elem. med. forens. 1808 1768 Kunnegiesser , Instit. med. leg. 1810 1775 Daniel (sen.) ; Sarnm. med. gutacht. 1812 1777 Ploucquet; Abhandl. ub.todesarten. Camper; on infanticide. 1813 1778 Baumer ; Med. forens. 1814 1780 Daniel (jun.) ; Comment .; 1784, Bibl. staats. 1816 1781 Plenk ; Elem. med. et. chip, forens. 1817 1782 Haller; Vorlesungen (posthumous.) 1819 1782- -4 Uden and Pyl; Magazin f. d.ger. aw. 1821 1785- -91 Schlegel ; Collectio opusnul. — 1793 Metzger ; Kurzgef. system ger. arzn. 1827 — Coder; An fangsgrunde d. staats . 1828 1795 Fahner ; Voltst’dnd. syst. d. ger. aw. 1831 1796 Muller; Entwurf d. ger. aw. 1833 1802 Schraud ; Elementa med. forens. 1835 " Roose ; Grundriss med. ger. vorlesungen. 1836 Schmidtmu.ler ; Handbuch d. staatsarzn. Knape and Hecker ; Krit-jahrb. d. stauts. Masius ; Lehrbuch d. ger. ak. Henke ; Lehrb. d. ger. med. ; 1816, Abhandl. Wildberg; Handbuch ; 1824, Lehrbuch. Bernt; Systemat. handb. d. ger. ak. Klose ; System, d. ger. physik. Sprengel ; /nstit. med. forens. Platner ; Quoestiones med. forens. Blende ; Ausfuhrliches Handb. d. ger . med. Meckel; Lehrb. d. ger -.med. Henke ; Zeitschrift fur. d. staats . Niemann ; Taschenbuch d. ger. aw. Klug; Auswahl med. ger. gutachten. Wildberg; Magazinf.d.ger.aw. _ Bischoff; Merkwurd . crim-rechts-f alle. Joerg; Faetuslunge in geborn. kinde. Schneider & Schurmayer ; Ann. d. ges. staats. FRANCE. 1582 Ambrose Par£ ; Rapports— impostors — poi- 1801 sons — wounds — suffocation, Ac. The 1805 earliest writer after the C. C. C. 1808 1589 Pigray ; saves fourteen persons who were 1813 condemned as witches. 1813 1598 Pineau ; signs of virginity. 1606 Henry IV. appoints one or two surgeon- 1819 jurists for every town in France. 1821 1611 Tagereau ; impotence. — 1651 Gendry ; Moyens de rapporter. — 1677 Actual congress abolished. 1823 i684 Blegny ; Doctrine des rapports. 1704 Devaux; V Art de faire Its rapports. 1824 1740 Bruhier ; V Incertitude des signes de la mort. 1829 1750 Petit ; retarded births, & c. 1830 1763 Louis ; hanging, drowning, signs of death, Ac. 1833 1789 Chaussier ; Observations chirurg. leg. 1834 1799 Fodere ; les Lois eclair ees. 1835 1801 Belloc ; Cours de mfd. legale. 1836 Mahon ; Mfdecine legale , et Pol. mfd. Vign6; la Medecine legale. [additions.) Marc ; Autopsie cadauerique (Rose, with Foder6 ; Traite de med. if gale. Ballard ; Principes de med. legale (Bletzger, with notes.) x Lecieux, Sec. (Chaussier,) Quatre theses. Biessy ; Manuel de med. legale. Briand ; Manuel de mfd. legale. Capuron ; Med. Ifg. des accouch. Orhla; Legons de med. leg. — Toxicol. &c. Esquirol ; strangulation, insanity, &c. Chaussier; Recueil de memoir es. f Leuret, Marc,&c. {Ann. d'hyg; etdemfd. leg.) Sedillot ; Manuel de med. leg. Velpeau; Embryologie. Trebuchet ; Jurispr. de la mfdecine. Brierre de Boismont; Manuel de med. leg. Devergie ; Med. leg. theoret. et pratique. ITALY 1597 Codronchi ; Methodus testificandi — feigned 1806 Sidoti ; Medicina forense. diseases, wounds, &c. 1811 Bene; Elementa medic. forens. 1602 Fortunato Fedeli; the first systematic writer 1818 Barzelotti ; Medicina legale. — De relationibus medicorum. 1819 Zacintho ; Rejlessioni med.-legale. 1616 Liceti ; on monsters, &c. 1822 Grottanelli ; Ricerche medico-J'orense. 1621 Zacchia; Qucestiones med. leg. : first complete 1832 Martini ; Elementa med. for . is c. edition in 1651 . 1761 Morgagni ; De sedib. et cans, morborum. 1780 Testa ; Della morte opparente. SPAIN. 1789 Caccia ; (Jsservaz. mcdico-legali. 1801 Tortosa ; Instituzioni di med. for. 1795 Vidal ; Cirurgia for. o arte do liacer relac. 1806 Celoni ; Chirurgia forense. 1796 Del Valle ; Cirurgia forense gen. y par tic. GREAT BRITAIN. 1650 Harvey; notices the effects of respiration 1805 on the colour of the lungs. 1815 1664 Charleton ; Disquisit. anatom, physicce ; 1816 death by lightning. 1817 1671 Coventry Act (22 Ch. II. c. 1.) 1821 1702 Mead ; Poisons. 1823 1735 Prosecutions for witchcraft abolished ( 9 1825 Geo. II. c. 5.) 1828 1776 Hunter, J. ; on death by drowning. 1829 1783 .Hunter, W. ; on signs of child-murder. 1830 1788 Farr; Elements med. jurisp. 1793 Baillle; Morbid anatomy. 1800 Johnston; Med. jurisp. on madness. 1831 1803 Ellenborough Act (43 Geo. III. c. 58.) 1832 1803 Percival ; Medical ethics. 1834 A Professorship of Bled. Jurisp. and Police instituted in the Univ. Edinb. 1836 Duncan, &c. ( Edinb . med. and surg. jourti.) Bartley; Treatise for. med. Male ; Epitome jurid. or for. med. Haslam ; Med. jurisp. of insanity. Gordon Smith; Principles forens. med. Paris and Fonblanque ; Med. jurisp. Beck ; Elem. med. jurisp. 1st Engl. edit. Lansdowne Act (9 Geo. IV. c. 31.) Forsyth ; Synopsis med. jurisp. Regulation for attendance of medico-legal lectures adopted by Soc. of Apoth. and Coll. Surg. Edinb. Amos; Lect. med. jurisp . (Med, Gaz.) Ryan; Manual med. jurisp. Chitty ; Treatise med. jurisp. Taylor; Elem. med. jurisp. MR. LLOYD ON THE TREATMENT OF NiEVI MATERNI. 13 OBSERVATIONS ON THB TREATMENT OF VASCULAR NiEVI MATERNI. By E. A. Lloyd, Assistant-Surgeon to St. Bartholomew’s Hospital, Surgeon to Christ’s Hospital, &c. The disease termed vascular naevus maternus is, I believe, as its name would imply, always a congenital affection : at all events, I never met with a mor¬ bid structure of precisely similar cha¬ racter, which had commenced after birth ; not that I know of any reason why such a case should not occur. Such naevi, however, at the time of birth, are almost uniformly of small size, — so small as in some instances nearly to escape detection ; and even at this period they are remarkable for their extreme vascularity ; in fact it is that chiefly which renders them distinguish¬ able. But those which at birth are mere specks, as it were, sometimes become in the course of a few weeks, or even days, of considerable bulk, so as to constitute a formidable disease. They are liable to extend in every direction ; and the larger the size they have acquired, the more are they likely to increase. I have many times seen them projecting as much on the inner as on the outer surface of the cheeks, lips, and eye-lids ; and in more instances than one I have observed the bones of the head and face implicated in the disease. They have also been met with occupying a large portion of a limb, and extending deeply between the muscles. Mr. Langstaff removed (after death) the leg of a child affected with disease of this kind : he afterwards injected it, and, on dissec¬ tion, found large portions of the dis¬ eased structure situated beneath the adipose membrane, and implicating in a greater or less degree the fascia and several of the muscles. A child about three months old, in the hospital, under Mr. Abernethy’s care, died from haemor¬ rhage arising from a large naevus in a state of ulceration, which occupied the front and a considerable portion of one side of the face, and which, at the pe¬ riod of birth, was very little larger than a pin’s head. It is therefore of great consequence to subject such cases to treatment at an early period ; and certainly not a mo¬ ment should be lost as soon as they are observed to be increasing. Moreover, as a surgical operation is generally re¬ quired for the cure of the disease, and as such operations, when performed on very young children, are always at¬ tended with more or less danger, it is important that in every case the opera¬ tion should be as simple arid little pain¬ ful as possible. In effecting the cure it is also desirable that means should be employed by which the least degree of deformity will be produced, and espe¬ cially if the head, face, neck, or arms, be the seat of the disease. To point out means by which these objects may be, in my opinion, most effectually attained, is the purpose of this communication. When any of the ordinary modes of treatment are employed for the removal of naevi of large size, very serious con¬ sequences sometimes ensue. If the dis¬ eased structure be excised, very profuse, and in some cases fatal, haemorrhage takes place. Mr. Lawrence states, in a fiaper published in the thirteenth vo- ume of the Transactions of the Royal Medical and Chirurgical Society, part ii., page 422 — “ The profuse bleeding at- tendent on the removal by the knife of even small naevi, is often alarming, and certainly dangerous, in the young pa¬ tients who are the most frequent sub¬ jects of the operation.” An infant who was born with a large naevus, which was excised by Mr. Wardrop, expired from the profuse bleeding which took place during the operation. Speaking of the destruction of naevi by caustic, Mr. Lawrence observes — “ It would probably be as dangerous as excision, though in a different way, in those of larger size.” A case in which caustic potash had been applied to one of these tumors, situated on the chest, ended fatally, under the observation of Baron Boyer. Wedelius mentions a case in which the naevus turned can¬ cerous on the application of “ aqua fortis*.” But I may add, that modern surgeons will not be deterred from em¬ ploying the remedy by any apprehen¬ sion that such an effect will be pro¬ duced. When naevi are treated by ligature, very alarming symptoms are liable to come on. Of this point, likewise, proof is to be found in Mr. Lawrence’s paper, referred to above. He states, in detail- * Vide Heister’s Surgery, vol. i., p. 344. 14 mr. Lloyd’s observations on the ing the particulars of a case treated in this manner, “ The infant seemed to suffer considerably when the ligatures were tied, the process being attended with considerable stretching and drag¬ ging of the surrounding skin, which was thrown into several large folds. For thirty-six hours the child was rest¬ less, crying almost incessantly, and oc¬ casionally convulsed.” In a case of th e same kind, which I had myself an opportunity of watching, exceedingly severe symptoms followed the operation, and continued for more than two days, so that the poor little sufferer’s life was despaired of. Mr. Langstaff also in¬ formed me, that in a case of large noevus treated by him in the same man¬ ner, such violent constitutional disturb¬ ance was excited, that the child’s life was for some time in the greatest dan¬ ger. I may also add, that the treatment by ligature, severe as it is, will not always, as will be seen by and by, prove successful as a remedy for naevi. The same, too, may be said of their treatment by excision. I have known them recur after having been excised by the most experienced operators. I witnessed a case of the kind in Mr. Abernethy’s practice. The nsevus was situated on the sternum, a situation most favourable for the operation. In fact, such is their nature, that whatever may be the operation performed, I be¬ lieve it will be invariably found, that if the smallest portion of the morbid struc¬ ture be left behind uninjured, it will act as a “ punctum saliens” (if I may use the expression), from which disease, perhaps more formidable than was ex¬ cised at first, will be reproduced. Another objection to all the modes of treatment adverted to above, is the un¬ sightly scar which is in all cases left be¬ hind. And this objection likewise ap¬ plies to the treatment of large ntevi, by vaccination, a plan of treatment free from danger, it is true, but which is also very likely to fail. With a view to obviate, as far as I was able, the inconveniences detailed above, I was induced to employ a mode of treatment, which, to me, was perfectly novel, as applied to ntevi. A few years ago I made a brief state¬ ment of my plan of treatment at one of the meetings of the “ London Medi¬ cal Society,” and it was subsequently noticed, though in a very imperfect manner, in some of the publications of the day. But it has been no where, as far as I have seen, accurately or com¬ pletely described ; and as I have subse¬ quently had repeated opportunities of employing* it, and with g'reat success, I feel it incumbent on me, without any further delay, to place the following succinct account of it before my profes¬ sional brethren. And it is the more necessary that T should do so, because, in a new edition of a surgical work since published, the plan is adverted to as possible to succeed, without (in ignorance no doubt) the slightest refer¬ ence to its author, or even the most dis • taut intimation that it had been ever attempted. The plan to which 1 allude, and to describe which it will be my principal object on this occasion, consists of the injection into the substance of ntevi of a stimulating, and, in some cases, almost an escharotic liquor. The success which occasionally attended the vaccination of such tumors had, I considered, esta¬ blished the principle that they might be cured by exciting in them inflammation, or that condition of a part, be it what it may, that sometimes leads to its absorption. To effect this end, I had tried various means ; but as they were not generally successful, it is not worth while to detail them here. The failures in such instances having arisen, as it appeared to me, from the means em¬ ployed not producing a sufficient degree of inflammation ; and having met with a very large pulsating neevus, so situated that it could not, without the utmost danger, be removed by the knife, by the ligature, or by caustic, I resolved to put to the test the plan adverted to above. I considered it a fair opportunity to adopt this mode of treating it, because in this case the morbid structure, of which by far the greater part was subcutane¬ ous, was soft and sponge-like — indeed so soft, that when pressed between the finger and thumb, the intervening sub¬ stance seemed to shrink away; but in an instant, the pressure being removed, it re- appeared of its former size, and as erectile as ever. The nsevus, which, as I stated, was of very large size, was situated on the left side of the face, ex¬ tending from the angle of the lip, w here it commenced, upwards to the temple, and transversely from the nose almost to the ear: moreover, portions of it occupied the eye-lids, projecting irregu- larly like varicose vessels, from their TREATMENT OF VASCULAR NAS VI MATERN'I, 15 inner surfaces, and its boundary was altogether very irregular. The whole thickness of the check was in some parts made up, as it were, of the nsevus, the dis¬ eased structure beingvisible, and project¬ ing as well on the inner as on the outer surface. It was, however, only at parti¬ cular points that the skin and inner membrane of the cheek participated in the disease, as over the greater portion of the tumor they were unchanged in struc¬ ture. But even where the skin and membrane of the mouth were unchang¬ ed, the purple colour of the subjacent disease was very visible. The nsevus, w hen first observed at the birth of the child, was not larger than the point of a quill. It began to enlarge very shortly after birth ; and at the time it was placed under treatment, it was increas¬ ing rapidly. The treatment of it was peculiarly difficult, in consequence of its great extent, and the irregularity of its boundary. The treatment consisted in injecting into the subcutaneous por¬ tions of the diseased mass a liquid com¬ posed of spt. eetheris nitrici and nitric acid ; and in applying to the more super¬ ficial portions, or to such portions of the skin as w ere in a morbid state, the con¬ centrated nitric acid. The injection did not enter very readily — by no means so readily as might have been expected, therefore much could not be accom¬ plished at once, arid the progress of cure was of necessity slow ; but by persever¬ ing in the same means, one portion after another of the disease was removed, till the g’reater part had entirely disappeared. At this period the child was taken ill with the measles, which unfortunately proved fatal to it. It may be said, therefore, that the case is not com¬ plete ; but it should be borne in mind that to the extent to which the remedy had been applied, it w7as successful, and thus its efficacy was established as far as it could be by a single instance. I had no opportunity of examining after death the parts that had been operated on. One of the next cases that I operated on, was in a patient of Mr. Austin, surgeon, of Red Lion-street, Clerken- well. The child was a few months old. The nsevus was situated on the fore¬ head, prominent, about the size of half a walnut, principally subcutaneous, and was increasing. I injected it five times. The liquid, which was the same as was employed in the former case, passed freely into its substance, and in about seven weeks time the cure was accom¬ plished. The effect of the injection was hardening of the part into which it entered, and as the hardness subsided the disease disappeared. Mr. Austin lately afforded me an opportunity of seeing the child, who is now about nine years old. The case is very satisfac¬ tory, the operation having’ been per¬ formed so long’ ago, and not a vestige of the disease remaining. That which was the cutaneous portion of the naevus is now7 quite white, and looks like a small cicatrix. Another case, which I also injected in the same manner successfully, was brought to me at my own house, by the late Mr. John Wood, wrbo had been house-surgeon to St. Bartholomew’s Hospital. The neevus was situated on the cheek, and it was one of the cases treated in the hospital by means of the needle and ligature, and had been con¬ sidered cured ; but unfortunately it reap¬ peared. By the same treatment, too, I suc¬ ceeded in curing one of the largest sub¬ cutaneous nsevi that I ever saw : it w as of the size of a very large orange, extending from above the angle of the jaw downwards, almost to the clavicle, and deeply into the substance , of the neck ; projecting also from the sur¬ rounding’ surface more than three inches. The mother lately said it w;as larger than the largest orange, and I believe she may be right. The skin covering it was for the most part healthy, except at its most promi¬ nent part, where it put on the usual deep red and vascular appearance of cutaneous nsevi. In texture it so much resembled a sponge, that when grasped in the hand it could be diminished to nearly half its size. The child resided a short distance out of town (Walworth) ; but I got it brought to the hospital on the operating day, when it was ex¬ amined by all the surgeons of the hos¬ pital who were present, and also by many visitors, who all agreed that they knew of no means by which the disease could be successfully treated. The ap¬ plication of caustic was quite out of the question ; and the same may be said of the ligature, and also of excision, as they could not possibly have succeeded, from the great magnitude of the disease and the depth to which it extended. The cure occupied about nine months, and the injection was at first sometimes 16 MR. LLOYD ON THE TREATMENT OF NA2VI MATERNI. thrown in twice a week, but generally only once, and occasionally not oftener than once a fortnight. T^o unpleasant symptom followed at any time. Sal volatile was the liquid generally in¬ jected, and sometimes in an undiluted state. At first the superincumbent skin did not contract so fast as the tumor became absorbed, so that it hung like a pouch partly emptied, pendulous on the side of the neck. The red part, or that portion of the skin which was implicated in the disease, entirely lost its apparent vascularity, became white and shrivelled, without any topical application being made to it, and assumed very much the character of an old cicatrix. The rest of the skin (that covering the great bulk of the tumor) was of natural co¬ lour and texture. I lately saw the child, who is nearly five years old : he was four months old at the time that the treatment was commenced. There is not a vestige of the disease remaining, and the skin is as closely adapted to the subjacent parts as on the opposite side of the neck. A very fine child, on whom I ope¬ rated in the same manner, for a very large naevus on the face, between three and four years ago, was lately brought to me by its mother, to show me how completely the disease had been cured. It was situated on the left side of the face, occupying the greater part of both the eyelids, a considerable portion of the cheek, and the whole of the cor¬ responding side, as well as the front, of the nose. When I first took the case in hand, the child was three months old, and a most disgusting object: it is now a very nice looking child, and it requires very close inspection to discover that the disease had ever existed. I have subsequently treated many other cases of naevi of various sizes, and in various situations, by injection, without the occurrence, in a single in¬ stance, of an untoward symptom, and generally with complete success. I have cured several situated on the head, three on one child, and some very large ones on the trunk and limbs; but as the preceding cases are sufficient to prove the efficacy of the plan, under different and very formidable circumstances, it would be unnecessarily occupying time to give others in detail : I shall therefore pro¬ ceed to describe more particularly the course I pursue in performing the ope¬ ration. I shall also point out, as clearly as I am able, the variations which it is necessary to make in the treatment of different cases, as that which is most applicable to one is not always equally so to others ; and I shall at the same time point out the great advantages which, in certain cases, I consider this plan of treatment pos¬ sesses over every other. I shall, more¬ over, subjoin a few general observations on the nature of nsevi, and on some other modes of treatment which I have found it advisable to employ, under particular circumstances and in particu¬ lar cases. For the injection of nsevi it is neces¬ sary to have a syringe with tubes of different dimensions, capable of being changed at pleasure. This is the case because nsevi are of different sizes : into those of larger size the injection enters more readily if projected in a larger stream ; in those whose size is smaller, it answers better for the stream to be in proportion small. The point of the tube should be introduced through an aperture in the skin, at some little dis¬ tance from the disease, as there is then greater facility in compressing the nse- vus, so as to prevent haemorrhage. It is easy to prevent a single drop of blood being lost; and after the injection has properly taken effect, it rarely happens that there remains any disposition to haemorrhage. Before injecting it the naevus should be compressed, so as to empty it of its blood, and the pressure should be kept up till the instant that the fluid is projected by the syringe. The fluid should be retained in the naevus for from five to ten minutes. This, of course, is easily effected by making pressure along the track w hich had been occupied by the tube of the syringe. It is not always equally easy to in¬ ject naevi, as they differ materially in their texture : some of them which are of a spongy structure, and of a mode¬ rate size, can be injected with facility and at once ; but this is seldom the case with larger ones. There are naevi so solid in their substance, that, whether they be large or small, it is exceedingdy difficult to inject them at all. Before it can be accomplished, it is requisite to puncture them in various directions ; but it should be done from a single point, so that the punctures shall pro¬ ceed like radii towards one-half of the MR. LLOYD ON TIIE TREATMENT OF NiEVI MATERNI. 17 circumference of a circle. It is likewise sometimes extremely difficult to excite in them the necessary degree of inflam¬ mation, — so difficult, that the operation is often obliged to be repeated several times, and this notwithstanding a very stimulating fluid has been employed. Moreover, a naevus may be too large, as in the cases I have adduced, to be treated all at once in the manner de¬ scribed above. If so, it must be divided into different sections, one, two, three, or more ; and each section must be made the subject of a separate operation. But to inject the whole of even the more spongy nsevi, if of moderate size, it is sometimes necessary to introduce the syringe at various points. When a naevus has been large, I have thrown the injection into three different parts on the same day ; but, generally, I only make one attempt on the first occasion. By operating on only one part at first, I ascertain with less chance of inconve¬ nience whether the liquor employed is too strong or too weak, and thus ob¬ tain information which enables me to proceed with more certainty in the sub¬ sequent steps of the operation. Until a person has practised the ope¬ ration a few times, it will be better that during the act of injection pressure should be made around the naevus, as otherwise the liquid will be liable to be forced into the contiguous cellular tis- sue, m which it would be pretty sure to excite inflammation, and consequent suppuration. For the purpose of mak¬ ing the pressure, the rim of the cover of a pasteboard or wooden pill-box, an¬ swers very well. The covers, as is well known, can be procured of almost any size ; and a notch can be easily cut in them for the admission of the point of the syringe. When a naevus is well injected it feels tense, and loses much of its spongy character; its colour likewise becomes changed, varying in some degree ac¬ cording’ to the nature of the fluid em¬ ployed. The change of colour is not always very considerable, as but little of the injection usually passes into the cutaneous portion of a naevus, although the subcutaneous part of it shall be readily and fully injected. The injec¬ tion is known to have taken effect by the tumor becoming incompressible, which in some cases it does in an hour or two, but in others a day or two will 4G1. — xix, sometimes previously elapse : after which it is rare for the disease to in¬ crease; but its subsequent absorption is sometimes very slow. I am not prepared at present to re¬ commend the exclusive employment of any one liquid as an injection for naevi. The spirit of nitric tether, with the ad¬ dition of a small proportion of strong nitric acid, I have used oftener than any mther ; about one part of the lat¬ ter to from ten to fifteen of the former. The spirit, ammonite aromaticus has been most efficient in some cases in which other liquids had failed. I have also employed successfully solutions of chloride of lime, of sulphate and acetate of zinc, of muriate of ammonia, of hy- driodate of potash, &c, 1 have never used wine for the purpose; but Mr. Stanley employed it in a naevus seated on the lip, and, as he informed me, with success. The.chief advantages of the plan of treatment which I have been recom¬ mending are, that it is applicable to neevi so large, and so situated, as to be wholly irremediable by any other means ; that it occasions no deformity (a point of some importance when the part affected is the head, face, neck, or arm of a female), the small mark re¬ maining where the syringe enters being at a subsequent period scarcely discerni¬ ble ; that it produces very little pain, much less than any of the other modes most relied on; and that there is no constitutional disturbance of any conse¬ quence resulting from it. I have stated, that from the effect which sometimes followed the vaccinat¬ ing of these tumors, I was led to adopt the practice of injecting them ; but I should also state, that having previ¬ ously investigated most attentively their nature and habits, if I may use the term, I had arrived at the conclusion that they were only to be cured by means which would effect the complete removal or annihilation of the morbid structure: and 1 may add, that, to be competent to determine what plan of treatment is most applicable to nsevi, it is indispensable to be acquainted, as far as possible, not only with their structure, to investigate which so much pains has been taken, but also more par¬ ticularly with the nature of the con¬ nexion that subsists between them and the surrounding parts. From in- C 18 MR. LLOYD ON THE TREATMENT OF NJ5VI MATERNI. attention in this respect, the most erroneous opinions have been enter¬ tained. Some surgeons still suppose (of which I have lately had evidence) that noevi consist of an enlarged artery, or vein ; and in accordance with this opinion is their practice : they endea¬ vour to compress the enlarged vessel, so as to prevent the transit of the blood through it, expecting by that means to remove the disease. For this purpose a ligature has been some¬ times put on what has been supposed to be the principal vessel supplying the morbid part; and 1 was shown, not long ag’o, an instrument which had been ingeniously enough constructed to effect the same end. I believe, however, it w ill be found, that, both in their pathology and treat¬ ment, such practitioners are g'reatly mistaken: indeed, I do not hesitate to say, that, as regards the more common forms of naevi materni, they certainly are in error. Their mistake, no doubt, arises from the success which has been known to attend a similar mode of prac¬ tice in true cases of “ aneurism by anastomosis a disease comparatively very rare. In the nsevi under consideration, there is a morbid structure to be got rid of ; a structure not dependent, for its nou¬ rishment and vitality, upon a single vessel, but capable at all times of de¬ riving sufficient blood for its subsis¬ tence, and also for its growth, from any of the vessels of the parts with which it is in immediate connexion. In Mr. Langstaff’s case, to which I have ad¬ verted, “ the naevus was principally supplied with blood from the muscular branches given off by the anterior tibial artery, which were greatly enlarged, and extremely numerous; it was also assisted by the external articular and the arteries given off by the popliteal, previous to its division into the three arteries of the leg.” I knew a case in which the diseased structure was nearly separated by incision from the sur¬ rounding’ parts, and a ligature applied to every vessel that bled, but without the least permanent change in the con¬ dition of the disease. Another case, too, w as treated on the same principle w'ith caustic; a deep slough having been formed all round the naevus, which w'as of very large size, so as almost completely to separate it from the body, and yet no good resulted ; for after the slough came awray, the parts re-united, and the disease remained as vascular and disposed to increase as ever. It follows, therefore, that it is no more reasonable to expect a naevus will be got rid of by merely obstructing the circula¬ tion through the principal vessel that supplies it, than w ould a fatty or any other tumor. To afford even a chance of success to any operation of the kind, the flow of blood to the contiguous parts must likewise be cut off, or at all events very much diminished. In fact, the only means that can be depended on, for the effectual removal of the morbid structure, are such as at once destroy its vitality, or such as, operating more gra¬ dually, occasion its absorption : and of all the means that have been recom¬ mended to effect its annihilation by the latter process, injection is, I believe, the most to be depended on. By that means a greater or lesser degree of in¬ flammation may be excited in it, the effect of which is to change its texture, converting what was a spongy into a solid substance. In this state its vascu¬ larity certainly becomes diminished ; but as its vitality remains, the cause of its subsequent absorption is not quite apparent. If, however, I might ven¬ ture an opinion, I would say that it is thus brought very much into the condi¬ tion of a foreig’n body, so that it be¬ comes an irritant to the surrounding parts, and, perhaps, in some deg’ree, to the general system ; the absorbents, con¬ sequently, are roused into action, by which, in a longer or shorter time, its removal is accomplished. Although my advocacy of injection is so decided, yet I wish to guard against its being supposed that I altogether re¬ pudiate all the other plans of treatment which have been recommended with the same object in view. I am well aw^are that there are many other means besides injection, by wdiich that change in the condition of the part conducive to absorption may sometimes be very satisfactorily brought about. The principal of them are the combined use of pressure and cold ; the insertion of the vaccine virus at different points of the skin covering’ the naevus: one or more setons made to pass directly through the morbid structure itself; and the repeated application of tarta- rized antimony, as well as of various MR. LLOYD ON THE TREATMENT OF NiEVI MATERNI. 19 other stimulating* substances, to the whole surface of the morbid growth. Acupuncturation has moreover been recommended by Dr. M. Hall, and also by Professor Lallemand, of Montpelier. 1 have several times attempted to cure the disease by this mode, but have never succeeded. For my own part, I must say 1 should have been surprised if there had been a different result ; be¬ cause I have seen noevi not only punc¬ tured in the manner recommended, but also a most stimulating fluid injected into the punctures, and yet a sufficient degree of inflammation not produced. This has been particularly the case in noevi of more solid texture. As, how¬ ever, the treatment has, in the able hands alluded to above, proved successful in a few cases, it may be considered right to give it a further trial : and the same may be said of all the measures just ad¬ verted to. There is likewise another plan, em¬ ployed, 1 believe, first by myself, by which I have succeeded in curing the disease; and as it operates principally by exciting the absorbents into action, 1 shall avail myself of this opportunity to describe it. In this plan, the advan¬ tages attending the use of pressure and of the seton are combined. By the means made use of, partial strangula¬ tion of the part is effected. Ligatures are passed through the substance of the tumor, by means of which, and pieces of bougie applied on each side, as in the quilled suture, the circulation of the part is placed under complete con¬ trol. In this manner, therefore, perfect strangulation of the part might be pro¬ duced, and its consequent death; but the object is to employ only such com¬ pression as will excite that degree of in¬ flammation in it which is required to oc¬ casion its absorption. The pressure can be increased or diminished with the greatest facility, according to circum¬ stances ; and even after having been remitted, or rather intermitted, for a few days, it can be again applied, if care be taken not prematurely to withdraw the ligatures. If no more pressure be employed than is really requisite, there will be very little pain occasioned by it ; but, on the contrary, if too much force be employed, suppuration will be pro¬ duced, and consequently there will be attendant a greater or less degree of pain and constitutional disturbance. I had recourse to this plan of treat¬ ment in a large neevus on the head of a child between three and four months old. The tumor projected full half an inch from the surface, and in its trans¬ verse diameter it measured nearly two inches. In twenty-four hours time the operation was followed by such inflam¬ mation and swelling, that it was neces¬ sary to loosen the ligatures. A slight degree of fever ensued ; a small collec¬ tion of pus also formed, which was dis¬ charged through a small opening in the centre of the tumor. After this every thing went on well, and the disease gradually disappeared. It w'as not ne¬ cessary to repeat the operation. I have not yet had sufficient experience on the subject to justify me in giving a decided opinion on it; but from what I have seen I am inclined to believe that it is a plan of treatment which will be found very efficient in a large proportion of the subcutaneous vascular noevi. I should consider it especially applicable to such as may be situated on the cheeks or lips, as well as to those cases in which the disease projects decidedly beyond the surrounding natural surface — to those cases, in fact, in which exci¬ sion, caustic, and the ligature, have been recommended as means by which the entire neevus and the superincum¬ bent skin should be completely de¬ stroyed. A great advantage of this plan of treatment is, that it cures the disease like injection, without occasioning any deformity : the large scar which remains after m,ost of the other modes of treat¬ ment being almost as great a blemish as the disease itself. It will also, I sus¬ pect, be found a much more efficacious mode of treatment than the seton, as usually employed. But in cutaneous nsevi — that is, in those which are seated principally in the skin, as well as in smaller ones of subcutaneous growth, the treatment by caustic is in many cases especially applicable. In the former I prefer the concentrated nitric acid as the remedy ; in the latter the potassa fusa. And if, in the use of these means, proper care and caution be observed, they will, I believe, never fail. Moreover, they would be applicable to the greater number of cases that occur, if employed at a sufficiently early pe¬ riod, inasmuch as, as has been stated before, a very large majority of noevi 20 FUNCTIONS OF THE MUSCLES AND NERVES OF THE EYE-BALL. are, at the time of birth, very small. I have, however, from the want of proper care and caution in the use of these means, seen much mischief ensue. I have observed the skin destroyed far beyond what was the intention of the operator; so that, after the cure of the disease, a cicatrix remained, so large as to constitute of itself a degree of de¬ formity greater almost than the original disease. It is hardly possible to keep an infant quiet while any thing is done to it which occasions pain. I therefore, be¬ fore making use of either the potash or acid, always apply a thick coat of seal¬ ing wax varnish to the parts surround¬ ing the ncevus. By this simple con¬ trivance I am able to confine the action of the caustic to the necessity of the case, and at the same time to operate with greater freedom. To some sur¬ geons who are not much in the habit of using the stronger caustics, it may ap¬ pear that I am recommending' an unne¬ cessary precaution ; but I feel pretty confident that if they make trials with and without it, they will readily admit the advantage of my plan. A singie application of the potash is sometimes sufficient, especially if it be used in the form of paste, as recommended by Mr. Abernethy for the making of issues; but it is g’enerally necessary to repeat the acid several times. I have found that it is generally better to prevent suppuration, if possible, in which case the destroyed part will be thrown off as a scab, and the consequent scar will be less. This can in most cases be accom¬ plished by keeping- the part exposed, and occasionally wetting it w ith a spi¬ rituous lotion, containing also mucilage of acacia and oxide of zinc. I have cured between tw-o and three dozen nsevi by these means ; but it would be unnecessarily occupying* the time of the reader to detail any of them, as it would be little more than repeating the description of the plan which I have been just giving. The caustic potash has been so strongly recommended by Mr. Wardrop, and the nitric acid has been so long em¬ ployed by different practitioners, that I claim no merit for adding- my testimony in their favour. My only object in no¬ ticing them has been to suggest a more judicious and a safer mode of using’ them, and to recommend their employ¬ ment at the first moment after birth that a nsevus is observed to be increasing'. I should have stated, that the cuta¬ neous portion of a rnevus will some¬ times, though rarely, remain after its subcutaneous parts have entirely disap¬ peared. In that case I apply to it con¬ centrated nitric acid, or the caustic potash, by which means every vestige of the disease is readily and easily re¬ moved : indeed, I believe whenever the cutaneous portion is large, this would be the better practice, as the skin which is the seat of a neevus not being of its natural texture, will never, of course, have quite its natural appearance : it will appear thinner than healthy skin, shrivelled, and more loosely attached. The scar left, too, after the healing of the wound occasioned by the caustic, if properly employed, is never so large as the original mark. Sept. 24, 1836. ON THE FUNCTIONS OF THE MUSCLES AND NERVES OF THE EYE BALL. To the Editor of the Medical Gazette. Sir, In the Medical Gazette of Septem¬ ber 24th, will be found a communication from my colleague, Mr. Walker, of Manchester, on the Functions of the Muscles and Nerves of the Eye-Ball ; in reference to which I have considered it my duty to trouble you with the fol¬ lowing remarks. A paper by Mr. Walker, containing similar views to those published in the Gazette, wras read at the last meeting of the British Association, held at Bristol. After Air. Walker had sent this paper to Bristol, he read a copy of it to me ; when I was much surprised to find that the explana¬ tion given by him of the functions of the muscles and nerves of the eye-ball vyas, with one exception — viz. the ac¬ tion of the superior oblique muscle — similar to my views on this subject, communicated to Mr. Walker some years since, contained in my Introduc¬ tory Lecture for 1834 (which Air. Walker had an opportunity of deli¬ berately perusing), and further ex¬ plained in a paper read by me to the Manchester Medical Society, Novem- ANALYSES AND NOTICES OF BOOKS. 21 ber 4 th, 18)5. To this may be added, that I had previously informed Mr. Walker that my views on this subject were sent for insertion in the last volume of the Transactions of the Provincial Medical and Surgical Association, but that, in consequence of being’ too late, the paper would not appear until the publication of the next volume. Whe¬ ther Mr. Walker has made sufficient acknowledgment in his paper, of the use he has made of the discoveries of another, can only be decided when an opportunity is afforded of comparing the papers ; but when the foregoing circumstances are considered, would it not have been more courteous in him to have reserved his observations until after the publication of his colleague’s remarks on the same subject? I am, sir, Yours respectful Ivy R. T. Hunt. Manchester, Sept. 20, 1836. ANALYSES and NOTICESof BOOKS. “ L’ Auteur se tue a allonger ce que le lecteur se tue a abreger.” — D’Alembert. De la Prostitution de la Ville de Paris , consideree sous le Rapport de VHy- (jiene publique , de la Morale , et de V Administration. Par A. J. B. Pa¬ rent- Duchatelet, Membre du Con- seil de Salubrite, Medecin de l’Ho- pital de la Pitie, &c. Deux Tomes. Bailliere. This is one of the most remarkable books we have met with of late. It abounds with information of a singular kind, interesting at once to the physio¬ logist, the moralist, and the medical statistician. The labour which it cost the author must have been immense: he was engaged upon it for several years, and after all, unfortunately, did not sur¬ vive to see it laid before the public. Parent- Duch atelet died in March last, at the comparatively early age of 45, exhausted by the toils of incessant re¬ search. As we intend to bring this work on more than one occasion before the reader, we shall limit ourselves for the present to a brief notice of its contents. The chapters of the first volume com¬ mence with generalities respecting the number of prostitutes in Paris, the parts of France from which they gene¬ rally come, the families they usually spring from, and the causes lead¬ ing to their ruin. The characteristic manners and habits of these unhappy females are then treated of : after which we have a sketch of their chief pecu- liarilies„ taken in a physiological point of view. The several arrangements of medical police and hygiene adopted with regard to the prostituees in Paris, are noticed at much length ; and we are next presented with such a picture of the mode in which the various maisons in that regularly- profligate capital are managed, as we might ex¬ pect from the author had he been assist¬ ed in his explorations by another Diable boiteux. An ample account is given in the second volume of the sanitory regula¬ tions observed with respect to (he JiUes publiques ; the hospitals for the treat¬ ment of syphilis are described ; and the houses of correction, with the several methods of punishment followed in each, are afterwards noticed. Certain details of a curious nature, but most important in relation to state-measures and admi¬ nistrative policy, form the conclusion of the work. The whole is said to be founded on documents the most authentic, procured, in fact, in the government offices of France; and no pains seem to have been spared by the author to supply, by actual observation and personal inquiry, all the knowledge which in that way could be obtained for the completion of his extraordinary undertaking. A very striking peculiarity of the work is the propriety and decency with which every question is discussed: we believe that notwithstanding- the deli- cate nature of very many of the subjects touched on, there is not the least impu¬ rity in the author’s mode of handling them ; his language, though free and unfettered, contains no expression cal¬ culated to give offence to modesty or good taste. Among the points noticed in the phy¬ siological portion of the work are, the embonpoint of most of the prostituees , the peculiar voice which many of them have, their infecundity, their stature, the prevailing colour of their 22 FACTS VERSUS FALLACIES. eyes and hair, &c. It might at first seem that it were impossible to avoid fanciful speculation in treating- of such matters, but, on turning- to the chapters referred to, we find that all rests on ob¬ servation and the official returns. MEDICAL GAZETTE. Saturday , October 1, 1836. ** Licet omnibus, licet etiam mihi, dignitatem Artis Mediate tueri ; potestas modo veniendi in publicum sit, dicendi periculum non recuso.” Cicbro. FACTS versus FALLACIES: BE TNG A FEW HINTS TO STUDENTS ON THE OPENING OF THE SESSION. Of all the qualities which the stu¬ dent needs to possess, who visits the metropolis with a view of pursuing- his professional education, there is none that he will find more requisite, even at the very first step, than caution. He should know that there are those abroad who lie in wait for his credulity, and that he must be particularly on his g-uard against volunteer g-uides. We feel obliged to give this hint, in limine , on observing the recent conduct of our dishonest contemporary — the Lancet. With this brief admonition to our young friends — to be cautious under whose guidance they place themselves — we dispense with giving further advice: in the remarks which follow, we appeal to their reason and understanding. There are two signs by which the dishonest proceedings of the party in question may be discovered and un¬ masked — first, the gross partiality with which he cries up a certain set of teachers ; and secondly, the falsehoods and lying statements with which he en¬ deavours to carry on his work of decep¬ tion. As to the first, it is so gross, that none but the most simple and inexpe¬ rienced can be deceived. The trick is perfectly well understood about town, and is only adapted to catch the novices who are very fresh and green from the country. To so shameless and brazen a pitch is the system now carried, that all the walls in the neighbourhood of London might as well be chalked with the emphatic puffing of — • Try Wakley’s Matchless. But the honour¬ able member for Finsbury has always some such respectable scheme on his hands, and is now only doing that for the Gower-street speculation which he lately used to do for that bantling of his in Lancaster Place. His Colle¬ gium Wakleyanum has been wholly exploded, or abandoned of late, to make way for his new favourites of “ Uni¬ versity College.’’ All this is so palpable and notorious, as not to require dwelling upon. But the systematic attempt of the Lancet to mis¬ lead the young men who arrive in Lon¬ don about this season, and to injure all the other medical schools of the metro¬ polis, to the teachers in which he is personally hostile, is so replete with falsehoods and wilful misrepresentation, as to require a special exposure. The last number of the journal just named contains what the Editor is pleased to call a “ resume of admonitory com¬ ments in referring to which he says — “ Neither there nor in this place, how¬ ever, shall we attempt to institute any comparison into the respective merits of the various establishments or teachers. The invidious nature of such an under¬ taking — the task which such an inves¬ tigation must impose — would require nerves of iron for its execution, with strict impartiality ; and, at last, great injustice might be done,” — et cetera , et cetera , et cetera. After this declaration of the under¬ taking being “invidious,” and of there being a risk of doing “ great injustice,” we felt confident that the “ comparison” FACTS VERSUS FALLACIES. 23 was to be made, and some mystification attempted : nor were we deceived ; for at page 19 the mask is thrown aside, and as pretty a specimen presented to ns of adulation of one party, and mis¬ representation of others, as any one could desire to see. The object is to represent the school of University College, Gower Street, as by far the cheapest in London ; and the mode of effecting this, is by taking the North London Hospital, and set¬ ting it in the foreground of the school to which it belongs. Now^ if all that a pupil bad to do in London were to at¬ tend an hospital, this would be very fair ; but as it happens that he has cer¬ tain lectures to attend also, it is quite clear that the only honest and rational method of calculating the comparative expenses of different schools, is to take the amount of fees for the lectures and hospital attendance together. If this be done, the account will stand very differently from that into a belief of which our dishonest contemporary en¬ deavours to betray the pupils. At once the simplest and most gene¬ rally applicable comparison between the different schools is, to ascertain for what sum at each the pupil may attend, during an unlimited period, all the lec¬ tures required by the College of Sur¬ geons and Society of Apothecaries. The calculation stands thus : — £ 5. Aldersgate School . 46 4 Webb Street . 52 10 Westminster School . 52 10 Middlesex Hospital ........ 53 H St. Thomas’s Hospital . 55 13 St. George’s Hospital . * 56 14 King’s College . 63 0 London Hospital . 63 0 St. Bartholomew’s Hospital • • 65 2 Guy’s Hospital . 66 3 University College . 74 10 [For farther details, see the table which follows the present article.] 1 his requires no comment : as regards lectures, the University College is the most expensive school in the metropolis, whether for the shortest attendance re¬ quired by the corporate bodies, or for an unlimited period ; for the latter, the dif¬ ference between it and some of the best private schools is nearly thirty pounds, while for the former it exceeds that sum. Now let us inquire into the facts con¬ nected with hospital attendance, and here we admit in limine , that a cer¬ tificate of having attended the medical and surgical practice at the “ North London” may be procured on terms— such as we trust will never be the case at any other hospital in the metropolis. Let us explain. When young gentlemen come to London they have enough to do, Hea¬ ven knows; one lecture following after another from morning to night in such rapid succession, as necessarily to leave but a very short space in the forenoon, during which even the most zealous can be in the wards of their hospital. Heretofore no pretence was ever made of attending both the medical and sur¬ gical practice at the same time ; and at the other hospitals the regulation of at¬ tending each separately still prevails. But the conductors of the North London Llospital do, what we cannot venture to designate as it deserves: they give certi¬ ficates of one year’s attendance on both the medical and surgical practice toge¬ ther ! at the expiration of twelve months after the payment of 21/. into the bands of their treasurer. Long may the North London Hospital stand alone in this respect, and may its conductors find consolation in the praises of the Lancet for this adoption of the “ certifi¬ cate system !” Considering the smallness of its size, and the necessarily very limited field of observation it affords, we have no doubt the North London is a very good hospi¬ tal ; but he who says “it stands for¬ ward from the rest in bold and brilliant relief,” knows nothing about the 24 FACTS VERSUS FALLACIES. others of which lie so confidently speaks ; for it so happens that he has been excluded from some, and has not the entree to any ; a circumstance which it is just possible may somewhat prejudice his opinion. By far the most common hospital at¬ tendance now adopted by pupils, is one year of the medical (which frees them for eighteen months), and one of the surgical practice— -this qualifying for their examinations. Assuming* the above as an average, we now return to our comparison of expenses. If the pupil takes his ticket at the North Lon¬ don Hospital, for themedical and surgical practice separately, the sum is 154 15s. each — making 31/. 10s. ; but we shall suppose that he takes out both at once, in such manner as to enable him to at¬ tend during tw'o successive years — and for this he pays 26/. os. The Lancet, for its own purposes, has chosen to institute an especial compa¬ rison between its favoured institution and three others — never mentioned with¬ out some misrepresentation — viz. St. Bar¬ tholomew’s, Guy’s, and St. George’s. We shall take the same, and in the same order. The paragraph is not very in¬ telligible — indeed, is scarcely English; but we shall quote it verbatim, to show the extent of the deception which it is attempted to practise : — “ But suppose we compare the 26/. 5s., charged at the North London Hospital, with the sums charged at the other hos¬ pitals for attendance to pupils who are not dressers. The charge, even then (the attendance, also, on the surgical practice being* limited to twelve months) will be more than 30/. higher at St. Bartholomew’s (for instance) and more than 24/. higher at Guy’s Hospital (as another instance), and more than 51/. higher at St. George’s, (perpetual there to both) than the charge at the North London Hospital.” Now, instead of following this calcu¬ lation, which we submit is nearly unin¬ telligible, we shall compare things w hich are similar, and which w ill afford useful information. We suppose that, as is usually done, the student wishes to attend the medical and surgical practice for the periods required by the College of Surgeons and Society of Apothecaries respectively — viz. eighteen months and one year. At St. Bartholomew' ’s a pupil may attend the medical practice for a year and a half, and the surgical prac¬ tice for ever, for 42/. But this sum, instead of being “ more than 30/.,” is only fifteen guineas above what he would pay at the North London hospital, containing only one-fourth the num¬ ber of beds. At Guy’s, the fee is within one shilling of being the same as at St. Bartholomew’s, wdiile the pupil has the advantage of attending also the surgical practice at St. Thomas’s. Come we now to St. George’s ; and here we particularly solicit the attention of the reader, because, when it is mentioned by our contemporary, a more impudent fabri¬ cation than usual is alw'ays sure to follow. It is intended to convey the idea, not only that St. George’s is enormously dearer than the North London, but that it is even more expensive than St. Bartho¬ lomew's or the Borough hospitals. Now the fact is, that a pupil may attend the surgical practice of St. George’s Hos¬ pital, for a year, for 21/., and the me¬ dical practice, during eighteen months, for 16/. 16s. ; or, if he take the medical ticket first , he may then attend the surgical practice for four guineas less; being, in all, 33/. 12s. But it would cost him 26/. 5s. at the North London hospi¬ tal ; so that the difference for the attend¬ ance required by the College of Surgeons and Society of Apothecaries, is only seven guineas ! ! ! — and setting aside the great disparity in the size of the hospitals, the St. George’s surgical pupil has the privilege included of acting as a dresser for three months. Ag’ain: taking* a general vie w of all the expenses, we find that the sum required FACTS VERSUS FALLACIES. 25 for attending' the lectures, and the hospital practice required by the College of Surgeons and the Society of Apothe¬ caries, at St. Bartholomew’s, amounts to 107/. 2s. ; at Guy’s, to 108/. 4s. ; at St. George’s, to 90/. 6s. ; at University College, to 100/. 15s. So that the whole expense at the magnificent establish¬ ment of Guy’s, and including the prac¬ tice of two great hospitals, exceeds the North London Hospital School, and its hundred beds, by only 71. 9s., and at St. Bartholomew’s, only by 6/. 7s., while at St. George’s Hospital the expense, in¬ stead of being greater, is less, by 10/. 9s. So much for the veracity and fair dealing of our advocate for Gower Street and its hospital. A word more, and we have done. If we turn for a moment from his exertions in favour of that establishment, to the men connected with it, or the man rather, who forms the special subject of his laudation, we must acknowledge at least the gratitude of the worthy editor, however we may wonder at his consistency and discrimi¬ nation. Mr. Liston, the present idol of Wakley’s attachment, is, we believe, the only person of any standing in the profession in London, who is desirous of the good opinion of the honourable member for Finsbury ; he has not been ashamed to be present at, and to take part in, meetings where Wakley has been prominent : hence, naturally, the reciprocal feeling on the part of the latter. The great attraction now at the North London Hospital is Mr. Liston : Mr. Liston is all in all, just as it used to be with Dr. Elliotson, who at present seems to be completely thrown over¬ board. Why is this? Not one little word even of passing courtesy is ex¬ pended on the Doctor, who could once boast the warmest support of the wor¬ thy Finsburian. How are we to account for this phenomenon ? Are we right in attributing it to the mortal hatred that subsists between Dr. Elliotson and the great surgeon of the North ? We doubt not we have hit the mark, as the partici¬ pation of feuds and fancies is one of the signs of firm and steady friendship: the idem velle and idem nolle is here com¬ plete ; and long may it subsist in its beautiful harmony and concord ! A word, however, on the consistency of the thing. Mr. Liston is held up as the model of surgeons — the greatest after Sir Astley Coop t, and so forth. How is this, when we have Mr. Law¬ rence still amongst us in all his pristine vigour and ability, who was once vest¬ ed with the championship by the same discriminating judg*e, nor was stript of it, that we are aware, for any deficiency or inferiority of skill? But Mr. Law¬ rence shook off the patronage of Wak¬ ley, and hence the rival that has been set beside his throne. But Mr. Wardrop, poor man ! what has he done to merit this unceremonious set down from the post of honour? Has he no means of intercepting the favours which are now so thickly bestowed on his brother surgeon ? Or are his inter¬ cepted favours exhausted, and his means of paying due homage to his patron extinct ? Whatever be the cause, it is clear that the once celebrated Mr. Wardrop is no longer a star in the ascendant, and that, though he would want some little support in resuming his difficult task of lecturing again in an obscure quarter, he can no longer reckon on more than a little “Flint praise” from his quondam panegyrist ! Be warned in time, all ye who aspire to the good opinion and the graces of our respectable contemporary. Let the things that have been be a warning to you ; and wait but a little, we advise you, to observe the career of the present protege of the North London Hospital. [Table, fyc. 26 0 AMOUNT OF FEES AT THE METROPOLITAN SCHOOLS. O o CO ' H o o Ol X o CO i-H — i rH l-H rH i-H •pnoj, T CO <M cO» CO to X X X X X H *o *° 40 to X X X X X O a3 • <D 03 • 03 • a> 03 03 03 03 QJ o •33J rn a a a a a a a a a uoiiBinoujBjy o a o a o a o a o a o G O a o a o a o a 01 •UOlltiUltUOU w B 10U 3 ABU 03 03 03 03 03 03 03 03 QJ QJ o P PJ a a a a a fl a r-H Ol|A\ 0SOl[^ 110 o o o o c o o o o O saSuiuao jad a a a a a a a a a a H ^Btioiiippv cn CO X H H H - Hi H H O •oupip 1 -aj\I oisuaaoj L. 3 H CO H H H ** H H H H CC H CO H H H H H H X O •iuujog; ►4^ H X H H H TF X X CO *0 X <o *o X »o X l> tO O o 'AiajtMpiw L. 5 X •o *o X *o X to O •B3ip CO T^l H X *o H X X H X o •31 BU3|BJ\[ L. 4 X h •rr X X H X Tji 03 co CO X X X X cc o 00 X X o •Xajsiuiaqo rH ►4^ X X X X 00 o CC X X o pH rH CO to *o X to *o to X *o to o •iUaS.ins »o X *o *o to X *o t' »o X CO CO X X X X X X l> i- X o •auioipaxvr 3*'° X X X X X X r- X X . ‘O <o X 00 X 00 o o o o •suoij ” 1— 1 r-H — H I-H rH rH rH -Bj^suouiaci pus Auio^Buy 3 2 *o *o X GO X 00 rH rH rH X i-H r-H rH r-H rH f-H Ol Ol Ol rH Cv CO 03 03 O -4-3 1=1 S3 O £ d 03 fed _a is 03 Xi O o 03 m 03 +-> e 3 fed w (h 03 -a < 03 03 (-> -M XI X 03 O O CS • i-H Ch co O a x 03 cn 03 X • r— ' P=H CD *CD C3 £ c X H m e3 • rH X co O a co *03 fed Ih O 03 o co 03 bo 03 o O fed a • r—* a c3 *£< CD c a a o -d a o H ks +-« • rH Oh cn O a CO % 03 a o X CO a CO g3 H-> * rH X CO C a ^CD 6 03 fad *o O CO S-i 03 > a o rd a o bo a 3 c3 S a 03 .10 O 3 a 3.2 P HH> *3 U 03 3 Q<t3 H QJ 2 " CL, 0) 1) — « & r^J ~ Ci H <U <U 5 G > o o « ■h a 2 ~ C c0 O „ •a a <0 3 feiS 0) -* £•2 a o> cd <y OJ %H £ — ' a. ca 0> 6 K Ol •* a) 0) 7; C3 O ^ *5 N S3 * O H a a o o CJ T3 S O o ^ >- aT o -Z ^ a H bn p, co Qj H S3 S3 o w a 3 3 03 H 2| O) o A o CO CO 5 V H ^ OJ *_> o o ^2 <L» CO > X o> o» CD £ H> C <3 6 • o> W ££ O CO o CD G« Sj O h r-< a> A * ON THE PRESENT STATE OF IRISH MEDICAL CHARITIES, 27 REMARKS ON THE PRESENT STATE OF IRISH MEDICAL CHARITIES. To the Editor of the Medical Gazette. Sir, The late Report of Dr. Borrett on the state of the medical charities of Ireland, published in the pages of your valued journal, must be viewed by English prac¬ titioners with surprise and astonishment. The existence of such a state of medical affairs has now been incontrovertibly esta¬ blished, and with a greater degree of weight and confidence than could be at¬ tached to the report of any local practi¬ tioner, the value of which, as prefatory to a more extensive investigation of the sub¬ ject, is too obvious to require my dwelling on. Abuses the most extensive, negli¬ gence the most culpable, have been clearly proved ; and I trust on a more general re¬ view of the subject, to a portion of which it is possible Dr. Borrett’s ambulatory commission did not extend, to demonstrate as clearly, that professional treatment, in¬ ferior to that of the darkest ages, or medico chirurgery in its earliest infancy ever produced, is daily practised at our dispensaries, an epitome of wrhieh I think indispensably necessary to a just appre¬ ciation of, and a more intimate acquaint¬ ance with, the inutility and really injuri¬ ous operation of those charities, although apprehensive, in this age of professional attainment, it might be viewed as the creation of fancy. If an opinion relative to the civilization of Ireland, and its degraded position in the scale of social existence (as advanced in a learned editorial article in a late number of the Medical Gazette), is to be based on the state of her medical charities, the estimate, without any great stretch of pri¬ vilege, must be extended to parties who, as members of an enlightened, a learned profession, support but indifferently enough its character for respectability or learning; for, after a most extensive and intimate survey of the state of our dis¬ pensaries, I am firmly convinced their de¬ based state cannot be attributed to the condition of the applicants, or solely to the careless indifference of the managers, but is to be chiefly imputed to the physi¬ cians and surgeons of those establish¬ ments, who could in a very considerable degree, if not altogether, counteract the negligence and supineness of the moral governors, were they to rouse themselves from that state of apathy and indifference to the comforts and healthful existence of the people committed to their charge, that so suddenly and incorrigibly usurps the place of an ephemeral zeal, w hich scarcely forced them through a hurried and imper¬ fect education. Were they lovers or cul¬ tivators of science, and acquainted with medicine and surgery in their present ad¬ vanced state, they could never hope to combat disease without the aid of those valuable medicines whose character prac¬ tical experience haslong since established, or those active remedies which modern discoveries have placed at our disposal. But slaves to a wretched empiricism, and prepossessed with a fatal but convenient faith in the powers of a single medicine, or twro at most, being sufficient for the radical cure of every disease, they slumber iD unlettered ease, satisfied with, nay, con¬ ceiving more than sufficient, that know¬ ledge hastily acquired during a few win¬ ter seasons of metropolitan residence. This is sufficiently evident from the paucity, the unvariedness, and vile description of the medicines usually found in those hovels, which are so badly calculated to afford relief to the unfortunate applicants; some of whom, being a certain description, of farmers recommended by their landlords, or any other subscriber, are not altogether uneducated, who, to a person familiar or intimately acquainted with their habits, manners, and dispositions, which cannot be acquired without a residence amongst them, appear shrewd, intelligent, and dis¬ criminating, appearing quite as conver¬ sant with ordinary acquirements and newspaper intelligence as their superiors* This description equally applies to the tradespeople, and extends, with some limi¬ tation, even to day-labourers, all of whom occasionally become the subjects of dis¬ pensary relief, are living on terms of most intimate intercourse and familiarity, dis¬ cussing medical affairs when grouped around their firesides as freely as politics, drawing their conclusions after their own peculiar fashion, but, of a truth, seldom erroneously ; canvassing the merits and demerits of the dispensary doctor and his practice with as great a degree of freedom and warmth as those of the Prime Mini¬ ster, and, if w'orthy of such feeling, be¬ stowing on him all that sincere and ar¬ dent affection so characteristic of the Irish¬ man. When illness invades the habitation of one of those people, or the member of a family becomes the subject of accidental and severe injury, recourse is immediately had to his own resources or those of his friends, and a variety of domestic reme¬ dies indigenous to the country, or pro- 28 ON THE PRESENT STATE OF IRISH MEDICAL CHARITIES. cured at a sufficiently low rate from tlie shop of an apothecary in some neighbour¬ ing town — medicines usually had recourse to on the invasion of every disease — are freely administered, as it may suit the wish of the sufferer, or accord with the views of some old crone pretending to su¬ perior and mysterious skill in those mat¬ ters, but, as often happens, without suc¬ cess. Long-continued disease, and conse¬ quent loss of employment, involve the unhappy sufferer, and perhaps a numerous family, in unparalleled and hopeless desti¬ tution. Now the victim of despair, appli¬ cation is made to the local dispensary; but what relief can be afforded from its resources ? None. The patient submits to a repetition of drenching with a farrago of rotten trash, remedies superior to which he has already used, and places reliance on advice equally rotten, musty, and inef¬ fectual-advice emanating from the head of some Esculapius, whose intellect, from a long oblivion of medico- chirurgical mat¬ ters, and a diligent pursuit of other ob¬ jects, has been rendered rusty and thread¬ bare. Professional incapacity, as usual, ends in failure of success; and this so very frequently occurring, begets a distrust and want of confidence on the part of the ap¬ plicants in our dispensaries, which fully accounts for the infrequency of attendance on advertised days, mentioned in Dr. Borrett’s report. Numbers of those fan¬ cied incurables might be daily seen mi¬ grating to the habitations of other distant practitioners, whose more successful prac¬ tice and superior attainments have esta¬ blished for them a respectable reputation, most of those invalids returning restored to health, and rendered useful members, if not to society at large, at least to their own immediate friends. I have known numerous instances where those people walked one hundred miles for relief, and successfully, submitting to ope¬ rations with a heroism instigated alone through a determination to rid themselves of disease at all hazards— diseases not comprehended, and operations wdiich could not be performed, at the district dispen¬ sary. Even while the writer was penning this article, a young man wras brought to him from a distance of thirty miles with fracture of the humerus, extending into the elbow-joint, passing during his jour¬ ney through a country containing six dis¬ pensaries; and W'hen inquiry was insti¬ tuted of his father w-hy he did not seek assistance at one of those institutions, he unhesitatingly declared he considered the injury of too serious a nature to commit to the management of a dispensary doctor. Such are the impressions on the minds of the people, such their faith in the relief and assistance afforded at our medical charities, where they witness disease, ex¬ cept of the most ordinary nature, allowed to commit unrestrained its destructive ra¬ vages ; indeed, with such evidences before them, any other feeling would pourtray an obtuseness of intellect which does not form a feature in our national character. What more successful result could be an¬ ticipated, when the medical attendant, viewing his dispensary appointment as a snug sinecure, an unalienable property, spends his days without restraint, indulg¬ ing in the allurements of the Irish chase; and a prince of good fellow's, devoting his nights to potations of the native, enliven¬ ing the festive board, or delighting the members of a union hunt with the variety and melody of his songs, and shallowmess of his wit; loudly expatiating on the pro¬ perties of the Irish fox hound, depicting the beauties of a previous chase, and de¬ scribing the various incidents of superior jockey ism and hairbreadth escapes during their last run, from the moment reynard first breaks cover, to the death, with a de¬ light and vividness of description, that proves this to be his dearest, his all-absorb¬ ing study. A devotion to such pursuits must alien¬ ate their minds from a close attention to the arduous duties of a profession; and the more usual result is, for those gentle¬ men still holding their dispensary appoint¬ ments, to settle themselves in life as farmers — to be seen from morning to night directing the movements of the plough, or as amateur cattle feeders, horse jobbers, and road makers, to be seen at every coun¬ try fair anxiously learning the prices of swine and black cattle, attending with punctuality every turnpike meeting, and, with an ill timed zeal, aping the ostensi¬ ble public character at the sacrifice of the professional, to the no small amusement of the country gentry, w'ho are unavoida¬ bly driven to the conclusion that his skill and taste lie more in the Macadamizing some public highw'ay than in the practice of medicine. To dw'ell much longer on this subject, would be, 1 fear, to trespass on your indul¬ gence, and the patience of your readers, the field for investigation being a most ex¬ tensive one: wrere I to treat of the manage¬ ment, or rather mismanagement, of every local dispensary, it would afford matter for a report too voluminous, as a single article, for the pages of your very valuable journal. And as the medical management of the Infirmaries of Cork has received a well-merited eulogium in the report of Dr. Borrett, to which the writer can bear ample testimony, the medical officers of those establishments being gentlemen of ON THE PRESENT STATE OF IRISH MEDICAL CHARITIES 29 respectability and acquirements, leaving them and the charities whose destinies they wield, to enjoy the honuors of a well- earned and richly-merited reputation, I shall, for the present, as a melancholy contrast, direct your attention to the abject state of an unfortunate and fallen brother, as a view of its medical operations will elucidate what must be the state of those charities in more retired districts, and ena¬ ble your readers to appreciate the subject with greater clearness and justice. I am now about to bring under review an hos¬ pital (not a county hospital) combining in one establishment a dispensary, fever hos¬ pital, with a wing of the building set apart more especially for surgical cases, altogether well calculated, from its archi¬ tectural arrangements, to meet the object for which it was destined, and, under better auspices, might be rendered a valua¬ ble establishment, spreading its sanative influence over a wide extent of country, and conferring blessings which would prove incalculable; but withering under the deleterious influence of a blind and besotted party spirit, which, ever reckless of evil consequences when goaded by the ungenerous desire of supporting some favoured object, in open violation of the claims, the calls of humanity, in this instance, benumbs the feelings of all parties to the sacred duty imposed on them, of rendering the hospital committed to their trust extensively useful to the suffering applicants, and causes them to rest satisfied that every thing connected with the establishment should savour of indolent inactivity, and to permit those funds committed to their charge— funds more than sufficient to meet every exigency, and for one of the most sacred purposes — to be frittered away without credit to the establishment, or benefit to the public. The financial arrangements of such an hospital are much to be deprecated; but when, to perfect the picture of ruin, pro¬ fessional incapacity must be added, an ac¬ cumulation of evil is heterogeneously amassed, the extensively felt, and destruc¬ tive effects of which, must be apparent to every individual. Here all is empty parade, and within its walls the usual em¬ pirical routine of treatment is adopted, in short, being a soil congenial to the growth of the principle of infallibility: in one or two remedies, every disease incident to human nature is encountered with the same all-powerful drench, quantities of which, from an old crock, are daily ladled out to the various applicants, with bowels already too much relaxed from a diet of potatoes, sour milk, and salt fish, or from a too free use of some domestic purge, previous to application : is it to be won¬ dered that patients indiscriminately sub¬ jected to such a regimen, without any ap¬ preciable benefit, should fly from the dia¬ bolical mixture, as they call it, to seek that relief from the house of some private practitioner, which the believer in one universal remedy was unable to afford? The natural result is a disinclination on the part of the people, except in cases of the most urgent and extreme necessity, to apply for relief, or enter the wrards of such an hospital; and when unavoidably forced to become interns, a want of confidence and distrust on the part of the patients in the medical attendant exists, but little calculated to afford relief to one party, or satisfaction to the other, every circumstance concurring most effectually to frustrate the benevolent intentions of the charity. The medical treatment of this hospital must be too apparent, from the general tenor of this paper. Of its surgical ar¬ rangements I sha.ll give but a brief sketch, in which I have to present the subjects of simple fracture of the middle third of the thigh, as recovering with considerable shortening and a bowed state of the limb, causing a deformity which renders the un- happy sufferer ever aftemards a cripple; fracture of the fibula, recovering with a lameness, and evil consequences resulting from the maltreatment of such an accident ; fracture of the clavicle, treated with a pad placed on the jn’ominent end of the frac¬ tured bone, and the other arrangements quite in keeping with such erroneous view's; dislocation of the lower head of the tibia forward, undetected, or at least no attempt made at reduction, and the injury left to the unaided operations of nature ; disease of the eye, very preva¬ lent amongst the poor, totally neglected and misunderstood, left to run its fearful course unchecked, and to terminate with most melancholy and wretched results; the operations of surgery never performed, and those whose diseases require operation left to pine in suffering or seek assistance as chance might direct, or the reports of some distant and more gifted practitioner might attract them. Such is an epitome of the practice of an hospital in the South-West of Ireland; and blush, oh, ye monopo¬ lizing guardians of Irish surgery, who up¬ hold the principle that all appointments of trust and consideration are to be com¬ mitted to your safe keeping, to the exclu¬ sion of all other surgeons, that such prac¬ tice could emanate from one of your boast¬ ed Licentiates ; and turn with disgust from the page, as I do from the subject, that in this age of professional advance¬ ment such practice could emanate from the veriest tyro. During this posture of affairs, I fear the endeavour to reform the Irish medical charities will prove a Her¬ culean labour, However, as the spirit of 30 THE MEETING AT CAMBERWELL. reform is beginning- to dawn on us, we anxiously look forward to the result of the late investigations as leading- to that reform wrhich is so imperatively called for; some such measure having been long and severely felt as indispensable to the establishing our Irish Dispensaries on a more respect¬ able and useful footing. Hibernus.* Co. Cork, Sept. 19, 1836. ORIGIN OF THE LATE CAMBER¬ WELL MEETING. LETTER FROM MR. CRISP. To the Editor of the Medical Gazette . Sir, For many reasons I feel reluctant to enter into a correspondence with Mr. J. F. Hulbert ; but I am compelled to reply to the misstatements contained in his letter, published in your last number, and I cannot better refute his assertions and insinua¬ tions than by giving a brief account of the origin of the meeting which took place at Camberwell ; and it is as follows : — The Poor-Law Commissioners recom¬ mended the Governors and Guardians of the poor of Camberwell (Peckham and Dulwich are both in this parish) to abo¬ lish the parochial surgeons, and form a medical club in their stead. The said Governors and Guardians (without first consulting the medical men) framed a set of rules, and sent them to all the practi¬ tioners in the parish. In this prospectus it is stated, “ that the poor will have the satisfaction of feeling that they will no longer be supported by charity [a blank space is left for donations and subscrip¬ tions], either in sickness or in health, and they will then become independent. All domestic servants whose wages do not exceed 121. are to be physicked for 4s. per annum. A mechanic receiving 35s. per week, to payjtor himself and wife, 5s. yearly. A single man, earning 25s. per week, 4s. &c. &c. &c. The medical attendant to find medicines. No person whose wages exceed the above shall become a member, except consent in writing be expressly given by the managing Committee.” [This Committee is composed solely of eight clergymen.] A few gentlemen, the greater number of whom, I have since learnt, acted without at all considering the matter, sent in their names as supporters of the scheme (con¬ ditionally, however). The Governors and Guardians next in¬ * We have altered the signature for a reason which our correspondent will understand.— E. G. vited the medical practitioners of the dis¬ trict to meet them at the Poor Plouse (September 7th) ; but the former, thinking that the affair principally concerned them¬ selves, retired into an adjoining room, and, after discussing the subject, it was agreed that the meeting should be ad¬ journed till the following Tuesday, when the medical men residing in the Camber¬ well district and its neighbourhood should be invited ; and a note to this effect was given, by Mr. Bristowe, the chairman, to Mr. Manico, the secretary : but, bv some unaccountable accident, the word neighbour¬ hood was omitted. Before these circulars were sent out, I had been invited ; and as I heard that it was the wish of all present at the late meeting that the practitioners in the neighbourhood should attend, I men¬ tioned the circumstance to a few friends, and also to Mr. Waterworth (who, on a late occasion, took the chair at Mr. Hul- bert’s house), whom I knew to be favour¬ able to the plan, and requested him to make it known to the gentlemen whose opinions coincided with his own. And now, sir, on referring to the list, it will be found that twenty one of the gen¬ tlemen are residing in the Camberwell district ; and I may add that all the dissentients spoke on the occasion alluded to, but only seven of the majority expressed their opinions : it is true that the former said but little, but I presume that they brought forward every argument they could adduce in support of their cause. I have, sir, in conclusion, to complain of Mr. Plulbert’s somewhat invidious mode of writing. I wish he would be personal enough to state names, and I dare assert that the gentlemen who descended to per¬ sonalities are prepared to justify them¬ selves for so doing, and to prove the cor¬ rectness of every statement they made. I am, sir, Yours respectfully, E. Crisp. Walworth, Sept. 27, 1836. ( Prospectus .) CAMBERWELL INDEPENDENT MEDICAL CLUB. STEWARDS. The Rev. John George Storie, Vicar of the parish; Rev. H. Melvill ; Rev. II. W. C. Hyde; Rev. S. Smith; Rev. E. Lilley; Rev. M. Anderson; J. T. Allen, Esq.; I/. B. Allen, Esq.; C. Baldwin, Esq.; Mr. S. Beale; J. Brett, Esq.; T. B. Bur- bidge, Esq.; J. Capes, Esq.; Mr. J. Deacon; C. Dodd, Esq.; R. A. Gray, Esq.; C. Harden, Esq.; R. Hieliens, Esq.; W. Hichens, Esq.; Mr. G. Marshall; A. Nairne, Esq. ; J. Pew, Esq., R. Pope, THE MEETING AT CAMBERWELL 31 Esq.; S. Pope, Esq.; E. Puckle, Esq.; S. Richardson, Esq.; R. Thomas, Esq.; J. Williamson, Esq. Treasurer, . — Honorary Secre¬ tary, ' . — Collector, Mr. T, Prebble, 13, Southampton street. The attention of the working and labour¬ ing classes is called to the formation of a medical club in this parish — the objects of which are, that all the poor families may have medical and surgical attendance and medicine during sickness, without recourse to parochial aid. The poorer classes, who are invited to belong to this club, will have the satisfaction of feeling that they will be no longer supported by charity , either in sickness or health, and will then become independent. It is intended to discontinue the attend¬ ance of the present parochial medical officers, as regards the parish engagement, and no medical relief after 25th March next will be afforded out of the workhouse ; it is therefore deemed advisable to form the club immediately, that it may come into full operation at Lady-day next. The principle upon which the club is founded, is, that all the labourers should belong to it, and each will have annually to subscribe accord¬ ing to family, as under mentioned— the payments to be made half-yearly. The following medical gentlemen have consented to attend the members and their families when ill, viz. : — - * * *. The inhabitants generally are reminded that the formation of this club will save the parish several hundred pounds per annum, besides having the effect of restor¬ ing to the English peasantry a feeling of independence, and creating a proper dread and di like, as well of a parish workhouse, as parochial relief. RULES OF THE CLUB. I. The members shall consist of la¬ bourers and servants in agriculture, or in handicrafts and trades, both male and female, strictly belonging to the working classes. But no domestic servant receiv¬ ing more than twelve pounds annual wages, nor any artizan, handicraftsman, or other workman, receiving more than one pound five shillings per week wages, or whose earnings, together with those of his chil¬ dren under sixteen years of age, exceed thiny-five shillings per week, shall be per¬ mitted to be a member of this club, except consent in writing shall be expressly given by the stewards. II. Each member, on admission, shall pay six months’ subscription in advance, and shall then be entitled to the benefit of the club ; and the same amount shall be paid half-yearly in advance, at Lady-day and Michaelmas; and the accounts of the club shall be annually balanced at Christ¬ mas. III. Members may be admitted at any time, on paying the full subscription for the current six months in advance: the next payment becoming due at the ensuing Lady- day or Michaelmas, as the case may be. IV. Every individual without a child, shall pay annually, 4s. ; eveiy widow or widower with one child, 5s. ; every man and wife, 5s.; every man and wife with one child, 6s.; every man and wife with three children, 8s.; every man and wife with four children, 9s.; every man and wife with five children, 10s.; and be en¬ titled to receive all requisite advice and medicine from such one of the medical attendants as the member may select. V. The children of members above sixr teen years of age (unless they be idiots or helpless cripples) shall not be included in the subscription of the family, but must pay for themselves as independent members. VT. The wife of a member may be at¬ tended during her confinement, on paying to the Collector of the Club ten shillings one month before the time at which she expects to be confined ; and may select her own medical attendant from the gen¬ tlemen before named. VII. A man and his wife may be per¬ mitted to subscribe for themselves alone, but not for their children alone, nor for any child separately ; if they subscribe for any one child under sixteen years of age, they shall subscribe for all their children under sixteen who may reside under their roof, according to Rule IV. VIII. Any member may be permitted to subscribe for bis aged and infirm parent or parents (if unable to support themselves, and residing with their son’s or daughter’s family) on the terms prescribed for a man and his wife and children under sixteen; that is, counting the parents as children. IX. No candidate who is actually ill, or any one of whose family is ill at the time of his or her application, shall be admitted a member, unless he or she pro¬ cure two healthy persons to enter at the same time, each paying the current half year’s subscription in advance; or unless he or she pay such admission fee as the medical attendant shall deem an adequate consideration for the attendance and me¬ dicine which such candidate, or any part of his or her family, may require in his, her, or their then illness. After admission on such terms, the annual payments shall be the same as those required for other members of the Club. X. Each member shall on entrance, and also at the time of paying his subscription, name the medical gentleman by whom he 32 BILLS OF MORTALITY.™ METEOROLOGICAL JOURNAL. wishes to be attended for the ensuing half year, and no member shall be at liberty to change his medical attendant, except at such time. XL Sick members shall furnish their own bottles and bandage's ; and when able shall attend on the medical man, who will visit them at their own houses when they are unable so to attend. XII. Habitual drunkards, and persons notoriously addicted to profligate habits, or who are knowm to be idle and disorder¬ ly, and individuals convicted of felony, shall not be admitted members of the Club, or if admitted, shall not be allowed to continue members. XIII. Every dispute or disagreement wrhich may arise shall be referred for arbi¬ tration to the stewards, and their decision thereon shall be final. XIV. The name, age, and residence of each member, shall, on admission, be entered in a book by the collector, with the name of the medical attendant whom the member may then select, and this re¬ gistration shall be renewed every six months, when the member pays his sub¬ scription. XV. All subscriptions shall be paid to the collector on the days named in Rule II.; and if any member shall fail to pay his or her subscription for the space of one fortnight after cither of such days, he or she shall ceace to be a member; and no mem¬ ber w^hose subscription is in arrear shall be entitled to receive medical aid from the Club. Any person thus disqualified, may, at the discretion of the stewards, be permitted to renewr his subscription, and to become a member, on payment of a fine of one shilling, and conforming to the Rules II. and III. XVI. The subscriptions of members shall be paid over by the collector to the treasurer as they are received, and the stewards will settle with the medical gen¬ tleman wdiom the members have respec¬ tively elected to attend upon them, every six months, by paying the amount of sub¬ scriptions received under Rule IV. WAX MODELS OF SURGICAL ANATOMY. We have seen two very fine models, just imported by Mr. Schloss, of Great Russell Street, which we think are wrell deserving the notice of the profession. One repre¬ sents the male pelvis, viewed laterally, shewing the urinary and genital organs, with the parts affected in inguinal and femoral hernia. The interior of this model displays the pelvic viscera in situ , together with the kidney and ureter, the course of the abdominal aorta, of the common inter¬ nal and external iliac vessels, with the distribution of their branches, the abdomi¬ nal rings, with the spermatic vessels and vasa deferentia. The second model presents a side view of the male pelvis, shewing the reflection of the peritoneum around the viscera. Here, also, we have an excellent represen¬ tation of the descent of a large scrotal hernia, dissected and slit open, so as to display its coverings and contents. Models of this kind must be invaluable to teachers of surgery; w'hile, as specimens of art, they must secure the admiration of all who inspect them. COLLEGE OF SURGEONS. LIST OF GENTLEMEN WHO RECEIVED DIPLOMAS IN SEPTEMBER. John Charles Langmore, Finsbury Square. Thomas W. L. Martyr, London. James Surruge, VVincanton. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Sept. 27, 1836 Age and Debility . 20 Apoplexy . . 3 Asthma . . 10 Cancer . . 1 Consumption . £6 Convulsions . 17 Dentition orTeething 1 Dropsy . . 6 Dropsy on the Brain 9 Fever ... 2 Fever, Scar-let . 2 Heart, diseased . 2 Inflammation . 11 Bo\vels& Stomach 2 Brain . . 2 Lungs and Pleura 2 Insanity . . 1 Jaundice . . 1 Liver, diseased , 4 Measles . . 6 Mortification . 1 Paralysis . . 1 Rheumatism . 1 Smali-pox . . 7 Sore Throat and Quinsey . . 1 Stone & Gravel . 1 Thrush . . 1 Unknown Causes 10 Casualties . . 9 Decrease of Burials, as compared with > r(. the preceding week . . I 00 NOTICES. Mr. May’s letter is an advertisement. “Medicus.” — A letter professing to state facts should always be authenticated. By the way, the letter signed Medicus, to w hich our notice of last week referred, wras dated from the Borough. “A Camberwell Practitioner,” too late for this number. “ T. G.’s” letter also reached us too late. 'I he Aylesbury “ Handbill,” given in a recent number, was stated, by mistake, on our wrapper, to be put forth by one of the surgeons of the Bucks Infirmary. To several correspondents we have apo¬ logies to offer for the temporary postpone¬ ment of their papers. Next week we trust to make amends. Wilson & Son, Printers, 57,Skinner»St. London, THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOTMAL OF fflt'bmnt anti tl)t Collateral &im\it$+ SATURDAY, OCTOBER 8, 1836. LECTURES ON FORENSIC MEDICINE; Delivered at the Aldersgate School of Medicine , By William Cummin, M.D. Lecture II. On Medical Evidence in general — Coroners ’ and other Courts — Mode of Examining' Wit¬ nesses — The Sy ting System — Quoting Autho¬ rities — Question of Privilege — Conduct of Medical Witnesses. Before we enter on the consideration of those special questions which consti¬ tute the main business of Forensic Medi¬ cine, it mav be well to dispose of certain generalities connected with the subject. From what was stated in the last lecture regarding the nature and objects of this study, it will have been gathered that one of the chief ends of medico-legal proceed¬ ings is the giving of evidence in courts of justice: it would seem, therefore, ad¬ visable, in the first place, to take a view of those relations in which the medical practitioner stands, in respect to our legal tribunals. COURTS OF JUSTICE. The courts of justice in which the presence of medical witnesses is most usually required, are those of a criminal jurisdiction — as the coroner’s, and the oyer and terminer sessions, — or those for the redress of civil injuries — such as the com¬ mon law courts, and the ecclesiastical. Of the former, or criminal kind, that which makes by far the most frequent de¬ mand on our services, is the coroner’s court. Coroner’s Court. — The circumstances un¬ der which a medical man may be sum- 4G2. — xix. moned to appear in this court are either general — such as might lead to the attend¬ ance of any other witness, to depose, for instance, to certain matters of fact of which he may happen to be cognizant — or special, as when he is expected to give his professional opinion. This is likely to be understood henceforth better than it has been hitherto. Until recently there was no difference observed betwixt summoning a medical, and any other witness. The pro¬ fessional man, when called upon, came, of course, but he frequently exercised a dis¬ cretion : he answered all ordinary ques¬ tions, and acted in every respect as a com¬ mon witness ; but when asked his opinions, or requested to open a body, or to analyze toxicologieally the contents of the sto¬ mach, he usually declined, till he was assured of a remuneration for his medico¬ legal services. This, however, was what the coroner had it not always in his power to give, and much unseemly squabbling was the consequence — the medical man in¬ sisting on his fee, and the coroner en¬ deavouring to extort the witness’s opinion without one. The case is now altered. A recent enactment (6 and 7 Will. IV. c. 89) secures to medical witnesses a fee of one guineafor simple attendance, and two where a post-mortem inspection, or a chemical analysis, is required. But the medical man must take care that he is specially summoned on these occasions, for an ordi¬ nary subpoena leaves him only in the con¬ dition of an ordinary witness, when he may seek in vain for his fee. The special summons runs in this form : — By virtue of this my order, you are required to appear before me and the jury, on such a day and hour, to give evidence touching the cause of death of * * *, and to make, or assist in making, a post-mortem examina¬ tion of the body, with [or without] an analysis, [as the case may be] and to report thereon at the said inquest. Signed by the coroner. There are some points connected with D 34 DR. CUMMIN ON FORENSIC MEDICINE. the coroner and his court, to which medi¬ cal men in general do not sufficiently at tend. The coroner is an officer of much power and authority. He has an extensive discretion in summoning witnesses, and ample means of enforcing their attendance. He sits as a judge, and if the finding of the jury lead to ulterior proceedings, he binds over the parties who have given evi¬ dence, to be forthcoming, and to repeat their testimony at the next assizes. His court, though it frequently be not a very showy one, the jury consisting in gene¬ ral of persons from the humblest classes of society, is essentially of high im¬ portance. In most cases of felony, such as manslaughter and murder, the initiative is taken in this court, and the person of the party, who by the inquisition is found guilty of the crime, is secured and com¬ mitted for trial. A medical man not duly impressed with these facts, is likely to fall into a serious predicament. He is summoned, we shall suppose hastily, and attends, it may be for the first time, in such a court. He finds the jury a set of very humble individuals, assembled perhaps in an ale-house. The circumstances are any thing but imposing. He is off his guard, and gives evidence, pro¬ bably, very different from what he would have given, had he attached more import¬ ance to the proceedings. In due time, another scene follows. The witness has been bound over to appear at the assizes, and has had an opportunity in the in¬ terval of deliberately forming his opinions of the case. He then appears before a very different tribunal, and is anxious, no doubt, to make a respectable figure before the bench, the bar, and the neighbouring gentry who fill the court. His examination proceeds, and he utters his sentiments with a becoming caution : he has probably forgotten or thought no more of the obscure scene of the inquest, and the evidence he gave on that occasion. But the judge is watching him ; the depo¬ sitions given at the inquest are before his lordship, and are narrowly compared with the present testimony of the witness. In accordance, too, with the new Prisoners’ Counsel Act (6 and 7 Will. IV. c. 114), those depositions are also in the hands of the prisoner’s advocate. It may well be conceived in how peculiar a situation the medical man is placed, should his second thoughts prove at variance writh those hastily given in the first instance, and espe¬ cially if through his means the prisoner have been thrown into gaol, perhaps for months, on a charge of which it now turns out that he is not guilty. Nor will the compunction of the medical witness be lessened by the consideration, that, had he died between the inquest and the trial, his depositions might have led to the con¬ demnation of the accused ! Courts of Oyer and Terminer. — By this title we are to understand those courts of commission, or assize, in which crown cases, such as treasons, felonies, and mis¬ demeanors, are disposed of. Medical evi¬ dence is frequently required in such cases, but the professional witness has no ex¬ press or special summons : he is sub¬ poenaed, and obliged to appear, under a heavy penalty; when in cour', he must “ true answer give to all such questions as are put to him,” nor has he any claim to remuneration for his time and trouble in attending. An act, however, was passed a few years since (7 Geo. IV. c. 6-1), by which witnesses for the prosecution, in all cases of felony, are entitled to their rea¬ sonable expenses : in prosecutions, also, for certain misdemeanors, the same indul¬ gence is granted ; the misdemeanors be¬ ing enumerated in the 23d section, — among which we find assault with intent to com¬ mit a felony, riot, breaches of the peace, wilful and indecent exposure of the per¬ son, &c. ; cases in which medical testimony is often required, but without any special privilege or immunity for the professional witness. Courts of Common Taw and Equity. — In these courts, constituted for the redress of civil injuries, the witness is differently cir¬ cumstanced from what he is in criminal cases. Where a civil suit is pending, such as an action for damages, a witness need not obey the subpoena unless his reasonable expenses be previously ten¬ dered. He must be compensated for his trouble and loss of time in going to, stay¬ ing at, and coming from the place where his testimony is to be given; otherwise he need not appear: or if he does come into court, he may refuse to give evidence until his reasonable demand be satisfied. His demand, however, must be very reasonable, for a shilling is the stated viaticum (a sum fixed at a time wdien money bore perhaps twenty times its present value) if the wit¬ ness reside within the bills of mortality, and be summoned to give evidence within the same. Whether medical men have a right to compensation for the sacrifice of professional emolument, incurred by their absence from home, is by no means a settled point : there are some cases re¬ ported in which they have been put on the same footing as attornies, but even the attornies’ right has been shaken by some still more recent decisions. Ecclesiastical Coui'ts . — The only other courts which I shall notice at present, are those which take cognizance of inju¬ ries of an ecclesiastical nature. Here ques¬ tions relating to the validity of marriage and the grounds of divorce are enter- medical evidence. 35 tamed; cases which call into requisition the evidence of medical referees perhaps more frequently than the public are aware of. Many of the circumstances submitted to the profession, in cases of this kind, would doubtless scandalize public decency. But, on the other hand, there is much to regret; it is to be feared that justice suf¬ fers; and, at all events, it cannot but be prejudicial to medico-legal science, as well as to the practice of the bar itself, that reports of some of the most remarkable cases should not in some shape be pre¬ served. The sanctions for attendance here are similar to those used in the common law courts; but in their dealings with medical witnesses, the parties engaged in suits ecclesiastical are understood to be bounteous, as, indeed, might be expect¬ ed from the suitors in a court where few, save the wealthiest, can venture to litigate. MEDICAL EVIDENCE. We shall now suppose the witness in due attendance, sworn in the usual man¬ ner, and prepared to tell the u whole truth.” May he always do so ? Does the discretion of revealing the entire truth rest with him ? The sifting system. — The freedom of a wit¬ ness in an English court of justice is greatly circumscribed. He is subjected, it is true, to several processes, such as those of exa¬ mination, cross examination, and re-exa¬ mination, besides, most likely, being ques¬ tioned by the bench and jury, — all with the express or ostensible design of eliciting the truth. But does it follow, after all, that the whole truth is elicited ? To war- rant such a supposition we should be sa¬ tisfied that the examining parties are fully capable of appreciating the extent of knowledge of the witness, which, where the latter is a man of science, it is not always easy for them to be. That the case is often otherwise we may be readily in¬ duced to believe, from the circumstance of able witnesses sometimes feeling obliged, through conscientious motives, to submit further information to the court after all the processes of silting them have been finish¬ ed. How many men, in such a situation, would feel deterred from volunteering one word in addition to what had been wrung from them in the ordeal they had undergone ! Much has been said of the excellence of the methods adopted in our courts for ob¬ taining evidence, and Blackstone has Placed in a strong point of view the supe- riority of parole over written testimony. he open examination of w itnesses viva vocef says the learned judge, “ is much more conducive to the clearing up of truth than the private and secret examination taken down in writing before an officer, or ms clerk, as in the ecclesiastical courts, and all others that have borrowed their prac¬ tice from the civil law,— where a w itness may frequently depose that in private wffiich he wrill be ashamed to testify in a public and solemn tribunal. There, an artful or careless scribe may make a wit¬ ness speak what he never meant, by dress¬ ing up his depositions in his own forms and language; but he is here at liberty to correct and explain his meaning, if misun¬ derstood, which he can never do after a written deposition is once taken. Besides, the occasional questions of the judge, the jury, and the counsel, propounded to the witnesses on a sudden, will sift out the truth much better than a formal set of in¬ terrogatories previously penned and set¬ tled; and the confronting of adverse wit¬ nesses is also another opportunity of obtaining a clear discovery, which can never be had upon any other method of trial. Nor is the presence of the judge, during the examination, a matter of small importance; for, besides the respect and awe with w'hich his presence w ill naturally inspire the witness, he is able, by use and experience, to keep the evidence from wan¬ dering from the point in issue. In short, by this method of examination, and this only, the persons who are to decide upon the evidence have an opportunity of ob¬ serving the quality, age, education, under¬ standing, behaviour, and inclinations of the witness ; in which points all persons must appear alike, w'hen their depositions are reduced to waiting, and read to the judge in the absence of those who made them ; and yet as much may be frequently collected from the manner in which the evidence is delivered, as from the matter of it.” All this must be admitted to be just and true in respect to the mode by which the knowledge of mere matter of fact may be arrived at; but it may be fairly ques¬ tioned whether the sifting method here described is best adapted for eliciting valuable scientific opinions. I am by no means disposed to advocate the course pursued in France and some parts of Germany, of drawing up medico¬ legal evidence wholly in writing — a sys¬ tem the palpable abuse of which is so clearly shewn in the lengthened and pro¬ lix documents to which it often gives rise, amounting sometimes to the pro¬ duction of controversial pamphlets ; but I do say, that the opposite practice which prevails amongst us, of confining the pro¬ fessional witness to mere verbal statements , controlled, too, by men of a different pro¬ fession, and who are acknowledged not to be, generally speaking, persons of very ex¬ tensive scientific attainments, is a course extremely open to objection. Citing of authorities. — But this is not all : the medical witness is subject to still fur- 36 DR. CUMMIN ON FORENSIC MEDICINE. ther restriction on another point: lie isoften prevented from citing authorities. He may not state the opinions of the greatest names in medicine in corroboration of his own — no vouchers, whether ancient or modern, for the correctness of his asser¬ tions, may be tendered, if it so please the bar and the bench. It is not easy to con¬ ceive any thing more absurd or unfair than this; for, in the first place, it is perfectly ridiculous to expect a medical man, in giving evidence, to state nothing but what he knows through his own experience : were professional witnesses always limited to this, their utility in courts of justice were scanty indeed, — for who could, or should, venture to offer an opinion on any difficult point of diagnosis or practice that has not been adopted from, or con¬ firmed by, the experience of others ? If given as purely his own, all rational men must know what value ought to be set upon it. Nor is the unfairness — the injustice of the practice — less striking : for the members of the legal profession should, of all men, be aware, and are aware, that individual opinion is worth nothing unless it be shown to be in accordance with prece¬ dent, and consistent with reason, that is, as the lawyers usually understand it, consist¬ ent with the expressed sentiments of the Cokes, the Hales, and the Eldons, of their profession. This wTas well pointed out on one occa¬ sion by a medical witness whose quota¬ tion of authorities was demurred to. At the trial of Mr. (afterwards judge) Cow- per, for the murder of a lady who was found drowned, Dr. Crell, among other witnesses, was called upon for his opinions as to the likelihood of death being caused by drowning, little or no water having been found in the body. “ My own opinion,” said Dr. Crell, “is, that a very small quantity of water, not exceeding three ounces, is sufficient to drown any body ; and I believe that the reason of the suffocation, or of any persons being stifled under water, is from inter¬ cepting of the air, that the person cannot breathe, without which he cannot live. I shall give you the opinion of several old authorities on the point.” The judge (Baron Hatsell) : “Pray, Doctor, tell us your own observations.” “ My Lord, it must be reading as well as a matfs own experience that will make any one a phy¬ sician; for without the reading of books of that art, the art itself cannot be at¬ tained to. Besides, my Lord, I humbly conceive that in such a difficult case as this, wre ought to have a great deference for the reports and opinions of learned men ; neither do I see any reason wfliy I should not quote the fathers of my profes¬ sion in this ease, as well as you gentlemen of the long robe quote Coke upon Little¬ ton in others.” And, accordingly, he pro¬ ceeded to cite the authority of Ambrose Pare on the point in question ; nor was such evidence in this instance refused. On the other hand, w'hen at the trial of Donnal (in 1817), Dr. Nfeale quoted the celebrated chemist Thenard, the judge (Abbott) objected, saying — “ We cannot take the fact from any publication ; we cannot take the fact as related by any stranger .” But there seems to be no fixed rule on the subject: while some judges have thus prevented, others have permitted the citing of published opinions, and have sometimes themselves appealed to au¬ thorities — to Dr. William Hunter, for in¬ stance, or to Llaller, or Mead. Nay, on one occasion, w'hen a medical witness flippant¬ ly uttered an opinion in court to the effect that the information in certain medical w'orks on a particular subject was good for nothing — “ that the writers of books would advance any thing,” — the judge (Dal¬ las) reprimanded him, and said thathewmuld not sit in a court of justice and hear science reviled, and the recorded researches of the medical W’orld represented by igno¬ rant tongues as leading only to uncer¬ tainty*. The objection commonly urged by lawyers seems to amount to this, that opinions and statements laid down in books, however eminent the authors, are only like so much hearsay evidence, not sworn to, and there¬ fore not legally admissible. The unrea¬ sonableness of such a doctrine is obvious ; for w7ho shall assert that the deliberately published opinions of a respectable author are in any manner the weaker for not be¬ ing confirmed by an affidavit ; or that his statements are the less to be relied on for not being sanctioned by an oath ? Some wrnuld even hold the very reverse. In Scotland a greater latitude is allowed to professional witnesses : authorities are permitted to be freely quoted ; and Dr. Beck informs us that in America no objection to such a course has ever been made. “ There is scarcely a case of any note,” says he, “ where medical testimony has been required, in which frequent reference has not been had to medical wrorks. They are quoted and commented upon by the bench, the bar, and the professional wit¬ nesses.” Notes to aid the memory. — There is ano¬ ther point on which the practice of our English courts is better defined, and appa¬ rently founded on more just principles. I allude to the notes which the medical witness is sometimes permitted to make use of. It is agreed that wffiere those notes * Amos i Medical Gazette, vol. vii. p. 613.- EVIDENCE OF DYING DECLARATIONS. 37 have been made immediately upon the oc¬ currence of the facts to which they refer' they may be used in evidence, for the ex¬ press purpose of refreshing the witness’s memory. Thus the account of a ’postmortem examination drawn up by the witness at the time it was made, or the memoranda noted down presently after a trans¬ action in which he has been engaged, are admissible afterwards in evidence. But where a person summoned to give his testimony in a court of justice relative to incidents that have happened, perhaps many years previously, sits down and compiles a written statement of what he knows or recollects of the matter, he will not be allowed to avail himself of such statement at the trial. Want of attention to these points has often led witnesses into unpleasant diffi¬ culties: ridicule and reprimand, too, have been the lot of some who have come into court confidently relying on the complete proofs they had to bring forward, these proofs being probably memoranda neither made by themselves, nor under their in¬ spection. It is not absolutely necessary that the memoranda alluded to should be noted in one’s own hand; but in such case it is indispensable that the witness should have personal cognizance of the act of making them. If they be entries in regis¬ ters which are adduced, the witness must either have made them himself, have seen them made, or be able to produce the par¬ ties by whom that office has been per¬ formed. All this is calculated to inculcate the importance of carefulness on the part of our profession, and to recommend the practice of keeping journals or memoranda of the transactions in which we may be person¬ ally concerned. As we are interested in the peace and security of families — as we are friends to humanity and justice — and as we value our own reputation, we are called upon not to omit so simple, yet so important a custom. Even a prescription book has sometimes been serviceable in the absence of other documents. Mr. Amos informs us that in a case in which he was engaged, where the trial was concerning a will, a physi¬ cian was able to throw great light upon the inquiry by means of a book in which he copied all his prescriptions, and which enabled him to trace the progress of the testator’s health at a distance of more than a dozen years, when otherwise it is probable that his memory might have af¬ forded him no assistance*. Evidence of dying declarations, of which medical men frequently become the depo¬ sitaries, can scarcely be given in an unex- * Medical Gazette, vol. vii. p. 547* ceptionable manner if the witness have neglected to take a contemporaneous note of them in writing. That hearsay evil deuce is not admissible in our courts, is the general rule; but there is a marked exception in the case of dying declara¬ tions. What a person utters in his dying moments, or when he entertains a con¬ sciousness of approaching dissolution, is valid as evidence upon trials for murder. The principle is a just one, for it implies that the awful situation of thedying indivi¬ dual is equivalent to the sanction of an oath, and that the absence of sublunary interest, on passing into another world, dispenses with the necessity of a cross- examination. But it must clearly appear that such is the condition of the party; if there be hope, however faint, of recovery, — if there be expectation that the adop¬ tion of further remedies may prolong life, the declarations will be rejected. This was the case in respect to Mr. Scott, who was shot in a duel. The surgeon who attended him on his death-bed was about to give the dying declarations of his pa¬ tient when the trial came on at the Old Bailey; but inquiries were first made as to the precise state of the patient, and whether any conversation had passed from which the sense he entertained of his situation could be inferred. The witness said, “ The deceased asked me if his wound was necessarily mortal? — upon which I told him that his case was one of extreme danger; but that there had been instances where persons had recovered under such a wound. The deceased then said, ‘ I am satisfied.’” The declarations were overruled by the judges, inasmuch as the language of the surgeon had pro¬ bably kept alive in his patient’s mind some hopes, however faint, of recovery. And in another case, where the dying declarations had already been duly taken, but the patient afterwards wished that more medicine might be sent for, they were rejected, because not made after all expectation of life was extinct. One or two other hints on the subject of dying declarations may be added — name¬ ly, that these forms of testimony should al¬ ways be purely voluntary, and thatthe dying person ought not to be induced to supply matter of accusation against living parties. The interrogations also should not be of a leading kind, or such as require from the declarator only a simple expression of assent or dissent — a yes, or a no ; for this may be fairly construed into a prompting of statements in which, though the patient may have acquiesced, he cannot be sup¬ posed to have felt any adequate concern. Besides, such a practice of questioning is only allowed in open court, under certain precise restrictions. 38 DU. CUMMIN ON FORENSIC MEDICINE. Question of privilege. — Having thus no¬ ticed the extent to which medical testimony is received as evidence, and the limitations to which it is usually subject, it may be interesting to inquire whether medical men have any peculiar privileges in courts of justice. In the first place, may they de¬ cline to give such evidence as would appear to compromise the honourable confidence reposed in them by families ? Are they privileged not to divulge secrets profession¬ ally and confidentially communicated to them ? This question has been decided in the negative. In the case of the Duchess of Kingston, who was tried for bigamy, in the year 1776, the professional attendant of her grace, Mr. Caesar Hawkins, endea¬ voured to evade some questions put to him, on the ground that if he answered them, he would dishonourably betray his patient. But it was held by the House of Lords, in the language of Lord Mansfield, “ that a surgeon has no privilege, when it is a mate¬ rial question in a civil or criminal cause, to know whether parties were married, or whether a child was born, to say that his introduction to the parties was in the course of his profession, and in that way he came to the knowledge of it. If a sur¬ geon was voluntarily to reveal those secrets, to be sure he would be guilty of a breach of honour, and of great indiscretion ; but to give that information in a court of jus¬ tice, which by the law of the land he is bound to do, will never be imputed to him as any indiscretion whatever.” Other decisions have since corroborated this view of the question; and it is now generally under¬ stood that professional confidence, as a ground of secrecy, can only be urged in the case of counsel, solicitors, and attor¬ neys, when employed as such, — on the principle that in such circumstances they become identified with their clients. There is one privilege, however, which medical men possess— namely, that of not being obliged to state any thing that may criminate themselves. All witnesses, in¬ deed, by the laws of England, are entitled to the same right of reserve; but peculiar indulgence in this respect seems to be extended to our profession. It is well known that a medical man who at¬ tends a party engaged in a duel, and is present at the combat, though only in his professional capacity, is considered in the eye of the law as an accessary, and may be put on his trial for murder. After the fatal duel between Col. Montgomery and Capt. Macnamara, in 1803, a surgeon of eminence who had attended one of the parties professionally, was arrested and sent to Newgate, by a warrant from the civil power, as a principal in the alleged murder, having been present on the occasion, and antecedently privy to it: nor was he liberated from prison till the grand jury were satisfied that there was no sufficient ground for the indictment. But it rarely happens that the law, in this respect, is severely administered : the more ordinary, practice is to dispense with the evidence which the medical attendant could give in such cases. On the trial of Mr. Patmore, second to Mr. Scott already mentioned, the sur¬ geon who attended the deceased at the duel, was summoned to identify the prisoner then in the dock, arraigned for murder. And he would have heedlessly done so, had he not been humanely warned by the judge not to expose himself to a criminal prosecution, by answering ques¬ tions which might compromise his safety. A few years since, at the trial of the seconds of Sir John Jeflcott, who shot Dr. Hennis, of Exeter, in a duel, a physician who was on the ground with the party, being called upon to give evidence, declined to do so, and the judge (Patteson) said he could not compel him. CONDUCT OF MEDICAL WITNESSES. I have already alluded to the im¬ portance of circumspection on the part of medical men in giving evidence — no matter how humble the court may be in which it is tendered : for if it lead to the committal and subsequent trial of the prisoner, the depositions will be forthcom¬ ing, and contrasted with the mature testi¬ mony of the witness. But there are some other hints respecting conduct, which it may be well to observe. Self-possession. — We should bewrare of being over-officious, or too profuse in giv¬ ing our testimony, for thereby we expose ourselves to the imputation of some motive, perhaps of a personal nature, in the issue of the cause. Nor, on the other hand, should we be too reserved — too costive, in our information, for this throw's us from Scylla into Charyb- bis, and we become liable to the suspicion either of shallowmess, or a design to con¬ ceal from the court some important parti¬ culars. The golden medium, in this as in most other things, is to be preferred. We should reply freely and cheerfully to the questions proposed to us, with self-pos¬ session, but with perfect submission to the tribunal before which we stand. Self-pos¬ session is necessary, for the consequence of its absence may be serious. “A scientific wdtness,” says Dr. Paris, “ fully acquainted with the subject in dispute, and by his particular knowledge well qualified to inform the court on the most important points, is too frequently render¬ ed miserable to himself, and absolutely ineffective to the ends of justice, by the diffidence which a man of real CONDUCT OF MEDICAL WITNESSES. 39 acquirement generally feels, when im¬ pressed at once with the novelty of his situation, a sense of the importance of the duty which he is about to perform, and a consciousness that the truths he is about to utter may be obscured, suppressed, or perverted, by technicalities for which he is unprepared with any defence : we do not mean to arraign the present forms of examination in general, when we assert that some abuse in practice too frequently places the witness in as painful a situation as if he were himself a criminal.” Technical terms to be avoided. — But it is not of the technicalities of the law alone of which the medical witness had need to be apprehensive ; those of his own profession, if not guarded against, will most probably entrammel him quite as much. Both for counsels’ sake, who are said to be generally “ very shal¬ low men of science,” and for our own safety, which so much consists in the inte¬ grity of our reputation, we had better ab¬ stain from the use of terms purely medical, where we can find others more popular that are at all suited to our purpose. The a ’.vice of my learned friend, Mr. Amos, on this point, is excellent. “ When in the "wit¬ ness-box, drop as much as possible the language which is known only to scientific men, and adopt that which is in popular use. If you have occasion to speak of a person fainting, do not say, as I have heard it said, that you found the patient in a. state of syncope; and you must not expect a court of justice to understand you if you talk of a person being comatose, and of the appearance of his stomach after death being highly vascular , or of your having discovered poisonous ingredients in his intestines by means of a delicate test. The judge and counsel are generally very shallow men of science, and it is a great advantage for them to raise a laugh at persons whom they would repre¬ sent to be using hard names for common things. Veterinary surgeons are a great game for counsel; and I remember, in particular, a veterinary surgeon, who, when cross-examined by Serjeant (now Baron) Vaughan, was so unfortunate as to make use of the term suspensory ligament , which the serjeant interpreted into the ‘hangman’s noose.’ In general the wit¬ ness is called upon to define, as he goes along, the technical terms which he em¬ ploys, and it is ludicrous sometimes to hear the words of which an explanation is gravely demanded. I have heard a learned chief-justice ask what the witness meant by an injection, where the context would seem scarcely to leave a loophole for doubt : the reply, howrever, that it wras a clystei- appeared satisfactory to his lordship; not, perhaps, because the Greek name was more intelligible than the Latin, but that the former was the more common, and it was probably the wish of the court to discounte¬ nance all technicality. Of the opening for ridicule afforded by the use of cer¬ tain terms, I cannot give you a better in¬ stance than one which was lately related to me by a friend learned in the law. A conceited shallow witness, a member of our profession, in undergoing the ordeal of cross examination, on a recent occasion, happened to drop, among other ill-assorted terms w hich he seemed proud to use, the word dyspepsia; the counsel, who was a wrag, immediately seized on it, and raised roars of laughter at the witness’s expense, by putting to him a question w hich he was unfortunately unable to answrer — “ Unde derivatur dyspepsia, Doctor? Eh, Doctor, unde derivatur dyspepsia ?” Ought witnesses to be made up Jor the occa¬ sion ? — A general subject of complaint brought against medical witnesses, is the contradictory nature of their opinions, as given in courts of justice. Much of this, no doubt, is owing to the difficulty of the questions on which those opinions have to be delivered: but perhaps still more to the witness’s wrant of preparation. Of the necessity for individual preparation there cannot be a doubt, when it is con¬ sidered that the professional man is not called upon to testify to mere matter of fact : he has an opinion to deliver, and will be expected to state publicly the grounds of that opinion. Nor does there seem to be much more question regarding the propriety of joint preparation, when two or more witnesses are to be examined, touching the same subject of inquiry. Of the correctness of this position we have a strong proof in a case related by Dr. Per- cival. “ Several years ago, a trial of con¬ siderable consequence occurred, relative to a large copper- work; and two physi¬ cians of eminence were summoned to the assizes to bear testimony concerning the salubrity or insalubrity of the smoke is¬ suing from the furnaces. The evidence they offered wTas entirely contradictory. One grounded his testimony on the gene¬ ral presumption that the ores of copper contain arsenic, and consequently that the effluvia proceeding from the roasting of them must be poisonous, because arseni¬ cal. The other had made actual experi¬ ments upon the ore employed in the works under prosecution, and on the vapours which it yielded: he was thus furnished with full proof that no arsenic wras disco¬ verable in either. But the affirmative pre¬ vailed over the negative testimony, from the authority of the physician who de¬ livered it: an authority which he probably would not have misapplied, if he had 40 DR. CUMMIN ON FORENSIC MEDICINE- been antecedently acqnainted with the de¬ cisive trials made by his opponent.” That medical men are expected to make due preparation for giving ample and sa¬ tisfactory testimony, is certain, at least in some instances, from the fact of the judge who has to try particular cases, having given directions to medical witnesses to make certain experiments on animals pre¬ viously to the day of trial ; a fact which serves to establish the principle, if, in¬ deed, there could be any reasonable doubt of the excellence of the practice. The only point in connexion with the subject, on which a question can feasibly be raised, is as to the extent to which the minds of the witnesses should be made up anterior to the trial ; for some have advised that they should come to a fixed decision, so as to prevent the possibility of differing when the investigation came on in public. But even were this practicable, it seems doubtful how far it were just and proper; for what would it amount to other than to inquire with a foregone conclusion, and thus to make a mockery of justice ? The practice usually observed with re¬ gard to medical witnesses in courts of justice, allowing them to remain dur¬ ing the trial, while other witnesses are secluded till called to give their testimony, is a still further proof of the wish of the court to obtain consistentevidence from the medical men. But it is curious to observe, that, in Scotland, the profes¬ sional witnesses are secluded during the trial, for the very same purpose. “ In the Scotch courts (says Mr. Alison, in his Practice of the Criminal Law) it is usual, when one medical man begins to give an opinion on the case, to cause the other medical men to retire. The reason of this is, that it has been found, by experience, that medical men, even of experience and information, are generally so prone to con¬ tradict each other, or to adhere to the side on which they are cited, that it is never safe to let them hear each other’s testi¬ mony. The proper way to do, therefore, is to allow the medical men who are to be examined as to opinion, to hear the whole evidence relating to the facts, whether from the ordinary or the medical witnesses, and to remove them as soon as medical opinion is about to commence ” Of the mischievous absurdity of ven¬ turing into court to give evidence with¬ out previous preparation, I cannot close this part of my remarks without offer¬ ing one or two examples. A man was indicted at the Assizes at Chelmsford, in March 1822, for having administered copperas to two women. The women had drunk two or three cups of tea, which tasted bitter, and in the evening were taken ill with a violent vomiting. Next day their tea was still bitter, and some copperas was found on a plate in the house. One of the women suffered from the effects for about a month afterwards. It was attempted to be proved on the trial that copperas was a deadly poison , as laid in the indictment. A chemist of the town gave it as his opinion that the substance was not, properly speaking, a deadly poi¬ son, for the stomach would reject a dose sufficient to produce death before it would have that effect, and probably it would require two ounces, dissolved in water, to produce serious consequences; but still he did not think it would cause death. A physician, however, of Chelmsford, gave it as his opinion that two drachms of copperas would cause death. But on his cross examination, it turned out that he was confounding copperas with verdigris; and he was obliged to confess his ignorance that copper did not enter into the com¬ position of the poison alleged in the in¬ dictment ! This, it may be said, was an instance of pure indolence : the blunder of the phy¬ sician was, perhaps, wholly attributable to his having gone into court without giving the sligh test attention to the point on which he was to be examined. But I shall now show that too much care cannot be be¬ stowed on preparation, and that even the most expert cannot calculate upon having it all their own way on these occasions. In the example I am about to adduce, we find a chemist of the highest reputation unexpectedly called upon to put forth his best abilities in his cross-examination by counsel. The gen¬ tlemen of the bar, it may be observed, are sometimes more than a match for the most intelligent witnesses who come before them; being often crammed for the purpose: and the conflict under such circumstances is always unequal. The professional witness is held to be fair game; and he is supposed to have no cause to grumble, as he is attacked on his own ground, and with weapons like his own. On the other hand, the counsel, whatever be the issue of the con¬ test, comes off scatheless: and he has no risk of character to apprehend even from an exposure of gross ignorance in his cross examination. At the trial of Stewart and his wife, in 1829, for the murder of a man, by giving him laudanum in strong ale, Dr. Ure, who had attended the post-mortem examina¬ tion of the body, was summoned as a wit¬ ness for the prosecution. The Doctor was positive as to the presence of opium in the contents of the stomach, from having relied on perchloride of iron as a test for meconic acid, and procured what he conceived to be the characteristic cherry red colour. He ON THE THERAPEUTICAL EFFECTS OF IODINE. 41 did not know at the time (though, by the wav, the fact was then far from new, Tiedemann and Gmelin having published it some years before) that the test he employed was rendered doubtful by the circumstance that human saliva contains a substance — the sulpho-cyanuret of potas¬ sium — which strikes the same red colour with the same salt of iron,— as indeed it is now perfectly well ascertained that there are other matters which might easily hap¬ pen to be present in the stomach— such as mustard, &c. — which would also render the test fallacious, in consequence of their presenting a similar appearance. Dr. Ure, however, not being acquainted with the fact respecting the saliva, was taken wholly by surprise when the counsel for the prisoners urged upon him the inefficacy of his salt of iron test, since sulpho- eyanic acid also struck a cherry red colour, when treated with perchloride of iron. In a paper in Brande’s Journal for 1830, Dr. Ure adverts to the facts of the case, and the objection raised by his cross - examiner: — “I was not then aware (says he) that this curious acid (the sulpho-eyanic) existed in the saliva, and I thought it merely a ruse de plaideur .” There is reason to believe that the “ inge¬ nious counsel” was primed for the occa¬ sion, by a rival chemist of Glasgow ; and probably the point urged might have had much weight, had not the medical witnesses been agreed, that, whatever ambiguity might attend the test em¬ ployed, the characteristic smell of opium given out by the contents of the stomach, was too perceptible to leave any doubt on their minds. The moral circumstances of the case, besides, were very strong; so that the prisoners were found guilty, and exe¬ cuted. General demeanour. — A few words on the general demeanour of witnesses, and I have done. It has been already seen how many difficulties beset the path of the professional man in coming in contact with our legal tribunals, and I have just no¬ ticed some of the perplexities and annoy¬ ances which may await him in court. It is scarcely surprising that the apprehen¬ sion of the sort of treatment which they have reason to expect, should render most men “ tremblingly alive ” to their posi¬ tion, and that some should even be be¬ trayed into intemperate or indignant sal¬ lies : but Dr. Haslam’s suggestions are well deserving of consideration : — “Thelawyer’s object is the interest of his employer, and, for the fulfilment of his duty, he is fre¬ quently compelled to resort to a severity of investigation which perplexes the theo¬ ries, but more frequently kindles the irritable feelings, of the medical practitioner. The distrust on the part of the lawyer, however unpalatable, is fully justified, most wit¬ nesses going into court with the precon¬ ceived intention of proving to a certain ex¬ tent ; and those most conversant in the history of human testimony have been ex¬ tremely scrupulous of admitting it as a uniform truth until it has been carefully sifted. Guarded with these precautions, and armed with professional experience, the medical practitioner may approach the tribunal of justice with confidence, and advantage to the cause of truth. How¬ ever dexterous he may shew himself in fencing with the advocate, he should be aware that his evidence ought to impress the judge, and be convincing to the jury.” Unhappily there are but too many in¬ stances on record of this disposition on the part of medical men to fence with the gen¬ tlemen of the bar : in some cases a contest in “ the flowers of Billingsgate” has been attempted ; the result has always been to be deplored. But I shall forbear to bring such examples before you, however power¬ fully they might serve as a warning to remain on all such occasions cool, steady, and collected ; and to impress you with the necessity of keeping your temper. To the danger of assuming an affected manner, or the appearance of false dignity, I need hardly advert ; it is hazardous at any time to venture before the public out of one’s proper character; in a court of justice it may be ruinous. In short, the golden rule of conduct seems to be — to preserve our natural manner — to have just so much confidence as may arise from the consciousness of being not unprepared — and, above all things, to be calm. ON THE THERAPEUTICAL EFFECTS OF IODINE, 7 i GIVEN IN VERY LARGE DOSES, In the forms of Iodide of Starch, Hy dr iodic Acid , and Iodide of Potassium. By Andrew Buchanan, M.D. Junior Surgeon to the Glasgow Royal Infirmary. In a former number of this journal (vol. xviii. p. 515) I pointed out a new me¬ thod of administering’ iodine, by means of which it may be given with safety in doses much greater than by the ordinary modes of administration. I likewise described the principal physiological effects resulting from the use of iodine in such doses. I am now to attempt the more difficult task of forming an estimate of the virtues of iodine in the cure of disease, in so far as the observa- 42 DR. BUCHANAN ON THE tions made in the surgical wards of the Glasgow Infirmary enable me to do so. The principal surgical diseases in which iodine was prescribed were sy¬ philis, sibbens, scrofula, ulcers depend¬ ing upon constitutional causes, noli me tangere, cancer, and tumors. It was also tried in lepra, psoriasis, ichthyosis, impetigo, and porrigo, diseases not usu¬ ally treated in the surgical wards, the patients being in the hospital for other diseases, or having been taken in for the express purpose of trying the efficacy of the remedy. Of 37 patients to whom, on looking over the hospital journals, I find iodine was administered in one or other of the methods described above, it would be useless to give the cases of the whole, because several of them, from the ambi¬ guous nature of the diseases with which they were affected, from other medicines having been previously employed, or from the iodine not being fully tried, do not furnish any satisfactory conclusions. I shall mention only those cases in which the disease was clearly marked, and the efficacy of the iodine fairly tried. Secondary Syphilis. I shall first mention four cases of se¬ condary syphilis. Archibald M‘Gillivray, set. 24, shoe¬ maker. January 7th, 1836: Contract¬ ed syphilis about three years ago. Since this, secondary symptoms have been ob¬ stinate, notwithstanding four or five complete courses of mercury, two of which he underwent in this hospital. About a year ago a node formed on each tibia, and some time afterwards one appeared on the ulna of the right arm. An eczematous eruption broke out on the face in July last: it was removed by means of sarsaparilla and mercury, but reappeared about three weeks since on left superciliary ridg'e and chin. The node on left tibia becoming painful, red, and fluctuating, eight days since he had it laid open by a free crucial incision. On admission the wound has an un¬ healthy appearance ; granulations are glassy, and discharge consists of brown pus, tinged with blood. Surface of tibia is bare, rough, and irregular, in centre of wound, for the space of about half an inch in diameter ; and a probe passes outwards beneath the integuments for a short distance. General health good. Jan. 8th. — Sumat ter indies Iodidi Amyli, ^ss., ex haustu Decoct. Aven. Curet. Ulcus, Ung. Oxid. Hydr. Ruhr. 13th. “Iodine agrees well, and urine strongly impregnated with it. Augeat. dosis Iodid. Amyl. ad^j. ter in¬ dies. 20th. — Fresh eruptive patches on nose and right leg ; node on left tibia and right ulna diminished in size, and free from pain. Medicine agrees well, only it renders him costive, for which he has had a laxative several times. Feb. 20th. — About eight days ag’o salivation and swelling of the face came on. Since yesterday has spat upwards of a pint of saliva, which is as strongly impregnated with iodine as the urine. Two small ulcers on inside of left cheek ; nodes gone, and eruption where ulce¬ rated has now healed ; sore of leg looks better, but there is still bare bone in the centre of it. Ossi nudato adhibeatur Acid. Muriatic. Dilut. March 12tb. — Salivation subsided soon after last report, and sore of leg healed very speedily after the bare bone had been dissolved away by the mu¬ riatic acid. Dismissed cured. James Kilpatrick, set. 34, flesher. March 30th : About three months ago observed several warty excrescences forming around anus ; his attention be¬ ing’ called to them in consequence of the irritation they produced. A week or two afterwards observed purulent matter exuding from below' prepuce, and, on examination, he found superfi¬ cial ulceration behind corona glandis. On admission ulceration is still found in this situation ; discharge is thick pus. Prepuce is somewhat swollen, and ori¬ fice contracted. On scrotum, body of penis, inside of thighs, and around anus, is an eruption of ulcerated patches, which appear to have commenced in slightly elevated round spots, about half an inch in diameter ; these became ex¬ coriated on the surface, and, by coales¬ cing, have assumed irregular forms in several places. The discharge is thin and sero-purulent ; parts are the seat of considerable itchiness; throat is in a state of superficial ulceration, and right tonsil is much enlarged. Scattered over the body and upper extremities are a few blotches of a coppery hue. Had THERAPEUTICAL EFFECTS OF IODINE. 43 gonorrhoea about three yrears ago, but denies ever having had chancres before. Never used mercury. March 31st. — Sum. ter indies Iodid. Amyl. 3SS. Ficis circa anum et ulceri- bus scroti adhib. Vapor Iodinii, et postea Ung Periodidii Hydr. April 29th. — The dose of iodid. amyl, was increased to one ounce, but it was found to occasion looseness of bowels ; he has therefore taken it for the most part in 3ss. doses. All the symptoms of the disease for some time gone. Dismissed cured. In the two following cases the iodine was given up, and mercury substituted, on account of the venereal eruption not going away, but, on the contrary, fresh patches of it appearing. I would not now, however, consider this a sufficient reason for stopping the iodine. In the case of M‘Gillivray, detailed above, in which a complete cure was ultimately effected, fresh patches of the eruption came out when the patient was fully under the influence of the medicine. Dr. Lawrie informs me that he has so often made the same observation, that he considers the fresh eruption as by no means an unfavourable symptom ; and he has further remarked, that it is only in cases of syphilis that any eruption shews itself under the use of iodine. David Struthers, ret. 32, weaver. De¬ cember 21st, 1835: Surrounding anus and between nates is a collection of small round superficial ulcers, slightly raised at their margins. The discharge is thin, sero-purulent, and irritating; intervening integuments red and tender. Several ulcers of a similar character are scattered over scrotum and integuments of penis. Contracted sores from impure con¬ nexion about ten weeks ag*o ; these are still open behind glans, near left side of frrenum. Disease appeared around anus about nine weeks ag’o ; and about a fortnight ago a lichenous eruption broke out over arms and body, accom¬ panied by itching. No treatment. Sum. ter indies Iodid. Amyl. 35s. 27 th. — Med icine agrees well. Urine abundant, and becomes as black as ink on addition of starch and nitric acid. I ngeat. dos. ad Jj. ter indies. January lltli. — For fifteen day’s took oiij - °f iodid. amyl, daily: it appeared to render bowels costive, requiring the use of castor-oil. Stools somewhat whitish. Took last dose on the morn¬ ing of 6tb instant ; tinge of iodine con¬ tinued in the urine till fifth day after. Little change upon eruption or sores. Rep. Iodin. sed Sum. solummodo, 3SS. ter ind. Curent. Ulcera Ung. Iodin. February 2d.— Iodine has agreed bet¬ ter in diminished doses. Ulcer around anus nearly healed, but little change on blotches of the skin, and two new ones have appeared on scrotum. Omit. Iodin,— Sum. Pil. Hydr. ij. V. et i. M. 16th. — Cured. The other case is that of a mail (James Hare, Ward No. 12), who was admitted for strumous sores in the groin, originally excited by venereal infection. He was put upon the beau¬ tiful new salt of iron, discovered by Mr. Graham — the peroxalate of iron and potass ; which appeared to act very effectually as a tonic, and was given in gradually increased doses, till he took of it gr. xv. twice a-day. He was next tried with iodide of starch, which was given at first in very small doses, as he was one of the first patients to whom it was prescribed. The dose was gradu¬ ally increased, and when he was fully under the influence of the medicine, a copious eruption of blotches took place all over his body. The iodine was in consequence intermitted, and first sar¬ saparilla and afterwards mercury sub¬ stituted ; under which remedies the cure was effected. Sloughing Sores of Penis. Four bad cases of this kind were treated with iodine, and all of them did well. These patients wrere Smith, M Kittrick, Norie, and Macdonald ; all of them in Ward No. 7. The two first used the iodid. of potassium, in 3,j* doses ; the tvvo last the iodid. of starch, in ^j. doses. It is to be remembered, however, that strong nitric acid as a caustic, opium, and other remedies, were also employed ; whence it is very difficult to estimate the value of the iodine. I shall not, therefore, insert these cases, but merely say that my im¬ pression was in favour of the utility of the iodine. In an exceedingly^ severe case which I saw in private, along with Dr. Black, Kent-street, the iodid. of potassium seemed also to be of service ; but the 44 DR. BUCHANAN ON THE strong- nitric acid being here likewise employed, there was the same room for scepticism. The only other case of syphilis to which I shall advert is that of M‘Gregor, (Ward No. 7); in w hich mercury was prescribed in the first instance, and to it the cure was undoubtedly to be ascribed. I only mention this case to illustrate the effects of iodid. of potassium introduced by inunction. An ointment was formed, containing 3j. of iod. potassii to jj. of lard. With this ointment the patient was directed to smear over the whole surface of the body. He used ^ss. of the ointment at night, and the other Jss. next morning. At the hour of visit, no iodine could be detected in the urine. He was in consequence directed to rub in a whole ounce of the ointment that evening and next morning. In the urine passed in the morning before the second inunction, there was merely a trace of iodine, while in that passed after mid-day it w'as exceedingly abun¬ dant. Sibbens. Considering the efficacy of iodine in syphilis, it w-as natural to infer, from the analogy of the two diseases, that it would likewise prove an useful re¬ medy in sibbens. It was accordingly tried in the following case, and the re¬ sult was highly satisfactory. Hugh Macgregor, set. 33, farmer, Balqhuidder. April 12th : On left side of isthmus of throat, occupying both pillars and the intervening space, and stretching over front of uvula, is a patch of superficial ulceration, with slightly elevated edges and indolent surface, covered with a yellow exuda¬ tion. Uvula is much relaxed, and from part of the velum on the left side being destroyed, it inclines to the right. Parts in the neighbourhood of sore are of a dusky-red colour. Ulceration ap¬ peared about 3^ months ago, and w-as treated with mercury, with good effect. It did not continue well, however, above a fortnight ; ulceration reappearing and spreading- to a greater extent than be¬ fore. Denies all syphilitic taint, and attributes his complaint to eating from the same dish and smoking the same pipe with an infected person. About ten years ago was much troubled with cynanche tonsillaris, advancing on the last attack (seven years ago) to suppu¬ ration. Sum. Iodid. Amyl, ad ^ss. ter indies. 15th. — Augeat. dos. Iod. Amyl, ad Jj* ter indies. May 4th. — Dismissed cured. Scrofulous Affections of Joints and Bones. The most formidable diseases of the scrofulous kind which come under the cognizance of the surgeon, are the af¬ fections of the joints. The most com¬ mon of those affections is that which originates in the ends of the bones form¬ ing the articulation, by the deposition of tuberculous matter in their cancel¬ lous structure. In one case of this kind, the iodide of potassium was prescribed, in the dose of 3ij. daily; but, in conse¬ quence of tbe medicine disagreeing, it was intermitted before any judgment of its efficacy could be formed. It will be seen, however, below, that in diseases of the same nature, only existing in bones not entering into the formation of any large joint, the iodine was decid¬ edly useful. In tbe scrofulous thicken¬ ing of the synovial membrane, another disease of the joints not less intractable, and in this part of the country little less frequent than that just mentioned, the trials made of the iodine were unavail¬ ing, as illustrated in the following case. Jane Montgomery, oet. 12. January 19th : Right knee-joint is much swollen, measuring* fully an inch in circumfe¬ rence more than left. Form of joint is lost, the shape of patella being* ob¬ scured in consequence of surrounding tumefaction. Above patella, and also on inside of knee, opposite head of tibia, there is evident fluctuation. These fluctuating swellings do not communi¬ cate with each other. There is also a fluctuating* spot, small in size, on the outside of head of tibia. Limb par¬ tially flexed, and any attempt at exten¬ sion produces pain. Little or no un¬ easiness is felt on pressing the articu¬ lating surfaces together, nor does pres¬ sure on the extremities of the bone ex¬ cite much pain. Complaint is of about twelve months’ duration, and has been treated with counter-irritants, with re¬ lief to the pain, but without benefit to the swelling-. General health impaired ; occasional night sweats ; pulse 124. Feb. 2d. — A blister applied over joint, with diminution of pain ; tongue clean ; appetite improved. Sum. Iodid. Amyl. 3ij. ter indies. 18th. — Little change upon knee; elastic swelling oil the outside of it less THERAPEUTICAL EFFECTS OF IODINE. 45 distinct, while that over inner head of tibia has more feeling’ of fluctuation. Pulse averages about 125, appetite good, tongue clean. Less pain of knee ; medi¬ cine agrees well, and urine strongly im¬ pregnated with it. 24th. — • Three days back, much increase of pain of knee, with increased swelling, and redness of surface ; pulse 144; tongue clean, but appetite im¬ paired. Leeches twice applied to knee, and iodine stopped. 28th. — On 25th, at a consultation, it was recommended to delay amputa¬ tion, and to puncture the fluctuating tumor over head of tibia. This was accordingly done, and about 3ss. of curdy matter discharged. March 15th. — Amputation was deter¬ mined on at another consultation, but the parents refusing’ to give their per¬ mission, the girl was removed at their desire. The following case was one of those in which the virtues of iodine were most remarkably exemplified. It will assist the mind in forming an idea of the appearance of the diseased parts, to men¬ tion that several medical gentlemen, who saw the case when first admitted, thought that partial amputation of the hand was the only remedy likely to be of any use. John Elliot, set. 24, sadler: Aug. 4th. Twelve months ago an abscess formed on back of hand, above the thumb, which burst some time after, giving exit to a considerable quantity of pus. About same time an abscess formed over ball of right thumb, which was opened. On admission, there exists over hand a large strumous-looking ulcer, inter¬ sected by undermined bands of skin, and secreting thin unhealthy pus. Hand is the seat of considerable aching pain. Through a part of this ulcer metacarpal bone of index finger is detected in a carious state ; over ball of thumb are also two openings of the same character, but through neither of these is bone found bare. Left knee-joint measures an inch more than right in circumference. Swell¬ ing principally confined to the bursa above patella; there is apparently but little affection of the synovial membrane around the knee; head of tibia is the ^eat of a good deal of pain, especially when pressed upon. General health pretty good ; diathesis strumous. Sum. 01. Ricini, Jj. ; et parti genu dolenti adhibeatur Empl. Mel. Vesie. Aug. 16th. — Knee much improved by blister; little change in sore of hand. R Iod. Potassii, 3j. ; divid. in pulv. xij. Sum. j. ter in dies. R Todinii, gr. x. Axungias, ^j. M. Fiat ung. quo caret. Ulcus. Aug. 19th.— Augeat. dos. Iod. Potass, ad gr. x. Sept. 10th. — Iodine ointment not ap¬ plied, sores having been dressed with a poultice all along. Has taken iodid. potassii in gradually increased doses, and for a fortnight has taken 3j. daily; medicine found in large quantity in his urine. Sore nearly healed ; no carious bone discharged. Continue. Sept. 14th. — Sores quite healed; dis¬ missed, cured. In the two following cases the use of the iodine was conjoined with a local application, which appears to me to be of much service in the treatment of many cases of carious bone. I allude to the application of diluted muriatic acid used altogether as a chemical remedy, for the purpose of dissolving- away the exposed bone. In this way portions of bone which are keeping up a lingering disease may be removed more speedily than by any other means, save excision. I have already men¬ tioned one instance of an obstinate sore upon the tibia, which was cured by means of the acid very speedily, and certainly with far less pain to the patient than could have been accomplished by the saw or the gouge. I have found an acid of the strength of the acid, muriatic, dilut. of the Pharma¬ copoeias, to have a solvent powrer suffi¬ ciently energetic, and at the same time to occasion very little irritation of the soft parts in the neighbourhood. It may be conveniently applied by means of a long- glass tube, which should be about half an inch in diameter, and drawn out at the lower end, so as to be little thicker than a probe ; or it may be applied by means of an apparatus like that used in the laboratories for washing precipitates from the sides of the funnel. John Kenney, set. 16, piecer. Feb. 6th : About 10 months ago, after a slight injury, right foot became swollen, but without pain, redness, or constitutional affection. A short time afterwards, small abscesses formed on outside of dorsum, and on the sole. Some were opened 46 DR. BUCHANAN ON IODINE. by puncture, and others allowed to burst spontaneously. Since this they have assumed an indolent character, shewing no disposition to heal, and discharging’ thin sero-purulent matter. Through two of those, on the dorsum, diseased bone can be detected. Into one of those on the sole, probe can be passed 1^ inches without detecting bone. The others are more superficial, extending but a short way beneath surface. Experi¬ ences no pain or uneasiness in the foot. A small sinuous abscess of a strumous character exists on neck, beneath left angle of the jaw, discharging thin mat¬ ter, mixed with curdy flakes. Probe passes for about an inch under integu¬ ments, which are red and thin. Gene¬ ral health somewhat impaired, with occasional rigors, but, he says, no night sweats. Pulse 108 ; tongue clean. At a consultation held upon this case, partial amputation of the foot was re¬ commended, but I preferred trying the effect of medicine in the first instance. Half an ounce of the liquid hydriodic acid was prescribed three times a day, and soon after the local application of the dilute muriatic acid was begun. In the course of three weeks the diseased bones were partially dissolved and sof¬ tened, but the fever did not abate, and the boy’s friends, apprehensive of an operation, had him removed frorn^ the house. Ann M‘Eachern, set. 27, March 16th : On left forearm are situated several ulcers, varying in diameter from half an inch to an inch and a half. The largest, situated on the anterior aspect, presents an indolent disc, covered with pale flab¬ by granulations. Edges are sharp, and slightly elevated. The others have thin slightly-livid margins, and are with¬ out any appearance of granulations : the discharge which issues from them concreting into yellowish green scabs. Through one, situated over lower third of ulna, probe passes, detecting rough bone, and in June last, a frag’ment of bone, about two inches in length, was discharged from this spot. Skin of nearly whole of forearm is altered in appearance, from the cicatrization of former ulcers. On left clavicle is a large narrow sore of a similar character, with large one on forearm. Those on the arm are of several years’ duration; that on the clavicle appeared about six weeks ago, from the bursting of a small abscess. Right knee-joint is somewhat swollen, swelling being soft and fluctuating, and presenting itself principally on either side of patellar ligament and tendon of rectus femoris. •Patella is raised from the condyles. Mo¬ tion of joint is unaffected, and disease is productive of little or no uneasiness. It appeared about a year ago, without evident cause. General health pretty good. Sum. ter indies lodid. Amyl. <ss. more soli to. March 31. — Iodine intermitted, on ac¬ count of slight febrile attack. Has since recommenced the use of it. Sores some¬ what better; ulna still bare. Ulnae adhib. Acid. Muriat. dilut. Cont. Iodin. April 28th.— Cured. Scrofulous Ulcers all over Body, with¬ out Diseased Bone. Jean Banks, set. 29. — On left arm are several ulcers, varying in size from ail inch to a few lines in diameter. The edges are thin and well defined ; dis- cba rge consists of thin pus, which con¬ cretes into dark greenish-coloured scabs. Integuments surrounding sores of a reddish hue; around left knee-joint are several sores of a similar character. Complains of occasional severe pain in sores, especially those on the leg. No diseased bone can be detected with the probe. Four years ago, sores of a simi¬ lar kind appeared on right ear and an- gde of jaw; they healed in about two months. Disease again broke out on nose, left cheek, arms, and legs, which places are completely covered with scars. Has undergone a variety of treatment ; general health somewhat affected. Ca¬ tamenia absent since attack. Sum. ter indies Acid. Hydriodic. ^ss. ex.haustu solutionis Amyli. Ulceribus adhib. Cataplasma et post. Ung. Ox. Hydr. rubr. February 28th. — Sumat. pnlv. Rhei c. Magnes. 3ij. March 27th. — Sores around knee-joint nearly healed, as well as those on arm. Soon after admission five front teeth of upper jaw were found to be loose, and there is now a discharge of matter from root of second incisor. The hydriodic acid frequently intermitted, on account of irritability of stomach. Extrahatur dens incisor. Repet. Acid. Hy dried, dosibus, 3ii. ter in¬ dies. April 12th. — Dismissed, cured. MR. BENNETT ON THE OTIC GANGLION. 47 Specific Ulcers. Under this indefinite title I do not comprehend the scrofulous and venereal ulcers which have already been spoken of; but certain anomalous forms of ulceration which seem to be dependent upon a defective state of the general function of assimilation, as they derive little benefit from mere local applica¬ tions, and can only be cured by remedies acting on the system at large. It was in the cure of such specific ulcers that the virtues of iodine were most signally displayed. John Balfour, ret. 20, weaver. Janu¬ ary 4th : On ulnar aspect of lower half of left fore-arm is a large irregular ul¬ cer, with slightly inverted edges, and an irritable surface. Discharge is thin, and occasionally tinged with blood. Surrounding integuments slightly dis¬ coloured. Sore commenced about four months ago, in the form of a few ecthy- matous pustules, which suppurated, burst, and ulcerated, and it has been spreading since by the formation of new pustules around margins. On legs and arms are a few patches of eight days’ standing, which have suppurated and scabbed, and seem to be disappearing. Had primary sores about two years ago, with sore throat some months after¬ wards, which was treated with mercury pushed to salivation. Has at present a muco-purulent discharge from the ure¬ thra, which he thinks is of two years’ duration. Sum. ter indies Iodid. Amyl. ^ss. more solito. Jan. 16th. — About one-half of sore has healed, and the rest looks very healthy. Bowels somewhat bound, and complains alittle of pain of belly. Sum. 01. Riein. 3SS. The sore healed completely not long after above report, when the treatment was altogether directed to the removal of the ecthymatous eruption, which jiroved very obstinate. Margaret M£Gillivray, set. 20, steam- loom weaver. March 1st : On middle and upper third of left leg, and occupy¬ ing outer and posterior aspects, are se¬ veral ulcers, varying from a quarter of an inch to fully an inch in diameter. They are somewhat irregular in form ; edges thick, white, and elevated, and their surface glassy. The upper one is deeper than the rest, probe passing into a small cavity in its centre for about half an inch ; surrounding skin of a livid hue. Sores commenced eight months ago, in leech-bites, which were irritated by the application of a blister. Denies ail constitutional taint. Cataplasm. Emoll. Sum. ter indies Iodid. Amyl. ^s. Adhibeatur ulceri- bus Ung. lodin. March 30th. — Ulcers cicatrized ra¬ pidly, and are now nearly healed. They have not, however, made any progress for the last ten days, during’ which iodide of starch has been disagreeing with stomach, and, in consequence, little used. Intermitt. Iodid. Amyl. Sum. Acid. Hydriod. 3ij. ter in dies more sol. April 9th. — Dismissed cured. Jean Macfarlane, set. 15, servant. April 13th : On inner side of right ankle joint is a patch of a honey-comb appearance, produced by an aggrega¬ tion of small ulcers, averaging about one line and a half in diameter. Inter¬ vening and surrounding skin is some¬ what red and swollen ; discs are indo¬ lent, shewing little disposition to gra¬ nulation, and their edges are thickened and slightly elevated. Appears to have had an attack of erysipelas about six months ago, giving rise to present affec¬ tion. Catapl. Emoll. 01. Riein. ^ss. April 16th. — Sumat ter indies Iodid. Amyl. 3SS. Curetur ulcus Ung. Nitr. Hydr. 27th. — Dismissed cured. [To be continued.] OTIC GANGLION. To the Editor of the Medical Gazette. Sir, I think it necessary to inform you, that since writing- the observations which appeared in your number for July 30, 1836, I have discovered the otic ganglion, small but distinct, in the dog. It has only been found once after many dissections, and may, therefore, be con¬ sidered of rare occurrence in that ani¬ mal. This circumstance renders it pro¬ bable that it may occasionally occur in 48 LIVING EARWIGS INFESTING THE ALIMENTARY CANAL. the cat, although my dissections hitherto have failed to demonstrate it. I am, sir, Your obedient servant, J. H. Bennett. Edinburgh, Sept. 10, 1S36. LIVING EARWIGS INFESTING THE ALIMENTARY CANAL. To the Editor of the Medical Gazette. Sir, As I have not seen on medical record an instance in which the common earwig was found to infest the intestine of a human being-, perhaps the following cases may be interesting- to your readers. Very faithfully yours, Wm. Griffin. 62, George-street, Limerick, Sept. 25, 1836. A young married woman had been complaining for some time of distress¬ ing headaches, for which I ordered her some purgative medicine. On my next visit she showed me an insect which she passed per anum. It was the common earwig-, and corresponded, in every par¬ ticular, with the characters assigned to the coleopterous insect of the genus Forficula. Dr. Pickells, many years since, related a very extraordinary case, in the Irish Transactions of the King and Queen’s College of Physicians, in which enormous progenies of apterous, dipterous, and coleopterous insects were discharged both by the mouth and anus, but he does not mention the common earwig among- them ; nor could I rea¬ dily bring myself to believe so formi¬ dable a little animal might infest the human intestine, without symptoms of greater distress and ill health than oc¬ curred in this woman’s case. She de¬ clared to me, however, that she found it alive in the vessel which she made use of on her bowels being moved, and that it was not in it before then. I or¬ dered her one or two doses of castor-oil and turpentine, with some relief to her head, but there was no further discharge of insects. Considerable doubt might be enter¬ tained as to the fact of the insect having been discharged per anum in this in¬ stance; and I should perhaps have thought lightly of it, had it not been for another case which my brother had been attending, and which I saw in the course of it, in consultation with him. The following* is a copy from his notes on the subject : — • James Naug'hten, a pale delicate- looking lad, 12 years of ag-e, w-as brought to the Dispensary, complaining of paroxysms of hysterical crying, w ith debility and loss of appetite. He was frequently attacked with severe fainting fits, which were often attended with spasms of an epileptic character. His tongue was whitish, pulse quick and weak, no thirst, his bowels quite free, and, according to the account of his parents, not suffering under any de¬ rail g-ement. The symptoms were at first attributed to general delicacy of habit, and he was ordered purgatives of calomel and jalap, and Epsom salts, W'ilh bitter infusion. These not appearing to serve him, the purgatives were repeated, followed by tonics. The same treatment was pur¬ sued, with some slight variety, for a month or six weeks, but without the least improvement. At this time his mother brought him to the Dispensary, and showed two in¬ sects, which, she said, the boy had draw'll from his throat with his fingers. They were of the coleopterous order, and, on examination, proved to be the common earwig. She said he had felt them running about his throat, and putting back two of his fingers, soon felt them passing round the ends of them ; he then watched for the moment when they ran between them, and drew them out. They were living-, and she described them as so swift that (to use her own words) “ nothing could catch them.” They died very speedily. She now said he was sometimes attacked with severe pain in the stomach and back of the neck, which he found much more violent than usual lately. He was immediately ordered half an ounce of the spirit of turpentine, in a draught with mucilage, with directions to give him a dose of castor-oil three or four hours after it. The next time he applied he ivas a good deal better, and, upon inquiry whether he had seen any more of the insects, he said, when the medicine operated, he had passed “ a hatful of them” all dead. Another dose, such as the former, with a course of tonics, entirely cured him. SURGICAL CASES ADMITTED INTO THE LIVERPOOL HOSPITAL. 40 A REPORT OF THE SURGICAL CASES ADMITTED INTO THE LIVERPOOL NOR¬ THERN HOSPITAL, From the 25th Avgust , 1835, to 25lh August, 1836. To the Editor of the Medical Gazette. Sir, In the sixteenth volume of the Medical Gazette, published in 1835, page 87, you inserted a report of the surgical cases admitted into the Northern Hospi¬ tal during the preceding year. Will you oblige me by admitting the report of the surgical cases for the last year, in an early number of your publication ? In the note accompanying* the last re¬ port I stated “ that it was in contem¬ plation to add thirty beds to the hospi¬ tal this has not yet been done ; conse¬ quently the number of beds remain the same, viz. thirty-seven. It will not be until October next that the hospital will be increased, when we shall be able to accommodate seventy -six patients. I remain, sir, Your obedient servant, John M. Banner. Liverpool, Sept. 13, 1836. Abscess of the knee-joint . 4 Aneurism, popliteal . 2 * - — of the aorta, ulcerating above the clavicle . 1 Ankle-joint, injury of . 5 Anthrax . * 1 Burns . 6 Caries, hones of the foot . 3 Concussion of the brain . .... 34 Compression of the brain . 3 Contusions of the hip . 8 - - back . 7 - knee . 6 - - - foot . 7 - arm and shoulder* ♦ 9 Dislocations of the shoulder . 7 - - clavicle . . ] . . . elbow, compound* • 1 - - - hip into the foramen ovale . 1 * - ankle . 2 - - - - compound ♦ • 2 Erysipelas . 5 Fistula in ano . 1 * . . . ■*- perineo . 1 Fracture of the skull, with compression 13 - without urgent symptoms 1 4G2. — xix. Fracture of humerus, simple . 4 - compound • * • • 3 - clavicle, simple . .5 - comminuted •••• 2 - - radius and ulna, simple •• 6 - - - compound 2 - - - ribs . 10 - with emphysema • • • • 4 - pelvis . . l - - femur, simple . 21 - comminuted . 2 - - tibia, simple . 3 - - compound . 1 • - - tibia and fibula, simple * • 13 - - - - compound 12 - fibula, with injury of ankle 5 - calcis, comminuted . 2 - metacarpal bones, &c. com¬ pound . 9 - toes* * * * . 2 - - cuboid bone, compound • • 1 - - patella . 3 - lower jaw . 2 - scapula (neck) . 1 - * - coracoid process of scapula 1 Gangrmna senilis . 1 Hernia . 5 - hum oralis . 1 Inflammation of the inner structure of large joints . 7 Iritis . 4 Perineum, laceration of . 1 Phlegmon and its terminations . 12 Polypus uteri . 1 Retention of urine . . . 2 Scirrhus mamma * * * . . ] Scalds . 2 Spine, injury of . 2 Suspended animation from immersion in water * * . . 7 Testicle, disease of . 2 Ulceration of the inner structure of large joints . 7 Ulcerated legs * * * * . 13 Veins, varicose . 2 Wounds . * . j 4 - of scalp . 12 — - — of cornea . 1 Total . 343 Nature of the Cases. It will be seen that there were — 247 accidents. 134 fractures ; 106 simple, 28 compound. 96 cases of disease. Result . Out of the whole number — 284 were cured. 4 dismissed incurable. 27 remain in the house. 28 died. E 50 MR. BANNER’S REPORT OF THE SURGICAL CASES Occupation. Of these eases there were — 136 labourers, porters, &c. 95 sailors. 53 masons, carpenters, &c. 59 women. Country. 156 English; 90 Irish; 38 Welsh; 18 Scotch; 17 Americans; 3 Germans; 2 Swedes; 2 Prussians; 1 Dane; 1 Maltese ; 13 unknown. 25 of the patients, when admitted with accidents, were in a state of intoxication. There have been 29 operations per¬ formed during the year : 11 amputations, 9 from accidents, and 2 from disease. The nature of the Accidents requiring Amputation. Case 1st. — A man was admitted with compound fracture of the tibia and fibula, a wound extending- into the ankle joint, with severe haemorrhage. On examin¬ ing the foot after amputation, we found the ends of the tibia and fibula fractured in seventeen places; the anterior and posterior tibial arteries were wounded. During the operation the patient was very faint; the arteries were secured, as we supposed, and the patient placed in bed. He had not been in bed many mi¬ nutes, when a severe haemorrhage took place; the tourniquet was immediately applied, the dressings removed, but no bleeding vessel could be seen; the tour¬ niquet was removed, and the haemorr¬ hage had ceased ; the artery was now compressed high up the thigh with the fingers, the pressure suddenly removed, and a large jet was observed from the posterior tibial artery, which was im¬ mediately secured. The operation was performed by candle-light. 2d. A pilot had his foot caught in a coil of rope, when his boat was sailing- very fast ; the foot was nearly torn off, there was severe laceration of the leg, and fractured tibia and fibula. 3d. A sailor fell from the main-mast, and produced a compound fracture of the humerus. The bone was much com¬ minuted, and there was a wound of the brachial artery : the fracture was close to the axilla. 4th. A plasterer fell from a roof, and produced a compound fracture of the tibia and fibula. Close to the knee- joint there was internal haemorrhage; the leg was much distended with blood, and quite cold; the swelling- extended above the knee-joint. A large quan¬ tity of blood was effused between the muscles and under the integuments. The anterior tibial artery was wounded. 5th. Is that of a sailor, who met with a similar accident to the last. In this case the fracture extended into the knee-joint, which was also filled with blood. 6th. A child seven years of age was leaning over the side of a flat, at the time another was passing’ : his arm w as caught betw een the two boats, and com¬ pletely smashed : it w as necessary to amputate close to the axilla. 7th. A Prussian sailor was carrying a heavy box: he let it fall, and with it was precipitated into the hold of the ship. He had injured his back and knee : there was effusion into the joint, and fracture of the fibula close to the knee. There was a clean wound over the cuboid bone, which could be felt fractured. The edges of the wound w-ere brought tog-ether with adhesive c5 t plaster. For ten days the patient went on well ; at the expiration of this time he complained of much pain in the foot, and exhibited symptoms of inflam¬ matory fever. There was a w-atery discharge from the w ound, which was offensive : the wound looked sloug’by. The tongue was furred, and he was delirious ; the pulse was quick and weak. In a few days a slough formed on the instep, and another over the inner ankle. The calf of the leg felt bag-g-y ; an opening was made into it, but without relief ; there was the same thin offensive discharge. The symp¬ toms became more aggravated ; the tongue was brown and dry; the pulse remarkably quick and feeble. He lay in a torpid state : he would not answer questions unless roused ; his breathing- was laborious ; lie had low muttering delirium ; there w7as little or no dis¬ charge from the foot; the sloughs had increased. A consultation was held, and it was thoug'ht that the patient was not in a fit state to Undergo amputation. On the following day the symptoms were evidently more unfavourable, and he appeared to be dying. The tongue was black and quite dry ; the voice weak, scarcely audible ; the countenance anxious; restlessness of the extremities; the skin dry and hot, which had been the case from the first appearance of slough ; the breathing w-as more diffi¬ cult, and the pulse wras more feeble and ADMITTED INTO THE LIVERPOOL NORTHERN HOSPITAL. 51 fluttering-. A consultation was held on this day. We agreed in thinking' that the patient could not long* continue in the state he was in; and although we thought that the patient might sink under amputation, yet we agreed in thinking that it gave him the only chance. The friends consented, and the leg was removed. Very little blood was lost during the operation, which was performed close to the patient’s bed. He suffered less than might have been conceived, and did not faint: he suffered more in the removal from and to his bed, than from the operation. Tn twenty- four hours the tongue became moist, the pulse much reduced in frequency, and the countenance more tranquil, and he slept. It is unnecessary to follow this case throughout the cure: it is sufficient to state, that he rapidly lost all his unpleasant symptoms, his health improved quickly, the stump healed kindly; and in five weeks he left the hospital well. 8th. Was a compound fracture of the tibia, near the ankle joint, and fracture of the fibula at its upper third. The patient had been a hard drinker, and was admitted in an intoxicated state. The leg was placed in a junk: he ap¬ peared to do well for two days, when delirium tremens came on; this was con¬ siderably increased by the circumstance of a rat falling* through the ventilator, which was situated over his head : it so alarmed him, that the idea of his being- devoured by rats could not be got rid of for three days. By the use of opium and stimulants this affection left him. On the eighth day he was attacked with traumatic delirium: he had violent spasms of the muscles of the extremities and face: this tetanic affection increased, and it was thought proper to perform amputation. When the spasmodic symp¬ toms subsided, he was occasionally af¬ fected with delirium. The stump was an unhealthy one ; he gradually became w eaker ; and on the tenth day after amputation died. On examining the leg, after the operation, the fibula was found fractured very obliquely, and the muscles in the neighbourhood of the fracture were dark-coloured and much torn : this probably arose from the rest¬ lessness of the patient, and from the spasmodic action. It will be seen, by the list of cases, that there have been eight burns and scalds admitted : three of these died ; tw'o severe burns, and one scald, which was accompanied with nervous delirium. Out of the fourteen cases of fractured skulls, ten died, each within two hours of their admission ; most of them in a shorter time. The trephine was not used in any of the cases. On dissection there was found in eight of the cases fracture through the base of the skull, and in all of them laceration of the brain. There was only one case with¬ out urgent symptoms : here there was scalp wound, with fracture of parietal bone : slight exfoliation took place in this case, and the patient got well. In the other three cases there was concus¬ sion of the brain : these got well. One of the three cases was attended with more interest than the others, and I w ill relate it. 9th. James Hay, set. 35, a sailor, was admitted on the 11th September, 1835. He had fallen from the mast of his vessel. He was insensible at the time of his admission. There was great tu¬ mefaction over the right temporal and part of the parietal bones. The right eye, and its surrounding cellular mem¬ brane, was much eccbymosed ; the lower extremities were cold, and there w as con¬ siderable haemorrhage from the mouth : this was much increased by a cough which occasionally affected him : the pulse wras very low and weak ; he had not vomited. Warmth was applied to the extremities, leeches to the temples, and cold to the head. By speaking loudly to him he would rouse, but what he said was quite incoherent. This state of insensibility lasted four days, when he could be more easily roused, though little better understood. He fre¬ quently applied his hand to his right ear, and also to his side, which was ex¬ amined, and the fourth rib w'as found to be fractured. On the fifth day he com¬ plained of pain in the right ear and temple, of numbness of the right side of the face ; he had difficulty in putting out his tong*ue, and experienced diffi¬ culty in deglutition ; this appeared to arise from pain. He had had a tur¬ pentine enema administered two or three times a day; leeches were daily applied to the head, and the cold had been con¬ tinued. He had continued to part with blood from the mouth, until the fourth day, w hen lie expectorated large quan¬ tities of pus. The tumefaction had now 52 CASE OF LATERAL DISLOCATION OF THE KNEE-JOINT. nearly subsided, and a fracture, with slight depression of the upper part of the temporal and lower part of the pa¬ rietal bones, was very perceptible ; the ecchymosis had also subsided in the eye¬ lid : the pupil of the right eye was found much dilated, that of the left con¬ tracted. On the application of light, there was not any action of the right pupil: the lid was paralysed. The ex¬ pectoration of pus continued for a fort¬ night, and then ceased ; the pain in the head gradually diminished, and the numbness of the face was very slight. He could swallow with ease ; his me¬ mory was perfect, and he was perfectly sensible; the pupil remained dilated, and the lid remained paralysed. This was the state of the patient five weeks after the accident, at which time he was obliged to join his ship. August 27, 1836. — It is now a year since the above accident took place, and on this day Hay called to see me : he had been a voyage to the East Indies. The depression of bone was more per¬ ceptible, and the right side of the head looked quit£ flat; the pupil of the right eye was much more dilated than the left, but acted freely on the application ©flight. There was still slight para¬ lysis of the lid; he stated that he had had pain in the right side of the head, and in the right ear, particularly in changes of the weather; and occasion¬ ally the imperfection of the vision of the right eye was increased. These symp¬ toms had gradually got less, and at this time he felt little or no inconvenience from the accident. Out of the 34 cases of concussion of the brain, one died. In this case the symptoms rapidly ran on to those of compression. On examining the head, laceration of the anterior lobe of the brain was discovered. In the two cases of popliteal aneu¬ rism which were operated on, the liga¬ tures came away on the 16th and 18th days. In one of the cases the patient had been cured by an operation for popliteal aneurism on the opposite leg, fifteen months before. When he was admitted into the hospital the first time, it was thought that there was disease throughout the arterial system. He re¬ covered well after both operations, and is again following his employment as an engineer. The polypus uteri was excised ; it was very large; its neck was thicker than a man’s thumb ; there was not any haemorrhage, and in a few days the woman left the hospital well. Of the five cases of hernia, four were reduced ; one (femoral) was operated on. The scirrhous mamma was removed in December 1835. The whole breast was removed; the wound soon healed, and the patient left the hospital. A few days since she returned, complaining’ of the symptoms usually attendant on scirrhus pylori; she also complained of pain in some enlarged glands in the neighbourhood of the cicatrix. In one of the cases of scirrhous mam¬ ma which was operated on last year, the woman returned in the course of eight months with jaundice; she com¬ plained of pain in the region of the liver, and of excessive debility. In two weeks after her admission she died. On dissection we found scirrhous liver, scir¬ rhous mesentery, and the commencement of scirrhous uterus. The twenty-nine cases that were ope¬ rated on did well, with the exception of two; one of which w-as the case of am¬ putation for traumatic delirium ; the other was a man who was attacked with peritoneal inflammation after amputa¬ tion. CASE OF LATERAL DISLOCATION OF THE KNEE JOINT. To the Editor of the Medical Gazette. Sir, Enclosed T have forwarded the parti¬ culars of a case of lateral dislocation of the knee-joint, being- rather an uncom¬ mon accident : I beg you will give it in¬ sertion at your earliest convenience. The man was a patient of Mr. Andrews, and being one of the house surgeons, the case came under my immediate notice. — I am, sir, Your obedient servant, J. B. Samuel. Vauxhall, Sept. 27, 1836. Henry Culpit, set. 30, farrier, was riding a horse home from his employer’s on the 22d last month, when the animal became restive, and in rearing, fell, the man being under: he was immediately brought to the London Hospital, w hen he was found to have sustained the above-named injury. The external con¬ dyle of the femur occupied the inner ANOMALOUS SPECIMEN OF DIABETIC URINE. 53 articulating* surface of the tibia, the other forming a considerable projection on the inner side of the knee; there was slight flexion of the leg, with eversion of the foot. Mr. Palmer and myself, the bouse surgeons for the week, by making extension and counter-exten- cj # sion, easily succeeded in reducing* it. The limb was afterwards placed on pil¬ lows. It is almost unnecessary to add that it was followed by immense swell¬ ing* of the joint, which required the repeated application of leeches, warm fomentations, &c\, under the use of which it rapidly subsided. There was no constitutional disturbance. ANALYSIS OF AN ANOMALOUS SPECIMEN OF DIABETIC URINE. To the Editor of the Medical Gazette. Sir, Should the following observations be considered worthy of notice, you will oblige me by inserting them in your Gazette. — I am, sir, Your obedient servant, G. O. Rees. bO, Guilford- Street, Russell-Square, Oct. b , 1836. A specimen of urine, supposed to be that of a diabetic patient, was lately sent me for examination by my friend Mr. Ed inborough. On taking the spe¬ cific gravity of the fluid, I was surprised to find-that it was far beloiv the healthy standard, being* only 1008. I was induced to make a particular examination of this specimen, in order to ascertain in which of the solid ingre¬ dients of the urine this deficiency oc¬ curred ; or whether the low specific gra¬ vity was caused by a dilution of the secretion, while it retained its solid in¬ gredients in normal proportion. I subjoin the result of analysis, as procured from 1000 grains : — Water . 985 0 Urea . 10 2 Extractive soluble in water, I not soluble in alcohol — am > 0*9 moniacal salts . ) Alkaline salts • • • * . 3*5 Earthy ditto . 0*4 Traces of lithic acid and vesical mucus. 1000 0 The constitution of healthy urine may be rep resell ted by the same formula, as follows : — Water . 933*0 Urea . 30-1 Extractive soluble in wrater, 1 and extractive soluble in al- f jg ^ coliol and water — ammo- f niacal salts . . . j Alkaline salts . 16 0 Earthy salts . 10 Lithic acid and vesical mucus* • 1*0 10000 It w ill be remarked on examining* these analyses, that the diseased speci¬ men is entirely wanting in the extrac¬ tive soluble in alcohol and water, and that the extractive soluble in water only, is in very small proportion. The urea, if taken in relative quantity to the solid constituents of the diseased urine, will be seen to exceed by far the proportion which that principle bears to the quan¬ tity of solid matter in the healthy fluid. The proportion of alkaline salts, if taken in relation to the propor¬ tion of solid matter, will be nearly normal. Th is diseased specimen is therefore to be regarded as a dilute urine, in which the urea has entirely supplied the place of the extractive soluble in alcohol and water; and, in part, that soluble in wa¬ ter only. The urea obtained during this examination was so pure, that it crystallized from the first alcoholic solution in perfectly white four-sided prisms. The proportion of solid matter in healthy urine is 67 grs. in 1000 grs. 30*1 (or less than half) being* urea, The solid matter of the diseased speci¬ men under consideration forms 15 grs. only, in the 1000 grs., 10*2 (or more than two-thirds) being urea. This diseased condition of urine is nearly allied to that mentioned by Dr. Prout in his work on the Urine, &c. ; differing only in possessing a very light specific gravity. I am not aware that the entire absence of the extractive so¬ luble in alcohol and water has ever, till now, been shewn in the analysis of dis¬ eased urine. 54 EXTRAORDINARY VERDICT OF A CORONEr’s JURY. EXTRAORDINARY VERDICT OF A CORONER’S JURY, IN A CASE OF SUSPECTED POISONING. To the Editor of the Medical Gazette. Sir, Having just perused the leading* arti¬ cle in your number for the 13th instant, T am induced to send you the following* account of an occurrence which came under my observation in this neighbour¬ hood. If it possesses no other value, it will at least prove that there is urgent necessity for the community and the legislature to view with suspicion and distrust the published reports of co¬ roners ; and that it is incumbent on them to demand an increased efficiency from these persons, as well as the medi¬ cal witnesses, in the discharge of their important duties. On the 28th of last June a surgeon of this place was requested to accompany a medical man, to examine the body of a servant girl, 16 years of age, who had died under suspicious circumstances. The previous evening she retired to bed in perfect health and excellent spirits, about ten o’clock, after making a supper of boiled milk. She was said to have been unusually cheerful in the evening*, and had been dancing. About twelve o’clock her mistress was disturbed by her moans, and noise produced by vo¬ miting, and went to her assistance. She was vomiting, and appeared very faint, and said she suffered severe pain at the pit of the stomach. She was conveyed to a window, and being some¬ what refreshed, back again to bed, — grew worse and worse, and died, in the arms of her mistress, about four o’clock, before medical assistance could be ob¬ tained. The stomach, with its contents, was removed ; the former presented such decided characters of the effects of arsenic, that any one having an eye practised in the morbid appearances produced by this poison, would have drawn that conclusion; and this was declared by one who saw it, without any acquaintance with the history of the case. The tests for arsenic in the hands of these medical men, — the gentleman who made the cadaveric inspection, and two others to whom he had given por¬ tions of the contents of the stomach, — were perfectly satisfactory. From the sulpburet of arsenic obtained, splendid coatings of the metal were procured, and from this, brilliant crystals of arse- nious acid. From the quarter of a grain of arseniuret of copper I succeeded in deriving a sufficient number of crys¬ tals to form a conclusive opinion of the presence of the poison. The fact of the presence of arsenic was made known by the surgeon before mentioned to the coroner, — a non -pro¬ fessional individual, but one who has long held the office, — who expressed great dissatisfaction to him on account of his having presumed to examine the body before the inquest had been held, — became extremely indignant, — assert¬ ed that he wras liable to an action for daring*, without his authority, to exa¬ mine the body,— and so on. At the inquest, this individual, from whose lips the coroner had heard, as a positive certainty, that the poor girl was destroyed by arsenic, was not called ; and from the (I suppose) coro¬ ner’s account, which appeared in the Stamford Mercury, which I shall ex¬ tract, it is probable that the jury were kept in complete ignorance of it. Extract from the Stamford Mercury of July 8, 1836. “ On Thursday, the 30th ult., an in¬ quest was held at Swinethorp, before ft. Bunyan, gent., coroner, on the body of Sarah Maltby, aged 16, who died suddenly, on the Tuesday morning previous. It appeared that the deceased was servant to Mr. Bottomlev, and had retired to rest in apparent good health. At about 12 o’clock she w*as seized w ith a violent pain in her stomach ; her mis¬ tress got up, and took her to the win¬ dow*, and, after remaining there for some time, she somewhat recovered, and again retired to rest ; but, about four o’clock in the morning, she was found dead in bed. Verdict — ‘ Died sud¬ denly.’ ” I shall not encroach upon your useful time, sir, by making any comment upon the inaccuracies of the statement of the circumstances which is placed before the public ; the object is percep¬ tible. — I am, sir, Your obedient servant, Indicator. London, Aug. 20, 1836. HOMOEOPATHY AND ITS LATE DOINGS. 55- ANALYSES and NOTTCESof BOOKS. u L’Auteur se tue a allonger ce que le lecteur se tue a iibieger.” — D’Alembert. The Botanist ; containing accurately coloured Figures of tender and hardy Ornamental Plants, ivitli Descrip¬ tions. Conducted by B. Maund, F,L S., assisted by Professor Hen- slow. 4to. To be continued Monthly. No. T. Since botany, which, as some are of opinion, never should have been di¬ vorced from medicine, of which it has been aptly styled “the hand-maid,” has been again included in the curriculum of medical education in this country, various works have appeared, calcu¬ lated to assist the student in acquir¬ ing- a knowledge of the principles of the science. Something- was still want¬ ing-, which, by appealing to the cor¬ poreal as well as the mental eye, should take captive, as it were, two senses at once, and so ensure the entrance of knowledge hy two loop¬ holes. A work with pictorial illustra¬ tions could alone do this. Such a one appears likely to be supplied by that of which we have copied the title above. A good introductory notice explains the nature of the assistance it is calculated to afford ; the plates are well engraved, and most exquisitely coloured, while the descriptive letter-press conveys much scientific and popular information respecting the plants delineated. The great peculiarity of this work seems to be, that the objects figured are not, as in other works, regarded as isolated in¬ dividuals, but as members of the vege¬ table kingdom, having- affinities to other individuals. It therefore leads to the consideration of the principles of the natural method of botany, and induces the reader to take comprehensive views of the plants which come before him, in respect to their organization and physiology. On this account, medical students are likely to feel more interest¬ ed in it, and it will constitute a valuable companion for them, when pursuing their studies, and a pleasing manual to refer to when settled in practice, and residing, as many will be, if not altoge¬ ther in the country, at least in houses with gardens attached, where, dur¬ ing their hours of leisure, they may enjoy a delightful recreation in the cul¬ tivation of many of the elegant pro¬ ductions of nature, of which they might, perhaps, never have heard, but for such a work as this ; the cheapness of which puts it within the reach of every one. To such of our readers as already possess a taste for botany, no further recommendation is necessary ; while, for those who are yet unacquaint¬ ed with it, we do not know any work better calculated to inspire a love for it, and gratify it when awakened. | MEDICAL GAZETTE. Saturday , October 8, 1836. ** Licet omnibus, licet etiam ntihi, dignitatem Artis Medicos tueri ; potestas modo veniendi in publicum sit, dicendi periculum non reeuso.” ■Cicero. HOMCEOPATHY AND ITS LATE DOINGS. The death of Malibrau, lamented as it is by the community at large, and as it must be by a great portion of the civi¬ lized world, has pjroved, it would seem, rather a God-send to a small knot of ignorant but mischievous pretenders: mem by whom any kind of notice, even though originating in a calamity itself, must be esteemed as a positive benefit. The disaster to which we regret to have to allude has conferred a transient noto¬ riety, however unenviable, on the homceo- patliic practices; audit was amerechance that it did not do more. Homoeopathy wanted but another step to put it on a footing with the hygeian quackery — the publicity of a coroner's inquest ; a distinction which it had just now nearly obtained. We do not mean to impugn the judg¬ ment of those gentlemen — the commit¬ tee at Manchester — who decided that an inquest in Madame Malibran’s case would have been improper, or might fairly be dispensed with. But we ob¬ ject to such a decision in the abstract: 56 HOMOEOPATHY AND ITS LATE DOINGS. strict justice would demand, that if the Morisoniafi manslaughters be exposed and punished as they deserve, the Hah- nemannian doing’s, which also deal in¬ sidiously and destructively with human life, should certainly not be screened. Some gentle reader may, perhaps, suppose that we are too severe on the disciples of Hahnemann : that, at the worst, they are but harmless quacks; and that their doses being' infinitely small, are capable, accordingly, of doing infinitely little mischief. We deny the inference, and must insist on the cor¬ rectness of our principle. The doses, we will suppose for argument sake, are in themselves perfectly innocuous ; yet such doses, when given at a moment when energ'etic practice is required, are fraught with dang’er ; and when an ig¬ norant practitioner, professing homoeo¬ pathy, rashly takes upon him the re¬ sponsibility of a critical case, Hinging away the moments that are most pre¬ cious, and on the right employment of which the balance of life or death turns, we say that such a practitioner is guilty of a great crime, and merits the sternest visitation of the law. In acute disease, and cases similar to that of the unfortu¬ nate Malibran, the expecting practice, as it has been called, or the “ leaving all to nature” — even if homoeopathy were as harmless as that — wTere to throw over¬ board our helm, sheet anchor, and all that might contribute to our safety, and to trust to the mercies of a provi¬ dence that ever frowns on the inactive. In the most stupidly savage state of society, nothing more barbarous could be done. When the means of depletion, or lowering the system, on the one hand, or those of stimulating it, on the other, offer the only hope of preserva¬ tion, homoeopathy — taking even the most favourable view of it — sits still and does nothing, — while it promises as much as, nay, more than, if the rules of art, de¬ rived from the soundest experience, were duly put in practice. But homoeopathy does not even pos-, sess this negative quality on which to rest its defence. It plays upon the imagination of its dupes: it works upon them by certain pretended latent affini¬ ties, as Mesmerism used to do in the golden days of animal magnetism : and in this employment of a powerful in¬ strument, for good or evil, it but too of¬ ten operates mischievously on suscepti¬ ble constitutions. It may happen, by its intrinsic inertness, to do no harm, but the chances are almost wholly against such a result. Here, then, is a system, pretending to belong to medicine, to be itself medi¬ cine re-organized and reformed — yet playing in the dark, practising secretly, and now and then vaunting of the in¬ effable virtues of imperceptible particles of matter. How long is medical science, extended and enlightened as it has been of late years, to afford the passport of its name to audacious adventurers thus using' it for the vilest purposes ? And will a community, ever professing* to enjoy the benefits of diffused informa¬ tion, always remain blind to such palpa¬ ble fraud ? It will, no doubt, be said by some of the brazen impostors who support the scheme, that all this is set forth in igno¬ rance : that Hahnemannism has not got O fair play: that prejudice is strong against it, and it has never obtained a trial. This is all false : the system (sys¬ tem !) is perfectly well known as far as it is intelligible : its principles (!) are as thoroughly understood by the gene¬ rality of well-informed medical men, as by the homoeopaths themselves : but what is better still, the fruits of the sys¬ tem, as they occasionally come before the public, are closely observed and ap * predated. Hare they deny, too, that they have had fair trial — when, not to HOMOEOPATHY AND ITS LATE DOINGS. 57 speak of others, Andral, in the largest and best appointed hospital in the French metropolis, afforded every oppor¬ tunity to the cleverest of the homoeopaths, and found that they failed to make good their pretensions P But what right have they, we would ask, to claim such an indulgence ? What have they done to entitle them to so much confidence as to have the lives of patients committed to them for ex¬ periment? Let them give us the gua¬ rantee of even one physician of emi¬ nence, who will assure us that we can conscientiously trust to Hahneman- nism in any one case. They have no such surety to offer. Yet here have these medical St. Simonians been for years endeavouring to make a stand, and have produced, after all, nothing better than their Belluomini (by importation), and their Quin : we had almost for¬ gotten — their Uwins, save the mark ! When we inquire for their literature, — their knights of the pen — we find their champion in the person of a wor¬ thy son of the church, whose talent for invective and the misapplication of texts of scripture, forms his chief claim to public attention. We have had a specimen of him, and can truly say that we congratulate Habnemannism on the possession of such a mild, meek, dis¬ creet, and sagacious partisan. There have been others also, who, like Dr. Uwins, have favoured the world with a silly pamphlet, or a set of apocryphal cases, from time to time ; hut they have all long since gone down the channel into the sentina of oblivion ! And these are the creatures that talk of the envy and prejudice of the medi¬ cal profession, and who call for a fair trial. It is likely they will have this ; perhaps sooner than they could wish. Let them only get possession of another case like the recent one — let the treatment be, as much as possible, like that applied to the unfortunate Malibran — let the remedies be kept se¬ cret, and the assistance of eminent practitioners be declined — let only this be done — the catastrophe will be certain, — and we shall warrant them publicity enough. The public will have a right to learn then, who are they that, under the g*uise of authorized practitioners, tamper with the lives of the liege sub¬ jects; and the coroner will take care to investigate the matter fully. Nor will it serve the turn of those who may them shrink from the consequences of their doings, to induce the nearest relative of the deceased to quit the kingdom, and to enjoin that the body shall not be meddled with — save for the purpose of burying it with all privacy and despatch. Such things as these cannot again occur. Homoeopathy must have a trial; it must have, it has a right to have, the same publicity and attention as has been bestowed on its rival system — that of Morison. Since the preceding remarks were written, a letter from M. Belluomini, the homoeopath who attended Madame Malibran in her fatal illness, has ap¬ peared in the newspapers. The Doctor, among' other weak and silly things, says, that after a careful examination, he found that “ the viscera of the chest and abdomen had not been attacked with malady,” — and yet that “ the first effect of the medicines was to allay the cough a little and again, that “ some hours after, the fever increased, and the cough and delirium returned.” We should infer from his account (and un¬ fortunately we have no other) that the ill-fated lady had inflammation of the chest, and was suffered to die homce op at hie ally . Dr. B., we should further observe, carefully concealing his treatment, says, “ I immediately set to work to administer to the patient those remedies which I thought desira¬ ble ;” but not a word as to what they 58 'ACCIDENTS IN MINES. were. He did not wish to meet the highly respectable medical men pre¬ viously in attendance : “ I do not think it necessary,” was his answer on being asked to do so ! So much for homoeopathy, and its fair and open dealings. AMOUNT or FEES AT DIFFERENT MEDICAL SCHOOLS. From the note which follows, it will be seen that some gentlemen have mis- tmderstood the table of fees inserted at page 26 of our last number. We did not compare the amount charged at different schools for the shortest period which will enable a pupil to apply for ■examination at the College of Surgeons or Society of Apothecaries, but our calculation referred to unlimited attend¬ ance, because we knew that the great majority of pupils take perpetual tickets for most, of the courses, viz. Anatomy, Medicine, Surgery, and Midwifery ; and we therefore thought that the most useful table to them would be one show¬ ing the expense of unlimited attendance on all the lectures entering into the curricula of the Corporate Bodies. But if, instead of taking perpetual tickets, they confine themselves to the courses absolutely required, then the amount will be somewhat less than in our table. Thus, as stated by Mr. Bayntin, at St. Bartholomew’s Hospital, it becomes reduced to 57 /. 155.; and we may add, that at Guy’s the reduction is to 56/. 145. ; at London Hospital, to 50/. ; at St. George’s, to 49 guineas ; the Aldersgate School, 35 guineas, &c. &c. Our object was to refute the misre¬ presentations in the Lancet, as to the alleged cheapness of University Col¬ lege, which we demonstrated unan¬ swerably to be by much the dearest school in Loudon. According to the present calculation (*. e. of the expense of those lectures merely which the cor¬ porate bodies require), the amount is not less than 67/. 125. to pupils 'who have not a nomination, and 63/. 25. to those who have. But for Mr. Wakley’s advocacy, this disparity might have escaped notice : so much for having an indiscreet friend ! To the Editor of the Medical Gazette. Sir, In the tabular view of the Amount of Fees at the different Schools for attend¬ ance on the Lectures required by the College of Surgeons and Society of Apothecaries, you have stated the amount of fees at the Medical School of St. Bartholomew’s Hospital to be 65/. 25. ; whereas by the Prospectus of the School it appears that the total expense for the above purposes is 57/. 155. As this inaccuracy is likely to mislead, 1 write to request that you will correct it in your next number. — I am, sir, Your obedient servant, W. J. Bayntin, Curator of the Museum. St. Bartholomew’s Hospital, Oct. 6, 1836. ACCIDENTS IN MINES, FROM EXPLOSIONS OF FIRE-DAMP. The public attention is eyer and anon painfully called to this subject ; yet it is surprising with how little effect. No steps are taken by government for af¬ fording protection from the frequent loss of life which occurs in the coal districts, nor do the mine-ow'ners profit in the least by the sad experience they ob¬ tain so constantly, of the inefficient means which they have hitherto em¬ ployed for preventing accidents. Only last week a fresh explosion of fire-damp destroyed eleven persons, at Newxastle- under-Line, where the work w'as being carried on with common candles : the verdict of the coroner’s jury was, “Acci¬ dental death,” How that can be called accident , of which the probabilities are so manifest, is to us an enigma. It is nearly a year since wre made some remarks on this subject, suggest¬ ing that a regvilarly organized board of visitors, or commissioners, appointed at the Home Office, should superintend the safety of the mining districts; and we insisted on the speedy adoption of those lamps which had been proved to be per¬ fectly secure. The government has re-- PROJECTED POOR-LAW CLUB AT CAMBERWELL. 59 mained supine in the matter, notwith¬ standing- the strong- representations con¬ tained in the Report of the Parliamen¬ tary Committee: but we are glad to find that a proper spirit has begun to prevail, touching the necessity of guarding more effectually against the explosive gases met with in the collieries. The insecurity of the Davy-lamp in currents of inflammable air (the very emergency in which its services would be most needed), has been demonstrated to the conviction even of the most incredu¬ lous ; and the superior merits of that lamp which stood every test and ordeal to which it was submitted, in presence of the Parliamentary Committee — wre mean that of Messrs. Upton and Ro¬ berts — are now almost universally ac¬ knowledged. We have derived much satisfaction from the perusal of the subjoined letter from Dr. l ife, of Newcastle: it will be recollected that this gentleman, last year, wrote a pamphlet on the fatal ac¬ cident which had shortly before occurred at Walsall, and by which above 100 lives were lost in a moment*. Among the preventives which he then suggest¬ ed, the construction of perfect Davy- lamps was dwelt on as of paramount importance. Dr. Fife, at that time, im¬ plicitly believed in the perfection of the Davy, if it were only properly made and duly attended to. He even challenged the statement of any well-authenticated case tending to invalidate his opinion. Let us now see his present impressions as expressed in the following letter to the Editor of the Newcastle Journal. We have only to add, that we think the Doc¬ tor’s candour does him great credit: — In reading the Courant of the 3d inst., my attention was arrested by the sub¬ joined passage in the report of the “ Natu¬ ral History Society,” read at its seventh anniversary meeting. The report con¬ cluded by enumerating the papers which had been read at the several meetings dur¬ ing the year, and the investigation which had been made of the Minhig Gas in this district, in consequence of its having been alleged to be of so highly explosive a nature as that the Davy Lamp was not a sufficient protection against it. The re¬ sult of the examination was, “that no free hydrogen was found, or any other highly explosive gas, against which the lamp in question was not a sufficient protection.” To the last sentence of the above extract I shall at present confine myself. As to the constitution and properties of the gas met with in our mines, I believe these were perfectly analysed and as thoroughly un¬ derstood by the illustrious Davy as by any modern chemist ; consequently the non¬ existence of free hydrogen cannot be regarded as a new discovery. Again, as to the high or low explosive power of any gas of our mines, I believe he was also fully aware that the explosive or detonat¬ ing power existed only when such gas was diluted to a certain point with atmosphe¬ ric air, and that when the dilution was either above or below such point, that eminent man knew', though inflammable, the mixture would not explode. He was also aware that a certain degree of at¬ mospheric pressure wras essential to deto¬ nation. I come now to the most im¬ portant part of the extract, viz. the asser¬ tion “ that no gas existed in mines against w'hieh the Davy Lamp was not a sufficient protection.” Had this statement been made prior to the publication of the evi¬ dence taken and the experiments made before the parliamentary committee “ on accidents iu mines,” I should have been less surprised ; as it is, I am at a loss to conceive upon wrhat grounds any scientific body could advance such a statement, as the fallacy of the Davy Lamp is by that evidence and those experiments fully esta¬ blished. At the time of the parliamentary investigation, no one could believe more firmly in the security of the Davy Lamp than I did; I am now, however, not only from the testimony of practical miners and the experiments of scientific chemists, but also from the repetition of those experi¬ ments myself, fully convinced of my error, and conceive it to be my duty to endea¬ vour to correct the propagation of an un¬ founded assertion, the only tendency of which would be to give unwarrantable confidence to the miner, and possibly lead to farther sacrifice of valuable lives. George Fife, M.D. Eldon-Square, Sept. 15, 1836. PROJECTED POOR LAW CLUB AT CAMBERWELL. To the Editor of the Medical Gazette . Sir, From the great impartiality with which your journal is conducted, I am induced to send you a few lines respecting the medi¬ cal club intended to be formed in the parish of Cambenvell. According to the Poor Law Amendment Act, no further medical relief w ill be given * See Medical Gazette, vol. xvii. p. 146. 60 NEW FARTHING CLUB ; OR to the poor of this parish after the 25th of March next, (except in the workhouse) : to avert the evils of such a measure, it was recommended by the Board of Guardians, that an independent medical club be form¬ ed to attend the poorer classes, for such small sums as they, with the annual sub¬ scriptions, might be able to afford. With this object in view, a meeting of the resi¬ dent practitioners was called, in order to make rules for carrying it into effect, and to divide the parish into districts, leaving the poor the option of selecting any one of the medical men of the district to attend them, upon subscribing a small sum to the club, which sum was to be paid whether ill or well, the scale of charges varying ac¬ cording to the number of the family. Judge, then, of the surprise, not to say indigna¬ tion, of the resident medical practitioners who were favourable to the measure, upon entering the room, to find it occupied almost entirely by medical men collected from different parts, the majority having no connexion whatever with Camberwell, and whose avowed object was a determina¬ tion, as one of them expressed it, to crush the measure ; applying to those who were willing to lend their support, terms of no measured censure, and making up by cla¬ mour what they were deficient in argu¬ ment; in fact there was not a single argu¬ ment against the principle * the only word that could be heard ‘ ever and anon 5 above the din and confusion that prevailed, were black sheep, degrading y lowering the dignity and honour of the^ profession ; and some gentleman went so far as to talk of post¬ ing the names of all who were favourable to the measure ; no doubt, in order that “ we petty men should walk under his huge legs to find ourselves dishonourable graves,” and with a view that we might be denounced by our brother practitioners. After witnessing such a scene as this, pray spare us from hearing any more of the cant about the liberality and honour of the profession. In conclusion, allow me to transmit the names of those who “(to their praise be it spoken)” are willing to lend their assistance to the much abused medi¬ cal club. Practitioners favourable to the forming of the Club. Mr. Bean, Mr. Wm. Bean, Mr. Tobias Browne, Mr. John Browne, Mr. Forbes, Mr. Flower, Mr. Hughes, Mr. King, and Mr. Young. Unfavourable. Mr. Bowen, Mr. Bristowe, Mr. Massey, and Mr. Scrimshire. It is proper to state that I confine my¬ self to the Cambemoell district, leaving out the Peckhum and Dulwich districts; also the Walworth, Blackfriars’ Road, London Road, Kent Road, Trinity Street, Union Street, Blackman Street, and Newington, thinking it absurd to suppose that any of the medical men residing in the omitted districts would be appointed to attend the Camberwell district. In order to guard against any misappre¬ hension, I beg to observe that the names stated as favourable, are those given in to the Guardians, as fully agreeing to the principle; and it was their intention to have made some required alterations in the scale of remuneration, as well as to have excluded domestic servants in situation, and to have reduced the scale of eligible members, from those receiving 35s. a week down to 25s. Other alterations, especially that regarding midwifery cases, were in contemplation to be proposed at the very meeting when the operation of crushing was so powerfully applied to the system by the practitioners of Walworth and neighbour¬ hood. After this plain statement, I confess that notwithstanding all that has yet been said or written on the subject, I cannot see why the medical men of Camberwell should allow themselves to be dictated to by those in no way connected with the Camberwell district, and suffer them to decide the question whether it is expedient to form a Medical Club or not. I trust the medical men of Camberwell will assert their independence by deciding this ques¬ tion for themselves. By inserting these remarks, you will greatly oblige A Camberwell Practitioner. Oct. 3, 1836. NEW FARTHING CLUB; OR ME¬ TROPOLITAN INFINITESIMAL DISPENSARY. ( From the Medico- Ch'rurgical Review .) A prospectus of this important institution has just reached us. It is to be under the direct patronage of a Prince of the Blood, a distinguished Earl, and many of the nobility and gentry. Its own merits, however, will insure it universal approba¬ tion and support. The superintendence of the Dispensary is placed in the hands of four of the most experienced homcepa- thists of this country. It is on a plan so much superior to the penny-clubs now spreading over the country, that it will soon supersede them all. The subscrip¬ tion is to be only one farthing per head per annum ! We may calculate that, taking the rich with the poor, there is an expen¬ diture, in London, of twenty shillings per METROPOLITAN INFINITESIMAL DISPENSARY. 61 head, on medical attendance and medicines — and as the Metropolitan Dispensary will do away entirely with the heavy fees and long bill of physicians, surgeons, (except¬ ing for operations), apothecaries, and che¬ mists, the saving to the public of this capital will be more than a million an¬ nually ! ! There can be no doubt that the whole population will subscribe at once ; but, under such patronage, a charter of in¬ corporation will certainly be obtained next session, and thus its success will be secure. Four homoeopathic laboratories are to be established, namely, at the Chelsea Water Works, on Primrose Hill — at the New River Head — at South Lambeth — and at Hampstead. From these sources infinitesimal doses of the choicest ho¬ moeopathic remedies will be daily issued, not only for the cure, but for the preven¬ tion of all diseases. Thus it is calcu¬ lated that, when scarlatina breaks out, a daily solution of twenty grains of bella¬ donna in the Chelsea reservoir, will pro¬ tect all individuals (within the range of that company) against the scarlet fever, besides curing those who have actually caught the disease. If cholera re appears, a lump of camphor is to be thrown into each of the four reservoirs, the. emanations from 'which will soon check the Asiatic pestilence *.” The great beauty of the infinitesimal system is this, that each remedy will only grapple with, or prevent, those diseases that are of its own nature — “ similia similibus curantur.” Thus a few grains of aconite daily dissolved in each of the reservoirs, will cure or prevent all the aconite diseases of this overgrown metro¬ polis, without producing any effect on those in health, or diseases or remedies The saving of money will be the smallest part of the benefits which must flow from this most fortunate discovery. In a few years, all diseases, excepting those resulting from casualties, will dis¬ appear, or nearly so, and the value of life will be so enhanced, that the insurance offices will be able to reduce their pre¬ miums nearly one-half ! The grief, anxiety, and sorrow of families, for the loss of children, &c. will be prevented, as all people will then die the death of Nature, far beyond the obsolete boundary of three score years and ten. It is true, however, that there is no un¬ mixed good in this world. Certain orders of society, now flourishing, will be re¬ duced to beggary. The Apothecaries’ Company (who are getting up a petition modifying any other * See Dr. Uvvins’s pamphlet. to parliament against homoeopathy) will be ruined by the “ atomic doses” of the Infinitesimal Dispensary. The College of Physicians, being ruined already, thinks it useless to remonstrate. The College of Surgeons, though they will still have the monopoly of operations, are preparing, nevertheless, to petition the legislature; because they well know that, though sur¬ gery is their 'profession , physic is the best part of their practice. The apothecaries may, of course, shut up shop — and all those drug-palaces, whose windows, at night, look like constellations of etherial fire — “flammisque imitante pyropo” — must be converted into gin-shops or soda- water manufactories. It is to be hoped that government may, in charity, grant a free passage to Australia for, at least, twenty thousand allopathics, who will thus be thrown out of work in this metro¬ polis. These are little specks of evil attendant on a public — a universal blessing. The homoeopathic superintendants have hu¬ manely determined to station one of their eleves, with a few small vials and pots, some miles beyond Oxford, in order to medicate the stream of the Thames, for the benefit of the University, Maidenhead, Windsor, Kingston, Richmond, and the various towns along the river as far as Gravesend. It is calculated that a scruple of oxvmuriate of mercury, and three pints of fluid extract of sarsaparilla, thrown into the Thames at Fulham, will prove a powerful alterative for all those who drink the water supplied by the Chelsea and South Lambeth Companies. A much smaller quantity will do for the New River Head. Infinitessimal Dispensaries will, without doubt, be established in all the great cities and towns of England. And, as the present race of practitioners will certainly be the last of their kind, so our great medical schools, and even our hospi¬ tals, will shortly vanish from the scene. Homoeopathic doses of medicine will na¬ turally require but “ atomic doses” of the science on which medicine depends. In¬ deed, wre see no reason why, on the homoe¬ opathic system, we should undergo the drudgery of studying anatomy, physiology, therapoeia, or chemistry. A very few me¬ dicaments, divided and subdivided into inappreciable tenuity, are endued with the powrer of penetrating the most minute tis¬ sues of the human fabric — with the in¬ stinctive sagacity — the more than chemical affinity, of searching out, seizing, and coalescing writh their “ similitudes” in these remote recesses, — and there neu¬ tralizing their morbid qualities, and ex¬ pelling them ultimately from the body! If this be not the millennium of medicine, 62 REGISTRATION OF BIRTHS AND DEATHS. we can form no idea of what a milennium is ! Homceopathy has, we conceive, brought us to the verge of this happy epoch ; and the infinitessimal physician is entitled to the infinite gratitude of man¬ kind ! P.S.— We have just learnt a piece of curious information. It is this: Ever since the new Poor Law Act came into operation, a celebrated homoeopathist of this metropolis has been giving lectures on the infinitessimal art, to pupils who have “ passed the Hall,” and who are qualify¬ ing for the office of “ contract doctors” throughout the provincial districts. We have now a solution of the low rales at which these undertakers contract to attend the sick poor. The homoeopathic system will enable these practitioners to beat the allopath res clean out of the field ! The training requires about six weeks, and the whole apparatus medica- minum consists of a few bottles of medi¬ cated mustard seed, labelled “ homoeopa¬ thic pills.” Our informant shewed us a single formula, and the mode of prepara¬ tion is the same in all. Five grains of extract of aconite are dissolved in a pint of distilled water, and the solution is poured off clear. Into this is put a pint of white mustard seed. In a few hours the seeds swell and absorb the whole of the solution. They are then spread out in the open air, when they soon shrink back to their original dimensions, being, how¬ ever, impregnated with the aconite, and fit for use. The dose is from 1 to 10 of these aconite pills. The mustard seed is medicated or imbued with alll other arti¬ cles of the homoeopathic pharmacopoeia in the same way. The cost of physicking a large parish on the “ atomic plan,” will, it is supposed, not exceed half a crown per annum. CHEAP PHYSIC AT AYLESBURY. To the Editor of the Medical Gazette. Sir, In the Medical Gazette of the 10th itist. I perceive a letter of a correspon¬ dent who signs himself “ An Observer,” and who affects disgust with my circular of terms; but Sufferer, I conceive, would have been a more appropriate cognomen. Permit me, Mr. Editor, to observe, had the waiter been a mere observer, and actu¬ ated by impartial feelings, he would have preceded his sarcasm by a candid avowal of the degraded state of the profession, in this quarter long ere the “ Hand Bill” appeared. In my opinion, the base mo¬ tive of revenge, or self-interest, prompted the “ Observer” to attack me individually , and allow others to pass with impunity, who had lessened the independence of the profession far more than I have. As an instance, I transcribe the following from the parish minute book : — “ We engage to attend the poor of Aylesbury in the town, and all adjacent towns and villages within ten miles, in every case of sickness and surgery — to furnish trusses, bandages, and leeches — to include all the midwifery cases — and to return any money for attendance on extra paupers, or fee due to us for attendance on coroners’ inquests, for the sum of forty pounds, from April 10, 1835, to April 10, 1836, payable by equal quarterly pay¬ ments. (Signed) - & - , Surgeons. The population of Aylesbury consists of 5000 inhabitants, and the pauperized state of this county is well known ; the reader will therefore readily perceive that the above paltry stipend is infinitely less lucrative than my system of charges. I remain, sir, Yours respectfully, J. A. Marshal. Aylesbury, Sept. 27, 18 6 . REGISTRATION OF BIRTHS AND DEATHS. To the Editor of the Medical Gazette, Sir, It is a well-known fact, that, from the to¬ tal want of accurate information regarding the causes of deaths in this country, the science of medical statistics is retarded in its progress. It is therefore extraordinary, that now an opportunity is offered to the medical profession to ensure the most accurate reports, by taking the registra¬ tion into their own hands, they should, (as has in many instances been the case) refuse to fulfil the duties of registrars under the new act. The refusal must arise either from the apprehension that the trouble wrould far exceed the remuneration, or from not having considered the important aid it is now in our power to give to science. If the former be the objection, it has probably been overlooked, that no per¬ son can obtain burial without the regis¬ trar’s certificate. This will ensure him immediate information of every death, without having to seek for it; and in the case of births, children unregistered within six months will not be legal inheritors of property. There can, therefore, be no doubt of the registrar having notice of all births, save those, perhaps, of the absolute pauper, and of them intelligence can be readily obtained from the relieving officer of the district. In the latter case, were the registration in the hands of our pro- NEW METHOD OF PRESERVING DEAD BODIES. 63 fession, tlie following facts, important to the public health, might be established. The number of deaths by diseases known to attend particular profes¬ sions and trades. The number, and nature, of the fatal diseases of particular districts or localities, in comparison with other districts. The rare fatality of some, and the frequent fatality of other, mala¬ dies. The remuneration (payable from the Board of Guardians) is 2s. 6d. each for the first twenty entries in every year, and Is. each for every succeeding entry, with an additional 5s. for the registration of every birth of which the registrar has not had notice within forty-two days. But it ought not to be considered in a pecuniary point of view, so much as a means of advancing medical science. In foreign states, where the registration of births and deaths is chiefly confined to medical men, the most beneficial results are known to ensue, while, as I have before said, our statistics are notoriously defi¬ cient. — I am, sir, Your obedient servant, T. G. September 28, 1836. CASE OF ANEURISM OF THE THO¬ RACIC DUCT. surrounding organs. How often it is com¬ pressed in the scrofulous and consumptive, by enlarged glans, tumors, &c. ! But these compressions are not attended by corresponding dilatations, as is the case with arteries and veins. Dr. A. has seen a case in which the thoracic duct, in the middle of its course, had been reduced by pressure to such a small calibre, that it would not admit even a bristle. In ano¬ ther case the canal was altogether oblite¬ rated ; but in neither was the calibre of the canal below the narrowed part altered by the compression. (See also Rokitanski, Austrian Annals, vol. xvii. p. 441.) The cause of this absence of dilatation in cases of compression lies, doubtless, in the na¬ ture of the fluid, in the weakness of its current, and also in the fact that there must be more branches of the thoracic duct anastomosing with the venous system than is generally supposed. A proof of this is, that in children in whom the cali¬ ber of the duct has been materially nar¬ rowed, no emaciation has followed in con¬ sequence. Wutzur has discovered a branch of the thoracic duct leading into the vena azygos. The most frequent cases of dila¬ tation of lymphatic vessels are those in which they contain tuberculous, scrofu¬ lous, and cancerous matters. Numerous descriptions of such cases are found in the works of Cruveilhier and Carswell. — Han- noversche Annalen , and British and Foreign Medical Review. By Dr. Albers, of Bonn. The patient, a man of fifty one, died of abscess of the liver. On examining the body after death, Dr. Albers found, in the region of the solar plexus, amongst several hard cartilaginous tumors, an elastic soft one, with a half-transparent tegument. It was knotty, and about the shape of a fig. At first he took it for an hydatid; but it was soon discovered that it was bound by membranous bands in several places, and that a canal led into it, both above and be¬ low. It contained a quantity of fluid lymph, in which flaky matter was sus¬ pended. The internal surface of the tumor wras smooth and uniform. A sound could be passed up the canal, both superiorly and inferiorly. In the latter direction its course was followed, and it soon became evident that the tumor was an aneurism of the thoracic duct. Its parietes were thicker and firmer than those where the duct had not lost its nor¬ mal calibre. l)r. Albers has only seen one similar case, viz. a dilatation of the cysterna chyli, found at the examination of a dropsical patient. It is singular that the thoracic duct is not oftener affected by the diseases of NEW METHOD OF PRESERVING DEAD BODIES. By Dr. Tranchina, of Palermo. The results of this method were first pub¬ lished in the Sicilian journal Fa Cerere , in May, 1834 ; but the actual process was first made known and openly practised by the author, on the 11th May, 1835, in the military hospital, Della Trinitd , at Naples. I he operation consists in the injection of the body, through the carotid artery, with a solution or mixture of two pounds of arsenic in twenty or twenty-four pounds of water, or spirit of wine, coloured with a little red lead or cinnabar ; and in the in¬ troducing, by means of a trocar, into the abdominal cavity, the same solution, in cases w here putrefaction had made some progress. In some cases it appears also that the solution is injected into the anus, nostrils, &c. By this process the body is kept fresh, flexible, without smell, and of its natural colour, during more than two months; after which it gradually dries, hardens, becomes of a darker colour, and can be preserved for years. For this dis¬ covery, the great importance of which is self-evident, and for its public disclosure. Dr. Tranchina has been presented, by the 64 BILLS OF MORTALITY.— METEOROLOGICAL JOURNAL King of Naples, with the sum of 3000 ducats, has been raised to the dignity of knight of the order of Francis I., and ap¬ pointed military surgeon of the second class. — British and Foreign Medical Review , Oct. 1836. CHAR1NG-CRGSS HOSPITAL. A meeting was held in Great Windmill Street, on Monday, for the ostensible purpose of expressing the opinion of the medical public with regard to the recent transactions at the Charing-Cross Hospital. The chair was taken by Dr. Birkbeck, but lie was not supported by any such numbers, or by such members of the profession, as to give weight to the proceedings. Reso¬ lutions were passed condemnatory of the plan on which the hospital is conducted, and much disapprobation expressed of Mr. How ship’s conduct in giving Mr. Pettigrew 500/. ; but we are not aware of any censure having been passed on the latter for accepting it. We quite agree with the resolution declaring the office of “ Director” an ab¬ surdity, but the time and manner in which public attention has been directed to the subject give it all the air of private pique. We cannot compliment any of the parties on the figure they make, and would advise them not to intrude themselves upon the public unless they have something to ad¬ duce much more to the point than any thing which has yet appeared. APOTHECARIES’ HALL. LIST OF GENTLEMEN WHO HAVE RECEIVED CERTIFICATES. September 29, 1836. William Ralph Peck, Kimbolton. Edward. George Baron, Hull. John Dickinson, Plunder Bridge. H enry Richard Smith, Newark. Robert Norton, Nailsworth, Gloucestershire. Robert Baget, Shrewsbury. Joseph Glover, York. Frederick Hanham, Bath. William James Clark, Skipton Bridge, Yorkshire. Richard Ley, Newton Abbott. Richard Thomas Morris, near Wigan, Lancashire. William Foster, Royal Navy, Yarm. Robert Fothergill, Bedale, Yorkshire. Charles Bruorton, Salisbury, Wilts. George Eveleigh. Mathew Moorhouse, Holmfirth, Yorkshire. William Marsden, Thornhill, Frederick Heald, Wakefield. James Naylor, Preston, Lancashire, Joseph Parkin, Workington, Cumberland. Charles Frederick Jenkins, Thames Ditton. Allen Joseph Taylor, Morpeth, Northumberland, Thomas Wright, Wolverhampton. Henry Poole Palmer, Winterbourne, Bristol. Alexander Wright, Birmingham. James Cowherd, Kendal. Thomas Truran, Exeter. William Field, Tong. Francis Harold Duncombe Lewis, London. Thomas Mackenzie Smith, Bideford, Devon. James Barton Nottage, Lancaster. WEEKLY ACCOUNT of BURIALS, From Bills of Mortality, Oct. 4, 1836. Age and Debility . 34 Inflammation .. 15 Apoplexy 5 Bowels & Stomach 5 Asthma 5 Brain 9 4 Cancer • 2 Lungs and Pleura 7 Childbirth . i Insanity • 1 Consumption . 55 Liver, diseased 4 T Convulsions 30 Measles . o 7 Croup • • • 1 Mortification • 4 Dentition or Teething 8 Paralysis . • 5 Dropsy 12 Rheumatism • i Dropsy on the Brain 8 Scrofula • 2 Dropsy on the Chest 1 Small-pox . 9 10 Epilepsy 1 Sore Throat and Erysipelas . 2 Quinsey . 9 1 Fever . . . 9 Thrush 9 1 Fever, Scarlet 2 Tumor . • 2 Fever, Typhus 4 Worms • 1 Gout . . . 1 Unknown Cause s 3 Haemorrhage 2 Heart, diseased . 1 Casualties • 8 Hooping Cough . 1 Increase of Burials, as compared with the preceding week METEOROLOGICAL JOURNAL. Kept at Edmonton, Latitude 51° 37' 32" N. Longitude 0° 3' 51" W. of Greenwich. Sept. 1836. Thursday . 22 Friday . . 23 Saturday . 24 Sunday . . 25 Monday. .26 Tuesday . . 27 Wednesday28 Thk rm o meter. from 30 to 55 50 63 51 67 50 68 56 67 55 65 49 58 Barombter. SO* 1 5 to 30 10 29 92 29 92 30 02 30 01 30-04 30-10 30 06 29-92 29-76 2975 2965 29-53 Prevailing winds, W. by S., and S.W. Except the 24th, 25th, and afternoon of the 26th, generally cloudy ; rain on the 23d and 28th. A little thunder in the morning of the 28th. Rain fallen, -275 of an inch. The sudden and great change in the tempera¬ ture from the 22d to the 23d, is worthy of parti¬ cular remark. Thursday . 29 Friday. . . 30 Oct . from 49 to 60 29 28 to 29-26 42 52 2932 29 50 Saturday . 1 36 53 29 38 30 04 Sunday . . 2 39 52 2915 29 28 Monday . . 3 41 50 29-86 29.35 Tuesday . 4 30 53 29-41 29-51 Wednesday 5 32 55 29-72 29-88 Prevailing Winds, W. by S. and N.W. - - r — / / - - - j o — - — J - - - with frequent rain. Rain fallen, 1 inch, and -825 of an inch. Charles Henry' Adams. NOTICES. Introductory Lectures. — We really cannot make room for “ Introductory Lec¬ tures.” Such addresses we presume to have been heard by the only parties to whom they can be useful j — we mean the pupils at the several schools: for others they do not possess sufficient interest to warrant us in giving them insertion. Mr. Walker’s reply has been received. Wilson & Son, Printers, 57, Skinner* St, London. THE LONDON MEDICAL GAZETTE, BEING A WEEKLY JOURNAL OF iWetuctne anti tlie Collateral J>ctencesi. SATURDAY, OCTOBER 15, 1836. LE CTURE S ON FORENSIC MEDICINE; Delivered at the Alder sgate School of Medicine, By William Cummin, M.D. Lecture III. On Age , medico -legally considered — Mode of ascertaining the Age from Physical Appear¬ ances — Age of the Foetus — Growth of the Embryo — Periods of Human Life — Infancy. The first subject of a special nature to which I shall call your attention, is Age. The consideration of age is an element in almost every investigation undertaken by the medical jurist. Whether his inquiries be relative to tbe living or the dead — whether his object be to ascertain the identity of an individual, or to appreciate the extent and nature of personal injuries — or whether his researches bear on questions of violation, pregnancy, parturition, steri¬ lity — in all these, and a number of other instances, which I need not stay to enu¬ merate, as you will be better prepared to estimate their importance hereafter, age requires to be duly considered. Legal distinctions respecting Age. — - Our laws are precise regarding certain epochs of life : there are certain ages to which particular rights and responsibili¬ ties belong. A male at twelve years old may take the oath of allegiance ; at fourteen he is at years of discretion ; may consent or disagree to marriage, may choose his guar¬ dian, and make a valid will of his personal property : at seventeen he may be an execu¬ tor, and at twenty-one is at his own disposal, with a perfect power to do as he pleases with his estate, both personal and real. A female at seven may be betrothed or given in marriage ; at nine she is entitled to dower ; at twelve is at years of maturity, 463. — xix. and therefore may consent or disagree to marriage; if proved to have sufficient discretion, she may at this age also be¬ queath her personal estate : at fourteen she is at years of legal discretion, and may choose her guardian ; at seventeen may be an executrix; and at twenty-one may dis¬ pose of herself and lands. Again, with respect to criminal liabilities and immuni¬ ties, a person under twenty-one (being in the eye of the law an Infant) is privi¬ leged as to common misdemeanors, so as to escape fine, imprisonment, and the like : in the case, however, of any notorious breach of the peace, such as riot or battery, he is liable to suffer the prescribed penalties, if he be above fourteen. A felonious crime still further abridges the privilege of age : for infants of ten have been hanged for murder — the evidence of malice having been clearly made out : and it is only under the age of seven that a person cannot be guilty of felony; for then it is considered that a felonious discretion is almost an impossi¬ bility in nature. In all such cases, where there is no do¬ cumentary evidence of age to produce — a circumstance far from uncommon in a country like this, so negligent hitherto in respect to registries of birth, and even of baptism — there is obviously no other resource than to ascertain the fact by reference to physical peculiarities. And here the assistance of the medical jurist is required. Other occasions of inquiry as to Age. — Among the qualifications and disqualifica¬ tions for military and naval sei'vice , age forms a special object of inquiry. Itis a highly im¬ portant element in the selection of recruits ; and we even find twenty fixed as a minimum, in a late order from the Horse Guards, relative to recruiting for service in tropical climates. Mr. Marshall justly observes on the subject, that “ as the exact age of men in this country cannot commonly be easily or satisfactorily ascertained, the surgeon who inspects a recruit should be F 66 DR. CUMMIN ON FORENSIC MEDICINE authorized to estimate the age by physical appearances.” In effecting policies of Life assurance, I need scarcely remind you that much de¬ pends on the age of the insuring party, the premium being almost wholly regu¬ lated with reference to that point; and it may be your duty, as medical officers either of the company or the applicant, to take care that there be no error or fraud committed in this respect. Thus it is evident how very properly the discussion of age should take precedence of other questions forming the subject of a course of Forensic medicine ; and it shall be my aim, in the present lecture, to point out to you the mode in which the physical proofs and evidence of age may be ascertained. Definition. — Age, as the term is commonly used in legal medicine, implies the time of life — the period of human existence which one has attained, or in which an individual lives. Object. — The determination of age is sometimes attended with difficulty. In certain cases it can be pretty exactly effected, as in the infantile or foetal periods; but, in general, we can do no more than come to certain average results: we cannot pretend, for instance, to fix the age of an individual, except in very pecu¬ liar circumstances, to the day, week, or perhaps month, which he has reached; but what we design to do, and, in general, can do, is to determine the period up to which he has lived — each period or portion of life being distinguished from other portions by a particular set of developments which pro¬ duce marked changes in the person. An acquaintance with the laws of growth necessary. — For a task of this kind, we must be prepared by being acquainted with the laws of growth. Now, these laws can only be fully appreciated by taking a view of them as they may be oberved in opera¬ tion, from the very earliest point at which they can be traced. In order to have a complete survey of the changes oc¬ curring in the course of time in the human being, we must therefore begin with the foetus, and even the embryo, and carry our observation through all the sub¬ sequent stages of existence to maturity and decline. AGE OF THE FOETUS. I must premise that it will be necessary to be much more full and minute in treat¬ ing of the first periods of life than those which will subsequently engage our atten¬ tion. The reason is this — that so many purely medico legal questions relating to pregnancy, prolicide, &c., are chiefly de¬ pendent on the appearances indicative of age, which are observed in the expelled ovum or foetus. We shall, therefore, com¬ mence with intra-uterinelife : and in doing so, wrill freely avail ourselves of the most authentic sources of information which have of late been opened to us. Earliest appearance of the ovum and embryo . — According to some of our ablest English obstetricians, nothing like an ovum, con¬ taining a definable embryo, can be detected in the uterus before the 20th or 22d day after conception. Haller says that the embryo is not perceivable till after the loth or 20th day. Of this period it is generally admitted that several days are consumed before the ovum reaches the uterus. In rabbits, three days elapse, and in the bitch, from six to eight, while the ovum is being carried along the fallopian tube to be deposited in the uterus. Is it likely that it should be less in the case of the human female, wrhere there are so many disturbing causes, physical and moral, to interfere ? And if this be so, what are wre to think of the story published by the late Sir Everard Home, in the Phi¬ losophical Transactions for 1817 ? Sir Everard Home's eight-day case — A female servant, aged 21, left her master’s house in the forenoon of the 7th January, 1817, and returned in the evening, com¬ plaining of illness. It was her regular time for being unwell, but no catamenial discharge took place. She continued me¬ lancholy and ill, and on the 13th had a fit of epilepsy, followed by delirium. She died on the evening of the 15th. On examining the body after death, the uterus, according to Sir Everard, appeared to be impregnated. The organ was removed and put in spirit. In its interior, to¬ wards the os tineas, was observed, after a close search, a small body — a corpuscle — so small, that Mr. Bauer, the microscopist, compared it to the egg of an insect : it re¬ quired an excellent instrument to find out what it wms — and behold it was an embryo ! But the whole narrative is ques¬ tionable. There is no sufficient evidence that the woman w'as pregnant, and even if she had conceived, it is scarcely probable that the ovum could have reached the womb. Besides, the human ovum is spherical — not like a minute grain of bar¬ ley, as represented in the plate attached to Sir Everard’s paper: nor would it have required the aid of a microscope to examine it even at the earliest. The additional absurdity of supposing it an embryo, des¬ titute of its envelopes, crowns the whole. In short, though this case has been implicitly received by several authors, it has, on the other hand, been generally scouted by competent judges. The state of the female, who w'as, probably ow ing to some accidental cause, labouring at the time under suppression of the menses, is sufficient to account for the appearances noticed in the interior of the womb: and AGE OF THE FCETTJ'. 67 there is every reason to believe with Vel¬ peau, that wliat Sir Everard Home took to be an embryo, was nothing else than a particle of mucus ! M. Velpeau's case of twelve days. — Velpeau, one of our ablest authorities on the subject of embryology, tells us thathe has had on three occasions an opportunity of examining the ovum when it could not have exceeded twelve days from conception. Its bulk was then about that of a moderate sized pea. In two of these instances he could not satisfy himself that he really detected an embryo in the interior. But the third case he considers as probably the most remarkable ever met with. Here are figures of the ovum entire, and laid open ; they are drawn of the natural size — fig. 2 being a little spread out. Fig. 1, and Fig. 2 .—An Ovum and Embryo of twelve days. The history of this ovum is curious, andis thus related by M. Velpeau. A midwife who attended his lectures— as many intelli¬ gent females in the French metropolis do, in order to prepare themselves for subse¬ quent practice, — happened to be at her menstrual period, and just as it ceased, her husband returned from a journey which had detained him from home for six weeks. No matrimonial intercourse occurred till the following day: and exactly on the thirteenth day after, she aborted of the ovum in question — so that it could 7iot have been more than 12 days old. She sent it immediately to M. Velpeau, who values it, very properly I think, as one of the most precious that has ever fallen into the hands of an embryologist- In the details which I am now about to give you, it is not my intention to present anything like a complete account of the structure of the embryo : my principal object is to call your attention to the size and proportions of the ovum and its contents, at different periods of intra-uterine life : so that should you be called upon as medical jurists to state your opinion of the age of an expelled ovum or foetus, you may be able, with some confidence, to do so. At the twelfth day, then, the ovum, which is about the size of a pea, is per¬ ceived to be covered with a villous shaggy outer coat, the chorion : the flocculent part, which becomes more circumscribed subsequently, being that which forms an attachment to the decidua, and constitutes the placenta. The embryo at this period, as represented in the above figure, is semi¬ lunar in shape, and rounded pretty equally at both ends. The globular appearance in the second compartment of the opened ovum (and d in fig. 3) is remarkable : it is the umbilical vesicle — an organ pecu¬ liar to the embryo in tlie first few months of its development. Three weeks to a month. — About the 21st day the ovum appears to be as large as a hazel nut. When laid open, as in the an¬ nexed figure, (fig. 3,) it looks, of course, much larger. Fig. 3. — Ovum and Embryo at 21 days — the Embryo seen through the Amnios. The embryo now measures two or three lines in breadth, and probably its length, were it straightened out, would be from three to five, or about half an inch. The different parts of the face become distinguishable at different periods. The aperture of the mouth is seen very early — say from the 12th to the 20th day. The nose, or at least the nostrils, at about 30 days: the prominence, not till five or six weeks, perhaps. The eyes are observable by the fourth week, if not earlier. The rudiment of the ear may be perceived as early as the 30th day : but that part un¬ dergoes no remarkable development for six or seven weeks. Towards the expiration of the first month, the ovum has attained the size of a large nutmeg. From, four to six weeks. — The ovum about the sixth week is nearly as large as a hen’s egg; and the embryo is about an inch in length. The extremities sprout forth from the trunk like vegetations, all about the same time. At from thirty to forty days the fore-arm and the leg may be distin¬ guished, and the points of the fingers and toes are to be perceived. The foot is even now distinct from the hand, evidently dis¬ playing what is to be its future function — to form the pedestal of the figure. It is remarkable, that about the expiration of the sixth week a point of ossification may be detected in each half of the lower jaw ; as also in each clavicle. Two months. — The embryo, or, as it now begins to be more properly called, the foetus, measures above an inch and a half in length ; it weighs about half an ounce. 68 DR. CUMMIN ON FORENSIC MEDICINE. Rudiments of the lungs are visible in the interior, and there are points of ossifica¬ tion in the frontal bone and some of the ribs. The placenta has assumed a distinct form, and the umbilical vessels become tortuous. The sex is scarcely yet distin¬ guishable. Fig. 4. — Foetus of about ten weeks , somewhat magnified by the spirit in which it is preserved. Three months. — The foetus is now nearly three inches long, and weighs about an ounce and a half. The fingers are very distinct. The eye-lids are formed, and the membrana pupillaris is perceptible. The ventricles of the heart are separated ; the sexual parts prominent ; the umbilical vesicle has disappeared. Fig. 5. — Foetus between three and four months, as seen preserved in spirit. Four months. — Above six inches long, and three ounces in weight. The nails begin to be observable ; there is meconium in the duodenum ; some points in the sacrum ossified ; the mouth large and open ; the skin of a pinkish hue. Five months. — The foetus has now at¬ tained the length of about seven inches, and it weighs about seven ounces. The head and heart both comparatively very voluminous; the kidneys large ; the gall¬ bladder distinct ; rudiments of the teeth may be detected, and there is a point of ossification in the calcis. Six months. — Above ten inches in length, and the average weight a pound. The membrana pupillaris is still observable ; feet of a purplish red colour; a sebaceous secretion begins to be formed on the skin ; a few silvery hairs are observed on the head ; a serous but not bitter fluid in the gall-bladder ; the testes close by the kid¬ neys; meconium in the small intestine; ossification in different parts of the sternum. Chaussier’s rule of admeasurement. — It is worth observing, that about this time the middle point of the whole length is usually found at thelower extremity of the sternum, whenceitgradually descends in the succeed ing months, till, at the mature period, it reaches the umbilicus. For this character in the foetal growth we are indebted to M. Chaussier, who founds upon it the practi¬ cal rule, — to take the length of the foetus, and then observe to what point half that length reaches : if it extend to the lower end of the sternum, it has attained its sixth month; if the navel, the ninth ; and so for the intermediate spaces. But it is right to add, that competent authorities have questioned the correctness of this rule : among others Mende, in his Ausfuhr - liches Handbuch (which, by the way, con¬ tains the most elaborate account I have seen of the growth of the foetus), asserts, that however plausible it may appear, it is not to be always relied on. “ The mid¬ dle point,” says he, “ by no means corre¬ sponds to the same part of the body in foetuses of the same age : a fact for which we might be prepared by considering that the several sizes of the foetus depend, now on its large head and neck, now on the trunk, and again on the magnitude of the limbs. This I have verified by numerous measurements, taken with great care and pains; and the conclusion I have arrived at is, that the directions laid down by Chaussier are uncertain for practical pur¬ poses, and more particularly for those of the medical jurist.” Seven months. — - Length above twelve inches ; weight from three to four pounds. The skin firm, of a pink colour, and co¬ vered largely with the sebaceous coat. 1 he membrana pupillaris generally disap- PERIODS OF HUMAN LIFE. 69 pears in the course’of the seventh month; the eye- lids are no longer glued together; the nails do not reach the ends of the fingers. In the astragalus there is observed a point of ossification ; the meconium dif¬ fused through the whole length of the in¬ testine ; the left lobe of the liver almost as large as the right. The lungs of a reddish brown colour, and of a compact liver¬ like structure, occupying the sides and back part of the chest ; the testes have de¬ scended a little from the kidneys; the brain comparatively firm, but without any observable deposition of white substance. Eight months. — The foetus now measures from fourteen to sixteen inches in length, and weighs commonly about four or five pounds. The nails have reached the tips of the fingers; the quantity of sebaceous matter deposited on the skin is considera¬ ble ; a point of ossification may be noticed in the last vertebra of the sacrum. The brain presents an appearance of convolu¬ tions ; but still there is no white sub¬ stance. The testes have reached the in¬ guinal rings. At nine months , or mature. — The length of the mature foetus averages above eighteen inches, and the ordinary weight is between six and seven pounds. Half the length reaches to the umbilicus, or very nearly. There is more or less hair on the head, — sometimes an inch long. An abundant deposition of sebaceous matter is observed on the skin, and appears to be propor¬ tionate to the development of the lympha¬ tic system in the foetus. The lower limbs are longer than the upper ; though, mea¬ sured from the arm-pits to the tips of the fingers, and from the groin to the toes, the reverse would seem to hold. The feet are a sixth of the whole length of the body. The cartilage of the ear is completely formed ; there is a point of ossification at the inferior extremity of the femur; the os hyoides not ossified; some appear¬ ance of white substance observable in the brain. The liver reaches the um¬ bilicus ; the testes have usually pass¬ ed the rings, and descended into the scrotum ; meconium is found in the rec¬ tum. The following are the principal measurements of the head, according to Devergie and Velpeau : — French In. Lin. Occipito frontal diameter 4 3 Occipito-mental . 5 0 Fronto-mental . 3 6 Bi-parietal, or transverse 3 4 Bi-temporal . 3 0 Greater circumference, or occipito-mental .... 14 0 Transverse . . 10 6 Engl. In. 4-52 532 3-71 3-54 3-19 14-91 11 18 Let us now sum up the various points to be attended to in collecting the proofs of foetal age. Nor can we do better than follow the order recommended by M. De¬ vergie. First, examine the annexes of the foetus, or, in other words, the ovum itself, independent of the foetus : observe the pla¬ centa as to its shape and consistence; the state of the membranes ; the umbilical vesicle, if it be present ; the funis, as to its length and degree of torsion. Secondly , examine the foetus and its organs ; weigh it; take its length ; observe to what point half the length reaches, and note the in¬ sertion of the umbilicus. Let the skin be inspected as to its colour, consistence, and sebaceous coat ; observe the nails, the eyes and eye-lids, and the presence or absence of the membrana pupillaris; the nose, mouth, and ears; the abdomen, and the state of the digestive tube ; the liver and gall-bladder; the kidneys and renal cap¬ sules ; the testes or uterus; the heart, with reference to the development of its cavi¬ ties; the arteries connected with it; the ductus arteriosus; the lungs; the larynx and bronchia. The muscular system ; the state of the bones, as to the progress of ossification ; and, lastly, the extremities, with a view to the comparative develop¬ ment of their several parts. Such are the leading characteristics by means of which wTe are to form an opinion of the age of an embryo or foetus. Where the object is to ascertain the age of a liv¬ ing foetus — of course, in utero matris, the inquiry becomes equivalent to that for ascertaining the period of pregnancy; but this we reserve for a future lecture. Nor let it be supposed that such researches are merely curious ; they are, in reality, im¬ portant and necessary; for both in a civil and criminal point of view the life of a child, even before birth, is an object of protection with our laws : it is avenged if injury be offered to it; an infant yet unborn is capable of inheriting an estate, and of becoming a legatee, from the mo¬ ment it is ascertained to be alive. PERIODS OF HUMAN LIFE. The periods into which the life of man has been portioned out are in great measure arbitrary. The gradations by which they pass into each other are im¬ perceptible, though the consequent changes are manifest enough. And it has long been popular, as well as convenient, to make a distinction in those periods, or ages, as they have been called. Threefold division. — Some of the oldest authorities, — and Aristotle among the number, — thought fit simply to distin¬ guish the stages of our mortal career into those of growth, perennity, and 70 DR. CUMMIN ON FORENSIC MEDICINE. decline, not perceiving', or not caring to notice, that, strictly speaking, no such period as that to which they attached the quality of durability existed, — there being, in fact, no moment during the existence of our corporeal system in which we can be said to be stationary. Letting this pass, however, the threefold division ap¬ pears to have been early supplanted by another, which seemed more practical. The Seven ages . — As early as the time of Hippocrates, we find man’s life por¬ tioned into seven ages. Both Hippo¬ crates and Proclus subdivide the period of growth just mentioned into infancy, boyhood, and puberty — that of peren- mty into youth and manhood — and that of decline into senescence and decrepitude. Thus we have the autho¬ rity of distant ages, and of the father of physic, for that division of human life which is popularly recognized amongst us, and which must popularly prevail as long as the writings of our great dramatist are extant — that is to say, as long as our language is understood. You are all no doubt familiar with the beautiful descrip¬ tion which Shakspeare has given of the Seven Ages, in the second act of “ As you Like It.” It should be mentioned, that attempts have from time to time been made by modern writers to introduce other more brief and comprehensive divisions than those they already found in use: Esehen- bach and Haller, and Bernt, for example, adopt a three!' old partition; Hebenstreit, Ludwig, and Hen ke, recognize/our periods; Plounquet^re ; Orfila also Jive ; Teiehmey- er, Wildberg, Meckel, and Mende, six ; Griiner seven ; and Metzger eight. But those who adopt less than six are obliged to subdivide the early periods, thus virtually employing a larger number. I shall only add, that Zacchia, Tortosa, Fodere, and Plenk, are among those who are decidedly for seven ages. Suppose, then, we adopt this popular, and let me also call i t physiological arrange¬ ment, what are the limits by which each period is to be defined ? Mere too we shall find a sevenfold order the most satis¬ factory, easy to be remembered, and suited in every respect to medico-legal purposes. The first age commences at birth, and runs on to the 7th year; the second, or boyhood, from that to the 14th; the third, or puberty, from the 14th to the 21st; youth, or juvenility, to about 35 ; manhood, from that to about 56 ; senescence, or old age, to 84 : after which decrepitude closes the scene. Now it is curious, and worth observing, that all these numbers are multiples of seven. The enumeration may be more striking when arranged thus: — Infancy . 0 to 7 Boyhood . 7 to 14 Puberty . 14 to 21 Youth . 21 to 35 Manhood . 35 to 56 Senescence . 56 to 84 Decrepitude . 84 to 0 Climuctericul years. — In noticing this coincidence — this curious harmony of numbers — I may take occasion to re¬ mark one or two other multiples de¬ noting epochs, to which great importance has been from the earliest times attached. Both 7 and 9 have long been held as mystic numbers : and peculiar influences have been attributed to those years marked by their special multiples. The three most critical epochs in the life of man were supposed to be the seventh return of the seventh anniversary, the ninth of the ninth, but above all, the ninth re¬ currence of the seventh. The first of these, the 49th year, was called the lesser climacteric — the second, the 81st, the grand climacteric — the third, however, or the 63d year, obtained, par excellence , the denomination of the climacteric year. A vfigoK\as, another epithet bestowed upon the latter, originated in the supposed effi¬ cacy of this mystical number in breaking down the constitution of man. Sir Thomas Browne, in his Enquiries into Vulgar and Common Errors, notices this superstition, and attributes it to the understanding which £; ascribeth unto many things far larger horizons than their due circum¬ scriptions require, and receiveth them with amplifications which their reality will not admit ;” upon which he proceeds to pour out a profusion of learning in dis¬ proof of the common opinion. Richerand also notices the subject in his Erreurs populaires. But the impression has been somewhat revived of late, under the patronage of our learned president of the College of Physicians. Sir Henry Hal¬ ford, in an ingenious paper, has shown that there exists a disorder to which men are subject about the time of their reaching their 63d year. It is attend¬ ed, he tells us, with well-marked symp¬ toms, and a peculiar breaking up of the constitution, which is frequently fatal, from not being well understood by practi¬ tioners : he calls it the climacteric disease : you will see his account of it in his collec¬ tion of Essays and Orations, I shall now request your attention to some remarks on the subject of each period of life separately, in the order just now selected. Infancy. Mith regard to the period of infancy, the chief question with which the medical jurist has to deal is — how is he to ascer- = IX 7 = 2X7 = 3X7 = 5X7 = 8X7 = 12X7 INFANCY. 71 tain the age of an infant within the lirst months, weeks, nay, days, of its extra- uterine existence ? The circumstances under which we maybe required to find an answer to this question are of frequent occurrence. I have already alluded to its connexion with cases of infanticide, and shall have again occasion to recur to that fact when treating of child-murder more at large. But suppose, for the pre¬ sent, a child found alive , exposed, and sus¬ picion resting on some female who is re¬ ported to have given it birth and then abandoned it. If the exact age of the infant can be ascertained, and there be no corresponding signs of recent delivery about the woman, the fact is strongly in favour of her innocence, in spite of all moral or circumstantial evidence to the contrary : if, on the other hand, the signs correspond, there will be a presumption of guilt. It will be convenient to subdivide the period of infancy into two well-marked stages— first, that from birth to the first eruption of the teeth; and second, the period of dentition, during which the temporary teeth are produced, and com¬ prehending the interval which occurs be¬ fore the permanent teeth are completed. (ti). First infancy. — What are the signs of a new-born infant’s age ? Our first proceeding with a view to satisfy this in¬ quiry should be to examine the umbilicus : to see whether the cord or any remnant of it be present, and what may be its con¬ dition. The umbilical cord, it is known, does not come away, in the generality of instances, till the fourth or fifth day after birth. An obvious inference, therefore, from its presence, would be, that the in¬ fant cannot have lived five days. We then proceed to examine the" state of the cord, in order that we may be able to approximate still further to the date of birth : now this we are enabled to do by attending to the valuable obser¬ vations and rules laid down by M. Billard, and which are thus practically summed up by Orfila and Devergie: — In the infant just born the cord is fresh and firm, bluish, and rounded off; there is blood also in its vessels. The first perceptible change that occurs after it has been divided and tied, is its shrinking {Jietrissure) : this proceeds from its extremity, where the ligature is, to its base at the umbilicus, and is observ¬ able in general before the lapse of a few hours. When this process is complete, which it generally is by the close of the second day, the cord is quite soft and flaccid, and a well-marked congestion is perceived around the umbilical ring. The next phenomenon to be noticed is the drying up of the cord. It becomes brown and semitransparent, losing the gelatine which it contains. As its membranes collapse it becomes flattened, and its inte¬ gument assumes the colour of parchment. This withering ( desiccation ) commences on the first or second day, and is generally completed by the third. It has been at¬ tempted to establish a distinction as to this process, according as it may have oc¬ curred during life or after death; there being, according to some observers, ap¬ pearances of inflammation about the um¬ bilical ring in the former case, and not in the latter; but such appearances are not sufficiently constant to warrant any positive conclusion from the fact of their presence or absence. The next phenomenon to be noticed is the fall of the cord, which takes place on the fourth or fifth day. Its base dwindles by degrees; the umbilical arte¬ ries give way ; but the vein lasts some¬ what longer. When this occurrence is at¬ tended with inflammatory action about the umbilicus, the traces of such inflam¬ mation continue till the tenth or twelfth day after birth, the epoch at which cica¬ trisation is effected. As to this latter phe¬ nomenon (i cicatrisation ), though it com¬ monly occurs at the epoch just mentioned, yet, when the cord is thin, it sometimes takes place earlier — that is to say, in less than ten days. A temporary umbilical cica¬ trix is first formed, which, in the course of about forty days, gives place to the per¬ manent one. The next sign indicative of the new¬ born infant, is the desquamation of the cuticle ; an appearance which is very different from the peeling off of the epidermis from putrefaction. The de¬ squamation alluded to has not been observed to take place sooner than twenty- four hours after birth ; and it is at its height by the third or fourth day. The process usually commences on the abdo¬ men, and then extends successively to the chest, arm pits, and groins, the back, the extremities, the feet, and the hands. In some children the epidermis comes oft' in the shape of powder — not in scales. If, then, on examining an infant, the de- squamation be observed, it may be presumed to have been born a day at least. When we have an opportunity of in¬ specting the body after death, there are other proofs of early age to be gathered. The ductus arteriosus wdll be perceived, at least contracted, in a child that has sur¬ vived birth, even though it w-ere but for a very short time. The foramen ovale, also, wdll probably be found to have undergone a change in size and figure; and the ductus venosus will perhaps be observed to have sustained an alteration in form. But all these appearances we shall have a bet¬ ter opportunity of noticing when we come 72 DR. CUMMIN ON FORENSIC MEDICINE. to treat the subject of infanticide, some of the proofs of which depend on the oc¬ currence of those changes in the circulatory apparatus. Among the signs of age of the new born, we ought not to omit those deriva¬ ble from the state of the alimentary canal : but they will require only a brief no¬ tice. If the stomach be empty, or contain only a little mucus, while the large intes¬ tine is still charged with meconium, and the bladder filled with urine, death has probably occurred immediately after birth, — if it be not, indeed, a question whether the infant were not still-born. If, on the other hand, the stomach contain milk, or other alimentary matter, and both bladder and intestine be empty, the child undoubt¬ edly lived for a time. The meconium, it must be recollected, is lodged in the large intestine for some time previous to birth. It is expelled presently after birth. Now the tube has been protected during the de¬ tention of the meconium, by a layer of mucus of considerable thickness and con¬ sistency. The layer is not removed imme¬ diately on the expulsion of the meconium; in some cases it is no longer observable after the first day ; but in general we need not expect to find it wholly gone till four days after birth : and when we see it, we may observe that it has contracted a green¬ ish hue. From these facts, M. Billard derives a practical rule: — “ If the colon be found of a deep and uniform greenish hue, the meconium has been only recently expelled ; the infant must be then one day, and may be at most three days, old. But should the colon have an irregular spotted appearance, the meconium has been still less recently expelled, and the infant is probably three or four days old.” It is right to add, however, that these indica¬ tions are by no means as valuable as those to be procured from the state of the funis. There are other well-known signs of early infancy, which need not detain us in pointing them out. I allude to the ex¬ treme softness of the bones of the head, the open state of the fontanelles, the downy face of the infant, its feebleness, and inferior size. At a period a little more advanced, we may avail ourselves of several moral circumstances in forming our estimate of the age; such as the smiles of the infant, the early dawnings of the deve¬ lopment of the mind, and the distinctness with which certain desires and wants are expressed. But we must be cautious, as medical jurists, how we derive more than collateral evidence from such phenomena. (/>.) Period of first dentition. — At length the teething period arrives about the sixth or seventh month, and is generally ushered in with a copious flowing of saliva from the mouth. The infant, too, mani¬ fests a certain restlessness, and is ever anxious to rub the gums. The order in which the teeth are cut is worth attending to, although the exact date of the successive appearance of each tooth cannot be precisely stated. First the middle incisors of the lower jaw are observed ; then those of the upper to cor¬ respond ; then the remaining incisors in like manner — first below, then above. Next appear the first molars of the lower jaw, then the opposite ones of the upper. The canine teeth follow ; after which the second molars, until the whole twenty milk- teeth, constituting the temporary set, have been produced. The process is generally completed towards the end of the second year*. The following may be considered as an approximation to the average epochs of the appearance of the milk-teeth : — The two middle inci-^ & t0 7 raonths. sors, trom . S The two lateral ineisors, 6 to 9 — Two first molars . 8 to 15 — Two canine teeth . 15 to 18 — Two second molars .... 1 8 to 24 — But there is usually a great diversity in different children, with respect to the time of cutting their teeth. Some are born with their incisors above the gums ; others have no teeth at all till the end of the second year ; and persons have been known who lived many years without having ever had a tooth. Growth of the bones.— I have already no¬ ticed some of the earliest epochs at w hich the osseous system begins to be developed, and shall now put together what further points remain to be considered in con¬ nexion with infancy. I am anxious to be¬ speak your attention to this subject, though it may seem somewhat burthensome to the memory, because it is from the progress of the bony structures (thanks to the re¬ searches of Beclard) that we may derive some of our best and surest indications of age at every period, but particularly in those of early life. About the 5th month of infancy, a trace of osseous deposit may be observed in the cuboid bone of the tarsus. The branches of the os hyoides are now7 ossified, and somewhat later the lower apophysis assumes the same state. At six months, an osseous point is found in the anterior arch of the atlas, and the great wings of the sphenoid bee one united with the body of that bone. At tw7elve months, or thereabouts, the middle of the coracoid process of the scapula is generally found to be ossified : osseous points are also found in the heads * See Medical Gazette, vol. xiii. pp. 160 and 237. DIt. GRIFFIN’S MEDICAL PROBLEMS. 73 of the long bones, the tibia and femur in particular ; and the vertebrae have some considerable changes operated on them. There is a point, for example, in the first coccygean vertebra ; and the two osseous points in the posterior arch of each ver¬ tebra become united. The pieces of the temporal bone are firmly joined. At the age of two years, the epiphyses of the metacarpal and metatarsal bones are ossified: and an osseous germ is found at the lower extremity of the radius. At 2-§ years, the patella becomes ossified, and so does the lesser tuberosity of the head of the humerus. At three years, the first molars of the second dentition make their appearance, and about six months later the second mo¬ lars of the same set. At four , the great trochanter and pyra¬ midal bone of the carpus, also the second and third cuneiform bones, become ossi¬ fied. Between four and five years, the upper extremity of the fibula, the epiphyses of the phalanges, the trapezoid, and the semilunar bodies, exhibit a bony structure. At six years, the pisiform bone is form¬ ed, and the constituent pieces of the ossa ilia are separated merely by a very thin cartilaginous layer : the descending branch of the os pubis, and the ascending one of the ischium meet. Numerous changes also in the progress of the bony formation now occur in the vertebral column : but I find my limits will not allow of their enumeration. We shall complete our view of the re¬ maining ages in next lecture. MEDICAL PROBLEMS. By William Griffin, M.D. Limerick*. HOW ARE NEURALGIC AFFECTIONS TO BE DISTINGUISHED FROM INFLAMMATORY? In treating- of peritoneal and enteric inflammations, Dr. Abercrombie states, as conclusions from facts, “ that exten¬ sive and highly dang-erous inflammation may exist in the intestinal canal, with¬ out obstruction of the bowels, and it may go on to a fatal termination, while these are in a natural state, or easily re¬ gulated by mild medicines, through the whole course of the disease.” “ That extensive and fatal inflamma¬ tion may be goingon with every variety in the pulse; it may be frequent and small, it may be frequent and full, or * This article, which has appeared in the Dublin Journal of Medical Science, we republish at the request of the author, who has corrected several errors which had crept into the original impression.— Eo, Gaz. it may be little above the natural stan¬ dard through the whole course of the disease.” “ That extensive inflammation may go on without vomiting and without constant pain ; the pain often occurring in paroxysms, and leaving long inter¬ vals of comparative ease.” “ Keeping in view these sources of uncertainty (he says), our chief reliance for the diagnosis of this important class of diseases, must be on the tenderness of the abdomen. This symptom should always be watched with the most anxious care, whatever may he the state of the bowels or of the pulse , or the ac¬ tual complaint of pain , and though the tenderness itself should be limited to a defined space of no great extent.” Whatever the experience of the pro¬ fession may have determined with re¬ spect to the greater part of these con¬ clusions before the appearance of Dr. Abercrombie’s work, I believe it has been always in accordance with the opinions of that distinguished physician on the importance which should be at¬ tached to the presence or absence of ab¬ dominal tenderness in cases of suspected inflammation ; but Dr. Abercrombie was very well aware, when he gave such just weight to this symptom as a means of diagnosis, that in itself it w as far from conclusive, and derived its value chiefly from the existence of many other corroborating signs. He states, indeed, distinctly, in another part of his w ork, “ that pain increased upon pressure does not appear to be a certain mark of in¬ flammation in the bowels, for it occurred in Case XXIV. (related by him), in which there was no inflammation ; and in several other cases it was met with before, probably, inflammation had commenced. From various observations, he states, he is satisfied that intestine which has become rapidly distended is ainful upon pressure ; it is, however, a ind of pain which, hy attention , can yenerally be distinguished from the acute tenderness of peritonitis.” Th is point of diagnosis applies alto¬ gether to the discrimination of cases of ileus from those of inflammation, and even as such, is, it would appear, often of doubtful value ; but in what light must we view it, in reference to those frequent neuralgic affections, which, whether hysterical or the results of irrita¬ tion of the spinal cord, are often esta¬ blished suddenly, with little preparatory disorder, and with no distension of the 74 DR. GlUFFIN’s MEDICAL PROBLEMS. intestinal canal to account for the acute tenderness on pressure ? No medical man is now ignorant of the fact, that the contents both of the thorax and ab¬ domen, as well as their parietes, are subject to attacks of a violent pain of a nervous or spasmodic character, jet with acute soreness to the touch, as in pure inflammations. These are so widely separated from the latter in their nature, and require such a very different, 1 might almost say opposite, mode of treatment, that a correct diagnosis be¬ comes a matter of still greater interest than in cases of ileus. There are few instances of ileus in which one effective bleeding might not be of effective ser¬ vice, while there are few of hysterical pseudo-peritonitis, or enteritis, or of similar affections arising from irritation of the cord, which might not be made worse, or indefinitely protracted by it ; yet we find in our best elementary works on this subject a most perplexing’ indefiniteness, a diffuseness of descrip¬ tion, and a labouring at discrimination, wholly unworthy of the present im¬ proved state of medical science, and unnecessary, if any real or essential difference of character could be pointed out. It is, indeed, because there is an essential agreement in all material points, that our attention is directed to the attitude, the expression of counte¬ nance, the manner of complaining, and even the temper of patients, although there must be sometimes very considera¬ ble differences as to all these in indivi¬ duals similarly affected, and in any case no slight degree of experience is re¬ quired to form a proper estimate of their value. We are told that one affection is frequent, the other rare in compari¬ son — that females are more liable to it than the other sex, and those of seden¬ tary habits in towns, than those leading- active lives in the country; all of which might be very useful information, so far as it tended to corroborate features of a more marked expression, but is essen¬ tially loose and vague if considered by itself. Again, we are reminded of one or two truisms; that if a disease has lasted long and done no mischief, or if it has been aggravated by an anti¬ phlogistic treatment, its character is not inflammatory. We may thus ar¬ rive at a correct diagnosis about the time the complaint ought to be cured and forgotten. But the climax of our difficulties on this subject is displayed in the admissions of experienced phy¬ sicians, that their practice, when in doubt, is to run the risk of erring on the safe side, and treat the disease as inflam¬ matory ; — perhaps a judicious plan enough under the circumstances, but certainly not so consolatory to the pa¬ tient, nor, as I have elsewhere re¬ marked *, very creditable to medical science. It may be questioned, too, whe¬ ther a rule of the kind with young phy¬ sicians would lead only to errors on the safe side. I have seen one valuable life lost, and others endangered, by such practice, and sometimes the antiphlo¬ gistic treatment vigorously adopted ; not, indeed, where doubts existed in the mind of the practitioner, but where the cases were altogether mistaken. I am far from assuming to myself a perfect freedom from perplexity in all possible cases simulating inflammations of internal organs which may come be¬ fore me, but with the facts I have stated impressed on my mind, 1 cannot but feel that the experienced physician is usually too well satisfied with that in¬ definable power of recognizing or iden¬ tifying diseases almost unconsciously acquired in the course of long practice. In reflecting on the melancholy steps by which it is attained — on the sad, thoug’h perhaps excusable, errors com¬ mitted — he consoles himself with the conviction that such experience only could gift him with a knowledge which neither books nor lectures had taught him, when he should rather feel that the true reparation to his conscience, the real duty he had to perform in acquit¬ tance, was to prevent the occurrence of such mistakes with others, by analyzing the characters of those perplexing- dis¬ eases, and endeavouring to trace the sources from which his late discrimina¬ tion was derived. It is not enough for a practitioner in a difficult case to be assured he is himself capable of deter¬ mining its nature ; he should consider whether his knowledge or ability admits of being communicated toothers; and when he believes it is, but not until then, he may also believe that he has acquired information of infinitely greater value to the public than any thing it could have suffered from his early mis¬ takes. I have been led to indulge in these obse.vations in consequence of the ap¬ parent inattention with which a sug- See Treatise on Functional Affections of the Spinal Cord. DR GRIFFIN*S MEDICAL PROBLEMS. 75 gestion with respect to the diagnosis of neuralgic affections, proposed by me some years since, was received by the profession : I then stated, that in any doubtful cases I believed if tenderness on pressure at the portion of the spinal column corresponding icitli the disturbed organ existed, it might be considered decidedly neuralgic; but if no such symptom was found, it was probably inflammatory. The suggestion was then offered rather as a result of indi¬ vidual observation, which I was anxious should be tested by the universal expe¬ rience of the profession, than with a view of claiming attention for an incon¬ trovertible fact; but I have since so re¬ peatedly derived ready assistance in simulated inflammation, by assuming it as such, and have had the diagnosis so invariably borne out by the result, that I do not now hesitate to assert, it is almost the only single symptom upon which a young practitioner can rely without danger. Without entering into the queslion of the nature of spinal irritation, which I have discussed at large in anotherplace, I may be permitted to claim the reader’s attention to two points connected with it, which must be regarded as physiolo¬ gical facts. That the spinal cord, as the experiments of Le Gallois have shown, is composed of portions inde¬ pendent of one another in their powers and functions, being centres from which the nervous actions of corresponding parts of the body emanate, and to which they tend ; and, secondly, in conform¬ ance with the well-known law, by which the pain and tenderness arising from disorder at the origin or trunk of a nerve, is referred to, or felt at its extre¬ mity, that affections of the spinal cord are not usually recognizable by pain at the part diseased, but at the termina¬ tions of the nerves in distant organs arising from it. From these facts there is one undeniable inference in deter¬ mining the diagnosis of cases re¬ sembling inflammation, — that wherever spinal tenderness exists, we must at all events set down pain and tenderness (the two most important symptoms in assisting us to detect internal inflamma¬ tion) as wholly valueless; inasmuch as, whether there be inflammation or not, these are not peculiarly the results of it, but may arise also from the tender state of the cord. I might perhaps go much farther, and assume, that where spinal tenderness exists, there also exists a state of the system scarcely compatible with acute inflammation. If, then, pain and soreness on pressure, those supposed characteristics of inflam¬ mation, are of all others the most equi¬ vocal symptoms, belong as certainly to irritative as to inflammatory affections, and almost necessarily exist if there be acute spinal tenderness ; what is to be our guide in deciding the diagnosis when called to a person suffering with violent pain of side, feverishness, dif¬ ficulty of respiration, and soreness of the intercostal muscles ; or with violent pain in the abdomen, accompanied by exquisite tenderness to the touch, and perhaps constipation and vomiting — if we do not examine the spinal column P We want to ascertain the simple fact in the first instance, of whether the pain is in the viscus supposed to be affected at all, or whether it be merely in the tho¬ racic or abdominal parietes. And since the patient shrinks and complains on pressure in both cases, what, 1 ask again, is to be our guide, if we do not examine the spinal column ? Are we to depend upon speculations on the attitude, ex¬ pression of countenance, temper or man¬ ner of a patient, when we can at once lay a finger on the spine, and detect both the cause and nature of his com¬ plaint. If in the former case we find acute tenderness of some of the dorsal ver¬ tebrae, or in the latter of some of the lumbar, I do not hesitate to say, the one is not pleuritis, nor the other enteritis, nor will either bear large depletion with impunity. The pain and tenderness are merely referred to the extremities of the spinal nerves, ramified through the in- tercostals or abdominal muscles, from the affection of the corresponding por¬ tion of the spinal column, and indicate nothing- whatsoever of the state of the viscera internal to them, which usually excites so much alarm. If these are facts, and I believe few will deny them to be so, on examining for themselves, is it not absolutely leading the young practitioner into those mistakes w hich we so much deprecate, to associate pain and tenderness on pressure so exclu¬ sively in his imagination with inflam¬ matory diseases ? Is it not strange too, that cases are every day published in our periodicals, with dissertations on the difficulty of their diagnosis, w ithout the slightest allusion to the spinal cord, the 76 DR. GRIFFIN’S MEDICAL PROBLEMS. state of which, in every case of presumed inflammation, our present knowledge of physiology must show us the necessity of ascertaining *. One would suppose where the obscurity of the diagnosis is ofteu so undeniable, that any adventi¬ tious light which could be brought to bear upon it would be sought for with avidity, but this, every day’s experience assures us, is very far from the reality. As illustration is very generally more impressive than argument, I shall offer two or three cases to the consideration of the reader. A young woman, aged 25 years, was attacked with pain in the bowels at night after a feeling of chilliness. She took some essence of peppermint and went to bed, but the pain gradually in¬ creased, and at tw o o’clock in the morn¬ ing she took twenty drops of laudanum. At seven o’clock, the pain still con¬ tinuing, she took castor oil, with ten or fifteen drops more of the laudanum, by the directions of an apothecary, and soon after ten drops were repeated in a saline draught. I saw her at one o’clock, and found her writhing with pain, chiefly round the umbilicus and to the right side. It became more violent by fits like colic, though never entirely subsiding, and during the intervals of comparative relief, she sometimes threw her arms about restlessly, sometimes lay as if insensible, w'ith the eyes turned * There was a paper from Dr. Samuel Cusack in one of last year’s Dublin Medical Journals, “ On certain Nervous Affections occurring prin¬ cipally in Females.” It was an essay, in fact, on the treatment and diagnosis of those chronic pains below the mammae, or between the false ribs and ileum, so often mistaken for phthisis, pleurisy, liver complaint, &c., to which public at¬ tention has been directed of late years by several writers, as instances of spinal irritation. Dr. Marshall Hall described them long since in his work on Diagnosis, and more at large in his work on the Diseases of Females. Mr. R. P. Player published a letter on the subject as long ago as 1821. Dr. Brown, of Glasgow, published pre¬ cisely similar cases in 1828, demonstrating the connexion of the pain with the spinal cord, and since then we have had essays from Dr, Darwall, of Birmingham ; Mr. Teale, of Leeds ; and Dr. Marshall, of Manchester ; all pointing out the nature of those pains, and the little connexion they had with a.disease of the viscera apparently affected. It is of course open to any physician to publish cases and observations in support of par¬ ticular views, however frequently placed before the public already by others ; but it seems singu¬ lar Dr. Cusack should conceive it necessary in 1834 to publish an essay on these affections, not only without the slightest allusion to their pos¬ sible connexion with the state of the spinal cord, but without the least mention of any of those writers, to whom we are indebted for- both the descriptions which he gives, and a diagnosis so much more accurate than his, in its not omitting - an examination of the vertebrae. up and the lids half open. Her com¬ plaints were low, scarcely audible, her respiration painful when deep ; turning from side to side increased her pain, although when the paroxysm occurred she turned sometimes on her face. There w as excessive tenderness of the abdomen, the least pressure making her scream. She had been constantly vomiting for the last few hours. The castor oil had operated once scantily ; her pulse was but little quickened, and there was no heat of skin. Here was a case of constant pain in the abdomen, chiefly about the umbili¬ cal region, liable to severe exacerba¬ tions, attended by exquisite tenderness on pressure, vomiting and constipation, and continuing for twenty-four hours. I am convinced that almost any young physician would have felt great dif¬ ficulty, indeed almost an impossibility, of determining, from a consideration of the symptoms, that the complaint was not inflammatory , and I believe that the great majority of either young or expe¬ rienced ones would at once infer the existence of inflammation, and bleed. I say so from having witnessed it, and from having early in my own professional life always prescribed in such cases with timidity, as if I felt that all consideration of the symptoms led to little better than conjecture. I had now, however, new ground for a diagnosis in the state of the spinal co¬ lumn, on examining’ which my mind was set at rest. As soon as I pressed on the upper lumbar vertebrae the girl started violently, caught my hand, and complained that I had hurt her dreadfully : the pressure, she said, had increased the abdominal pain : she had never had any hysterical attack in her life. I ordered the abdomen to be fo¬ mented freely, and gave her five grains of calomel with half a grain of opium, directing five grains of aloes and five of extract of henbane, to be taken every two hours. The calomel and the first dose of the aloetic pills remained on the stomach, but the succeeding’ doses were rejected; a purgative draught was also thrown off : she then got a purgative enema, which was repeated in an hour, but both passed off without any appearance of faeces. The vomit- ing, pain, and tenderness of abdomen, continued very severely throughout the evening. At night she got a turpentine enema, and was placed in a hot bath, DR. GRIFFIN’S MEDICAL PROBLEMS. 77 which gave some relief, and procured a scanty evacuation. The pain, however, soon recurred, and she was ordered a grain of opium, to he repeated every hour until it should subside. The bowels were freely moved soon after taking1 the first dose, but she did not experience any considerable relief until she had taken the third, after which she fell into a sound sleep, and in the morning was in every respect improved. The pain had altogether subsided, and the exqui¬ site tenderness was now felt in the right epigastric region only. She had threat- enings of a return of the attack in the course of the day, but it was readily subdued by a repetition of the opiate. On the following morning there was scarcely any pain or tenderness, and if the complaint had been inflammatory, I would now have left the patient’s bow els perfectly at rest. But believing it to be an affection of the spinal cord, arising from disorder of the digestive functions, I ordered another dose of castor oil, which operated freely, and w as followed by no recurrence of the attack. Mrs. - , ag’ed 30 years, of a full habit, complained of pain in the right iliac region, which gradually increased until the whole of the abdomen became sore to the touch ; on the third day she took castor oil, which operated Treely, but gave no relief. I saw her on the fifth day, when she complained of being much w’orse, and directed her to get to bed, to have the bowels fomented, and to take pills of aloes and henbane every second hour until relief was obtained. In the morning I received a letter, stat¬ ing that she had been in agony all night, was much swelled, had not had her bowels moved for three days, and was now feverish and throwing every thing off her stomach. I became ex¬ cessively alarmed, and regretted I had not bled her on the night before. On arriving at her residence, I found her complaining of violent pain all over the abdomen, but most acutely in the right iliac region, and almost down to the pubes on that side. There was fulness of the bowels, and the greatest tenderness on pressure. She could not bear the slightest touch in the iliac re¬ gion, and one spot she described as ex¬ quisitely sore. It was on this account, !)erhaps, that she bore the weight of my land laid flat, and pressed very gradu¬ ally, better than pressure with the points of the fingers, as, in the former case, the pressure on the most painful spot was not so direct. Her pulse was ninety- six, her skin feverish, and tongue white ; she had nausea and occasional vomiting*, and could not turn or move in the bed, without considerably increasing her suf¬ ferings. The only symptom that could lead me for a moment to doubt that I had here a case of very serious inflam¬ mation to deal with, was the expression of the countenance, which did not be¬ tray the deep anxiety and distress I have usually seen in the inflammation of vital organs, although her own descrip¬ tion of her suffering was sufficiently alarming. The treatment of the case with deci¬ sion and confidence now depended alto¬ gether on the examination of the spine. If I found a state of increased sensibility and excitement of that part of the cord which gave origin to the lumbar nerves, the pain and tenderness of abdomen would be accounted for, and I need not infer a more alarming cause for them. If, on the other hand, there was no spinal tenderness, the existence of acute inflammation was almost certain, and the most active treatment was demand¬ ed. On pressing the spinal column, as soon as 1 reached the lumbar vertebrre she started and screamed aloud. She also felt excessive pain on my touching the sacrum, or making* pressure behind the trochanter, or at the front of the hip-joint in the groin. I therefore un¬ hesitatingly concluded it was one of those nervous affections simulating in¬ flammation, in which the progress of the case fully bore me out. A few leeches were applied to the most painful part of the abdomen, and a grain of opium was directed every second or third hour until there was some abatement of pain. She was also directed, as soon as the vomiting abated, to resume the pills of aloes and henbane, and take a dose of castor-oil. She got considerable re¬ lief, but passed a restless night. In the morning she took the aperient medi¬ cine, which operated freely, and now had pain occasionally only, and at long in¬ tervals; the vomiting had ceased, but the soreness of the abdomen was still exquisite in the right ileum and groin, and she screamed when I pressed on the vertebra, or immediately behind the trochanter. Fomentations were now directed ; belladonna plasters were af¬ terwards laid over the painful parts, and the opium pills were g’lven every fifth or sixth hour. She spent the day well, but the pain recurred in the night very 78 DR. GRIFFIN’S MEDICAL PROBLEMS. severely, and was relieved by the ano¬ dynes. Next morning1 the bowels were agained moved, but the soreness on ressure, or on moving much in the ed, still continued. The case went on in this way for several days, abating very gradually, but the soreness of the abdomen and of the hip-joint was not perfectly removed until she was for some days driving out in her carriage. I attended this lady afterwards for an attack of acute bronchitis, which was of a similar character in its advanced stag-es. The cough, oppression, and ex¬ pectoration, were evidently the result of nervous irritation, and required tonics rather than the continuance of any an¬ tiphlogistic treatment. She told me that in a former illness, which she called inflammation of the lungs, the doctor had bled and, 1 believe, blistered her more than once ; that she was going- on from bad to worse, with incessant cough and debility, until at last, in de¬ fiance of all advice, she took a glass of pure wine, which cured her like a . charm. I mention this, not that one can infer much from such loose state¬ ments, but because it gives some idea of the irritability of her nervous system. Mrs. - , of a delicate nervous ha¬ bit, after a natural labour, had internal haemorrhage, with pallid countenance, cold clammy sweats, chilliness, and an almost imperceptible pulse at 156. The haemorrhage ceased on the extraction of several clots with the hand, but the de¬ bility continued to an alarming degree for several hours. She had large doses of laudanum, with dilute sulphuric acid, through the night, which seemed to re¬ lieve her much ; but in the morning the debility was still great, the pulse weak at 130, the features sunk, and the re¬ spiration much hurried. On the follow¬ ing evening she had a severe rigor, and was soon after attacked with pain and tenderness in the uterine region, exces¬ sive pain in the head, brow, and eyes, with sickness of stomach and vomiting. There were thirst and heat of skin, and the pulse became rather hard at 140; the tenderness on pressing over the uterus was considerable, the pain constant, the lochia diminished. On examining the spine, there w;as found acute tenderness of the lumbar vertebrae, upon which it was assumed to be a case of nervous irritation, and not inflam¬ mation. A dose of calomel w ith ex¬ tract of henbane was given, fomenta¬ tions were applied to the lower part of the abdomen, and she got diaphoretics at intervals. Under this simple treat¬ ment the symptoms declined, and on the succeeding night she felt quite relieved ; the lochia and secretion of milk becom¬ ing abundant, and the pulse soft at 125. After the lapse of some days she was up and well. Mrs. M - , a married woman, aged 26 years, had very severe flooding in her lying'-in. On the fifth day after, she w'as seized with pains in the abdo¬ men, attended by excessive soreness to the touch, and fever. She got castor oil on the sixth day, which operated twice without giving much relief. In the evening she had a slight rigor, and felt very weak. The milk had left her from the first moment of the attack, and the lochia had nearly ceased. I saw her for the first time on the night of the seventh day from her delivery, and found her lying on her back, with her knees up, complaining much, and inca¬ pable of the least motion on turning to one side or the other w ithout the great¬ est torture. The pain was constant, but w'as increased to an excessive de¬ gree at intervals ; coughing wras very distressing to her, and the least pressure on any part of the abdomen made her scream. Slow, steady, cautious pressure with the flat of the hand was unbeara¬ ble, but she could stretch down her limbs without increasing her sufferings. Her countenance, which was pale from the flooding, had an expression of dis¬ tress, and the brows were knit as with pain. The skin was warm, the tongue moist and white, and the pulse weak, at 112. There was excessive tenderness of all the lumbar vertebrae. The abdo¬ men was fomented, and she got two grains of calomel and a grain of opium every third hour. After the second dose the pain abated, and she got a good deal of sleep; but in the morning the symp¬ toms returned, and the pills wrere re¬ sumed with the same good effect as before. The tenderness of abdomen w'as now rather less, though the bowels ap¬ peared more full, not having been moved for the last forty- eight hours ; she could turn from side to side with less suffering ; the pulse still 112, and the skin warm and moist; she took cas¬ tor oil, and afterwards pills of aloes and extract of henbane every second hour, which operated freely ; she passed a to¬ lerable night and seemed easier, but got the pain more violently than ever on to DR. GRIFFIN’S MEDICAL PROBLEMS. the following- morning-, when it was re¬ lieved by forty drops of laudanum ; it continued in the intervals of these pa¬ roxysms, but not severely. In the evening- the paroxysm recurred, and was again relieved by the laudanum. Not¬ withstanding- these recurrences she felt herself on the whole much better, could turn from side to side with more free¬ dom, and wished for nourishment; she complained of some headache. She was now directed to take three grains of sul¬ phate of quinine three times a day, and to repeat the laudanum if seized with the pain. I also allowed her to get a little chicken broth or beef tea. She passed a good night, and although the pain recurred at intervals on the follow¬ ing- morning-, it was much less severe; she threw up some aloetic and henbane ills which she had taken to free the ow-els ; the abdomen, though still pain¬ ful on pressure, was much less tender; the soreness of the spine was nearly gone, and her milk was returning. As her bowels had not been moved for the last thirty-six hours, she got some cas¬ tor oil, and the quinine and broth were continued ; she complained much of headache. The pain recurred again violently in the night, soon after which the flooding returned for a short time, and then ceased. The pain was relieved by a grain of opium ; felt much better through the day, and ate a little meat without permission ; the soreness of the abd omen almost gone, and none what¬ soever of the spine ; her headache was better; she continued her quinine and nourishment, and was well in a few days* *. V * The above ease, at the first moment I was called to it, so perfectly answered the descrip¬ tions given of simple peritonitis (see Abercrombie on the Viscera, p. 151), and so truly resembled the cases of that disease which had fallen within my own experience, that I watched its progress with much anxiety. I was, indeed, somewhat distrustful of the diagnosis ; fur although the extreme tenderness of spine would fully account for the tenderness of abdomen, the great torture experienced on the least motion from side to side was a symptom more characteristic of true peri¬ tonitis than of a neuralgic affection ; the progress of the complaint, however, fully satisfied me of its nature. I believe there is no practical physi¬ cian will assert that a case of acute peritonitis would have been arrested by the treatment adopted, which was, in fact, little else than pal¬ liative. It was only on the first day of my at¬ tendance that the opium, combined with calomel, was given with any regularity, five grains having been taken within twenty-four hours ; for al¬ though the pain recurred with equal violence, subsequently she had seldom occasion to take an I might multiply cases of this nature to an extent that would be tiresome, without making the point much clearer. Perhaps it may be said, that an expe¬ rienced eye would have detected some anomalous symptoms in all of these, which would have led to doubts of their inflammatory nature. I am not dis¬ posed to deny that much may be in¬ ferred in such attacks from the sudden¬ ness with which violent symptoms su¬ pervene, the absence of deep distress and anxiety of countenance, and, above all, from a freedom in the movements of the lower extremities unusual in acute abdominal inflammations. There was, indeed, at least one of these discrepan¬ cies observable in a greater or lesser degree in each of the cases detailed ; but how are young practitioners to form a diagnosis on such grounds? People suffer similar degrees and kinds of pain with very dissimilar degrees of fortitude ; and, at all events, any reasoning- on such signs must be founded on compa¬ risons, which, to be worth any thing, would imply an experience no young practitioner can be supposed to possess. In all acute inflammations of vital organs, I believe that no spinal tender¬ ness will be found, except where it ex¬ isted previous to the supervention of the attack*, or where the spinal cord itself happens to be the seat of such inflam¬ mation. In all neuralgic affections, on the contrary, tenderness of some portion of the spinal column, usually that cor¬ responding to the affected organ , may be detected, except in some rare cases, in which it seems probable the gangli¬ onic nerves alone are concerned. As these cases must still present a difficulty in their diagnosis, we must rest con¬ tented with those general characteristics, which, however vague or liable to lead us into error, are all we have to g'uide us, and all we have hitherto had to de¬ termine our opinion in that large class of neuralgic affections, for the detection of which I have here been offering a new, and I believe less doubtful sisn. opiate more than once or twice in the day. I may, however, point out one symptom in which the case differed from peritonitis--the ease and freedom with which she could stretch down her limbs. In spinal affections the least motion of the spine, especially turning or twisting motion, will sometimes increase the abdominal pain, but it scarcely ever occasions difficulty or uneasiness in the motions of the lower limbs. * Some writers on spinal irritation state that they have found spinal tenderness, with inflam¬ mation of liver. 80 DR. BUCHANAN ON THE The observations offered respecting1 the diagnosis of cases resembling- acute inflammations, apply with almost equal truth to those resembling chronic dis¬ eases ; I mean those pains affecting the chest, and attended by cough and per¬ haps oppression, leading to apprehen¬ sions of phthisis — the side, between the false ribs and ilium, suggesting affec¬ tions of the liver or bowels — or the pubic region simulating disease of the womb or ovaries. It is, however, wholly unnecessary to extend this paper to an unreasonable length on the subject of those nervous affections, the nature and diagnosis of which I have discussed so fully in another place ; I need only re¬ mark, that deducing inferences from acute or chronic pain, apparently affect¬ ing any viscus, without examining- the state of the spinal cord, seems to me little less absurd than omitting to exa¬ mine the state of the hip-joint in those painful affections of the knee, the na¬ ture of which is not immediately ob¬ vious. In either case the disease may not exist at all in the part apparently affected; and the real source of the pain can only be ascertained with certainty by an examination of the origin of the nerves distributed to it, or of any organ with which the part affected may be supposed to sympathize. ON THE THERAPEUTICAL EFFECTS OF IODINE, GIVEN IN VERY LARGE DOSES, In the forms of Iodide of Starch, Hy dr iodic Acid, and Iodide of Potassium. By Andrew Buchanan, M.D. Junior Surgeon to the Glasgow Royal Infirmary. [Concluded from p. 47. J Noli me tanyere. Under the head of noli me tangere and lupus, surgeons comprehend ceitain ulcerative affections of the nose, the in¬ tractable nature of which seems to have suggested the first name, while the se¬ cond is expressive of the wide-spreading destruction of parts which they not un- frequently occasion. There appear to be three distinct affections to which these names are often indiscriminately applied. The first seems to have its seat in the bones and cartilages of the nose. The ulcers of the surface occur only on the nose, or on parts in the im¬ mediate vicinity, being apparently a mere secondary affection, excited and kept up by the deep-seated irritation. The other two diseases have their seat in the cutaneous tissue; the evidence of which is, that they often affect other parts of the skin, as well as that covering the nose. The one appears to be a disease of the strumous kind ; it comes out in the form of papulae and small pustules* having irritable inflamed bases, which speedily become the seat of ragged su¬ perficial ulcers. The other is the can¬ cer of the skin, which, while it may occur in other situations, is very often observed on the nose. The two following cases are exam¬ ples of the first and second of these dis¬ eases. In the first a complete cure was effected under the use of iodine. It ought, however, to be borne in mind, that in such cases, on the diseased bones, which are the great source of irritation, being discharged, a spontaneous cure is often effected. In the strumous disease of the skin the benefit obtained was much less considerable.