ful at the bed-side, which is the only true test. I confess that I have no system of my own to offer in place of that which I hope to destroy. It is, indeed, my earnest wish to see a pathological System of Medicine established, but it can never be the work of one man; fortunately, however, there is scarcely a corner in Europe or in America, in which there is not to be found some ardent cultivator of patholo pursued. My opinion is quite different on all these points, and I should be happy to join issue upon them at this opportunity, but the length to which this paper is already extended, forbids further comment than to beg the experienced pathological reader to refer to the work itself, with a view of ascertaining whether he can obtain sound views of the pathology of any disease from it. For example, let him peruse the Chapters on Phthisis-gy, and it is by the efforts of the whole Pneumonic Inflammation-on Inflammatory Affections of the Abdomen—or, on Inflammation of the Brain :-To this last subject he devotes two pages and a half, while Odontalgia occupies no less than five!! It may be asked by those who are not very well acquainted with the present state of advancement at which practical medicine has actually arrived, What good can accrue from the destruction of Cullen's System--have you a better to offer as an equivalent? All systems which have hitherto been promulgated, are too arbitrary to be use that the great and important task is to 31, Albany Street, Edinburgh, POSTSCRIPT TO No. XV. Mrs. Denmark's Case-tying the Subclavian Artery for Aneurism of the Innominata.—Mr. WARDROP'S Reports to the Lancet. Fourth Report.* In this report, (the longest of the whole) Mr. Wardrop seems to consider Dr. Barry's modest statement as quite unworthy of the brilliancy of his success. He accordingly charges Dr. B. with having given a very imperfect account of the case, such as might mislead the public, and immediately publishes this fourth report, for the express purpose, as he declares, of saving the public from being misled. In this document, the history of the case is brought up to the 5th December. It is there stated, in the most unqualified terms, that, with the exception of a slight attack of bronchitis, which she had about a fortnight ago, the woman has continued to improve progressively ever since the operation, and that she is now perfectly cured. We shall now briefly remark upon the different items of these reports. First, then, the whole jet of the very prolix discussions which Mr. Wardrop has entered into his first and fourth reports, as to the principles upon which he was led to perform the operation, is contained in the following sentence of Dr. Barry's speech. "If, under these circumstances, (viz. aneurism of the innominata, with stoppage of the carotid,) the subclavian be tied, a still less quantity of blood will be seut into the brachio-cephalic trunk, the motion is, consequently, diminished, and the cure, which Nature had commenced, is expedited."t Mr. W. labours under a sad mistake, when, in order to show the originality of his own views, he asserts that surgeons, up to the present day, "will insist," that a total stoppage of the circulation within the aneurismal bag, is indispensable to the formation of coagula, and consequent organization of fibrine. Cooper's Dictionary will settle this point. Mr. W. takes to himself the credit of having noticed the imperfect dislocation *Lancet, No. 223. Lancet, No. 220. and motion of the sternal end of the clavicle. The merit of this remark, if there be any in it, belongs to Dr. Barry alone. chest, Mr. W. after the most minute and With regard to the examinations of the careful examination with the stethoscope, and by percussion, states, that the contents of the thorax were sound, except the innominata; yet he publishes Dr. Barry's notes, in which it is asserted that there was true aneurism of the aorta, as well as of the innominata. But, at the time these notes were sent to the Lancet, Dr. Barry's opinions, whether well founded or otherwise, could only add to the eclât of the operation, because the woman had been already reported as nearly, if not entirely cured. We now come to the most important points of all, the final result of this operation, and the actual state of the patient who was the subject of it. Immediately after we had seen Mr. W's last report, we sought for, and found out Mrs. Denmark. We saw her on the 12th December, and afterwards on the 16th. She was still alive, and may continue to live for some days. We examined her chest, and observed the symptoms under which she laboured with There is aneurism of the much attention. aorta, in a very advanced state, pressing upon the bronchi and root of the trachea. Such is the successful termination, (says Mr. W. in his report dated the 5th Dec.) of an operation, the principles of which seem to me to be now perfectly understood, and completely established." We shall abstain from all further comment on this very extraordinary case, until Mr. W. shall have either reconciled the assertion just quoted, with the present most deplorable state of the patient, or, by delaying to do so, shall have left the world at liberty to form its own conjectures. We shall look forward with much interest, to the publication of Dr. Barry's Notes, alluded to in his letter (to the Lancet) of the 15th December. N. B. In our Fasciculus, for January, 15th, we shall offer some observations on the operation for aneurism, ultra tumorem, and fear we shall be obliged to give the conclusion of Mrs. Denmark's case. 21st. Dec. 1827. DR. COOKE. INTELLIGENCE, &c. WE have received a rather sharp remonstrance, amounting almost to a reproof, for a question which we asked the College of Physicians in our last number, namely, whether they could turn out a more erudite physician than Dr. Cooke, who never breathed the air of Oxford or Cambridge? It can hardly be supposed that we meant to hurt the feelings of Dr. Cooke by this allusion; and any thing we could now say by way of retractation, would probably make matters worse. In this dilemma, we can only, like a true penitent, promise never so to offend again. We may be permitted, however, to remark that, as the question did not imply a superiority, but only an equality of erudition, on the part of Dr. Cooke, so we really imagine that the doctor is too sensitive on this point, and that there is nothing in the passage which need render him uncomfortable as to his brother-fellows in the College. At all events, on our heads be the sin, and also the errorif we were in error. MR. GUTHRIE'S ACTION AGAINST THE LANCET. On the 18th December, after the lawyers had unfolded their briefs at Guildhall, and all was clear for action, the proceedings were suddenly stopped, and the trial postponed till next term! The CAUSE of this postponement is not, at present, (20th December) clearly ascertained, though rumours are afloat, to which we do not, in the present state of the business, consider ourselves bound to advert. We shall return to the subject in a short time. ment of Diminution of Hearing, arising from imperfect Secretion, &c. with Cases: being a Sequel to the Guide, and to the Illustrations of Acoustic Surgery. THOMAS BUCHANAN, C.M. By In the press, and will be published in a few days, a Practical Treatise upon Sticture of the Rectum; illustrating, by Cases, the connexion of that Disease with Affections of the Urinary Organs, the Uterus, and with Piles. By FRED, SALMON, Surgeon to the General Dispensary, and formerly House-Surgeon to St. Bartholomew's Hospital. Dr. ARMSTRONG is preparing for publication an octavo volume on the Remote Causes, Prevention, Nature, and Treatment of Diseases of the Stomach, Liver, and Bowels. This work, which will appear in the Spring, will be preceded by a series of coloured drawings, in quarto, with copious letter-press, illustrative of the morbid anatomy of the stomach, liver, and bowels. They will be published in six monthly fasciculi, each containing about five plates accurately coloured from Nature the first Number will be ready early in December. LITERARY NOTICES. In the press, and speedily will be pub Jished, in royal octavo, with plates, Phy siological Illustrations of the Organ of Hearing, more particularly of the Secretion of Cerumen, and its effects in rendering auditory perception accurate and acute, with further remarks on the Treat N. B. Books transmitted for review will be registered, as usual; but no literary notices will be inserted in the Fasciculi, except as advertisements on the cover. The Journal will be kept free from all matters, not strictly connected with the Review and Periscope depart ments. Medico-Chirurgical Review, No. XVI. [FASCICULUS I JANUARY 12, 1828. ART. I. Eclectic Review of the Etiology, Pathology, Diagnosis, and Treatment of Peripneumony.* WHATEVER may be the case in the more genial climates of the earth, there can be no doubt that, under the gloomy skies of northern Europe, and especially of England, inflammation of the respiratory apparatus, acute and chronic, is at least three times more destructive of human life, than that of any other internal organ of the body. If we take into consideration the developement of tubercles, and, consequently, of pulmonary phthisis, as materially influenced, if not produced, by peripneumonic inflammation, the ratio of its fatality will be greatly increased, and the importance of its study rendered more conspicuous. Common as is the disease in this country, we venture to affirm, that there are few internal inflammations in which more mistakes are made, as regards the seat, the extent, or the stage of the malady. Yet, on an accurate knowledge of these hinges the proper and successful treatment—and on the absence of this knowledge hangs the fate of the patient-sometimes the reputation of the practitioner. If these observations be founded in truth, the utility of widely diffusing a rather extended article on this important subject will not be disputed. It is the first of a series of ECLECTIC REVIEWS on the more important diseases to which we are liable, and in which series we shall endeavour to concentrate the best information which literary research, modern pathology, and practical observation can yield. It is well known that Cullen and Frank combined pleurisy and peripneumony as either indistinguishable, or useless to be distinguished. Nothing can be more erroneous or improper than either of these conclusions. Dr. * Laennec's Work-Dr. Forbes' Notes to Translation-Louis-Andral-Broussais, &c. &c. |