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state, that it had existed for eighteen months, had been removed by the forceps twenty-three different times, and was constantly bleeding. After putting the patient under proper diet, &c. Mr. Earle attempted to dissect it out by an incision, commencing at the top of the right nasal bone, and extending through the ala nasi. The polypus was attached to the nasal and maxillary bones, which were rough, and their Schneiderian membrane thickened. Each stroke of the knife was fol. lowed by profuse hæmorrhage, and it was thought necessary to remove part of the nasal and maxillary bones, and to apply the actual cautery. The operation, which does no discredit to Mr. Earle, was performed on the 29th September, and, by the 30th October, the fungus had again made its appearance. It went on increasing in size, bled profusely, and, on the 30th Dec. the patient died.

On dissection, the fungus appeared to have taken its origin from the membrane covering the vomer, superior turbinated bone, and cribriform lancella of the athmoid. The lungs, the liver, the spleen and pancreas, the renal capsules, fat surrounding the bladder and rectum, &c. &c. were studded with tumours, some of them medullary, some of them resembling clots of blood, and readily breaking down under the fingers.

STRANGULATED EXOMPHALOS IN THE EIGHTH MONTH OF PREGNANCY.*

E. Wright, æt. 31, had been always subject to a tumour at the navel, which, about the 4th or 5th month of pregnancy, invariably swelled and became painful, but subsided under the use of a purgative. On the 30th Sept. being then 7 or 8 months gone with child, she was seized with pain in the umbilicus and vomiting, which, not being relieved by castor oil, she entered the hospital, on the 1st Oct. under the care of Mr. Lawrence. hernial tumour was soft, irregular, not very tender, and consisted principally of omentum, whilst there was no tenderness whatever of the abdomen. Castor oil, leeches, taxis, &c. were employed in vain, and Mr. Lawrence, notwithstanding the mildness of the symptoms, determined

*Lancet, No. 228.

The

on operating. On laying open the sac, a quantity of omentum, and a small portion of discoloured intestine, were exposed. The latter was returned, and a part of the omentum removed, one or two small vessels requiring a ligature. She had four or five motions after the operation, but, next morning, there came on inflammation about the wound, for which she was bled to sixteen ounces-had twenty leeches to the abdomen, &c. On the 3d, the bleeding and leeches were repeated, and a poultice applied to the wound. Oct. 4th. Better. V.S. ad 3xiv. An abcess formed "on the tumour," (this means, we suppose, in the omentum,) which was opened, and the patient did very well.

It is not many years since recovery from the operation for hernia, at some of our hospitals, was no very common occurrence, whilst at present, when circumstances are tolerably favorable, patients as rarely sink under or after it. This change in the comparative results of the operation, we have no hesitation in ascribing to the circumstance of surgeons resorting to it much earlier than they used to do. In the case, however, under review, we are not quite sure that the protrusion might not have been returned without the operation, for the symptoms were exceedingly mild, and the reporter makes no mention whatever of the state of the stricture. It may have been firm, it may have been lax, or there may have been no stricture at all, from any thing which appears to the contrary on the face of the report, although the direction of the cuts, the sutures, and the straps, are detailed with the most laudable fidelity. We observe that in this, as in most other instances, Mr. Lawrence removed a portion of the omentum, and certainly, as far as the case goes, without any ill effect. We should be glad to hear the results of Mr. Lawrence's experience on this point, as it is one of much interest, and a good deal of difficulty.

COLLEGE OF PHYSICIANS v. Dr. HARRISON.

We were right in our information, that a committee had been appointed to collect proofs of Dr. Harrison's practice. They have effected their purpose (as they be

lieve) and notice of action has been served. We said that, had we been in Dr. Harrison's place, we should have given up the admission of practice at once, and thus met the action boldly. Dr. H. by halting in the commencement of the battle, has lost the "vantage ground" as far as concerns himself personally, without gaining any adequate security of position by this ill-timed caution. This, however, makes no difference in the general result of the contest. Nothing will give us greater pleasure than the fact of a verdict being gained by the College. It is just what we ardently hope for. While an unjust law slumbers it is safe. The moment it is put in execution, the process of abrogation commences. A statute originally designed for the suppression of quacks, is now turned against regular physicians of the first medical university in the united kingdom. We had little idea that the council of the College would, in the year of our Lord, 1828, prove the truth of the ancient adage

"Quem Deus vult perdere, prius dementit."

Anxious for the establishment of LIBERAL INSTITUTIONS and JUSTICE, we shall restrain ourselves on the present occasion, lest we should disturb the natural course, of events. Mr. Brougham will remove the veil, and the picture which will be drawn of the state of this branch of the profession, in a court of law, will open the eyes of statesmen-while the general indignation of the Profession, at such a flagrant insult to the diplomas of the Edinburgh, and other regular universities, will lead to the desired object--a general investigation of the state of the profes

sion.

LIBERALITY AND ILLIBERALITY.

We were much grieved to see a letter, lately published in the MEDICAL GAZETTE, from a correspondent of Dr. A T. Thompson, reflecting, in rather illiberal terms, on foreign schools of medicine. Those who know how openly and hospitably English students and practitioners are received in the public schools and institutions of the Continent, cannot but deplore the impolicy and narrow-mindedness of individuals, who, from hasty and crude views of things, permit themselves to in

jure their countrymen, and the whole of the English medical profession, in the eyes of liberal foreigners, by such prejudiced and unfounded statements as those alluded to.

But what shall we say to the disgraceful scenes that are now exhibiting in the medical press, in respect to the injuries sustained by the medical officers of public institutions from the misrepresentations of FALSE REPORTERS? Let any man read the deluges of abuse which have been poured on Mr. Earle and Mr. Keate, in the last Number of the LANCET, for hav. ing merely corrected the wilful falsehoods of ignorant reporters, and say whether or not the SATURNIA REGNA are returning in this country! The Lancet is playing a desperate game. It seems determined to try how far the most vulgar ribaldry and Billingsgate slang can be crammed down the throats of a learned and liberal profession, as a substitute for knowledge, candour, and practical information. Thus, whole columns of that journal are filled with the most low-lifed and disgusting epithets, lavished on men of acknowleged probity, talents, and honour, while all their statements are distorted, garbled, and misrepresented, so as to make a few of the very lowest and most ignorant of the profession laugh, and all the sensible and ingenuous grieve-if they can permit themselves to wade through such detestable trash! We confess, however, that we are not sorry to see justice, good sense, and proper feeling thus violently outraged. It is precisely in this way that evil works its own ruin. Whatever may be the proportion in which good and bad principles are mixed in human nature, a time always arrives, when the former is approved, and the latter spurned. That period is rapidly approaching, if we be not much mistaken. At all events, the advocates of the evil principle are taking the most direct paths to bring about the triumph of the good. We would advise the advocates of the LATTER to oppose a calm, but steady resistance, in the detection of error and misrepresentation, trusting to the good sense of Englishmen, and the justice of their cause, for a final and signal victory.

"When Peace and Mercy, banished from the plain, Sprang on the viewless winds to Heaven againAll-all, forsook the friendless, guilty mindBut HOPE, the charmer, lingered still behind !"

Periscope;

OR,

CIRCUMSPECTIVE REVIEW.

"Ore trahit quodcunque potest, atque addit acervo."

[FEBRUARY 9, 1828.]

1. THORACIC DISEASES.

IN à late sitting of the Medico-Chirurgical Society (22nd Jan.) the President, Mr. Travers, communicated two cases of medullary disease in the chest, which led

to

some interesting observations from three or four of the members present. It is not our intention to give any details of the papers read at this Society, seeing that they will now be regularly published every year; but in the present instance we cannot notice the oral discussions, without some particulars of the cases that gave origin to them.

The first case was one that occurred at St. George's Hospital, about a year ago, and of which we took some notice at the time. A man came in under Dr. Hewett, with evident symptoms of watery effusion in the left side of the chest, in which no respiratory sound could be heard. The heart was found beating in the right side, and the sound, on percussion, was dull on that side. The poor man being threatened with suffocation, Mr. Brodie performed paracentesis thoracis, and drew off a very great quantity of serosanguineous fluid. A temporary mitiga tion of the symptoms ensued; but, in two or three days, the patient died. Meantime, the heart returned to its natural position, when the fluid was drawn off. On dissection, a fungoid tumour, of malignant character, was found growing from the diaphragm, and projecting into the left side of the thorax. The lungs were congested, but there was no other material disease.

The second case was one in private practice. A young gentleman, till within three weeks of his death, was supposed to be in perfect health, and could tire out men and horses in the sports of the field. About Christmas, 1827, a sudden stop was put to these exercises, VOL. VIII. No. 16.

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by pain in the right side, difficulty of breathing, and other phenomena which induced the medical attendants to consider the liver in fault. In a short time afterwards there were pretty strong evidences of a fluid effused in the right pleural cavity, evinced by a bulging out of that side-by an inability to lie on the opposite side-and, in short, by distinct fluctuation in that side. A trocar was introduced, and a large quantity of fluid, of a clear straw-colour, was drawn off. Great relief was thus obtained-and considerable hopes of cure were entertained by the medical attendants, and communicated to the friends. But these hopes were soon dissipated. The chest filled again, and the young gentleman breathed his last, on the road to London, in about three weeks from the apparent commencement of the disease. On dissection, there was found a very large medullary fungus occupying the whole of the upper portion of the right lung, and weighing about three pounds-effusion into that side of the chest-universal tuberculation of the pleura costalis and pulmonalis of that side-an almost complete obliteration of the left lung, which was reduced to a condensed lamina, three lines in thickness, adherent to the left pleura costalis. Thus, the only portion of respirable lung, was the inferior lobe on the right side. There was no disease in any of the abdominal viscera. No mention of auscultation or percussion was made in the paper; but the President requested that members would give their opinions how far the stethoscope might have elucidated the pathological condition of the chest. Dr. Johnson observed that, as only the inferior lobe of the right lung was in a respirable state, so, both auscultation and percussion would have proved that fact, without the smallest difficulty. It was quite impossible that

the respiratory murmur could have been heard in any part of the chest, except in what was occupied by the said lobe. So far auscultation and percussion might have prevented the favourable prognosis which was given to the friends. And now a ruse de guerre was played off, and a masked battery opened against auscultation. Mr. Travers immediately stated that, "a gentleman who carried a stethoscope, gave a most favourable prognosis of the case." A smile of congratulation mantled on the animated countenances of the anti-auscultators—and, while Mr. Travers was pronouncing sentence on the stethoscope, their ears could actually be seen to stand up-we will not venture to say how far beyond their usual longitudes. But the ruse de guerre failed-the the masked battery missed fire, and the trap which was laid for auscultation was occupied with other subjects. Dr. Johnson instantly put the question to the President, whether, by this verbal statement, (not on the record of the case,) he meant to throw the error of prognosis on auscultation, or on the auscultatoron the measure, or on the man? The President candidly attributed the error to the man! The dimpling smiles faded at once-and not a single anti-auscultator even attempted to invalidate the position maintained by Dr. Johnson.

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Mr. Lawrence adverted to the question, was this immense quantum of disease developed in the short space of three weeks, or might the origin of it be dated back to a former period, when this young gentleman had had a small medullary tumour removed from one of the lower extremities ?" an event we forgot to mention in the narrative. Mr. L. was inclined to suspect that the disease did not exist prior to the recent fatal illness-and he was led to this suspicion, by the rapid progress which medullary diseases usually make. In illustration of this, he related the case of a young gentleman who complained of pain in his knee, about three months before his death, without any visible affection of the part.* This increased-a swelling,

* We were informed by a young gentleman in the Society, who knew the patient, that the latter had complained for a much longer time than three months, of the pain in his knee.

of a pulsatile kind, took place and, in three months, his health was so completely broken up, that amputation was performed to give him a hope of preservation. The operation did not save him. On dissection, a medullary tumour was found to have commenced between the heads of the tibia and fibula, involving all the contiguous parts in destruction. Mr. L. related another case which had very little reference, except to Dr. Hewett's case, where the heart was displaced A boy had been jammed between a cart and a post, and was brought into Bartholomew's, in a state of great depression, from which he was not expected to recover. In a few days, however, a smart re-action came on, and now it was discovered that the heart was beating tremendously in the right side of the thorax. Mr. L. was inclined, at first, to look on this as a malformation, or transposition. But, in process of time, the heart gradually came round to its proper place in the left side, and the boy recovered. On being asked by Mr. Earle, if the stethoscope had been applied in this case, Mr. L. answered no-the phenomena were so evident to the senses, that auscultation and percussion were unnecessary. L. was then asked by Dr. Johnson, "what it was that had displaced the heart, seeing that the phenomena were all so evident?" Mr. L. replied that he could not tell. So then, Mr. L. knew that the heart was in the right (or rather in the wrong) side-but what was in the left side of the chest God only knew. It might be air from a fractured rib and wounded lung-or it might be a serous, or sanguineous effusion, but as the nature of the case was so evident to the senses the left side of the chest was never examined by auscultation or percussion!!

Mr.

He

Mr. Earle, in illustration of the rapid growth of these medullary tumours, related the case of a young gentleman, from whom he removed a small tumour of this kind, a few months ago, which was seated over the parotid gland. was then in apparent good health, but has since died, presenting a great number of tumours in the liver and abdomen generally. The body, however, had not been examined. Notwithstanding these proofs of the rapidity of growth, in medullary tumours, we cannot agree with Mr. Lawrence in believing that, in the se

!

cond case, the mischief might be produced in three weeks. The immense size of the principal tumour-the complete tuberculation of the pleura-the annihilation of the left lung-and the serous effusion, were the work of longer time.

There was one other subject mooted at a late hour in the Society, which we deem worthy of notice, on account of the confident, but, we apprehend, somewhat hasty opinion, delivered by Mr. Lawrence. The president asked the Society whether it was consonant with their experience, to find dropsical effusion in the chest, independent of organic disease. Mr. Lawrence argued that such effusion did not exist, independent of organic affection. This opinion we hold to be erroneous. There are several states of the system, especially inflammatory states, where serous effusion takes place into the pleural as well as into other cavities of the body, totally independent of organic disease, in any of the vital organs. Effusion obtains more or less, in all severe attacks of pleuritis-which, we conclude, Mr. Lawrence would not designate as an organic disease. The same takes place in peritonitis, into the abdomen-and into the ventricles of the brain, in meningeal inflammation. But there is the very best reason to believe that, without some inflammation, there may be a dropsical effusion into the chest, and other parts of the body—as, for example, after severe hæmorrhages, from accidents or operations. These considerations induce us to dissent from the opinion delivered by Mr. Lawrence-particularly as it is a doctrine which leads to despondency in the treatment, and takes away all hope from a surgical operation.

2. FOREIGN BODIES IN BODIES
NATURAL.*.

Some curious cases have lately been given to the public, by our esteemed contemporary, where pins, needles, teeth of combs, &c. have been taken out of various parts of the body, no account being furnished

* London Med. Gazette, Nos. 3, 6, 7, passim.

a

of how they got in. The first was that of a girl, admitted into the Middlesex Hospital, with violent pain in the belly. On examination, there was found, a little below the umbilicus, a hard point, and on making an incision, out started the head of a pin! It was taken hold of by the forceps, and drawn out one-twothree-five inches-and, at last, on coming away, proved to be a brass hat pin, six inches in length! The young woman, of course, had not the remotest idea how it could possibly have come there, unless, indeed, she had swallowed it by mistake, This case is followed by another, related by Mr. Brodie himself. Mrs. H. " middle-aged woman," (was she married?) was subject to hysteria and pain in the side. One evening she called up her maid servant, and told her that she had dropped a paper, containing fifty needles, upon the foot stool, and thought that some of them had stuck into her leg. Her medical attendant was called, and extracted two small ones, from a little above the ankle; but eight only of the fifty could be found in the paper! In a few days, Mr. Brodie was sent for, and removed, at intervals, twenty-six needles from the legs, which became cædematous, with much general disturbance of the health. One evening, towards the end of June, she fell into a state of insensibility, and at two o'clock next morning expired. On examination, the leg from which the needles had been taken was found loaded with lymph and serum, and sufficient needles were found still imbedded in the cellular tissue to account for nearly the whole number missing. Mr. Brodie hazards no conjecture upon the mode in which this paper of needles was disposed of. That he imagines they actually did "stick into" the foot, and travel thence up the leg, we cannot believe, but we suppose that such being the account given, Mr. B's well-known gallantry would prevent his doubting the lady's word, whatever opinion he might hold to the contrary.*

Mr. Brodie is followed by Mr. Bell, who somewhat startled us by stating, that "the

* No two persons agree in their interpretation of this paper of Mr. Brodie's. One party thinks that the lady swallowed the pins, the other that they got into the member via the foot. For our parts,

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