3

We have given insertion to Mr. Lawrence's letter verbatim, because it is short, and touches on a subject of great interest in the surgical world-we mean the late operation of Mr. Wardrop. We have, in this, violated a rule which we laid down at the beginning of the year, and given just cause of offence to other correspondents. We have treated Mr. Lawrence with more respect than he can reasonably claim from us, after the supercilious preamble of his letter; but we shall take care, in future, not to tax our readers with altercations between two individuals, for neither of which, perhaps, the public care a straw. The Lancet (which now is absolutely destitute of professional information) is the proper channel for this species of medical literature, and to that publication we shall refer all applicants.

PROSECUTION OF MR. STANLEY.

It is a very general law, we believe, among animals, that individuals of the same species avoid preying on each other. It is true, that many of them are very pugnacious. Cocks will fight while life remains-dogs will worry each otherand bulls will meet with tremendous clash, when enfuriated by animal passions. The history of the human race, unfortunately, proves that nations will unite to exterminate nations, while individuals are perpetually engaged in the ignoble pursuit of supplanting, cheating, scandalizing, and betraying one another! With all these imperfections in poor weak mortals, there has long existed among the liberal and learned professions, a kind of universal compact that men of the same

where we do not mean on Mr. Lawrence's part. However, we have but one short reply to make :-We defy any member of the Medico-Chirurgical Society to show that we have ever published "misstatements," (the term applied in the Lan cet) while reporting the proceedings of that body. Whoever asserts, by letter, by word, or by print, that we have mis-stated, or misrepresented, any case read, or any opinion given, in that Society, commits himself a "misstatement.” Qui capit ille facit.

faculty should obey the Christian precept-" do unto others as ye would be done by"-put the most merciful construction on things-and never attempt to exaggerate their neighbour's failings, or exasperate the passions of the popu lace against one of their own brethren. This tacit compact has very generally been exemplified in the three learned professions. The recent action, in which Mr. Stanley was amerced in 30 pounds damages, for not discovering the precise nature of an accident, after swelling and inflammation of the parts had come onand for mistaking a foreign body jammed along-side or beneath the patella, for a portion of that bone broken off, has called forth such a stormy effusion of vituperation from a junto of his brethren, that human nature sickens at the scene!* Heaven knows we owe Mr. Stanly no obligation; nor are we the toad-eaters of the Medical Aristocracy to which he is said to belong; but were he our bitterest enemy, we should detest our own existence, if, for one moment, we permitted personal feeling to interfere with the dictates of justice. Mr. Stanley may have committed an error in judgment-errare est humanum-but we do most solemnly protest against the fiat of that professional tribunal (if it deserves such a name) which condemns Mr. Stanley, without knowing all the particulars of the case, and merely because an ignorant jury gave a verdict in direct opposition to the judge, and to several of the most eminent surgeons in London. We have no terms expressive enough of our indignation, at seeing a portion of the medical press take advantage of such a verdict, in order to harrass an individual, who happens to be one of a different party. But Mr. Stanly may console himself with the reflection-nay, with the certainty, that this procedure of the press, will defeat its own illiberal purposes-and that the

* If the writers of these inflammatory effusions were acquainted with the prejudices, which medical men have to encounter in their intercourse with the. public, they would not be so ready, on all occasions, to increase that prejudice, by holding up the most eminent men in the Profession to ridicule. By this procedure, they put arguments into the mouths of every little tradesman to scoff

Profession, so far from joining in the vulgar outery, will support him through the momentary struggle. We have said before, that we owe Mr. Stanley no obligation, but we owe our tribute to justice, as well as to generosity-and while unmerciful critics point their black artillery at his head, we will publicly and privately espouse his cause-and so we are convinced, will every member of the profession, who has a spark of christianity, philanthropy or magnanimity in his

breast!

at, and insult the GENERAL PRACTITIONER in attendance, whenever he claims a reward for his services. This we see done every day--and this, every practitioner is aware of; but the literary garreteer, who fires off his inflammatory harangues among the public, knows and feels nothing of the matter.

The Lancet boasts of having been the instrument that enlightened the Jury to give damages against Mr. Stanley, in this case, contrary to the opinion of the Judge, and against the evidence of a Cooper, a Brodie, a Bell, a Travers, &c. &c.! Be it so! If the lancet has been able to raise this prejudice in the minds of the " profanum vulgus," against such men, it requires but little divination to see that, henceforth, no medical practitioner is one hour safe from prosecution! "These are thy glorious fruits-parent of ill!"

charge, by reading, from the Lancet of last Saturday, the prediction, that "the yellow Goth would be scarified by Mr. Brougham on Monday." This passage excited strong symptoms of disgust in the countenances of judge, jury, and auditors. Mr. Brougham felt it necessary to apolo gize for the bad taste of his client, and moved heaven and earth to keep this passage from the face of the record. At length he succeeded by a legal quibble--namely, a denial that there was any proof of Mr. Wakley being editor of the Lancet during the last week! In this he succeed

ed.

But the moral effect of the passage was produced beyond redemption.

Mr. Brougham did all that man could do-(but, under the circumstances in which he was placed, his exertions were of little avail)-to persuade the jury, that the false assertions against Dr. Macleod originated in a mistake, and that the violent language in which they were conveyed, was a mere ebullition of feeling for an injured friend-Mr. WARDROP. But, shewed admirable tact, sound sense, and in this delicate position, Mr. Brougham consummate policy. Instead of comply. ing with the savage anticipation of his Goth," not a single expression was per"the scarification of the yellow client, mitted to escape his lips, which could hurt the feelings of the most sensitive mind on earth! On the contrary, he paid Dr. Macleod many handsome compli ments, in lieu of the expected scarifications! By this judicious procedure, and by the non attempt of the plaintiff to prove any damages, the defendant was probably saved from a heavy amercement. The verdict was all that could be expected, and five pounds were awarded, which car. ry the costs of both sides.

The charge of Lord Tenderden (Judge Abbott) will long be remembered by the defendant. Not a single palliating circumstance was mentioned to the jury. The accusations (his Lordship observed) against Dr. Macleod were proved to be unfounded in truth-and if the jury were not convinced of this, they ought to find for the defendant! We suppose a full account of this trial will be published.

Never were judge, jury, and knights of the long robe, so puzzled with carotids, ligatures citra et ultra tumores, postmortem researches after vanished aneurisms, &c. as on this occasion.

M. BOUILLAUD ON DISEASES OF THE
BILIARY DUCTS.

In a former number of this Journal, we presented our readers with some interesting facts relative to this point of pathology, from the work of M. Andral, the younger:-we shall now bring forward some observations from a zealous cultivator of pathological science, M. Bouillaud.

are

Among the alterations of structure observed in the biliary ducts, some common-others rather peculiar. In the former class, we may reckon inflammatton and its consequences, as induration, suppuration, ulceration, thickening, &c. Also dilatation, contraction, and obstruction. Of those lesions which are somewhat peculiar to the parts in question, are biliary concretions, and various other morbid changes which the bile itself undergoes, as well in its consistence as in its chemical composition. It is but seldom that we find any one of these lesions uncomplicated with one or more of the others. Thus, inflammation of the internal membrane may produce contraction or even obliteration of the ducts-and the presence of biliary calculi may induce inflammation, and so forth.

The symptoms indicative of different lesions in the excretory apparatus of the liver are far from being satisfactorily ascertained. Hence the greater necessity for accumulating such facts as may enable future observers to distinguish diseases that are, in their nature, obscure, though in their effects, extremely distressing and embarrassing.

Case 1. Peter Voisenat, aged 50 years, rather embonpoint, entered the Cochin VOL. VIII. No. 16. 69

Hospital, on the 12th March, presenting the following phenomena. He stated that he had been ill about three months. The skin and the conjunctiva were of an orange colour-there was evident fluctuation in the abdomen-but no infiltration of the lower extremities. The tongue was red-the pulse febrile. This feverish state persisted for three weeks, at which time, coma supervened, and the pa

tient died.

Dissection. On the inferior surface of the liver, a tuberculous mass presented itself, enveloping the situation of the gallbladder, not a vestige of whose parietes could be found, by the most minute investigation. Neither could there be discovered any trace of the ductus cysticus, hepaticus, or choledochus. There was a cavity or pouch in the situation of the gall-bladder, containing a purulent Auid, in which were several biliary concretions. This pouch was adherent to the arch of the colon, and here there was a commencing ulceration which would soon have opened a communication with the intestine, and through which, no doubt, the biliary calculi would have been discharged. The vena portæ was completely obliterated.

Case 2. B. Lebant, 68 years of age, having experienced severe and long-continued mental anxiety, entered the hospital on the 4th November. On examination with the stethoscope, it was ascer tained that she had valvular disease of the heart, especially of the left auriculoventricular opening, of which she died a few days after she was admitted. During this period, there was not any symptom evinced which led to the supposition of disease about the excretory ducts of the liver. On dissection, the convex surface

of this organ was found adherent to the abdominal parietes. The edge of the liver descended as low as the iliac fossa on the right side. The substance of the organ was rather gorged with blood, but otherwise healthy. The gall-bladder contained 90 gall stones, of polished surface, light yellow colour, and various magnitudes. The parietes of the biliary receptacle were thickened-its internal membrane red, and covered with mucus.Threre was bile in the small intestines.

In this case there was no pain complained of in the hepatic region-nor was there any jaundice. The auriculo-ventricular opening was contracted and puckered.

Case 3. Mary Dumé, aged 38 years, had experienced severe moral afflictions, and entered the Cochin Hospital, on the 5th September. She had been affected with jaundice for eight months previously, which she attributed to mental anxiety. After a miscarriage in the month of June preceding, a tumour slowly formed in the right side of the abdomen, unaccompanied by any pain. On examination at the hospital, this tumour was of considerable dimensions, being moveable, and apparently the size of a fœtus, rather attached to the right hypochondrium. There was fluctuation in the abdomen, but no œdema of the lower extremities. The patient complained of great debility, but not of any pain. The skin and eyes were yellow, inclining to a green hue. The urine was of the same colour. The stools were generally white-sometimes black and watery. M. Cayol and others examined the patient, but were unable to determine on the nature of the disease. The patient died on the 25th September, in extreme marasmus.

Dissection. The abdominal cavity contained a large quantity of yellow serum. The liver was of middling size, hard, and apparently infiltrated with yellow bile. On its inferior surface were three large tubercles. The gall-bladder was enormously distended, being the size of a child's head. It touched the spine behind, and bulged out the abdominal parietes in front. The neck of the gall bladder, as well as the ducts, were encircled by a mass of tubercles extremely hard, in which was involved the head of

the pancreas. The duodenum was compressed by this mass against the spine, but not obliterated. The immense gallbladder was filled with a dark coloured viscid fluid, and contained more than a hundred biliary calculi, of various sizes. The parietes of the gall-bladder were very much thickened. The stomach was enormously distended with half-digested aliment. There was no other disease of importance.

This case will elucidate some observations which we made in a preceding number-especially on a case that occurred in Panton Square.

Case 4. Obliteration of the Cystic Duct. A female was brought to the hospital for the treatment of acute pneumonia, of which she died, in spite of all the means they could use. She was evidently jaundiced-and it was remarked that after each

bleeding, for the pneumonia, the colour bladder was found much distended with became deeper. On dissection, the gallbile, and its duct completely obliterated. There was inflammation of the stomach, and ulceration of the pylorus. Bile was found in the small intestines. It was interesting to observe, in this case, that after each bleeding, the yellow colour of the skin and eyes became more and more intense.

Several other cases are detailed by our author which we cannot notice in this paper. In one case there was found a great dilatation of the ductus communis

ductus cysticus-and ductus hepaticus, without any ostensible obstruction in any of these canals. But there was inflammation of the mucous membrane of the duodenum and small intestines, which I was probably the cause of the dilatation, by preventing the bile from getting into the primæ viæ.

The author enters his protest against the use or rather the abuse of irritating and often repeated drastic purgative medicines which, he thinks, produce inflammation of the excretory tubes of the liver -gall-stones-and even hepatitis.-JourNAL COMPLEMENTAIRE.

2. LIVERPOOL OPHTHALMIC IN

FIRMARY.*

OPHTHALMIA PORRIGINOSA.

Under this term, Mr. Christian, consulting surgeon to the Liverpool Ophthalmic Infirmary, has treated of an affection which is usually denominated scrofulous ophthalmia. Mr. C. thinks himself authorized to give the disease this title, not only from its appearing in connexion with porrigo, but from its bearing certain features, sufficiently characteristic in themselves, to warrant such a distinction. The coincidence has been regarded as casual, and the ophthalmic disease treated on general principles. Not unfrequently, when the symptoms have run high, the porriginous eruption has been encouraged, with the hope of relieving the local affection. As Mr. Christian looks upon these

two in the relation of cause and effect, he conceives that treatment of derivation, according to that principle, must be erroneous, if not injurious. The following description of the disease is worthy of record in this place.

"Porriginous ophthalmia is a disease of early life, affecting principally children, though sometimes seen in the adult sub. ject. It is usually accompanied by an eruption of pustules on the face or head, which go through the various stages of suppuration, ulceration, and desquamation and if the eruption in its pustular form shall have disappeared before the inflammation of the eyes have commenced, still there will, almost always, be found some traces of the original disease, in the form either of scabs or fissures, situated behind the ears, at the commissures of the palpebræ, or at the junction of the alæ nasi with the cheeks. It is worthy of remark, that when the fissure or chap is situated between the lips, attended with excoriation of the nostrils, the upper lip often swells, assuming the appearance of what is vulgarly termed the scrofulous lip, which may be one cause of the disease being referred to this origin.

"Sooner or later, however, the ophthalmia commences, and the eye in a short time presents a highly vascular 'state of the conjunctival membrane. The inflammation appears in different degrees

* Glasgow Medical Journal, No. 1.

of intensity, in different parts of the albu ginea; and the vessels which are much enlarged, are seen to run in clusters, towards certain parts of the cornea, whilst this transparent tunic contiguous to these vessels is more or less clouded. On minute inspection, a pustule or vesicle will frequently be discovered at the apex of each of these fasciculi, or bundles of red vessels; but, very often, depressions will be found to exist, instead of raised pustules, situated at the margin of the cornea, or on the intermediate surface. On some occasions, the cornea will be perfectly transparent, and free from either pustule or ulcer, whilst the albuginea, with its vessels fully distended with blood, will present one or more yellowish spots, apparently elevated above the surrounding vascular superficies. These are so many ulcers, which by their extreme irritability keep up, if not give rise to, the inflammatory excitement in these parts. Similar ulcers are sometimes found on the lining membrane of the palpebræ. Whermotions of the eyelids very painful; so ever they are situated, they render the that the eyes are generally kept fast closed, and their inspection, in conse quence, becomes a matter of extreme difficulty. The sight being affected, only in proportion to the degree of opacity, and as this is but inconsiderable in some instances, the vision remains perfect; but the sight will necessarily be more or less impaired, according to the extent and density of the opacity of the cornea. Very often black spots may be observed arising from the attenuation of the cornea, occasioned by the ulcerative process, which sometimes perforates this tunic, and causes the incarceration of a portion of the iris. The discharge which issues from the eye, consists principally of tears, mixed more or less with a sanious fluid, which discolours the linen applied to the parts, and is often considerable in quantity. Although the pain attendant upon this affection of the eyes is not very great, yet, from the great irritability of these parts, the patient not only carefully shuns the light, but desires to lie with the face downwards, whilst the hands are almost unceasingly applied to the forehead."

The disease often assumes a chronic form, and last for months, leaving one or more opake spots on the cornea, the consequence of effused lymph. The con