196

The great enlargement of the mesenteric glands, fromabundant infiltration of typhous deposit, is well worthy of ourconsideration. Its amount was out of all proportion evenwith that so lavishly accumulated within the coats of thebowel. Now it was taught by the school of Broussais, thatthe change in the mesenteric glands was the result of, and itsamount a measure of, the intestinal changes. Clearly anerror; for not only is such proportion between the two thingsa matter of mere imagination, but the lymphatic glands con-nected with portions of bowel free from change may bedeeply involved. We learn, through the microscope, thatthe same kind of material enlarges the lymphatic glands, andthickens the walls of the intestine; blastema is in each sitethrown out independently, and in each makes an independenteffort at germination. But nothing has yet been ascertained,or been sought to be ascertained, concerning the relative datesof deposition in the lymphatic glands and the bowel. Now, re-flecting on the lengthened duration of the prodromata, in thecase of Pettit, and the abundance and relative excess of ac-cumulation in his mesenteric glands, I am disposed to believethat the initiatory period of loss of flesh, strength, &c., mayhave corresponded to a time, during which those glands mayhave been almost the sole seat of deposit. The disease wouldthen be a sort of acute tabes mesenterica, while, on theother hand, the actual outbreak of the continued fever woulddate from the moment the irritative influence of the sub-mucous deposit became felt by the mucous tissue itself.- Inthis way the pathologist is provided with a material and in-telligible reason for the presence of prodromata in some cases,and their absence in others. Let me observe, too, that thisidea harmonizes completely with what is known of the greaterfatality of cases distinguished by slowness of invasion.The spleen, liver, and kidneys were enlarged by congestion;

the consistence of the two former considerably impaired. Letme take the opportunity of insisting upon the anatomical con-ditions of the splenic enlargement and softening, which proveits want of connexion with inflammation. The enlarged andsoftened spleen is equably affected through its entire sub-stance ; inflamed organs never present their alterations in thesame stage and same degree throughout their whole mass.Pus is, sometimes at least, found in every organ, when thesubject of acknowledged inflammation; pus has never beenseen in the condition of spleen we are considering. Paren-chymatous organs, when inflamed, transmit the morbid actionmore or less constantly to their serous investment, (so muchso, in the instance of the lung, that, with some pathologists,the word pleuro-pneumonia is convertible with pneumonia.)Now, local peritonaeal -inflammation is not an attendant ontyphoid enlargement of the spleen. 1The state of the meninges justified us in the opinion we had

formed of their implication, anatomically considered. The,subarachnoid serosity proved this, and rendered the generalabsence of injection of the membranes insignificant. Note,too, gentlemen, that though the delirium in this case was asviolent as is ever, perhaps, witnessed in continued fever, thedynamic substance of the convolutions was " paler" than usual-an apparent hint that -it may not only be excess of bloodin the intellectual centre of the brain that causes deliriousexcitement, but that an alteration in the converse directionmay be equally effectual.The clamminess of the surface of the lungs, of the abdominal

muscles, and some other textures, which existed here, is veryconstantly met with in persons cut off by continued fever, andin all probability depends on a peculiar condition of the blood.The state is not, however, proper to this disease alone; I havefound it under very various conditions of death; and in thepresent state of knowledge, it appears to me to be withoutdiagnostic signification.

§ 6. Unconnected with the fatal disease, yet deserving briefnotice, were certain appearances in the heart and lungs. Theleft ventricle was very distinctly hypertrophous,-sufficientlyso to raise the weight of the heart above the healthy standard.Can the over-work of which the youth, it appeared, had com-plained, be in any measure the cause of this A surmise, I ad-mit, vague enough,-yet one perhaps not to be rudely rejected,so long as the etiology of the hypertrophy in question con.tinues in its present obscurity. The patient was precocious,rather, in regard of the atheromatous deposit in his aorta; buthis age was precisely that at which commencing reticulation ojthe sigmoid valves might be looked for. And so, in fact, tw(of the aortic valves were semi-reticulate-that is, their intraserous tissue had given way transversely in one or more pointsthe double serous layer still remaining sound; the other valvlwas completely perforated. These changes have been veringeniously shown, by M. Bizot, to become of suddenly in

creased frequency at about the age of this youth, and to depend(with some probability) upon coetaneous enlargement of theheart.The absence of staining of the great vessels, although the

blood was perfectly fluid, and the patient cut off by typhoidfever during close, damp September weather, is not devoid ofinterest, more especially as the aorta could not be consideredto be perfectly sound in texture. Its unsoundness,it appears,was not of the kind to facilitate imbibition of blood.During life, it was ascertained that the right infra-clavicular

region was faintly less resonant, under percussion, than theleft. Now many of you, gentlemen, have seen me demonstratethe fact, that in a certain number of persons whose lungs areperfectly sound the right infra-clavicular region gives a morewooden note under percussion, and is at the same time lessresilient than the left. This peculiarity is perfectly uncon-nected with excess of muscular substance on the right side,and depends upon some hitherto unascertained condition.But its reality is so unquestionable, that I attach no absolutesignificance to very trifling deficiency of resonance under theright clavicle. Now I believe that the faint inferiority ofclearness, noticed under Pettit’s right clavicle, was a3 much,

i if not more, of the kind I now refer to, than of a morbid cha-

racter. It is true, after death, the substance of the right apexwas slightly less aerated than that of the left; but it is most,probable that the blood-points had not formed till the closinghours of life, and increased after death.

At some period of his life, the patient had had local acuteperitonitis, in this situation, (adjoining the liver,) which iscertainly, in the male, its most common seat.

§ 7. The case we have now considered is one of that rarerclass of continued fevers, of the intestinal type, in which themorbid changes and the symptoms stand in fair proportion toeach other. If the intestinal symptoms were severe, so werethe anatomical alterations of the bowel highly marked; if thecerebral symptoms were carried to an extreme point, so didthe meninges exhibit distinct material signs of morbid action.

ABSTRACT OF THE

HUNTERIAN ORATION.

Delivered, before H.R.H. Prince Albert and a nume-rous assembly, in the Theatre of the Royal College ofSurgeons of England, Feb. 14th, 1849,

BY CÆSAR H. HAWKINS ESQ.,COUNCILLOR OF THE COLLEGE, EXAMINER IN SURGERY IN THE UNIVER-

SITY OF LONDON, AND SURGEON TO ST. GEORGE’S HOSPITAL.

The works of Hunter in anatomy, physiology, pathology, andsurgery. Flourishing state of the Hunterian Museum, andprogress of the pathological collection and catalogue. The ex-tended nature of the views of Hunter; his ideas plagiarizedand copied by modern authors. Deceased members of thecouncil: Mr. Callaway, Mr. Briggs, and Mr. S. Cooper. Ex-tent of the library of the college. Modern progress of surgery,pathology, chemistry, and comparative anatomy. Advantagesof extended co-operation amongst the cultivators of medicalscience. Conclusion.

AFTER alluding to the period of birth of the illustrious founderof the magnificent museum of the college, the orator pro-ceeded to comment on the labours and exertions which hadbeen made by him to advance the science of anatomy. Noindividual could justly appreciate the vast extent of John.Hunter’s labours, during the short period of thirty-five years,who had not studied his numerous works/and witnessed thewhole of his collection which was formed within that period;yet the revolution which his researches have brought aboutin the scientific position and practical value of his favouriteobjects of pursuit, are sufficient evidence on this point. Heit was who first pointed out the path through which practical’knowledge could be obtained through the study of the loweranimals, and who showed how phenomena, previously in-explicable, could be unravelled by extended observation ofhealthy and morbid structure. It was, of course, not to beunderstood that anatomy and physiology had not been ad-vanced since Hunter’s time, but it was a fact, that it wasHunter who gave theffirst impulse to the scientific pursuit of

, the sciences on which the practice of the healing art moreimmediately depends; and which, within the last few years,

, had received an additional impulse from the new fields of re-search opened up by increased facilities for observation. It’

197

would never have been supposed that Hunter was so far be- contains no less than 28,000 volumes, and is, in fact, the mostyond his age, had not his pupils’labours, and the zeal of the complete library on subjects connected with medicine andcollege, tended to rescue much interesting and valuable in- surgery in the three kingdoms. The fact that there are 2500formation from destruction. By the joint labours of the pre- volumes on subjects connected with natural history shows thatsident and the junior professor, the members will shortly be the scientific as well as the practical wants of the memberspresented with a catalogue of the pathological collection, are fully attended to. That such is the opinion of the mem-which had been commenced by John Hunter with a series of bers of the college, and that they fully appreciate the advan-preparations intended for the illustration of his more peculiar tages derivable from access to such an extensive and valuabletheories on diseased structure, and on the proper mode of collection of books, is shown by the fact that no less thantreating diseases. The council of the college, desirous of 5508 visitors had made use of the library during the last year.making the collection of morbid preparations worthy of the Mr. Hawkins then commenced to pass a high eulogium oninstitution, have expended X4000 in the purchase of a the memory of Samuel Cooper, lately deceased. This distin-number of valuable specimens; and this, with donations from giiished surgeon was stated to have been educated more thanmembers, (though not so numerous as they will hereafter be half a century ago at St. Bartholomew’s Hospital, to whichfrom the timulus of the forthcoming catalogue), will, no institution he was ever most warmly attached. As staff-sur-doubt, render it all that can be desired. The pathological geon in the army he won the estimation of all professionallypart of the museum has been already more than doubled since connected with him. For fifteen years he was Professor ofthe year 1830, and it, as well as the physiological part, may Surgery to University College, and he was an Examiner -ofnot only claim comparison with any similar collection in this the College of Surgeons. His first literary production was theor other countries, but that superiority which has always work on " Diseases of the Joints," which gained for him thebeen accorded to it. The study of diseased structures was Jacksonian prize. The next work was his elaborate and justlycarried out to a great extent by Hunter; ,and, in connexion celebrated " Surgical Dictionary," which offered an admirablewith this, a question arises how far he is entitled to the praise digest of all the French, German, and American surgicallavishly bestowed on him for the advances he made in the works, was translated into the two former languages, wentstudy and practice of the art of surgery ? All the most dis- through no less than seven editions in this country, and wastinguished-surgeons of the day are conversantwith his works; reprinted by our transatlantic brethren. This work was atand there is not one who, if asked for his candid opinion of one time the only text-book which students could refer to, atHunter’s contributions to surgery, would not state that much least, with the exception of his Outlines of Surgery," a workthat has been advanced of late years as original, was brought of great merit. The dictionary is a most valuable work, wereforward and acted upon by him who has left behind him it only for the complete bibliography which accompanies thethe magnificent monument of his zeal, talent, and labour various articles. Indeed, the numerous references to the mostwhich adorns the institution. The practice of pirating from celebrated authors, both at home and abroad, form the mostothers who have stolen the information themselves, has be- prominent, or rather, at present, the most useful part of thecome so common, that it may be considered a matter of no work. Now-a-days, the profession appears to have altered itsslight difficulty to discover the rightful owner,.alld to appor- idea of the utility of such ponderous volumes, and to place alltion to each their just meed of praise. No one has ever been their reliance in couipendiums, manuals, and the like; but it ismore subject to peculations than John Hunter. Even at the questionable whether this aversion to the study of large bookspresent day, facts are paraded in the works of authors as will tend to the advantage of the practitioner and of theoriginal, which, on further inquiry, will be found to have patient.

e of the practitioner and of the

belonged to him whose memory the members were assembled Although the general history and progress of surgery doesto honour. If a tab-inference be drawn from Hunter’s works- not entitle it to be considered an exact science in the true andthat is, from a deep and earnest study of his observations- most comprehensive meaning of the term, yet the advancea task which requires much acumen and great attention on which anatomy, both healthy and morbid, has made of latethe part of the reader, it will be found that his reputation as years, entitles us to consider it as a science worthy of beinga surgeon is nearly as great as that derived from his ana- fostered. Within, a few years the whole character of thetomical and physiological researches. On every subject con- science has undergone great alteration, and this has caused thenected with surgery he was a master, and all who follow study of pathology to advance with rapid stride. The im-after him must be content to find themselves his pupils. mense amount of labour expended on its investigation bv many

Perhaps it is worthy of remark, that throughout the whole talented men; the spirit of research which has actuated them;of Hunter’s works there is a tendency-indeed, more than a the close attention paid to the principles of induction; andtendency-to explain everything according to what is termed probably the wide field opened up for original observation,the vital principle, in opposition to the idea that animal and have all tended to bring the pathological division of thevegetable organisms are governed by physical laws, an idea science to great perfection.which he had to combat with more than ordinary vigour. This advance is mainly to be attributed to the increased zealHunter invariably searched after general laws, or broad of comparative anatomists and physiologists who, while pur-principles regulating the structure and functions of the suing a path apparently opposed to the elucidation of dis-organic world, and his efforts were, by his unwearied industry, eased structures, have shed much light on subjects before in-fortunately crowned with success, at least in the more im- volved in mystery, and have done more to rescue medical prac-portant points of anatomy and physiology. Itwasbyenforc- tice from empiricism than might be imagined. The increaseding those principles to the attention of his pupils, especially and, increasing attention paid to the investigation of generalthose who had the advantage of assisting him in hisdissec- anatomy has, perhaps, mainly contributed to the advance of ourtions, that the great revolution he brought about in all the scientific knowledge. And, at the present day, when we havebranches of surgical science, and which is still felt at this day increased facilities for observation, it is interesting to noticeof rapid advance, is to be attributed. that the conclusion drawn by the illustrious Bichat, that the

It then became the painful duty of the orator to allude to cartilage of joints are covered with a synovial membrane, hasthe deceased members of the council. There had been three come to be proved strictly correct, by the detection of epi-vacancies in the council during the past year, by the demise thelial scales on their free surfaces; at least, in the fcetus be-of Messrs. Briggs, Callaway, and Samuel Cooper. The first fore the full time, if not long after birth. Many other ex-two presented a great contrast in their habits and career. amples of the value of an acquaintance with general anatomyMr. Callaway was a man who had great practical knowledge, could be given. That it has already caused a change in ourand was enabled to apply it to the relief of those patients who ideas of life, and of the mode in which living bodies performwere entrusted to his care, in such an able manner as to call their various functions, is a fact of some significance. Indeed,forth the admiration of all those who were competent to appre- our ideas regarding the functions of digestion, of secretion,elate talent. As a literary character he was nnknown to the pro- of muscular motion, and of excretion, have, during the lastfession. Mr. Briggs was a modest, unassuming, studious, and few years, undergone a most complete revolution. We nowliterary surgeon. He had an important public appointment, view the phenomena of life with more interest, because ourand was the translator of Scarpa’s celebrated work on Aneu- knowledge of structure and our power of observing the lowestrism. That Scarpa’s work should have met with so much ap- animals in their living state has been greatly increased, nay,probation is not to be wondered at, considering that he was almost perfected, by the advantages afforded us by the achro-one of Hunter’s pupils, and that he was induced by the prin- matic microscope.-ciples of his preceptor throroughly to investigate a subject By the progress general anatomy has made, and by the cor-which was before involved in much error, and has been so ably responding advance of chemistry, as applied to organic bodies,described by Hunter and his pupils, as to leave scarcely any- much of the mystery which previously surrounded surgery hasthing to be investigated at the present day. Mr. Briggs was been removed. The anatomy and the chemistry of the blooda liberal contributor to the library of the college, which now show that in it is contained all that is necessary for nutrition,

198

for secretion, and, to a great extent, for excretion. The factthat muscular motion is necessary for the elimination of urea,that this is a most subtle poison, and requires an organ pur-posely to abstract it from the blood, and that it is composed ofa substance easily formed by the chemist in his laboratory,may be cited as an instance of the relation of chemistry tophysiology. Again the power of absorbing gases is an instanceof the same kind, and one which has completely altered ourideas of respiration. The chemist can convert starch intodextrine and sugar, or into fatty matter, or butyrine, by theaddition of substances which do not themselves lose any oftheir properties; and this shows how easily the nitrogenizedand non-nitrogenized elements which are found in plants andvegetables are converted into substances fitting to be assimi-lated into the human body.

Having, then, drawn the attention of his audience to the factsof pathology which had been gained by studv of the fluidsand solids of the human body, and alluded to the observationof Dr. Garrod, that urate of soda existed in the blood ofhealthy individuals, the learned orator proceeded to comment()n the theory of cellular formation, which has effected suchan alteration in our ideas of function, and more especially onits connexion with physiology and practice.

Further allusion was then made to the dependence of lifeon physical causes, and the audience were cautioned againstplacing reliance in statements made by men who allow theirimaginations to run riot. As an illustration of this, the state-ment of Matteucci, that the heat evolved from the humanbody in walking a given distance consumed about thirty-fourtimes as much fuel in proportion as a locomotive engine; andthe various old conjectures respecting the force of the heart,were referred to.The attention of the members was then directed to the

revival of the humoral theory in pathology, in consequence ofthe tendency of the cellular theory in anatomy; and in con-nexion with this, the absorption of remedial agents in agaseous form was more particularly alluded to. The dis-covery of the anaesthetic power of ether was made by acci-dent, by a man who was not a chemist, and was therefore notaware of the chemical composition of the substance lie wasusing; yet this disoovery led to the investigation of other sub-stances, and subsequently to the use of chloroform as a sub-stitute. By the means of these fluids, pain is removed, theshocks of operations are avoided, and the ultimate result isrendered more favourable. It is worthy of notice, thatalthough the discovery of the astonishing effects of inhalationof these substances was accidental, Sir Humphry Davy longago advised the employment of nitrous oxide gas as an anaes-thetic agent, clearly proving that if more attention had beenpaid to purely scientific pursuits, the profession and the publicwould both long ago have been benefited.

. Why should there not be full co-operation amongst medicalmen for the advance of science! was a question fully com-mented on by the orator, and by illustrating his point withthe advantages derived from the co-operation of astronomers

-and others, over every part of the habitable globe, he showedhow desirable it was that there should be observations madeby medical officers to our public establishments, so as tocorrect errors, and give surgery its proper position as a

science. This was now likely to follow from the feelingwhich existed amongst scientific men at home and abroad.The Royal Society of this kingdom has often conferred itsmedals on illustrious foreigners-men distinguished for theirscientific attainments; and it is pleasing to notice that theFrench Academy has elected Sir David Brewster ae one ofits associates, in room of the late distinguished Swedish che-mist-Berzelius.The increasing sense of the necessity of a truly scientific

education, amongst all classes and every rank of life, wasa guarantee that science would not be neglected; on the con.trary, that it would advance with rapid strides. Nothing,indeed, could be more certain than this, when the illustriousvisitor whom he had the honour of addressing stood foremostin the ranks of the well-wishers to the progress of science,and had already effected an incipient reform in the great uni-versity of which he is Prince-Chancellor. The inhabitants ofthis realm looked forward to the increased happiness andprosperity of the nation, from the happy rule of the presentsovereign, and they hailed with a happy augury a rising gene-ration of princes, and congratulated themselves that the over-throw of thrones and of dynasties which had lately occurredin such violent succession, it had been their lot only to-%vitness, and not to share.

In the evening, the President and Council entertained alarge and distinguished party at dinner, ircluding Sir Robert

Peel, Sir James Graham, the Bishops of Norwich and Oxford,the President and Censors of the Royal College of Physicians,&c. The dinner and wines were provided by Mr. Bacon, ofthe Freemasons’ Tavern, who well maintains the character ofthat renowned establishment.

Medical Registration Committee.

MINUTES OF EVIDENCE.Friday, June 30th, 1848.

MEMBERS PRESENT.

Mr. Wakley. Mr. Hamilton.Sir Henry Halford. Mr. Grogan.

THE LORD ADVOCATE IN THE CHAIR.(Continued from page 173.)

John Storrar, Esq., M.D., examined.4660. Mr. Wakley.J-Are you aware that it is also proposed,

before he would be entitled to rcgiste1’, that a bachelor in medicineshould be examined before the College of Surgeons ?-I am.

4662. Do you approve of such arrangement ?-I stronglydisapprove of it, and for this reason; our degree of bachelorof medicine is an evidence of our having gone through astringent examination in surgery as well as in medicine, con-sequently that degree is evidence of our surgical as well asmedical attainments.

4663. You yourself were a bachelor of medicine before Y6Ubecame a doctor of medicine ?-I was.

4665. Was your examination extensive in an elementarysense ?-In an elementary and in a practical sense, it was.

4666. Was it towards the latter part also of an extensilepractical character?-As practical as it could be over thetable in the examination-room; I refer from this answer toone that I gave in the early part of the examination; that Ipreferred that medical examinations should be conducted, inpart, by the bedside.

4667. There is a clinical examination now, is there not, atthe University ?-Yes, there is a commentary on a case inwriting.

46C9. Have you ever been examined before any othermedical institution ?-Some years ago I was, before theSociety of Apothecaries.

4670. Placing the examinations together by contrast, or incomparison, what would you say of them ?-They could onlybe placed in contrast, and the contrast I think would behighly favourable to the examination of the University ofLondon, at least to a competent candidate.

4675. Are you acquainted with any other institution in theUnited Kingdom which inflicts upon its candidates for medicaldegrees a more severe examination ?-I am not aware of anyplace where so severe an examination is required.

4676. Do you know of a more highly educated body ofmedical men than the doctors of medicine of the Universityof London ?—I speak with some diffidence as a doctor of medi-cine. but I do not.

4677. You have already stated, notwithstanding the extentof their education, that they have no external legal rights,and no internal privileges?-They have none.

4678. What is the proposal that you now make to the com-mittee, with reference to the future status of the body whomyou have described; I refer more particularly to the subjectof registration ?-If you were to ask me for my own scheme,I would prefer that the whole of the medical affairs should bedirected by a central board, and that all the medical exami-nations and licensing in the kingdom should emanate fromthat board; but if such a scheme be not found practicable,then I would limit myself to claiming for the graduates ofthe University of London, whether bachelors of medicine ordoctors of medicine, the highest privileges which are con.ferred upon medical practitioners in this kingdom, that theyshould be admitted to as much at least as the graduates ofany other academical body.

4679. Reducing your propositions still further into detail,in what character would you have a doctor of medicine of theUniversity of London register, and in what character wouldyou have a bachelor of medicine register, assuming for theoccasion that he is not to undergo any examination beforeany other body, and that he is not to be enrolled among themembers of any other body ?—Simply A. B. M.D., (7. D. M.B.

4680. You would allow them to make a selection of theclass in which they should register, or you would have thementitled to register in all three classes ?-If they chose, bul