23

fallen under out notice, and so we shall continue to do. Othello’s language is ours.At the Westminster, too, although there are some old gentlemen, who like the broken

teacups on the village shelf, hold their

places more for ornament than use, thereare others who have the capacities to be-come good surgeons, who are willing to learn,and are ready to communicate what theyknow. A book is kept by one of the surgeons,in which the best cases falling under his careare recorded; a very laudable thing, andtherefore deserves to be mentioned. Mr.

Guthrie’s book is kept in the pupils’ room,and is open to their inspection at all times.Why do not the other surgeons do the same’! ?The trouble is very little to them, and the ad-

vantage to the students very great. This prac-tice is quite novel in the West End Hospitals;no such thing was dreamed of, until lately.The pupils pay no sixpences to witness a

post-mortem examination, the fees paid forthe hospital practice being considered a

sufficient title to the FREE entrance to the i

dead-house. There is no such tax upon

pathological study at the West-end hos-

pitals. St. George’s is still under the evil

genius of Bacchus, we may say of Momus ;for the individual who nods the law there

at present, attends to little more than drink-

ing and sleeping. It is high time for the

surgeons of St. George’stobestir themselves,if they wish the profession to remember thatany such hospital exists, or if they wish thepublic to build them another house. We

feel glad to strengthen the hands of Charity,but we would see her blessings fairly dis-tributed, and fairly used.

WE perceive by the newspapers that

Mr. LAWRENCE has resigned the situationof Surgeon to the LONDON OPHTALMIC

INFIRMARY, Moorfields. Several candidates

have already started for the office, of whosemerits we shall at present be silent ; but asthis Institution has been the seat of a vast

deal of shuffling and intrigue on the partof those persons who have conducted its

affairs, we earnestly entreat the Governorsto be cautious in giving their votes to anycandidate, until they are fully satisfied thatlie is qualified for the proper execution ofthose duties which it will be his province to

discharge. Let them look with suspicionon the recommendation of the presentCommittee.

DEATH OF DR. BARCLAY.

THE professional world has lately lost oneof its brightest ornaments, in the person ofDr. JOHN BARCLAY, the celebrated teacherof anatomy in Edinburgh, who died at hishouse in Argyll Square, on the 21st of

August. Dr. BARCLAY was originally des-tined for the Church, but turning his atten-tion to physic, he took his Doctor’s de-

gree in 1796, and soon after commenced the

teaching of anatomy and surgery, in whichhe was eminently successful. Few teachershave left behind them a greater reputation,and few authors more durable proofs of in-dustry and talent. His works on Anatomi-

cal Nomenclature, on Muscular Motion,on Arteries, and on Life and Organization,are too well known and valued, to stand in

need of our eulogy. The Nomenclature,which applies to the same parts in all

positions of the body, and in all animals,cannot be too highly prized, or too implicitlyfollowed, if precision of language be de-

sirable, in anatomical disquisitions, whetherhuman or comparative, in the lecture-room,or in books. Dr. BARCLAY’S Museum,which, according to the Edinburgh Journalof Science, is given to the College of Sur-geons of that city, " with a reservation infavour of his successor, Dr. Knox, is a noblemonument of that zeal for the science he

taught, with which he not only animatedhimself, but inspired his auditors." His

age was sixty-six.

24

To the Editor

THOMAS FRYER,Surgeon.

To the Editor of THE LANCET.

SIR,—Should you consider the followingcase worthy a place in your widely circu-lated Journal, you will oblige

Your obedient servant,

THOMAS FRYER,Bath-street, Bristol, Surgeon.

Sept. 1826.

The case that I have to present to thenotice of your numerous readers, is one, inmy opinion, of a very interesting character,as it will give us some idea how far diseasemay extend itself in the body, without pro-ducing any very considerable pain or anx-iety, and disorganize those parts more im-mediately subservient to life, to a very greatextent, without producing a total cessa-tion of animal existence, until a very pro-tracted period after the disease has actuallyset in. The following case occurred in theperson of a youth eetat. 7 years and 5 months,whom I was requested to visit in this city,in March, 1825. He had, previous to myseeing him, laboured under slight attacks,as was supposed by the parents, of cold, fol-lowed with considerable weakness and inac-tivity of mind, unusually shown at his age.There was a fullness observed in the bowels,with other symptoms, that led me to consi-der the mesenteric glands to be the seat ofdisease, which in a short time became moreevident. Alterative doses of mercury, withoccasional stomachic aperients, with othermeans, were resorted to, together with localabstraction of blood by leeches, &c., thesewere varied from time to time, as the

symptoms indicated ; he was seen byseveral eminent physicians during the

progress of his complaint, which re-

sisted every plan of treatment proposed.The disease advanced progressively, tilldeath put a period to his existence in July,1826. The liver could be distinctly feltthrough the integuments, advancing into thehypogastric region on the one side, and thespleen descending on a parallel in the oppo-site side, and very considerably indurated.Some months previous to his decease, oedemaof the lower extremities commenced, with aneffusion of water in the bowels, formingascites. It was considered necessary to re-lieve the symptoms by an operation; I

tapped him about six weeks before his de-cease, and drew off three quarts of water ;the relief was almost immediate ; but in thecourse of a week he had increased nearly tothe same size ; he became excessively irri-table, had a quick pulse, and occasionalhaemorrhage from the nose up to the periodof his dissolution. . -

Post-mortem Examination.—Body ex-

tremely emaciated, with a very considerableenlargement of the abdomen, and fluctuationof a fluid within. Having first removed sixpints and a half of turbid serumfromtlie cavityof the abdomen, I commenced an incisionfrom sternum to pubes ; on turning back theparietes, the liver was seen to occupy theright hypochondriac region, and extendinginto the left; the left lobe very much en-

larged, and reaching as far as the spleen.The posterior surface of the liver thickenedand indurated, the right lobe advancing intothe hypogastric region. Liver of a dark

clay colour, with a very remarkable

change in its structure, and studdedwitliincipient tubercles, with a sealing up of thepori biliari exsanguineous in appearance ;weight three pounds and a half. Thespleen situated in the left hypoch. region,extending from underneath the false ribs,nearly in a parallel with the right lobe ofthe liver, reaching as far as the hypogastricregion ; there was very considerable adhe-sion to the left side, external appearanceresembling mottled soap, and considerablyindurated, not yielding to pressure, par-taking of the same characteristic disease asthat of the liver, viz. tuberculated and ex-

sanguineous ; weight 21 ounces. On theleft head of the pancreas in proper capsules,were situated two supplementary spleensabout the size of walnuts. The left kidneyconsiderably enlarged and otherwise dig-eased, having lost its lobulated character.The mesentery thickened and indurated.The mesenteric glands enormously increasedin magnitude, and consequently arrestingthe progress of chylification, so that thelacteals could be distinctly seen meanderingover the convolutions of the small intestines,completely filled with chyle : on puncturingone of these ducts, a portion of this milkyfluid exuded. I regret to say, I did not,from peculiar circumstances, examine the

thorax, though there were no symptomsduring life that indicated disease of thechest, &c.

To the EditorTo the Editor of THE LANCET.

SIR,—My attention having been directed,in an especial manner, to two circumstancesin the medical periodicals of the presentmonth, I solicit your courtesy in favour ofa constant reader, for permission to occupya small space in the ensuing Number of yourvaluable hebdomadary, to give currency tomy thoughts.

1st. The Trustees of the Hunterian Mu-seum have, in their zeal for medical science,lately opened the portals of the Royal Col-lege of Surgeons twice every week, to the

members of that college, and to Fellows ofthe College of Physicians, also to persons

25

recommended by members of these corpora- sicians make an ungrateful return to Almations. This increased facility is, as far as Mater by stooping to accept licenses, ratherit goes, commendable ; but, in the name of than contend openly for an equal participa-common sense, and of common decency, tion of rights. Let them found their claims

why is leave of entrance restricted to Sur- entirely upon their degrees, and reject thegeons, and Fellows of the College of Physi- license of the College as derogatory and use-cians 1 Let those questions be fairly put to less. Such a course would be manly-wouldthe Trustees generally, and its decision will be dignified, and would be effectual in’sub -be no longer governed by the dicta of a few duing the College and purifying their mea-capricious doctors. We shall then see re- sures. It has already been successfullygulations enacted for the benefit of the adopted by some respectable practitioners,whole profession. In the mean time, I de- who have signified their readiness, when-sire to state the following questions to the ever called upon, to try the validity of cer-Trustees. Is not the Museum 2zational pro- tain excluding and offensive by-laws. This

perty ? Was it not purchased with the offer having been repeatedly declined, provespeople’s money, for their use and improve- tacitly the admitted nullity of their boastedment? If so, ought it not to be equally pretensions.accessible, as in other countries, to persons In answer to arguments like these, I haveof every denomination, who take an interest heard it said, that a physician, on fixing inin the cultivation of anatomical knowledge? London, is obliged, in his own defence, toBesides the Corporation of Surgeons, and the become a licentiate, otherwise the Fellowslittle junto of the Fellows of the College of would refuse to meet him professionally, andPhysicians, are there not in London a nu- this determination would blight his fairestmerous list of physicians denominated licen- prospects in life. Mv reply is simply, dotiates, and a much longer list of physicians they actually refuse, or only fume andresident in the counties of England, Scot- vapour’! Will the stiffest of them declineland, Wales, Ireland, and other divisions of a fee, rather than commit a breach ofthe imperial dominions, who have actually etiquette The octogenarian, Dr. Hamilton,contributed pecuniary aid in the form of is able to solve both difficulties ; or referencetaxes to realise this noble establishment ?

may be made to Dr. Alerriman, to Dr. Har-Unless the medical Trustees venture to deny rison, and many others, who laugh at thethe above position, I shall be glad to learn College anathemas, and are still in posses-on what plea of utility, of equity, or of right, sion of the field.they have closed the door against this meri-torious class of their brethren. Is it be- Really and truly, Sir, this is all fudge;cause, refusing to become parties to their no physician, whether licentiate or non-

own degradation and dishonour, they spurn licentiate, has any favour to expect fromconnexion with the College as it is now truckling to the Fellows. They are too

managed ? firmly bound, and engaged to each other, toThe Licentiates, and those Doctors of phy- forward his views. The compact, which

sic who disdain to become licentiates, are, connects them together, necessarily placesfrom education and acquirements, entitled them in perpetual hostility with the Licen-to the greatest consideration, and will not tiates. This community of design, moreveil their bonnets to any of the college mono- than any other circumstance, enables thempolists. They derive their respectability and to triumph over the disunited licentiates.

privileges from the highest authority-their When they and their true brethren, the in-medical degrees obtained at universities, dependent physicians, can be made to un-

where the healing art is carefully taught and derstand their own interests, and to asso-practised. The Fellows, on the contrary, ciate for common objects, the spell will beprocure theirs from Oxford and Cambridge, broken, and the talisman change sides. Thewhere the most diligent students are but Fellows, aware of their delicate position,very scantily supplied with medical lore. and well understanding the maxim " divide

I will not detain your readers with the et impera," occasionally elect some feebleencroachments of the Fellows, or complete licentiate into their body. This paltry boon,diversion of the College from their original which should be scornfully rejected, ap-purpose of benefiting the public, to the ag- peems to stultify that class. Self-love makes

grandisenrent cf their own members. Both each of them fancy, that he shall be the dis-are ably explained in " An exposition of the tinguished candidate ; and a few ambiguousstate of the Medical Profession in the Bri- hints, artfully scattered by the high priest,tish dominions, and of the injurious effects confirm the delusion. In the foregoing re-ef the monopoly, by usurpation, of the Royal marks, I neither allude to Dr. Southey, who,College of Physicians in London," lately it is said, owes his introduction to an exaltedpublished, and to which I beg leave to refer. personage, nor to Sir James Macgregor,

So long as these illiberalities and perver- who was admitted a Fellow, according tosions are suffered to continue in force, phy- common report, in order, through his in-

26

fluence, to draw the army physicians into thecollege net.Were the physicians in London, and the

country, fully impressed with their own

power, and determined to connne consulta-tions to individuals of their own order, thegolden current would speedily flow intoanother channel, and the sick would gainconsiderably by the change. A resolutionof this kind, would work like a charm uponboth the Fellows and Licentiates. Thismotive for action is no longer utopian ; Ianticipate its speedy adoption after an unionis formed. The Licentiates, goaded, insult-ed, and debased, already manifest some in-ternal heavings, which promise to displaythemselves in outward acts.

They are aware that when any office ofhonour or emolument opens to view, it is

immediately forestalled by one of the Fel-lows. Should an hospital, for instance, be-come vacant, a College tyro rushes into thearena, and is always victorious. Not, cer-tainly, by his native prowess, but throughthe confederated aid of his colleagues. Theinterests of the sick are the least considered.If examples are required, look to what latelyoccurred at the Middlesex, St. George’s,the Westminster Hospitals. &c. As to Bar-tholomew’s, it has long been a close borough.Even the dispensaries have, of late, been toosuccessfully invaded.What, besides a well managed con-ibina-

tion, raised the present examining physicianof the East India Company to that situa-tion 1 a person who had never crossed theline, or, perhaps, traversed the channel.Such selections are quite preposterous, andif the subject did not excite far other feel- ings, would deserve to be treated only withridicule or contempt. Nothing can be con-ceivedmore absurd than to choose for examin-ers of medical men destined to hot climates,persons practically ignorant of the topics onwhich they are to examine, in preference toothers well acquainted with tropical cli-mates, and their diseases, and who have,moreover, given abundant proofs of medicaltalent and erudition. I shall only mentionamongst them Dr. Maclean, and Dr. JamesJohnson, as men in whom the magnificentmerchants of Asia might safely confide, if

saving of lives merely were their object.The same principle will explain the regu-

lation lately adopted for choosing the RoyalPhysicians, and the almost total exclusionof Licentiates from the higher walks of so-ciety. It is time that the public should takesome cognizance of these matters.

2d. The appointment of a commission toinvestigate and report upon the constitu-tion and direction of the l’niversity of Edin-burgh, and the other Scottish Universitieswill form a distinguished era in the literaryhistory of that enlightened portion of the

United Kingdom. It is, indeed, an auspiciouscommencement, and ought to be joyfullyhailed’in every quarter. Whatever is foundamiss will, I trust, be effectually corrected,and these ancient institutions restored totheir original splendour. Medical diplomaswill then deservedly rise in public estima-tion, because they will cease to be objects ofdisgraceful traffic, as they unfortunately havebeen in some of the minor universities.

Henceforward they will become, what

they ought always to have been, honourabledistinctions, and real passports to profes·sional confidence.The conclusions at which I wish to arrive

from the foregoing premises, and to impressupon your readers, may be communicated infew words.

1st. If the Licentiates, the permissi, thealieni homines, (such are the humiliatingappellations, in college phraseology, for anhighly meritorious description of practition-ers,) really wish to recover their lost privi-

leges, and former stations in the kingdom,they must fortify themselves by associatingextensively for determinate objects. It has

been clearly proved, by their abortive efforts,that individually they can never succeed. Arespectable society of Licentiates, supportedby the provincial physicians, would imme-diately assume an imposing attitude, andclaim attention from the ruling authorities.The trite fable of the old man and bundle ofsticks, is as true as it is appropriate to ourpurpose. In addition to the efficacy of merecombination, gentlemen should also call tomind the close connexion of country phy-sicians with members of parliament, and theconsequent respect which they can commandin the senate.

2d. Moreover, since inquiry is abroad,and the Legislature will be applied to in theensuing session for new enactments in favour

of general practitioners and surgeons, it be-hoves the Licentiates and independent Phy-sicians to be prepared to march into thefield en masse, with their several detach-

ments, or they will assuredly be vanquishedin the approaching conflict, and what is

worse, the public will be left dreadful suf-ferers by the defeat.

3d. The tendency of this address is neitherto excite clamour, nor to encourage preju-dices. Its purport is simply to induce theunprotected Physicians to combine, for therecovery of their lost privileges, and to ob-tain such additional ones as will conduceequally to their own benefit, and that of thepublic. Surely, Sir, these are praiseworthymotives, and for the accomplishment of

’ which, the most diffident may safely exalthis voice. In merely advocating our ownrights, we cannot be accused of invading theprerogatives of others.

27

The Fellows, the Surgeons, and the Apo-thecaries, have each of them spacious Hallsto meet in, while the alieni homines have noplace of assembly to converse together, anddiscuss measures for the general good. Itis high time to correct this fundamental de-fect, and to construct a suitable institution,where the provincial and metropolitan phy-sicians may not only mature their plans inprivate, but renew their friendships, andrevive the memory of past scenes. A triflingcontribution from each member wouldsuffice to complete the establishment. Thetimes are auspicious.

Let us trifle no longer, but seize the op-portunity, or it will be lost perhaps for ever.

I am, Sir,Your very obedient servant,

A PIIYSICIAN.

HOSPITAL REPORTS.

GUY’S HOSPITAL.

CANCEROUS DISEASE OF THE FEMALE MAMMA,OCCURRING AT THE AGE OF 26.

R. B., ætat. l6, an unmarried woman ofdark complexion, and not unhealthy appear-ance, came into the Hospital on 30th ofAugust; under the care of Mr. Key, on ac-count of disease of the left breast. *

She stated that the disease was of eightmonths standing, and that she first perceiveda hard moveable tumour under the integu-ments, of about the size of a hazel nut. Thedisease went on gradually increasing, untilwithin a few weeks previous to admission,when its growth became rapid, and she hadfrequent lancinating pains in the part.Leeches and plasters were applied underthe direction of her medical attendant, butwithout being productive of any benefit.There was a tumour occupying the inner

half of the left mamma, very firm, and notyielding to pressure ; irregular on its sur-face, having several distinct but small pro-jections ; it was not attached to the partsbeneath, nor was the nipple retracted. Theskin was discoloured, almost over the wholesurface of the tumour ; the cutaneous ves-sels loaded, and large veins running over thebreast. Near to the sternum, there werenumerous minute subcutaneous tubercles.The glands in the axilla were not en-

larged. The pain experienced was of alancinating kind, occasional, and not se-vere. The patient stated, that her generhealth was, and always had been, tolerablygood; the catamenial discharge had notbeen regular for some months.

Mr. Key having ascertained the particu-lars enumerated above, observed, that heconsidered the disease to be of a malignantnature; although occurring at an unusuallyearly period of life. The patient was di-rected to apply cold lotion to the part; inthe mean time, it having been intimated toher that it was necessary to undergo an

operation, she left the Hospital abruptly.

CASE OF IRRITABLE DISEASE OF THE

MAMMA.

By way of contrast to the former, we herereport a case of irritable disease of themamma, occurring in a young female:M. Pluckrose, aatat. 27, an unmarried

woman, of delicate appearance, admitted on9th of August, on account of disease of theright mamma. On examining the part, thewhole of the breast was found to be so

exquisitely sensible, that the patient startedback on its being slightly touched, and shesaid that she could scarcely bear her clothesto press against it. The pain, she said, ex-tended from the breast to the shoulder, anddown the arm to the ends of the fingers.The disease had existed for several months,and her menstrual discharge during this

period, has always been very small in quan-tity. About the time at which the cata-mepia appear, the pain in the breast is

always very much increased ; indeed so

much, that it amounts to agony.The plan of treatment pursued in this

case, consisted in the application of a plas-ter of belladonna to the breast, the exhibi-tion of three grains of blue pill at bedtime, and five grains of compound rhubarbpill twice a day, for a fortnight. The mix-ture of myrrh with iron was then exhibited,and the former riedicines omitted. The

patient, under this system, gradually im-proved ; the healthy functions of the uteruswere restored, as was evinced by the in-creased flow of the menses. The pain andsensibility of the breast gradually diminish-ed, and the patient was soon dismissed fromthe Hospital, cured.

Mr. Key’s admission of cases on 30th ofAugust, presented nothing worthy of no-tice, with the exception of the case of can-cerous disease of the mamma, reportedabove.