698 more remarkable, that notwithstanding the unsoundness of the bone preceding its fracture, union of it should take place in the ordinary period, and occasionally within it."-p. 239. The fourth and last part of the work treats of the diseases which are found in special parts,-these include morbid growths from the jaws, disease of the bones of the spine, and periosteal affections. The author enumerates the various tumours of the lower jaw, and describes the operation of removing a part or the whole of the bone. He cautions the surgeon against an oc- currence which may take place, after the removal of a part of the jaw, and which proves of serious consequence :- " After the removal of a large portion of the front of the jaw, inclucling its base, the lateral portions of the bone are very apt to fall inwards, whereby the molar teeth cannot be applied to those of the upper jaw, and thus the power of mas- tication will be wholly lost. In such instances, the two por- tions of the jaw do not fall inwards, simply from the want of support, but they are drawn forcibly inwards by muscular action, probably by the mylo-hoidei muscles:’-p. 275. This is an occurrence of a serious nature, and if it take place, it can only be remedied by some suitable apparatus. If the portion of jaw removed should include the angle and part ’of the vertical ramus, the distortion may be very great, in consequence of -the powerful action of the internal ptery- goid, of the opposite side. An instance of this kind has lately fallen under own observation: after the operation the patient was in a worse condition than before, for a time, in conse- quence of the remainder of the jaw being carried much in- wards, but by the adoption of a suitable apparatus to keep the teeth in apposition, the patient gained the power of masti- cation. The morbid growths from the upper jaw are enume- rated by the author as "fibrous, cartilaginous, encephaloid, fatty, erectile, or osseous." Mr. Stanley calls attention to the difficulty of diagnosis between a morbid growth and a mere accumulation of fluid within the cavity of the antrum. He quotes one or two remarkable instances, as illustrative of this point. The fol- lowing is worthy of recollection:- " A child, thirteen years of age, had a large tumour in the cheek ; the arch of the palate was depressed, the nostril closed, and the nose pushed to the opposite side of the face. It was determined to remove the superior maxillary bone. The incisions in the soft parts had been made, when it oc- curred to M. Gensoul to pass an instrument into the tumour before dividing the bone. A yellow fluid escaped from the antrum, and on freely opening its cavity, this was found greatly enlarged, and its lining membrane of a red colour, but not otherwise altered. On passing a finger into the an- trum, the canine tooth was found lying in the bottom of the cavity, and adhering to its walls. The operation was here concluded:’-p. 285. The mode of proceeding to be adopted in the formidable operation of removing the upper jaw is minutely detailed. The very free incisions in the face, recommended by the author, are not always necessary. Even after the removal of the greater portion, or of the whole, of the superior maxilla, it is wonderful how little deformity there exists, when the parts have entirely healed; the surgeon, therefore, should be careful in making the incisions as limited as possible. In two instances, under our own observation, the greater portion of the bone, with the morbid product, was removed by simply making an incision from the nose through the upper lip; and some time after the proceeding, it required close observation to detect that anything so serious had been done. Mr. Stanley objects to the use of chloroform in this opera- tion, fearing that blood may get into the windpipe; his objec- tion also rests upon the alleged fact, that a fatal case has occurred. No doubt he refers to a well-known case, which happened in one of the London hospitals, but we believe it has been denied, by competent authority, that the chloroform caused death in this instance; we believe, also, that Dr. Snow has determined that the irritability of the glottis is never lost, although there may be complete insensibility produced. In three instances of this operation, under our own observa- tion, chloroform was inhaled without any injury, and with great relief to the patients. In the last two chapters, Diseases of the Spine and Peri- ostitis are considered; several valuable observations are to be found respecting these diseases; but as we have devoted so much of our space already, we must refer the reader to the work itself. In concluding this somewhat lengthy, but necessarily im- perfect analysis, we cannot but express our opinion, that this treatise is one of great merit, and that it will be appreciated as it deserves to be by those who make themselves ac- quainted with it. Some of the subjects are, perhaps, not treated so fully as they might be, but yet, taking the work as a whole, a large amount of valuable information will be found therein. The numerous cases related by the author form a prominent feature in the work, and show that he has exer- cised great industry in collecting the proper materials, and that lie has not thrown away the vast opportunities which he has possessed, as surgeon to one of the largest hospitals in London. We have no doubt that this treatise will be esti- mated in the same light as are the admirable works of Hodg- son, Lawrence, and Sir Astley Cooper-works of which British surgeons may well be proud. With regard to the handsome folio volume of Illustrations, we can only say, without making particular mention of any delineation, that it forms an admirable companion to the prac- tical treatise, the drawings are vivid and expressive, and we strongly recommend both works to be studied together. Stricture of the Ui-et7tra, its Pathology and Treatment, comprising Observations on the Curative Powers of the Potassa Fusa in that Disease; with Cases. By ROBERT WADE, F.R.C.S. &c. Second edition. Churchill. 8vo, pp. 247. THE author of this work informs us, in the preface to this edi- tion, that it gives the results of a further experience of eight years, in the treatment of stricture of the urethra, particularly with the potassa fusa. We expresed an opinion favourable to the work on its first appearance, some years since, and we are glad to see that a second edition has been called for. The plan of treating stricture of the urethra as practised by Mr. Whateley, has fallen into unmerited disuse, doubtless from the rash and often ignorant mode in which that treatment was at- tempted to be carried out. The plan pursued by Mr. Wade, whilst it is, in many respects, more decided and vigorous, ap- pears to have been not only more effective, but as safe as that of Mr. Whateley. The work, indeed, with the exception of the anatomy, may be said to be a complete treatise on stric- ture, and it is satisfactory to observe, in the list of cases pub- lished, that the author has not made a " hobby-horse" of his plan, but resorts to it in those cases only in which it seems to offer a better chance of success than the more ordinary modes of treatment. It is essentially a practical work, and is evi- dently the result of extensive experience. Foreign Department. Sequel to the Cholera in Paris. Mucn stress is laid by Dr. VIDAL (DE CASSIS), Surgeon to the Venereal Hospital of Paris, on the immunity from cholera enjoyed by the patients of that hospital. This gentleman does not, as yet, deduce any practical measure from this fact, but requests an inquiry on the part of the leading members of the profession. It seems to us, that the immunity here spoken of, having likewise existed in 1832, is well worthy of notice, though the circumstance of twenty-one cases and seven deaths from cholera having, up to the 13th of June, occurred at the Hôpital de Lourcine, (Female Venereal,) rather mili- tates against the position, that either the syphilitic virus, or mercury, is an antidote to the choleraic poison. Still we find
Transcript
698
more remarkable, that notwithstanding the unsoundness ofthe bone preceding its fracture, union of it should take placein the ordinary period, and occasionally within it."-p. 239.The fourth and last part of the work treats of the diseases
which are found in special parts,-these include morbid
growths from the jaws, disease of the bones of the spine, andperiosteal affections.The author enumerates the various tumours of the lower
jaw, and describes the operation of removing a part or thewhole of the bone. He cautions the surgeon against an oc-currence which may take place, after the removal of a part ofthe jaw, and which proves of serious consequence :-
" After the removal of a large portion of the front of thejaw, inclucling its base, the lateral portions of the bone arevery apt to fall inwards, whereby the molar teeth cannot beapplied to those of the upper jaw, and thus the power of mas-tication will be wholly lost. In such instances, the two por-tions of the jaw do not fall inwards, simply from the want ofsupport, but they are drawn forcibly inwards by muscularaction, probably by the mylo-hoidei muscles:’-p. 275.
This is an occurrence of a serious nature, and if it takeplace, it can only be remedied by some suitable apparatus.If the portion of jaw removed should include the angle andpart ’of the vertical ramus, the distortion may be very great,in consequence of -the powerful action of the internal ptery-goid, of the opposite side. An instance of this kind has latelyfallen under own observation: after the operation the patientwas in a worse condition than before, for a time, in conse-quence of the remainder of the jaw being carried much in-wards, but by the adoption of a suitable apparatus to keep theteeth in apposition, the patient gained the power of masti-cation. The morbid growths from the upper jaw are enume-rated by the author as "fibrous, cartilaginous, encephaloid,fatty, erectile, or osseous."Mr. Stanley calls attention to the difficulty of diagnosis
between a morbid growth and a mere accumulation of fluidwithin the cavity of the antrum. He quotes one or tworemarkable instances, as illustrative of this point. The fol-
lowing is worthy of recollection:-" A child, thirteen years of age, had a large tumour in the
cheek ; the arch of the palate was depressed, the nostrilclosed, and the nose pushed to the opposite side of the face.It was determined to remove the superior maxillary bone.The incisions in the soft parts had been made, when it oc-
curred to M. Gensoul to pass an instrument into the tumourbefore dividing the bone. A yellow fluid escaped from theantrum, and on freely opening its cavity, this was foundgreatly enlarged, and its lining membrane of a red colour,but not otherwise altered. On passing a finger into the an-trum, the canine tooth was found lying in the bottom of thecavity, and adhering to its walls. The operation was hereconcluded:’-p. 285.The mode of proceeding to be adopted in the formidable
operation of removing the upper jaw is minutely detailed.The very free incisions in the face, recommended by theauthor, are not always necessary. Even after the removal ofthe greater portion, or of the whole, of the superior maxilla,it is wonderful how little deformity there exists, when theparts have entirely healed; the surgeon, therefore, should becareful in making the incisions as limited as possible. In two
instances, under our own observation, the greater portion ofthe bone, with the morbid product, was removed by simplymaking an incision from the nose through the upper lip; andsome time after the proceeding, it required close observationto detect that anything so serious had been done.Mr. Stanley objects to the use of chloroform in this opera-
tion, fearing that blood may get into the windpipe; his objec-tion also rests upon the alleged fact, that a fatal case hasoccurred. No doubt he refers to a well-known case, which
happened in one of the London hospitals, but we believe ithas been denied, by competent authority, that the chloroformcaused death in this instance; we believe, also, that Dr. Snowhas determined that the irritability of the glottis is never
lost, although there may be complete insensibility produced.In three instances of this operation, under our own observa-tion, chloroform was inhaled without any injury, and withgreat relief to the patients.In the last two chapters, Diseases of the Spine and Peri-
ostitis are considered; several valuable observations are to befound respecting these diseases; but as we have devoted somuch of our space already, we must refer the reader to thework itself.In concluding this somewhat lengthy, but necessarily im-
perfect analysis, we cannot but express our opinion, that thistreatise is one of great merit, and that it will be appreciatedas it deserves to be by those who make themselves ac-
quainted with it. Some of the subjects are, perhaps, nottreated so fully as they might be, but yet, taking the workas a whole, a large amount of valuable information will befound therein. The numerous cases related by the author forma prominent feature in the work, and show that he has exer-cised great industry in collecting the proper materials, andthat lie has not thrown away the vast opportunities whichhe has possessed, as surgeon to one of the largest hospitals inLondon. We have no doubt that this treatise will be esti-
mated in the same light as are the admirable works of Hodg-son, Lawrence, and Sir Astley Cooper-works of which Britishsurgeons may well be proud.With regard to the handsome folio volume of Illustrations,
we can only say, without making particular mention of anydelineation, that it forms an admirable companion to the prac-tical treatise, the drawings are vivid and expressive, and westrongly recommend both works to be studied together.
Stricture of the Ui-et7tra, its Pathology and Treatment, comprisingObservations on the Curative Powers of the Potassa Fusa in thatDisease; with Cases. By ROBERT WADE, F.R.C.S. &c. Secondedition. Churchill. 8vo, pp. 247.
THE author of this work informs us, in the preface to this edi-tion, that it gives the results of a further experience of eightyears, in the treatment of stricture of the urethra, particularlywith the potassa fusa. We expresed an opinion favourableto the work on its first appearance, some years since, and weare glad to see that a second edition has been called for. The
plan of treating stricture of the urethra as practised by Mr.Whateley, has fallen into unmerited disuse, doubtless from therash and often ignorant mode in which that treatment was at-tempted to be carried out. The plan pursued by Mr. Wade,whilst it is, in many respects, more decided and vigorous, ap-pears to have been not only more effective, but as safe as thatof Mr. Whateley. The work, indeed, with the exception ofthe anatomy, may be said to be a complete treatise on stric-ture, and it is satisfactory to observe, in the list of cases pub-lished, that the author has not made a " hobby-horse" of hisplan, but resorts to it in those cases only in which it seems tooffer a better chance of success than the more ordinary modesof treatment. It is essentially a practical work, and is evi-
dently the result of extensive experience.
Foreign Department.
Sequel to the Cholera in Paris.Mucn stress is laid by Dr. VIDAL (DE CASSIS), Surgeon to the
Venereal Hospital of Paris, on the immunity from choleraenjoyed by the patients of that hospital. This gentlemandoes not, as yet, deduce any practical measure from this fact,but requests an inquiry on the part of the leading membersof the profession. It seems to us, that the immunity herespoken of, having likewise existed in 1832, is well worthy ofnotice, though the circumstance of twenty-one cases and sevendeaths from cholera having, up to the 13th of June, occurredat the Hôpital de Lourcine, (Female Venereal,) rather mili-tates against the position, that either the syphilitic virus, ormercury, is an antidote to the choleraic poison. Still we find
699
Dr. Debroutelles, of Dieppe, writing to the Academy of Me-dicine, and recommending calomel in cholera, upon thestrength of the freedom experienced at the Venereal Hospital,just as if calomel could not be recommended (as, for instance,on Dr. Ayre’s suggestion) upon its own well-known action. Amadman, named Provençal, house-physician at the Mont-pelier Hospital, writes, on the same subject, to the Academy,and proposes that the syphilitic virus should be inoculated, as aprophylactic of cholera! M. Velpeau remarked, in a latemeeting of the Academy, that many of his colleagues hadtreated cholera patients affected with syphilis; and M.Gimelleadded, that he had lately had under his care a young man oftwenty-six, affected with chancre; he was taking proto-iodideof mercury for this affection, when he was carried off bycholera in a few hours. M. Ricord explicitly maintains, in aletter addressed to L’ Union Médicale, on June 16, that neithersyphilis nor mercury, nor the two influences combined, areproved to preserve from cholera. He attributes the immunityof the Hopital des Veneriens to the comparatively few pa-tients of the establishment, and its salubrious situation; andvery aptly remarks, that the Maternity Hospital, situated onlya few yards from his hospital, enjoys the same immunity fromcholera. Thus, we find the two surgeons of the H6pital duMidi-viz., M. Vidal (de Cassis) and M. Ricord, differingwidely on this subject. The latter gentleman enters into ex-tremely interesting details in his letter. We regret that wantof space forbids our entering more fully into the considerationof this important communication. Among the remedial mea-sures proposed, we must not omit M. Piorry’s. This gentle-man, considering that cholera patients die for want of waterin the blood, had this liquid thrown, in large quantities, intothe bladder of a man dying of the disease. No less than twoquarts were injected in one hour, and absorption was rapidlyproceeding, as ascertained by the plessimater: the pulse rose;the veins, which were almost empty, began to refill, and theman was improving; the ultimate result is not yet known.This fact was communicated to the Academy of Sciences onthe llth June: at the same meeting, some very interesting ’’
statements were made by M. Audrand, respecting the absenceof electricity in the atmosphere, during the present epidemic.This gentleman has made his observations with a circularglass-plate machine, which, in ordinary times, gives sparksabout an inch long, by two or three turns of the plate. Hehas been unable, since the breaking out of the epidemic, ofonce producing this result. In April and May, a great manyturns were necessary to produce sparks of an inch, and thevariations in the size of the sparks have accorded with theoscillations of the disease. During the very hot days, on the4th, 5th, and 6th of June, nothing but crepitations, withoutsparks, could be obtained; on the 7th, the machine could notbe made to yield anything, (720 persons died on the 8th.) Afew sparks re-appeared on the morning of the 8th, and afterthe storm, which broke out on that day, numerous sparkscould be obtained by the slightest touch of the plate.M. Raspail, well known by his chemical works, and still
better by his extreme politics, maintains that he can cure cholerawith camphor, and the public of Paris are quite enthusiasticabout the smoking of camphor cigarettes. These, our readersare aware, have been long recommended by M. Raspail assovereign remedies in all diseases; and though there are noactual facts giving the slightest support to this method, as faras the present epidemic is concerned, it is reported that theauthor, who is locked up at Doullens, cannot reply to all thehuge medical correspondence which he carries on from hisprison. Numerous deaths from cholera, among medical men,have been reported: among them we find M. Bourgery, theauthor of the work entitled L’ Anatomie de 1’Homme,"which, unfortunately, is left unfinished, and upon which twentyyears’ labour have been bestowed; M. Boudet, member of theAcademy of Medicine; and M. Mojon, of Genoa, an eminentsurgeon under Napoleon, and long settled in Paris. ProfessorBouillaud is likewise reported to be suffering from a very severeattack of cholera. A little village of the department of theOise,numbering about 2000 inhabitants, has been attacked bothby the cholera and the sweating sickness; in a short time nearly100 people had died. Medical men, hospital pupils, and sistersof charity, were speedily sent down from Paris, and theirefforts, guided and organized by M. Melier, a member of theBoard of Health, who volunteered his attendance, are likelyto do much good. A drunkard finding his wife dying of cho-lera, had the cruelty, whilst in a state of inebriety, to beat herviolently. This rough usage, far from destroying her, as mightbe expected, roused her, brought on powerful reaction, andsaved her. This reminds us of the flagellations recommended
in cases of poisoning by opium. The dissecting-rooms of Cla-mart have been closed, by order of the Director of Hospitals,till the end of June, to prevent any insalubrious effects fromthe accumulation of subjects. The municipal body of Parishave voted X6000 for burial expenses, and X2000 for the ex-traordinary cholera dispensaries. The Council of the Bank ofFr.mce have sent £1000 to the Prefect of the Seine, to be dis-tributed to poor families bereft by cholera. Two large man-sions belonging to the state, one lately occupied by GeneralCavaignac, the other by the Austrian ambassador, have beenconverted into cholera hospitals. Opinions are still at varianceas to the contagious nature of cholera. A warm discussiontook place on the subject the other day, at the Academy ofMedicine, and it is but right that our readers should know,that so high an authority as M. Velpeau affirms that the dis-ease is contagious. A contagionist medical practitioner of acertain village, having struck terror into the minds of thepeople, the sick remained without assistance, and the deadwithout burial, so much so that the clergyman was obliged tobury them himself. M. Mélier, who mentioned this circum-stance in the Academy, promised to name the place to thecholera committee. Eating-houses and butchers’ shops arebeing examined by the police, upon an order from the Boardof Health.
THE JOHN-HUNTER CLUB.
:L ’0 LILB .P.iCb2LO7" qJ THE juAJtUN’r.
SIR,-I yesterday received the enclosed communication fromMr. Wormald, who, as you will perceive, complains loudly ofthe injurious operation of a self-constituted body of fellows,calling themselves the John-Hunter Club. The assumption ofthe name of John Hunter appears to be the least important oftheir proceedings; indeed, it becomes too evidently a moreserious question in what way the operations of such an asso-ciation should be counteracted by the fellows in- general.
" It is come to my knowledge," says Mr. Wormald, " thatmy introduction into the council will be opposed by this club!’The eligibility of the candidate next on the list is, if Mr.Wormald’s statements be correct, determined by some formof ballot, but it is an integral principle of the association thatthe majority should carry with them the minority, and so,therefore, the full force of the entire club is uniformly broughtto bear against the obnoxious candidate on the day of election.I should be glad if you could find me space enough in thisweek’s LANCET to inquire whether any fellow be prepared witha plan calculated to counteract in some measure the viciousinterference of this cabal with the fair and legitimate purposesfor which the fellows have been invited to assemble on Thurs-day. Something must be done, or the non-clubbists may aswell remain at home. The only method which suggests itselfto me at this moment is the immediate formation of a counternnalifinn T ,.nmoi" .G’i,Sir your obedient servant
Dorset-place, Dorset-square, June, 1849.*.* This note was accompanied by a copy of a circular from
Mr. Wormald, to which we have given insertion in anotherplace.-ED. L.
____
To the Editor of THE LANCET.
SiR,-The thanks of the profession are due to you for having,by the remarks in the last two numbers of your influentialjournal, given the death-blow to the doings and intentions ofthe " John-Hunter Club." But, Sir, it is due to the professionthat the names of these conspirators, alike against its peace,honour, and independence, should be known; and I venture toaffirm, than such an exposure would be quite sufficient to com.plete your work of demolition, if any remnant of this execrableand miserable piece of cliquism should still linger. Who areMr. Soden, Mr. Charles Hawkins, and Mr. Richard Partridge,that they should pass a vote of condemnation upon Mr. Wor-mald, Mr. Pilcher, Mr. Bishop, and others ? Have they beenelevated to the censorship of the profession on. account of anyadvantages which their labours have conferred upon it ? Letthe names of other actors in this drama be brought out; andthen we shall know, when the time arrives, who are the menwhose position in the council (if they get there) would seri-ously obstruct the spread of those principles which it has beenyour object as well as that of the great body of the professionto disseminate. I am, Sir, your obedient servant,June 25, 1849. A FELLOW.
