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404 tific instruction will be under the direction of Dr. A. W. Hofman, formerly assistant in the Giessen Laboratory and teacher of Chemistry in the University of Bonn. The method adopted will be that followed with signal success at Giessen, where the students seldom fail to distinguish themselves by the publication of origi- nal researches before they quit the Laboratory." , In the appointment of a Professor, the Council have, we think, been most judicious and fortunate. Dr. Hofman is not only known to every man who has visited Giessen, as the most promising of all the teachers who have sprung from that school, but he has al- ready made himself an European reputation, and Professor Liebig says of him-" Dr. Augustus William Hofman, of Giessen, has, during many years, cultivated at this University, mathe- matics, physics, and chemistry, with the most signal success, and by my advice and recommendation he resolved to devote himself to the profession of a teacher of Chemistry. On account of his eminent acquirements, and practical talents-combined in him with a decided genius for original research-I chose him for my assistant, in which appointment he has given me the greatest satisfaction. According to my heartfelt conviction, I should con- gratulate any University in obtaining the invaluable services of I Dr. Hofman as a teacher. His chemical researches on the organic I bases formed in the distillation of coal, are before the scientific ’, public, and they are acknowledged to be one of the most important and arduous labours of the age." This was written in 1844 to the Prassian government. The statement proceeds to quote a letter written lately by Liebig, in which lie says-" I believe you will in Dr. Hofman obtain the very man who possesses the moral courage, the talents, energy, and every other qualification, to ensure the success of the college," (of chemistry) " and to impart a high scientific character to an institution, which has now become so indispensable to England." To these encomiums it is almost superfluous for us to add any- thing, bnt Dr. Hofman’s recent labours proclaim his qualifications for the professorship of the new college more forcibly than any verbal testlmony whatever. In the Memoirs of the Chemical Society of the last year only, will be found papers on the Meta- morphoses of Indigo," " on Tolicidine, a new organic base," " on the true composition of Chorandatmit," " on Styrole, and some pro- ducts of its decomposition," displaying profound scientific acquire- ments, enlarged philosophical views, with immense industry and practical skill, and manifesting that these are but the beginning of the contributions to science which may be expected from Dr. HOFMAN. The arrangement for students of chemistry at the college is novel and most judicious. The fee is fixed for six days work weekly during the session, but a student may work in the labora- ory one, two, three, or more days at a corresponding fee. Exa- minations will be instituted, and a diploma conferred on successful camlidates. A student who manifests an aptness for chemical research, and who distinguishes himself by diligence, may, after his second session, on the recommendation of the professor, be admitted by the council to continue his studies in the laboratory, without the further payment of fees. With such encouragement, such a teacher, and under such auspices as the College of Che- mistry commences its career, we feel assured that the new gene- ration of English chemists will rival at least, if not surpass, those of any country. HOSPITAL REPORTS. HERTFORD INFIRMARY. CASE OF VESICO-VAGINAL FISTULA. BY FREDERICK G. REED, Esq., Surgeon to the Hertford Infirmary. ELIZA NORTH, aged 27, a domestic servant, unmarried, of spare habit, sanguine temperament, and healthy appearance, was ad- mittedas in-door patient of the Ilertford Infirmary, under my care, 26th December, 1844, in consequence of her complaining of inability to retain her urine. She gave the following history of her case:-Six weeks pre- vious to her application for admission, whilst in the act of stooping to lift a pailful of water out of a butt, she felt some- thing burst, but attended only with momentary pain, and her urine gushed from her, since which time it has dribbled away from the bladder continually, without her possessing the power to restrain it; previous to this occurrence, she was in perfect health; in fact, had never experienced a day’s indisposition in her life; her bowels had acted the evening previous; she had passed her urine about three hours before, in the usual quan- tity, and cannot recollect restraining any desire to relieve her bladder naturally. She continued in excellent health, and performing her accustomary domestic duties for three weeks subsequent, but greatly inconvenienced by the urine continu- ally passing from her: at this time she left her situation, and went home to her parents, being attacked with symptoms of a severe cold, from the effects of which she recovered, under the care of a medical gentleman, at Welwyn, in this county, who / advised her applying for admission to this Infirmary. At the present date, December the 26th, her upper and lower ex- tremities are partially paralyzed; she is unable to support herself without some assistance, or to grasp any object firmly; she is free from pain; the sensibility of the surface is con- siderablv impaired, but on pressing the ulnar or sciaticnerves, pain is distinctly felt, and conveyed to their ramifications; the skin is dry, and colder than natural. She states, these symp- toms came on about a week since, and affected both extremi- ties equally and contemporaneously, commencing with a feeling of numbness, and want of perfect controul over her limbs; and when she used her hands for prehension, any small substance slipped from her fingers, which she was noT aware of, until convinced by seeing or hearing it fall. She has not men- struated for the last six weeks, but, previously, her catamenia were regular and natural, and has not been subject to hysteria; her bowels act regularly, and she has perfect controul over the sphincter ani; her senses are unaffected, and there is no symp- tom of any cerebral lesion; she has no rheumatic symptom. Upon a careful examination of the spine, no sign of the exist- ence of disease can be detected; her rest is bad, and her appetite depraved; and she has some slight irritative fever. Upon local examination, together with Mr. Towers, the resident medical officer, the external parts are somewhat irri- tated and inflamed, from being continually moistened with urine; the mucous membrane of the vagina is healthy in ap- pearance, and upon introducing a catheter through the meatus, the bladder is empty. In the median line, at the inferior and posterior part of the bladder, about one inch from the neck, there is a longitudinal rent, with a serrated edge, of about an inch in extent, devoid of inflammation, extending through the vaginal mucous membrane, so that the instrument can be passed freely from the meatus, through this aperture, into the vagina, from which the urine appears to escape entirely; the mucous membrane of the bladder appears healthy. She has never been pregnant; her moral character is stated to be irreproachable; and not the slightest evidence exists of her having had any ulceration in the parts, or their neighbourhood. The following is the treatment adopted :- Dec. 27th.-Ordered some aperient medicine. 28th.—By means of the speculum, I applied the solid nitrate of silver, brought to a fine point, to the edges of the laceration, and then passed a dry piece of sponge, about three inches in length, and cut of an oval shape, into the vagina, so as to fill but not distend it, carrying it as high up as practicable; se- cured a catheter in the bladder, and directed her to remain in bed, and lie on her face as much as possible, and a fresh sponge to be introduced three or four times in the course of the day, by means of the speculum. Ordered her half a grain of acetate of morphia, to be taken at bed-time, and citrate of soda in ealumba infusion, three times a-day. 30th.-Has sufferecl but little inconvenience from the appli- cation, or the presence of the sponge. The urine has passed chiefly through the opening, but little by the catheter. Has slept better. Jan. 2nd.-Again applied the solid nitrate freely, the edges of the ruptured surface looking red and somewhat inflamed; urine still passes almost entirely from the wound; paralysis of the extremities certainly increasing, and sensibility less; rest, however, improved; appetite better. 8th.-Again applied the nitrate. The edges of the lacera- tion, at some points, presenting a granular appearance: a greater quantity of urine has passed through the catheter, as she has been enabled to accommodate herself more to its use. Her general health has improved, with the exception of the paralysis, which has gradually increased, and she is now unable to move. or assist herself, and is only sensible of feeling when the trunks of the nerves are pressed upon, but retains perfect controul over the sphincter ani. Ordered full diet.
Transcript
Page 1: HERTFORD INFIRMARY

404

tific instruction will be under the direction of Dr. A. W. Hofman,formerly assistant in the Giessen Laboratory and teacher of

Chemistry in the University of Bonn. The method adopted willbe that followed with signal success at Giessen, where the studentsseldom fail to distinguish themselves by the publication of origi-nal researches before they quit the Laboratory.", In the appointment of a Professor, the Council have, we think,been most judicious and fortunate. Dr. Hofman is not only knownto every man who has visited Giessen, as the most promising ofall the teachers who have sprung from that school, but he has al-ready made himself an European reputation, and Professor

Liebig says of him-" Dr. Augustus William Hofman, of Giessen,has, during many years, cultivated at this University, mathe-matics, physics, and chemistry, with the most signal success, andby my advice and recommendation he resolved to devote himselfto the profession of a teacher of Chemistry. On account of hiseminent acquirements, and practical talents-combined in himwith a decided genius for original research-I chose him for myassistant, in which appointment he has given me the greatestsatisfaction. According to my heartfelt conviction, I should con-gratulate any University in obtaining the invaluable services of IDr. Hofman as a teacher. His chemical researches on the organic Ibases formed in the distillation of coal, are before the scientific ’,public, and they are acknowledged to be one of the most importantand arduous labours of the age."

This was written in 1844 to the Prassian government. The

statement proceeds to quote a letter written lately by Liebig, in

which lie says-" I believe you will in Dr. Hofman obtain the

very man who possesses the moral courage, the talents, energy,and every other qualification, to ensure the success of the college,"(of chemistry) " and to impart a high scientific character to aninstitution, which has now become so indispensable to England."To these encomiums it is almost superfluous for us to add any-

thing, bnt Dr. Hofman’s recent labours proclaim his qualificationsfor the professorship of the new college more forcibly than anyverbal testlmony whatever. In the Memoirs of the Chemical

Society of the last year only, will be found papers on the Meta-morphoses of Indigo," " on Tolicidine, a new organic base," " onthe true composition of Chorandatmit," " on Styrole, and some pro-ducts of its decomposition," displaying profound scientific acquire-ments, enlarged philosophical views, with immense industry andpractical skill, and manifesting that these are but the beginning ofthe contributions to science which may be expected from Dr.HOFMAN.

The arrangement for students of chemistry at the college isnovel and most judicious. The fee is fixed for six days workweekly during the session, but a student may work in the labora-ory one, two, three, or more days at a corresponding fee. Exa-

minations will be instituted, and a diploma conferred on successfulcamlidates. A student who manifests an aptness for chemical

research, and who distinguishes himself by diligence, may, afterhis second session, on the recommendation of the professor, beadmitted by the council to continue his studies in the laboratory,without the further payment of fees. With such encouragement,such a teacher, and under such auspices as the College of Che-mistry commences its career, we feel assured that the new gene-ration of English chemists will rival at least, if not surpass, those ofany country.

HOSPITAL REPORTS.

HERTFORD INFIRMARY.

CASE OF VESICO-VAGINAL FISTULA. BY FREDERICK G. REED, Esq.,Surgeon to the Hertford Infirmary.

ELIZA NORTH, aged 27, a domestic servant, unmarried, of sparehabit, sanguine temperament, and healthy appearance, was ad-mittedas in-door patient of the Ilertford Infirmary, under my care,26th December, 1844, in consequence of her complaining ofinability to retain her urine.She gave the following history of her case:-Six weeks pre-

vious to her application for admission, whilst in the act of

stooping to lift a pailful of water out of a butt, she felt some-thing burst, but attended only with momentary pain, and herurine gushed from her, since which time it has dribbled awayfrom the bladder continually, without her possessing the powerto restrain it; previous to this occurrence, she was in perfecthealth; in fact, had never experienced a day’s indisposition inher life; her bowels had acted the evening previous; she hadpassed her urine about three hours before, in the usual quan-tity, and cannot recollect restraining any desire to relieve herbladder naturally. She continued in excellent health, andperforming her accustomary domestic duties for three weekssubsequent, but greatly inconvenienced by the urine continu-ally passing from her: at this time she left her situation, andwent home to her parents, being attacked with symptoms of asevere cold, from the effects of which she recovered, under thecare of a medical gentleman, at Welwyn, in this county, who /advised her applying for admission to this Infirmary. At thepresent date, December the 26th, her upper and lower ex-tremities are partially paralyzed; she is unable to supportherself without some assistance, or to grasp any object firmly;she is free from pain; the sensibility of the surface is con-siderablv impaired, but on pressing the ulnar or sciaticnerves,pain is distinctly felt, and conveyed to their ramifications; theskin is dry, and colder than natural. She states, these symp-toms came on about a week since, and affected both extremi-ties equally and contemporaneously, commencing with a feelingof numbness, and want of perfect controul over her limbs; andwhen she used her hands for prehension, any small substanceslipped from her fingers, which she was noT aware of, untilconvinced by seeing or hearing it fall. She has not men-struated for the last six weeks, but, previously, her catameniawere regular and natural, and has not been subject to hysteria;her bowels act regularly, and she has perfect controul over thesphincter ani; her senses are unaffected, and there is no symp-tom of any cerebral lesion; she has no rheumatic symptom.Upon a careful examination of the spine, no sign of the exist-ence of disease can be detected; her rest is bad, and herappetite depraved; and she has some slight irritative fever.Upon local examination, together with Mr. Towers, the

resident medical officer, the external parts are somewhat irri-tated and inflamed, from being continually moistened withurine; the mucous membrane of the vagina is healthy in ap-pearance, and upon introducing a catheter through the meatus,the bladder is empty. In the median line, at the inferior andposterior part of the bladder, about one inch from the neck,there is a longitudinal rent, with a serrated edge, of about aninch in extent, devoid of inflammation, extending through thevaginal mucous membrane, so that the instrument can bepassed freely from the meatus, through this aperture, into thevagina, from which the urine appears to escape entirely;the mucous membrane of the bladder appears healthy. Shehas never been pregnant; her moral character is stated to beirreproachable; and not the slightest evidence exists of herhaving had any ulceration in the parts, or their neighbourhood.The following is the treatment adopted :-Dec. 27th.-Ordered some aperient medicine.28th.—By means of the speculum, I applied the solid nitrate

of silver, brought to a fine point, to the edges of the laceration,and then passed a dry piece of sponge, about three inches inlength, and cut of an oval shape, into the vagina, so as to fillbut not distend it, carrying it as high up as practicable; se-cured a catheter in the bladder, and directed her to remain inbed, and lie on her face as much as possible, and a fresh spongeto be introduced three or four times in the course of the day,by means of the speculum. Ordered her half a grain of acetateof morphia, to be taken at bed-time, and citrate of soda inealumba infusion, three times a-day.30th.-Has sufferecl but little inconvenience from the appli-

cation, or the presence of the sponge. The urine has passedchiefly through the opening, but little by the catheter. Has

slept better.Jan. 2nd.-Again applied the solid nitrate freely, the edges

of the ruptured surface looking red and somewhat inflamed;urine still passes almost entirely from the wound; paralysis ofthe extremities certainly increasing, and sensibility less; rest,however, improved; appetite better.8th.-Again applied the nitrate. The edges of the lacera-

tion, at some points, presenting a granular appearance: agreater quantity of urine has passed through the catheter, asshe has been enabled to accommodate herself more to its use.Her general health has improved, with the exception of theparalysis, which has gradually increased, and she is nowunable to move. or assist herself, and is only sensible of feelingwhen the trunks of the nerves are pressed upon, but retainsperfect controul over the sphincter ani. Ordered full diet.

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405

Calomel, one grain; blue pill, three grains; extract of hyos-cyamus, two grains,-for two pills to be taken night andmorning; iodide of potass, four grains; infusion of calumba,one ounce, to be taken three times a-day; castor-oil, half anounce occasionally.

12th.-Agai-n applied the nitrate. Cicatrization evidentlytaking place; much less passes from the wound; paralysis notimproved. Cont. med.

20th. Applied the nitrate; opening much smaller; she isnow sensible of the bladder becoming distended, and when thedesire to evacuate it comes on, she has the sponge removed,which is saturated with urine, and is thus enabled to void twoor three ounces naturally; paralysis not improved; complainsof great debility. Cont. mercury. jRp. Tincture of sesqui-chloride of iron, ten minims; infusion of calumba, one ounceand a half, to be taken three times a day.February 1st. Now evacuates the bladder naturally, four or

five times in the twenty-four hours; on removing the sponge,but little passes from the wound; aperture nearly closed;again touched it with the nitrate; paralysis not improved; isperfectly helpless, and obliged to be lifted to and from her bed;her menses have appeared; the bowels being affected, I directed,mercury with chalk gr. iv.; opium gr. night and morning,to be substituted for the calomel. Cont. tonic.

9th. Laceration completely closed; now voids the urinenaturally; mouth slightly affected; continue the pills everynight only; increase the tincture of sesqui-chloride of iron toxx. minims in each dose.

13th. Paralysis decideclly improved; sensibility more acute;feels better and stronger. Cont. med :

20th. Improving. Cont. tonic. Pills every other night.March l0th. Greatly improved in all respects. Discontinue

mercury; voids her urine without the slightest inconvenience.April 10th. Discharged. Can walk about with very little

assistance; and is able to use her hands and fingers, so as to

pick up a pin from the floor. From this date her improvementwas gradual and marked; at the present date, August 1, I learnfrom her friends she has entirely regained the use of her limbs,is in perfect health, and about to be married.After reviewing this interesting case, it appeared to my

mind, that the paralysis and the injury were perfectly distinctin their origin, no symptoms of the former having presentedthemselves, until five weeks subsequent to the laceration ofthe bladder; and although she had not been previously subjectto hysteria, still so much disturbance in her general system,having been excited by her indisposition, from the effects ofcold, and the accident, and also some catamenial irregularityhaving occurred, I viewed the paralysis as depending on a con-gestive, or sub-acute inflammatory state of the membranes ofthe medulla spinalis, associated with hysteria; and the result ofthe treatment, I think, justified the supposition, as, until shebecame under the influence of the mineral, no amelioration inher symptoms took place, and from that period her improve-ment was progressive until her recovery. By what means thelaceration of the bladder was produced is a matter of question,but my impression is, that it must have been occasioned by the forcible introduction of some instrument. Never havingtested in my own practice the method recommended of paring I,the edges of the wound, and uniting them by suture in casesof vesico-vaginal fistula, I am unable to speak of its compara-tive value, but the success of the treatment in this instancewould induce me to prefer its adoption in others of a similarcharacter, it appearing to me less objectionable, and attendedwith but little inconvenience to the patient. ’,

SAINT MARGARET’S CHURCH-YARD.To the Editor of THE LANCET.

SIR,-Nothing of late has occupied public attention, or roused thecommon feelings of our nature, so much as the horrors of intra-mural, or metropolitan sepultures; the danger of such proceedingshas been universally admitted by all those disinterested, scientific,and practical men, who have deeply investigated the subject; andthe outrageous desecrations of the sanctity of the graves of thedead, recently brought to light in Spa-Fields, have, I really believe,excited public indignation to the highest pitch. Your readers willremember, that THE LANCET of February last chronicled thefacts, and in the same article you gave some original observations,regarding that shameful place. The Westminster Review haswell remarked, " that so long as these matters do not seize violently,and continuously by the nose, the people of quality, no public com-motion is raised, no parliament petitioned, no sound is heardabout the neglected healths of the community!" It is too evident,ir, that powerful influence is at work to smother or overlay this

question. I am much mistaken if the persons who attempt to doso will not ultimately regret, that they had not acted np to the oldadage-°° Honesty is the best policy." Meanwhile I desire to puton record in your Journal, the following brief narrative of facts.On August 23rd, 1845, I was requested to attend the funeral of

my late patient, Miss -, at St. Margaret’s Church-yard, West-minster-during the performance of the burial service, the situa-tion of the parties was as follows:-the clergyman stood to the.windward, or at the head of the grave; the mourners were placedlaterally; whilst a mute occupied the foot, and to the leewardside, of the grave. The mute, as the service advanced, staggered,was unable to keep himself erect, and became deadly pale;he was removed to the vestry-room, suffering from pain in thebowels, which ended in diarrhoea; his health was deranged duringthe two subsequent days; on the night of the funeral, the under-taker was seized with diarrhoea and faintness, and continued in adebilitated state for some days after; one of the mourners on hisreturn home was affected with the same symptoms, and renderedunable to follow his employment for an entire week; and it maybe as well to observe here, as a remarkable coincidence, that the wifeof one of the mourners, was, late on the night of the funeral, orearly next morning attacked with apoplexy, and expired in two orthree days. In conclusion, I beg to say, that I felt during thefuneral, and for some time afterwards, very unpleasant sensations,although my health ;was not deranged by the inhalation of theanimal gases or poison. All these circumstances tend to

strengthen the preconceived impresssion, that illness of a seriousnature may be produced, and even death in many instances ensue,by attendance at the burial grounds of this metropolis, which areknown to be more than commonly charged with human putrefac-tions : although the above mentioned cases, did not terminatefatally, yet, I consider the subject of extraordinary interest to thosewho are seeking to discover tangible sources of disease, and toemploy preventible means of suppressing its operations. Thefacts already spoken of, may be compared with many others onrecord, but especially the cases given in THE LANCET in June,1840, regarding the burial ground in question. The grave-digger,in that instance, whilst engaged in opening a grave, was struckdown by the effluvium, and after suffering fur a few days from theworst type of malignant fever, expired. The medical attendant,a young friend of mine hoping to attain at some future day tohonourable distinction in his profession, who was called in,was seized with similar symptoms, and died in a few days; hisfaithful servant, by her assiduous attention to her master, imbibedthe like disease, and soon fell a sacrifice. The commissionersfor the improvements in Westminster, reported to Parliament,thirty years since, that hardly could a single grave be obtained inSt. Margaret’s Churchyard. Without further comment I leavethis subject. I am, Sir, your obedient servant,

J. C. ATKIKSON.Romney Terrace, Westminster, Sept. 29th, 1845.

J. C. ATKINSON.

THE LAWLESS COMMITTEE.To the Editor of THE LANCET.

SiR,-In Friday’s impression of the Times appears an excuse, orapology, in the form of an advertisement, from the sub-committeeof the National Association, written in the vain hope that theexplanation which it an-brds would be sufficient to account to themembers for its shuffling conduct in not having noticed, in thelast transactions of the Association, the amended, but not im-proved, Bill of Sir James Graham.The address of the sub-committee is dated August the 13th; r

the Bill was ordered to be printed on the 28th of July, and wasiactually in the hands of several members of the " Committee ofSurgeons " some days before the transactions of the associationwere issued, and yet the sub-committee has the hardihood to assertthat the Bill was not out until " two or three weeks subsequently."Bad must be the cause which requires falsehood to sustain it.

In the advertisement the sub-committee likewise inform themembers that the " discrepancies" found in the last Bill of SirJames Graham are "purely accidental." It must have been asingular "accide2,tt" indeed which could so ingeniously havetransformed the various clauses of that Bill-that could have socleverly contrived them as that they should be made to aim suchdeath-blows at the respectability of the medical profession. Thisaccount of the affair reminds me of an anecdote which I haveheard related of a Jew dealer who kept a diary of his mercantiletransactions. One of the entries in his diary, on a certain day,was as follows-,, bropped into my great coat pocket, by accident,a pair of silver candlesticks." Now, " the accident," as regards thesame "Bill," and that of the "candlesticks," may be placed upon thesame footing. Truly this sub-committee of the National Associationmust have a very indifferent opinion of the perceptive powers of


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