54

A correspondent inquires, if we have our Iprice, because we have not given reports, of ,late, from the Middlesex Hospital; the re-

ply is, that our friend JoE told us he had

nothing there to sell. Joking apart, the

cases having been worth nothing which have

been admitted there for some time past, we

have not felt disposed to trouble our devils

with printing them.

The following case may serve to illustrate

the sort of discipliiie observed at that Hos-

pital :.

Yesterday afternoon, (June 26th,) a grand I‘ set to took place in one of the wards of this ’,

Hospital, between Tom Russell and another’ lad of the fancy"-both patients here.

At the commencement, betting was even.but after the second round, Russell’s oppo-nent was the favourite, and 3 to 1 was

readily taken by the dressers and nurses.The eighth round decided the point, andTom was fairly thrashed ; his antagonisthaving " queered one ogle," Tom was" floored," and, in the fall, BROKE IIIS LEG.This is no joke.

Mr. BELL, in his clinical lecture of last I

week, recommended the pupils to take

copious notes of all the cases alluded to byhim:-" Gentlemen," said Mr. Bell, " every

facility will be afforded you for so doing, and without such attention on your part,

my observations will be of little avail to

you:’It happens that Mr. Bell’s ideas of

note-taking, have undergone some change.- -How long have such facilities been af-

forded 1

LONDON MEDICAL SOCIETY.

THE first meeting of the Society, for thepresent session, was held on Monday

evening, the 24th of September.Dr. CLUTTERBUCK, the president, an-

nounced to the Society, that during the

last recess, the Council had been occu.

pied with a subject of great importance tothe Society, namely, the present state ofthe library. It bad been found that thecatalogue was in a very imperfect state ; arevision of it had been made, and it was de.sirable that it should be printed ; but notwishing to break in upon the regular fundsof the Society, which would abridge the sup-ply of new works, the Council thought itbetter to recommend that the necessarysum should be raised by the voluntary suh.scriptions of the members, and for that pur-pose a paper would be laid on the table forsignatures. It is to be hoped that it willnot be allowed to lie there long ; as withoutsuch a catalogue, the literary treasures ofthe society are rendered almost useless.The minutes of the last meeting having

been read by Mr. Firt,D, Dr. CLUTTERBUCKcongratulated the Society on its prosper-ous conclition, and expresed his convic-tion, that the present session would be asinteresting as the preceding : and it wouldbe in the recollection of the members, thatthe last session had been productive of moreinteresting and satisfactory discussion, thanmany of the former. In adverting to theiaoie regular business of the Society, he ob.served. that no subiect was more deservingtheir attention than the character of the pre-vailing diseases at the present period, as wellas the state of the general health during thelate recess. He saw many gentlemen pie-sent, who had extensive opportunities ofwatching disease, and he hoped that theywould communicate the results of their ob-servations, especially as during the autumnmany diseases had assumed an epidemiccharacter. By thus giving the results oftheir experience upon these subjects,whether orally or in writing, they couid ac-complish the essential objects of the So.

ciety. The question of contagion shouldnot be lost sight of, as it was one of gleatimportance, on account of its influence on

treatment, and was as yet far from being set-tled; it was deserving therefore a thoroughinvestigation, and the opportunities anordedto pathologists for making inquiries, werefar from being limited. It was not to be

forgotten that the healing art was, andprobably ever would be, progressive ; it wasnever likely to attain perfection, but we hada light to expect that something should becontinually added to the store. By the joint

55

aid of observation and experiment, we (were gradually penetrating the dark recessesof the animal economy ; physiology was on Ithe advance, and with it of course pathology,and the principles of medical science ; forin proportion as we arrived at a more inti-mate acquaintance with physiology, we ac-quired a better knowledge of the nature ofdiseases, and, what must follow as a neces-sary consequence, a more successful methodof treating them.Among the improvements in physiological

science, he would read to the Society someingenious experiments that had been madeon the brain, by Dr. Hertwig, of the Vete-rinary School of Berlin; for an account ofwhich the public were indebted to one ofour medical periodicals :’ as it was to be

regretted that the knowledge of the Germanlanguage was very limited in this country.They had led to the most important con-clusions, which the President then read tothe Society. The important bearing of thefacts deduced from these experiments uponpathology, would easily be seen ; p.nd if ex- periments upon living animals were ever justifiable, it was in cases where they wereso well ccnducted as in the hands of Dr.

Ilertwig, and from the light they tended to throw upon diseases and their treatment in the human subject. ’,

Dr. CLUTTERBUCK then mentioned thetract lately published by Professor Munro,of Edinburgh, " On Spasm of the Canalsfor the Passage of the Food, the Bile, andthe Urine;" which (he said) had not yet,perhaps, reached the Society. It was oneof high interest in a physiological and pa-thological point of view : its main objectwas to show, which it did to him satisf’ac-

torily, that not only the alimentary canal,hut the biliary and urinary passages w ere

possessed of muscular contractihty, how-ever difficult it might be to demonstrate adistinct lbrgiis or muscular structure. Ifthat point could be satisfactorily established,it must tend to lessen the diRieuity felt bymany in admitting the muscular powers ofblood-vessels ; a point in which the generaldoctrine of the circulation was deeply in-volved, as well as a considerable number ofdiseases. He next observed that he had a

subject to mention, which he had no doubtwould excite considerable interest amongthe Members; it was the account of a newmedical doctrine which had sprung 1!p inthe Cejman L Diversities, and which ap-peared to be extensively diiiused tliruushoutGelmany and some of the neighbcuringcountries. It originated with a. Dr. llo:.sr:-MANN, a physician of Leipzig, about thirtyyears ago, Mid was called HOMOŒPATHIA

* See LANCET, ’No. 1(,,0, vol. x. pages 817and 818.

a term derived from the Greek, as itwas the leading dogma of the doctrine thatdiseases ought to be combated by meanswhich excite actions similar to the diseaseto be removed. There was much ingenuity,and probably some truth, in the doctrine, -fanciful as it might appear at first sight.It rejected the maxim that contraoia contrariiscurantur, and substituted the opinion thatsinzilia similiLus curantur; ; for example,diarrhoea was to be cured by purging, andit was known that purging was generallythe most effectual remedy : that feverswere to be cured by stimulants, of coursereferring to the action of sudorifics, and soon ; but, as he had been favoured with anexposé of the doctrine by a gentleman thenpresent, Mr. SPRY, who was well versed inGerman literature, he should defer sayingany thing more of it until a future occasion.During the recess another subject of some

importance had occupied his attention,Namely, the French practice of administer-ing grain doses of tartar emetic, every fourhours, as the principal remedy in cases ofinfiammatory diseases.He had entertained some doubts, whether

the two preparations of antimony, used inthe two countries, were alike; but havingprocured, through his nephew, Dr. WooD-roRDf, some of the French preparationfrom an eminent chemist in Paris, liehad found that, as regaided their sensible

effects, they were perfectly identical. Hehad tried this remedy in grain doses, ad-ministered every four hours, in about onehundred cases, with the following results :In some cases, the two or three first doses

vomited; in ethers, it acted also on thebowels, producing vomiting and purging ;after which, there was no farther apparentaction. As to its diaphoretic quality, it wasdifficult to determine whether it possessedany considerable power in that respect:although antimony had, from time imme-morial, been extolled as a diaphoretic, andhad acquired the name of febrifugum mag-num; yet he was not prepared to say, thatit possessed any such efficacy, as it was wellknown that the tendency cf many diseases,was to terminate naturally in that way. Aaa substitute for bloodletting, for which pur-pose it had been extensively used by theFrench, he could not, therefore,recommend it

There was a subject of considerable in-terest, which he begged leave to introduceto the notice of the society ; and although aminor branch of surgery, it was of consider-able importance, on acccuat-cftlie object tit was,designed to accomplish, namely, the removalof -ci very common and distressing affection,

, the tocth-ache. He alluded to the operation.of cutting off the crowns of diseased teeth, asproposed by Mr. FAY, hi these cases oftooth-ache in. which drawing the teeth had

56

hitherto been deemed necessary ; and from Iall he had heard of that operation, it ap-peared to him capable of accomplishing theproposed end, in a very satisfactory manner.But as he saw some gentlemen present,who, he believed, had seen the operationtried, they would, perhaps, favour the So-ciety with their observations on the subject.He mentioned these topics to show thatthere was no lack of matter to engage theattention of the Society, and hoped that themembers and visitors present, would com-municate their opinion without reserveThe Society was, for the remainder of the

evening, occupied in discussing the meritsof Mr. Fay’s operation.

Mr. SPRY said, that he had seen Mr.Fay cut off a carious and painful tooth forthe. wife of a solicitor, a patient of his, andthat the operation occasioned no pain; itwas the first bicuspid tooth, of the left side,in the upper jaw. It was about six weeks

ago; and by a letter he had received fromthe husband of the lady, then in the country,he had learnt that she had not experiencedthe slightest uneasiness since the operation.

A Member then observed, that this couldnot be deemed a new operation, as the den-tis.ts of this country had been in the habit offiling teeth, and that it was a common caseto break off a tooth, in attempting to extractit, that as to the stump left in the jaw, itwas generally found to produce great incon-venience, and was obliged to be drawn.

IBlr. SPR replied, that there appeared tohim an essential difference between themodes of removing the carious part of atooth, mentioned by the last speaker, andthat adopted by Mr. Fay ; as the jar of thestump in the operation of filing, to say no-thing of the injury usually done to the softparts, was sufficient to excite the mischief

complained of. That as to the cases inwhich the necks of the teeth had beenbroken off, in the rude attempts to extractthem, which were usually made with the keyinstrument, it was fair to infer, that a stillgreater injury must be done to the mem-brane serving as the periosteum to the fangsof the tooth, and consequently after-inflam-mation was a very probable result : whereas,by excising the diseased tooth at its neck,by any mechanical contrivance which wouldnot disturb the membranes and vessels con-

necting the roots to their sockets, it wasfair to suppose that these structures wouldcontinue to receive their due share of nutri-tion, and remain perfectly inoffensive, if itcould not be shown that they were produc-tive of some good. If, as he believed, theywere capable of affording the necessary sup-port to the adjoining teeth, not only by theirmechanical resistance, but by their prevent-ing the absorption of the alveolar process ofthat part of the jaw, he thought that a very

important discovery had been made in thisbranch of surgery. He believed that it was

only necessary to appeal to the experienceof every one who had allowed teeth to beextracted, to decide whether, in the courseof some years, the neighbouring teeth had notmuch approximated, and whether that fall-ing towards each other of the crowns of theteeth might not go on until such teethshould fall out; although, from the little at-tention heretofore paid to the subject, thefact of teeth having fallen out had been sel.dom traced to such a cause as the absorp-tion of the alveolar process of that part of £the jaw, before occupied by the stumps of £the removed tooth, and the consequence ofextraction.Mr. KINDON asked whether it was Mr.

Fav’s design to cut off the crowns of allpainful teeth as he had had a tooth plug-ged by a dentist many years ago, which wasat that time very painful, and the dentisttold him he had scraped out the wholeof the cavity containing the expansion ofthe nerve in the tooth, and that it had re-mained since very useful ; he wished to

know, therefore, whether that practice wasresorted to by Mr. Fay first ?

Mr. SPRY asked Mr. Kingdon whether,from a consideration of the figure of thecommon cavity of the tooth, he consi-dered that it was possible to accom-

plish that, which the dentist had informedhim he had achieved, admitting that theextreme sensibility of the delicate nervousstructure occupying it, would have allowed ofthe introduction of any such scraping instrn-! ment ? It was more reasonable to supposethat the caries had extended through thebody of the tooth, until a thin plate only ofthe bony structure intervened between thecavity and the air, by which painful im-

pressions were easily made on the nerve

by sudden differences of temperature, andthat the dentist had carefully scrapedout such a cavity, and plugged it. He

believed that the cavity alluded to being

once absolutely opened by disease or acci-dent, produced excruciating pain, and wouldnot allow of the pressure of any foreign bodyinto it. Mr. Fay’s operation was intendedto remove the tooth below this cavity, andthat only in cases where, as he understood,the tooth could not be saved by plugging.

Dr. BLAKE mentioned a remedy for tooth-ache, which we did not distinctly hear.

Mr. LXSGSTAFF, Mr. CHEVALIER, andMr. RAY, took an active part in the dis-cussion, but adduced no facts, either in fa-vour or against the operation.

Mr. Fay was, at the suggestion of one ofthe members, requested to attend the nextmeeting.

57

AT the second meeting of the Society, onMonday, (Oct. ,) the discussion respect-ing the excision of teeth was renewed,Mr. Fay being present, at the invitation of

the President. This gentleman very kindlybrought his instruments, and a variety ofpreparations of teeth, for inspection.

Mr. FA stated he had practised this

operation for seventeen years; and thatits origin was the result of accident. Afterteeth had been accidentally broken off inattempts by different persons to extract

them, he had frequently observed, that in-stead of any unpleasant effects ensuing,benefit rather was derived. There were

undoubtedly many cases in which excisionwas improper, and where extraction only,was practicable ; as in cases where thesocket or root was diseased. One curiouscircumstance Mr. Fay mentioned, whichis deserving of notice ; namely, that the canalin the centre of the tooth becomes filledwith ossific matter, after the crown hasbeen excised. Now this admits of an im-

portant practical application. If the toothexcised be one of the iucisores, and if itshould be necessary to apply an artificialtooth soon after, a stylette or pivot shouldbe inserted immediately after the crown ofthe tooth has been excised; otherwise thecanal becomes obliterated; and for this

purpose he generally used a small piece ofwood, as hickory. In this way the depositionof bony matter, and consequent obliterationof this canal, would be prevented.The liossibility of ossific matter beiug de-

posited, was here brought in question bysome members, and among others by Mr.Langstaff. This gentleman considered theteeth of adults inoro-anic, for he had neverbeen enabled to inject them, and hence hewas unable to conceive how bony mattercould be deposited. This objection, how-ever, was soon overruled. Mr.W ADE, who was

present, had one of his teeth excised, and thecanal within the tooth had become oblitera-ted by the deposition of bony matter.One of the members asked why ossific

matter was deposited in the canal of excisedteeth 1 as this was not observed in teethwhich had been accidentally broken.Mr. FAY replied, that whenever a tooth

had been broken by attempts to extract it,its vascular connexion with the alveolar

process had been broken, and hence the

deposition of ossific matter could not occur.Mr. Fay then showed his instruments for

excision. He stated, that he never hadoccasion to remove the fangs of a toothwhich he had excised. After excision, heplied the cajuput oil on a little cotton wool.Mr. Fay’s extracting forceps are some-

what similar in shape to his excising forceps.Instead, however, of laying hold of thecrown of the tooth, Mr. Fay’s method isto lay hold of the neck and the upper partof the fangs, so that he could as easilyextract a tooth which had been excised,as one which was whole. The extractingforceps were of different shapes, accordingto the shape of the tooth to be operatedon. Some of them had small projectingpoints from the inner side of the beak ofthe instrument, and which were intended tofix between the fangs of the teeth.Mr. Fay then showed to the Society his

new method of stopping the teeth. Themetal he used was apparently some kind ofamalgam (which melts at a low tempera,ture). A small piece of it being placedin the tooth, an instrument slightly warmedby a spirit lamp was then applied to themetal, which was sufficient to melt it, andthus the hole was filled with the metal.

In answer to a question put to him by aMember of the Society, 1Blr. Fay stated,that he had never observed any part of thefang of a tooth which had been excised, be-come absorbed; and he accounted for it bythe circumstance of the nutritient vessels

being undisturbed and uninjured in the ope-ration.

Dr. Blake here stated, that excision wasunnecessary. He was enabled to cure themost desperate cases of tooth-ache (unlessthe disease was connected with rheuma-

tism,) by the application of the followingremedy to the decayed tooth :

Alum, reduced to an impulpuble powder, twodrachms;

Nitrous spirit of œther, seven drachms;mix, and apply them to the tooth.

Mr. Fay admitted, that in 95 cases out of100, where surgeons and dentists were ap-plied to for the purpose of extraction, reliefmight be obtained without extraction or

excision. The first point was to inquireif the tooth could be plugged ; secondly,if it could not be plugged, to examine if theroots were healthy, as in that case pxcisicncould be safely performed ; if the roots orsockets were diseased, extraction became

absolutely necessary. In the cases in whichthe tooth could be sltved by plugging, heobserved that he frequently obtained tem-porary relief for the patient by applying alittle of the oil of cajuput on cotton to thehollow tooth, directing a little eastor oil, orsome mild aperient to be taken ; and whenthe pain had been thus relieved, he recom-mended the tooth to be plugged, as the mosteffectual way of preventing its recurrence.The President thanked Mr. Fay for the

candid manner in which he had answeredthe inquiries of the Society, observing, thathe considered the explanations afforded verysatisfactory,