827

purpose would violate the oath that he has

taken, and be guilty of most dishonest con-duct -in the discharge of his duty. He has

no right to summon a medical witness fromany such motive. The Medical-Witnesses’

Act confers upon him no such power or au-

thority,-offers to him no justification or

excuse for such a proceeding. We are

quite aware of the hardships which our me-dical brethren suffer in consequence of their

not being paid for their attendance in nume-rous cases of accident and sudden death

occurring to poor persons; but, great as arethe losses and annoyances to which they areexposed in such cases, still, nothing couldjustify a Coroner in summoning a medicalpractitioner at an inquest merely for the pur-pose of paying him for services which hadbeen rendered in the character of a medical

attendant. The " witness" is simply to bepaid as a witness, and in no other character;and if the Coroner depart from the rigid rulewhich he ought to observe in regulating thebusiness of his court, by summoning a per-son, and paying him, nominally as a witness,while the individual is ostensibly paid inanother capacity, such a Coroner violates his

trust, acts most dishonestly by a public fundwhich is committed to his charge, and by hisconduct shows that he is utterly unqualifiedfor occupying the important office in which

he is placed.We should be heartily rejoiced if we could

find that our professional brethren had deli-berated on this subject dispassionately, andpermitted their minds to assume a correctand healthy mode of thinking on the pointunder consideration.

Pulmonary Consumption : its Prevention andCure established on new Views of the Pa-thology of the Disease. By HENRY GIL-BERT, M.R.C.S.L. 8vo. Renshaw. Pp.296. 1842.

Pulmonary Consumption : its Prevention attrt’Cure established on new Views of the Pa-thology of the Disease. By HENRY GIL-BERT, M.R.C.S.L. 8vo. Renshaw. Pp.296. 1842.

THIS work is dedicated to Dr. J. Green

Gosse, of Norwich, by an old pupil, Mr. H.Gilbert. Mr. Gilbert has studied his sub.

ject with " close and unremitting attentionfor some years, partly in this country, andfor some time in Paris, in the clinical ward:of Louis ;" and we know that he is a sensible

and energetic practitioner. We regret tosay that he has not done himself justice inthis book. He lays it down in his pathologyof phthisis, that the disease " consists pri-marily in a want of discrinzinating power inthe mouths of the lacteal vessels, wherebythey are so far changed from their naturalstate, as to admit those inorganisable parts,the residue of the materials of nutrition,which in their normal and healthy statethey instinctitiely reject:’ Now all that weand Mr. Gilbert really know is, that tubercu-lous matter is found at an early period in themesenteric glands. Further than this we donot care a pinch of snuff for Mr. Gilbert’stheory ; and we can only hope that in inves-tigating it he may, like the philosophers whosought the unfound stone, discover some use-ful truths. His practical remarks and casesare the redeeming parts of the work. Weshould be glad to see the following cases,and others like them, which are certainly notof every-day occurrence, in greater detail.

In his second edition we have no doubtthat Mr. Gilbert will view his lacteals intheir true light, and perform experiments tosupport or upset his theory. In the meantime we hope that, like Louis’ dutiful pupil,he will conscientiously observe and recordthe facts occurring in his practice :-

" CASE I." W. M., aged 45, by trade a coppersmith,

born of healthy parents, had been in the en-joyment of sound health till within the lasttwelve months-his chest was well deve-loped, muscles large, dark hair, and hazel! eyes ; in fact, the entire appearance of thisman repelled any idea of his being naturallypredisposed to pulmonary consumption.For some years he had addicted himself tointemperate habits, such as dram-dranliing,late hours at night, exposure to wet and cold.In consequence, his appetite began to failhim; his muscular strength was much im-paired ; and for the last fifteen months hewas attacked with cough and profuse expec-toration : for this he was bled, blistered, andtook aperient and expectorant medicines, ac-cording to the account of the medical attend-ant who had charge of him. The cough,however, still continued, with the expectora-tion : he also had night-sweats, and the othersymptoms of hectic." At this time I was called in, and I found

him in the following state :-considerableemaciation; pulse frequent and rather weak;dyspnoea, more especially on ascending aheight; can rest equally well in any posi-tion ; sleeps badly at night ; cough verytroublesome, and expectoration profuse. Onapplying the stethoscope I detected distinct

828pectorilo quy under the right clavicle, withccavernous respiration; dulness on percus- ‘

sion over the lower portion of the right lungwith puerile respiration in the superior por-tion of the left lung."Here the indic4tions, ofpure were obvious

- the size of the cavity in the right lung wasof small extent; some tubercular infiltrationin its lower part. ’I employed counter-

irritation forthwith, first by means of tartar-emetic ointment, and afterwards by a suc-cessioh of small blisters ; attended carefullyto’the state of the digestive organs; had the

patient removed from London to a morehealthy ’situation near town ; prescribed astrict regimen, with such medicinal meansas mighttend to soothe the cough and facili-tate expectoration ; gave him an occasionalopiate at night. At the end of about sixweeks there was perceptible improvement inall the symptoms ; the patient had evidentlygained flesh and strength ; cough was con-siderably diminished, and with it the expec-toiation ; his appetite was restored; the

stethoscopic signs were much improved, nopectoriloquy; there was, however, an ab-sence of the vesicular respiratory murmur inthe site of the cavity, over a small extent ofsurface, with dulness on percussion in the

same place. After another month the patientwas able to resume his ordinary occupation,and still continues free from cough, or anyuneasiness with respect to the functions ofthe respiratory organs. He rigidly adherest6 the strict regimen which I originally pre-scribed for him, and is much improved inevery way; in fact, he states that his healthis now better than he has felt it for the lastsix years.‘’ Remarks.—Here was a case well calcu-lated to shake one’s faith in the necessity ofulceration for the elimination of tuberculardepositions from the lungs. Such elimina-tion was evidently owing to the effects of thewell-regulated employment of counter-irrita-tion. We leave it ’as’a problem, for thesolution ’of the physiological pathologist,How Was the tubercular deposition, whichevidently existed through a considerableportion of the right lung, removed? Wemust not reject the advantages of a therapeu-tical agent because we cannot account for itsmodus operandi- ..

.

"CASE II."E. L., a lady, 27.years of age, married,,

4pcl- the mother of four children, rather deli-cate in appearance, tall, dark eyes and hair,with a narrow chest; parents still living andin good heh1th ;.’ brothers and sisters all:

healthy. This lady consulted me for a

cough, which had come on her within thelast three months without any obvious cause:the cough was not very severe, but of thatcharacter wtnch is popularly termed ’ teas-ing. She has been for some time subjectedto considerable depression of ,mind, from

family annoyances, finds some difficulty ingoing up a mill, or even in ascending thestairs; her appetite much impaired fleshrather naccid ; sleeps badly, but can lie in-dinerently’bn either side ; the expectorationpurely cif a mucous character." On percussing th6 right side of the chest,

there was some dulness on percussion underthe right clavicle, the respiratory murmur inthe same part being also diminished. Ithought I detected a slight mucous rate under ’the clavicle of this side; this was not, how-

‘

ever, very decided ; no pectoriloquy.11 Here I prescribed counter-irritafien by

means of a small blister, which I kept’open,for some weeks, and after allowing it to healI examined the same part of the chest again,where, though the vesicular murmur was notquite as loud as in the normal state, still Iwas decided that no rale was audible in thepart. Strict attention was paid to the func-tions of the skin, those of digestion, &e., and

again counter-irritation was resorted tovin-vthe same place as before. After a few weeks=more there was a decided improvement inher appearance ; her cough was entirelygone ; her appetite restored ; no appearanceof hectic now about her; in fact, she nowenjoys as good health as she has done forthelast seven years.

CASE III.. ;A. C., a young gentleman, 17 years &f’

age, of delicate appearance, fair, hair, pa-rents healthy, still thebody exhibits all --the-’outward signs of a strumous dia-thesisi Inconsequence of an attack of haemoptysis hisparents had to remove him from a boarding.school, where he had been residing., Thisyouth never complained of any pulmonaryaffection previously; had always enjoyedtolerably good health. On being called tosee him I- examined, his chest, but foundnothing wrong. I ordered him to he keptperfectly quiet, to sleep in.a: well aired room,bled him from the arm to a small amount,applied a blister of the size of half a-crown,which I kept open for a fortnight; gave himsome aperient medicin&s ; prescribed a strictregimen ; and since that time (now sixmonths ago) he has had no returns of thehaemoptysis, and is able to resume hisstudies.

. , ’ CASE IV." M. L., a married woman, aged 32, has

had several-children, and has enjoyed goodhealth until within the last six months, when,in consequence of cold, she was attachedwith a rather 4severe cough, attended withcopious expectoration, for, which she wasbled, blistered, and took some aperient mo-dicine. These means relieved considerablythe severity of the fever, and the other moreviolent sy,mptoms; but the cough and expec-toration still continued with but little abate- ment. On being consulted on the case

829

certained her state to be as follows:—Chestwell developed emaciation considerable;mucous and sonorous râles on the anteriorand posterior part of the chest; in the sub-clavicular region on the right side there wasobservable some bronchophony, with theratio between the inspiratory and expiratorymurmurs, as it exists m .the normal state,completely subverted. Sound, on percus-siom, dull on this part of the chest, but withthe natural clearness every where else. Hereit was evident that tubercular depositionwas commencing, but had as yet occurred inbut very small quantity. From the veryearly stage at which the disease was pre-sented, to. me, I formed rather favourablehopes , of preserving my patient’s life, inwich -I-,-,was, not at all disappointed, as, bythe adoption of the means obviously indi-cated,,, and ;by steadily persevering in thetreatment, both hygienic and medicinal, thelupg., was, after the lapse of about two

months, perfectly restored to its healthystate. .. .

CASE V."J. W., a married man, aged 37, a shoe-

maher, had indulged, for several years back,in the habitual,, use of ardent spirits ; abouttwelve months before I saw him he had gota wetting, and was confined to his bed forsome days with a cough, pain in the chest,with- severe expectoration; for this he wastreated in the ordinary way, with bleeding,blistering, &c., which relieved him very muchfrofn the. more urgent symptoms ; -still thecough remained, being much worse duringthe last winter. On percussing the chestthere was evident dulness under the left cla-vicle, with some resonance of the voice inthis-part: -_the respiratory murmur was ratherindistinct here, and the healthy relations be.tween the iuspiratory and expiratory mur-murs did not exist. I put him under treat-ment, and after some time there was anevident improvement in the case; the tuber-culous infiltration of the left lung began ob.viously to diminish, and he began evidentlyto gain, fleab and strength. He again re-

turned to hisordinary employment, and againresumed the use of spirits,,, the effect ofwhich,, -after some time, was to induce allthe bad symptoms: his cough again becamesevere ; the sputa were occasionally tingedwith blood ; a cavity became developed inthe apex of the left lung ; the tuberculisationwent on in this lung, extending downwards ;hectic fever set ia, -and the patient sunk atlength." There never was a: case wherein theCM-rability .of consumption was more clearlydemonstrated than this. When iirst the pa-tient came under treatment he evidently hadtubercular deposition in the left lung, as

evidenced by dulness on percussion, bron.

chial respiration, resonance of the voice, withsubversion of the normal ratio between the

inspiratory and expiratory murmurs. These signs were removed by treatment; and it ismore than probable that, patient ad-:’)hered to the prescribed regimen, he wouldhave lived many years.

"CASE VI.

" A naval officer, who had seen much ser-vice, and had been exposed to various vicis-situdes of climate, . complained some time since, on returning home from a voyage toIndia, of cough, night-sweats, and muco-purulent expectoration ; the cough had beenon him, more or less severely for a month orsi1’ weeks before his return home: he hadbeen before this attack in the enjoyment ofrobust health, but had been, foe the last fewyears of his life, addicted to the use ofardent spirits, after which his digestive,powers became some what deranged; he lost,,’desh ; did not sleep as .well a.s usual bowelsbecame irregular, sometimes being relaxed,and sometimes costive, with other symptomof deranged nutrition and digestion. WhenI saw him he complained of a feeling oftightness and slight pain in the upper part ofthe chest; he was also some what hoarse:had spit blood twice or thrice within the pre-ceding fortnight ; sound dull on- percussionin the right subclavicular region ; the vesicu-lar murmur rather feeble in this same part,with bronchial respiration and resonance.Considering the habitual strength of thepatient, and the recent nature of the attack,I adopted the use of small bleedings, applieda small blister to the subclayicular region,which I kept open for about three weeks;removed the deranged state of the digestivefunctions, and employed such other means asmight best eliminate from. the system thetubercular matter which I had every reasonto suspect was being formed in it. Pre-scribed strict attention to diet and regimen,and in the course of about two months fromthe commencement of my treatment the re-spiratory and digestive apparatus weye per-fectly restored, all cough and other symptomsof an unfavourable character’ disappeared,and the patient, having gained his ordinarystrength, was soon able to resume his usualemployments."

A Practical Treatise on the Diseases of theScalp. By JOHN E. ERICHSEN. London :Churchill. 1842. Pp. 192.

A Practical Treatise on the Diseases, of theScalp. By JOHN E. ERICHSEN. London :Churchill. 1842. Pp. 192.

HERE are nearly two hundred pages of dulland confused compilation on tne diseases ofthe scalp that- might-, have been condensedinto a fractio.n of that number. The author’sobject appears to have been to endow withmystery and importance a matter ’of every.day practice, and to accumulate hard nameson tbe heads of her Majesty’s devoted sub-_=jects, to the utter discomfiture of all simpl- city of practice. Overweening conceit peers