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eliminated, or where the function is of a high order, as alongthe electric organs of the Raia torpedo, and other electricfishes, in the spinal column of the vertebrata, &c., and it ap-pears to increase in quantity in the brains of animals in anexact ratio with their psychical endowments..

I painfully feel that I have not been able to enforce my po-sition so lucidly or so completely as I had intended. Circum-stances have compelled me to make an abstract only of thefacts which are in my possession, and to forego the assistancewhich comparative anatomy would have yielded. I hope,nevertheless, that enough has been said to attract your atten-tion to this topic. My great wish has been, to free this part ofpathology from some of its apparent discrepancies, and toteach you not to despair of attaining practical results, evenamid all the perplexities which beset the subject. Do notattach too much importance to the writings of illustrious men,especially when they attempt to assign the limits of the know-able, or speak of the uselessness of any pursuit. I yield tonone in my reverence for great names, and those who knowme will, I trust, acquit me of presumption; but truth is dearerthan authority, and history teaches us, that even great menmay err. I cannot forget, that if Esquirol and Pinel, and someothers who will hereafter rank by their side in fame and use-fulness, have regarded pathology with distrust, and havedespaired of anything being attained from its cultivation;that the greatest chemist of the age declared, that gas couldnever be employed to useful purposes as a lighting agent, andwe now see it gleaming in our streets with perfect safety,converting the gloom of night into the brightness of day. Weknow that Dr. Lardner called it madness to think of crossingthe Atlantic by steam; and we now read of the Great Westernsteam-ship crossing its waters " like a thing of life," defyingits fiercest rage, and moving majestically on, without a pause,amidst tempest and storm, amid sunshine and calm, and ac-complishing her journey from Bristol to New York in sixteendays. We know that knowledge is progressive, and that theman breathes not who can assign its limits, or mark itsboundaries, but, as Dr. Conolly eloquently reminded you inhis first lecture, we must not measure the advances of truthby the limited span of our existence. By no means. For howmany centuries did the bloodrun its unchanging circle, and howmany men caught faint glimpses of some portion of its career,before the industry and genius of a Harvey revealed it in itscompleteness and beauty. For how long did the lacteals pourtheir milky treasures into the blood, before their discoverygladdenei the soul of Asellius, making him adopt the languageof Archimedes, and shout "Eureka ! Eureka!" For thousandsof years did the lungs and the heart murmur of disease, un-heard and unheeded, till the ear of Laennec caught thesound, and interpreted the meaning. Instances further crowdupon the memory; but these will suffice to keep you fromdespair. Oh! do not despair because of the difficulties thatbeset the subject! Study the pathology of insanity, and oneof you may perhaps prove a Harvey to unravel the mechanismwhich, in its deranged state, interferes with and disturbs themanifestations of mind. We want some able and industriousobserver to rise up, and reveal the precise nature of the dis-ease. Happily, its treatment has been greatly improved-nay, the disease itself has been deprived of much of its repul-siveness by the benign skill which has been brought to bearupo nit, so late as our own time, and by one, too, who has, I trust,many years to live; and it may undergo still greater modifi-cations for the better, (as other diseases have done,) if onlyit be guarded by good and wise men from improper treatment.It has been elegantly observed by a late biographer of Harvey," Were there not successive generations of men, the worldwould stand still; the death of the individual was not merelya necessary condition to the enjoyment of life by successivegenerations, but essential also to the onward progress of man-kind. No man who had attained to the age of forty years, itis said, was found to adopt the doctrine of the circulation; ithad to win its way under the safeguard of the Drakes andLeroys especially-that is to say, of the youthful and unpre-judiced spirits of the age." To you, then, young, hopeful, andstudious, I consign the interests of the insane in your respec-tive localities, feeling assured that neither the philosophy ofthe subject nor the subject of the philosophy will suffer atyour hands, but that Science will join with Virtue in pro-moting the health and securing the comfort of the helplessand broken-hearted.

A veterinary surgeon at Haddington, says the /1ÙJerpoolTimes, has successfully used chloroform to render. h01’e in-sensible to pain, while the operation of cutting thQ nerves ofSensation in its fore-feet was being performed.

Hospital Reports.ROYAL FREE HOSPITAL.

Dijùsed aneurism occupying the entire forearm; ligature of thebrachial (t1’tery; sloughing of the muscles &c. of the Joreann,terminating win fungus hcA-7natodes; amputation of the arna;safety of using the ether in an almost moribund condition of thepatient; complete 1’ecovery.

Reported by WEEDEN COOKE, EsQ., Resident Surgeon.

CASE 1.ńMorris Mahoney, aged seventy-fve, an emaciatedIrishman, was admitted September 4th, 1847, under the careof Mr. THOMAS WAKLEY. Five months previously he hadbeen knocked down by a cart; his hand was forcibly turnedbackwards upon the forearm, producing at the time consider-able pain. After a day or two he felt but little inconvenience,and worked as usual. At the expiration of two months theulnar side of the wrist began to swell, and continuing to doso for a week, he became a patient in St. Bartholomew’s Hos-pital. He remained there three weeks, and the swelling con-tinued to increase. Subsequently he placed himself underthe care of his parish surgeon, who twice lanced the arm:blood was profusely poured out each time; the swelling in-creased, and extended up the forearm, but did not proceedbeyond the fascia of the biceps.

Sept. 4th.-He now complains of most excruciating pain inthe forearm; it is at least twice as large as the other forearm;the surface is redder than natural, and the superficial veinsare greatly distended; there is pulsation in the brachial andradial arteries, but none in the ulnar; the sense of fluctua-tion from the wrist to the bend of the elbow is very distinct;the swelling does not encroach upon the arm; it is entirelyconfined beneath the fascia bicipitis. The last opening madeby the lancet, before he came to the hospital, is not closed,but discharges occasionally a small quantity of blood, and the-part surrounding the opening is elevated in a conical manner.Upon the introduction of an exploring needle, florid bloodescaped. The old man, although irritable, and wasted fromsuffering, with bluish gums and lips, and a red, rather drytongue, has all his important organs-heart, lungs, liver, andkidneys-in a healthy condition. The secretions are regularand natural. He was ordered to try gentle bandaging andthe application of cold, with some full doses of opium to re-lieve the pain, from which he experienced great comfort.The swelling, however, continued to increase, the arm beinglarger, by three lines, in eight days after his admission; itwas therefore deemed advisable, on a consultation amongst themedical officers, to tie the brachial artery-thus treating thecase as one of diffused aneurism. Mr. Wakley performedthis operation on the 13th of September. The artery wasperfectly isolated, the ligature made fast, and the pulsationof the radial artery ceased. The ether was successfully em-ployed during the operation.

14th.-IIe had an opiate last night, and slept at intervals,but complained of pain; the heat of the arm is undiminished;the veins, which were previously distended and dark-coloured,are now apparently empty, forming, as it were, canals betweenthe muscles; the arm is enveloped in cotton wool; very littleconstitutional disturbance; appetite good; bowels open; skinmoist. Ordered, beef-tea during the day, and a grain of mor-phine at night.

15th.-Slept soundly for fourteen hours; tongue dry incentre, somewhat brown; the whole of the forearm is of adeep-red colour; complains of pain; says his hand is cold, butit does not feel so; the forearm is hotter than before th.e ope4ration; pulse 96, small, compressible; secretions natural. Re-peat the morphine at bedtime.

16th.-Pulse 90, of good power; tongue moist, verv red atedges, furred in centre; slept well all night; the lancet-woundmade before he came into the hospital has become sloughy;there is a small quantity of ragged pale cellular tissue pro-truding from it; the arm is very warm, and its colour lessdark. Repeat the morphine.

, 17th.-Was in pain, and slept badly last night; pulse 90;

tongue still red and furred; appetite good; the W0111ld made intying the artery is healing. Ordered, one grain andahalf of morphine at bedtime; meat and porter; and cold lotion to the arm.

18th.-Slept well during the night; pulse 90, soft; rather-weak ; tongue dry in the centre, and rather brown; the ansis increasing in size; the livid appearance is less; the integu-ment at the upper part is recovering its natural hue; at theinner side of the forearm, near the wrist, there is a smallpatch of ecchymosis; there is much less pain. Ordered, beef-tea, meat, and two pints of porter; and repeat the morphine,

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CARE i.-The above eneravins- exhibits the state of the arm before the brachial artery was tied.

19th.-Tongue is now dry, and very red; his appetite is ex-cellent ; had a good night, and is quite easy.20th.-The wound made by the lancet is sloughing, and the

ecchymosis near the wrist proves to be a slough also; the restof the arm is of natural hue and temperature.21st.-Appetite not so good; is depressed, and complains of

pain. Ordered, six ounces of port wine.22nd.-Is much improved; slept well, and is nearly free

from pain; sloughing process going on rapidly.- 23rd.-Pulse 96, small; tongue dry, and red in the centre,moist at the edges; the bellies and tendons of the flexormuscles are exposed and protruding, but the skin at the edgesof the slough is healthy; the discharge is slight, of asanious character, and not peculiarly foetid; the morphinewas not given last night, and in consequence he was veryrestless. Ordered, bark and acid; port wine, porter, beef-tea,and mutton chop; repeat the morphine.24th.-This morning a portion of the sloughing musclescame away; increased discharge of the same character;pulse 84, much more power; tongue less dry; eats and drinkswell; slept soundly all night. Wash the arm with solution of

Ichloride of lime, and apply carrot poultices.27th.-The ligature of the artery came away this morning; ,,

the greater part of the flexor muscles has sloughed away.Mr. Wakley removed the tendons with the scissors : thereis a good deal of sero-sanguineous fluid discharged in thepoultices; some dark clots may be observed clinging to theulna, which is exposed; the tongue has now become moist,clean, and less morbidly red; appetite good; takes two bottlesof Guinness’s stout, besides wine, two chops, and two eggs,daily; secretions still regular and natural; sleeps well; is inno pain; countenance cheerful, and spirits good; pulse rangesfrom 80 to 100; the skin around the part sloughed has a

healthy hue, and is granulating at the edges; there is nowmore foster.

30th.-Sat up yesterday for a short time.Oct. 2nd.-The sloughing process appears to have ceased;

the excavation is very deep, completely exposing the innersides of both bones, and the interosseous membrane; granula-tions are springing up from the edges of the excavation; sleepsnow without the morphine.5th.-Some venous haemorrhage has occurred occasionally

since last report; a small, spongy growth has made its appear-ance, lying upon, and partly covering, the ulna; continues totake his food, and sleeps well.8th.-The spongy growth has increased, bleeds upon being

touched, and especially when washed. There have been threehaemorrhages, since the 5th, of about three ounces each time,which have reduced him considerably. He, however, continuesto take food, and sleeps well. To apply cold vinegar-and-water, and continue the stimulating diet. The blood dis-charged, upon examination under the microscope, exhibitedno caudate cells-nothing but pus and blood-globules. It

was, however, considered that the disease could not be otherthan fungus hematodes; that the haemorrhages, althoughsmall, were exhausting the patient; and that consequentlythe only chance of saving his life was by removing the arm.He, however, refused to consent.12th.-The repeated haemorrhages have reduced him to so

low and perilous a condition, that the intention of amputatingthe arm is abandoned: happily, he still continues to take foodand stimulants.13th.-He now lies in an almost moribund state, and it is

considered that his death will inevitably take place in thecourse of a few hours.

CASE i.-The above engraving shows the appearance of the arm at the time of amputation.

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14th.-Has rallied to some extent. In the afternoon heconfessed to his priest, and took leave of his children, asthough certain of death. But after "confession" he ex-

pressed a wish to have the operation performed. Although thecase appeared to be utterly hopeless, Mr. Wakley immediatelyconsented to operate, and stated that he should administerthe ether, as, from what he had witnessed of its sustainingpower in some other instances of extreme debility, he ex-pected benefit from it, in addition to protecting the patientfrom the shock of the operation. The ether having been in-haled for about a minute, Mr. Wakley amputated the arm.He preferred the flap operation, as it enabled him to cutbelow the point where the brachial artery had been previouslytied. By adopting this precaution, he hoped to limit the lossof blood to a very small quantity. Although there wereseveral small arteries which required ligatures, not two ouncesof blood were lost in the operation. The patient did not feelpain until after the operation and dressings had been quitecompleted. Having taken, at intervals, some brandy, am-monia, and opium, he passed the evening and night quietly,and obtained some sleep.15th.-Very slight oozing of blood; quite relieved from all

pain; pulse 96, rather hard, and small; tongue dry and red;took an egg and some tea this morning. To have beef-tea, andfish for dinner.

16th.-Slept well last night without an opiate; is cheerful,and takes nourishment well; pulse is now soft, 96.17th.-Stump dressed, healing by first intention; is troubled

with hiccough this morning. Ordered four ounces of wine.18th.-Hiccough continues; slept well; bowels regular.

Ordered an ether draught, and to continue the wine.19th.-No hiccough to.day; going on well.23rd.-The tongue, which from the commencement had been

remarkably red and glazed, is now assuming a natural ap-pearance ; the stump discharges healthy pus; he is still ex-tremely feeble, but is much improved in his looks. Theligatures came away to-day without the least haemorrhage; heis taking four ounces of port wine and two chops daily, be-sides an egg for his breakfast.27th.-He has very little pain; it is sometimes necessary to

give a small dose of opium at night; he sits up now every dayfor an hour or two; stump healing.

30th.-Complains of more pain at the inner part of the armthan usual; there is some thickening and tenderness in thecourse of the vessels, with considerable discharge of ratherthin pus from the inner side of the stump; tongue clean; sleepswell; appetite good; some oedema of the legs.Nov. 8th.-The attack of phlebitis has been very slight;

discharge now healthy and thick, and tenderness in course ofvessels gone; the secretions are all natural.

15th.-Complains of pain sometimes in the stump, whichdisturbs his rest; he gains strength slowly; the cedema of thelegs has disappeared; he can now walk about the ward, totter-ingly. Ordered, an opiate at night when necessary.20th.-Stump healed; he now walks with a steady gait; the

blueness of the lips has given place to a more healthy hue,and the anxious countenance to a smile of cheerfulness andgratitude; the tongue, which was so peculiarly red for a longtime, is now quite that of a healthy man, whilst his shrivelledand attenuated form is beginning to show signs that thebalance between deposit and absorption is in his favour.

24th.-Discharged quite well.

Fungus H aematodes; Amputation at the Shoulder-joint)" Recovery.CASE 2.-Jonathan Wilson, aged seventy-three, shoemaker,

was admitted on November 3rd, under the care of Mr.THOMAS WAKLEY. Two years ago he observed a tumour, of thesize of a hen’s egg, at the back of the arm; there was no painin it, it was quite hard, and he could move it up and down.It gradually increased; but from there being no pain in it, hethought it was of no consequence, and took no surgical advice,until he applied to a distinguished surgeon a few days ago.This he did on account of the tumour having bled consider-ably. The first bleeding took place on the 28th of October.The skin had become very dark-coloured at a point of thetumour, and then broke. In a day or two a fungous massbegan to protrude from the opening in the skin, and a portionof this mass came away on the 2nd of November, after con-siderable hsemorrhage. The tumour now forms an enormous

fungoid mass, occupying the arm. It is nodulated and hardin some parts, but softer near the fungoid protrusion. Thebrachial artery can be traced into its substance. No pain isproduced by handling. The glands in the neck and ax a

CASE 2.-The above engravings show the appearance, of the am previous to amputation, and the state of the parts upon dissection.

651

are not implicated. There is a small, dark-coloured swelling,like a nsevua, on the right side of the tongue. He had nevernoticed it himself, and does not know when it came. Hasalways been a healthy, sober man; has a florid countenance,but is somewhat emaciated; says he has been getting thinthese six months. Last January he had a fit, which renderedhim insensible for a few minutes; this occurred after a hardday’s work, but he soon recovered; there was sickness, butno other illness. There is a little emphysema at the lowerpart of the right lung, otherwise the lungs are healthy. Heart’ssounds good; but the hand discovers a rubbing sensation, as ofold adhesions or effused lymph, on the surface of the peri-cardium. Has a hernia of the left side. Bowels regular;urine natural; tongue clean; good spirits generally; sleepsand eats well.Nov. 4th. - Considerable haemorrhage last night. Mr.

Wakley now deemed it necessary, as a remote chance of savingthe man’s life, to amputate the arm at the shoulder-joint.It was evident that he must sink, from haemorrhage, in avery short time, if the operation were delayed; accordingly,Mr.Wakley operated this day at half past two o’clock. Heformed his largest flap from the deltoid muscle, in order toavoid the chance of being obliged to keep diseased skin tocover the internal flap, the tumour extending very high uptowards the axilla. Very little blood was lost. The arterieswere perfectly healthy. The amputation occupied less thana minute. Ether was used, and again appeared to be veryperfect in its effects. Ordered, opium and brandy.-ThreeP.M.: No haemorrhage; pulse 100 ; doing well.-Ten P.M.:Ordered one grain of morphia.

’

5th.-Slept well all through the night; tongue furred; pulse100, compressible ; bowels confined. Castor oil, one ounce;broth; eggs; camphor mixture and opium; two ounces ofbrandy ordered at night.6th.-Pulse 102, soft; bowels well opened; passed a good

night; very small quantity of venous haemorrhage last night.7th.-Sleeps and eats well; bowels free. Port wine, five

ounces.

8th.-The stump was dressed to-day; the healing processwas going on successfully, excepting that there was a-smallslough at the inner side of the wound, and the discharge fromthat part was thin; he is in good spirits; eats and sleeps well;Is sitting up. Repeat mixture ; meat and wine.

10th.-Bowels purged. Ordered, an egg, arrowroot, milk,and beef-tea.

llth.—Bowels still relaxed. Ordered, a mixture composedof aromatic confection, compound spirit of ammonia, and com-pound sulphuric ether.12th.-Bowels more composed; has passed a good night;

the discharge is thick laudable pus.17th. - Ligatures came away yesterday; healing process

going on favourably; sleeps and eats well; bowels regular;tongue clean.

Nov. 29th.-Has not had one unfavourable symptom; stumphealing; discharges thick laudable pus. Ordered, meat, andporter, one pint.

Dec. llth.-The wound has continued to heal regularly; thegranulations are rather pale and flabby, and have requiredoccasionally, touching with caustic; the discharge is slightand healthy.13th.-The wound is perfectly healed. The patient is mud

stouter than before the operation.15th.-The man appears to be quite well in all respects.

Original Papers.A MEDICAL HISTORY OF

SIX CASES OF POISONING BY ARSENIC.BY ROBERT BARNES, M.B.,

LECTURER ON FORENSIC MEDICINE.

ON the 30th of May, 1847, Mr. Abercromby, of Kensall NewTown, was summoned, at half-past two P.M., to see the familyof Thomas Hickman. The family, consisting of nine persons,had all been dining off rhubarb pudding, and all had beenseized with nausea or vomiting during the meal. Mr. Aber-cromby took notice of the following symptoms:ŅAll com-plained of a feeling of sickness, and all vomited immediatelyafter eating of the pudding, excepting the father, who vomitedsoon after Mr. Abercromby saw him. The infant, aged oneyear and five months, was in a state of collapse. In a short

time, the patients all complained of more or less of pain in

the stomach, and burning in the throat" dryness" was their.own expression. Copious vomiting continued, followed byincessant thirst, and great prostration of strength. The fatherexhibited great anxiety of countenance.Mr. Abercromby administered a mixture of white of egg,

flour, and milk, to all by the teacupful, which was almost im-mediately, in all the cases, rejected. The dose was renewed,at short intervals, for about an hour. The prostration, how-ever, increased, and Mr. Abercromby sent to request myassistance. On my arrival, at twenty minutes past four p.H.,I observed the following symptoms:-The father, aged thirty-three, was pale, exhibiting great prostration and anxiety ofcountenance, and without being unconscious, some degree ofstupor; he complained of some pain (not great) in the stomach;the pulse was quick, and depressed in character. The twowomen-the mother and her sister-did not exhibit any greatprostration; the pulse in both was quick, but pretty strong.The mother was flushed in the face, and did not complain ofmuch pain. The eldest boy, aged twelve, did not appear tosuffer anything particular; he was a little flushed. The fiveremaining children-all under nine years of age-were allgreatly prostrated; their countenances were pallid and anxious;pulses scarcely perceptible; and their extremities cold. Oneboy-James, aged nine-complained, in addition, of severepain in the stomach and bowels, and drew up his legs. Theinfant was profoundly collapsed; the pupils acted under alter-nations of light and shade.Mr. Abercromby, Mr. Brown, and myself, concurred in ad-

ministering a mixture of ipecacuanha and sulphate of zinc, inwater, to all. All vomited freely in consequence. A mix-ture of hydrated sesquioxide of iron, in milk, was then freelygiven. All the patients took the remedies offered readily,excepting the man, who, from his .great prostration, was withdifficulty prevailed on to take the sesquioxide of iron.After this, the vomiting continued at intervals ; and to

counteract the increasing prostration, brandy, ether, andammonia, were administered, at intervals, by Mr. Abercrpmbyand Mr. Brown; but with little effect, for five children suc-cumbed in the course of the night, as follows:-James, aged nine years, sunk into perfect collapse, with

blue lips, cold extremities, and no pulse, and died at six P.M.: John, aged three years, died in a similar manner, at half-

past seven P.M.Henry, aged one year and five months, died convulsed, at

nine P.M.Mary-Ann, aged four years and ten months, died in like

manner as James, at half-past ten P.M.Harriet, aged six years, died at half-past eleven P.M.On the following day, at nine A.M., the father had fallen

into greater prostration; the pulse was scarcely perceptible;the body was generally cold and clammy; hands and feet verycold; did not complain of much pain; had been freely purged;’the vomiting abated about midnight; after which time he hadretained fluids, (milk and linseed tea.) He had had a blisterto the stomach, and had taken opium and ether at intervals.The two women did not appear to suffer much; the tongues

were red and clean at points, and round the margin, andpresented a slight, white, creamy fur in the middle. Thesister complained of headach; was flushed; pulse 100, ratherstrong; skin warm and moist; thirst; had passed no water;had been purged; some tea taken in the morning remainedon the stomach. The mother was less feverish than the sister;had passed water.The eldest boy presented no remarkable symptom.The man died at noon, no reaction having occurred. He

retained his consciousness to the last.On the third day, at eight A.M., the sister still complained

of headach; no pain at the stomach or throat, but sometimesviolent throbbing in the stomach; the pulse was full, 90; faceflushed; had passed some water, which was scanty, and veryred; has had leeches to the temples. The symptoms all gaveway in a few days, and she perfectly recovered.The mother and eldest boy may be said to have recovered

on this, the third day.I have collected the results of the post-mortem examina-’

tions of the six patients who died, into a tabular arrange-ment. Dr. Chowne, Mr. Abercromby, Mr. Brown, and myself,were present at all the examinations.

(See the table in the following page.)

Analysis of Autopsies.1. All showed marks of inflammation in some part of.the

intestinal canal.2. No one of the four examined presented distinct inflamma-

tion of the ossophagus.