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the astragalus, in 1826 ; Muzzy’s removalof the scapula and clavicle together, in

1837; and Dr. R. Butts’s removal of theulna, published in 1825 ; are, so far as we

know, all original and successful innova-tions. Besides which, Drs. Brown andHunt’s operation for dissecting out the headof the humerus and fractured portions ofthe scapula, on a soldier injured at the bat-tle of Plattsburgh, in 1814, with the effectof saving both the limb and the use of thejoint, is worthy of special observation.

In operations for diseased joints, Dr.John Rhea Barton has rendered himselfconspicuous. His operation for artificialhip joint, in 1826, and that for straighten-ing an anchylosed and contracted knee, in1835, were peculiarly original aud success-ful. In the first of these he has been fol-lowed by Dr. John Kearny Rodgers, ofNew York, also with success :-and thesetwo are the only operations of the kind thathave ever been performed.

In the treatment of diseased bursas andof hydrops articuli, as practised by the lateDr. Hubbard, of Yale College, thel surgeryof the joints has been improved. In thetreatment of morbus coxarius, Dr. Physick’sapparatus is worthy of praise. It has been

applied successfully by other surgeons,especially by Dr. A. H. Stevens, in treatingthe diseases of other joints. Dr. Physick’soperation for ununited fracture, too, is

known, appreciated, and successfully em-ployed both in America and Europe.The mode of arresting capillary heemor-rhage by exposing wounds for a time to theair, so as to expedite the adhesive processafter capital operations, first adopted byDr. David Hosack, in 1813 (who, at thatperiod, devoted much attention to surgery),is worthy of special notice here, inasmuchas it has since been recommended by thesurgeons of Edinburgh, who, doubtless unaware of Dr. Hosack’s claims, have takento themselves much credit for the practice.*

In the operation for artificial anus, Dr.Physick, in 1809, successfully instituted apractice which has been imitated in othercountries, and is claimed by the French asone of the inventions of Baron Dupuytren.

In the operation on spina bifida, by ex-cision, Dr. Sherwood, of Rutland, in 1811,was completely successful ; and about a

year since, Dr. A. H. Stevens succeeded incuring an aggravated case by a modificationof Sir A. Cooper’s practice by puncture.

In amputation of the joints, American sur-geons, it is true, have no right to claim theprecedence; nevertheless, we may refer toDr. Buy )ey’s amputation at the shouldet-joiniin 1782, as among the first successful ope-rations of the kind ; Dr. Mott’s amputationat the hip joint, in 1824 ; and Dr. J. Kearny

* See the " Amer. Medical and Philoso-phical Register," vol. iv. p. 63.

Rodgers’s amputation at the elbow joint, in1825, all successful.

Besides these might also be mentionedextirpation of the parotid gland ; orthoplas-tic operations of various kinds; extirpationof the uterus, and of ovarian tumours ; litho-trity, litbotripsy, improved modes of litho-tomy, and the removal of calculi from thebladder without cutting; the treatment ofaneurism by cold ; and the diseases of theanus by dilatation; the Csesarian sectionfor the removal of the extra-uterine foetus,and an analogous operation for the removalof metallic bodies lodged in the small in.testines ; all performed with success, and allillustrative of the rank of this art in America.

In operations upon the arteries, the prin-ciples laid down by Hunter, and the appli-cation of them by himself, Abernethy, andCooper, have been successfully carried outin America; and have led to a number ofbold and important precedents, determiningwhat should be, as well as what should notbe again attempted in this department ofsurgery. In these achievements, the namesof Post, Mott, Muzzy, Gibson, White, andothers, are peculiarly worthy of distinction.

Such, then, is an outline, and but a briefand imperfect one, of some of the most im-portant and memorable points in the historyof medicine in America.

ROYAL MEDICAL AND CHIRURGI-

CAL SOCIETY.

Tuesday, January 14, 1840.

Dr. COPLAND, President.

Contributions to the Pathology of New-born.Infants. By THOMAS H. BURGESS, M.D.APOPLEXY and asphyxia in new-born.

infants require such speedy and oppositetreatment, that their diagnosis is extremelyimportant. Dr. Burgess undertakes; in thispaper, to illustrate apoplexy, intending, onsome future occasion, to pursue the subjectby observations on asphyxia. He details acase of birth, in which there was some, butnot unusual delay, which would ordinarilylead to little fear of injury from mechanicalcauses. The child cried loudly after thebirth of the head, and again after the expul-sion of the body ; some mucosities were dis-charged from the mouth; some food wastaken; but within the first hour the handswere observed to be of a slaty, mottledcolour. Dr. Burgess, when sent for, foundthe ehild of a blue colour all over, exceptthe nose, which was pale and cold ; theinfant moaned feebly, the mouth was drawnaside, the fingers were clenched, and, after alittle blood had flowed from the left nostril,the child died.

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Serous and bloody effusions were dis- coverings of the brain became distended,covered within the skull, and under the Admitting, however, that the case in ques.scalp, which the author minutely details. tion was really apoplexy, then he wouldA large quantity of serum was also ef- inquire how the disease had been induced.

fused into the pleural cavities of the chest. In apoplexy occurring in adults, we usuallyAfter noticing the opinions of various found it depending upon organic disease of

writers, the author is inclined to think, that the heart, or some other important organ,in this case the most probable cause of he was not aware that any cause could bedeath was one suggested by M. Cruveilhier, found for the occurrence of the disease inthat the uterine contractions exercised a Dr. Burgess’s case. He would repeat, thatfatal compression upon the umbilical chord external injury would readily explain thecontained within the womb. After recount- presence of all the signs and symptoms oh.ing the morbid appearances commonly ob- served in the case under discussion.served in similar cases, Dr. Burgess says, Dr. BURGESS said, that the remarks of the11 None of these authors have noticed the last speaker corroborated, in some measure,sanguineous effusion beiieuth the arachnoid, the statements of M. M. Valleix and Cru.and the engorgement of the choroid plexus, veilliier, as to the vagueness and uncertaintyboth of which conditions obtained in this of our information respecting the cerebrafinstance." and meningeal haemorrhages of new-bornThe remedy, according to all authors, is infants. Here was the case of an infant,

blood-letting from the chord, which is di- born within the period of a natural labour,rectly opposed to the treatment required in no untoward symptoms occurred duringasphyxia. The characteristic mark of in- parturition, and although the head was ex.fantile apoplexy, is, according to Gardien pelled a few moments before the body, theand the author of this paper, the livid hue child continued crying during that period.of the body, while in asphyxia the infant On its birth, there were no evidences of dis-comes into the world, as Baudeloque says, ease, either natural or excited, not even the" exsanguine." slightest discolouration. For several hours

Dr. J. JOHNSON enquired of the author of after birth this child appeared lively andthe paper, on what principle pressure upon well ; the meconium was discharged with.the abdomen had been recommended, as an out the aid of medicine, and, after the lapseadvisable mode of treatment, in the apo- of a certain time, apopletic symptoms sud.plexy of new-born infants? denly supervened. Similar cases had been

Dr. BURGESS replied, that pressure had recorded by French and German writersonbeen recommended in those cases in which the subject. Now, he (Dr. Bu.rgess), wouldthe haemorrhage from the divided umbilical ask the last speaker, if the extensive effu.chord was not sufficient to effect the indica- sion of blood on the brain, observed in thetions that the symptoms presented. It was case related, and the engorgement of theapplied during the time the infant was in longitudinal sinus (a point likewise noticedthe warm bath, with the view of promoting by M. Valleix, in one of his cases), tugetherbleeding from the chord, with the morbid condition of the spinal mar.

Dr. COPLAND remarked, that the cause of row, and the other lesions detailed, did nGtthe disease under consideration was very denote the state known to us by the namefar from being evident, in many cases, of apoplexy of new-born infants, what didand was a point of much interest to decide. constitute that disease ? With regard to theMr. LLOYD had never seen a case of in- probable origin of infantile apoplexy, for we

fantile apoplexy, but he considered the case could not go further than conjecture on thisthat had been read was by no means clearly point, it appeared to him (Dr. Burgess),made out to be one of apoplexy at all. In- that it arose, iu some instances, from nearlydeed, he should be inclined to believe that the same cause as that which 1B’1. Valleix:the lesions which were observed were the had ingeniously advanced, as producingresult of external injury, inflicted upon the cephaiasmatoma, a disease peculiar to theinfant during the process of parturition. same period of existence as that under con.The head of the child, as was stated, was sideration. M. Valleix supposed, that cir-detained a long time in the pelvis, and the cular pressure, produced by the contractionsymptoms present were such as would lead of the neck of the uterus, and opetatmg onto the opinion, that injury had been in- the head of the infant during its passageflicted during the period of the detention. through it, was the exciting caue of theseThus, the fontanelle, instead of being more bloody cranial swellings. Now, if circularprominent than natural, was, in point of pressure, produced by the same means, andfact, depressed. Had the child died of apo- acting on the neck of the infant, so as toplexy, this would not have been the case. impede the return of the blood from theHe would observe also, that, unless the dis- brain, was sufficiently prolonged, it would,tension of vessels within the cranium was no doubt, produce one or other of the formsvery great, apoplexy was not likely to occur of infantile apoplexy noticed by writers.in so young a patient, in consequeace of the In the case he had related, however, thisgreat readiness with which the external could not have been the cause of the disease.

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On a remarkable Effect upon the Gums, pro- two hospifal patients, under treatment forduced by the Slow Introduction of Lead variousc3iseases,whichwerenotcomplicatedOxide into the Human Body. By HENRY with either lead colic or lead paralysis.BURTON, -II.D., Physician of St. Thomas’s He is, therefore, inclined to rely on this

Hospital. symptom as an infallible proof of the pre-In explanation of the circumstances by sence of lead oxide in the system, and that

which the author was first induced to inves- in all cases of illness originating from this

tigate the effects of lead oxide on the gums, oxide, about the symptoms of which someDr. Burton says, he had been taught to be- ambiguity exists, an examination of the

lieve, from the perusal of Dr. Warren’s gums will materially assist in making a"Essay on the Effects of Lead," published correctdiagnosis. The author notices, briefly,in 1772; and of Dr. Christison’s description the conditions of disease in which this am-of the symptoms produced by the same oxide biguity is sometimes remarked, and asserts,on man, published in 1829, and republished that, in the majority of cases of which thein 1836, that salivation was occasionally lead oxide is the cause of illness, a carefulexcited by its slow introduction into the inspection of the gums will immediately re-human body, and during which the saliva veal the origin of the evil, and suggest anwas increased in quantity, as well as render- appropriate plan of treatment. In six casesed, according to Dr. Christison, bluish in in which acetate of lead was administeredcolour. In no other author, among several internally, the appearance of the narrowwhich were consulted, could Dr. Burton leaden-blue border line preceded the acces-meet with any additional notice of any un- sion of other symptoms, indicating the pre-usual symptoms having reference to the sence of lead oxide in the system, and thestate of the mouth produced by the absorp- use of the last was discontinued in conse-tion of lead oxide; but his attention was quence ; in two of these cases colic symp-first practically directed to its influence on toms followed its appearance, but in thethe salivary glands in 1834, when his friend remaining four they did not follow. ThisDr. Roots, and late colleague at St. Thomas’s sign, Dr. Burton thinks, cannot be impli-Hospital, had a patient in one of his wards citly relied on as a means of always avert-who was said to have been salivated by the ing the pains of lead colic, nevertheless, heinternal use of acetate of {lead. From that believes, that it may be depended on with asperiod to the present time, an interval of much safety as the copperish taste of theabove five years, Dr. Burton has continued saliva is confided in, as an indication to

the examination of the mouths of patients withhold the further use of calomel, for thewho have been admitted into his wards purpose of avoiding the other symptoms ofwith lead colic, and lead paralysis, the re- mercurial salivation.sult of which has been a belief, that saliva- Dr. GEORGE BURROWS had been informed,tion, in the ordinary sense of the word, does a few weeks since, of the facts which hadnot occur in one case of twenty-eight well- been observed by Dr. Burton, and detailedmarked cases of disease from the absorption by him in the paper before the Society. Heof lead oxide, which have come under his (Dr. Burrows) had since embraced everytreatment. Dr. Burton does not deny that sa- opportunity of putting these facts to the testlivation has occurred, and may recur again, of experience. In three cases of paralysisbut, he contends, that a peculiar appearance from lead, occurring among the out-patientsis invariably produced by lead oxide on the of St. Bartholomew’s Hospital, he had in-gums, and which may be considered as indi- spected the gums, and found the appear-cative of its presence in the system. Of these ances so accurately described in the paper.twenty-eight patients, the edges of the gums, In a very severe case of lead colic, occurringwhere they were attached to the necks of in a man who worked in a white lead manu-two or more teeth of either jaw, or both factory, the appearances on the gums werejaws, were distinctly bordered by a narrow very decidedly marked. It was thought,line, of a deep leaden-blue colour, about the by some gentlemen who saw this case, thatone-twentieth part of an inch in width, the appearances observed were possibly thewhilst the remainder of the gums, for the result of want of cleanliness ; but, on ex-most part, retained their usual colour and amining a great number of other patients,condition. This phenomenon, observed on not affected by lead, and who were notthe gums of patients affected by lead oxide, particularly cleanly, no such appearancesdiffers entirely from one characteristic of could be detected. In another case, whichthe presence of mercury in the system, as had lately occurred to him, the valne of thewell as of scorbutus, and is never seen un- new fact was tested in reference to the as-less the patient has been exposed to the sistance it afforded in our diagnosis ofkeg-continued operation of lead oxide. In doubtful cases. A man applied, as an out-support of these opinions, Dr. Burton adds, patient at St. Bartholomew’s Hospital, withthat he has iutentiouatiy produced the pecu- partial paralysis of the upper extremitiesliar appearance alluded to, by the internal from lead. The patient said, that he haduse of acetate of lead, and that he was un- never worked in any way with lead; he wasable to distinguish it upon the gums of fifty- a silk weaver. On examining the gums, the

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precise appearances observed in the other produced upon the gums by the presence ofcases were presented. On making further lead in the system, he contended that it

iuquiries, it was ascertained, that he had suf- was essentially necessary that that state.fered a few months before from lead colic ; ment should be founded on the productionand he recollected that, previous to that at- of unequivocal proofs that lead was reallytack, he had been working with some small present when this symptom was observed.needles, which were pliable, and made of Two cases had been related, by the authorlead. In pointing out the appearances ob- of the paper, in which the presence of leadserved in this case, to his pupils, he had been in the system was inferred from the disco.informed by a friend, Dr. Baly, that the cir- louration of the gums, and the only way incumstance had been noticed by a German which lead could possibly have got into thewriter, in a recent number of " Froriep’s system was stated to be from the patient’sNeue Notizen," in which it had been drinking water out of a leaden cistern. Hebrought forward as a new fact ; the disco- (Dr. Chowne) contended, that if it were pos.louration of the gums was there stated to be sible for the system to become impregnatedthe result of the action of the sulphur in the with lead from a person drinking water outsaliva upon the lead. He believed that the of a leaden cistern, then multitudes wouldpublication of this fact had attracted a good be so affected. What said Dr. Christisondeal of attention in Germany. with reference to this point? Why, that

Dr. J. JO[INSON said, that the importance unless the water in the cistern were as pureof the fact detailed in Dr. Burton’s paper, in as distilled water, it would not act upon thereference to diagnosis, was very great, and lead, the smallest possible quantity of thehe had no doubt that lead was being con- salts contained in water, not distilled, beingstantly introduced into the system from sufficient to render it inert in reference tosources which, in many cases, were with the metal with which it was in contact.

great difficulty appreciated. The only He should not be satisfied with the evidencedoubt in his (Dr. Johnson’s) mind, was, of the system being affected by lead, as ad.whether the appearance of the gums in duced in the case related by Dr. Burrows,question preceded the other symptoms pro- in which a mechanic had used a few leadduced by lead. If he recollected rightly, needles some months previously to his beingthe paper which had been read detailed no affected with colic. He thought the proofcase in which the gums had become affected had failed in that case, both with referencepreviously to the occurrence of colic or to the quantity of lead, and the distance ofparalysis, while one or two cases were de- time.tailed in which the other symptoms pro- Dr. BURTON had stated clearly in hisduced by lead were present, and the gums paper, that he had accurately noticed thewere unaffected. If the appearance in the discolouration of the gums in those casesinmouth was merely a symptom occurring in which he had exhibited the diacetate ofcommon with others, as the result of lead, lead, in cases of hsemoptysis, and other dis.the fact would be far less valuable, in a eases. He had related the two cases, com.practical point of view, than if it preceded mented upon by Dr. Chowne, merely in re-the colic, paralysis, and other symptoms in- ference to the value of the appearance induced by the presence of lead in the system. question, as assisting in our diagnosis of

Dr. BURTON in reply, stated, that in many doubtful cases. The cases, on which hepatients in St. Thomas’s hlospital he had had founded the opinion advanced, wereused the diacetate of lead as a medicinal those in which the presence of lead in theagent, and the discolouration of the gums system was unequivocal and decided. Thehad invariably preceded the other symp- appearance, in the two cases alluded to, wastoms. He considered this appearance, in- precisely the same as that which was pre.deed, to form a diagnostic mark of the time sent in those cases in which lead had beenwhen the medicine should be left off, as also administered as a medicinal agent. The dis-of the extent to which it could be safely car- colouration was a permanent symptom, andried, without the production of colic or para- continued with the paralysis after the sub.lysis. He had examined the mouths of a sidence of the colic, even for years. Thegreat number of workmen in a white lead colour was not easily obliterated; pressuremanufactory, and, in many instances, the would for a moment cause it to disappear,gums were affected without the persons but it almost instantly returned.having suffered from either of the other Mr. MACILWAIN wished to call the at.symptoms resulting from lead ; while, in tention of the Society to two points. Theother cases, the discolouration was attended first, referred to the observation of the au.with colic or paralysis, facts which tended thor of the paper, that the appearances heto prove that the first effect of lead on the had observed were decidedly the result ofsystem was made upon the gums. lead ; and the second would form itself into

Dr. CHOwNE made some remarks on the an inquiry, as to whether those appearancesnecessity of forming our general principles resulted from lead, and from no other cause.on the clearest and most indisputable facts. He would merely remark, that he con.When it was stated, that there was an effect sidered it very early to decide either of

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these points. Great caution was necessaryin the conducting of this kind of examina-tion. He had, during the last fourteen

years, been instituting a series of exami-nations on the gums, with the view of deter-

mining the effects of mercury on various

systems, and these effects were so various,and sometimes so obscure, that he could nothelp thinking that the author of the paperhad been a little hasty in deciding, that noagent but lead would produce the appear-ances in question.Mr. LLOYD remarked, with reference to

the influence of water on leaden cisterns,that it was a well ascertained fact thatwhen plants were watered from this source,their growth was much interfered with.He knew that rain-water did act uponleaden cisterns, because he had lately beenobliged to get a cistern mended, from itshaving been injured by its contents.Dr. COPLAND observed, that there ap-

peared to be some misapprehension in Dr.Chowne’s mind, with reference to the evi-dence of the presence of lead in the system,as brought forward by the author in thecases detailed, and which he, Dr. Cop-land, considered was incontrovertible. Hetherefore thought, that the appearance ofthe gums, in the two doubtful cases re-lated, formed a sufficient reason for suspect-ing the presence- of lead in the system.Persons might become contaminated withlead in various ways, and even through theatmosphere. In a case he had attended, inwhich the lead symptoms were unequivocal,the presence of the metal in the systemcould only be accounted for by the resi.dence of the patient near a factory wheresome kind of work in lead was carried on.Dr. BURTON replied, that the action of

water upon lead cisterns had been knownfrom a very early period. Sir GeorgeBaker had mentioned it ; Vitravius, in theearly periods of Rome, had suspected thatthis influence existed; and it was known,that manv cisterns near London were af-fected and perforated in various places bythe water contained in them. He (Dr. Bur-ton) knew that lead was not soluble in Iwater, but a carbonate was formed, whichfell to the bottom. When the water wasagitated by any means, such, for instance,as a fresh supply coming in, a portion of thiscarbonate became mixed with the whole ofthe water in the vessel, and in this statewas used for domestic purposes. Instanceshad been known, in which entire familieshad suffered from this cause. Dr. Alder-son, in the last volume of the "Society’sTransactions," had related a case, in whicha family were affected by lead colic from

drinking water out of a leaden cistern.Dr. CHOwNE explained. He was fully

aware of the facts alluded to by Dr. Burton ;Dr. Christison had expressed his opinion,after careful observations, that the appre-

bensions which existed, with reference tothe effect of water contained in leaden cis.terns, were unfounded. If other metals be-sides lead entered into the construction ofpumps and cisterns, as was occasionally thecase, then, by galvanic action, the waterwould acquire a solvent power. But, as ageneral principle, he (Dr. Chowne) con-tended still, that water, unless it were per-fectly pure, had no influence whatever onleaden cisterns.

Note.-In allusion to the fact stated byDr. George Burrows, in the foregoingReport, to the effect that a correspondingcolouration of the gums had been observedin Germany, and an account published of itin the work quoted, No. 246, for 1839, Dr.Burton thus remarks :—’ We have beenfavoured with a translation of that account,from which it appears, that the author, Dr.Schilbach, of Nenstadt, in the month ofAugust, IS39, was called to a consulta-tion upon the health of a father and fivechildren who had been poisoned by theuse of bread containing lead oxide. In allthese patients Dr. Schilbach observed analmost characteristic ash-grey coating ofthe gums, at the part where they surroundthe teeth."’ No further notice is taken ofthis appearance by Dr. Schilbach ; the sen-tence above quoted, however, strongly con-firms the accuracy of Dr. Burton’s observa-tions, whilst it in no way deprives him ofthe priority of the discovery, and we haveauthority for unequivocally denying, on hispart, any knowledge of Dr. Schilbach’spaper, previous to the discussion abovereported.

WESTMINSTER MEDICAL SOCIETY.

Saturday, January 18, 1840.

Dr. CHOWNE, President.MISTAKES.-CASES OF DISCOLOURATION OF

THE GUMS FROM LEAD.-" SPONTANEOUSSALIVATION."-TREAMENT OF ABORTION.

Dr. REID said that, as the Society wasfounded, among other things, for the purposeof its members relating curious cases, hewould detail the following. A few eveningsago a portion of a body was found in acourt in Drury-lane, and, after being pro-nounced human by some medical man towhom it was taken, it was brought, amidmuch popular excitement, to St. Giles’sworkhouse, when the pathological specimenwas found to be the thorax of a dog. Someyears since, in this parish, a Coroner’s juryhad been summoned to sit upon the body ofa new-born child, found in a privy, whenthe deceased was discovered, on examina-tion, to be the body of a cat denuded of itsskin !