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ROYAL MEDICAL AND CHIRURGICAL SOCIETY. Tuesday, November 12, 1844

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266 .The great merit; of the " Vestiges" is, the attempt made to shew the mutual bearing of sciences, at present too often re- garded as far apart. The doctrines advanced are not so new as the author seems to fancy, but they are none the worse for being thrown open to the general reader, instead of being, as hitherto, eonfined to the timid coteries of the so-called scientific world. MEDICAL PROTECTION ASSEMBLY. EXETER HALL, Monday, Nov. 18, Mr. JANES in the chair,- At the usual meeting of the committee, letters were read from numerous correspondents: amongst them (enclosing subscrip- tions) were communications from Mr. Bellet and Mr. Rayner, of Stockport; Mr. Philott, Mortlake ; Mr. Forman, Teignmouth; Mr. Mee, East Retford; Mr. Messeener, Poplar; Mr. Wood, Bridge-street, Southwark; Mr. J. Hargreaves, Tunbridge Wells; Dr. R. Lanyan, F.R.S., and Mr. R. Lanyan, sen.; Mr. Anderson, York; Dr. Johnson, Golden-square ; and Mr.H. Oliver, of Hilton. It was also resolved that a notice be published, requesting 11 that any subscriber whose communication may be unacknowledged either by the treasurer or in the weekly report of proceedings, will immediately write to the secretary, who will institute the necessary inquiries." A well-digested plan of active agitation for medical reform was submitted to the meeting by Mr. Curtis, and that gentleman was requested to bring forward the same at the proposed meeting of delegates. CHEMICAL SOCIETY.—MONDAY, NOV. 18, 1844. A CONTINUATION of Mr. Sweitzer’s paper on the analysis of mineral waters was read. In the Bonnington water, near Edin- burgh, which has been extolled as containing iodine, Mr. Sweitzer found seven thousandths of a grain in a pint, but about ten times that amount of bromine.-Mr. Solly described a chemical lamp furnace which he has devised, very ingenious and useful in scientific chemistry.-Dr. Percy, of Birmingham, described what he thought to be a new phosphate of lime, but Mr. Graham said it was merely a neutral phosphate, with five atoms of water of crystallization.-Mr. Warrington exhibited a portion of bone from Ichaboe guano, in which all trace of phosphate of lime had vanished, and its place become supplied with sulphuric acid, potash, and ammonia. Mr. Warrington expressed an opinion that a large portion of the guano found in that locality has been produced by the decomposition of the flesh and bones of seals. It has long been the practice of the South Sea sealing vessels to touch at Ichaboe to render down their oil, and to throw away the - carcasses of the animals, which are then fed on by sea fowl. ROYAL MEDICAL AND CHIRURGICAL SOCIETY. Tuesday, November 12, 1844. EDWARD STANLEY, F.R.S., PRESIDENT. THE society commenced the session this evening. There was a large attendance. Busts of several former presidents have been placed round the library. CASE OF ULCERATION OF THE DUODENUM, IN WHICH THE GALL-BLADDER WAS FILLED WITH A COLOURLESS AQUEOUS FLUID, AND CONTAINED NUMEROUS GALL-STONES. By C. J. ROBERTS, M.D., Physician to the Welch Charity, &e. The author only saw this case a short time previous to death. The patient was attacked with violent vomiting on Tuesday evening, which resisted all the means employed to subdue it, and he sunk on the following Thursday, at two P.M. On examination, after death, the intestines were very slightly glued together by lymph; the inner membrane of the stomach had many ecchy- motic spots on it, of a very deep colour; the duodenum was ulcerated through its entire length; the liver small, but healthy; the gall-bladder was distended, and at its apex there was a small vesicle, more translucent than the other portions of the bladder, looking as if from a rent of the two outer coats and a protrusion of the inner one. On opening it, more than four ounces of a per- fectly limpid, transparent fluid escaped, but, unfortunately, none of it could be collected for examination. There were more than one hundred gall-stones in the gall-bladder, about the size of peas. The kidneys and bladder were healthy. The author remarks, that cases where a number of gall-stones have been found after death without their presence causing irri- tation, or being suspected, are not rare, but that the total absence of bile, or rather, its place being supplied by an aqueous fluid, is not common. He observes, however that allusions are made to it by some of the older authors, as Fernelius and Haller, and also, that mention is made of an altered condition of the biliary secretion by Andral, and by Drs. GraTes and Stokes, as well as by Dr. Thomson, in his " Practical Treatise on Diseases of the Liver." He concludes by observing that the most extraordinary part of the case is the fact that the man never made any complaint of hepatic derangement during his life-time. He was never jaun- diced, nor had pain in the right side, notwithstanding one of the calculi was firmly grasped by the duct. CASE IN WHICH THE VENA CAVA INFERIOR WAS OBLITERATED BETWEEN THE COMMON ILIAC VEINS AND THE HEPATIC VEINS. BY THOMAS BEVILL PEACOCK, M.D. This was a case of complete obstruction of the inferior cava from the uterine and common iliac veins to the entrance of those from the liver. The obstruction in the former vessels, and the inferior portion of the cava, was the result of adherent masses of pale lymph, while above, the vessel was converted into a liga- mentous cord. The right kidney was in an advanced stage of granular dege- neration ; the left completely atrophied; the liver was also of small size. The author èonsidered the disease of the vein to have been wholly unconnected with the death of the patient, and ascribed the general dropsy under which she laboured during the last period of her life, to the condition of the kidney and liver. The circulation had been maintained by means of the branches of the vena azygos. The author was of opinion that the adhesions of the uterus to the adjacent organs, and the appearance of the veins, as exhibited in the preparations shewn to the society, were con- clusive of the dependence of the obstruction in the vein on inflam- mation of the vascular tunics. The PRESIDENT remarked, that the chief points of interest in the paper before the society were, the entire blocking up of the chief vein of the inferior half of the body, and the carrying on of the collateral circulation by means of the vena azygos much en- larged, while the superficial veins of the abdomen retained their natural size. Dr. BUDD drew attention to the effects of adhesive phlebitis in producing atrophy of the glandular organs, a point which he thought was illustrated by Dr. Peacock’s case. He had seen cases in which the liver was atrophied to such an extent that it was cut across by fissures; the branches of the portal vein corresponding to these fissures having been obliterated by adhesive phlebitis. He had lately seen a case of atrophied kidney, in which the renal veins were completely blocked up by fibrin. In this case there was no albuminuria, and no granular disease of the organ. The connexion between disease of the coats of the veins and atrophy of glandular organs was not sufficiently known, although we were tolerably well acquainted with the effects of adhesive phlebitis when affecting the veins of the extremities. Mr. STANLEY inquired if members had seen cases of adhesive phlebitis of the superficial veins of the extremities, in which the channel of the vessel had resumed its caliber? He had seen two cases of the kind in St. Bartholomew’s Hospital; in one, the veins of the arm were affected-in the other, the popliteal vein. In both cases there was evidence of the presence of adhesive phle" bitis; the veins were tender and hardened, and in the latter case the limb below the popliteal vein was oedematous. In both these instances the circulation was completely restored. Dr. C. J. B. WILLIA3Ts agreed with Dr. Budd with respect to the study of the pathology of the veins. He referred to Mr. Paget’s paper on the subject, and said that he had had a case a few weeks since illustrative of the pathology of these vessels. It was a case in which obstruction in the veins co-existed with lung disease. The symptoms were those commonly observed in pleuro- pneumonia, but the difficulty and obstruction of the breathing, and the lividity of countenance, were to a greater extent than could be explained simply by the presence of this disease. In the early stage it was found by the stethoscope that two-thirds of one lung were incapacitated from duty. The symptoms increased in severity, the countenance became more livid, and the lower ex- tremities cedematous. The patient sunk. On examination, two lobes of the right lung were found in a state of carnification; on cutting the lung across, he was struck with the large size of the pulmonary veins, which, on examination, were found to contain large clots adherent to their walls. In other veins, as the ascend- ing cava, &c., the same condition of the lining membrane was observed. There was no sign of recent inflammation present; the lining membrane, on the contrary, was pale, softened, and contained patches of atheromatous deposit. This condition of the circulating vessels explained the severity of the symptoms. He suspected that that which was considered to be inflammation
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Page 1: ROYAL MEDICAL AND CHIRURGICAL SOCIETY. Tuesday, November 12, 1844

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.The great merit; of the " Vestiges" is, the attempt made toshew the mutual bearing of sciences, at present too often re-garded as far apart. The doctrines advanced are not so new as

the author seems to fancy, but they are none the worse for beingthrown open to the general reader, instead of being, as hitherto,eonfined to the timid coteries of the so-called scientific world.

MEDICAL PROTECTION ASSEMBLY.

EXETER HALL, Monday, Nov. 18, Mr. JANES in the chair,-At the usual meeting of the committee, letters were read fromnumerous correspondents: amongst them (enclosing subscrip-tions) were communications from Mr. Bellet and Mr. Rayner, ofStockport; Mr. Philott, Mortlake ; Mr. Forman, Teignmouth;Mr. Mee, East Retford; Mr. Messeener, Poplar; Mr. Wood,Bridge-street, Southwark; Mr. J. Hargreaves, Tunbridge Wells;Dr. R. Lanyan, F.R.S., and Mr. R. Lanyan, sen.; Mr. Anderson,York; Dr. Johnson, Golden-square ; and Mr.H. Oliver, of Hilton.It was also resolved that a notice be published, requesting 11 thatany subscriber whose communication may be unacknowledgedeither by the treasurer or in the weekly report of proceedings,will immediately write to the secretary, who will institute thenecessary inquiries." A well-digested plan of active agitationfor medical reform was submitted to the meeting by Mr. Curtis,and that gentleman was requested to bring forward the same atthe proposed meeting of delegates.

CHEMICAL SOCIETY.—MONDAY, NOV. 18, 1844.A CONTINUATION of Mr. Sweitzer’s paper on the analysis of

mineral waters was read. In the Bonnington water, near Edin-burgh, which has been extolled as containing iodine, Mr. Sweitzerfound seven thousandths of a grain in a pint, but about ten timesthat amount of bromine.-Mr. Solly described a chemical lampfurnace which he has devised, very ingenious and useful inscientific chemistry.-Dr. Percy, of Birmingham, described whathe thought to be a new phosphate of lime, but Mr. Graham said itwas merely a neutral phosphate, with five atoms of water ofcrystallization.-Mr. Warrington exhibited a portion of bonefrom Ichaboe guano, in which all trace of phosphate of lime hadvanished, and its place become supplied with sulphuric acid,potash, and ammonia. Mr. Warrington expressed an opinionthat a large portion of the guano found in that locality has beenproduced by the decomposition of the flesh and bones of seals.It has long been the practice of the South Sea sealing vessels totouch at Ichaboe to render down their oil, and to throw away the- carcasses of the animals, which are then fed on by sea fowl.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.Tuesday, November 12, 1844.

EDWARD STANLEY, F.R.S., PRESIDENT.

THE society commenced the session this evening. There wasa large attendance. Busts of several former presidents have beenplaced round the library.CASE OF ULCERATION OF THE DUODENUM, IN WHICH THE

GALL-BLADDER WAS FILLED WITH A COLOURLESS AQUEOUSFLUID, AND CONTAINED NUMEROUS GALL-STONES. ByC. J. ROBERTS, M.D., Physician to the Welch Charity, &e.

The author only saw this case a short time previous to death.The patient was attacked with violent vomiting on Tuesdayevening, which resisted all the means employed to subdue it, andhe sunk on the following Thursday, at two P.M. On examination,after death, the intestines were very slightly glued together bylymph; the inner membrane of the stomach had many ecchy-motic spots on it, of a very deep colour; the duodenum wasulcerated through its entire length; the liver small, but healthy;the gall-bladder was distended, and at its apex there was a smallvesicle, more translucent than the other portions of the bladder,looking as if from a rent of the two outer coats and a protrusion ofthe inner one. On opening it, more than four ounces of a per-fectly limpid, transparent fluid escaped, but, unfortunately, noneof it could be collected for examination. There were more thanone hundred gall-stones in the gall-bladder, about the size of peas.The kidneys and bladder were healthy.The author remarks, that cases where a number of gall-stones

have been found after death without their presence causing irri-tation, or being suspected, are not rare, but that the total absenceof bile, or rather, its place being supplied by an aqueous fluid, isnot common. He observes, however that allusions are made to

it by some of the older authors, as Fernelius and Haller, andalso, that mention is made of an altered condition of the biliarysecretion by Andral, and by Drs. GraTes and Stokes, as wellas by Dr. Thomson, in his " Practical Treatise on Diseases ofthe Liver."He concludes by observing that the most extraordinary part of

the case is the fact that the man never made any complaint ofhepatic derangement during his life-time. He was never jaun-diced, nor had pain in the right side, notwithstanding one of thecalculi was firmly grasped by the duct.

CASE IN WHICH THE VENA CAVA INFERIOR WAS OBLITERATEDBETWEEN THE COMMON ILIAC VEINS AND THE HEPATICVEINS. BY THOMAS BEVILL PEACOCK, M.D.

This was a case of complete obstruction of the inferior cavafrom the uterine and common iliac veins to the entrance of thosefrom the liver. The obstruction in the former vessels, and theinferior portion of the cava, was the result of adherent masses ofpale lymph, while above, the vessel was converted into a liga-mentous cord.The right kidney was in an advanced stage of granular dege-

neration ; the left completely atrophied; the liver was also ofsmall size.The author èonsidered the disease of the vein to have been

wholly unconnected with the death of the patient, and ascribedthe general dropsy under which she laboured during the lastperiod of her life, to the condition of the kidney and liver. Thecirculation had been maintained by means of the branches of thevena azygos. The author was of opinion that the adhesions ofthe uterus to the adjacent organs, and the appearance of the veins,as exhibited in the preparations shewn to the society, were con-clusive of the dependence of the obstruction in the vein on inflam-mation of the vascular tunics.The PRESIDENT remarked, that the chief points of interest in

the paper before the society were, the entire blocking up of thechief vein of the inferior half of the body, and the carrying on ofthe collateral circulation by means of the vena azygos much en-larged, while the superficial veins of the abdomen retained theirnatural size.

Dr. BUDD drew attention to the effects of adhesive phlebitis inproducing atrophy of the glandular organs, a point which hethought was illustrated by Dr. Peacock’s case. He had seen casesin which the liver was atrophied to such an extent that it was cutacross by fissures; the branches of the portal vein correspondingto these fissures having been obliterated by adhesive phlebitis.He had lately seen a case of atrophied kidney, in which the renalveins were completely blocked up by fibrin. In this case therewas no albuminuria, and no granular disease of the organ. Theconnexion between disease of the coats of the veins and atrophyof glandular organs was not sufficiently known, although we weretolerably well acquainted with the effects of adhesive phlebitiswhen affecting the veins of the extremities.

Mr. STANLEY inquired if members had seen cases of adhesivephlebitis of the superficial veins of the extremities, in which thechannel of the vessel had resumed its caliber? He had seen twocases of the kind in St. Bartholomew’s Hospital; in one, the veinsof the arm were affected-in the other, the popliteal vein. Inboth cases there was evidence of the presence of adhesive phle"bitis; the veins were tender and hardened, and in the latter casethe limb below the popliteal vein was oedematous. In both theseinstances the circulation was completely restored.

Dr. C. J. B. WILLIA3Ts agreed with Dr. Budd with respect tothe study of the pathology of the veins. He referred to Mr.Paget’s paper on the subject, and said that he had had a case afew weeks since illustrative of the pathology of these vessels. Itwas a case in which obstruction in the veins co-existed with lungdisease. The symptoms were those commonly observed in pleuro-pneumonia, but the difficulty and obstruction of the breathing,and the lividity of countenance, were to a greater extent thancould be explained simply by the presence of this disease. In theearly stage it was found by the stethoscope that two-thirds of onelung were incapacitated from duty. The symptoms increased inseverity, the countenance became more livid, and the lower ex-tremities cedematous. The patient sunk. On examination, twolobes of the right lung were found in a state of carnification; oncutting the lung across, he was struck with the large size of thepulmonary veins, which, on examination, were found to containlarge clots adherent to their walls. In other veins, as the ascend-ing cava, &c., the same condition of the lining membrane wasobserved. There was no sign of recent inflammation present;the lining membrane, on the contrary, was pale, softened, andcontained patches of atheromatous deposit. This condition of thecirculating vessels explained the severity of the symptoms. Hesuspected that that which was considered to be inflammation

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the veins was in reality not so, but often a mere coagulation ofthe blood or adherence of its fibrinous portion to the coats of avessel rendered rough by previous disease. We found disease ofthe lining membrane of arteries, arising from old age, and othercauses, totally independent of inflammation; and he thought therewas good reason to suppose that the same condition might obtainin the veins.Mr. TwissEN stated that it had fallen to his lot to meet with

two examples of obstruction of the vena cava-one in the superior,and the other in the inferior : that in the superior vena cava hadbeen in a subject in the dissecting-rooms ; that in the inferiorcava had happened in private practice. The examination madein the dissecting-room enabled him to corroborate the descrip-tion given by Dr. Peacock as to the collateral circulation ; for hehad remarked the great enlargement of the vena azygos, and thebranches which communicated with it, and had no doubt thatthis vessel was most important in carrying on the circulation incases such as those under consideration. The other examplewas chiefly remarkable in consequence of the absence of anysymptoms, during life, indicative of such a condition. The casewas that of a female who died three weeks after childbirth ; andalthough she was seen by various parties who had great skill inthe treatment of females under such circumstances, no one hadany suspicion of the true state. He had been asked to examinethe body ; and it was only after they had failed to detect any-thing very unusual, that he looked closer to the parts in front ofthe spine, when he found the vena cava inferior completelyob-structed by lymph, having also pus in its interior as well as onits outer surface.

- -

With reference to what had fallen from the President, as to ther’e-establishment of circulation in veins which had been affectedwith inflammation, he himself had frequently made similar obser-vations ; opportunities of doing so had been common amongsurgeons, of late years; and he doubted not that many in theroom could make similar statements. In the present day, whenthe practice of obliterating veins was so common, it was noticed,that in the attempts of the surgeon to induce inflammation in theveins of the lower extremity, in their enlarged and varicose con-dition, by passing needles under and string over them, whenthere was every indication of that process having been esta-

blished, after the lapse of ten, twenty, forty days, or even more,the blood commenced to flow again through such vessels. Hehad frequently observed this, and had long been of opinion, thatinstead of adhesive inflammation in the inner tunic of veinsbeing a process of common occurrence, and easily established, aswas the current doctrine of the day, it was in reality rare, and byno means so readily induced as was generally imagined.Dr. PEACOCK differed from Dr. Budd in his opinion that the

atrophy of the liver, and other glandular organs, in his (Dr.Peacock’s) case had depended on the disease of the veins, inas-much as he considered that the glandular preceded the venousdisease. It would, moreover, have followed, had Dr. Budd’stheory been correct, that there should have been no atrophy ofthe liver, (which, however, did exist,) inasmuch as the portalvenous system was healthy. The atrophy of one of the kidneysdepended on granular degeneration, and the other was affectedwith the same disease in a less advanced stage, and was largerthan natural from that cause; he therefore thought the kidneyswere first affected, and that there was, moreover, evidence of in-flammation of the veins having existed.Mr. SNOw said, that the obliteration of the vena cava in this

case most likely arose from inflammation, which commenced inthe uterus, involved its veins, and spread to the large venoustrunks. There were proofs of such inflammation at some previ-ous time in the morbid adhesion of the uterus to the neighbouring parts, and the obliteration of its veins. Inflammation of theuterus was perhaps the most frequent cause of extensive phlebitis,and Mr. Fergusson had just related a fatal instance of it after con-finement, where the vena cava was obliterated. Although in-flammation and consequent obstruction of the veins were not un-common in granular degeneration of the kidneys, he consideredthat as there was a more evident cause for the phlebitis in thiscase, the disease of the kidneys had no connexion with it,either as cause or effect, but was a separate and independentdisorder.ON THE CLASSIFICATION, STRUCTURE, AND DEVELOPMENT OFTHE ECHINOCOCCUS HoMINIS, SHEWING REASONS FOR RE-

GARDING IT AS A SPECIES OF CYSTICERCUS. BY ERASMUSWILSON, ESQ., Consulting Surgeon to the St. Pancras Infirmary,Lecturer on Anatomy and Physiology in Middlesex Hospital.

The author agrees in the opinion, now become general, of theuniversality of this curious entozoon in the sacs of the commonacephalocyst, but differs with all preceding writers in regardingit as a fixed or pedunculate animal, in its perfect state, as well as

in its undeveloped form. The cases in which it was observed werethe common hydatid tumour of the liver: the little animal mea-sures in its longest diameter, from 1-200th to 1-125th of an inchin diameter, is scarcely distinguishable by the naked eye, and isenclosed in clusters of from two to one hundred, in a propermembrane, which is devoloped from, and attached by, a point tothe internal membrane of the acephalocyst. To give an idea ofthe number of echinococci contained within an hydated tumour,the author counted their number in an acephalocyst of about thesize of a hazel-nut. In this small cyst he found forty clusters,several of which contained eighty individuals, and the entirenumber of separate echinococci was about one thousand. Theanimni is found in two states-namely, a contracted and an elon-gated state ; in the latter, there is perceived a circle of bookletsat the cephalic extremity, with four suctorial processes : thenfollows a cyst-like body, or caudal portion, into which the cepha-lic portion is drawn in the contracted state, and at the caudal ex-tremity is the peduncle. After giving a minute description ofthe animal, the author proceeds to describe the changes whichtake place in the creature after death, and gives a full account ofthe progressive stages of its development. The author considersthe offices of the booklets and suctorial processes to be involvedin obscurity, the creature having neither mouth nor organs ofprogression. The identity of structure of the echinococcus withthe cysticercus he considers to be complete, and proposes for itthe name. of cysticercus pedunculatus. The paper was accom-panied by upwards of forty well-executed figures, drawn to ascale.

Dr. BUDD referred to the frequency of the echinococcus inhydatid tumours. He had invariably found these animalculea inthe hydatids removed from sheep, and was able to bear testimonyto the accuracy of Mr. Wilson’s description of them. He hadlately read, in a work by M. Liroi, that the echinococcus wasinvariably fonnd in hydatid tumours, and that it was the cause ofthe hydatids. This gentleman had examined eight hundredhydatid tumours, and found that these animalculoa were presentin every instance. He (Dr. Budd) had examined seven speci-mens of hydatids, which had been for many years in the museumat King’s College. In some of these, he had difficulty in findingthe animalculae, but succeeded, at last, in discovering the teeth ofthese beings, the teeth being the last part of the animal to decay.In two of the hydatid tumours no animalculae were found; butthis was explained by the fact, that in one of these, the hydatidhad been expectorated, and having burst, its contents escaped; andin the other, the tumour had become inverted, and the echinococcihad been washed away. It was curious that the animalculea werethe same in the hydatid of both animals and men, although thehydatid of one floated in a cyst common to a number, while thehydatid of the animal was a simple cyst.

OBITUARY.DEATH OF DR. ABERCROMBIE.

IT is with great regret that we announce to the profession thedeath of Dr. John Abercrombie, which took place, suddenly, athis house, York-place, Edinburgh, on Thursday morning, No-vember 14th.

Dr. Abercrombie was the son of the late Rev. Mr. Abercrom-bie, one of the ministers of Aberdeen. He took his degree atEdinburgh on the 4th of June, 1803, writing for his Thesis, z6 J9efatuitate Alpina." After studying in London for six months, hebecame a fellow of the Royal College of Surgeons, Edinburgh,and settled in that city. At this period Drs. Gregory andMonro Saunders were in full practice as consulting physiciansDr. Abercrombie commenced as a general practitioner, but fromthe first he succeeded in gaining, to a remarkable extent, theconfidence of the public. His success is said to be owing to theassiduous attention he paid his patients. This he carried to anextent previously unknown, frequently visiting them three orfour times a day. His unusual success created many rivals andenemies: these he disarmed, and even ultimately convertedinto friends, by the inoffensiveness of his conduct, and frequentlyby practising the Christian doctrine he professed, of returninggood for evil. In 1808 he married a lady of considerable for.tune, which enabled him to keep his carriage. In 1806 he madehis first communication to our respected contemporary, theEdinburgh Medical and Surgical Journal, entitled, "A Caseof Cynanche Laryngea." It is inserted in the twelfth volume ofthat periodical. In the pages of its subsequent numbers he be-came a frequent contributor, and they will be found to containmost of the cases and observations, which he afterwards embo.died in his well-known works on the Pathology of the Brain andAbdominal Organs.On the death of Dr. Gregory, in 1821, he became a candidate


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