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peculiar habits induced by surgical ma.nipulations; second, a want of acquaint.ance with the condition of the living blad-der, especially whilst influenced by thepresence of calculi.There is nothing singular in the depend.

ence on the touch only which is observed inlithontritic operations ; for the obstetric sur-geon, in his manoeuvres, is equally deprivedof the assistance of sight. Indeed the educa.tion of the touch generally, is a subject ofso much importance in the practice of sur-gery, that a power of discrimination throughthis sense has been termed the tactus ertt-

ditus. The manipulation of these instru-ments, therefore, out of sight, is a taskthat may be easily mastered.

There is this peculiarity in almost all

surgical instruments, that they have no

moving property, except what they derivefrom the hand of the surgeon. The knifeand the forceps move in exact obedience tohis volition, and produce an effect no greater Ior less than that which he meditates. The I

importance of this circumstance may be con-ceived, when a tissue as fine as a spider’sweb under the knife, is the difference be-tween life and death to the patient. Theintervention of elasticity, or any other ec-centric mobile property, would materiallyincrease the difficulties of the case. The

surgeon’s hand is, therefore, not preparedimmediately to adapt itself to these se-

condary properties. The difficulty in ma-nocuvnng hthontritlc instruments appears tome to arise, if difficultv exist from their

possessing this property of elasticity. Amechanic would probably find less difficultyin ther management than a surgeon. The

knowledge of the anatomy of the bladder isusually derived from an examination of thedead organ. In the usual mode of showingthis organ, it is distended to the utmost,and consequently but one of its relationswith the surrounding parts is exhibited.In the living state, since the sides of theorgan exactly adapt themselves to its con-tents, its shape must constantly varyac-cording to the quantity of fluid it contains.While the organ is empty, it forms a disk

applied on the posterior aspect of the pubichone, and presents a concavity in that view.As it enlarges, its form varies according tocertain laws, which it is beside my pur-pose to specify.That rash attempts with these apparently

complicate instruments, without prelimi.nary practice, or a clear conception of thefield of action, should have been unsuccess-ful, cannot excite surprise.

At the conclusion of the lecture, Mr.Faraday came forward and made the usualaddress on the conclusion of the season.

He stated, that in consequence of the want

of patronage * the publication of the Journalof the Institution had been abandoned. Inother respects, he was happy to say the in-stitution was in a flourishing condition.The business of the evening was con-

cluded at the request of Mr. Edwards, bya demonstration of the action ofthelithon-tritic instruments upon real calculi, inwhich BARON HEURTELOUP exhibited suchtact and dexterity.

ST. GEORGE’S HOSPITAL.

CLINICAL REMARKS

MADE BY

MR. BRODIE.

May 31, 1832.

’ ABSCESS IN THE MEATUS AUDITORIUS.

A MAN was admitted with this abscess,arising from disease of the bone whichhad been caused by a blow, and a poul.tice has been applied to the part. Mr.Brodie said, that such an abscess fre-

quently arose from disease of the bone,and that disorganization frequently went onto a very great extent ; matter was formedbetween the dura mater and the bone ; themembranes of the brain became inftamed,anddeath was the result. " I once attended a

young gentleman," continued Mr. Brodie," who had always been from his earliest

youth remarkably dull and listless. He hada discharge from the ear, and as long’ asthat discharge continued things went on

very well. This discharge, however, oneday stopped ; he died’very soon after-

wards ; and on examining his body afterdeath, an abscess as large as an orange wasfound in one of the lobes of the cerebrum,and a small aperture through the temporalbone, leading to the meatus auditorius in-ternus, was also discovered, through whichthe matter had been discharged. This

aperture had been stopped up, and the pa-tient had died from the collection of matterpressing upon the brain. But such casesas this are rare ; one, however, somewhatsimilar to it has been in the hospital underthe care of Mr. Hawkins ; and after deathabscess in the brain was discovered."

25. Mr. Brodie examined this patientagain to-day ; and after probing the meatusexternus, to discover if there were anvdead bone, and where it was situated, hefound he could not detect any ; and said that

* We marvel at the use of such a word, on suchan occasion, by Mr. Faraday. He should havesaid, " in consequence of the want of sense dis-played by the public."—ED. L.

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he should not do anything further in the icase at present." You know, Gentlemen, that one of the

first rules of our art is to prevent futureand further mischief and danger; and if Imeddle any further with this case at pre- Isent, I may produce inflammation of the !,membranes of the brain, and the patient,may die. This man, too, has some bad

symptoms of mischief in the chest; andeven in patients who are in very goodhealth, I am very cautious how I meddlewith such a delicate organ. I confess I donot like to do anything in this case. I feelmore inclined to let this man wait andwatch the symptoms as they occur. Iknew a little girl who was in this hospital,and who had broken a piece of slate pencilin her ear ; inflammation of the membranesof the brain came on, and she died."A pupil here inquired, whether a foreign

body might not be extracted from themeatus externus by the suction force ofa syringe." Why, I do not know," replied Mr.

Brodie. 11 You know suction is nothingmore than the drawing off the atmosphericpressure from one part to have it appliedwith more force to another. If the foreignbody, whatever it may be, completely fillsup the passage, why then suction may do ; Ibut if the body is too small for this, -and Ilets the air pass by it, why then your suc-tion will be of no avail, and 1 do not knowthat it is a plan which 1 should recom-mend."The pupil said that he had known a a

case in which a glass head had got into theCM, and had been removed by a syringe ;and the gentleman in whose practice it hadoccurred, meant to follow the same .planwhenever any future case of the kind pre-sented itself to him.

After this digression the patient’s chestwas examined hv Dr. Hamson (who waspresent), and Mr. Brodie asked the Doctorwhether he had ever had an opportunity ofexamining the man’s chest.

Dr. Hamson replied 11 that he had, andthat in his opinion the man had incipienttubercles forming in the apex of the leftlung; for if you strike the upper and outerend of the clavicle of that side, you willfind a very different sound given out tothat which will result from striking theopposite clavicle in the same place."" But," remarked Mr. Brodie, somewhat

astonished, " Do you strike on the bone ofthe clavicle to ascertain the presence of dis- Iease in the chest."" Yes I do ! and," added Dr. Hamson,

* Mr. Brodie ought to have made some mentionof the far operation performed at St. BaLrtholo-mew’s by the " Little Cork Sparrow."—ED. L.

somewhat pointedly, " the wise laugh atit" (Mr. Brodie and several of the pupilswere smiling at the time*), 11 but it is onlya proof of their ignorance, for it is underthe outer prominence of the clavicle thatthe apex ot the lung is to be found,* and it

is there that the disease in this instance

exists. Pectoriloquism also over the mid-dle of the clavicle, and over the great ves-sels, will also frequently detect the pre-sence of disease."

I Mr. Brodie and Dr. Hamson now pro-ceeded toexamine the patient’s chest with

the stethoscope, and having fully satisfied‘ themselves of the presence of disease, the- man was sent back to his bed. and Mr.Brodie then made the foregoing remarksbn the case. The man has a pale phthi-sical appearance ; he ccmplains of greatpain in the situation of the intercostalmuscles when he coughs; he expecto-rates a great quantity of frothy pus and

mucus, and sweats profusely at night. Hewas ordered to be kept quiet, his bowels tobe kept gently open, and to take infusionof roses, with diluted sulphuric acid andsyrup in a draught. When ordering these

medicines, Mr. Brodie asked whether the‘ apothecary put syrup or sugar into themedicines ttdfHno* that be merely nrdpri-,d

it in this instance to cover the taste of theacid. lllr. Fernandez answered that theynever put in either one or the other, ercept itwas underlined iia guriting the prescription.In this instance the syrup was underlined,so that the poor man will stand a chance of

having it put into hie medicine.

Another instance of culpable neglect inhospital practice !Some few days since, Mr. Brodie, afte

dividing the sphincter muscle in a case orfistula in ano, ordered the patient to takethe sulphate of quinine. Upon visiting himsome days afterwards, Mr. Brodie seemedsurprised that the quinine had been of no

benefit to him, when the man handed downthe puper in which the pills were, and theywere found to be as hard as stones, and had

evidently been made up for some veeks past ;they were so hard, tlrat those he had takenhad in all probability passed through theintestines without being in the slightestdegree acted upon. Mr. Brodie imme-diately ordered the pills to be discontinued,and the quinine was prescribed in anotherform. Mr. Brodie said that he was once

consulted by a gentleman respecting an

intermittent affection, for which he pr6scribed quinine ; the gentleman had theprescription (pills) made up at Savory’s,yet he derived no benefit from the medi-

* Cruikshank only could have done justice tQthe scene that presented itself at this moment.

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cine, and on its being given in a different Iform, he recovered rapidly...Amongst the different officers connected

with the hospital, we find the followingvisiting apothecaries :—

E. A. Brande, Esq. John Nussey, Esq.H. P. Fuller, Esq. M.W. Andrews, Esq.

Apothecary (who resides in the house),Mr. Hutchins.

Assistant-apothecary (ditto), Mr. Hamil-ton.Now here are six gentlemen whose duty,

we presume, to be to see not only that thepatients are supplied with the medicinesordered for them by the physician or sur-geon in attendance, but also to see thatthose medicines are made up correctly—whether the different substances ordered inthe prescription be underlined or not; andif such be their duty, who will not say that Iin the above instances that duty has beenmost shamefully and disgracefully neglect-ed 1 What a miserable subterfuge is thisunderlining system-what a despicable ar-tifice to save the hospital funds at the ex-pense of a poor patient’s feelings. Outttpon all vile charity-mongers.

ABSCESSES IN THE LOINS.

" In opening such abscesses as these,"Mr. Brodie remarked, It Mr. Abernethyused to be very fearful of air getting intothem; for my own part, I open these ab-scesses in the same simple manner that Ido all others, and leave them to heal or toremain open just as the result may prove."

June ist, 1832.

MINERAL ACIDS.

In the case of the scrofulous disease ofthe ancle joint, which we adverted to in aformer number, Mr. Brodie asked Mr. Fer-nandez what medicines the man was taking.11 A pint (1) of infusion of roses, with onedrachm of diluted sulphuric acid everyday." ’ Oh ! but be careful not to increasethe dose of the acid beyond one drachm."" What benefit have you found to resultfrom giving large doses of the acid 1 askedDr. Hamson. Why I really never gaveit in large doses," answered Mr. Brodie;What I have ordered has generally beenthe nitric acid, and I do not know that Iplace much reliance upon that. In somecachectic or mercurial diseases, acid, theysay, is sometimes of benefit, but I cannot saythat I have ever lound any very good effectsto result from the use of it. 1 will tell youwhere I have found acid of very great ser-vice, and that is in cases of offensive, stink-ing, alkaline urine, where I have changedits character to acid by giving from tttxlv

j of nitric acid in the day. In one case

I recollect that it had this effect in twenty.four hours."

DISEASE OF THE LOWER JAW.

A man was admitted on Wednesday lastwith a tumour on the left side of the lower-

jaw. Mr. Brodie saw him to-day: thetumour burst and discharged before he cameto the hospital, and through the openingMr. Brodie believes he can detect diseased

bone with the probe. The last molar toothI but one being loose, Mr. Fernandez ex-tracted it. The body of the tooth wassound, but the fang appeared as if it hadbeen in contact with diseased bone. The

man’s health is good, but Mr. Brodie saidhe had known a case somewhat similar,which nevertheless had turned out to be

malignant.

TURPENTINE TN RHEUMATISM.

! "order the spirits of turpentine inrheumatism for a two-fold reason,-first forits local action on the part, and, secondlv,because I believe some portion of it is ab-sorbed, and does good in that way."

OLD CUSTOMS TO BE RESPECTED.

On examining a patient’s fractured leg,Mr. Brodie remarked to the house-surgeon,that there was no foot-board attached to the

junks to support the man’s foot. Mr. Fer-nandez said, that the man did not feel thewant of it theu. ° Oh, but that is no rea-son why he should not feel the want of ithereafter. In these cases the foot getstired, and cannot support itself, and, besides,its weight if not supported, tends to drawdown the bone, and thus prevents the re-union of the fracture ; further, you may hesure that there is always some good reason at thebottom of all these old rules and regwdations,and therefore they should not be departedfrom, except some equally good reason for sodoing can be assigned."FRACTURED RADIUS V. DISLOCATION OF

THE WRIST.

A man was admitted into the hospitalwith fracture of the radius just above thecarpus. Mr. Fernandez had put on twosplints and a bandage, and slung the pa-tient’s arm to his side in the usual manner.Mr. Brodie, however, took these off andsaid, " Gentlemen, this is a case of whatthey call dislocation of the wrist, and,

strange to say, books and authors of the

present day, even down to Sir AstleyCooper, still speak of dislocation of thewrist; now, for my own part, I never sawsuch a thing, nor do I think such a thingcan occur, for in the wrist the ligaments are

’ much stronger than the bones, and, there.

351

ore, where any force was used, the boneswould certainly give way first. :

Now I will show you the way in which’I do up these fractures; it is a plan too which1 have always followed with success. Yousee that here is one projection below, arising !from the dropping down of the fractured endof the radius, and here is another projec-tion above, of the carpus. Well, now, I put acompress above and below on each of these

projections, then I put a piece of strappingto each; the piece of strapping below Ifasten over the splint above, and the pieceof strapping above I fasten under the splintbelow, and thus steadily confine them, andI then put a roller over the whole. Whenthe man’s arm was thus put up, he ex-pressed himself much easier. "About ten

years ago," said Mr. Brodie, " a man cameinto the hospital, with a very severe acci-dent. I beiieve it was an injury of thehead, a compound fracture, or somethingof the kind. However, this man had twolarge bulging lumps, one above the wristand the other below the radius. On ex-

amining the body after death, I cut acrossthe muscles and tendons, and there I founda large quantity of extravasated blood ; anddown dropt the hand, and there was a frac-ture of the radius, just as in this case. Amedical gentleman once sent to me to say,that he had a ease of dislocated wrist,which he could not reduce, and from hisdescription I was led to believe, that it wasa subluxation. This patient died, and themedical gentleman examined the body ;and on opening the wrist, he found just sucha fracture of the radius as this."To some remarks from some of the pupils

who said they had seen a child’s wrist fre-quently dislocated, Mr. Brodie said, " thatsuch cases might be, but that he bad neverseen them;" adding, "Indeed, I believeDupuytren says he never saw one."

DISLOCATION OF THE METATARSAL BONE

OF THE GREAT-TOE—EXCISION OF THE

BONE.

A man was brought into the hospital afew days ago with a dislocation. Mr. Fer-nandez, who saw the case immediately,states that the bone was fixed trafM-iersely, and so firmlv that he could notmove it, and, therefore, he thought thatthe best practice he could adopt was to cutdoun on the bone, and take it out, which he

accordingly did. On illr. Brodie’s visitingthe man to-day, he said that he supposedfrom what Mr. Fernandez had said, that hecould do no other than he had done ; butthat the loss of the bone would prove a veryserious one to the man, as it would en.

tirely deprive him of the use of his great-toe, which was more used in walking than

all the others put together. Mr. Brodiehere asked Mr. Fernandez whether he hadleft behind any of the periosteum. Mr.Fernandez replied that he had, because on.this depends a great deal. If a portion ofthe periosteum be left behind, ossific mattermay be again deposited, or, at all events, aligamentous band may be formed similar tothat which is formed when a portion of the-lower jaw is excised. Let the man be keptquiet, and light dressings be applied to thewound. With reference to this case, wecannot help considering, that Mr. Fernan.dez’s treatment was somewhat too prompt,and that he should have paused before headopted the line of practice which he did.

He states that the bone was fixed firmlv, andcould not be moved, being bound tightlydown by the tendons, but we have heardnothing of how long a time elapsed fromthe period of the accident to the man’s ad-mission to the hospital. Of course Mr.Fernandez would amputate a dislocatedthumb or thigh, if, in either case, he were tofail in his attempt at reduction.

BIRMINGHAM SCHOOL OFMEDICINE.

ANNIVERSARY DINNER AND DISTRIBUTION

OF PRIZES.

TtiE public anatomical examination ofthe students of this school, conducted byBransby Cooper, Esq., was held on the 4thof June, and nearly all the medical men ofthe town and several strangers, including-Sir E. E. Wilmot, Bart. and Sir C. Throg-morton, Bart., were present. On the same*

day the anniversary dinner, given by thestudents to the lecturers, took place at

Dee’s Royal Hotel, and was attended byupwards of sixty students and friends tothe institution. Dr. E. Johnstone presided,supported by Sir E. Wilmot, Bart., B.Cooper, Esq., Drs. Hasting, Conolly, Johnand James Johnstone, J. W. Unett, Esq.,the Lecturers, and numerous professiona1Jmen from the adjacent districts. EdwardTownsend Cox, Esq., officiated as vice-

president. During the evening the follow-ing prizes were awarded. The Johnstoniamprize of ten guineas, by Drs. Pearson,Eccles, and W. S. Cox, Esq. to Mr. Wilkes;the prize of five guineas, offered by E. T.Cox, Esq., was adjudged by Sir A. Cooperto Mr. Hammond, alsoAnatomy-B. COOPER, Esq., Examiner.

. lst Silver Medal—Mr. Walton.2nd ditto-Mr. Vaux.Materto Medica-Dr. CONOLLY, Exam,.lst Silver Medal—Mr. Wilmott.

’ 2nd ditto—Mr. Taylor.