-No. 7.] LONDON, SUNDAY, NOVEMBER 16, 1823.

SURGICAL LECTURESDELIVERED BY

SIR ASTLEY COOPER, BART.

CNo Lecture on Monday, in con-sequence of its being Lord

:&bgr;;fnyor’s Day.]

Theatre, St. Thomas’s Hospital,WEDNESDAY EVENING,

Nov. 11, 1823.

. LECTURE ELEVENTH.

WE have endeavoured to de-

scribe to you the first mode in

which the union of wounds takes

place, and the mode of filling upthe cavities, namely, by the pro-cess of adhesion. We shall now

proceed to consider the other modeof union between divided parts ofthe body, namely, that by GRAN1:-LATION ; for the two modes which

nature institutes for the purposeof filling up the cavities of the

body for the cure of wounds areadhesion and granulation. If you

are asked for a definition of theterm granulation, you will saythat a granulation is a newly-formed substance, generally redin colour, and having the powerof secreting pus. The mode in

which a granulation is produced,is as follows:-You will find it

very similar to adhesion, but dif-

ering from that process in one

respect. When an abscess has

been opened, or when a woundhas been produced, if the abscessbe not immediately closed, or ifthe edges of the wound have notbeen brought together, inflamma-tion is excited, and this inflam-

mation occasions an effusion of

the fibrine of the blood upon thesurface of the wound. This fibrine

is poured out in a layer whichcovers the surface of the wound.

The layer of fibrine soon becomesvascular, for blood-vessels, which

are elongations of the vasa vaso-rum, are forced by the action ofthe heart into the layer which hasbeen deposited, and this layer con-sequently becomes vascular. The

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difference between the mode of abscess are brought together byunion by adhesion and by granu- passing a roller round it, we maylation, is, that in the latter the often prevent the future formationvessels shoot to the surface of the of matter, as I have before had

layer which has been thrown out, occasion to explain to you. But

terminating by open mouths on if the union by adhesion does notthe surface of the newly-formed take place, then granulations aresubstance, and secreting pus at formed in the following manner:the same time that a layer of When fibrine is poured out theves.lymph, or fibrine, as it is more sels shoot up to its surface, permeatecorrectly termed, is effused. The the newly-formed substance, andfibrine which is poured out, be- terminate by open mouths on thesides this purulent secretion from surface of the layer. This layerthe vessels, forms a second layer; becomes the means of filling up ainto which the vessels shoot as be- portion of the cavity ; it is soon

fore. The vessels supporting the succeeded by another; the vesselsfirst layer are the means of sup- become elongated, effuse matter

porting the second layer, where on the surface, and shoot up asthe vessels terminate as before by before to the second layer of

open mouths on the surface of the fibrine. In this manner one layersubstance effused In this manner after another is formed until the

layer after layer is formed until cavity of the wound is entirely,the cavity becomes filled.. filled. The vessels shooting intoThe characters by which gra- granulations are very numer-

nulations are distinguished are ous ; they are principally arteries.these : their surfaces are uneven; If you inject an ulcer of the leg,they are generally red in colour, the great degree of vascularity inand they secrete matter. I know the granulating surfaces is aè.

not whether you have followed counted for by the number of ves-me or not, but this process may sels divided into radiated branches,be easily explained. Suppose which we see entering the granula.we open an abscess; the result tions, and producing the arbore-is that adhesive inflammation is scent appearance, which is ob-

produced in the internal sur- served in them. In examining theface of the cavity. A layer of structure of granulations, they ap-adhesive matter is in this way pear to become vascular in the

thrown out, and if the sides of the following manner <---An artery en-

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ters at the base of the granula- and the fluid conveyed by the vet-tion, and is then divided into ra- sels is partly converted into pusdiated branches ; from these ves- on the surface of the ulcer, andsels pus is secreted, and an incrus- partly returned back to the heart.tation is formed producing a layer Granulations are not good ab-of adhesive matter on the surface sorbent surfaces in ulcers recentlyof the granulations. This is a formed; but if the ulcers have

little difficult to conceive ; it is existed for any length of time, thea circumstance which, I believe, absorbent vessels readily take intohas never been observed, and the system any substance whichwhich I learnt in the following may be applied to them. In this

manner. I took a, portion of way we frequently see persons

injected ulcer from the arm, and salivated by the use of injectionsthrew it into alcohol, in order of the oxymuriate of mercury. It

to observe its vascalarity. After is not an uncommon practice toit was thrown into the alcohol it inject a solution of a grain or twowas so opaque on the surface that grains of oxymuriate of mercuryno blood vessels could be seen. It into sinusesy for the purpose ofis the fibrous matter therefore co- stimulating the vessels. If the

vering the surface of the granula- sinus has existed for a considera-tions which receives the blood ves- ble time, the oxymuriate of mer-sels. In this view a granulation cury is frequently absorbed, andmay be considered as a gland, the mouth becomes affected in theand the surface of an ulcer merely same manner as if the mercuryas a glandular surface. Now a had been absorbed into the systemgland is a part of the body in by rubbing it into the skin, or tak-which a secretion from the ex- ing it into the stomach. This provestremities of the arteries takes that old granulating surfaces bareplace, and the blood, which is not the power of taking in by absorptionemployed in the secretion, is re- a fluid of this description. I haveturned to the heart by means of known what is commonly calledthe veins that accompany the ar- the black wash, which is com-

teries. So in granulations; the posed of the liquor calcis, and thearteries throw a quantity of blood submuriate of mercury, when ap-near the surface of the wound, plied to the surface of ulcersand there secrete pus. There is a produce an effect upon the mouthveiu accompanying each artery, in persons who are easily affected

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by mercury. I believe that the the use of the solution. The ap.wash of the liquor calcis- and plication was continued; the paincalomel often produces good ef- in the stomach became excessivefects in the cure of sores, by the convulsive tremors of the musclesmercurial action which it excites succeeded ; and the patient died.in the system, and not merely I was quite sure that he died fromby its local effects on the sore to the influence of arsenic in thewhich it is applied. Ulcers are, system ; and upon examination ofhowever, frequently the means of the body after death, I found theproducing baneful effects upon stomach in the highest degreethe constitution, , by the readiness inflamed, and exhibiting the peeu.with which they absorb any sub- liar appearance which is pro-stances which are applied to duced by arsenic, and not by poi-them. Thus, arsenic applied to sons generally. I believe, there-the surfaces of sores is very fre- fore, that this person died from the

quently absorbed into the system; application of the arsenical soln-and on this account, arsenic is to tion. Quacks are in the habit-ofbe regarded as a very dangerous destroying tumours of the bretexternal remedy. With respect to by the use of arsenic. Womenthe use of arsenic as an internal are sometimes, though very rarely,remedy, it ought never to be em- foolish (a laugh) ; and they, willployed without extreme caution, undergo any torture which is’notand unless the patient is watched inflicted by a knife, rather thanfrom day to day. submit to an operation that

I remember a case in the other would not give them a tenth partHospital, of a patient, who was of the pain which they ’sutril’brought in with a fungus of the from such applications. They goeye, and who was under the to a person who tells them of the

care of Mr. Lucas, a man of number of cures he has performedgreat skill in his profession, and by means of a specific used .forthe father of the present Surgeon the purpose of destroying scifof that name. Mr. Lucas ordered rhous affections; and, indeed, thesea solution of arsenic to be applied Quacks very frequently destroy.to the part. After it had been used the scirrhous part, and thepa-for three days the man complained tient too. Mr. Pollard, the sur-of pain in the stomach, but this geon, told me, the other day,’ ofwas not supposed to arise from a person in town, who applied

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an arsenical preparation for a reason of the convexity of his

scirrhous affection of the breast, shins ; he was persuaded, in short,in consequence of which the pa- that his bow shins stood between

tient died in less than a week. I him and his preferment. Under

had myself occasion lately to per- this impression, he went to a veryform an operation for a scirrhous noted person in this town, and

breast, to which arsenic had been showing him his bone, (a lau!Jlt)applied. I asked the woman which said to him, "Pray, Sir, do yougave her most pain, the applica- think you can make my legstion of the arsenical preparation, straight? " "Sir," said the Doc-or the operation. She replied tor, I think I can; if you will

that the pain of the operation was take a lodging in my neighbour-not so great as that of the appli- hood, I think I can scrape down

cation, and that the arsenic had your shins, and make them as

been applied ten or eleven times. straight as any man’s." A lodg-The consequence of these applica- ing was taken ; the father of thetions is that they become absorbed patient assisted in the operation,into the system, and produce de- and all three of them, the father,rangement of the stomach, the the son, and the doctor, took aintestinal canal, and the nervous turn in scraping down the convexsystem, and sometimes paralysis. shins. A great deal of raspingWhile I am on this subject, I will was required ; an incision of verymention a case to you which oc- considerable extent was made in

curred in this town, and which I the shin, the integument was turn-should have scarcely believed, if’ ed aside, and an instrument whichit had not come within my own was at that time contained in the

knowledge. A person in this metro- surgeon’s case, called a rougee,polis happened to have bow shins. was employed to scrape the shin

A part of his duties was to teach bone. When the doctor was tiredladies to draw and paint, and in of rasping, the father took a spell,the prosecution of’ this branch of’ and the patient, in his turn, re-his profession, he found his bow lieved his father. ’At last the

shins, as he himself declared to shell of the bone became so

me, a very great evil (’l laigh). thin, that the doctor said theyHe felt that his merits were less must proceed no further with thatfairly appreciated, and his in- leg. The other leg was then

struction3 less kindly received, by rasped in a similar manner, and

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thus large wounds were produced hazard’of his life, to have his legsin both of the shin bones. The sur- made a little straighter. He re-

faces granulated very kindly, and plied that he would (a lauglt) ; ;very little exfoliation of the bones and under these circumstances Itook place; but unluckily the gra- was of opinion, that, as the youngnulations would form bone, so that man was content, it was a folly toup jumped the bones of the shin think of prosecuting the doctor.

again (much laughter). The Doc- The patient in this case, appear.tor, however, was resolyed not ed to be as great a fool as theto be d,efeated, and accordingly doctor whom he consulted, and

put a layer, of arsenic over the deserved to be punished for hiswhole surface. It was in con- folly. I have no wish to injuresequence of the effects of’ this individuals; and I shall not,application, that I saw the patient. therefore, mention the name of theThe arsenic was absorbed into the operator. Some time has elapsedsystem, and he became paralytic since the case occurred, and thein his arms and lower extremities. transaction is now almost buried

A great number of exfoliatlons in oblivion. One of the partiestook place in his legs ; and he is since dead; not the person,showed me a large box, in which however, who underwent the ope.the exfoliated portions of bone ration, for he still lives, and is

were contained. I recommended proud of his improved legs.him to go into the country, and Opium, when applied to the

he went to Bath, where he surfaces of sores, is very readilystayed for some time, and got rid of absorbed into the system. I believehis paralysis. This case made a that it is often a very useful ap.

good deal’of noise in town ; and plication to the surfaces of sores.there were some surgeons who I mentioned, on another occasion,-expressed a strong wish to prose- a, case in which a tetanic affection

cute the doctor. I recommended was produced in a child, whosethem, however, not to take any leg had been amputated by Mr.steps until I had seen the patient Lucas, the present surgeon of

himself; and when he next came Guy’s, and where the applicationto me, I asked him whether he of opium to the stump gave morethought his legs improved, and immediate relief than I ever re-whether he would again undergo member to have witnessed. It

the same operation, at a similar relieved the spasms, and, as I

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believe, saved the child. If opi- have touched him, he will sayum, applied to the surface of ’No;’ but if you apply the probesores, be absorbed into the system, to the edge, or neaw the edge ofit produces excessive costiveness, the wound, he will feel it. Granu-

extreme pain in the head, and lations, therefore, springing fromtorpor of’ the system, which is only ; bone in an uninflamed state of theto be removed by the frequent bone, are not sensitive. Granu-

administration of active purga- lations, however, which springtives. The effects on the consti- from the cancellated structure of

tution, when absorbed from the the bones, are, sometimes, ex-

surface of sores, are very much tremely sensitive. I have at pre-the same as when it is introduced sent, a patient who had a com-into the stomach. pound fracture of the leg; the

Granulations possess nerves as fracture was attended with abs-

well as arteries,veins and absorbent cess, and a small exfoliation of

vessels. Granulations are some- the bone took place. In this case,times extremely sensitive ; but when a probe was put down intothis is far from being the case in the cavity, the granulations fromall granulations. We shudder at the cancellated structure of the

seeing a person handle a sore bone were extremely sensitive.

roughly, supposing that it must When the inflammation passes

give the patient extreme pain. away, the sensibility of the partGranulations which spring from is diminished. The same thingparts endued with great sensibi- happens with respect to granula-lity, such as muscles, are indeed tions (springing from tendons, asextremely sensitive; but many the tendo acbillis, for instance,)granulations, such, for instance, which are entirely insensible. So

as arise from bones, have no granulations arising from fascia

sensibility whatever. If ul- and the aponeurosis of muscles areceration be produced to a con- endued with little sensibility. In

siderable extent in an exposed general, therefore, although gra-bone of the head, a probe may be nulations springing from partsput into it, while the patient is possessed of great sensibility, arequite insensible of your touching sometimes exquisitely sensitive;his head. If you do this in the those arising from parts in a greatgranulations arising from bones, degree insensible, or entirely so,and ask the patient whether you as tendons, are not sensitive. ; a

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circumstance, which you cannot of granulations, by bringing theat any time go round a large hos- surfaces of which together with

pital without,-having an opportu- adhesive plaster, a wound whichoity of witnessing. would otherwise require weeks in

Granulations are very readily healing will be healed in a veryunhed to each other. The mode short time. It was upon this prin-in which union is effected, is, by ciple, namely, that of bringingbringing the edges of the two together the granulating surfaces,granulating surfaces together, so that Mr. Baynton proceeded withas to produce the adhesive pro- so much success in the treatment

cess. The surface of the granu- of ulcers ; so that our hospitals arelations will be covered by adhe- now much less filled than theysive matter, and you have only to formerly were with those oppro-apply the two surfaces to each bria of our art.

other to produce an union. The The next subject to which I

knowledge of this principle is very shall direct your attention is the

often useful in the pratice of sur- closing of sores by CICATRIZA-

gery. A man has a considerable TION. The formation of new

portion of the scalp raised from the skin with which a sore is co-

skull, and the percranium throws vered over is called Cicatriza-

out granulations, whilst the raised tion, which is produced in the fol-portion of scalp is also granu- lowing manner. The vessels at

lating. Instead of waiting for the edge of the skin form ganula-the tedious process of the union tions, and these granulations uniteof both surfaces, by granula- with the granulations of the sur-tions filling the cavity, you have face of the sore. The granula-only to place one portion of’ tions produced from the edge pro-the granulations upon the other, ceed towards the centre, and thosebind them well down with adhe- on the edge inosculate with thosesive plaster, and they will be sure on the surface of the sore, and areto inosculate. In this manner, a united by the adhesive process.surface, which it would otherwise The vessels become elongatedhave taken a long time to close, from the edge of the sore, and pro-will be healed in a few days. ceed in radii from the circumfe-

The cavity-of the scrotum, after rence to the centre. Day after dayremoval of the testicles, is often an addition is thus made to the

covered with a great number cicatrix, until at last the vessels

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reach the centre from every part vascular ; but when it has existedof the circumference ; when the for any length of time, the bloodprocess of cicatrization is com- vessels become contracted, and itpleted. It may be said by some is whiter than the original skin.persons that this is not the only, Hence the white appearance ofmode which nature takes for the the cicatrices after small-pox; for,formation of new skin, for that it although they are more vascularoften happens that the process of than the original skin, when firstcicatrization commences from the formed, in a little time they losecentre of the sore. If these per- this vascularity, and are enduedsons mean to say that insulated with less living power than theportions of skin are sometimes surrounding parts.seen in the centre of sores having The readiness with which theno communication with its edges, surface of a sore is covered in bythere can be no doubt of this fact. cicatrization, depends very muchBut how does this happen ? 2 It is on its form. A sore of a circular

not that the centre of the sore has form, requires a very consider-

the power of forming new skin, able time before it will heal ;but the new skin in the centre whereas a sore of much greateris produced in consequence of length, but of less diameter, willthe whole of the skin not hav- heal more quickly. You may al-

ing been ulcerated away, and gra- ways pronounce, therefore, that anulations arising from the part of round sore will be longer in

the skin which was left. This healing than a longitudinal one,only happens in irregularly formed c&aelig;teris paribus, as for example, insores, where the healing process the same patient, where the con-has gone on to the centre and then stitution is the same. The reason

the sore has broken out in the cir- is, that the vessels have to elon-cumference. If granulations arise gate much less from the edge tofrom any portion of skin in the the centre in a longitudinal, thancentre, these granulations produce in a circular sore. The form of

new skin, and an insulated portion the sore, therefore, has an influ-of skin is produced forming a ence on the readiness with whichpart of’ the cicatrix, which is not cicatrization takes place. Sores

afterwards ulcerated away. are very often difficult to heal

When a cicatrix is formed, in from their situation. Thus, if athe first instance it is extremely sore be situated at the back of

226

the leg, there will be often great to any of you. Deformities of

difficulty in healing it.. Indeed this kind generally arise after thesuch a sore can only be healed process of healing is completed;by raising the heel, and so loosen- they are the effects of the con.

ing the skin, in order to give it a traction of the cicatrices, and not

power of being drawn in to form of the-contraction of the sliin at

a new cicatrix. By this means the time of the accident. Here

the vessels are more. readily elon- the skin is contracted so as to

gated, and continually draw the pull down the chin, and evert theskin nearer the centre of the sore. lip, so that the saliva runs overIt appears, then, that the form the surface of the breast, and isand situation of the sore, have a constantly excoriating it. All

very considerable influence on these results proceed, not fromthe healing power. the production of the new skin,

Here Sir Astley exhibited to but from the contraction of the

the class, a model in plaster, cicatrices after the production. I

which had been placed on the say this from having seen, amongtable-previously to the commence- many other cases of the kind, thement of the Lecture, representing case of a child, who was a shortthe case of a patient who had been time since admitted into Guy’s.severely burnt, and in which ex- In consequence of the contractiontensive deformity had supervened of the cicatrices the upper armon the cicatrization of the wounds. adhered to the fore-arm, and theThe chin had become united to thumb was drawn back so as to.

the breast, the arms to the sides, be immovably joined to the upperand the upper arm to the fore-arm. arm. (A drawing of this case byNow, said Sir Astley, in look- Mr. Girome was exhibited to theing at a case like this, some of class.)you might be induced to exclaim, I will mention another case ofHow abominabty inattentive must this kind. Some time ago, a

the medical man have been who young gentleman, who was play-had the care of this patient, for ing with fire-works, happened toall these consequences might have be slightly burnt in the forehead.been prevented. If you said this, His father, who was a very intel-

your censure would be culpable; ligent man, showed considerable

you have no right to say so ; for anxiety, and expressed his appre-it is a case which might happen hensions at the time that some

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horrible deformity would - arise keeping the head back,the contrac-from this accident; for he had tion will ultimately be the same.himself witnessed instances in There are some parts of the body,which the eye-brows had been however, in which deformities of

drawn up, so that the patient had this kind may be removed ; as inno power of closing his eyes from cases in which the thigh is united toa similar cause. Granulations, the abdomen ; where the bridle

however, very soon arose on the may be divided, and the joint af-surface of the forehead ; the sore terwards straightened ; but wherehealed kindly, and the father was the bridle is broad, as under the

delighted to see what he supposed chin, no operation will avail.to be the favourable termination In the formation of cicatrices

of the case. Some time after, the original parts may all be re-however, I saw this gentleman, produced, except two. In the

and upon inquiring after the child first place, new skin, though dif-he told me that he was very well, fering somewhat in texture andbut that a horrible deformity had smoothness, is still a substance

ensued from the accident; the similar to the original skin. Skin

eye-brows were drawn up, the may be defined to be a substance

eye-lids elevated, and the fore- producing rete mucosum and cu-head was quite wrinkled. This ticle. Are both produced by thetook place a few weeks after the newly formed skin Undoubtedly.healing of the sore, in consequence The cuticle is produced veryof the contraction of the cicatrix ; quickly ; and with respect to theand unfortunately this was a de- rete mucosum or covering matterformity incapable of’ being reme- of the skin, a little time elapsesdied by any means which art before it is produced; but it is pro-could suggest. I have never seen duced, as the following fact willa case like that represented in the show :-The new skin of a Negroplaster bust on the table, where does not become white as in Euro-

the chin is united to the breast, peans, but is at first red, andwhich was capable of being cured. after a little time turns blacker

You may, by putting a knife be- than the original skin. I was

hind the bridle and dividing it, struck with this in the other Ilos-

separate the chin to a consider- pital, in the case of a Negro,able extent from the breast; but who had been a sailor in a priva-whatever force you may use for teer, and had received several

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wounds in many parts of his body. an ingenious experiment with re-I observed that the cicatrices were spect to the union of nerves. Heevery where blacker than the ori- divided the par vagum, or eighthginal skin. We may conclude pair of nerves, in a dog, on onetherefore, that the skin which is side, and then let the animal live

reproduced is true skin; that the for some time ; he then divided

cuticle is very quickly reproduced, the par vagum on the oppositeand the rete mucosum after a short side, and after suffering both

period. The cellular membrane nerves to unite, he then dividedis also reproduced, though it has them at the same moment, whenat first the appearance of a solid the animal died.

fibrous mass which requires some In tic douloureux, after the ope-time before it is drawn into the re- ration of dividing the nerve, eventicular texture, similar to the ori- when the sensibility of the part toginal membrane. Tendons are which the nerve was distributed

very easily reproduced.. If the is not entirely restored, and al-

tendo achillis be divided in an though numbness still remains inanimal, it will be reproduced in the cheek, the painful sensation

about a fortnight or three weeks; will still return. An old gen-but it will be somewhat larger than tleman, from Bury, in Sufolli,the original tendon. The same had undergone the operation ofthing takes place in the human the division of the nerve for

subject; as you may see from a tic douloureux several times.

specimen in our Museum of a When he came last to me there

tendo achillis which had been re- was still a little numbness re-

produced, and which is larger than maining in the lip, yet the painthe original tendon. Every body of the tic douloureux was’ as

knows that bones are reproduced ; great as ever. I divided the

not only the shell of the bone, but nerve, but the operation didthe cancellated structure; not only not afford him the same reliefthe salt or phosphate of lime, but as before. He came againthe cartilaginous substance in some months after, and wished

which it is deposited. Nerves are the nerve to be again divided.

also reproduced, but there is some The pain in the part had returnedlittle doubt whether they assist atall to its former degree, although’in the restoration of sensation by the numbness of the lip was muchanastomosis. Dr. Haighton made greater than before.

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The parts of the body which arenot reproduced, are first, muscles.In the case of a man who had a scar

in the fore-arm, which appeared Ito have long existed, I found, thatinstead. of muscular fibre under

it, a tendinous structure hadformed. A muscle, when divided,’ [’unites by tendon, and not by mus- cle. Secondly, the cartilages ofthe ribs unite by bone, and not bycartilage. (Sir Astley exhibitedto the class a specimen of car-tilage of the human rib, whichhad been divided, and in whichossific union had taken place.)This, however, will depend in

some measure on the age of the

person ; for in very young sub-

jects cartilaginous union will be

produced, but in subjects moreadvanced in years, the cartilagesof the ribs invariably unite bybone.

To the Editor of the Lancet.

SIR,&mdash;Having been a constantreader of your work since itscommencement, and feeling con-vinced of the good etfects whichsuch a publication must pro-duce, I have ventured to ad-dress you upon a subject deeplyinteresting to those by whom,from its nature, I presume it is

principally supported, viz. theFaculty. In Volume I. No. 5,1 observe a letter signed &laquo; Juve-

nis." The nuisance of which hecomplains, no one certainty candeny or justify; but the remedvhe prescribes, it is plain, wouldbe quite ineffectual. What, forinstance, is to prevent the personwho writes over his door = Sur-geon, Apothecary, or Medical’Practitioner," from adding the word &deg; Authorised ! ’’ In fact, Imuch doubt if many who couldrightly make that addition, are

justly entitled to the distinction.Of Surgery I know nothing,

and consequently am unable to

form an opinion of any man’s pre-tensions. With the other branchesof the profession, however, fromthe nature of my occupation, I amin constant intercourse ; and cer-tainly do, in the course of my ex-perience, meet with some splendidinstances of consummate igno-rance. The circumstance to

which I wish particularly to callyour attention, is the frequentoccurrence of accidents arisingfrom the improper application or

administration of medicines. Weall know that an error will some-times occur, from the common

frailtv of humanitv ; it is unavoid-able; and in common charity mustbe forgiven. I am convinced,however, that errors do very fre-quently occur from a cause, theforgiveness of which would requirethe exercise of an uncommon

charity-I mean, from the igno-rance of the dispenser. No onewill wonder at the frequency ofthese accidents, who is capable ofexamining the chemical and phar-macuetical knowledge of thoseengaged in this branch of the pro-fession. The increase within thelast few years is enormous, the

liability to accidents is of coursein the same ratio ; and yet I will

230

venture to assert, that there arevery few who have an adequateknowledge of chemistry (which isessentially necessary), and verymany whose pretensions merelyconsist in a knowledge of the,labels on their bottles. The onlyremedy that I could suggest forthis evil would now be attendedwith too cruel consequences for

present application ; and I am

only astonished that it has been suf-fered to continue so long. Anothercause which I shall venture to

point out, to which these accidentsare sometimes attributable, willadmit of a very easy remedy;and a slight hint to certain supe-riors of the profession may proba-bly have the effect, in some mea-sure, of checking its increasingprevalency. It arises from whatshall take leave to call " pro-fessional puppyism," viz. makingan- ostentatious display of theirown acquirements by the use ofscientific terms, to the great an-noyance and discomfiture of theapothecary and retail druggist,and the imminent risk of their

patient’s life. I can assure them,that, to the generality of thisclass of’ persons, the present no-menclature is almost unknown;and that such names as protoxides,duetoxides and peroxides, per-chlorides and protochlorides, per-sulphates, ssibpersulphates, and

protosulphates, imposing as theymay appear, are as unintelligibleas though their prescriptions werewritten in Greek or Hebrew. Itwill be useless to argue that per-sons in such situations ought tohave knowledge and abilities com-petent to the duties of their pro-fession ; it is well known that theyhave not: the consequence is ob-vious; and any man would rather

hazard the detection of an error,than acknowledge his own igno.rance. With this knowledge,then, the responsibility, if any beincurred, rests with the physician.It is too serious a matter that a

person’s health, or perhaps life,should be endangered or sacri.

ficed, to gratify vanity and aeec-tation.

Should you think this worthyof insertion, I shall take theliberty of pointing out some othermaladies, in which the applicationof The Lancet might be veryuseful: With my earnest wishesfor the success of your under-taking, I am,

Your obedient Servant,ANTI-STAILL.

MEDICAL AND SURGICALINTELLIGENCE.

METEOROLOGICALSOCIETY.

ON the 15th ult. a meeting washeld at the London Tavern Cof-fee-house, Ludgate-hill, to takeinto consideration the proprietyof forming a Meteorological So-ciety. Among the gentlemen pre-sent were Drs. Clutterbuck, Shear-man, Armstrong, Copland, &c.&c. The chair was taken by Dr.Birkbeck, several resolutions wereagreed to, and the Meeting ad-journed to the 12th of November,to meet at the same place andhour.On Wednesday last, Nov. 12,

the second Meeting of this Societywas held, which was attended byseveral individuals of eminence inthe- profession, and others distin-guished for their attainments in