770

an operation which I still hold to be essen-;tially had.Remarks of M. Blandin, and Replies of

M. Lisfranc.M. BLANDIN prefaced his attack by

some observations on his peculiar attach-ment to anatomy, which was the reason,said he, of attacking M. Lisfranc on thatground, in preference to any other. Therewere a few anatomical points in the thesisto which he could not assent. Thus, indescribing the anatomical structure of thearteries, you say the middle coat is com- posed of spiral fibres. I deny that thefibres are disposed like the spring of a

suspender; I have examined the structureof the arteries with great care, and havealways found the fibres transverse, mak-ing only one turn round the vessel, so thatyou could separate them from one anotherwithout rupture.M. LISFRANC.—There is a great differ- I

ence between anatomists on this point. Iknow that some deny the spiral form, butmost authors describe them as being alittle oblique, and I agree in this opinion.M. BLANDIN.—After having quoted

several modern anatomists of high repu-tation who agree with him, observed thatin page 38 he found another anatomicalerror. In speaking of compression on thebrachial artery, you advise it to be em-ployed as low down as possible, to avoidthe compression of the radial nerve. NowI say there is not the slightest danger ofcompressing the radial nerve even in themiddle of the arm; your observation iscorrect for the median nerve, but not atall so for the radial.

M. LISFRANC begged that words wouldnot be put into his mouth which did notbelong to him ; he never spoke of the ra-dial nerve, but of the orbital; he hopedhe knew the position of the radial nerveas well as M. Blandin, and when he spokeof compression low down to avoid thenerve, he did not mean to say the nervewas there, but that by compressing highup, it might be injured. ,

After this followed a long discussion onthe treatment of a wounded vessel.

1B1. LISFRANC says he would tie bothends, " when the artery is not very deep."M. BLANDIN insisted that he should

have added, " when I can tell exactlywhat vessel bleeds," for if the surgeoncannot precisely determine the vessel, heought to tie the main trunk, and cited as

a proof a wound of the neck.M. LISFRANC then cited other cases in

opposition, and attacked M. Blandin’spractice in this case as bad.As we have remarked, the concours will

yet occapy a little more of our space.

THE LANCET.

London, Saturday, Aug. 23, 1834.

SOME of our contemporaries have stated,with becoming gravity, that the Chairmanof the Medical Committee presented to

the House of Commons, on Wednesdayweek, the report of the Committee, on theevidence which has been elicited relative

to the state of medical education and

practice in the British dominions. An

extract taken from the Parliamentary re-cord of a daily newspaper, inserted at

page 735 of the last LANCET, may, from: the construction of one of its sentences,

have led to a similar. inference. The

exercise of a little reflection, however,must have convinced our readers, that itwas not possible for the Committee to re-port on the evidence so early as Wednes-day last,-the day, in fact, on which the

sittings of the Committee were concluded.What actually passed in the House was

this: The Chairman stated that the sit-

tings of the Committee having been neces-

sarily protracted until that day, the Com-mittee had not been enabled to preparetheir report on the evidence. The Com-

mittee having, then, recommended that theminutes of evidence still in manuscriptshould be printed, a motion to that effectwas carried, nem. con. It is necessary that

we should publish this explanation, in

order, first, to relieve the minds of the

profession from a suspicion that the Com-mittee, after carrying through such a la-borious inquiry, had formed a hasty, and,consequently, an imperfect report; and,secondly, to remove any impression thatthe House of Commons would wilfullywithhold, for a single hour, any informa-tion which might be likely to afford satis-

faction to such an influential body of men

as the members of the medical profession.When the importance of the inquiry is

771RE-APPEARANCE OF THE MALIGNANT CHOLERA.

sufficiently considered, and when the great profession with the best means of formingobject sought to be obtained by the inves- an opinion as to the mode in which the

tigation is kept in view, it must be regard- inquiry has been conducted, and the exed as a fortunate circumstance that the tent to which it has been carried. Further,Chairman of the Committee will not be it may be advantageous as well as satis-.called on to furnish his report until some factory to let them know, without delay,months have elapsed. The mass of evi- the unceremonious grinding to which

dence which that gentleman will have to certain Presidents and other official par-

scrutinize, is one of prodigious extent, ties have been subjected. In the next

occupying, possibly, not less than a thou- LANCET we shall begin by exhibiting asand folio pages of print. few of the contortions of the eel-backed

If the inferences which may be deduced Baronet.

from such an immense assemblage of facts _ -

are to be made with effect, it will be ne-

cessary to arrange the testimony of the AT length we are compelled to abandon

witnesses into classes,-to draw compari- the silence we have hitherto maintained

sons with respect to the Universities,-to relative to the renewed outbreak of malig-institute contrasts between the hospitals nant cholera in this metropolis, and inand the Universities, and between the various parts of the country.

capabilities of public and private schools, When it was reported that the disease- to present a summary of the anomalies had made its appearance in London in the

which arise from the present defective autumn of 1831, we ascertained by actualconstruction of medical statutes,-to ex- observation that the report had facts to

pose, with a bold hand, the acts of injus- sustain it, before we gave publicity to thetice which have been perpetrated by the terrifying announcement in the pages ofmedical corporations,—and, having thus this Journal. Having satisfied ourselveslaid bare the deformities and corruptions by an actual inspection of the sick, that

of past and present systems, the Chairman, the cholera of India, or a disease exactlyaided and supported by the Committee, resembling it in its effects and generalwill be required to recommend to the symptoms, if not in its remote cause, hadHouse and to the country the principles attacked a portion of the inhabitants ofand details of a scheme of medical govern- this metropolis, we hesitated not to warnment which will prove equally conducive the public of such an occurrence, and

to the security of the public health, and to urge the profession to make everythe honour and protection of the members effort to check the course of the distem-

of the medical profession. per, and we admonished the Government

While Mr. WARBURTON is thus patrio- to adopt those sanatory arrangements

tically and benevolently labouring for the which experience and reason indicated aspublic welfare, the minds of the profession the best means of protecting health. At

may in some measure be beneficially pre- first we encountered no small portion ofpared for exercising a sound judgment on ! obloquy because we dared to publishthe report, by being made acquainted from the truth on the subject. It was perti-time to time with some of the items fur-, naciously denied that any new disease hadnished in the minutes of evidence taken made its appearance in London; and thenbefore the Committee. We shall now, it was contended that if a fatal disease,then, occasionally turn over the leaves of unknown in past times, had really brokenour reporter’s note-book, and furnish the out amongst us, it was not the cholera of

772 RE-APPEARANCE OF THE MALIGNANT CHOLERA

India. Unfortunately, however, the state- sible form, and left no doubt on the mindments which we at first published, and of the beholder that the malady wasiden-from time to time repeated, received a I tical with the malignant cholera of India.melancholy confirmation in the fatal events Virulent as is the pestilence in the heartof every day. When it was no longer of London, it has been remarked that it is

possible to deny the existence of the dis- not less so in the suburbs of the metropo-ease,-when it was no longer possible, lis; and its fatal effects have been expe-without the most unblushing effrontery, rienced in villages, ten and twelve milesto allege that it was not that direful disease from town, which have been long cele.which had slain its hundreds of thousands brated for their salubrity.in India, then was the public attention As heretofore, this frightful disease is nocalled to the question of contagion, and respecter of persons. It has attacked the

the ravages of the malady were, for a high and the low, the rich and the poor,

time, almost concealed from the public, by the overfed and the underfed, the infirmthe veil which several heartless disputants and the robust, the aged and the young.endeavoured to throw over its supposed As it has alike visited the houses of the no-causes. Ibility, and penetrated the workhouses andWithout, at this time, resuming the sub- jails, selecting its victims as well in theject of quarantine further than to state most airy, open, and apparently healthyour firm belief, that no restrictions which situations, as in the darkest courts, alleys,may be imposed upon common intercourse, and cellars ; no sound or satisfactory in-connected with trade, can prevent the ference can be drawn as to those circum-

spread of this dreadful malady, whose stances which govern its movements orpoison, there seems much reason to be- I influence its visitations.lieve, floats in the air,—without again In this state of uncertainty and bewil-

taking up the question regarding the derment relative to the primitive sourcescontagiousness of cholera, or its com- of the disease, we are bound to be go-municability from man to man,-we find verned in our conduct by those facts

ourselves called upon, as journalists, to which we do understand, and which

record the fact, that the malignant cholera have already furnished to us amplehas again broken out in London and dif- means of admonition. Instead, therefore,ferent parts of the empire, and with a de- of engaging in controversies which, fromgree of virulence which was unprecedented the existence of prejudices, can scarcelyin the two previous pestilential visitations.. be guided to any beneficial result, weThat the attacks are not so numerous as ought, as men of sense and prudence, toduring the worst periods of 1832, is true; seize whatever advantage our experiencebut it is remarked by all who have had an of the disease has already furnished, andopportunity of noticing or treating the employ it unhesitatingly and boldly fordisease, that the violence of its onset has, the benefit of the afflicted.unless opposed by a form of treatment Already, then, has it been proved thatto which we shall presently advert, been we ought to avoid at a time like this everytoo terrific to admit of resistance by the occurrence which is likely to lead to a de-powers of the human constitution. In the rangement of the health. But it is of es-

numerous cases which have fallen under pecial importance that the most scrupu-the notice of private practitioners of our lous care should be. observed in the selec-

acquaintance, the disease, almost from the tion of our daily food,-that those sub-first moment, has assumed the worst pos- stances should be avoided which are crude

773

and indigestible, which produce flatulenceand uneasiness of the stomach, or gripingsof the intestines. At the same time a

careful abstinence should be maintainedwith respect to the drinking of fermentedliquors. We notice this circumstance be-cause it has been observed in many very

many instances, that after a looseness of

the bowels has existed for some days,cholera in its worst form has suddenlymade its appearance, and carried off its

victims in a few hours. Not to mention

other instances it may be stated that a

wholesale stationer of opulence and re-

spectability, after having been the sub-

ject of an unheeded diarrhoea for two orthree days, lately experienced an attackof cholera, and although he was suffi-

ciently well to walk from his private resi-dence in Buckingham-street, Adelphi, tohis place of business in the city in the

morning, he was a corpse in his counting-house in the afternoon. So dreadfully se- vere were the spasms, and so sudden the

death, that time was not allowed to re-move the patient to a bed, or even to takeoff his clothes. Had the premonitorysymptoms which characterized the caseof this gentleman, received that due shareof attention which their importance de-manded at a threatening epoch like this,he might at this moment have been aliveand in good health, but until an hour ortwo of his death, he obstinately refusedwhatever assistance it was in the powerof medical skill to afford. In other placesfour, five, and six persons, attacked in one

dwelling, equally negligent or thought-less, have delayed applying for medicaladvice, until, alas ! medicine could be 01

no avail. At Camberwell, last week, in E

single house, of five persons attacked

four expired within a very brief periodand the following passage, extracted frorra letter which was published in The Time,of Thursday, will show that in one dwelling in the densely-populated neighbour

hood of Clare-market, within one hundred

yards of this office, the disease has been

equally violent and fatal. The letter is

from Mr. F. SnoBERL, Jun., of No. 4,Leicester-street, Leicester-square .-

" The following circumstances, to theaccuracy of which I can bear witness, oc-curred within the last few days :—A woman, who lodged at the Old King’s-arms,ill Houghton-street, Clare-market, died.The disease was pronounced to be the trueAsiatic cholera. Nevertheless, it excitedno alarm in the house, and no precaution.was taken to prevent its further influence.A woman who had some clothes to washfrom the house was attacked soon after

washing them. The next case was Mrs.

Spraggs, the landlady, who, after eating ahearty supper, was seized, and died in the

’ course of 48 hours. Soon after, a compo-sitor, named Hulme, in my employ, wholodged in the house, was likewise attacked.All these cases occurred within a few

- hours of one another; all the patientswere similarly affected, all had everysymptom of the malignant blue cholera,

and in all alike the disorder terminated

. fatally."Here, again, four individuals perished

in one house, and in the ca e of the wash-erwoman it certainly would appear thatthe disease had been communicated bycontagion or infection. Let us, however,turn from this sad and gloomy picture toone of a more gratifying character.We have seen that the disease is most

violent in its attacks, most fatal in its

effects. Experience has taught us, then,that we should avoid all the excitingcauses of the malady, and, amongstothers, none with a more rigid or pru-dential care than indigestible or unwhole-some food, avoiding strong drinks as poi-son, and giving the preference, whenever

there is the opportunity, to home-brewedbeer, rather than to the acid compound

called "porteu," which is sold by the greati brewers. In all things, at a crisis like

this, frugality is enjoined. But should we

be incapable, by precautionary measures,of warding off the disease, what is thento be done ? On this point-viz. that ofthe treatment of cholera, we refer with

774

feelings of infinite satisfaction to the com-munication of Mr. BEAMAN, inserted at

page 754 of this week’s LANCET. The

concurrent testimony of all practitionerswith whom we have conversed on the

subject, the evidence of many authors of

eminence who have written on malignantcholera, stand recorded in favour of treat-

ing the disease by emetics. Accordingly,many practitioners, observing the de-

cidedly good effects which have resultedeither from the ejection of noxious mat-ters from the stomach, or from the power=ful efforts made by the stomach and mus-cles to discharge such matters, have la-

boured with praiseworthy zeal to dis-

cover what medicine would act the most

speedily as an emetic in attacks of cho-lera. Various have been the remediesrecommended with this view, and, amongstothers, one of the earliest that was em-

ployed, was the common culinary salt in astate of solution. An incidental reference

to the utility of this remedy was madeat the London Medical Society when thedisease first appeared in this country. It

was adverted to on various occasions

afterwards, but from some cause it ap-

pears to have fallen into disuse, or only tohave been rendered a valuable remedial

agent in the hands of a few practitioners.Of late again we have heard it men-

tioned in terms of the highest commenda-

tion, and these circumstances combinedtend to stamp the communication of Mr.BEAMAN as one of the most importantthat has been made connected with the

treatment of malignant cholera. To those

of our readers who are unacquainted withthe professional character of Mr. BEAMANit may be necessary to state, that he is ascientific practitioner, a lover of his pro-fession, and a most honourable man,-agentleman, in fact, on whose testimonythe most implicit confidence may be re-

posed. If there were no other evidence

but that of this eminent surgeon, relative

to the eflicacy of ’Balt emetics in the worst,- observe, the worst-cases of cholera,we should be content on his recommenda.

tion alone to announce it as a remedydeserving of a general trial by the mem-bers of the faculty ; but as we read andhear that it has also been successful in the

hands of other practitioners, thus givingan ample confirmation of the testimony ofMr. BEAMAN, we take this the first sa-

tisfactory opportunity of advising that it

should be employed in every case whereit appears to be demanded. Let it be

given as prescribed by Mr. BEAMAN; letit be administered in the worst cases, for

while there is life there is hope. The ob.

ject, be it remembered, is to produceenergetic vomiting as quickly as possible.Hence the dose of the solution should be

repeated at brief intervals, in order thatthat object may be accomplished.In making trial of this remedy, we must

entreat our professional brethren to notedown the results of their practice, andfurnish us with the particulars at the ear-liest opportunity. We do not ask for long

detailed cases, which would require muchtime in the concoction. A communica-

tion of the leading facts will be sufficientto answer every good public purpose, andwe do hope and believe that there is nolegally-qualified medical practitioner in

the empire who will conceal from the pro-fession what may be the results of this

or any other remedy that may be em-

ployed by him in the treatment of sucha dreadful disease as the malignant cho-lera.

! THE EDINBURGH WITNESSES.

! (From our Edinburgh Correspondent.)’ WE have been all kept alive here on thesubject of " medical reform " since the

return of the witnesses, and it is quiteevident, from all I can see and learn, thatthey consider, to use a homely expression,that the " game is up." Perhaps you are not

775

aware that but few of these witnesses were I

summoned by the Committee. Drs. ABER-

CRO1fBY and CHRISTISON were the onlypaid men; Drs. M’LAGAN, THOMSONjun., and BazLmGar.L, went as amateurs,or, rather, as emissaries, to support themonopolists and corruptionists. As I re- B’marked to you before, nothing of any con-.sequence was elicited from the craftyABERCROMBiE. Dr. CHRISTISON de-

fended, powerfully, the indefensible part ofthe University, but Dr. ALISON was toohonest and single-minded to make anystand in favour of corruption, and the" liberals " had the satisfaction of seeinghim break down.

Dr. BRIGGs, of St. Andrew’s, is under-stood to have made a strong impression infavour of the rights and privileges of thatUniversity, and candidly stated that he andhis professional brethren there had never’been interfered with or molested by theMedical Faculty of the Edinburgh Uni-versity, as long as they sold degrees cheap,and could produce some good certificates"of London manufacture ; but wheneverthe price was advanced at all, and anexamination of the candidates was required,then came forward the Edinburgh junto,conceiving their personal interests to bein danger, and endeavoured to throw odiumon the St. Andrew’s degree.

Dr. ROBERTSON, one of our privateteachers, and one of the examiners of theSt. Andrew’s faculty, disgorged some im-portant information. He detailed, in par-ticular, the whole system of chair-makingin the Edinburgh University, which wasfirst laid bare to public view in the pagesof your Journal, and when the undisputedtalents of Dr. JOHN THOMSON, in intrigueand chair-making, were denounced to theCommittee, Hogarth would have found inJOHN’S son’s countenance, I am told,ample occupation for his pencil.

’

Dr. SHANKEY’S appearance was made as

that of a vol2cnteer, and the corrupt objectof his mission rendered his examination

truly contemptible. Dr. PooLE, the sonof our old hotel-keeper, was sent up towait upon Mr. WARBURTON, and givehim an account of the College of Phy-sicians ; he is said to have given no intel-ligible or direct answers, and, so far, dex-terously performed the duties of his

metropolitan visit. Enough, however,was squeezed out of the learned doctor toshow that the College of Physicians hereis even at a lower ehb than is the vene-rable institution in Pall Mall East, andthat scarcely any persons belong to it

but the professors of the University, andthe accoucheurs, one and all, of auld

I Reekie.

REFUSAL OF A PHYSICIAN OF GUY’SHOSPITAL TO VISIT A SICK PUPIL,SINCE DECEASED FROM CHOLERA.

7o the Editor of THE LANCET.

SIR,—Your valuable pages having al.

ways been open for the exposition ofabuses of all kinds relating to the medicalprofession, I trust that the observations

, which I am about to make may not be

deemed unworthy of a small space in yourensuing Number.

On Sunday afternoon, Mr. Tanner, apupil of Guy’s Hospital, was seized withincipient symptoms of cholera. Two gen-tlemen, pupils of the Hospital, remainedwith him at his request throughout theevening, during which time he becamegradually worse. At about 11 o’clock heexpressed a wish that Dr. Back’s* adviceshould be obtained. Accordingly, one ofthe gentlemen immediately proceeded tothe Doctor’s house, which was certainlynot more than five minutes’ walk from theresidence of the patient. He sent up a

message by a servant to the followingeffect, namely,-that a pupil of Guy’sHospital was taken ill with cholera, andwished to obtain his advice. The gentle-man heard this message delivered by theservant to the Dr. when what was his sur-

prise to receive in answer to his messagethe following courteous reply from theDoctor:—" That he (Dr. B.) would notcome, as he made it a rule never to visitafter dark !" The gentleman went backand stated the Doctor’s reply to Mr.Tanner, who, after a short time hadelapsed, expressed a desire that Dr. Brightshould be sent for. The other gentlemantherefore immediately proceeded to thewest end of the town, where the residenceof the Doctor is situated, who, the momenthe heard of the case, came down with allpossible celerity. Notwithstanding all hisefforts, however, the unfortunate youngman expired at 1 o’clock on the ensuingmorning (Monday).

*Dr. BACK is one of the phys.cians of Guy’sHospital.—ED. L. a