377

THE LANCET.

London, Saturday, December 9, 1837.

THE BAYONET-WOUND CASE.

THERE are few persons, save those on

whom devolves the noble, the painful, dutyof administering to the wants and necessi-ties of the sick-poor, who are in a positionto appreciate duly the immense influence

which is exercised by the humane, diligent,and skilful surgeon, over the well-being ofthe unfortunate individuals who are en-

trusted to his charge, as contrasted with theeffects of carelessness, cold-heartedness,or ignorance, of their medical attendant.

The patient who can afford to pay hand-

soinely, as the phrase runs, for the servicesof a physician or a surgeon, is sure to obtain

prompt and efficient medical aid, while self-interest, the most potent of all stimuli, com-pels the attending practitioner to assume at

. least a semblance of humanity and of in-

terest for the well-being of his patient ; in

public or hospital practice the relations

which exist between the medical man and

the individual whose life is placed in his

hands, are essentially of a different nature.The destitute inhabitant of an hospital hasno gold to give in exchange for services

which may be rendered ; he offers no pros-pect of future patronage to the person who

may be the means of restoring him to health;his friendless and abandoned condition is

little calculated to excite the sympathy ofthose in whom the kindly feelings of humannature have been blunted by an inordinatedesire of worldly advancement, and should he

perish through neglect or mismanagement,the history of his sufferings, were it not forthe existence of THE LANCET, would be buriedwith him in the tomb. It is, therefore, thebounden duty of those under whom the

direction or administration of hospitalsor other public medical charities is, for thetime being, placed, to watch, with vigilanteyes, the conduct of all officers whom theymay appoint to such institutions ; to stimu-

late the zeal of the lukewarm, reprove the

negligent, punish the guilty, and by a Srm,uncompromising exercise of the vast powerswhich they have assumecl, ensure efficientaid to the suffering poor who confidinglythrow themselves on them for protection.

In all parts of civilised Europe, save inthe United Kingdom of Great Britain andIreland, the duty of providing medical

assistance for the sick-poor, is amply ful-filled by the executive Government, in theestablishment of public hospitals, suppoi tedat the expense of the community.

In Great Britain, subject as it now is to

the Poor Law Amendment Act, a semblanceof provision is made for the sick-poor, bythe appropriation of a sum of money whichadmits of about a mite per head beingannually paid for medical attendance on pan-pers, medicines included. This bountifulexpenditure of the public money, is, how-ever, not quite adequate to meet the neces-sities of a population which is peculiarlyexposed to the exciting causes of disease,and to accidents; hence the necessity, in

large cities more especially, of calling uponprivate charity to supply that medical aidto the destitute sick which’should have been

provided by the executive Government ofthe country, were that Government impressedwith a proper sense of its duty. We freelyand cheerfully admit that the voice of suffer-ing humanity has not been raised in vain.

The medical institutions of Great Britain

which are, in part or exclusively, supportedby the contributions of humane individuals,are not inferior in number, or in intrinsic

wealth, to any similar establishments in Eu-rope. Indeed, we may affirm, without fear ofcontradiction, that a much larger amount ofmoney is voluntarily subscribed by charita-ble persons in England, for the purpose of

supplying medical and surgical aid to the

poor, than that which is raised by taxationfor the support of public or, as they mightbe termed, state hospitals in any kingdomthroughout Europe. What we complain ofis, that these vast sums of money do not

produce one-half of the good which would

378 IN11t. SAMUEL COOPER AND

result from their expenditure under a well- i

directed system of administration ; whatwe deprecate is, the method of appointing ’,medical men to hospitals universally adoptedthroughout the British empire ; what we

demand is, some mode of organisation bywhich a responsibility for plans devised,and for acts committed, shall fall upon someindividual or body of individuals. As affairsare now conducted, we look in vain for morethan a pretence of responsibility ; yet the

slightest knowledge of human nature teachesus, that even the most virtuously-disposedmen are led astray by the opportunity of

exercising unlimited power.Public opinion can act but iiiellicieiitly

towards correcting the abuses which resultfrom the mal-administration of our hospi-tals, because the otlicers of those establish-ments, aided by connivance or supinenesson the part of the" governors," generallycontrive to escape the ordeal of publicexposure on occasions when their conduct

loudly demands investigation. Such an ex-

posure, however, is the only remedy thatwe at present possess, and, as independentmedical journalists, we have never ceased,nor shall we cease, to bring to light, andcomment upon, such abuses, connected withmedical affairs, as may come within our

cognizance. It were, undoubtedly, a far

more easy task to live in peace with all

men, to win the favour and approbation ofthe corrupt, by unmerited adulation and

praise; but, fortunately, Nature has deniedus an instinct for the pursuit of these occu-pations.The lamentable case of punctured wound,

which recently occurred at the UniversityCollege Hospital, is one of those which we

have felt it to be our duty to submit to theconsideration of the profession and the pub-lic. It is prolific of questions of vast im-portance ; hence we shall expose it, fromtime to time, to the public gaze, and in so

doing never omit to require from Mr.SAMUEL CoopER, who did not see his patient ’,until eleven hours after he was admittedinto the hospital, a justification of his i

public professional conduct upon thatoe-casion.

Mr. CoorFr, we understand, is stung byour remarks ; we are glad of it; but his

agony, we suspect, will he less severe thanwas that of his unfortunate patient.Mr. COOPER, we are further told, com-

plains that he has been treated unjustly byus, because we preferred founding our com-ments on some parts of the transaction

alluded to, upon the statements of an eye-

witness, instead of publishing a report takenfrom the books of the hospital, and eluci-dated by observations which this unfortu-

nate surgeon had delivered in the form of a

clinical lecture. He shall now be gratifiedto his heart’s content. Ah, SAMUEL, fromthine own lips will we now convict thee.But first, we beg to remind the profession,and,the thinking and humane portion of thepublic, what are our allegations against thisunfortunate surgeon, in relation to his treat-

ment of his still more unfortunate patient.They stand thus :-

1st. That a man, having a dreadfullysevere bayonet-wound of the abdomen, wasadmitted into University College Hospital,under the care of Mr. SAMUEL COOPER, oneof the surgeons of that establishment, be-

tween the hours of eleven and twelve o’clock

at night, and that the patient was not seenby the said Mr. SAMUEL CooPFR until a fewhours before his death.

2nd. That the patient, during the brief

space of his existence, manifested symptomsof strangulated intestine, which escaped therecognition of the surgeon in attendance.

3rd. That after the decease of the patient,when a post-mortem examination had been

instituted, a strangulated portion of intes-tine was found lodged in the wound whichhad been made by the bayonet through the

parietes of the abdomen.4th. That Mr. COOPER was not present

at the coroner’s inquest which was held onthe body of the slaughtered patient, andthus th.e responsibility of the case, appa-rently, fell upon another individual.Keeping these grounds of complaint in

379HIS BAYONET-WOUND CASE.

remembrance, we entreat of the professionto read, as attentively as their astonishmentand indignation will allow, Mr. SAMUEL

COOPER’S defence of his own conduct ; andwe also entreat the students of UniversityCollege to recollect that their Professor of

Surgery, the said SAMUEL COOPER, has beenguilty of the impertinence and temerity of

accusing us, ex cathedhâ, of an injusticetowards him, in not publishing the reportwhich we now print, and of not making that

report the foundation of such comments

as we had to offer on the case of the

miserable and unfortunate JAMES CHAPLIN.

To this charge we might easily answer,first, that we did not see the reportuntil after the first articles on the bayonet-wound case had been printed; and, secondly,that we know hospital surgeons too well toplace any great reliance on their own ac- i

counts of unfortunate cases. We now, how-

ever, publish the report of the clinical

lecture alluded to, exactly as it has reached

us, merely observing, that it was actuallycopiedfi-om notes which were furnished to our

reporter by Mr. SAMUEL COOPER himself.

UNIVERSITY COLLEGE HOSPITAL.

Penetrating Bayonet-wound of the Abdomen." In a clinical lecture, delivered early in

November, on the case of James Chaplin,Mr. Cooper observed, that the patient, agedtwenty-six, was admitted October lith,under his care. He was a shoemaker, andhaving received a wound from a bayonet, ina scuffle with a soldier, at half-past nineo’clock, was brought to the hospital at half-past eleven at night, prior to which he hadbeen seen by a surgeon, who applied a coiii-press over the wound. On admission hewas in a collapsed state, face pale andanxious, surface cold, pulse small. A ci1’.

cular elastic swelling was discovered in thelower part of the abdomen, about two inchesabove the middle of Poupart’s ligament; inthe centre of it was a punctured wound, ofhalf an inch in length, and at the bottom ofit a shining membrane, supposed to be intes-

tine, was seen. There was no discharge ofany kind from the wound. The man con-tinued in the same state until one o’clock,when the pulse began, to rise, but again

sank on the commencement of severe uml

constant vomiting of bilious matter, uccornlrzt-rriecl by tenderness of the epigastrium. Two

clysters were administered ; the first was

retained, the second came away with somefmcal matter, and, as was stated, a smallquantity of blood.

" Oct. 12. The vorraitirz; and collapse con-tinue. Twenty minims of the liquor opiisedativus were given, and fomentations em-ployed. Death took place at a quarter pasteleven, P.M." When he (Mr. C.) first saw the patient

in the forenoon of the day following that ofhis admission, he found the external wound,which was very narrow, closed up, and asoft swelling behind it, which, on gentlepressure being made, slowly and graduallyreturned, as if it consisted, at least in part,of some effused fluid, either intestinal matteror blood, or air within the bowel. He wasnot THEN (itilai-e that anything like intestinehad been seen, in the first instance, at the bot-tom of thc wound, and inferred that the

swelling chiefly arose from blood, or otherfluid, passing through the wound, and get-ting under the skin. The man had been ina state of collapse, with a pulse hardly per-ceptible, and a pallid, cadaverous counte-nance from the first. This condition never

ceased, and implied the wound of some im-portant organ, with or without effusion ofblood, or other matter, into the cavity of theabdomen. Had the prostration of the sys-tem and pale anxious countenance been theresult of mental alarm, they would not havelasted so long. Sickness and vomiting arecommon in wounds of the alimentary canal,and also in cases of extravasation of blood.He was afraid of exhibiting any active pur-gative, lest there should be a wound of thebowels; hence the confined state of the

bowels, and the sickness during the shorttime the man lived, threw but little light onthe question, whether any portion of bowelreally protruded, and was strangulated inthe wound. Under these circumstances,and being convinced that there was effusioneither of blood, or intestinal matter, into theabdomen, he did not divide the skin, beingunwilling to disturb the wound, or to lessenthe chance of the effusion being boundedby the adhesive inflammation, if it hap-pened to be restricted to the vicinity of thewound.

" The body of the patient was examined

380 MR. SAMUEL COOPER AND

thirty hours after death. An incision was

nlade through the parietes of the abdomen,from the umbilicus to each crista ilii, andthe flap, including the wounded portion, re-Nectpd downwards. The cavitv of the abilo-men, thus exposed, was found extensivelyoccupied by effused blood, which amountedperhaps, altogether to three cr four pints.The intestines and peritoneum were highlyvascular, and lymph was poured out, so asto render the bowels adherent to one an.other. A portion of small intestine pro-truded into the wound, and was so pinched,or strangulated in it, that when air was blowninto it for the purpose of ascertaining whetherthere was a woxod in the protruded part, noneof it passed the stricture. The protrudedportion was pierced through by a woundabout half an inch in length. In the pro-

gress of dissection a wound in the rectum, Iand one in a branch of the internal iliac

vein, were detected, from which last vesselthe extravasation of blood had proceeded.Mr. Tayloe was of opinion, that only theserous and muscular coats of the rectum were

pierced, but some other gentlemen suspectedthat the mucous coat was also penetrated.If blood were discharged with the clyster,as the nurse affirmed to have been the case,the wound of the rectum would account forit. This patient, then, died principally fromthe effects of the wound of the intestine, ofcopious extravasation of Llood into the ab-domen, and of the entangled state of the bowelin the wound. But if this had been relieveddeath must have resulted from the perito-nitis, the inevitable consequence of so greatan effusion into the cavity of the peri-toneum.

" The case was particularly instructive,because it raised the question, what oughtto he done where there was any doubt of a

protrusion of the intestine. To this he (Mr.Cooper) would answer, that if the symptomswere such as only justified a suspicion, ittvoiild be advisable to divide the skin, andascertain the fact.

" In the first place, if effused intestinalmatter formed the tumonr under the skin,the making an opening might be useful, asaffording an outlet for the effused matter,and thus lessening the chance of its gettinginto the cavity of the peritoneum.Secondly. If the swelling arose from

blood, as he believed it did partly on themorning of the 12th, when gentle and con-

tinned pressure made it gradually return, themaking Gf an opening, though not called

for in relation to this kind of effusion,would not increase the patient’.} danger.

" Thirdly. But, if the tumour arose froma protrusion of intestine, and strangulationof it, unaccompanied by profase extravasa-tion, or other fatal mischief, the division ofthe skin, and the reduction of such piece ofbowel, with or without dilating the openingfor its easy return, WOULD then be the pro-ceeding urgently indicate, and without

which all chance of recorery would be out

of the question. In one case, as there was a

copious and diffused extravasation, and thepatient’s doom was sealed by it, the defecti7t the diagnosis, and the omission to reliere thewounded and pinched piece of intestine, madeno difference in the result. But, under othercircumstances, the omissiott would have beena very serious one, leaving the patient nochance of recovery. This case affords one

consolation, which is, that it is fraught withvaluable instruction, such as will enable allof us to undertake the management of suchan accident in future, with a full determina-tion to leave no important indication unful-filled, and in the event of doubt about in-

testinal protrusion, to make an incision onthe grounds and for the reasons which havebeen already explained. The parts (saidMr. Cooper), exactly in the state in which

they were found, are here upon the table.Ycu see the very close stricture on the fold ofthe bowel, and that the portion external tothe opening in the muscles, is quite emptyand flaccid. It proves that the air origi-nally in it must have been pressed back

again into the intestinal canal. There was

some appearance of extravasation aroundthe puncture beneath the integuments, whileclose behind it, within the abdomen, lay agood deal of blood. Now, previously tothe wound in the muscles being closed upby the effects of inflammation, did any partof this blood escape through the track ofthe bayonet, and get beneath the skin,whence it was made to return by the pres-sure employed ? Either this, or the returnof the contents of the bowel, must havehappened, for the swelling on the morningof the 12th subsided almost entirely undervery moderate pressure. You may inquirewhy bleeding was not resorted to. The

answer is, that the collapse in which the

patient remained, with cold skin, and a

381HIS BAYONET-WOUND CASE.

pulse scarcely perceptible, forbade this

measure, so essential in all cases of abdo-minal inflammation, under ordinary circum-stances. As the case was further compli-cated with a wound of the strangulatedpiece of intestine, if the stricture had been

dilated, the injured part of the intestineshould have been kept near the externalwound, in order that any of its contents

which happened to become extravasated,might pass outwards, and not be diffusedinto the peritoneal cavity. The various cir-cumstances of this complicated case left theman no chance of recovery under any treat-

ment."

There! Was an act of self-condemna-

tion ever more complete ? Beyond this con-fession of Mr. SAMUEL CoopER’s ignoranceof practical surgery,-beyond this broad

and distinct confession of his own ignorance,no evidence can be required.Our readers are now in a condition to

decide, from evidence, which even a personof Mr. SAMUEL COOPER’s character will not

be disposed to dispute, how completely we

were justified in bringing against that indi-vidual the several charges which we enume-rated in recent numbers of this Journal. ’’

To the accusation of having left a danger-ously wounded man without surgical aid

for more than twelve hours, Mr. SAMUELCOOPER does not respond one syllable. Heis necessarily silent on the subject of thatneglect.The fact of the intestine having been

strangulated, and the inevitable conse- quence of such strangulation, the presenceof well-known symptoms, are abundantlydemonstrated by the words of llr. SAMUELCOOPER himself,—which we have marked initnlics in order to supersede the necessityof casting, by comments of our own, addi-tional disgrace on so silly and weak-mindeda personage.The absence of Mr. SAMUEL COOPER from

the inquest was one mark of good feelingevinced by him throughout this unhappyand memorable an’air. He was probablyunwilling to look the dead man in the face,and, through respect for this contrition we

shall here simply remark, that it was the

bounden duty of the coroner to call for

such evidence as was most likely to throw

light upon the real cause of poor JAMES

CHAPLIN’s death, and not to receive the tes-

timony of an irresponsible person instead ofthe evidence of the principal.The only question, then, upon which I.Ir.

SAMUEL CooPrat and ourselves are at iseic,relates to the quantity of blood effused intothe cavity of the peritoneum. Mr. COOPER

states it to have amounted to from three to

four pints. We, on the other hand, havebeen informed by persons on whose obser-vation and credibility we place the highestreliance, that the quantity of effused bloodwas much less. Now, without dwellingon the respective value of iatteresled and dis-intenested testimony, we may advert to theimprobability of such a copious effusion ofblood co-existing with rapidly-excited andvioleitt inflammation of the peritoneal liningof the intestines. Such an effect is infinitelymore consonant with the idea of effusion of

fcecal matter, or strangulation of the intestine.The former did not exist in the case of

CHAPLIN, and we leave it to our professionalreaders to determine whether reduction of

the calibre of a gut to such a degree as to

pl’el’ent ereit tlte passage of air, affords, or

not, pretty conclusive evidence of the exist-ence of strangulation.But the most curious and instructive part

of Mr. SAMUEL COOPER’S own report, now

published by us, is to be found in the con-

cluding paragraphs, in which the treatmentand complications of penetrating wounds ofthe abdomen are laid down with consider-

able care and precision. Mr. COOPER evi-

dently betook himself, (iftei- the loss of his

patient, to his study, and there the ingeniouscompiler concocted a " clinical lecture "

from his own " Dictionary," ia the same

way that the " Dictionary" itself was coil-cocted from the writings of the illustriousdead. Would that he had shown the same

diligence at the bedside of his patient; butthe mind of Mr. SAMUEL COOPER is evidentlymore adapted for the contemplation of an-

382 MR. COOPER AND I-IIS LATE PATIENT.

cienthistories, and antiquated theories, thanfor the purposes of practical surgery. Thus

accurately are the indications relative to thecase of JAMES CHAPLIN, laid down in Mr.

SAMUEL COOPER’S own report. The various

complications of abdominal wounds are

carefully described, and the appropriatetreatment, under each circumstance, is

pointed out; but why did not Mr. SAMUELCOOPER put all this into practice at the bed-side of his patient ? " The case," says Mr.SAMUEL COOPER, " is fraught with valuable

" instruction, such as will enable all of us

to undertake the management of such an

" accident in future, with a full determina." tion to leave no important indication un-" fulfilled," &c. This determination is, no

doubt, very virtuously formed, but it can

afford hut a small degree of consolation tothe maIZes of the departed patient. We

strongly recommend Mr. SAMUEL COOPER to

lay aside this paulo-post-futurum surgery,and to fulfil the indications of each case

which may fall under his treatment, duringthe patient’s life.Mr. SAMUEL COOPER, we uuderstand, is

excited in a high degree, in consequence ofthe comments which we have thought it to

be our duty to offer on his conduct; and it is ’’

said that he has, since the appearance of our

strictures, abused THE LANCET in good setterms. We thank him. If he did not

smart it would be a proof that the lash hadnot been judiciously applied. As a publicculprit, exposure is, in this instance, a por-tion of the common fate of all persons who

are similarly circumstanced with himself.

Probably the relatives of the unfortunate

JAMES CTIAPLIN have feelings as well as

Mr. SAMUEL COOPER. Is their, cause of dis-

content less urgent,-is their agony of mindless poignant, than that of the surgeon who" would " have relieved the strangulated in-testine if he had known that such a thingexisted. The late JAMES CHAPLIN was ad-

mitted into the hospital between 11 and 12o’clock at night. This vigilant, assiduous?and sagacious surgeon saw him fbr the firsttime at about eleven o’clock on the following

day. But there was "collapse." What saysthe entry in the hospital books? What saysMr. SAMUEL CourER’s own report? Why,that at one period the pulse rose, but that,soon after, there was sickness, with a vomitingof bilious matter. Yes, " there was collapsefrom first to last," says Mr. SAMUEL COOPER.There were " pints of blood extravasated

"into the cavity of the abdomen." Yet,strange to say, the man could raise himselfin the bed, and, in a cheerful mood, puttinghis hand upon the tumour, remark, "care" not a straw if I get over this." Poor fellow !He felt the pang which the tightly-bound,severely-corded, gut produced. Oh, yes!There was vomiting of bilious matter, ac.

cording to the entry in the hospital books,-according, also, to Mr. SAMUEL COOPER’S

own report. Yes, there was a vomiting ofbilious matter. Why, whither could the

bile flow ? After having passed from its

ducts, where could it run, flowing, as it

did, over the excited membrane of an irri.

tated stomach and intestine? What course,we ask, could it take, if it did not escapefrom the body through the oesophagus?For Mr. SAMUEL COOPER himself tells us, in

his own report, that even air could not be

blown through the strangulated gut sotightly were the sides of the intestinal canalbound together by a stricture, which wasnot discovered until the ghost of JAMESCIJAPUN had become the witness of the sur-

geon’s want of sagacity.The reflections which such a case suggests

are too numerous, and too important, to berecorded hastily, or dismissed summarily.Discussions on subjects of this descriptionshould be maintained with patience and for.

bearance, and ought to be resumed, fre-

quently, for the benefit of students and

young practitioners. Even Mr. SAMUEL

COOPER is profiting by the lessons which wehave been, and are, inculcating; and, as weare charitably disposed, although we knowthat lie is not our friend, we shall returngood for evil, and render him, before he isdismissed from our service, fully competentto afford relief in instances of strangulated

383WOILLEZ ON DEFORMITIES OF THE CHESE.

intestine caused by protrusion and strictureof the gut in punctured wounds of the ab-domen.

We hope to be enabled to render Mr.

SAMUEL COOPER capable of looking his

dead men in the face.

Recherches sur la Valeur Diagnostique des

Déformations de la Poitrine, &c.On the Diagnostic Value of Deformities of the

Chest, produced by Diseases of the ThoracicOrgans. By E. J WOILLEZ. 4to. Paris.

Recherclaes sur kt Valeur Diagnostique des

Déformations de la Poitrine, &c.OM the Diagnostic Y’ulue of Deformities of the

Chest, produced by Disetises of the ThoracicOrgans, Hy E. J. WOILLEZ, 4to. faris.

IT has often struck us as peculiarly un-fortunate that the production of a printedthesis is not, in this country, included

amongst the qualifications essential for amedical degree. The only British school atwhich anything of the kind is required, as

far as we are aware, is that of the EdinburghUraiversity, and even there the demand isnominal only; for, in fact, from the Senatusnot requiring the thesis of candidates to bepresented in a printed form, this part of theacademical ordeal is given an air ot’ minorimportance, and few are willing to exert

themselves in order to produce what is, be-forehand, judged to be valueless. Why theprofessors of that school look on inauguralessays as of such trifling consequence weknow not ; but there seems amongst them adetermination to show that such is the case.Else why should the defence of thesis, ofwhich there is such high-sounding mention iin the University statutes, he so utterlycontemptible a form as it now unquestion-ably is? IVUy should the argumentationconsist, on the one hand, of a few half-intel-ligible phrases of praise or censure on thepart of a professor who, in many instances,gives evident proof of not having read thaton which he presumes to decide ; and, onthe other, of a few random words of replyfrom the candidate ? Why else should wehave to record a fact, of which we vouch forthe authenticity, that the comments of a

learned professor, on one of the essays laidbefore him last year 1836), were confinedto objections to the hand-writing of the

work,—certain eulogia on calligraphy, andan exceedingly instructive and writing-master-like lecture on up-strokes and down-strokes ? .r But this would have been all

very well, had not the gentleman alluded to

gone so far, in his enthusiasm for clear andbold hand-writing, as to gravely inform thecandidates, that nothing was expected fromthem but a plainly written selection from clas-sical works. This gentleman was, no doubt,one of the patrons of the glorious stand-still-pcrsons, who will ask you, with the con-sciousness of sound views twinkling in theireye,-

Thut nicht pin braver mann genug,Die kunst, die man ihm ubortrug,Cewissenhaft und punktlich anszutiben ? *

The consequence of this systematic dis-regard of thesis is, that an original essay,or one valuable in any respect, is, at Edin-burgh, a thing unknown. How different isthe case at Paris. There the productionand defence of a thesis is, in reality, as itought to be, the final test of medical pro-ficiency ; and in consequence of this, someof the most brilliant works of which that

great pathological school can boast, are tobe found in embryo in its inaugural disser-tations.

We were led to this comparison, which isso unfavourable to our own country, and ofwhich we should, in consequence, be happyto find the justness disproved, by the peru-sal of M. Woillez’s Essay. The work of anardent pupil of M. Louis,-it is drawn upwholly from personal and extensive obser-vation, and the labonr which such a methodof arriving at results requires, has been

lavishly bestowed. The author first con-

ceived the idea of his undertaking, fromseeing the daily examination made by Louisof the form of the chest, especially in caseswhere the existence of pulmonary emphy-sema was suspected. But in order to esti-mate the positive value of deformities of

the chest, as signs of disease, M. Woillezsaw, that the first step was to ascertainwhether or not such deformities existed inthe physiological state. In pursuance ofthis idea, the author examined and measuredthe chest of 116 individuals of the male sex,taken without regard to the affections whichbrought them to the hospital. In each case

he noted the age, height, trade, existing andformer diseases, health of parents, habitualstate of the respiration and of the heart’saction, terminating his inquiries by themensuration of the thorax. The means em-

ployed to ensure freedom from error, in

estimating its form and dimensions, were

* Faust.