401

cient to lead to a correct diagnosis, it wasby no means clear that even with a moreminute investigation that the true nature

of the disease would have been discovered ;the aneurism being so small, so deep-seated,and so involved in the surrounding parts.The case, however, was one of extreme in-terest, practically and physiologically : thetrain of symptoms which had attended ithad long been admitted by physicians as oc-curring in conjunction with aneurism of thearch of the aorta, although not necessarilyindicative of that disease. Most observershad attributed these symptoms to compres-sion of the trachea and bronchi, and hadoverlooked the condition of the recurrentnerve. In this case, at least, there was themost ample evidence that the pressure uponthat nerve occasioned the laryngeal distress,the loss of voice, and the other symptomswhich so closely resembled those of chroniclaryngitis. The muscles atrophied were

only those supplied by the recurrent, andupon which vocalisation and the opening ofthe glottis mainly depended. The partialatrophy of the arytenoid muscle must haveoccasioned a very unequal action of it ; sothat, in short, the larynx was given up tothe muscles of the right side with the crico-thyroid of the left: this latter muscle,whichwas supplied by the superior laryngeal!nerve with its fellow of the opposite side,made tense the vocal chords, and, therefore,tended to the constriction of the glottis.The dilators of that aperture being much im-paired in their action, the constrictors expe-rienced no opposition from their antagoni-sation ; hence the difficulty which the pa-tient experienced in inspiration, the stridu-lous noise produced during her laboriousefforts to inspire, and the imperfect vocali-sation. The case likewise afforded a veryinteresting proof of the anatomical distribu-tion as well as of the ptiysiological office ofthe recurrent nerve ; the atrophy affectedonly those muscles which derived their ner-vous energy from it, whilst all the othermuscles were plump and well nourished.It was pliin, then, that the nerve in ques-tion must be the principal muscular or motornerve of the larynx ; it was equally plainthat the erica-thyroid muscle, the only oneon the left side not atrophied, must havederived its supply from another source;namely, as all anatomists now admitted,from the superior laryngeal.Dr. Todd quoted three cases quite analo-

gous to the present one. The first was re-corf3ed by Dr. R. Graham ; the second byDr. Alison; and the third by Mr. Lawrrence.They were referred to in 1-)r. Hugh Ley’sEssay on Laryngis.us Stridulus. Theywere all aneurisms of the aorta, compress-ing the recurrent nerve, and producing thesame symptoms.

THE LANCET.

London, Saturday, June 12, 1841.

MORTALITY AMONG CONVICTS.

ON Saturday (June 5th) an inquest washeld at Woolwich on the bodies of six more

con’icts, who had died within the last fewdays on board the Justitia hospital-ship. The

following are the names and cases of the de-ceased convicts :-

1. Robert Clarke, aged 57, convicted atLeeds 7th March, 18-10, died June 3rd, 1841,after six weeks’ illness.

2. William Matthouse, aged 31, convictedat Glasgow 14th May, 1840, died June 3rd,1841, after two months’ illness.

3. Frederick Bottwood, aged 26, convictedat Chelmsford 30th June, 1840, died June2nd, 1841, afterfour week/!’ illness.

4. James Hosie, aged 34, convicted at

Edinburgh 3rd February, 1840, died June2nd, 1841, after three weeks’ illness.

5. John Clarke, aged 32, convicted atChelmsford 30th June, 1840, died June 3rd,1841, after four months’ illness.

I 6. Joseph Denman, aged 27, convicted atKirton Lindsay 4th January, 1839, diedJune 5th, 1841, after four M,’eeA:.s’illness.

The above particulars have been extractedfrom the Times of Monday last (June 7th) ;in which it is stated that the deceased con-

victs had all been attended by Dr. HOPE ;that every attention had been paid to them

during the time they were under his charge ;and that their deaths were the results of natu-

i-al causes, and chiefly from affections of the

chest. Their bodies presented an appear-ance of great emaciation. Verdicts were re-

turned of 11 Natural death."

We have already called the attention of

the Government twice to the alarming mor-

tality which has been prevailing among theconvicts in the Woolwich hulks for the last

seven or eight months. We do not wish to

say anything to excite the public feelingunnecessarily on a subject, which we areconvinced has engaged the notice of the

Home-office ; and we are aware that no sys-tem of imprisomnent and punishment can beenforced, which does not involve the sacrifice

402

of a certain number of lives-a much greater

number, in fact, than now perish by the handsof the public executioner.

There can be no doubt, however, that thepresent mortality at Woolwich is excessive ;and so far from considering the deaths to bethe natural results of spontaneous disease, wecontend that they are as distinctly to be as-

signed to external causes as are deaths byhanging. In the latter case, life is destroyedby the rope ; in the former, by the circum-stances in which the convicts are placed.Mr. Fox MAULE, who had evidently made

inquiries on the subject, stated in the

House of Commons, that the mortality was I

caused by an epidemic which prevailed alsoin the barracks at Woolwich, and was notconfined to the hulks. But this should rather

increase than diminish the public solicitude.An epidemic generated in the hulks, on the

river, may spread through the metropolis.We have no official returns later than those

which were submitted to the readers of THE

LANCET of April 10, whence it appeared thatin the year 1840, one hundred and forty-fourconvicts died in the hulks, while the averagemortality there was ninety-four out of thesame numbers in previous years. It is evi-

dent, from the newspaper reports of inquests,that the mortality has gone on increasingduring the present year.The deaths from the disease of the Mill-

bank Penitentiary were not so numerous.

During the time that Dr. LATHAM and Dr.

RoGET were in attendance,only thirty prisonersdied : twenty-two fell victims to the disease insome of its forms. Atthe hulks the deaths from

the disease have probably been a hundred-and the rate of mortality in some of the hulkshas unquestionably been as high as ever it

was at Millbank. Yet no searching inquiryappears to have been instituted in the presentcase. Than the published reports of the

superintendent and his colleagues, nothingcan be conceived more vague or unsatis-

factory.We entreat the Government to have a full

medical and statistical inquiry instituted intothe causes of the mortality in the hulks. In

the first place, because effectual steps shouldbe taken to remove those causes, inasmuch

as the criminals, on the strictest prin-ciples of justice, to say nothing of humanity,should not be thus wantonly destroyed-more than counterbalancing the diminu.

tion of capital punishments. And, in the

second place, because the inquiry may throwmuch light on the causes of disease generally,and is called for by the present state ofmedi.cal science. The Millbank monograph of

Dr. LATHAM, in the preparation of which hewas assisted by Dr. RoGET, is one of the

most valuable works in the archives of medi.

cal literature.

According to the imperfect information atpresent in our possession, we might incline tobelieve that the Woolwich disease has been

generated by the accumulation of too manyconvicts in the hulks; and that it can only bearrested at once by breaking up the presentestablishments ; but that its ravages may bediminished by a better diet, and by lodgingthe prisoners in double the actual number ofvessels.

The mortality in the workhouses appearsto have been three or four times as great asthe mortality in the hulks, and to have arisenfrom the same causes; but the paupers die

unredressed, as inquests are not held in their

cases ; for the poor of England have not yetobtained either the diet, the medical attend.

ance, or the protection afforded by the coro-ner’s inquest, which was extended many

years ago, by Act of Parliament, to felons.

THE readers of THE LANCET cannot have

forgotten the VACCINATION BILL, as it was

introduced into the House of Commons bySir JAMES GRAHAM, in the last session of

Parliament. The Bill had then been dis-

cussed, and, having passed through the

: House of Lords, had reached the table of theHouse of Commons, sanctioned by the deci.sion of one great branch of the Legislature.The provisions of tJtat Bill are but too well

known to the profession. They were pub.

403

lished at the time in the columns of this

Journal, and obtained, and justly obtained,the execration of an excited, indignant pro-fession.

But before the Bill could be read a second

time in the Commons, the Editor of this

Journal prepared a second Bill, on the same

subject, containing new and extensive provi-sions, and, by the exercise of some indus-

try and perseverance, he obtained a dis-

cussion of the principles of the two Bills,on one and the same evening; and,finally, he succeeded in ejecting from the Billof Sir JAMES GRAHAM several of the most ob-

noxious of its features, and introducing intheir stead the leading provisions of his ownmeasure. Thus much, also, is already wellknown to the profession. ,

In the present session of Parliament a Bill z’

was introduced to " amend" the Act of the

last session, containing two provisions only.The first, to authorise the payment of theservices performed under the Act of the last

session, out of the monies which are raised

for the relief of the poor ; the second, a de-

claratory clause, providing that any personwho might be vaccinated in conformity withthe provisions of the Vaccination Act, should Inot be disqualified or deprived thereby of anyright or privilege whatsoever, declaring, in

fact, that the act of vaccination should not

constitute or be considered to be 11 parochialrelief," and, therefore, should not depriveeither a parent or a guardian of the right of

voting at the election of members of Parlia-ment.

Before this Bill was considered in Com-

mittee, 1B’[1’. FRENCH, the member for Ros-

common, gave notice that he should on that

occasion move the introd uetion of two clauses

therein, and the opportunity of so doing wasafforded to him on the 20th day of Maylast, when he made the attempt regardingthe first of his intended clauses, but without

success ; whereupon the failure of the hon.member had the effect of eliciting the follow-ing editorial articles in two worthless pro-ductions which are dignified by the titles of" MEDICAL JOURNALS," one of them printed

in Dublin, the other manufactured in Lon-don. Where they are published, or wherethey find blockheads to read them, Heavenonly knows :-

From the Dublin production.ryir. WAKLEY’S OPINION OF THE INTEGRITY

OF HIS MEDICAL BRETHREN.

" We have frequently had occasion to soli-cit the admiration of our readers for Mr.Wakley’s great and judicious exertions in thecause of medical reform; for the unequalledtact with which he has kept up the spirit ofreformers, bye exciting distrust and dissen-sions in their ranks; for the delicacy of feel-ing, and the thorough knowledge of thehuman heart, evinced in his efforts to encou-rage the honest and stimulate the active, bycasting seasonable doubts upon the inte-

grity of the one class, and upon the zeal ofthe other. We take to ourselves some creditfor having attracted attention to these pointsof management which have so creditably dis-tinguished the administration of the JackCade of medical politics. A new feature inthe moral portrait of the hon. member for

Finsbury we have to-day the satisfaction ofexhibiting to our readers: they will find itin our short report of the conversation whichoccurred in the House of Commons, on thecommittal of the Vaccination Act AmendmentBill." Our readers will there see that Mr.

Wakley, the true friend and supporter of thehonour and dignity of the medical profes-sion, strenuously and successfully opposedthe attempt made by Mr. French to rescuemedical men from the degrading position oftenderers for sixpenny vaccination contracts,in which they are placed by the VaccinationExtension Act." In further explanation of this matter, we

may mention that Mr. Fox Maule was will-ing to admit Mr. French’s clauses, had henot received p1’îrate intimation of the intendedopposition to them. The hon. Editor of THELANCET was the man to get up in his placein the House of Commons, and advance thedoctrine that medical services must be pro-vided by contract or tender; that the medicalpractitioners of Great Britain could not beentrusted with the performance of a profes-sional duty, except under the special stimu-lus of sixpenny fees. Mr. Wakley has, oflate, been loud in his calls upon the profes-sion to remember that they are charged withthe duties and privileges belonging to theelective franchise ; we trust the medicalelectors of Finsbury will, at the approachingelection, not forget the opinion as to their in-tegrity, expressed in the House of Commonsby their worthy and honourable representa-tive."

From the London production." VACCINATION ACT.

" Our readers will peruse with equalastonishment and indignation the report ofthe line of conduct which the Editor of Tux

404

LANCET has been pleased to pursue, relativeto the Vaccination Act Amendment Bill.’Such an utter abandonment of principle onthe part of the English Cato,’ can only beaccounted for on the theory of ’ quem Deusvult perdere, prius dementat;’ or of the appo-site proverb, set a beggar on horseback,nd he will ride to, &c.’" The history of the transaction is briefly

as follows :-The introduction of the Vacci-nation Act Amendment Bill was thought toafford a favourable opportunity of aiming ablow at two of the worst features of the Poor-law Act; viz., the contract system, and thepower conferred on guardians of employingany one, whether qualified or not, as medicalattendant of the poor. In order to attain sodesirable an object, Dr. Maunsell and Dr.Nugent, delegates from the Irish Association,prepared, we understand, the two clauseswhich are printed in our report: the objectsof the clauses were—Ist, to abolish the con-tract or tender system ; and 2nd, to preventpoor-law guardians from employing any butqualified medical men. :

" The carrying of these two clauses was ofimmense importance, because, if once ad-mitted as principles of legislation in any par-ticular act, they might, at some future oppor-tunity, be adopted in other measures of moreextensive application. Mr. F. French kindlyundertook to propose the addition of thoseclauses to Mr. Maule’s Bill, and we believe itwas generally understood that they would beadopted and made part of the law of the land,unless some influential member of the houseshould oppose them."

Having placed the above worthy andhonourable emanations of just and candidminds before the profession, we now submitto the view of our readers the clauses which

Mr. FRENCH intended to propose, but onlythe first of which he actually did submit tothe consideration of the House :-

MI’. French’s clauses.

1. "And be it further declared and en-acted, That it shall be lawful for the guar-dians of every parish or union in Englandand Ireland, and the overseers of every parishor union in which relief for the poor shall notbe administered by guardians, and they arehereby directed to employ any legally-qua-lified medical practitioner or practitionersfor the vaccination of persons resident in suchparishes or unions respectively ; and to ap-point and pay such reasonable annual stipendor remuneration for the same as to the said

guardians or overseers shall seem fit, and todefray the same out of any rates or monieswhich may come into their hands respectivelyfor the relief of the poor, anything in anyother Act contained to the contrary notwith-standing.

2. " And be it further declared and en-acted, That no person shall be deemed to bea legally-qualified or competent medicalpractitioner, within the meaning of the saidrecited Act or this Act, who shall not beduly authorised by some university or col-

lege, or other public body, having authorityin that behalf, to practise medicine or sur.

gery."On reading the veracious statements of our

worthy critics, and finding that those state-ments contained distinct allegations, Mr.W AK.LEY applied to Mr. Fox MAULE on the sub-

ject, and was immediately and unhesitatinglyauthorised by that hon. gentleman to declarethat he (Mr. W.) had not privately addressedone word to him on the subject of the clauses,and had not, directly or indirectly, held the re-motest communication with him (Mr. MAULE)on the questions they involved. Further,-andthis, assuredly, is sufficiently damnatory of

the "delegates," who, virtually, must havebeen the authors of the two vituperative ar.ticles which we have quoted,-Mr. MAULEauthorised Mr. WAKLEY to state that when

the clauses were first shown to him, in pri-vate, by Mr. FRENCH and the two Dublin" delegates," he (Mr. MAULE) informed Mr.FRENCH that he should oppose the introduction

of them into the Bill.

Here, then, is an answer,-a decisive reo

futation,-of the accusations of the « dele·

gates " and their brother scribblers.But this is not all. It is not even true

that Mr. FRENCH submitted the two clauses

to the House. Mr. FRENCH proposed thefirst of them only ; and as that was rejected,he did not mare the introduction of the secondclause at all. Just before the discussion

occurred, Mr. WAKLEY informed Mr. FRENCH,in the House, that he cordially approved ofthe second clause, and would give it his un.

hesitating support ; but the opportunity of its

receiving that support was not afforded, asno motion was made for the introduction of theclause into the Bill.

It is almost useless to say another word on

the subject. The exposure of our worthycommentators is already complete. But al-

though no further evidence of their audaciousmendacity can be required, a word may be

405

added as to their stupidity. What a rare

combination in the minds of critics ! Have

they any readers ? It would be worth a day’sjourney to see a collection of such curiosi-

ties.. The first clause was entitled to sup-

port, because, forsooth, it was to prerenl CON-TRACTS and TENDERS ! ! Indeed ! Where is

one line in the clause which could have the

effect of preventing either the one or the other ?What is there in it to prevent even the adver-

tising for a tender as to the annual stipend?And what is the agreement to pay and re-

ceive the annual stipend, but A CONTRACT?And this is the clause, is it, which « dele-

gates" were sent over from Dublin to prepare,and then cause to be proposed to the House

to prefer tenders and contracts ? Bah ! It

is utterly disgusting to waste a moment uponthe fooleries of such ninnies and others of

their tribe.

MALIGNITY and STUPIDITY constitute rather

an unfavourable combination towards obtain-

ing the sanction and support of the generalpractitioners of medicine in this country. Thenoss are playing at an unprofitable game.We advise them, with no unfriendly feeling,to abandon it as quickly as possible. The

sooner they cultivate an acquaintance withJustice and Truth, the better will events ad-vance their interests. A contrary course of

action may place them in a position whence

they could not so easily extricate them-

selves. A word to the wise is sufficient.

How many words blockheads may require, wehave yet to learn.

In concluding this notice, in which we

have amply exposed the bad feeling and follyof our commentators, we have merely to re-mind the profession, that in the VaccinationBill of the last session, it was proposedto place the vaccination of all the children

of England in the hands of the medical

officers of the Unions ; and the Poor-lawCommissioners were empowered by the

Bill to enter into contracts only with those

medical prizciitioners. That object was com-

pletely and effectually defeated by the pro-vision which Mr. WAKLEY caused to be in-

troduced, for enabling the Poor-law Com-

missioners to enter into contracts for vaccina-

tion with ANY legally-qzsalified medical practi-tioner who might be residing in the Unions

where the vaccination was to be performed.And then, again, as to another provision,

which was introduced relative to the pay-ment being in proportion to THE NUMBER vac-cinated. Why was that done ? Because it

was evidently INTENDED to rob medical gentle-men of the rercard which was justly due to

thernfor their labours. It was not disguisedby the abettors of the Bill, that it was intendedto make the medical officers of the Unions

execute the whole vaccination of the countryWITHOUT ANY ADDITION TO THEIR SALARIES ! !

In one parish, even after the altered Bill hadbeen enacted into A LAW, this bold and scan-

dalous experiment was tried, namely, in the

parish of St. Marylebone ! The resolution of

the Guardians to that effect was sent to the

Poor-law Commissioners, and there the matter

rested, until the foul iniquity was exposed inTHE LANCET, and then, and not until then,the parish authorities were informed that thenew law required a distinct payment for eachcase of vaccination. That law, we repeat, hassecured to the legally-qualified vaccinators

somepaynzent for their services. But with-

out such a provision as Mr. WAKLEY

caused to be introduced into the Bill of Sir

JAMES GRAHAM, not afarthing of remunera-tion would have been received by his medi-

cal brethren. In accomplishing this objecthe did no more than discharge his duty to thepublic, and to the members of his profession,but in return for his services he is exposedto the falsehoods of a set of worthless DUBS.

He is, therefore, more than rewarded for

the value of his labours.

HEALTH OF MEMBERS OFPARLIAMENT.

THE House of Commons was never, it

would appear, in better (bodily) health thanat the present time. Not a single Conserva-tive member—excepting eleven pairs-wasabsent from the division on June 4th and if

the eight absent Ministerialists laboured