798

however. say a few words on one symp-tom, which, if our memory does not deceiveus, is given as a frequent attendant uponpericarditis ; this is fainting: it was ob-served in two cases only, where the diseasewas complicated by other grave affections :one patient suffered under this symptom atthe commencement of the disease ; anotherfelt faint whenever he attempted to sit

upright. The same phenomenon was ob-served only once by M. Louis, and once byM. BOUILLAUD ; never in simple cases ofpericarditis. Fainting, then, does not belongto pericarditis, and may, ia all probability,be attributed rather to the dangerous com-plications which exist in all cases where thisphenomenon manifests itself.

Diagnosis.—In the cases observed by M.HACHE, the pain about the precordium, pal-pitations with or without dyspnoea, troubleddreams, or sudden awaking with fright, were nearly constant symptoms; but these arenot sufficient to determine in a certain Imanner the existence of this disease, whichcan only he discovered by exploration of the chest. Then the development of theleft side of the chest, the dulness of soundover the whole precordial region, with ab- ‘senceof the respiratory sound in that space, i,the displacement of the sounds of the heart, ifrequently attended with absence of iiri-

pulse,-all these signs indicate the presence Iof effusion into the pericardium, and arethe more important, because in most casesinflammation of that membrane determineseffusion, and we are rarely called upon toexamine a patient in the first days of hisdisease. These observations apply only topericarditis with effusion; the author hasnot had an opportunity of seeing what Dr.STOKES calls the dry variety.The march and termination of simple

pericarditis are usually favourable. The dis-ease terminates by cure from about the 15thto the 22nd day, under the influence of anti-philogistic treatment; however, this maladyis more frequently complicated than simple :thus in five of the eight cases reported by M.HACHE, he observed the following compli-cations ; in one inflammation of the lungs;in two rheumatism ; in two tubercles. Thecoincidence of rheumatism is regarded asvery frequent by M. BouiLLAUD, who says"rheumatismal pericarditis is incomparablymore frequent than any other species; itexists in about the half of all subjects af-fected with severe articular rheumatism."This assertion is rather too general; in com-posing the cases reported by M. BOUILLA UD,ANDRAL, Dr.STOKl’;S, LOUIS, and M. HACHE,have a total of 72, and find that acute ar-ticular rheumatism existed only sixteentimes, or less than one-fourth.The age and sex have a certain influence

in the frequency of pericarditis. Thus theoldest of M. HACHE’s patients was 38 yearsof age : of fifty..fiye cases contained in the

worlcs of ANDRAL, LOUIS, and BOUILLAUD,we find only six whose age passed 40, andthe majority was below 20. Pericarditis,then, is a malady of young persons, but it ismuch more frequent in the adult than in thechild. Females are less subject to the diseasethan males. In 107 cases collected by M.Louis, we find 27 women, 80 men; and inthe 36 observations of M. BOUILLAUD, wehave only 7 females, 29 males. It is unne-

cessary to enter into any details upon thetreatment of this disease by M. Loins. Inall cases, a moderate antiphlogistic methodwas employed with success. Digitalis wasadministered to five subjects during a periodof from six to thirty days, one grain thefirst day, carried gradually to six grains intwenty-four hours : in two cases it produceda manifest lowering of the pulse, but theother symptoms were not relieved in pro.portion, and the pulse soon rose again, al.

though the medicine was continued for a

length of time and in elevated doses.

THE LANCET.

London, Saturday, February 13, 1836.

REQUEST TO THE PROFESSION TO PETITION FOR

NEVER was there a more favourable pe-riod than the present for promoting a little

gentle agitation on the subject of medicalreform. But although there is an overflow-

ing catalogue of abuses which require to bedemolished, yet there are questions stand-

ing apart for consideration, which are alto-

gether unconnected with the misgovernmentand malpractices of our medical colleges,corporations, and hospitals. On some

points a great difference of opinion pre-vails, many contending that a liberal sys-

tem of government would be injurious tothe interests of the community, while others

believe that if the self-perpetuating prin-ciples in the election of the rulers in our

colleges were abolished, good governmentin medical matters would be the certain

, and speedy result.’

There is one grievance, however, which,although it is itself the source of much

heart-burning and injustice, does not owe

3 its origin to any enactments of the Legisla-? ture, or to any charters granted by the Grown.

799THE MEDICAL WITNESSES BILL.

We refer to the unjust treatment to which medical man shall be devoted in aid of the

medical practitioners are subjected, who proceedings at à Coroner’s Inquisition, with-attend as witnesses at Coroners’ Inquisitions, out making him an adequate return in theWe, therefore, earnestly and en phatically way of compensation ? In fact, the entireentreat our professional brethren to use their proceeding, in many instances, constitutesutmost endeavours to obtain support for a a worthless, nay, even a mischievous farce,bill which, in all probability, will be placed in consequence, almost entirely, of the

on the table of the House of Commons on want of a law which authorizes the coroner

the 2nd of March next. The mode of pro- to direct the payment of a sufficient sum for

ceecling in that as in every other case in medical attendance. Be it observed, too,which the interference of Parliament is that a medical witness, on being summoned

required, is by petition; but we would to attend at the inquest, is liable to be com-remark here, that it is a great mistake mitted to a jail, in contempt of the mandateto suppose that one petition, however nu- of the Court, if he omit to be present at

merously signed, is, or can be, equal in in-, the inquiry. Ought such a state of the

fiuence to a great number of petitions law to last? Is it possible that it can last

coming from various cities, towns, and much longer if the medical profession dis-other places in the country ; because in charge their duty to themselves and the

the latter case a numerous body of public ? This is a public and not merely amembers of both houses of Parliament professional question. The welfare of the

will be enlisted on the side of the profes- community is the point at issue. Often as

sion. If there be but one petition, it can be we have thought and stated that the Courtpresented by but one member. If there be which is held by the Coroner, is one of thenumerous petitions, they are necessarily most important institutions in the kingdom,placed in the hands of many members, who never has it struck us as being so vitallyare then made to feel an interest in the sub- momentous as when we have reflected ou.

ject, which could not from any other cir- the great value of the efficient and honour-cumstance occupy their minds. Besides, able medical testimony of witnesses whoeach petition may ensure an application by have been educated in the science of medi-letter, or a personal interview, or, at any cine. Even if the Coroner were himself a

rate, some communication between a medi- medical practitioner, it should be recol-

cal practitioner and some member of Par- lected that he is not a witness in the in-

liament with whom he or his brethren quiry; but where the Coroner is not a me-may be acquainted. Had we anything to dical practitioner, as we have a thousandfear from an investigation of the subject, times alleged he ought to be, in one half of

we might be chary and cautious in hazard- the inquests that are held the money which

ing such applications, but the demand of is paid out of the county rates for the ex-medical witnesses to be paid for the time penses of the Court, might as well be tossedand services required in attending at Coro- into a river. Preposterous indeed, in thisners’ Inquests, is founded on such a just latter case, is the whole proceeding. It is

and immoveable basis, that no danger can then nothing but a solemn farce, which is

arise from its discussion,-none from the calculated to lull unreflecting and ungiftedseverest scrutiny into the correctness of the spectators into a state of pernicious delu-claim. What, we ask, is the value of the sion.

inquest, in five cases out of ten, unless there f It may be alleged that witnesses are not

be a medical witness present on the occa- ordinarily reimbursed in our Courts of jus-sion ? And what right have the public to tice, except for the bare expenses which

insist that the professional services of a are consequent on their attendance. The

800 MEDICAL WITNESSES BILL.

parallel, however, does not hold when it is medical practitioners will but use their in-

attempted to be drawn between such fiuence in sending petitions, short petitions,persons and medical practitioners who to members of both Houses of the Legisla.give evidence at Coroners’ Inquests. In the ture, praying that such a measure may beone case the witness generally attends be- enacted into a law. We say to members of

cause he was accidentally cognisant of the boUt Houses of the Legislature, because it isfacts on which he is to be examined. In of the utmost consequence that an impres.the other case the witness attends officially, sion which is produced in one House of As-and the value of his testimony depends on sembly should not experience a counter-

the time and money he may have devoted, vailing check in the other.in order to acquire a scientific knowledge of It should be understood, also, that it is

his profession. not necessary that the petitions should beAgain. Without such testimony, the in- written on parchment, as a sheet of com-

quest is useless to the public. And, yet mon writing-paper is amply sufficient forfurther, the entire duty of this attendance the purpose.is necessarily restricted throughout a whole Beyond praying for such remunerationdistrict, to the few practitioners who may as the Houses of Parliament may con-

be resident within its circle. Upon a very sider it wise and just to grant, it will

few persons the toil and responsibility of only be necessary to point out the hard-attendance on these occasions imperatively ships to which medical practitioners are

devolve. Upon what principle of justice, subjected by their being so often required totherefore, can a very few gentlemen, who attend at inquests which are held manyhave expended many years of their time, miles distant from their places of residence,and many hundreds of pounds of their capi- occupying many hours of their time in thetal, in the mere attempt to render them- journey and in waiting during the progressselves competent to execute the general du- of the proceedings. The folly, also, of draw-ties of their profession, be required to make, ing money from the county fund for the

- systematically and regularly make,-the payment of the expenses of an inquest when

heavy sacrifices which the summonses of efficient medical testimony is not received,the Coroner usually demand ? On our side should be shown, and allusion may with

of the question the entire justice of the propriety be made to the necessity of insti-

arguments rest. On the other side of the tuting post-mortem examinations for the in-

question,-if there be an opponent,-he can formation of the coroner and jury, and ofbe armed only with the weapons of preju- the danger to life which often attends suchdice. In the face of such instrument, the investigations.advocates of a correct principle stand in no And now let us hope that this grievancedanger. will no longer exist from want of applications

But we must not remain passive and quiet for redress, or indisposition on the part ofn this emergency. It were folly, indeed, the Legislature to grant what is so truly andto continue gazing, stupidly gazing, at the unquestionably just. Let us hope that a

progress of events, without taking some wiser state of things will arise out of the

pains to turn the current of improvement simultaneous exertions of the medical prac-to our own and the general advantage. All, titioners of this empire. Let it especially bethat is, every friend to the cause of medical remembered that no good result can follow

justice, should resolve to take part in the any efforts which may be made, unless both

struggle. No doubt can be entertained of houses of Parliament become the points to-the successful progress of the MEDICAL wards which every effort is directed. Fi.

WITNESSES BILL through Parliament, if nally, we conjure every surgeon who may

801

concur in opinion with us on this subject,to let his narne forthwith appear on the

table of the House of Commons, attached to

a petition in aid of the cause we now advo-cate. If there be no petition already await-

ing signatures in his neighbourhood, let

him write one out himself, and if he cannot

procure other signatures besides his own,

let two copies of the petition, with the

single name, he transmitted, the one to amember of the House of Commons, and theother to the House of Peers. Such peti-tions will not have a trifling effect, becausethey have but one signature attached. It is

the petition, be it remembered, and not thenumber of signatures appended to it, that

brings the subject before the house to whichit may be addressed.

WITH regard to the unfortunate positionin which W. CUMMIN, M.D., of the Alders-

yate-street Sclaool, is placed, we have the

authority of the gentleman who questionedhim on the 3rd inst. for stating, that that

portion of the letter which appeared in THE LANCET of Jan. 30, containing the replyof Dt. CUMMIN to the student’s inquiry, is

strictly and positively correct. We take this

opportunity of stating, that up to the pre-sent hour, we have received no denial fromDr. CUMMIN to the allegation that he is theofficial colleague of MACLEOD in editing a

journal which has been systematically de-voted to slandering the general practitio-ners of this empire.

INTERCEPTED LETTERS.

(( DEAR Sin HENRY,—At this moment 1am placed in a difficult predicament. I musteither conceal from you the truth, or, bymaking to you a full disclosure of my senti-ments, run the risk of your displeasure. I

hope, however, that you will not blame mefor cautioning you about certain individualswith whom you are now acting. I am posi-tive that their motives are not pure, and, ifit appears to them to be necessary for theirown selfish purposes, they will have no hesi-tation in throwing you, and all of us who

atlore you, overboard. I can trace hypocrisy,sycophancy, and apostacy, throughout thewhole of their lives. It is vour own unsus-picious, straight-forward, and benevolentdisposition that prevents you from seeingtheir real characters. You have too goodan opinion of mankind, and therefore itbecomes the duty of your friends to pointout to you the black side of the picture.Because you yourself detest intrigue (Imean political intrigue), you do not believethat it is the mainspring of action in others.With you all is open day. With a certainother person, who shall be nameless, all is’ dark as Erebus.’ With you all is aboveboard, plain, and unvarnished; but yoursurgical coadjutor does everything under-ground. He must always go round aboutthe bush to accomplish his purpose ; every-thing is obscure, mystical, and plasteredwith flattery.. You, ever regardless of your-self, look but to the public weal, whilst yourmock coadjutor thinks of no one, and neverdid think of any one, but his own dear self.You are, indeed, what a true liberal oughtto be. He is an ultra humbug, double dis-tilled. In all your transactions you walkstraight forward, whilst 7its movements, likethose of an old fox who is endeavouring toescape from his pursuers, are oblique,_ tor-tuous, and difficult to be traced, more par-ticularly by an unsuspicious observer likeyourself. You, Sir HENRY, contemplatemankind with an eye of henignity and jus-tice ; lie looks on them as a rich compound,like himself, of seltishness and corruption.Such differences in character are unfoldedin each of your countenances, - the truemirror of the human heart’ Your open,manly, and persuasive manner, in conver-sation, forms a remarkable contrast with theover-cautious hesitating mode of address soremarkable in the sanguineous knight of thelancet. The open straight-forward look of

your fine blue eye, conveys a very different

impression of your heart, from that of theunfixed and wandering gaze of those blackorhs which by no chance ever looked a manin the face. The grovelling demeanour ofthe surgical prostitute forms a melancholycounterpart to your elegant and accom-

plished gait. Every one is struck by theair noble with which you enter a room. Inthe other, the head is bent forward anddownward.

" While I thus license my pen in this de-lineation, I am led to reflect on the historyof the individuals whom I have portrayed,and endeavour to account for such discre-pancies in the attributes of each. In doingso the mystery is at once unfolded, and the

i striking differences of character are satis-

factorily explained. You have certainly hadi many advantages in birth. education, andexample, and all these you have amply hadrecourse to for raising a superstructure cal- culated to adorn the medical profession in