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statement in THE LANCET is " wholly false "and " perfectly untrne."* I remain, Sir,your obedient servant,

FRANCIS DAVIES.

Mr. Davies to Mr. Cole.11 Pershore, Dec. 15, 1838.

° My dear Sir :—Will you do me the fa-vour of saying whether the statement madein THE LANCET of Nov. 17th is substantiallycorrect, as far as regards the Worcester

Infirmary. I remain, dear Sir, yours verytruly,

" FRANCIS DAVIE3.« To Herbert Cole, Esq., &c., &c.

Worcester Infirmary."

Mr. Cole to Mr. Davies.

" Worcester Infirmary," Dec. 15, 1838.

"My dear Sir :—I have seen the case ofThos. Attwood, as reported in THE LANCETof the 17th of Nov., and it is correct as faras the infirmary is concerned, with the fol-lowing exceptions: the hernia had been

down, from the man’s own account, six-and-thirty hours ;t the integuments were black,but not sphacelated. I remain, my dearSir, faithfully yours,

" HERBERT COLE." To F. Davies, Esq."

Mr. Pierpoint to Mr. Davies." Worcester, Dec. 15, 1838.

" My dear Sir :-I have seen the state-ment in THE LANCET of Nov. 17th, respect-ing the case of Thos. Attwood. The reportof the poor man’s state is generally correct,as to the description of him when broughtto the infirmary. The bowel had been

strangulated much longer than the reportmentions ; in other respects I see no reasonwhy the report of his case and consequentsufferings should be found fault with. Thepoor man was under the immediate super-intendance of my colleague, Mr. Sheppard.Yours faithfully,

" J. PIERPOINT." To F. Davies, Esq., Pershore."

Mr. lllartizz to Mr. Davies. Pershore, Dec. 16, 1838.

« Dear Sir:—I have read the statementin THE LANCET of Nov. 17th, respectingThos. Attwood, and, as far as my name is

concerned, it is perfectly true." JAMES MARTIN, Guardian."

* The expressions used by the Memberof the Board of Guardians in denying thetruth of the report.—ED. L.

t In the report in THE LANCET it wasstated that the hernia had been down onlytwenty-four hours.-ED. L.

FRANCIS DAVIES.

HERBERT COLE.

J. PIERPOINT.

JAMES MARTIN, Guardian."

WESTMINSTER MEDICAL SOCIETY.

Saturday, December 22, 1838.

Mr. HALE THOMSON, President.NEW BED FOR INVALIDS.-HEART DISEASES.

A VERY ingenious bed, invented by Mr.Knox, of Jermyn-street, was exhibited tothe Society. The bed is constructed some-what upon the principle of the celebratedfracture-bed of the late Mr. Earle, but pos-sesses many and very great advantages overthat machine ; the patient can, without theslightest inconvenience, be placed in anyposition that may be required, his linenbe changed, and all the necessary evacua.tions effected without, in the slightest de-gree, disturbing him. It certainly possessesgreat advantages over every other inventionof the kind. The bed excited great interestin the members, several of whom spoke inhigh terms of its usefulness, and consideredit a boon to the profession.* *

’

Mr. D. 0. EDWARDS referred to three

cases in which this apparatus had been ofessential service in St. Thomas’s Hospital.One of these cases was that of a man, thirtyyears of age, who fell and fractured thefirst lumbar vertebra, the injury being ac-companied with displacement of the upperportion of the fractured bone; the sphincterswere paralysed, and complete paraplegiaexisted. He was placed on Mr. Knox’s bedon the fifth of July. As the urine and faecespassed involuntarily it was necessary to

change his linen, blankets, and bedding veryfrequently; this was effected without occa.sioning the slightest inconvenience to the

patient; the bed was often moved for theconvenience of the sufferer by the nurses,the other patients, or the friends; thepatient was placed occasionally on his back,or his side, or prone, according to his ownpleasure ; he lay prone for various lengthsof time, such as periods of 2G, 18,12,10, or6 hours ; he generally preferred laying onhis back or stomach to laying on his side,on which he seldom remained longer than acouple of hours. Towards the end of hislife he was incapable of laying in any posi-tion for more than two or three hours. Inorder to change his bedding the attendantsmoved the bed round till the face of thepatient was downwards. Whenever hewas fed an inclined plane was formed bymoving the plane of the internal frame uponan axis, and thus raising the head and

depressing the feet to any extent desired,and to relieve the ennui of uniform position.Whilst he was supine his lower limbs were! placed on a single or double inclined plane.

* Mr. Knox, in answer to a question,stated that the cost of the bed was seventeenguineas, which, considering the great quaii-tity of work in it, is cheap.—REP. LANCET.

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The patient lay on the couch from the fifth ofJuly till the. sixth of December, when hedied. He always expressed himself gratefulfor the great ease and confidence of securitywhich the apparatus afforded him. Anexamination after death exhibited the spinalmarrow, though not lacerated, pressed uponby the displaced arch of the vertebra, butperfect ossific union had taken place be-tween the broken surfaces which were keptin contact, a fact showing the perfect qui-escence secured to the fractured parts bythe apparatus. In the second case, thepatient fractured one of the lower dorsalvertebrae. Mr. South trephined him, but,upon removing the arch of the vertebra, thespinal chord was discovered to be completelydivided; of course no ultimate good occurredfrom the operation; the bed, however, wasfound of great use; the patient was raisedfrom the operating table, and placed proneon the bed; the bedding was placed overhim, and he was gradually, and, withoutsnccussion, turned round till he lay supine.In this way, during the short remainder ofhis life, he was moved, and his fasces re-

moved and dressings altered without excit-ing any motion in the injured part. A thirdcase is one of concussion now laid on thebed ; the patient is recovering, and is ardentin the expression of gratitude for the comforthe has experienced.Mr. HALE THOMSON bore testimony to the

value of the bed as employed in some casesin the Westminster Hospital. Other mem-bers also spoke in high terms of the appa.ratus, and much interest was excited by thedemonstrations of the facility with whichthe different changes were effected, as shownby Mr. Knox.

OPEN STATE OF THE FORAMEN OVALE.-^BLUE-

NESS OF THE SKIN.-THE EXCITJ-MOTORY

SYSTEM.

Dr. BIRD exhibited the heart of a patient,respecting whom he related the followingparticulars :-He was consulted on the 15thof November by a tall, well-formed, youngwoman, twenty-eight years of age, whopresented an exquisite specimen of chlorosis,having all the symptoms of that conditionmarked in a high degree. She complainedof unpleasant feelings about the uterinesystem, occasional palpitation of the heart,with dyspnoea on going up stairs, and onmaking exertion ; she said she had sufferedfrom the dyspnoea from her infancy. Pur-gatives, followed by the preparations ofiron, relieved her. About a month afterthis Dr. Bird received a hasty summons toattend her, as it was expected she wasdying. He found her lying on the bed suf-fering from extreme dyspnoea, and breathingwith a loud crackling noise; her counte-nance was intensely anxious and pallid ; shehad not spit blood; there was evidence ofexcessive emphysema of both lungs in the

anterior region of the chest ; no sound indi-cating its presence, however, was detectedbehind. On examining the heart a loud,sharp sound, like the bruit de rape, wasaudible ; at first it was taken little noticeof, as occurring in connection with the chlo-rosis ; the next day, however, on examiningthe cardiac region, the sound was peculiarlysharp and grating ; it accompanied the firstsound of the heart, and was heard loudestjust to the left of the sternum ; it was notdistinct posteriorly, probably from the pre-sence of the emphysema; the sound waspretty constant; it was more audibleunder excitement, and was not affected bychange of position. On inquiring furtherinto the history of the patient he was in-formed that when she was about seven

years of age, after great exertion, she suf-fered from palpitation, and her countenanceassumed a colour like that observed in

persons who were cold ; she had never suf-fered from the symptom since; she diedsuddenly under a little mental excitement.On examinatiun after death the contents ofthe abdomen and pelvis were found healthy,with the exception of that condition of theovaries which precedes dropsy; there weremarks of extreme emphysema in the lungs;the heart was firmly contracted, and therewas a fibrinous deposit in its left cavity;the left ventricle was slightly hypertro-phied ; the valves were healthy, with theexception of a slight roughness of one of theaortic valves; the foramen ovale was patu-lous, and would admit the point of the littlefinger, and was guarded by a valve, which,though it prevented the blood from escapingfrom the right side, admitted its entrancefrom the left; the mitral valve was a per-fectly healthy specimen. The case was

interesting, as showing the presence of anopening between the auricles, though therehad been no blue tinge of the skin for twentyyears. Cases of an analogous kind wererecorded, but in this one he (Dr. Bird) con-sidered it difficult to account for the bruit.Did it arise from the slight roughness of theaortic valve ’?

Dr. ’VILLIA1IJS said that it was difficult toaccount for the bruit ; he did not consider itarose from the slight roughness of the aorticvalves, as he had frequently observed theirroughness in cases in which there was nomurmur; it was not at all uncommon inpatients of thirty or forty years of age. Hewas inclined to think the mitral valve wasthe seat of the sound, for though it mightbe, at the first glance, considered perfectlyhealthy, yet the slightest displacement of itwould allow of the passage of blood. Hehad seen many cases, particularly in chlo-rotic females, in which this displacementwas the only sign to account for the pre-sence of the murmur. He believed thatthere was always something imperfect,either congenital or acquired, before mur

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mnrs could be produced, even in chlorosis.The condition of the blood in this allectiou,it was true, was such as to lead to themore easy development of these imperfec-tions. He had seen many cases in whichthis defect consisted in a slight disease ofthe mitral valve. In the case under con-sideration there was rigidity of the entiresurface of the valve, with a degree of thick-ening of its margin. The blue appearanceof the skin was not always present in caseswhere the foramen ovale was open ; but thissymptom was very rarely absent if therewas obstruction also to the pulmonary eir-culation, as this obstruction produced a

more patulous condition of the foramen.In the case related by Dr. Bird, however,though there was pulmonic disease, and,no doubt, admixture of the venous and arte-rial blood, this blueness did not occur. Whatwas the cause of this? He would inquire ifthere was really enough of blood in the faceand lips to produce discolouration ; hethought not. He had seen several cases ofthis change of colour arising from diseasedheart ; chlorotic patients did not show itwell. It was necessary that the capillawiesshould be more distended with blood thanis the case in chlorosis, for the discolour-ation to take place.Dr. BIRD recollected a case in which

there was an opening in the septum ventri-culorum, and a patulous state of the fora-men ovale, and the patient was never blueuntil a few days previous to death. Hehad thought the mitral valve healthy in thecase he had first related, because on pouringwater into the left ventricle it was retained

by the valve.A MEMBER considered that in cases where

the foramen ovale was open, and there wasno blueness, it did not necessarily followthat the occurrence of pulmonic diseaseshould produce it; there might be obstruc-tion to the flow of blood through the luugs,and yet not be greater pressure on the pa-rietes of the heart. Cases had occurred,and Dr. Bird’s case was one, in which theopen foramen was valvular in form, andwould resist the escape of blood from oneauricle to the other, on whichever side thepressure was exerted. He did not considerthat the state of the blood in chlorosis wassuch as to account for the absence of theblue tinge in the countenance as diagnosticof an open state of the foramen ovale, for ifyou pricked any part of the skin with aneedle blood would flow.Mr. GREGORY SMITH had examined a great

number of hearts, and he had found in themajority of cases that the foramen ovale wasopen, though rarely to the extent observedin Dr. Bird’s case.

Dr. WILLIAMS could not agree that theform of the foramen in the case under dis-cussion, would induce a valvular action inboth directions. Any undue pressure from

the right side would, he believed, force theblood through the opening. Of conrse, ifthe lips of a chlorotic patient were prickedby a needle blood would flow, blood bemgnecessarily present for the nutrition of thepart. What he contended was this, that asthere was not suflicient blood to produce anatural colour in the skin, the slight admix.ture of the arterial with the venous bloodwould not be observable. Dr. Williamsthen related a case in which a woman wasfree from any discolouration of the skin untilher twenty-fifth year, when phthisis settingin she became much discoloured. In thiscase there was an opening through the fora.men ovale, which was valvular and obliquein its direction, producing closure whenpressure was exerted from the right, butnone when the pressure was from the left.Regarding’ the test employed by Dr. Birdto prove the normal state of the mitral valve,he had long since abandoned it as worth.less. It was no proof that the valve wssound when the passage of water was pre.vented, neither was the passage of water

any proof that the valve was diseased.Dr. BIRD said that Andral had found the

number of cases in which the foramen ovalewas open to be about one-half percent.Some conversation followed on various

physiological points, which offered little forreport, except the following remarks by Dr.Hall, and a statement made by Mr. Horne,which caused some astonishment in the

meeting, to the effect that in several cases ofcut-throat in suicide which he had seen,where the parts were divided even to the

spinal marrow, priapism always existed.Dr. MARSHALL HALL said that his views

of the nervous system, so much called inquestion, might be conveyed in a mere de-tail of a series of indubitable experiments,without one word of commentary, the in.ferences from them flowing so naturally asto occur to every mind. With this objectDr. Hall exhibited drawings of the turtle,and enumerated the experiments made byhim on that animal, with which our readersare already well acquainted. These expe-riments (said Dr. Hall) were not only newin themselves, but unfolded entirely newmodes of action in these parts of the ner-vous system,-modes of action at variancewith the laws previously laid down by Hal-ler and Prof. Müller. If the trifacial nervebe irritated in its distribution on the nostril,or the palatine fringes, or the pneumogas"tric, in its distribution to the larynx, or eventhe trunk of the pneumogastric be dividedin the neck, an immediate act of inspirationis induced. Is not this experiment an ap-plication of the vis motoria to physiology,the first ever made ? Does it not display theanatomy and the physiology of a peculiarset of nerves,-nerves pursuing theircourse,not from, but into, the spinal marrow,—aodinducing, under the influence of a stimulus,

533

appropriate actions? In a word, does it notset forth, in the clearest manner, the fact ofthe existence of appropriate excitors of in-spiration ? In his former remarks, Dr. Hallshowed, by a detail of experiments, equallyplain, that the trifacial nerve is the excitor,the facial the motor, in the action of theorbicularis in the closure of the eye. It has

recently been shown, by Dr. J. Reid, thatthe superior laryngeal is the excitor, the in-ferior the motor, in the closure of the glot-tis. The action of the pharynx, oesophagus,and cardia, in deglutition ; of the expulsorsof the fæces, and of the semen, and of thesphincter, depends upon similar reflex ac-tions through excitor and motor nerves, andtheir universal medium, the spinal marrow.Is it not, then, proved that the vis motoriaacts in adirectiun not known to former phy-siologists, and that this action takes placethrough special nerves, and that, therefore,there is a distinct system of such nerves;that this action is the ruling principle in theimportant acts of inspiration and deglutition,and, in a word, in all ingestion and eges-tion ; not one of which things could be ima-gined or understood without the first expe-riment which he (Dr. H.) had detailed-thevery first step in this demonstration, for sohe would venture to call this plain andsimple detail. If lie be asked whetherthere be distinct sentient and excitor, dis-tinct voluntary and motor fibres, he wouldreply that he thought there were. Bothexperiment and pathology render this mostprobable, to say nothing of Mr. Greainger’sinteresting investigations, on which he (Dr.Hall) was not prepared to oner an opinion ;but that such a view forms no part of whathe conceived to be demonstrated. He hadthus shown them :-1. That the vis motoriaacts in directions not known before. 2. Thatit acts along incident excitor, or incidentmotor nerves, not known as such before.3. That it has an exclusive application tophysiology, not known before ; he did not

mean, to refer to the " sympathetic actions,"but the actions of ingestion and of egestion,and of the orifices and sphincters. &c. &c.He had here stated what was positive in thismatter, and confidently left the result withthe Society, happy, indeed, if he had ex-cited in its members any interest in this in-

vestigation. They had now only to readthe various works on physiology, upon theacts of deglutition, of inspiration, &c. &:c.,to discover in what an inextricable maze ofcontradiction and ignorance we were, six

years ago, upon this extensive series offunctions.

CONDITION OF THE IRISH.

DR. MAUNSELL’S LECTURE.

To the Editor of THE LANCET.SIR:—In your Journal of Saturday last

(Dec. 15) I perceive there is an extract froma letter of a correspondent of yours, who isdispleased at my having made the follow-ing assertion :-" Take the case of an in-fectious fever breaking out in one of thosesmall villages into which the irish peasantsinvariably cougregate their dwellings. Amember of one family is attacked ; he, suchis the utter barbarism of the country, sleepsunder the same blanket (not even protectedby night-clothes) with his father, mother,sisters, brothers, sisters-in-law and brothers-in-law."Your correspondent denies the accuracy

of this statement, on the grounds,—1st, Thathe never saw such a case ; and 2nd, Thatthe Irish are too religious a people to admitof such events occurring. In answer to yourcorrespondent’s first position, I can only saythat there may be many things in this worldwhich he never saw ; but that I saw thecase which I described, with my own eyes,many hundred times, and that any one whoever examined the interior of an Irish cabinof the lower class, needs no proof to coii-vince him that all its inhabitants must oc-cupy one bed and be covered by one blan-ket, if, indeed, they possess so great a

luxury. With regard to " J. T. H.’s" secondposition, it is the first time that I have heardthat religion furnished men and women withnight-shirts and night-shifts. I should nothave noticed this matter, but that you have,no doubt inadvertently, permitted my ob-servations to be termed, in your list of con-tents, " Aspersions on the Irish."* I cer-tainly consider poverty and misery to be nodisgrace, and I have yet to learn that it isan " aspersion on the Irish " to state thatthey are poor, wretched, and neglected. If

your correspondent supposes that I meantto cast any imputation upon their morals hedoes me an injustice. I lcnow them well,and have had as much opportunity of closelyobserving them as most men of my age, andI have no hesitation in stating my belief,that in the narticular to which " J. T. H."alludes they are as moral a peasantry asany in Europe. I wish, from my heart, itwere also in my power to say they are as

The word alleged %vas accidentally omit.ted from before the term "aspersions."However melancholy were the facts record-ed by Dr. Maunsell, he could not have men-tioned them with a view to reflect on thecharacter of his countrymen. The conditionof the indigent and suffering portion of thecommunity in Ireland is the result of mis-

rule, not of choice or disposition.—ED L.