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good chemists, are not known (with the exception of ProfessorHofmann, of whose testimeny the Board has already had theadvantage) to have devoted any special attention to the sub-ject of water, upon which they are now called suddenly togive a weighty opinion; while, on the contrary, the evidenceadduced by the Board has been furnished by men of not lessstanding and reputation than themselves, and who have de-voted years to the study of the subject, and who were qualifiedto give, not merely chemical opinions, but to enter into themedical, physiological, and other bearings of the inquiry.
It now only remains that we give expression to the greatsatisfaction which we have derived from the fact, that avery large portion of the scientific evidence procured by theBoard has been supplied by members of the medical profession- -a circumstance highly creditable to their intelligence. Whenwill governments learn to treat our ill-requited but merito-rious profession with justice and liberality?The next Report of the " Analytical Sanitary Commission"
will be onCHICORY,
ITS PROPERTIES AND ADULTERATIONS,which we have been compelled to omit this week.
Correspondence.
CÆSARIAN SECTION AND OVARIOTOMY.DR. LEE AND DR. SIMPSON.
"Audi alteram partem."
To the Editor of THE LANCET.
SIR,—By making limited and partial quotations, the truth,as you are aware, of almost any statement or any doctrine,may be totally perverted and misrepresented.
All of us have heard of the lunatic atheist, who undertookto prove-and to prove from the Bible, too-the soundness ofhis absurd doctrine. For taking the text, " The fool hath saidin his heart, there is no God," he insisted upon being allowedto quote, and found upon the latter limited paragraph, " thereis no God," as an ample admission and recognition of his insaneand unhappy creed.
Dr. Lee insists upon the propriety of Dr. Lee being allowedto come before the Medico-Chirurgical Society and the profes-sion, and reason upon obstetric subjects and statements in thesame way as the lunatic atheist. For example, in the Edin-burgla Monthly Medical Journal for July, 1847, I described acase of mollities ossium, in which, in accordance with the opi-nions of every one of our highest authorities in midwifery, Iconsidered the Caesarian section would be necessary, becausethe transverse diameter of the outlet of the pelvis was underan inch, and its conjugate not three inches in length.* I havedescribed, as follows, the morbid conditions and contractionsof the pelvis in this patient.
" The sacrum was straight above, so that its promontory didnot probably encroach on the brim; but its inferior extremitywas strongly and anormally curved forwards. In front thewalls of the pelvis felt doubled or collapsed together; and theoutlet, which was the only part that could be very accuratelyexamined, was exceedingly deformed and diminished in size.The transverse diameter was particularly contracted. I foundit impossible to introduce two fingers between the tuberositiesof the ischia: hence this diameter of the outlet was evidentlyunder an inch. Posteriorly, or opposite the sacro-sciatic liga-ments, there was transversely more space, but the strong an-terior curvature of the coccyx and lower end of the sacrumseemed to curtail the conjugate diameter of the opening, andto prevent the probability of its admitting, when fully dilated,more than three or, at most, four fingers even in this direction."
In stating to the Medico-Chirurgical Society the groundson which it was deemed probable that the Caesarian sectionwould be required in this case of deformity, Dr. Lee (see THELANCET, p. 155) mentioned to the Society in the way of quo-tation, and within inverted commas, that " the sacrum wasstraight above, so that its promontory did not probably en-
* Without citing the statements on this point of Drs. Barlow, Hull,Burns, Bedford, Hamilton, Ramsbotham, Dewees, Campbell, &c., let me ad-duce the latest published opinion on the point, that, namely, of Dr.Churchill, in the last edition of his "Theory and Practice of Midwifery,"published in 1850, (p. 328.) " We may therefore safely conclude, that whenfrom any cause the antero-posterior diameter of the upper outlet, or thetransverse diameter of the lower, is not more than one and a half inches,there is no possibility of delivery "per vias naturales," but that we must.have recourse to the Caesarian section."
croach on the brim." Dr. Lee stopped his quotation here, andadded, " It was then decided that the pregnancy was alreadyso far advanced as to preclude, under such a degree of de-formity, the idea of the induction of premature labour, andthat the Caesarian operation should be performed."*The quotation and inference thus given to the Medico-
Chirurgical Society were dishonest, in so far as they entirelyleft out all the most important facts and grounds upon whichan opinion was formed by myself and others. Dr. Lee gaveas the reason for our belief, that hysterotomy would be re-quired, what he knew was not our reason. And he palmedthis discreditable and disingenuous misrepresentation of factand opinion deliberately and knowingly upon the Society; forit seems his speech was read, and hence previously writtenand prepared. Nay, in the last LANCET, he maintains he didwhat was right and honourable, for " in doing this, I merely"(he observes) " quoted his (Dr. Simpson’s) own words fromthe Edinburgh Monthly Journal of Medical Science, No.lxxviii.p. 30." He still omits to state that he quoted one sentence only,and that a sentence which, when taken by itself, was calcu-lated to give his hearers a perfectly perverted idea of thedifficulties of the case; while with great care, but great dis-ingenuousness, he omitted to cite all those remaining portionsof the paragraph, which, when given, impart quite a differentview to the amount of deformity and contraction which existedin the pelvis of the patient.
It is, I believe, altogether unnecessary to point out moreexplicitly to your readers the perfect identity, in this respect,between the insane mode of ratiocination of the poor atheist andthe mode of ratiocination of Dr. Robert Lee before the Medico-Chirurgical Society. His speech was full of similar instances.Again, Dr. Lee attempts, in the last number of THE LANCET,
to justify himself for having made to the Medico-ChirurgicalSociety an untrue statement, as far as I was concerned, re-garding a case of ovariotomy. As the ground for this mis-statement, he used and published a letter, the author of which(Mr. Lizars) tells me was sent to Dr. Lee as a hurriedly-written,private communication; and he deems Dr. Lee highly blam-able in having printed any such private letter without leaveasked and given. I am sure every gentleman in the professionwill be of the same opinion in regard to such a public misuseof a private communication.Dr. Lee, in the last LANCET, states that any correction re-
garding the case that may be required must come from Edin-burgh. At the time Dr. Lee wrote this sentence, he wasaware that I had previously sent him a correction of his mis-statement from Edinburgh, and from Dr. Myrtle, the gentle-man who had the care of the cfse and of the dissection whichhe had misrepresented. Still, however, Dr. Lee had not thecandour and uprightness to correct the public misstatementof the case which he had made to the Medico-ChirurgicalSociety. In publishing this same case at length, in the lastnumber of the Edinburgh Monthly Journal, Dr. Lee’s strangeobliquity in this matter is commented upon by Dr. Myrtle, inthe following words :-
" In THE LANCET for the 18th and 25th of January, pp. 80and 93, it is stated that Dr. Robert Lee, of London, mentionedto the Medico-Chirurgical Society that Dr. Simpson believedthe tumour to be ovarian, until the two unaffected ovarieswere shown to him at the dissection. Now, Dr. Simpsonnever made, during the patient’s life, any physical examina-tion or diagnosis of the case, so as to ascertain the precisenature of the tumour; and certainly, at the dissection, he was,as I have stated, the first to point out to us that the tumourwas truly a fibrous tumour of the uterus, and that both ovarieswere untouched. On having my attention drawn to THELANCET, I wrote a letter to Dr. Simpson, pointing out theentire incorrectness of the statement that had been given tothe Medico-Chirurgical Society by Dr. Lee; and I understandthis note was forwarded by Dr. Simpson to Dr. Lee, with arequest that, as he had made inadvertently a misstatement ofthe facts to the Society, he would now be so good as to set thematter right. But ’ there are more false facts than falsetheories in medicine,’ said Dr. Cullen, and so it has proved inthe present instance. Dr. Lee stated, in relation to this in-dividual case, what was incorrect, to the fellows of the Medico-Chirurgical Society, and his mistake (though pointed out) isyet unretracted. This fact will show the degree of reliancethat the fellows of the Society ought to place upon any
* In describing the case, I have stated, that when Dr. Wiseman first sawthe patient, "the pregnancy was already so far advanced as to preclude,under such a degree of deformity, the idea of delivery by the induction ofabortion nr premature labour. Besides, all attempts to touch the os uteriproved ineffectual, so that none of the ordinary means of arresting preg-nancy, and exciting uterine action, could have been put into practice." ’
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similar statement of Dr. Lee’s. He gave a statement, somemonths ago, to the Society, relative, professedly, to all theknown cases of the operation that M. Berry was submitted to- viz., ovariotomy, and their results. But if, with regard tothis single case, Dr. Lee has fallen into, and persists in, error,of what use is it that he should pass in review all the othercases of the operation ?— what credit can we attach to hisresults ?"—Monthly Journal for March, p. 232.
Yours &c.,Edinburgh, March 3, 1851. J. Y. SIMPSON.J. Y. SIMPSON.
THE CÆSARIAN OPERATION.[LETTER FROM DR. MURPHY.]
To the Editor of THE LANCET.SiR,-i’n the last No. of THE LANCET, (March 1,) Dr. R. Lee
has published an interesting case " of great distortion of thepelvis, in which delivery was accomplished by the operationof craniotomy." I should not have thought it necessary toallude to Dr. Lee’s account of it, had he not appended thefollowing paragraph, explanatory of the object of its publica-tion:-" The history of the preceding case illustrates in astriking manner the truth of all my statements made to theMedico-Chirurgical Society, respecting the Csesarian opera-tion, and the importance of the induction of premature labourin cases of high distortion of the pelvis."However the history of Mr. Dunn’s case may illustrate the
importance of the induction of premature labour, permit meto say, that in no manner does it establish " the truth of allDr. Lee’s statements recently made to the Medico-ChirurgicalSociety respecting the Caesarian operation." The questionbefore that Society was, the propriety of the Cæsarian sectionin a case of extreme distortion of the pelvis from mollitiesossium. Dr. R. Lee condemned the operation in that instancein the strongest terms he could employ, and now brings for-ward a totally different case-different in the character of thepelvic deformity, different in the disease, different in theperiod of pregnancy in which the operation was performed-in order to illustrate the truth of the statements he has sorecently made.
I shall not revive the discussion that took place in theMedico-Chirurgical Society, unless, indeed, Dr. Lee compelsme to do so; but without entering upon it I may be permittedto repeat, that the question for consideration is not betweenthe comparative merits of the Csesarian section and the in-duction of premature labour, upon that point there is nodispute,-but between the Csesarian section and craniotomy,not at the seventh month, but at the full term of pregnancy, incertain cases of extreme distortion of the pelvis from mollitiesossium. Mr. Dunn’s case, in which Dr. Lee operated, was oneof rickets, the disproportion being only in the antero-posteriormeasurement of the brim of the pelvis. In this instance, itwas supposed to be an inch and a half, and through this spacea seventh month’s feetus was extracted by the crotchet. Mr.Wren’s case, in which Drs. Ramsbotham, West, and myself,were consulted, and Mr. Skey operated, was a case of extremepelvic distortion from mollities ossium, the disproportion beingnot merely in the brim, but also in the cavity and outlet of thepelvis. The distance between the tubera ischii would scarcelyadmit two fingers. The patient had arrived at the ninthmonth of gestation, and was some hours in labour. It will be ’,
perceived, therefore, that there is not the slightest parallelbetween the two cases, nor can anything that was done in theformer illustrate in the least degree what should have been Idone in the latter case.The questions to decide in Dr. West’s and in Mr. Wren’s
case were, the practicability of delivery by the crotchet, and,secondly, even supposing that operation to be within the limitsof possibility, whether the risk to the patient was not as greatas would result from the Caesarian section. I gave it as myopinion, that it was extremely doubtful that craniotomy couldbe performed; that the attempt, even if successful, would befatal to the woman ; and that, under such circumstances, wherecraniotomy would give no security that the patient would besaved, we were bound to consider the safety of the child. Tothis opinion I adhere, and I am happy to say that, my col-leagues taking the same view, we were enabled to save atleast one life; and had not the strength of the patient beengreatly reduced by the haemorrhage, so that she could notresist the shock of the operation, it is highly probable thatshe also would have been preserved.
I am, Sir, yours, &c.,Henrietta-street, Cavendish-square, EDWARD W. MURPHY.
March 3, 1851.EDWARD W. MURPHY.
ON THE AFTER - TREATMENT OF MR. SYME’SOPERATION FOR DIVISION OF STRICTURE OFTHE URETHRA.
JOHN WILLS.
To the Editor of THE LANCET.SIR,—I trust you will give space in the valuable columns
of your paper for the following observations on the treatmentof stricture of the urethra. It is not on the practicability ofthe operation as performed by Mr. Syme, which has alreadybeen so much disputed, and as I think admits not of a doubtboth of its practicability and its permanent curative effects ifits after-treatment be properly attended to. It is to this all-essential point I wish to direct the attention of surgeons. Itis the object of most men of the profession to procure asspeedy a recovery as possible for their patients after opera-tions, by allowing adhesions to take place by the first inten-tion ; and the practice I doubt not to be a good one in mostcases; but there are always exceptions to a rule, and this ex-ception I wish to call the attention of the profession to in thisoperation - viz., that in all cases union ought only to besought for by granulatioit, and not by adhesion, and to thissole cause I think has been the return of the stricture dueafter operation; for it is only reasonable to suppose that apart once prone to such submucous thickening would be moreliable to relapse when contraction by adhesion has takenplace. On the other hand, if you allow the catheter to re-main in longer, and keep the edges of the wound apart withlint, and allow it to granulate from the bottom, you let in apiece of new material (like a wedge), thereby preventing theleast chance of re-contraction of the parts, and I doubt notcutting off the local tendency to stricture; by so doing, notonly conferring a permanent benefit on the patient, but creditto the operator. These observations I only suggest to theprofession, and will now leave it for them to decide on thepreferable mode of treatment.
I am, Sir, your most obedient servant,Frederick.street, Edinburgh, March, 18-50. JOHN WILLS.
DR. GREGORY ON VACCINATION.To the Editor of THE LANCET.
SIR,—It is due to the profession and the public, after thenotice which you have been pleased to take of my remarks atthe Medico-Chirurgical Society, that I should either admit orrepudiate the facts-either adopt or reject the impressionwhich they have made on your mind. In two points you havesomewhat exceeded the limits to which I would have restrictedmyself, but the requisite corrections will doubtless be suppliedby the minuter detail of the Society’s proceeding, promised inyour next number. I am free to admit that you have put thematter in a fair light, and I am prepared to prove that myinductions are neither "rash nor unstable." But your practicalcommentary on the text is, in my apprehension, imperfect.
If what I stated be true, not only does it follow that theprohibition to inoculate vaccinated persons is unwise, andought to be repealed, but it follows also that the legislature isbound to interfere in behalf of the helpless victims of ignoranceand prejudice, and to make the vaccination of children cona-pulsory on parents. I am as much persuaded of the perfectefficiency of vaccination in the young, as I am of its inade-quacy to meet the just requirements of the adult. I claim forthe vaccinated adult the right of testing the efficiency of theprocess to which his parents subjected him in infancy nolensvolens. I say it is a hardship to compel the adult, who has, inobedience to the spirit of the law, submitted to vaccination ininfancy, to remain through the rest of his life in a state ofdoubt and dread,
" When he himself might his quietas makeWith an arm’d bodkin!"
I claim for myself and the members of the medical profes-sion the right of private judgment on occasions when thatjudgment does not and cannot prejudice the public interests.
I say unhesitatingly that the practice of re-vaccination isunsatisfactory, and the confidence placed in it illusory. What-ever good can be done by vaccination is done by one circuitof the constitution. Re-vaccination has never been acknow-ledged by the constituted authorities of this country, and Ihope it never will. It has never been enjoined by law, and itnever can be. Those who profess faith in vaccination as apreventive of small-pox through the whole term of life shouldbe the last to offer objections to the measure. If their posi-tion be true, nothing need be dreaded from the practice. Onthe contrary, it would throw additional lustre on the discovery
