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the many advantages which would accrue to the profession,and hence to the public generally, were regular reports of allthe "fe/M" in each separate metropolitan hospital periodi-cally published; as such official statements he thought wouldprove of much interest and practical value. Every charitableestablishment of the kind throughout the country shoulddo this; and if some master-mind would then take thewhole facts thus supplied, and arrange them in a lucid andinstructive manner, the great desideratum now adverted towould be effectually supplied. If reports of the kind de-scribed were published, they would for the future, to saynothing of the past, become, not only of great benefit to allnow in practice, or entering the profession, but to posterity.As an illustration of the importance of such documents. Dr.’Webster shortly referred to hernia and fractures, aboutwhich considerable difference of opinion sometimes prevailsin reference to the treatment. Could the surgeon, the authorsaid, refer with facility, when necessary, to a large array ofcases reported by the able&t practitioners, much of the presentdiscrepancy of opinion, on either of those subjects, must giveway before the weight of evidence derived from such sources.The treatment likewise of medical diseases, the value of par-ticular remedies, the symptoms characterizing epidemics, thetypes of even ordinary maladies, the rate of mortality ob-served, and many other interesting questions, would be allgreatly elucidated by the system suggested. Consequently,Dr. Webster hoped the parties who had the power wouldtake the subject now mooted, along with the plan suggested,into their consideration, so as, by an united effort, to removeevery difficulty which might retard its realization. The excessof births over deaths was afterwards noticed; it amounted to13,532 individuals during the last six months. If to these beadded the 10,128 constituting the excess of births over deatlisinthe two quarters immediately preceding, the total increase of thepopulation by this source would be 23,660 during the past year;which furnishes one cause, amongst others, of the constantly in-creasing number of inhabitants throughout this now enormousmetropolis. London, in the opinion of the author, is not per seinsalubrious; but it is the manner of life followed by thosewho dwell in town, which so often proves inimical to thehealth of its inhabitants. The various questions bearing uponthis important subject Dr. Webster discussed next, and alsocontrasted the rate of mortality met with in the British me-tropolis,contradistinguished from that observed in various Euro-pean capitals, all the facts stated proving the great superiorityof the former as a salubrious place of residence; Londonbeing, in fact, more healthy than Paris, Berlin, Vienna, andeven Rome, so famed as a refuge for, but often the grave ofinvalids. The author afterwards proceeded to make a few ob-servations on several circumstances, the judicious or improperapplication of which materially influences the health of indi-viduals, and hence of communities. These were-1. Food;2. clothing; 3. habits or customs; and 4. bodily exercise.After investigating some of the above topics, Dr. Websteranimadverted strongly upon the present system of tight-lacingin females, which fashion sanctions, although reason and expe-rience condemn such practices, seeing they very often prove ex-ceedingly inimical to health. Intemperance and tobacco-smok-ing likewise received decided condemnation from the author;who further disapproved of the modern custom now rather pre-valent, in the fashionable world especially, of frequently drink-ing tea on an empty stomach, and previous to meals. If oftendetrimental to nervous females, this habit is even more so tochildren and infants, as that beverage excites and rendersirritable their physical constitution, by unduly developingtheir granular structure and its functions. Hence he con-sidered the vegetable in question should be put in the samecategory as opium, tobacco, ardent spirits, or even wine; andit ought never to be allowed to any young person, unless asmedicine. After some other remarks, Dr. Webster concludedhis paper by alluding to the great benefits accruing to indivi-duals from properly regulated bodily exercise, judiciouslyemployed; he added, however, that the human frame mayhave too little as well as too much exercise; and on this sub-ject, as in reference to dietary rules, the author stronglyurged, that extremes should be always avoiclecl; to these

questions the well-known saying was most applicable, "ha.7nedio tutissirnus 1’bis." Dr. Webster concluded his communi-cation by remarking, that, as the physical constitution of manoften wastes from the want of sufficient muscular movement,so will the nervous organization, on other occasions, becomeexhausted, or worn out, by excessive toil, as well as from toogreat mental excitement. There being no time for discussion,the first half hour of the next meeting is appointed for thatpurpose.




RESEMBLING MALIGNANT GROWTHS,and exhibited two preparations of necrosis of the os calcis,in which the dead bone, infiltrated with pus, was still entirelyconnected with the living bone, although the disease hadcommenced eight years previous to its removal by amputationthe joints between the and the os calcis were par-tially attcliylosed: and, although the astragalus itself was

quite healthy, the joint between it and the tibia showed thecommencement of ulceration of the cartilages, demonstrating,as Mr. Hawkins remarked, the manner in which the i::fJam-mation of the soft part sometimes conveyed disease from onetarsal or carpal joint to another, and causing the reulaval ofpieces of necrosed bone, or the excision of even an entirebone to be not always successful. The case was remarkable,however, more from its history, as illustrative of the difficultyoccasionally observed in distinguishing between simply scro-fulous diseases and malignant affections. The patient, ayoung woman, was admitted into St. George’s Hospital, witha large’ phagedceuic ulcer of the inside of the ankle, exces-sively painful, and requiring large quantities of opium for itsrelief, with much thickening of the soft parts, looking, in thesections, not unlike scirrhus, and having in the centre somewarty granulations, resembling the cancer of cicatrices, (ofwhich Mr. Hawkins has written a description;) in the centreof which the probe passed down into the joint between theastragalus and os calcis, without touching dead bone. Aftersome attempts to heal these parts amputation was proposed,butdeclined by the patient. After a few months, a mass ofglands appeared, low down in the groin, as large as an

orange, as if enlarged by the contamination from the apparentcancer below, which did not suppurate like strumous glands,but sloughed gradually away. After previous ulceration ofthe skin, and as some were destroyed, fresh masses formed bytheir side, which went through the same process of sloughingduring two or three months. About the same time thereformed at the lower part of the femur, on its inside, a firmelastic tumour, obviously connected with the periosteum, butwithout bony deposit, about four inches in length, and perhapstwo inches in height; and soon after this a growth took placeon the left side of the frontal bone, soft in the centre, andconsisting apparently of a morbid growth in the diploe,making its way by pushing out the outer table, with a littleabsorption of the bone in the centre. Thus was formed acontinuation of appearances, in every respect seeming to con-firm the supposition of the malignant nature of the originaldisease, and quite sufficient to deter Mr. Hawkins from opera-tion, for which the woman was now desirous. In two or threemonths more, however, and as it seemed chiefly from the use ofiodide of potassium and sarsaparilla, all these latter growthsdisappeared; the tumour of the thigh gradually subsided, theglandular masses all sloughed out, and the part healed; thegrowth of the diploe disappeared, the bone recovered itsformer level, the skin recovered from the sallow com-

plexion it had assumed, and amputation was performed. Thepatient was quite well a year and a half afterwards, and it ispresumed, therefore, that the deceptive growth of the femurand cranium and glands could not have been malignant, andperhaps not so the morbid texture in the ulcer of the foot. Itseemed, therefore, not undeserving of the attention of theSociety, in conjunction with the case about to be related byMr. Hewett, in which a similar difficulty of diagnosis existedas to the strumous or malignant nature of the disease.Mr. PRESCOTT HEWETT presented a specimen ofCRUDE TUBERCLE IN THE MEDULLARY CAVITY OF THE FEMUR,

an affection which lie announced to be very rare, more parti-cularly in this country. The preparation was taken from aman, of about thirty years of age, who was admitted into St.George’s Hospital, a few years back, with a tumour situatedat the union of the middle and lower thirds of the thigh, tit

careful examination of which proved that the disease wasintimately connected with the bone, apparently springingfrom it, and occupying the greater part of its circumference.Somewhat globular in shape, this tumour was unyielding inits nature, but not painful when handled; its surface wasmostly smooth, and the circumference of the affected bonewas larger in this part by two inches than that of the oppositeone. The patient reported, that fifteen months previously to



his admission into the hospital, he for the first time, began tosuffer much shooting pain in the bone, which deprived him ofrest. Three months after this, the swelling made its appear-ance, and gradually increased in size; at this time, lie alsosuffered from swelling and induration of the testicles; thissubsided, and then recurred once or twice, leaving the righttesticle and cord somewhat enlarged, and hard. His healthhad begun to fail about seven months after be was firstattacked, and the pain in the thigh had, with few intermissions,been continual, and of a severe character. The countenancewas anxious, sunken, and sallow; there was little or no appe-tite, and the general health was much broken. The prevalentopinion was, that in all probability the disease about thethigh was of a malignant nature. No operation was accord-ingly proposed, the aspect of the case being too unfavourable.The patient was put upon sarsaparilla, and blue ointment wasapplied to the testis. In a few days the gums were affected,the countenance became very anxious, and the skin slightlyjaundiced; he also now complained, for the first time, of greatpain in the right hypochondriac region, where the liver wasfound to be much larger than usual, hard, and very tender.Blisters were applied to the abdomen; the mercury was dis-continued, and hydriodate of potash was ordered with thesarsaparilla. Under this treatment, the general health beganto improve, the hardness and swelling of the testis graduallydisappeared, and in some little time the tumour of the thigh, ! ’ ’when measured, was found to be less by an inch. These Bfavourable symptoms continued steadily, and in a few monthsthe man was made an out-patient, the hepatic symptoms beingat that time but slightly marked, and the thigh presentingmerely some general thickening of the bone at the part whichhad been affected. He was re-admitted, in the following year,into the physician’s ward, for ascites, and while there wasattacked with erysipelas, of which he died.At the post-mortem examination, extensive deposits of

Btubercular matter were found under the peritonseal coveringof the right lobe of the liver, as well as in numerous parts ofthe sub-peritonæal cellular tissue generally. Similar depositsexisted also in the structure of the kidneys, spleen, and lungs.On examining the parts which had been involved in the dis-ease of the thigh, great thickening and condensation wereobserved about the cellular tissue uniting the muscles, and inthat between the muscles and the bone; the periosteum,which was also very much thickened, presented on its freesurface a large patch of tubercular matter, enveloped in adense cyst. The bone itself was irregular in shape, muchhypertrophied, and very hard; at this part the medullarycavity was filled with tubercular matter, surrounded by gray,semi-transpa.rent lymph, presenting very much the appearanceof the well-known granule of the lung. No other bones wereexamined. In addition to the rare occurrence of crudetubercle in bone, Mr. Hewett thought that the history of thiscase afforded a very good illustration of the great difficultiesconnected with the diagnosis of tumours affecting the osseoussystem. The more marked symptoms of the case certainlyled to the supposition that the disease was of a carcinomatousnature; but this opinion was found to be erroneous by thedisappearance of the tumour, which in all probability hadbeen formed for the greater part by lymph effused around thetubercular matter found in the cellular tissue between thebone and the muscles.

(To be continued.)



"Audi alteram partem.11 ’

To the Editor of THE LANCET.

SIR,—If, out of respect to Mr. Allison’s powers of discrimi- ‘nation, I omit to state whether my observations on his letterwere intended as ironical or complimentary, I cannot hesitate Ia moment to assure him that it was from no want of courtesythat I did not reply to his letter of August 31st. Inde-

pendently of its being no answer to what I had previouslywritten, his suggestion, " that our mutual explanations by longletters would be neither useful nor entertaining to yourreaders," seemed so appropriate that I at once adopted it.Whether Mr. Allison’s deviation from such reserve, by the

publication of his letter of the 19th instant, will have aneffect contrary to what he anticipated, and will prove

useful and entertaining to you and your readers, to whom it isspecially addressed, is more than I am permitted to decide’upon; nor can I form a, judgment whether his friends, atwhose instigation it is written, will be satisfied that he hasgiven the coup de grace to my comments, or, whether they willrather think with me, that

- " Telum imbelle sine ictuConjecit."

His letter of July 10th comprised an account of the twodeputations that waited upon Sir George Grey on May 2nd;and after certain criticisms on the balloting-papers, summedup with the following sweeping conclusion:-" I think all medical men will bo now pretty well satisfied

in their own minds upon six points."Amongst these-(3rd.) "That the combination, or company, (or deputation,)formed by the Provincial Association with those gentlemen

represented by Mr. Cartwright, Mr. Bottomley, and Mr.Wakley, are applying for merely a trifling alteration ii2. theCollege Of Surgeons."

Such an assertion can be considered as nothing less than amisconstruction of the proposals submitted to Sir GeorgeGrey by the deputation from the provinces,—the substitutionof a fractional part of them for the whole,-and as those pro-posals were detailed in full in the Provincial Journal for May

29th, Mr. Allison, as a constant reader of it, must have been

fully aware that the combination or company, as he styles us,

did not limit their views to a trifling alteration of the College,inasmuch as the memorial presented by Sir Charles Hastings,and the proposals introduced by the deputation, embraced,not only a remodelling of the College of Surgeons on therepresentative system, but a much more extended scale ofmedical reform.Mr. Allison now says, he simply meant to show the position

in which he thought the balloting-papers, if acted upon, wouldplace the parties differing in opinion from the National Insti-tute ; but by what process of reasoning lie arrives at such aconclusion is not very clear. The balloting-papers were the

. ingenious device of Mr. Wakley, to confirm an uncertain and, hesitating minister as to the current of professional opinionrelative to the desire or otherwise for a new college ofi general practitioners, and well they appeared to have, answered the purpose, as no contra-indication has been shownby the Institute by means of any published summary of their1, balloting-papers.

An abstract opinion on one question such as was asked bythose balloting-papers could not, unless to serve party ends,be construed into an alteration of the views of the provincialdeputation, who has so recently laid their proposals in fullbefore the Minister and the public; I am, therefore, of opinion,that Mr. Allison had no just grounds for stating that theaforesaid combination, or company, were applying for merelya trifling alteration of the constitution of the College of Sur-geons; and, when he adds, at the end of his letter, "that,although the Council of the College of Surgeons have suc-ceeded in arresting the progress of medical reform duringthirty-five years, yet the before-named combination or com-pany will not be tolerated by the Government, in effectingthe same purpose, by dividing the house against itself, duringthe next thirty-five, nor even the next five years!"

I much question if the same indirect charge cf obstructingthe progress of reform had been made against himself, or hisparty, whether he would not have been (to use his own ex-pression) sufnciently thin-skinned to consider the imputationboth illiberal and uncharitable! Mr. Allison, however, nowstates, " that the general remarks in the conclusion of hisletter (above quoted) were meant not to cast imputations, butto speak out boldly and generally, and to remonstrate againstany plan from any party which leads to mystery, confusion, or

’ delay.I therefore assent, in all charity, to one who is somewhat

coerced into explanation by the pressure from without, thatmy interpretation of his remarks may have been erroneous.To revert to the general subject: Mr. Allison says, there

are two questions at this time before medical reformers.1st. "Shall the general practitioners of England and -BVales

be planed entirely under the control of, and as ft second classin, either of the existing special colleges’-."

2nd. " Shall the general practitioners be emancipated fromthe trammels and shackles of the Society of Apothecaries,and of the College of Surgeons, with power to educate them-selves under collegiate regulations!"

j I am sorry I cannot compliment Mr. Allison on the fairness! with which the nrst of these questions is put; on the contrary,can asseverate that no class of reformers has in contem-

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