ANATOMY.

LETTER ON THE STATE OF ANATOMY, FROM

512

themselves admit, held out an’ geons in London, have the honour of adyour Lordship on a subject of painencouragement " to the commission of the dressing ful interest to the whole communitv, but worst of crimes. After violating all the especially to the members of the medical sacred obligations imposed by the profession. The Royal Collegeof Surgeons are emand the still more sacred obligation of their powered by their charter to examine ceroaths-after pertinaciously withhotding from tain individuals as to their knowledge of the members of the College their legal rights surgerv, and they are especially required cil

now

"

charter,

to

institute such examination

and

respecting

privileges-after filching from the those who are candidates for the situation in the army or navy. pockets of the medical students the most ex- of surgeons It is not possible that any one should be tortionate fees-after attempting to prevent properly qualified to practise in this departthe study of anatomy and surgery through- ment of the healing art who has not ob. out every part of England except London- tained a due knowledge of human anatomy, and explored, with his own hand, the after refusing to examine those gentlemen I structure of the dead body; proofs of who enjoyed the most advantageous oPP,9T- their having done so have therefore been of candidates who have tunities of dissecting in Paris-this worth- always required themselves for examination. presented less Jumo address Lord MEL-

I

presume to

BOURNE as

though they

themselves

were

The Council believed that they could not properly perform their duty to their Sove-

reign,

from whom the College received its to the public, for whose benefit lations" of which they are themselves the it was granted, without insisting on the of anatomy by dissectien, as themost authors-as though they were the virtuous imDortant nart of surff ical education. abhorrers of those crimes which they have They have, however, been aware that the brazen effrontery to confess have, in some serious objections might be urged to the course which they thus ventured to great measure, been encouraged by the take. operation of by-laws framed solely with a In the present state of the common law, view to the promotion of " sound chirur- as it is construed by the law authorities, the individual who dissects a human body, " When brass itself or even has it in his gical knowledge ! possession for any other shall exhibit the crimson blush of shame,purpose than that of burial, is guilty of a unless it be the body of a then may we expect that these men,- misdemeanour, for murder. malefactor hanged acknowledging their guiltiness-will not Bodies used for dissection in the anatoomit to supplicate with contrite hearts for micalschools have necessarily been procured by illegal means,-by the invasion of the sins which they have committed against consecrated ground, and the disturbance of their brethren, and also against the general graves, in a way disgusting to society at large, and especially offensive to the fticnds welfare of society. and relatives of the deceased. After the reader has bestowed some atThe regulations of the Council have tention upon this " confession," his mind therefore had a tendency to encourage both teachers and students to a direct violation will be better prepared for those comments of the law, and to establish, in the procurwhich, from want of space, we must defer ers of dead bodies, a set of men living by until the publication ofour ensuing Num- practices which are revolting to the feelings of society, exposed to the hatred and con. ber. tempt of those around them, and likely, by the joint operation of these causes, to become trained and gradually habituated to the comANATOMY. mission of still greater crimes.., The Council felt that could onlv do Copy ofa Letter from the Council of the Royal what was, on the who’e, thev for the best, in the in to Viscount College of Surgeons London, dilemma in which they were placed. The Melbourne, dated the 16th of Dec. 1831. circumstances which have just been enume. Royal College of Surgeons in London, rated did not escape their attention, and Dec. 10. have continually excited their most deep members of regret. But, on the other hand, they were Lord,—The undersigned, My the Council of the Royal College of Sur- called upon to regard the obligations of the innocent victims of those

very " Regu- charter, nor

study

513

their charter. They were aware that the’ conducted, want of pro perl y-educated surgeons would laws.

be

adopted

under the

existing

In the other countries of Europe anatomy Howa serious evil to the public. much they might be inclined to en- is taught only under a license, and in cercourage the use of preserved parts and mo- tain places appointed by the Government, dels as subsidiary means of teaching ana- and an exact register is preserved of all the tomy, they were convinced that these are of bodies consigned for dissection. But it is themselves quite inadequate to afford that a contradiction to suppose that any such minute, complete, and accurate knowledge license can be granted, or such register which is necessary in surgical practice, and preserved in this country, where the study which the student only requires by dissec- of anatomy is barely tolerated, and where tion. not only the procurers of dead bodies, but The Council further submit that they the anatomical teachers and students, are have laboured under much embarrassment alike engaged in illegal pursuits. from the inconsistencies and contradictions In offering this representation to his Maof the law itself, which at the same time jesty’s Government, the Council are not that it declares the student to be guilty of without hopes that some plan may be devised a misdemeanour if he attempt to obtain anaby the legislature calculated to remove the tomical knowledge, renders him also, when serious evil of which they now complain. afterwards engaged in practice, liable to a At the same time they beg leave to declare civil action on account of any mistake on their own part, and on that of all the which his ignorance of anatomy may lead other members of their profession who are ’ him to commit. now in practice, with the exceptioh of the But, whatever may have been the extent very few who devote themselves to the of the difficulties which haveheretofore ob- laborious and often unprofitable task of structed the Council in the execution ofteaching anatomy, that the question is one duty, they may well be regarded as in which they have no direct or personal insignificant when compared to those which interest. Whether anatomy be taught lethey have to encounter at the present mo- gally or illegally, or not at all, does not ment. concern the existing race of practitioners in The large prices which have of late been medicine or surgery, who have completed given for anatomical subjects have operated the period of their education ; but it deeply as a premium for murder. If the Council concerns the public : and it is under a of the College continue to require thatstrong’ sense of the evils which society may those who present themselves for examina- ultimately experience, and from a desire tion shall have studied practical anatomy, conscientiously to perform their duties, who can venture to say that crimes similarthat the Council of the College have ventured to those which have just now filled the pub- to make this demand on your Lordship’s lic with dismay will not be again committed ?patieiiee and attention, at a moment which, More criminals will undoubtedly arise;on an occasion of less importance, they new victims will be added to the list; andshould have deemed unseasonable. the medical profession will be necessarily (Signed) degraded from the high situation which it ought to hold, as having in its relations to’ Robert Keate, President. society no object but that of conferring benefit on others. Presidents. . The Council have no expectation, whileG. J. Guthrie, the law remains as it is at present, and surThomas Copeland, gical students continue to cultivate theWilliam Blizard, science of anatomy, that any means can beAstley Cooper, John Howship, contrived which will prevent a repetitionWilliam James Briggs, Lynn, of the horrible offences to which they have Wm. Lawrence, A. J. Hawkins, just alluded. Attention and constant suspicion on the part of the teachers may effectt Anthony Carlisle, B. C. Brodie, much, but not all that is requisite. Benjamin Travers, It is v ai,n to imagine it always possibleH. Leigh Thomas, to distinguish the body of a person who hass Anthony White, Henry Earle, been murdered from that of one who hasJ. G. Charles Bell, Andrews, died a natural death. The very individuals who have latelySamuel Cooper, Joseph Swan. suffered on the scaffold would probably haveP escaped detection if they had been more circumspect and wary in their conduct: no] can all the precautions with which it is

prove ever

their

John P. Vincent,Vice

desirable the

study

of anatomy should be

514

softened and covered

thin reddish

skin, Edinburgh Medical and Surgical Journal. which soon ulceratedby and a discharged January, 1832. sanious fluid. The disease was of twelve 1’N the current Number of our Edinburgh years’ duration, and commenced at the angle contemporary, there occur some original of the jaw with an induration the size of a articles well deserving an extensive cir- walnut. Within the year preceding the culation. Of these we may particularise, time now described, the swelling increased in the order of their location rather than of rapidly, and was accompanied by cousider. their merit, Dr. Stedman’s Contributions able pain ;to Operative Surgery," a history of the Operation.- The operation may be discarlet fever of St. Bartholomew, by Dr. vided into two parts. The first consisted Cock, tending to show that the Dandy is but in tying the common carotid artery, the a modification of that disease; a continua- second in extirpating the tumour.

The

"

" Theman being laid on his back on a tion of Dr. James C. Gregorv’s excellent firm cot, and his chin turned to the left article on the pathology of diseased kidney, side, an incision was made along the interconneoted with an albuminous state of nal margin of the sterno-cleido mastoideus, urine ; amedico-legal examination, by Mr. commencing from a point on a line with Alexander Watson, of twocases of death the middle of the thyroid cartilage, and from injuries of the head; and, lastly, an extending to near the sternal extremity of the clavicle. The fibres of the important article on the effects of opium- myoides were next cut through, andplatysma I proeating on health and longevity, by the’ ceeded cautiously to dissect through the Edinburgh Professor of Forensic Medicine.. cellular substance to find the sheath of the Of the articles now named, we proceed to, artery. This part of the operation was ren. offer a sufficient analysis; the remainingdered very embarrassing by the quantity of ’ blood, both venous and arterial, that flowed papers shall receive a passing notice. at each touch of the knife, for as fast as it was sponged, the wound was filled up again EXTIRPATION OF A SCIRRHOUS TUMOUR. with blood. As the bleeding continued, To begin with Dr. Stedman’s contribunotwithstanding five small arteries had been tions to operative surgery, we find the nar-- tied, by the advice of Dr. Hornbeck, 1 en. rator describing three rather remarkablee larged the incision backwards towards the This was a circumstance of little operations performed by him at St. Thomas’ss tumour. as this incision would have been in the West Indies. The first was the ex-moment, at all events, in the subsequent necessary, tirpation of a large scirrhous tumour in thee operation. This gave me more room; and situation of the right parotid gland, pre-- by waiting patiently for a short time, the v wound was so far cleared of blood, as to ceded by the of the carotid artery at the same side. The patient was a free allow me to distinguish the sheath of the carotid artery, with the descendensnoni on black, a boatman in the harbour. The its anterior part. The artery lay very deep, tumour extended from behind the concha so that after repeated attempts to cut open of the external ear, to one inch below the the sheath, I was obliged to make the man angle of the jaw-bone. Upon the upper sit up. On turning his chin to the left the artery now became much more part of the tip of the ear, and part of the side, superficial ; and 1 was easily enabled to cartilage of the concha were embedded in open the sheath, by pinching up a part of the swelling, which extended on the fore- it with the forceps, and dividing it, by cutpart from a little below the malar bone to ting with the knife laid flat. Having passed the upper portion of the thyroid cartilage. the common aneurismal needle, armed with It dipped under the jaw-bone to the depth one stout well-waxed silk thread, closelv roundthe the artery,and and havingsatisfied satisfied the of nearly two inches. Its dimensions were in attendance that there was gentlemen 4½ inches in length from its attachment to nothing but the artery included, I drew the the jaw, 16½ inches in its largest circum- ligature firmly and strongly. The pulsation ference, 9 inches from the base of the ear immediately ceased in the upper purtion of to the bottom of the tumour, 10½ inches the artery, which I could distinctly feel its sheath for at least a third of an across its middle from the posterior to the through inch above the piace where it was tied. anterior boundary. The greater part was The internal jugular vein gave me not the exceedingly hard, but on the top of the least embarrassment, nor did I even see it the The artery was tied swelling there were two lobe-like, parts,

ligature

artery,

! during

operation.

having

515

This space was therefore a point about a line opposite to the mid- unsoundness. This first covered with adhesive strap, and allowed dle of the thyroid cartilage. and to granulate." operation lasted fifty-five would probably have been concluded in half The second operation lasted about fortythe time, but for the embarrassment caused eight minutes. The loss of blood was inby the superabundant flow of blood." considerable, and the patient showed no The patient was now allowed to rest for signs of weakness. The cure proceeded most a quarter of an hour, and some refreshment favourabiy ; the ligature came away on the At the expiration of this24th day, and on the 27th he was dismissed was given him. quite well. Dr. Stedman’s remarks on this period the operation was again resumed. are so brief and pithy, that without " An incision was made behind cùnclw of the ear to the termination of thebeing prodigal of our space, we may allow tumour in the neck. I next dissected the him to suppiy his own commentary, with skin from the tumour until I had arrived which we entirely coincide. near its base. An oval incision was then " Remarks.—The two sketches prefixed made on the front part of the tumour, exrepresent the patient with the tumour, and tending from the front of the ear to the ter- when cured. It will be observed that there mination of thefirst incision. I was unable is a slight contraction of the mouth to the to save so much skin as I had wished, flOm left side. There was something of this beits being tuberculated, and of a suspicious fore the tumour was removed, but it has appearance. The tumour was dissected out somewhat increased since ; probably owing cautiously on this side also. Notwithstand to the labial branch of the ves anserinus ing the ligature of the common carotid being cut in the operation. artery, several arteries sprung’ in the course " There hae been some dispute among of the dissection,
minutes,

from

I

thecase

I

finger,

this,

and

supplies

516 the epidemic. fever of 1827’, and establishes, entirely to The appearance of the disease and its treat- our satisfaction, a complete identity bement next receive attention. Of the former tween the diseases. He dwells with much Dr. Cock speaks in these terms :judgment on the impropriety of applying and of constituting ’° The first case of scarlet fever which I new nosological terms, new of diseases, on the strength of genera saw on the 2d of December, 1829. This I believe to have been the earliest instance of the accidental complications to which all that disease, as I am not aware of any other epidemic maladies are exposed. having previously come under the notice of Of the treatment of the disease, Dr. the medical men of this place. It occurred in a little girl from six to seven years of Cock speaks at some length. As his gene. age, was exceedingly mild, and attended ral observations can only be interesting to with little, if any, soreness of throat. SeveIndian practitioners, we pass them ral members of the same family were atover, and extract his interesting remarks on tacked, but in a much more violent manner. the reputed power of belladonna as a pto. The disease in them assumed the anginose character. Thence it soon extended to a phylactic against the contagion of this neighbouring family, whose friendly atten- malady. tions were repaid by one of its severest " Bellladonna.—Having read some time visitations. The mother of four children having ago in the Edinburgh Medical and Surgical visited a young lady who was labouring Journal (vol. xxvi. p. 222) the observa. under the disease, was speedily affected tions of Dr Randhahn on the efficacy of as a preventive against scarlet herself, and waf the means of communicat- belladonna I felt anxious to ascertain the value fever, it to the her Her members of ing family. of his remarks ; but the difficulty of obtain. case was mild; that of her family very fresh preparation of this medicine severe ; and three of her children exhibited ing any me from making any experiments specimens of the disease in its most malig- prevented nant form, and one fell a victim to it. It on this subject until the 12th of April. The an individual never became epidemic, but continued iiii- scarlet fever having attacked til the end of June, creeping gradually from of a family consisting of seven or eight per. one familv to another. It seldom existed sons liable to the disease, I embraced that of trying what power it posin more than one house at a time, and its opportunity source could always be traced to a commu- sessed in guarding the rest of the family nication with the infected. The fever was from the contagion. I accordingly gave to believed to be imported from America by a each of those who had not yet suffered from the disease a pill of the extract of bel. lady who arrived here with her children, ladonna every night and every morning. who were attacked on board with it; and it The effects which were produced by the in the in she first which family appeared similar in all ; they slept well, lodged during her stay in this island. She pills were more freely than usual, and hada left this for Montserrat, where I under- perspired stand the disease broke out soon after her soft and full pulse. Only one of the seven, however, escaped an attack of the disease, arrival. ‘° The greatest proportion of cases were of and 1 cannot say thathis exemption was due the anginose and malignant species; but to the belladonna, or to a constitutional imboth forms were distinguished by being munity. The disease, however, in the was not severe, and appeared ceraccompanied with, or complicated by, rheu others, to have been modified by the use tainly matic pains of such singular severity as to make some approach to the fever formerly of that drug. It appeared to me, that, if it was useful as a preventive, it must described under the name of Dandy." be by keeping up a state of action of The author next describes the semeiology the system incompatible with the existence of the anginose and malignant varieties ofof scarlet fever, and that this action conthe epidemic, and under the first he particu- sisted in preserving a full and soft pulse, and a tendency to perspiration in the cutalarly dwells on the occurrence of violent neous vessels, and that, if such be the case, and long-continued pains of the head, back, it ought to he not only useful in warding ot1’ wrists, elbows, and knees, and of the joints an attack, but in subduing the disease when of the toes and fingers, aggravated much at it already existed. I accordingly used it in several cases of scarlet fever, and in all with night, and remittent in their visitations. advantage ; it induced sleep, rendered the his observations on Grounding principally slower, and produced a perspirable pulse these symptoms, Dr. Cock traces a close condition of the surface, which is very de.

logical phenomena preceding

West

parallel between them and the Dandy

sirable in this disease.

I

employed

it in

517 he places much reliance, as it existed of which threatened to be but all terminated well, in various they grades of intensity in one-half vetyviolent; and in a short period. In some it acted the patients. The cases recorded, also illikewise as a purgative. Its value as a

six

which

cases, some

forcibly, the slow and insidious progress of the symptoms, and their tendnumber of ency to recur, often without any obvious

preventive or a remedy, should the disease occur in public schools, or any other public

lustrate,

establishment where there are a individuals susceptible of its contagion, cause, and in a more aggravated form, and, might easily be ascertained. In private occasionally, after long intervals of apparent practice, opportunities for makingsuch ex- good health. periments do not often occur. 1 think, With regard to the treatment, Dr. Grehowever, that it will be found more valuable as a remedy than as a prophylactic." gory considers venesection to be admissible only in a very early period of the sympRENAL DISEASE. toms. Of diuretics and mercury he speaks Dr. Gregory’s paper next demands no- in these judicious terms :tice. It consists of the details of thirty°° Diuretics generally acted well, and in five cases of renal disease, accompanied bv many cases very rapidly and powerfully. albuminous urine, and in which the reme- Those most commonly employed were digidial measures were attended, if not with talis, squill, and supertartrate of potass; permanent, at least with lengthened, benefit. and they were generally found to act best In a former number of this Journal, it will when combined, as, for example, digitalis and squill in the form of pill, or squill pills be recollected that we gave a brief anaand supertartrate of potass in doses of half lysis of Dr. Gregory’s first paper on this an ounce dailv continued for some time. subject. We observed that he differed from In such doses, supertartrate of potass proved Drs. Elliotson and Graves, the latter of in these cases, as Dr. Bright aud Dr. Chriswhom supposes that the low specific gra- tison found it to do in their practice, one of the most certain, and, at the same time, vity, and coagulability, of the urine, were most powerful of the diuretics employed. characteristic of chronic hepatitis, and unThe spirit of nitrous ether, acetate of potass, certain in their indication regarding the and mercury, appeared to act well as diurepathology of dropsy. Dr. Elliotson, again, tics in some cases. It is proper to remark contended, that the numerous examples of that, in six out of eleven cases, including those in the former part of the paper, in recovery from deceased conditions, accom- which mercury was given, soreness of the panied by these phenomena, showed that mouth and gums, with mercurial fetor, was we could not depend upon them as diasproduced by a small quantity in a very nostic signs. We now find Dr. Gregory short time, and in three of these violent set in with great pain and swellsumming up his excellent article by a gene- salivation ral review of all the conclusions afforded ingof the mouth and face, and in one, of the tongue and external fauces, requirinby the multitude of facts it contains. active measures of depletion. These cases, Dr. first remarks, that of the therefore, would seem so far to confirm the cases described minutely in his observation of Dr. Bright as to the tendeighty to rapid and violent salivation even essay, none were below the age of puberty, ency small doses of mercury, which exists from while in a large proportion of the whole in this disease, and as to the difficulty which number they were above forty years of age. is frequently experienced in restraining its They moreover pointedly illustrate the fre- efIects. Diarrhoea was best cheeked bv solid opium quent complications of this disease with affections of other organs ; symptoms of the in full doses, when existing- either alone or lungs or heart, existing in twenty out of in an urgent form ; the opium was advanthirty-five cases. Again; more or less tageously combined with chalk or the ace> dropsical effusion existed in fifty eight tate of lead. The concluding twelve pages of Dr. G recases, denoting that hydropic accumulation, , a is no means essenan though frequent by g’ory’selaborate memoir are devoted to a tial companion of this malady. The symp- minute inquiry into the specific gravity of toms next in point of frequency were the urine in health and disease ; into the vomiting and diarrhoea, which occurred tests by which albumen is detected in that sooner or later in 46 out of the 80 cases. fluid ; and into the circumstances under which Lumbar pain is, another phenomenon on it occurs, and the relation of the quantity of

(Gregory

518

present to the quantity of albumen and of urine. In fifty patients labouring’ under this disease the urine was examined as to its specific gravity with that accurate instrument Twaddel’s hydrometer, and the average of 1011.88 obtained in the fatal cases, and of 1014.48 in those which recovered, the maximum being 1023.5 and the minimum 1004.5. In all these cases the specific weight was ascertained before any diuretics or other remedies were employed. Collecting the results of these experiments with those previously obtained by Drs. Bostock, Bright, and Chistison, the mean sp. gr. is found so nearly identical, that Dr. Gregory justly concludes lowness of sp. gr. of the urine to be a constant accompaniment of this disease. urea

The average specific weight of healthy urine next engages the author’s attention. He notices the great discrepancy between the best authors on this subject, and then communicates the results of his investigations on the urine of fifty young, or middleaged, healthy men. Here also every precaution was observed in guarding against any circumstances calculated to render the results fallacious, and it was found that the maximum average sp. gr. attained 1026. 63, that of the lowest 1017.72. It will be remarked that the minimum of the healthy is higher than the maximum of the morbid secretion. Dr. Gregory fiaallystates the curious and important fact, that the albumen of the blood is considerably diminished in quantity, the sp. gr. of the serum being so low occasionally as 1018. 25. We have thus

given

densed notice of the

our

most

readers

a con.

prominent points

in Dr.

pathology effect-what therapeutic blessings might there not be lavished on man. kind ! next we shall give a detailed of analysis Dr. Christison’s excellent paper, and offer some remarks on the other essays which the present number contains.

In

our

PREVENTION OF CHOLERA. APPEAL TO THE RICH ON BEHALF OF

THE

POOR.

IN No. 433 of TilE LANCET, I read the very important communication of your Sunderland correspondent, and there is a point insisted on in that letter which appears to me of such superlative importance that I must beg leave to intrude on your attention The suba few observations respecting it. ject I allude to is that of ameliorating the condition of the poor. For some time past I have felt an impression on my mind, that the attention of the British public was not sufficiently awakened to the necessity of taking speedy and decided measures in order to eflect the removal of all those states and circumstances which might tend hereafter to invite, to accept, and to foster the threatened pestilence. It is true that something has been done, that much exertion has been used, that much valuable time has been employed in removing filth and other nuisances, which, in ail probability, will soon collect again ; but as far as regards the improvement of the condition of the poor, in mv opinion nothing- shortof radical reform can avail us any-thmg. I hnow that it has been proposed, at meetings of the wealtherinhabit. unts of certain parts of London, to raise a fund in order to provide clothing, food, and fuel, for the poor, in case of the arrival of the cholera; but this has been opposed on the score of the impossibility of raising a sum, by subscription, ot maunitude sufficient to meet the demands which would be-made upon it. Now when we look at the circumstances under which we

Gregory’s instructive essay, but the pathologist will find it necessary to make are placed, a great and populous kingdom it the subject of much more detailed and already invaded, and threatened to be over-. deliberate study. We esteem it as one of run, by a pestilence which presents amost forthe most important contributions to the midable aspect to us individually, and collecscience of semeiology which modern prac- tivelv as a nation, shall we not under such circumstances make exertions!

titioners have

and we are happy to compliment the author on the evidence it affords of the industry and ability with which he cultivates the facilities supplied him by his situation of hospital physician. Did the drones our huge asylums for the sick follow Dr. Gregory’s example but for

afforded;

of

five short years, what progress

might

extraordinary

Is this not a season tenfold more urgent than ha. ever, during the lifetime of any of this benelation, presented itself for mal,mg a pecuniary sacrifice for the public good ? And if there be enormous poverty in this great city, is there not also unmeasurable wealth ? If appeals to our benevolence alone, have brought forth a guinea from our purses, shall not not an appeal made simultaneously to our