GLASGOW ROYAL INFIRMARY.

GLASGOW ROYAL INFIRMARY.

111 In a note which appeared elsewhere last says Mr. Edwards, " is extremely complicated, yet still so palpable is its ap-- week from M. Heurteloup, ...

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111

In a note which appeared elsewhere last says Mr. Edwards, " is extremely complicated, yet still so palpable is its ap-- week from M. Heurteloup, he states, that the plication, that the veriest simpleton under-space between the neck of the bladder, and stands it." Would Mr. Edwards infer thatthat part of its sides immediately opposite,

clock,"

M. Heurteloup’s instrument may be ma- may sometimes be too narrow for the free naged with the same precision by the mostt expansion of a three-branched instrument. ignorant?—A few words will expose theThis objection is removed at once by the fallacy that lurks beneath this assertion.statement of the fact, that neither M. Civiale Air. Edwards, satisfied with the clearness ofnor myself, operate on large stones in the his illustration, is heedless of the grosshas-fond of the bladder. The position which fault of logic, which he commits in com-we give the patient, places the stone on the paring things, which, inter se, have no pointposterior wall of the bladder, where there is of comparison. If simplicity be the ob-always sufficient space for the full and gentle ject, every surgeon should have it in view inexpansion of the branches. It has been said the construction of a surgical instrument;that the branches of this instrument must be but, on the contrary, if it be the objection, extended to a considerable degree beyond or the evil, he ought to avoid it; the lancet,the tube, to seize a large stone. This is a the scalpel, the bistouri, &c. must be thrownstrange objection. The part of the branches, aside, and replaced by some self-acting me-which extends beyond the tube, must be an chanism, which reduces the duty of the sur-inch, to obtain a separation of three-quarters geon to that of a mere spectator. Theof an inch, and three inches, to produce a difference between the machine, or clock,, separation of two inches and a quarter, and the surgical instrument, is this : a clock which suffices for seizing a stone of the same is managed by a rustic, because the delicatediameter. machinery is already adjusted to his hand ; This separation of the branches is in rigohe has but to wind the cords, and all goesrous relation with their strength and length;

the litliolritic instrument is alto-for the strength of the branches is an indisdifferent engine. Its operationspensable condition to the success of the opeare not concerted beforehand ; they are quiteration, whether our object be to crush a uncertain. Its effects are not produced persmall stone, or to fix steadily, a large one. se, and independently ; on the contrary, theyIt would certainly be an easy matter, to are altogether controlled by the hand of him diminish this length, and still obtain the who holds the instrument. It is introduced same degree of separation ; but this could into delicate organs deeply seated, and out not be done, without making the blanches of view of the operator : here complexity of much more slender ; thus depriving them of that strength, which is the only guarantee mechanism in the instrument, requires direction both of a cool head and steady of safety in this operation. In the infancy of lithotrity, its author, hands. The slightest obstacle or derangement may confuse the one and the other, M. Civiale, employed an instrument with and thus render dangerous an operation, four branches, which he afterwards reduced which, with simpler means, would have been to three, in order to have greater solidity not only harmless but salutary. There is without augmentation of bulk. Experience then a substantive disparity between the moreover proves, that with the three-branchtwo cases. A clock, if I may so speak, instrument, the calculus is seized with knows exactly the duty it has to perform, much greater facili’y ; and yet, nevertheless, and cannot go wrong; the lithontritic instru- the new improvement of this instrument which is now proposed, consists in fourment must be informed every moment what it has to do ; it must be wielded by branched pincers, which had been already found to be not only embarrussing, but danLands familiarized by long practice to movements, and endowed with no ordinary gerous. I have the honour to be, Sir, I Yours, &c. delicacy of tact. It were perhaps W.B. COSTELLO. while, and it will not be irrelevant, to give Baron Dubois’ opinion of those instruments. i 108, Jermyn Street, Oct. :)3th. M. Duhois briny much pressed for his nion as to their relative merits, before be Lad himself undergone the operation, very GLASGOW ROYAL INFIRMARY. pithily remarked, "Que l’instrument soit surtout simple cela pcsé rant vaut l’homme, To the Editor of THE LANCET. tant vaut l’instrument." It would be impossible. in a few words, to express more SIR,—Since you ceased taking notice of powerfully his approbation of M. Civiale’s ingsru:oent. Translation might diminish its its surgeons, matters have been daily chanfor the worse. The salutary restraint force; I therefore leave it in the original. Mr. Edwards being an. able translator of upon them by the influence of the French, will readily understand it. press, is, in a great measure, gone. During

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ourRoyal Infirmary, andthe proceedings of ging

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112 the

summer

we

have had

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doings. It is my intention,

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present,

to

at your may as well for artificial pupil are me, if perforuied iu private, and if privacy, such cases, is essential to the safety oftLe answer this at the same

time, You aud, operations question sure, may

trouble you only with a few of these. In the first place, allow me to ask you, if you think the following specimen of our surgery calculated to inspire the patient? student with ideas of sound chirurgical ?— Probably you are not aware that our ir.. A young man, a sailor, about 24 years of surgeons are famous for thpi. IUtf propriety. Nothing, indeed, can exceed age, of a weak and debilitated constitution, was admitted, during the spring of the for- the purity of their morals ; every case where mer vear, under the Cilre of Dr. J. Couper, can, in any way, wound the feelwith non-union of the humerus. He had ings of female delicacy ia kept religiously his arm broken, a considerable time before, sacred. None are allowed to approach her by his fallingfrom the rigging of a vessel, but the surgeoll, his friend, aud his class. in which he was employed. The bone pro- Many whispers are afloat among the stutruded through the skin, and a portion had dents on a case of this kind, which lately to be removed before it could be reduced. occurred ; but, from the impenetrable mysDr. Couper frequently declared, in the pre- tery in which the whole is imolvcd, I Lare sence of the students, that, from the account not only felt considerable difficulty, but have of the patient, rie appeared to have been been totally unable to obtain any account most judiciously treated ; yet, notwitli- on which implicit reliance can be placed, standing all this, when his good, or rather Report does, however, say, that it became evil, fortune directed him to the ulasoow necessary to remove one of the nymphæ Royal Infirmary, in an impaired state of from a patient in the infirmary, and the ope. health, we were told, that nothing less than ration, as a matter of course, was to be pri. an operation was contemplated. Now what vate. How far privacy was observed in this operation could be of any advantage to the case our hospital functionaries best kn6w, it be tiue, as has been asserted, that poor fellow, except the removal of a useless member, I was totally at a loss to imagine ; the apprentices of the operating surgeon but this, it appeared, was not to take place; were allowed to be present, at the very the students of the hospital were nothing, in short, would satisfy our worthy surgeons but cutting down upon the bone, denied admission. So much for the justice, and exposing and removing a portion of its the impartiality, and, though last not least, reunited surfaces. t’iie day for the per- the conscience,-of a hospital surgeon. I was here about to cloe my letter, and formance of the operation was already fixed, but, in the meantime, an attack of enteritis intended reserving a few remarks on a supervened, which obliged them to defer it, case of lithotomy, which we will suppose From the treatment neces’;arity employed might occur in a Royal Infirmary. to a fu. for the patient’s recovery, he was left in a ture opportunity; but when I remembered wretched state of debility. In this condition that this anticipated opportunity might be he was sent to the country, with injunctions somewhat distant, and that there was stilla to return at the end of a fortnight and have portion of my paper unoccupied, I thought the operation performed. He did return, I could not do better than embrace the preand shortly aftt’r his re-admission into the sent occasion. It is by no means my inteoto describe every step and circumstanff hospital, he was placed under the care of Dr. Auchinloss, who performed the operation, of this supposed—only supposed—operawithout its beingfollowed hyany benefit. tion. We may merely amuse ourselves by Now, I ask you, Sir, if this was a warrant- imagining, that, after a devout able operation? The man, it was co-afessed, Mr. Key’s admirable little book on lithohad been most judiciously treated. Every tomy, a certain surgeon, no matter whom to proceed to the performance of this attention had been paid him, and, if the boue did not reunite when he was in a state operation, and that a wonderful crewd cf ofexcetlent health, was it, I ask, at all pro- youngand old, arave and gay, have assenr bable that union would take place, after the ou the occasion, to witness the crerapoor fei!ow had been weakened so by confinedexterity. F,.r the s’tke of data, we ment and disease? will say the patient might be fiftv, thitt the external incisions are made with the Having mentioned this case, perhaps vou will aiiow me to inquire, if it is customary,scalpel, the membranous purt of the in the hospitals of the metropolis, to ope!.erl, and the lithotome ran along thr the saw more frequently than once in 3m-! groove of the staff hito the bladder. Having putation ; and, if employed at two sue- supposed all this, we may likewise imaging cessive opt-rations, whether it would be ne- thta BB’e see, tirst the then the forceps counted a specimen of, what we, in these ! successively passed into the wound; but parts, call bungling, or an accident which, whether the opening in the bladder is too srliall to admit of their irtroduction, is, ra might happen to themost gifted

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113 course, no business of ours to

inquire. We DR. KNOX’S THEORY OF HERMAPHRODISM. think-we behold the THE Edinburgh Journal of Natural scalpel once, twice, aye, perhaps even thrice Science, for the present month, a new periothe wound, and, after all applied to enlarge has published the following theory of tais, that the forceps are at length intro- dlCaJ, duced. and the stone extracted, with some hermaphrodism, as the abstract of a lecture difficulty, on account of its being attached, lately delivered by Dr. Knox to his class of as is said, to the fundus of the bladder, at comparative anatomy. It is the intention of the end of six, or perhaps seven, minutes. the learned lecturer to make public the We will now suppose the patient put to bed ; that he passes his fxces by the wound ; whole of his inquiry into this recondite that he complains of insupportable pain on subject, through the medium of the Royal going to stool, and that this statement of Society, Edinburgh. Few men in this counthe patient is confirmed by the testimony of have pushed actual research into comhis wife, who attends him; that he gets try further than Dr. Knox, worse and worse, until the fourth or nrth parative anatomy this is contained the germ in abstract day, when be dies. Being dead, we will next suppose his body inspected, and be s. of deep and important views in philoso. foolish as to expect that this will be done phical anatomy,-a subject discussed by publicly, in the presence of the assembled more persons who carry no real anatomical students, that every imputation may be re- research to the inquiry, than by those who moved, and if there should, as is insinua- do. ted, have been any error committed, that it Knox stated, that it was by no means may be held up as a beacon for those entering the profession to avoid, by a candid andhis intention to submit to the class the whole honourable avowal. Being disappointed, of the inquiries he had been engaged in on the however, in this expectation, we may as’ subject of hermaphroditic structure ; neither well reverse the picture, and suppose it done would he occupy their attention with the in secret and in private; that no information details which had led him insensibly to the is given the students of the same ; that on the meet with indefinite adoption of those views, a portion of which subject and contradictory replies ; and that it is it was his intention to lay before them ; but done at an hour when few, if any, can posbeing pledged to produce these inquiries sihly be present. Into this cause of privacy elsewhere, he would limit himself entirely and concealment, it of course does not’ beto a bare announcement of some of the more come either you or me to intrude ; but, on the results. following day, we may as well suppose our- striking " selves seated in the operating theatre of a The object of this inquiry had been twoRoyal Infirmary; that a small portion of a fold. First, To explain the doctrine of the rectum, with the bladder attached, is brought ancients, as to the double course of the before us; that we are told there is no seminal fluids from the ovaria; and this led opening whatever in the rectum ; that what to the determination of the organs minutely the patient and his wife asserted was fasces, described by Casper, Bauhin, Lllalpigiii, and We will next others, in certain ruminating and pachyderwas Mucus—merely Mucus. imagine some of the students (unbeliev- matous animals,—organs which they took ing dogs) requesting the house-surgeon to for portions of female structure, because they hand them the preparation, and that one of were found in females, and for which they them succeeds in passing his finger through invented functions, in direct contradiction the rectum into the womb, and that he has to their anatomical structure, adding therethe impudence to point out the same to his by errors in matter of fact, to errors in theory fellow students, who are so very foolish as or speculation. These organs, Dr. Knox t) behove this opening has actually been proved to be the remains of male organs, caused by the knife, and is not, as in a though existing in the females of the rumiformer case of lithotomy, the result of ulcer- nants; and this proof was fully borne out by ation. his own dissections, by those of Mr. Hunter, The consideration of this supposed case ;and of all anatomists, though conductedby of lithotomy has occupied so much quite other views. To show how extended that I must, however unwillingly, for ithe errors were on this matter, the lecturer present, postpone some other observations ;referred to a late number of the 4itnales dtc to a future epistle. Museum, where these organs, which have I am, Sir, your most obedient servant, been so well described bv Bauhin, lIalpighi, in his letter to Spon, Gartner, and many AN INFIRMARY STUDENT. , and whose anatomical connexions others, cannot possibly escape the notice of any Oct. 1829. 2, Glasgow, careful anatomist, are denominated uterowill

now

think-only

and

Dr.

inquiries

space,

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vaginal ducts, although they have never, in1 pupil, and having done so, proceeded to any instance, been found to communicatee accuse me of having come there wholly for with the uterus, and were moreover shownathe purpose of interrupting the lecturer; by Dr. Knox to have no connexion whateverr and charged me with using language too vile with the system of female organs. for his lips to repeat, or for Mr. Key to hear, " Secondly, To determine what are male—In answer to the former accusation, I beg and what female generative organs, and thee to state, Sir, that I did not go purposely to laws of formation with regard to these sys-- interrupt the lecturer, but to participate, tems. The law was shown to be simple andi with many others, in manifesting my disap. bermapliroditical, and the doctrine ofana-- proval of Mr. Key’s violation of promise in logies, as laid down by ancient and modern1 omitting to give the prize which he had anatomists, was endeavoured, by the lec-offered to the best-informed of his pupils.turer, to be disproved, and was declared, byWhat language I could have employed "too him, to be contrary to daily observation, andI vile " to be named by Mr. Bransby Cooper, or to be heard by Mr. Key, I am at a loss to to common sense. " The type, apparently, agreeably to) conjecture. Those who have been accus.

nature (selecting, as seems usual, thetoraed to frequent the annual meeting of the complex) had formed the generative3 pupils and surgeons of Guy’s Hospital, or organs, was hermaphroditical, and the organs5 who were present when Mr. Key paid a being restricted to male and female, in thosewell-remembered visit to a certain patient, groups of animals whose functions and orga-No. 10 in the Accident ward, will readily nization required that two individuals shouldI absolve me from the guilt of so improbable, constitute the species ; but it was also) so impossible an allegation. Does not lllr. shown, that the type existed in many ani-Bransby Cooper recollect, at the last anni. mals, aud that even in those species iniversary dinner, his making use of language which the sexes were most strikingly sepa-with which one gentleman (the father of one rated, the rudiments of all, or of many off of the pupils) was so much disgusted that the organs, required by nature to constitutelie left the room? Has Mr. Charles Aston the original type,remained as evidence off Key forgotten the language he employed to her great plan. Finally, aberrations fromThomas Grant, the fishmonger, who was regular structure, as regards the generative; admitted into the Accident ward on the 20th organs, hitherto described as hermaphro-’ of May last, (and who now resides near the dites, lusus naturæ, monsters, ill-formed Old West Country Packhorse, Turnham males or females, &c., were reduced to the Green) upon his, Mr. Key’s, being accused simple law of a return to the originalby this patient of actually re-breaking a type." recently united fracture of his thigh;

which

most

OUTRAGE BY MESSRS. KEY AND COOPER AT

To the Editor

GUY’S.

of THE LANCET.

SIR,—As you have taken an interest in the proceedings of last Tuesday evening, at Guy’s Hospital, in which, in consequence of the conduct of Mr. Bransby Cooper, I was

unavoidably compelled to take a more active part than 1 had previously intended, I trust

you will allow me the early insertion of a few remarks, relatire to the transactions on that occasion. Those who were not present, or have not perused your last number, will find, by referring to it, an ample detail of the and will learn how conspicuous a figure Mr. Bransby Cooper then cut. It would appear from the position which this gentleman took in the Theatre, among the pupils, that he was deputed to fill it by his colleacruei, as the most fit person to perform his menial and disgiaceful office. IBlr. Branshy Cooper, seemingly conscious of the grade to which his attainments may be considered to entitle him, said, on that occasion, that be then only felt himself to be a

proceedings,

did not lie, amidst a torrent of vociferations, tell the man, in the ward, that he was a " d—d liar ;" bid him 11 go home," and,, go to h—I?" Are these affectedly fastidious gentlemen so absurdly inconsistent as to accuse another of a vice, which they themselves do not hesitate to practise? Should they complain of the illiberality of these disclosures, let them attribute it to the ungentlemanly, the coercive measures which they employed to prevent me from address. ing llr. Key in vindication of myself What is the character of, and who is Mr. Key, that he should lead another with the vilest of epithets, and then wonder that the object of his unmerited vituperation should have the audacity to attempt a reply? Whence has he derived his self-importance, and his professional honours, save from the vanity of his disposition, and the matrimonial chair of Guy’s Hospital? With regard to Mr. Key’s reply, on the subject of his broken promise.-Does Mr. Key consider the printed announcement of a promise indispensable to ensure its performance ? If so, what must lie sav of his " invulnerable" colleagues, who had adrertised, in their last year’s prospectuses, that clinical lectures should be given. Have