MEDICAL SOCIETY OF LONDON. MONDAY, MAY 28, 1849.—MR. HANCOCK, PRESIDENT.

671 situated near the lacrymal duct, and, from proximity to that its fellow; she has now sight sufficient to follow her household organ, partaking much of the same structure; so, in the tu- duties. The third case occurred in a wayward boy of fourteen, mours described, they had the appearance of the gland in opacity of the cornea, and attachment of the iris to it, oonwhich, or near which, they were situated. So growths near stituting a further complication; the sight had been lost some the bone assumed a bony structure, or, near fat, a fatty one. years before by severe inflammation, and an ulcer had peneHe then referred to some lectures of his own, in which he had trated the cornea of the left eye five years later. This ulcer called these tumours " conglomerate," not being of the neigh- existed at the date of his admission, and the pupil was occubouring structure, or connected with it, except by contiguity. pied with a broad film of very dark uvea; the lens was opaque, Mr. BiRKETT said that some obscurity hung about his paper, but pale. Keratonyxis was twice performed, the capsule of from the former part of it not having been read. Authors the lens being opened, and the uvea freely divided. The had given most indefinite names to these tumours. He agreed capsule was subsequently detached from, the iris, after three with Mr. Hawkins as to their nature, but differed in regard or four attempts, the boy’s resistance rendering the operations to their connexions. He had seen no tumour which was not through the sclerotic very difficult. The pupil subsequently connected with the mammary gland, though it might be sur- expanded freely. The needle was subsequently introduced rounded by. dense fibro-cellular tissue, the result of the pres- three times through the cornea, to cut off a large conjunctival sure of the tumour. They were as much hypertrophy of the vessel, and detach the lower- edge of the pupil from the back gland as enulis was hvnertronhv of the gum tissue &.c. of the cornea, at the seat of the perforating ulcer. A satisresult followed, the lad having sight sufficient for all CASE OF POPLITEAL ANEURISM. By J. D. WRIGHT, Surgeon- factory common purposes. Major, Grenadier Guards. Mr. DixoN remarked that the author had called his’ cases a. This case derives its interest from the fact of a favourable " peculiar" form of obstructed pupil, treated by a " peculiar" termination having followed the application of a ligature on operation. Now the obstruction was the common one, and the femoral artery after the aneurismal sac was ruptured, the. operation that commonly resorted to. compression having previously failed in effecting its obliteration. The patient-was aged thirty-seven. Six days prior to his admission into the hospital he had become aware of a popMEDICAL SOCIETY OF LONDON. liteal swelling, to which his attention was directed by pain in the, knee. The tumour, on examination, was found. to be as MONDAY, MAY 28, 1849.—MR. HANCOCK, PRESIDENT. large as an orange, and presented all the characteristics of true aneurism. He was bled, and the pad of an Italian tourDr. THEOPHILUS THOMPSON, in reference to the discussion at niquet applied over the femoral artery, just before it enters the last meeting of the Society, respecting the increase of the Hunter’s canal. Effectual pressure could not be borne conspecific gravity of the urine when lemon-juice was given with tinuously ; but the limb gradually became accustomed to par- advantage in rheumatism, said, that on inquiry amongst his tial interruption of the flow of blood through the artery, and friends, he had found that no such increase in the specific the tumour became smaller and more solid. On the eighth gravity had taken place in some cases. Sometimes there was sac burst whilst the was at and day, however, the patient rest, an increase to a certain extent; but even this was not conit was deemed advisable to tie the femoral artery, which was noticed in the cases treated in Guy’s Hospital. done after the lapse of only three hours. The ligature sepa- stantly Mr. W. F. BARLOW read a paper rated on the twenty-sixth day, and the wound healed kindly. ON VOLITION AS AN EXCITOR AND MODIFIER OF THB A twelvemonth has since elapsed; theman is well, and the RES-PIRATORY MOVEMENTS. tumour is reduced two-thirds of its volume. Mr. CHARMS HAWKiNS mentioned a case of popliteal aneuobserved, that it was important as -a practical subject. rism successfully treated by pressure. The patient was ninety The question of respiration was extremely complex, and it years of age, and under the care of Sir B. Brodie. He had must be considered accordingly. The respiration during sleep been the subject of various maladies, and seven or eight and wakefulness presented a great contrast. To illustrate the months before death, a pulsating tumour presented itself in effect of the mind upon this function, the author cited a very the. ham. There- was no trace of any other disease in the eloquent passage from the work of Sir Charles Bell, depicting vascular system. A piece of amadou plaster was placed over the influence of emotion on the respiratory movements. Then, the swelling, and kept in position with a bandage. All pulsa- proceeding more immediately to his subject, he dwelt -upon tion ceased in four or five months. He died of other diseases. the information which a person might derive respecting the All the usual appearances of - a cured aneurism were found power of his.will over the breathing motions, by the examination of himself. He thought it useless to attempt a definition after death. of the will. We were ignorant how it acted on the bodyas A PECULIAR VARIETY OF CLOSED PUPIL. CASES ILLUSTRATING Sir John Herschel had admirably stated; we must observe for By P. C. DELAGARDE, Surgeon of the Devon and Exeter ourselves, and make. moreover, observations upon ourselvesif Hospital, and of the West of England Eye Infirmary. we- would comprehend what it accomplishes, as Locke had The form of closed pupil referred to by the author is cha- I, long ago remarked. To show that.a personmight become for racterized by the existence of dark-brown pellicles, extending awhile the sole exciter of his respiration, Mr. Barlow infrom the iris to the capsule of the lens, the consequence of stanced the case of Hunter, as related by himself, in which, inflammation of the former texture, and conjectured by him when involuntary respiration stopped, that physiologist, thinkto be portions of the uvea retained at their point of adhesion, ing he might die in consequence, purposely dilated his chest and partially detached from the retracted iris; these pellicles by the power of his will. He then cited the remarliable- inmay cross one another, occupy the pupil, and close iis aper- stance of Dr. Bateman, who, when affected by erethismus ture. The author cites three illustrative cases, and details mercurialis, was obliged to be aroused frequently, lest sleep their treatment. In the first, which occurred in a man of should be fatal to him. This was because volition was necesfifty-four, the crystalline and its capsule had been previously. sary to assist his breathing. Mr. Barlow dwelt upon the removed, and the dark elongations of the uvea filled the whole various and obvious modes in which the respiration was modiarea of the pupil. The iris and obstructing uvea were divided fied, in acute diseases of the chest. The state of the will, and transversely, by introducing a sharp-pointed iris knife through the energy with which it was exerted, had no little concern, the sclerotic, behind the ciliary body, and the cure was per- sometimes, with the issue. There was much more to be conmanent. In the second case, dark matted bands of uvea sidered in reference to dissolution, than could be learnt from concealed the crystalline lens, and adhered to its capsule. the traces of disease. One person lived under an amount of The patient, a female of fifty-three, had been the subject physical disorganization which would have killed another. of syphilitic iritis six years before, which-attack terminated The voluntary exercise of respiration in certain pulmonary in loss of vision. The crystalline lens of the right eye diseases was a very important topic for inquiry. The "Medical (being opaque) was first dispersed, and the capsule torn up, Notes and Reflections" of Dr. Holland contained an essay on and the pupil cleared of uvea in four operations, the needle this question, the suggestions wherein, as Mr. Barlow thought, being introduced twice in front of, and twice behind, the might be carried much farther than appeared at first. Not iris. Belladonna was afterwards freely employed. A similar only in pulmonary diseases, but in other diseases which very operation was twice repeated on the left eye, after which she frequently involved the lungs, the state of the respiration suffered from rheumatic iritis, resulting from imprudent expo- required the closest watching, and especially if sensation and sure, which was followed by hypopion, and the pupil was perma- the will were abolished, or nearly so. In typhus fever the nently closed. Some months after this the perception of light respiration was wont often to be very impcrtectly performed, was strong, but the author did not recommend the division of the blood to be partially oxygenated only, and the greatest the iris, as the new pupil could not have corresponded with mischief was the consequence. The author had found much

He

672 by exciting forced inspirations from time to application of cold to the face and chest. When patients slept after seeming recovery from asphyxia, it was incumbent on the practitioner most carefully to watch the breathing. Then one exciter of respiration was withdrawn-the will. The patient might relapse, and cease breathing altogether for want of the timely excitement of involuntary respiration. The author instanced atelectasis, of which affection he sketched an outline, as an excellent example of the dependence of the healthy state of the lung on the vigour of the respiratory movements, and referred to an interesting example of it which he himself had lately witnessed. It happened in a girl of eleven, who died of pericarditis. The lungs on inflation resumed their proper colour, texture, and weight. What was the remedy for this affection ? Clearly the excitement of involuntary inspiration, repeated again and again. The remarks were concluded by a reference to that all but exclusively voluntary breathing which was maintained after the division of the vagi nerves. The animal became tired of exertion, the will acted more and more faintly, the blood became less and less oxygenated, and in the end asphyxia was completed. The author related an experiment which he had performed; the results, so far as the affection of the breathing was concerned, were just those described by Legallois. He quite agreed with that distinguished physiologist, Dr. Marshall Hall, in his view of the pneumogastric being the ordinary excitor nerve of respiration, and in what he had said respecting the voluntary breathing when that nerve was divided. He (Mr. Barlow) considered that the state of lung found in animals who died after this experiment, benefit result

time, by

the

resembled that of atelectasis. The

Society adjourned until

the last

Monday in September.

ON THE TREATMENT OF ULCERS BY MECHANICAL PRESSURE.

[REPLY

OF MR. CRITCHETT TO DR.

ARNOTT.]

To the Editor of THE LANCET. the last number of your journal, Dr. Arnott, o: SIR,— In Brighton, has published a letter, the object of which seems t( be to put an end to the claims of two separate aspirants foi originality of invention, by quietly appropriating all priority and merit to himself. How the case may stand with regard to the uterine apparatus I leave to others more conversant witb such matters to determine; I wish to confine myself to the part of Dr. Arnott’s letter, in which he suggests, that second in cases of ulcers of the lower limbs requiring mechanical support, his very simple method, by means of two long Indiarubber tubes, a bladder, and a piece of cloth, is far preferable to the complicated methods recommended either by Mr. Critchett or Mr. Chapman. Here is a remarkable instance of the proneness of man to ride his hobby-horse into a territory where it is at least useless, if not injurious. So anxious is the doctor to substitute his air-pressure for all other means, that he treats as of no moment the fact, that the patient must be kept at rest during his method. Now, considering that one of the principal advantages of mechanical support is, that it allows the sufferer to pursue his usual avocations during the whole time,-a matter of extreme importance to the poor, and, indeed, to almost all,-I think it is rather too bad that the doctor, for the sake of thrusting in his plan, should condemn methods of which he is evidently uninformed or misinformed, both theoretically and practically. I am willing to concede, that Dr. Arnott may have physically rivalled the poet, in "giving to airy nothing a local habitation;" but I would counsel, for the sake of his own reputation and the cause of science, that suitable habitations be chosen for it, and that ulcers of the leg be spared this intrusion. We all remember the story of the famous currier, who, when asked what lie would use for defending the besieged town, recommended leather; in point of suitableness of the means to the end to be accomplished, I think the currier and the doctor are about upon a par. Dr. Arnott suggests, that these contentions for originality on the part of Messrs. Critchett and Chapman (the very existence of which, by the by, I was not previously aware of) are ridiculous; it seems to me that he will probably have the laugh rather against than with him. I have too much confidence in the good sense of the profession and of the public to suppose that they will abandon a method at once simple, effectual, and rapid, and sanctioned by long and repeated experience, and allowing the patient to pursue his ordinary avocations, for the sake of air-pads, which are at least superfluous, inasmuch as every practical surgeon knows that all cases of ulcers of the leg will heal by very simple means, if rest be superadded. I think,

then, that both Mr. Chapman and myself may feel that our professional reputation and our respective methcds of treatment are in no peril if they receive no harder hit than from the

pellet

of Dr.

Arnott’s airgun. .

I remain, your obedient servant, GEORGE CRITCHETT. Finsbury square, June, 1849.

MEDICAL FEES AT ASSURANCE OFFICES. To the Editor of THE LANCET. the SIR,—On subject of payment of medical men by life assurance societies for information required, and on which their profits are based, there ought only to be one opinion. The pocket of the ordinary medical attendant is the proper channel to direct their fees for professional information respecting the health and habits of any particular person. Reference to a medical man not acquainted with the habits, general condition, &c., of a person, and who has to find out all essentials, by hurried questioning, at a time when any adverse circumstance is likelv to be suppressed, can only be looked upon as a form, I will not say " more honoured in the breach than the performance;" but only observe, that information so received can only be looked upon as second in importance to that obtained from the family medical attendant. Here’s a question to answer any body of men without a fee. Is temperate in his or her habits of eating and drinkingHow any assurance society can have the bold effrontery to make such a demand upon any one whom they never saw in their lives, and especially a professional man whom they have no idea of feeing, but expect to receive it with tacit obedience; such obedience as is demanded of a witness on oath before a court of law,—can only be looked upon as one of the gross things of this world-an indelicacy which makes a man stare with amazement, and go away wondering at the vulgar impudence of some people. I send you the following brief correspondence, to use at your discretion; and if my remarks meet with your approbation, they are much at your service. Please add my name to the "Five-Hundred-Pounds Medical Reform Fund" for £1 —I am. Sir. vours obedientlvWILLIAM Lowther street, Carlisle, 1849.

REEVES, Surgeon &c.

SIR,-An application has been made to me to-answer certain As I am the questions relative to the life insurance of ordinary medical attendant, and as your office will receive from me the most particular information regarding the health &c. of -, I wish to know whether any fee is allowed by -.

your office for such information.

ltlost of the

assurance

offices

acknowledge the propriety of granting such a fee. I am,

Sir, your obedient servant,

WILLIAM REEVES.

To Mr. Lidderdale.

sun Lue Assurance

.society, .a pru, tS4g.

SIR,—In reply to your note of the lst inst., I beg to inform you that it is not the practice of this Society to pay fees to the medical attendant of the life proposed for insurance, it being incumbent on all persons whose lives may be proposed, to produce evidence, at their own expense, that their lives are

eligible for insurance.-I

am.

To William Reeves, Esq.

Sir. C.

vour

H.

obedient servant.

LIDDERDALE, Actuary.

POOR-LAW MEDICAL RELIEF.—PETITION OF THE MEDICAL OFFICERS OF THE HUNGERFORD UNION. THE medical officers of the Hungerford Union have forwarded (for presentation to the Right Honourable the House of Com-

mons)

to T. H. S. Sotheron, Esq., member for North Wilts, a similar to that of the Bury Poorlaw Union, published

petition

in a late number of THE LANCET. The Hungerford petition has been signed byDAVID KENNARD, Surgeon, Lambourn district. JOHN GALE HILLIER, (late Union Surgeon,) Lambourn. JOHN LIDDERDALE, Surgeon, Kintbury district. H. H. P. MAJOR, Hungerford district. RICHARD DAVIS, M.D., Ramsbury district. RICHARD H. BARKER, (late Union Surgeon,)

Hungerford.

JAMES LIDDERDALE, Surgeon, Great Bedwin district.

These medical officers express a hope that the advice of the Poor-law Medical Committee, to petition, as circulated in THE LANCET, may be still more generally followed, so as to command the attention of Parliament.