ON THE PHYSIOLOGY OF THE UTERUS.

136 THE LATE

INQUEST AT PUTNEY.

To the Editor

of THE LANCET. the SIR,—As person directly implicated by your remarks in the last number of THE LANCET, in reference to the unfortunate event recently the subject of inquiry at Putney, I feel called upon to trouble you with the following remarks, trusting to your sense of justice for their insertion; for I cannot persuade myself you can, after so personal an attack, refuse the reasonable request I make, to be allowed to defend myself through the same channel. In entering upon this detail, I am perfectly well assured that I expose myself to further censure

at your hands if I mis-state

even

the most unim-

portant facts; but inasmuch as I am borne out by the family of the deceased, as well as by the medical gentlemen who gave their testimony at the inquest, I have no hesitation in asserting, plainly and distinctly, that the statements in THE LANCET, which serve as a basis to your editorial article, are at variance with the truth in very many important particulars ; and the report, as awhole, garbled, incomplete, and partial. The facts, even if correctly stated, would, in my humble opinion, apply as well to Dr. Cormack as myself. That gentleman, though a physician, is the proprietor of a druggist’s shop, as like my own in appearance and objects as is possible to render it; he would be a bold man to deny this; and I will venture to assert, had any one gone to that shop before this melancholy occurrence, and asked the assistant to supply medicine for a person labouring under a supposed bilious attack, that drugs of a similar description to those supplied by me to the deceased, Miss Dallett, would have been handed over the counter with as little hesitation, and perhaps in exchange for as few pence. Will Dr. Cormack, then, or any one else, be good enough to point out to me why a mild mercurial, and an equally mild aperient, coming from one shop, should be set down as " rank poisons," and as " razors placed in the hands of suicides;" whilst out of another shop, two or three hundred yards distant, the same drugs should be

deemed efficient and proper remedies for disease ? I shall be told, perhaps, that the medicines in the one case being dispensed by a mere pharmaceutist, and in the other by a person who had the distinguished privilege of mixing salts and senna together before 1815, makes all the difference. It may be so, but common sense refuses to mark this distinction; but even without having recourse to an hypothesis, it may be remarked that there is still in the possession of Mr. Dallett an aperient mixture, prescribed and sent by Dr. Cormack, to be taken by the unfortunate deceased on the very morning which closed her existence. If, then, medicines of this description, at the outset of a malady, when merely functional disturbance is suspected, surely the intended exhibition of a similar medicine, at a time when organic lesion ought to have been evident to a "gentleman having an adequate knowledge of his profession," must be open to strictures of a much severer character. But admitting that druggists act illegally in administering to the relief of the most simple ailments,admitting, too, if you will, that, as a druggist, I have no right to supply even a black draught to an individual applying for the same, is it fair, is it honest, to place the whole onus of such a case as that of Miss Dallett-the mistake about the narcotism-the misdirection of the pills, &c.-upon my shoulders? I may know but little of the practice of medicine, (as a druggist;) you seem to think I cannot possess capacity enough to embrace even the first rudiments of the science, but I flatter myself I may know sufficient to form a judgment, in common with the public, upon the possible result of a different mode of treatment, had it been pursued, in the unfortunate case that has given rise to so much discussion; that is to say, had the patient been treated, during her latter hours, for the prostration and collapse consequent upon fever, instead of being hurried from room to room, slapped, pinched, &c., lmder the impression that the poor young girl was labouring under narcotism, by the doctor’s own confession, and, as he said, arising from his own remedies. Again, Sir, permit me to ask, Is the sworn testimony of the medical witnesses, in reference to the medicines furnished by me to Miss Dallett, to go for nothing? What says Dr. Cormack himself? "Idid not convey, nor do I wish to convey, the impression that the disease arose from improper medicines furnished by Mr. Farmer." If this alone does not acquit me of all blame in the transaction, I have still the testimony of Dr.Wane in my favour: although the following important part of Dr. Wane’s evidence has been suppressed in the reports of the inquest in the public papers, I am fortunate in having it

give the substance of it, (from the notes of a gentleman present at the inquiry,) kindly furnished me, in my power to

" Does not think the medicines furnished by Mr. Farmer were of that nature to produce any of the appearances he had

described. Does not consider them dangerous medicines, or medicines that were in any way hurtful to the deceased; and certainly were not such as were calculated to hasten the result." Now, in the face of such evidence as this, and bearing in mind that no imputation was cast upon me, either in the charge of the Coroner, or in the verdict of the jury, among whom were a medical man and a barrister, I think I have a right to ask, on what grounds I am directly charged with a crime little short of homicide, in fact, with the death of a young lady, for whom, on being applied to, I furnished a mild mercurial and a black draught, medicines which persons in every station of life are in the daily habit of prociuring from chemists, upon their own responsibility, albeit, they may be within reach of multitudes of medical men of first. rate talents.-I am. Sir. vour most obedient servant, JOHN FARMER. Putney, July, 1847. have it We insert the to ** thought right foregoing letter from Mr. Farmer. Of course it does not alter our opinion of the impropriety and danger of druggist-practice. Our remarks applied to the system of suggesting or ordering medi, cine over the counter for patients labouring under dangerous or fatal diseases, or indeed at all.-ED. L.

LIFE ASSURANCE.—FEES TO MEDICAL MEN. To the Editor of THE LANCET. SIR,—As the question of "Life-Assurance Offices versus Medical Men" is once more revived, I think it right to state, that for the last ten years I have invariably returned the list of " confidential questions" to the Secretary, unanswered, merely saying that when the usual fee of one guinea is for. warded, I should be happy to give my best attention to the matter, as I am perfectly convinced the assurance offices are the parties most benefited by the information. In about two cases in each year I have had fees remitted to me, and in one case very lately, (where the life was refused,) I received the thanks of the directors for the facts rendered to them, which they could not possibly have obtained through their appointed medical officer. It appears to me that the standing appointments of surgeons and physicians to life offices are great pieces of humbug, and were probably created, originally, by the directors, for some of their young friends. That they have no confidence in them is very clear, and in my opinion, very properly so, as I am convinced that in many instances they may be very readily imposed upon by applicants who, when about to insure their lives, will live very moderately for a time, in order (as they have often told me) to put themselves in trim for the " overhauling" of the said standing medical officers. In conclusion, I would advise my professional brethren to invariably refuse the required answers, except to those offices who pay medical men for the services they require, and to make a point of rejecting the fee from’their patients, at the same time explaining to them our views upon the subject. T a.m. Sir-

Spital-square, July, 1847.

vfrnr

obedient sm’vnnt-

JOSEPH HODGSON, M.R.C.S.E., L.A.C.

ON THE PHYSIOLOGY OF THE UTERUS. To the Editor of THE LANCET. SIR,—At the present time, there is no subject of deeper interest to the physiologist, pathologist, and practical ac. coucheur, than the anatomy of the unimpregnated and gravid uterus. Without a correct knowledge of the anatomical structure of the uterus, it is obvious that all our reasonings respecting the functions and diseases of the organ must be hypothetical, and without any solid foundation. Allitsstriietures, cellular, vascular, and muscular, appear to be positively ascertained by dissection. About these there is no difference of opinion, and all admit that they enlarne during pregnancy; but about the nervous structures of the uterus there still exists great diversity of opinion, and some maintain that the nerves undergo no change during pregnancy. From the functions and diseases of the uterus, it might, à priori, have been inferred that the uterus does possess a great and peculiar system of nerves, and that these must grow with the other structures after conception. Great structures, accompanied by bloodvessels, and having all the character of nervous ganglionic plexuses, have been demonstrated to exist at the

137 neck of the impregnated and gravid uterus, and on the body of the uterus, continuous with the sympathetic and spinal nerves. These structures have been examined by many of the most distinguished anatomists throughout Europe, and have been declared to be true nervous structures, and some of the best microscopical observers have arrived at the same conclusion. There are, however, still a few anatomists who maintain that these structures are not nervous; that the uterus has no ganglia, and only a few small filaments of nerves, which

him amongst authors in this country in the abbreviated language of the report, and had so passed from Dupuytren to ’, my paper in the Society, on which I was speaking, he would have had no ground for complaint. As to my stating who really did first point out these cases, Mr. Hird had already done that in mentioning Dupuytren, whose cases, now that Dr. Rees has just alluded to them for the first time, he tries to show differ from his own, though to me that is not appa-

l

rent. The letter I am now answering commences by a statement, undergo no change during pregnancy. They affirm, in fact, that Mr. Hird’s paper was a transcript, to some extent, of one as Rehsends did, respecting the heart, that the uterus is -an by Dr. Rees. I feel assured that Mr. Hird knew nothing of insensible organ; and, unlike all other muscular organs, that that paper till I alluded to it. Dr. Rees, indeed, says, a it is almost wholly destitute of nerves. transcript, " most probably without the author being aware The only individual who has formed such an opinion, after of it." Now, it so happens that Mr. Hird wrote nothing, and dissecting the nerves of the uterus, is Mr. Snow Beck; and read nothing, but only related a case or two, and made some the Royal Medal in Physiology for 1848 having been awarded remarks on them. But supposing that he had really written to him, on the strength of a report to the Physiological Com- and read a paper, as he said that he had intended, and that, in mittee, by Drs. Sharpey and Todd, which is now proved to some peculiar state of unconsciousness, he had made a " tranhave been a false report, a certain adventitious importance script to some extent" of Dr. Rees’ paper, how could that has been given to these two dissections, which they little gentleman be aware of such transcription, as the supposed has not been published, but only, as he says himself, merit, and could never have acquired by any other means. paper It is impossible to deny that these dissections are altogether " mentioned" ? I shall be much obliged by the early insertion of this reply; worthless, and that no physiological inference whatever can be drawn from them. The bloodvessels and all their accom- and I remain, Sir, your obedient servant, nerves have been cut away, and the ganglia at the JOHN SNOW. Frith-street, Soho-square, July, 1847. cervix uteri torn into shreds. In the plates, the gravid uterus is actually represented with a smaller supply of nerves than To the Editor of THE LANCET. in the unimpregnated state. What would be the value of a ’ the of if the of nerves the heart, representation coronary SIR,—In the last week’s number of your journal, I observe, arteries, and all their accompanying nerves, were cut away in as a sort of preface to some remarks upon a peculiar dethe dissection, and not displayed ? What would be the value formity of the chest occurring in children, by Dr. G. A. of a map of India, without the Ganges and the Indus; of Rees, a statement, charging me with reading a paper at the Egypt, without the Nile; of Germany, without the Danube Westminster Medical Society, in which I made a transcript and the Rhine ? Such is the estimation in which the dissec- to some extent, probably without my knowledge, of a paper tions of Alr. Beck should be held by all physiologists, patho- published by Dr. Rees in the Medical Gazette in 1839. Allow me to state, that until this day, when my attention logists, and practical accoucheurs-as not only worthless, but mischievous,-I am, Sir, your obedient servant, was drawn to the subject, I have never read any contribution SENEX. to medicine by Dr. G. A. Rees. London, July, 1847. I never read a paper before the Westminster Medical Society upon the subject alluded to by Dr. Rees, and conseON DEFORMITY OF THE CHEST IN CHILDREN. quently could not make a transcript from any paper the proTo the Editor of THE LANCET. duction of that gentleman. SIR,—I feel it my duty to reply to a very grave, though My communication to the Society was a verbal relation of totally unfounded, charge made against me by Dr. G. A. Rees some cases that had occurred both in my practice at the in the last number of THE LANCET. He says that a paper Royal Infirmary for Children, and in my private practice, ilread by me to the Westminster Medical Society in 1841 lustrative of the advantages to be derived from the treatment contained exact quotations from a paper of his in the Medical recommended by Dupuytren, and published in his " Lecons Gazette, but without any mention of the source whence the Orales," in 1828, eleven years prior to the time Dr. Rees quotations were derived. The very reverse of all this is true. states his paper to have been written. I referred to his paper in the most handsome manner, stating I trust you will do me the favour to insert this explanation. his name, and the date and place of it, but made no quotations —Ihave the honour to be, Sir, your obedient servant, from it, as any one may ascertain. My paper was published FRANCIS HIRD. Cleveland-row, St. James’s, July, 1847. in the Medical Gazette of April 9th, 1841. The title of it was, " On Distortions of the Chest and Spine in Children, from A LEARNED CHIROPODIST. Enlargement of the Abdomen." Dr. Rees’ communication was entitled, On Deformity of the Chest in Young Children, To the Eaztor of THE LANCET. from Disease of the Lungs." How any extract from his SIR,—the enclosed appeared in your Paper THE LANCET a paper could have served my purpose it is not easy to conceive. In his former complaint to which he alludes, he did fortnight ago which is intended to do me harm and Injure not accuse me of making exact quotations, but chiefly con- me professionally without any just cause on your part-I beg fined himself to endeavouring to show that my cases were of to draw your attention to some of your remarks. the first the same nature as his own, and that they did not depend on you Term me a quack-without having the slighest knowenlargement of the abdomen. He did, indeed, make an in- ledge of me in any way whatever-you then say he Adversinuation, for which he ought to have apologized after my tises certificates real or false-from several medical men some reply, which appeared in the following number of THE LANCET of their names you have mispelt which will tend to hurt me as - that of April 10th, 1841, at page 112. As Dr. Rees has many will say there is no such medical men in Leicester. withdrawn his opinion, that the change which he met with in You then rank me with such men as a Mr. Woolf—I the lungs was the result of inflammation, and as he now ashure you sir I unfortunately have had a great deal to put admits that there is usually abdominal enlargement, I am in- up with from the public through such fellows-whose conduct clined to believe that his cases are of the same nature as I am not accountable for-I beg to inform you that my practhose which I described. In the case detailed in my paper, tise is strictely honourable and I visit the same Towns two the greater part of the lungs was collapsed, and void of air. or three times over-and advertise my Fees in the public I offered no explanation then of the cause of this, but I now newspapers-which I think none of the other chiropodists consider that the deformity in question, after it attains a cer- do, and know my profession so that the medical men are tain degree, may cause compression of the lungs, and have always glad to encourage the true practioner from the humthe same effect on them as a pleuritic effusion would have, bug-in fact there is no other chiropadist holds such Testiand thus terminate life. In my opinion, then, the condition monials of cures as myseluf-though I have nothing to do of the lungs, which Dr. Rees considers to be the cause of the with any of them, I do all in my power to oblige all persons deformity, is an occasional consequence of it. When deformity on whom I have the honour to wait, and think it very hard is the result of disease of the lungs, it does not affect both that I should have been delt with so unfairly I think there must have been some mistake I have spoken to several of my sides of the chest alike. On the late occasion I alluded again, in the Society, to Dr. medical friends and they all think the same oppiuon—I Rees’ paper, and stated his opinions, previous to should suppose it is not you desire to Injure me, in any way my own paper, although if I had not done so, but had included as I have given not the slighest cause-I beg to submit my

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