STRICTURES UPON REMARKS BY MR. SYME ON THE OPERATION OF EXCISION OF THE HEAD OF THE FEMUR.

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with nearly all the leading influential life offices, and I Berkeley more happy in stating, that "many scientific officers of the highest class had been educated in the gun-room or aware of one of them who pays this demand, although I believe there are a few (principally new ones, and those pro- cockpit." The persons to whom he thus alludes obtained would not their nautical knowledge, not in these places, but on deck; prietary) who do so. As I am sure Mr. wish you should do any service for him without being re- and whatever other acquirements they become possessed of have been the result either of study ashore, or perhaps in the munerated, I will recommend" him to pay you the fee. retirement of some considerate lieutenant’s cabin; though:’I I am, Sir, yours obediently, that in most cases their scientific or literary pursuits " To J. I. Ikin, Esq., Leeds.’ JOSEPH MARSH, Sec. believe have not been commenced until after they had, by promotion, obtained a cabin for themselves. To the Editor of THE LANCET. We cannot thank him for his low estimate of our character, the of a few weeks I have received SIR,—Within space four applications from as many different life assurance offices, when he would view the whole affair as a matter of pounds, and pence. We have never grumbled at encountertouching the present state of health, the habits, and the con- shillings, expense of the ward-room, and as the sufferstitutional peculiarities of patients of mine, and requesting ing the increased it ought to be left to us first to complain. But we from me, to themselves most important information, without ing party, our professional character as of far more importance offering me an equivalent remuneration. In all these cases I regard than such a consideration; nor are we by any means inclined have uniformly replied, that the information required should to weigh our long withheld rights against the additional outbe furnished forthwith upon my receipt of the customary-or lay required by the transference. Captain Berkeley’s long rather, of what should be the usual-fee of one guinea. absence from the gun-room may possibly furnish an excuse for From the secretary of one of these assurance offices (assu- his singular hallucination, that it is " superior, if possible, ta rance enough they have, in all conscience!) I received a the ward-room." True, there are no cabins to block it up; letter, stating that as I had declined giving the necessary but then the numbers in it are much greater. In the one medical information, so they, the directors of his office, also there are usually sixteen or eighteen officers, while the other had declined insuring the life of my friend. is occupied by twenty-five or thirty, and in flag-ships, often as a week this said friend afterwards, however, Upon meeting Still it is not this which makes the as fifty members. and mentioning this matter to him, he quickly said, " Oh! it many so disagreeable; it is the noise and disorder which gun-room is all right!" and that the office in question had insured him must alwayspervade it, and the being compelled to mess with without further reference! our inferiors in age, information, and education. In Now, Sir, does this conduct of an assurance company require ships also, on " general quarters"’ day, the gun-room many bulkany comment? Surely but one-namely, that corporate bodies heads are knocked down, and the whole furniture and traps and companies can in the aggregate do things which in- turned out, which acts as an effective barrier to any attempts dividuals, having respect for character, dare not. to improve our comforts in that place. Three of the offices to which I have alluded are-The I have no intention, neither is there any necessity, for any European, Pelican, and Sovereign; the more contemptible lengthened recapitulation of our grievances or our claims; fourth I could name if necessary. with some remarks on the cabin ordered for our use therefore, I am, Sir, yours very respectfully, in 1840,I shall conclude. This was not meant for our use CHIRURGO-MEDICUS. alone, as we were directed to share it with mates, second masters, and clerks; but the order has been complied with in To the Editor of THE LANCET. so few instances, that we are inclined to look upon it as having SIR,—Ibeg leave to draw your attention to the inclosed been given, not for the purpose of being fulfilled, but that it circular (of the Westminster &c. Life Assurance), as also to might be used in silencing our just complaints : indeed, in one (sent by me to your office some four weeks ago) from the some ships, far from granting this place, the request on our Mitre Assurance Office, both of which acknowledge the value part that it might be provided for us, would call forth a severe of services rendered by us to them, and for them chiefly. It reprimand. will be the duty and interest of our profession to support and Such replies as the one I have now attempted to criticize. recommend these and similar offices, in preference to the non- will, so far from silencing or intimidating us, only make us theremunerating ones. It has been my unvarying practice to more urgent in pressing our demands, as it shows how hard solicit payment before granting the required certificate, and, our opponents are driven to seek for objections; intimating when refused by the office, to charge the patient with the fee, also, very plainly, that their stock of ingenuity has been nearly or recommend him to assure in one of the offices to which I exhausted in framing excuses. I am, Sir, your very obedient servant, was the appointed medical referee. Some of these offices W. only pay 10s. 6d. fee for a policy for any sum less than £500. I Mediterranean, Nov. 2, 1848. This appears a very absurd regulation, inasmuch as the examination is as efficient in the .6100 as in the higher sum; STRICTURES UPON REMARKS BY MR. SYME ON but since the minor fee recognises in semi-proportion the THE OPERATION OF EXCISION OF THE HEAD reasonableness of remuneration, I have submitted to the rule. OF THE FEMUR. To all the offices refusing any fee I not only have declined To the Editor of THE LANCET. the certificate, but have added the word "humbug" at the former remarks on this subject have appeared "in confidence" the strictest SIR,—As my end of paragraph. in THE LANCET, I beg to call the attention of its readers to I have the honour to be, your obedient servant, the Medical Times of last week, in which there is a report of W. W. MORGAN. a lecture on Morbus Coxarius by Mr. Syme. Mr. Syme has in his lecture made some observations tending to throw disNAVAL ASSISTANT-SURGEONS. credit upon the attempt to cure that disease by the removal To the Editor of THE LANCET. ’, of the head of the femur, as well as upon those surgeons who SIR,—Being on a foreign station, it is but a few days since have performed this operation; and coming from a gentleman we received English papers, containing an account of a discus- holding so high a position in surgery as Mr. Syme, they are sion which took place in the House of Commons on the 29th of likely to have great weight with members of the profession August last, on the claims of naval assistant-surgeons being I feel that many will consider it presumption in a young and introduced by Mr. Wakley. On reading Captain Berkeley’s comparatively inexperienced surgeon like myself to pretend laboured defence, I was much surprised at his re-introduction to differ in opinion from Mr. Syme on a purely practical point, of the now worn-out and oft-refuted objections already so or to reply to any strictures which he may have thought fit to frequently brought forward. When the honourable captain make concerning so important a subject as that under notice; asserts that assistant-surgeons mess " with a class of young but I feel compelled to do so, because his assertions respectmen about the same age as themselves," he is far from being ing disease of the hip are incorrect, and his objections to the correct, as in almost every ship, on this station at least, the operation for its cure, in some instances, are rendered invalid assistant-surgeons are considerably senior to the rest of their by facts I have myself ascertained. Mr. Syme, in the course messmates, the age of the former being from twenty-two to ’, of his remarks, says, " Lately, in some of the London hospitals, thirty, or upwards, while a large majority of the latter are it has been attempted to cure the disease by removing the under eighteen. The mere fact of a midshipman’s being carious head of the femur, but this is improper, as caries of "highly connected" will go very little indeed to improve his the joint never exists without the bones of the pelvis being behaviour, or make him a more pleasant or more useful com- equally involved." Now, Sir, I beg to state that King’s Colpanion ; on the contrary, it has unfortunately, in not a few in- lege Hospital is the only one where this operation was perstances, produced quite an opposite effect. Nor is Captain formed, and not only has it been attempted to cure the disease, not

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22 but the attempt has been attended with signal success. With to the second part of the statement, I am surprised to find such an assertion coming from one who has paid the attention Mr. Syme has to diseases and operations on the various joints. I think if Mr. Syme were to call to mind the cases of disease of the hip which I should suppose he has examined after death, and if he were to take the trouble to examine the morbid specimens of this disease which are preserved in the museums, he would find that his assertion, that leg caries of this joint never exists without the bones of the pelvis being equally involved," is quite erroneous. It is at variance with what has been observed by pathologists and practical surgeons, and its incorrectness is amply proved by the results of the very operation Mr. Syme so much condemns. In the first case which was performed in this country, Mr. Anthony White, in 1818, the head of the femur was alone diseased, as was proved by the complete recovery of the patient, and as is also beautifully illustrated by the specimen of the parts now in the Hunterian Museum, where, it is seen, i a strong and effectual new joint had been formed, which could not have been the case had the pelvic side of the joint been carious, and the diseased portions not removed. In Mr. Fergusson’s first case, also, the head of the bone was -alone carious: this was clearly ascertained by that gentleman at the operation, and was, moreover, proved by the "great fact" that the patient entirely recovered without any carious portion of bone coming away through the wound, as I can myself testify to, from having had the dressing of the case in my own hands for several weeks; and here, as in Mr.White’s case, neither gouge nor bone forceps were applied to the acetabulum. Moreover, if it could be established that in - every case some disease of the pelvis exists, this fact alone would not be a valid objection to the operation; for if the disease is limited to certain portions, it may be got at and removed by proper instruments, in the same manner as carious portions of the scapula may be removed in the operation of excision of the head of the humerus; and I apprehend Mr. Syme would not object to perform this operation because the glenoid cavity should be affected; nor would he say, that in every case of disease of the shoulder both sides of the joint are equally involved. I admit, Sir, that the circumstance of disease of the pelvis existing in many cases of morbus coxarius constitutes a grave difficulty in the operation; but no surgeon would think of performing it where he knew such to exist; and the mere difficulty of ascertaining it should not deter him from operating, if he has good reason to believe, through certain symptoms and the history of the case, that the head of the femur is alone chiefly affected. The circumstance of disease of the kidneys accompanying stone in the bladder, and being difficult of detection, often proves a serious objection to lithotomy; but would Mr. Syme refuse to perform the operation altogether because such frequently exists, and not unfrequently proves a source of death .after the operation ? Again: would Mr. Syme object to tie the subclavian or femoral artery for aneurism, because patients who have been operated on have died, sooner or later, from the bursting of an aneurism in the abdomen or chest? Further on Mr. Syme says: "If the disease admits of recovery, excision of the head of the thigh bone is superfluous and useless." True; but it is not in such cases that a good it surgeon would either recommend or perform the operation; is in cases where there is no hope of recovery by natural or - remedial measures, and when the surgeon has good reason to suppose that he may by the proceeding prolong or save life, that he is justified in resorting to it. Again: Mr. Syme remarks, "If the patient recovers after the head of the bone has been cut out, it is a distinct evidence of the uselessness of having excised it." I must confess Sir, I cannot understand this reasoning: it is most extraordinary and unfair. Had he witnessed the deplorable condition of the two patients in King’s College Hospital prior to the operation, and then seen them some months afterwards, he would, I am sure, not have used such an argument, which might be employed by any one wishing to decry some particular line of practice. Mr. Syme ends his philippic in the following manner: ’" Common sense and their unsuccessful results will no doubt ultimately show the impropriety of such operations." Here, again, this gentleman is unfair. He speaks of the unsuccessful results" as though the operation had never been attended with success; but he surely must know that it has been successful in several instances, both in this country and abroad,-if not, I would refer him to a paper which he will

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find in THE LANCET for March and April of the past year. I have, in the compilation of that paper, been at great pains in collecting accounts of all the cases of the operation, but as I have not met with one performed by Mr. Syme, I infer that he has not attempted this operation, and am therefore less surprised at the manner in which he so strongly protests against it. I am sure, Sir, that all of us who are devoted to our profession must acknowledge the great benefits which the practice and researches of Mr. Syme have conferred upon the science of surgery, and I hope that he will still go on adding to it; but this good work will not be promoted by the hasty rejection of the experience of others equally gifted with himself, or by raising unreasonable objections against any particular line of Dractice thev mav Dut in force.-I am. Sir. vours obedientlv. HENRY SMITH. Caroline-st., Bedford.square.

USE OF COLLODION IN RESTRAINING HÆMORRHAGE FROM LEECH BITES. To the Editor of THE LANCET. SIR,—Iwrote to you yesterday, recommending collodion as an application useful in restraining haemorrhage from leech bites; but I had not then seen the letter of Mr. Tucker, on the same subject, in THE LANCET of December 9th, as that number, through some irregularity, did not reach me till last night. I mention this, because,’ if you insert my note of yesterday, Mr. Tucker may think it odd that I took no notice of his communication. It appears that the idea of using collodion for the purpose referred to occurred to Mr. Tucker and myself at about the same time. On the 1st of December, in the morning, I ordered leeches to a gentleman’s leg, and as five of the bites continued to bleed during the whole day, I determined on trying the collodion. Not having any lint with me, I dipped some of the fur of a beaver hat in the fluid, and after applying it, and touching it two or three times at different points, where there was a little oozing, bv means of a camel’s-hair brush moistened with the collodion, the haemorrhage entirely ceased. In the hope that you will excuse my thus trespassing on vour space.

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Seething-lane,

am.

Sir.

vour

Dec. 28, 1848.

obedient servant.

ROBERT TRACY WYLDE.

PHYSIOLOGY OF THE NERVOUS SYSTEM— "WALKER VERSUS BELL." To tlte Editor of THE LANCET. and speculations of Sir Charles Dell, that so labours SIR,—The remarkably yielded him success, and honours which heseemed to bear"unblushingly," are now threatened with a scrutiny

searching than may be agreeable to many of the worshippers of the "mighty dead." Still, however, the halo of the tomb ought not to be allowed to darken the lamp of virtue on the brow of a living though less fortunate and exalted brother. The profession, as a body, should endeavour that not only Mr. A. Walker, but all true philosophers, may have their labours and merits timely appreciated and rewarded. It is not only painful, but dispiriting in the extreme, to contemplate the fate of Mr. A. Walker in regard to this matter, and it is the bounden duty of the profession to grant a full inquiry and hearing to the subject, that it may without delay be set at rest, and " honour be given to whom honour is due," ere it be too late-although this must be but an inadequate recompence for prolonged neglect and injury. I believe that the profession more

is at present in a mood more favourable for cool and impartial inquiry on this particular matter than it had ever been previously, while dazzled by the brilliancy and success of Sir Charles Bell’s career, and when, perhaps, dunned by his dogged and indefatigable perseverance in keeping his views before the public; so that his more retiring rival had but little chance of being heard. It has always struck me, in perusing Bell’s writings on the nervous system, and particularly those in reference to the relative functions of the two roots of the spinal nerves, that his theories depended much more upon his special reasoning than his experiments; many of which experiments, and all those of Magendie, Müller, Kronenberg, &c., went rather to the support of Walker’s views, in referring sensation to the anterior, and motion to the posterior roots, respectively, though indeed both roots were found capable of eliciting phenomena, both sensory and motory. Moreover, now-a-days, we are led to refer to comparative anatomy as an infallible guide in such doubtful points; and no doubt here, if we seek for division of