3rd, the rapid growth-in twelve months. This is not decided evidence, but adds greatly to the probability. It was, therefore, most probable, but yet not actually certain, that the tumour was medullary. We ought to act on probabilities, and proceed cautiously. The puncture of the tumour, at the time of the operation, would not always decide the question as to its nature. The matter in the trocar, in this instance, might have been taken for myeloid.

Mr. Paget next spoke on the grounds on which we ought to operate in such cases. He said that it was impossible to be actually certain that the disease was cancer, until the operation was half over. Also, he would not say, that it was not justifiable to remove cancer of bone, as, although the disease is sure to recur, there is generally a period of immunity from it. In many cases, we must operate almost against hope, with a very small probability of recovery. This is so when we are certain that the disease will ultimately recur. When uncertain, the grounds for operation are all the stronger. He had two cases in mind which showed clearly that life was lost from not giving the patient the chance of operation in what was supposed to have been malignant disease. In one, a tumour grew rapidly in the upper part of the thigh. It was thought to be malignant, and was, therefore, left alone. The patient died a miserable death. Then it was found that the tumour was simply cartilaginous. This patient might have lived to old age if his leg had been amputated. Mr. Paget related another case somewhat similar. In this instance, the tumour, also of the thigh, was cystic. It is very rare (he said) that we can arrive at such absolute certainty as to decline to operate. Another question as regards operation in case of cancer of bone is,-Is it sufficient to remove the part affected, or should we take away the whole bone? The answer is,-That if the removal of the whole bone does not increase the risk to life, do it; but otherwise remove only the part affected. As regards disease of the scapula, the question is not often raised; a disease of this bone is rare. But in cancer of the lower end of the femur, we ought not to remove the whole femur, as amputation at the hip-joint is an operation involving great risk to life. If, however, we have cancer of the middle of the tibia, we ought to amputate above the knee.

THE LONDON HOSPITAL.

HYPERTROPHIC ELONGATION OF THE CERVIX UTERI-FAILURE OF CAUTERISATION-AMPUTATION BY MARION SIMS' METHOD-SUCCESSFUL RESULT.

(Under the care of Dr. BARNES.)

G., a woman aged 35, was admitted an out-patient on February 12, 1862. She has had five children and one abortion. The last labour was two years ago; it was a cross-birth. Since then she has suffered much from metrorrhagia, dysuria, painful defecation, leucorrhoea, pelvic and dorsal pains, loss of strength and flesh, and bearing down. The os uteri was near the vulva, but there was no marked descent of the body of the uterus; the uterine sound penetrated more than three inches; the apparent prolapsus was due to the greatly hypertrophied and elongated condition of the cervix. The anterior lip was especially affected; it expanded into a hard tumour, which fretted the vagina by constant pressure and friction. The potassa cum calce was applied to the anterior lip, so as to produce a large eschar, and it was thought that some diminution of bulk followed the healing of the sore. The cauterisation was repeated several times in the course of the ensuing four months. The ultimate advantage was very doubtful. She then wore a stem pessary for some time, but this only doubled up the elongated cervix, without producing any diminution of bulk, or bringing the patient material relief. Dr. Barnes, therefore, determined upon amputation as the only means of restoring the patient's health.

On September 5, she was admitted as an in-patient. Under the influence of prolapsus and friction, the enormously enlarged cervical portion, acting as a polypus or foreign body would, had caused considerable inflammation of the vaginal mucous membrane, as well as of that covering the cervix. Dr. Barnes kept her in bed some days, to allow this condition to be relieved under rest. This being accomplished, and a menstrual period having passed by, Dr. Barnes proceeded, on September 27, to amputate the vaginal portion of the cervix on the method practised by Dr. Marion Sims. The patient

being placed under chloroform, the uterus was pressed downwards by firm pressure over the abdomen, whilst the cervix was seized and drawn forwards by Museux's vulsellum, the vagina being opened by a duck-bill speculum on either side. The anterior and posterior lips of the hypertrophied cervix were then successively cut off by bent scissors. An even incised surface was secured by paring off the mucous membrane at the angles of union of the lips. Very little bleeding occurred. A small roll of lint, soaked in solution of perchloride of iron, was placed in the canal of the cervix. The stump was then covered by bringing together the edges of the mucous mem brane by iron wire carried by the curved tubular needle. In this manner a very neat and perfectly covered stump was made.

B

The dotted line A B represents the line of amputation. V. Vagina expanded above by the hypertrophied cervix uteri.

No examination of the patient was made for ten days. At the end of that time, the greater part of the stump was found to have healed. The sutures were removed at the end of fourteen days. There was a little healthy suppuration from the central part, but the cure was essentially complete. The patient suffered very little; she passed a menstrual period without discomfort, was free from vaginal distress, and was made an out-patient on October 21. In November, having returned to laborious avocations, she experienced some degree of prolapsus, which might be anticipated from the longmaintained relaxation of the pelvic structures. In general health she was quite restored. What little local distress remained was effectually relieved by the use of the stempessary generally adopted by Dr. Barnes in this Hospital. There is now no excess of cervix in the vagina, and the os uteri may be considered normal.

KING'S COLLEGE HOSPITAL.

CLINICAL REMARKS ON RE-EXCISION OF THE KNEE-JOINT FOR DEFORMITY. (Case under the care of Mr. FERGUSSON.) MR. FERGUSSON made the following remarks in reference to a case in which he operated to restore deformity, which had followed after excision of the knee :

The operation was a re-excision of the joint, or rather the cutting out of a wedge-shaped piece of bone. The patient, a girl about fifteen years of age, was first operated on by him about a year ago. She had chronic disease of the joint and a distorted limb. The limb was arrested in its development by the disease; it was bent and useless. He, therefore, performed an operation to take out the remainder of the joint, and a wedge of bone, in order that he might put the limb straight. In cases of deformity from disease of joints, it was right (he said) to try ordinary mechanical means. In some cases they

were efficient, but a case like this was not a fit one for extension treatment. He, therefore, took out a piece of bone; the result was, that the limb was at once placed in a perfectly straight position. Soon after the operation, however, the girl had severe fever-very like pyæmia. She had abscesses in various parts of the thigh, none of them directly communicating with the wound of the operation; it was, therefore, impossible to retain the limb in the position in which it had been placed after the operation. No splint could be applied, so that during the time of her illness the limb got out of place. After all, however, she recovered well, the wound healed, and anchylosis took place, but, as stated, the limb was in a wrong position, the leg being much flexed on the thigh. There was, however, nothing left but deformity; there was no actual disease. At one time (Mr. Fergusson said) it was thought that, if a diseased joint could be removed safely, the result was very good, and the case would then have been thought a very satisfactory one.

Sir Philip Crampton once removed a knee-joint, and thus got rid of all the disease. The patient recovered, but the leg was bent at a right angle. It was useless, and would have been better off. The patient, however, was delighted with the result--so well satisfied that she bequeathed her leg to Sir Philip. The leg is now in the College of Surgeons' Museum. Such a result, however, would not satisfy him (Mr. Fergusson). His object was to give the patient an useful limb, as well as to get rid of the disease. This latter seemed to be the only result aimed at by some of the curers of diseased joints. Surgeons might do a great deal, but to say that disease of a joint was cured, when the result was that the limb was useless, was a perversion of language. It was better to amputate than to leave the patient with a leg which was simply cumbersome. As he had said, there were cases in which mechanical means would straighten bent limbs; but, as this was a case of anchylosis, it was better to cut out a piece of bone. This was, therefore, a second excision. In one instance he had excised portions of bone no less than three times, and with a most satisfactory result. Of course, in case of excision of a joint the limb could never be quite as good as its fellow. This could not be expected any more than that a limb, after the so-called cure of disease of a joint, should be perfect. Some writers seem to him (Mr. Fergusson) to expect that the leg, after excision of the knee joint, should be as good as it had ever been. If compared, however, with a wooden-leg, or the best possible mechanical contrivance, it was much superior. The worst feature in case of excision, and one much dwelt on, was, that the leg was shorter than the other; granting that, the result was still better than many cases of cures, or than amputation. Another thing against the operation often spoken of was, that the muscle of the calf wasted. This was contrary to fact. In his cases the muscles had regained their fullness and vigour after the operation.

In the case he had just operated on there was less risk than in amputation. In fact, no one could compare the risk of taking a wedge of bone out of an anchylosed limb, and amputation of the thigh.

ST. THOMAS'S HOSPITAL.

CASE OF TYPHUS RESEMBLING TYPHOID, AND
PROVING FATAL AT AN UNUSUALLY LATE
PERIOD OF THE DISEASE-WITH REMARKS.
(Under the care of Dr. PEACOCK.)

A NIGHT nurse, 27 years of age, was admitted into Elizabeth's ward, St. Thomas's Hospital, on November 25, under the care of Dr. Peacock. She had been ailing for nine days, but so severely ill as to be confined to bed for three or four days. When admitted, she complained of pains in all parts of the body, and especially in the head and back, and of sore throat; and, on examination, the fauces were found red and swollen ; the pulse was quick, the skin hot, and perspiring profusely. On examining the body, spots, bearing a complete resemblance to those of typhoid, were found on the abdomen and thorax. They were insulated, elevated, of a rose colour, and faded completely on pressure, and were only few in number. Two days after, she had become prostrated and torpid, and the spots had much altered their appearance; they were still elevated, but no longer of a rose colour, and had become livid, and did not entirely fade on pressure. An obscure purple mottling was also visible in the interjacent skin. At a still

later period of two days, the original spots were no longer to be distinguished, but their situations were indicated by small purple patches, not elevated, and not affected by pressure; and the obscure mottling of the interjacent skin had become a full livid rash, which was perfectly characteristic of typhus. With the progress of the disease also, the symptoms had become more decided: her intelligence was greatly impaired, so that she could not be got to take sustenance, or to protrude the tongue; the tongue was dry and black; sordes formed on the lips and teeth: the face was excessively flushed; the pupils contracted; the conjunctivæ injected; and there was tremor of the extremities, great distension of the abdomen, and the involuntary discharge of fæces. The urine was partly retained, partly passed unconsciously. The bowels also were, from time to time, much relaxed. By the employment of blisters to the back of the neck, scalp, etc., and the exhibition of stimulants and support, by the mouth when possible, and by the rectum, she was partially rallied, but the coma recurred; there were slight convulsive movements of the head and neck, and extreme prostration, and she died on December 9, or the seventeenth or eighteenth day of serious illness, and the twenty-third of indisposition.

On examination after death, there was found scarcely any fluid beneath the arachnoid or in the ventricles at the base; the brain retained its natural consistence, but the red dots were unusually numerous. The posterior and inferior parts of the lungs were congested, and in places collapsed. The bronchial tubes, generally of the left lung, and the smaller tubes of the right, contained an unusual amount of secretion, and the mucous membrane of the former was congested. The heart was flaccid, and contained blood in all its cavities, but no coagula. The mucous membrane of the alimentary canal was free from any appearance of disease, except some passive congestion of the cæcum and colon. At the lower part of the ileum the plates were barely visible; not distinctly defined; depressed below the level of the adjacent surface, and marked by the dark spots or lines usually seen after death from acute affections not connected with the bowels. The mucous membrane was not injected, and retained its natural tenacity, allowing of being drawn off in stripes of the usual length. The serous coat was free from any appearance of redness, and the mesenteric and mesocolic glands were not enlarged. Some solid fæcal matter was contained in the colon. The spleen was large, and somewhat soft. The liver, supra-renal capsules, and kidneys were congested.

This case was made the subject of some observations by Dr. Peacock, in one of his lectures. He remarked

1st. That it showed how closely a case of typhus may sometimes simulate typhoid. The mode in which the case commenced was not that which is usual in typhus. The patient had been ailing for several days before the severe symptoms commenced; and, when admitted, she had rather the appearance of a patient suffering from a feverish cold than from specific fever. She had been acting as night nurse in the ward since the opening of the temporary Hospital in September, and had, during all that time, been exposed to the contagion of typhus from patients under treatment. She had, however, been sleeping in a room on the ground floor, in which there was no proper system of under-drainage, and where, consequently, she might have contracted typhoid. The eruption also, when first seen, bore an exact resemblance to the usual appearance of typhoid spots, and it was only by watching the case that the true character of the rash was made apparent. Dr. Peacock had referred to cases of the same kind in his lectures on the "Discrimination of the Varieties of Continued Fever "(a); but he said that the present was the most striking instance of the kind which he had

seen.

2nd. Though the cerebral symptoms were, during the greater part of the attack, very marked, and the patient became comatose, and was slightly convulsed before death, the brain did not present any signs of disease; and even the congestion which was detected was probably only the result of the obstruction to the pulmonary circulation in the last periods of life.

3rd. The congestion and collapse of the dependant portions of the lungs, were very marked; but these also may be ascribed to the failure of power in the heart and of respiratory movements, from the influence of the fever poison. 4th. The patient died at a later period than usual in cases

(a) Medical Times and Gazette, 1856.

of typhus-certainly not before the seventeenth or eighteenth
day, probably as late as the twenty-third; and during the
latter part of her illness had diarrhoea, at intervals very
profuse, and great abdominal distension. If, then, these
symptoms had been indicative of any active disease in the
intestines, there was ample time for such to have manifested
itself. The examination after death showed, however, that
the intestinal tissues were entirely healthy, except that some
passive congestion existed in the large intestine, correspond-
ing with that of the chylopoietic viscera, and of the body
generally. These conditions, therefore, like the involuntary
discharge of fæces and the retention of urine, are all to be
ascribed to the excessive prostration of strength and of nervous
power.

That these various changes may be traced to the direct
influence of the febrile poison on the system is in accordance
with the deduction, from widely-extended experience, that
the various symptoms which accompany fever are to be com-
batted chiefly by means directed to the support of the patient's
strength, in the hope that life may be sustained for a sufficient
length of time for the poison to be decomposed or eliminated
from the system, and for its effects to cease.

ST. GEORGE'S HOSPITAL.

ANEURISM OF THE ARCH OF THE AORTA PRE-
SENTING BENEATH THE LEFT CLAVICLE.

(Case under the care of Dr. FULLER.)

J. A., a stableman, aged 35, was admitted into the York ward
of St. George's Hospital on April 2, 1862. He had been an
out-patient for nine months, suffering from cough, pain in the
chest, and between the shoulders, shooting down the left arm,
and frequent giddiness and headache. When first attacked,
he brought up about half-a-pint of dark-coloured blood, and
six weeks afterwards had a slight recurrence of hæmoptysis,
since which time the sputa have been streaked with blood
occasionally. Three weeks before admission, he for the first
time perceived a small circumscribed swelling, attended with
pulsation on the sternum towards its left side, and on a level
with the second rib. Twelve years previously he had a kick
on the chest from a horse, but recollects little about it, except
that such an occurrence took place.

A

On admission, his aspect was natural; tongue white;
bowels reported regular; urine clear; his pulse was 72, soft
and regular; the right radial pulse was scarcely perceptible.
There was dyspnoea and some degree of orthopnoea, and fre-
quent cough, with expectoration of thick yellow mucus.
circumscribed pulsating tumour, about the diameter of a
hen's egg, existed to the left of the mesian line of the sternum,
on a level with the second rib. He reported that this swelling
increased in size after coughing, and on two occasions, after
long freedom from cough, had entirely disappeared. The
heart's impulse was natural, and its sounds were clear both
at the base and apex. The pulsation of the tumour was
synchronous with the systole of the heart. Both sounds of
the heart were heard over the tumour, and there was no per-
ceptible murmur. Both pupils were moderately and equally
dilated.

He was ordered-Tr. hyoscyami, 3j.; haustus nitri., 3xj.,
ter. die.; haustus morphiæ, 3j.; olei ricini, 3jv., p.m.,
(ordinary diet); emplastrum belladonnæ, regioni cordis.

He went on without much variation until the 7th, when
the tumour had increased considerably in size; the integu-
ments around it were somewhat oedematous; he suffered much
pain in the region of the tumour, was extremely restless,
and was unable to obtain ease in any position. Slight ptosis
of the right eyelid was also observed, and extreme contraction
of the right pupil. The left pupil was moderately dilated,
and both acted under the stimulus of light.

On the 8th, paroxysmal attacks of urgent dyspnoea oc-
curred; he complained of frequent giddiness, the pulse was
72, irregular, and the pulse at the right wrist was imper-
ceptible.

From this time the tumour rapidly increased in size, and
the symptoms became more urgent and distressing. Consider-
able pain was felt around the tumour; the dyspnoea became
constant; frequent attacks of fainting occurred; and he was
usually bathed in a clammy perspiration.

On the 12th the ptosis of the right eyelid was observed to
have decreased, but the contraction of the pupil continued as
before.

On the 15th, whilst eating his dinner, a paroxysm of
dyspnoea suddenly came on, and, after half an hour's struggle,
he died.

The post-mortem examination was performed twenty-four
hours after death. A soft livid prominence, nearly circular,
of about three inches in diameter, covered the upper part of
the sternum, and reached as high as the notch. This was
most prominent a little to the left of the mesian line. A
deep hemispherical cup was hollowed in the upper part of
the sternum. This might have held half a tennis-ball.
Between the articulations of the two first ribs on the left side
the sternum was absorbed and worn through, and the sternal
extremity of the first rib was also destroyed. The heart
was natural. In front and to the left of the ascending aorta
was an aneurismal pouch, which formed two-thirds of a
sphere, and was about an inch in diameter. This was con-
nected with the aorta by a smooth round opening, about an
inch above the semilunar valves. At the superior part of the
arch was another smooth circular opening, of rather more
than an inch in diameter. This was placed slightly towards
the anterior aspect of the vessel, and led to a large globular
sac, thickly lined with coagula. The innominate artery
opened into this sac near to its orifice, and, from its position,
it was obvious that the artery must have been compressed by
the tumour which laid against its anterior wall and its orifice,
obstructed by the coagula which lined the sac. The carotid
opened into the sac in a similar manner, just within the
orifice of the sac and to its extreme left; the subclavian
sprung from the aorta just beyond the boundary of the sac.
These vessels appeared to be healthy; but the lining mem-
brane of the aorta was raised in many places by soft athero-
matous deposits. The right lung was oedematous; it con-
tained a few crude tubercles, and a small vomica at the
apex. The left contained several small vomica at the apex,
crude tubercles scattered throughout, and an old tubercular
cicatrix near its inferior edge. Both lungs were adherent to
the diaphragm. The kidneys and other abdominal organs
were congested, but structurally sound. The arachnoid was
somewhat thickened over the superior and lateral portions of
the brain, and was studded with minute opaque spots. At
the base of the brain it was quite natural in appearance.
The substance of the brain was watery; and seven drachms
of fluid were collected. The blood throughout the body was
very fluid.

HOSPITAL FOR THE EPILEPTIC AND
PARALYSED.

EPILEPSY-AURA FROM THE TIP OF THE RIGHT
INDEX FINGER-CONVULSIONS AND CRAMPS
ON THE SAME SIDE OF THE BODY-RECOVERY.
(Case under the care of Dr. BROWN-SEQUARD.)
HENRY E., aged 17, was admitted an in-patient on May 7,
1862. As the interest lies chiefly in the peculiarity of the
aura, and on the treatment of the case, many things noted
according to a certain scheme at the Hospital are here omitted.

There was no history of any of the class of diseases sup-
posed to be hereditary, except that his mother had a fit of
some kind about a year before her death, which was at the
age of 37. He had had, he thought, some kind of convulsive
seizure in infancy, but could not be certain of it. He had
never had worms, except ascarides five years before the first
fit of the present series.

The first attack occurred in sleep. He was in it, he was
told, for three hours, but he knew nothing of it next day;
except that he was a little sickly, he felt quite well again.
On the day after the fit, he had, what he then thought little
or nothing of, a cramp in the right side of his body, the face,
arm, and leg. He, however, kept well for six months, and
then had another fit. Altogether, he has had twelve. He
has no tremor, nor giddiness, nor petit-mal, and rarely headache,
and his memory is good. His sight and hearing are good,
and he has no loss of sensation or of motion anywhere, and,
except a little temporary loss of power on one side, after an
attack of cramp, he is quite well, except when he has the fits.
In other words, his condition between the paroxysms appears
good. His urine is free from albumen and sugar.

He always knows when the fit is coming on by a twitching
and sensation of "pins and needles" in the tip of the right
index finger, and this point is at all times tender to the touch.

Next, the feeling of "pins and needles" goes up the arm to the shoulder, and then down the side to the foot, so that after a while he has the sensation on the whole of the right side, except the face and head. Very soon after this warning he becomes insensible, but he has no twitching of the arm and leg before this. No accurate description of the fits was to be obtained, as he only had one after he came to the Hospital, and in this he was not affected quite in the same way as he had previously been. He had no warning. He was convulsed, however, on one side, that on which the aura was felt. He had several attacks of cramps in this side, and probably these were abortive fits, not going on to complete insensibility. In these attacks the face was drawn to the right side, and the arm and leg of the same side were drawn up. Once, after a rather more severe attack than usual, he lost power on this side of the body, the arm, and leg. When he flexed the last joint of the finger it caused pain, which "ran up the arm as high as the shoulder; it was like a cramp.' He had the attacks of cramp about two or three times a-week. Sometimes, also, the hand would simply "crumple"

up.

Iodide of potassium was given, and the cramps were kept off by blisters round the finger, below the point from which the aura started. This kept off the cramp for long periods. Next, an ointment of aconite was applied to the finger. He had but one real fit after admission, and after August 18 he had no attack of any kind. Up to this date, December 5, he is well.

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Medical Times and Gazette.

SATURDAY, JANUARY 3.

1863.

THE intelligence of Dr. Knox's death last week cut short the article in which we had proposed to ourselves to review the current events of 1862. That year was ushered in by a cloud that overshadowed every grade of society. The death of one so reverenced for qualities of heart and head as was the Prince Consort-a man who, by the sole force of moral and mental worth, and by unobtrusive, though unremitting toil for the good of people and Sovereign, had won the esteem, nay, the affection of a nation notoriously slow in surrendering national prejudices, and insular in feeling as in geographical position-sat like an incubus on all. Bitter the regrets, and all the more poignant, because the worth which death has indelibly stamped, in life too often escaped recognition. With the Sovereign the nation sympathised, as only a people can whose home-ties and domestic affections are the ruling powers of their national life. But time has softened, although it has not repaired the loss, and the year wanes amid brighter hues, and under a more joyous sky. True, a dark shadow still hangs over a large portion of the national industry. But it has called into play, on the one hand, the noblest qualities of the sufferers; on the other, the most generous efforts on the part of those who are removed from its immediate influence. The pulse of the nation beats healthily, and its aspect is

hopeful. The marriage of the heir to the throne, accompanied by every circumstance of political and personal fitness, will throw a brightness over the coming year, which must penetrate at once the humblest cottage and the proudest hall. Our Profession will cordially join in the general hope that, in the new ties which are thus to be founded, our beloved Sovereign may find alleviation under her burden of life-long sorrow.

We, too, sustained heavy losses by death. The mind reverts to the familiar names of Brodie, Stanley, McWilliam, Farre, Waller, Fyfe, Traill, O'Beirne, Crozier, and many others of minor note. Abroad, Medicine has lost one of its brightest ornaments by the death of Professor Schroeder Van der Kolk. No word of ours is required to embalm their memories or extend their fame. To us their example and their works remain,—a memorial and a heritage.

To turn to lighter topics. 1862 was productive of many events which directly affect the position of our calling. On the brighter side of the picture we find certain efforts that were made, on the part of the General Medical Council, and of most of the examining bodies, to extend and improve Professional education; the growing appreciation, on the part of the public, of the pre-eminent fitness of the Physician to investigate judicially the cause of death in doubtful cases, and the extension or adoption of sanitary improvements. in many towns and districts. The election of Dr. Lankester to the coronership of Central Middlesex, uninfluenced as it was by political motives, may be taken as an exponent of the general reception of a truth which has been only gradually winning its way. Then, again, the meeting of the British Medical Association in London-the gathering together in our metropolis the representatives of foreign Medical science, attracted by the great Exhibition in Hyde-park, and the consequent traffic in intellectual wealth, and establishment of reciprocal friendships, are all circumstances which tend to enhance the position of the Profession scientifically and socially. Medical science, too, has itself advanced. New means of examination and diagnosis are being discovered, or old ones improved, every day. We need only point to the use of the laryngoscope and of the ophthalmoscope in the investigation of obscure disease of the vocal organs, the eye, and the brain. Curative measures are now daily adopted, which, a few years ago, were scouted as impracticable or worse. The operation of ovariotomy is saving many lives, which, not long since, were hopelessly condemned. The conditions of safety and cure are being reduced to something like mathematical certainty, and the Profession are daily proving their claim to be regarded the benefactors of mankind.

Amongst the most notable recent advancements in science is the discovery of dialysis by Mr. Graham-a process which, by taking advantage of the different rates of diffusibility of liquid substances, effects the analysis of composite fluids by a very simple process, manageable by those who have no great knowledge of analytical chemistry, and applicable, among other things, to Medico-legal inquiries, therapeutical preparations, and inquiries in physiology and organic chemistry. A full notice of the process and its applications will be found at page 111, vol. ii. of our journal for 1862.

If we now turn to the future, the point to which the attention of the Medical press is likely to be emphatically directed in 1863, is the action of the General Medical Council. Long denied to that passionate importunity which accompanies hope deferred, Medical Reform came at last. A Council was elected, representing institutions rather than the Profession directly, but certainly consisting of an unexceptionable selection of the best names in the Profession. Assured of peace at last, and of the existence of an authority whose word should be final, our members submitted quietly to what was virtual disfranchisement, and consented to pay a somewhat heavy fee for admission to the new register. Ere long, it was found that the Council afforded no protection to the Practitioner; they refused to

definite relation between the daily work, bodily and mental, and the daily food of man; his demonstration of the greater amount of food required by brain-workers than by mere mechanics; and his estimation of the relative nutritive values of Hospital diets, will be interesting to all of our readers. Equally so, no doubt, will prove an account of his researches upon the antagonism of strychnia and nicotine, of his investigations into the phenomena of saccharine and insipid diabetes, and of his experiments on the mode of action of the muscles by the determination of the pitch and note of the muscular susurrus. For this purpose we have secured the assistance of Mr. A. W. Foot, M.B., who is familiar with the views of Professor Haughton on these subjects, having been fortunate enough to have assisted in many of his experiments.

prosecute offenders. Their delay in issuing the new British Pharmacopoeia has been unlucky, though unavoidable. They responded promptly and efficiently to the voice of the Profession in repudiating the new grain weight. But the delay in issuing the Pharmacopoeia, coupled with the activity of the leading pharmaceutists in devising new forms of medicine, seem to show that the functions of a Pharmacopoeia will henceforth be very limited. There must be standard strengths for solutions and compounds of the more energetic and poisonous medicines, and for the preparation of some of the more commonly-used compounds, such as the colocynth pill. But for the future, the list of the "Materia Medica" will depend on the repute of medicines for usefulness; the preparation of the chemical compounds will be directed by the considerations of cost and convenience to the manufacturer, whilst, as for prescriptions, properly so-called, they must and will vary at the pleasure of prescribers. Some new belladonna liniment may any day be discovered which will supersede that which has already acquired an undesirable notoriety.

But it is in respect to the functions of the Medical Council, as a Council of Education, that the greatest disappointment has arisen. It is now matter of history, that the Council propounded a certain scheme of education; that the College of Surgeons set them at defiance, and proposed another scheme, diametrically opposite to that which constituted its main feature; and that the Council, after discussion, quietly submitted to the revolt of the College of Surgeons. Thus, ancient chaos would seem to resume her sway, were it not that the growing appreciation of sound and prolonged Medical education by the public, and the good sense of students, will impel them to pursue the higher and better course marked out by the Medical Council, and to give that body a moral support against the defection of one of the most powerful corporations.

The peculiar function of a weekly journal is to lay before its readers the most advanced researches,-things that are not yet to be found in books. The substance of most of the best books appears in our columns, in the form of vigorous first sketches, a year or more before it is collected into those masses which, out of deference to ancient civilization, we still call "volumes." Another is to furnish an easy vehicle for bringing forward those results of long experience which are enumerated in the private notes and case books of the ablest Practitioners. The lectures and papers of Laycock, of Gulliver, Arthur Mitchell, Rolleston, William Adams, Professors Owen, Williams, Beale, and Radcliffe, Spencer Wells, Ramskill, and Soelberg Wells, well illustrate one department; and those by Conolly, Ramsbotham, John Adams, W. R. Wilde, and Whitehead, the other; whilst the crowd of original observations by such men as Paget, Le Gros Clark, Wilks, Risdon Bennett, Bulley, Peacock, Kirkes, George Johnson, Basham, Richardson, Cock, Prescott Hewitt, Barnard Holt, Gull, Aitken, Fincham, Hillier, Lawson, Cotton, Leared, Price, De Morgan, Fayrer, Alison, Ogilvie, Haynes Walton, Hutchinson, Hughlings Jackson, well show the advancing position which our Profession is taking up in its warfare against the multiform causes of mortality.

So far as the future is concerned, we can assure our readers that we have at our command a mass of original and spontaneous communications which gives us the occasional embarrassment of selection, but that, with due foresight, we take care to secure contributions on those points in which there is something to be learned which has not yet found its way into books. For instance, we propose, in some of the following numbers of the Medical Times and Gazette, to give an account of the details and results of the series of experiments on the urine of healthy men, recently undertaken by the Rev. Professor Haughton, M.D., with the object of founding a theory of work applied to man considered as a machine, mechanical and mental. His establishment of a

Professor Simpson will favour us with lectures on Fibroid Tumours of the Womb; Professor Quain, F.R.C.S., with clinical Surgical observations; the experiences of Conolly and Ramsbotham will be continued. We are promised some more of the clinical records so carefully kept up by Dr. Robert Lee, whose great authority in Midwifery makes us regret his opposition to some new curative procedures. We shall, with the aid of a numerous and able staff, direct the attention o our readers to the subjects of Chemistry, Philosophical Anatomy, the Microscope, and Blood-letting. But, instead of more promises, we will ask any one of our readers to estimate the enormous mass of fresh and varied Professional information contained in our volumes for 1862, and accept them as evidence of what we shall give them in 1863.

THE WEEK.

DR. RADCLIFFE'S LECTURES AT THE ROYAL COLLEGE OF
PHYSICIANS IN LONDON.

In his eighth and last lecture, Dr. Radcliffe spoke of pain and paralysis, prefacing what he had to say with some remarks on the "state of irritation." It is impossible, in the few lines at our disposal, to give even the barest outline of the argument used when speaking of the "state of irritation"; and it must suffice to say, that a physical explanation was offered which was in accordance with the physiological view of muscular action and sensation propounded in the first four lectures, and that the "state of irritation," thus explained, is seen to have nothing to do with an inflammatory or congestive condition, except that it may, in some instances, give rise to such a condition secondarily. Speaking of pain, and sensation analogous to pain, Dr. Radcliffe adduced evidence to show that their physiological and pathological conditions were, in every particular, analogous to the physiological and pathological conditions of the various forms of convulsion, spasm, or tremor. The physiological evidence adduced was very curious, the facts themselves being at once novel and striking. The pathological evidence amounted to this-that pain, and the sensation analogous to pain, were, as a rule, associated with a state of wanting vigour in the circulation, respiration, and innervation, and not with the contrary state. It was argued, for example, that pain, as a rule, is the precursor of inflammation, and not the attendant; that pain gives place to tenderness when inflammation is developed, except in those cases in which the inflammation is in a place where the due amount of swelling cannot take place, and where, consequently, this resisted swelling becomes a very intelligible cause of pain. The treatment suggested by these considerations is analogous to that recommended in the different forms of tremor, convulsion, and spasm; and, with respect to this matter, the lecturer said, that his own experience left him no room to doubt that this mode of treatment led to more satisfactory results than that which is dictated by the notion, that pain and the sensation analogous to pain are the signs of exalted vital activity in nerve tissue. With respect to paralysis, the lecturer had much to say upon the current views which look upon cramps and other disorders of muscular motion,