592 SURGERY. would come near me, although it is a received opinion among them that doctors do not convey contagious miasmata. Three weeks before Pentecost the surgeon of the country called to Klaksvig to exercise his skill, had been obliged to pass a night in the village; measles appeared fourteen days afterwards in the house where he had lodged. The development of the disease could be attributed to no other cause, for not a single inhabitant of the house or island had had communication with an infected locality, and no other stranger had entered the village. At Midtvaag measles was introduced by a midwife, who had attended the sick in a neighbouring island. The girl who washed the midwife's clothes was the first to suffer. These instances tend to show that measles possesses a contagious power more virulent than is usually assigned to it. Whatever may be the value of simple prophylactic means, I consider it unquestionable that isolation is the most effectual means of arresting the development of the disease. Thus in several villages by interrupting the communicaDiftions with neighbours, families were saved. I may cite as instances 2 families at Saxen; 10 at Midtvaag; 10 at Sandevaag; half the village at Thorsvig. ferent localities were preserved by a rigorous "cordon sanitaire"-their respective populations varying from 26 to 240. About 1500 islanders may, upon the whole, be said to owe their escape to these sanitary cordons or quarantine regulations. In 6000 cases, of which I myself saw and treated 1000, there did not occur a case tending to prove the existence of "morbillose miasmata." Everywhere the disease passed from man to man-from village to village-contagion mediate or direct was evident. The two physicians of the Feröe Islands regarded the measles as of miasmatic nature, and as susceptible of transmission through the atmospheric air. Hence, at the outset of the disease, no precaution was taken by the authorities to interrupt communications and prevent the extension of the disease. Experience had, in 1781, shown what services quarantine could render -recourse was not had to it till the time for good was past. It is to be hoped that the experience so dearly bought in 1846 will have its fruits. The contagious nature of measles is so clearly proved that, in my opinion, the physician would violate his duty who should act as if it were not so.-(Translated from Archives Générales de Médecine, April 1851. P. 451. Originally published in Archiv. f. Physiol. Heilkunde, t. ii.) SURGERY. REMOVAL OF THE LOWER JAW ON THE RIGHT SIDE FOR CYSTIC DISEASE; RECOVERY. The "Lancet" of Saturday, 17th May, contains, under the above-mentioned title, a case which seems to require serious notice. The patient was a "professor of music," aged 48, who, about eight years ago, after suffering from toothach, and having two grinders removed, observed a swelling in the gum where the teeth had been extracted. This he opened with a penknife, when "some glairy fluid escaped, and the parts seemed after a little while to be cicatrised. But the tumour did not completely subside; it filled again, and the patient fell into the habit of puncturing and evacuating the contents of the swelling whenever it became distended with fluid." By-and-by, "the body of the lower jaw on the right side, about midway between the joint and the symphysis, began to expand outwardly; this swelling increased very slowly, and occasioned no pain; the protruded part felt hard and smooth, but on pressure a slight crackling could be heard. Within the last twelve months, the growth has been more rapid; and the patient having consulted Mr Fergusson about five months ago, the latter made an opening into the tumour within the mouth, where it was slightly protruding, and this measure gave exit to some glairy fluid. The part continued to discharge the same kind of liquid for some time, when the patient applied to 21 SURGERY. another surgeon, who inserted potassa fusa, and kept open the part with lint 593 tents. "This proceeding occasioned severe pain, and entirely changed the character of the discharge, which became fœtid, mixed with sloughs, and increased in quantity. Besides the two molar teeth already mentioned, the patient lost another molar and a bicuspid on the same side: the first fell out spontaneously, and the second was extracted. It is worthy of note that neither of these had any fangs left. "On examination, the tumour was found to be the size of a large orange, forming a solid mass, seemingly attached or forming part of the lower jaw on the right side, and extending from the angle of the maxilla to the symphysis. At the latter spot the bone appears to be gradually expanding into the tumour, which latter is hard, smooth, and painless to the touch. degree altered, and the swelling does not project much within the mouth; an opening exists, however, in the gum, through which the probe passes very easily The skin over it is not in the slightest into the cavity of the tumour. This bony cyst is filled with fœtid matter, which escapes when the patient inclines his head forwards. The gum is rather spongy, but the general health good. "Mr Fergusson ordered a silver double-grooved plate to be adapted to the interior of the mouth, with the view of receiving the upper and lower molar teeth on the sound side, by which means those of the affected side were kept about an inch apart. It was evident that no remedial means could be of avail, except the complete removal of the diseased portion of the jaw; and as the tumour had plainly involved the greater part of the latter, Mr Fergusson resolved to remove the right half of the lower maxilla from the articular process to the symphysis. "On the 22d of March the patient was brought into the theatre, and rendered insensible by chloroform. Mr Fergusson began by extracting a lower incisor tooth and the canine on the right side; he then passed the point of a bistoury into the mouth, about half an inch below its angle, without dividing the red part of the lip. The knife was then made to run along the lower margin of the jaw to about the middle of the tumour, and the soft parts having been detached from the bone, Mr Fergusson introduced the common straight saw, with which the bone was very cleanly divided at the symphysis. The next step consisted in carrying the external incision over the tumour, nearly up to the articulation, and dissecting up the flap towards the eye and nose. separated the muscles attached to the inner surface of the jaw, and the latter having been disarticulated, the whole mass was removed." After the operation,Mr Fergusson then rapidly "Mr Fergusson then proceeded to divide the tumour longitudinally, and the latter proved to be of the cystic kind, presenting a cavity which would have lodged a small orange. It was filled with a foetid secretion, the shell of bone forming the walls of the cyst being generally about a quarter of an inch thick. It was now evident that the cyst had been formed by a dilatation of the walls of the jaw, and was lined by the same kind of membrane which is seen in chronic abscess. This membrane had now passed into a state of gangrene, probably from the caustic solution which had been used." fore he left the hospital, we were struck by the small amount of deformity produced by the ablation of so important a portion of the face; and as Mr Fergusson "In examining the patient just behad not divided the red portion of the lip, the continuity and symmetry of the mouth was uninterrupted, and the lines of incision hardly distinguishable. This result is the more satisfactory, as it may be presumed that fibrinous matter will in time be thrown out, and give the parts a useful amount of firmness. The small amount of hemorrhage during the operation will go far to prove that Mott, Cusack, Walter, Græfe, and Gensoul, were rather too timid when they tied the carotid artery previous to the operation. Lisfranc very wisely dispensed with this preliminary step." Now, in regard to this case, we think it our duty to state that it was performed in direct opposition to the established rules of surgical practice, which require that all cystic formations, whether of the upper or lower jaw, shall be afforded an NEW SERIES.-NO. XVIII. JUNE 1851. 4 Q opportunity of contracting and healing through a free opening of the cavity, not merely by incision, but by removing a portion of the osseous or membranous parietes, before any other more serious measure be employed for their remedy. The patient's punctures with his penknife, though they might and did palliate the evil, could not be expected to prove effectual, and the opening made by Mr Fergusson was obviously not sufficient, since it appears that application for relief was soon afterwards made to another practitioner, who inserted potassa fusa, and kept open the part with lint tents. We trust that few of our practical readers need to be told that the cavities of abscesses, whether of the soft or hard parts, essentially require for contraction that the matter secreted by them should have free vent, and that the old plan of introducing tents into the orifice, so as nominally to open, but in truth to cork them tightly, was the most certain means of increasing the evil, instead of lessening it. From what we have seen of similar cases, we entertain little doubt that in this one, if the reflected mucous membrane between the cheek and gum had been divided, so as to expose the expanded bone, and permit a portion of it, the size of a shilling or half-crown, to be removed, the patient would have speedily recovered without any further trouble. At all events, until this step had been taken in vain, we beg to repeat that excision of the jaw was not warranted by the present established rules of surgery. In the second place, we beg to remark that the disease having originated in the base of the jaw, not having extended into the ramus, and not being malignant, there was no warrant whatever for disarticulation, even if it had been found necessary to remove the expanded portion of bone. As to the advantage of leaving undivided the margin of the lip, we beg to remind our friends in London that if there be any merit due for this mode of proceeding, it belongs entirely to Mr Liston, who adopted, practised, and enforced it as of great consequence in lessening the amount of deformity. For our own part, we are of opinion that, as the incision, if directed obliquely outwards and downwards from the angle of the mouth, can hardly be detected after recovery, while the great additional space obtained by making the mouth continuous with the incision wonderfully facilitates the procedure of dividing or disarticulating the bone, the advantage of allowing the lip to remain entire is somewhat questionable, unless when the tumour is of a large size. Thus, in disarticulating on both sides the entire jaw for an enormous growth, we have found a simple incision under the chin from ear to ear quite sufficient for the purpose. But of all the statements connected with this case, the one which seems to us the most extraordinary, is that regarding ligature of the carotid artery as a precautionary measure. To say nothing of the other gentlemen whose names are mentioned so disparagingly, surely that of Mr Cusack might have been spared, not only in consideration of his not tying the artery in the numerous and successful cases which were chiefly concerned in establishing the operation in this country, but in gratitude for his clear and convincing demonstration, that the internal maxillary and temporal arteries might be avoided with certainty in effecting disarticulation, by opening the joint on its fore part, so as to remove all excuse for ligature of the carotid. NEW MODE OF TREATING FISTULA IN ANO. BY MR MARSHALL, ASSISTANT- We have heard that there is a newspaper advertiser in London, who undertakes to cure fistula "without cutting," and fulfils his contract by conveying a wire through the sinus and anus, so as to include the septum between them, and divide it through ulceration caused by gradual twisting. The prolonged confinement and discomfort, to say nothing of the pain and pecuniary exaction attendant upon this tedious substitute for an instantaneous incision and speedy recovery without any sort of annoyance, have been to us rather agreeable subjects of consideration, as a just and fitting punishment for the folly of trusting unprincipled impostors. The reader, therefore, may imagine our sur MEDICAL NEWS. 595 cart prise and concern, in finding the wire gravely recommended by a regular member of the profession, with the agreeable addition of being used red hot!! "The patient having been put under the influence of chloroform, Mr Marshall introduced one end of the platinum wire into the fistulous tract, and made it reappear at the anus; the two ends were then connected with the poles (of a galvanic battery), the circuit completed, the wire became red hot, and was gently brought downwards, dividing all the interposed tissues, and cauterizing them at the same time so effectually as to prevent any amount of hemorrhage. The only dressing used was a piece of lint dipped in cold water applied externally," 66 In entering our decided protest against this most unprofitable, though ingenious proposal, and also the employment of a red hot wire for removing hemorrhoidal tumours, we venture to hope that we shall not be charged with making a personal attack" upon the author, especially as we have reason to believe that he is a gentleman of great merit and promise in his profession. While freely criticising published facts and opinions, as it is our duty to do, we cannot regard the groundless charge of personality reiterated from week to week, as any reply to the statements bearing upon medical science and practice, for which we are responsible. Part Fifth. MEDICAL NEWS. RESOLUTIONS OF THE ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH, AND OF THE HOMEOPATHY. At Edinburgh, and within the College Hall there, the 9th day of May 1851, an Extraordinary Meeting of the Royal College was held, pursuant to a Resolution agreed to at the last Quarterly Meeting, and of which Extraordinary Meeting due notice was given. were moved, seconded, and unanimously agreed to:The President in the chair. The following Resolutions 1. That the Royal College of Physicians of Edinburgh did, several publicly express its opinion of homoeopathy and homoeopathic practitioners, by peremptorily declining to admit into its body a candidate for its Fellowship who belonged to that denomination; and, consequently, that no Fellow of the College years ago, can possibly be ignorant of the light in which all those who practise homœopathy are regarded by the College. 2. The College regrets that, notwithstanding this decided expression of its opinion, more than one of its Fellows, after being admitted in a different character, have endangered the reputation of the College by becoming homoeopathic practitioners; and the College expresses an earnest hope that these Fellows, seeing they have thus virtually separated themselves from the College, will spontaneously sever their further connection with an institution which repudiates them, and from which they can derive, as merely nominal Fellows, nothing else than a false position and a spurious credit. 3. The College feels the more bound thus to express its opinion, seeing that those Fellows who have become homœopathists, and any other medical practitioners who follow homœopathy, must necessarily be aliens to the other Fellows, and to the profession at large; inasmuch as no Fellow of this College, or any other physician, can, by any possibility, without derogating from his own honour, and from the honour of the profession, meet practitioners of homœopathy in consultation, or co-operate with them in the other common duties of professional life. 4. That although the College has not thought it expedient hitherto to take any active steps for disclaiming those Fellows who have become Homœopathic Practitioners subsequently to their admission to the College, nevertheless, since it has the power of dealing summarily with those who act in a manner so unbecoming the character of a Physician, it reserves its right to exercise that power when it shall be so advised. Signed in Name, and by Authority, of the College, J. Y. SIMPSON, President. At a meeting of the Royal College of Surgeons of Edinburgh, held on the 16th instant, the following Resolutions were moved by the President, and unanimously adopted : 1. The College having considered a series of resolutions transmitted by the Royal College of Physicians, in regard to homeopathy, feel called upon to express their opinion that the system so designated being entirely inconsistent with the principles professed by candidates for the diploma of the College of Surgeons, any Fellow or Licentiate who practises it, or countenances others in doing so, by meeting them in consultation, will justly incur the disapprobation of the College. 2. That a copy of the above resolution be transmitted to the Royal College of Physicians. Signed in Name, and by Authority, of the College, JAMES SYME, President. VARIETIES. AWKWARD POSITION OF AN IRISH REVIEWER.-With reference to a case lately related in this Journal, of an aneurism affecting the radial artery, which was remedied by pressure applied to the wrist, the "Dublin Quarterly Journal of Medical Science" for May, is carried, by its favourite hobby, into the following extravagance:"Now, Professor Syme, we appeal to you, as a surgeon and a gentleman, is this fair dealing with the salient points of the question at issue? What! The radial artery lies directly under the skin, rests upon the bone, and has no associate disposed to resent the effect of compression." No tyro in anatomy can be ignorant that the radial has two venæ comites, and as for their disposition to resent injury, we are not in a position to answer whether it be greater or less than that of any other satellite vein under similar circumstances." On the part of the gentleman to whom this affecting appeal is addressed, we beg to reply, after the established practice of our countrymen, by asking the advocate of pressure, if he really thinks that compression, or even complete obliteration of the venæ comites of the radial artery at the wrist, could produce the slightest appreciable effect on the circulation of the limb? or that these minute vessels would resent injuries inflicted upon them in the same fearful fashion as the great venous trunk of the lower extremity? Should our brother of Dublin answer this question in the affirmative, we shall probably be held excused for declining any further discussion with an opponent entertaining such very peculiar opinions; and if he repudiates the folly that would thus be implied, we shall then desire him to explain how he has ventured to insult his readers by pretending to believe that there was any parallel between the two cases. In the meantime, we leave him to choose whichever horn of this dilemma may promise the more comfortable repose. PROFESSIONAL ETHICS OF SIR B. BRODIE AND SIR P. CRAMPTON.-In the last Number of this Journal, there are two letters which seem to claim attention, irrespectively of the circumstances that led to their production. One of these is from Sir B. Brodie, and the other from Sir P. Crampton,-both being in reply |