has brought many thousands of poor famished creatures, either already in a state of disease, or highly predisposed to fever and dysentery, has clearly shown that this high rate does not arise solely from un. healthiness of the town itself-of its resident population. From this debilitated class of persons, however, and from other non-resident classes--sailors and foreigners, a considerable number of our patients are furnished. The severe and urgent nature of the cases is also such, that it not unfrequently happens that patients are brought to us in articulo mortis, while others, who have just landed from ships, and have been long ill, survive but a few days. PROVINCIAL on an investigation, that there was "scarcely a ward in the house, for the reception of either healthy or sick, in which there were not twice as many persons as there ought to be, and that there were many in which there were four times the number." The address goes on to show that, "at the time that this statement was made, the average cubic dimensions allowed for each of 601 persons, and his bed, was only 300 cubic feet, and that of this number, each of 289 had only 233 cubic feet, and that each of the remaining 312 had an average of 363 cubic feet. In other words, 601 persons slept in less than one-third, 289 of them in less than one-fourth, Medical & Surgical Journal. and 312 in little more than one-third of the WEDNESDAY, JUNE 16, 1847. We have received a copy of an Address from the Honorary Medical Board of the Liverpool Workhouse and Fever Hospital, to the ratepayers of the parish of Liverpool, which is fraught with matter of such immediate importance to the best interests of the public, that we deem it our duty to lose no time in bringing the subject to which it refers before the members of our widely extended Association. The town of Liverpool has been placed in an unfortunate position, by the immigration of so large a number of our suffering fellow-countrymen from Ireland, bringing with them as they did, not only the call for large pecuniary assistance, on account of their starving condition, but also the seeds of fatal disease, which has but too rapidly communicated itself to, and carried its ravages among, the native population. The great increase of fever cases appears to have led to increased demands for hospital accommodation by the district surgeons, for those who were the sufferers under it; and the parochial authorities, after a long period of indifference, were induced at last to take some steps to meet the evil, the growth of which has, no doubt, been greatly augmented by the want of earlier attention in this respect. Under these circumstances it seems that "the Medical Board of the Workhouse was in the middle of February last," we quote the words of the address, "for the first time consulted, in the form of a call to sanction the appropriation of a part of the Workhouse, then occupied by the infirm and aged men, to the purposes of a fever-ward." The over-crowded state of the house very properly operated with the Medical Board in inducing them to refuse to sanction the introduction of fever-cases into the infirmary of the institution, or the appropriation of a ward as a fever-hospital, it appearing space deemed necessary by the Commissioners of Prisons for the preservation of the health of the inmates of a gaol. An arrangement was afterwards proposed, and cordially assented to by the Medical Board, by which "the whole of the Infirmary looking towards Brownlow Hill" was to be cleared out, for the reception of fever-patients; the medical, surgical, and lying-in patients, to be removed to wards selected by the Board in a new building. In direct contravention of this arrangement, the Workhouse Committee removed a part of the inmates-the infirm and aged to cells "little better than under-ground cellars ;" and the medical, surgical, and lying-in patients were "carried off in the dead of the night to the old nurseries, which had been disapproved of as wards by the Board, where they were found next morning, by the physician and surgeon in attendance, huddled together, in some cases two in a bed, and without any provision for their comfort, at a time when a very fatal epidemic of dysentery prevailed." The consequences may readily be anticipated. "On the 17th of April it was represented that thirty-seven men slept in eight beds, and ninety-six women and chil dren in thirty-eight beds, and that eight cases of fever were removed to the fever-wards the next morning. On the 24th of April, twentyone cases at least of fever were removed from different parts of the house to the ward in one day; fourteen deaths in the course of the week had taken place from fever and dysentery in the cleansing wards: a deputation from the Board on this day found twenty cases of fever in these wards, a general prevalence of severe dysentery, and, in one instance, three cases of fever in one bed." It is unnecessary here to pursue the subject farther, excepting to state, that in the collision which necessarily took place between the Medical Board and the Workhouse Committee, and REVIEWS. subsequent investigation before an Assistant Poor-Law Commisioner, that functionary took part with the Committee; when, after a fruitless application to the Poor-Law Commission, the Medical Board feeling their efficiency to be at an end, with the utterly inadequate means placed at their disposal to enable them to discharge their duties properly, have withdrawn themselves from all responsibility, and from the charge of the hospital. This cannot but be regarded under existing circumstances, as a public calamity to the town of Liverpool, and it is greatly to be feared the inhabitants will suffer en masse by this ill-judged parsimony, for we presume that the item of expense is at the root of the conduct of the Committee in thus opposing themselves to the wise precautionary recommendations of the Medical Board. With the contagious and fatal fever which exists in, or threatens, not only Liverpool, but most of the larger towns in the western districts, and from the same cause, it is earnestly to be hoped that every attention will be paid to those sanatory precautions, and especially the avoiding of over-crowding in Union Workhouses and other public establishments, which the knowledge and experience of the medical profession enable them to point out. trifling cost to the public, almost indeed inappreciable, at which the services of the medical profession are obtained in the charge of the sick poor, should at least facilitate the employment of all fitting arrangements for preventing the spread of contagious disease. The very The greater part of the public and private medical charities throughout the kingdom, it is justly observed, are worked by Honorary Medical Officers. How the Union officers are remunerated may be learned from the subjoined extract:-"In the rich town of Liverpool, now proverbial for the amount of disease existing in it, the whole remuneration for skilled medical relief, under ordinary circumstances, exclusive of that afforded by the private charities, is less than £1600 per annum, being little more than one halfpenny in the pound of the annual value of the rateable property, and from £1120 of this, paid to sixteen district surgeons, is to be deducted the amount expended in supplying the pauper population with medicine." We beg to direct attention to the announcement made in the last number, and repeated in another column of the present number, on the subject of the Council Prize. From the subscriptions and donations made to the Council Fund since its establishment at the last Anniversary at Norwich, the Committee there 325 appointed to manage this fund have been enabled to offer the sum of fifty pounds as a prize for the best Essay or Report "On the Cerebral Affections of Infancy." Other subjects have been under consideration, and it is hoped that the fund for the succeeding year will be so far augmented, as to allow not only of some of these being proposed for competition, but at the same time of subjects of original research being named for investigation, and other measures being brought forward for the advancement of medical science. Reviews. 4 System af Surgery. By J. M. CHELIUS, Doctor in Medicine and Surgery, &c., &c. Translated from the German, and accompanied with additional Notes and Observations. By JOHN F. SOUTH, late Professor of Surgery to the Royal College of Surgeons of England, and one of the Surgeons to St. Thomas's Hospital. London: 1847. 8vo. 2 vols. pp. clxvii., 814 and 1009. We have great pleasure in announcing the completion of this truly important work, and it is no small credit, both to the translator and the publisher, that the promises of regularity of appearance made at its commencement have been fulfilled to the letter. Many works published in a similar manner, but far less elaborate, and with little excuse for failure in this respect, still linger in the hands of author or printer, the earlier numbers of which, already becoming obsolete, long preceded the appearance of the first instalment of the work before us, and it is with regret we learn that the publisher (if not the author,) is likely to be deprived, by the very merits of the work, in an extensive field at least, of the fair reward of his rare and commendable perseverance. Any review of so comprehensive a work, in the limited space which we are able to devote to noticing the publications of the day, is out of the question; we are compelled, therefore, to a very brief exposition of its contents, with a general expression of approbation of the manner in which Mr. South has executed the translation, and an acknowledgment of the greatly increased value which the original work of Professor Chelius derives from the numerous comments in this edition. So numerous indeed are these, and so important to the elucidation of the subject treated upon, to its general literature and practical utility, that it cannot but be observed, that the "System," in its English dress, is as much the work of Mr. Smith as of its German author. The "System of Surgery" of Chelius and South, as it may be justly termed, is arranged under eight secions or divisions. The first of these is devoted to the subject of inflammation; the second treats of diseases which result from the disturbance of physical continuity; 1 the third, of diseases dependent on unnatural coherence; the fourth, of those dependent on the presence of foreign bodies; the fifth, of diseases which consist in the degeneration of organic parts, or in the production of new structure; the sixth treats of loss of organic parts; the seventh, of superfluity of organic parts; and the eighth, and last, of the elementary proceedings of surgical operations. The first two divisions Occupy nearly the whole of the first volume; the other six forin the contents of the second volume, We shall not stop to inquire into the merits of this arrangement, whether it is the best which might have been constructed, or whether in the following of it out, the several subjects succeed each other, in a natural or convenient sequence. The treatise is essentially a work of reference and consultation for the advanced practitioner, rather than a guide-book for the mere student; and any deviation from the various systems of arrangement which different individuals may prefer is more than compensated by the very copious analytical iudex, extending to nearly one hundred and eighty closelyprinted pages. This index adds greatly, in our opinion, to the value of the work, as it enables those, with whom time is an object, at once to obtain an epitome of what is to be found in the body of the work, or any subject on which information may be looked for. The Surgeon's Vade Mecum. By ROBERT DRUITT, numerous wood-cuts. of Shropshire, was held on Friday, at Shrewsbury, sion. In the present anomalous state of the profession, the general practitioner was excluded from the College of Physicians, and insulted by the Council of the College of Surgeons, and the profession, as a body, was left unprotected, and stripped of that collegiate and social standing which they had legally acquired at great trouble and expense. The Council had exercised the powers of their new charter invidiously, and the persons selected for the fellowship had no more claim to that distinction, on the score of merit, than the thousands on the college list who were passed over. If the selection had been confined to hospital and infirmary surgeons, and the right to elect the Council had not The merits of this work are so well known and so justly appreciated, as to render it unnecessary to do more than briefly announce the appearance of another edition. It is, however, right to mention, that much new matter of interest to the surgeon has been added, chiefly in the practical parts of the work. Among these may be enumerated the sections on inflammation; on malignant diseases; the treatment of aneurism by compression; the section on diseases of the ear; and some very useful directions on bandaging, accompanied by illustrations. The number of the illustrations throughout is also very much increased, and, notwith-been granted to the fellows, he did not know that there standing the acknowledged excellence of the preceding editions, the present will be found considerably to surpass them. Proceedings of Societies. SHROPSHIRE AND NORTH WALES BRANCH ANNUAL MEETING. would have been so much to complain of, but he thought they had a right to complain, when individuals were elevated to the rank of fellows to the great disparagement of others equally worthy of the title. The petition he should have the honour to lay before them would, he believed, embody their sentiments on the subject of the Registration Bill, and the more important subject of medical and surgical education, and he hoped their exertions might aid its being carried through Parliament. The following resolutions were then adopted :— The Annual Meeting of the Shropshire and North | 1st.-Proposed by S. WOOD, Esq., seconded by R. P. Wales Branch of the Provincial Medical and Surgical Association, and of the resident medical practitioners WESTON, Esq. "That the Medical Registration Bill, in forming a SHROPSHIRE BRANCH MEETING OF THE ASSOCIATION. "That it is incumbent upon the legislature to provide, by every means in their power, for the suppression of quackery, by which the public are grossly imposed upon, and many valuable lives annually lost." 327 "1st. That ignorant and unqualified persons have the power of assuming, with impunity, professional titles and degrees, and thereby grossly and injuriously imposing on the public. "2nd. That no uniform standard of conjoint medical and surgical education exists, and that divers colleges and bodies corporate have the privilege of granting degrees and titles at rates of education and qualification essentially differing from each other. "3rd. That the Colleges of Physicians and Surgeons hold an irresponsible power, which, in the instance of the College of Surgeons, under their recent charter, has been arbitrarily and injuriously exercised 3rd.-Proposed by W. EDDOWES, Esq., seconded by towards its members. T. PIDDUCK, Esq. "That it is essential to the best interests of the Medical Profession, that one uniform standard of conjoint medical and surgical education, combined with practical examinations, be established, as a test of capability for practice for all those who shall hereafter enter the profession under any title whatsoever." 4th.-Proposed by J. DICKIN, Esq., seconded by Dr. DRURY. "That the numerous corporate bodies having the power of granting degrees ought to be assimilated in the amount of qualification required for the attainment of each degreee of a like denomination, and that the Medical Registration Bill will be highly beneficial in effecting this object." "4th. That the Apothecaries' Company is the only body corporate capable of granting a licence to practise in England and Wales, and may thus interfere to prevent those from practising who possess higher qualifications than the members of that body. "Your petitioners, therefore, considering it essential to the health and safety of the public, as well as to the improvement of the profession, that these grievances be redressed, entreat your Honourable House, "Ist. That the Medical Registration Bill be passed into a Law. "2nd. That one uniform and determinate standard of conjoint Medical and Surgical Education, combined with two or more practical examinations be established, and that no person after the passing of the Medical Registration Bill, be registered, or entitled to practise, 5th.-Proposed by E. BENNION, Esq., seconded by who cannot produce testimonials of having completed J. R. HUMPHREYS, Esq. "That your petitioners beg respectfully to impress their gratitude for the consideration you have evinced towards the medical profession by the appointment of Committee to investigate the subject of medical registration and of the state of the law relating to the practice of medicine and surgery in these kingdoms. "That your petitioners are of opinion that the grievances which affect the medical profession arise from the following causes : such conjoint education and examination, excepting always those in actual practice at the time of the passing of such Bill, and qualified to be registered under it. "3rd. That a just and fair system of representation be accorded to the great body of the members of the profession in their several Colleges, and, in particular, that the irresponsible power now possessed by the Colleges of Physicians and Surgeons, be so modified on the representative system, as to impart to those institutions a greater influence, security, and efficiency, "And your petitioners will ever pray." 7th.-Proposed by W. HOWLETT, Esq., seconded by Dr. WILLIAMS. "That the members of the county and the different boroughs therein be requested to support the Medical Registration Bill." 8th.-Proposed by Dr. DRURY, seconded by R. BROUGHTON, Esq. "That the thanks of this meeting be given to PEPLOE CARTWRIGHT, Esq., for his impartial conduct in the chair, and for the unwearied energy with which he has, upon ail occasions, exerted himself to promote the interests of the Medical Profession." At the conclusion of the meeting the members and visitors adjourned to the dinner table, where, on the removal of the cloth, the healths of the various officers of the Association were proposed from the chair, which was ably filled by Mr. Cartwright; and the question of Medical Reform made the subject of extended comment and discussion by several gentlemen present. Altogether the anniversary was both more numerously attended, BATH PATHOLOGICAL SOCIETY. Mr. NORMAN in the Chair. were found minutely studded with miliary tubercles, all of small and uniform size. The specific gravity of both lungs was so much increased that they sank rapidly in water, and shewed but little tendency to float in a saturated solution of alum and nitre; there was slight thickening of the mitral valve, though not sufficient to render it incompetent for its office; the liver was enlarged and fatty; the brain and kidneys were not examined. The period within which the disease proved fatal was as nearly as could be ascertained twenty-one days. Mr. Field remarked on this case as illustrating a form of disease, rapidly and apparently certainly fatal, and alluded to similar cases that have been placed on record by Louis, especially one case, where the duration of the disease was as nearly as possible the same. Mr. Field then alluded to the question as one of much interest,— whether this acute form of tuberculization was to be considered as an effect of inflammatory action or not? and gave as one reason against such a view, that in acute tuberculization both lungs are almost invariably affected, whilst double pneumonia is comparatively rare. CASE XVI.-No history. Dissection :-Adherent pericardium. Mr. Waldron related the history of a case, with an account of the post-mortem appearances; the specimens could not be obtained. The patient, a woman about 63 years of age, first came under Mr. Waldron's care about eight or ten months previous to her death, at which time he learned that she had been much subject to palpitation of the heart from an early period of life. On examination there did not seem any enlargement of the left side of the chest; the action of the heart was irregular, and she complained of dyspnoea, which was increased by any exertion, palpitation at the same time being induced; the heart's action was accompanied by a bruit, heard most distinctly at the lower part of the sternum; there was also a thrilling sensation communicated to the hand when placed over the region of the heart; the pulse at the wrist was feeble and became intermittent on slight exertion. Her symptoms for a time appeared to yield to treatment, but after exposure to cold and over-exertion she was attacked with syncope and died without rallying. The body was examined forty-eight hours after death; the heart was found much enlarged, softened, and of a yellowish grey colour; the right cavities contained a CASE XVII.-No history. Sudden death. Dissection :considerable quantity of fluid blood; the right auricle was much enlarged; the tricuspid valves at their base were contracted and cartilaginous. Mr. Bush exhibited a heart taken from the body of a man, about 70 years of age. Concerning his previous history there was not much known, except that he had suffered from a severe attack of what was called asthma, about six years before. On dissection, the pericardium was found very much thickened and adherent throughout; the heart was much enlarged, and the aorta more capacious than natural; the endocardium was healthy, and the valves sound; a portion of the pleural covering the right lung was adherent to the pericardium. Rupture of the aorta. Mr. Hunt exhibited part of the arch of the aorta of a man, concerning whom he had no history, except CASE XV.-Acute tuberculization of the lungs; death in that death had taken place rather suddenly. The twenty-one days from first symptoms. Mr. Field exhibited portions of both lungs taken from the body of a girl, 15 years of age; her history is as follows:-Until within a week of the time Mr. Field first saw her, which was twelve days before her death, she had enjoyed tolerably good health, though never robust; she had never suffered under any pectoral symptoms, neither cough, short breathing, nor pain of chest. She had never menstruated. On examination she complained of slight pain under the sternum and in the region of the heart; percussion elicited an unsatisfactory sound beneath both clavicles, and beneath the right there was slight crepitation; the respiration was rather hurried, and the expansion of the chest imperfect; her pulse was quick and weak; no expectora tion; her general appearance was that of a person labouring under serious disease, which, combined with the physical signs, led Mr. Field to consider the case as one of acute tuberculization. The last six days of her life she was very feeble. On dissection, both lungs portion of the aorta was much dilated, and presented a longitudinal (as regards the course of the vessel,) rupture of the internal coat; and at some distance from the seat of injury of the inner coat, was an irregular opening in the aorta through which the blood had escaped. CASE XVIII.-No peculiar nervous symptoms; sudden death. Dissection:-Calcareous deposit in the nervous matter of the cerebellum, and also in the arteries of the brain. Mr. Skinner exhibited a portion of the cerebellum of a middle-aged woman, in whom there had not appeared any peculiar symptoms referrible to the nervous system; death took place suddenly and unexpectedly. On dissection, the brain was found much congested; the arteries exhibited extensive calcareous deposit; the portion of the cerebellum shown was so loaded with calcareous deposit that there remained little appearance of nervous matter, except the form. |