REVIEWS. for a qualified physician in undertaking the responsibilities, the labour, and the danger inseparable from the charge of a large feverhospital, crowded with patients, and overflowing with infection; while the workmen who are employed on the building,-bricklayers, carpenters, painters, &c.,-are absolutely paid for their mere manual labour at a higher rate. We had intended to extend these considerations to what is going on on this side of the Channel, where the medical officers of unions in Liverpool and other large towns, lately visited by contagious fever, have been in like manner bestowing their services and their time, and sacrificing their lives, receiving in return, at the hands of PoorLaw authorities, a similar amount of grateful consideration; but we are compelled, by want of space, to postpone the questions which arise until another occasion, when we purpose to review the entire subject of public medical remuneration, together with its bearings on the status and prospects of the members of the profession. Reviews. 379 can no longer be borne, and the tolerance of the mineral is exhausted. Its exhibition is then stopped, and if the disease for which it had been given should fail to be alleviated, the remedy falls into disrepute for what has rather been an error in the mode of administering it, and the case, usually one in which numerous other remedial measures have been previously tried, is pronounced obstinate, intractable, perhaps incurable. One great merit of the practice recommended by Mr. Hunt is, that it accords with the rationale of the action of other medicines of a like character; and we are so much in the habit of using medicines empirically, to produce an immediate and specific effect, and are so little acquainted with the physiological action or modus operandi of of the action of medicinal agents on the general system almost all of them, that any contribution to our knowledge is fraught with instruction and benefit, the ultimate results of which indeed can scarcely be calculated. The administration, then, of arsenic, is these minute doses, (five drops of Fowler's solution, three times daily, with, or shortly after, the meals,) seems well calculated to insure its absorption and diffusion through the system. Given in this manner it may be expected gradually and safely, as far as the tolerance of the mineral can be established, to induce those alterative changes in the blood, and through that on the organism, which its indi Practical Observations on the Pathology and Treatment of certain Diseases of the Skin, generally pronounced intractable. By THOMAS HUNT, M.R.C.S., Eng.,vidual properties enable it to effect. The point of L.S.A., &c. London. 8vo. pp. 156. Some months ago the author of the present work | directed attention in this Journal to a method of administering arsenic in some intractable forms of skin disease. We have here an amplication of his views, with more precise directions as to the use of this remedy, and illustrated by details of cases, exemplifying its powers and the general indications for its employment. tolerance is, it seems, indicated by the action on the conjunctiva, an inflamed state of that membrane being after a time induced. The dose of the medicine must then be lessened, perhaps, for a time, the use of it altogether discontinued, to be again resumed in smaller quantities, and its influence kept up for weeks or months, until, as in the case of cutaneous diseases, the morbid disposition is counteracted or destroyed by the prolonged use of the remedy. The employment of arsenic in chronic cutaneous affec-This is, in brief, a summary of the history of Mr. Hunt's tions is no new practice, but the directions given for its cases, and among those special affections which have use by Mr. Hunt, are very different from those generally yielded to the constitutional influence of arsenic thus laid down by preceding writers, and approximate rather induced, the most satisfactory instances will be found in to the method followed in prescribing alterative doses of those well-known opprobria medicinæ,-prurigo, lepra, mercury, where the intention is to produce an alterative psoriasis, eczema, acne, and even lupus. action, without affecting the system so decidedly as to bring out the more evident effects of the mineral on the salivary glands. Accordingly, in the same manner, as the tender state of the gums, induced by the prolonged action of small doses of mercury, becomes at once an evidence of the system being brought under the influence of the medicine, and an indication for the diminution of the dose, so in like manner is the effect produced on the conjunctival membrane of the eye by the lengthened use of small doses of arsenic, an evidence of the system being brought under the influence of this remedy, and an indication also for reducing the dose. The usual mode of administering arsenic is, as our readers well know, to commence with very small quantities, gradually augmenting them until the stomach shews that a further increase in the dose of the poison The failures of arsenic as an internal remedy for cutaneous affections is attributed by the author,-1st, to the syphilitic characters of many of these cases being overlooked,-arsenic is prescribed when mercury is wanted; 2nd, to its being administered during the inflammatory or febrile stages of the disease; 3rd, to the exhibition of the remedy on an empty stomach, when it is frequently obliged to be abandoned from the gastric irritation excited; 4th, to the doses in which it is ordered being too large, and the intervals too distant; and lastly, the most common and most serious error of all, the giving it in gradually increasing doses. The properties of arsenic to be kept in view in its medicinal action on the system are, according to the author-1st, its cumulative character; hence the necessity for avoiding the common practice of gradually increasing the dose to the utmost verge of toleration by the stomach. 2nd. The sudden arrest of diseased action often observable under the administration of the maximum dose. "A full dose being administered at regular intervals, in a few days (or possibly weeks,) a pricking sensation is felt in the tarsi, and the conjunctiva becomes slightly inflamed. At this crisis the disease is brought under arrest, and generally from this period appears to be shorn of its strength. The return of healthy action in the cutaneous vessels often becomes visible, and is sensibly felt by the patient, on the very day on which the eyes become suffused with tears." 3rd. The effect of an over-dose on the nervous system, producing for a lengthened period subsequent intolerance of the medicine even in the smallest doses. 4th. That while in large doses it irritates the bowels, in small doses it soothes them, tending to check the diarrhoea and gastric irritation, which frequently accompany skin diseases. And lastly, that the susceptibility of some individuals to the influence of arsenic, is so great as to amount almost to complete intolerance, and that yet in persons of this description, suffering under diseases of the skin, in very greatly reduced doses it proves equally beneficial in curing the disease, as in those of ordinary susceptibility. The treatise is divided into four sections: the first is devoted to the introductory observations; the second contains cases illustrative of the use of arsenic according to Mr. Hunt's method; the third contains some general observations on the cases in the preceding section; and in the fourth is considered the important questions, "Are local diseases ever salutary to the system at large? are there any cases which cannot be cured without risking the general health? and The Half-Yearly Abstract of the Medical Sciences. This volutae of Dr. Ranking's Abstract contains the usual amount of selections of the more important contributions in practical medicine, systematically arranged under the several beads of I., Practical Medicine, Pathology, and Therapeutics; II., Surgery; and III., Midwifery, and Diseases of Children. To these are added three Reports on the same subjects, by the Editor and Mr. Ancell; a Report on Pathological Chemistry, by Dr. Day; a Report on Forensic Medicine and Toxicology, by Professor Guy, and a Report on the Surgical and Medicinal Application of the Vapour of Æther, by Dr. Ranking. In Mr. Ancell's report on the Progress of Surgery, there are special sections onVenereal Diseases, and on Aural Surgery. The Editor's report on the Inhalation of Æther will be regarded with peculiar interest. Our present object will be attained by quoting the concluding sentences which embody the result of Dr. Ranking's deliberate examination of all that has hitherto been adduced in favour of and against the practice : "We now bring our report on the subject of etherinhalation to a close, and in doing so, beg to guard ourselves against the imputation of a premature admission of all that has been said in its favour. In the criticism we have thought it right to make upon the various objections which have from time to time appeared, our sole intention has been to point out the non sequitur style in which the adverse argumentation has been conducted. We do not deny that other and more logical objections may, upon further experience, be In reference to this last subject, the author lays down justifiably adduced; but we do maintain that up to the following propositions : "I. Local disorders of local origin may be safely treated locally, if the general health be sound. "II. Local disorders of constitutional origin cannot be treated locally without risk. "III. Disorders of mixed origin, partly constitutional, partly local, require-first,-general, afterwards local treatment." The observations introduced in the discussion of these propositions are highly judicious, and the entire section is worthy of attentive perusal. Although indiscriminate local treatment is justly censured, and the use of local applications discouraged, in many of those affections in which they have very generally been had recourse to, it should be observed that the author does not omit to call to his aid those other adjuvants in the general treatment of chronic cutaneous diseases which the symptoms indicate. In concluding these remarks, we have only to add, that we consider Mr. Hunt's mode of administering arsenic as an alterative, a rational practice, and worthy of extended trial, not only in chronic cutaneous disease depending on constitutional causes, but in other constitutional diseases, in which benefit may be looked for by impregnating the system with this powerful agent. the present time no evidence of injurious effects has been brought forward, which ought to weigh against the accumulated testimony, in surgery more particularly, which has caused many to regard the introduction of ether-inhalation as one of the most merciful dispensations of Providence.” Proceedings of Societies. SOUTH-EASTERN BRANCH OF THE PRO- ANNUAL MEETING. On Wednesday, the 30th June, 1847, the third Anniversary Meeting of this Branch Association was held at the Town Hall, Reigate, when the following gentlemen were present:-- Messrs. Wallace, of Carshalton; Henry M. Holman, of Hurstpierpoint; Smith, of Crawley; Martin, of Pulborough; Pickance, of Penshurst; Drs. Sibbald and Plomley, of Maidstone; Messrs. West, of Tunbridge; Chaldecott, and Napper, of Dorking; Powel and Turner, of Tunbridge Wells; Giraud, of Faversham; Barrington, of Tunbridge; Pout, of Yalding; Gould, of Wateringbury; Martin, Peter Martin, Steele, and Sisson, of Reigate; Bottomley, and Fletcher, of SOUTH-EASTERN BRANCH MEETING OF THE ASSOCIATION. Croydon; Drs. Sylvester, of Clapham; Mackness, of Hastings; Forbes, of London; Jenks, of Brighton; Messrs. Cordy Barrows, of Brighton; Harris, of Northiam; Whitfield, of Ashford; Wallis, of Hartfield; Thompson, of Westerham; Stedman, and Napper, of Guildford; Hunt, of Herne Bay; Davies, of York Town, Bagshot; Long, of Barham; Reid, of Canterbury; Hextall Smith, of St. Mary Cray; and other gentlemen, not yet members of the Association. Dr. Sibbald, the retiring President, having taken the - chair, addressed, the meeting to the following effect: On retiring from the office which your kind partiality assigned to me last year, I shall delay the proceedings of this meeting for a very few moments only; for there will doubtless be much interesting matter to engage your attention during the short period for which we have met, and I should not readily be excused, if I were needlessly to trespass on the valuable time required for the special business of this meeting. That I have been considered as worthy to occupy this chair I feel as a high distinction. Your approbation gives real eminence; and to merit your favourable opinion I hope is a pure and rightly directed ambition. I beg to offer my congratulations on the appointment of my worthy successor, Mr. Wallace, to whom, with the greatest pleasure, I shall resign my office. The minutes of proceedings at the Ashford meeting were then confirmed by the present meeting, and signed by Dr. Sibbald, who then left the chair, and handed in Mr. Wallace, who addressed the meeting as follows:Gentlemen,-The kind partiality of friends, rather than any merit of mine, has placed me in this chair; and I throw myself on your indulgence, when I request that you will impute my deficiencies, not to my want of zeal to maintain the credit of these meetings, but to my incapacity. It would be wanting in respect to this meeting, and also imposing restraint on myself, were I not to make you a short address upon the motives which have induced the parent Society to institute these Branch meetings; and, gentlemen, short it must be, as your Committee have arranged that the business of this meeting do cease at five o'clock, in order that the remainder of our time this day may be devoted to social intercourse at the dinner table, to which I trust all of us will be able to adjourn. Let us bear in mind, gentlemen, the main objects to effect which our Association was established, namely, to communicate knowledge, and to promote social and friendly intercourse. The communication of knowledge has been carried out in an eminent degree by the machinery adopted for that purpose; and nothing farther was required to make it perfect. But in order that social and friendly intercourse might be rendered more available, Branch Associations have been established, as the Parent Society considered, and considered very justly, that the more such intercourse was promoted the greater would be, not the attainment of knowledge merely, but also the elevation of character and consequence of the medical practitioner in his own eyes as well as those of the public. That such intercourse cannot but produce these good effects, and has already produced them, I need only call to your recollection the last Anniversary of this Branch held at Ashford, which was attended by a considerable number 381 of medical men who, for the talent, and for the acquirement which they displayed, and also for gentlemanly conduct, would have done honour to, and have raised the character of, any class of persons how high soever their station might be. And when some of us are able to recollect the change which has taken place in the last thirty years, we may impute this highly gratifying manifestation of improvement, partly to the advancement of knowledge in society generally, partly to the obligation to observe a more severe course of preliminary study, and also to that social intercourse which medical such meetings as ours, this day, tend in an eminent men have enjoyed during that period, and which, degree to advance-for not only is the knowledge of all increased by the medical cases reported, and by the observations which they call forth, but also a stimulus association. But, gentlemen, the beneficial effects of is given to induce us to prove ourselves worthy of such these meetings do not stop at this point; I consider that a great moral good is effected. We are led by such these meetings, we should know nothing of; and, by intercouse to respect and esteem those whom, but for comparison, to think less well of ourselves. We leave these meetings wiser and better men. Medical Reform is at this time so engrossing a subject that it cannot entirely be lost sight of; and although I hope and trust that this meeting may not become the that we have cause to congratulate each other on the arena of political discussion, I would merely remark higher degree of estimation in which the medical profession is held by Parliament, and by the public, at this time than formerly. This is attributable to the advancement of medical men in all that adorns the scientific gentleman, and also, ín no small degree, to the good feeling which exists amongst them, of which the public soon become well aware-and the more conspicuous these qualities are rendered, the sooner will the Legislature do us all justice. Therefore let us go on in the course which we are this day pursuing, and let the meeting at Reigate not fall short of the high estimation in which the Ashford meeting is held. Let it be our constant endeavour to suppress all unworthy sentiments as respects each other, and to encourage every kind and friendly feeling, and let that be said of us which was said by the Pagans, of the early Christians, and which tended mainly to advance their views, "See how these Christians love one another." REPORT. The Committee of this Branch of the Provincial Medical and Surgical Association, beg to report as follows: Since our last Annual Meeting at Ashford, it was approved by an unanimous resolve of the great meeting of the Parent Association at Norwich, that the whole of the counties of Kent, Sussex, and Surrey, should be included in the South-Eastern District, as being of convenient form and size; with the probability that the Annual Meetings thereof would be so appointed, that every member residing in those counties might be enabled to attend them, without the necessity of very long journeys, or of being absent from home more than one entire day. This resolution of the Parent Association, grounded on one of our own adopted at the Ashford meeting, bas been communicated by the Secretary to every member residing in the three counties, not previously a member of the Branch; and some have, in accordance with it, expressed their wish to be considered as members of the Branch, but others have not done so, and it is of course entirely optional. of Camberwell, received the Jacksonian prize of the College of Surgeons, for an essay on the diseases of the great blood-vessels. This essay has now been expanded by Mr. Crisp into a volume, containing a most complete and trust worthy account of the state of our knowledge on this most important subject. The author has collected a very large number of facts respect Soon after the annual meeting at Ashford, that is to say, on the 15th of July, the Secretary wrote to almost all the offices of the highest eminence established for pur. poses of life-assurance, seventy-six in number, enclosing the diseases and the wounds of arteries and veins; ing copies of the resolution adopted at that meeting on the refusal of these offices to give any fee or remunera. tion for opinions and statements required of medical men respecting the health of their patients applying for life-assurance. To these applications your Secretary reports that he received not more than three or four answers, expres sing the readiness of those three or four offices to give fees in return for compliance with their requests. The others took no notice of his application. Since our last meeting three important contributions to medical literature have appeared from members of the South-Eastern Branch. and applying the numerical method to the analysis of these facts, he has arrived at several important and valuable deductions. In particular, it may be mentioned that in cases of external aneurism, Mr. Crisp considers a large amount of success may be expected from the careful application of pressure, when the situation of the disease admits of it, and that in cases of popliteal aneurism, and of aneurism at the bend of the elbow, pressure will in a majority of cases prevent the neces sity of an operation. If the responsibility of a provincial practitioner is great in the daily routine of practice, it is unusually so with reference to wounds of arteries. A thorough knowledge of the subject, as well as presence of mind to apply that knowledge, are indispensable; and the Committee strongly recommend the study of Mr. Crisp's work to those who desire to be prepared for more than the "ordinary emergencies" of practice. In reference to the Benevolent Fund attached to this Association, the Committee beg again to recommend it to the consideration of members; although perhaps no cases of destitute widows and orphans of medical men occur in this district, which are not sufficiently attended Mr. Hunt, of Herne Bay, has long devoted much attention to the difficult bat interesting subject of diseases of the skin; and he has given his views on the subject to the profession in a volume just published. Mr. Hunt considers a variety of chronic and intractable eruptions to be manifestations of one disease of the general system, and to be amenable to one general plan of treatment. Arsenic has been long known as the most powerful alterative applicable to skin diseases; but Mr. Hunt appears to have met with unusual success from its use in small and long-continued doses after a pre-to, numerous cases do occur in other parts of the paratory antiphlogistic treatment. Mr. Hunt's experience teaches that few cases of lepra, psoriasis, eczema, impetigo, and other chronic eruptions, fail to yield to a well-directed arsenical treatment. kingdom, well worthy, of the sympathy and pecuniary assistance of members. A small contribution from each member would be well and worthily applied. Your Committee would neglect an important duty if they did not allude to the subject of medical reform― a subject peculiarly interesting to us all, because, while the Profession continues in its present unsettled state, it is a source of perpetual discussion and vexation. It were greatly to be desired, that some legislative measure could be devised, which would allay and set at rest this uneasy state of the medical mind; so that we might apply ourselves exclusively to the science and the practice of our profession. But after mature consideration, your Committee are of opinion that this can never be accomplished until the general practitioners are incorporated by royal charter into a collegiate institution. That all attempts at medical legislation for the profession, as a whole, have failed, and will for ever fail, is the decided opinion of your Committee, until justice be rendered to the general practitioners, by conferring on them independent powers to regulate the education and qualification of candidates for membership in their own class. Then, and not until then, a general plan of reform may be arranged which would, or at least ought to give satisfaction to all sections of the profession, and which would be worthy of the sanction of Parliament, while a partial measure would be worse than useless. Any act which would virtually leave the government and qualifications of In the year 1844, our associate, Mr.. Edwards Crisp, the general practitioners in the power of the Colleges. Few subjects are more interesting and important to the medical practitioner than that of medical ethics; and it should more especially engage our attention at the present time, when the altered state of society, and the great advancement of education have in a greates measure removed the ancient land-marks of professional distinction, while legislators have hitherto failed in their endeavours to establish new ones. The Committee consider the "Akesios" of Dr. Mackness to be a valuable contribution to this branch of medical literature. It is not only required of the accomplished physician or surgeon that he should be able accurately to diagnose disease, and to direct the remedies for its cure; a right consideration of the "moral aspects of medical life" is of the utmost importance to his successful career, and to his general usefulness. We may say, with some complacency, that in the performance of its duties towards society, no profession shows fewer instan ces of failure than our own. It is in the internal intercourse of medical men that an improvement is most to be desired. The examples of the great men who are addressed in the elegant letters of Dr. Marx, will not be lost upon us. The important topics treated in the commentaries of Dr. Mackness, will receive attentive consideration; 1 and in the biographies of Cheyne, Gregory, Pinel, Lettsom, Desgennettes, and Boerhaave, every practitioner will find instructive lessons which should guide him in his conduct to his patients, to society, and to his medical brethren. BATH PATHOLOGICAL SOCIETY. That it appears to this meeting that Tunbridge Wells will be a convenient place for the general meeting in June, 1848; and therefore that the members of this Branch of the Association be invited to assemble at Tunbridge Wells on that occasion. That Mr. Hargraves, of Tunbridge Wells, be re quested to accept the office of President at the Tunbridge Wells meeting, and for the ensuing year. That Mr. West, of Tunbridge, and Dr. Mackness, of Hastings, be requested to accept the office of Vicepresident. That Mr. Martin, of Reigate, be requested to con. tinue in the offices of Secretary and Treasurer for another year. That Messrs. Thompson, of Westerham; Pickance, of Penshurst; Gorham, and Hitchings, of Tunbridge; Wallis, of Hartfield; Kelson, of Sevenoaks; Gream, Duncan, and Trustram, of Tunbridge Wells; and Starling, of Hadlow; do form the next committee of management. 383 made their appearance, threatening death by way of coma. At this time some blood was drawn, and on submitting the serum to evaporation, a powerful urinous odour was exhaled, and on the addition of nitric acid a copious crop of crystals of nitrate of urea was formed. The urine at this time was highly albuminous, and contained numerous fibrinous casts of the urinifer ous tubes. Some of these were shown by means of the microscope. The patient ultimately recovered; the albumen gradually diminished; pus-globules took the place of the fibrinous casts; and shortly thereafter the urine returned to its normal condition, and the patient to his wonted health. Dr. Budd remarked on this case as exemplifying an important form of complication, occurring in the course of continued fever,-viz., the non-elimination of the urea by the kidneys, and its accumulation in the blood, and stated his belief that the retained urea circulating in the blood is the probable cause of continued fever so frequently assuming the typhoid type, with the dangerous and often fatal nervous symptoms which accompany that form of fever. tubercular disease of the lungs; in the other two there was obstruction of the left side of the heart. In three of the cases there was no deposit of fat in any other organ; in two there was, both in the liver and in the lining membrane of the arteries. Microscopic speci mens were exhibited. & Dr. Budd then exhibited two kidneys in the advanced stage of granular degeneration, and stated that he had recently met with five cases of that disease, and in all That the best thanks of this meeting are due to the of them the secreting cells of the kidney were found officers and other members of the committee of manage.loaded with fat. In three of the five cases there was ment for the services which they have rendered to this Branch Association at and since the last meeting to the present time, and that they be requested to accept the grateful acknowledgments of the members present. The Secretary then submitted to the meeting the claims of the Benevolent Fund of the Association, as adverted to in the foregoing report, urging small contributions towards it. He also adverted to Mr. Daniell's "General Medical Annuity Fund," which, although it was not in immediate connection with the Association, was first propounded at the Sheffield meeting, and expressed as hope that Mr. Daniell's appeal will be responded to as it deserves, by the general approbation and adoption of this plan of insurance by members of the Association, many of the most influential members of which have already given Mr. Daniell's institution their cordial support, and aided its advancement by liberal donations, as well as annual subscriptions. [The papers read at the meeting will be given in a subsequent number of the Journal.] BATH PATHOLOGICAL SOCIETY. CASE XXII.-Severe gastric affection, with frequent vomiting; tumour in the umbilical or left hypochon driac region.-Dissection: Cancerous tumour attached to the lesser curvature of the stomach. Mr. Bartrum exhibited the stomach, with a cancerous tumour attached, and also the liver, of a woman, aged 76, and gave the following account of the case :-The patient when eighteen years of age, while in the West Indies, had an intense attack of jaundice, for which she came to England, since which time she has never had a similar attack, though often told that she laboured under an affection of the liver. She has had two attacks of partial paralysis. For at least five months previous to her death she had complained of peculiar pains about the unbilicus, with a sensation of weight and flatulence of the stomach after her meals, especially Fifth Meeting, February 1st, 1847. Mr. NORMAN in after dinner, when there was a sense of distension the Chair. CASE XXI.-Typhus fever; acute nephritis; accumulation of urea in the blood; comatose symptoms: Recovery. with suppressed eructation. A month before her death the severity of these symptoms much increased, and at uncertain periods a portion of partially-digested food was rejected, intensely acid, but presenting no Dr. Budd brought under the notice of the Society other peculiarity. For several days there might be some specimens illustrative of the pathology of albu. no vomiting, when it would again recur with unconminuria,—first, in the acute form. The subject of his trolable severity. These symptoms contiuued, with remarks was a young man who had laboured under little variation until death. The bowels, though always typhus fever, marked by the miliary eruptions. In the requiring aperients, were easily acted upon throughout course of the disease symptoms of acute nephritis were the illness, if she were sitting up. On examining the set up, and soon afterwards formidable nervous symptoms abdomen, there was felt in the umbilical or left |