GENERAL RETROSPECT. the part of the head on which he fell, and also entertained the delusion that these pains were caused by his mother beating him. Otherwise, his intellectual faculties were sound. Various symptoms of disease of the moral principle were present. He was morose, taciturn, and insolent. He entertained an ungrounded dislike to his relations, and was subject to violent fits of passion. After being some time in the asylum, his delusion gave way, and the intellectual powers of his mind became sound; his conduct, however, continued ungovernable, and his language abusive, while kind words made no impression on his wayward temper. He still complained of pains in the injured part. On examining the head, I discovered a very distinct depression on the posterior superior margin of the right parietal bone, the situation to which he referred the pains. In consultation with my colleague, Mr. Furness, of Percy Street, Newcastle, consulting surgeon to the Institution, it was decided that the depressed portion of skull be removed by the trephine. On the 3rd of January, 1846, the operation was skilfully performed by Mr. Furness. The patient bore it well and the wound healed without a bad symptom. The portion of the cranium removed was healthy in appearance on both of its surfaces. It adhered very firmly to the dura mater, requiring considerable force for its removal. It was altered considerably in form, appearing to have been indented, rather than fractured, which is not improbable, seeing the accident occurred to the patient when only thirteen years of age. By the 1st of February his conduct was, and had been, since the operation, in every way improved. He had had no bursts of passion; answered civilly when spoken to, and was grateful for the relief afforded him. He looked forward with pleasure to his return home, which was promised to take place as soon as the weather improved. He had for the last fortnight been working on the farm, and stated that since the operation, he had been free from pain in the head, from which he formerly suffered. On the 20th of March he was discharged "cured," having, since the performance of the operation, shewn no symptom of his previous malady. MIDWIFERY. LESIONS OF THE NERVOUS SYSTEM, &c., IN THE PUERPERAL STATE, CONNECTED WITH ALBUMINURIA. Dr. Simpson has related some cases illustrative of the effects of Bright's disease, as denoted by the appearance of albumen in the urine under the action of heat and nitric acid. He draws the following conclusions: 1. Albuminuria, when present during the last periods of pregnancy and labour, denotes a great and marked tendency to puerperal convulsions. 669 3. Edema of the face and hands, going on occasionally to general anasarca, is one of the most frequent results of albuminuria in the pregnant female. 4. The presence of this cedema, or of any of the lesions of the nervous system, with or without the edema, should always make us suspect albuminuria ; and if our suspicions are verified by the state of the urine, we should diligently guard, by antiphlogistic means, &c., against the supervention of puerperal convulsions. 5. Albuminuria and its effects are far more common in first than in later labours, and these constitute a disease which in general disappears entirely after delivery; but Dr. Simpson has seen one case commencing with slight blindness, but no œdema, and ending gradually in hemiplegia, where the palsy par tially remained after delivery, and after the disappearance of the albuminuria. In another patient amaurosiscame on with delivery, and had been present for six months when Dr. Simpson first saw her. There was no cedema or other symptom of albuminuria except the amaurosis; but, on testing the urine, it was highly albuminous. 6. Albuminuria, with convulsions, &c., occurring in any labour later than the first, generally results from fixed granular disease of the kidney, and does not disappear after delivery. 7. In puerperal convulsions, &c., produced by albuminuria, the immediate pathological cause of the nervous lesion is perhaps some unascertained but poisoned state of the blood. Is there a morbid quantity of urea in the blood! In several specimens of the blood of patients suffering under severe puerperal convulsions, furnished by Dr. Simpson to Dr. Christison and Dr. Douglas Maclagan, these gentlemen had been unable to detect any traces of urea. Is the poisoning material caseine in morbid quantity or quality? The dependence shown by Gluge and others of albuminuria upon stearosis of the kidney, makes this connection worthy perhaps of some inquiry. 8. In cases of severe puerperal convulsions, &c., from albuminuria, the renal secretion is in general greatly diminished, and Dr. Simpson has found active diuretics apparently of great use along with or after venesection, antimony, &c., especially where the case was offering to become prolonged. 9. Sometimes hemiplegia supervenes during preg nancy without albuminuria, but this form does not seem to interfere materially, or very dangerously, either with the pregnancy or labour-the disease running its own usual course. In one case Dr. Simpson has seen the patient gradually but imperfectly recover the use of the palsied arm after delivery. In another no improvement occurred.-Transact. of Edin. Obstetric Society. PUERPERAL CONVULSIONS CONNECTED WITH INFLAM MATION OF THE KIDNEY. 2. Albuminuria, in the pregnant and puerperal state, sometimes gives rise to other and more anomalous derangements of the nervous system, without proceeding to convulsions, and Dr. Simpson has especially Dr. Simpson has pointed out the connection of observed states of local paralysis and neuralgia in the puerperal convulsions with derangement of the kidney, extremities, functional lesions of sight (amaurosis, &c.,) as a very striking fact in obstetric pathology. He has and hearing, hemiplegia and paraplegia more or less seen post-mortem appearances of nephritis in some fatal cases of convulsions, fully developed. of severe headache when the convulsions supervened. Dr. Niven promptly and easily delivered the child, which was dead, by turuing. The convulsions gradually subsided, but re-appeared several times. In the intervals she was profoundly comatose; and, in this state she died about forty hours after the first attack. Post-mortem appearances.-When the lateral ventricle of the right side was opened, fluid blood escaped. The corpus striatum and outer part of the optic thalamus were broken up, and mixed with a large quantity of coagulated blood, forming a clot of large size. The fluid blood was found in the opposite lateral ventricle, and also in the third and fourth ventricles. The right kidney was converted into numerous cysts, of about the size of a walnut, containing unhealthy pus, which passed along the ureter and filled the bladder. The left kidney exhibited an advanced stage of Bright's disease, CASE I. In this case, the patient, a delicate female, | (as her friends suppose,) of a person from whom she was exhausted by the pains of labour, and complaining had received the most marked attention, and to whom she had been attached prior to her marriage with her late husband. When Dr. David saw her, about three hours after she had taken the vinegar, she was in bed, covered with a cold perspiration, and trembling from head to foot, and apparently alarmed at everybody, and everything about her. Her breathing was very laborious and hurried; her countenance perfectly wild, and the pupils dilated; the tongue was dry and cold, pulse 96, and fall; the abdomen much distended, with extremely acute pain at the scrobiculus cordis, so much so that the slighest pressure there caused her to shriek out. She did not know any one about her, not even her own children, nor had she any recollection of anything that had happened from the time of taking the vinegar, which was about eleven at night, not even of her having gone to bed, which she was the last in the house to do. At one, the inmates were all awakened by her shrieking for cold water, of which she had drunk an enormous quantity before Dr. David was called to see her. There was not any pain, heat, nor constriction of the throat or fauces, but there were slight efforts to vomit. Having procured some sulphate of zinc, he gave her two scruples in a cup of water, which soon produced full vomiting, with great straining. He had then to leave her, but ordered full and repeated doses of carbonate of magnesia till he could see her again, which he did about six hours after, and found her much relieved, and only complaining of headache, which left her after the operation of a dose of castor oil. Two days after she was taken ill with a slight attack of continued fever, but is doing well. CASE II.- Dr. Simpson lately saw, with Dr. Carmichael, a lady, who had so perfectly recovered after a labour which was quite uatural, as to have been out at church, &c. Seven weeks, however, after delivery, after some sudden anomalous affections of sight and hearing for thirty or forty hours previously, she was seized with the most severe convulsions. Despite free evacuations, &c., they continued to recur from time to time, and proved fatal in three hours; the patient during that time never being perfectly sensible. The pelvis of each kidney was filled with a whitish purulent-like matter, and its mucous lining membrane coated with large patches of adherent coagulable lymph, or false membrane. The ventricles of the brain were distended with serous fluid. The urine, when tested, presented no sign of albumen. Dr. David mentions that the quantity she threw up from the effects of the zinc was very great, and smelt strongly of vinegar, which she still perseveres in saying CASE III. In a third case, one fit of convulsions she did not take, although she was seen with the bowl came on a month before delivery, and recurred again filled with it in her hands by some of the family, when in a severe and fatal form fourteen days after confine. they were retiring to rest, she maintaining that she ment. During the intervening six weeks the patient used the whole of the vinegar in bathing her head. was free from any symptoms, and the labour was natural. However, Dr. David thinks we have strong presumptive The last attack came on suddenly in the evening, about evidence against her having so used it, and are nine o'clock; the convulsions were again and again justified in concluding that she took the whole of it. repeated, and she died comatose in eight hours. Dr. The only case of poisoning by acetic acid that the Maclagan, Dr. Handyside, and Dr. Simpson, examined author has been able to find is the one related by the urine during this last attack, but found in it no Orfila in the Annales d' Hygiene, and quoted by both traces of albumen. On inspecting the body, some Beck and Christison: The experiments instituted by whitish turbid fluid was found in the renal pelvis, and Orfila prove that common vinegar in large quantities was could be pressed out abundantly from the renal papillæ. found destructive to dogs when vomiting was prevented. It looked like pus. On microscopic examination, it Taylor, in his work on "Medical Jurisprudence," seemed to contain merely a very large quantity of says " Acetic, citric, and tartaric acids are not comepithelial cells, and no pus-globules. Was this inflam-monly considered to have any poisonous action on the matory? There was no effused fibrin or coagulable lymph. MEDICAL JURISPRUDENCE. POISONING BY VINEGAR. Dr. David, of Montreal, narrates the case of a widow woman, with four children, who took, as near as he could ascertain, a quart-bowlful of common vinegar. It appears she had been dull and low spirited for two or three days previously, in consequence of the neglect body, at least as far as I know, there is no case reported of them having acted injuriously on the human subject,”. and he is the only modern writer on medical jurisprudence who takes any notice or makes mention of the acetic acid.-British American Journal. MEDICAL INTELLIGENCE. CEREBRAL DISEASES OF CHILDREN. TO THE EDITOR OF THE PROVINCIAL MEDICAL AND SURGICAL JOURNAL. SIR, Mr. Salter has, I think you will find, made a mistake in his paper upon the "Cerebral Diseases of Children," in a late number, when he refers to the celebrated induction of Louis, which Mr. Salter states to be," that if tubercles be found in the brain, they are sure to be met with in other organs, especially the lungs," Now, it is quite true that Louis considered tubercles of the brain and grey semi-transparent granulations of the pia mater as morbid changes proper to phthisis; but I am not aware he ever drew the deduction, that "tubercles being found in the brain, they are sure to be met with in other organs, especially the lungs." What I have always understood as the great deduction of Louis, is the general law, stated in the summary to his Pathology of Phthisis, p. 153, of the translated edition, published by the Sydenham Society, "That after the age of fifteen, tubercles do not present them selves in any organ without being likewise seated in the lungs." It is necessary that we should be very careful in correctly stating the deductions of a man like Louis, and therefore I venture to call Mr. Salter's attention to it. Mr. Salter will also, I think, find that the quickening of the slow pulse of hydrocephalus acutus by the slightest exertion, is a fact well known to systematic writers. I refer him more especially to the "Cyclopaedia of Practical Medicine," and to Watson's Lectures. Your obedient servant, C. R. BREE. EFFECTS OF CHLOROFORM. TO THE EDITOR OF THE PROVINCIAL MEDICAL AND SURGICAL JOURNAL. SIR, I yesterday had an opportunity of trying the effects of chloroform on a boy, seven years old, who had met with severe injury to the ancle-joint. A small piece of sponge was dipped in the liquid and applied to the nostrils, and in about two minutes he sank into apparently a sound sleep, the lips and countenance retaining their usual colour. I then amputated the leg below the knee, assisted by Mr. Gibbon, and Mr. James Roughton, the boy remaining quite unconscions until all was finished; he was then placed in bed, passed a good night, and up to the present time he has had no unfavourable symptom. I am Sir, your obedient servant, Kettering, November 28th, 1817. MEDICAL REFORM. TO THE EDITOR OF THE PROVINCIAL MEDICAL AND SURGICAL JOURNAL. SIR, The most, I take it, to be complained of in the recent Charter of the College of Surgeons, is its retrospective effect,—that is, if the name or distinction of « Fellow" | 671 gives any material advantage to its possessor, seeing that all the members before the granting of the Charter (exclusive of the Council,) were de jure equal. The Fellowship confers no legal or positive advantage on those who have been some years in practice, neither is the possession of it in one likely to injure another, who does not hold it, but who has acquired a welldeserved confidence in his professional character. I believe that much good will ensue from what will be required of those who, from motives of laudable ambition, seek for the Fellowship; and I contend, that so far, the Council is to be commended for its onward movement. The public is becoming daily more acquainted with these distinctive tests of qualification, and I am of opinion the more that is required as a proof of fitness, the higher will be the estimation of the public towards those who have undergone the superior ordeal. Here then, I hold, that it is altogether illiberal and impolitic, to frustrate or hinder the changes of every succeeding age, so long as justice and fair dealing is kept in view by the authorities which promote them. To my mind " it seems strange, passing strange," in the general question of Medical Reform, that the great interests of the medical profession, as a body, should be so utterly thrown aside and uncared for; that, as a profession, it should neither be legislated for, or its position at all a matter of public concern, because forsooth, of sections and divisions amongst its own members, whose jealousy is roused as soon as any general scheme does not comprehend or provide for their particular cases. Mr. Garlick may use his statistics, and Mr. Daniell may continue to declaim in his own energetic perorations; but if medical practitioners do not observe towards each other that consideration and forbearance which, as professional men, they ought to do, it is frivolous,-nay, more, it is useless, to complain of guardians, commissioners, or others. 'Quæque ipse miserrima vidi." The lawyers and the clergy do these things, better and it behoves the men of physic to pursue a widely different course than they have hitherto done, in order to obtain a security and a safeguard for their real and permanent benefit. How common is the remark amongst medical men that theirs is an ill-used profession! It is notorious that we are not only the servants, but even the slaves,' of the publie; and we find injustice perpetrated against us in such a diversity of ways as to find no parallel in any other profession or calling. Your readers have been often gratified at the stand which you have frequently made against injustice and oppression on the part of coroner's juries, guardians of the poor, and the public. It appears to the writer that this is a very fitting opportunity for a full and searching investigation into all the causes and attendant circumstances of a state of things which all deplore, and from which we should rejoice to be delivered. Our interests loudly call for inquiry, and the honour of our profession demands it. It was with no inconsiderable degree of pleasure that a month or two ago we observed a letter signed "Scrutator" bearing upon this question, and an able, bat not conclusive leading article, about the same time. Since then, however, the subject has been suffered to die away until your last number appeared, containing a "Report of a Meeting of Poor-Law Union Officers." It is to be hoped that this will prove a fresh occasion for you to buckle on your armour afresh, and to stand forth in all the strength of a righteous cause, as the champion of the oppressed. Before I conclude, allow me respectfully to suggest the following query :-" How far is the profession itself to blame for the low and degraded position in which its members too often find themselves placed? I am, Sir, Your obedient servant, PREMIUM. Manchester, November 8, 1847. Medical Entelligence. PROGRESS OF THE CHOLERA. The cholera is stated to have reached St. Petersburg and Cronstadt, and has also appeared, but in a very mild form, at Dunaburg, about forty miles from the frontier of Prussia. APPOINTMENTS. Thomas Shapter, Esq., M.D., has been elected Physician to the Devon and Exeter Hospital, in the room of Dr. Blackall, resigned. George Johnson, Esq., M.D., Medical Tutor of King's College, London, has been appointed Assistant Physician to King's College Hospital. Edward Cock, Esq., has been appointed one of the Surgeons of Guy's Hospital, in the room of Mr. John Morgan, deceased. Sir Henry Marsh, Bart., late President of the College of Physicians in Ireland, has been appointed to the Irish Board of Health, to succeed Sir Robert Kane, who has resigned. ROYAL COLLEGE OF SURGEONS. Gentlemen admitted Members on Friday, November 19th:-J. P. Teebay; W. Pearce; G. R. Pemberton; W. Fincham; J. W. Elliott; W. J. Edwards; G. Raper; J. Urquhart; J. F. Uniacke; G. H. King; N. D. S. Wallich; T. Green. Gentlemen admitted Members on Friday, November 26th:-R. Dowell; H. W. H. Richardson; M. T. Mason; T. H. Mitchell; J. Marshall; E. Stride; G.T. Banks; J. Robinson; T. Smith, E SOCIETY OF APOTHECARIES. Gentlemen admitted Licentiates, Thursday, November 11th, 1847:-Walter Thompson, London; William Braithwaite, Plymouth; William Pearce, Bingley, Yorkshire; Thomas Watson, Bristol; Charles Pratt ; John Braxtor Hicks, Lymington; Stewart Blackér Roberts; John Glendarvnie Winstone, London; Benjamin French, Neath; James Lardner Green, Holywell. Thursday, November 18th: :- Robert Walmisley Baxter, Bromley, Kent; Benjamin Kealley, Westminster; John Beecroft, Ely; Robert Alexander Wm. Westley, Bombay. OBITUARY, Died, November 10th, at Ardee, Felix M'Donnell, Esq., M.D. November 11th, aged 52, at Berlin, of apoplexy, John Frederick Dieffenbach. This celebrated surgeon was born at Konigsburg, in the year 1795, and was originally a student of theology. He entered the medical profession after having served as a volunteer during the war in 1814 and 1815, and became a pupil of Dupuytren, at the Hotel Dieu, Paris, in the year 1822. November 14th, at Dundalk, of fever, Lawrence Martin, Esq., M.D. November 15th, aged 75, Joseph Toulmin, Esq., M.R.C.S., of Hackney. BOOKS RECEIVED. On Indigestion: its Pathology and Treatment, by the Local Application of Uniform and Continuous Heat and Moisture. By James Arnott, M.D., Physician to the Brighton Dispensary. London: Churchill 1847. 8vo. pp. 107. An Essay on the Diseases of the Jaws, and their Treatment. By Leonard Koecker, Surgeon-Dentist, &c. &c. New Edition. By J. B. Mitchell, M.D., Surgeon-Dentist. London: Churchill. 1817. 8vo. pp. 94. Inaugural Address of the Pharmaceutical Institution. By Samuel Wright, M.D., F.R.S.S.A., Professor of Clinical Medicine in Queen's College; Physician to the Queen's Hospital, &c. Birmingham: 1847. pp. 14. The Calendar of the Queen's College, Birmingham. 1848. Edited by the Dean of the Faculty. Birmingham. Tonks. 1848. pp. 110. TO CORRESPONDENTS. Communications have been received from Dr. J. Y. Simpson; Mr. C. R. Bree; Mr. C. J. Thicke; Mr. Bottomley; Dr. Oke; E. L.; the Sheffield Medical Society; Mr. Crompton. The important paper on "Hernia," by "a Retired Surgeon of the Irish College," has been unavoidably delayed, but will appear in the next number. Mr. Crompton's communication was received too late for insertion in the present number. PROVINCIAL MEDICAL & SURGICAL JOURNAL. MEMOIR ON TURNING, AS AN ALTERNATIVE By J. Y. SIMPSON, M.D., F.R.S.E., &c. &c. PART I. SECT. I.-ILLUSTRATIVE CASE, AND INTRODUCTORY At a meeting of the Cbstetric Society, of Edinburgh, held on the 20th of January, 1847, I had an opportunity of shewing to the members a large infant, extracted on the preceding evening by the operation of turning, through a pelvis, the brim of which was greatly contracted. The following particulars were at the same time stated regarding the history of the case. the membranes still entire; and the head, which was (the labour had commenced in the forenoon,) to make the distorted brim was a more difficult task. After CASE I.-The mother was very lame, with the lumbar vertebræ much distorted, and had been twice pregnant. Her first labour had been extremely protracted, in consequence of the promontory of the sacrum pro-respiration could not be established. Its head was jecting forwards and downwards, so as to diminish much the conjugate diameter of the brim. After being several days in labour, symptoms requiring interference supervened, and Mr. Figg, her medical attendant, availed himself of the able advice of my friends, Drs. Malcolm and Marr. These gentlemen considered it proper to ascertain whether the child might not be capable of being delivered, without the dire necessity of embryulcio. After a long and cautious trial, how ever, of the long forceps, they found it impossible to advance the head with them, and were at last driven to have recourse to craniotomy. Even after the cranium was perforated, and freely broken down, it was found a matter of much time and difficulty to drag with the crotchet the collapsed head of the fætus through the distorted brim, and the patient made a very long and protracted convalescence. She was earnestly advised to have premature labour induced, provided she again fell in the family-way; but Mr. Figg was not made aware of her state till she was near the end of the ninth month of her second pregnancy, and when it was too late to justify interference. Parturition supervened in a few days. I saw her with him in the afternoon of the 19th of January, a few hours after the first labour-pains had commenced. The os uteri was tolerably well dilated, No, 25, December 14, 1847. compressed laterally, the left parietal region flattened, The preceding case was, at the time of its occur- B2 |