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to the council of the Provisc1 AL MEDICAL AND SU it GICAL ASSOCIATION. Gentlemen,-The Committee appointed at the Annual Meeting of the Provincial Medical and Surgical Association, held at Norwich, in August last, for the purpose of enquiring “whether any and what alteration is required or desirable in the General Publications of the Association,” having devoted considerable attention to the subject, and obtained the opinions of many influential members of the Association, think it proper to make a Report to you, founded upon the information so obtained, in order that if deemed advisable, the alterations they are desirous of suggesting may come into force, with the commencement of a new volume in 1847. Your Committee, deeply sensible of the importance of the duties entrusted to them, and the essential influence which the decision at which they may arrive must have upon the interests of the Association, have divided the object of their enquiries into two parts. I. As to the propriety of making any change in the form and period of publication of the Journal and Transactions. II. As to the best means of giving the highest possible character to the literature of the Association. To the first question, upon which your Committee have obtained considerable information, representing the opinions of a large portion of the members of the Association,” they will confine themselves upon the present occasion, reserving the second question for farther deliberation * Each correspondent with the Committee is considered
to have obtained and expressed not only his own, but the opinion of the Associates in his neighbourhood,
No. 1, January 13, 1847,
and a second Report on or before the Annual Meeting to be held at Derby, in 1847. In commencing their remarks, your Committee are desirous of expressing in the strongest terms the high opinion they entertain of the able manner in which the present Editor of the Provincial Medical and Surgical Journal has performed the duties entrusted him. They wish it expressly to be understood that if any fault is to be found with that publication, they consider it arises from the paucity of materials at his command, and the necessary limit of space and matter which the funds of even so large an Association, must enforce in the present form of the Journal, and your Committee feel that they are only acting with bare justice to Dr. Streeten, in stating that he has placed the Association under considerable obligation; not only by the ability which he has displayed, but for the gentlemanly tone and highly honourable feeling which he has at all times evinced as Editor of the Society's Publications.
That some alteration, however, is absolutely necessary in the arrangement of the Society's Publications, the opinion of the members who have communicated with the Secretary to your Committee has been unanimously in the affirmative. As might have been expected among so large a body, some difference of opinion exists as to the best method of effecting that change. An analysis of the letters received by the Secretary, shews the following result:— To discontinue the Journal ... ... ... 2 To publish the Journal weekly ... ... ... 3 To publish the Journal fortnightly, double its present size, with an annual supplement 13
To publish the Journal monthly ... ... 3 To establish a Quarterly Journal in lieu of
the present publications “. . . . ... 2
Total . . . . . . 25
Of the above number, twenty expressed a desire
that the “Transactions” should be discontinued
as an annual volume;—two that they should be
continued as at present ; and one gentleman * A
advised the discontinuance of the Journal, and the publication of a volume of “Transactions,” as at present.
Upon the opinions expressed and the various proposals made by the above gentlemen your Committee would remark:— I. It is quite impossible to throw any additional force into the Publications of the Society, if the present arrangements continue, because the expenses already incurred, are fully as large as the funds of the Society will admit. In any alteration, a saving of expense must be held in view, to enable the Council to expend the money or a portion of the sum so saved, in obtaining Reports, Essays, Extracts from Foreign Journals, and Papers upon various subjects connected with Medical Science, for insertion in the new publications of the Society. II. A discontinuance of the Journal would, in the opinion of your Committee, be a most unwise proceeding, and highly prejudicial to the interests of the Society, comprising as it does so large a proportion of Provincial Practitioners in Medicine and Surgery, whose means of obtaining practical information is very great, and whose ability to make that information available to the general body of subscribers is undoubted ; your Committee consider, that the Society should not only publish a Journal, but that it should hold a position not inferior to any other similar publication in the United Kingdom. HII. In considering the form of the Society's Publications, it is important to bear in mind the facilities of transmission through the Post to the most remote rural districts. A Monthly or Quarterly Journal, however, in many respects desirable, could only be issued either through local Secretaries or London booksellers, to both of which means there are the objections of additional expense and much trouble to those gentlemen who already devote considerable time to the affairs of the different Branches of the Association, and it would be impossible by either plan to ensure that regularity in delivery, which is so important a feature in periodical literature. IV. All of the above objections would be obviated by publishing the Journal double its present size once a fortnight, and transmitting it as at present, through the Post. By this change #200 a year would be saved in stamps alone. With regard to the “Transactions,” your Committee are fully sensible of the many valuable papers already published in them by the Society, but they consider that the necessity of their publication is very much lessened by the probability of a discontinuance of the Retrospective Addresses, in consequence of this division of
medical literature being now occupied by the
At a meeting of the Central Council held on Friday, December the 18th, 1846, the Report of the Committee appointed at Norwich, to consider the publications of the Association, and several letters forwarded with the Report by Mr. Bree, the Secretary to the Committee, were laid before the Council.
The Council having taken the foregoing
LECTURE ON CLINICAL MEDICINE. 3
Report and documents accompanying it into consideration, think it right immediately to adopt the recommendations of the Committee, and begin the publication of the Journal fortnightly, at the commencement of the year 1847. The Council also fully concur in the propriety of the recommendation of the Committee, that a Sub-Editor be appointed, but think it most respectful to the Association to leave that appointment to be filled up at the General Meeting at Derby, having full confidence that the Editor of the Journal will in the mean time make such arrangements for its improvement as circumstances seem to call for.
CHARLES HASTINGS, M.D.
(Published by order of the Council.)
A COURSE OF LECTURES ON CLINICAL MEDICINE.
By W. R. B.Ash AM, M.D., Physician to the Westminster
Case of Apoplery complicated with fracture of the temporal bone: Post-mortem appearances; apoplect c clot; ramollissement; ertravasation of blood between the pia mater and arachnoid, &c.; emphysematous condition of the lungs; encysted carbonaceous deposit in right lung ; spurious melanosis of some authors.Otserrations on the coincidence of fracture of the temporal bone, and its importance in a medico-legal point of view.—Chemical characters of the carbonaceous deposit in the lungs ; distinction between black pulmonary matter and true melanosis ; reference to previously-reported cases ; deposit prolably occasioned by an impure and loaded atmosphere, principally in miners and others similarly employed. Case of anomalous cerebral symptoms occasioned by ulceration of the ileum and capcwm : Post-mortem report.—Character of the symptoms during life, with general observations on the peculiarity of the cerebral indications in enteric disease. The case of S. G., an old man seventy-five years of age, who was brought into the Hospital comatose, and who died a few hours afterwards, is, in respect of the post-mortem appearances, of some interest to the student in pathological anatomy. He was admitted into the Hospital on the evening of the 31st of October, and when brought in was quite insensible, breathing stertorously; pulse 40, full, labouring and jerking ; limbs flaccid and powerless; extremities cold; temperature of the surface low; face pallid and cadaveric; pupils dilated and immovable. He was seen by a policeman to stagger and fall heavily on Westminster Bridge. He was raised up quite insensible by the policeman, and brought to the Hospital on a stretcher. Some blood was taken from his arm, and by midnight his pulse had risen to 72, but he did not rally, and died at three a.m, eight hours after the first seizure. It was subsequently ascertained from his
wife, that for the last few weeks he had suffered from vertigo, frequent sensations of giddiness, and a constant dread in the street of being run over; such feelings doubtless arising from the confusion of thought incidental to the state of brain then existing. He, however, had never complained of headache, nor any partial loss of sensation in any part; but had, for many autumns and winters been subject to severe paroxysms of cough, such as occur in asthmatics. He was an old soldier, having been for many years in the Sappers and Miners, and had enjoyed excellent health, his winter cough never preventing his attention to his ordinary avocations.
Post-mortem examination thirty hours after death.Body well formed, limbs proportioned, and muscular system highly developed. An extensive ecchymosis appeared on the scalp, about the posterior portion of the left temporal muscle; there was no external injury of the skin. On reflecting the scalp, the ex-. travasation of blood between the calvarium and scalp was rendered more evident, a layer of coagulated blood being observed between the scalp and bone. No sanguinolent effusion existed between the skullcap and dura mater, but beneath the latter membrane and the brain, especially on the left side, and extending over the superior surface of the left hemisphere, an extensive coagulated exudation existed. The arachnoid was of the ordinary aspect; beneath it, as well as in the ventricles, some small amount of serous cadaveric exosmosis was apparent. The pia mater was throughout injected, but not highly so, but towards the lower portion of the middle lobe of the left hemisphere, and near the fissure of Sylvius, some blood had extravasated between the pia mater and arachnoid; and at the most inserior portion of the middle lobe, at the point corresponding with the part that lies in the left temporal fossa, the cerebral surface was stained of a chocolate brown, was soft and pulpy to the touch, and when incised developed a small clot of blood, surrounded by softened and yellowish cerebral matter, to the extent of about the eighth of an inch. The vessels of the cerebrum that led from or into this clot, and within a few lines of it, contained coagulated fibrin, distinctly moulded in the vessels, and from which it could be drawn thread-like. No other evidence of diseased action could be traced in the cerebrum or cerebellum, excepting a general hyperaemia of all the tissues. The white matter of the cerebrum appeared of its ordinary firmness, and did not indicate any condition approaching ramollissement except in the spot indicated in the middle lobe. The temporal bone of the left side was fractured, the line of injury passing in the direction of the petrous portion of the bone, and running between the groove of the middle meningeal artery and the superior ridge of the petrous process of the bone, it passed through the squamous portion and upwards a short distance into the parietal bone, of the Externally, the fracture had not descended so far as the auditory meatus, nor internally could it be traced to the anterior extremity of the petrous portion of the bone. Some blood was extravasated between the fractured edges. On raising the sternum