more "hole and corner" doings
TRANSCRIPT
No.8.] LONDON, SATURDAY, MAY 28, 1825.
MORE "HOLE AND CORNER"
DOINGS.
THE public will recollect that Mr.Abernethy, in December last, ap-
plied to the Court of Chancery for
an Injunction to restrain the pub-lication of his lectures in this work.
The Lord Chancellor very property,as we conceive, refused the appli-cation, but, at the same time, po-!ittty invited Mr. Abernethy to appearthere again, not exactly as a " blue
pill," but in a somewhat different
form-in the shape of an "implied con-tract." Mr. A. does not take his lord.
ship’s kind advice—suffers January,February, March, and April to passaway, and we hear nothing of him.
During the months just mentioned we
regularly continued the publication ofMr. A.’s lectures, and in the first weekof April presented our readers withthe last of them, and, of course, wereled to believe, that the" Chancerymixture" and "blue pill" did not wellassimilate, that Mr. Abernethy wouldnot again try a remedy which hadbeen attended with such disagreeableeffects ; we concluded then that wehad quite done with Mr. Abernethyand his Chancery suit—events provedthat we were wrong, and unfortunate-ly it is not the first time we have
keen deceived in our forebodings.
Comical as we know Mr. Abernethyto be, we did not expect, after
we had concluded the publication of
his lectures, after we had presentedthe last of them to the world, that
he would call upon the Chancellor
to prevent our doing that which had
actually been done several weeks pre-vionsly ; but it appears that Mr. Aber-
nethy’s notion of law is, that it canalter the past as well as the future.He may possibly have’vanity enough
to suppose that we shall repnint his.
lectures. On this point his mind maybe perfectly at ease ; our pages havebeen already obscured with his hypa-thetical nonsense during six tediousmonths, and when we read the proofof the last paragraph we felt relieved,as we formerly stated, of a most in-tolerable incubus.
This renewed attack is one of aseries of legal proceedings which the"Hole and Corner" people long agoresolved upon instituting against THELANCET, with a view of deterring usfrom discharging our public duty, andwith a view of subduing that exultingtone of independence in which wehave proclaimed to the world their
abominable malpractices. We havehitherto smiled at their impotent ef-
forts, and smile at them till ; for
really their imbecility renders themthe most ludicrous of opponents. Wesometime since alluded to a meeting
f
226
of certain of the lecturers and hospitalsurgeons,held for the purpose of adopt-ing such measures as should have theeffect of putting down The Lancet.Our information on this subject was
exceedingly loose until Wednesdaylast, when, having heard it whisperedthat one or more of those meetingshad been held at the Freemasons’
Tavern, it struck us that we might,by a little manoeuvre, get possessionof the secret; knowing how ferventlythe " Hole and Corner" people wor-
ship the molten god, we consideredit extremely probable, (as they hadmet on such a disastrous subject,) thatthey had forgotten to pay their bill.
Now, as the meeting was held on ouraccount, we thought it but right thatwe should go to the landlord of the
tavern-ask how matters stood, and, if
unpaid, offer to settle the account.It is not a little extraordinary that
our conjecture was realised. We in.formed Mr. Cuff’s clerk, without anypreliminary observation, that we hadcalled to pay the expences of a Meet-ing of Medical Gentlemen, friends ofMr. Abernethy, which had been heldthere in December last—" Oh yes,
sir, said he, I recollect, one Saturdaynight in that room."- Pointing to
a room at the bottom of the stairs;a low situation, calculated for low
company and low deeds.)—" Theaccount is not settled, we believe?"41 No, it is not." " If you will get itdrawn out, as we see you are busy now,we will call and pay it in the morn
ing." The following morning we werepunctual; obtained the bill, paid it,and presented the waiters with 2s. 6d.,for they had been forgotten too. One
of the gentlemen was so affected thaihe was compelled to have a coach tctake him away. The landlord paidthe coachman, which was also forgot-ten. This Tavern account of a Meet-
ing of Gentlemen is really so rare-so choice a morsel, that we must present our readers with a faithful tran
script of it :-
Mr. STANLEY,To J. J. Cuff,
1824. £. s. d.Dec. 27. To room....,....... 15 0
Paid for coach...... 1 0
16 0Waiters........ 2 6
May 25. -
Reed for J. J. Cuff, 18 6T. Hoggray.
Here was a jovial meeting! Look atthe charges for refreshments! Nota
solitary glass of Burgundy or of Mr.Cuff’s fine old Port. The only thinginquired for was a preserved peachby Mr. Travers, but when that gentle.man had made the lateral incision
and found that it was stoneless, he te-
jected it with apparent nausea; how-ever upon its being represented tohim, shortly afterwards, that one of thewaiters had discovered the stone in
an old musk box, he became some.what better, and soon after left the
room. Mr. Cuff, we should suppose,from the appearance of this bill, can-not wish to have another Medical tMeeting. It was a " Hole and Cor.
ner" proceeding to the very letter,for it appears, by the bill, that al. ;
though it took place at the latter endof December there was neither firenor candle. -
, Mr. Green, we understood, orderedthe room, but who attended besides
227
that gentleman, Stanley, Travers,Brodie, and Vincent, we cannot say.Mr. Stanley, we expect, will thank usfor discharging this funny little bill,and we have no doubt he -will feelparticularly grateful to us for haynrggiven it this publicity, more especiallyas the cause for which it was incurred
is one which does him and his co-
adjutors so much hononr. We ought111 have stated, that this meeting wasconvened by letter, addressed to
nearly all the Hospital Surgeons andLecturers.
Who can now doubt that we have
been the objects of a conspiracy, andthat these repeated law proceedingsare systematic attacks, which it is
hoped, (vainly enough, God knows,)will ultimately conquer us ? The Lec-turers are loud in their complaintsagainst us, upon the ground that theirlectures are a valuable property to
them, and that it is not fair to publishthem to the world. How can a
man of .sterling talent make such
a complaint as this ? Did Sir AstleyCooper do so ? Will the present Sur-
geons of Guy’s Hospital do so ? Will
a man possessing the professionalknowledge of Mr. Lawrence utter sucha senseless cry as this ? Never. And
we cannot but express our astonish-
ment that such a man as Dr. Arm-
strong should have offered any objec-tion to the publication of his lecturesthrough the medium of the periodicalpress. Dr. A.’s objection was on the
ground of the infringement of privateright; he acknowledged, at the sametime, that the practice might be at-tended with great public utility, whichindeed caunot for a moment be qaes-
tioned. But, as this subject will be-
argued more fully in the Court of
Chancery on Tuesday next,* we shallfor the present drop it, for the
purpose of introducing to the noticeof our readers, a specimen of LondonHospital practice, and after havingread the following depositions, is thereone individual who is capable of dis-tinguishing between the extremes ofright and wrong, who will say that such,a publication as THE LANCET is not re-
quired to correct such barefaced igno-rance, such disgraceful, nay criminal,negligence, as will be discovered on aperusal of the report of the followingInquest ?
(COPY.)City and Liberty of Westminster, in
the County of .Middlesex.INFORMATIONS OF WITNESSES severally
taken and aeknowledyed on the behalfof our Sovereign Lord the King, touch-ing the death of JAMES WHEELER,at the dwelling-house of Mary Wo-mack, called or known by the name.or sign of the White Horse, situatein Knightsbridge, in the Parish ofSaint George Hanover-square, in thesaid Liberty, in the County a foresaid,on the third day of March 1825, be-fore me, JOHN HENRY GELL, His31ajesty’s Coroner for the said Cityand Liberty, on an INQUISITIONthen und there taken on view of thebody of the said JAMES WHEELER.JAMES RICHARDSON, of 73, Sloane-
street, Surgeon, on his Oath depo-seth,-In the beginning of this week,I do not recollect the day, the de-
* In addition to the Soliciter Gene-ral and Mr. Rose, our opponents haveprovided themselves with two othercounsel, Mr. Abercrombie and Mr.D nckworth. To meet this new array,we have armed ourselves with Mr.Brougham, whom we have speciallyretained. Mr. B.’s appearance in theCourt of Chancery will not be theleast interesting part of this curiousaffair. -..
228
ceased’s widow called on me, and re-quested 1 would see his body ; I wentthe following day, and found the bodyin a house near Wilton-place. Onexamination, 1 saw that MoRTIFICA-TION in the middle of the arm had en-sued. There was an incision in thatpart, as if for the purpose of takingup an artery; this was in the part ofthe arm where it is usual to open avein. JAMES RICHARDSON,
Surgeon.
WILLIAM EGGLETON, servant to thewidow of the deceased, on his Oathdeposeth,-The deceased is 32 yearsof age. I was sent for last Sundaynight, to attend to his business, as hewasunwell. I saw him in St. George’sHospital that evening, between fiveand six. I afterwards went betwixtmine and ten, and staid. He told me,about a quarter of an hour before hedied, that he was sensible he was dying,and he then said, he was " A MUR-DERED MAN." I did not inquire whohad murdered him, nor did he explainwho had ; he died about five minutesafter twelve o’clock of that night. Ihave omitted to state, that when hesaid he was a murdered man, headded, that it was by having been bledin the arm.,
WILLIAM EGGLETON,his mark.
WILLIARI COWELL, House Surgeonto St. George’s Hospital, on his Oathdeposeth,—The first time I saw thedeceased was Wednesday the 23d ofFebruary last, he was then an out-patient ; he had inflammation of thelnngs; he was a physician’s patient.About four o’clock in the afternoon ofthat day, I was told there was anaccident in the Oxford ward. I wentthere directly, and found an acci-dent had happened in BLEEDING thedeceased; I then was convinced that anartery in his right arm was wounded;this artery was directly under thevein which is usually opened ; I stop-ped the haemorrhage, and ordered thedeceased to bed ; he was tolerablywell for the next 24 hours. Symptomsof inflammation of the lungs gainedground, and I requested a Physiciano see him: this was on the followingFriday evening. I explained the state
of the case to the physician, (Dr.CHAMBERS,) who said, that from theseverity of the disease of the chest, anope1’otiort was unadvisable. The Sur-geon (Mr. JEFFERYS) saw the de-ceased the same evening ; he yieldedto the opinion of the Physician, thatno operation could be performed. Theoperation alluded to was the tying theartery. The deceased, after this, sankand died, grartly from the disease of thechest, and partly fr om the inflammationwhich enszsed in the arm FROM THETIGHTNESS OF THE BANDAGE WHICH]HAD BEEN APPLIED TO STOP THE BLEED-
ING. He died on Sunday night, before.12 o’clock. I told Mr. Jefferys theNATURE OF THE ACCIDENT on the next
morning after theuccident. Since deathI have examined the body ; there was ,
acute inflammation found in the chest, ’which certainly did a great deal to- ‘wards killing the man ; some swellingand effusion in the arm, not necessa.rily dangerous. I am of opinion thathe died from the joint causes of theinflammation of the chest with theirritation caused by the wound in the iarm. The dressers are in the habit ofbleeding patients. The name of thedresser who bled the deceased is -
BEASE, he appears about the age oftwo or three and twenty years; hecame to George’s Hospital about two ,
or three months ago; he has con.
stantly attended the Hospital. Hewas dresser to Mr. EwBAXK.
W. COWELL.
MARTHA WHEELER, widow of thedeceased, on her Oath deposeth,—My late husband was admitted an out-patient of St. George’s Hospital lastWednesday week ; he had a kind ofcongh ; he went there that day ; I didnot accompany him. Soon after liesent my little girl home, AND SENT.WORI) HE SHOULD SOON RETURN HOD!Ejhe remained there a long time, andwent to the Hospital and saw himstanding in the ward ; his arm loas
bandaged up; he shook his head, andsaid, HE KNEW IT WAS ALL OVEIt
WITH HIM. I saw him again in theevening of that day, he then said HisARM WOULD KILL him. I saw himagain on Thursday, and every followring day ; he always said he should notrecover from his arm, and begged Iwould not fret. I have applied at th
229
Hospital to know who it was that bledmy husband, but have always been re-fused the name of the person.
MARTHA WHEELER.
Verdict.—Died FROM THE ACCI-DENTALLY OPENING AN ARTERY INTHE ARM, AND FROM THE WANTOF PROPER ATTENTION.
It is unnecessary that we should
make any comments on this case.
Do not the facts speak home to everymind? Do they not exhibit a case ofmost atrocious negligence, and of themost disgusting ignorance ? Yet bad
and disgraceful as the affair is, is it
a solitary instance of a human beinghaving lost his life through ignoranceand inattention in one of our Public
Hospitals? No, it is not, and the
experience of every week furnishes
examples’of nearly equal infamy. Wehave been-on the spot, we have seenthe relatives of James Wheeler, wehave seen the jurymen who sat on the
Inquest, and we do not hesitate to
say, that if the affairs of St. George’sHospital had been differently con-
ducted, Wheeler would have been
living at this moment, and assistinghis unfortunate widow and her infant
children. Here is a man who from some
trifling indisposition went to the lios-pital on a Wednesday afternoon, at fouro’clock, for advice, as he entered thedoor a tradesman, of the name of
Pngh, saw him cheerful and smiling.On the Sunday night following hedied from the injury which was in-flicted by a person who was incom-petent to perform the simple opera-tion of bleeding. The artery was punc-tured, the arm bouud up to stop (the
haemorrhage, the bandage tied so
tightly, that the circulation of the
blood became completely stopped,and upon the removal of the bandage,tltre days afterwards, the arm wasfound in the most horrid state of in-
flammation and mortification. Howcan Dr. Chambers or Mr. Jefferys,and the other medical officers of the
Hospital, reconcile it to their humanity
to allow an unhappy creature to re-main in the state in which this ;man
remained for three or four days, with-
out doing anything effectual for his,relief? Oh! say they, we could do no-thing for his arm because of the veryviolent inflammation of his lungs; sothat, according to the doctrine of thesegentlemen, preventing the return ofblood from the arm, even to the pro-duction of gangrene, is likely to pro-duce less injurious consequences thana slight, well-adapted pressure, or tiretying of the brachial artery. Is it.
customary for severe cases of inflam-mation of the lungs to be unattendedwith difficulty of breathing? whichwasreally the case here, and is it nsual,Mr. House Surgeon, in your Hospital,to administer to persons labouringunder inflammation of the lungs as
much qcine and brandy as they candrink ? Yet such was the practiceadopted in this man’s case for morethan fourteen hours previous to hisdeath. Is not this fact alone a com-
plete refutation of there having beeivsevere inflammation of the lungs ? Isit not evident that the joint causeswhich produced this individual’s deathwere ignorance and neg ligence? Did
not the tightness of the bandage com-
230
being small in proportion to the quan-.tity of.the ingesta. The patient in itsprogress is affected in his appetite,liable to bjea,4-aches, palpitation otthe heart, and frequently spasmodicattacks in different parts of the body,but especially in the stomach, bowels,or about the neck of the bladder.Br. A. believes that a long continuedand large accumulation of faeces inthe colon is sometimes a cause of apo-plexy, by pressure, probably, on theabdominal aorta; and he related two
. eases where that vessel was found-contracted after death, while the tho.-racie portion of it was greatly dilated.
. This affection, however, rarely seemsto produce any organic disease of thiskind, and is generally easily managed.The warm bath used about twice aweek, warm resinous purgatives, as-sisted by cold drawn castor oil, andthe moderate use of animal food twicea-day, with regular exercise in the
open air, and strict attention to the
sleep, will almost always ensure regu-lar evacuations. But the colon havingbeen perfectly unloaded, the patientshould endeavour to procure a dailyand sufficient relief, by instituting a-habit at a certain time in the morning,.and that once established, ought not,if possible, to be disturbed by anyof the exciting causes before men-tioned. Dr. ARMSTRONG noticed a con-trary state of the colon, nameiy, diar-rhœa, and recapitulated the causes
to which he had referred that affec-tion in a former Lecture, namely, an
excess of bile, as sometimes happensin hot weather; a sudden chill of thesurface, not uncommon in this climate;an overloaded state of the colon; thethinner part of the fæces passing onlyaway ; offending ingesta, such as thefibres, skins, or seeds of fruits, por-tions of radishes, or the like; and
lastly, inflammation of the upper por-tion of the mucous membrane of thecolon, so frequent a concomitant ofdiarrhoea, that in every case its exist-ence, or non-existence, should beascertained satisfactorily.
. Dr. ARMSTRONG briefly pointed out
the treatment most appropriate foreach of these forms of diarrhoea, andconcluded his Lecture on affections ofthe large intestines, by some obser-vations on stricture of the rectum,and on piles, both-of which he was of
opinion most frequently resulted fromconstipation, chronic inflammation ofthe peritoneum and tubercles. He
remarked, that chronic inflammationof the peritoneum was denoted by adiffused obscure pain over tile abdo-
men, increased by pressure. Theface was generally pale, the breathmore disturbed than natural, the pulsea little accelerated usually, the bow-els constipated, the appetite capri-cious or prostrate, and the sleep un-sound. If neglected for a conider-able period, the coiivolittioiis of theintestines were apt to he glued toge.ther by the exudation of lymph, whichbecame organized; and trom thattime the patient became more andmore emaciated, the skmatlastbeiugof a sickly sallow hue all over, but
especially about the face and hands.In some cases, however, the effusionof serum xt as so copious as to lead toabdominal dropsy, an effect of thisdisorder not very titiconiiiion, Theremedies for this affection were, in theearlier stages, rest, a spare diet,bloodletting general and lecul, andthe mildest laxatives occasiona!lv ex.ltibited, with a few grains of coiehi.cum, and when the stoats showed adeficiency of bile, a small duse of ca-lomel ought to be given now ahd then,so as to restore the natnrat seei-etion.As to tubercles, they sometimes
arose on the peritoneum, from the ir-
ritation . apparently of a previous in-flammation there, especially when thestrength of the body had becntitketiup by debilitating causes, snch as
copious losses of blood, or the longcontinued ensployment ot’ mercnry, abad diet, cold, or a confined atmo-sphere. Dr. A., however, was equallycertain, from examinations which hehad made, that tubercles arose in theperitoneum. as in other parts. withoutinflammation, and gave some tacts toprove this assertion. Tubercles inthis, as in other structures, were mostfrequently connected in their originor development with the applicationof cold, under a debilitated eomliuonof the body, as before explained, inspeaking of pulmonary consnmption,The existence of tubercles in the pe-ritoneum was denoted bv an anetea.feel of the integuments of the nbdo-men, when the ends of the fingerswere pressed and passed oter them,
231
as if hard knots had been deeply im-bedded in the cellular connectingmembrane, though their seat is inside.The surface is generally pale, and thepatient mostly complains of the diffi.culty of keeping himself warm, parti-cularly in the extremities. The toagneis furred, the bowels constipated, andalmost invariably pained on the admi.nistration of a purgative. In somecases the pulse is quicker than natu-ral, but in others he has found it slowwhen the signs of inflammation wereabsent. The tongne is furred, andthe body for the most part graduallywastes, the skin having a withered ap-pearance. Dr. A. knows of no cnfefor actually existent tubercles, butthinks that they may remain latentfor years in the peritoneum under aregulated regimen, to prove which, headduced some instances in which theyappeared so to have existed. But whenan attack of inflammation arises, hethinks it ought to be treated on thecommon principles, having saved somelives by that method. ’He cautionedthe pupils against the use of harshpurges in all cases of this kind, whichhe had seen very prejudicial. A littlecold drawn castor oil, or the electuaryof senna, answers very well, or an
injection, merely to prevent an over-accumulation of faeces in the colon.
Chronic Affections of the Liver.
Dr. ARMSTRONG observed, that theliver had been made a sort of lumber-house in physic, into which almost allanonmalouscomplaints had been thrownby some authors; and yet the patho-logy of this organ was capable ofmuch precision. So much had beenwritten about bilious complaints, andsnch was still the rage in London forthe blue pill, that many persons thoughtit almost necessary to their existence ;hut such would do well to be guidedby common sense, to discard the con-stant use of so pernicious an ingre-dient, and so to regulate their hahits,as to render all medicine unnecessary.It was a serious mistake of the pnb-’lic opinion, in this country, that chro-aic affections were solely to be coun-
teracted by medicine; under this im-pression, which accords with theirwishes cf animal indulgence, theylake t!tesr daily pills and potions, and
also their dainty dishes-and favouritedrinks, by which the disorder wascreated in the first instance, and ismaintained afterwards despite of the-farrago of drugs which they swallow.Independently, however, of any er-, °
rors of diets or of drinks, the emotionsof the mind, and the ocean of variableatmosphere, at the bottom of whichwe breathe, greatly influence thecondition and functions of the liver,-and yet such is the corrective power-of the system, that all the slighterdisorders thus produced are mostly-removed by those spontaneous actionsby which an organ itself either recti-fies an irregularity, or by which it is-rectified through the compensatingoffices of some other part. So true isthis position, that if any person ofcommon observation would take thetrouble to observe the changes whichtake place in the kind or quantity ofthe biiiary secretion, as evinced in theevacuations, lie would find that thoughfrom diets, drinks, mental emotions-,or atmospherical influence, the secre-tion of bile varies considerably in thecourse of a week in many persons,yet abstain from physic and physi-cians, and it shall become perfectlynatural in a few days. It is of theutmost consequence that medical pu-pils should be thoroughly acquaintedwith such facts, lest they fall into thecommon error, particularly in regardto the liver, of prescribing medicineof an active quality, when none isnecessary. It ought never to be for-gotten, that medicine, and especiallymercurial medicine, now so much iavogue for chronic ailments, is not a
neutral agent, but it either does agreat deal of liarm or a great deal
of good, just as it is discreetly admi-nistered, or the contrary. If commondiets and drinks, if ment-al emotionsand atmospherical vicissitudes effectthe secretions of the liver, it oughtalso to be known, that many drugshave a similar influence, and none somuch so as the preparations of mer-cur-y. One respectable author, in arecent compilation on Indigestion,had laid it down as a rule that mer-
caary should be continued as long asthe stools remained unnatural. Now,according to Dr. ARMSTRONG’S expe-rience, no general rule could be moreerroneous or pernicious, since in many
232
It will also be borne in mind, thatMessrs. Cartwright and Bell were,on Tuesday April 5th, directed by theWeekly Board to draw np and lay be-fore them a report of the actual stateof the case ; and accordingly, on the
subsequent Tuesday, apreared the
following manifesto, which we shallnow present to our readers. It was
stenographed at the time, but the
extreme pressure of other matter has
hitherto prevented its appearance. It
is as follows :-‘ John Moore was brought into the
Hospital between five and six o’clockon the morning of Wednesday, Fe-bruary 23d. He was visited by theSurgeon at nine, and four times insuccession during the day. The symp--toms were very obscure throughout,but he was uniformly treated on thebelief that the case was hernia, or
There were Two circnmstances re-markable in this man’s condition :-
1st. A tumour on the scrotum of
very unusual form and alarming ap.pearance, the surface being black,with an emphysematous sensationcommunicated to the finger.
2d. An absence of those symptoms’which usually accompany strangulat-ed hernia, although he had bad cotin--tenance and great depression ; he had
’ing strings—Exemplary advice to aing strings—Exemplary advice to aSenior Surgeon-, He knows THAT’4 It does not cut quite to the point’-Don’t hurry yourself."—" Take the
forceps, that is the sac."—"Ah! Jo-bern.,;, I thought you were going onwell,’ &c. &c.- Humiliating spec-tacle ! ! !8thly. Subsequent treatment—Death
of the patient, and its probable cause!—Reflections.Snch is a brief recapitulation of theoutlines of this melancholy case, andit has never fallen to our lot to de-scribe a scene so truJy humiliating-so unequivocally demonstrative of thefatal effects of delay-or of the dread-ful results of INDRECISION !!! "
neither hiccough nor vomiting, nor
swelling of the belly, or tenderness
upon pressure.The questions which arose in the
surgeon’s mind will explain the treat.ment.Could this blackness be a conse.
qaence of the condition of the stran-gulated intestine ? If so, then theintestine was mortified, and past allhope.
Could the blackness arise from vio.lence in the attempt to reduce thegut, or from a blow? If so, it indi.cated nothing as to the condition ofthe gut, or the necessity for operating,but much as to the conduct to be fol-lowed.
In the course of the morning itbecame the surgeon’s opinion, thisblackness arose from extravasation ofblood, and had nothing to do with thecondition of the inclosed gut, bothbecause the blackness began some.what to dissipate and becaase the
symptoms did not correspond withmortification of the parts; thereforeit was decided, that the patient wasto be treated in the usual maunerwhen there is a portion of intestinedown and in danger of strangulation.The reduction of a rupture by the
hand is a very slow operation, andthere is no danger from it when pro.perly performed. When the first at-tempts fail, it is usual to employ avariety of other means before resum-ing the attempts at reduction; noneof those means were omitted on thisoccasion, and on the supposition thatthe extravasation and blackness ofparts resulted from attempts made toreduce the rupture before the patientwas brought into the Hospital, it didnot follow that those attempts shouldnot be renewed ; they were renewed,but failing, the operation was decidedupon in consultation, and pelformedby the snrgeon (Mr. Jobons) rsithgreat care, and successfully as far asregards the immediate object of te-lievinly the gut from stricture.The intestine was found to be in-
flamed ; that inflammation spread,and caused the death of the patient,to whom every attention was paid,fi om the time of his admission to his.decease.
We cannot conclude this repoitwithout reminding the Board, they
233
have taken up this matter on anony-mous testimony; but we trust thatthe Board will proceed to the perfectvindication of their Senior Surgeon.We are conscious of h.:ving done ourduty, and the matter is now in your[their] hands. We leave it to any onewho reads the publication to say,whether it was written for the pnr-poses of charity and justice, or to gra-tify some sinister fceling.
(Signed) R. CARTWRIGHT.C. BELL."
Here then is a document uponwhich the decision of the Senate has
long since been obtained, consequentlyit cannot be How said that we are
wiiting to gratify "some sinister feel-ing." Our object is the promulgationof truth, which, without prejudice toany individual, lies at present in a
deeper well than ever ; and, as it
would seem, far beyond the ken ofsuch mortals as the senators of the
Middlesex; with them, however, wehave nothing to do at present, it is tothe profession we appeal, and it is ’,,for their amusement that we have
again reverted to a subject which,however serious in itself, becomes la-dicrous in the extreme by being as-sociated with the name of JOE BURNS.
But we are digressing.Having furnished our readers with
the report of the Surgeons, we shall
proceed, in the first place, to examineit in se, and aftewards in relation to
our own. ’
We shall set out by admitting thetruth of no less than three positionsin this report, and our readers shall
presently see that we could not, withany semblance of justice, have ex-
tended our liberality -to -more.We will concede then-
1st. That John Moore was brought
into the Hospital between five and sixo’clock on the morning of Feb. 23.
2dly. That an operation was (nomi-nally) performed by Mr. Joe-Burns.
3dly. That the patient died !Having extracted the truths from.
the report, what remains is composed,1st—Of the history (perverted) of
the case.2dly.-Fantastical reasoning and.
false principles of surgery.And first of the latter:
-
" The questions which arose (mira-bile!) in the surgeon’s mind will
explain the treatment"explain the treatment" !!!" Could this blackness be a conse-
quence of the condition of the stran-
gulated intestine ? If so, then the
intestine was mortified, and past all.
hope"!!! What was past all hope?.the mortified intestine? Truly, if thisbe the meaning of the passage, the
surgeons who signed the report mustbe mighty clever fellows,since it wasreserved for them to discover that
a mortified part is " past all hope."Why did not the wiseacres say at
once, that a dead part was a dead
part, or a dead intestine a dead in-
testine, and therefore past all hope ?Oh dear ! oh dear! oh lack-a-daisie!
was it reserved for a Professor of
the College to discover this? Verilywe consider him already as one of
the leaven.But supposing the passage to mean,
(which it does not,) that, because apart of the intestine 11 was morti-
fied," the recovery of the patientwas " past all hope," then these
Surgeons have either demonstrated
their entire ignorance of their profes-sion, or have made a wilful misstate-
234
MtCKi’. We do not take them to befools, and shall be the last to call themby a harsher name. We shall not
multiply authorities, but shall contentourselves with quoting CHARLES BELLHIMSELF.*
Again, "Could the blackness arisefrom violence done in the attempt to
reduce the gut or from a blow?" Worseand worse. ‘° Could the blackness arise
from a blow " !!! Could it have been
congenital, think ye? or, had the pa-tient received a blow, could he nothave told ye ? ! ! ! Well, well, it wasneither congenital nor was it" caused
by a blow." " If so," they continue,(if what?) "it (that is the blackness)indicated nothing as to the condi-
tion of the gut, or the necessity for
operating, but much as to the con-
duct to be followed." Now, herewe are told that, because a hernia isirreducible, it indicates nothing as tothe necessity for operating, but muchas to the conduct to be followed;
* In his Operative Surgery, Vol. 1st.p. 279, he says, "If in consequenceof a gangrened intestine, an anus atthe groin is formed, it entails a mostuncomfortable existence. It hashappened, that from the fortunatecircumstance of the diverticulumilii being in the sac, the patient hasperfectly recovered, not with standingthe mortification of the intestine !!!But I believe it has also happened,that after the sloughing has takenplace, by the close union of the portions of the intestine, they havecom-municated by ulceration, and re-
stored the food to its natural course;and I conceive it practicable to en-
sure the formation of this commvini-cation in the event of a portion ofcation in the event of a portion ofgut sloughing. off in the herniarysac." !!! So wrote CHARLES BELL,iai 1814. What he has written or signediu 1825 the reader has already seen.
which means, of course, to leave na-
tnre to do the best she can!!!
Once more, " In the course of themorning, it became the Surgeon’sopinion, this blackness arose from
extravasation of blood." Wonderful!
So that " in the course of the morning"they discovered that the blackness
was neither congenital nor "causedby a blow," that is, they found out, "inthe course of the morning," that thepatient had neither been kicked nor
born with a black scrotum ; in fact,that his scrotum only became black
and blue after repeated applications ofthe taxis in the Middlesex Hospital !!!Having satisfied themselves of this
important particular, they continue," therefore it was decided that the
patient was to be treated in the usualmanner, (i. e. in the manner usual with
them,) when there is a portion of in-testine down and in danger of stran-
gulation." In danger of strangula-tion !!! How long a portion of intes.tine is in danger of strangulation, be-fore it is actually strangulated, they donot inform us; but from the proposalof MR: JOE-BURNS to pastporae the
operation to the following day, (which,a& all were present in consultation, allmust be supposed to have sanctioned,)we may infer, that it happens at someperiod between 40 and 48 hours fromits first descent!! which is somethinglike the story of the Tronningholmgardener, who, falling into a pond,remained undemowater for 16 hours,and afterwards perfectly recovered, asit appears, became he was only i7t
danger of being°d<rowned !!!*
See Anatomy, by John Bell, p.197. Vol. 1st.
235
Again, "The reduction of a ruptureby the hand is a very slow operation,and there is no danger from it, when
properly performed," &c. Now,here we will put a simple question tothese simple apologists. By your ac-
Count,.(which accords with our own,)the patient was admitted between
five and six o’clock in the morning, I,and the operation was performed be-tween five and six in the even-
ing, (although you have not statedthe time,) now, how does it happenthat yon, with all your ingenuity, havenot accounted for this unpardonabledelay? How comes it, that you havenot even attempted to explain it, ex-
cept by saying, that " the symptomswere very obscure throughout," whichamounts, in fact, to an acknowledge-ment, that you did not understand
the case, that you did not know it was
a hernia till the arrival of Mr. Cart-
wright, eleven hours after the man’sadmission! But then you say,
" he
was uniformly treated on the beliefthat the case was hernia." Aye ! soit seems!’ and it further appears, that
you wished the poor patient to enjoythis uniform treatment" for at
least 14 hours longer !!!* Verily the"reduction of a rupture by the handis a very slow operation," and we willcQncede to you, "that there is no
* See the interrogatories of JoeBurns in The Lancet, Vol. 6. No. 10.p. 312 " Do you think you wouldlike to run the risk of deferring it tilltomorrow morning ? said the seniorSurgeon, about five o’clock, p. m.-Now the earliest hour in the morning,that we can imagine him to mean,would be seven o’clock, making 14honrs as above, which’ is like readinga bill this day six months.
danger from it when propeoly per-
formed," by which we mean carefullyperformed, and for a short period only.We have now pretty.well disposed Qfyour reasonings, and your principlesof surgery. We come now to ex-
amine your misstatements,,and shallthen make some general remarks onthe performance as a whole.The following assertions are nntrqe1st. That " the symptoms were very
obscure throughout."2dly. That there was ° a tumour
on the scrotum of very unusual form."A tumour on the scrotum ! ! ! (risumteneatis ?)
3dly. That " the symptoms whichusually accompany strangulated her-nia* were not present."
4thly. That there was no "tender-ness" of the abdomen upon pressure,But it is useless to multiply contra-
dictions, as the reader will find a mi-nute description of the case in Vol
6th. No. 10. pp. 311 et seq. of The
Lancet
It may beurged by some, that theaccount we e have published is less
likely to be accurate than the apolo-getic report of the Surgeons.Be it so. Every man of common
sense, who may read the account ren-
* It will be observed, that theyhere, in the’ first place, speak of" strangulated hernia," and after-wards of" intestine in danger ofstran-gulation" ? Thus making the catas-trophe precede the plot’’There is an error of the press, at
page 317, 2nd colunm, eight lines fromthe bottom, (which was corrected inthe subsequent number,) viz. for" wants some of the characters of ahernia, viz. swelling," read « wantssome of the characters of a hernialswelling."
236
dered by Messrs. Cartwright and Bell,must see that it carries with it the
impress of ignorance, not only of thecase, but of many other subjects. It
may not be amiss, however, to ask bywhat means these Gentlemen could
become so thoroughly cognoscent asto the facts of the case.
Things of every day occurrencemay be known in two ways ;
1st. By observation.
2dly. By report.Bell saw the patient at one o’clock,
(six honrs and a half from his admis-sion.) Cartwright at half-past four,
(11 hours from his admission.) What
could they know of the case by thefirst method? The answer must be,Nothing satisfactory. All they knew,then, must have been by report, whilstour account was drawn up from actual
observation, and it will be observed,
that they have not attempted to in-
validate the facts as stated by ns, norneed they, for had their report been tentimes more foolish than it is, (if it bepossible,) had they indeed transcri-bed a page from Paracelsus or the
Koran, it would have answered everypurpose, would most likely have beenreceived as a complete vindication ofthe senior Surgeon’s conduct, andhave entitled him, as this has done, tothe thanks of the board !!!* Arcades
’omnes.
’
* We will tell this Conclave, withreference to their conduct on Tuesdaylast, ’to a poor but honest man, that-several gintlemin are much more de-serving of punishment than he. Alas !it is sad work
Where little sinners must submit tofate,
That great ones may enjoy the worldin state. GARTH.
The case of the unfortunate personMoore has been long before the pub-lic, and our readers have now in theirpossession the vindication of the se.nior Surgeon, (as attempted by his col.leagues,) and they will form their ownopinion on its merits. Upon this re.
port, it wilt be recollected the Board
decided that the conduct of the senior
Surgeon had been most exemplary,such as entitled him to their warmest
thanks,* which were accordingly votedhim, and, in return for the honour,the old gentleman penned the sub.
joined reply,! which is perfectlyunique, and may, for aught we knowto the contrary, have been wtitten
before dinner.
* It was rather a 2varm businessaltogether, as the manuscriptspeeches of DR. MERRYMAN and DR.SouTMEY will testify. We have noroom tc chronicle bear gardens, or toexhibit the feats of a merry-man ora merry-andrew.
t " Gentlernen,I can hardly express, how much I
feel the value of your communication,in as much as it affords me the grati-fying assurance, that I am in full pos-session of the confidence of so manyrespectable individuals and steadyfriends to the Institution. Whilst thnssecure of your approbation, I shallcontinue to disregard anouymons at-tacks, and shall despise, as I hithertohave done, the dark designs of envy,ignorance, and malice.The flattering manner in which youhave been pleased to express your re-
spect for that conduct which I havefor more than 20 years endeavouredto maintain in my situation as Sur-geon to the Hospital is, at the presentmoment, most gratifying to my feel.ings. It is the best answer to myenemies, and the most acceptablereward for the services I have renderedthe Charity." (How very modest! Ser-vices quoth he.)
237
To conclude our analysis of this
apologetical report, we will, in theirown words, " leave it to any one, who
read. it, to say whether it was written
for, the purpose of Charity, or to gratifytome sinisterfeeling ":!!
REVIEW.
Practical Observations on the symptoms,discrimination, and treatment ofiome of the most important Diseasesof the lower Intestines and Anus;
illustrated by numerous Cases. (TheTitle would fill a page.) By JOHNHOWSHIP, Member of the RoyalCollege of Surgeons, &c. London,1821. 8vo. pp. 234. Longmannd Co.
THE present work, we may presume,has now passed the ordeal of pub-lic opinion, consequently whatever
we may have S6 say upon it can
neither depreciate its merits nor ex-
tenuate its defects. All that is left
to us is to give an impartial analysisof the contents of a volume which has
tain so long neglected on our shelf.We say neglected, not in referenceto any high opinion that we entertainof the book, but because, in yieldingto the pressure of more interestingmatter, we have hitherto deprived itof a niche in the pages of The Lancet.
The work is divided into eightChapters;
-
1st. On Contraction, or Stricturein the Rectum.
2d. On Ulceration of the internalsurface of the Intestine.
3d. On the growth of Tumourswithin the Bowel.
4th. On the prolapsus Ani or thedescent of the Bowel.
5th. On haemorrhoidai Tumours,or Piles.
6th. Fistula in Ano.
7th. On the Haemdrrhoidat Ex-
crescence.
8th. On the best means of obtain-
ing a regular state’ and action of the
Bowels, as essentially conducive tothe prevention of the above diseases.For the present, we shall pass over
the first Chapter of the work, whichin reality contains nothing new; byand bye, however, we may have occa.sion to revert to this part of the au-thor’s performance, in order to afforda summary of the contents of thevolume.
Chapter 2d.-On the causes of thedisease.
And here there are many cruda
opinions, of which we take the fol-
lowing to be an example :-" In some late researches," says he,
into the minute appearances of dis-ease in the bones, I have unqnestion-ably detected absorption, or, in otherwords, ulceration, unconnected withany character of preceding intlamma-tion ; and on the dissection of thosewho have died from disease in thealimentary caflal, I have, in variousinstances, found so little trace of in-flammatory action around spots ofapparently recent ulceration, that Icannot help doubting whether, undersome circumstances, irritation in thebowels may not establish some de-gree of excitement sufficient to induceulceration without any distinct appear-ance of inflammatory action."—pp.76, 77.
Here it may be observed, that theauthor has asserted some things andobscurely hinted at others. Thus, inthe first instance, it is roundly stated,that " absorption implies nothing less