inquiry existed or not. The inquiry itself is a consequence of this tide in the stream of time-a tide which no human ingenuity can arrest, or long impede. 66 MEDICAL REFORM is now taken out of the hands of angry disputants, and of zealous or interested declaimers, and is in a fair way for a liberal adjustment. As far as we can discern, the investigation has gone almost entirely in favour of reform. The STATIONARIES, or advocates of things as they are, have made but a very sorry figure in the examinations before the commitmittee. If not a single individual of the MOUVEMENT" phalanx had been interrogated, the stationaries would have ruined their own cause before any dispasionate tribunal. They broke down in almost every instance. They either admitted the existence of evils and abuses, or endeavoured to veil them with such a flimsy and gossamer covering, that their deformities became more glaring than ever. It would be premature and improper for us to remark on the evidence which has been adduced before the committee. That evidence will form a volume, which we shall analyze with care and comment upon with freedom. We shall probably be able to furnish our readers with much useful and wholesome food for reflection from the parliamentary report. If we may judge from the tendency of the questions and the nature of the replies, the following will hold a distinguished place in the catalogue of reforms. First, The establishment of one central board, council, faculty, academy, or whatever else it may be called, for the purpose of regulating the whole of the profession throughout the three kingdoms. Secondly, Uniformity of education, throughout the three kingdoms, for each grade of the profession. Thirdly, It seems probable that there will be only two grades in medicine -a higher and a lower, with a proportionate rate of education and acquirements-and without any other impediment to the passing from the lower to the higher grade, than compliance with the terms prescribed for that higher grade. Fourthly, We think the apprenticeship to the inferior grade will be greatly abbreviated, if not abolished. Fifthly, The legality of charging for medical attendance will be established beyond cavil or doubt, though it is probable that the practitioner will be left the option of claiming his remuneration through the medium of medicines, of skill, or of both conjoined, according to circumstances. Sixthly, We apprehend that a far greater amount of preliminary education will be demanded than now obtains, as well as a much longer period of professional study. This will throw back a little the usual age of commencing practice-a consummation devoutly to be wished. Seventhly, What the amount of power and privilege to be left with the present colleges of physicians and surgeons may be, we cannot conjecture: but we apprehend that the college of apothecaries, in Bridge-street, stands little chance of holding the scales of fate over the general practitioner much longer. Their dominion will probably be transferred to another class of subjects, very useful in their way, but not ranking so high in the science of medicine as of medicines. Lastly, It is not improbable that considerable modifications will be made in the management of public hospitals, and in the mode of appointing medical officers, though we doubt whether Parliament can interfere much with institutions that are chiefly, often wholly supported by private and voluntary subscriptions. We beg to state that the above are mere conjectures, founded, as we said before, on the tendency of the queries and the nature of the replies in the House of Commons. The alterations and reforms which are here anticipated are those which we wish, and, therefore, we may be very much deceived by our own too sanguine hopes. In this case we shall be grieved as well as disappointed. Another year will solve the mystery. BIBLIOGRAPHICAL RECORD; OR, Works received for Review since last Quarter. 1. Medica Sacra; or, Short Expositions of the more important Diseases mentioned in the Sacred Writings. By THOMAS SHAP TER, M.D. Physician to the Exeter Dispensary, &c. Small octavo, pp. 191. Longman and Co. 1834. Price 7s. 2. Observations on the Preservation of Sight, and on the Use, Abuse, and Choice of Spectacles, Reading Glasses, &c. By JOHN HARRISON CURTIS, Esq. Oculist and Aurist. Octavo, pp. 48. Highley, 1834. This little work should be in the hands of all young people, and would thus save annually many valuable eyes. 3. A Letter to Henry Warburton, Esq. M.P. on the Grievances affecting the Medi cal Profession. By a Junior Practitioner. Octavo, pp. 48. Churchill, March, 1834. A very good digest of the ills which press on medical society. 4. Six Introductory Lectures on the Institutes and Practice of Medicine. By BENJAMIN RUSH, M.D.. Philadelphia, 1801. 5. The Philosophy of the Human Voice, embracing its Physiological History; together with a System of Principles by which Criticism on the Art of Elocution may be rendered intelligible,and Instruction definite and comprehensive, &c. &c. By JAMES Rusн, M.D. Second Edition, enlarged. Philadelphia, 1833. I This is a very talented and elaborate treatise on the subject which it embraces. 6. The Physiology, Pathology,and Treatment of Asphyxia; including Suspended Animation in New-born Children, Drowning, Hanging, Wounds of the Chest, &c. &c. By JAMES PHILLIPS KAY, M.D. Octavo, pp. 344. Longman and Co. March, 1834. 7. Suggestions respecting the intended Plan of Medical Reform, &c. By Jos. HENRY GREEN, F.R.S.,F.G.S. &c. Octavo, pp. 49. Highley, 32, Fleet Street, March, 1834. 8. Outlines of the Anatomy and Physiology of the Teeth, &c., their Diseases, and Treatment, &c. BY DAVID WEMYS JOBSON, M.R.C.S. &c. Octavo, pp. 268, with plates. Edinb. and London, 1834. 9. Hippopathology; a Systematic Treatise on the Disorders and Lamenesses of the Horse, with their modern and most approved Methods of Cure, &c. &c. By WILLIAM PERCIVAL, M.R.C.S. Veterinary Surgeon in the First Life Guards. Vol 1. Octavo, pp. 331. Longman and Co. 1834. I Reviewed. 10. The Principles and Practice of Obstetric Medicine, &c. & By Dr. Davis. Parts 29, 30, 31, 32 1834. 23, each. Malignant Diseases of the Uterus. 11. Encyclopédie des Sciences Medicales, Premiere Division, Anatomie et Physiologie. Premiere, deuxieme et troisieme livraison. Paris, 1834. IP Each livrasion contains about 130 or 140 pages of close type in double columns. It is to be comprized in 100 livraisons, or 25 volumes, in monthly numbers, one franc and a half each. The work is remarkably cheap, and is on a novel plan. It is edited with great ability, if we can judge by the first three livraisons. 12. A Series of Anatomical Plates, in Lithography, &c. &c. By JONES QUAIN, M.D. Fasciculi XI. XII. XIII. & XIV. Division, Muscles. April, May, June, 1834, price two shillings each, folio. 13. Pathological and Surgical Observations on the Diseases of the Joints. By B. C. BRODIE, V.P.R.S. Serjeant-Surgeon to the King, and Surgeon to St. George's Hospital. Third Edition, with Alterations and Additions. Octavo, pp. 344. London, 1834. 14. The Signs, Disorders, and Management of Pregnancy:-the treatment to be adopted during and after Confinement; and the Management and Disorders of Children. EXTRA-LIMITES. TO THE EDITOR OF THE MEDICO-CHIRURGICAL REVIEW. SIR, The objects of my Essay on the Secondary Effects of Inflammation of the Veins were, an attempt on the one hand, to shew how death was produced in this disease, and on the other, in what way abscesses originate in distant parts after injuries. The conclusions to which I came were these. I demonstrated that death does not take place from the inflammation of the vein extending to the heart;-I shewed that facts and reasoning tended to establish the conclusion, that the principal cause of the alarming consequences arose from the entrance of pus into the circulation, a similar influence being perhaps also possessed by any inflammatory secretion from the vein; and, finally, I adduced a number of facts, which led me to conclude that the inflammations and abscesses which arise in distant parts after injuries and after parturition, were attributable to the existence of phlebitis in the part of the body primarily affected. In the last number of your Journal, Dr. Wise pretends that, in some remarks appended to a report of cases of phlebitis treated at St. Bartholomew's Hospital, printed and intended by him for publication in the Medical and Physical Journal for 1827, but withdrawn, proofs will be found of a resemblance between his opinions and mine on the subject of phlebitis. I have referred to the Report alluded to, and which is in your possession. There are no opinions therein expressed resembling mine. The question of the extension or not of the inflammation of the vein to the heart is not considered, much less decided; the entrance of pus or other inflammatory secretion into the circulation is not mentioned; and the occurrence of inflammations and abscesses in distant parts after injuries and after parturition, is neither broached, nor an explanation attempted to be given. Indeed Sir, in that report, no conclusions are drawn-no opinion is expressed as to the primary question of all, the cause of the constitutional affection in phlebitis, and when it is stated that they (the effects) follow "either from the structure or the function of the part inflamed," the writer (Dr. Wise) shews that he had formed no opinion, and as regards him, the question is left precisely as it had been by Mr. Hunter, who stated that death took place" either from the extension of the inflammation to the heart, or from the entrance of pus into the circulation." And yet this gentleman, Dr. Wise, now talks of having pointed out the cases of phlebitis which occurred at St. Bartholomew's Hospital to the attendants there, as "proofs of the justness of conclusions at which he had previously arrived,"-conclusions which he does not describe, (not even in his two communications to you,) which no one seems to have heard of but himself, and which are not to be found in the report to which he now refers. Pleuritis as an effect of phlebitis is alluded to in the remarks accompanying the Report, but purulent deposi ions, affections of the joints, and of the eye, are not mentioned; and and as regards pleuritis, no endeavour to account for it is made, so that an opportunity is not afforded of ascertaining, if Dr. Wise had any opinion upon the subject, whether they were not identically the same with those recently promulgated in a country where he had been residing, by M. Velpeau, in his "Memoire sur la Pleurisie a la suite des grandes Opérations Chirurgicales, ou d'un Suppuration plus ou moins abondante."-Revue Médicale, 1826. Unable to support his very general and very vague charge of "appropriation" by any specific or tangible proof, Dr. Wise, in his inability to make out a crime of commission, seeks to help himself by alleging one of omission in the following sentence:-"He, (Mr. Arnott,) was obliged to leave out the peculiar changes in the blood, which is so remarkable a consequence, from being aware I had published a note in the Medical and Physical Journal for the year 1827." Now whatever might be my reason for not noticing this change, it certainly was not because Dr. Wise had published "a note"-the change in question had been previously far better described by M. Ribes. "The note" is entitled "Remarks on some of the Phenomena of Inflammation, as they appear on Dissection;" the subject is the proximate cause of Inflammation, in which a principal part is given to the capillary veins. When a vein inflames after bleeding, it is "plugged up by consoli dated blood some distance above and below the wounded part." "Such a consolidation of blood appears to be a constant effect of a certain degree of inflammation in the branches of veins; and, as the structure and contents of these vessels seem to be the same, may I not be allowed to infer that the same cause will produce the same effect, and that, there fore, a like consolidation of blood takes place in the capillary veins ?" Such is Dr. Wise's language. Now let us turn to what was written and published two years previously in a paper entitled, "Exposé succinct des Recherches faites sur la Phlébite, par M. F. Ribes, Révue Médicale, 1825." After stating that in one stage or degree of inflammation the vein may be lined by a false membrane, or that it may be filled with pus, he proceeds "mais quelquefois la veine légèrement enflammée se laisse dilater et distendu par le sang. Ce vaisseau etant malade, ne peut que difficilement, reagir sur le fluide qu'il contient, le sang y stagne, s'y arrete, s'y coagule, se durcit, se dissêche, adhère fortiment et fait, corps avec la veine, alors la membre est plus en moins enflée." P. 11. And two pages farther on, M. Ribes endeavours to shew that the veins are inflamed in erysipelas, which he represents to be essentially seated in the capillary veins. And yet Dr. Wise talks of plagiarism! From the expression "changes in the blood," although one only is described, but more especially from the tone of his two communications to you, one would almost be disposed, Sir, to infer, that Dr. Wise had other pretensions in view as well as the foregoing, and that he desired it to be supposed that the pathology of the blood equally with inflammation of veins had not previously attracted attention, and was exclusively his own. Besides the paper by M. Velpeau already alluded to, did Dr. Wise never hear of another paper referred to by me in my Essay, and likewise published two years before his note and report? I mean that by M. Bouillaud, "Recherches Cliniques pour servir a l'Historie de la Phlébite, Revue Médicale, 1825;" and who, in ascribing the typhoid symptoms in phlebitis to the presence of pus in the system, refers to the experiments of Baglivi, Majendie, and Gaspard, as having produced apparently analogous effects in animals by the injection of acrid and putrid matter into their veins? And does Dr. Wise think that we, living in England, were ignorant of M. Velpeau's "Recherches et observations sur l'altération du sang dans les Maladies, Revue Medicale, 1826," and the experiments of M. M. Trousseau, Dupuy, and others? Dr. Wise states that I suggested to him the publication of a report of the cases of phlebitis, which occurred at St. Bartholomew's Hospital, and that I corrected one if not two of the proof sheets. It would be difficult to correct one sheet even of a report which does not consist of nine pages, but I recollect looking over some part of it at his request, which I presume was made because I had suggested to him as house-surgeon, that an account should be drawn up and published;-(the cases had not then been any where reported.) Neither circumstance however would seem to indicate a disposition on my part to do Dr. Wise a disservice, but directly the reverse; and if this publication of the cases was to give him a pretence to claim opinions which he had not formed, or conclusions which he had not drawn, as well might the Editor of the Lancet, in which they (the cases) subsequently appeared-the late Mr. Rose, of whose paper on depositions of pus and lymph the same cases formed a part-or Mr. Lawrence, in whose practice they occurred, and who communicated them to Mr. Rose, have come forward after the publication of my Essay, and sought to arrogate to themselves the views which I had taken of the cause of the constitutional affection in phlebitis, and of inflammations and abscesses in remote situations after injuries and after parturition. Dr. Wise states that a very few months after he left England, I presented my Essay to the Medico-Chirurgical Society. The point is of no consequence, but it shows the animus and something more. That gentleman left England in June or July, 1827, my Essay was presented to the Society in October, 1828, and had the reading of it been deferred a couple of months, M. Dance would in all probability, and with as much justice as myself, have had to sustain a charge of plagiarism, for in the Archives Générales de Médécine of December, 1828, the first part of that gentleman's paper on uterine phlebitis appeared, in which he expresses opinions almost identical with my own. In conclusion, Sir, I have to repeat what I formely asserted, that my views on the subject of phlebitis originated in personal observation of the extraordinary circumstances of the cases I witnessed-not in the suggestions of any one: that the general results and conclusions at which I arrived were formed after a long and laborious investigation of a very extensive subject, and that whatever they may possess of merit or demerit belongs to myself. As regards Dr. Wise, I repeat that I did not derive any materials, facts, or opinions from him-that I never saw a dissection by him of a patient who died from phlebitis, nor do I know what were his opinions thereon, and even now that I have had the advantage of reading his two communications to you I cannot discover what they are. I have the honor to be, Sir, Your obedient servant, London, May, 1834. JAMES M. ARNOTT. |