The following DIAGRAM, DESCRIPTION, EXPLANATION, and DIRECTIONS, will serve to demon- | index of the patient properly using the instrate the nature and modes of using Fig. 4. M STARTIN'S PNEUMATIC INHALER. Fig.3. DESCRIPTION. K Fig.2. The inhaler, it will be observed, comprises four parts, viz.: -1. The inspirator or mouthpiece, with brass spring for compressing the nostrils; 2. The receiver and hot-water stand; 3. The injector; 4. The fumigator, heater, and hook. THE INSPIRATOR is furnished with two valves of Hancock's vulcanized indiarubber, oiled silk, or other thin substance; one valve, 4, opening without the cavity of the mouthpiece, protected by a cap and a valve, B, within its cavity. To the opening of the valve B are attached three or four feet of light flexible tubing, CC, which must at least be the size of the human windpipe; the tube C opens through a perforated stopper into the second part of the apparatus or receiver, D. THE RECEIVER, D, consists of a three-pint or larger glass vessel, EE, to receive the vapour to be inspired, mixed with sufficient air for a single inspiration. A small quantity of hot or cold liquid, F, covers the bottom of the receiver, into which a glass or metallic tube, G, dips a quarter of an inch; this tube passes through the stopper of the receiver, and communicates with the air by an inverted conical opening. A second tube, H, also descends a few inches into the receiver, and is connected by the tube CC with the mouthpiece. The receiver is placed in a hollow stand, Q, which contains hot water, to be kept up to a temperature of 200°. THE INJECTOR, I, consists of an inverted cone of metal, furnished near its apex with a small stopcock and injecting-pipe, K, which passes through the stopper into the receiver; the top of the injector is composed of very thin elastic metal, which yields to atmospheric pressure, so as to inject into the receiver, at each vacuum created by inhalation, a jet of ether or other liquid which is formed into vapour by the hot water, F, or decomposed, if the fluid be of a chemical nature. THE FUMIGATOR, L, is to be substituted for the injector I, when it is desired to inhale matters requiring the agency of fire to render them volatile, as mercury, morphine, &c. It consists of an iron funnel fitted with a moveable perforated lid, M, and an iron heater, O, in its cavity, and ends at its apex in a small tube, P, to replace the pipe K, which opens into the receiver: it may also be inserted into the orifice of the tube & when it is desired that the inhaled matters should pass through water or other liquid. R is a small hook for placing the heater in the fumigator. EXPLANATION. The pneumatic inhaler acts by admitting into the lungs enough air for a single inspiration, mixed with a graduated quantity of the volatile matter to be inspired, the quantity is regu Fig.1 B strument. Fill the injector then with ether lated either by the stopcock in the tube K of the ceiver. DIRECTIONS FOR USING. The Pneumatic Inhaler. Remove the perforated stopper, and pour into the receiver warm water (the temperature of which can readily be borne by the hand) until the bottom of the vessel is covered to the depth of half an inch. Replace the stopper, and particulaly observe that the lower orifice of the tube C is beneath the water. Adjust the flexible tube CC to the opening D, fixing the inspirator 1 to its other extremity. Half fill the stand Q with very hot water, which will require occasionally to be replenished, as the temperature of the receiver and its contents must be kept up, as its bubling will be a sure It is intended shortly to publish a series of cases illustrative of the use of ether, as also of various other remedial agents, by the pneumatic inhaler, to which will be added testimony in its favour, from the highest members in the medical profession. (From the Gazette Médicale.) We The experiments with ether for the destruction of sensibility during operations continue; but they Proceed without order, regularity, or definite aim. It is undoubtedly a useful conquest, of which we cannot foresee all the applications; but, unhappily, it is the privilege of confused and mal-adroit persons to mar and obscure the most simple things. In what manner does it act? First, verify the fact by establishing its purely experimental reality, by ascertaining its conditions and laws; secondly, by determining the theory and physiological signification. Instead of this, what is really done? have seen persons more desirous of mixing their names with what is popular and marvellous in this discovery, than of doing anything useful for science and humanity. The greater part of the trials hitherto made show strong signs of this unreflecting precipitancy; patients, who might have dispensed with operations, have been sacrificed to this desire of personal popularity; and instead of having produced precise, well-analysed results, have only furnished useless food for public curiosity, and pretexts for obstinacy and aspersion to persons already jealous of all progress. Without doubt this is a part of the precipitation and infatuation inseparably attached to everything new. But it is to be regretted that serious men should favour this injurious tendency with the sole hope of seeing their names quoted in a journal, or bandied about in drawing-rooms. We, who have rarely the privilege of performing painful operations, do not pretend to solve the various questions connected with the subject, but we may be permitted to point them out to others, It is certain that, in some instances, sensibility has been completely suspended; in others, incompletely; and in a third set it has completely failed. The first thing to be done, was to reflect on the differences of conditions and circumstances in the three cases. First, it was proper to ascertain the state of the patients; their age, profession, temperament, disease? At what hour of the day, and the length of time from sleep? Were they fasting, and how long? What apparatus was used? What quantity and quality of ether was employed? How long the inspiration was continued? Was the inspiration performed by the nasal or respiratory passages?which causes a difference. We include the whole of these questions, to which we could add many others of a similar character, having for their object the establishment of the reality of the fact, and its conditions of falfilment and variation, A second set of questions relate to the analysis of the fact itself. In those cases where the result was complete, were the patients in a state of sleep? Had they preserved their consciousness? Were they totally insensible? What has been the comparative state of animal and 'organic sensibility? Has the pupil retained its contractility? Was the mucous membrane of the nostrils still sensible? Was the muscular contractility still under the control of the will? Could it be excited by pinchings of the skin or other means? Where the effect was incomplete, which of these phenomena have remained, which disappeared? Has the stupefaction shown any differences in its different degrees of production and cessation? What have been the differences in succession and degree, regard being had to sensibility, contractility, and the intellectual functions? Lastly, is it the sensibility or the perception of impressions which has been suspended? Such is the useful and scientific programme we should seek to carry out, rather than run a race in the production of sterile and vulgar experiments. No one has yet proceeded on the plan we have indicated. Some persons who formerly noticed the soporific or intoxicating effects of the vapour of ether, have claimed in part the American discovery. What has happened to this, has happened to all discoveries. We have very little sympathy with these claims, they are usually founded in error and tend to injustice. In the present case it is easy to show that what had been hitherto observed of the stupefying influence of ether, had only a very slight and completely unperceived connection with the physiological fact which forms the basis of the new method. Now, what is this fact? The abolition or suspension of sensibility. Who has shown, who has said, that the vapour of ether causes insensibility, that we may pineh, prick, or cauterize persons subjected to its influence? If some physiologist, if some experimentalist, had ascertained the fact, there can be no doubt that he would have supplied the premises of the new method, and that this would be simply a corollary of his researches. But, unless the fact of the insensibility produced by ether has been stated in an exact manner, the premises and conclusions belong to the American surgeons; they have discovered the physiological fact, and they bave applied it. As we have said above, all pretension to the contrary is at once an error and an injustice. his disease. Immediately upon our arrival we tried the effect of the inhalation upon him, and in one minute and a half he became so entirely insensible that we might have done anything to him withoutTM his being aware of it. At the end of one minute he awoke, and experienced no disagreeable sensation in consequence of it. bylaw vioo tud Having thus satisfied ourselves that the desired effect would be produced without injury to the patient, the operation was at once commenced. The patient having been secured in the usual way, and the staff introduced, I applied the mouth-9 piece of the inhaler and closed the nostrils; in two o minutes be became perfectly insensible, of which I gave notice to Mr. Beales, who at once proceeded i to perform the lateral operation, and, with his aces customed dexterity, at the end of four minutespɔ extracted a large stone, weighing two ounces and wo quarter. As soon as the stone was extracted I withdrew the inhaler, and the patient awoke; he then stated that he was not at all aware of what them in detail. Mrs. B., aged fifty-eight years, made application to me to insert an issue in her leg for the cure of an old standing ulcer situated over the spine of the tibia, a few inches above the ankle, and expressed a desire to inhale the vapour of ether, prior to its insertion. She did not appear at all timid, and began to inhale the vapour with the greatest confidence; after five or six inspirations, she suddenly became deadly pale, and stated that she was suffocating, and refused to continue breathing the ether; she had scarcely done speaking before she coughed violently for three or four times; the flow of blood to the head was instantaneous; she became quite purple in the face, the temporal veins were much distended, and the arteries throbbed violently; she was perfectly sensible, and complained of a sense of suffocation, and that she should die; she remained in this state for five minutes at least, when the face began to assume somewhat of its natural colour. I must confess I felt considerably alarmed for her safety, and was glad to observe her recover a little ; she was a long had passed; that he had suffered no pain of any? time before she was able to leave my house, and, description, and that the first circumstance of after she had been home about two hours, she had which he was conscious was hearing one of the a fit, but, as I did not see her until some time after bystanders observe, "There is the stone!" which it was over, I am unable to say of what character occurred at the moment at which he awoke; he has › it was; her daughter told me that she was not had a single unfavourable symptom since the "stiff and insensible for ten minutes." Although operation, and slept unusually well the two folupwards of a fortnight has elapsed since she in-lowing nights, without taking any anodyne. haled the vapour, she is far from recovered from the effects of the inhalation, complaining of a great deal of pain and confusion about the head, and oppression at the chest. The next case was a boy, aged fourteen years, who wished to be operated upon for the relief of squinting. After having inhaled for a short time, instead of depressing him, he became furious, called out loudly, and we had difficulty in pacifying him. Finding that I could not succeed with him, I tried another boy, about the same age; it brought on a most distressing cough, which continued so long as he breathed the vapour; after a time it produced precisely the same effects as the nitrous oxide: he laughed most hearty, and looked quite idiotic. Of course it was impossible to operate upon either of them. After waiting half an hour I again tried them, but with the same results. I afterwards operated upon a man for cataract; also upon a girl, aged ten years, for strabismus; and extracted a tooth from a young man, with perfect success, after having subjected them to the effects of the vapour. They had no knowledge whatever of the operations, and suffered no inconvenience from the ether. One young man whose tooth I extracted stated that he was dreaming all the time "that it could not be true, that teeth could be extracted without pain." I have seen sufficient of the effects of the vapour of ether to convince me that it is a most powerful agent, and cannot be used with impunity indiscriminately in all cases. The utmost caution is necessary in its use; unless due caution be observed in the kind of instrument used, and the mode of administering it, I am afraid before long we shall hear of some casualty occurring which will effectually stop all further use of a most valuable means of deadening the sensibility of the nerves. The instrument I use is "Robinson's Inhaler," manufactured by Mr. Hooper, operative chemist, Pall-mall. The instrument is a most perfect and complete one for the purpose, and reflects great credit upon the inventive genius of Mr. Robinson, and also upon the skill displayed by Mr. Hooper in its manufacture. I am, Sir, your obedient servant, Spalding, Jan. 21. [To the Editor of the Medical Times.] SIR, I have much pleasure in forwarding to you the following case of lithotomy, performed under the influence of ethereal inhalation. [To the Editor of the Medical Times.] SIR, I am desirous, through the medium of On Wednesday, Jan. 20, I was requested by my your columns, of laying before the profession my friend, Mr. Beales, of Halesworth, to accompany experience during the last fortnight with the vapour him to a case in which he proposed to perform the of ether. I have administered it to upwards of a operation of lithotomy, and to bring with me dozen persons, and, with the exception of three cases, Robinson's ethereal inhaler, which I had just with perfect success. These three cases presented received from London, as he wished to try its some peculiarities, and in one, symptoms of an alarm-effects. The patient was a healthy man, aged ing character, which must be my apology for giving sixty-seven, who had suffered for five years from During the whole period of the operation I re- " tained the inhaler in the mouth of the patient, but... → after insensibility had been once produced, at every fourth or fifth inspiration, I turned the stopcock of the instrument, cutting off the communication" with the ether, and, at the same time, removing my fingers from the nostrils, allowed the patient to take two inspirations of common air, and thus, successively, till the completion of the operational by this means the state of insensibility was kept up during the whole operation, and might, probably, have been maintained during a much longer period with perfect safety to the patient. VALENZH The ingenious apparatus constructed by Mr. Robinson appears well adapted for the continued exhibition of the ether, in consequence of the facility which it affords of proportioning the amount of ethereal inhalation to the effect produced, and of maintaining the desired insensibility without producing any injurious effects upon the patient. of I cannot conclude these observations without expressing a hope that the person who first saggested so valuable a remedy will not be lost sight of: for, if the accidental discovery that the juxtaposition of two pieces of metal produced at elec-*** trical current was sufficient to immortalize the *** name of Galvani, surely the name of the individualga who first applied ethereal inhalation to the allevia- ** tion of suffering should be associated with discovery so fraught with blessing to the whole human race. I remain, your obedient servant, WILLIAM E. CRON FORT, F.R.C.S. Beccles, Jan. 23. C The inhalation of ether has been tried by C. Cotton, Esq., at the Lynn Hospital, and the results help to establish the fact either of its power to produce complete insensibility to pain; or an obliviousness of it, as the effect of the medicinal agent subsides. In the first case, a female with cataract, its influence was speedily produced, the operation completed, and the eye bandaged, before the patient recovered from her state of at apparent unconsciousness. In a second case of 2018 cataract, of an old unsusceptible man, at least teu minutes elapsed before insensibility could be effected, when the operation was completed with-t out pain, and the man almost immediately recovered his consciousness. In a third case, that of an old man with cancerous fungus involving thes whole lower lip, a few inhalations sufficed to prepare the patient, and the lip was completely pared by the knife, without the slightest indication of pain or the least flinching. In this case the inha lation was again repeated, and during its influence a glass rod, dipped in strong nitric acid, was repeatedly applied to restrain the bleeding, flowed rather freely from the incised part; a slight involuntary retraction of the muscles was only which observed, and the man on coming to himself said, that he had felt no pain, and it was only on the application some time afterwards of a ligature to an obstinately bleeding vessel that he first complained of pain. The apparatus used was an imperfect modification of the tube and bladder recommended by Mr. Herapath, Robinson's not being procurable at the time. The bladder was not inflated, but only washed out with hot water prior to the ether being placed in it. Mr. Cotton has also tried the ether vapour in private practice. In one case, during a painful operation, the most perfect com. posure and serenity were preserved. In a second case, boisterous, hysterical-like spasms followed, as observed by Professor Parker requiring all the force of the bystanders to hold the patient. Further inhalation, however, served to effect the required degrees of unconsciousness, and the operation was completed without the knowledge of the patient on the slightest indication of pain. I hatest 2b7 (From the Provincial Medical and Surgical Journal.) SIR, Having seen Markwick's patent spongio piline advertised, I ordered some of it to be procured, and feel bound in justice to state that it hus proved remarkably beneficial, as well as comfortable, to a patient of mine who was suffering severely from acute bursal rheumatism, affecting several of the joints. I ordered it to be steeped in warm spirit lotion, and kept constantly applied; and am so entirely satisfied with the result, that I venture to recommend its employment to the readers of your valuable journal. ༄ I have the honour to be, Sir, Your obedient servant, J. C. BADELEY, M.D. Chelmsford, Dec. 26, 1846. -། On Sunday, the 27th of December, 1846, at Stonewall-park, Penshurst, Kent, the seat of Edmund Wakefield Mead Waldo, Esq., James Johnson, Esq., Surgeon Major, late 1st or Grenadier Regiment of Foot Guards, aged 52 years. The subiect of this notice was born on the 4th of June, 1795, near Inniskillen, county Fermanagh, Ireland. He evinced an early predilection for the medical profession, and commenced in the Dublin schools, under the auspices of the celebrated Surgeon Kirby, those studies which were completed at St. Bartholomew's Hospital, London, under the late Mr. Abernethy. In March, 1813, Mr. Johnson passed an examination as regimental surgeon, before the Royal College of Surgeons, in London, and on the 25th of the same month was appointed hospitalassistant. On the 20th of July, in the same year, he was gazetted Assistant-Surgeon in the 102nd (afterwards the 100th) Regiment of Foot. On the 9th of August, 1813, he joined his regiment at Bermuda, and, in June of the following year, proceeded with it to North America, where he remained until October, 1817. On the 15th of May, 1818, he was placed on half-pay, on the reduction of his regiment; and on the 25th of the same month, in consequence of the exceeding high character of his testimonials, was appointed AssistantSurgeon in the 1st or Grenadier Regiment of Foot Guards. On the 25th February, 1819, he was again placed on half-pay, on reduction. Mr. Johnson now returned to his native country, and stood successfully a most severely-contested He did not long hold this appointment, having election for the dispensary of Manor Hamilton. been called, on the 23rd of Nov., 1820, upon fullpay of the Grenadier Guards. On the 13th of March, 1828, he was promoted to the rank of Battalian-Surgeon, and, on the 17th of April, 1840, to that of Surgeon-Major. Having completed his full period of service, he retired on the 7th of February, 1845, On his retirement, the medical officers of the Household Brigade, at a dinner given him on the occasion, Feb. 12th, 1845, presented him with a silver tea service, "as a testimony of the high esteem and regard in which he was held by them, and expressive of the deep and lasting regret they felt at parting with so valued a friend." Whilst the medical officers of the brigade were thus testifying their respect and sorrow, the commanding officer of his own regiment, not less sensible of the loss the regiment had sustained by his retirement, issued the following regimental order: "REGIMENTAL ORDER-Feb. 8, 1845. "The retirement of Surgeon-Major Johnson being notified in yesterday's Gazette, Colonel Clive cannot allow Mr. Johnson to quit the service without returning him his best thanks, and expressing his regret that the Grenadier Guards should lose those services which have so long been devoted to the benefit of the regiment. 270[To the Editor of the Medical Times.] MR. EDITOR,-Have the kindness to state in an early humber of the Medical Times, in reply to the question of "Justus" and of other friends, that I have no intention whatever of abandoning the course of Lectures on Physiology and Physiological Anatomy, commenced some time ago in your journal. For a considerable period my leisure has been wholly occupied with preparing the course of lectures on the "Races of Men," "Colonel Clive feels assured, and begs to conwhich I had engaged to deliver in various philo- vey that assurance to Mr. Johnson, that every sophical institutions. This course of lectures I member of the regiment-those who have themshall immediately have the honour to place before selves been indebted to Mr. Johnson's skill, your readers and subscribers, if agreeable to you; kindness, and attention, and those who have witafter which I shall resume, without further delay,|nessed those qualities in his treatment of others— the publication of the lectures kindly inquired will unite with their Commanding Officer in offerafter by your correspondent, & I ing to Mr. Johnson their best wishes for his future welfare. (Signed) AS I have the honour to be, Sir, Your very obedient servant, 3 la & : banal5 0 R. KNOX, "ALEX. GORDON, Adjt. Gren. Guards.” As an officer, Mr. Johnson commanded, by his manly and straightforward conduct, the respect and veneration of those over whom he was placed. If he did not exact of his subordinates a rigid performance of their several duties, he yet, by the scrupulous discharge of his own, set them an example which they could not fail to follow. As a medical man, his perceptions were keen, his diagnoses accurate, his judgment matured, and his treatment vigorous and successful. No private consideration was allowed, even for an instant, to step in between him and his duty. The welfare of his patients was his first care. His anxiety for their recovery was unbounded. Hour after hour, day after day, night after night, was he to be found at the bedside of the sick and of the dying, ministering with the most unwearied solicitude to their every want, not only as their medical at-a tendant, but as their kind and tender nurse.MATAN Mr. Johnson's intellects were of the highest order, and his judgment sound and matured. He possessed in an eminent degree the faculty of, analyzing the most complex subjects, and, by a kind of intuitive and inherent power, stripping! them of all their difficulties and subtleties, and reducing them to the level of the meanest capacity. He exhibited the most undaunted courage, the most unflinching straightforwardness of purpose, a high and manly bearing, a keen sense of honour, with an ineffable contempt and loathing for the slightest deviation from the strict line of gentlemanly conduct. Mr. Johnson, though naturally of retiring habits, possessed strong feelings, a warm and generous heart, a kind and gentle amiableness of disposition and character, which secured for him the friendship and regard of all who knew him. As a friend, Mr. Johnson is mourned by a large circle by whom he was esteemed, beloved, and idolized., ནིམ་ Mr. Johnson did not long survive to enjoy the ease and retirement of private life; he sank from repeated attacks of hematemesis, from visceral disease, the consequence, in all probability, of typhus fever, of which he was the subject in January, 1833, in common with many of the men of his regiment, which was then quartered in the Tower of London. The first symptoms of the fatal disease, under which his athletic and robust frame subsequently sunk, made their appearance during some gymnastic exercises in which he had been indulging at Greenwich, in August, 1844. After a sudden fainting, he passed inky discharges from the bowels, which continued for many months. 1 In May, 1845, he had just reached Inniskillen (from England), when he complained of chilliness. During the night he vomited several pints of florid blood, and passed a large quantity of dark blood per anum. The hemorrhage from the stomach and bowels continued, with almost unabated violence, for five days and nights, when itsen suddenly ceased. From this attack he was slowly recovering and had reached his home, Swanlinbar, when in June the hemorrhage returned as violently as before,.. though its duration was much shorter. Stilet The consequence of these repeated losses of me blood was anasarca and ascites, to an extent 259 threatening suffocation. The opinions of the ang highest medical authorities in Dublin confirmed pola the views of his medical attendants, that the ope- 2013 ration of paracentesis should be had recourse to€ without delay, but to this he objected on accountsos of the extreme tenderness of the abdomen onli pressure. Eventually, the kidneys carried off the effused fluid, and he regained a moderate share of usi health, and returned to England. In August, 1846, when at Brighton, he became the subject of jaundice, which continued more or less during a period of three months. During this time the alvine dejections were, for the most part, slate-coloured, and the urine of a deep saffron hue. th On the 29th day of October, when at Stonewall-park, he vomited, without any previous indisposition, two pounds and three quarters of ning sot gaduya (or od se mi m florid blood. Another similar vomiting followed | Societies, is about to be established, under the An examination of the body was made on the morning of Monday, the 28th, sixteen hours after death, by his relative Dr. Dundas, and Dr. Pickford, formerly of the Grenadier Guards, when the following apppearances were met with. On open ing the abdomen, the diaphragm was found flaccid and hanging down into the cavity of the abdomen. The spleen was enlarged bloodless, and firmer than natural, and its capsule about one-third of an inch thick; this organ was adherent to the diaphragm and lining membrane of the costæ. The liver was somewhat smaller than natural, and in a state of genuine cirrhosis throughout. The lobulus spigelii was the least affected-this organ tore under the finger; the gall-bladder was full of healthy bile; the liver was firmly bound to the diaphragm, and to the lining of the costa, by fleshy bands. The ascending portion of the colon was firmly adherent to the inferior surface of the liver, and sent a solid band into the fossa umbilicalis. There was no communication between this bowel and the liver. The stomach was opened throughout, and the duodenum and jejunum, but nowhere could any ulceration or open vessel be discovered. The exsanguined condition of the viscera militated against any opening of a vessel being found, The aorta was actually empty, a perfect "air tube," as well as the veins. There was not blood enough left in the body to soil a cambric handkerchief. The whole of the viscera were removed from the body, and upwards of two hours occupied in their examination. Lungs healthy; heart empty and flabby. Mr. Johnson was buried on Saturday, the 2nd of January, 1847, in the chancel of Hever Church, Kent. His body was followed to the grave by a large number of old and attached friends and brother officers; the pall being borne by three officers of his own regiment, and by the SurgeonMajor of the Scots Fusilier Guards. GOSSIP OF THE WEEK. MORTALITY OF ENGLISH TOWNS.-The mortality of England is 1 in 45; that of the metropolis is 1 in 39; of Birmingham and Leeds, 1 in 37; of Sheffield, 1 in 33; of Bristol, 1 in 32; of Manchester Union, 1 in 30; of Liverpool parish, 1 in 29. Dr. Branson relates an interesting case of ascites, in which an immense number of hydatid cysts were evacuated with the fluid by paracentesis. The disturn until more than five years after, when it was ease was removed by the operation, and did not reremoved a second time by a similar operation. Dr. Bellingham gives a decided preference to from the tumour, the artery is obliterated, both at The late High Sheriff of the county of Brecon, present Coroners for the city of Brecon, are medical the county of Brecon to have one of its coroners a IMPORTANT TO MEDICAL MEN!-Medical pro- Wanted, as head butler, in a gentleman's family at the west end of town, a respectable middle-aged man, well acquainted with the duties of his office. Salary £60 per annum. Address to A.Z., 64, Piccadilly.-See Times, passim. MEDICINE MADE INTERESTING. "If born purblind, the Eyes in 27 days, 'unshell' a skin. "Life,' Restoration after 'Railway nervous Shock,' by special request, address to C. Ackerley, Esq., 5, Swallow Street, Quadrant, London. "N. B. For Cure, none need repine, as tranquil SLEEP is a consequent, to Asthmatic's on 'reliquification' of the blood at the four seasons... "Zodiac Virgo 30A. Tacit. His. iv. 81.! "A marriage-ring, etc. suspended (three inches from the right fore-finger and thumb) over a tumbler glass, oscillates hourly in tranquil' health, the last hour night and day: as the fibril touching proof-in unison to every 15 degrees of the passing shadow on a Sundial, graduated to 360 degrees-the horizontal circle." THE LONDON MEDICAL DIRECTORY FOR 1847. CHURCHILL.-We notice with pleasure the appearance of this useful annual. The Directory for 1847 is much improved, and the editors appear not to have overlooked the suggestions which have appeared in our pages. Altogether, the "London Medical Directory" is so creditable a production that we shall revert to it more fully when in possession of its sister production, the 'Provincial Medical Directory." OBITUARY.-On the 22nd inst., at Burtonupon-Trent, John Spender, Esq., M.D., in the 77th year of his age. On Monday, the 25th inst., at Denmark-hill, John Buxton, Esq., M.D., of Brownlow-street, Bedford-row, in the 28th year of his age. APOTHECARIES' HALL.-Gentlemen admitted members on Saturday, Jan. 21:-George Wilms hurst and William Sutherland Meek. SCARCITY OF PROVISIONS IN ADEN.-We are sorry to hear that our countrymen in the barren colony of Aden have been suffering from want of vegetables. Our last advices from that colony state that provisions of this kind are obtainable with difficulty from Arabia, and are mostly obtained from Bombay. THE PRICE OF BEER.-It was stated by the Chancellor of the Exchequer that the London brewers had raised the price of porter twelve shillings a barrel. This is not true. The advance has only been five shillings a barrel, or rather less than one halfpenny a quart. The additional advance has no doubt, in many instances, been made by the retailers. MORTALITY TABLE. Causes of Death. Total. 5 Winters, ALL CAUSES.... The following advertisment appears in a recent Zymotic (or Epidemic, En number of the Silurian : SPORADIC DISEASES. and "St. EDWARD the Confessor's' CO FIBRIL RESPIRATIVE-TOUCH. Saint Edward.. &c., Dropsy, Cancer, and other maintained for skin-cures, as SCROFULA, A. D. 1051, that the thread like, air nerve fibrils, from the brain, seat of sensibility, to and down the sides of fingers & toes, to their end-points in Death became joined. That during health, these tubular fibrils-intuitively touch-in antagonistic ROYAL COLLEGE OF SURGEONS.-Gentlemen'cor'-respondence, as touching together' in admitted members on Friday, Jan. 22:- S. second-time, for balanced animated locomotion. 'M. C. A. A. Smith, J. Goodlad, J. L. Johnston, Hence, by this Physiological insight' varicose veins E. D. Allinson, T. Bridgwater, A. G. Willington, change colour within the hour,' by the OXYDE H. G. Grayling, G. R. Skinner, C. H. Dunhill, J. of BEES' WAX, for flame-vacuum dilation of Hyslop, W. E. Hughes, J. Bucroft, C. W. Wray, these fibrils in Scrofula. On lactic acid offset; the W. A. Salmon, W. Weston, W. F. Tomkins, T. H. agonized Mother regains each 15 lest breastTanner. milk-jets for babe,* in comet'-like cause. Contractions of Limbs' through chill, &c., are eased on renewing antagonistic muscular-elasticity, as in the cuse of the Earl of Derby in 1845, and Dr. King's (right hand for 'writing') at 'Queen's Coll.' Cambridge, when paralysed. ROYAL COLLEGE OR SURGEONS.-The appointment of Professor of Surgery to this institution, vacant by the resignation of Mr. John Flint South, caused by severe indisposition, has just been conferred on Mr. James Paget, the warden of the collegiate establishment in St. Bartholomew's Hospital. THE CAVENDISH SOCIETY.-A new society on the plan of the Parker, Camden, and Sydenham "References will be given, on taking ADVICE, from 6 to 8 A.M., & 11 to 12 daily, for outing of fire-damp sufflation gas, and all'incurable' consumptive like cases. Diseases of uncertain or Violence, Privation, Cold, ORIGINAL LECTURES Course of Lectures on Clinical Medicine, delivered at Queen's College, Birmingham, by S. WRIGHT, M.D. PROGRESS OF MEDICAL SCIENCE 355 FEB. 6. linger, and require a little attention to diet, and Academy of Sciences; Meeting of Jan. 25........ 356 357 Faculty of Medicine 357 COURT OF QUEEN'S BENCH-WAKLEY v. THE 363 MORTALITY TABLE ORIGINAL LECTURES. In the autumn, again, simple fever is not un375 frequent, and it is apt, like the spring variety, to acquire certain complications, or to lead to ailments more definite in their type, and more serious in their tendencies. Of these, the chief are diarrhoea and dysentery. A peculiarity in the epidemic visitations of 1846 was the reverse order in which they came-for we had the diarrhoea and dysentery in the spring and summer, and the fever, in its several varieties, in the autumn and commencing winter. A COURSE OF LECTURES ON CLINICAL Delivered in the Theatre of Queen's College, Birmingham. Summary and object of generalities already treated common ailments of the spring season, and complications of them; autumn fever and its complications; appearance of bowel complaint in the spring of 1846; varieties and complications of it; symptomatic and idiopathic; circumstances under which it proved fatal; illustrations; symptoms of this diarrhea; variety of fæces, and analyses of them; composition of certain of them-barmy, green, and rice-water evacuations; nature of the vomited matters; terminations of the diarrhea; dysentery in the spring and summer of 1846; varieties of it; idiopathic and symptomatic; difference between bilious and bloody stools; mode of discriminating them; vomiting in this dysentery; matters ejected. GENTLEMEN,-I have now said all I have to say on the generalities of clinical medicine. I have introduced these things in a preliminary form, so that they may be in some sort a guide to you, during the further period that you prosecute your practical studies under my personal superintend ence. I took occasion, at the commencement of this course, to tell you that I wished my introductory observations to be regarded, not for themselves alone, but for the further and more valuable truths to which I hoped they would direct your attention, and which, also, I hoped they might aid you in acquiring. Let me once again impress you with the fact, that all I have heretofore said in this class-room has been with the simple object of giving you an estimate of how valuable is clinical experience, and how it is best to be obtained and applied. I have now to proceed with the more special and direct duties of this chair. But before considering the cases which have been treated in the hospital, and under your immediate observation, it will perhaps be well for me to say something concerning the epidemic diseases of last year, with which Birmingham was visited somewhat roughly. They involve some pathological considerations not uninteresting, and, moreover, their detail, with a practical commentary, may not be without its usefulness in your future medical career. You are aware that in the spring season, simple fever is apt to be prevalent. People say " it is a cold that is going about ": it is chiefly characterized by alternations of heat and chilliness, impaired appetite, listlessness, thirst, frontal headache, pale furred tongue, dry skin, and quick, weak, irritable pulse. These things will commonly pass off, unassisted, in the course of from a few days to a fortnight; but sometimes they seasons. It was about the latter end of April, last year, that the bowel complaint made its appearance in this town. The previous part of the spring, and indeed the whole winter, had been unhealthy: adynamic fever was common, and smallpox was more general and more fatal than is usual at such manifested, appeared to be a result of the fever, The simple diarrhoea, as it was first for it only occurred (to my own observation) in subjects that had previously suffered from "cold," as they called it. In some of these the fever was perceptibly heightened on the advent of the diarrhoea, and yielded less easily to treatment; in others the type of the fever was changed by it, the pulse becoming quicker but more feeble, the tongue dry and dark-coloured, the strength much reduced-the tendency being clearly to a typhoid condition; in others, again, the purging appeared to be salutary, and to constitute a crisis of the fever. In several instances, indeed, it proved completely curative, all unpleasant and untoward symptoms subsiding almost directly that it came | on. the man simply sunk from exhaustion, caused by sudden, and rather profuse, purging: this would probably have done nothing more than debilitate him for a time, had he been in previous good health; but, weakened as he was by impaired nutritive function of some duration, he was prostrated at once by the discharge, and the shock of its suddenness, and had no power to rally. As the spring advanced, this diarrhoea manifestly increased, and though in many instances it was evidently consecutive of fever, in many more it plainly originated from other cause than this. Still the cause was not evident. We had, then, two varieties of the intestinal affection: one sympto matic of fever, the other idiopathic, so far as we could judge. The latter, in the majority of cases, implicated also the stomach, and epigastric tenderness and nausea were concomitants of the diarrhoea. In this form the ailment was seldom severe, and very seldom intractable, except in old people, or in such as had been disordered or debilitated by previous circumstances. In a few cases of this kind the powers of life were quickly reduced, and the patient sunk without affording any chance of being saved. In particular, I may mention a case in the post-mortem of which I assisted Dr. Mackay. The subject was a man in about middle life. He had suffered from dyspepsia of several weeks' duration, frequent nausea or vomiting, and diminished appetite. He improved, however, under treatment, but was one day suddenly seized with profuse purging, which resisted all remedies, and killed him in less than twelve hours. The body had a wasted, exsanguined appearance, but was otherwise not unhealthy, except in its gastric portion. The cardiac extremity of the stomach was strongly marked by injected vessels, which were conspicuously arborescent all over it. The mucous coat was thin and easily detached with the scalpel, and the muscular texture was finer and less firm than natural. The pyloric orifice was somewhat contracted, and the membrane, to some extent around it, had a dusky red tinge. The stomach_contained four ounces of greenish fluid, chiefly bile. The intestines were, here and there, slightly patched with vascularity, but other wise presented no morbid aspect. In this case In another case which I inspected with Dr. Moffatt, of Erdington, the man, about forty years of age, died after a few hours' purging, by no means severe. The only morbid appearance was dilatation of the heart, especially in the right auriculo-ventricular opening, and extreme thinness of its parietes. So thin was the right auricle that it was quite a wonder how it could have cóntracted upon its contents. This man's life must have long been in jeopardy; and we can easily understand how any debilitating cause, mild though it might be, would paralyse the functions of such a heart as he had. With exceptions furnished in cases like those above, and in other such, I am not aware that the simple diarrhoea I am speaking of had any fatal tendency or termination. Its periods of accession were irregular, but were chiefly early in a morning, or shortly after breakfast, or after dinner. A little twisting of the bowels, with or without antecedent nausea, was the first sign, and was shortly followed by an urgent desire for evacuation. This, at first, genematter, more fluid, but still distinctly fecal. After rally consisted of solid fæces, intermixed with other this, the repetition of the intestinal action was very variable; in some cases occurring not more than half a dozen times a day, in others as often in the space of an hour. These dejections were not constant in their character. The most frequent was a frothy motion, looking exactly like yeast. It was not commonly offensive-sometimes I observed it to be almost odourless-and it was not deficient in bile, but this seemed to be of a poor quality. These fæces appeared to be chiefly composed of bile and intestinal mucus. By agitating a portion with twice its volume of alcohol, the mucus, though not coagulated as it would have been if thus treated alone, was yet sufficiently thickened not to pass through filtering paper. If thrown upon this, and exhausted with further additions of alcohol, the colouring and other matters of bile, soluble in this menstruum, passed through, and were obtained free from extraneous mixture. On evaporating these solutions to dryness, it was found that they afforded scarcely less biliary matter than should have been contained in the original fæcal fluid, but it was not deepened to an ordinary extent on the addition of nitric or muriatic acid. The substance left upon the filter was not capable of diffusion through water, seemingly in consequence of the action of the alcohol, but, after agitation in water, rendered feebly alkaline with caustic soda, it formed a mixture whose chief ingredient presented all the ordinary characteristics of mucus. This barmy kind of evacuation, therefore, I consider to have been mainly composed of an inferior kind of bile and intestinal mucus. Other of these fæcal discharges were, for the most part, bile itself, and of a good quality, uniformly liquid, nearly odourless, bright yellow, and imparting a distinct turmeric sort of tinge to writing paper. These fæces were uniformly alkaline, but others were acid, and were chiefly distinguished by their grassgreen colour. This, I have no doubt, was occasioned by the bile being acted upon by some acid secreted by the stomach, or intestines, or both; for I produced exactly the same appearance by adding a small quantity of nitric or muriatic acid to the yellow bilious stools. In some rare cases of this diarrhoea, the dejections were pale, like rice-water or thin gruel. This appeared to be owing either to an excessive secernent action on the part of the intestinal mucous membrane, or to a simple straining, or transudation, through the coats of its bloodvessels, of the watery part of their contents. In the one case a very dilute form of mucus was produced, in the other the |