An Epitome of Toxicology, beates, and some other metallic preparations, when swallowed, are partly converted into sulphurets, chlorides, &c. DESIGNED FOR THE BUSY PRACTITIONER AND Calomel forms a soluble compound in the stomach, and by ANALYTICAL CHEMIST. (COMPILED FROM THE LATEST AUTHORITIES EXPRESSLY FOR THIS WORK.) (Continued from p. 407.) a new arrangement of its atoms, yields bichloride of mercury, which immediately unites with fresh organic matter. Some liquid substances, as certain aqueous solutions, alcohol, ether, oils, &c., merely mechanically mix with the fluids with which they come into contact, and in that state are absorbed. The same remarks apply to many solid substances which are soluble in the fluids of the body, Substances which are perfectly insoluble are rejected, unchanged, and merely act mechanically during their passage through the body*. In our next number, we intend to present the reader with a summary of nearly all that is known in connexion with this part of our subject. (To be continued.) The CHANGES WHICH POISONS UNDERGO IN THE LIVING BODY have long been matters of consideration and research, These changes depend on the chemical and physical forces that are called into operation by contact between the foreign substance and the tissues, or by the action of the organism, to which we have already referred. Variations of tempera- The changes which poisons undergo subsequent to their abture, the quantity of the deleterious body present, the rela-sorption, and whilst still within the system, form a subject tive vitality or energy of the system, and fluctuations in of considerable interest and importance. Our observations the respiratory process, the circulation of the blood, &c., are for this purpose are directed to the condition in which they circumstances which modify this action, and the degree and are detected in the living tissues, and in the fluids and rapidity of these changes, Many substances, which are excretions of the body; and we are assisted by a knowledge not deleterious so long as the integrity of their composition of the mutual affinities which exist between the respective is maintained, are thus converted into poisons by suffering substances and the constituents of the organic matter with decomposition, or by entering into new combinations, which they are placed in contact. In some cases, however, forming new compounds. Such is the case with Acetate of "The compounds found in the excretions may have been lead, (Sugar of lead,) of which considerable doses may be formed after their constituents were thrown out of the system. borne, if its administration be accompanied with a sufficient Thus the union of oxalic acid with lime, and the formation quantity of acetic acid to prevent gastro-intestinal decom- of the octohedral crystals of oxalate of lime must have position, but which is otherwise converted into the poisonous taken place after the oxalic acid was secreted by the kidcarbonate of lead, (White lead,) either by the decomposition ney."t of its own acid, or by its base combining with the carbonic acid it meets with in the system. Other substances which, whilst in the solid state, owing to their insolubility, are comparatively inert, become active poisons by meeting with a solvent in the fluids of the body. On the other hand, some substances which enter the circulation as soluble and non-deleterious compounds, form new combinations in the blood, and become insoluble, in which state they act as mechanical irritants and poisons, by accumulating in the capillaries, and producing organic chages. The artificial production of changes of the composition and physical character of bodies in the living system, will be referred to when we The king thought it a duty of his regal office to consult in come to treat of the subject of chemical antidotes to poisons. Some poisonous substances suffer little or no change in every way the happiness of the inhabitants of his realm; and the organism, and are thrown off unchanged from the therefore to repress the audacity of the wretches who pracsystem. This is the case with Chloride of Barium, Nitrate tised medicine from avarice, rather than a good conscience; of Potash, &c. There are several other substances, as pow. whence many disadvantages arose to the rude and credulous dered glass, enamel, &c., that pass through the prima viæ people. He instituted the College to repress, in the name unchanged, and whose primary action, from their insolu- of public utility, the ignorance and audacity of the evilbility, is that of mechanical irritants only, producing poi-doers, by the example of its associates, by the laws, and by soning by the physico-vital changes which ensue therefrom. its regulations. The college thus constituted of all the The investigations undertaken to ascertain the changes The charter gave a common seal, the right to sue and be physicians in London, had to elect a president annually. which bodies suffer on their first contact with the organism, have not been either numerous or precise; but the changes sued, &c.; and power to hold lands and tenements not exwhich poisons undergo subsequent to their absorption by ceeding 121. in annual value. No one was to practise in the system, the parts of the body in which they are localised, London, nor within seven miles round, unless he had been the fluids in which they appear, and the state in which they admitted by the College. This clause gave the College a are expelled from the body, and the excreting organs by monopoly; as it enabled it to restrict the number of licensed which this elimination is effected, have formed the subjects practitioners. The president and College were to elect four of continual and elaborate research. The results of these persons annually to have the supervision of all practitioners, investigations fully demonstrate the vast importance of ac- their decision to be enforced by fines and imprisonment. and all medicines-et earum reception' per dictos medicostual experiment in this department of Toxicology. Before the charter was brought to Parliament, the usual The changes which bodies undergo on FIRST coming into contact with the fluids and tissues of the body are frequently of a character which greatly modify their chemical properties and physiological effects; and on the new properties thus acquired many of the chemical changes which occur in the system subsequent to their absorption depend. Thus most of the metallic oxides, and the metallic, alkaline, and earthy salts, form new compounds with the albumen, casein, ptyalin, pepsin, or other substances with which they come in contact. The acids combine with bases, and the resulting salts form new combinations with organic matters. The alkalis, alkaline earths, and alkaline and earthy carbonates are decomposed by the acids of the alimentary canal. Chaly See also some remarks at page 308 on some circumstances which obscure or modify the action of poisons. HISTORY OF THE MEDICAL PROFESSION ས་ It has lately been asserted that insoluble substances may be absorbed by the organism. This statement is made on the authority of the experiments of Oesterlen, which are, however, far from conclusive. It appears probable in the supposed cases of absorption referred to, that either the substances are not strictly insoluble, or that their composition or condition undergoes a gradual change from chemical or electro-chemical action being set up, producing a soluble compound. (Vide Monthly Jour. of Med. Science, 1847. + Pereira Materia Medica, Vol. I. This is probable, but not so certain as the authority quoted seems to think. The which under ordinary conditions are insoluble, but which ne instances are numerous, in which compounds are formed, vertheless continue in solution long after their formation. This property of substances in connexion with precipitation and crystalization is known to every chemist. LONDON: PUBLISHED AT THE OFFICE, 20 KING WILLIAN characteristics of the old corporate system betrayed themselves; the six physicians desired to turn the College to account, and usurped the presidency. They prayed no more that the college might elect the president annually, but that the six may choose two more of the community, to be thenceforward called and cleped elects: the elects to choose one of themselves annually to be president, and, in the event of death, the survivors to admit a new elect from among the most cunning and expert men of the faculty in London. The new elect to be strictly examined. No person was henceforth to be suffered to practise physic, in England, until he had been examined by the president and three elects, except he were a graduate of Oxford or Cambridge, who had accomplished all things for his form without any grace. The 32 Henry VIII, c. 40, (anno 1540), exempted the fellows from keeping watch and ward, from the office of constable, and any other office of the city, as they had been before exempted from the office of jurymen. It gave the right of searching apothecaries' shops, and of destroying bad drugs. The act 14 and 15 Henry VIII had not the customary Le Roy le veut attached to it, and the Chief Justice St John would not admit the patent as a record. This was alleged in a trial 33 Car. II, and, moreover, that Wolsey had received a great sum of money to foist it in among others. The act, however foisted upon Henry VIII, was confirmed by 1 Mary, sess. 2, c. 9, anno 1553; which also enjoined Jailers of all prisons, except the Tower, to receive transgressors committed by the College, and to keep them at the prisoners' charge. Magistrates and all officers of justice were commanded to aid the president of the College in the discharge of his duties. All the licentiates of the College entered the College; they elected the four persons afterwards called censors, who exercised the powers and asserted the privileges of the whole body. The elects only chose the president. In Goddard's case (1660), Wilde argued for the College, that, by the act of Parliament, 14 Henry VIII, there were none but president, elects, and censors; that all the commonalty were socii; and that the thirty then chosen were called socii by the bye-law, not by the act of Parliament. On this ground the College gained the trial. In the first Pharmacopoeia (1618) there is a list headed, Nomina DD. Collegarum Socictatis Medicorum Londinensum, hodie viventium. H. Atkins, M.D., is president; he is also called physician in ordinary to the king. Theodorus de Mayerne, M.D., regiarum majestatum medicus primarius, is followed by W. Paddy, J. Craig, regii medici ordinarii, and thirty other names without any further distinction. In the third edition (1627) the names are the same as in the first edition, but the seven first are denominated seven of the eight elects. In the fifth edition (1638) the orthography of the names only is altered. Harvey is called medicus regius juratus; J. Craig, junior, is archiater to Prince Charles. In 1651 the list was revised: after the lapse of thirty-three years seven of the thirty-four remained. The list comprised forty-six names, nine of whom were called candidates, including Scarborough, Warton, and S. Collins. In 1662 the names remain literally as in 1651, not having been corrected in the interval. George Ent was president in 1677 and 1678, when fifty-four names of the fellows (sociorum) of the Royal College are enumerated in the Pharmacopoeia; and twelve candidates, fifteen honorary fellows, and ten licentiates (permissi). OUR Friends and decided kind as to accessible locality. In Dr Fothergill's case (1770), the College of Physicians asserted that so early as 1555, the faculty was divided by a bye-law into three classes-fellows, candidates, and licentiates, the latter class not being of the commonalty. But it was admitted that the bye-law did not exist in writing; and it is certain that the distinction was not recognised in the Pharmacopoeia of 1662. So early as 1552, however, practitioners in the country were examined and licensed by the president and three elects, and this probably suggested the application of the principle to London. The founders of the College practised physic, surgery, and pharmacy; they prepared medicines, notwithstanding the existence of the grocers; and the 32 Henry VIII, c. 4, § 3, declared surgery a part of physic, and sanctioned its practice by the fellows; it is therefore evident that they were, in the strict sense of the word, general practitioners. They were not consulting physicians; they recognised no right in the apothecary to practise; he was in their eyes a mere druggist; the physician conducted the treatment of the case from the beginning to the termination. The new company first aimed at limiting the number of practitioners. A bye-law fixed the number of licensed fellows in London to twenty; public opinion drove the College to extend the number, and thus defeated to a certain extent the attempted monopoly, which, by making medical advice scarce and almost inaccessible, secured the corporators, however slender their qualifications, high fees and an extensive practice. The heads of the College resolved to retain the government, at least, in the hands of a small number. A bye-law limited the number of members who sat in comitiis to thirty; a charter (1633) extended the number to forty. This charter named forty fellows and ten elects: the place of the fellows, like that of the elects, was to be filled up by self-election from "the commonalty or members of the College." This corrupt charter vested all the power in the forty fellows. Charles II expressed his readiness to give his royal assent to any bill based upon the principles of the charter, and the College made a grand attempt to pass a bill which they had prepared; but in the words of Mr Huybert, "a parliamentary committee dismissed the College-men as re infecta, and they returned home with a flea in their oar." This did not prevent them from acting, to a certain extent, on the principles of the charter. The commonalty became merely permissi-licentiates. Goodal (The College of Physicians Vindicated, by C. Goodal, Doctor of Physick, anno 1676'), after stating that none was admitted a candidate until he had practised physic four years, gives from the bye-laws the alleged "reason of not receiving the licentiates into the government of the College." "It is because many practise physick in this city whome we think altogether unfit (inidoneos omnino) to be admitted into the number of fellows or candidates, as being not Englishmen by birth, or not having taken the degree of doctor, or not sufficiently learned, or not of a competent age of gravity, or for other such like causes; yet seeing they may be serviceable to the commonwealth, and procure the health of men, at least in some cures, we do therefore ordain that, after due examination and approbation of the president and censors, they may be permitted to practise (permittantur ad praxin.)" The examinations were three, and "much of the same nature" with those of the candidates; the first turned on anatomy and physiology, the second on pathology, the third on the method of cure. (To be continued.) SUCCESS OF THE MEDICAL CIRCULAR.' Patrons will be gratified to learn, that the success of the CIRCULAR' is of that justify our REMOVAL to more commodious Offices, situated in a more public and After the 25th of June, our friends will find us at No. 128 STRAND, Directly opposite the Lyceum, and next door to the Globe' Newspaper Office. 1853.] Biographical Notices. HUGH CAMPBELL, ESQ. This gentleman was apprenticed in Belfast, December 1837, to Dr J. D. Marshall, the professor of Materia Medica in the Royal Academical Institution, and also at the same time to Dr J. M. Sanders, Surgeon to the Belfast Hospital, the first operative Surgeon in the North of Ireland, who, had he lived, would have earned a large and lasting reputation. After attending the classes in the Institution and seeing a large amount of hospital practice for a period of four years, Mr Campbell matriculated in 1841 in Trinity College, Dublin, where he continued for two years, attending the lectures of such men as Harrison and Montgomery, and giving a considerable portion of his time and attention to the clinical practice of the Meath Hospital, then the seat of the labours of Crampton, Stokes and Graves. After this period he went to the University of Edinburgh, with the intention of graduating there according to the plan usually adopted by young men in the north of Ireland, who seldom or never continue altogether at one school of medicine, but prefer attending the lectures of eminent men wherever they can find them; and generally have a course in Belfast, then one in Dublin, and spend the last two years of their academical life in Edinburgh or Glasgow, at either of which Universities they take a degree. Edinburgh has heretofore been preferred, from the difficulty of the examination and the greater range of study required, its diploma being more respected in that part of the world where generally the future scene of the candidate's labours will be laid. to GEORGE FREDERICK COLLIER, M.D. When we civilly wrote to thee asking thee for the details "P.S.-Dr C. would not even trouble himself to reply, Oh, George Frederick Collier! thou seemest to prefer a jest Having remained here more than a year, private affairs made it desirable that Mr Campbell should settle in London, and knowing the difficulties the young and friendless physician has to contend with in the great metropolis heart not one of those gentlemen with souls all points and abondoned the idea of mere academical honours, and determined to work his way amongst strangers as a general practitioner. He therefore passed the College of Surgeons of England in 1845, and, after devoting nearly one year continental hospitals and schools, and another to making himself conversant with the details of the system of business Here he as a general practitioner, so different from the usual customs of Ireland or Scotland, he settled in Bedford row. tried hard to work his way into practice, but finding the ground preoccupied, he determined to alter his locality. He then removed to his present neighbourhood, where he has continued ever since, and where, we have reason to believe, he has ample opportunities for applying whatever stores of medical knowledge he may have gathered during his academical career. He resides at Lawford villa, Ball's pond. J. COLES, ESQ. He This gentleman is well known for the attention he has bestowed on Spinal diseases; being the Founder and late Senior Surgeon to the Hospital for Diseases and Distortions of the Spine, Chest, and Hip-Joints in Newton street. passed his examinations at the Apothecaries' Society and the He is the inventor College of Surgeons in the year 1825. of what he terms an Orthopedic Sofa for the treatment of Spinal Affections. In 1845 he published a Work on Spinal Affections and the Prone system of Treatment. He also published in 1850 a Treatise on the Medical virtues of the Alga Marina, a concentrated essence of Sea-weed; and in 1852 on the Tapeworm, its History and Cure by means of the Brayera Anthelmintica, or Kousso. He resides at 26 Edward street, Langham place. CHARLES COLLAM BELL, ESQ. (Vide London Medical Directory,' 1853.) When an explorer wishes to convey an accurate know. "For though the thing be neither rich nor rare, Dr Collier passed the Society of Apothecaries in the year The Translation of the London Pharmacopoeia' by Dr AR LONDON: PUBLISHED AT THE OFFICE, 20 KING WILLIAM ST D. On the Excision of Enlarged Tonsils. betray the spirit of the anthor, who seems to delight in exposing the faults and mistakes in the book he translates. Unlike most other translators, who generally fill their footnotes with expressions of suggestive praise, or self-humbling veneration for the genius of their author, the Doctor puts [Esteeming the following correspondence of considerable on his spectacles for no other purpose but to discover blun-importance, and deserving of the utmost publicity, we have ders, and whets his wit only to expose them. He seems to reprinted it from the columns of the Medical Times and nurse some unappeasable grudge against the authorities of Gazette.' Mr Toynbee's letter would have appeared on the that respectable College, who, by the way, endeavoured to week after it was published, but that we were anxious that procure an injunction to stop the publication of his book. the reply should accompany it, in order that the profession Dr Collier has also translated Celsus, and has written might be in possession of the entire evidence to enable them a book about cholera, intituled Code of the Laws of to form a satisfactory judgment on the matter.-ED. Epidemics.' 'MED. CIR.'] Some years ago Dr Collier engaged in an angry controversy with the authorities of Westminster School, and we believe that this affair resulted in an amelioration of the discipline of the school, and was a public benefit. The Doctor has been chiefly known as a translator and editor of works for students, and as a "grinder" to prepare candidates for examination at the College of Physicians and similar licensing bodies. He is now fading into the sere and yellow leaf, but, as his note to us evinces, he has not yet lost any of the vigour and vivacity of his intellect. So much, then, for Dr Collier, whose character we trust that we shall not be considered to have expatiated upon with undue levity. His note was written to us for publication, and he therefore invited the strain of comment in which we have indulged. However, let us not forget the Hora tian maxim: OUGHT THE TONSILS OR UVULA TO BE Fellow of the Royal College of Surgeons, Aural Surgeon to I feel that the surest way for a medical man to support his own dignity and that of his profession, is to search perseveringly after the truth, turning neither to the right hand nor to the left, but laying the results of his labours before competent medical or scientific tribunals. I have always endeavoured to pursue this course; and, when urged to expose the fallacy of some nostrum, or the absurdity of some novel procedure in reference to the diseases of the ear, I have declined to do so, from the conviction that the most effectual mode to extinguish error is not so much by attacking it, as to throw upon it the light of truth, under which it must inevitably wither and die; and as empiricism was eases of the eye, when those diseases were studied earnestly by scientific men, so likewise will aural surgery stand out honourably when investigated with patience and zeal. Nor should I now deviate from the course I have hitherto pursued in wholly abstaining from personal controversy, did I not feel it my imperative duty to the profession and the public to remain silent no longer. Qui, ne tuberibus propriis offendat amicum, Postulat, ignoscat verrucis illius. Equum est, Peccatis veniam poscentem reddere rursus." We believe him to be a worthy though an eccentric man, and to have higher parts and warmer affections than he has cared to show. He has set up for a wit, and while perform-driven out of its former stronghold, the department of dising in that character has managed to cramp his powers, and to give an ugly twist to his understanding. A man who is always doing one thing may perchance do that well, but he can do nothing else. If he will persist in hopping on one leg, he must expect the other to shrivel and contract. However, each man has his tastes, and we should not quarrel with Dr Collier's if he had not solicited our judgment. Pretermitting that murderous gibe he sent to us we find no fault with him he is a clever, courageous, honest man, and the worst thing we wish him is, that when the failure of life shall finish his jokes, may he have his revenge, and, like many a jester before him, finish life with a joke. He resides at 32 Spring gardens, and Bohemia House, Turn-tubes," In a letter in the Medical Times and Gazette,' of ham green. THOMAS POOLE COLLIER, ESQ. JULIUS COLLINS, ESQ. J. COMLEY, ESQ. EDW. THOS. COMPLIN, ESQ. (Vide 'London Medical Directory,' 1853. ADMINISTERING CHLOROFORM TO ANIMALS.-At Hitchin, on May 18, Mr James, veterinary surgeon, administered chloroform to two hunters, previous to the operation of firing. The horses were entirely insensible to pain. MEDICAL REFORM.-On Monday, Mr Hutt presented a petition to the House of Commons, signed by Charles Sea, Medical Practitioner of Hull, complaining of the unsatisfactory and conflicting state of the law relating to the practice of medicine. Chirurgical Society, on the 'Diagnosis and Treatment of In a paper lately read before the Royal Medical and Diseases of the Eustachian Tube,' I took the opportunity of impressing upon the members the fact, that "enlarged tonsils are never the cause of obstruction in the Eustachian April 23, Mr Yearsley denies the accuracy of my statements, and he takes occasion again to advocate the operations on the tonsils and throat, which he says he has performed more than three thousand times. Feeling convinced that such operations have been productive of the most calamitous results, and that my silence now would be construed into a tacit admission of their propriety, I submit the following observations respecting them. Mr Yearsley advocates the excision of the tonsils, uvula, or portions of the palate, in four distinct classes of cases, which I will examine separately. The first class consists of those cases where the tonsils "press on the mouths of the tubes so as to cause obstruction or occlusion." An opinion formerly obtained a certain amount of credence in the medical profession, that enlarged tonsils can press upon and close the faucial orifices of the Eustachian tubes. There can be no doubt that this opinion was erroneous. In order to convince himself that it is so, the surgeon needs only to make an examination of the relative position of the tonsil and of the trumpet-shaped extremity of the Eustachian tube; he will find the tonsil situated from an inch and a quarter to an inch and a half below the tube; he will find the tonsil placed between the arches of the palate, the palato-glossus, and palato-pharyngeus muscles, the latter muscle separating the tonsil from the tube; and he will find the Eustachian tube Yearsley on 'Throat Deafness,' page 4. 1853.1 * excision may generally be dispensed with except in extreme Secondly, Mr Yearsley advocates the excision of the ton- close to the base of the skull, against the basilar process of the occipital bone, and surrounded by the tensor and levator palati muscles, the office of which I have recently shown in a paper read before the Royal Society, is to open the tube during the act of swallowing; at all other times the tube is closed, and the tympanum is a shut cavity. Repeated examinations have convinced me, that, even should the tonsil enlarge to its greatest possible and known extent, it never reaches the Eustachian tube : for, with the enlargement of the tonsil, the palato-pharyngeus musele also hypertrophies, and effectually separates them; that, as a general rule, the Eustachian tube can be shown to be pervious by the observer listening to the patient's ear with the otoscope, while the patient swallows some saliva with the mouth and nares closed (that when the tube is obstructed this obstruction depends upon the thickening of its own lining membrane), and that the deafness, thought to be attributable to the enlarged tonsil, arises from a co-existent thickening of the I do not stand mucous membrane of the tympanum. I feel confident alone in the opinion here expressed. that the intelligent members of the profession fully agree In page 9 of the same brochure it is asserted, that twowith me. Kramer, in his Treatise on the Diseases of the Ear,' translated by Dr Bennett, and published so thirds of all cases of deafness arise out of morbid conditions far back as the year 1837, says, at page 237, "I alto- of this mucous membrane of the ear; allusion is made, in gether deny the connection of closure of the Eustachian proof of this assertion, to 2,000 cases treated in public and tube with enlargement of the tonsils. I have frequently private practice. Then comes the following passage :-" In This reads as if the seen this enlargement, both with and without the least dul- 120 dissections of deaf cases, the aural mucous membrane ness of hearing, but always with the Eustachian tubes per- was diseased in no less than 91 cases, or upwards of threefectly free. I confess that I cannot at all comprehend how fourths of the number examined." swollen tonsils should press together the mouth of the dissections were by the author of the pamphlet; but they Eustachian tube, and close it against the admission of air; are evidently those published by myself, in the second and may assert that none of the practitioners who have series of Researches into the Pathology of the Ear, published admitted such mechanical effects, have ever satisfactorily in the 25th Volume of the "Medico-Chirurgical Transacinvestigated, by means of the catheter, the closure of the tions," 1843, and they are cited by Mr Yearsley as Eustachian tube, in any one single case of the kind. This remarkable corroboration of the novel views of the nature reproach applies even to Itard. From his very defective and treatment of deafness previously developed by him on method of investigation, he ought not to have been surprised various occasions." Now, it is right to state, that, instead that so frequently no melioration of the dulness of hearing of " 120 dissections of deaf cases," they were the dissecIt is true, that, in 91 specimens, a occurred in those cases in which he attempted to cure it by tions of 120 ears' of which only two were from a person excision of the tonsils." Mr Harvey, who has written a known to be deaf. book to demonstrate, not merely the uselessness, but also the greater or less derangement of the mucous membrane of the very injurious effects arising from excision of the tonsils, has tympanum was present, but which it is absurd to imagine arrived at the conclusion "that the enlarged tonsil or elon- could have been affected by tonsil-cutting. In what way, gated uvula does not, per se, give rise to imperfect hear- for example, could this operation influence the membranous ,-a diseased condition by far the most freing." But it is useless to quote further authorities against bands connecting together the ossicles and various parts of this view, for Mr Yearsley's own words are a sufficient the tympanum,refutation of it. He says ('Medical Times and Gazette,' quent in the 120 dissections? Could a rigid condition of the April 23, 1853), "I saw cases of very large and projecting chain of bones, or anchylosis of the stapes, be relieved by tonsils, and no deafness. I saw other cases, with thickening it? I do not believe that even a thickened state of the about the region of the tonsils, and I passed in my finger to mucous membrane of the tympanum would be relieved in feel between the arches for the condition of the glands, and the most remote degreee; for, in the sixth series of Rethey were frequently found enlarged and stealing upwards searches into the Pathology of the Ear now before the Thus Medico-Chirurgical Society, one of the results of between towards the mouths of the Eustachian passages. it was that I arrived at the conclusion, that enlarged 1500 and 1600 dissections is to show, that, even in cases of tonsils did sometimes produce deafness, and upon this co-existing hypertrophy of the mucous membrane of the idea I proceeded to act!" Mr Yearsley then sums up his fauces and tympanum, the lining membrane of the inner conclusion, "that occlusion of the tube does occasionally half of the Eustachian tube remains quite healthy; I have arise from the presence of an enlarged tonsil." Now, I ask seen at least one case in which, during scarlet fever, the any anatomist or surgeon whether Mr Yearsley has adduced mucous membrane of the fauces and tympanum were both a particle of satisfactory evidence in favour of the position, ulcerated, and yet the principal part of the lining membrane that the Eustachian tubes are pressed upon by enlarged of the Eustachian tube, that which is wholly protected, was tonsils; is it not, on the contrary, most palpable, from his healthy. In this second class of cases, it is evident that the own words, that, with all his anxiety to do so, he can bring operation of excision of the tonsils could, therefore, have forward no proof in support of his position. But, suppos- been of no benefit, and temporary improvement, in any case, ing him to believe that the Eustachian tube is pressed upon has, doubtless, arisen from the excitement of the nervous "occasionally by an enlarged tonsil, and that deafness system. That such operations have been followed by an is thereby produced, much mischief might not result from aggravation of the deafness, my own experience, corrobohis occasionally" excising a small portion of the hyper-rated by that of Mr Harvey, fully testifies. Thirdly, Mr Yearsley advocates the excision of the Uvula in cases of deafness. trophied glaud. My own opinion, however, is, that this On the Muscles which Open the Eustachian Tube. I have no doubt, that in the very small number of cases His words are, "What Mr Toynbee's experience may LONDON: PUBLISHED AT THE OFFICE, 20 KING WILLIAM ST |