tious men, these were enough, and often more than enough-and many a one broke down under them. "But a few years ago, a set of literary plunderers broke in on the peace and quiet of our profession. Lecturers, who had spent their lives in collecting knowledge, arranging it for communication, and acquiring the difficult art of oral instruction, saw the produce of their lives suddenly snatched from them, and published for the profit of others, with the additional mortification of finding what they had taken so much pains with, disfigured by bad English. and ridiculous or mischievous blunders. Whoever attempted to arrest these piracies became the object of furious and unrelenting abuse. Hospital physicians and surgeons, who have to prescribe and operate in public, and at stated times, in whatever condition, of bodily health or mental feeling they may happen to be, and exercising in the face of critics not always competent to decide on their merits,-a science so avowedly imperfect, as to afford abundant scope for uncandid and ill-natured remarks, however judiciously practised, were held up to public scorn for errors, to which, even if actually committed, the ablest men are occasionally liable, while those who are leagued in secret with their calumniators, and who, with one or two exceptions, were as insignificant in station and talents as they were equivocal in character, were represented as at the summit of science and professional eminence. "Such, among others, have been the results of a system, which has no parallel in the records of any liberal profession. We do not deny that public exposure may have, in some few instances, done good; it may have abolished some foolish custom, or led to the reformation of some trifling abuse; but weigh the evil against the good-it has deprived eminent men of their intellectual property, and destroyed the mutual confidence between, pupils and their teachers; it has lowered the respectability of the profession and has spread general distrust; it has broken up private friendships; it has placed man in hostility to man; and has set so many bad passions into ferment, that well-disposed men become disgusted with the state of their profession, and vow that they never will inflict it on their sons." V. DR. HOPKINS' PRIZE MEDAL. We are at all times happy to bear testimony to the efforts of medical professors in forwarding the views and welfare of their pupils. Amongst the foremost of these, we may remark the great exertions used by Dr. Hopkins, to increase the means, and rouse into activity the energies, of his pupils, to acquire a thorough knowledge of that most important branch of medical study, the science and practice of midwifery. Now, we conceive the methods Dr. H. has adopted to effect these desirable purposes, cannot fail of meeting with that approbation and success which his liberality alone, for we can call it by no lesser mark of distinction, as will presently appear, should entitle him to expect. Dr. H. had contemplated, for some time past, on the plan of distributing prizes to his class; and accordingly, with this intention, Dr. H. has invented an appropriate and elegant design, from which a gold medal has been cast, and is now held out, as a prize, to his pupils at the Borough School, for the best Essay on the Various Causes and Treatment of Protracted Labour and likewise to his pupils at the West End School, for the best Essay on Complex Labour. We may further observe, that, with the commendable anxiety to excite the utmost exertions of his pupils, and in consideration of a number of well written essays having been sent in, the Doctor has been induced to offer a silver medal (the same design as the gold one) for the second best essay. We are given to understand, besides fostering the most laudable feelings of emulation amongst his classes, by confering these handsome and valuable prizes, the Doctor is constantly assisting and improving their studies, by attending patients with them at the bedside, and making those useful and practical remarks which he considers applicable to each individual case. Society at large will at once acknowledge, such a man not only deserves well of his brethren in the profession, but also of every philanthropist and well-wisher of mankind, in thus endeavouring to further this most important pursuit. EXTRA-LIMITES. Observations on Cullen's System and Doctrines of Fever, showing the Necessity of their being abandoned by Teachers of the Principles and Practice of Physic, forming the third Communication on Fever.* By JonN MACKINTOSH, M. D. Acting Surgeon to the Ordnance in North Britain; Physician to the General Dispensary, Brown Square; and Lecturer on the Practice of Physic, &c. in Edinburgh. It is the proud boast of the present æra, that the arts and sciences never flourished in such an extraordinary degree; while the uncertainty of physic, and the unsettled nature of medical opinions, are too notorious to require being insisted on in this place. For this difference there must be sufficient reasons;-one of the most obvious, it appears to me, is, the errors of Cullen's System; another is to be found in the present plan of medical This paper was announced in the 93d No. of the Edinburgh Medical and Surgical Journal, to appear in the next No. in the following terms :-"The object of my next communication will be, to show the necessity of abandoning the doctrines of Cullen, in teaching the principles and practice of physic." It was accordingly forwarded to Dr. Cragie,early in November, for that purpose: that gentleman mentioned to me, that he had taken the liberty to mark several passages, which he thought had better be erased, to which I freely assented. But, subsequently, he waited upon me, to state that he had since had a consultation with "the other gentlemen," and they wished to decline printing it, as it was too controversial for this Journal. At the same time, I think it due to Dr. Cragie to state, that he made many polite apologies for now declining that which he had previously promised more than once to do. It would have been more becoming, if the Editors had commenced the reformation with themselves. But I think no one can fail to discover the true motives of the professorial Editor, or Editors, after perusing the paper itself. VOL. VIII. No. 15. education-but I must confine my present observations to the first-mentioned cause. Let me ask, in what state would mechanics and chemistry now have been, if the improvers of these sciences had, like Cullen, assumed false facts upon erroneous theories, as the vary basis of their systems? Surgery obtained the start of physic, and still maintains the pre-eminence, in consequence of its professors proceeding upon wiser principles than those which have generally guided physicians. The public has seen this, and the consequence is, that, in London, surgeons of eminence derive a far greater part of their revenue from the practice of physic, than from that of pure surgery. In Edinburgh, the medical practice is enjoyed, not by pure physicians, but by surgeon-apothecaries, who have obtained the confidence of the public. From this class, the consulting physicians, strange as it may appear, are at present chosen, which is a proof that they possess the confidence of the rest of the profession. Some of these have their medical degrees from universities which formerly granted them without any examination; and these individuals have no reason to blush at this statement. In the first communication, on Intermittent Fever,t I drew several conclusions from the facts previously detailed, the last of these I shall take the liberty "If these cases of quoting in this place. possessed no practical merit whatever, they promise to be productive of great advantage to medical science, by destroy + Published in the 91st No. of the Edinburgh Medical and Surgical Journal. 36 state, being four days from its commencement. There is some constitutional excitement, the skin is dry, pulse full, and tongue white; there is thirst, and her bowels are constipated, unless moved by medicine. Ordered, Hirud. xxx.; Lot. plumbi subacet. dilut. c. cataplasm misca, panis. Hydr. submur. gr. v. hac nocte sumend.; M. s. c. cras mane sumend. et rep. ad sedes liquid 24th. Excitement increased, and local symptoms more severe. Hirud. xx. cat. lini. 25th. Improved-she has slept, and her skin is moist. Hirud. xxx. 27th. Pain and redness of the arm are gone, but have left considerable swelling, which pits on pressure. Some watery fluid, resembling pus in colour, has escaped from the puncture of the venesection. All fever, is gone. 30th. A second puncture was made, and a large quantity of thin watery discharge was evacuated. Some hardness left. 2d August. Emp. saponis to be applied up the fore-arm. This case although it may not have been so severe as is often presented to us, will serve to illustrate the usual practice at this hospital of treating similar cases, Mr. Tyrrell has a great objection to the decided measures proposed by Messrs. Earle and Hutchison, viz. of incisions; for, in his opinion, the only real benefit is the loss of blood; but, then, we have no command over the quantity, and patients have repeatedly been known to sink from that cause; while, by leeches, the same object is arrived at, with comparative certainty, and its success has been fully established. With Mr. T. this plan has never failed, where he has had the commencement of the attack to deal with. portion of the tibia, and a small piece of the upper portion lay detached within the wound; there was no difficulty in reducing it, and but little blood issued from the wound; a small dossil of lint was laid upon the orifice, and the leg was placed between two splints, laid upon the back, and raised at the heel. In the evening some swelling was perceived, and the patient complained of great uneasinessthe splints were loosened, and a spirit lotion to the whole leg; after which, nothing untoward occurred until the evening of 1st July, when the parts surrounding the wound appeared much inflamedpulse raised, skin hot, and thirst-his bowels were confined. Ordered s. c. cochl. iij. 2dis horis donec alvus respond. 2d. A small sloughy spot covers the wound, and an inflammatory blush extends over the whole leg-pulse is full, but very compressible-tongue brown, skin hot18 leeches were ordered; a poultice over the wound; the spirit lotion to be continued; and the splints to be entirely removed. Rep. m. s. c. 3d. Sloughing has continued. P. 4th. The lower portion of the tibia is exposed-slough increased. The leg was to-day placed in Sir A. Cooper's fracture box, which operation produced no pain. 5th. Some healthy discharge-fever gone--pulse much lessened in volume, and quicker. Porter j. quotidie. 7th. Limb looking better-inflammation subsiding, but his bowels are very relaxed, and he is scarcely able to retain his stools. Mist. cretæ c. to be taken after every liquid stool. Port wine, 3ij. and porter. 9th. Debility increased-bowels still purged-tongue brown-pulse quick, and very compressible. Omit the porter, in the fear that it gave rise to the diarrhoea. Wine, 3 iv. R. T. opii gtts. x.; Ammon. carb. gr. v.; Mist. camph. 3 iss. 6tis horis. s. sago and syrup.-Continue the poultice. 12th. Restless-pulse irregular-vital powers evidently sinking. Brandy ad libitum. From this report he gradually sunk. His age and constitution were both points of great consideration. The same degree of inflammation in a young and robust subject might have been combated with blood-letting, but certainly could not have been treated without its employment. The pulse here was of that full, but powerless volume, which indicated a flabbiness rather than excess of action in the heart and arteries, and, as such, the small abstraction of a few ounces of blood would have been attended, perhaps, with a fatal syncope. The case might be contrasted with a similar injury, in a middle-aged man, where a great destruction of parts was attended with very little suffering of the constitution. JOHN ELLIS, æt. 22, was admitted, after having received a blow upon the upperarm from the handle of a winch, while nearly a ton weight was hanging to it. On examination, a fracture was found, extending obliquely downwards and outwards, through the shaft of the humerus, at its lower third-a small wound communicates with the lower portion-there is not much tumefaction. The wound was dressed with adhesive plaster, and the limb supported by two splints, one on the inner and the other on the outer side. A cold lotion was ordered, and the forearm kept at right angles with the upper, raised on a pillow. A few days after, he complained of uneasiness, for which the splints were loosened; but, the wound being on the under side, was not examined, from time to time, so regularly as would have been permitted, had it been situated elsewhere. On the 7th day, great pain was experienced, and febrile symptoms developed themselves; this was considered to arise from the riding of bones, since the splints could give no support, from their looseness. The patient was, therefore, directed to sit up, when the wound, which was in a foul condition, was discovered to be surrounded with a large slough; it was, therefore, dressed with the red precipitate ointment, and supported by four well padded splints, lightly applied. He was desired to remain in the semi-erect position, and suspend the elbow, while he supported the fore-arm only, at right angles with the upper, in a sling. This gave him great ease; and, from this time, the splints were gradually drawn tighter, as the inflammation subsided, and the sore would bear pressure. His health suffered but little, and all excitement subsided so soon as the irritation was withdrawn. It must be desirable, in compound fractures, that rest, and the recumbent posture should be enjoined until all inflamVOL. VIII. No. 15. matory symptoms shall have subsided, even in the upper extremity, where motion need not be used: and the present case is an exception, only because the wound being on the under side, the limb was necessarily disturbed at each dressing; and, from the riding of the ends of the bone, in consequence of its obliquity, the inflammation must, thereby, be kept up, if not altogether excited. But the extension which the weight of the elbow afforded, got rid of the real source of irritation, and allowed of sufficient pressure to support the limb, and effect a comfortable apposition of the broken ends. Nothing afterwards retarded his gradual recovery. XVIII. A CASE OF POISONING BY ARSENIC. A woman, apparently about 60 years of age, was brought into the hospital, under Dr. Elliotson, in a state of exhaustion; her pulse was scarcely perceptible, skin cold, and pupils fixed-she was incapable of answering when spoken to-pressure in the epigastric region gave excessive pain, under which she would writhe and exclaim some imperfect sound; her breathing was not at all affected; her tongue was dry,and she appeared to wish for drink constantly. Those who brought her, knew little or nothing about her, but informed us that, on entering a neighbour's kitchen, about an hour ago, she had begun to eat some bread-crumbs, which were lying in a plate mixed with arsenic, for the purpose of destroying black beetles, but would not desist on being warned of it. The stomach-pump had been used, sufficiently merely to obtain a specimen of the contents of the stomach, which, together with the remaining crumbs of bread, were analyzed by Dr. Bruton, and found to contain arsenic. Another pump was procured from the hospital, the former being out of repair, and a second attempt was made by the dresser, when the stomach was emptied and filled several times with luke-warm water, until the fluid came unchanged by any admixture from the stomach; it having received a tinge of blood each time. Nearly two hours had now elapsed since the accident. The treatment became then a matter of consideration. Inflammation existed, as was clear from the excessive pain about the region of the stomach, no less than from the blood which stained the water. The 35 |