Case. Mr. D. æt. 46, received, in the year 1811, a blow from a bar of iron, which wounded the scalp and fractured the frontal bone. He was taken to the hospital, but there were no symptoms, and he was not trephined. In a few weeks he left the hospital quite cured, but epileptic fits, after a short time, came on. At first there were considerable intervals between these accessions, but latterly he had two or three in the day. When Mr. Rogers, the narrator of the case, saw the man in 1825, he was almost idiotic-had a voracious appetite-and complained of pain over the left superciliary ridge of the frontal bone, where there was discovered a large cicatrix and "a depression sufficiently large to admit the extreme point of the finger." The pain extended down the neck and left arm`; the eye of that side was diminished in size, and its vision much impaired; the memory was almost destroyed. Under these circumstances, Mr. Rogers determined on removing the depressed bone, and on the 7th July, 1825, with the assistance of Professor Mott and Dr. Ring, he proceeded to apply the trephine. The operation however was difficult, in consequence of the saw having to pass through the upper part of the frontal sinus, and, unfortunately, the dura mater was cut through for one half of the circumference of the circle. A portion of the internal table was found to have been fractured, separated from its attachments to the frontal plate, and driven back upon the substance of the brain, All went on well, and there was no return of the fits until the 25th day, when, in the absence of the nurse, the patient overloaded his stomach with food. A fit, almost like apoplexy, was the consequence, and this was followed by a severe inflammation of the brain. This was checked by active depletion, and on the 20th August, he was discharged cured. Nine months afterwards he had had no return of the fits, and his memory had almost recovered its strength.

Mr. Rogers has appended to this case some observations which prove him a stanch anti-trephinist. He says, that, in simple fractures with depression, antiphlogistic treatment alone will be found for the most part sufficient, and in this, perhaps, he is right. But he next attempts to subvert the distinction, which Sir A. Cooper has so ably elucidated, between simple and compound fractures of the cranium; and in this we are sure he is wrong. The mode in which he controverts this position is singular enough. He says "the only difference in the two cases proceeds from the bone-in one case being exposed to the air, while in the other it is covered by the integuments.' This is the only difference to be sure, but it makes a vast deal of difference for all that. If all the "symptoms" arose from mere compression, as we have again and again observed, then, perhaps, this only difference would be but a trifling one; but since they arise, for the most part, from irritation, and since we know that the access of air to parts naturally excluded from it, is a great source of irritation and inflammation, so we can easily account for this only difference proving a most material one.

The next argument Mr. Rogers brings against the trephine is the stale one of cases doing well without it. No doubt many patients, with severe affections, will do well without the use of the doctor at all; but the doctor is a very useful personage notwithstanding. In fact we think this a most childish argument, for it is not on exceptions that we are to ground the rule.

Mr. Rogers adduces two cases of compound fracture of the cranium with depression, in which active depletion alone conducted to a complete

recovery.

In the first, the fracture was of the right side of the frontal bone, and the depression four inches in circumference. The patient lost by the lancet 161 ounces of blood in the course of six days.

A

A case of extensive fracture of the cranium occurred lately at St. Thomas's Hospital, and is recorded in the number of the Lancet for October, 21st. A boy, æt. 13, was brought into Hospital, Sept. 25th, having received a blow on the head from a falling pole two hours previously. There were some of the symptoms of concussion present, drowsiness, &c. but he could answer questions correctly. At and about the posterior and superior angles of the parietal bone, was a circular fracture three inches in diameter. The bones were divided into several portions, one of which was depressed full half an inch. The scalp above was puffy, but not wounded. Over the right frontal sinus the integument was torn in consequence of the lad's having fallen on that part. He had frequent retching, and vomited occasionally matters streaked with blood. The symptoms of compression not being present, Mr. Green, under whose care the boy was, determined not to operate. Five grains of calomel were taken immediately, and cold lotions applied to the head. V. S. ad 3xij. 26th. The scalp had become much swollen. Pulse 40 and oppressed. Severe pain in the head-incoherence-V. S. ad 3xvj. Five grains of calomel immediately-house-medicine-an enema. During the bleeding the pulse and the boy felt himself relieved. For the next two days, he continued much in the same state-there was occasional incoherence but he could generally answer questions-the pulse was irregular, ranging from 48 to 60 and upwards. He was bled twice, and on the 29th was evidently improving-the pain in the head had disappeared-the skin was cool-the bowels had been freely opened, and the heaviness of the countenance was gone. On the 13th October, the patient was playing about the ward.

The reporter of this case seems to have thought it a mighty strange thing that there were no " symptoms" immediately after the receipt of the injury, but, perhaps, when he has seen a few more cases of fracture of the cranium, he will not consider the circumstance so very extraordinary. Now contrast this case with the one we have related in Art. V. of the Periscope, as occurring at another hospital, and we think that any unprejudiced person will allow the distinction of fractures of the skull into simple and compound correct. In this case the scalp was not wounded, and although the depression was certainly more extensive than in the other, the symptoms of re-active inflammation were by no means so violent. It will be said indeed, that in the former case the brain itself was injured, but experience tells us that if the foreign body, the bone, be removed, the mere wound of the brain is by no means necessarily fatal. The subject is one of such paramount importance that we shall, as opportunity offers, return to it again,

57. SPASM OF CANALS."

Since Dr. Monro's paper on this subject, published in the 3d No. of our junior Northern contemporary, and reviewed in our 10th Number, Mr. Allan has communicated to the author, two facts illustrative of the spasmodic power of the urinary bladder. The first was in a case of lithotomy, operated on about ten years ago, where one stone being extracted, and another found to exist in the bladder, the operator repeatedly introduced the forceps, without being able to effect his purpose. This arose, Mr. Allan avers, from the spasmodic contraction of the bladder, for, on introducing his finger, he found the stone firmly held in its situation above the pubes, by the vesical spasm. The extraction was deferred till the evening of the third day,

* Dr. Monro. Additional Observations, &c. Ed. Journ. Med. Science,

when it was easily hooked out by the finger alone. The patient recovered without one bad symptom.

The next case was that of an irritable boy, three and a half years old, who was operated on, June 6th, 1826. Mr. Allan anticipated a spasmodic affection of the bladder, and, therefore, prepared the little patient by previous anodynes and aperients. A dose of laudanum was also given on the morning of the operation. Still the dreaded spasm took place. On introducing his finger, Mr. A. readily felt the stone, but whenever the forceps were introduced, "it disappeared"-or rather, we should say, vanished. This repeatedly occurred, and Mr. A. gave up the idea of extraction by metallic instruments, and managed by gentle means to hook out the stone by means of his finger and a small lever constructed for the purpose.

We have no doubt but that this spasmodic contraction of the bladder is sometimes the cause of embarrassment in extracting calculi. From the facts before us it does not appear that precautionary measures, in the way of lessening irritability of the part, are to be much depended on. There is one comfort in Dr. Monro's doctrine-namely, that all difficulties in getting a stone out of the bladder, in future, can be conveniently laid to the charge of spasm. We all know that, in every house, there is a certain personage, better known to the servants than to their masters, whose name is "NOBODY," but who is the reputed author of every breakage, spillage, and mischief committed in the house, from January till December. This personage too, like the spasm of the bladder, is never seen, though very plainly felt, not only at the time he plays his pranks, but afterwards when the mischief is to be repaired. Sat verbum sapienti.

58. MR. LAWRENCE'S LECTURE ON RE-MODDELLING THE

MEDICAL CONSTITUTION.

This gentleman has discovered that no accurate line of distinction can be drawn between physic and surgery-and in this we agree with him. We also concur in his opinion that the education of the physician and surgeon should be the same in kind, though perhaps differing in degree-that is, that each should study, as far as his circumstances will allow, all the branches of medical science. On this point, we think it is impossible for men of observation or reflection to differ, unless they labour under a bias of their judgment. But when Mr. Lawrence contends that there should be no division of the healing art, whether as respects tuition, practice, or rank -we differ from him toto cœlo. Instead of the recent progress of medical science giving "a fatal blow" to the divisions of labour, either in teaching or practising, we see these divisions almost annually increasing; and we are really astonished how Mr. Lawrence can reconcile what he says in the lecture-room, with what he sees every day around him. What would be thought of the state of brain in that man who should open a lecture-room in this metropolis, for the purpose of teaching anatomy, physiology, pathology, therapeutics, surgery, midwifery, botany, chemistry, materia medica, medical jurisprudence, &c.? He would soon be put under restraint in the New Bedlam. Did it never happen to strike Mr. Lawrence's mind that, if a gentleman, after studying all, should cultivate one of the above branches with more care than the rest, he might be able to teach that branch with more success? And if he looked about him, might he not perceive that the same observation applies to practice. Would any man (any general practitioner, for example) who had a child seized with typhus fever, dream of sending for Sir Astley Cooper to give his advice-or run past Sir Astley's door, in Spring Gardens, to summon Dr. Maton, if another child had his leg

jammed off by the wheel of a carriage? Or, if craniotomy was to be performed, would he dispatch a messenger for Mr. Lawrence, notwithstanding that gentleman's very profound knowledge of the brain? No, verily :-and why? Because, although the student may take lessons from all the different teachers of the different branches of medical science, it is his experience afterwards which alone gives him knowledge, the former being learning, which is a very different thing. Now the man who lays himself out for one department, as for example, operative surgery, will have greater experience than others in that department-he will be more expert from experienceand he will always (till the end of the chapter) be sought after by the public, on account of his expertness. The same may be said of all other departments.

Medical science is too extensive for all its branches to be either studied or practised by one individual, with that minuteness and success which commonly attend the study and practice of a single branch. Every year this truth is becoming more and more conspicuous. Look to Mr. Bennett's lecture. There we find that one of the branches of medical science (anatomy) requires "a number of individuals, each devoting himself to the cultivation of particular parts of it," before perfection can be attained. For all practical purposes, then, there is sufficient distinction between physic, surgery, and midwifery, for the metropolis and every large city to afford practitioners devoted to one or other of these branches. Still, for general use, there must be general practitioners; but he who can study and practise every branch of the profession, and arrive at as much perfection in all these branches, as he who only studies one in particular, must have a genius equal to that of Mr. Lawrence himself, which, it will be, of course, acknowledged, is impossible.

Mr. L. expends a monstrous deal of wit in his dissection of the COLLEGE of PHYSICIANS, "instituted by a monarch more famous for lust than medical knowledge"-of that young whelp, the COLLEGE of SURGEONS, “ fortunately for us entirely destitute of power" and of that CoLLEGE of APOTHECARIES, "who keep a shop for the sale of drugs." Like a true radical, he is dissatisfied with all existing institutions of this kind, and proposes the appointment of "an examining body," (in which somebody would doubtless take a leading part) empowered to test all candidates for medical practice, "without any regard to the present artificial distinctions ;" which examination "should authorise the individual to practise any or all parts of medicine, and none should be allowed to practise without it." Thus, then, according to this Utopian plan, the metropolitan physician and surgeon, and the village apothecary and accoucheur, must undergo the same examination, and consequently must have the same general and medical education! This is EQUALITY, with a vengeance! Now, if Mr. Lawrence had given himself the trouble to think for one small minute before he spoke, he would have perceived that such an equalization would place the necessary acquirements above the reach of a great proportion of general practitioners in the country-and that it would reduce the said acquirements to too low a standard for those who aspired to honours and distinctions in cities and in the metropolis. The consequence of such an attempt at equalization would be, a degradation of the upper classes of medical society-an exclusion of the lower classes-while it left the middling classes just where it found them. If the examination were at all impartial, and adapted to the wants of society, it must be calculated at a medium rate-and, consequently, it would be too low for the one extremity, and too high for the other. But the fact is, that Mr. Lawrence's scheme in medicine, is just what the scheme of Hunt aud Cobbett is in society at large-EQUALITY. The one scheme is as feasible as the other, and both will be accomplished about the same period of time.

59. PUZZLING POINTS FOR A COURT OF CONSCIENCE.

It is well known, that all members of the Royal College of Physicians, fellows and licentiates, take an bath not to derogate from the honour of the College by any word or act on their parts. In the recent paper-war respecting the Hunterian Museum, a fellow of the College has charged a licentiate with violation of his oath, in daring to censure a censor, while the latter was in the execution of his public duty. The licentiate repels the charge, averring that, as a public journalist, it was his duty to criticise the public conduct of men in office; and he moreover charges the fellow of the College with a much greater derogation from the honour of the College, by not only publishing letters in the Radical Press, but publicly acknowledging himself to be an anonymous writer in that vehicle!

We understand the Bench of bishops are to decide this knotty point. In the mean time, we may be permitted to observe, that we have not met with an instance of such daring intrepidity, on record, since the descent of Orpheus in search of Eurydice, as has been evinced by a fellow of the Royal College of Physicians, venturing his name in the pages of the Radical Press. We think we may assert, that the gentleman in question, who has otherwise deserved well of his brethren, will never again degrade himself, by communication with a Press which openly avows hostility to every established order of things in the profession.

60. EXHUMATION-FUMIGATION.

In consequence of the great scarcity of subjects, and the important discovery of Labarraque, respecting chloruret of lime, as a disinfecting agent, a joint-stock-company has been formed, for the exhumation of all those dead, the term of whose patent coffins has expired. The experiment has lately been tried, with great success, by the new company, on the body of the late Mr. J. C. Saunders. The exhumation and post mortem investigation lasted upwards of six weeks; and was conducted with the greatest sang froid by the company's resurrection and dissection men. We understand, however, that, notwithstanding the power of the chloruret, the offence against the sanctuary of the grave appeared to the bystanders to be "rank, and smelled to Heaven." The company are sanguine in the hope that TIME and HABIT will reconcile the olfactories of its customers to these unsavoury suits."

61. NEW REGULATIONS OF THE COLLEGE OF SURGEONS.

In our last Number we published these regulations, but had not time for any observations on them. This defect has been amply supplied by the Radical Press, which seems to have exhausted every term of vituperation on the new regulations. We do not wonder, however, that the Press should be in a passion, when such men as Cooper, Abernethy, Cline, Home, Guthrie, &c. are conspiring to rob the Radical Press of a portion of its daily bread.

"We will not say that they are rogues by nature, but do not hesitate to assert, that their proceedings are characterized by a most roguish aspect. A thief at the Old Bailey would act in a manner precisely similar."

To this mild and courteous remonstrance are added some choice epithets, as corporate tyrants"-" gross injustice"-" deeds of infamy"-" acts of cowardice and meanness". "floundering imbecility"-" slippery rep tiles”—“ maggots of hospital corruption," &c. &c. &c.