Chapter D: M'Millan, æt. 40, seaman;--while he was employed in the hold

of a vessel, a heavy iron block, of a round form, fell from the rigging, a height of 20 feet, and struck him on the head. He was knocked down and stunned, but was able to rise and to walk with a little support. He was brought about a mile and a half in a hackney-coach to the hospital, and admitted by Mr. Cowan at one o'clock P.M., half an hour after the accident. At this time he had a stupified look, but was quite collected, and was able to walk across the ward; breathing and pupils both natural; pulse 75, of moderate strength. There was a wound in the scalp, commencing nearly over the centre of the sagittal suture, and running about three inches backwards and towards the left; along this a portion of skull, corresponding to the wound in size, was felt fractured, detached, and irregularly depressed. His right arm was benumbed and nearly powerless, but no mark of injury was observed on it.

It was determined to remove the detached piece of bone, and the original wound being extended lengthwise in both directions, an incision was made through the scalp at right angles to it over the left parietal bone, thus bringing the fractured portion into view. This was found to be broken down into several fragments, some of which were firmly impacted under the surrounding cranium, and one spiculum, driven through the dura mater, had penetrated the brain. The trephine was applied a little to the left of the fracture, and the intermediate part removed with Hey's saw; the detached pieces of bone, ten in number, of various sizes and irregular shapes, were removed with the forceps, the scalp replaced and retained in position by a stripe of adhesive plaister and very light dressings. During the operation one artery required ligature, and about ℥v. of blood were lost: he had lost perhaps as much before. He remained quite sensible, bore it well, and shortly afterwards had half a glass of port wine in warm water.

Ten P.M.--Has been tolerably easy; complains of pain of fore-part of head; pulse 82, firm.

Fiat V. S. ad ℥xviii.

Sumat statim Submur. Hydr. gr. viii. Pulv. Antimon. gr. vi.

Applic. Capiti Lotio ex Alcohol. et aq. calcis.

Second day.--After bleeding, thought feeling of numbness of right arm somewhat lessened, and to-day has rather more power of it. Passed a tolerable night; a little head-ache; countenance pretty natural; tongue slightly loaded; thirst; no stool.

Sum. stat. Sulph. Magnesiæ ℥j. et rep. vesp. si opus.

Third day.--From an aversion to use the bed pan, he rose to stool last night, and fell forwards on the floor, seemingly from having entangled himself in the bed clothes; he got into bed without assistance; had a shivering fit shortly after, but has had a pretty good night; bowels freely opened; head-ache slight; pulse 84, soft; tongue dry in middle. Towards the evening of this day he appeared drowsy; and on the fourth day he is reported as seeming confused and uneasy; countenance anxious; articulation difficult; the right arm was more paralysed, and indeed the whole right side seemed now to partake in the paralysis; a small part of the wound had adhered, the remaining part was flabby, discharging thin serum. In the evening the difficulty of articulation and drowsiness had increased. Twelve leeches were applied to each temple, and in a short time he seemed a little livelier.

Fifth day.--Much in the same state; took a little beef tea.

Sixth day.--Paralytic symptoms increased; breathing laborious. Blister to the neck. It may be worthy of remark, that in the few words he now spoke he never made use of the English language, but of the Gaelic, which was his native tongue; and even when told that he was not understood, he persisted in repeating the Gaelic phrase.

Seventh day.--A small fungus was observed in upper part of wound, to which lint dipped in lime water was applied, and moderate pressure. The fungus continued to increase.

On the eleventh and twelfth days he had slight bleedings from the scalp, which stopped spontaneously. Stupor, &c. greatly increased, but he still recognised his friends; took a very little chicken soup or beef tea daily, with lemonade, &c. for drink.

On the evening of the thirteenth day bleeding to the extent of ℥iv. or v. took place from fungus: it was checked by application of saturated solution of alum, but he sunk rapidly, and died that night.

_Inspection 36 hours after death._--The fungus protruded considerably beyond the scalp, and was rather larger than a hen's egg, of a dirty brown colour, and a soft spongy consistence; it completely filled up the opening made in the skull by the trephine and removal of detached bone. The pericranium to the inferior side of this opening was found detached from the bone, to the extent of a crown piece, and beneath it the bone was rough, and covered with thin purulent matter. The dura mater, for two inches around the fungus, was covered with pus; this membrane, by sloughing, had allowed the fungus to protrude, and its edges adjacent to the aperture were thickened. On removing the dura mater, the fungus was observed to arise, partly from the middle, but chiefly from the posterior lobe of the left cerebral hemisphere: it occupied a space about three inches in length, and an inch and a half in breadth, extending to within a line or two of the roof of the ventricle; at its anterior part was an abscess, containing ℥ss. of pus. The fungus seemed to be a degeneration of the cerebral substance; sections of it showed the cerebral matter first dotted with an unusual number of bloody points, then assuming a greyish colour, which gradually passed into a dirty brown. With the exception of these bloody points, the brain presented no unusual vascularity: it was quite firm, except in the immediate neighbourhood of the fungus, where it gradually became softer as the colour of the cerebral substance became deeper, till in the centre of the fungus it was nearly of a broken down consistence. A quantity of serum was found in each ventricle.

Another man who had been struck by the piece of iron which fractured M'Millan's skull was brought up to the hospital at the same time. He had received the blow on the vertex of his head. On admission he was in a state of fury, requiring the efforts of several men to hold him. His head was bruised out of all shape, quite depressed behind, and a fracture also of the frontal bone; there were evident symptoms too of fracture of the base of the skull. The case was hopeless. Several large depressed and detached pieces of bone were removed, but he died a few minutes after the operation.

During the same week an old woman was brought up to the infirmary, who, the day previously, had fallen headlong down a stone staircase. She laboured under the severest symptoms of concussion, and besides had a comminuted fracture of the humerus into the elbow joint, and of the radius into the wrist joint of left arm. She was past all treatment, and died on the second day. The case is mentioned chiefly to remark, that although no external injury of the head could be observed, on inspection a fracture was found extending completely across the anterior part of base of cranium.

There are no dispensaries in Glasgow, but such of the poor as are unable to obtain admission into the Royal Infirmary, and those who are not so ill as to submit to the confinement of an hospital, or for other reasons prefer remaining in their own houses, are prescribed for, and, if necessary, visited at the public expense. For this purpose the city is divided into districts, and a surgeon appointed to each. The "district shop" thus resembles a dispensary, where the surgeon prescribes in the presence of his pupils, who indeed, under his superintendance, have the management of many of the cases, both among the patients who receive advice at the "shop," and those who are visited at home. Although under the care of a surgeon, the diseases treated are both medical and surgical, for there is little distinction made between the two branches of the profession here.

The following case occurred under the care of Mr. Stirling:--

W. M. æt. 28, while returning home during the night in a state of intoxication, fell from a height of ten feet, into a court paved with stone. He was rendered insensible for some time, but on recovering was able to crawl to the nearest door, and was conveyed home. Medical assistance was immediately procured. On the forehead, about an inch above the nasal process of the frontal bone, was a cut an inch and a half in length, extending obliquely downwards from the right side; through this a triangular fracture was felt, the base of which was in the direction of the external wound, and the apex pointing downwards; the fractured portion of the bone was slightly depressed; the bones of the nose were also fractured, and there was great discharge of blood from the nostrils. One third, or nearly, of the upper lip was cut off, and a good deal of blood had been lost from the labial artery; the lower jaw at the symphysis was fractured and comminuted, and several pieces were perceived to be loose. Was quite sensible, remembering every thing up to the period of the accident. Pulse 80; has vomited frequently. Wound of forehead was dressed with adhesive plaister; the loose pieces of bone were removed from the lower jaw, and it was afterwards retained in juxta-position by a chin bandage.

Early next morning he was bled to ℥xii. and had a purge of jalap and calomel, by which his bowels were freely opened. That night he felt considerable pain of head; pulse 90, full, and strong. He was bled again to ℥xxv. Blood first drawn had the buffy coat. After the bleeding the pain of head diminished, and he continued to do well. When the swelling and tenderness of face had subsided, it was observed that the fracture communicated with the frontal sinus. On holding his nose and attempting to blow it, matter and air escaped by the fracture. The man was anxious for a speedy cure, and for this purpose an operation to remove the depressed piece of bone was at one time thought of; there was no constitutional disturbance, however, and the case was left to nature. The discharge gradually diminished, and the wound healed up in about a month. The bones of the nose retained their position, and the broken ends of the jaw, after the swelling had subsided, were kept in their proper situation by a pasteboard splint till re-union took place. The lip also healed easily, and no deformity is now observable.

GUY'S HOSPITAL.

_Inflammation of Hernial Sac._

The previous report of this case (Gazette, No. 51) conducted it to Nov. 18th, the tenth day from the operation, and the third on which fæces had been discharged from the wound; that discharge continued on the 19th, but on the 20th pus only was seen.

Nov. 22.--Yesterday the dresser, Mr. King, observed a portion of _solid_ fæces make its escape, and to-day a similar discharge, in the fluid form, is manifest.

Nov. 26.--Since the 22d, nothing but healthy pus has been seen; the wound is rapidly healing, and the patient's general condition as good as can be desired.

Dec. 4.--He has begun to wear a truss, and is to-day allowed to leave his bed.

Dec. 8.--As regards his original complaint, the man is perfectly convalescent, but he now discloses a small abscess in the scrotum, which has been gradually forming, and will detain him in the house some time longer.

If it be a sound surgical maxim that, in strangulated hernia, the patient's safety depends upon an early operation, it is also a maxim no less sound, that where the evidence and symptoms of strangulation are imperfect, or dubious, the benefit of the doubt should be given to the operation, and it should be performed: for it is better that buboes should be laid open, or inflamed sacs cut into, twenty, aye, fifty times in succession, than that in one case a man should be suffered to die with strangulation of the intestine unrelieved.

These remarks apply strikingly to this case of Mr. Key's, in which, although no hernia was found, they perfectly justify the operation. No case of strangulation could be more distinctly marked, or more clearly call for the knife, than did this; and had Mr. Key refused to use it, he would have deserved the scoff which, by a contemporary, has so preposterously been thrown on the "no hernia case." But, more than this, the operation was not only justifiable, but beyond a doubt _beneficial_--beneficial inasmuch as it at once relieved the distress of the patient, secured him from more extensive suppuration, from farther sloughing of intestine, and probably from extravasation of fæces into the abdomen; rendering also the process of reparation more easy and rapid.

_Hereditary Hare-Lip._

Dec. 4th, Mr. Key performed the operation for hare-lip on a child a few months old, whose case was remarkable only as it afforded an instance of _hereditary_ malformation. The father of the child had congenital hare-lip, for which no operation had been performed, and of his six children _two_ were born with the same malformation.

_Queries._--1. If the father's lip had, in his infancy, been restored to the natural form, would the malformation in that case have descended to his children?

2. Is the casualty in these cases to be traced _directly_ from the father to the incipient embryo, or _indirectly_, through the medium of the mother's imagination--It has been said that paternal resemblances are produced in the latter mode.

G.

PARIS HOSPITALS.

_Hôtel Dieu._

_Cases of Gangrene of the Lungs._

Some interesting cases of gangrenous suppuration of the lungs were published by Dr. Chambers, about eighteen months ago, in which he particularly pointed out the horrible fœtor of the breath as a diagnostic mark of the disease. The following cases which recently occurred at the Hôtel Dieu are good illustrations of more extensive destruction of the lung by a similar disease.

CASE I.--A man, aged 32, of good constitution, laboured under bronchitis for some weeks, to which he paid little attention, when he was suddenly seized with pain in left side, dyspnœa, considerable cough, and a rigor, followed by fever. He was admitted into the Hôtel Dieu next day. Crepitation was perceptible over the whole extent of the left lung, posteriorly, and reaching to the site of the pain in the side, which was increased by percussion; great oppression, with frequent cough, and expectoration of violet-red colour, mixed with mucus; pulse frequent and small; constant chilliness; cheeks flushed.

Next day the symptoms remained unabated, and _fœtor of the breath_ was observed. Two days after it is stated that the expectoration maintained the same appearance, but _was now fœtid_; the breath was, however, still more offensive, and during the fits of coughing particularly so. In the evening the breath is said to have become _gangrenous_.

21.--The cough was small, difficult, and painful, producing an expectoration of violet-coloured matter, approaching to chocolate, _with a characteristic odour_.

22 to 25.--Expectoration and breath emit an _intolerable stench_. On the latter day the patient died.

_Examination._--The body not emaciated. Strong adhesions of the left lung to pleura costalis. At its posterior part a large gangrenous layer, occupying the two superior thirds of the lung, covered at some points by a false membrane. The lower third, and the parts round the gangrenous portion, in different degrees of inflammation, and hepatised; the putrid mass was in great part black or violet-coloured, containing fragments of the pulmonary texture; the smell gangrenous, but less so than that of the breath during life; pus might be squeezed from the adjacent part of the lung.

CASE II.--A man, aged 55, enjoyed good health till the beginning of May, at which time he experienced pain in the left side of the thorax after exposure to cold. During the next few days the cough was frequent, and the expectoration tinged with blood. A rigor now came on, followed by a distinct exacerbation of fever, and he came to the Hôtel Dieu. At this time he presented symptoms of inflammation of the lungs, and was bled with relief; he left the hospital in twelve days, being sufficiently well to resume his occupation. Scarcely had he done this, however, when he had a relapse, accompanied by great lassitude, oppression of breathing, and frequent cough. At the end of a week he returned. He was now at the twenty-first day of the attack. His skin was yellowish; face pale or of leaden hue, and greatly altered; his cough frequent, with abundant expectoration of matter like chocolate, with small specks resembling pus, and little bodies about the size of peas, which appeared to be portions of the lung. This putrid mass exhaled a _gangrenous odour_, and the expired air was impregnated in a high degree with an equally disgusting smell, which surrounded the patient's bed with a contaminated atmosphere. Percussion gave a clear sound over the whole extent of the chest; auscultation did not discover the pulmonary expansion on the right side. The pulse was weak, but not frequent; the patient was in a state of extreme prostration. Next day the odour of the breath and expectoration was, if possible, more dreadful. He lingered two days longer, during which time the fœtid smell somewhat diminished, and the proportion of pus in the expectoration increased.

_Examination._--The left lung had contracted firm adhesions, particularly above and behind. It was torn in attempting to remove it, and there issued from the middle and posterior part a large quantity of dark-coloured matter, similar to what had been expectorated. An incision was made along the back part of the lung, and laid open a large cavity, occupying all the extent of the pulmonary organ, and still in part filled with the same kind of dark putrid matter. On washing out the cavity it was perceived that it was lined with a smooth and white membrane, to which were still adherent, at some points, dark filamentous shreds; these were removed by the least touch, and left the surface smooth beneath. The boundary was formed by a false membrane, about a line in thickness, which separated the mortified from the sound parts. The lung was reduced to a kind of bag, the parietes of which were on an average about an inch thick. In the upper part of the lung, which was hepatized, an incision discovered a number of smaller tubercles, which in the centre were in a crude state; and at one point several had suppurated, forming a cavity large enough to contain a nut.

[The Editors of the _Journal Hebdomadaire_, from which these cases are abridged, add, in a note, that although the fœtor of the expectoration, such as above described, is usually dependent on gangrene of the lungs, yet that this is not invariably the case. In confirmation of this assertion they refer to three instances of fœtid expectoration--in the first, the patient is still alive; in the second, there was chronic bronchitis, with considerable dilatation of numerous bronchi; and in the third, bronchitis with some appearances of chronic pneumonia. Laënnec gives a case of dilatation of the bronchi, with remarkably fœtid expectoration. The argument derived from the first patient having survived we consider to be altogether erroneous, as patients more frequently recover from this than other forms of purulent expectoration.--ED.]

PROCEEDINGS OF SOCIETIES.

WESTMINSTER MEDICAL SOCIETY.

December 6th, 1828.

JAMES ARNOTT, ESQ. IN THE CHAIR.

Pursuant to announcement, Mr. MacKelcan introduced the subject of concussion of the brain. After remarking on the several symptoms, and mentioning the other affections of the head with which concussion is apt to be confounded, Mr. M. directed the attention of the society more particularly to the treatment in the stage of collapse, adopted by Professor Andrini of Florence.

Dr. Duffin stated, that having been in Florence, he had witnessed the employment of three, four, or six ounce bleedings employed by the Professor in the stage above-mentioned. The principle on which they were used was that of their acting as a stimulus to the brain; and really the plan was not apparently attended with any bad effects. When re-action has ensued, the practice of M. Andrini is the same as that resorted to in this country.

The discussion then wavered between apoplexy and concussion, and ended by some good-humoured sparring between Dr. Addison and Mr. Gilbert Burnett, on the capability of the brain containing more blood at one time than another.

The President announced from the chair that a special meeting would take place on Friday evening, December 12, at 7 P.M.

December 20th, 1828.

CÆSAR HAWKINS, ESQ. IN THE CHAIR.

After some business had been dispatched, to which we shall allude in another place, Mr. Jewel related the particulars of a case of "supposed extra-uterine fœtation." The case, which is one of much interest, is as follows:--

Mrs. F. a robust, healthy woman, ætatis 27, had been married one year, and aborted once; when, in the month of September 1827, she quitted her husband in London, and accepted a situation in the country. After the expiration of a few weeks she received permission to come to London for a day; and, naturally enough, passed that night, (November 8th), with her husband, returning again to the country next morning. Soon afterwards, the morning-sickness, heart-burn, and other sympathetic affections of pregnancy, appeared; but the catamenia still returned at the regular periods, though scanty and paler in colour than natural. She now quitted her situation, returned to her husband, and engaged a midwife to attend her in her expected confinement. The circumstance of quickening occurred in the latter part of February, and was accompanied by a severe paroxysm of fainting, whilst the abdomen gradually enlarged, and the motions of the child (as was imagined) could not only be easily detected with the hand, but were visible to the eye. On the 9th of August, making a period of 274 days, she was seized with the usual premonitory symptoms of labour; the midwife arrived; found her walking her chamber, and concluded that the process had considerably advanced. Three distinct uterine contractions took place subsequent to the midwife's arrival, the last of which was so severe as to compel the patient to grasp firmly the back of a chair, and induce, after its subsidence, excessive faintness. From this time no further parturient effort was made; no examination per vaginam was instituted; neither was there noticed any sanguineous vaginal discharge. When Mr. Jewel saw her, examination detected nothing unusual in the os uteri, and the symptoms she presents are these. The abdomen is about the size of a woman's in the sixth or seventh month of pregnancy, the enlargement being general. Her general health is much disturbed: she complains of pain in the left hypogastric region, particularly when the abdomen is compressed by the hand or stays--and she also complains of weight in the abdomen, especially on leaning forwards. The woman herself has a strong prepossession that "something is to come away," or that she might be relieved by an operation. The woman believes that she still feels the motions of the child, though feebly.

Having read this case, Mr. Jewel concluded by offering some observations on the subject of extra-uterine fœtation. He considered this as probably an instance of "graviditus abdominalis," and remarked that the uterus not having expelled its dezidua, was no conclusive proof to the contrary, Dr. Blundell and Mr. Langstaff having examined cases where this was wanting.

Dr. Locock never saw a case where laceration occurred in the early months of pregnancy. Dr. L. remembered the particulars of a case where the uterus was lacerated in the fourth month, and the ovum escaped into the cavity of the abdomen, and the symptoms of pregnancy were exceedingly strong. Dr. Locock almost doubted whether Mr. Jewel's was an instance of pregnancy at all, for frequently women enjoying sexual intercourse have enlarged abdomens, and many of the other symptoms of pregnancy, which a few doses of purgative medicine will remove.

Two remarkable instances of extra-uterine fœtation were related by Mr. Burnett and Mr. Cæsar Hawkins; and towards the conclusion of the evening the discussion turned on the powers of the ergot of rye. Dr. Locock had frequently tried it in amenorrhœa, and, on the whole, without any very good effects. In one remarkable case, where the lady particularly wished to have children, Dr. Locock having boiled an ounce of the ergot in a pint of water down to half a pint, gave an ounce and a half of this decoction three times a day. After the young lady had taken about half a pint, the most violent convulsions succeeded, which placed her life in imminent hazard, and from which it was long before she completely recovered. She menstruated twice after that, but then the discharge again was arrested, and has never since returned, nor has she become pregnant.

The practice of "bougieing the uterus" in cases of dysmenorrhœa was brought upon the tapis, and excited a good deal of laughter, the members appearing to consider the proposal ridiculous in the extreme.

MR. LAMBERT.

At the last meeting of this Society it was proposed, on the recommendation of the Committee, that Mr. James Lambert should be expelled; and after some discussion it was agreed that the sense of the members should be taken by ballot at the next meeting, Saturday, January 3, 1829. It was thought that proceeding at once to his expulsion might give the appearance of the measure originating with a party, and that the delay would enable the deliberate judgment of the whole Society to be passed upon his conduct.

HUNTERIAN SOCIETY.

Dec. 10, 1828.

DR. BILLING, PRESIDENT, IN THE CHAIR.

Mr. Leese, Jun. exhibited to the meeting a specimen of medullary sarcoma, taken from the forehead of a man after death, with a portion of the os frontis. The man was fifty-eight years of age, long asthmatic, and appeared to die of hydrothorax. He never suffered any pain in the tumor, but expressed a sense of distention. It was immoveable at the base, and there were some fissures in the os frontis, from caries. The dura mater at the corresponding part adhered firmly to cranium, and on its being removed some spiculæ from the carius inner table remained adhered to it. There had never been any symptoms of cerebral affection. A tumor of the same nature had formed on the scapular extremity of the clavicle, and had occasioned anasarca of the limb.

Mr. Key supposed that the tumor had originated from the diplöe, and believed that the only chance of relief in such a case would be trephining; but he acknowledged that there was little encouragement to operate in these cases, owing to the tendency of the disease to return in some other part. He related an instance of the true medullary fungus taking its origin from the cancellous structure of the os femoris. The limb was removed, but the patient died. A circle of fungoid glands was observed at the base of the heart, and some of the bronchial glands were in the same condition.

Dr. Conquest expressed his belief that carcinoma was always a constitutional affection, and stated that at least in nine cases of cancer uteri out of ten, there was carcinomatous affection of the pylorus, mesenteric glands, or liver.

Mr. Key and Dr. F. Ramsbotham had not observed, in their examinations, the coincidence noticed by Dr. Conquest.

The remainder of the evening was occupied by a discussion on the different kinds of ulceration that occur about the os and cervix uteri, and the circumstances under which the removal of the uterus, or the amputation of the cervix, may be warrantable.

Dr. Babington adverted to the occasional existence of a family disposition to carcinoma. He had known three sisters successively die of cancer in the breast.

MEDICAL SOCIETY OF LONDON.

Dec. 13th and 20th, 1828.

DR. HASLAM IN THE CHAIR.

The subject of discussion, at the first of these meetings, was stricture of the rectum, when the diagnosis and treatment of carcinoma of that part came under consideration. There was a remarkable discrepancy in the opinions of Messrs. Lloyd and Salmon as to the symptoms and management of carcinomatous affections of the rectum. Mr. Lloyd maintained that these affections of the intestine were sometimes attended with pain and sometimes not, and that the patients were often materially benefited by the use of bougies; while Mr. Salmon affirmed, that the disease was always painful, and not to be mitigated by the employment of these means.

A variety of subjects came before the society at the next meeting. The president read a letter from Mr. Wansborough, of Fulham, describing the "original stomach-pump," a specimen of which accompanied the letter: the instrument Mr. W. stated to be of 25 years' standing.

Mr. Shearly exhibited, among other morbid specimens, a uterus, on the external surface of which the disease termed the "white tubercle" was in progress: there was also a small polypus near the os uteri. Mr. Pereira exhibited to the society a fine specimen of medullary sarcoma of the liver. The organ was so enlarged as to have occupied two-thirds of the abdomen. The other viscera were not involved in the disease. The progress of the disease, as far as it could be ascertained, was excellently detailed by Mr. Smith, a visitor. The symptoms were obscure.

Mr. Armstrong read an extract of a letter from Mr. Morgan, of the Bristol Infirmary, a corresponding member of the Society, describing a curious conformation of the œsophagus in a child, which lived 106 hours only, during which period every attempt to swallow food produced considerable distress. The œsophagus was found to be divided into two portions; the upper or pharyngæal extremity terminating in a _cul de sac_ behind the bifurcation of the trachea; and the lower or ventricular extremity arising from the trachea at this point, between the bronchi, proceeding down the spine, and terminating, as usual, at the cardiac orifice of the stomach. Mr. Drysdale mentioned a somewhat similar malformation occurring in two children in one family. Mr. Callaway related a case of concussion of the brain, which terminated fatally, after the restoration of the intellectual functions. The whole of the anterior lobes of each hemisphere of the brain was broken down, and mixed with effused blood. The remarkable feature of the case was, the return of consciousness, and the possession of this power for six days, under the disorganization of the brain described; and the questions particularly agitated were, Did this extent of mischief exist immediately after the concussion? What was the degree of laceration of the brain at that period? and, How could the recovery of the intellectual faculty be reconciled with so much injury of the brain?

The Society then adjourned to the 12th of January, 1829.

COOPER _v._ WAKLEY.

Notes of the Cause, Cooper _v._ Wakley--We understand that Mr. Cooper is about to publish a verbatim account of the above trial, from Mr. Gurney's short-hand notes.

ERRATA.

The Advertisement of Mr. B. Cooper's, in our last Number, ought to have been dated "_December_ 15," instead of "_Oct._ 15." Also, for "_Mr. Elton_," the name of one of Mr. Cooper's witnesses, read "_Mr. Hilton_."

In our last leading article, _for_ "can no friend of Wakley be named?" _read_ "can the name of no friend of Wakley be mentioned?" The alteration is necessary, to connect it with the conclusion of the paragraph.

W. WILSON, Printer, 57, Skinner-Street, London.

FOOTNOTES:

[1] General thickening of all the valvular apparatus on both sides of the heart. (St. B. 33.)

[2] Andral, vol. iii. p. 411.

[3] Pl. 1, fig. 5.

[4] Opacity and thickening of the lining membrane on both sides of the heart, without unevenness or alteration of form. (St. B. 33).

Opacity and thickening in the valvular apparatus between the left auricle and ventricle, with shortening of the chordæ tendinæ, and such alteration of structure and form as to produce a considerable contraction of the aperture. (St. B. 26).

Such thickening of the whole valvular apparatus as to narrow the aperture of communication between the left auricle and ventricle to a mere slit. (St. B. 19).

Shrivelled and contracted state of the semilunar valves, in which a cartilaginous substance has entirely taken the place of the natural structure. (Hodgson, pl. 1, fig. 6).

[5] Osteum aortæ almost closed by ossified valves. (St. B. 15); (Hodgson, pl. 1, fig. 2).

[6] Fungus growing from the aortic valves, which are thickened and shortened. (St. B. 6, 20).

Fungus form the aortic valves, which are ulcerated. (St. B. 21).

Larger specimens of fungus, growing from the ulcerated edges of two of the valves of the aorta. (Hodgson, pl. 1, fig. 7).

[7] Dr. Baillie's plate.

[8] Polypous coagulum in the ventricle. (Coll. of Phys. 4, A. 16).

Coagulum firmly attached to the lining of the left auricle, with enlargement of its capacity. (St. B. 19).

[9] (St. B. 13).

[10] It occurs sometimes in the uterus.

[11] Memoir. de l'Acad. des Sciences. Morand, 1732. Morgagni, Epist. 27.

[12] Andral, v. 3, 466; Hodgson, plate 1, figure 7; St. B. 14.

[13] Corvisart, cap. 4. sect. 1.

[14] Active dilatation of the left ventricle. (College of Phys. 4, c. 10.)

The thickened walls of the left strikingly contrasted with the attenuated walls of the right ventricle. (St. B. 9).

Active dilatation of the left ventricle. Its capacity is strikingly contrasted with that of the right. (College of Phys. 4, c. 11.)

Passive dilatation of both ventricles, especially of the right. (St. B. 10).

[15] Morgagni, Epist. xxvii. 7.

[16] Ibid. 2.

[17] Ibid. 3.

Rupture of the left ventricle, with attenuation of its muscular structure. (St. B. 18).

Rupture, without attenuation, but with softening and looseness of texture in the muscular substance. (St. B. 22).

[18] Harvey, Exercit. altera.

[19] Rupture of the left ventricle without change in its structure. Bone deposited at the commencement of the aorta. (St. B. 27).

In turning over the Memoirs of the Royal Academy of Sciences, I find two cases of rupture of the heart, reported by M. Morand. They both occurred in the year 1730; and, strange to say, one was that of a Duchess of Brunswick, who was of the same family as George II. who also died of a ruptured heart. In the one, that of the Duchess, there was a manifest ulceration through the walls of the right ventricle, its structure being otherwise unimpaired; in the other, where the aperture was in the left ventricle, there was probably a simple rupture, for the flesh of the heart was so soft that the point of a probe would pass through it wherever it was rested. (Mem. de l'Acad. Roy. des Sciences, Ann. 1732).

[20] The trial as published in the Lancet occupied less than 21 pages--in the Gazette it extended, in the same type, to 33 pages and a half. In the Lancet, those parts, both of the evidence and speeches, which told most against Wakley, were omitted.

[21] See passage in Italics, page 137.

[22] The defendant, on leaving the court, was cheered by the populace in Palace Yard.--Lancet, Dec. 20.

[23] This we believe is false; nothing of the kind either occurred, or was stated at the trial.--E. G.

TRANSCRIBER'S NOTE

Obvious typographical errors and punctuation errors have been
corrected after careful comparison with other occurrences within
the text and consultation of external sources.

Except for those changes noted below, all misspellings in the text,
and inconsistent or archaic usage, have been retained.

Pg 116, 'immedate contact' replaced by 'immediate contact'.
Pg 119, 'and attennuation in' replaced by 'and attenuation in'.
Pg 126, 'Tue valuable paper' replaced by 'The valuable paper'.
Pg 132, 'probably impossibly' replaced by 'probably impossible'.