the ligature came away from the artery, and the ulcer of the pharynx had begun to cicatrize. On the 16th the right side of the pharynx and palate had cicatrized. The ulcer which remained at the back of the pharynx was an inch in length, half an inch in breadth, yellow, and at one part deeply excavated. Blue pil internally, and a mercurial ointment to the ulcer were employed, healing went on rapidly, and on the 22d Nov., the last date of report, there was every reason to believe that a few days more would complete the cicatrization.

"Till the ulcer in the throat assumed a healthy appearance, I felt considerable anxiety lest the hemorrhage should return; and I regretted that, instead of tying the common carotid, I had not tied the internal and external carotids separately at their origin. This operation (which, if I were again called to a similar case, I should probably adopt,) is calculated to give the patient an additional security against a recurrence of hemorrhage; inasmuch as it would cut off, not merely the direct flow of blood upon the ulcerated artery, but also the principal anastomotic supply.

In these remarks, I take it for granted that the hemorrhage in the case described proceeded from a branch of the external carotid. They would not, it is evident, apply if the ulcerated vessel were the internal carotid: in that case, it is to be feared that nothing would save the patient.

In the present instance, I am inclined to suppose that the ulcerated artery was the lingual, for the following reasons: 1. The patient tells me that the soreness in his throat, which he latterly experienced, seemed to him deeply seated within the angle of the jaw; and thus referred to the exact situation of the lingual artery, which as regards the cavity of the fauces, is singularly exposed and superficial at this part. 2. In a case attended by Dr. Watson, in some respects very parallel to Webb's where the patient died through hemorrhage into the fauces from ulceration, the artery which bled was proved, by dissection, to be the lingual artery."

Cases similar to the preceding are of rare occurrence. In some the first hemorrhage is fatal; in others, the ulcerated artery, having bled for a time, spontaneously closes, and the bleeding does not recur: in others, the patient is carried off by a return of hemorrhage. In the case of Webb, there can be little doubt that the latter result would have ensued if the artery had not been tied. I believe the case to be the first of the kind in which this operation has been performed: it is extremely gratifying to me to have to state that the practice has proved successful."

The successful issue of the case is a flattering panegyric on the bold and decisive operation performed by Mr. Mayo. But we have the same remark to make on the treatment, which we made on that adopted in the case of Dr. Watson, and we cannot but regret that none of the usual medicinal means employed for checking hæmorrbage, were resorted to previous to the use of the knife. The patient was in the house for nearly, if not quite, twelve hours before a recurrence of the bleeding took place, and during that time the employment of the acetate of lead, &c. would have done no harm, but possibly might have been productive of good. These observations can hardly apply to Mr. Mayo, for the patient was admitted at a late hour in the evening, and probably was not seen by Mr. M. till the next morning's catastrophe, which required more prompt and energetic measures.

IV. HÆMORRHAGE FROM SLOUGHING ULCERS IN THE THROAT SUCCESSFULLY TREATED WITHOUT AN OPERATION."

Case. Wm. Stennet was admitted into Lazarus's ward, Bartholomew's Hospital, Oct. 9th, 1829, in a very debilitated state, with a large sloughing ulcer occupying the whole of the back of the fauces, and extending to the edges of the soft palate and uvula. He

London Med. Gaz. No. 113, Jan. 30th. 1830.

stated that at the latter end of April he was affected with an ulcer on the inner membrane of the prepuce, near its junction with the corona glandis. The sore was not excavated, but notwithstanding was very red and hard at its base. He took some mercury, and the sore skinned over without his mouth being affected. About the end of July a bubo appeared in each groin, which suppurated and burst spontaneously. On the 27th of Sept. his throat became sore, and gradually got worse until he was admitted into the hospital. At this time there was an open sinus in the groin; the cicatrix of the original sore was hardened; and, in addition to his sore throat, there were several darkcolored tubercular eruptions on his forehead. He was in so weak a state that mercury was not at first resorted to. He was ordered a very strong preparation of the red Jamaica sarsaparilla three times a day, and the throat was painted over with the linimentum æru ginis. He was also directed frequently to wash the throat by throwing a stream of water from an elastic gum-bottle upon the ulcer, while he held his mouth open over a basin-a simple plan of cleansing a throat, which has been found far more efficacious than gargling.

On the 21st, as he did not appear to gain any ground, and the sloughs were deeper and very extensive, and his stomach rejected the sarsaparilla, he was ordered Quinæ Sulph. gr. ij. ter die ex infus. rosæ. Vini. Rubr. Oss. quotidie, and a strong solution of Nitrate of Silver was applied to the throat. 23d. His general health was improved, but the sloughing still extended. He was ordered to fumigate with cinnabar night and morning. The second application produced such violent bronchial irritation that it was necessary to bleed him, and to desist from the fumigation.

By the 27th he had recovered from the bronchial affection, and his throat was much cleaner. The pure nitrate of silver was applied over the surface; milk and arrow-root diet, and sarsapa rilla, were again resorted to, and he was removed into a clean ward. His general health improved, his throat began

to granulate, and he was apparently going on well until the 25th of Nov. when the remaining portion of the uvula sloughed away, and the whole of the fauces again assumed a very threatening aspect. As the local application of the mercury had before benefitted it, the lotio flava was directed to be applied to the throat; and he was ordered to take Hydr. Oxymur. gr. § ter die.

"On the 4th of Dec. as the throat was not improved, he was again ordered to employ the fumigation, with greater precaution than on the former occasion. During the night he felt a peculiar sensation in his throat, requiring him frequently to swallow. At 4, a. m. he vomited up nearly three pints of blood, and became alarmingly faint. The house-surgeon, Mr. Chapman, was sent for, who ordered him Plumbi. Acet. gr. j. Opii. gr. ss. 4tis horis, and directed him to take every thing quite cold. The bleeding did not recur before I visited him at half-past 12. He was then in a most alarming state; his pulse so feeble that it could hardly be distinguished; and his whole body bathed in a cold clammy sweat. It was quite obvious that a recurrence of bleeding must prove speedily fatal. I had just heard of Mr. Mayo's successful operation, and should have been disposed to give the patient the chance of success from the same means, but it was quite impossible to determine from: which side the bleeding took place, so very extensive was the sloughing in every direction. Under these circumstances he was directed to take Alum. gr. x. ex Inf. Rosa. Ziss. c. acid. Sulph. dilut. M x. et Træ. Opii. m v. 4tis horis. He was kept in a state of the greatest quietude; fed entirely on iced fruits and milk; and most narrowly watched. Without detaining your readers with too minute a detail of the case, suffice it to say, no return of bleeding took place. In a week he was much recovered in his strength, though very feeble. As the throat was still in a very bad state, and the sores on his head were spreading, the nurse was desired to rub Ung. Hyd. fort. 3j. night. and morning, into the axilla. The mercury speedily began to have a most

beneficial effect; the sores gradually improved, and are now nearly healed; his strength and general health have also improved in proportion. He has since left off the mercury, and has resumed the sarsaparilla."

Mr. Earle, under whose care the preceding case turned out so happily has added some observations that are worthy of attention. They certainly conspire with the issue of this case and of another to which Mr. Earle alludes, to support the suggestions we have offered. "I have stated that I should have been induced to have tied the trunk of the lingual, or the external and internal carotids, in this case, if it could have been clearly ascertained from which side the bleeding took place. I need hardly add, that if such an operation had been performed, and the patient had recovered, it is probable that the recovery would have been attributed to the employment of the ligature. It is on this account that I think it due to the profession to publish the case; at the same time I wish it to be distinctly understood that I do not pretend to offer an opinion respecting Mr. Mayo's or Mr. Luke's cases. I am desirous of taking this opportunity of concurring in opinion with Mr. Mayo in the propriety of tying the external and internal carotids separately in all such cases as may require the ligature of these vessels; but I should prefer tying the trunk of the lingual where such an operation could be effected. In Mr. Luke's case it is obvious that the circulation continued through the bleeding vessel, as several slight returns of arterial hæmorrhage took place. It is probable that in this case, if the force of the heart and arteries had been greater, the operation would have failed, from the collateral circulation.

A case in every respect similar to Stennett occurred in Sewell's ward in the autumn of 1828. In this case a young, very delicate female, had repeatedly extensive hæmorrhage from foul ulcers occupying the whole fauces. The bleeding was successfully arrested by the same means as were employed in Stennett's case-namely, large doses of Sulph. Aluminis in infus. Rosa, and

feeding the patient on iced milk and fruits."

By the way, neither Mr. Earle nor Mr. Luke have alluded to another very powerful measure in arresting hæmorrhage, we allude to venesection. If a patient were swooning or sinking from violent bleeding, no one would of course be so mad as to open a vein in his arm, but generally the fatal loss of blood is preceded by several slighter ones, and that is the time for moderate bleeding from the arm, aided by acids or astringents, cool air, cool drinks, position, local pressure, and the other items of the anti-hæmorrhagic regimen. If these fail, the surgeon has the cases of Mr. Mayo and Mr. Luke, as precedents to guide him. The subject is very interesting, and the facts we have now brought together are calculated to be instructive.

XL.

MEDICAL SOCIETIES-REPORTING.

No impression, however keen, no sensation, however vivid, can last longer than nine days in the public mind-not even in the grave and sad mind of physic. We have a very recent instance in illustration. We were informed, by a most veracious cotemporary, that an "intense excitement" existed in the professional public on the 15th of April last, respecting the "great public dinner" to Mr. Handey. We think, on reflection, that this must have been the fact-for so intense was the excitement, that it destroyed all appetite before the first of May-and that profession which,' according to our cotemporary, was in a complete state of effervescence in the middle of the month, became as vapid as stale infusion of senna, before the end of the same month! This is the case with all fervid emotions of the" mind, whether in individuals or societies. They cannot last long-like the Irishman's love, they would "burn through the clothes," if they existed beyond the ninth day. Our good friend Wakley should have been aware of this,

and not set the profession in a flaming state of excitement for a "great public dinner," fourteen days before the beef was put on the spit! How could he suppose that John Bull's patience would last out such a time, when the pleasure of eating was in view? The " ensuing Autumn," however, will make up for all disappointments; and, as the town is then generally in the country, there will be plenty of room in the Freemason's Tavern for the "great public dinner" during the dog-days.

This reminds us of another "intense excitement" that was kindled up, not long ago, respecting reports from the different medical societies. The system of reporting was to introduce a new æra in medical science—to diffuse the knowledge and talents of the metropolitan lions among the humblest members of the profession-to call forth modest and pining merit from the darkest "holes and corners" of our London lanes and alleys-and, in short, to foster talent and to check pretension wherever they were found! These fond speculations have not succeeded. From whatever cause, the fact is, that the attendance on medical societies, in the metropolis, never was at a lower ebb than during the session just terminated. The first effect of reporting was, to call forth a host of candidates for the honor of appearing IN PRINT and especially those who, of all others, were least capable of affording useful information to the members of societies or the public at large. The next and natural effect was, a cessation of attendance on the part of those who were most likely to render discussions interesting or useful; and the third consequence was, a disappointment of those splendid results of REPORTING," which the "REPORTERS" of sanguine temperaments had anticipated. Our readers must have seen that the reports of the last session exhibited a sad falling off, and were little more than professional puffs which had outlived their ingenuity and died a natural death.

66

Our attention was drawn to the subject by reading, in the last Number of our Glasgow cotemporary, certain stormy proceedings in the medical so

ciety of that flourishing city, respecting the propriety of "REPORTING" their proceedings. It appears that our cotemporary has got into a scrape by following the routine of the day, and attempting to fix or freeze the wordy thoughts of the Glasgow lions, and thus to give them "a local habitation and a name." The members of the northern congregation do not at all assimilate with those of the south. So far from fighting for publicity, and going on their bended knees to REPORTERS, to beg for a niche in the TEMPLE of FAME, they are said to have viewed, "with feelings of indignation and astonishment," the attempt that was laudably made by our cotemporary to transmit their names to posterity.

"It was then stated, with feelings of indignation and astonishment,' that a gross breach of confidence had been. committed by some member or members; that the laws had been violated; that the Society had been betrayed, and was about to be utterly ruined; in a word, that the Proceedings of the Society had been reported in the Glasgow. Medical Journal, an unprincipled publication, not a whit better than the Lancet."

Now we must declare that this last insinuation is utterly devoid of foundation. We have regularly perused the pages of the Glasgow Journal, from its commencement, and we never saw any thing like illiberality or party-feeling in its columns. Indeed it formed a complete contrast to the LANCET, with which it is compared on this point; and, therefore, we cannot but suspect that the above declaration was founded on those very personal feelings and motives which are decried in the proceedings of the society. In the course of an angry discussion on the subject of REPORTING," our cotemporary affirms that a final majority was in favour of the measure; and, consequently, that the Editors of the Glasgow Journal might have fairly and honourably pursued the course which they commenced. But, unlike some of their cotemporaries, they have modestly deferred to the minority-and chose to sacrifice their own interests, and even what they conceive to be the

66

interests of the profession, rather than offend the feelings of any members of the society. This procedure alone is a proof of the falsity of the parallel which was attempted to be drawn between the Glasgow Journal and the Lancet. We wish we could verify, to the full extent, the following flattering picture of medical societies in general. "An assemblage of medical men, however, is of all others the least apt to be led away by mere declamation. Habituated, by daily practice, to the command of their feelings, and to seek, even in the most perplexing circumstances, for some sure principle on which to rest their conclusions, their minds acquire a hardihood, which renders them little susceptible of momentary excitement, and a decision, which enables them to view every question in its pure practical bearings, and form their judgment without regard to extrinsic considerations."

We believe that, upon all important occasions, when the judgment as well as the feelings of medical societies are fully called forth, the foregoing results will obtain. But we have had too much knowledge of the world, and of medical societies, to acquiesce, to the full extent, in the foregoing proposition. In the cold regions of the North, it may be as our Glasgow cotemporary represents it. But, whether it be owing to the brilliancy of the skies, or the heat of the gas, in modern Babylon, it so happens that the judgment is not always formed "without regard to extrinsic considerations." We respect the feelings which dictated the following passage, and the resolution therein promulgated, though the sentiments will scarcely bear the scrutiny of rigid and cold philosophy.

"The Glasgow Medical Society consists of individuals, not merely related as members of a medical association, but related still more intimately by friendship, kindred pursuits, and habitual intercourse. The relations of the latter kind we value still more highly than those of the former, and should be sorry to infringe them. Having ascertained, then, that the publication of the reports of the Society is obnoxious

to several Gentlemen, whose opinions we respect, even while we differ from them, we, for that reason, abandon our proposed plan. We repeat, however, that we abandon it, solely, from motives of private feeling."

Whoever, after the above declaration, pronounces the Glasgow Journal to be "an unprincipled publication, not a whit better than the Lancet," must be totally incapable of distinguishing light from darkness. Indeed, we conceive that our brother editors of the north have carried their delicacy even too far; for, after a majority of a society had determined the right of publishing their transactions, there could be no violation of propriety or delicacy in giving a fair and correct exposition of their proceedings. We begin, however, to doubt very much the ultimate utility of these reportings, since they draw with them a host of evils when the medical press is corrupted by party feelings, and, consequently, incapable of giving a fair representation of the facts or opinions broached in a society. By this procedure all well authenticated cases of much interest are necessarily held back, for fear of exposure to the eyes of relations or friends in the public newspapers-for which vehicles matters are now-a-days got up in medical journals, and not at all for professional perusal.

XLI.

PROSPECTUS OF THE "METROPOLITAN SOCIETY OF GENERAL PRACTITIONERS IN MEDICINE AND SURGERY."

GENERAL PRACTITIONERS. A SOCIETY has been formed, which is entitled, "THE METROPOLITAN SOCIETY OF GENERAL PRACTITIONERS IN MEDICine and SurgERY," and is intended as an union of the Practitioners of this class throughout England and Wales, for the protection of their mutual and individual interests; having the following objects in view :

1st. Such alteration of existing laws and customs as shall promote the prosperity and respectability of the general body of Practitioners.