bours in that field-but we see no reason why provincial periodicals should not be productive of great benefit (both to the country practitioners, and to the profession at large. They will be of essential service to the former, by establishing a system of literary and friendly correspondence between the members of neighbouring counties, and by calling forth a generous rivalry in the cultivation and publication of medical and surgical information, not only among themselves, but between them and metropolitan practitioners. That such journals should be beneficial to the whole republic of medicine, there is no need of argument. Facts are facts, whether observed and recorded in Worcester, Winchester, or Londonand their value has no reference whatever to the name of the recorder, or of the spot of ground on which the record was made. Vaccination is coupled with Gloucester only as a matter of history-and not in the way of causation. Had Jenner made the discovery in London, his name would not have travelled over one foot of ground more than it has done-though he lived and died a country practitioner.The truth is, that taking the general run of medical practioners in provincial towns and in the metropolis, the balance of knowledge, science, and literature, would preponderate in favour of the former. There might not be found so many SUNS, but there would be more STARS of the first magnitude. These SUNS of the metropolis, from whom the light can be readily and quickly borrowed, whenever there is any obscurity in the case, are most unquestionably the cause of internal darkness in their own satellites. Medical practitioners in the country are obliged to lean more on their own resources, and consequently their energies are more called forth-their intellects are more exercised-their observations are more acute-and their judgment more correct. Under these impressions we have no fear in predicting that the medical periodical press may flourish, in the country as well as in London. Do we not see as great talent and as great circulation in provincial newspapers as in those of the metropolis? The medical gazettes of the country have greatly the advantage of the newspapers; because medical facts are imperishable, while the "ON DITS" of the day die at the rising of the next sun.

But to return to the PROVINCIAL MEDICAL GAZETTE. The following extract VOL. X. No. 21.

21

from the introduction will show that this periodical is not likely to be a "milk and water production, as far as medical politics are concerned. The medical and surgical science of the new journal will be amply analyzed in other parts of our work.

CHARACTER OF THE LANCET.

"With regard to its personal criticisms of public lectu ers nd practitioners, we admit that they are within the proper pale of animadversion: but in a science still so imperfect as Medicine, and an art yet capable of so much improvement, opinions ought to be analysed with all the caution and candour of philosophy, and practice approved or condemned with modesty and forbearance-facts being carefully ascertained, and fairly stated. Whether the LANCET have uniformly acted up to these rules, the Records of Justice have repeatedly shewn. The history of Medicine has handed nothing down to us so truly dis graceful, as was disclosed on the late trial of Cooper v. Wakely. The internal evidence of falsehood in the recorded libelthe kind of witnesses produced to verify it-their ignorance, conceit, want of charity, and, at least in one instance, perjurythe tuition and tampering with them before the trial-the apparent attempt of the Reporter of the libel* to produce, post mor tem, for the purpose of deception, that which was insinuated to have been perpetrated during life-the attempt of the defendant to influence the feelings of the jury, by producing the models, preparations and instruments of a harrowing operation, and by an artful, blinding, and inflammatory address-all these have been so ably commented on and exposed to the public

* "This person has, since the trial, been expelled from the Westminster and London Medical Societies; a sufficient proof of the opinion these bodies entertain regarding his conduct."

by our contemporaries, that it would be superfluous to add any thing on our part. Suffice it to say, they have removed the film from the eyes of those, who were before blind to the principle which moves this great engine of discontent. And it is not its undiminished boasting, and stale attempts to identify the freedom of the press with the liberty of libelling--nor the secret assistance of precocious and unruly homunculi, who spurn at their indentures -nor that of the little unknowns,' who assembled at the Freemason's Tavern to condole with the defendant, and resolve that a good dinner is a capital thing-nor their modest pence put down to build him, doubtless a monument of brass-nor anything, in short, but unequivocal contrition, and an instant forswearing of those proceedings by which he has so disgusted the profession, that will prevent it from being banished by acclamation, wherever charity, good sense, or the feelings of candour and honour exist.

Nay, our enmity or friendship to the LANCET ought not even, as we conceive, to depend on the comparative quantum of good and evil it has done. It is our duty as well as our interest, to obtain the greatest degree of good with the smallest proportion of evil possible: and, unless it can be shewn, that the good which this Journal does or has done, cannot be obtained without the great and multiform mischief it has wrought, let all good men, and all wise men deny it their support.― Has any one formed so mean an estimate of those engaged in the study and practice of medicine, as to doubt that talents and acquirements, of a far higher order than any the LANCET can boast, will be found ready to prosecute whatever has been good in its design and conduct, if properly supported? And who has so degrading an opinion of them, as to think that those talents cannot be found without a deficiency of the moral and nobler sentiments of our nature? We trust, that none can think so, and we call upon every one who thinks otherwise, to aid in st pping the pestilence which is fast corroding all that is vital and honourable in the constitution of the profession." 8.

"In summing up our opinion of this 'leading journal,' or, first of medical newspapers, we beg to repeat,that we think it has, in many respects, been of great service to the profession; and that we considered it to have been conducted with no little talent and activity. But, while we may admire its boldness and cleverness, we must detest its want of moral principle --and admitting the good that it has done, we cannot shut our eyes to the fact, that it has introduced into a previously untarnished literature, a system, which if persisted in and encouraged, would very soon destroy all charity and trust among the members of our profession-sap its respectability -and render it a reproach to belong to it. Let it not be said, that we ought to overlook the faults of the Journal, in consideration of its usefulness-for many a wretch has suffered on the scaffold, who was by no means destitute of good qualities. We presume, it would somewhat disturb the gravity of the court, if a convicted felon were to plead that he should not 'die according to law,' because he had done the state some service in the course of his life!

Severe as are the foregoing criticismsand not more severe than just, we venture to remark that our provincial contemporary, as well as most others who have taken the trouble of publicly characterizing the LANCET, has failed to point out one striking defect, which would inevitably ruin any journal, however buoyed up by a temporary storm of the passions. It is the total want, the entire destitution of all practical knowledge of medicine and surgery in its pages, as evinced in the editorial department. We defy the most strenuous admirer of the LANCET to shew one single iota, in the various volumes of that journal, indicative of the slightest acquaintance with practical medicine in its editorial criticisms. Whatever influence, therefore, the work may have in medical politics, it sinks beneath contempt, the moment that medical science comes on the tapis. A

few years will determine whether men unconnected with medical practice, and consequently incapable of judging between what is right and what is wrong-what is useful and what is useless, or worse than useless, in the science of medicine and surgery, can be considered proper persons to assist the judgment and to direct the taste of their

brethren.

to brutalize the medical profession in these isles, and render it an object for the finger of scorn in every country where letters are known, or the lowest rudiments of civilization established!

In respect to the influence which the abuse of the LANCET has had, or can have, on the fortune or fate of the abused, we venture to say that a very false estimate has been formed by many who are not in a situation to judge of the facts. Of all the personages on whom the vials of its wrath have been emptied, from the first day of its publication up to the present time, the Editor of this Journal has been the most conspicuous object of incessant obloquy. If we except the dagger and the bowl, there is scarcely an engine of persecution, or a measure of malice which the heart of man (fallen and depraved as human nature is) ever devised or executed, that has not been uninterruptedly directed against Dr. Johnson, during the last five years. And what has been the final result? The profession is now pretty well aware of the candour of the LANCET. Yet Dr. Johnson has not the slightest objection to leave the estimate of damage which he has received, to the arithmetic even of that very journal itself.

The profession at large, indeed, has long learnt to despise the wild ravings of the Journal of defamation. Like the log of wood hurled down by Jupiter into the pond, the splashings did certainly alarm a considerable portion of the croaking tribe. They are now raising their heads above water, and even jumping on the back of their despised and harmless Log King.

The PROVINCIAL MEDICAL GAZETTE (a strange name for a quarterly journal) has our best wishes for its success. The tone of honourable and manly feeling which it breathes, argues well for the profession, and is indicative of the rising spirit of indignation which is now bursting forth through town and country, against the bold attempt

VI.

PHLEBITIS AFTER VENESECTION.

An interesting case of this description has been related by Mr. Chinnock, a very intelligent surgeon of Bromptom, in the March number of the Med. and Phys. Journal. The issue, as unfortunately it amost always is in acute phlebitis, was fatal.

The patient was a labouring man, of robust plethoric habit, who was bled at St. George's Hospital, in consequence of a fall, and two or three days afterwards, consulted Mr. Chinnock, with some slight febrile symptoms which assumed no appearance of severity till the evening of the second day from Mr. C.'s visit. It looked, and was treated like a case of common inflammatory fever, and Mr. Chinnock bled the patent freely from the left arm. Next day, on proceeding to repeat the venesection from the right (the one he had been bled in at the hospital, and of which he had not hitherto complained) the lancet wound was found to be inflamed, the arm and shoulder generally swollen as high as the axilla, and considerable stiffness and pain experienced on moving or meddling with the limb. Twenty leeches were applied to the part, the patient bled again from the other arm, and salines with antimonials, calomel and opium, and a brisk aperient next morning prescribed. On the 4th day he felt himself relieved, but the countenance was anxious-the pulse 120, sharp, and small-the coating of the tongue darker coloured-the tumefaction and sensibility in the neighbourhood of the arm-pit evidently increased. Leeches, poultice, tincture of hyosciamus and acetate of ammonia in camphor mixture, and the opiate at bed-time, were the means employed, but in the night he had two distinct rigors, and

on the 5th day was worse. The swelling on that day being greater about the axilla, the pain even agonizing, and the general characters such as to indicate the formation of matter in the axillary region, Mr. Chinnock made a free incision with a sharp-pointed bistoury, and let out a great quantity of healthy pus. Relief, and that very marked, ensued, but it proved to be fleeting and fallacious, for next day there was found to be additional excitement-acute shooting pains were felt running down the shoulder to the fore-arm-the limb was smaller, but a reddened inflammatory line marked the whole course of the cephalic vein, which was felt distinctly hard and corded, whilst pain was produced in it by pressure, and a little pus made to issue from the orifice-the spirits of the patient were sunk, and with difficulty he agreed to the application of eighteen leeches to the vein, poultice and fomentation, and salines with henbane and opiates. In the evening he again appeared somewhat better, but on the 7th day the typhoid symptoms were unequivocal, and the patient was at times incoherent. The discharge from the wound and from the vein was sanious and thin, the integuments in the axilla flabby and livid, the red line of inflammation of the vein had disappeared, a difficulty was felt in the right side of the chest in drawing in his breath, which could only be imperfectly done, in consequence, not of pain or cough, but a sense of choking. A slight tumefaction, with tenderness and increase of heat, were also perceived in the opposite axilla. From this time he rapidly sank, became delirious, and died in the evening of the 9th day of Mr. Chinnock's attendance upon him. Previous to his death the tumefaction in the left axilla increased, he would not submit to an incision, and the part, like opposite limb, assumed a disposition to gangrene.

Sectio Cadaveris. The orifice at the bend of the arm opened distinctly into the vein, which was pervious to air from a blow-pipe. The soft parts immediately around the vein were considerably thickened and required much care to be separated from the vessel. The median cephalic and cephalic were double their natural size, thickened in their coats, the external injected and more vascular than natural, and the vessels alto.

gether looking like an artery rather than a vein. The internal tunic was red and much thickened, and no blood was contained in the cavity of the vessel, which was partially filled with purulent matter in patches like clotted cream. These appearances were observed till within about an inch of the termination of the vein in the axillary, where they ceased; the median basilic and basilic shewed feeble traces of inflammatory action. About an inch below the wound the morbid appearances ceased, but dark-coloured semi-fluid matter was formed in the interstices of all the muscles in the front of the arm, whilst the fibres of those which bound the axilla were gangrenous, and neighbour. ing cellular membrane was slougby, and injected with sanious matter.

In the left axilla was an ounce and a half of thin grumous fluid, and in the right cavity of the chest, Mr. C. was surprised to discover from four to six ounces of semi-purulent matter. The pleura on that side had contracted some trifling adhesions, but presented no further evidence of inflammation. The right lung was greatly engorged-the opposite side of the chest was healthy-the heart and pericardium sound-the brain and abdominal viscera not examined.

The above was an interesting and well marked case of phlebitis, terminating as the majority of such cases do, at any rate, of those which we have witnessed, by a disposition to purulent effusions either into the pleural cavity or elsewhere. Mr. Chinnock brings it forward as serving to confirm Mir. Arnott's views, but to this we shall merely refer for the present, as we purpose to defer expressing our opinions on the subject, till the paper of the gentleman in question comes properly under our cognizance.

VII.

ANEURISM OF THE BRACHIAL ARTERY FROM WOUND DURING BLEEDING.

Some interesting and instructive cases of the above accident, for accident we suppose it may be generally called, have been contributed by Mr. Smith, senior surgeon to the Bristol Hospital, in the first number of the Provincial Medical Gazette. The paper in question has oddly enough been headed, a "Letter on Blood letting," though with ordinary blood-letting it has very little indeed to do.

Case 1. About two years ago, Mr. Smith was summoned to a patient in great haste, in consequence of an apprentice having opened the brachial artery with a lancet, in mistake for the vein. When Mr. S. arrived, the patient had lost a large quantity of blood, though the haemorrhage had been arrested by the tourniquet. Mr. Smith cleaned the orifice and arm, and accurately closed the former by placing over it a small buttonlike compress, secured by adhesive straps and well regulated pressure. The tourniquet was then slackened, and the man sent to bed. The bowels were opened, and in two or three days there being some febrile excitement, the patient was copiously bled, but the arm was left undisturbed for a fortnight, when the pressure was removed. No tumour had appeared, an adhesive strap was re-applied pretty tight, to serve as a support, and from that time to this Mr. Smith has heard nothing of the patient.

Case 2. On the 15th of April, our author was summoned to a stout healthy workman, whose right brachial artery had been opened instead of the vein. The hæmorrhage had been very profuse, but a tourniquet was applied, and before Mr Smith's arrival (three hours and a half after the accident) it was checked. The instrument had been screwed so tight that the man was in excessive torture, and the arm extremely swollen and livid. This case was treated in a similar

manner with the former, and then the tourniquet, gradually loosened when the circulation was restored, and the pain by degrees disappeared. The bandage was cautiously tightened from time to time, and on the 2d of May every thing was removed. No tumour existed, and the man was directed not to use the arm roughly, an adhesive strap being placed around it as a measure of precaution. Mr. Smith has since learned, that the man experiences no inconvenience in the part injured.

"I might relate other cases in my own practice or that of my friends, of the same kind, amply sufficieni to shew that well-regulated pressure will generally succeed in preventing the formation of aneurism. Doubtless, occasionally it will fail, and we have had many cases of brachial aneurism sent to the infirmary from various quarters, in some of which very likely pressure had been properly applied."

The two cases above detailed were certainly more favourable cases for the employment of pressure than those where the artery was punctured through the vein. We perly applied, should not prevent the egress can see no good reason why pressure, proof blood from, and effect the healing of a clean cut in a vessel so much under our command as the brachial. Reasoning, á clusion, and the experience of surgeons, priori, would naturally lead us to this conMr. Smith's for instance, goes to establish its correctness. When, however, both vein and artery are wounded, pressure, however employed, will, beyond all doubt, be often unavailing in preventing the formation of one or other of the different species of aneurism which follow this particular injury, and if the aneurism be actually formed, it will very seldom suffice to cure it. Colles, we believe, of Dublin, succeeded in curing a circumscribed aneurism of the brachial artery after bleeding, but such cases are much too like angels' visits-few and far between. The following presented some unusual symptoms, and deserves to be recorded.

Mr.

Case 3.-A school-master twenty-four years of age, of irritable temperament, re