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will do so. Not the hearts of oxen generally, because theyare stunned by blows before they are bled.Thirdly. Mr. Warde "throws a passing glance" at the
knowledge which connects all spasm with irritation. Dr. M.Hall has surely taught this gentleman that all spasm had itsorigin in irritation applied either to the extremities of theincident nerves, or to some part of their course or their origin.Yes, he (Mr. Warde) says, " Spasm of the glottis from drink-ing boiling water from a kettle-spout; but what of spasmodiccroup, what of spasm of the diaphragm of the iris ?" &c.
What, indeed ? Does Mr. Warde know the cause of spasmo-dic croup ? Has he never, in such cases, lanced the gums forthe relief of dental irritations according to the most properdirection of Dr. Hall ? Has he ever cured spasm of the dia-
phragm-hiccough, by a dose of magnesia or a drink of coldwater, which in the one case neutralized, and in the otherdiluted, some local irritation of the stomach ? Has he everseen a spasm of the iris without a good and sufficient cause ?No, Sir, they are totally different things. When Mr. Wardecan show me the blood brought into the condition of the urine e ’which suffices to produce spasm of the bladder-(he says," ithas not occurred to this sage pathologist that the urine, beingeliminated in Nature’s great laboratory from the blood, thatthe same chemical power which can render urine [the naturalstimulus of the bladder] acrid and irritating, and a produce[cause] of spasm, may so change the blood [the natural sti-mulus of the heart] into an equally offending agent,")-then,Sir and nnf, +ill then shall T believe that ct,aam nf the heart
can occur, its tissue being healthy. A word more, Sir, and Ihave done. Two writers in the same number of THE LANCETquote cases as illustrating spasm of the heart. One of thesecases is that of a lady who had had puerperal mania and diedsuddenly during a succeeding pregnancy. Suffice it to say inthis case, that the head was not examined. The other caseis that of a gentleman who gives a description of his ownsufferings. The case is evidently one of dyspepsia. Thepains &c. are excited by smoking, wine, malt liquor, or anxiety,and are relieved by brandy. I notice this case, because thewriter asks, Why not the heart, as the diaphragm or the uterus,be excited to spasm ? For this reason-that there is nothinganalogous in the cases. In nearly all respects, the function ofthe heart differs from that of all other muscular organs, butparticularly in this, that its movements are apparently independent of the central nervous axis. The brain and spinalcord may be removed and the heart still continue to beat.Neither can the heart be excited to contraction when theaction has ceased, by irritating its nerves, as can other mus-cular textures. It can be excited in no other way thanby irritation applied to the tissue of the heart itself. If thiscan be accomplished during life, spasm may occur, not other-wise, " the tissue being healthy." It will, Sir, so far as theargument has hitherto gone, demand far more convincingproofs than Mr. Warde has hitherto produced to induce theprofession to believe in the existence of this lesion. Whydoes not Mr. Warde publish the whole case ? Why does henot afford the profession the means of judging for them-selves ? As you have remarked, Sir, it leaves room for themost vague rumours to circulate, and affords those who havethe disposition to do so an opportunity of questioning Mr.Warde’s conclusion.—Sir, your obedient servant,
London, Nov. 20, 1848. MEDICUS.
PROPOSED INCORPORATION OF THE GREATBODY OF THE MEDICAL PROFESSION WITHTHE UNIVERSITY OF LONDON.
To the Editor of THE LANCET.
SIR,—In your correspondent’s communication of last week, I
relative to the proposed incorporation of general practitionerswith the University of London, signed " A General Practi-tioner," I know not for what he is most to be pitied, whetherfor his miserable attempt at puffing into importance the classto which he himself belongs, for his incapacity at discoveringthat the London University graduates hold a superior positionin the profession to the general practitioners, or for his pitifuldiscontent at not being able to occupy the same without anexamination, or, in other words, because he is not allowedto pass easily " from one extreme of the profession to theother."Let us see how far his language tends to excite this com-
Dusemtion. He informs us that the examination by theSociety of Apothecaries is eminently practical; (if the can-didate has been practised at cramming!) that for many yearspast their curriculum has been gradually improved, and that
the subsequent examination is confessedly superior to theexaminations of the Universities of Oxford, Cambridge,Edinburgh, Glasgow, and Aberdeen, as also of the Collegesof Physicians and Surgeons. Surely this is ridiculously modest,emanating from a member of the renowned institution atBlackfriars !
Is it not notorious in every medical school in the king-dom, that the most practical and best men, who alwaysabominate the system of grinding, and discountenance itin toto, are constantly much annoyed, and even sometimesplucked at Rhubarb Hall, whilst idlers, ignorant of even therudiments of medical knowledge, after three months’ cram-ming, almost invariably pass their examination with credit,and frequently carry off what are called the honours of thecourt ? How absurd, then, to compare such a place with Ox-ford, Cambridge, Edinburgh, &c., notwithstanding in thoseuniversities the candidates receive their degrees from theirown teachers !Having disposed of the old institutions by bearding them
in a lump, he challenges the youthful university single-handed, and informs us that after a careful examination ofthe question-papers, having perused several of them, he haddecided that it would be necessary to place himself on thestudents’ benches again to understand them, therefore thatthey are not sufficiently practical, (particularly as the grind-ing practice does not succeed there ;) hence he could not fora moment allow the examinations of the London Universityany superiority over the examination of the unassuming in-stitution at Blackfriars ! If this be true, a very intimate re-lation exists, and an amalgamation may forthwith take placewithout injury to either ; but the quotation, in answer to’" X. P.," of your opinion, as also from the British and ForeignMedico-Chirecrgical Review, would make this General Practi-tioner" savour very strongly of the pretender, and fully con-firm how pitifully silly such incapacity, in not being able toappreciate the great distinction between the classes he at-tempts to confound, must make him appear.
Atter such an amount ot vain parade relative to the supe-riority of the examination at the Hall, he hopes that bothparties may be satisfied with a sort of compromise, and asksthat practitioners above a certain age-say forty-may besold the M.B. degree, or, in different words, have it on thepayment of certain fees without an examination, or merelya practical one-of course the collateral sciences, with yourcorrespondent, have no bearing on the practice of medicine !
Now, " in these days of liberalism," what is it that thiswould-be liberal, vain’boasting, discontented general practi-tioner proposes ? After asserting that the stringent and ex-tended examinations of the London University are less prac-tical, and therefore inferior to the two hours’ examination atthe Hall, and informing us that for many years past the cur-riculum of the latter has been gradually improved until itmay be fairly pitted against that of any other medical insti-tution, he begs that those only who have attained the age offorty, and who, by his own admission, must have passed theirexamination when the curriculum was at a very low ebb, maybe allowed to associate themselves with the graduates of theLondon University on the payment of so much money tBear in mind that he asks this as a boon, after having toldus that the University is even inferior to the Hall ! In thename of common sense, would it not be the height of injus-tice to confer any such favour, and more particularly sincethat which is sought is of so partial a character ? Is not theseeking of such eminently selfish? If any are eligible, anddoubtless some are, is it not mnch more probable that theyare to be found among those who have been admitted sincethe curriculum has been so much improved ? Then why askto sucH lur me baku of uitttnug muse only who passed their examination when the curriculum of studywas as low as it could possibly be ? Our friend, the "GeneralPractitioner," must by this time have seen how truly absurdis his position, _and have felt the utter impossibility of thecompromise he has proposed. He must perceive that theLondon University graduates can only receive those whohave passed through the same ordeal as themselves, andshown that they merit an honourable distinction-that theymust always raise their voices against side-door entries, andoppose to the utmost any such proposition as that of " X. P.’and his supporters.
It should not be forgotten that the general practitionerswere the aggressors in this controversy-that the proud posi-tion of the graduates of the London University was in
jeopardy, and that they have only defended it. If truths dis-
agreeable to some have been made to appear, they have onlythemselves to thank for them, since no other course was open,
and the same means will be again resorted to, should anyhave the hardihood to make a like attempt. They have nowish to ride rough-shod over their medical brethren, but theywill prevent-what is not uufrequently attempted-theirmedical brethren taking from them that which is their due.They earnestly desire that as many as are able will pass
through the same portal as themselves, and then will they begladly received as associates by the graduates of the LondonUniversity.—I remain, Sir, yours most respectfully,
Nov. 27, 1848. A LONDON UNIVERSITY GRADUATE.
FURTHER NOTE ON TIIE OPERATION OFTRACHEOTOMY.
To the -E, ditor of THE LANCET.SIR,—I have to propose, in this note, that the tenaculum,
tracheotome, or instrument for the operation of laryng-otomyor tracheotomy, be of the proper size for children. In ope-rating on adults, it will only be necessary to repeat the appli-cation of the instrument, above or below the place of thefirst opening. In this manner, that opening may be augmentedand made of any magnitude that may be desired, and it willhave the advantage of being o2al, or nearly so.The surgeon will thus have to possess himself of one instru-
ment only.-I am, Sir, your obedient servant,London, November 19, 1848. MARSHALL HALL.MARSHALL HALL.
THE CHOLERA IN PECKHAM HOUSE ASYLUM.To the Editor of THE LANCET.
SIR,—I shall reply but briefly to the letter of your Cor-respondent " T. A.," dictated as it is by the most bitter ani-mosity, conve3-ing the most groundless insinuations, and, in aword, written with feelings for which few will envy him. Hecommences by a wilful misrepresentation of facts, in statingthat my letter to the Times newspaper was inserted underthe puffing heading of Chloroform a2s’ew Remedy for Cholera,"whereas by referring to the journal in question, (ofOctober30,)it will be found headed simply " The Cholera." The publi-cation, again, of the letter through that channel, was suggestedand strongly urged by the commissioners in lunacy, as beingthe readiest mode of bringing under the notice of the pro-fession the success we had met with in the use of chloroformin the treatment of a disease of such awful fatality.The total number of patients in the asylum is 500, of whom
sixty are private, and 440 are pauper. The drainage of theasylum has always been considered good and efficient, and,moreover, kept properly clear, and the cesspools havebeen regularly cleaned out when required. In order, how-ever, to render it still more efficient, the proprietor has of late,at a considerable outlay, had the whole of the establishmentthoroughly re-done, by means of the glazed stone-ware drain-pipes, which lead into a newly-made sewer running under the-public road, at a much lower level than the old one into whichthey formerly led, and by which means all offensive matterscan be effectually washed away from the premises in thecourse of a few minutes. There is a large farm-yard on thepremises, at some distance, however, from any inhabited partof the establishment, where both horses and cows, as well aspigs and poultry, are kept, but no communication whateverhas been made to us by the board of guardians relative to itsbeing at all considered in the light of a nuisance.The dietary of the patients is good and wholesome in quality
and ample in quantity, and such as is approved of by thecommissioners in lunacy. - - - -
As to the probable cause of the breaking out of the cholerain the asylum, it is doubtless to be attributed to the circum-stance of the drains and cesspools having been opened shortlybefore, and the inmates exposed in some degree to the emana-tions arising from them, in connexion with the peculiar stateof the atmosphere, which renders the disease epidemic, theformer acting as a predisposing cause. Its great prevalencealso, in so far as my experience goes, is likewise to be attri-buted to its having been communicated, in several instancesat least, by direct contagion. As to the mortality, again, being4c greater" than over every other place in the metropolis, ithas been, on the contrary, " considerably less" than either inthe metropolis generally, or in any other part of the king-dom, as will be seen from the tabular statement of our cases aspromised to appear in your number of December 2nd. Andas to the cases treated by chloroform a still smaller rate ofmortality will be observed.
I may add that our operations for draining were commencedlong before the appearance of cholera in this country, and
would have been completed some time ere the epidemic hadtravelled this length, had they not been delayed by the longcontinuance of wet weather.
Finally, as I tm by no means ambitious of figuring in thecolumns of any periodical, I shall decline all further cor-
respondence on this subject.-I remain, Sir, your obedientservant, JAMES HILL,Pcckham House Asylum, Nov. 1848. Medical Superintendent.P.S.-I have now given a candid reply to the queries of
your anonymous correspondent " T. A.," which probably fewwill consider him entitled to, in consequence of his not havingthe courage to adopt his own signature.
JAMES HILL,Medical Superintendent.
EXAMINATIONS AT THE UNIVERSITY OFLONDON.
To tlte Editor of THE LANCET.SIR,—As " General Practitioner" who writes in last week’s
LANCET has chosan to compare the examinations of differentboards, and to condemn those of the London University asnot practical, and in no way superior to that at Blackfriars’, Imust request that you will insert the pass and honour examina-tion papers for this month, that he may have the opportunityof correcting his opinion on the subject. I think he will findthe questions as practical as possible, and that the greatdifference between these examinations and others consists inthe much wider range of subjects which they embrace. Imust say that I think one who has passed this, in addition tothe two ordinary examinations, is as competent to form anopinion as to their respective merits as " a General Prac-titioner." This gentleman labours under a mistake if hesupposes that M.B.’s of London have not also the diplomas ofthe hall and college. These they must of necessity obtain, asthe London degree gives its possessor no licence or privilegewhatever. If I am not mistaken, I can discover in your cor-respondent’s observations a secret strong desire to obtain thedegree of the very university whose examinations he despisesand condemns. Now, if it is a degree merely for which he isso anxious, I would, with a former correspondent, advise himto get it at some Scotch university, and then present himselfat the College of Physicians, where he would be receivedwith open arms. In this way lie might obtain all that isattainable in the way of titles without the necessity of" placing himself again on the students’ benches"—without along, deep, and extensive course of reading and observation,and, of course, without that useful information which alonerenders any degree really valuable to its possessor and to thepublic. If the wild scheme of incorporation should ever meetwith success, I presume the NI.B.’s would be arranged in twoclasses-viz., those by examination and those without; and ifregistered in this way, the whole matter would be devoidboth of objections and utility.-I enclose my card, and remain,Sir, your obedient servant,
A LONDON GRADUATE AND GENERAL PRACTITIONER.Nov. 27. 1848.
*** We regret that we cannot at this time find space to
publish the 11 pass and honour examination papers" of theUniversity of London; but our correspondent must be fullyaware that the value of the examination does not depend somuch upon the questions as upon the replies to them. Itis only an act of justice, however, to the university, to theexaminers, and to those who have passed the examinations, toobserve that the written answers to the questions are regu-gularly filed, and are open for inspection. Many of the gra-duates, we understand, have in their examinations givenevidence of extraordinary learning and ability.-ED. L.
ON A SEVERE CASE OF DYSPEPSIA.To the Editor of THE LANCET.
SIR,—I beg to suggest the trial of diluted sulphuric acid tothe country surgeon who has been so long a sufferer fromdyspepsia, and whose letter I have read in to-day’s LANCET.
It calls to my mind at once a case that was under my careabout two years since, similar in many circumstances, ofeleven years standing, but not in so aggravated a form.The third or half of a tumbler of water was given with suffi-
cient acid to make it agreeable to the palate, three times aday, with almost immediate benefit; and continued severalweeks, (I should think about three or four,) when my patientexpressed himself quite well, and most grateful. He hascontinued well ever since.