622

lastly, that I bave wilfully countenancedmisrepresentation and ignorance. If it bea fact, as Dr. Nagle states, that I agreewith him in opinion, Dr. Kennedy seems toargue that the truth of these charges mustinevitably follow. It will be my businessto show,that my own innocence of the abovecharges, and Dr. Nagle’s veracity, are quitecompatible with Panh nthfr. I

It witt appear, on referring to Dr. Nagle’spaper, that the only one of his views andstatements in which he says that I coincidewith him, is that which relates to thesite of the souffiet. It is, therefore, un-

warrantable to impute to Dr. Nagle the de-sire of identifying himself with me in allhis views, and it is perfectly gratuitous toassert that the one opinion in which Dr.Nagle says we agree, was adopted by me onhis authority, without previous examination.The contrary is the fact. I have long enter-tained the opinion, that the sound which iscalled the placental murmur is not seated inthe placenta itself, but in the large arteriesaround the uterus. In this opinion I havebeen confirmed by the facts and argumentscontained in Dr. Nagle’s paper ; for he wasso kind as to communicate them to me, whenhe was making that point the subject ofparticular investigation. He was thereforeperfectly correct in stating that I agreedwith him in opinion respecting the site ofthe soumet. But it does not by any meansfollow"tlat the charges brought against meby Dr. Kennedy are true ; for it appears thatthere is no ground whatever in Dr. Nagle’spaper for the charge of my adopting ALL hisviews, as that paper mentions only one in-stance of an agreement in opinion betweenus, nor any ground for the insinuation thatsuch opinion was received by me withoutinquiry, as it, in fact, was previously enter-tained by myself. It is true, however, thatthe opinion in question was formed withoutconsulting Dr. K.’s paper, and what perhapswill surprise Dr. Kennedy much more, it isequally true that it still remains the same,although I have since considered it with theadvantage of all the lights afforded byDr.Ken-nedy’s able production. Perhaps the know.ledge of this circumstance will induce Dr.Kennedy to change his opinion respectingthe facility with which I may be led to

adopt the views of others without due ex-amination. It is not very probable that theopinions of a man who could resist theforce of his arguments would yield to thoseof another, whom Dr. Kennedy considersvery ignorant ; nor is it likely that such aman would unthinkingly intrust himself intothe hands of any writer, even though itwere Dr. Kennedy himself.As to the supposition that my name was

brought forward to overthrow Dr. Kennedy’spaper, it. scarcely deserves a serious refuta-

I tion. It can bardly be imagined that Dr.! Nagle could expect to derive any support tohis opinions, from the authority of a manwho was not known to have paid any atten-tion to the subject in dispute between h:mand Dr. Kennedy. Besides, Dr. Nagle iswell aware that facts and arguments alone candecide a disputed question in science, andthat the authority of any individual, how.ever respectable, scarcely deserves any con.sideration. I therefore ascribe the use

which he has made of my name to a verydifferent motive, to a desire of making itknown that 1 was not inattentive to a branchof medical science, which all those who knowme might suppose to be wholly neglected byme. To me it is a matter of wonder, thatthose who know Dr. Nagle, who is one ofthe most accurate auscultators with whom Iam acquainted, should suppose he could de.rive any advantage from appealing to myauthority in support of his particular viewsregarding obstetric auscultation.

It is obvious that, as I had not read Dr.Kennedv’s paper before Dr. Nagle’s waspublished, I could not be a party to thealleged misrepresentations contained in thelatter ; and this I hope will preserve mefrom the calamity of forfeiting Dr. Ken.

nedy’s good opinion, which I shall be veryhappy to retain as long as I can do so,without the hazard of losing my own.

It will also be granted that, as I havenow attempted to correct the unintentionalmisrepresentations of Dr. Kennedy, it isnot very probable, that I would sanction thewilful misrepresentations of Dr. Nagle, ifI knew of any such. It appears, however,that as far as I am concerned, the charge ofmisrepresentation against the latter is quiteunfounded ; and I may now add that I donot know any man who is less capable ofwilfully misrepresenting another than Dr.

Nagle, and least of all a gentleman for whomhe entertained a high respect, as I know hedid for Dr. Kennedy, at the time of publish’ing his first letter.

I am, Sir,Your obedient humble servant,

P. CLINTON.Dublin, Jan. 21, 1831.

REPLY OF DR. NAGLE TO DR. KENNEDY.

"Neque ego illi detrahere ansim,’Hæreret’ capiti ’si ulla’ cum laude, curonam."

’ To tlae Editor of THE LANCET.SIR,—If in his letter, published in Tus

LANCET of the 8th inst., Dr. Kennedy hadconfined himself to facts and arguments, in-stead of resorting to intemperate and un-courteous declamation, he would have act-

623

ed better for his own respectability at

least. Indeed, could I condescend to aimat -’victory in dispute" over him, the vitu-ptrative language in which he has been

pleased to indulge, would furnish the verybest proof, that he felt himself deficient inarmament. To °’ misrepresent" him inten-tionally, would be not only the extreme ofto’.)B’ on my part, his paper having gone be-fore the profession, but quite inconsistentirith the feelings and principles by whichI Lope I have hitherto succeeded in regu-latinn my conduct.He has been pleased to say that I affixed

11,D." to my name ! The pages of THELANCET prove the contrary ; and I can as-snre him, that I should be extremely sorryt3 take " M.D." as a substitute for M.B.Though I admit that, " a rose, by any otherMme would smell as sweet;" yet, if therebe any.thing in a title, it will be conceded,by the intelligent at least, that those whoenjoy the privilege of attaching M.B. to

their names, need not be anxious to sacri-fee it for even Dr. Kennedy’s " M.D."His creditable attempts to prove me

"ignorant of anatomy," I am sure that you,Sir, and gentlemen of your cultivated un-derstanding, have read with that pity andforbearance towards him which are alwaysthe characteristics of a superior order of in-tellectual endowment.Does it follow that, because I said " the

murmur from the epigastric arteries can beheard at the mesial line," the vessels them-sdves must necessarily be situated there’!I shall prove even to him, that I at leasthave not fallen into a mistake of that kind.In THE LANCEr, p. 398, col. 1, sixth last

hue, I laid it down as an incontrovertiblefact, that 11 the resonance extends a con-siderable way from the point de depart, orcentre of radiation." On this principle letus examine my words, of which he so veryjudiciously (!) attempts to avail himself:- " Iwas unable to detect the murmur under themesial line, except when it proceeded fromthe epigastric arteries, from which it can,in such a case, be easily (mark !) proved toarise." LANCET, p. 397, col. 2, line 24. Nowwhen we move the cylinder from the mesialline outward, the murmur faintly heard atthat line gradually increases until we come ’,en the trunks of those vessels, and it isheard with loudest intensity over that trunk .,

onlv; and this intensity can be traced alittle outward and downward towards theinternal abdominal ring. So much for hisjudgment and accurate stethoscopic re-

8-arcl)es! It is very unlikely that I, notintending myself for a " mere accoucheur,"should, during my anatomical studies at theadmirable schools of this house, and theC,lIege of Surgeons, have neglected so im-portant a part of anatomy as the course of

the epigastric arteries. For a mere ac-coucheur such knowledge I admit may notbe requisite, and Dr. Kennedy might beprudent in excluding from the " store-houseof his memory" all unnecessary " lumber."’ Equally unsuccessful shall I prove himto have been in the other, as it were, but

yet is not, instance of my ignorance of

anatomy. Suppose me unacquainted withthe course of the lateral uterine artery,would that instance he sufficient to establishmy ignorance of the important parts of ana-tomy to be learned in the dissecting-roomalone, and not from the convenient inspec.tion of casts and plates’!" But even such in-spection might satisfy Dr. Kennedy, thatthe lateral uterine artery passes forwards,inwards, and runs between the laminae of thebroad ligament to the inferior part of the sideof the uterus, where it divides into a num.berof branches, which anastomose with thoseof the opposite side, and are all greatly en-larged during pregnancy and disease of theuterus." (Harrison on the Arteries, Vol. II.2nd edit. p. 82.) This extract may not onlysilence Dr. Kennedy, but prove to him thatwhen the gravid, or diseased uterus ascends,the murmur may be traced " upward," in-ward, and forward, towards the mesial line.So much for my

" ignorance " of anatomy ! !

How Dr. Kennedy can reconcile it with

prudence to say, that the feeble murmur,occasionally audible in the " stillness onlyof night," and to which description of mur-mur alone did I allude, "is at least’ tentimes’ louder than the foetal pulsation!" Iam perfectly at a loss to account for anyother principle than this,-that his stetho-scopic ear may be endowed with the rare andenviable faculty of magnifying sounds in aproportion scarcely less remarkable than hadthat augmenting power possessed, as we areinformed, by the celebrated- ear of the sus-picious tyrant Dionysius, who convertedinto a stethoscope his ingeniously- con-structed prison, sarcastically denominatedthe "ear of Dionysius;" and thus, like Dr.Kennedy, had recourse to " mediate auscul-tation," for the purpose of ascertainingmurmurs, aye, and the workings of the hu-man heart.That I have not even attempted to "mis-

represent" Dr. Kennedy, will appear evidentto any one who is pleased to take the trou-ble of consulting The Edinburgh Medicaland Surgical Journal for January, 1831.Where (page 151) it will be found, that heentertained the following opinion :!’ Ano-ther advantage resulting from the use of thestethoscope in ascertaining the existence ofthe placental thrill is, that it enables theaccoucheur to pronounce on the life or deathofafoetus in utero." (See D. H. Rep. vol. T.p. 267.) Not a word said here respectingthe necessity of taking into consideration

624

’ the pulsations of the fcetal heart." Theeditor, forsooth, had some unworthy mo-tive for " misrepresenting him." Again,Journal, p. 148, ,The placental sound ispresent in pregnant women only when theutero-placental circulation exists, and ceaseswhen the vessels which perform this officebecome impervious (D. H. Rep. vol. v.

p. 242), where, in continuation, Dr. Ken-nedy says, " a fact which we can ascertain

by examining a woman shortly before partu.rition, when we observe this phenomenonin full energy ; and again, when the uterusis empty and perfectly contracted after deli-very, or when the foetus, having died inutero, an obstruction in this system of ves-sels is produced, in all which cases not theslightest vestige of the phenomenon can bediscovered." Now mark how inconsistentis all this with what follows, "for the deathof the foetus in utero and consequent cessa-tion of the foetal circulation, do not of ne-cessity cause the discontinuance of the souf-flet, although they alter its characters." (D.H.Rep. vol. v., p.244.) This is but one in-stance of the numerous inconsistencies withwhich, I must take the liberty of saying, hispaper is replete ; and which justify me inhaving said that " I regretted to think itwould scarcely stand the test of serious ex-amination." The Edinburgh Journal, p. 149,sect. 3, says, " From several cases, two ofwhich are given in detail, the author showsthat, when the foetus expires within thewomb, and before the placenta is detached,there still continues a thrill, abrupt, how-ever, and short and voicl of the sibilous

lengthened sound by which the placentalcirculation in its healthy and entire state isdistinguished." (D. H. Reports, vol. v.

p. 245.)This is part of the " dangerous theory"

I have taken the liberty of combating, with-out, I hope, condescending to have recourseto unbecoming observations. It will be seenevidently from these extracts, that I haveneither misrepresented nor unfairly sup-pressed any part of Dr. Kennedy’s opinions,yet he has been pleased to do me the injus-tice of insinuating, at least, that I am guiltyof both. If at any time I can succeed byfacts and arguments in establishing my po-sitions, I am sure the profession will con-cede that I need not envy Dr. Kennedy thatsingular species of felicity derivable fromundeserved vituperation and assertions, un-supported by a single satisfactory argument.

I deny, in the most unequivocal terms,having said in any part of my paper on " ob-stetric auscultation," that Dr. Kennedy, at lileast, considered the placental souffiet as an" unquestionable test of impregnation."When showing that " the presence of a

placenta is not necessary for the productionof a murmur, such as we ordinarily hear in

the advanced stages of gestation," I usedonly the expression" test of pregnancy,"(p. 399, col. 1, line 5, of THE LANCET.)Also in p. 396, col. 2, line 16, I said merelythat "the placenta has, in my mind, nothingto do with the production of the murmur,though I know the contrary opinion is con.fidently maintained by Dr. Kennedy." Hewill not deny that, under certain restrictions,he does " consider the placental" soufflet a" test of pregnancy." How could I say" unquestionable test," when (LA.CF.1,p. 501, col. 1, line 22) the words " their

knowledge of practical midwifery in a veryquestionable shape," taken from his paper,show that the point is levelled directly athim, as not considering auscultation the" only unequivocal sign of pregnancy,"which (202) he should admit if he deemedeven the souflet an unquestionable test ofit. Thus, Sir, can I easily repel even thischarge which he (I will not say so disinge.nuously) would endeavour to fasten uponme."

Having through the middle of his paper(D. H. Rep. vol. v. pp. 241-2-4-67-9) laidit down that, the abrupt murmur indicatesthe death of the fcetus in utero, he attemptsto support such theory by giving cases illus.trative of his views. Then, by way of pero.ration, and to make certainty doubly sure,he comes to the following conclusion (H.Rep. pp. 268-9)--" We have elsewheretreated of the manner by which the placen-tal soufflet affords us an indication of thedeath of the child, viz., either by ceasingentirely after having been previously heard,or having its character altered from thecontinuous murmur with its lengthy sibiloustermination, to an abrupt, defined, and muchshorter sound." So much for the certainty,and that too elsewhere. Now for the doublysure. " This," he very sapiently subjoins," together with the impossibility of detect-ing the foetal heart’s action, particularly ifsuch had been before observed, places thefact of the child’s death beyond a doubt."What valuable information this ! He theaasks,-" Why was the concluding portionof this quotation so cautiously, so unfairly,suppressed 1" My answer, I hope, will

appear quite satisfactory to the profession.First, because no such concluding portioncan be found in the part where he else.where treated of the manner, &c.; se-

condly, he himself did not consider :s

absolutely necessary ; thirdly, even the

Edinburgh Journal could not find it givenby Dr. Kennedy as a necessary adjunct;fourthly, his own friends have been givingout (for I discussed the question with someof them), as an important " discovery," thatthe " abrupt" murmur (see LANCET, p. 495,col. 2, last lines) is sufficient to indicate thedeath of the child i fifwy, and laatlv, he

625

ougJJt to recollect that I disputed the verypoint with himself in the presence of somepupils of the hospital (LANCET, p. 500, col.1. 15 from bottom) ; that 1 then, followedby some of the pupils who were present,took him up to one of the labour-wards toconvince him, by an instance, that his

theory was not correct; that he still per-severed, and made use of these very modestwords—" Read nzy paper, and you willthen be convinced ! " He cannot deny allthis. How then could he assert, " for Ihave given a case (p. 250, D. H. Itep.)where the-sound was not abrupt, althoughthe fcetus was dead 1 " Well, then, the ab-rupt murmur is no longer to be considered adia,nostic malk of the infant’s death ! -KOIV, I hope I shall be able to convince

even Dr. Kennedy himself, that he did con.sider the sound abrupt in the very case healludes to, for there he says-°° No foetalheart’s action could be discerned ; the pla-cental sound was, however, audible in eachiliic region, less abrupt, and approachingmore to the natural soufflet than in thoseabore described." Here a clear admissionis imphed, at least, that the murmur was

abrupt, but less so; was not natural, butapproaching more to the natural than intLose above given ; and that he himselfconsidered it abrupt will appear evidentfrom the following observations relating tothis very case too (pp. 250-1, D. H. Rep.)" From these observations, let it not, how-ever, be supposed, that the placental soundis always observable, even of this modifiedcharacter." So much for the applicabilityof his logical crotchets, the suppressio veriand the assertio fa!si! !With respect to the soufiiet he found

produced by an enlarged liver (D. H. Rep.rol. v. p. 26), I thought it really undeserv-ing of attention ; first, because he does noteven say in what part of the abdomen it

ouurred ; secondly, he, without addingeren a qualifying teim, says, " it resembledthe placental soufllet," which, in the nextpage, he admits to be

" quite distinct initi nature, and easily recognised by personsat all conversant with it, resembling a soundquite distinct, and one easily recognised."What consistency ! I must be pardoned fortl:,1l1’; the liberty of dissenting from twoassortions of his in p. 267, D. H. Rep.;first, that " the placental soufflet can beheard iudifl’erently over the abdomen ;" se-, " that the souffiet produced by atumour can be removed by altering theposition of the patient." For in Corrigan’scase LANCET, p. 399, col. 1) the soumetcontinued, no matter what position the pa-tient was put into. In the same case therewas heard by me and others, as I stated,"the self-same, identical description ofmurmur, which usually occurs in the ad-No. 388 .

vanced stages of pregnancy.’’ I am, there-fore, warranted in withholding my assent toDr. Kennedy’s assertion, that " the placen-tal soufflet is iu its nature quite distinct andeasily recognised ;" and, indeed, one of twoconsequences must follow from this asser-tion of his, namely, that either his opinionis iucorrect, or the souffiet placental, as Laèalls it, must be considered as " infallible"proof of pregnancy, " if it be owing to thepresence of a placenta, and if it be of such.a quality as to be, in its nature, quite dis-tinct and easily recognised by persons at allconversant with it." For, if it be " owingto the presence of a placenta," as he thinks,but I take leave to deny, we can have itonly where there is a placenta, and, conse-quently, pregnancy ; and, if " it be in itsnature quite distinct and easily recognised,"as he says (p. 267), I should like really toknow how he can reconcile it with rightreasoning to deny, that it, when heard,should not be considered an. " infallible .test" of utero-gestation. But, talented andaccurate logician as he is, I apprehend hewill find it rather difficult to extricate himselffrom such a dilemma. It must strike everyrational man, as a manifest absurdity, thatthis souffiet should be designated ‘° quitedistinct in its nature," and also placental,yet be denied as an I infallible test of utero-gestation." He, however, denies it ! andis found to have expressed himself to thefollowing effect (vol. v. D. H. Rep. p. 257):" When a perfect placental soufflet existsin any part of the abdominal tumour (par-ticularly if the fostal heart’s action also can.be detected), we may pronounce the womanpregnant." Suppose the foetal heart cannotbe heard, and that, however, " a perfectplacental souffiet" is audible, it must, ac-

cording to his theory, appear to any one,that " we may pronounce the woman preg-nant."

I cannot condescend to notice his obser.vations on the expression " ninety-nine in.a hundred," a very general phrase in ourlanguage, and never used in its strict, lite-ral sense. Though Dr. Kennedy evidentlyprides himself on the perspicuity of hisstvle, for he is astonished how even 1 couldmisconceive his meaning, yet he is, I am

sorry to think, often contradictory, unclear,and unhappy in his mode of expressing thatmeaning, as in the following (p. 496, col. 2,of THE LANCET) :-" I would, however, andwith justice, have been to blame, as well

upon my own account as on that of the pro-fession generally, had I allowed such atissue of misrepresentation to remain un-contradicted. Having now done so, 1 must,"&c. Having done what ? Why, havingallowed such a tissue to remain uncontra-dicted. Besides ; a tissue uncontradicted !

It is true I cannot prevent hitn from--.

SS

626

*’ doubting whether I am capable of recog-Tilsing the phenomenon of which I treat;"but he ought to have recollected, that I am,

. however, the first in these countries, atleast, who detected, by means of ausculta-tion, the existence of twins in utero (p. 232of THE LANCET) ;-what he, with all thefacilities afforded him by one of the mostsplendid hospitals in Europe, was never yetable to accomplish ; else we should haveheard something of that’/ discovery" also-c, Hinc illœ lachrymœ," inanesque ululatusin auras! I am sure it will be conceded

by the profession, that he has done megreat injustice even respecting my much-valued friend Dr. Clinton, whom, as willbe seen by reference to p. 400 of THELANCET, I have not even attempted to iden-tify with any one of my views and state-ments, further than by merely saying, Ifelt gratified having my opinion coincidewith his, as far as related to the " site ofthe souffiet." .

Thus far, Sir, have I endeavoured tomeet candidly, fairly, and fully, I hope, theunmerited imputations thrown out againsttne in Dr. Kennedy’s letter; and I shalltake leave to avail myself of this opportunityof assuring bim, that should I, in future,have occasion to speak of the contents ofhis valuable paper, it shall be done in thewords, but not in the spirit, of the sarcasticRoman poet-" Euge, orrcnes, omnes, benetnire erit2s res ! "

Believe me, Sir, sincerely yours,DAVID C. NAGLE.

33, Trinity College, Dublin,January 18th, 1831.

THE LANCET.

London, Saturday, Feb. 5, 1831.

ATTORNEY CORONERS.

To the scandal and deep injury of the

public, and to the insult and degradation ofthe members of the medical profession, at-

tornies, grasp-alls, or land-sharks-or what-ever other term may be used to denote ava-

rice, conceit, and ignorance,-continue to

occupy the office of CORONER. Publicopinion, however, has at last decided thatattorneys are not competent to dischargethe high and mighty functions of the Coro-ner’s Court; and powerful and cunning asare the parchment-mongers, they are not

strong enough to bear up against the torrent

whieh is opposed to them, and on theymust swim upon the surface of the stream in

all sorts of company, or sink to the bottom

never more to rise. The latter catastrophewould be a great loss, a sad misfortune to

the public. Attorneys are so reverenced bythe public, their labours produce so much

wealth, their demands are always so mode.rate for their kind and attentive services,

they are so charitable withal, constantlyproviding for the poor and houseless the

most secure of lodgings-in a word, their

labours are of such value, that society wouldlong deplore the loss, if by any sudden andunforeseen calamity the whole race of attor-neys were to be swept from the face of theearth. Mark us well !-we refer to attor-

neys-to the practical, the operative attor-

ney ; not to the men as a body of social andintellectual beings-not to the man who

feels delight in reprobating the abuses ofthe law, who refuses to employ the law asan instrument of extortion and vengeance

against the victim of misfortune; we repro-bate the trade, and not the men, unless the

man, or all that should be excellent in the

man, be absorbed in the villany of the

occupation. In denouncing the sanguinarycharacter of our criminal code, in reprobat-ing the uncivilised and barbarous executionsfor the crime of forgery, the voice of hu-

manity is not directed against the men, butagainst the legislators-not against the in-dividual who carries into effect the remorse-less decrees of the law-not against the man,but the hanger of men. The occupation is

condemned. So we, in speaking of attor-

neys, refer to the character of their plofi’s-sion, and not to the private and individualcharacters of the gentlemen themselves. A

horse in a mill is compelled to proceedwithin the limits ofa certain circle, becausehe is confined to the lever; and attorneys,in a great measure, are bound by the un-

yielding fetters of the law, and cannot

escape from their trammels. When, how-

ever they do contrive, either by the infla-