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appeared to be exerting a very perceptible influence. It wassteadily continued, and now, after the lapse of six months, notmore than a dozen remain, and those mostly on the scalp. Itis intended to apply the nitric acid to these remaining ones,should they not diminish. The infant has retained excellenthealth, and the ointment (which is a favourite with Mr.Huthinson for this purpose) has never caused any materialirritation to the skin.

RESECTION OF THE HEADS OF THE PHALANGESOF THE RIGHT FOREFINGER.

AMONGST Mr. Price’s patients at the Great Northern Hos-pital is a girl about ten years of age, who met with an accidentto the forefinger of her right hand, about five weeks since.The first phalangeal articulation was opened by the patientfalling upon some broken crockery. The finger, about thefifth week after the accident, becoming very painful, and thejoint being entirely destroyed, it became necessary that thedisorganized articulation should be removed. Amputation ofthe finger would have been of serious consequence to the poorgirl, precluding her from various occupations; so Mr. Priceadopted a proceeding which it would appear is somewhat novelin its application to disease of the joints of the finger-resectionof the articulation. A single incision was carried longitudinallyalong through the knuckle, and the soft parts carefully sepa-rated from the bone, care being taken not to wound the digitalvessels and nerve on either side, nor to disturb in any way thedisposition of the flexor tendons. The joint was then removedentire by means of the angular bone pliers. There was no

bleeding. The forefinger, shortened about half to three-

quarters of an inch, was placed upon a splint. In the treat-ment a false joint will be sought for. We shall watch thiscase with some degree of interest.

REMOVAL OF A LARGE TUMOUR UNDERTHE JAW.

THE subject of this case was a healthy-looking young womanin St. Mary’s Hospital, who was suckling a child three monthsold. The tumour, about the size of a large apple, was directlyunder the jaw, projecting backwards to the os hyoides. A partof the under surface was superficially ulcerated. When the

patient was brought into the theatre, Mr. Walton advised hisclass to look well at the disease, as there were peculiar featuresabout it. He remarked that at first sight it might be supposedby most surgeons to be a fibrous growth from the jaw-anopinion, however, that would not be entertained when it was

closely inspected. He showed that it was somewhat elastic,and possessed a very firm attachment; that it did not encroachon the floor of the mouth, nor was there evidence of intimateadhesion to the jaw-bone. He gave the following sketch of thehistory:-The patient was twenty-one years old, and her gene-ral health good. Rather more than a year ago a lump was ob-served on the right side, just under the jaw. She states mostunequivocally that for several months this lump was movable;she considered it to be "the gland of the ear that had enlarged. "It grew fast, and gradually spread to the centre of the chin,and then to the left side. In about four or five months itceased to be movable. Ulceration has existed but a fewweeks. The glands in the nelghbourhood were not affected.There had been complete absence of pain. Mr. Walton ex-

pressed his conviction of the malignancy of the growth. Heconsidered it as cancer of a lymphatic gland, or of severalglands. He alluded to the rarity of such a manifestation ofmalignant deposit under the jaw, but still more of it towardsthe chin. Why then, said he, do I operate when I entertainsuch an opinion? I answer, because by so doing I hope to ob-tain for my patient a respite from suffering for at least somemonths. In all probability the most distressing symptoms ofthe malady are not far off, and that they will soon appear ifthe disease be left alone, there can be no doubt. Thus theemployment of chloroform renders such a proceeding more ad-missible.The operation was thus performed : The ulcerated, as well

as the unhealthy portion of skin at the apex of the tumour,was circumscribed bv a circular incision. Two lateral cutswere then made in a direction from the angle of the jaw down-wards, so as to form an. upper and a lower fiap. During thedissection the two facial arteries were divided. All of the sur-face that was covered by skin had a distinct cellular capsule,and was easily separated; but above, the new product was I

adherent to the muscles, and parts of the dygastrics and mylo-hyoids were removed. To the os hyoides also was there attach-ment, and on the right side, so intimately did it adhere to theinner surface of the right horizontal ramus of the jaw, that itcould not be got away without denuding the bone of its peri-osteum to the extent of an inch and a half. However, everyparticle, so far as the naked eye could detect, was taken away.Very little blood was lost.A section of the tumour displayed the characteristic appear-

ance of hard cancer. Mr. Walton has submitted portions tothe microscope, and discovered the usual minute structure oftrue scirrhus.We have seen the patient several times since the operation,

and the wound remaining has almost completely cicatrized,and will, we have no doubt, perfectly heal up for the present.

RECOVERY FROM PYÆMIA AFTER AN EXOSTOTICREMOVAL

A LAD, about sixteen years of age, by occupation a page,was admitted into the Royal Free Hospital, Oct. 27th, for anexostosis of the size of a marble, which had been growing fromthe right side of the forehead for some years past. It was re-moved by Mr. de Meric, when the boy was under the influenceof chloroform, with the aid of a fine saw; and there was everyprospect of the wound healing by suppuration. This pro-cess ensued; but some days afterwards the boy presentedsevere symptoms of pyaemia, which was very nearly provingfatal; but thanks to the energy displayed in supporting thepowers of life, the patient completely recovered from it. Thisfact, of itself, is one of some interest in the case; but wenoticed another circumstance on the 7th December, well wor-thy of mention, and that was the complete covering with adelicate membrane of the surface of bone which had beenexposed. There was no exfoliation in this case, and a goodrecovery ensued.

__________

EXCERPTA MINORA.

Threatened gangrene. -We recently noticed an old man,about sixty-five years of age, in the Charing-cross Hospital,under Mr. Hancock’s care, whose feet were threatened with

gangrene, but which has been prevented by the timely appli-cation of wadding, thus keeping them warm and encouragingfree circulation. He had all the appearance of an imbiber, hisnose being of a preternatural redness.

Clblo?-ate-of-_potas7b lotion.-This is frequently prescribed byMr. Cooke, at the Royal Free Hospital, as an excellent deter-gent and antiseptic in chronic feetid suppurating ulcers of theleg or other part of the body. It proves very serviceable also inulcers exhibiting a tendency to sloughing. It is composed ofhalf an ounce of the chlorate of potash to a pint of water, withforty drops of strong hydrochloric acid. It is stimulating inits action, also, and converts a foul ulcer into a healthy-lookinggranulating sore. Another form of lotion, which combines theadvantages of being, perhaps, more stimulating and less irri-tating, used occasionally by Mr. Cooke also, is a, combinationof potash and manganese (a modification of the caustic recently

introduced by him), in the proportion of ten grains to the ounceof water.

Labarraque’s solution is similarly used in the above hospital,but is more frequently employed by Mr. de M6ric as an appli-cation to warts and condylomata around the anus and vulva,previously to dissecting them with calomel, the specific influ-ence of which it seems to increase.

Reviews and Notices of Books.On Epilepsy and Epileptifrom Seizures: their Causes, Patho-

logy, and Treatment. By EDWARD HENRY SIEWEKING,M.D., F.R.C.P., Physician to, and Lecturer on, MateriaMedica at St. Mary’s Hospital, &c. pp. 267. London:Churchill. 1858, (sic.)THE writer is well known to the profession as the translator

of Romberg, "On the Nervous Diseases of Man," and the authorof several papers on epilepsy and allied subjects. Without

having anything very new or particular to tell us, he has

presented us with a good epitome, both of what we do know

65

and do not know about the malady in question. A markedcharacter of the book is the modest and unpretending styleof its writer, which in an easy manner places us in possessionof the little Science can teach of the pathology of epilepsy,and of the same small amount that Art is master of in minis-

tering to its treatment. The particular tenour of Dr. Sieve-king’s views will be gleaned from the following extracts :-Our knowledge of the physical changes in the brain is not

sufficiently advanced as yet to speak positively of the exactpathological disorders that accompany or induce epilepsy; butthe analysis of the symptoms of the disease based upon theknowledge we do possess of nervous physiology; the study ofthe consequences of epilepsy as shown in a large majority ofepileptic post-mortems; the impossibility of rigidly carryingout the distinction between essential and non-essential, idio-pathic, or symptomatic epilepsy-all justify us in discardingsuch an arrangement.......... With the exception of Esquirol,whose observations of the affection in the spinal meninges inepilepsy have been recorded at page 156, and Marshall Hall,all pathologists are unanimous as to the fact that the partswithin the cranium are the organs immediately involved in theepileptic seizure." (p. 163.)......" believe that in the greatmajority of instances, the first attack is due to an irritation

produced by derangement in the amount, or quality of theblood circulating in the brain." (p. 170.)The treatment recommended by the author is almost pre-

cisely that we ourselves have found the most beneficial, speak-ing generally.

" If I were to formularize the prevailing mode of treatmentwhich I myself adopt, I should say it consisted in local deriva-tion, or counter-irritation directed against cerebral congestion,and in general, roborants or tonics; the selection of the specialmode in which the latter indication has to be carried out neces-sarily depending upon the results of the inquiries into the con-dition of the individual organs." (p. 207.)A seton at the nape of the neck, purgation by aloes and the

sulphate of potash, with the administration of the sulphate ofzinc, combined with small doses of the tincture of valerian, aremeasures upon’ which we more generally rely than upon any.others.The author’s chapters on the treatment of this intractable

malady are, in our opinion, the best in the book. To thelatter a tabular summary of the history of fifty-eight cases isappended.

Handbook of the Science and Practice of Medicine. By WIL- LIAM AiTEEN, M.D. Edin., late Pathologist attached to theMilitary Hospitals at Scutari. &c. pp. 756. London and

Glasgow: Richard Griffin. 1858.WE took up this work with some distrust, knowing how

a,mply we are now provided with systematic treatises on medicine, (e. g., Watson, Williams, Wood, Barlow, Copland, Vir-chow, Grisolle, &c.,) whether as manuals for students or as

encyclopædic tomes for advanced practitioners. We concludedit to be a superfluous compilation, if there was nothing worseabout it. We are bound to say that we have altered our

opinion now we have examined Dr. Aitken’s handbook. It,no doubt, is mainly a compilation; this the author admits.But it will be found a very useful and complete one, and cha-racterized by its information being of the most recent and ad-vanced kind. It, indeed, forms quite an abstract of the neo-pathology of the day. Some of the articles form really valuable,though of course terse, epitomes of all we know about the mala-dies they treat of-e. g., Fevers, Rheumatism, Tuberculosis,&c. &c. There is, no doubt, some inequality in the execution,particularly as relates to diseases attacking children. The

chapters on Croup, Hydrocephalus, for instance, evince a con-fused and rather past pathology. Again, whilst the informa-tion given on " Melituria" may be as extensive as the nature ofthe Handbook permits, that on " Bright’s Disease" is by nomeans equivalent either to the importance of the subject or theintention of the book. On the whole, however, Dr. Aitken’scompilation permits at our hands recommendation and praise.

One feature, and quite a novel one of his work, is the additionto it of a chapter on " Medical Geography, or the GeographicalDistribution of Health and Disease over the Globe." Mr.Alexander Keith Johnston, F.R.S.E., has’reduced his mapillustrative of this subject in his " Physical Atlas of NaturalPhenomena" to a scale suited to the size of Dr. Aitken’s trea-

tise, and has liberally permitted the use of it in illustration ofthe author’s views. It may not be out of place to point ostthat the present "Handbook" has its origin in an article onthe Elementary Principles of Medicine, contributed to the

"Eiicyclop8edia Metropolitana" by the late Dr. RobertWilliams,of St. Thomas’s Hospital, the work now forming vol. xxxvii. ofthe cabinet edition of the above Encyclopaedia.

Glossology; or, the Additional Means of Diagnosis of Diseaseto be derived from Indications and Appearances of theTongue. By BENJAMIN RIDGE, M.D., F.R.C.S., &c.Second Edition. London: Churchill. 8vo, pp. 84, withPlates.

AFTER the lapse of fourteen years, since the first edition ofthis work was published, the author remains, as he states, con-firmed in the conviction of the accuracy of the principlesthere laid down in revealing the characters of diseases. Thework was briefly noticed in this journal shortly after its firstappearance :* we now proceed to describe more fully its contents.

Dr. Ridge portions out the tongue longitudinally into twocentre-lateral divisions, one on each side of the median line;two lateml divisions, one on either side of the foregoing; and,outside of the lateral divisions, the edges. Transversely hesubdivides the organ into the anterior and second fourths, whichembrace the free portion; and the centre and posterior fourths,comprising that portion of the organ which is fixed by itsseveral attachments within the mouth. In addition, the tip,extending for about one-third up the anterior fourth; the sides,consisting of segments of the anterior and second fourths; theoval, midway between the "sides," and behind the tip,-arecounted as separate regions; as are, at the back of the tongue, theroot and the two cornua, which last, however, are little referredto by the author in the way of diagnosis. Dr. Ridge considersthe appearances presented by the lateral portions as indicativeof the condition of the alimentary canal and the viscera con-nected with it; the cen tre. laterals, of the states of the tracheaand lungs; the edges to be chiefly in relation with the brain; thetip with the large intestine; the oval with the pleura; andthat a cracked or fissured appearance of the tongue longi-tudinally attends simple dilatation of the heart; whilst trans-verse chaps, fissures or sulci, particularly on the anterior two-thirds of the organ, (of which he gives a delineation,) aresignificant, in most cases, of hypertrophy of the heart. He

adds, that asperity of the papillae at the tip and under edges ofthe tongue will indicate the presence of internal hæmorrhoids,or congestion of the hæmorrhoidal vessels; that redness of theapex of the cone at the tip leads to the diagnosis of an inflam- .mation of the colon; that if disease, on the contrary, be con-fined to the stomach alone, the red appearance of the apexof the cone will not be present ; that in pleuritis the ovalwill be found bare, and the villi denuded and distinctly seenwhen the surrounding parts are covered with pile, &c.

It will naturally be expected that anatomy ought to furnishsome reasons why different portions of the tongue should corre-spond with different sets of organs of the body. If we findcertain parts of the tongue deriving their arterial or nervoussupply, or both, in conjunction with other organs from a com-mon source, we may readily admit such a connexion to existbetween them, that the state of the more hidden organs maybe revealed by that of the corresponding portions of the tonguewhich is under the direct observation of the physician. In sofar as the connexion can be traced anatomically, a rationalemay be discovered for the diagnosis ; where the nervous or

In THE LANCET of March 16th, 1844.

66

sanguineous communication is less obvious, the correspondence,if any, is proportionately inexplicable, and, it must be added,doubtful.The laws of the fouling and cleaning of the tongue are briefly

discussed, and plates are given illustrative of this part of thesubject. In fine, Dr, Ridge considers that " the pulse is morefallacious than the tongue*’ in the detection of disease. In7MC signum cst.

EDUCATION AT THE ROYAL MEDICALBENEVOLENT COLLEGE.To the Eclitog- of THE LANCET.

SIR,-Doubtless many of your readers had their attentionarrested by the speech of Mr. Thackeray on the occasion of hispresiding at the annual dinner in honour and support of theCommercial Travellers’ Schools. What Mr. Thackeray said ofthe heavy expenses of ordinary schools must have come hometo the " business and bosoms" of medical men. The speakerlamented very feelingly that literary men, the men of the" line," had not their special school as well as the men of the"road." As my own boy, like the sons of the friend whose caseMr. Thackeray referred to, came home with a heavy billin his box, I bethought me whether I might not send mytwo younger lads to the school of the Royal BenevolentCollege, of which I have the pleasure to be a life governor.I determined forthwith to make some inquiries into the

management and working of the school from some of myfriends whose boys are there, and also from the boys them-selves. I now jot down the results of my inquiries and cogita-tions, having, I assure you, no other end in view, than thegood of the College, and the desire that it may be rendered asperfect as possible.

I must confess in lim-ine to the weakness of not liking theword " Benevolent." I should rather not, except on stronginducement, send my boys to a place so patented and labelledas a chritable institution, and I suppose this to be so commona feeling that many others must think with me. Eton is, infact, a " benevolent" institution like our own College, so isWinchester, so is the Charterhouse, and the Carthasians at thehtter much resen2ble the decayed brethren we are proud tosupport at Epsom ; so also is the Marlborough College, intendedspecially for the sons of clergymen, and so are many of thefoundation and other schools throughout the kingdom; but itwould a little grate upon the ear if they were called the EtonBenevolent College, the Charter-house Benevolent School, andso forth. Why should not the word" Benevolent" be expungedfrom the title of the noble institution which Mr. Propert, aidedby the zeal of the profession, has founded ? It,is not a trueword, as regards the majority of the boys who are beingeducated in the school; and it must be distasteful to parents,as well as to those collegers who are old enough to think at allof the matter. Furthermore, it is little calculated to add tothe pride of the masters in being connected with the College.A good master would do his duty under one name as well asanother, but it is only fair that the prestige of the heads of theschool should be promoted as far as in fairness is possible.Why, then, should it not be called the " Royal Medical Col-lege" ? Surely the contributions of the profession would flowin quite &s freely for its great and good purposes without thetitular parade of charity, and its accompanying disadvantages.My further criticisms will relate to the regulations and

discipline of the school, and I must beg that they be takenonly for what they are worth. No one will be more happythan myself to hear them satisfactorily disposed of.And, first, as regards the school terms and holidays. At

Christmas, 1S56, three weeks’ holidays were given. ThisChristmas, the boys have a month. Easter twelvemonththree days were given; last Easter the holiday was extendedto a week. At Midsummer, the hoJidays extend to six weeks.I have no objection to the month at Christmas, though it is a Ishorter time than is usual at other schools. But the week at Easter is, I submit, too short. It is absurd that a number ofboys, coming from different parts of the kingdom, should be dis-tributed and collected again for so short a time, with littlepleasure to themselves and considerable expense to theirparents. At the public schools three weeks is the usual timefor Easter holidays, and if the boys have but a month atChristmas, it is hardly too much in the way of relaxation.

The six weeks at Midsummer is rather longer than the holidaysat our public schools, and one of the two weeks I would pro-pose to give at Easter might be taken from the Midsummerholidays. If a week only can be given at Easter, it would bebetter to dispense with it altogether at that time, and add theweek to the Christmas holidays. I should, however, prefer, aais usual with the best schools in the country, three weeks atEaster. The happiness of the boys should count, and three-times a year is hardly too often for parents to see how theirchildren are getting on, as regards health, looking overclothes, &c.The next item I shall refer to is the time occupied in school

work. The boys are at chapel for about three-quarters of anhour; they then work in school three hours in the morning,three hours in the afternoon, and two hours in the evening.This makes eight hours and three-quarters in close confinement.Now, I do not hesitate to say that eight hours’ school is toomuch for boys of the age of those at Epsom, or indeed for anyboys. It is a waste of the time both of masters and boys.Boys cannot work effectually for so many hours. It must wearyrather than strengthen their minds, and the masters must be atthe disadvantage of dealing with jaded instead of clear andfreshened intelligences. The common time of work in thepublic and best private schools is from four to six hours a day;in the case of four hours, some of the work being done out ofthe ordinary school-time-a plan which does not obtain at all,I believe at Epsom. Take the eight hours and three-quartersper diem, add thereto the time occupied by meals, and whathours can there be left for play and pastime ? There is no.

adequate time; and I am told the boys have little to do withthose games which are the pride of our great schools, andwhich, as means of physical eclucation, we at all events in ourrespect for Hygeia, ought to value for our boys almost as muchas book learning. The boys have only one regular half-holidayin the week-i. e., Saturday, though the rule of having Wed-nesday, in addition to Saturday, is now almost universal inschools. I think, then, if what I have stated be, as I believe,correct, the poor little fellows have rather a hard time of it asregards work.

I now come to the all-important question of food. Surelythe dietary of the children of medical men in their own school;settled by medical men themselves, should be generous andabundant! They, above all others, must know and recognisethe importance of building up the growing frames of youth instrength and vigour. Let us see. I am told the breakfast houris half-past eight or a quarter to nine. The meal consists ofbread-and-butter and cocoa, the quantity unlimited. Thedinnerhour is a quarter to one. The supply of animal food is liberalpbut the vegetable element is very scanty. Up to the last schoolterm, one potato for each boy was the allowance; the lastterm the quantity was a little increased, and grew to a potatoand a half on the average. Greens are had one day a weekonly. Puddings only once, and pie only once in the week. The-boys have tea at half-past five some days, on others at six, themeal consisting of tea and bread-and-butter without stint. Nosupper is allowed; and if a boy is caught cribbing from his teato satisfy his hunger at bedtime, he is flogged. Upon thedietary I would remark that the vegetable element is very de-ficient, and should certainly be increased. The dinner hour istoo early, and the tea follows too soon upon the heels of dinner.If the boys have no supper, they should have their tea at leastan hour ltter. As it is, all the eating is thrown into ninehours, and the other fifteen hours of vacuity must be despe-rately trying to the stomachs of growing boys.

There is one other grave matter left to touch upon-that ofpunishments. From all I can learn, flogging is much morefrequent than it is in the generality of schools, and is resortedto upon very trifling occasions. At first, all the masters

flogged; now, I am told, the head master only flogs, and veryproperly was this amendment made; but I have heard, in morequarters than one, that a good deal of the time now spent inthis way by the head master, might be better employed. 1,have been informed, the daily number of floggings is more thawI should like to mention. Discipline must, no doubt, be pre-served ; but I suppose no class would look with less favourupon any undue severity than medical men.Such things as I have dwelt upon should certainly furnish

matter for consideration, and, if need be, amendment, or the

College can hardly flourish as its friends, and I class myselfmost sincerely amongst the number, would desire. Let theboys, I would say in conclusion, have less work and more rilay;a bettei, diet, and fewer floggings.

I am, Sir, your obedient servant,January, 185S. PATERFAMILAS.