124 DR. WILSON—HYDROPHOBIA—KING’S COLLEGE.

any want of clinical instruction which theymay suffer during the ensuing winter,

They have paid the required fee for hospitalattendence, and the fault rests with them-

selves if they do not obtain an equivalent,in the way of instruction, for the money so

oxpended. If clinical lectures were re-

gularly delivered within the wards of thewhole of our metropolitan hospitals, it

would tend to remove a portion of the

hideousness of the monopoly of the college.

Many and important are the advantagesthat the Medical Student is likely to derivefrom the ’° King’s College." We under-stand that the knowing Owl of the Middle-sex, has proffered his Services, as Professorof Anatomy. The celebrated Professor of

Cambridge, Dr. Cornwallis Hewett, is to

be Professor of Medicine; P. Pettigrew,Professor of the Theory and Practice of

Surgery; Benjamin Brodie, Professor of

Clinical Surgery; Mr. Stone, Professor of

Obstetrics; and the Yellow Fungus, Pro-fessor of Botany.

THE amiable RODERICK will publish, in

an early number of his Fungus, a full and

particular account of the accouchement

which recently took place in St. George’sHospital, under the special care of the

learned Dr. Wilson. The abdominal tumour

was, in many respects, similar to that whichoccurred in the Cambridge professor’s ob-stetrical case, and the treatment was con-

ducted on the same " sound " principles.

FOR the information of those persons whobelieve that chemists and druggists are notlegally empowered to prescribe and dispeuse,we insert the following clause, taken fromthe Apothecaries’ Act of 1815 :-" Provided always, and be it further

enacted, that nothing in this Act containedsball extend, or be construed to extend, to

prejudice, or in any way to affect, the tradeor business of a chemist and druggist, inthe buying, preparing, compoundmg, dis-pensing, and vending drugs, medicines, andmedicinable compounds, wholesale andre.tail ; but all persons using or exercising thesaid trade or business, or who shall or mayhereafter use or exercise the same, shall andmay use, exercise, and carry on the sametrade or business in such manner, and asfully and amply to all intents and purposes,as the same trade or business was used, ex.ercised, or carried on by chemists and drug.gists before the passing of this Act."

ST. BARTHOLOMEW’S HOSPITAL.

CLINICAL LECTURE

BY

MR. EARLE.

f Bin. EARLE, at eight o’clock on Saturday0evening last, began his gratuitous course of

clinical lectures. The theatre was well at.tended, and the most hearty welcome wasf tendered to the lecturer. In the course of

Mr. Earle’s prefatory observations, he ear.nestly solicited the junior pupil to overcome

any diffidence he might feel in putting ques-tions to him, on whatever points he might

feel the slightest difficulty, either as he

passed the bed-side of the sick, or subse.quently. Nor would the more advancedpupil, he hoped, hesitate to present his inquiries ; he promised them, on every occa-sion, attention, and all the information itwas in his power to communicate.He was aware (Mr. Earle continued) that,

in strictness, clinical lectures could oulv bedelivered at the bed-side ; to this practice;however, there were many objections. Inthe first place, those pupils only who wereat the elbow of the surgeon could hear hisremarks. Next, it would be impossible forthe practitioner to state all that was passingin his mind on such occasions, for his state-rnents could not fail to be occasionally heardby the patients, and, in some instances, thedisclosures which must be made would be

nothing short of signing their death war.rants. Delicate females would, in manyinstances, fall victims to disease, if theyknew their cases were to form subjects ofdiscussion in the open wards ; it would, infact, be more than cruel, in incurable cases,to deprive the patients, from the moment ofseeing them, of hope of recovery, by thaopen declaration of their state. It was pro-per that the surgeon should feel, that beought as carefully to consult the feelings ofthe most humble individual committed to

125

his hands, as tboee of the first nobleman inthe land, and not rudely tear aside the veil,and expose death in all its naked horrors.In the theatre be could state his sentimentswithout disguise, but in the wards, were heto be content with all he could say with

propriety, he must withhold much necessaryinformation. In pursuing his clinical obser-vations in the theatre, he should act aa incases of private consultation, with the ex-ceptinn of being rather more explicit. Inconsultation, it was usual to retire and de-liver opinions without disguise. Here heshould be enabled to act in the same way.At the same time, in his visits through thewards, he should continue to make properobservations on certain cases. No oppor-tunity of the many which this liberal Insti-tution afforded would, he trusted, be lost bvgentlemen of making observation for them-selves. It was a lamentable failing amongstlecturers generally, that they exhibited onlythe fair side of the picture to their hearers ;this, combined with the too great reliancewhich was placed on oral instruction, leftthe pupil in a miserable plight when he cameto enter upon the execution of his profes-sional duties. Oral instruction could, at

best, only convey information of a generalnature ; it was an assiduous attendance onhospital practice, and the diligent use of thescalpel, that would alone qualify the studentfor the satisfactory exercise of his art. He

earnestly recommended his hearers, there-fore, to be close observers in the wards, tobe diligent collectors of original facts, to beindefatigable in the dissecting room, and byno means to rest satisfied with the garbledsentiments they might find in books.

Cicatrices following Burns. lllr. Earlethen entered upon the subject of the firm,bard, and horny cicatrix that happens aftera burn, particularly in the neighbourhood ofjoints, which, without a surgical operation,often greatly impairs, and sometimes entire-ly destroys, the motion of the joint. It isthe cause of much, and, frequently, very just,censure, on the practitioner into whosehands the cure of the injury is first commit-ted. The case of Joseph Montague, six

years of age, at present in Darker’s ward,who had been severely burned in Novemberlast, and lately had the cicatrix removed byMr. Earle, was chosen in illustration of thepresent remarks. This deformity generallyarises from mistaken feelings of humanity,and a desire to avoid subjecting patients tomore pain than could possibly be avoided,or from supposing that wounds occasionedby burns heal more readily in the neighbour-hood of joints, when the parts are permittedto remain flexed. The truth is, the lecturerobserved, that a cicatrix occupies much less.pace than an original wound ; and where alimb, for instance, is suffered tq remain for

a considerable time flexed, there is, subse-, quently, a continual dragging, and attemptat extension, which cracks the newly-healeds surface over and over again ; and thus, for

3 years, prevents an entire cure. The extra.

i ordinary degree of induration that takes

place after burns is very peculiar, and,though difficult to explain, is referrible tonumerous causes. If the limb be kept con-.stantly extended, not only during the wholeprocess of healing after a burn, but for alength of time subsequently, this hardened. state of cicatrix will never be found to takeplace. In performing the operation for the! removal of the deformity, surgeons were for- merly content with simply cutting acrossthe indurated web ; but this proceeding wasuniversally unsuccessful. The modern ope-ration is that of removing the entire web. Ifthe cicatrix has existed long, the action of themuscles will have acquired a new sphere ofaction, and the joint, in all probability, willnot admit of complete extension on the re-moval of the web. The new muscular ac-

tion, then, is to be overcome by endeavour-ing gradually to straighten the limb, andretaining it in as extended a condition as

possible, by the use of splints. This conti.nued attention to the part is to be kept upfor months after the wound is healed. Thetime is not limited at which the operationmay be performed. In a youth, fourteenvears after the occurrence of the accident,Mr. Earle had performed it with completesuccess.

Stnangnilated Hernia. llIr. Earle nextadverted to a case of strangulated inguinalhernia. The young man had been broughtinto the hospital a few days ago, the acci-dent having happened five weeks before.When admitted, there was a tumour in theright inguinal canal, the parts very tender tothe touch ; there was a disposition to vomit,and every marked symptom of strangulatedrupture. The patient was bled, and put intoa warm bath, until he became extremelyfaint. In this condition the taxis was em-ployed, but without success. A tobacco

clyster was afterwards used, (the infusion ofa drachm,) and soon afterwards, under theinfluence of the last remedy, the herniaspontaneously returned. The tobacco had apeculiar effect in exciting the peristaltic ac.tion of the bowels. In several cases, in this

way, he (Mr. E.) had known it to occasiona spontaneous return of the gut ; it is, there-fore, a valuable medicine; though at thesame time a very dangerous one. It is ne

cessary to use it with the greatest caution,and, frequently, the proper course is to resortto the operation, without attempting to ad.minister tobacco at all.