I request your attention to the few observations I am about to make respecting the arrangements in the Anatomical department, concerning which you are, I presume, now interesting yourselves. "There are certain regulations emanating from the Governors of the Hospital, for the management of the school established by them within its walls. According to these regulations, certain parts of the Anatomical department are to be arranged by the Anatomical teacher, with the concurrence of the medical body of the hospital, composed of the Physicians and Surgeons, "And I have now to state that no arrangements have been made in any other way than that here pointed out by the Goveruors, namely, with the concurrence of the Physicians and Surgeons. "I hold myself responsible for the communication of the most complete instruction in the departments of science with which I am especially concerned. "If, however, there are any gentlemen not disposed to trust to this pledge, and who will still feel themselves aggrieved, who will think that the instruction now proffered to them is not so good as that which they have hitherto received, I shall be most ready to give to such gentlemen every facility in making those arrangements for themselves which they may conceive will be most conducive to their advantage. "I assume that disapprobation can be expressed only by those gentlemen who, having entered to the lectures, may feel that the instruction now proffered is not so good as that they have hitherto received. And, accordingly, to such gentlemen I declare my perfect readiness to return to them the portion of their fees they may wish to receive. "And as an assurance to the class of my having performed this promise, I shall be ready to publish upon the walls of this theatre or elsewhere, the names of those gentlemen by whom such applications have been made to me." GENERAL DISPENSARY, ALDERSGATE-STREET. It is whispered that some juggling is on foot between the Committee of the Aldersgate-street Dispensary and the medical men who are now doing duty there. The rumor is, that they are to be elected without becoming candidates. We cannot credit it: no body of men can be so blind to the distinction between right and wrong as to imagine that they can without disgrace accept an appointment which they acknowledge it would be unprofessional, and little short of infamous, openly to seek. If they do accept appointments thus thrust upon them, then is their present reserve but affectation-a fear of public censure, not a love of professional honour; then is their declining to ask for what they secretly covet, the result of cowardice, with just sagacity enough to know what is wrong, but without virtue enough to do what is right. It would in short be such a contemptible piece of dirty shuffling, that we will not believe it, notwithstanding the source of our information, and feel convinced that the gentlemen alluded to will be the first to rebut the charge*. WAKLEY OUTWITTED. SOME satirical rogue has written to the Editor of the Lancet, complimenting him upon his “ powerful" leaders in support of the medical officers of the Aldersgate-street Dispensary, which, he says, have made him quite the "Times" of the profession; and not content with the puff direct, he farther indulges our contemporary with the puff collateral, contrasting his spirit and consistency with the "cautious special pleading" of the Gazette on the same subject. It is astonishing that Wakley should have Since writing the above, the mask has been thrown off. Two of the surgeons on duty have openly announced themselves as candidates. been such a blockhead as to be taken in by this, and not perceive that "Praise undeserved is satire in disguise" the thing being evidently written in irony, though he has actually published it in pure simplicity, and has thus compelled us, in self-defence, to expose his total want of any thing like consistency on the subject his veering with the changes of the wind-the most mobile and obedient weathercock in the metropolis. But it will be asked, does he not support the medical men ou this occasion? Oh, yes; nothing can exceed the virtuous indignation which he now displays against the insult offered to their medical officers by the Dispensary Committee, except the insult which he himself offered them when the discussion first began; nothing can be more unqualified than the support he now gives the medical officers against the Committee, except the support he then gave the Committee against the medical officers; nothing can equal the abuse he now vents against those who may become candidates for any of the vacancies, except the abuse he then poured forth against the men who lately held the appointments. When the law was first proposed by the Committee, that persons subscribing only three days before an election at the General Dispensary in Aldersgate-Street should be allowed to vote, the medical Wakley's Appeal to the Governors of the Alders. gate-Street Dispensary against the Medical Men, and against preventing the appointments from being sold. "The officers of the General Dispensary in Aldersgate-street have forwarded to us a copy of a circular which they have addressed to the Governors of that institution. [Here follows an extract showing that the medical men called upon the Governors to oppose the abrogation of the law, that no one should vote who had not subscribed six months before, and proposed substitution for it of one empowering any person to vote who paid his money three days before the day of men addressed a circular to the Gover nors, calling upon them to come forward and reject it. We seconded their appeal, and have never held but one straightforward, uncompromising, and consistent course throughout. The Editor of the Lancet has also recorded his opinions: he advised the Governors to disregard the appeal of their officers-whom he represented as having obtained their own appointments by "lying and intrigue." He gives a supposititious case of "a thorough-going intriguer," and then ironically adds, "such a man is well entitled to call upon the Governors to adopt a more pure system of election."! t Now all this is nothing to us, and being but part and parcel of the character of the publication, we should never have dreamt of alluding to it but for the inconceivable folly of our contemporary, in inserting a sneer against the Gazette, and thus challenging a comparison with us on this subject. He shall be gratified. For the strength and consistency of our humble support to the cause of the profession on this occasion, we appeal to every sentence in this journal in which the subject has been alluded to;-in proof of the nature of Wakley's support, we shall also adopt an analogous proceeding: we shall give him the benefit of his own words-shall adduce not a syllable against him, except from his own pages. Wakley's Appeal to the Medical Men against the Governors of the Aldersgate-Street Dispensary, and against allowing the appointments to be sold. "At this meeting-[i. e, one at which the question as to the mode of election was decided against the medical men,] - the whole of the medical officers, physicians and surgeons, resigned their offices. Why? Because the Governors, in the opinion of these medical officers, shewed a wanton disregard of the respectability of the profession and the welfare of the sick poor. Is there a legally qualified member of any one of our Colleges or Halls who will so debase himself-who will so insult all his election; the Lancet then continues:-] So much zeal and apparent liberality in a good cause is entitled to our admiration. But in casting our eye over the six names which are subscribed to the circular, one is led to inquire how, in the name of all that is wonderful, a majority of those selfsame gentlemen happened to be elected physicians and surgeons to an important institution. Was fame the cause of their success? No. Their discoveries in medicine? No.-Great skill exhibited in the performance of medical duties? No. * The subscribers of the charity need not in 1833. professional brethren who will be so So much for the "Times" of the medical profession. Two or three things have happened this week connected with Coroners' Inquests which we think deserve a word or two of notice. In the first place, there was a medical man who declined to say what was the cause of death in a very simple case, unless he was first permitted to hold a post-mortem examination. The jury found a verdict of "accidental death," without consulting him further. We think the jury was right, both in point of fact and of conduct; and that the medical man was needlessly fastidious about giving his opinion. It is a very mistaken notion that is entertained by some medical witnesses, that a postmortem examination is essential in every case before an opinion regarding the cause of death can be given. Why, even in cases of poisoning, the internal lesions are often immaterial, and the whole corpus delicti is manifest either from the symptoms preceding dissolution, the external marks, or the moral circumstances: an inspection of the morbid appearances may often be very well dispensed with. Besides, where in a trivial case sufficiently intelligible to a jury of common understandings, a medical man steps in, and calls for a post-mortem examination, he has the air of wishing to mystify a plain matter of fact, and gets the character of being only bent upon having his fee. With regard to the fee, it were very desirable that some legal arrangement were made; for the Coroner has not the power, in the present state of things, of allocating one: the demand, therefore, at present, on the part of the medical witness is fruitless; and to avoid any squabble about it, the Coroner and jury very often prefer going without a medical opinion at all. Another case has occurred, in addition to the one noticed last week, in which a medical man refused to answer a question of the simplest nature without a fee. Perseverance in this practice, though it may be ultimately attended with benefit to practitioners, has, we are sorry to say, a very poor appearance in the eyes of common observers. A third point which we would remark upon is what occurred very recently, in an inquest on a child. This child was strongly suspected to have come by its death in consequence of violent treatment received from the brutal father: the symptoms of the child's death and the moral evidence almost proved the fact; yet there being no morbid appearance or marks of lesion discoverable on the medical inspection of the body, the inference was, that the violence inflicted was not the cause of death: nay, one of the witnesses ventured to say, that if the injury just referred to had been the cause of death, marks of it would have been apparent. With submission to this learned jurist, we can only say that we are astonished at the hardihood of his assertion. It is a great mistake to think that death cannot occur from blows or kicks without the marks of these injuries being discoverable on the body. Every tyro in legal medicine knows to the contrary, and can point out decisive cases on the point. Loose opinions of this kind thrown out by men, called medical, who happen to be summoned before Coroners' juries, do much mischief, from the handle which they afford to contradiction, and thus to lowering the value of medical testimony in the estimation of the public. CLINICAL OBSERVATIONS ON THE AMPUTATION AND REMOVAL OF PORTIONS OF THE LOWER JÀW. BY BARON DUPUYTREN. From the "Leçons Orales," published periodically, under the Baron's inspection." A FRIGHTUL cancer has devoured a lipit has seized upon the jaw-the bone is deeply disorganized, or destroyed-the evil makes rapid progress, which the resources of art cannot arrest-the patient is doomed to certain death. Before he reaches the fatal goal, however, he is the victim of the most cruel tortures that can afflict humanity. His hideous aspect renders him an object of disgust and horror both to himself and bis acquaintances; In the present "Leçon," it will be seen that the reporters take upon themselves the whole responsibility of sounding the praises of the surgeon of the Hotel Dieu, sometimes in the highest strain of panegyric.-Transl. they fly from him: sequestered from society, he courts death, and complains of the slowness of its approach. On behold. ing such an object, the heart even of the professional man shudders: he seeks, in the resources of his ingenuity, for some means which science denies; a bold operation is attempted; the whole evil is removed; the most brilliant success crowns the hopes of the operator; the wretch whom death had just now menaced is delivered from all suffering; in a short time all the horrible traces of his disorder have vanished; and he re-enters society, to enjoy all his privileges and advantages, and he may live a long life after. . . . shall we hail the man to whom humanity is indebted for so great a benefit?... But let us hasten to proclaim it aloud-to the glory of its author-to the glory of French surgery-that it was in France, in Paris, and by our own illustrious surgeon, M. Du. puytren, that this admirable operation was first conceived and executed. It was in the year 1812. It now belongs to the general domain of science; and numerous examples of success, obtained by many surgeons in various countries, have completely confirmed its efficacy. How which the subject is susceptible, we think it our duty to record the first case in which amputation of the lower jaw was ever performed. Before we enter on the development of The earliest Case of Amputation of the Lower Jaw-Complete Success. Lesier, a cabriolet proprietor, aged 40 at the time when he was operated upon, had experienced, in the year 1797—that is to say, fifteen years previously-certain dull pains in the lower jaw. The left canine tooth soon after became prominent, and fell out, being presently replaced by a fungous excrescence which sprung from the bottom of the socket. This tumor, though frequently attacked with the actual cautery, as often sprung up again, more large and painful than ever: it degenerated at last into carcinoma; and when the patient at length, in 1812, after much hesitation, came to put himself under M. Dupuytren's care, and agreed to permit an operation, his state was as follows:-The cancerous tumorextended from the second molar on the right side to the ramus of the maxilla on the left. base of the tongue was turned backwards; the teeth were embedded in the fungus, whence there flowed a disgusting and foetid sanies. The lower jaw was of triple its natural size, and the sarcoma was buried deeply in its substance. The tumor was reddish, mixed with white, and it obliterated and protruded beyond the opening of the mouth, which it kept extended as The wide as the articulation of the jaw would permit. It formed three projections; one of which rose between the dental arcades, whilst the other two pushed forward each a cheek. The only means of putting food into the mouth was by drawing aside the right commissure. Respiration difficult; ptyalism abundant; mastication almost wholly impossible; the utterance extremely indistinct. Yet the appetite was still active, and the constitution of the patient seemed so little impaired that no fear was entertained of the slow fever under which he was continually labouring. Having given him a purgative on the 28th November, M. Dupuytren, assisted by Messrs. Breschet, Lebreton, and some other surgeons, proceeded two days after to the operation. It should be noted here, that the patient had the imprudence to drink, in the morning, a litre and a half of wine, to give him strength. He was placed sitting as for the operation for cataract. The labial arteries were compressed against the rami of the maxilla. The surgeon, placed before the patient, seized with his left hand the right side of the lower lip, whilst an assistant attended to the left side. An incision was then made through the middle of the lip, and extended nearly to the hyoid. The two flaps thus formed were dissected off, leaving the tumor uncovered. A section was then made of the jaw on each side, about an inch from its angles: the instrument used was a hand saw. There was no blood of any consequence lost in proceeding so far; but as soon as the muscles attached to the apophysis and the mylohyoid were divided, the arteries, which were more voluminous in relation to the tumor, became engaged. The hæmorrhage, however, was less than could have been expected. The fingers of the assistants, or of the surgeon, applied to the branches of the submental and lingual arteries, suspended the effusion of blood, and the carcinoma was in short wholly removed. The trunk of the submental was tied, and the wound was cauterized with an iron at a white heat. Charpie was put before each stump, and the flaps were drawn together. In order to encourage a flow of pus, a wick was placed in the lower part of the wound, near the hyoid; and, finally, the external parts were covered with charpie and compresses, and the apparel supported by a chin cloth. But no sooner was this done than a hemorrhage took place, and the patient had to be undressed again. A cauterization more severe than the first was effected; and after being dressed once more, the patient was able to put himself to bed. The parts removed weighed a pound and a half; the bone was exostosed, carious, necrosed, and softened, in several places; the fungus was hard; fibrous, and crepitous under the knife. Every thing went on favourably after the operation. Upon removing the apparel on the 5th day, the part of the flap which were brought together were found perfectly reunited. The eschars became detached on the 15th day; the appetite of the patient was good; and there was no disturbance in the system. On the 27th day Lesier drove one of his own cabriolets; on the 30th two little pieces of bone came away from the stump; and in fifteen days more the cure was complete. The tissues gradually hardened; the two stumps approached each other; and a sort of chin, which was newly formed, almost wholly removed any deformity. It is now twentyone years since the operation, and M. Lesier is at this moment in the enjoyment of the best health. His picture, representing him such as he was previous to the operation, may be seen in the museum of the School of Medicine. Having thus related the circumstances which gave occasion to M. Dupuytren to practise this important operation, it will now be proper to state how he was induced to contrive it; what are the circumstances which indicate its adoption; in what consists the essence of the operation, and the varieties which it presents, according to the part of the jaw that is concerned; and what are the consecutive accidents likely to be developed. We shall then give a very succinct account of the numerous operations of the kind since practised, both in France and in other countries. It was proved long ago by the effects of wounds from fire-arms, attended by com. minutive fractures, that considerable portions, or even the whole, of the lower jaw might be destroyed, without death resulting from those mutilations. M. Larrey speaks of a soldier who lost nearly the entire of it, and who yet lives; and since the year 1815, a number of soldiers with simi. lar lesions may have been observed at the Hôtel des Invalides; some of them are even still to be seen. Other causes also, such as caries or necrosis of the bone have often destroyed more or less of it, and yet the patients have recovered without any great deformity being left. Hippocrates himself relates such a case. one of the most remarkable on record is that which Guernery observed at the Bicêtre: the whole of the lower jaw exfo. liated, and then grew again, so as even to allow of mastication. Van Wy speaks of a patient who lost the jaw almost wholly, yet survived for a long time. Two similar cases are to be found in Desault's journal. A woman at Bourges lost the right half. M. Boyer relates, in Plenk's Bibliotheca, But |