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pectoral muscle. He therefore meter. There is scarcely a sinused the lenticular knife employed gle surgeon who has not witnessed in trepanning, inserting it under the fatal consequences of caries the edge first of the seventh rib, of the ribs. After profuse supand then of the sixth, and cutting puration, enduring for months or round each till it was divided. years,-emaciation, marasmus,and The subjacent pleura, which had death ensue. It is useful to know, been much thickened, was cut in therefore, that the diseased parts, several places. A considerable which constitute the origin of the quantity of blood flowed from the fistulous sinuses, may be removed lacerated branches of the inter- by the knife without material costals; but the hemorrhage was risk.”- Edin. Med. & Surg.Jour. easily arrested by compresses and à tight bandage. No notice is Rheumatism, and some Diseases of taken of difficulty of breathing
the Heart and other internal Or. having been produced by the open gans : considered in the Gulstoings into the pleura.
nian Lectures, read at the Royal lasted six months, and was com College of Physicians, May 1826. plete.
By FRANCIS HAWKINS, M.D., V. A young woman bad, for Fellow of St. John's College. several months, on the left side 8vo. pp. 144. London, 1826. of the chest, a fistulous sinus, This little volume contains the leading to the third rib, which was substance of the first series of denuded. The chief disease was Lectures delivered in the Theaon the upper surface, near the tre of the new College of Physiunion of the bone with the carti- cians in Pall Mall East, and we lage, where the patient had for- would hail it as the forerunner to merly received a severe contu- some valuable contributions to the sion. All the usual remedies had general stock of medical science been tried without avail. Citta- from the learned body, whose dini removed the diseased portion splendid edifice is at once an orin the same manner as in the last nament to the metropolis and a case, but left the lower side of credit to the profession. We the cartilage, as it was not dis- most earnestly wish that we could eased. The cure lasted two induce the Fellows of the College months, and was permanent. of Physicians to emulate the
We cannot conclude the fore- praiseworthy efforts of their progoing narrative better than in the fessional brethren in Lincoln's Inn writer's own words. “ It fol- Field, and to afford us annually lows,” says he, “ from the obser- the results of that experience, vations related above, that resec- and the fruits of those high taltion of the ribs is not one of the ents, which are possessed by mavery dangerous operations, as sur. ny among the members of this geons have hitherto believed; and highly educated body. The exthat hemorrhage of the intercos- ample of the College of Surgeons tal arteries may be checked sim- is, in this respect at least,
well ply by compression, without hav. worthy of imitation. The oldest ing recourse to the ligature, pro- and most experienced members vided they are cut near the ster- of this branch of the profession num, where they are small in dia- have not disdained to come for
ward as our instructers; and they analyse it, our readers will perhave met their reward in crowd-ceive that it is chiefly occupied ed audiences, and in increase of with speculations in pathology, reputation. We do not mean to which, though highly ingenious, draw any invidious comparisons, are not to be compared, in point but it cannot be denied that the of value, with the results of exCollege of Physicians have, for perience in the administration of the most part, confided the post remedies. It is only at an hospiof lecturer to some one of the ju- tal that such a disease as rheumnior fellows; and, with the single atism can be properly studied ; exception of Dr. Cooke, whose but even here, with every possiCroonian lectures for 1819 were ble attention that can be given by so favorably received by the pub- an intelligent physician, many lic, we do not remember any in- years must elapse before he has stance in which the senior fellows made himself conversant with all have lately put their shoulders to the varieties of the disease, and the wheel. We hope to see this qualified himself to speak with altered ; and indeed reports have confidence on those difficult and already reached us that some recondite points in its pathology change in this respect may be and treatment, on which the mespeedily looked for. We have dical world are really anxious to in our eye at this moment many receive instruction. But it is physicians, whose experience, time that we bring the author of could they be induced to give it, the Gulstonian Lectures for 1826 would be most gratefully receive more immediately before our ed by a large proportion of the readers ; and this we shall do by medical public in London; and we giving a succinct view of the subconfidently predict that, in such a jects discussed in each of the case, the theatre of the new Col- three lectures of which the volege would be found totally inad- lume is composed, selecting one equate to the number who would or two passages out of each, as attend. It will probably be a best showing the author's style of matter of surprise to our country treating his subject, or as illusreaders, when we inform them trating some point of particular that the lectureroom of this mag- " novelty or interest. nificent building will with difficul The first lecture is occupied ty accommodate a hundred per- with speculations on the seat of sons.
rheumatism. The author first Though we have been led into inquires whether the muscular this train of reflection from the texture be in any case the seat perusal of the work before us, of this affection, and he argues in we by no means wish to insinuate favor of such an opinion, from a that Dr. HAWKINS was undeserv. consideration of the symptoms of ing of the honorable post assigned rheumatism, the situation of the him. On the contrary, we think pain in certain cases, and the althat he has produced a volume leged appearances on dissection, useful to others and creditable to as described by some foreign himself. It shows much learning, writers. The author very canand is clearly and neatly put to- didly states that these arguments gether ; but, when we come to are not conclusive, and that they
only give a degree of probability The author then proceeds to to the opinion. We are next in- notice that peculiar modification structed that the chief seat of of rheumatism in which the nerves rheumatism is in the fibrous and are principally attacked; and from tendinous structures of our frame. analogy he is led to believe that, "It is in this quarter that rheum- of the parts which belong to the atism makes its most frequent in- nervous apparatus, the fibrous tuvasions, exerts its most violent nic, or neurilema, is the one most and extensive influence, and too subject to the attacks of rheumaoften establishes a permanent do- tism. The fibroserous memminion.” We are told that Bi- branes, the pericardium and dura Chat was the first to collect mater, are then brought under these parts under the general review, and the fibrous capsules name of fibrous tissue.
of certain joints, especially the “ They are frequently divided hip and shoulder; and then we into two classes :-1.
classes :-1. Those come to the synovial membranes, which serve to connect parts to- comprising the subcutaneous burgether; and 2. Those which di- sæ, the synovial sheaths of tenvide and envelope particular or- dons, and the synovial capsules gans.
of joints. “To the first class belong the C. These are all of them subtendons and ligaments, and apo- ject to the attacks of rheumatism; neurotic expansions of tendons. and, when it occupies these struc
“ To the second, the muscular tures, it may be recognised by fasciæ, or bands, and enveloping the situation, the degree, the aponeuroses; the periosteum; the character, and the form of the fibrous coats of the nerves ; the swelling. The swelling is much membranes which have on one side greater in degree, and occurs à serous lining, as the dura mater much earlier after the comand pericardium ; also the fibrous mencement of the attack than sheaths of the tendons and cap- that which is caused by an affecsules of those joints which are tion of fibrous structures. The provided with fibrous capsules, character of the swelling is that and the ligaments surrounding the ., of an elastic, circumscribed, flucother joints. To these may be tuating tumor ; and its form is added the membranes which have that of the distended synovial a mucous covering spread over membrane, modified of course by them ; such as the portions of the the surrounding ligaments and tenperiosteum which line the palate, dons, according as these confine the nasal sinuses, and other inter- or admit of its free distension and nal cavities; and, finally, the cap- protrusion. sule of particular organs, as the " Another point of difference sclerotic coat and cornea of the between rheumatism of the synoeye, the tunica albuginea testis, vial and that of the fibrous memand the capsules of the kidneys, branes, which may be here briefovaries, &c. All these parts, ly alluded to, is that the fever with the exception of the cap- and constitutional disturbance are sules of the solid organs, appear much greater in proportion to the to be the frequent seat of rheum. degree of local inflammation in atic affections."
the latter, than in the former case.
" Again, it may be mentioned gout, those which induce debility that, of internal organs, the heart appear to give a tendency to and pericardium are chiefly prone rheumatism. Cautiously as this to sympathise with an affection of doctrine is worded, we yet think
fibrous structures; but the brain, it quite untenable. The occurand its meninges, with that of the rence of acute rheumatism in fat synovial membranes.”
and plethoric persons is far from The author sums up by giving uncommon; and accidents producthe following as the varieties of tive of local weakness, such as rheumatism founded on the pecu- strains and contusions, are just as liarities of anatomical structure : often the forerunners of gout as -1. Rheumatism of the fibrous of rheumatism,- perhaps even membranes, including under it oftener. the three subdivisions of, 1, rheu After giving us but one page on matism of the tendons, fasciæ, li- the predisposition to rheumatism, gaments, and muscles; 2, rheum- we were surprised by finding five atis in of the periosteum ; and, 3, pages devoted to the compararheumatism of the nerves or their tively uninteresting subject of the fibrous sheaths.-2. The second Diagnosis of Acute and Chronic great division of rheumatism in- Rheumatism. cludes the affections of synovial Rheumatism of the Fibrous membranes.
Structure, as distinguished from The second Lecture is devoted that of the synovial membranes, to a description of the general and next comes under notice ; and, as diagnostic symptoms of these this is the main feature of the forms and modifications of rheum- work, we must dwell a little on atism, and to an explanation of it. The author acknowledges to their separate appearances and have imbibed this distinction from occasional combinations. Pre- one of the physicians to St. vious to this, however, a few re- George's Hospital. The publimarks are offered on the exciting cation of a series of Cases of and predisposing causes of rheum- Rheumatism in some late Numatism, and on its intimate nature bers of this Journal, July and Auor essence. Dr. Hawkins, after gust, 1826, will at once suggest expressing his distrust of Sir to our readers the name of Dr. GEORGE Baker's theory, that CHAMBERS as the individual here neither gout nor rheumatism are referred to.
These views of really inflammations, but that rheumatism, indeed, are familiar they have their seat in the exqui- to all who have been in the habit sitely fine and slender radicles of of attending St. George's Hospilymphatic vessels,” briefly notices tal for some years past ; and, as the distinction between common we are informed, they have been and rheumatic inflammation; and fully developed in the lectures then proceeds to the predisposi- now in the course of delivery by tion to rheumatism. This part Dr. Chambers, in the Theatre of of his subject is discussed with Great Windmill Street. Popuextraordinary brevity. We are lar language, as Dr. Hawkins iesimply told, that, whereas all cir- marks, has long borne testimony cumstances which encourage cor- to such a distinction, the term pulence and plethora predispose to rheumatic gout being applied to
the synovial species of the disor- these affections differ from each der; and we are disposed to agree other more in degree than in kind, with the author, that, at the com we must hesitate ere we agree mencement of a rheumatic attack, with the author's concluding obthe discrimination of the affected servation, that, “if the varieties structures may be made; not per- of rheumatism are more attenhaps, as he states, invariably, but tively studied, a still closer adapat least very frequently. It is a tation of means to their cure may matter of doubt with us whether, even yet be effected.” beyond this, the distinction is of Some useful observations occur any real value. The quantum at page 64, on the symptoms of of practical benefit resulting from periosteal and nervous rheuinathis nicety in pathology, may be tism, which we regret that our estimated from the author's own limits will not permit us to transtatement :
scribe. We pass on, therefore, “Some advantage of this kind to Lecture third, which treats of has already been obtained in the the Rheumatic Affections of the choice of remedies for the treat- Heart, and other internal organs, ment of rheumatism. It has been with a slight allusion to Rheumaascertained that colchicum is al- tic Ophthalmia. The obscurity most specifically adapted for the in the symptoms of pericarditis is cure of the synovial species ; but first touched on, and two interest: that it more frequently disap- ing cases are related, wherein fupoints our expectation in fibrous rious delirium was the leading rheumatism, the acute form of symptom during life. The folwhich yields most readily to cal- lowing remarks are too valuable omel and opium in considerable to be passed over. doses, with the interposition of " From an examination of the occasional purgatives, and follow- cases which have been recorded ed up by moderate sudorifics ; of rheumatism of the heart, it and, finally, by the administration appears that a large proportion of cinchona. Topical remedies, of the subjects of this affection as has been mentioned, are chief- were young persons under thirty ly proper for articular rheuma- years of age : in most of them tism; but blisters have also a good there were marks of constitutioneffect in lumbago and sciatica, al or acquired debility : many and deepseated pains of the joints. were of a slender and delicate Sarsaparilla and alteratives are form, and pale and languid in required for chronic and cachec- their appearance. In these cirtic cases, particularly for affec- cumstances we have a strong contions of the periosteum."
firmation of the remark, that exWhen, however, we consider cessive bleeding in the treatment that the different kinds of rheum- of acute rheumatism, or any meaatism are frequently met with insures calculated to induce debilicombination, or in close succes- ty, increase the danger of metassion to each other,—that both tasis to the heart and pericardium; species are avowedly under the and that the exhibition of bark, influence of the same causes, as soon as it can be borne with predisposing and exciting,--and safety, is of considerable efficacy that the respective remedies for in counteracting this tendency.