now in the House of Refuge, were not sufficiently exposed to the contagious influence before their removal, I may mention that I know it to be the opinion of a medical gentleman, whose authority on this or any other point connected with the profession, stands as high as that of any other medical man in the island, that if cholera is at all contagious, a very slight contact with per sons affected is sufficient for the purpose. Will any gentleman pretend to say that if as many people had been equally exposed to measles, scarlet fever, or small pox, who had never been vaccinated or inoculated, diseases undoubtedly contagious, that an infinitely greater proportion would not have been seized? What must render this fact of no small weight, is the great number of individuals of different ages upon whom this experiment, if I may so call it, has been tried, since I believe that a great deal of the endless discussion on contagion and noncontagion has arisen from hasty generalization, from inquiries drawing general conclusions from insulated facts, as the rise and progress of the disease in one situation cannot be applied to every other; for what epidemic or contagious disease is there, whose type and character is not altered by time or place? It is, therefore, with great pleasure that I find the general question of the contagion or non-contagion of cholera to have been carefully avoided in the resolution now proposed to the meeting, and that we are only requested to give our conscientious opinion of what we have seen in Dumfries. I should wish that the gentlemen who look out for those cases which apparently serve to strengthen the doctrine of contagion would also give us all the insulated cases which have fallen under their observation. Now, if their experience has been similar to mine, they will find these to have been pretty nearly equal, and since the introduction of the disease has been clearly and indisputably shown by Dr. Jameson to have been dependent upon epidemic influence alone, I am astonished that these gentlemen should think it necessary to call in the agency of another cause whose existence is at least problematical, when all the cases can easily be explained by the agency of a cause whose existence is undoubted. I therefore most heartily support the motion of my friend, Dr. Jameson, who certainly deserves the best thanks of this meeting for the very able manner in which he has investigated the subject now brought before us. Mr. MACBRIDE.-As an argument against the present epidemic originating from atmospheric influence, it has been asked, how does it break out in one place without shewing the least symptom in the immediate vicinity? and how can you account for an individual having caught the disease after seeing a near relation, but by contagion? To such querists I would answer-that it was not from the person affected that the visitor caught the disease, but from inhaling the atmosphere where the disease originated-being predisposed by fear, or by agitated feelings in seeing his friend in such agony. It is well known, that at a certain height there are currents of air moving in opposite directions, and from late experiments it has been proved beyond doubt, that these currents sometimes come in contact with the earth. Now, Sir, from what I have stated, it is easy to conceive how one place may be affected, and its immediate localities escape; for instance, the current or vein of air containing the epidemic virus may have come in contact with the earth in that particular spot, and thereby affecting those who are predisposed in a very severe form, owing to the virus being concentrated; but as the virus intermixes with pure air, and becomes more diluted, in like manner the disease becomes more mild. Dr. GRIEVE stated that in addition to the case already adverted to by Dr. Jameson, he could adduce many which had occurred in his private practice, and in the hospital, in proof of the non-communicability of cholera, but he thought it unnecessary to enter into a detail of them at present when so many facts illustrative of the non-contagious nature of the disease had been brought forward. He thought that the absence of all proof of the malady having been imported was much against those who advocated the He doctrine of contagion. Inanimate matter, as clothes, furniture, &c., in his opinion, were not capable either of receiving or communicating the supposed contagion. had no doubt that the disease originated in Dumfries from a local miasma-the specific nature of which he would not attempt to explain-as it had done at Jessore, in Bengal, in 1817. Dr. Ross JAMESON.-I beg leave to say a few words in reply. If I understand aright the opinion of Dr. Thorburn, he denies the existence of an epidemic influence as affecting the rise and progress of cholera. His arguments rest solely on the fact that occasionally cholera attacks the majority of a family. But this by no means bears upon the point in dispute. All epidemic diseases do the same. I think I have pretty clearly proved that the rise and progress of cholera are to be attributed to a morbid epidemic influence. Now as far as regards the opposite side of the question the onus probandi lies with my opponent. No man can prove a negative. The fact of infection or contagion (as I have already remarked) can only be proved by an individual coming from a diseased into a district decidedly healthy, taking the complaint and communicating it to the attendants who alone in the locality are affected. It is by the production, not of one or two isolated cases, but of a very considerable number of such facts alone that the infectious or contagious nature of cholera in Dumfries can be proved. These facts do not exist. The motion was then put from the chair, and carried by a majority of 11 to 1. Mr. Spalding moved that the thanks of the meeting be tendered to Dr. Jameson for the trouble he had taken in calling them together, and for the opportunity thus afforded them of declaring their sentiments upon the subject so ably submitted by him to their consideration; which, being seconded by Dr. M'Culloch, was unanimously carried. Dr. Ross Jameson returned thanks. After a vote of thanks to the Chairman for his able and impartial conduct in the chair, the meeting separated. XLVI. INJURY OF THE PENIS, AND AMPUTATION OF THE ORGAN. THIS case is related in the Lancet for Sept. 22d, by Mr. Williams, an intelligent surgeon of Llandovery. We will give an abridged account of it. Case. In April, 1832, a farmer's son, æt. 11, had his penis bitten through his trowsers by a brood mare. No wound was inflicted, but mortification ensued, and on the separation of the slough the glans was left attached to the body of the penis by a small isthmus inferiorly. The wound was healed under the superintendence of an old woman, and on the 22d July the boy was taken for the first time to Mr. Williams. The penis now presented no great deformity, but the urine escaped guttatim through an opening in the cicatrix scarcely large enough to admit the point of a bristle, and situate on the dorsum of the penis, just behind the corona. The portion of urethra lying in the glans was quite impervious, and formed a stricture, about three-fourths of an inch in extent. The bladder was much distended. Mr. Williams determined to amputate the penis, just behind the injured part, and in this opinion Dr. Bowden, of Carmarthen, coincided. The operation was performed as follows: The root of the penis being held by an assistant, the glans and prepuce were grasped between the fingers and thumb of the left hand, and gently drawn forward, so as to elongate the penis; then, with a straight-bladed bistoury, the whole of the parts that constitute the organ were extirpated at one stroke, directing the incision from below upwards. The urine was immediately evacuated in a full stream, and the force with which it was propelled, showed that the bladder had not lost its power of action. After making pressure for a short time on the bleeding vessels, the flow of blood was arrested, without having recourse to ligatures, and the wound was dressed simply with dry lint. I found the next morning that a slight hemorrhage had taken place in the night, but it had now completely stopped; the urine freely passed, and a poultice was applied to the wound, which had now become considerably inflamed and swelled. A slight hemorrhage returned two or three times, generally in the night, but the inflammation and swelling soon subsided, the bleeding disappeared, and the surface began to granulate." In order to try whether the orifice of the urethra would contract if left to itself, no bougie was introduced. At the end of nine days the wound was nearly healed, and the orifice so contracted that the point of a small probe could scarcely be introduced. Bougies were employed, and in four days a common-sized one could be passed. At the end of a fortnight the bougie was discontinued for 24 hours, when the urethra was again found very contracted. The bougie was resumed, and has been continued up to the 12th Sept. the date of Mr. Williams' communication. It will be seen, on referring to the operation, that no precaution was adopted to preserve integuments, yet they overlap the extremity of the stump sufficiently to offer no impediment to future erection of the penis. We must confess that, so far as we can judge from the description of Mr. Williams' we should have been rather tempted to save the glans than to have removed it. Amputation of the glans is a serious evil-first, because it is the seat of much of the venereal pleasure-secondly, because the penis is much disfigured by its absence-thirdly, because the extremity of the urethra on the surface of the stump, after amputation is especially liable to contraction. We should have been inclined to attempt opening up the impervious urethra in the glans, not by the caustic bougie, but by a small trocar, and the subsequent employment of bougies. -Supposing that this attempt had failed, we believe it would have been better to have dilated the orifice on the dorsum of the penis behind the glans, than to have amputated the latter.. XLVII. REMOVAL OF CALCULI FROM THE FEMALE In the number of the Lancet containing the preceding case, is a short communication from Mr. Lovegrove, of Horsham. A young woman, æt. 20, had distressing symptoms of stone in the bladder. After trying "various alkaline medicines," Mr. Lovegrove determined to remove the stone by dilatation of the urethra. He introduced the dilator, and gradually expanded the blades till they were opened to their greatest extent; this occupied forty minutes. The dilator was allowed to remain twenty minutes and was then withdrawn, when a calculus the size of a walnut was expelled. The patient was ordered an opiate and nothing untoward occurred. For three weeks all went well, but then other calculous symptoms occurred.—The operation was again resorted to, and was repeated three different times at varying intervals, the bladder on each occasion expelling two, sometimes three calculi, from the size of a walnut to that of a hazel nut. The patient retains her urine "as well as before the operation," but we are not informed how well that is. Mr. Lovegrove should have stated the kind and composition of the calculi, and also the condition of the urine. We cannot judge of the propriety of administering “various alkaline medicines," in the absence of such information. Supposing that the urine was already alkaline, and that the calculi were composed externally of triple phosphate, we need scarcely inform our readers how injurious alkaline medicines would be, how calculated to establish or maintain an alkaline diathesis. We do hope that practitioners will attend to these points, and that they will record cases in a more scientific and exact manner than many have hitherto done. XLVIII. PHYSIC AND SURGERY. We have been much pleased with the perusal of the introductory lecture of Mr. Samuel Cooper, delivered to the surgical students of the London University on October 3d, 1832, and reported in the London Medical and Surgical Journal for October 6th. After giving a brief, but distinct and interesting sketch of the history of surgery and physic, he takes up the consideration of the present actual division be tween them. The sentiments of Mr. Cooper on this head, perfectly coincide with what we have ourselves on several occasions expressed, and we cannot allow the opportunity of recording them to escape us. "An interesting question now presents itself has the division of the profession, into physicians and surgeons, assisted or retarded its improvement? This is a point on which it may be difficult to give a ready answer. Perhaps I should be justified in saying, that the division of practice, the division of labour, has had good effects, particularly when such division was exercised by men, who had the same foundations, and began their respective careers, enriched from the same stores of science; for, gentlemen, if I am certain of any thing, relative to professional education, it is that medical and surgical practitioners should all go through precisely the same elementary studies. Thus far I concur with many enlightened members of the profession; because, in whatever way the question, about the division of practice, may be disposed of, the unity and indivisibility of the science itself must continue. But I completely disagree with those who seem to desire nothing less than the annihilation of the physician and regular surgeon altogether. Human life is not long enough, and human faculties are not powerful enough, for any one man to attain, in both departments of the profession, the point of per. fection, to which the talents and industry of many generations have now brought them. Had he the longevity of a patriarch, his time would yet be insufficient for so ambitious a purpose. I calculate, that the young physician, and the young surg on, who mean to reach the temple of fame, ought to commence their journey and travel together many miles along the same road; but that, when they have proceeded a certain distance, they must diverge a little, each taking the path leading to the summit of that branch of practice to which he is particularly devoted. Each carries along with him, however, the knowledge both of physic and of surgery; and each is endowed with all that variety of information, which I have represented as forming the basis of medical science. For my own part I should never have any confidence in a physician ignorant of surgery; nor is it possible to suppose any man entitled to the name of a surgeon, who knows nothing of physic." We can scarcely add any thing to these observations, unless we were to state in still stronger terms our disapprobation of the attempt, or rather the wish, for the attempt would be preposterous, to annihilate the physician and consulting surgeon altogether. Such a notion argues an utter ignorance of the natural progress of civilization, and the entertainers of it might as well proclaim at once that they think the establishment of Owenite communities possible. As man becomes civilized and social establishments gain strength, the division of labour likewise increases. In the wigwam of the savage, each individual is the manufacturer of most, if not the whole, of his necessaries and comforts. When a village is formed, the same individual practises many trade is cobbler, tailor, and draper. When commerce has erected that village into a town, the united trades are dissevered, and one person follows but one calling. The town increases to a city, such perhaps as the mighty one we dwell in, and with the augmentation of inhabitants is a proportionate augmentation of the subdivisions of labour. The tailor is no longer the artisan, he does not make, perhaps he scarcely One workman sees, the clothes he sells. The point to which all should direct their attention is the education of the young man. Let that be rendered as general as possible, and let circumstances or inclination determine his subsequent choice of a particular department. This, however, is not the whole of the case, nor is this the perfect solution of the difficulty. The general practitioners are a class continually increasing in itelligence and respectabil ty, qualifying themselves for a high station in medical society, and determined to assume it. Yet the general practitioner is a sort of homo non in our constitution-he belongs to the College of Surgeons and Society of Apothecaries, he really supports them, and yet he is an out-cast from either. These are anomalies that need not exist, that cannot endure. They are not the produce of present civilization, but the remains of institutions of a former æra. The day for the destruction of such things y be more or less protracted, but so surely as the mind of man does not retrogra e, they will sooner or later be swept away. " of clinical instruction in Edinburgh was so infinitely superior to that adopted in London, that the latter was quite undeserving of the name. In the Introductory Lecture, delivered by Dr. Elliotson, in the London University, on October 1st, that able physician takes up the gauntlet, and vindicates his own system of clinical instruction from the injurious aspersion of the reviewer. The comparison is interesting, and may perhaps afford some useful hints. "Really, when he says that the clinical teaching of London will not bear comparison with that of Edinburgh, for that we ought to show the pupil 'how to use his eyes, his ears, his hands,' he convicts himself of perfect ignorance of the present clinical teaching of London, in those hospitals where clinical instruction is given at all. My plan has always been, to spend two or three hours at the visit; to converse familiarly with the pupils on the cases; to request every one to observe the countenance of the patient, the expression and hue of which are often sufficient to indicate the changes that have occurred since the previous visit; to request every one to notice the appearance of the tongue, and to feel the pulse; to present each with my stethoscope who has not one, and stand patiently at the bed-side while he is listening; in short, to act the part of a private tutor in the wards to each, just as the demonstrator does in the dissecting-room. A true clinical lecture is thus given at every visit, though it does not bear the name, and is not published. Once a week I take a general view of the cases that have terminated, classing similar css for comparison, contrasting others, applying general remarks to particular case, and presenting a short abstract of each case and its treatment. XLIX. CLINICAL INSTRUCTION. IN the quarterly Journal of Education, for June last, it was asserted that the system In Edinburgh, the lectures, as far as I have heard and read them, are similar; and if two are delivered in the week, and the remarks are sometimes of a more clementary character, this is but a compensation, and in my opinion, is very far short of a |