748

provided with large venous reservoirs, simi-lar to that which has been stated to exist inseals, sea-divers, and the cetaceous animals.*These reservoirs are placed as near as pos-sible to the chest, but external to it, so asto be exposed to a constant pressure of fluidwhich surrounds them, and which pushes theblood which they contained across theheart.. 16th. We therefore see, that these ani-mals are obliged to come, from time to time,at the surface of the water, to fill theirreservoirs by a new expansion of the chest.Thus we now see, that the true antagonistsoX .the muscles of the heart are the inspira-tory muscles, and the elastic parietes ofthe chest, and that contractility alone pro-duces every motion necessary, as well

ifor circulation as respiration. The cavi-ties of the heart are pumps, whilst the

organ taken as a whole, produces, by itsmotions, the effect-of the piston of a sucking,pump placed in the middle of the chest;but this piston is hollow, and, by the effectof its position, being forced to dilate, itmaintains a continual struggle against thepowers which act on it.

Moreover, art could never imitate this

species of pump, because it could not giveactive contractility. As physiology is onlyuseful in so much as it contributes to theadvancement of science, I shall deduce, fromthe considerations and experiments alreadycited, the following pathological propo-sitions :-

1st. When the contractile force of theheart does not offer sufficient resistance tothe power which dilates it, there is a ten-dency to a morbid dilatation of the cavitiesof this organ ; and if, on the contrary, thispower is tao weak, the heart tends to con-tract and produce the diminution of itscavities.

2d. The two sounds which the heart

presents to auscultation, are produced bythe dilatation of its cavities, and not by theircontraction.

3d. The first sound, which does not al-

ways correspond to the arterial pulsations,is the result of the expansion of the appen-dices, and the- second of that of the ven-tricles.

4th. In the case of hypertrophia of theheart, when its contractions are stronger,the sounds, intead of being more vivid, aremuch more dull; whilst the impulse is

stronger, for the reasons already advanced.5th. If, on the contrary, the parietes of

the heart are found thin, and the cavities

* Cuvier, Lee. d’Anat. Comp. Tom. IV.p. 265 et 274; Haller, Phys. Lib. 4. sect. 2.tom. 1.

dilated, the sounds are clear, but the con-traction and the impulse weaker.

6th. Hence, according as the one or otherof the two sounds is more or less clear, thestate of hypertrophia, or atrophia, with orwithout dilatation of the cavities, can beaccurately ascertained.

LATE INQUEST AT THE ST. FANCRAS

INFIRMARY.

To the Editor of THE LANCET.

SIR,—In THE LANCET of Saturday, Sep.tember 1st, you state your intention of

bringing the subject of Lunatic Asylumsbefore your readers, and, by way of com-mencement, you insert a statement purport-ing to be an account of the evidence given atan Inquest held at St. Pancras, on the bodyof Ann Goldstock, a pauper lunatic, whodied at the White House, Bethnal-green.An erroneous report of the said inquesthav-ing appeared in the Morning Herald of the20th ult, I deemed it necessary to procurea correct copy of the several depositionssworn to on that occasion, and to request theeditor to give it insertion, for the purpose ofcorrecting impressions which might proveinjurious to myself and others. This state-ment was inserted in the Morning Herald ofthe 25th ult. ; on that occasion I carefullyabstained from publishing any remarks,considering the evidence alone sufficient toremedy the unintentional inaccuracies of thereporter. I feel it necessary, however, onthe present occasion, not only to insert thestatement published in the Herald, for thepurpose of giving your readers a fair viewof the gross falsehoods and wilful misrepre-sentations, which the author of the state-ment in THE LANCET has thought fit to in-troduce, but also to accompany it with afew remarks, and some little informationconcerning the manner in which the inquestwas got up.The readiness you have ever shown to

correct statements prejudicial to individualcharacter inserted in your columns, inducesme to’request, without fear of a refusal, .theinsertion of the following.

- I am, Sir,Your very obedient servant,

PIENRY BEESTON.12, Old Broad-street, Sep,7, 1827.

The woman in question, after an illnessof about seven weeks, died on the 13th ofAugust last, at the White House ; was

removed a day or two after to St. Pancras,without any notice being given, either to

749THE INQUEST ON WARBURTON’S PATIENT.

Mr. Jenniags of the White House, Mr.Dunston, or myself, that it was the inten-tion to hold an inquest on the body, and thepost-mortem examination was made withouteither Mr. Dunston or myself being request-ed to be present. The impropriety of re-moving the body from place to place pre-viously to the inquest being held, will, Ithink, be allowed by every body, as well asthe want’ of etiquette and common decencymanifested towards the medical attendantsof the deceased, in not inviting them to bepresent to judge of the post-mortem appear-ances for themselves ; but no, the intentionwas, to keep them in total ignorance untila verdict of a particular tendency shouldhave appeared in the public papers ; andhad it not been for the coroner’s clerk, whotook the trouble to send the summoningofficer to the White House, for the purposeof learning who the deceased’s medical at-tendants were, and for evidence to provethe time of the death of the lunatic, neitherof them would have been present ; as itwas, I only received information of the in-quest, in Old Broad-street, at two o’clockon the day on which the inquest, appointedfor three, was to be holden at St. Pancras,and I arrived a few moments before it took

place, and without the slightest opportunityof consulting my memoranda, for the pur-pose of refreshing my memory with the par-ticulars of the case.The following is the evidence brought

forward at the inquest, and by comparingit with the statement published in THELANCET, your readers will have some op-portunity of judging whether the misrepre-sentations, &c. are accidental or wilful.

To the Editor of the MORNING HERALD.

SiR,—The report in the -4loi-ning Herald I’

of Monday, the 20th instant, of an inquestheld at St. Pancras, on the body of AnnGoldstock, being erroneous, and conse-

quently injurious to individual character,and presuming you will feel anxious to cor-rect such injurious reports, I enclose a copyof the several depositions, made on oath, byDr. Sigmond, Mr. Wright, Mr. Dillon, andmyself, not doubting but that you will givethem the same ready insertion you havepreviously done that of Dr. Roots.

I am, Sir,Your very obedient servant,

HENRY BEESTON.12, Old Broad-street.

Dr. George Sigmond-Had never seenthe deceased previous to the 14th of Julylast; found her at the White House, Beth-,nal-green, whither witness went with Mr.Dillon, at his (Mr. D.’s) request, to visitthe pauper lunatics there ; found her in a

HENRY BEESTON.

state of great emaciation and debility. Shewas not capable of moving without the sup-port of the table (what might be calledcrawling along) ; the complaint that shemade was, that her bowels had been acted

upon twenty or thirty times during thecourse of the day ; that she was preventedsleeping at night by the noise that wasmade by the other lunatics. The question waspitt to her whether she had any medical treat-ment. She said she had nothin- done for her.She was asked if any thing had been givento her, and it appeared that a little brandyhad been given shortly before. She was

perfectly rational during her conversationwith witness. She appeared about 50. Shesaid she had been ill three weeks ; conceivedher to be in a dangerous state ; saw heragain on the 30th July ; she was then in bed,and seemed better altogether, and did notcomplain of her treatment. She seemed per-fectly rational. She said, on the 14th of

July, that she had been with the other luna-ties in the yard, in the day time. On the14th, she ought to have been in bed ; in thestate in which she was, she was not fitted tobe about. Understood she was brought outof bed to see witness ; that she had beensent to bed that morning. Mrs. Jennings,the superintendent of the house, was pre-sent. Brandy and opium were recommendedby Mr. Dillon to be given to deceased. Mrs.Jennings did not contradict deceased’sstatement. It is difficult for witness to saywhat was the first cause of her illness. Didnot assign a reason as to the cause of herdisease. Said she had been in goo’d healthprevious to coming there. Made no com-

plaint of ill-treatment, except that she wasshut up without a cause, and neglected as tomedical treatment. Considered that medi-cal assistance should have been earlier af-

: forded her. TT’itness did not consider that in-flamination had taken place. Did not see herafter the 30th July. Considered her in veryimminent danger the first time witness sawher. Taking her out of bed on the 14th ofJuly was injudicious. -

Henry Beeston-Has attended since the’ latter end of May, in consequence of theabsence of Mr. Dunston, occasioned by the

! illness of his wife, ’11010 deceased. Saw AnnGoldstock first about the 15th of June last.About a week after she was attacked with abowel complaint, she had given to her a

composition (kept in the house in case of

accident) of calomel and opium, in the formof pills, and amixture composed of preparedchalk and tincture of opium. She continuedill for about ten days. In two or three daysafter, the 2d of July, witness ordered herto be taken down stairs for the benefit of

the air. As she was in a very weak state,the diet that was ordered her was nutritiousbrotlis, and she had powders composed of

750

Columba root. About the 15th of July she Iwas again taken ill with a similar complaint, ifrom the effects of which she never reco- ivered. Her diet consisted of port wine and iarrow-root and sago, and brandy diluted withwater for her common drink, She died on

Monday morning last, witness considers ofdia7rhwa. ltIlo. Dunston visited her three ti.2)zesin the course Y’ witness’s attendance. Mr.Cor-dell, a surgeon, attended there daily, and sawthe deceased whenever witness debired. Shecomplained of no bad treatment of thehouse. Saw the medicine administered toher, as well as the food, several times. Wasnot present when Mr. Dillon called. Sawher on the 13th of July. She was veryweak from former illness ; did not considerher then in danger. Did not see her on the14th of July. Witness attended on the 15th,at the request of Mr. Jennings. Never sawher confined in one of the straw rooms. Didnot consider there was inflammation at anytime.

Charles Wm. Wright, of the St. Pancras

Infirmary, surgeon.-Sent the deceased, onthe 13th of June, 1827, to the White House.Saw her once since that time, but not totake particular notice. Was asked to ex-amine the body of deceased, in conjunctionwith Mr. Dillon and other medical men.Examined the body on the 16th. Under-stood she had been brought into the deadhouse the night before. A body having beendead three days, there would be a changeexternally, but not much internally, butthere was no particular change. Did notopen the body himself. There was inflam-mation of a chronic form, and ulceration ofthe intestines. The inflammation mighthave been existing a length of time, pro-bubly before she was sent from the izifirmary.The post mortem examination proved she diedof inflammatory disease. There was a slight ichronic inflammation of the brain, and

thickening of the membranes. Saw nothingin the intestinal canal approaching to gan-grene. Thinks that mental affection wouldproduce debility, and that inflammation

might ensue.Garret Dillon.-Saw deceased, for the

first time, on the 14th of July. She saidshe was fifty years old, that she had beenvery ill since her admission into that house.Understood /)’om deceased that she had nomedical attendance up to that time. Shewas collected on the 14th of July. Con-sidered she was labouring under an inflamma-tion nf the unucous membrane of the intestines,under which witness supposed she had beenlabouring some time. She was so sunk anddebilitated, that witness suggested that a

dose of brandy and opium should be given toher, and that a medical man should be calledto her. She was severely purged, andstated that she had had no sleep, from being

put with the noisy lunatics. At that timeshe was perfectly composed. She made herstatement in the presence of Mr. Jennings,and Dr. Sigmond made no further sugges-tion as to the treatment of her disease.

Reported the facts to the Directors of thepoor of this parish on the following Tuesday,and, in conformity with their wish, visitedher that day, in order that she might be re-moved to the Parish Innrmary, should shehe in a fit state. Found her in the In-

firmary, in a comfortable bed, at the White,House. She told witness she had beenvisited by the medical man, and attended to.She was certainly better in bodily health. Didnot consider it safe to move her and, un-derstanding she had a medical man to attendher, witness allowed her to remain. Neversaw her before the 14th of July. Was ofopinion, that she had not been attended toprevious to the 14th. She was not so com.

posed in her mind on the 17th. Observed toMrs. Jennings, on-the 14th, that she oughtto be a bed in the Infirmarv. Learned thatshe had been in bed, and brought out thatday, to be seen by witness and Dr. Sigmond.She said, on the 14th, that she had been inthe Hall, amongst the other patients.

Dr. Roots, of Guildford-street, Russell-square.-Saw the deceased at the requestof the Directors of St. Pancras, on the 3d ofAugust, at Bethnal Green. Found her in

bed very ill, and very weak and febrile, andevidently labouring under a disease of themucous membrane of the intestines, and

probably ulceration had ensued. She wasin a comfortable bed, and witness was in-formed that she had a medical attendantwho saw her every day. Was shown a

bottle containing a mixture, which was

probably chalk mixture, with opium. Wit-ness was informed that she had beef tea,

arrow root, gruel, and four or five glasses ofwine, in twenty-four hours, and brandylandwater for common drink. There appeareda verv remote hope of her recovery, and re-ported to the Board accordingly. Did notsee her again. Witness suggested to Mr.Jennings, that she should have a litte less

wine, that the brandy should be omittfd

altogether, and that leeches should be ap-plied to the abdomen, and also a blister.Was informed she was labouring under asevere diarrhaea.

Mr. Dillon, in his address to the coronerand jury, states, the deceased was neglectedfrom the commencement of her illness, up tothe 14th of July (the day he first visited

her). Now what ground has Mr. Dillon forthat assertion ? ‘l The statement, forsooth, nf thelunatic herseLf; and without inquiring of themedical attendants of the house, whethershe had been prescribed for or not-he,poor credulous man, runs with open mouth,

751

a ’few days after, to the parish directors,stating what the poor lunatic asserted, andadding, that unless proper medical assist-ance should be rendered to her, she wouldcertainly die in twenty-four hours ; and, inthis opinion, he is joined by his friend Dr.Sigmond. So that both these gentlemen,according to their own showing, left the

woman, believing she had no medical at-

tendant, (with only a recommendation,made to an unprofessional person, that sheshould have some brandy and opium, withoutstating the quantities,) for the space n,f’ threedays, when it was theirfirm belief she would diein twenty-four hours, and without coming toinquire, whether the request that a medicalgentleman should be sent for, had been

complied with. I thinlc I may venture toconfront my deposition on oath with thestatements of a lunatic, ; and if so, it far-nishes a complete refutation of the chargeof neglect up to the 14th of July, (as statedby Mr. Dillon,) unless that gentlemanmeans to charge himself with neglect, andthis I think his own assertions fully substan-tiate ; and, as he says, " she was certainlybetter in bodily health on the 17th ;" andhis friend, Dr. Sigmond, 11 that she wasbetter altogether on the 30th of July ;" theirawn evidence proves she had proper medical as-sistance for without it they state she would havedied in twenty-four hours.Asa contradiction to the assertion, that

the patients were left solely under my carefrom May to July, you will find it stated inmy evidence that a surgeon attended dailyat the White House, and that Mr. Dunstonsaw the deceased three times during my at-tendance. The cause of Mr. Dunston’s ab-sence is also omitted. It would have beenb!it fair for the author of the statement in

question to have inserted it.The assertion that the pills composed of

calomel and opium are used in all cnmalaintsof the bowels, is too insignificant to notice, aswell as the insinuation that I did not knowthe quantities of the ingredients comprisingthem. I certainly said I could not swear tothe exact quantities without consulting mymemoranda ; but I stated, to the best of mybelief, that they were composed of aboutthree grains of the pill of soap and opium,and between one. and two grains of calomel,and not the reverse, as stated in THE LANCET.They are five-grain pills, composed of threeand a half grains of the pill of soap andopium, and one and a half of calomel ; sothat I was as nearly correct as possible.

That I prescribe, in man cases, ,frnm the

reports of the nurses, without examining the

patients, is totally false. I stated, in answerto a question from Dr. Sigmond, " WhetherI consulted the patients themselves, or at-tended only to the reports of the nurses ?"

that my rule was, to judge for myself as faras I was able ; but that, for informationconcerning the habit of body, &c., I inva-

riably questioned the nurse in attendanceupon the lunatic in preference to the lunaticherself. It is true, therefore, that I am notin the habit of placing such implicit confidencein the statements of lunatics as Dr. Sigmond andMr. Dillon are ; and although these gentle-men of course possess greater experiencein these matters than myself, I find noreasons adduced against the propriety of mypractice to induce me to alter it: on the

contrary, their practice is likely to lead to

the most mischievous results.

For example-A lunatic, of the name ofSharpe, states to me, one moment, that hisbowels have not been relieved since his ad-mission (a period of more than two months),and the next, that they have been actedupon ten or twelve times a day.Query-What mode of treatment would

the gentlemen adopt?Another man states that he has not a drop

of blood in his body ; according to Dr. Sig-mond and Mr. Dillon, I ought to performthe operation of transfusion.

I have also to state, that Dr. Sigmondwas not authorised to visit the establish-ment at all, and was only permitted, out ofcourtesy, to accompany his friend Mr. Dil-lon. It is clear, however, from the noteshe took, for what purpose his visit wasmade, and his subsequent conduct sufE-

ciently proves it.As to my mistaking the nature of the

disease, I am content to rest my accuracyupon the evidence of those present at theexamination of the body ; for what are thepost mortem appearances of a " chronicdiarrhoea ’!" but inflammation and ulcerationof the mucous membrane of the intestines :and neither Mr. Dillon, nor his friendDr. Sigmond, agree as to the time when in-flammation took place. Mr. Dillon states

she was suffering from inflammation on the14th of July, Dr. Sigmond not consideringthat inflammation had taken place on the30th of that month.

Previously to delivering their verdict, theJury expressed their opinion that they hadbeen called together unnecessarily. Theverdict was, simply, " Died by the Visitationof God." I was present, and heard no im-putation of neglect. If there was such animputation, it must have referred to Mr.Dillon, who proved so satisfactorily the

inutility of his visits, that a Juror recom-mended to the parish the immediate cztrtailmentof so unnecessary an expense.