144

to prove, that a substitute could be borne,,and with a beneficial result, the voice, witha little practice, being evidently improved ;when a new difficulty arose, in consequenceof the India rubber decaying, the decompo.sition being so rapid in its progress, as toneed renewal at the expiration of two, orthree days at the furthest.The patient, greatly encouraged by the

prospect of success, learnt to prepare andreplace them for herself; but the constantrenewal of them being attended with greatinconvenience, in addition to the uncer-

I ainty of making them always exactly alikewater-proof cloth was tried, and found tobe equally pliable, while it was divested ofthe tendency to decay ; at the expiration ofa few weeks the irritability of the parts hadso much decreased, as to admit of very de.licate gold springs being introduced in lieuof the bristles. Although so short a timehad elapsed, * the articulation was alreadymore distinct, attended with a greater faci.lity in speaking, so much so, that the con.vulsive movement of the lips, occasioned bythe exertion, had entirely disappeared.

To avoid repetition, the letters refer to thesame part in each figure.

Fig. 1. a front view of the contrivance.A The flap that covers the aperture.BC Two teeth on each side having springs

attached for its support, the arm D, bybearing against the roof, effectually securesit against dropping down at the back.

Fig. 2. A side view E a nut and screw,by means of which the flap A is easily re-moved by the wearer, either to cleanse, orto renew it.

Fig. 3. Represents the whole as it appearswhen figed in the mouth, the form and extent of the cavity being distinguished by thedotted line at A.

14, George Street, Hanover Square.

* It should be observed, that the patientnever having spoken correctly, supposingnature to have suddenly restored the parts,it would require as much practice as the in’fant does, probably much more, before per.fection in speech could be attained.

MEDICO-CHIRURGICAL SOCIETY.

Tuesday, October 28, 1828.

Mr. TRAVERS, President, in the Chair.

The remainder of Mr. Arnott’s paper onthe secondary effect of inflammation of theveins was read to the meeting.The cause of the constitutional disturb-

ance, and of death in cases of phlebitis, hasbeen attributed to the inflammation extend-ing to the heart ; to the entrance of pus intothe circulation, and to the constitution ne-

cessarily sympathising deeply with parts soimportant in the economy as the veins.-Having related some cases which came under

his own observation, and cited others, theauthor proved that the inflammation doesnot extend to the heart, and that all the badconsequences sometimes ensue from inflam-mation of a very limited extent, perhaps ofa few inches only. The morbid changes areusually bounded on the side of the heart bythe junction of a vein. The contents of theinflamed veins are pus and lymph. Theconstitutional symptoms bear no direct reolation to the extent of the inflamed vein,they are marked by fever, restlessness, greatirritability and exhaustion. During thecourse of these, depositions of pus take

place in distant parts, into the cellqlar sub.stance, the joints become affected, a diseaseof the eye has been observed, and especially

145

abscesses in the lungs, with effusions of fluidinto the chest. The resemblance betweenthe course and character of these symptoms,and those succeeding to the inoculation ofa morbid poison, is striking, and, consider-ing the veryinnited extent of local affectionin the vein, in some instances, the inferenceis unavoidable, that they depend upon the in-flammatorv secretion from the surface of thevein ente;ln,, into the circulation, contami-nating the blood, and operating’ as a poison.The occurrence of abscesses and inflam-

mations in remote situations, after the punc-ture, division, or ligature, simply of a vein,offers an explanation of those which followmore extensive and complicated wounds.-Cases were detailed, where depositions ofpus into the lungs, the cellular substance,and joints, took place after amputation andcompound fracture ; and where a vein or

veins of the injured limb were found inflamed,and containing purulent matter and lymph.-Examining a number of instances where ab-scesses occurred in the liver and lungs afterinjuries of the head, it was shown that the

injury has been sometimes very slight;without either fracture of the shuli, or con-cussion of the brain ; but that there has al-ways existed a suppurating wound of thesoft parts. In two instances, inflammationand suppuration of the superior longitudinalsinus was found on dissecticn, and the conelusion is, that secondary affections of theviscera of the abdomen and chest are also

dependent, like those of the extremities, oninflammation of the veins.Inflammation of the uterine veins after

labour is not of unfrequent occurrence, andcases were related of abscesses in the liverand lungs, taking place in connection withthis.—A disease also of the joints occurs inthe puerperal st..te, as well as a destructiveinflammation of the eye, and a depositionof pus into the cellular substance, which, inthe author’s opinion are referred to inflam-mation of the uterine veins, and to the intro-duction of pus, or other inflammatory secre-tions, into the system from their surfaces.

In conclusion, Mr. A., having shown thatthe admixture of diseased exhalations fromthe inflamed veins, with the blood, is theCause of the secondary local affection in thecases which he has described, abstainedfrom an attempt to account for the deposi-tion of pus and lymph in the latter withoutsigns of inflammation, as this requires thatthe share which a diseased alteration in theblood has in the production of the phenomenaof inflammation, should be first investigated.A conversation then took place on the

nature and decree of the derangement ofthe nervous system in cases of phlebitis;but the discussion of the other importanttopics mentioned by Mr. Amott was post-poned to the next meeting of the Society.

nearly the whole of the time having beenoccupied in the reading of the paper. To

say that Mr. Arnott’s paper is the best we

possess on phlebitis, is, perhaps, not saving’much in its praise ; it is an interestingcommunication on an interesting subject, andthe manner in which the author consideredthe subject proves him to be a diligentand accurate observer of disease, and capableof the greatest research.

DUBLIN APPRENTICES.

To the Editor of THE LANCET.

SIR,—Your valuable periodical has everbeen the exposer of the grievances of the ju.nior portion of the profession. I trust, there-

fore, that mine will obtain a notice. Iam a "Dublin apprentice;" my "master"is rather eminent in his profession, andpossesses the means (if he had the inclina-tion) of bestowing on his apprentice everynecessary instruction; but, what is thefacf instruction from him, I receive none ;information, none. I am, indeed, blessedwith the sight of him once, perhaps, in everymonth ; he smiles, I bow, and off he goes.This, Sir, will do very well for the first twoor three years. But when a young manfinds his examination approaching, findshimself neglected by those to whom he paida large fee for instruction, and feels the dis-credit which attaches to those who are un-able to " pass their examination," shortlyafter their time has expired; he cannot

so readilv remain contented. But whatresource has he ? the consolation of the" grinder"-to him he has to pay thirtyor forty guineas for obtaining that instruc-tion which his " master’s" disgraceful in-attention denied him. The " grinder"rubs him up ; teaches him his business, aswe teach a parrot to talk, by rote ; andwhen he considers him sufficiently °‘ flip.pant," he sends him up to his examination.The " apprentice," perhaps, " passes," and

then launches into life, " "to learn his business.’’Perhaps he is rejected; why then, he re-turns to the " grinder" again, and, after afew more months of ‘° repetition," is per-haps fortunate enough to sneak through hisexamination. This, Sir, is not an uncem-nion case ; it is the case of almost all the" Dublin apprentices" at this instant.There are, however, thank God, some

men yet lere, who are too honourable topocket their apprentices’ money, and thenleave them uninstructed. They are but

few; on a future occasion I may, perhaps,send you their names, and then you, and thepublic, will be able to discover by whom aconfidential trust is, and is not neglected.

HIBERNICUS.Dublin, Sept. 29th, 1828.