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sure of air, forced in by the air-pump. Thesubstance of the leather being thus saturated,it should now be removed from the oil, andsubmitted to the pressure of a pair of steelrollers, or other expedients, to remove thesuperfluous oil, and condense the leather.It should be now dried, when it will be fitto cut up for use. Thus prepared, it wouldbe perfectly water-proof, every portion of it,and doubly durable. That Captain N. mayrecognise an old friend in this communica.tion, I beg leave to add, that I am the personwho held medical charge of her Majesty’s34th regiment at Villores, in 1816, and am,Sir, yours obediently,

C. S.March 13,1843.

ILIAC DISEASE.—PROBABLE INTUS-SUSCEPTION,SINGULAR TREATMENT, AND FAVOURABLE

TERMINATION OF THE CASE.

A LABOURING man, forty-eight year of age,and of a robust constitution, was attackedwith a sudden and violent pain in the abdo-men to the right of the umbilicus. The painpersisted, though not with sufficient acute-ness to hinder him from continuing his em.ployment; and for several days no evacuationof the bowels took place. Aperient medi-cines and lavements, now employed, werefar from producing any benefit, and thepatient soon took to his bed. Agitation andrestlessness continual; the tongue furred ;pulse small, though regular ; abdomen in-flated, particularly its gastric region, butpainful only at the one point to the right ofthe navel. Frequent excrementitious eructa-tions, and in twenty-four hours afterwardsstercoral matters were vomited. The pain,anxiety, &c., continued to increase, while thepulse fell so as to become almost impercep-tible. The medical attendant, Dr. Schrobitz,of Gaudenz, first obliged the patient to takea warm bath, and then had him placed onhis back and raised his legs over the shouldersof a strong man. The latter, having graspedhis ankles, the rest of the patient’s body wassupported by two other persons, so as to hanghead downwards. The patient was thenshaken briskly several times, while the prac-titioner kneaded the abdomen with both hishands. After about twenty-five minutesincessantly occupied with this kind of mani-pulation, the patient experienced all at once,in the chief seat of pain, a sensation of some-thing having given way (le sentiment d’uneiessie qui se serait dechirée), when the painimmediately and wholly ceased. Warm bathsand gentle aperients now insured completerecovery.-Schrobitz, in Gazette des H6p.,Suppl.

THE glands, properly so called, separatefluids from the body, and discharge them bya duct. They are all situated on the heador trunk.-Dr. Alison.

AN EXPOSITION OF THE LAWSWHICH RELATE TO THE

MEDICAL PROFESSION IN ENG-LAND,

SO FAR AS REGARDS THE

COLLEGE OF PHYSICIANS.

As Sir James Graham’s Bill for MedicalReform is on the eve of being brought for-ward in Parliament, and as it is proposed tomodify the present charters of the two Col.leges of Physicians and Surgeons, or to grantnew charters to them, it may not b unin-teresting to your readers to be made ac-quainted with the present state of the lawin England, as regards the medical profes-sion in its several departments ; they willthen be the more able to form an estimate ofthe expediency or value of the new projectsabout to be submitted to Parliament by theHome Secretary.By your permission, then, I will, in a few

letters, furnish those who are not fully ac-quainted already with the subject, with ashort exposition of the several charters andActs of Parliaments which govern the pre-sent medical corporations in England, andunder which medicine is now permitted to bepractised therein.

I will, first, begin with the College of

Physicians, not only because it is the mostancient of the medical corporations in thiscountry, but also, as facts will prove, be-cause it is the most liberal and least close of

any one of them. Moreover, as some spar-ring has lately taken place in THE LANCET,respecting the relations subsisting betweenthe college and the licentiates, as well asbetween the licentiates intra urbem, andthose extra urbem, it may be as well to setthat dispute at rest at once.The charter of inorporationof the College

of Physicians bears date September 23rd,in the tenth year of the reign of Henry theEighth. There were several Acts of Parlia-ment passed before that period for the pu-nishment of unqualified practitioners, bothmale and female. The first of which weknow anything is that of the 9th of Hen. V. ;this Act imposes a penalty of 401. and " longimprisonment" on any one who practisesphysic without letters testimonials from oneof the two English universities in whichhe had taken his degree ; and the sheriffs ofEngland were to give notice to all those whopractised within their several jurisdictionsthat they might resort to either of the univer-sities, at which they would be examined,and, if approved, admitted to their degree, &e.This Act continued in force legally, if notpractically, until the 3rd of Hen. VIII.

The Act of 3rd Hen. VIII. is important inone respect, namely, inasmuch as it declaresthe " science and cunning of physic andsurgery (to the perfect knowledge whereofbe requisite both great learning and ripe ex-

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perience)" to be one and the same. The twodepartments, according to common sense,ought never to have been separated in prin-ciple whatever they might be in practice.This Act ordains " that no person within

the City of London, nor within seven milesof the same, take upon him to exercise andoccupy as a physician or surgeon, except hebe first examined, approved, and admittedby the Bishop of London, or by the Dean ofSt. Paul’s, for the time being, calling to himor themfour doctors of physic; or, for surgery,other expert persons in that faculty," underthe penalty of 51. for every month of so exer-cising and occupying.The second clause applies a similar provi-

sion, and the same penalty, to all the diocesesof England, the bishop of each diocese, or hisvicar-general, " calling to them such expertpersons in the said faculties," &c. The Actis in no way to affect the privileges of thetwo Universities of Oxford and Cambridge.

According to the period at which this Actwas passed, it is, perhaps, the best thatcould have been devised ; for the bishop wasbound to call to his aid persons the most dis-

tinguished in the two faculties of physic andsurgery, who, of course, were the bond fideexaminers.

Seven years after the passing of the last-mentioned Act Henry granted a charter toLinacre and five other physicians, incorporat-ing them into a College. This is the firstcharter or Act of Parliament of which wehave any record, that went to bind togetherany number of medical practitioners in thiscountry into a body politic. The charterconfers upon the body the name and title of11 President and College or Community of theFaculty of Physic in London."* It gives

them the power of holding meetings and of’ making rules and regulations for the salu-

tary government, superintendence, and cor-rection of the college or community, and ofall persons of the same faculty in the saidcity, or within the circuit of seven miles ofthe same.From the tenor of the following passage in

the charter there is reason to believe that allthe legally-gualified physicians practising inLondon, or within seven miles of the same,were comprehended in that document :-" Collegium perpetuum doctorum et graviumvirorum, qui medicinam in urbe nostra

Londino et suburbis, intra septem milliapassuum ab ea urbe quaqua versus publiceexerceant, instituti volumus atque impera-mus."As there has been a good deal of cavilling

abaut this part of the charter, and claimsfounded upon it set up for the fellowship of

* " Et quod ipsi per nomina prassidentiset collegii seu communitatis facultatis medi-cinae Lond., placitare et implacitari possintcoram quibuscunqne judicibus in curiis etactionibus quibuscunqne."

the college, it may not be amiss to make oneor two remarks upon the subject.

It would be absurd to suppose that thecharter contemplated ignorant or unqualifiedpractitioners to be taken in at the formationof the college, because the very object of theestablishment of that college or communitywas to discountenance and punish such per-sons. Who, then, were the persons, " quimedicinam in urbe nostra Londino et sub-urbis exerceant"? The answer must be, ofcourse, those who had coml)lied with the lawas it stood before the granting of the charter;namely, graduates of the two English uni-versities, and those others who had been" examined, approved, and admitted by theBishop of London, or by the Dean of St.Paul’s, having called to him or them fourdoctors of physic," according to the 3rd ofHenry VIII. Having been thus constitutedof legally-qualified physicians, the college be-came then the ruling power of the faculty,authorised to hold lawful meetings, and tomake rules and regulations for the govern-ment, superintendence, and correction of thecollege or community aforesaid, and of allmen of the same faculty in the aforesaid city,or within a circuit of seven miles round thesame,-« et omnium hotninum eandem facul-tatem in dicta civitate, seu per septem mil-liaria in circuitu ejusdem," &c.

. It does not follow because the college hasthe power given it to make rules and regtila-tions for its own government, and for the go-vernment of " all men of the same faculty,"&c., that all men of the same faculty, that is,all those subsequently qualified under thecharter to practise physic, should necessarilybecome a part of the governing body of thatcollege. Certainly, neither the charter northe subsequent Act of Parliament (14Hen. VIII.) gives them any such claim. I

speak, at present, only as to what the law is,-whether it would be better or worse if itwere otherwise, is another question. Ac-

cording to this charter, any one who exer-cises the faculty of medicine in the city ofLondon, or within seven miles round the

same, without being first admitted by thepresident and college, by letters testimo-

nials, sealed with the common seal of the

college, renders himself liable to a penaltyof 5l. for every month for which he continuesto exercise the same.*

* " Concessimus etiam eisdem presidentiet collegio seu communitati, et successoribussuis, quod nemo in dicta civitate, aut perseptem milliaria in circuitu ejusdem exerceatdictam facultatem, nisi ad hoc per dictampresidentem et communitatem, seu succes-sores eorum, qui pro tempore fuerint, ad-missus sit per ejusdem presidentis et collegiiliteras sigillo suo communi sigillatas, subpoena centum solidarum pro qualibet mense,quo non admissus eandem -facultatem exer-cuit," &c.

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901

It has been contended that the term ° ad.missus sit" in the charter indicates that itwas contemplated that all those who provedthemselves qualified for practice on examina-tion, should be admitted as parts of the i-ul-ing body of the college. It does not neces-sarily follow that such should be the inten-tion of the charter, for the terms " examined,approved, and admitted," are alike used inthe Act of 3rd Hen. VIII., wherein the

bishop or the dean is the nominal examiner.The term merely implies that those who ob-tained letters testimonial of examinationwere legally entitled to exercise the facultyof medicine to the extent of the jurisdictionof the college under the charter, namely, inthe city of London, and seven miles roundthe same.

As a royal charter cannot supersede anAct of Parliament, and as the Act of 14thHen. VIII., for confirming the college char-ter, did not pass for four years after the grantof that charter, there is no doubt that thebishops, in their respective dioceses, pos-sessed the legal right still of granting letterstestimonial to practitioners; that is, duringthe intervening four years. Indeed, there isno proof that the newly-constituted collegeexercised any of the privileges nominallygranted to it, until it obtained an Act of Par-liament for their confirmation. This fact fur-nishes a remarkable instance of the influenceof Parliament over the power of the Crown,even at that early period, and under a sove.reign, too, not disposed to be intimidated byshadows.

There is, also, reason to believe that thenumber of legally-qualified physicians prac-tising in London at the time of the establish-ment of the college was very small, although,probably, the irregular ones and the empiricswere vastly numerous. We shall find in an-other letter that the number of surgeonsabout that time practising in the metropolisdid not exceed a dozen. With regard to thenewly-established college, the small numberof qualified persons existing at that period inLondon will account for the smallness of theruling body during several years afterwards,because the first code of by-laws would belikely to be adhered to for many years un-

changed, especially as, probably, the pres-sure for admission into the college was notvery great at that early period. About theyear 1647 we find that the number of fellowswas not to exceed thirty ; it is now above onehundred and fifty.

It will have been noticed that the chartergave the new college no jurisdiction whateverbeyond seven miles round London. Beyondthat limit the bishops still possessed thepower of licensing physicians in their seve-ral dioceses ; indeed, no one could practise" throughout England"without their licence,except graduates of Oxford or Cambridge.But in the 14th year of Henry the Eighth’s

reign an end was put to the whole power ofthe priesthood over our profession.The Act of 14th Hen. VIII. is a most im-

portant one, and is that which has regulatedthe proceedings of the college down to thepresent time. -

This Act of Parliament was granted uponthe petition of the six persons originallynamed in the charter, and it is from thetenor of the Act that we infer that theLetters Patent had not been put into opera-tion up to this period, that is, a period of fouryears after they had been granted. Its firstenactment goes to confirm, in every part, thegrants, articles, and other things containedin the charter ; that is, it gives the collegethe full control over the profession in Lon-don, and within seven miles round the same.The second section creates a new power, forthe purpose of putting the wheels of the

college in motion ; and also, most importantly,for the regulation of the practice of physicthroughout England. This new powrr con-sists in the creation of the Elects, who areto consist of the six persons originallynamed in the charter, with two more persons,chosen by themselves, in order to make upeight in number.

" And that the same Elects yearly chooseone of them to be president of the said com-monalty ; and as oft as any of the roomsand places of the same Elects shall fortuneto be void, by death or otherwise, then thesurvivors of the said Elects shall choose,name, and admit, one or more, as need shallrequire, of the most cunning and expertmen of and in the said faculty in London, tosupply the said room and number of eightpersons," &c.

It will be seen from this clause that theElects are a sel-propagated section of thecollege, and that the power of appointingthe president not only rests solely with them-selves, but that he must be one afthemselves.But let us see what besides the duties of theelects consist of. These are very important,as the last clause of the Act will show.i " And where that in dioceses in England,out of London, it is not light (easy) to findalway men able sufficiently to examine (afterthe statute) such as shall be admitted toexercise physick in them, that it may beenacted in this present Parliament that noperson from henceforth be suffered to exer-cise or practise in physick through Englanduntil such time as he be examined at London,by the said President and three of the saidELECTS; and to have from the said Presidentor Elects letters testimonials of their approv-ing and examination, except he be a gradu-ate of Oxford or Cambridge, which hathaccomplished all things for his form, with.out any grace."Whereas the charter, confirmed in all its

points by the first clause of the Act of

Parliament, does away with the power ofthe Bishop of London and the Dean of St.

902

Paul’s to grant letters testimonials to prac-tise in London and within a circuit of sevenmiles, so does the last section of the Actsweep away all the power of the ruraldiocesans with respect to the rest of England.The explanatory letter, therefore, issuedsome time ago by the poor-law commis-sioners in reference to their regulations with

’’

regard to the qualifications of union medicalofficers, is not correct where it states that

every bishop may still license physicianswithin his own diocese. It is clear that thisAct deprives the bishops of all privileges ofthat kind which they possessed before thepassing of it; and I am not aware of the

granting of any act or charter since, whichrestores such privileges to them.

I shall now point out the relation whichthe licentiates intra-urbem and the licentiatesextra-urbem bear to each other-a subjectwhich, I find, has already been somewhatilliberally canvassed by some of the corre-spondents of THE LANCET.

It is hardly necessary to notice, in the firstplace, that the two classes of licentiates areequally ancient, because they are bothcreated under the same Act of Parliament,that is, the Act, ipso fiteto, creates theext7-a-licentiates, and it ratifies the power ofcreation of the iretra-liceutiates, which powerwas conferred by the charter four years pre-viously, but does not seem to have beenexercised until the passing of the Act in

question.In the second place, extra-licentiates can-

not legally practise in London, or within acircle of seven miles round the same, first,because the college abstains from attachingthe common seal of the corporation to theirdiploma, which is required by the charter,confirmed by Act of Parliament, to beattached to the diploma of all those who areentitled to practise within seven miles of thecity ; and, secondly, it is doubtful whetherthe president and elects, as such, are notconfined by the Act to the granting of letterstestimonials to those only who 11 exercise orpractise physick through England, in dio-ceses out of London." However, the by-laws of the college are a suflicient bar to theextra-licentiates practising in London. The Ipenalty is a fine of 5l. for every month fortransgressing this law.In the third place, with regard to the right

of the licentiates intra-urbem to practisebeyond the limits of seven miles round thecity, the Act of Parliament negatires such aright in the most positive terms. It enacts," That no person from henceforth be suf-fered to exercise or practise physick throughEnland until such time as he be examinedat London by the said president and three ofthe said ELECTS, and to have from the saidpresident or elects letters testimonials of theirapproving and examination," &c. The col-lege could not supersede the Act of Parlia-ment by any by-law, even if they attempted

it, but I am not aware that they ever had awish to do so.Now, it is well known that the intra-urbem

licentiates are examined by the presidentand CENSORS, and that their diploma bearsthe signatures of the president and censors ;whereas no person can practise "in diocesesin England, out of London," " until suchtime as he be examined at London by thesaid president and three of the said ELECTS,"and his diploma must bear their signatures.It is true that the Act does not attach anypenalty to a breach of this injunction ; butit is well known that whenever an Act ofParliament forbids anything to be done with-out awarding a penalty for non-compliancewith its enactments, a breach of it becomesa misderneaaaour at common law. ’

It is, therefore, perfectly clear, first, thatan extra-licentiate renders himself liable toa fine of one hundred shillings for everymonth" he presumes to practise in London,or within seven miles of the city; and,secondly, that every licentiate intra-urbemrenders himself liable to fine and imprison-ment at common law, every time he pocketsa fee beyond the limits of seven miles of thecity of London.

It must be admitted that the law showsgreat inconsistency upon this point; but myobject in the present letter is to give an ex-position of the law as it is. However, Imay be allowed to remark, in passing, thatwe ought to consider the early period atwhich this law was enacted, and the com-paratively low state of medical science atthat time. As the law now stands, it isevident that no person can legally practise asa physician both in Londou and in thecountry, without possessing a double licence,excepting graduates of Oxford or Cambridge,who must be, at the same time, fellows orcandidates of the College or Physicians.

SCRUTATOR.February 25, 1843.

WET-NURSES.—At a late meeting of theWestminster Medical Society a case wasrelated in which the milk of the wet-nursewas found to have disagreed with the infant.By accident it was ascertained that thenurse’s own child, instead of being only afew weeks old, as she had represented, wasnearly twelve months of age. Other caseswere related by members present to showthe absolute necessity of strict inquiries re-garding wet-nurses. One accoucheur, ofmuch experience, had known an instance inwhich a woman had a child to wet-nursewho herself had never even been pregnant,but had managed by some means to eludethe vigilance of the medical attendant and ofthe mother of the infant.

* It has been decided that if a personpractises for a shorter period than a monthhe is not liable to the penalty.