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have offered to him will rest with him if he suffer it to pass.The Council of the College of Surgeons must agree to any sup-plementary charter which he thinks right to require them toaccept. A vigorous and united effort on the part of the honour-able and high-minded members of the college, made immediately,and based on the clearest justice, cannot fail of effect. In thefirst instance, then, the admission of the members at large to thefellowship must be insisted on as a matter of right, but with thefull understanding that the next step will be to frame such regu-lations as may draw a broad line of demarcation between themere trading practitioners and those whose course of practicetends to uphold the true dignity of the profession. I

HOSPITAL REPORTS.

WESTMINSTER HOSPITAL.CASE OF ACUTE LARYNGITIS, TERMINATING FATALLY BY CEDEMA

GLOTTIDIS. WITH CLINICAL REMARKS.

JOHN P-, aged forty-four, a batcher, came to the hospital onthe evening of March 29th, and was admitted under Dr. Bashaminto Burdett Ward, suffering from the following symptoms :-Inspirations laborious, long and deep drawn, attended with a loud,hissing, and croupy sound. Countenance pale and anxious, fore-head bedewed by copious perspirations; the throat was muchtumefied, particularly about the base and angle of the jaw; arti-culation indistinct; inability to open the mouth to any extent;tongue, as far as could be seen, but little loaded, and moist; eye-balls fixed and staring; the patient is conscious ; skin somewhatabove the natural standard, but moist; pulse full, somewhatsluggish. Soon after admission, and while being put to bed inBurdett Ward, according to the statement of his sister, was sud-denly seized with a slight convulsion, and immediately becamequiescent, and apparently a corpse, respiration not having beenincreased in difficulty, nor any of the symptoms aggravated, or inany degree worse, since he walked up into the ward. On thearrival in the ward of the apothecary and clinical assistant, thepulse was found still beating with some degree of power, frothwas issuing from the mouth, and two or three gasping effortswere made at inspiration. Tracheotomy was performed byMr. Stockwell, the house-surgeon, without a moment’s delay, andartificial respiration through the opening attempted; but thepulse failed, and all signs of life quickly ceased. His sisterstates that he was first taken unwell early on the 28th, the daybefore admission, at first complaining of swelling about the

angle of the jaw, with stiffness on opening it, and considerabledifficulty in swallowing solids; the symptoms became more andmore aggravated until about four hours before he came to thehospital, when the hissing and croupy inspirations first occurred.He had taken some beer and brandy in the morning as a remedyfor his uneasy sensations, and subsequently had rubbed his throat i,with harsthorn and oil. He had also applied a few leeches before i,admission. The patient was a stout, well-made, muscular man,of intemperate habits.

March3lst. Sectio cadaveris thirty-six hours after death.-Bodymuscular, well formed. On opening the cavities of the lungsand abdomen, the several viscera presented externally a healthyaspect; but the lungs, internally, were much gorged withblood, as were also the cavities of the heart, the blood being in astate of fluidity. On opening the larynx, trachea, and bronchii,the mucous membrane was observed deeply tinged with a brightvermilion, inflammatory colour, which, commencing in the larynx,of a fine, rose-coloured blush, increased in intensity, and extendedto the minutest ramifications of the bronchi. The vocal chords,the vocal sinuses, the glottis, and epiglottis, did not partake of theinflammatory blush, but were tumefied and distended by fluidthrown out into the submucous tissue. The free edges of the epi-glottis and subjacent parts were injected with serous infiltrationto such an extent as to close the rima glottidis, and present anapparent imperforate narrow fissure. The whole of the respira-tory mucous membrane, especially that involved in the inflamma-tory hue, was smeared with a glutinous secretion like gum-water ; the viscidity of this secretion became greater in thesmaller tubes. There were no traces of any inflammatory actionin the substance of the lungs. Nothing irregular was noticedin the pulmonary tissue, except the engorgement, and the pre-sence of many minute spicula of a calcareous deposit (phosphateof lime) in the apex of the left lung. The other viscera pre-sented nothing remarkable.

.7?emarhs.-Dr. Basham observed that this case presented veryeharact eristic features of the sudden formation of general hyper-

eemia of the mucous membrane of the lungs, terminating fatallyby asphyxia ; the oedema of the glottis presenting a mechanicalobstruction to the entrance of air to the lungs. One of the prin-cipal characteristics of this case was the fearful rapidity of the.symptoms. According to the evidence of the sister, scarcelythirty hours elapsed from the commencement of the disease andits fatal termination. Dr. Basham did not see the patient duringlife, as he died within a quarter of an hour of his admis-

sion ; but he hazarded the question, whether, had the patientcome earlier under medical treatment, means could have beenemployed to relieve the mechanical obstruction to the functionof respiration, and thus gain time for other remedies to act. Bythe testimony of the sister, the remedies applied before admissionwere of the most injudicious character, evidently the notionof the patient himself, or the suggestion of some imprudentfriends, and calculated most effectually to hasten on the disease toits fatal termination, beer and brandy only adding to the generalcondition of sthenic hypereemia, and the external stimulating-application augmenting the local mischief. The leeches appliedwere few in number, and totally inefficient to make any sensibleimpression on the circulation of the part, and, moreover, wereapplied too late to be in any way efficient in controlling the on-ward progress of the disease.The symptoms in this case were very expressive of the patho-

logy of the affection; so much so, that no mistake or differenceof opinion in regard to diagnosis could possibly exist. There isno very accurate record of the earlier or premonitory symptoms.The sister states that he first complained of stiffness about theangle of the jaw, and difficulty of deglutition. We hear of nosuch premonitory symptoms as rigors, dyspncea, or anything tosuggest a state of inflammation first existing in the laryngeal andbronchial mucous membrane. The state of intense inflammation.existing in these parts, as proved by the post-mortem examination,leads us to infer that this condition arose consentaneously andproceeded, paripassu, with the laryngeal and glottidean affection.The swelling about the jaw, the uneasy sensations about thethroat, and the difficulty of swallowing, were soon followed by animpeded freedom of inspiration, expiration remaining easy, theformer act being accompanied by a loud ringing hiss. This symp-tom of difficult inspiration and easy expiration is pathognomonicof this disease. The lodgment of a foreign body in the trachea,or larynx, gives rise to similar sensations on the part of the pa-tient as those now recorded ; a feeling of suffocation, inability anddifficulty of swallowing, swelling about the throat and jaw ; butin such cases, both inspiration and expiration are equally difficult,the impediment acting as an obstruction to the ingress as well as.

the egress of the air. But in oedema glottidis, the serous infil-tration of the submucous tissue of the free edges of the rima.glottidis, as well as of the epiglottis, brings the edges of the rimain apposition, and any external pressure, such as of a column ofair entering the lungs, pressing on the swollen edges, narrowsthe fissure, and causes the singing hiss heard on drawing in thebreath ; but the pressure of a column of air passing from withinoutwardly, tends to force the rima open, and to raise the epiglottis,.and by enlarging the aperture, allows the air to pass compara-tively unimpeded. The relative facility of expiration and inspi-ration may be taken, therefore, as a good diagnostic symptom ofthis disease. The frightful rapidity with which the symptomssped on to a fatal result was, in all probability, dependent on theintemperate habits of the individual-habits which, while theybring on a state of active congestive plethora and stheniohypersemia, at the same time deprive the system of that con-servative power which healthy vital energy possesses, of resist-ing the influence and effects of morbid action, and therebypresenting an efficient check to the destructive agencies ofdisease.Tracheotomy was performed, but too late to be of any service.

The patieut walked to the hospital; he walked up to bed inBurdett Ward, and his symptoms at this period, by those whoadmitted him, were not considered sufficiently urgent to proceed!at once to this operation. When the trachea was opened, theconvulsive shudder, the abortive gaspings, the express indices ofvenous blood circulating on the left side of the heart, alreadyemphatically declared the patient to be dying, 11 poisoned by his.own blood."Had the case come earlier under notice, the indications of

treatment wou1d, unquestionably, have been to relieve the tume-faction about the throat and angle of the jaw, by the applicationof a large number of leeches, and promoting the depletion causedby them, by the frequent application of hot poultices, or hotfomentations ; large doses of calomel, and bringing on copioussudoresis by the hot-air bath, administered as the patient lay inbed; investing the surface of the body in a temperature of hotair, as high, if possible, as 1600 or 180°. By obtaining a copioussecretion from the skin by such means, the most marked benefit

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may be obtained, and the system is quicker relieved than by anyinternal remedy that can be administered. If relief be notquickly evident, tracheotomy ought to be performed. But theprognosis in all sueh cases is from’the first unfavourable; forinflammatory action is not confined to the glottis and its appen-dages ; the larynx, trachea, and bronchii, are all involved; for incedema glottidis, it is erroneous to suppose the disease located

only in the oedematous or infiltrated parts. The fatal conditionnow illustrated is but a termination of a peculiar and malignantform of acute laryngitis; and it may be questioned whether,whenever the symptoms have progressed so far as to indicate<edema glottidis, the powers of life have not ebbed too low tohope that any remedies can be successfully employed.

PROVINCIAL MEDICAL AND SURGICALASSOCIATION.

Thirteenth Anniversary Meeting, held at Sheffield, on Wednesday,July 30, and Thursday, July 31.

(From the Provincial Medical and Surgical Journal.)

FIRST GENERAL MEETING.THE Council having met at half-past nine, at the Cutler’s Hall,the first general meeting was held at the same place at one

o’clock, when the chair was taken by the President, Dr. Ro-bertson.

Dr. HASTINGS then announced that the president elect, Dr.Corden Thompson, who was nominated at Northampton, in thepreceding year, to succeed to the chair on the retirement of Dr.Robertson, had written to the secretary of the Association, andhad declined to accept the office, on the ground that he differedfrom some members of the Association on the subject of medicalprotection. The meeting would therefore have to choose asuccessor.

Dr. J. C. WILLIAlIfS, of Nottingham, said he did not expect tobe called upon to address the meeting, because he was not tillthat time aware of the non-acceptance of the office of president.Indeed, it did not seem at all in accordance with the usual prac-tice of the Association, the meetings of which were proverbialfor harmony and good feeling. He therefore felt that to thesociety Dr. Thompson was lost, but de mortuis nil nisi bonunt.He (Dr. Williams) had resided in Sheffield many years ago, whenhe had the pleasure of living with the father of the present Dr.Favell, and from his knowledge of that gentleman would, if itmet with the pleasure of the meeting, propose that Dr. Favellshould be the president of the Association.

Dr. JEFFREYS, of Liverpool, begged to second the motion. Hewas placed in somewhat an anomalous position, for there hadhitherto been little difficulty in finding a president to succeedthe gentleman who was about to retire. That position hadusually been considered a high honour, and therefore, the posi-tion in which he now stood, was one of complete novelty ; and itwas the more so, inasmuch as the society was now at the veryheight of its prosperity. He was himself a perfect stranger toDr. Favell; but, at the same time, was fully aware that his qua-lifications and conduct were precisely such as had been so welldescribed by Dr. Williams. He hoped, therefore, that the Asso-ciation would have Dr. Favell in the chair next year, and wouldfeel great pleasure in seconding the motion which had been pro-posed by Dr. Williams.The motion was carried unanimously.Dr. RoBERTSON then said -Gentlemen, permit me, before

resigning the chair to my successor, to express the pleasure Ifeel at meeting you on the present occasion, and at seeing theProvincial Medical and Surgical Association assembled to holdits thirteenth anniversary in the important and populous townof Sheffield. The year during which I have had the honour ofpresiding over the Association has been one of unusual agitationand excitement. Suspense and anxiety have pervaded allclasses of the profession, on account of the legislative measuresproposed to parliament for the reform and re-construction of ourprofession. It is not my intention to trouble you with any com-ments on this all-engrossing subject; were I to do so, it wouldbe only the 11 crambe bis m!7/:’es coeta," inflicted upon you, at therisk of much weariness and some disgust. On this point I can-not do better than borrow the eloquent language of a highly-gifted and distinguished member of our Association-I meanDr. Cowan, of Reading. His words are of such sterling valueand importance, that it were well if they could be stereotyped, asa motto to each successive volume of our Transactions; I hadalmost said, to every weekly number of our Journal. They areas follows: " We should not forget that the true elements ofmedical reform are rather personal than corporate; that a highstandard of individual conduct must be adopted, if, as a body, we

would be purified ; and that whatever delays may attend the in-troduction of legislative reform, there is a power entrusted to

every one of us of internal reformation; of a sound and healthytraining of the moral and intellectual faculties; of diligence inthe pursuit of science ; of modesty in the self-estimation ofattainments ; of moderation in all desires for mere applause oremolument; of refusal to stoop to what is selfish and degrading;of rightly estimating the holy luxury of doing good-a powerfar more important than the best regulated charters, the true andonly lasting element of our individual or collective prosperity.It has been truly said, that a profession, every member of whichhad these qualities in abundance, might indeed have quacks forits rivals, but would triumph without a combat."

.

PRESIDENT’S ADDRESS.Dr. FAVELL then took the chair, and proceeded to thank the

Association for the high honour they had conferred upon him bychoosing him to occupy the distinguished position in which theyhad that day placed him. He also accepted the office with plea-sure, inasmuch as it gave him an opportunity of welcoming tothe town of Sheffield the learned body whom he had then thehonour of addressing. It was true, that they had no magnificentspecimens of architectural skill to which he could direct the at-tention of the Association on its visit to Sheffield, nor had theyany splendid squares connected with the town ; at the same time,there were some things which could not but afford intense inte-rest to every man of scientific mind. Sheffield is situated in abasin, or rather, on the side of a hill surrounded by hills, whichcontributed much to the health of its inhabitants. Indeed, Shef-field was pretty well off as regarded comfortable houses andsewerage, for the town was thoroughly drained. These circum-stances, combined with others, had rendered Sheffield a veryhealthy place of its size, although most of the members of thatAssociation would be aware that a disease was very prevalentamongst the grinders-and since he had pledged himself thatwhenever the town should be honoured by a visit from that So-ciety he would bring the subject before them, he would proceedto make it the subject of his inaugural discourse. The manyfires from furnaces rarefied the air of the town, and this, therewas no doubt, caused a greater draught from the high hills whichsurrounded the town, rendering it, as compared with some others,comparatively free from epidemic diseases, nor was it often theseat of any malignant fevers. These things, too, might be partlyattributed to the healthy state in which the dwellings of the lowerorders were kept; for in Sheffield they had no cellars to live in,as they had in some places.

Dr. Favell then read an excellent and elaborate paper on thegrinder’s asthma, the subject referred to.

Dr. STREETEN read the-

REPORT OF THE COUNCIL.

Notwithstanding the difference of opinion entertained by gen-tlemen belonging to the Association upon some important pointsconnected with the reconstitution of the profession, now sokeenly agitated, your Council have the gratification of statingthat no falling off has taken place in the number of members.The total number of members, on the 6th of August last, the daybefore the anniversary meeting, amounted to one thousandseven hundred and fifty-six. The accession of the TauntonAssociation on the day of meeting brought the number up to onethousand seven hundred and eighty-four; and the number nowon the lists of the Association, notwithstanding the secession ofsome gentlemen, who, mistaking, in part at least, the objects ofthe Association, have been led to differ from the principleshitherto acted upon, and a serious loss sustained in the decease ofseveral respected members, amounts to one thousand nine hun-dred and twenty-seven.The customary detailed statement of accounts will be laid

before the meeting by the treasurer, for the inspection of themembers; but as the attention of the meeting is necessarilyotherwise much occupied, your Council would recommend theappointment of two gentlemen as auditors, to whom this state-ment may be referred for examination, in order that it may be

regularly verified, and if approved of, subsequently passed bythe Chairman of the meeting. The gross receipts and expen-diture during the past year are as follow:-

TRANSACTIONS AND JOURNAL.

The Council, in compliance with the practice adopted on pre-vious occasions, have now to draw attention to the publicationsof the Association. The volume of Transactions, which has