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been lactate of urea, which was supposed to be hippuric acid.The uric acid in this case was found in the urine in quantitiesquite as great as in healthy urine, thus confirming his originalstatement, that the two acids existed independent of each other,and that the one was not formed at the expense of the other. Inhis experiments he always noticed a deficiency of the urea in theurine when benzoic acid had been taken; this should be the caseif his supposition of the benzoic acid uniting with the elementsof starch, or lactic acid and urea, be correct.

In a communication on the constitution of the urine in man andcarnivorous animals, published in THE LANCET in June last,Professor Liebig has shewn that hippuric acid always exists inthe healthy human urine.

Hippuric acid is found in the urine of all herbivorous animals,as the elephant, horse, ox, sheep, goat, beaver, &c.; in these ani-mals it exists in considerable quantities. In the carnivorousanimals, he (Dr. Garrod) was not acquainted with any experimentsproving its existence. In man it exists naturally in very smallquantities in the urine, but occasionally, as in the case that hehad given above, in very large quantities.The practical deductions, with regard to the administration of

benzoic acid, to be drawn from the preceding facts, are these:-Benzoic acid is of no service when given with the same purposefor which it was originally proposed-viz., for preventing theformation of gout stones, or tophaceous deposits, for these consistof urates of soda as their chief constituent ; and as benzoic acidhas no influence in ’preventing the formation of this acid, or indestroying it when formed, it cannot prevent these deposits.The same may be said with regard to its use in cases of uricacid diathesis, where calculi of this substance were apt to beformed. He had repeatedly tried the effect of this acid in suchcases, but without the slightest benefit: it is very likely to pro-duce a deposition of uric acid by rendering the urine very acid,and thus causing the uric acid to be set free, and rendered lesssoluble. The property that benzoic acid has of causing the urineto become more acid, seems to be one of its most useful qualities.It causes the urine to become slightly irritating, and when givenin cases where there is a deposition of a granular kind of mucusmixed with the phosphates, it is often very efficacious.

EFFECTS OF BENZOIC ACID IN URINARY DISEASES.

Dr. GOLDING BIRD said, that he had long ago ascertainedthat the idea of benzoic acid being a chemical remedy for gout,by converting uric into hippuric acid, was quite a mistake ; andthe experience of Drs. Addison and Barlow had fully confirmedhim in this opinion. Benzoic acid, by combining with the azo-tised and effete elements of the blood, and forming hippuric acidin the urine, might be of benefit in some forms of uric aciddeposits. It was utterly valueless as a remedy in phosphatic de-posits ; it was often of service in cases of catarrh of the bladder,but not from any chemical influence it exerted, its action beingpurely physiological. It had been long known to have a power-ful influence on the skin and mucous membranes. With respectto the case related by Dr. Garrod, in which the urine was re-markably full of hippuric acid, he (Dr. Bird) had heard of nosimilar case, and only one in which it existed in any quantityfrom the mere ingesta of vegetable food; this case was related Ito him by Professor Liebig himself. The patient was an hysteri-cal girl, and ate a large quantity of apples: the urine was alka- ’’

line, and contained hippuric acid. He had confirmed, by experi-ment, a statement lately made by Liebig, that lactic acid was notto be detected in urine; that which had been mistaken for lacticacid, had as yet received no name, but was a highly azotized car-bonized material.

Mr. HEADLAND remarked, that we should pause before we de-termined so decidedly that benzoic acid was not of service incases of urinary disease. The phosphatic diathesis, it must beremembered, was often dependent on constitutional causes, andwas not likely to be benefited by remedies applied to the urinedirect, but rather to some remote cause, as disorder of stomach,&c. Benzoic acid might, by restoring the system to its healthystandard, diminish, if it did not completely remove, the phospha-tic diathesis.Mr. HIRD had employed benzoic acid in cases of gout concre-

tions without any effect whatever. In cases of catarrh of thebladder this remedy was far inferior to buchu.

Dr. G. 0. REES could, perhaps, explain why benzoic acid re-lieved some cases of phosphatic diathesis, and failed to relieveothers. This diathesis was of two distinct and different kinds;in one the phosphate was produced by the bladder itself, in theother it had its origin in the system. Cases presented themselvesto us, in which the urine was alkaline, full of mucus and thephosphates ; we administered acids, and we found them of nobenefit, the urine still continued alkaline. If we gave our pa-

tients liquor potassa and tincture of henbane, the phosphateswould decrease in quantity, but the urine would be still alkaline.Presently, we leave off the medicine, and the urine becomes acidand healthy in composition. Now, the bladder in these cases pouredforth something containing a large quantity of ammonia. Thiskind of case depended on a disordered condition of the bladderitself. Dr. Prout had spoken of these cases. In the more com-mon cases of phosphatic deposit, acids were of service.

Dr. RISDON BENNETT had found the remarks of Dr. Rees tobe borne out by his own experience, and that acids were notalways applicable to cases of alkaline urine.

Dr. GOLDING BIRD thought there was an easy mode of dia-gnosticating between the two causes of phosphatic deposits in theurine, as mentioned by Dr. Rees. Thus he had found, that wherethe presence of deposits of phosphates is independent of the irri-tation of a calculus, or of organic disease, it is most abundant inthe urine passed in the evening, (urine of digestion,) and absentor replaced by uric acid, or urates, in the morning urine, (urineof the blood,) the urine being always of tolerably natural colour,never below, and often above, the mean density. Where thepresence of phosphatic salt depends on the irritation of a calculus,or of organic mischief in the urinary passages, the urine is paleand whey-like, of a density below the average, often considerablyso, and the earthy deposit is nearly equally abundant in thenight and morning urine.

Dr. REES remarked that this mode of diagnosis was not ofavail in the cases he had alluded to, for in those the specificgravity of the urine was not low. He knew of no mode of form-ing an opinion of the true nature of these cases, except by ob-serving the effects of remedies.

Mr. DENDY made some remarks on the necessity of attendingto the condition of the chloporetic viscera in cases of urinarydisease.

’

Monday, Nov. 11, 1844.

SIR JAMES GRAHAM’S BILL.

The society was occupied this evening, it being a general meet- .ing, with discussing those clauses of Sir James Graham’s in-tended bill, which had reference to the constitution of the Councilof Health, and the withdrawal of all protection from the qualified ,practitioner of medicine. It was the general opinion that thesepoints of the intended bill were highly objectionable, and calcu-lated not only to injure most deeply the public, but to destroy thecharacter of the profession, and altogether to subvert the pro-visions contained in the preamble of the bill. It was ultimatelydetermined that a deputation should be appointed to wait uponSir James Graham, to explain to that gentleman the views of thesociety.

HOSPITAL REPORTS.

LONDON HOSPITAL.

TWO CASES OF SEVERE FRACTURE OF THE CRANICN, WITHDEPRESSION, TREATED WITHOUT OPERATION.

EXTENSIVE DEPRESSED FRACTURE OF THE CRANIUM.

CASE 1. T. D-, aged thirty, labourer, was admitted into theLondon Hospital, under the care of Mr. Luke, having met with thefollowing accident: On May 16th, he was standing in the holdof a ship, when a large stone, weighing twenty-seven pounds, fellfrom the deck, a height of sixteen feet, directly upon his head,and stunned him; he was brought to the hospital in the courseof an hour. Upon examination of the head, there was found tobe an obvious depression of the cranium, apparently to the extentof a crown-piece, the surrounding part of the scalp, and that op-posite the fracture, being very much contused. The depressioncorresponded to the right parietal bone, near its junction with itsfellow and the occipital bone. It did not appear at all probableat the time that it could be a case of effused blood simulating afracture, which is known to all experienced surgeons not unfre-quently to occur; for, in this instance, so marked was the depres-sion, that when a finger was placed upon it, and another upon thecorresponding point on the other side of the head, the alteration inthe level was evident to the eye ; it was also to be taken into ac-count that the appearance of depression was found immediately afterthe accident, and not, as in many of the fictitious cases, a few daysafter, when the blood had become hardened, or fibrin effused inthe surrounding part, and giving the impression to the finger ofan edge of bone; the conclusion thus arrived at was, as willbe seen, justified by the result of the case, in the edge not disap-pearing as the blood effused was absorbed, but becoming moredistinct.

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The patient appeared, when brought to the hospital, to be justrecovering from a rather severe concussion: he was sensiblewhen spoken to, but somewhat confused. Neither voluntarymovement nor sensation generally was destroyed; the iris acted

freely upon the stimulus of light, and the patient vomited severaltimes. There was haemorrhage from the right ear; he com-plained of pain in the head, and had no recollection of the ac-cident occurring. As there were no symptoms of compression,it was resolved to perform no operation on the bone; some purga-tive medicine was prescribed, regular doses of calomel to be atonce commenced, the head to be shaved, and cold to be applied.On the 17th, he was pretty well, but complained f pain in hishead, and of sickness. On the 18th, however, he was muchworse, and the symptoms appeared likely to become such asto call imperatively for the use of the trephine; he experiencedgreat pain in the head ; did not sleep, but was continuallydrowsy, and lay with his eyes shut; the pupils were slightlydilated; he appeared to be rather deaf, and answered questionsvery slowly; but the chief symptom existed in the fact thatthe pulse, which had previously been normal, and beating aboutseventy strokes per minute, had sunk to fifty, and become veryfeeble. Leeches having been applied, and the purgative repeated,it was resolved to bleed him. At the termination of the bleed-ing, the pulse beat rather more rapidly, but fell back, in a shorttime, to the fifty strokes; the pain, however, was much relieved.The next day the patient was much better, and improved from

this time ; the mercury, in a short time, produced ptyalism, withgreat relief to the symptoms, and the pulse gradually became nor-mal. When the blood had become entirely absorbed, the edge ofthe fracture could be traced in its whole extent, and shewedthe depression to be greater than it at first appeared, the diameterof the circular depression measuring three inches. The patientleft the hospital quite well on the 30th of July, with the intentionof remaining quiet in the country for a time, until he mightsafely return to his work.The patient was kept upon a milk diet for a long period.

DEPRESSED COMPOUND FRACTURE OF THE CRANIUM.

CASE 2. J. H-, aged nine, was flying a kite at a backwindow, when he pitched out, and fell on his head ; the windowwas twenty-five feet from the ground. The accident occurred onthe 5th of June, and the patient was almost immediately broughtto the London Hospital, and admitted under the care of Mr.Luke. There was a crescentic wound, two inches in extent,over the frontal bone, its convexity looking downward towardsthe face, and the most depending part being two inchesfrom the root of the nose; the integument above was indentedin a circular form, the size of a crown-piece. The bone wasfractured, and depressed in the following manner:-As far as

was apparent, there was a ridge of undepressed bone, extend-ing across from one side to the other, for more than an inch inextent, and seen through the wounded integument; the bonewas tolerably thick ; both tables were broken through, and thefracture was evidently higher than the frontal sinuses; above theridge, the bone was depressed to the extent of the size of a half-crown piece, the part contiguous to the fracture having its outertable forced lower than the inner table of the undepressed por-tion, the remaining part gradually inclining up to its proper level.There was no protrusion of brain, nor was there any haemorrhagebeyond a few drachms of blood. The boy was perfectly sensible,and had no paralysis, did not vomit, nor, in fact, were there anysymptoms either of compression or concussion when admitted;if any concussion had occurred, which is most probable, he’ hadrecovered at once from its effects. He complained, however,of pain in the head. Besides the fracture of the skull, two ribs andthe lower end of the right radius and ulna were fractured. Thewound of the scalp was closed by means of suture and plaster,the other fractures being treated in the usual manner: some pur-gative medicine was given at once, and calomel commenced insuccessive doses. The wound was dressed on the fourth day, whenthe greater part had united; a slight blush of erysipelas extendedbetween the eyes, but soon subsided; the wound closed entirely ina short period, and the calomel was carried merely to theslightest effect. The boy recovered, without one unfavourablesymptom, and left the hospital on July llth.The diet was rigorously attended to, and merely milk and

bread allowed.Remarks.—Both cases are interesting, from the extent to

which they bear out the principles of modern surgery, in its ruleswith regard to the trephine, or even the elevator. In both cases,the fracture was such as not to leave a doubt that an amount ofpressure must have been exerted on the brain: in the first,from the extent of the depression; and in the second, thoughnot so extensive, yet from the mode in which the depressed bone

was driven in upon the encephalon. As there were no symptoms ofcompression following the reception of the injury, and the patientsrecovered without any unpleasant consequences, we may justly inferthat the use of the trephine, or any attempt, however mild it maybe thought, to interfere with the bone, would not have accomplishedany good purpose, and might, perhaps, by inflicting additional in-jury, have led to unfavourable results. The occurrence of thesymptoms, on the second day, in the first case, which seemed toindicate that some cause of more severe compression was arising,is also interesting, inasmuch as they were checked by anti-phlogistic measures, without having recourse to the more severetreatment. Certainly, from the experience which has been ob-tained in this kind of cases, abstinence from all excitement byfood or drink for a considerable period after the return of the

patient, to all appearance, to sound health, is most important; thefirst case fully exemplified this doctrine, for, on the patient in-dulging in an extra amount of diet, he had an attack of severepain in the head, which was speedily relieved by resuming amore moderate plan.

THE

INCORPORATION OF GENERAL PRACTITIONERSABSOLUTELY NECESSARY.

THE PROVINCIAL MEDICAL AND SURGICAL ASSOCIATION, ANDSIR J. GRAHAM’S BILL.

(LETTER FROM DR. WEBSTER.)To the Editor of THE LANCET.

SIR,—I have been anxious to address a few remarks to myfellow-reformers-now, I am rejoiced to think, a most numerousclass-on Sir J. Graham’s bill, and to draw their attention to theconviction which occurring events have forced upon my mindthat nothing will now save the general practitioners from absoluteruin and degradation but their incorporation into a College ofMedicine and Surgery. The idea of a faculty of medicine tocomprehend the whole profession, must, for the present at least, begiven up. It is clear that the Government and the Colleges aredetermined to draw the line of distinction and separation betweenthe general practitioner and pure surgeons and physicians morestrongly than ever; instead of union, they will insist upon dis-union and degradation. Well, if it must be so, let it be so. Iexceedingly regret the spirit which has been evinced in highplaces towards the mass of the profession, and I have done allwhich I could do in my limited sphere to avert such an evil. Itremains now only for the general practitioner to fight for hisexistence, and to look to his own interests. I cannot do more at

present than to inclose the copy of a letter which I have felt it myduty, as a member of the Provincial Medical and Surgical Asso-ciation, to address to the secretary previously to the meetingabout to be held at Derby, and specially summoned to considerSir J. Graham’s bill. I sincerely hope it may have some littleeffect in preventing the meeting from greatly injuring instead ofadvancing the cause of medical reform. As the letter containssome of my views of Sir J. Graham’s bill and the main remedyfor our grievances, I am induced to beg a corner for it in THELANCET, promising to aid my brother reformers, to the best of myabilities and energies, for the attainment of their just rights andprivileges.

I remain, with best thanks for your exertions in the good cause,Your obedient, faithful servant,

GEO. WEBSTER.Dulwich, Nov. 12, 1844.

GEO. WEBSTER.

(COPY.)To Dr. STREETEN, M.D., Secretary qf the Provincial Medical

and Surgical Association, and Editor of their Journal.DEAR SIR,—I am much obliged to you for the circular copy

of the " Resolutions intended to be submitted to the Meeting ofthe Provincial Medical and Surgical Association, to be holden atDerby on Thursday next." I deeply regret that I see no pros-pect of my being able to attend this meeting, which I consider to bemore important than any former one, because fraught with moreof weal or of woe to the future welfare and respectability of thegreat majority of the members of the association. I cannot, there-

fore, allow such a momentous occasion to pass without addressinga few words to my respected fellow-members, and I beg that you,as the organ of the association, will do me the favour either toinsert this letter in this week’s journal, or read it to the meeting,so that it may reach the eyes or ears of those who shall attend.

I have no wish unnecessarily to depreciate or disparage SirJames Graham’s Bill; on the contrary, I have, in conjunctionwith my colleagues of the council of the British Medical Associa-