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the Caesarian section. He might here remark that he had thebest reason to believe that one fatal case of Cæsarian section hadoccurred since the discussions on that subject before the Society;and this, too, in an instance in which it would not have been sodifficult to effect delivery as in the case before the Society. That

operation. however,-he meant the Csssarian section,-had notbeen recorded. )

Dr. JoHN CLARKE, in reply to one of the questions of Dr. Lee,might observe, that he had seen two cases, in which, by the in-duction of premature labour before the seventh month, the childhad been extracted alive. The distortion in one of these cases hadbeen very great, but not so great as in the case recorded that

night by Dr. Lee; but to such an extent, that unless delivery hadbeen effected before the seventh month, the child could not havebeen born alive. The extraction of a child from a deformed

pelvis had been aptly compared to the extraction of the kernel ofa nut by making a hole in the shell ; and one well competent togive an opinion upon the subject had said that he had never seena case in which, by patience, perseverance, and time, this couldnot be effected.

Mr. WOOD, in relation to the opinion expressed by Dr. Lee,that in the case he had recorded the bones had yielded to thepressure of the head of the child, inquired whether it was not

possible that the ligaments might not have yielded under the ex-pulsive efforts of the uterus and the pressure of the fcetal head ?

Dr. LEE inquired what ligaments could have yielded-whatligaments, in fact, were concerned in the act of parturition?To this no reply was given.Dr. TYLER SMITH would not enter into the question of the

propriety of inducing premature labour at or before the seventhmonth, in certain cases, for in this he entirely agreed with Dr.Lee; he would, however, take the opportunity of saying a fewwords respecting the mode in which the operation should be per-formed. It was well known that Dr. Lee’s favourite method of

inducing labour was by puncturing the membranes with a

stiletted catheter, and evacuating the liquor amnii; but his own(Dr. Smith’s) opinion was, that very considerable advantageswould be gained by inducing uterine action without rupturingthe membranes. In cases of deformed pelvis, one of the chiefdangt-rs to the mother was the rupture of the uterus from exces-sive action of this organ. In his " Clinical Midwifery," Dr. Leehad himself related a case in which he had induced prematurelabour at the seventh month, in a woman with deformed pelvis,by puncturing the membranes; but incessant labour-pains cameon, causing rupture of the uterus, from which the woman died.The danger of such an accident would be very much diminishedby dilating the os uteri before the evacuation of the liquor amnii.The points to be aimed at in such cases were the dilatation of theos uteri and the descent of the fœtus, so as to admit of operativeproceedings for its extraction. These objects might, he believed,be obtained much more safely by the ue of the water douche, asproposed by Professor Kiwisch, of Wursburg, than by punc-turing the membranes. In a case of pregnancy with deformedpelvis, he had himself used the douche with the most satisfactoryresults.

Dr. LEE had no possible objection to the douche after theseventh month, to induce premature labour. No doubt it was Idesirable to effect this without rupturing the membranes bypuncturing. He had with this view given ergot of rye, anddetached the membranes all round the os uteri, but withouteffect. He believed in these early cases nothing was gainedbefore the seventh month, until the membranes were ruptured.

Dr. TYLER SMITH remarked, that the object to be gained bythe plan he recommended was that of averting the danger ofrupture of the uterus, a danger which certainly occurred as earlyas the seventh month. When uterine action was induced whilethe membranes remained entire, the pains were moderate andthe os uteri could be sufficiently dilated without risk. Whilethe liquor amnii remained in contact with the internal surface ofthe uterus, the organ was defended by the fluid pressure from ex-cessive stimulus. But when the liquor amnii was evacuated, thesolid limbs of the child came in contact with the uterus andexcited powerful contractions. This might occur before thedilatation of the os uteri, and before means could be taken todiminish the foetus. Under such circumstances there was greatdanger of rupturing the uterus. Rupturing the membranesbefore the dilatation of the os uteri was, in principle, very muchlike giving the ergot of rye before its dilatation.

Dr. LEE said, that cases had occurred in which the uterus hadbeen ruptured though the liquor amnii had not been expelled.It must be recollected that in these cases complete dilatation wasnot to be expected, but only so much as to enable the practitionerto introduce o_e or two fingers into the uterus.Dr. TYLER SxiTH would beg to ask one practical question of

Dr. Lee-Was rupture of the uterus more likely to take place in

these cases before the liquor amnii was discharged, or after-wards ?

Dr. LEE said, no doubt after the discharge of the liquor amniias he had before observed, he should have no objection to

employ the plan recommended by Dr. Smith after the seventhmonth of pregnancy.

In reply to a question, Dr. SMITH said, it appeared obviousthat a tube containing a harmless jet of water could be directedto the os uteri more safely and easily than a catheter containinga stilette capable of puncturing the membranes or of injuring otherparts with which it came in contact. He also referred to some

cases in which fatal results had followed the operation of puncturing the membranes, and to some cases, lately published in thisjournal, in which the douche had been successfully employed,Those cases must be fresh in the recollection of our readers.

MEDICAL SOCIETY OF LONDON.

MR. BISHOP, PRESIDENT.

MR. CHARLES CLARK exhibited some

EXTRAORDINARY BODIES PASSED WITH THE URINE,

occurring in a patient of his, a young married woman, about

twenty-four years of age, and now about seven months advancedin her second pregnancy. She stated that she had felt for sometime past a dull, aching pain and tenderness in the region of theleft kidney; but that on Wednesday, the 2nd instant, it in-creased in severity, and appeared to shift to the front of her leftthigh, and shoot up from that through the left iliac and lumbarregions to the back; that she felt excessively sick, and sufferedintense agony from that time until between eleven and twelveo’clock on Thursday night, when those singular bodies cameaway in her urine; after which she felt relieved, but was verymuch exhausted by her sufferings: her symptoms, in fact, weresimilar to those produced by the passage of a calculus throughthe ureter. Six or seven of those substances had been voidedupon the present occasion, and she stated that the stream was.interrupted in its flow as they made their exit from the bladder.Some of them being evidently broken and crushed in their pas-sage, he had found their remains in small pieces in the urinepassed afterwards. The bodies themselves, it would be seenupon examination, were about the density and consistence of aboiled rea or bean; and although differing a little in size andshape from each other, were all larger than peas, some beingroundish, others flattened, and of an irregular or triangular form;their external coat was smooth, and of a dark-brownish colour,and their interior pulpy and granular. Altogether they weresingular substances to be passed in the urine; and although hehad been in nearly all parts of the world, he had never seen any-thing like them before, except some which she had voided in aformer attack. This had occurred in November, 1850; andbeing called in at the time of the attack, he found her lying onthe bed, pale, vomiting, and in great pain, having a short timepreviously passed some water containing about eighteen or twentyof those substances in presence of the nurse. They, however,differed from the present, in being rather smaller, rounder, of afirmer consistence, and greenish colour. She was then unmarried,and stated that, although this was the first time she had noticedthese substances in her water, yet for several years she had atintervals suffered somewhat similar paroxysms of pain, but of amilder nature; and the last, she says, has been the most severe ofall, which may perhaps be accounted for by the larger size of thebodies and her pregnant condition. At one of the meetings ofthe Pathological Society, in January, 1851, he had exhibitedthose passed in the former attack; but then, as now, the greatestdiversity of opinion existed as to their real nature. Some com-

pared them to lupin-seeds; o:hers to rabbit’s-dung; whilst hehimself thought with many they looked more like large capers.No one, however, could tell exactly what they were. Thoughexamined chemically and microscopically by Dr. Bence Jones,Mr. Quekett, Dr. Quain, Dr. Lankester, and Mr. Medlock, of theCollege of Chemistry, each ot those gentlemen differed in theiropinion, and failed to determine what they actually were. Some,who could do nothing else, jeered and laughed, and thought itmust be some clever trick; but although he had no means ofdisproving their assertions at that time, he endeavoured to showthem the utter impossibility of any girl being able to procuresubstances which had baffled the skill of all the members of alearned society, and of all who had seen them, even to say whatthey were. This second attack, however, occurring above twoyears afterwards, resembling the former in all essential parti-

Culars, yet differing sufficiently and in such a manner, as to thesize, shape, and colour of the bodies themselves, that no artificial

188

means known could have ever produced it, was alone enough todemonstrate the absurdity of this view. Without pretendinghimself to determine the exact nature of the-e singular bodies,his confident opinion, from all he knew of the history of the case,was, that they were some peculiar morbid product of the kidney,hitherto unknown, which, if thoroughly understood, might ulti-mately lead to a more lucid view of’ kidney pathology, beneficialboth to science and humanity. In this idea he was sustained bythe opinion of Mr. Quekett, who had once seen somewhat similarbodies in the cysts of a kidney, and who, after a diligent micro-scopic and careful examination, considered them as decidedly ofthis nature. Having a high opinion of his friend, Dr. Hassail’s,abilities in this department of pathology, he had submitted someof the present bodies for his examination, but had not yet re-ceived his report. He hoped, however, at some future day to beable to lay before the Society some further researches into thenature of those interesting substances, which at all events tendedto show that, notwithstanding the wonderful progress of sciencein late years, yet there still remained something " more in naturethan was dreamt of in our philosophy."

Correspondence.

KING’S COLLEGE.

"ALidialteram partem."

To the Editor of THE LANCET.SIR,—The praiseworthy desire, which seems ever to have

actuated the Editor of THE LANCET, of ameliorating the condi-tion of the medical profession, has lately had the effect of per-mitting the appearance in your columns of several very lengthyletters, complaining of the misconduct of the authorities of twoof our largest and most important medical schools. I do notintend to comment upon the letters respecting St. Bartholomew’s,for the men there seem to have some real cause of complaint ; Ivery much regret, however, that the eacoethes scribendi shouldhave spread westward and seized some of the young gentlemenat King’s College.

In the first place, a " King’s College Student" suddenly imagineshimself an injured individual; he commits his grievances topaper, and forthwith appears a letter in THE LANCET, full ofdeans and secretaries, solution and tow, lectures and hot water,crowded together in the most extraordinary and indiscriminateconfusion. These intended complaints were shown to be utterlygroundless, when we have a letter from a gentleman who styleshimself a Superannuated Student," in which it appears that,even in his day, the morbid feelings of Kings’ Students led themto imagine they were suffering under the same fanciful burdens.Another letter appears in THE LANCET for February 5, in whicha most ungenerous and unfounded attach is made upon ourdemonstrators. I can assure the writer of that libel, that had hereally wanted assistance in his dissection, a demonstrator was athand, and would readily have afforded him any aid in his power.The letter, however, is so obviously an excuse for his own idleconduct, that it is not worth more time and attention.

I believe, Mr. Editor, that these letters, in themselves, will beconsidered by most men as trivial and insignificant, but as

affording very fair evidence of the unpleasant feeling existing,unhappily amongst Kings’ men; I think they are worth a littleserious consideration. With your permission, I will explainwhy, and by whom they were written.

I am a great admirer of King’s College on the whole, but amby no means blind to the very obtrusive system of control whichhas of late years been carried out in that institution. I freelyacknowledge that the students are harassed and hampered in

every way, but they have themselves only to thank for theseinconveniences, and have the remedies in their own hands, werethey capable of using them in a proper manner. It is a well-known fact that the class of medical students at King’s College isthe most juvenile of any in London. Many of’ them come totown direct from school—boy s in ideas in manner, in behaviour.What is the consequence? Attend a lecture, and you are peltedwith small pieces of paper ; others are engaged in the equallyintellectual proceeding of cutting their names on the benches, &c.Often have I heard the lecturer remonstrate with the class uponthis highly indecorous behaviour. Again : enter the library, andthe contrast with the same room in any other medical school isindeed remarkable : in the latter, men are reading, or at leastthey are perfectly quiet; in the former, the young gentlemen visitthat room for the purpose of talking and laughing, thereby annoy-ing all industrious men. This and similar conduct induced theauthorities to enforce that schoolboy discipline so bitterly men-

tioned by an 11 old King’s Man’’ in the very last words of his letter,and which naturally enough raises the indignation of the juveniles.and is a source of great annoyance to the men who have been

unluckily tempted to enrol themselves at King’s College. It isin consequence of the extremely childish conduct of the classthat the secretary occasionally appears cross; that the dean isoften compelled to turn a deaf ear to complaints which one onlyhears at a boarding-school and King’s College. Let the pupilsat this institution learn to conduct themselves with that dignity,that firmness which becomes the man; let them put away all pettyideas and childish behaviour; let them pursuade themselves thatthe authorities are not in league to deprive them of instruction;let them not come before the public with complaints which, atbest, are fit only for the dissecting-room ; let them behave andwrite as men, and they will be treated as men: as it is, let meassure them that they and their effusions will escape ridicule andcontempt only when they escape notice altogether. I firmly be.lieve that it is this schoolboy discipline, carried into effect inevery possible way, that is the real source of all the bickeringsbetween the authorities and students; but so long as the lattershow themselves unfit for liberty, so long will they be under strictcontrol.

May I say a word, Mr. Editor, on the mode of teaching atKing’s College? Surely the exact routine system of educationso rigidly followed up does not act beneficially. Why are ourmen rejected at the College?—at the Hall? They used to besatisfied with nothing less than honours at the University, theynow think themselves lucky to see their names in the seconddivision. Our teachers are a body of men who deservedly standthe very highest in the opinion of the profession, and yet where,of late years, has King’s College appeared in the pass-lists?Nowhere. I can attribute this falling off to nothing but the ex-ecrable routine mismanagement pursued. All our men are not

fools, but the attempt to make differently-constituted minds followin the same track of education, will most assuredly be attendedwith failure.

I apologize very much for occupying so much of your valuabletime, but as the letters which have appeared might, unless ex.plained, give rise to erroneous impressions, I have thought it myduty to trouble you with this.

I have the honour to be your obedient servant,Feb. 1853. A LATE KING’S STUDENT.P.S. I send you my name and address as a guarantee of my

assertions.

MR. MARTINEAU’S MODE OF OPERATION INLITHOTOMY.

To tlte Editor of THE LANCET.SIR,—It is equally due to the memory of a celebrated and

successful operative surgeon, and to those who shall be anxiousto emulate his reputation by imitating his method of operating,that no misapprehensions should be permitted to remain intheir minds as to the principles on which he conducted one ofthe most difficult and important operations in surgery, inwhich his practical skill and dexterity were so eminentlysuccessful.

It is to correct such misapprehensions in reference to Mr.Martineau’s operation of lithotomy that I trouble you withthis communication. The reporter of a case of stone in thebladder, lately operated upon by Mr. Bransby Cooper, at Guy’sHospital, in several passages of the report, assnmes that Mr.Martineau operated without dividing with the knife any portionof the prostate gland, but used forcible dilatation only with ablunt gorget. The following paragraph fully explains theideas of the reporter as to Mr. Martineau’s method of pro-ceeding:—

" This method of proceeding is similar in principle to thatwhich, some years ago, used to be performed by Mr. Martineau,of Norwich, whose success exceeded that of any of his con-temporaries. The system of Dr. de Borsa agrees with that ofMr. Martineau, inasmuch as both avoided making any incisioninto the prostate, the object being merely to cut into the mem-branous part of the urethra, and then dilating the prostaticportion of the canal. This object was eftected by Mr.Martineau with a beak-pointed blunt gorget, narrow at theextremity, and gradually widening towards the handle; andhe gently inserted this instrument through the prostate glandinto the bladder. Dr. de Borsa uses his finger instead of thegorget, &nd this constitutes the only difference between thetwo operations."Mr. Cooper’s operation performed in this manner was snc-

cessful ; but my object is, not to criticise this method of pro-ceeding, but to prove that it was not that of Mr. Martineau;and for this purpose I shall adduce two authorities, which I