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memorialists state that " they regard as a most important feature Iin medical reform the proposal to unite the entire mass of generalpractitioners and surgeons under the auspices of the College ofSurgeons; and they respectfully and earnestly entreat Sir James

I

to avail himself of the opportunity which is now presented ofredressing the grievances which have been so keenly felt by up-wards of ten thousand members of the College who have beenrecently excluded from the fellowship, by providing that all ex-isting members of the College who have completed, or as soonas they shall have completed, their [tenth ?] year of membership,shall, on being registered as ’ Surgeons,’ be ipso facto Fellows.’By such an arrangement, in the opinion of the memorialists, thegreat mass of the profession would be conciliated, and the outcryfor a separate incorporation would cease." The memorialistsadd, that they can scarcely conceive a greater evil than thegrant of a separate charter of incorporation to the general practi-tioners. Such a measure would permanently degrade them, andwould be a fruitful source of disunion and misunderstanding inthe profession; whereas a legislative enactment, which should rallytogether, under the banner of the College of Surgeons, all thegeneral practitioners and surgeons, in such a manner that nomember of that great body could feel that the position assigned tohim was one of degradation, would prove the greatest blessing tothe profession."

NORFOLK LENT ASSIZES.NISI PRIUS COURT.

Before MR. BARON PARKE.—Saturday, April 5.Gibbs v. Tunaley.—(Special Jury.)

MR. SEEJEANT BYLES and Mr. Gunning were for the plaintiff,and Mr. Prendergast and Mr. Evans for the defendant.

This was an action to recover damages of the defendant fornegligence and want of skill in his profession as a medical man.From the statement of Mr. Serjeant Byles, it appears that the

plaintiff is a poor boy, whose friends reside at Thorpe, by Norwich;and who, in the month of August last, went to work upon the rail-way at Wymondham. On the 5th of that month, he was hooking ahorse to one of the carts, and by some accident he fell, and verymuch hurt his left foot, between the heel and the ankle. He wastaken to his sister’s house, at Wymondham, and the defendant,who is a surgeon residing in that parish, was sent for. He at-tended the boy, and did nothing, apparently, beyond strappingup the wound and putting on lint. Lotions, from time to time,were applied ; and after several days had elapsed, the foot hadnot become better, and the boy was in great pain. In about ten

days mortification took place, and amputation was at last obligedto be resorted to. It was alleged that Tunaley had grosslyneglected his duty, and had treated the boy most unscientifically,which gave rise to the present action. In support of the plaintiff’scase, the following witnesses were called:-Emily Shirt deposed:—I am the sister of Gibbs, who is fourteen

years of age, and was at work on the railroad on the 5th of ,August last. I heard him cry out, and saw him down on therail, on the outside; he was hooking a horse unto a wagon,which was laden with earth. He was brought home and putto bed; I saw the ankle of the left foot was hurt, between theheel and the ankle-bone. Tunaley was called in, and the bloodwashed off and strapping put on. Lint was on the strapping;the wound was bandaged up. He left word, if bleeding came on,to send for him again. The bleeding came on again very much,and Tunaley was sent for. Mr. Skoulding, a chemist, also came,who put on fresh lint and tied a bandage round the foot. Thebandage was about an inch broad, the lint two inches. Tunaleycame again the same evening, between seven and eight o’clock,and looked at the foot. I told him the bandage was too tight,and he said it would do. I said again it was t. tight, and hereplied, " Then you know better than I." Swelling had com-menced on the instep. He came on the Tuesday, between elevenand twelve o’clock, and looked at the foot, but not at the wound.The mother of the plaintiff came to my house to nurse him. Iremained at Thorpe a few days, and returned to Wymondhamagain on the following Sunday. He was then in greatagony; the foot appeared black and swelled, the bandage ap-peared in the same state ; there were blisters, a large one belowthe bandage, and several about the foot; the blisters were white.The part above the bandage was rather green. Tunaley cameagain on the Sunday. I sat with him on the Sunday, and he wasin great agony. The top of the foot was much swelled and dark;one knot of the bandage was untied, but this did not loosen it,as it was held together by the blood, and the moisture of thelotion. The plaintiff was very ill in the evening, when Tunaleygave me a powder for him; and I asked him, by my mother’sdirections, to bring some one else with him in the morning. Heonly brought his man-servant. On the 28th, the leg was taken

off by Mr. Lewis. The plaintiff had been in great agony fromthe time of the accident. After Lewis was called in, he providednourishing refreshment.

Sarah Gibbs, the mother of the plaintiff, deposed:-I live atThorpe. On Tuesday, 6th August, I arrived at Wymondham.I examined plaintiff’s foot, and observed it was dark over theinstep. The skin was not broken, and there were no bruises;there was a swelling all round the foot. Tunaley came on theTuesday; he said he was glad I had come, and hoped the boywould do well, but it would be some little time. On the Wednes-day the boy began to complain of pain; this increased, and after-wards Tunaley said, he would bring a board and put the foot in.( witness then corroborated the greater part of the evidence givenby the preceding witness, and added:] On the Friday night Itold him the foot began to be quite cold; he said, that was oflittle consequence, as I was to keep it cool, and apply the lotionas usual- The next morning, I told him the boy was full of pain,and the foot was very bad ; he made no reply, and I said Iwished for some other gentleman to attend with him. He stillmade no reply; and I said, he would be paid, let it be what itwould; I did not wish the boy to be lost. The boy’s headwas getting into great disorder; he was getting weak andnoisy. Tunaley said, undoubtedly it would be so. On theSaturday, the boy began to bite himself with pain, and callout very much.Lewis Lewis deposed:-I am a surgeon and apothecary at

Wymondha.m. On Thursday, the 15th of August, I went to seethe boy Gibbs, and saw his foot. It was then in a complete stateof mortification ; it was an advanced state of mortification; itmust have been visible six or seven days ; the bandage had beenremoved when I saw it. The application of such a bandage, puton tight, and kept on it, would, during that time, produce mortifi-cation. The boy was very low in health. My opinion was, thathe must lose his foot and leg, or he would have died ; his healthwas too weak to undergo the operation at once. I orderedhim some porter and wine, and nutritious animal food.Amputation took place on the 28th August. Mr. Colman, thesurgeon, Dr. Skoulding, and Mr. Mills, surgeon, of Norwich,were all present. I examined the bones of the foot after it wasremoved, and they were not injured in any part. Blisters andthe dark appearance of the foot ought to awaken the attention ofa surgeon. Coldness of the foot is a symptom of gangrene, whichis the first symptom of mortification. There are two arterieswhich supply the foot with blood, an injury to one of thesearteries would cause the bleeding spoken of.On re-examination, the witness explained the proper way in

which bandages should be applied.Thomas Colman, surgeon, at Wymondham. I attended the

amputation, and saw the foot after amputation. I examined it,and found the cartilages denuded from the bones ; the bones wereuninjured. If the cart had gone over the foot the bones musthave been injured.

Mr. Mills deposed:—I am a surgeon at Norwich, in goodpractice. I have been a lecturer on anatomy, and have been inpractice twenty years. I was present at the operation, andexamined the foot; it was totally mortified, and extended abouttwo inches above the ankle-joint. The foot was a perfect pulp.In order to save life amputation was indispensable. I observedno fracture in the bones. I have heard the evidence given in thiscause, and such a bandage, to keep on beyond an hour or two,was highly improper ; it was only fit for a temporary purpose; itwould cause an improper stricture over the foot; as the legswelled the pressure would become gradually greater. Thestoppage of circulation would arise from pressure. If there wasmuch bleeding in the first instance, bandaging would be improperwithout first securing the vessel. The surgeon ought, most un-questionably, to have inspected the wound the next day, and tohave removed the bandage. If the vessel had been secured, nobandage would have been necessary; there ought to have beensuch a bandaging as would have controlled the circulationthroughout the foot.

This was the case for the plaintiff.Mr. PRENDERGAST made a long and able speech to the jury on

the part of the defendant. The present case, he observed, wasnot one of an ordinary character; it was most important to hisclient, and calculated, if the verdict went one way, to injure himfor the rest of his life. The defendant was charged with, hemight say, a most serious crime ; for it could not be pretendedthat Mr. Tunaley was ignorant of his profession; and if he wasnot ignorant of his professional duties, then really the chargeagainst him would seem almost to amount to actual malice. Thelearned counsel contended, that his client had shown prompt anddue attention to the case, and had done everything which profes-sional skill could devise; and he would call witnesses to provethat his conduct had been right and proper. After observing

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very fully upon the evidence given for the plaintiff, he called thefollowing witnesses :Joseph Webster, late servant to the defendant, said, I went for Mr.

Tunaley to attend upon Gibbs; I saw the wound, and saw Tunaleyprobe it with a silver instrument. I saw the stocking taken off,and a piece of flesh upon it. I heard Tunaley say it was a verybad place. I was at the house afterwards with my master ; hetook the bandage off, and then the lint and plasters ; he had thensome warm water brought up, and washed round the place. Hehad some more warm water brought up, and warmed the

plasters, which he again put on, and bound up the place withanother bandage ; the place was not bleeding at this time. On

Wednesday a splint was brought, a cloth laid into it, and theleg put in, and then a bandage wound round the splint. Onthe Thursday after, similar dressings were again applied. Thesame thing was done on the following day. On Wednesday,the 7th, Mrs. Gibbs said to Tunaley, she thought it was a badbusiness for her son, and she was afraid he would lose hisleg. Tunaley said, perhaps not; he was young, and he wouldtry and do the best he could to save it. Every other day, to myknowledge, the bandages were removed, and fresh plastersapplied.John G. Crosse, Esq., deposed:-I am a surgeon in Norwich.

I have heard all the evidence, and consider from the accountsgiven, that it was a severe injury; that inflammation ensued,and the results have not been clearly made out to have arisenfrom the pressure. I think there must have been considerablecontusion in the seat of the wound. The evidence as to thestate of the cartilages in the ankle joint, I particularly noticed,and their being denuded from the bone was a strong circum-stance, in my mind, of the severe injury sustained. I think

suppuration took place, and matter escaped into the joints; thisclearly might arise from the injuries sustained at the time of theaccident. I have met with many cases of matter escaping intothe joints. The absorption of the cartilages I should not attri-bute to mortification arising from the pressure on the arteries.The account given of the substance like marrow escaped fromthe wound at the time of the accident, I can only, explain by sup-posing the contused cellular substance. There might rye absorp-tion of the cartilages, the result of inflammation, and not frommatter escaping into the joint. The foot is very liable to morti-fication ; more so than other parts, in proportion as it is furtherfrom the heart.

Dr. Evans said,-From the most attentive consideration I havegiven to the evidence, the injury, in my opinion, arose from theextensive violence inflicted, and not from compression of thebandage. I am of opinion, that inflammation would not, at anytime, have resulted from mere pressure. If inflammation hadcommenced, then hard and severe pressure might have been thecause of gangrene. As to the severity of the pressure, presumingthat any took place, it is impossible for me to form any idea of itfrom what has taken place to-day. Such a bandage would notproduce gangrene, unless there had been previous inflammation.From what I have heard to-day, I am of opinion that the pressurewould neither produce inflammation nor gangrene. The externalinjury might have caused all the subsequent consequences.Assuming there had been the most correct treatment, by the mosteminent surgeon, I am of opinion that the nature of the accidentmight have caused mortification. I attribute the mortificationwhich took place, not to any external pressure, but to the natureof the accident, by the wheel passing over the heel. I attributethe denuding of the cartilages to external violence, and not to any I,pressure. If there had been inflammation, a tight bandage would ’,have been injurious.

Mr. Sergeant BYLES then addressed the jury in reply, andcharacterized the action as one of the greatest importance bothto the defendant and the plaintiff, as well as to the public; and,perhaps, above all, particularly important to the medical world.He was exceedingly sorry that either on one side or the otherperjury must be imputed. (The learned JUDGE here intimatedthat he did not think there was any ground for that charge, itmight only be a mistake, and was capable of reconciliation. Mr.Sergeant BYLES, with the most profound regard for the opinionof his Lordship, hoped it might be capable of that construction.He then referred to the discrepancy between the evidence ofTunaley’s servant and Mrs. Gibbs, the mother of the boy. Thelearned Sergeant, after contrasting the evidence of the differentwitnesses, closed his reply, by a warm appeal to the jury forsomething like substantial damages, which the nature of the case,he said, warranted him in doing.

Mr. Baron PARKE summed up with great minuteness, andcalled the attention of the jury to every part of the evidence;particularly to that of the medical gentlemen. They were not toexpect, he said, from a country practitioner, the same amount ofeminent skill to be met with as in large towns; but they had a

right to expect from a person so situated, the usual and ordinaryamount of skill, care, and attention, which it was only reasonableto suppose he would possess ; and if, in the discharge of his duty,he applied his professional skill and knowledge to the best of hisability, then, however unfortunate the termination of the case, hewas not to be visited with an action to mulct him in damages.Such a step would be most unjust, and hare a fatal tendency asit would check that degree of independent action so necessary formedical men to possess.The summing up of his Lordship was evidently in favour of

the defendant; and, at half-past nine o’clock, the jury retired toconsider of their verdict, the Court being adjourned to theJudge’s lodgings.At midnight, the jury repaired to the apartments of the Judge,

and returned a verdict for the plaintiff-Damages, one farthing.The case excited considerable interest, and occupied nearly

thirteen hours.

THE QUEEN V. RAYMOND GACHES.

IN THE LANCET of March the 22nd, page 341, we gave anaccount of a coroner’s inquest, held on the body of a woman,named Jane Mary Lovett, who had died after childbirth, whilstattended by Mr. Raymond Gaches, a medical practitioner, resid-ing in the parish of Costessey, Norfolk. From the evidencegiven at the inquest, which we reported at some length, it appearsthat the labour presented nothing peculiar, but was followed byinversion of the uterus, and that Mr. Gaches tore away the in-verted uterus, using scissors to complete its separation. A ver-dict of manslaughter was returned against Mr. Gaches by thecoroner’s jury. The latter contrived to escape from the custodyof the policeman to whom he was confided, but was subsequentlyrecaptured and committed for trial.The details which we gave at the time render it unnecessary

that we should now report the trial at length. We shall, there-fore, merely reproduce a few statements calculated to elucidatethe case still further, the defence of the prisoner’s counsel, andthe charge of Mr. Baron Parke.Mary Ann Money deposed.-I am the mother of the deceased;

I recollect my daughter being taken ill about ten o’clock on theSunday morning; the prisoner was sent for, and came; I was inthe room when the child was born; I went away, and returnedin about two hours; the prisoner was there then; I went to thebed and spoke to my daughter; I saw the prisoner using greaterexertions than I had ever seen used before; there was a substancecame ; I saw the last witness lift up her hands, apparently muchsurprised, and then lift up the bedclothes. the witness thenspoke to seeing the prisoner take the scissors and cut some11 strings," which she described as the bowels, which were at-tached to the body of the deceased, which he took away withhim in the chamber utensil, and soon after her daughter died.]The following morning she saw the prisoner again; he then saidthat it was a false conception; she saw him again, and he said hehad found out what it was he had taken away ; it was a tumour,,weighing three pounds and three ounces. I asked him what hewas going to do with it ? P He said he had put it into spirits, andwas going to take it to Mr. Crosse, of Norwich; I asked him ifthe strings had any right to have come away with it? He did notmake me any answer.

Mr. J. G. Crosse examined by Mr. Palmer.-I am a surgeonresiding at Norwich; I have practised midwifery thirty years; Iwas present at the opening of the body of Mrs. Lovett; it was atthe time the inquest was sitting. Mr. Francis opened the body ; 9I assisted and directed. I observed in the cavity of the body thestomach lying in its usual situation; the small intestines laybeneath ; in the cavity there was blood, but the only parts visiblewere those I have named, and the urinary bladder; the solidviscera found in the body were the liver, spleen, and kidneys;the womb was entirely absent, with all its appendages; all the

large intestines were absent except thirteen inches from their ter-mination ; the caput coli was also absent, and a large portion ofthe small intestine next it; a great part of the vagina was foundthere ; the omentum was almost all removed, with the large in-testines, small shreds only being attached to the stomach; theduodenum continued in its usual situation, and the extent of smallintestines there was sixteen feet; I think there should have beensome few feet more; they were measured in the presence ofnumerous medical gentlemen, and they measured sixteen feetthree inches; some of the small were missing ; I cannot say howmany feet were missing; the large intestines were all gone butthirteen inches; the removal could only have been through thepassage, and pulling down the part, and tearing or cutting itaway. The womb appeared torn from the vagina, but from theposterior I cannot say whether it was not cut; when the separa-tion had taken place it was partly torn; I said it appeared so at

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the coroner’s inquest, but I know now the separation of thesmall bowel was partly by tearing and partly by cutting; thelarge intestine was separated, it appears, by Iaceration; it wouldhave been necessary to use considerable force to get away thewomb ; when he came to the bowels, the mechanical force wouldbe less; to tear the uterus at all betrayed ignorance; there arecases of a prolapsed inverted uterus-in these cases it should berestored; it would be dreadful practice to pull it away; the wombbeing away, the bowels would follow afterwards ; the large intes-tine must have been pulled down.

Cross-examined.-I have known an instance of a medical manwho has passed his hand into the abdomen of a woman by acci-dent. I know only of one instance in Norfolk. I have seen theinverted womb of a woman taken out, and the woman did not4ie; but it is very dangerous. Cases occur when the removal ofthe placenta by the hand is absolutely necessary. It is not

dangerous to leave the placenta, if there is not much bleeding.Dr. Hunter used not to remove the placenta. I have removedthe inverted uterus, and I have replaced it, sometimes ; wherehours had elapsed, I have not been able to replace it; I have, inother cases, replaced it. I know of very few men in Norwichwho have replaced an inverted uterus. I have heard of caseswhere the bowels have protruded through the womb.

Mr. PRENDERGAST addressed the jury for the defence.-Theyhad heard the case against the gentleman at the bar, whowas a man of education, and had conducted himself respectablythrough life. They knew that at Apothecaries’ Hall no man passedwho was not qualified in anatomy. He did not mean to say,though he had passed that examination, that he was as skilful as Dr.Conquest or Sir Astley Cooper. This he would not pretend tosay. They could not expect the extreme of skill at Costessey, andhis client was very well qualified to practise at that place, andthat was his principal defence. Women were the persons who

originally performed these offices, and one of the witnessesexamined that day had said she had delivered many women:might she not as well have been indicted for manslaughter?That was the case with his client,-he had some of the ignoranceof a female under such circumstances, but still he possessedsufficient skill for usual and ordinary cases. Mr. Crosse hadsaid, the case of an inverted uterus was extremely rare anddifficult of management-then why should his client be indictedfor exercising his best skill to meet an extremely difficult andurgent case? Moreover, it was known there was no safety forthis woman unless the after-birth was taken away; but when itadhered to the placenta, the difficulty of removing it would beextreme; and yet there was no evidence that undue force wasused, because the most experienced of all the witnesses-thewoman who helped to deliver so many women, the midwife whowas present-deposed that the prisoner used no unnecessaryforce, neither did he seem to use greater exertions than medicalmen usually do under such circumstances. Now, with regard tothe medical evidence, it was very much at variance, for Mr.Crosse said the after-birth was not in all cases necessary to becarried away, because Dr. Hunter had been in the habit of leav-ing it, though the science of the present day maintained that Dr.Hunter was deceived. If, then, Dr. Hunter was deceived, hemust have unwittingly killed some women in his time; yet hewas not indicted. Mr. Prendergast proceeded at some length tocontend that his client was not guilty of inattention, criminalneglect, or want of skill, because he had treated an extremelydifficult and dangerous case with all the skill he possessed, andunder such circumstances was not guiltv of the crime for whichhe stood indicted. He would call before them a number ofwitnesses to character, and the prisoner’s patients, who would sayhe was a man of skill, humanity, and competency to perform hisduty. He hoped they would bear in mind what Lord Ellen-borough had said, that to make a man guilty of manslaughter, itwould be necessary to show criminal neglect and wilful inatten-tion. Such a charge, in the case of his client, could not be sup-ported, for it was proved that he had always been as kind andattentive as it was possible to be. Lord Ellenborough hadfurther said, that to substantiate a case of manslaughter it wouldbe necessary to prove that the prisoner had been guilty ofcriminal misconduct, arising from gross ignorance or criminalinattention, for either the one or the other must be necessary toprove a charge of manslaughter. That learned judge added, thatif medical men were liable to be indicted, like felons, for an errorof judgment, when they were doing everything within their

power and skill, no man of honour or reflecting mind wouldenter the profession at all. The jury should moreover bear inmind the great difficulties the prisoner had to encounter. Mr.Crosse had declared that the case, which was one of an inverted wuterus, was extremely difficult, and of rare occurrence. The

prisoner had endeavoured to meet it with all the skill and abilityhe possessed, but he was not to be indicted for a felony if these l

exertions were not crowned with success. Mr. Prendergast con-cluded by contending there was no case of manslaughter sup-ported, and stating his intention to call witnesses, persons who hadbeen patients of the prisoner, to show that he had, in all instances,exercised all the humanity, attention, and skill, which could bereasonably expected under the circumstances. He then calledseveral witnesses.The Learned Judge said, in summing up the evidence, that he

perfectly agreed with the opinions of Lord Ellenborough,-if hemight say so much after so great a man,-that if a medical manwas to be punished for the death of a patient, whenever he usedthe most skill he was possessed of, such would be fraught withmuch danger, and no persons of honour or integrity would enterinto the profession at all with such an apprehension continuallyhanging over their heads. What man would enter into the pro-fession with such a danger hanging over his head, when he mightmake an error in judgment, and have no idea of criminal neglect?He did not think in the present case that the grossest ignorancehad been exhibited, and there was not any proof of criminal neg-lect. This was a different case from that which he had to try ona former occasion at Derby, where the medical man was in a stateof intoxication: this appeared to him to be an error in judgmentand nothing more, and one which he doubted ought to have comeinto that Court. There was a remedy by an action for damages.It was quite manifest to him that the case had not been made out.It appeared that there was a large substance which was takenfrom the woman by the prisoner through mistake, which oughtnot to have been removed; but they ought to bear in mind that,for decency’s sake, all medical men worked in the dark, and assuch, he nor any other man could be exactly accountable for whathe did take away. He no doubt at first thought it was a tumour;that was a proof it was an error in judgment. They mightperhaps say that he had a right to know; but how could a personlearn without some practice, and if a man happened to make anerror in judgment, was that to be considered gross ignorance, andimputed to criminal neglect? Doubtless, if the man had knownbetter, he would not have done so. Judge Hale was of opinionthat these cases were of the greatest importance, and ought to bewell considered. He had given the jury his opinion, and he didnot see that, by reading over the medical evidence, he should beenabled to impart anything they did not already know. Thefacts were very short, and Mr. Crosse had stated that it was avery difficult case, and one which but few persons could haveperformed with success. Indeed, Mr. Crosse said there were butfew medical men in the city of Norwich experienced in doing it.They would therefore consider their verdict; but he would juststate his opinion, and he thought they would agree with him, thatthere was no case of criminal neglect, nor had the grossest igno-rance been displayed; but it was quite clear that it was an errorin judgment, and if they were of the same opinion with him, theywould return a verdict of not guilty. The Jury instantly re-turned a verdict of Acquittal.

HOSPITAL REPORTS.

LONDON HOSPITAL.(Prepared for publication by BERNARD E. BRODHURST, Esq. House Surgeon.)

I IRITIS.

S. C-, aged seventeen, of a delicate frame and constitution,which had been much impaired during the last two or three yearsby the irregular life which she led. Towards the end of thesummer of last year she had primary and secondary syphilis-

i. e., chancres, succeeded by sore throat, and rupia on the backand extremities, for which she had been treated in one of themetropolitan hospitals. At a later period she had gonorrhcealrheumatism in many joints.On December 19th, 1844, she was admitted an in-patient of the

London Hospital, under the care of Mr. Andrews, for iritis,which had already existed a week. The iris, naturally dark, wasin the affected eye of a redder tint, dull, and muddy; the pupilwas excessively contracted, and the pupillary margin of the irisirregularly adherent to the anterior capsule of the lens. On thepupillary margin of the outer side of the iris were tubercles oflymph, (condylomata,) of a reddish-brown colour; the scloroticaand conjunctiva were both much injected, and the grey zonearound the cornea was distinct. The eye was irritable, andintolerant of light; vision was greatly impaired, so that objectscould scarcely be discerned. There was severe ocular and supra-

orbitar pain, and that increased at night, more especially the painin the brow, which was so considerable as to prevent sleep.

! Small doses of mercury were given, together with sarsaparilla;

counter irritation was applied behind the ear, and a generous dietwas allowed.