447majesty King William the Fourth, intituled "An Act torepeal an Act of the present Session of Parliament, intituledAn Act for the more effectual abolition of Oaths and Affir-mations taken and made in various departments of the State,and to substitute Declarations in lieu thereof, and for themore entire suppression of voluntary and extra-judicial Oathsand Affidavits, and to make other provisions for the abolitionof unnecessary Oaths."

LEAGUE BREAD COMPANY: We, Eleanor Myers, of 1, Univer-sity-street, Tottenham-court-road; Jane Hyde Burfield, of 10,Charles-street, Middlesex Hospital; and John Alford, of 46,James-street, Oxford-street, agents respectively for more thantwelve months last past of the League Bread Company, doseverally solemnly and sincerely declare that we have never,since we have acted as agents for the said Company, sold anyother bread than that which has been delivered to us by thesaid Company. And we further say, that we believe a state-ment which has been published in THE LANCET journal, on thetwenty-fifth day of October instant, to the effect that alum i,was contained in three samples of bread purchased at ourdepots, is entirely unfounded. And we severally make thissolemn declaration, conscientiously believing the same to betrue, and by virtue of the provisions of an Act made andpassed in the sixth year of the reign of his late majesty KingWilliam the Fourth, intituled " An Act to repeal an Act ofthe present Session of Parliament, intituled An Act for themore effectual abolition of Oaths and Affirmations taken andmade in various departments of the State, and to substituteDeclarations in lieu thereof, and for the more entire suppres-sion of voluntary and extra-judicial Oaths and Affidavits, andto make other provisions for the abolition of unnecessarypaths "

ELEANOR MYERS.J. H. BURFIELD.JOHN ALFORD.

** We simply stated that aluna was present in the bread,and made no imputation as to who put it there. It will be

seen, elsewhere, that we adhere to the accuracy of our report.°ED. LANCET.

Medical Societies.

PATHOLOGICAL SOCIETY OF LONDON.DR. P. M. LATHAM, PRESIDENT.—OCTOBER, 21ST, 1851.THE first meeting for the present session was fully attended.

The President commenced the proceedings at eight o’clockby calling upon Dr. OGIER WARD, who presented a specimen of

DIAMOND-SHAPED HEAD FROM COMPRESSION AT BIRTH,in a child, aged seventeen months. The child, the tenth, anda female, was born after a natural labour of six hours’ dura-

. tion on May 5,1850. At this time the head was compressedlaterally, and elongated upwards and backwards; the rightparietal bone rising in a ridge over the left, along the sagittalsuture. On May 20, the head remained in the same state,the child being easily started by the least noise, and much"convulsed" with flatulence. It looks healthy, but is verysmall. Sept. 21st: the child has lately begun to thrive, havingfor a long time scarcely appeared to grow at all, It is much!

less troubled with flatulence, but it starts and screams occa-sionally without any apparent cause, unless it be from its teeth,which are beginning to distend the gums. The head is muchdistorted, though the right parietal no longer rises above theleft. It is more deformed than the ordinary oblique-shapedhead, for besides the right side of the head being advancedbefore the left, it is very much flattened above the ear, whereit is over-arched by the left side, giving the child a wry-necked appearance. The left side of the head projects morebackwards than the right does forwards, and the whole rightside appears smaller than the other. The point of the hairyscalp is over the right eye. Since the last report the headhas very much improved in symmetry, and the child is nowthriving, though still troubled with convulsive movements,attended by screams.Three crania from the museum at St. George’s Hospital

were at the same time exhibited by Dr. Ward, presenting thelike deformity, the right side projecting before the left,which was also the case in all the crania and living instanceshe had met with, and was attributed by him to the left sideof the head at birth being compressed against the sacrum,while the right side turned upon it just previous to its expul-pulsion from the pelvis.Dr. PEACOCK expressed his belief that the malformation wasdue in most instances to the position of the head whilst thechild is being nursed, or carried, the weight of the brain itselfbeing sufficient to cause the distortion in ricketty children.The statement of the mother in the present instance as to theposition in which the child’s head was most frequently placedwhen being nursed, corresponded with the opinion thus ex-pressed.

Dr. BRINTON pointed out the lengthened period duringwhich it was necessary to retain pressure on the head inorder to cause the malformation peculiar to the Caribbeanand other Indian tribes. He thought the necessity thusshown inconsistent with the possibility of the malformationbeing caused by the pressure during the short period of par-turition.

Dr. M’lNTYRE inquired the pathological signification of thesecases, what effects they gave rise to, and how they were to betreated! g

Dr. COPLAND said that he had many years ago pointed out,in his Dictionary of Practical Medicine," the existence ofthese cases, and their connexion with idiocy, convulsions, andsimilar disease. He thought that the malformation precededand was altogether independent of parturition. He had re-cently examined a case in which the form of the brain cor-responded to the deformity of the skull.

Dr. OGIER WARD could not adopt the explanation offeredas to the mode in which these malformations were produced.He had traced many of them from birth, and they were ob-served in children who were free from rickets, and who werenot nursed in an uniform position. These malformations dis-appeared in all the cases he had seen, with one exception,and in that case the head of the mother was also malformed.They certainly gave rise to the serious and troublesome effectsdescribed by Dr. Copland and himself.

I DISEASE OF THE URINARY ORGANS; STONE IN THE KIDNEY.

’[ Mr. CouLSON exhibited a specimen taken from a man, fifty-three years of age, who had suffered upwards of twenty yearsfrom stricture of the urethra, occasional abscess in the peri-nseum, and retention of urine. On the 19th of September,he was admitted into St. Mary’s Hospital; the urine passed indrops, both through an aperture in the perinseum, and theurethra; it was alkaline, and contained a good deal of mucusand albumen; no instrument could be passed through thestricture, which was seated at the bulbous portion of theurethra. As the pain and difficulty of passing the urine werevery great, it was thought that a free exit for the discharge ofthe water might lessen the patient’s sufferings. On the 8thof October, Mr. Coulson divided the stricture through the peri-nseum, and easily introduced a catheter, which was retainedin the bladder forty-eight hours. The first effect was reliefto the pain, but on the next day it returned, and increasedin severity until the 14th, when he died.

Post-rrzortem Examination.-There was a wound an inch inlength in the median line of the perinaeum, dividing the bulbousportion of the urethra, which was considerable thickened. Inthe membranous part there were two openings, one leading tothe abscess in the perinæum, and the other going towards thopelvis. The bladder was very much thickened, and its mucousmembrane in several parts destroyed. On the posterior surface ofthe prostate there was an abscess about the size of a hen’s

egg, not communicating, however, either with the bladder or

448

the rectum. The left kidney was enlarged and distendedwith pus, the whole of its proper structure being absorbed; inits lower part there was a large calculus, which occupiednearly the whole of the lower half of the kidney, projectinginto the infundibulum and pelvis. The ureter was very much

enlarged and thickened, the mucous membrane being roughand of a dark colour about the centre; there was a contractionof the canal and hardness of its coats. The right kidney andother organs were healthy, with the exception of the liver, inwhich there was incipient fatty degeneration.Dr. W. T. GAIRDNER presented a drawing of

A REMARKABLE CYST IN THE OMENTUM.

The cyst was found beneath the anterior layer of the greateromentum in a woman who died unexpectedly, having a verylarge fibrous tumour of the uterus. It consisted of a highlytransparent closed sac, between three and four feet in length,and from half an inch to an inch and a half in breadth, havinga lobulated appearance externally, like that of a distendedcolon, but in no part subdivided by any approach to completesepta. The sac was fed by numerous vessels running withinthe omentum, and ramifying over it in every part; these com-municated with a large artery and vein, the size of the largestgoose-quills, which ran along the greater part of the cyst, andopened into other hypertrophied vessels, especially one arteryand vein of equal size passing from the lower border of thestomach down the centre of the omentum. The fluid in thesac was a transparent colourless serum, containing numerousflocculi; these, on microscopic examination, showed the ordi-nary filamentous appearance of fibrinous or albuminous matter,entangling various nuclei and imperfect forms of epithelium,evidently detached from the inner wall of the cyst. Nothinglike ova or like any portions of the structure of the trueentozoa could be discovered in the fluid, nor did the examina-tion of the interior of the cyst’s membrane (so far as it couldbe pursued without altogether spoiling the preparation) revealany more organized structure than that of an epithelial mem-brane. The peculiarity of the cyst is its anatomical disposition;and if it is to be regarded as belonging to the class of simpleserous cysts, it is probably an undescribed variety of thatclass. The serous cysts hitherto mentioned by authors as notbelonging to the class of animal parasites, have been simplyglobular structures, in some cases clustered together, or

assuming some peculiarity of form in their anatomical rela-tions, but not departing far from the globular type. The re-markable elongation in the present instance, the lobulatedform, and the great enlargement produced in the vessels ofthe parent structure, seemed to imply a higher power of inde-pendent organization in this than in any previously described simple cyst. The mode of origin of such a structure, especiallyin the omentum, where non-parasitic cysts are exceedinglyrare, appears quite open to speculation. The case is renderedmore remarkable by the fact, that in conjunction with thestructure above mentioned, there was found in the cellulartissue of both groins a cluster of globular cysts of the ordinarytype; that similar cysts were found in the interior of thefibrous tumour, and that in the velum interpositum occupyingthe position of the gland there was a globular cyst of the sizeof a bean. The organs of the body, with the exception men-tioned, healthy.

Dr. QUAIN remarked, that the origin of this peculiar cystwas a subject of much interest. It must be either a newformation, or a modification of some of the existing tissues.Of the former mode of origin, there appeared to be no evidence.Could this peculiar elongated cyst, then, be due to a serousinfiltration-to a dropsy, in fact, of the cellular sheaths ofsome of the mesenteric vessels which had been congenitallyor morbidly enlarged, and so modified by disease as to admitof this peculiar change ?

Dr. GAIRDNER thought that the complete formation of thecyst, and the presence of epithelium, militated against thisview.Mr. PRESCOTT HEWETT presented a specimen of

LACERATION OF THE RIGHT LATERAL SINUS, WITH EXTENSIVEEXTRAVASATION OF BLOOD BETWEEN THE BONE AND THE

DURA MATER.

The patient, a middle-aged man, was admitted into St. George’sHospital, at the latter end of August, with the followinghistory :-At two o’clock in the afternoon, it appeared that hehad fallen out of a cart, and struck his head; this was followedby very slight symptoms, which soon passed off; and afterhaving taken a little brandy-and-water, he proceeded abouthis business, and drove six miles out of town. At six in theevening, however, whilst delivering his last parcel, he suddenly

became quite insensible, and fell. He was seen by a medicalman, who bled him. He was subsequently brought to thehospital, and when admitted, presented well-marked symp-toms of pressure on the brain. The various parts of the skull,having been carefully examined, were found to present anatural appearance; but pressure on the right parietal, justabove the ear, and only in this spot, made the patient shrink;and the movements of the left arm appeared to be somewhatmore sluggish than those of the right. The countenance wasnot in the least distorted. Mr. Prescott Hewett, thinkingthat the symptoms of compression might depend upon an ex-travasation of blood between the bone and the dura mater,produced by a fissure of the parietal, with the laceration ofthe middle meningeal artery, determined upon making an in-cision down to that bone. The incision was carried across thetwo anterior thirds of the lower part of the parietal, but nofissure was detected; neither was there any single sign toshow that the bone had been in any way injured. The patientcontinued much in the same state, and died about two hoursand a half after his admission.At the post-mortem examination, a fissure was found in the

right parietal, but at the most posterior and inferior part ofthe bone. Traced out, this fissure passed downwards, and

divided into two branches, one of which crossing the petrousand mastoid portions of the temporal, terminated in theposterior fossa of the skull. The lateral sinus, just as it turnsunder the petrous part of the temporal, presented an ex-tensive laceration in its outer wall,.which had given rise toan immense extravasation of blood between the bone and thedura mater, and a corresponding depression of the brain. Theother branch of the fissure terminated in the middle fossa ofthe skull. The brain itself was healthy in structure, save inone or two spots, where it was slightly bruised.

Dr. PEACOCK presented a specimen ofOBSTRUCTIVE DISEASE OF THE AORTIC VALVES, DEPENDENT ON

MALFORMATION; SMALL ANEURISM IN THE VENTRICULAR

SEPTUM.

The subject of this case was a man forty years of age, whowas admitted into St. Thomas’s Hospital, under Dr. Peacock,,in July last. He had been ailing for eleven weeks, but beforethat time had never suffered from any serious disease or

injury. His illness commenced with slight rheumatism anddyspeptic symptoms, and to the latter were superadded, soonafter his admission, considerable difficulty of breathing andpain across the epigastrium. A loud and harsh systolicmurmur was audible over the upper part of the sternum andin the pericardia, and no second sound could be detected.The difficulty of breathing and epigastric pain increased, andhe became the subject of double pneumonia, under which hesank about three weeks after he entered the hospital. Theleft ventricle of the heart was somewhat hypertrophied anddilated, and the aortic valves were very extensively diseased.The contiguous sides of the right and posterior valves wereunited so as to produce one large valve, imperfectly dividedon its upper surface, and the posterior and left valves werealso partially adherent. The fusion of the valves was

evidently of very old date, and most probably congenital. Atthe base, and rather to the right side of the right valve, therewas a small aperture leading into a sac situated in thesubstance of the septum of the ventricles, and which formeda slight protrusion into the right auriculo-ventricular aperture;a second and larger aperture leading into the same sac, wassituated in the space between the right and posterior valves,and a communication also existed between it and the rightsinus of Valsalva; but this was probably the result of de-composition after death. The sac was of sufficient size tolodge a hazel-nut, and was lined by a distinct membrane, butit did not contain any laminated coagula. There were vegeta-tions of recent date in the aortic and mitral valves, and in theendocardium of the left ventricle. Dr. Peacock regarded thecase as one of congenital malformation of the aortic valves,and he supposed that at the time the slight rheumaticsymptoms oecurr’ d-eleven weeks before the admission of thepatient into the hospital-the valves had become the seat ofendocarditis, and thus the obstruction at the aortic orifice,originally only slight, became much aggravated, and probablyled to the formation of the small aneurism. Cases very similarin many respects have been placed on record by Dr. Hope andDr. Thurman, and more recently by Dr. Todd.

Dr. Peacock also presented a specimen ofOBSTRUCTIVE AND REGURGITANT DISEASE OF THE AORTIC

ORIFICE.

This specimen was removed from a female, aged thirty-three,who first came under Dr. Peacock’s care, at Thomas’s

449

Hospital, in May, 1850. She stated that she had been firstseized with the symptoms under which she laboured when inan advanced stage of pregnancy six months before, and thatshe had never had rheumatism, inflammation of the chest, norany other disease to which her illness could be ascribed. Shesuffered from palpitation, great difficulty of breathing, and asevere pain in the epigastrium, extending thence to thespine, and down the left arm. A loud systolic murmur washeard over the upper part of the sternum, and this was i

succeeded by an imperfect second sound, terminated by adiastolic murmur, which was most distinct at the lower part ofthe sternum. While in the hospital she improved so as to beable to resume her usual avocations, and Dr. Peacock did notsee her again for some months. She then applied at thehospital as an out-patient, and stated she had been pretty welltill she had again become pregnant, and her breathing wasthen extremely difficult. She died about two months ago,three or four days after her confinement. The heart wasfound very large, and the left ventricle especially was muchhypertrophied and dilated. The aortic orifice was consider-ably diminished in capacity, the outlet measuring in circum-ference only twenty-two French lines, and at this point therewas a very considerable deposit of atheromatous material underthe lining membrane. The inlet of the orifice was relativelylarge, measuring thirty-one lines. The valves were diseased;the left and posterior valves being much thickened and theirsacs very shallow, while the right valve, together with thecorresponding series of Valsalva, had undergone considerabledilatation, and presented at its most dependent part an orificeby which a column of fluid freely regurgitated from the aortainto the left ventricle. The case afforded a good example ofone of the modes in which alterations in the relations as tocapacity of the inlet and outlet of the aortic orifice operateupon the valves so as to occasion their incompetency.

THE ROYAL COLLEGE OF SURGEONS OFENGLAND AND HOMŒOPATHY.

THE following letter, from Dr. J. C. Hall, of Sheffield,addressed to the Council of the College of Surgeons, has beenplaced in our hands for publication. We shall be curious tosee what answer the Council will give to it; it is quite im-possible that that body can longer remain silent. We are cer-tain Dr. Hall will have the thanks and best wishes of everyhonest member of the profession.To the Council of the Royal College of Surgeons of England.

. Sheffield, November 1st, 1851.

GENTLEMEN,-I very much regret that beyond a formalacknowledgment of the receipt of my last letter, dated Sep-tember 22ud, 1851, by Mr. Belfour, you have not thoughtproper to give me any reply to the questions then put to you-viz.:

lst. Does a Member of the Royal College of Surgeons of Eng-land by practising homœopathy render himself, in the judgment of.the Council, disgraceful to the College? and,

2ndly, If a Member by so ctcting be considered to have brought‘ disgrace upon the College," are you prepared at once to put intoforce the powers you possess for his removal?

I can assure you the continuance of this correspondence ismost painful, for I cannot but remember how proud I havebeen of the friendship so long extended to me by several ofthe members of the Council of our College; and I most deeplyfeel the course you are now taking with regard to the pro-fessors of the homoeopathic quackery who are members ofour College, is little calculated either to reflect credit uponthe Royal College of Surgeons, or to promote the cause ofhonesty and truth; nay more, fear that much of the quackeryat present existing, has, to some extent at least, arisen fromthe apathy you have displayed.

I have now under my care, in common with the other pro-fessors at the Sheffield Medical Institution, a number ofyoung gentlemen who hope to become Members of the RoyalCollege of Surgeons of England, and who are looking forwardto the time when, having passed their examination, they mayobtain the honour of your diploma. But how can we urgeupon them to walk honestly in their profession ? how can webid them do their duty in that state of life unto which it haspleased God to call them how can we beg of them to re-member that the day will come when they will be requiredto "maintain the dignity and welfare of the College," and totake a solemn oath, calling on God to help them so to do,when you are so indifferent, or at any rate apparently so in-different, to the conduct of your members as to permit cer-

tain of them to practise a quackery the most foolish andwicked, and that, too, in direct violation of the oath theyhave taken, without expulsion-even without admonishingthem that such conduct is improper, and cannot be permittedby you so long as they continue members of this College ?

I must again most respectfully request that an answer maybe given to the questions to which your attention has beendrawn. If you do not think it right to exclude from theCollege lists the followers of the homoeopathic quackery-,ifyou think it right, and are desirous that your own names shouldstill mingle on the same page with their names,-

" Pares cum paribus,-"well: but it will be for myself, and for the great body of themembers of the Royal College of Surgeons of England whofeel with me, whose assistance I ask, and whom I am verycertain will act with me also, to say whether this state ofthings can be permitted to continue.For my own part, however painful, I scruple not to say that

if the honour and dignity of the College cannot be maintained,.if the open enemies of science and of medicine are not ex-cluded, by the powers you possess, from the walls of the Col-lege, it will only remain for me to return into your hands thediploma of your College, and thus to do myself that justicewhich, up to this moment, you have thought proper to deny.With every good wish for the prosperity of our College,

I have the honour to be, gentlemen,Your obedient servant.

JOHN CHARLES HALL, M.D.,Fellow of the Royal College of Phy-

sicians, Edinburgh; Lecturer onAnatomy, Pathology and Physi-ology at the Sheffield Medical In-stitution.

P.S.-A copy of this letter will be sent to THE LANCET.

Correspondence.

COMPLICATED INJURY TO THE LEG.—QUESTIONOF PRACTICE.

"Audi alteram partem."

To the Editor of THE LANCET.

SIR,-Riding with another medical man past a quarry, in ø.very remote district, we were requested to see a labourer whohad just suffered a frightful mutilation by a fall of stones andearth from the quarry roof. There was a scalp wound ex-tending from the vertex to the top of the forehead; a piece ofthe pericranium, the size of a half-crown, was stripped off thebone; there were fractures of the tibia, with a bleeding open-ing at the shin; compound fracture, and dislocation inwards,of the knee-joint; and a laceration of the thigh above theouter condyle, exposing the torn edge and tendon of thebiceps. Through this laceration I put my forefinger into theknee-joint, and took away two pieces of bone, about the sizeof a broad-bean, cartilaginous on one side, rough on the other- pieces, so far as I could judge from the hurried glance Igave them in passing them into the hands of my medical com-panion, of the inner condyle of the femur. The joint, there-fore, was laid open, and the ligaments lacerated to a greatextent. There appeared to be other fragments of bone; butas the man was suffering great agony, and as I at once madeup my mind that the only course was to wait for, or rather tryto bring about, reaction, and then, if nothing forbade, to ampu-tate the thigh, I did not attempt to remove them from thejoint. Twenty-eight hours after the accident, reaction wasestablished, and I gave the friends my opinion that the timewas come to try to save the man’s life by amputation. Ilearnt, however, that a bone-setter of great local reputationhad been sent for; and knowing the strong prejudices of thevery worthy but very primitive peasantry in his favour, Ithought it in vain to be displeased, or to remonstrate in anyharsh tone, and therefore merely warned them that they were,in my opinion, running a much greater risk, in attempting tosave the limb, than would be incurred by removing it.Meeting the bone-setter, (who had the coolness to ask me

whether I meant to attend with him,) I thought it my dutyto inform him also of the serious nature of the accident, andwarned him that he was incurring a very serious responsi-bility in undertaking a case like this, by the consequences ofwhich he must abide. However, he went forward, and, atwhat agony to the patient may be supposed, adjusted thelimb. The operation could not have been more severe thansuch a " setting:’