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lives might be prolonged by it. In some of the casesrecorded by Amussat this happened, but he believed thatin no instances had so much advantage been derived fromthis operation, as in the important cases which had that ’Ievening been laid before the Society by Mr. Field and31r. Clarkson. With regard to the difficultv of deter-mining where the obstruction was situated, as Mr. Hilton hadsaid, when it existed in the large intestines, vomiting did notoccur so early as when the small intestines were the seat ofthe obstruction. This he believed to be true; and he thoughta careful examination and attention to the history of the casewould, in many instances, enable the surgeon to determinewith tolerable precision whether the impediment was seatedabove or below the descending colon. He also remarked thatin general, when the patient was not very fat or muscular, ifthe obstruction is situated below that part, there will be atympanitic fulness in the left loin, especially when the patientis in the prone position produced by fasces and air accumu-lated in the colon. In the cases related to-night, the opera-tion was performed in the loin, which he considered far pre-ferable to the proposal of opening the intestine in the iliacregion, by incisions similar to those employed in the ligature ofthe external iliac artery. In the latter situation there is moredanger of infiltration of fæcal matter into the cellular tissueand amongst the neighbouring parts, which is a most seriousevil, and had, lie believed, been the cause of a fatal result insome cases. He (Mr. Hodgson) also alluded to some cases ofintestinal obstruction, in which the bowel had been openedby incisions made into the cavity of the peritonaaum; and heespecially referred to two cases, in which this had been donewith success. One occurred in this country, in the practiceof a friend of his, and he hoped would shortly be communi-cated to the Society; the other was related by Dr. Adier, ofGeneva. Looking at the result of some of the late formidableoperations for removing diseased ovaria, in conjunction withthese cases, he thought that the fears generally entertained ofopening the peritoneal cavity might perhaps be rather over-rated.

Mr. B. PHILLIPS spoke of the importance of the operation,and his desire not to throw cold water upon it, and trustedthat it might continue to be performed when there was areasonable amount of evidence to render the proceeding pru-dent. He made some remarks on the difficulty of diagnosisin cases of obstruction in the bowels, and showed the fallacyof trusting even to injections, or the rectum tube, in both ofwhich there were manifest sources of fallacy. He related acase in point. After some further general remarks on thedifficulty of diagnosis, the Society adjourned with a few wordsfrom Mr. Macilwain.

WESTMINSTER MEDICAL SOCIETY.

SATURDAY, JANUARY 12, 1850.—MR. HIRD, PRESIDENT.

LENGTH OF THE UMBILICAL CORD.

Dr. TYLER SMITH exhibited a funis, which, measuring fromthe attachment to the umbilicus to its insertion into the pla-centa, was fifty-nine inches and a half in length. The averagelength of the cord is about eighteen inches; but fprty inchesare spoken of as a great length; the largest of which he couldfind an account was in a case of Baudelocque, where the cordmeasured fifty-seven inches. In Dr. Tyler Smith’s case, thecord presented, with the head. Such an extraordinary lengthillustrated one of the causes of funis presentations, and alsothe power of the foetal circulation. In this case, includingthe placenta, the length of the blood-channels beyond theumbilicus was upwards of ten feet, and still longer, consider-ing the spiral arrangement of the umbilical arteries.

Mr. HAYNES WALTON presented a well-marked example ofthe

CONVERSION OF TCBERCLE INTO EARTHY MATTER.

It was taken from the lung of a patient who had been underDr. Taylor, of Guildford-street. She was forty years of age, andhad been subject to palpitation for six or seven years. Dr.Taylor had attended her frequently, during the last six orseven months, for chronic bronchitis. She had improved undermercurials and counter -irritation over the larynx, but wouldnot persevere with the mercury. Mr. Walton had beencalled in, to apply nitrate of silver to the larynx. She diedsuddenly, on the eighteenth of this month. There musthave been a very large tubercle originally, for there isa large cartilaginous cicatrix, and much puckering ofthe surrounding substance of the lung. The earthy deposit isBomewhat bigger than a pea, and of stony hardness ; and the

walls of the cavity is lined with a smooth membrane. Exceptsome lobular emphysema, the rest of the lung was healthy.The right lung had miliary and crude tubercles in each of itslobes. There was considerable disease of the heart. Theconsolidated aortic valves were exhibited. The most interest-ing morbid part, the oedematous larynx, was unfortunately leftbehind.Mr. CANTON related the following case of

HYSTERICAL PTOSIS,which came under his care at the Royal Westminster Optlial-mic Hospital. Emily T-, aged seventeen years; had men-struated at the age of thirteen years; the flow continued pro-fuse for a week, when it suddenly ceased, in consequence ofher being much frightened, and had not re-appeared untilthree weeks ago. She remained very sickly for a year aftermenstruating, when her eyes became inflamed, in consequenceof some matter getting to them from the face of a child shewas nursing. For this complaint she was under treatmenttwo months; and since that time has complained of dimnessof vision in both eyes. She suffers pain occasionally in thehead, but not of a severe kind. Light is stated to increase theimpairment of sight; and when attempting to read for anytime, " the letters run into one another;" or if working, she" misses seeing her needle" after a while. The pupils are di-lated, but the irides are active in their movements. The pa-tient is very hysterical, and suffers from globus, palpitation,waywardness of appetite, constipation, &c. The treatmentadopted by Mr. Canton had been with a view to the establish-ment of the menstrual flow, by the exhibition of aloetic, steel,lytta, and similar remedies, without, however, any resultingbenefit. In October last, the patient found, suddenly, thatshe was unable to open’ the right eye, except by raising theupper lid with her finger, which, being removed, the lid againfell, and remained drooping. Pricking pain was now com-plained of in the eye, and in the corresponding temple, andshe complained of still further diminution of vision. The iris,nevertheless, moved with its former activity, and the ptosiswas unaccompanied by external strabismus, or a pupil largerthan the one of the opposite eye; the fellow-organ continued,in all respects, the same as previously. Symptoms of an hys-terical character being again present, in a marked degree, thesame plan of treatment was again resorted to by Mr. Cantonas he had previously employed, and which for two months hadbeen suspended. Mercury, strychnine, blisters, and such re-medies as are ordinarily employed in the usual examples ofptosis were avoided, from the peculiarities presented by the case,which Air. Canton considered might be fairly regarded as onehaving for its origin uterine derangement; and the sequel hadproved this view to be based on fact; for, at the expiration ofa month, (during which time the remedies were perseveredin,) the ptosis disappeared as suddenly as it had occurred;and in a fortnight afterwards, the menses appeared, and con-tinued to flow for ten days. Since this time, vision of botheyes is improving.

STRICTURE—EXTRAVASATION OF URINE.

Air. HANCOCK was called, during last July, to a gentlemansuffering from extravasation of urine. He had sufferedfrom stricture for nineteen years, and had had the stricturedivided through the perinæum, and also the bladder puncturedthrough the rectum, but without relief; as, in the first instance,the wound in perineo was allowed to heal up without attentionbeing paid to the urethra, Mr. Hancock treated the extrava-sation in the usual way; and in the course of a few days, withthe patient’s consent, again divided the stricture through theperinæum. He kept the wound open by passing a No. 10 gumcatheter into the bladder by that passage until a No. 11 silvercatheter could be readily passed along the urethra into thebladder, when he allowed the perineal wound to close, and thepatient is now recovered. He considers the case of interest,as bearing upon the questions, mooted during last session, withreference to the treatment of abscess of perinaeum connectedwith obstinate stricture of the urethra, and also with referenceto the operation for opening the urethra from the perinænm,and its after treatment, especially in relation to the employ-ment of the catheter; that when the abscess is unconnectedwith opening into the urethra it is better to abstain from theemployment of the catheter, notwithstanding the patient mayexperience difficulty in urinating, but that where such com-plication exists, which lie believes is most frequently the case,the employment of the catheter should be carefully attendedto, particularly when it has been found necessary to open theurethra through the perinaeum, in which case the instrumentought never to be entirely discoutinued. To this cause he

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attributed the failure of the first operation in the case just related, as well as in others to which he alluded; the catheterhad been neglected, the parts allowed to heal and contract,and thus the patient became as bad as ever. In conclusion,he offered some remarks on the usual perinseal operation foropening the urethr,. Be considered that the difficulties-of itsperformance were greatly enhanced by the situation at whichthe urethra was usually opened, the opening being made to-wards the anterior part of the membranous portion of theurethra, which is sometimes completely cut across, so thatwhen the catheter is introduced and passed along the anteriorpart of the urethra, it comes out through the wound, but theposterior part having nothing to support it, the sides of thecanal fall together, close up, and great difficulty is experiencedin hitting it with the point of the catheter; this difficulty maybe obviated by making the opening in the urethra furtherback, close to the front of the prostate gland. In performingthe operation, the surgeon will be greatly assisted by recol-lecting that the urethra, passing through Cowper’s ligament,corresponds exactly to the points in the raphe of the perinæum,midway between the posterior root of the scrotum and the an-terior margin of the anus; that a knife plunged straight in atthis point will reach the membranous portion. After describingthe various steps of the operation, he concludes his paper byobserving that the catheter employed should be sufficientlylarge to fill the canal of the urethra, otherwise the portion ofthe urethra behind the stricture when divided will fall to-gether, and the point of the instrument catch, and thus beprevented entering the bladder.

MEMORIAL OF THE ASSOCIATED PHYSICIANSAND SURGEONS OF SHROPSHIRE.

{FORWARDED TO US FOR PUBLICATION BY PEPLOE CARTWRIGHT, ESQ.,OSWESTRY.]

To the President, Vice-Presidents, and Council of the RoyalCollege of Surgeons of England.

The Memorial of the Associated Physicians and Sur-geons of Shropshire and North Wales, showeth,-

That your memorialists have always considered, and onseveral occasions have urgently represented, by petitions to theLegislature, and by memorials to the Home Secretary, (thelast of which, presented in June, 1849, received 500 signaturesin a few days,) that the Colleges of Physicians and Surgeons ofEngland, if properly modified, were amply sufficient for allthe requirements of the profession -,-and that the institutionof a new college of general practitioners would be a greatpublic and professional calamity.

Desirous as your memorialists are to see the Royal Collegeof Surgeons maintain that high standard of surgical attain-ments which has made British surgery renowned throughoutthe world, they cannot bring themselves to think, that anextension of its privileges to the surgeon in general practicecan in any way tend to lessen its dignity or impair itsefficiency. On the contrary, your memorialists are of opinionthat if provision were obtained in an amended charter for thecompletion of the education of the surgeon in general practicewithin the College itself, or by connexion with the College ofPhysicians, the sphere of its usefulness would be greatly ex-tended, and the necessity of a new college of general prac-titioners would not exist; a consummation highly desirable,both as regards the interests of the College and the futurerespectability of the profession.

Acting under such conviction, your memorialists wouldearnestly impress upon the Council the expediency of ob-taining in an amended charter powers to carry out the fol-lowing suggestions in alteration of the constitution of theCollege :-

First. That all who were members of the College antecedentto the grant of ’the Charter of 1843 be elected to the Fellow-ship in rotation, so soon as they shall have been memberstwelve years, and subject to the restrictions specified in thelate resolution of the Council.

Secondly. That if necessary, an augmentation be made inthe number of the Council and of the Court of Examiners, butthat all who shall hereafter be elected to the Council, OJto the Court of Examiners, be so elected for a limited termof years only, subject to re-election.

Thirdly. That Fellows of the College practising midwiferyor residing in the country, or in general practice, be not ineligible to the Council, provided they do not charge for thfmedicines they dispense, nor at any time form collectivelymore than one-third part of such Council.

Fourthly. That the examinations required on the admissionof the fellows and members be extended to medicine, mid-wifery, and all those collateral branches of science, a know-ledge of which is essential to a competent medical and sur-gical practitioner.

Fifthly. That the curriculum of education for the futuremember of the College be extended to five years, that he berequired to adduce proofs of a classical education, and amongstother things, that he be examined in practical anatomy andsurgery on the dead body.

Sixthly. That no one hereafter be elected a fellow of theCollege unless he shall previously have been elected a mem-ber, and that all the examinations for members and fellows bealike open both to members and fellows.

Seventhly. That in case of proof of any disgraceful. conducton the part of a member or fellow, the Council be empoweredto erase the name of such individual from the lists of theCollege.

Eighthly. That the examinations herein proposed be carriedout by an extension of the present Court of Examiners, or bythe formation of a conjoint Medical and Surgical Board, incombination with the College of Physicians, or otherwise.These suggestions, it would not be difficult to your memo-

rialists to show, have emanated originally from men of highstanding in the profession, but your memorialists beg moreespecially to direct your attention to the circumstance of theCouncil having formerly, on more than one occasion, agreed tothe appointment of examiners in midwifery, and that suchexaminers would then have been appointed had it not beenfor a defect in the charter: also they beg to observe, that inthe evidence given before Parliament in 1834, the conjointMedical and Surgical Board, herein recommended, receivedthe high sanction and approval of the late Sir Astley Cooper,Bart., Sir B. Brodie, Bart., Messrs. Travers, Lawrence, andGreen, and Sir Charles Bell, and at the present crisis, whenthe Apothecaries’ Company have expressed their readiness todissolve themselves, and that those gentlemen who have un-towardly sought a new incorporation of the general practi-tioners, are willing to be reunited to the College of Sur-geons, it appears to your memorialists that a serious responsi-bility rests upon the Council of the College, (in applying forany alteration of the charter of the College,) not only to seekto reduce the wrongs of its aggrieved members, but also toobtain powers for regulating the education, and superintendingand upholding the status, of surgeons in general practice.Your memorialists, in conclusion, with most heartfelt wishes

for the prosperity of the College, cannot refrain from expres-sing a strong opinion that nothing less than the adoption ofthese suggestions will suffice to put at rest the long-litigatedsubject of medical reform, or restore that peace and harmonyto the profession that is so essential to its well-being.

On hehalf of the memorialist.HENRY JOHNSON, M.D., President.PEPLOE CARTWRIGHT, M.R.C.S., Secretary.

Shrewsbury, Jan. 10, 185

MEMORIAL OF THE MANCHESTER COMMITTEE.To the Editor of THE LANCET.

SIR,—I am directed by the committee to forward you theenclosed copy of a Memorial to the Council of the RoyalCollege of Surgeons, and to request you to insert it in the nextnumber of your journal.

I am, Sir, your obedient servant,Manchester, Jan. 12, 1850. GEORGE BOWRING, Hon. Sec.

To t7te President of the Royal College of Surgeons of England.SIR,—In conformity with a resolution passed by the Man-

chester Medical Reform Committee, I beg respectfully toconvey, through you, to the Council of the College, the highsatisfaction they feel at the announcement of an intention onthe part of its Council to apply to the Crown for an amendedcharter.

In reflecting upon the probable details of such charter, ithas appeared to the Manchester committee, after muchanxious deliberation, that a measure which shall embrace thefollowing provisions would be generally acceptable to theprofession.

First.-That upon the grant of a new charter, all existing,members of the College who have attained, or may hereafterattain, a standing of fitteen years, shall, upon the recommendartion of six fellows, be elected to the fellowship without thepayment of any fee, provided that the candidate do not openlytrade in medicines.