of the glands. It should rather be considered as a disease sui generis." Both Dr. Baillie and Dr. Marshall Hall, regard diminution as an essential element in the disease, and the latter adds, "it is uniformly attended by ascites but without icterus." In the case under consideration there were ascites and anarsarca, but no icterus. The kidneys were in the last stage of granular degeneration. It may perhaps be worth while to remark that this patient was considered on his admission into the Infirmary, to be labouring hopelessly under acute renal dropsy. The heart-disease was regarded as chronic, and the liver affection was not and indeed could not have been detected on account of the ascites. The urine was examined the day after admission, and again the day before he died. On the first occasion its specific gravity was 1.012, on the second 1.015; it was coagulable on neither of these occasions. Of the urine in the earlier stages of the disease, nothing is known. Perhaps it is not quite obvious how far coagulable urine is connected with that structural lesion called Bright's disease.

RUPTURE OF THE POSTERIOR TIBIAL
AMPUTATION: PHLEBITIS.

ARTERY;

Mr. Micklethwait then related the following case :A married woman, aged 51, was admitted into the Hospital in September, 1844. The whole of the back of the right leg from the popliteal space to the ankle was uniformly swollen, was red, painful, and tender; no pulsation or bruit could be detected over the swelling, which had existed nearly two months previous to her admission. At the end of a month the lower part of the leg was reduced to nearly its natural size, but in the situation of the belly of the gastrocnemius it continued as large as ever. During the next fortnight the leg increased in girth, and became generally softer; there was a well-marked sense of fluctuation between the heads of the gastrocnemius, and the pain had become much more severe, and in addition, there was an ædematous state of the dorsum of the foot. At the end of another month the countenance had become sallow and extremely haggard; the pain was even more severe, and there was a secretion of a yellowish green transparent fluid from the skin, which at this part was thickened and appeared irregularly roughened. In one place a small excrescence, soft, smooth, and shining, had appeared, and the outer and back part of the calf of the leg had also become of a purplish hue, with enlarged cutaneous veins, the swelling thus assuming an aspect of malignancy. The sense of fluctuation remained distinct. After a fornight's interval of comparative ease, a violent attack of pain recurred without apparent cause, and continued for some days in spite of frequent and large doses of morphia. As she was anxious for something more to be done, an incision was made into the tumour, when its contents proved to be coagulated blood. On passing the finger through the clot, florid arterial blood gushed out profusely; the tourniquet was tightened and immediate amputation determined upon.

On the tenth day after the operation she had a severe rigor, unattended by pain in any part, or by cough, but there was increased rapidity of the pulse,

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which was exceedingly small. There was more restlessness and uneasiness from position, the features became extremely pinched, emaciation increased, and there was complete loss of appetite. Notwithstanding the free administration of stimulants, the rigors continued, and the weakness increased. Slight cough came on unattended by pain even on deep inspiration; respiration became hurried and obstructed, the pulse extremely feeble, and she gradually sank.

nerve.

On dissecting the leg, the gastrocnemius was found expanded tightly over a cyst. On removing the soleus, a cyst was exposed, formed apparently by the deep fascia of the leg. The cyst seemed girt from above downwards, along the inner third by a tight cord, which proved to be the posterior tibial artery, vein and The cavities of the two former were not obliterated, but impervious from pressure; the vessels curved outward and forward to join the popliteal above, and resumed their natural position below the cyst. On opening the vessels, their inner surface seemed healthy. There was a small longitudinal rent in the anterior wall of the posterior tibial artery, about threequarters of an inch from its origin, communicating with the cyst. The interosseous ligament was forced forwards, so as to be convex anteriorly instead of flat, and the posterior surface of the tibia was denuded of its periosteum, and rough.

The body was examined sixteen hours after death; it was much emaciated. There was nothing abnormal in the appearance of the stump; the divided structures were already contracted and agglutinated by organized lymph. The artery seemed healthy and pervious to within an inch of the ligature; this part was filled by a clot not yet conical, for the end of the artery was not completely contracted. The vein was blocked up from the divided end to the point where the internal, iliac joins the external iliac vein; the divided end was perfectly contracted. On opening the vein, and passing upwards for about two inches and a half, the diminished vessel was completely filled by coagulum, and in one part of this, entirely within it, was a small collection of matter, about the size of a hempseed; the next three inches were filled by a dirty brownishred mixture of blood and pus. Higher up the vein was filled by adherent coagulum, and in the substance of this, an inch and a half below Poupart's ligament, was another abscess as large as a cherry stone; the contents of this, as well as the other, were thick, whitish, unequivocal pus. The internal iliac vein was filled with free pus. The common iliac and vena cava were pervious and apparently healthy. The glands in the groin were enlarged, but healthy in structure. There were small deposits of pus under the mucous membrane of the os uteri and adjacent part of the vagina. The uterus was oblique, and one lateral ligament considerably shortened; the ovary and Fallopian tube of that side being firmly adherent by lymph. Several patches of acute inflammation, with deposits of light reddish brown lymph, were found in the spleen, and in the centre of one patch there was semipurulent fluid. The liver was healthy, except in one part of its upper surface, which presented an ecchy

mosed appearance, but which really consisted of a number of small veins distended with blood in an arborescent form. In the upper lobe of the right lung, not the apex, two deposits about the size of nuts were found, of a yellowish-white friable matter, much resembling recently deposited lymph and pus. The lower lobe of the left lung gave evidence of previous pneumonia. There were no tubercles, nor was any disease found in the other organs.

Mr. Micklethwait mentioned two other fatal cases of phlebitis following amputation, and remarked that no allusion to this somewhat unusual termination is to be found in either the works of Sir Astley Cooper or Mr. Fergusson.

MR. WAKLEY'S MEDICAL REGISTRATION BILL OF 1847.

A BILL

For the Registration of Qualified Medical Practitioners, and for Amending the Law Relating to the Practice of Medicine in Great Britain and Ireland.

Preamble. Whereas the laws relating to the Practice of Medicine in Great Britain and Ireland are numer. ous, complicated, and contradictory, and the public possesses no certain means of distinguishing between legally qualified physicians, surgeons, and apothecaries, and the mere pretenders to a knowledge of medicine and surgery, and it is desirable that the names and qualifications of the regularly educated practitioners in medicine should be duly registered by competent authority:

1. Registrars to be appointed.—Be it enacted, by the Queen's Most Excellent Majesty, by and with the advice and consent of the Lords Spiritual and Temporal, and Commons, in this present Parliament assembled, and by the authority of the same, That one of Her Majesty's Principal Secretaries of State shall, within one month after the passing of this Act, nominate and appoint three fit and proper persons, being at the time of such appointment qualified to be registered under the provisions of this Act, to be the registrars for carrying this Act into execution, one such registrar to be called the "Medical Registrar for England," another, the "Medical Registrar for Ireland," and the third, the "Medical Registrar for Scotland," and that he shall also from time to time appoint such clerks and other officers as he, the said Secretary of State, shall deem necessary for the assistance of the said registrars in carrying into execution the provisions of this Act; and that the said Secretary of State may at his discretion remove any registrar or other person so appointed aforesaid; and that upon the death or resignation of as any such registrar or other clerk or officer as aforesaid, or other vacancy in either of the offices so filled, the said Secretary of State shall appoint other proper persons to be such registrars, clerks, and officers

respectively; and there shall be paid to the said registrars, clerks, and messengers, out of any monies to be received by the said registrars by virtue of this Act, such salaries as shall be from time to time fixed and allowed by the Lord High Treasurer or the Commissioners of Her Majesty's Treasury, who may also allow such reasonable travelling expenses as may be incurred by any registrar, clerk, or messenger in the performance of his duties/under this Act, and such other reasonable expenses for putting and carrying this Act into execution, as the said Lord High Treasurer or the Commissioners of Her Majesty's Treasury shall think fit.

2. Monies to be paid to Medical Registration Fund of Great Britain.-And be it enacted, that all monies received by the registrars aforesaid, in carrying this Act into execution, shall be paid by them into the Bank of England, at such times and in such a manner as the Secretary of State aforesaid shall direct, to the credit of the Lord High Treasurer, or the Commissioners of Her Majesty's Treasury, and in the name of the "Medical Registration Fund of Great Britain and Ireland."

3. Registration of Names, &c., of Qualified Medical Practitioners. And be it enacted, that the several registrars shall, within thirty days after their appointment, and from time to time aftewards, register, according to the form in schedule (A) to this Act annexed, in books to be kept for that purpose, and without any fee whatsoever, the name and place of residence, together with a description of the legal qualification or qualifications, with the date or dates thereof, of every physician, surgeon, and apothecary who shall apply to be registered, and who, prior to the passing of this Act, shall have taken a degree in medicine in any English, Irish, or Scotch University, or who shall apply to be registered, and shall produce his diploma, certificate, or license, or other proof of his having obtained a diploma, certificate, or license to practise as a physician, surgeon, or apothecary, dated prior to the passing of this Act, and granted by any English, Irish, or Scotch University, College, or Society, or any corporation, sole or aggregate, in England, Ireland, or Scotland, legally entitled to grant the same; and also of every person who shall apply for the same, who was actually practising as an apothecary in England and Wales prior to the first day of August, one thousand eight hundred and fifteen, and who shall sign a declaration according to the form in schedule (B) to this Act annexed, and also of every surgeon and assistant surgeon of the army and navy, and in the service of the Honourable the East India Company, who shall apply for the same, and of every physician, surgeon, and apothecary, upon the payment of Two pounds, who, after the passing of this Act, shall take a degree in medicine as aforesaid, or produce a certificate, licence, or diploma as aforesaid, dated subsequently to the passing of this Act.

4. Registrars to issue Annual Certificates to Registered Practitioners.-And be it enacted, that the several registrars aforesaid shall issue a certificate, according

within his jurisdiction, for a term not exceeding one calendar month when the sum does not exceed forty shillings, and for a term not exceeding three calendar months when the sum does not exceed five pounds.

20. Application of Penalties.-And be it further enacted that any sum or sums of money arising from conviction and recovery of penalties for offences committed against the authority and provisions of this Act, shall be paid to the account of the Medical Regis. tration Fund aforesaid, towards defraying the expenses of this Act.

21. Uniformity of education, qualificatirn, and fees throughout the kingdon.-And be it enacted, that the several colleges and other examining bodies shall, from time to time, prepare and lay before the said Secretary of State a scheme or schemes of the course of study, and particulars of the examination, to be passed by all persons applying to such colleges and other bodies respectively for letters testimonial as a physician, or surgeon, or apothecary, and also an account of the fees proposed to be taken by the said colleges and bodies respectively for such letters testimonial. And whereas it is expedient and desirable that the qualifications and fees for the said testimonials should be uniform, according to the nature thereof, throughout Great Britain and Ireland; such scheme or schemes shall therefore be of no force or effect until they shall have been submitted to her Majesty in council, and shall have received her Majesty's sanction and approval.

22. Inspection and Supervision of Examinations.And be it enacted, that the said Secretary of State may, from time to time, require returns to be made in such form, and including such particulars as he shall think fit, respecting the examination to be conducted for medical degrees, diplomas, and licences, and it shall be lawful for any person deputed by the said Secretary of State, being a physician, surgeon, or apothecary, registered under this Act, to be present at any of the said examinations, and to report to the said Secretary of State, and if he shall be of opinion that the regula. tions approved by her Majesty in council for the examination and grant of letters testimonial as physician, surgeon, or apothecary, have been infringed, evaded, or neglected by any of the examining bodies, it shall be lawful for the said Secretary of State to admonish the said offending body; and if such admonition be neglected, then to direct the registrars as aforesaid to refuse to register upon the testimonials of the body so in default, until the conduct of such body shall be altered to the satisfaction of the said Secretary of State.

23. Examiners may take Candidates to Hospitals, &c. for practical Examination.-And be it further enacted, that the duly appointed examiners of candi. dates for degrees, diplomas, and licences in medicine, shall be empowered, under such regulations and restrictions, and at such times, as shall be approved by the

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public medical institutions, and also at any workhouse, for the purpose of ascertaining the practical knowledge of such candidates, from an inspection of sick and diseased persons.

24. Act not to affect examinations of Students of Two Years' standing.-And be it enacted, that students in medicine who at the time of the passing of this Act shall have been engaged two years and upwards in attending lectures in any medical school, or the practice of a public hospital, or other institution, in conformity with the regulations of any college having power to confer degrees or diplomas in medicine or surgery, shall not be affected, while completing their studies, or in passing their examinations, by anything in this Act contained; but such students shall be entitled to complete their education, and undergo their examinations, as though this Act had not been passed.

25. Act not to extend to Dentists or Cuppers in business before 1st September, 1846.-And be it enacted, that not anything in this Act contained, shall extend, or be construed to extend, to the profession or business of any dentist or cupper, who has engaged in such profession or business on or before the first day of September, eighteen hundred and forty-six; but every such dentist or cupper shall conduct such profession or business in as free and ample a manner as though this Act had not been passed.

26. Act not to affect the trade or business of Chemists and Druggists. (Fifty fifth George III., c. 194, s. 28.) Provided always, and be it further enacted, that nothing in this Act contained shall extend, or be construed to extend, to prejudice, or in any way to affect, the trade or business of a chemist and druggist, in the buying, preparing, compounding, dispensing, and vending drugs, medicines, and medicinable compounds, wholesale or retail; but all persons using or exercising the said trade or business, or who shall or may hereafter use or exercise the same, shall and may use, exercise, and carry on the same trade or business in such manner, and as fully and amply, to all intents and purposes, as the same trade or business was used, exercised, or carried on by chemists and druggists before the passing of this Act.

27. Registered Medical Practitioners exempted from serving on Juries, Inquests, &c.—And be it enacted, that every person who shall be registered and possess a certificate in force under the provisions of this Act shall be exempt, if he shall so desire, from serving on all juries and inquests whatsoever, and from serving all corporate, parochial, ward, hundred, and township offices, and in the militia, and that the name of such person shall not be returned in any list of persons liable to serve in the militia, or in any such office as aforesaid; and no person shall be entitled to such exemption as aforesaid on the ground of being a physician, surgeon, or apothecary, who does not possess such certificate then in force as aforesaid, any Act to the contrary notwithstanding.