MEMORIAL OF THE NATIONAL INSTITUTE. class of Practitioners of which your Memorialists constitute a large proportion, practising not only Physic and Surgery, but Midwifery also,—the last mentioned branch not being comprised in the range of practice generally undertaken by the members of either of the two former classes; and that this tripartite division of the practice of Medicine must continue to exist. That, of every hundred Practitioners in this country, more than ninety belong to the class which your Memorialists represent; and that the greater number of the individuals constituting this numerous class are Legally and fully qualified as General Practitioners, by possessing a Licence to practise Medicine, and a Diploma, granted after an examination by the College of Surgeons, and qualifying them as Surgeons; although there are many exceptions to this rule, arising out of the anomalous state of the existing laws relating to Physic aud Surgery. That the General Practitioners have ever been, and still continue, the ordinary professional attendants of many members of the aristocracy, and of by far the greater proportion of the middle classes of society, and that they may be considered exclusively the Medical Advisers of the labouring population of this country; Physicians and Pure Surgeons acting as Consulting Practitioners, and their assistance being called for in cases of great emergency or difficulty arising in their respective departments; and that the Physician or the Pure Surgeon, or both, educated specially, and confining their practice to their respective departments, can Dever supersede the necessity which exists for a competent body of Medical Practitioners performing all the functions of the present class of General Practitioners, and educated to the highest practicable standard of qualification in the science and art of Medicine and Surgery. That, in further illustration of the views of your Memorialists, your Memorialists regard the division of Medical Practice into distinct departments, as those of Physic and Surgery, presided over by special Institutions, and represented by different individuals, as an arrangement chiefly adapted for densely-populated and wealthy communities, and generally available by the rich only; and that, even in the Metropolis and in the larger towns, the General Practitioners must always constitute a majority of the Profession, while in country districts, the division of labour here indicated is totally impracticable; and your Memorialists have a thorough conviction that the well-being and comfort of every class in this great community are more or less dependent upon the competency and skill of this class of Practitioners; and that every defect in the Medical Institutions of the country, or any line of policy cal. culated to retard the progressive improvement of the General Practitioners, or to depress the standard of their qualification, or to diminish their scientific and practical attainments, or in any way to lower their status in society, has not only the effect of debasing the character of the Profession in this country, and of retarding the progress of Medical Science, but is fraught with incalcalable, direct, and consecutive evils to society at large. That, notwithstanding these considerations, the 49 General Practitioners of Medicine, Surgery, and Midwifery are without a head or home amongst the Institutions of this country, and their position is at present most anomalous. They are acknowledged as Practitioners of Medicine alone, under the Apothecaries" Act, and they have been recognized as Practitioners of Surgery alone by the College of Surgeons: neither the Society of Apothecaries nor the College of Surgeons recognizes them as Practitioners of Medicine and Surgery-as one Profession. The College of Physicians, by its constitution and bye-laws, can have no sympathy with them, but a direct interest in maintaining the class in point of education, general and professional, and qualification to practise Medicine at as great a distance from the standard of that College as possible. Since the recent grant of a Charter to the College of Surgeons, that College has no sympathy with them, but has a direct interest in maintaining them in point of general and Professional education and qualification to practise Surgery at as great a distance as possible from the standard of qualification adopted for the fellowship of that College; and the College of Surgeons has, moreover, rendered it totally impracticable for any great proportion of them as General Practitioners-although possessing its own Diploma as Surgeons-ever to become Fellows of the College. The examinations instituted by the Apothecaries Society, and their Certificate relating only to the practice of Medicine, obviously are inadequate to their present requirements; and yet, by a singular anomaly, this Society is the only body capable of giving a Legal title to practise. Thus, although, as your Memorialists have shown, the General Practitioners constitue an indispensable professional body, which has been created by the customs and necessities of the community at large, and although they have progressively increased in numbers, and may now be estimated at many thousands, and have rapidly advanced in scientific and professional acquirements, and are possessed of great individual influence, they are unknown in a collective capacity; and legislative enactments have been attempted under the auspices of special Institutions, representing particular sections of the Profession, having interests peculiar to themselves, and diametrically opposed to those of the General Practitioners, without even an allusion to their existence. And your Memorialists most emphatically declare, that this anomalous state of the Profession operates as a direct infliction of the greatest evils upon society, especially by the systematic efforts which it engenders to depress the attainments, the character, and the status of the General Practitioners, and by arresting the progress and preventing the diffusion of knowledge in the great body of the Profession. That, for these and other considerations, it has for a long time past been acknowledged by all parties, that the laws affecting the Medical Profession are most defective; and your Memorialists having been led to hope that the present Government may entertain the question of Medical Reform during the ensuing Session of Parliament, your Memorialists have felt it their duty respectfully to call the attention of the Government to age, is worthy the consideration of a paternal Govern. ment, and of a social reform Ministry; and that such a step would develop the energies of the Medical Profession in a manner and to an extent hitherto unprecedented in this country,-would maintain the respectability of the great mass of the Profession-would promote the science and art of Medicine and Surgery; and, inasmuch as the duties of the General Practitioners have an intimate connection with every Legislative proceeding bearing upon Public Hygiene and Sanatory some of the more prominent circumstances relating to the class which they represent; and they have felt called upon to do so at the present moment more especially, as various attempts have been made from time to time to induce the Legislature to revise the said Laws; which attempts have failed, owing-according to the belief of your Memorialists-to the interests of the General Practitioners, as before recited, not having been duly recognized, and the Public welfare, as connected with the efficiency and respectability of the great mass of the Profession, having been accord-improvement, would be one of the most direct and ingly entirely overlooked. That, in the opinion of your Memorialists, the principle objects of Legislation in Medical affairs are, to promote the Public health, by securing the education of a sufficient number of persons for the practice of the Profession to meet the Medical and Surgical exigencies of the community, to ensure the advancement of Medical and Surgical knowledge and its general diffusion among all classes of the Profession, and to protect the rights and privileges of the Public, and of qualified Practitioners, by rendering it penal for unqualified persons to practise. That different plans of Medical Reform having been suggested, but every attempt to effect such reform having hitherto proved abortive, and your Memorialists having stated truly what they believe to have been the efficient means of ameliorating and preventing those social evils which are acknowledged to prevail to a lamentable extent in this highly civilized community. That your Memorialists therefore pray that no Bill affecting the Medical Profession may be brought into Parliament which does not recognize the General Practitioners as a class, and provide for them an efficient control over the education of the members of that class, so that they may not only maintain the high standard of qualification which is now adopted, but that, by the cultivation of collateral sciences, they may promote the progressive improvement of the class, and thereby secure the true respectability of the great body of Practitioners in this country, to whose skill and judgment the limbs and lives of the mass of the population are entrusted. chief cause of failure in these attempts, our 2% 138Na ists do not desire, upon the prseent occasion, Your Memorialists, in conclusion, have only respect fully call the serious attention of the Right Honour sentiments contained in this Memorial, in full confidence that matters of so much importance to the Profession of Medicine in this country, and to the Public interests, will meet with due consideration, and respectfully to request that an opportunity may be afforded them of giving, as they are prepared to give, the fullest explanation that may be required by a Deputation from their body, or otherwise, as may be most convenient. (Signed,) ROBERT RAINEY PENNINGTON. President. General Retrospect. to press their own opinions upon the Government, asable the Secretary of State, to the facts, opinions, and to the principles, or to enter into the details of a measure of Medical Reform; but they are anxious to assure the Government that they would most gratefully accept of a settlement of this long-agitated question, from whatever source it may come, provided the interests of the General Practitioners were duly regarded in any measure that may be proposed, that efficient Medical and Surgical advice and attendance were secured for all classes of the community alike, and that proper encouragement were given to the advancement and diffusion of Medical and Surgical knowledge. At the same time, your Memorialists, aware, from their former Offices, pro tem: Hanover Square Rooms, experience, of the obstacles that are likely to he opposed to Legislation on the subject of Medical Reform, feel it their duty further to state that, although they would be willing to accept such a modification of either of the existing Institutions as should make it the head and home of the General Practitioners, giving the General Practitioners therein the means of securing a complete and efficient Medical and scientific educa. tion for their own class, yet they have a strong conviction that the objects of Medical Reform can only be certainly attained by the stablishment of a New College, distinct and different from either of the existing special Institutions, which shall embrace all persons possessed of any recognized qualification or license whatever, and in actual practice as General Practitioners at the time of its foundation, and shall provide for the education and qualification of all its future members; and further, your Memorialists cannot refrain from the remark, that the founding of a New College, in accordance with the spirit of the present PATHOLOGICAL CHEMISTRY. ON THE CHARACTERS OF THE URINE, THE BLOOD, Heller has recently published a long memoir in which he has displayed the results of numerous researches relative to the pathological characters of the Auids, in albuminous nephritis. As this memoir gives a very complete insight into our knowledge on the subject, we think the following brief analysis may be acceptable to the readers of the Provincial Journal. 1. Characters of the Urine.-The progress of albuminous nephritis comprises three distinct periods, each of which is characterised by particular modifications in the urine. In the first or period of congestion, the secretion has a deep red colour, which is due to GENERAL RETROSPECT. the presence of blood, or at least to its colouring matters. Nevertheless the reaction is ordinarily acid, excepting blood be present in an unusual quantity. In the second or chronic stage of the disease, the urine is more pale, of a straw colour; while in the third period, it again contains blood, but it is at this time strongly alkaline, ammoniacal and foetid. The secretion of urine is usually diminished during the whole course of the disease, excepting in some rare instances in the chronic stage, when its quantity is augmented. 51 seen in the urine at the time of excretion, but are often visible after it has stood for some time. They appear as a crystalline mass of an indistinct blue colour.-5. Crystals of ammoniaco-magnesian phosphate.-6. Carbonate of ammonia. Both these are peculiar to the last stages. ammonia. The The specific gravity is variable. In one instance observed by Heller, it ranged from 1.006 to 1.048. In order to gain a correct measure of the specific gravity, the albumen should be first coagulated by heat and afterwards separated by filter. The re-action of the urine is almost always acid in this disease, which reaction Heller thinks is sometimes due to the uroxanthin, as it cannot always be accounted for by the presence of uric or hippuric acid. In the first period, the urine, which is turbid, and effect of the presence of blood in any quantity is to render the urine alkaline. In the latter stages the high coloured, deposits either a whitish sediment, or a sediment which is coloured by the mixture of blood-alkalinity is due to the development of carbonate of globules; the super-natant liquor is at the same time clear and red. The presence of the perfect bloodglobules is not, however, in all cases, the cause of the deep colour of the urine; it is sometimes due to the bæmatosin alone. The urine may be acid, neutral, or alkaline, and its specific gravity is always below par. In the second period, in which the urine is turbid but clear, the deposit is of a browner colour; in this period the reaction is acid. Later, the urine is often very pale, like thin whey, and deposits a light-coloured flocculent sediment; the urine at this time rapidly becomes ammoniacal; its specific gravity is, as before, diminished. In the latter periods the deposit is again reddish, from admixture of blood-globules; it is sometimes ammoniacal at the moment of excretion, but at all events soon becomes so; the specific gravity also rises. Among the different substances contained in the urine of albuminous nephritis, there are some which require special mention, and first of the uroxanthin. This substance presents itself in solution as a yellow colouring matter, and exists in considerable quantity, changing either immediately or more slowly to a violet colour, after the precipitation of albumen either by beat or nitric acid. Albumen is another constant ingredient, but varies greatly in quantity; sometimes it is scarcely to be recognised, at others the urine coagulates into a solid tremulous mass. At the close of the disease the albumen often nearly disappears. Urea is always present but in diminished quantity. The salts are less abundant than natural, not only absolutely but relatively. 2. Characters of the Blood.-The blood in this disease loses its density in a notable manner, in consequence of the loss of albumen. It, however, retains its natural appearance and coagulates perfectly. The serum is pale and of a low specific gravity. It contains urea in considerable quantity, but no biliary colouring matter. The fibrin and globules are not materially changed. The chief alteration therefore consists in a loss of albumen and the presence of urea; the latter condition, however, is not peculiar to the disease in question, but is observed also in cholera and in ischuria renalis. In examining microscopically these various sediments, it is perceived that they are composed of two classes of materials, one comprehending those which are normally and constantly present in urinary deposits; the second, those which are accidentally present. The constant ingredients are:-1. The Pavement epithelium. This epithelium is always found in large quantity, especially at the commencement of the disease, at which time the deposit is almost entirely composed of it. The epithelial cells are not, however, of a natural figure, being rather round than oval, with very distinct nuclei.-2. The Epithelium of the tubes of Bellini. This epithelium is generally small in quantity at the commencement of the malady, wherein it differs from the former. It presents itself under the form of colourless canals, containing brownish nuclei of variable size. Considerable attention is required to detect the species of epithelium in the urinary deposit, as it is frequently so transparent as to elude observation.-gravity. It contains albumen in small quantity, a 3. Albuminous flocculi. (Albumin pilze.) These are very distinct, especially when the urine is alkaline, of various shapes and sizes, and resemble fragments of pearls.-4. Mucus-globules.—5. Inflammatory globules. These are found for the most part during the stage of congestion.-6. Fatty globules. Which exist principally in the chronic stages of the disease. The accidental matters found in the urine of Bright's disease, are,-1. Crystals of uric acid, for the most 3. Characters of the Dropsical effusions.—This fluid is of a pale yellow colour, alkaline, and of a low specific circumstance which distinguishes it from the fluid of other forms of dropsy, in which, on the contrary, albumen is abundantly present. It never contains the colouring matter of the bile. By rest it deposits a small quantity of fibrin. It contains also epithelial cells, and salts in large quantity, and more particularly the chloride of sodium. that the constituents of the urine, blood, and serous effusions in albuminous nephritis preserve a certain definite relation. The water which should pass into the uriue is found in the effusions; the albumen which is missed from the blood, is found in the urine, It is evident, therefore, from the above researches, and to a small amount in the effusions; the urea deficient in the urine is discovered in the blood; and lastly, the salts which are absent from the urine appear in the dropsical effusion. (Archiv. für Physiolog.und Patholog. Chimie und Microscopie. 1846. t. 2. PATHOLOGY. BRIGHT'S DISEASE OF THE KIDNEY. The following conclusions, drawn by Dr. George Robinson, are the result of his researches on the pathology of Bright's disease : 1. That the epithelial or secreting cells of the healthy kidney contain a certain quantity of oil; the proportion of which, under certain circumstances, and, within certain limits, may fluctuate considerably. 2. That it is an excessive increase of this fat leading to engorgement of the epithelial cells, and of the urinary tubes, which constitutes primarily and essentially Bright's disease of the kidney. 3. That the presence of albumen and blood in the urine, and the wasting of the tissue of the kidneys, are secondary phenomena, dependent on the mechanical pressure of the accumulated fat. 4. That, in the majority of cases, Bright's disease is associated with a similar fatty degeneration of the liver and arteries, and frequently of the valves of the heart; these diseases being related to each other as joint effects of one common constitutional cause. 5. That probably acute inflammatory dropsy, occurring in a person previously healthy, and the dropsy which occasionally supervenes upon scarlatina, have no necessary connection with Bright's disease of the kidney. been produced by physical lesions of the nerve,-such as wounds, punctures, contusions, ligature, compression by a tumour, &c.; in fact, neuritis is always, or nearly always, the result of mechanical injury, while neuralgia originates spontaneously, and depends upon a particular, and little understood, condition of the economy. But if it is sometimes possible and useful to establish this distinction in practice, especially in neuralgia and neuritis of recent date, it cannot be denied, that in a certain number of cases of chronic neuritis, the distinction becomes impossible; for although it has been ascertained that neuralgia of very old standing (thirty or forty years for example,) may have preserved its original character throughout, and yet left no traces of disease after death, it happens in the majority of cases, that under the influence of the repetition of the paroxysms, the texture of the nerve eventually becomes altered to such a degree, as to render it quite impossible to decide whether the inflammation has been secondary, or has depended upon an original neuritis. These cases shew the inutility of attempting a diagnosis in the chronic forms of the affections.- Gazette Médicale de Paris, No. 40, 1846. THE URINE IN ASCITES. In ascites, dependent on lesion of the liver, the urine is always more or less deeply coloured; whilst in renal ascites, (Bright's disease or otherwise,) the urine is white and colourless-(Rayer.) This characteristic condition of urine in ascites was perfectly known to the Arabian physicians.-Monthly Journal of Medical Science, December, 1846. TINCTURE OF CANTHARIDES IN BRIGHT'S DISEASE. This medicine, in the dose of from fifteen to twenty drops," par pot de tisane," combined with the use of decoction of bark and chalybeates, is the remedy which has given the best results in the treatment of albumi already been cured by this treatment.-Ibid. 6. That most important evidence of the approach and presence of the renal disease may often be derived from a microscopical examination of the urine, in which will be found fat in unusual quantity; partly in the form of free oil globules, and partly contained in epi-nous nephritis,-(Bright's Disease.) Many cases have thelial cells which have escaped from the urinary tubes. 7. That the insight which we have obtained into the peculiar change which the kidney undergoes in Bright's disease, and the knowledge we possess of the simultaneous occurrence of a similar change in other organs, may serve as important guides in the prevention and cure of the disease.-Medico-Chiurgical Transactions, Vol. 29. PRACTICAL MEDICINE, &c. DIAGNOSIS OF NEURALGIA AND NEURITIS. Although in some cases the symptoms of these two affections of the nerve are so nearly similar, that it is difficult to distinguish at first sight the one from the other, the confusion will cease in general, if, instead of inquiring into the actual condition of the patient, our inquiries are directed to the prior history of the attack, its progress, and exciting cause. While, in fact, neuralgia is a very common affection, arising without apprecíable cause, or from causes the most opposite in character, neuritis is a rare affection, and is determined by causes which are readily appreciated. In analyzing the best authenticated cases of neuritis, it will be found that, with the exception of some few cases, in which it followed parturition, neuritis has almost constantly TREATMENT OF EPISTAXIS BY INSUFFLATIONS When hemorrhage from the nasal cavities assumes a dangerous aspect, recourse is generally had to plugging, a measure both inconvenient and painful. M. Lecluyse has successfully employed means far more simple, and at the same time, according to his own account, more certain-namely, the insufflation by means of a quill of equal parts of powdered gum arabic and alum. In one case this succeeded after three repetitions; other means, and plugging among them, having entirely failed.-Gazette des Hôpitaux, Nov. 3, 1846. SURGERY. SALIVATION FROM CAUTERIZATION OF THE CERVIX M. Lisfranc has observed that the application of this form of mercury will produce salivation in about one case in two hundred; but the symptoms are not in general severe. In one case, however, a female, in the ward of St. Augustin, in the Hospital of La Pitié, a single cauterization produced an abundant and obstinate GENERAL RETROSPECT. ptyalism. [This fact is worthy of being remembered, not only as contradictory of the opinion generally entertained of the comparatively low vitality of the cervix uteri, but as a caution which should not be without value, in reference to the mode of treating uterine engorgements now much in vogue.]-Gazette des Hopitaux, Octobre 17, 1846. ON THE DIVISION OF THE TENDO ACHILLIS. Professor Stromeyer has lately published the following propositions, in which he lays down the indications for, and the manner to proceed in, dividing the tendo Achillis : 1. The tendo Achillis ought be divided with a small thin knife, with a sharp point, and slightly rounded, employing the subcutaneous section, and cutting from within to without, taking care to make but one puncture of the skin. 53. irritated, and perhaps even the new tissue will give way. 13. It is impossible to name precisely the duration of the treatment. This must in some degree depend on the state of the patient, the degree of the deformity, and the extensibility of the articular ligaments.—Ib.. Nov. 10, 1846. FORENSIC MEDICINE. ON THE POSSIBILITY OF PRODUCING BURNS AFTER DEATH RESEMBLING THOSE PRODUCED DURING LIFE. A reference to any work on Forensic Medicine will shew the reader that the distinction between burns inflicted prior to, and after death, is considered to be sufficiently precise. It would appear, however, from the experiments of M. Champouillon, that vesication which is considered to be characteristic of burns occurring during life, may be exactly imitated under 2. The tendon must be entirely cut through or the certain circumstances after death. "It is not," says M. operation will be unsuccessful. 3. When other muscles or the plantar aponeurosis are retracted at the same time as the tendon, the former must always be divided before the latter. 4. After the operation the wound must be dressed with compresses, bound on with a bandage in the figure of eight. 5. With adults, on the fourth or fifth day after the operation, and with children, on the third or fourth, the first dressing must be removed, and if (as is often the case,) the wound is found to be healed, it must be opened again; this must never be done when there is great ecchymoses, or when the wound suppurates. 6. Before putting the foot in the machine for extension, the limb must be surrounded by a sound bandage, and some pads of cotton must be placed on all the parts that are to be submitted to great compression. 7. Extension must be proceeded with gradually and slowly, lessening it each time it gives pain to the patient. 8. The dressings must be removed if the patient suffers much and continued pain in the parts compressed, in order to avoid excoriations, erysipelas, or mortification of the tissues. Champouillon, "by the immediate contact of a heated body, with an infiltrated limb, that it is possible to induce phlyctenæ in a corpse; we may in this manner induce vesication, it is true, but the elevated epidermis encloses air and not serosity." The number and size of the vesications according to him depend upon the temperature of the heated body, its distance from the skin, and the length of time the latter is submitted to its influence. "If," he adds, " a heated body, such as a red-hot bullet, be placed at a few centimetres distance from an anasarcous limb, no appearance of vesication is produced." If, on the contrary, it be placed within a convenient distance, one or more vesications are constantly produced. An attentive study of the causes which give rise to this phenomenon have shewn him that it is due to the effect of caloric upon an œdematous part,-a tissue charged with serosity. The action is no other than the rarefaction produced by the calorific body on the circumambient atmosphere, which rarefaction is proportioned to the degree of heat and the radiating power of the heated body. In anasarca the effused fluid diminishes the force with which the different laminæ of the cutaneous tissue cohere 9. Immediately upon taking off the dressings the together; and it happens, therefore, that when by the limb must be enveloped in wool. 10. It ought to be known, that all those who have bad the tendo Achillis divided, have felt a sensation of cold and numbness, which is sometimes limited to the heel, sometimes extends over the whole limb. This sensation gradually diminishes, and generally disappears entirely by the sixth or eighth day. 11. The first day or the next morning after the operation, a viscid sweat of a disagreeable odour comes out on the foot, although the patient has never previously been subject to perspiration of the feet. 12. In placing the foot in the extension machine, it ought to be put in such a direction as to form a right angle with the leg; and this position ought to be maintained for eight days. After this period has elapsed, the limb must be enveloped in a circular bandage, and the patient must not be allowed to make any attempt to walk before the fourth week. Without this care, the limb will swell, the wound become rarefaction of the air near the heated body the atmospheric pressure is removed from the subjacent part of the corpse, the fluid accumulates there in virtue of a well-known physical law, and thus induce an elevation of the epidermis. M. Champouillon remarks, that these phlyctenæ do not appear instantaneously, but require the application of heat for six hours as a mean. As regards the red circle which Christison so strictly insists upon, as a proof of burning during life, Champouillon states that he has in no case failed to produce it in the corpse; but he allows, that however closely the red circle thus produced resembles that produced during life, the semblance is only superficial, and a difference is at once perceived by incising the skin. In the first case there is but a simple injection of the cutaneous capillaries; in the other there is evidence of vital re-action, in a concomitant extravasation of blood. The results of the authors' researches tend to establish |