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class of Practitioners of which your Memorialists con. General Practitioners of Medicine, Surgery, and Mid. stitute a large proportion, practising not only Physic wifery are without a head or home amongst the Instituand Surgery, but Midwifery also, the last mentioned tions of this country, and their position is at present branch not being comprised in the range of practice most anomalous. They are acknowledged as Prac. . generally undertaken by the members of either of the titioners of Medicine alone, under the Apothecaries* two former classes; and that this tripartite division of Act, and they have been recognized as Practitioners of the practice of Medicine must continue to exist. Surgery alone by the College of Surgeons : neither the
That, of every hundred Practitioners in this country, Society of Apothecaries oor the College of Surgeons more than ninety belong to the class which your recognizes them as Practitioners of Medicine and Memorialists represent; and that the greater number Surgery as one Profession. The College of Physicians, of the individuals constituting this numerous class are by its constitution and bye-laws, can have no sympathy Legally and fully qualified as General Practitioners, wich them, but a direct interest in maintaining the by possessing a Licence to practise Medicine, and a class in point of education, general and professional, Diploma, granted after an examination by the College and qualification to practise Medicino at as great a of Surgeons, and qualifying them as Surgeons; although distance from the standard of that College as possible. there are many exceptions to this rule, arising out of Since the recent grant of a Charter to the College of the anomalous state of the existing laws relating to Surgeons, that College has no sympathy with them, Physic aud Surgery.
but has a direct interest in maintaining them in point That the General Practitioners have ever been, and of general and Professional education and qualification still coutinue, the ordinary professional attendants of to practise Surgery at as great a distance as possible many members of the aristocracy, and of by far the from the standard of qualification adopted for the greater proportion of the middle classes of society, and fellowship of that College ; and the College of Surtbat they may be considered exclusively the Medical geons has, moreover, rendere it totally impracticable Adrisers of the labouring population of this country; for any great proportion of them as General Physicians and Pure Surgeons acting as Consulting | Practitioners-although possessing its own Diploma Practitioners, and their assistance being called for in as Surgeons-ever to become Fellows of the College. cases of great emergency or difficulty arising in their The examinations instituted by the Apothecaries respective departments; and that the Physician or the Society, and their Certificate relating only to the Pure Surgeon, or both, educated specially, and con- practice of Medicine, obviously are inadequate to fining their practice to their respectire departments, can their present requirements; and yet, by a singular Lever supersede the necessity which exists for a com. / anomaly, this Society is the only body capable of giving petent body of Medical Practitioners perforining all a Legal title to practise. the functions of the present class of General Prac. Thus, although, as your Memorialists have shown, titioners, and educated to the highest practicable the General Practitioners constitue an indispensable standard of qualification in the science and art of professional body, which has been created by the customs Medicine and Surgery.
and necessities of the community at large, and although That, in further illustration of the views of your they have progressively increased in numbers, and may Memorialists, your Memorialists regard the division of now be estimated at many thousands, and have rapidly Medical Practice into distinct departments, as those of advanced in scientific and professional acquirements, Physic and Surgery, presided over by special Institu. and are possessed of great individual influence, they tions, and represented by different individuals, as an are unknown in a collectire capacity; and legislative arrangement cbiely adapted for densely-populated and enactments have been attempted under the auspices Wealthy communities, and generally available by the of special Institutions, representing particular sections rich only; and that, even in the Metropolis and in the of the Profession, having interests peculiar to them. larger towns, the General Practitioners must always selves, and diametrically opposed to those of the constitute & majority of the Profession, while in General Practitioners, without even an allusion to their country districts, the dirision of labour here indicated existence. And your Memorialists most emphatically is totally impracticable; and your Memorialists have a declare, that this anomalous state of the Profession thorough conviction that the well-being and comfort of operates as a direct infiction of the greatest evils upon every class in this great community are more or less society, especially by the systematic efforts which it dependent upon the competency and skill of this class engenders to depress the attainments, the character, of Practitioners; and that every defect in the Medical and the status of the General Practitioners, and by Institutions of the country, or any line of policy cal. arresting the progress and preventing the diffusion of culated to retard the progressive improvement of the knowledge in the great body of the Profession. General Practitioners, or to depress the standard of their That, for these and other considerations, it has for a qualification, or to diminish their scientific and practical long time past been acknowledged by all parties, that attainments, or in any way to lower their status in the laws affecting the Medical Profession are most society, has not only the effect of debasing the character defective; and your Memorialists having been led to of the Profession in this country, and of retarding the hope that the present Government may entertain the progress of Medical Science, but is fraught with incal. question of Medical Reform during the ensuing Session calable, direct, and consecutive evils to society at large. of Parliament, your Memorialists have felt it their duty
Tbat, notwithstanding these considerations, the respectfully to call the attention of the Government to
some of the more prominent circumstances relating to age, is worthy the consideration of a paternal Govern. the class which they represent; and they have felt ment, and of a social reform Ministry; and that such called upon to do so at the present moment more a step would develop the energies of the Medical Pro. especially, as various attempts have been made from fession in a manner and to an extent hitherto unpretime to time to induce the Legislature to revise the cedented in this country,-would maintain the respect. said Laws; which attempts have failed, owing-accord ability of the great mass of the Profession-would ing to the belief of your Memorialists-lo the interests promote the science and art of Medicine and Surgery; of the General Practitioners, as before recited, not and, inasmuch as the duties of the General Practitioners having been duly recognized, and the Public welfare, have an intimate connection with every Legislative as connected with the efficiency and respectability of proceeding bearing upon Public Hygiene and Sanatory the great mass of the Profession, having been accord. improvement, would be one of the most direct and ingly entirely overlooked.
efficient means of ameliorating and preventing those That, in the opinion of your Memorialists, the prin. social evils which are acknowledged to prevail to a ciple objects of Legislation in Medical affairs are, to lamentable extent in this highly civilized community. promote the Public health, by securing the education | That your Memorialists therefore pray that no Bill of a sufficient number of persons for the practice of affecting the Medical Profession may be brought into the Profession to meet the Medical and Surgical Parliament which does not recognize the General exigencies of the community, to ensure the advance Practitioners as a class, and provide for them an ment of Medical and Surgical knowledge and its general efficient control over the education of the members of diffusion among all classes of the Profession, and to that class, so that they may not only maintain the high protect the rights and privileges of the Public, and of standard of qualification which is now adopted, but qualified Practitioners, by rendering it penal for un- ihat, by the cultivation of collateral sciences, they may qualified persons to practise.
promote the progressive improvement of the class, and That different plans of Medical Reform having been thereby secure the true respectability of the great body suggested, but every attempt to effect such reform of Practitioners in this country, to whose skill and having hitherto proved abortive, and your Memorialists 'judgment de limbs and lives of the mass of the populahaving stated truly what they believe to bave been iba-tion are entrusted. chief cause of failure in these attempts, gour Memorial Your Mémotialists, in conclusion, have only respect ists do not desire, upon the prseent foccasiohi, runden fully call the serious attention of the Rigbt Honourto press their own opinions upon the Goyernment as able the Secretary of State, to the facts, opinions, and to the principles, or to enter into the detajls of a sentiments contained in this Memorial, in full confi. measure of Medical Reform; but they are mostoas to dence that matters of so much importance to the Pro. assure the Government that they would most gratefüITflession of Medicine in this country, and to the Public accept of a seltlement of this long-agitated question, interests, will meet with due consideration, and respect. from whatever source it may cowe, provided the interests fully to request that an opportunity may be afforded of the General Practitioners were duly regarded in any them of giving, as they are prepared to give, the fullest measure that may be proposed, that efficient Medical explanation that may be required by a Deputation and Surgical advice and attendance were secured for from their body, or otherwise, as may be most conall classes of the community alike, and that proper venient. encouragement were given to the advancement and (Signed,) ROBERT RAINEY PENNINGTON. diffusion of Medical and Surgical knowledge. At tbe
President. 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
General Retrospect. they would be willing to accept such a modification of either of the existing Institutions as should make it
PATHOLOGICAL CHEMISTRY. the head and home of the General Practitioners, giving the General Practitioners therein the means of securing
ON THE CHARACTERS OF THE URINE, THE BLOOD,
AND THE DROPSICAL EFFUSIONS IN ALBUMINURIA. a complete and efficient Medical and scientific education for their own class, yet they have a strong convic.
Heller has recently published a long memoir in tion that the objects of Medical Reform can only be which he has displayed the results of numerous recertainly attained by the stablishment of a New searches relative to the pathological characters of the College, distinct and different from either of the ex. Auids, in albuminous nephritis. As this memoir gives isting special Institutions, which sball embrace all a very complete insight into our knowledge on the persons possessed of any recognized qualification or subject, we think the following brief analysis may be license whatever, and in actual practice as General acceptable to the readers of the Provincial Journal. Practitioners at the time of its foundation, and shall 1. Characters of the Urine.- The progress of albuprovide for the education and qualification of all its minous nephritis comprises three distinct periods, future members; and further, yoor Memorialists cannot each of which is cbaracterised by particular modificarefrain from the remark, that the founding of a New tions in the urine. In the first or period of congestion, College, in accordance with the spirit of the present the secretion bas a deep red colour, which is due to GENERAL RETROSPECT.
the presence of blood, or at least to its colouring matters. seen in the urine at the time of excretion, but are Nevertheless the reaction is ordinarily acid, excepting often visible after it has stood for some time. They blood be present in an unusual quantity. In the second appear as a crystalline mass of an indistinct blue or chronic stage of the disease, the urine is more pale, colour.-5. Crystals of ammoniaco-magnesian phosof a straw colour; while in the third period, it again phate.-6. Carbonate of ammonia. Both these are contains blood, but it is at this time strongly alkaline, peculiar to the last stages. ammoniacal and fætid. The secretion of urine is The re-action of the urine is almost always acid in usually diminished during the whole course of the this disease, which reaction Heller thinks is sometimes disease, excepting in some rare instances in the chronic due to the uroxanthin, as it cannot always be accounted stage, when its quantity is augmented.
for by the presence of uric or hippuric acid. The In the first period, the urine, which is turbid, and effect of the presence of blood in any quantity is to high coloured, deposits either a whitish sediment, or render the urine alkaline. In the latter stages the 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 saine time I ammonia. clear and red. The presence of the perfect blood
| The specific gravity is variable. In one instance globules is not, however, in all cases, the cause of the observed by Heller, it ranged from 1.006 to 1.048. deep colour of the urine; it is sometimes due to the In order to gain a correct measure of the specific bæmatosin alone. The urine may be acid, neutral, gravity, the albumen should be first coagulated by or alkaline, and its specific gravity is always below par. | heat and afterwards separated by filter. In the second period, in which the urine is turbid but Among the different substances contained in the clear, the deposit is of a browner colour; in this urine of albuminous nephritis, there are some which period the reaction is acid. Later, the urine is often require special niention, and first of the uro.xanthin. Fery pale, like thin whey, and deposits a light-coloured This substance presents itself in solution as a yellow flocculent sediment; the urine at this time rapidly colouring matter, and exists in considerable quantity, becomes ammoniacal; its specific gravity is, as before, changing either immediately or more slowly to a violet diminished. In the latter periods the deposit is again colour, after the precipitation of albumen either by reddish, from admixture of blood-globules; it is some. beat or nitric acid. Albremen is another constant times ammoniacal at the moment of excretion, but ingredient, but varies greatly in quantity ; sometimes at all events soon becomes so; the specific gravity it is scarcely to be recognised, at others the urine also rises.
coagulates into a solid tremulous mass. At the close of In examining microscopically these various sedi.
the disease the albumen often nearly disappears. Urea ments, it is perceived that they are composed of two
is always present but in diminished quantity. The salta classes of materials, one comprehending those which
are less abundant than natural, not only absolutely but are normally and constantly present in urinary depo
relatively sits ; the second, those which are accidentally present.
2. Characters of the Blood.-The blood in this disThe constant ingredients are :--1. The Pavement case loses its density in a notable manner, in conseepithelium. This epithelium is always found in large quence of the loss of albumen. It, however, retains quantity, especially at the commencement of the dis- | its natural appearance and coagulates perfectly. The ease, at which time the deposit is almost entirely com- | serum is pale and of a low specific gravity. It contains posed of it. The epithelial cells are not, however, of a urea in considerable quantity, but no biliary colouring natural figure, being rather round than oval, with very matter. The fibrin and globules are not materially distinct nuclei.-2. The Epithelium of the tubes of changed. The chief alteration therefore consists in a Bellini. This epithelium is generally small in quantity | loss of albumen and the presence of urea; the latter at the commencement of the malady, wherein it differs condition, however, is not peculiar to the disease in from the former. It presents itself under the form of question, but is observed also in cholera and in colourless canals, containing brownish nuclei of variable | ischuria renalis. size. Considerable attention is required to detect the 3. Characters of the Dropsical effusions.—This fluid is species of epithelium in the urinary deposit, as it is of a pale yellow colour, alkaline, and of a low specific frequently so transparent as to elude observation.- gravity. It contains albumen in small quantity, a 3. Albuminous flocculi. (Albumin pilze.) These are circumstance which distinguishes it from the fluid of very distinct, especially when the urine is alkaline, of other forms of dropsy, in which, on the contrary, various shapes and sizes, and resemble fragments of albumen is abundantly present. It never contains pearls.—4. Mucus-globules.-5. Inflammatory globules. the colouring matter of the bile. By rest it deposits a These are found for the most part during the small quantity of fibrin. It contains also epithelial stage of congestion.-6. Fatty globules. Which exist cells, and salts in large quantity, and more particularly principally in the chronic stages of the disease.
the chloride of sodium. The accidental matters found in the urine of Bright's! It is evident, therefore, from the above researches, disease, are,—1. Crystals of uric acid, for the most
that the constituents of the urine, blood, and serous part colourless and of a rhomboid figure.-2. Urate of effusions in albuminous nephritis preserve a certain Ammonia, which exists principally in the early stages.
definite relation. The water which should pass into 3. Pus, generally seen in the early periods.-4. the urine is found in the effusions; the albumen Crystals of uro-glaucin. These crystals are seldom which is missed from the blood, is found in the urine,
and to a small amount in the effusions; the urea | been produced by physical lesions of the nerve,-such deficient in the urine is discovered in the blood; and as wounds, punctures, contusions, ligature, compression lastly, the salts which are absent from the urine appear by a tumour, &c.; in fact, neuritis is always, or nearly in the dropsical effusion. (Archio. für Physiolog. und always, the result of mechanical injury, while neuralgia Patholog. Chimie und Microscopie. 1846. t. 2. originates spontaneously, and depends upon a parPATHOLOGY.
ticular, and little understood, condition of the economy.
But if it is sometimes possible and useful to establish BRIGHT'S DISEASE OF THE KIDNEY.
this distinction in practice, especially in neuralgia and The following conclusions, drawn by Dr. George neuritis of recent date, it cannot be denied, that in a Robinson, are the result of his researches on the certain number of cases of chronic neuritis, the dispathology of Bright's disease :
tinction becomes impossible ; for although it has been 1. That the epithelial or secreting cells of the ascertained that neuralgia of very old standing (thirty healthy kidney contain a certain quantity of oil; the or forty years for example,) may have preserved its proportion of which, under certain circumstances, and, original character throughout, and yet lest no traces within certain limits, may fluctuate considerably of disease after death, it happens in the majority of
2. That it is an excessive increase of this fat cases, that under the influence of the repetition of the leading to engorgement of the epithelial cells, and of paroxysms, the texture of the nerve eventually becomes the urinary tubes, wbich constitutes primarily and altered to such a degree, as to render it quite impossible essentially Brighi's disease of the kidney.
to decide whether the inflamination has been secondary, 3. That the presence of albumen and blood in the or has depended upon an original neuritis. These urine, and the wasting of the tissue of the kidneys, are cases shew the inutility of attempting a diagnosis in secondary phenomena, dependent on the mechanical the chronic forms of the affections. Gazette Médicale pressure of the accumulated fat.
de Paris, No. 40, 1846. 4. That, in the majority of cases, Bright's disease is
THE URINE IN ASCITES. associated with a similar fatty degeneration of the liver and arteries, and frequently of the valves of the heart;
In ascites, dependent on lesion of the liver, the urine these diseases being related to each other as joint
is always more or less deeply coloured; whilst in renal effects of one common constitutional cause.
ascites, (Bright's disease or otherwise, the urine is 5. That probably acute inflammatory dropsy, occur.
white and colourless-(Rayer.) This characteristic ring in a person previously healthy, and the dropsy
condition of urine in ascites was perfectly known to which occasionally supervenes upon scarlatina, have no
the Arabian physicians.- Monthly Journal of Medical necessary conuection with Bright's disease of the
Science, December, 1846. kidney.
TINCTURE OF CANTAARIDES IN BRIGHT'S DISEASE. 6. That most important evidence of the approach This medicine, in the dose of from fifteen to twenty and presence of the renal disease may often be derired drops, “ par pot de lisane," combined with the use of from a microscopical examination of the urine, in which decoction of bark and chalybeates, is the remedy which will be found fat in unusual quantity; partly in the has given the best results in the treaiment of albumi. 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. already been cured by this treatment.--Ibid. 7. That the insight which we have obtained into the
TREATMENT OF EPISTAXIS BY INSUFFLATIONS peculiar change which the kidney undergoes in Bright's
OF ALUM. disease, and the knowledge we possess of the simultaneous occurrence of a similar change in other
When hæmorrhage from the nasal cavities assumes organs, may serve as important guides in the preven.
| a dangerous aspect, recourse is generally had to plug. tion and cure of the disease. -Medico-Chiurgical ging, a measure both inconvenient and painful. M. Transactions, Vol. 29.
Lecluyse has successfully employed means far more
simple, and at the same time, according to his own PRACTICAL MEDICINE, &c.
account, more certain--namely, the insufflation by DIAGNOSIS OF NEURALGIA AND NEURITIS, means of a quill of equal parts of powdered gum arabic Although in some cases the symptoms of these two and alum. In one case this succeeded after three affections of the nerve are so nearly similar, that it is repetitions ; other means, and plugging among them, difficult to distinguish at first sight the one from the having entirely failed.- Gazette des Hôpitaux, Nov. other, the confusion will cease in general, if, instead of 3, 1846. inquiring into the actual condition of the patient, our
SURGERY. inquiries are directed to the prior history of the attack, its progress, and exciting cause. Wbile, in fact, neu- SALIVATION FROM CAUTERIZATION OF THE CERVIX ralgia is a very common affection, arising without appre UTERI WITH ACID NITRATE OF MERCURY. ciable canse, or from causes the most opposite in M. Lisfranc has observed that the application of this character, neuritis is a rare affection, and is determined form of mercury will produce salivation in about one by causes which are readily appreciated. In analyzing case in two hundred; but the symptoms are not in the best authenticated cases of neuritis, it will be found general severe. In one case, however, a female, in the that, with the exception of some few cases, in which ward of St. Augustin, in the Hospital of La Pitié, a it followed parturition, neuritis has almost constantly single cauterization produced an abundant and obstinate
ptyalism. [This fact is worthy of being remem- irritated, and perhaps even the new tissue will give bered, not only as contradictory of the opinion generally way. entertained of the comparatively low ritality of the 13. It is impossible to name precisely the duration of cervix vteri, but as a caution which should not be the treatment. This must in some degree depend on without ralue, in reference to the mode of treating the state of the patient, the degree of the deformity, uterine engorgements now much in vogue.]-Gazette and the extensibility of the articular ligaments.-10.. des Hôpitaux, Octobre 17, 1846.
Nov. 10, 1846. ON THE DIVISION OF THE TENDO ACHILLIS.
FORENSIC MEDICINE. Professor Stromerer has lately published the fol. ON THE POSSIBILITY OF PRODUCING BURNS AFTER lowing propositions, in which he lays down the indi
DEATH RESEMBLING THOSE PRODUCED DURING
LIFE. cations for, and the manner to proceed in, dividing the
A reference to any work on Forensic Medicine will tendo Achillis :
shew the reader that the distinction between burns 1. The tendo Achillis ought be divided with a small
inflicted prior to, and after death, is considered to be thin koise, with a sharp point, and slightly rounded, I sufficiently precise. It would appear, however, from employing the subcutaneous section, and cutting from the experiments of M. Champouillon, that vesication within to without, taking care to make but one punc- l which is considered to be characteristic of burns tare of the skin.
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.
Champouillon, “ by the immediate contact of a heated 3. When other muscles or the plantar aponeurosis body, with an infiltrated limb, that it is possible to are retracted at the same time as the tendon, the induce phlyctens in a corpse; we may in this manner former must always be divided before the latter.
| induce vesication, it is true, but the elevated epidermis 4. After the operation the wound must be dressed encloses air and not serosity.” The number and with com presses, bound on with a bandage in the figure size of the vesications according to him depend upon of eight.
the temperature of the heated body, its distance from 5. With adults, on the fourth or fifth day after the
the skin, and the length of time the latter is submitted operation, and with children, on the third or fourth, the I to its influence. “If,” he adds,“ a heated body, such as first dressing must be removed, and if (as is often the a red-hot bullet, be placed at a few centimetres distance case,) the wound is found to be healed, it must be from an anasarcous limb, no appearance of vesication opened again; this must never be done when there is is produced.” If, on the contrary, it be placed within great ecchymoses, or when the wound suppurates. | a convenient distance, one or more vesications are con
6. Before putting the foot in the machine for exten- stantly produced. An attentive study of the causes sion, the limb must be surrounded by a sound bandage, which give rise to this phenomenon have shewn him and some pads of cotton must be placed on all the parts | that it is due to the effect of caloric upon an ædema. that are to be submitted to great compression. tous part,-& Lissue charged with serosity. The action
7. Extension must be proceeded with gradually and is no other than the rarefaction produced by the caloslowly, lessening it each time it gives pain to the patient. rific body on the circumambient atmosphere, which
8. The dressings must be removed if the patient rarefaction is proportioned to the degree of heat and suffers much and continued pain in the parts com- the radiating power of the heated body. In anasarca pressed, in order to avoid excoriations, erysipelas, or the effused Auid diminishes the force with which mortification of the tissues.
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.
rarefaction of the air near the heated body the atmos10. It ought to be known, that all those who have pheric pressure is removed from the subjacent part of bad the tendo Acbillis divided, have felt a sensation
10 Acbillis divided, bave felt a sensation the corpse, the Auid accumulates there in virtue of a of cold and numbness, which is sometimes limited to well-known physical law, and thus induce an elevation the heel, sometimes extends over the whole linnb. of the epidermis. M. Champouillon remarks, that This sensation gradually diminishes, and generally
gradually diminishes, and generally these phlycteuæ do not appear instantaneously, but disappears entirely by the sixth or eighth day. require the application of heat for six hours as a mean.
11. The first day or the next morning after the As regards the red circle which Christison so strictly operation, a viscid sweat of a disagreeable odour insists upon, as a proof of burning dưring life, comes out on the foot, although the patient has never
the foot, although the patient has never | Champouillon states that he has in no case failed to previously been subject to perspiration of the feet. produce it in the corpse; but he allows, that how
12. In placing the foot in the extension machine, I ever closely the red circle thus produced resembles it ought to be put in such a direction as to form a that produced during life, the semblance is only right angle with the leg; and this position ought to superficial, and a difference is at once perceived by be maintained for eight days. After this period has incising the skin. In the first case, there is but a elapsed, the limb must be enveloped in a circular simple injection of the cutaneous capillaries; in the bandage, and the patient must not be allowed to make other there is evidence of vital re-action, in a concomiany attempt to walk before the fourth week. Without | tant extravasation of blood. this care, the limb will swell, the wound become The results of the authors' researches tend to establish