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250 gentlemen under an annual fine or mulct of 201-the sum demanded for a license; and thus to acquire a revenue of 5,000l. a year at their expense. What the Apothecaries' Company aimed at was, not to prevent unskilful persons from practising as apothecaries, but to benefit themselves in a pecuniary point of view, and keep up their monopoly. They never inquired if a man were skilful or not, but whether he was able to pay the penalty. When he paid it, they sent him a certificate of practice without any examination. It appeared perfectly ridiculous that persons capable of acting as physicians, surgeons, and apothecaries in the army and navywho had retired on half-pay, and who were sufficiently skilful and intelligent in their profession to be of the utmost service to the community—should not be qualified to act as apothecaries without license from a body of men such as the Apothecaries' Company. Yet that was the situation in which 250 practitioners in the north of Ireland were placed, and from which they prayed to be relieved. The petitioners deprecated the monopoly, and the unjust taxation imposed by the Apothecaries' Hall. He called the attention of his noble friend (the Chief Secretary of State for Ireland) to the subject, which he conceived to be one that could not be passed over without investigation. The petitioners prayed for relief from the operation of the act of 1791, on their own behalf, and on that of all persons who had obtained licenses or degrees from any of the royal medical colleges in Great Britain or Ireland. That did not appear an unreasonable proposition: a diploma thus obtained was a better security than a certificate of the Apothecaries' Company. He hoped his noble friend would bring in a bill without delay to remove the inconvenience of the present system. The Apothecaries' Company were so well aware that the subject was one which would never stand the test of inquiry, that they were giving orders to levy the fines with the utmost expedition against the gentlemen who had rendered themselves liable to them. No time should be lost in taking the matter up; the subject was one which called for the interposition of the house, not only for the sake of the medical profession, but for the sake of the inhabitants of the country, more particularly of the north of Ireland."

"Lord F. L. Gower assured his hon. friend who had appealed personally to him

on the subject, that he had not overlooked the matter to which his honourable friend now directed his attention. Upon the presentation of a petition from the county of Down, on a former evening, to the same effect as those now presented, he took an opportunity of expressing his concurrence in the object of it as far as he could do without prejudging the case. He had put himself in communication with the authorities on the other side of the water for the purpose of ascertaining whether any answer could be made by the Apothecaries' Company to the allegations of the petitioners. He did not yet know the nature of the representations that would be made by the company; but he wished as much as any man, that the evil, if it were of the kind, or to any thing like the extent stated, should be remedied. He believed that under the statute incorporating the Apothecaries' Hall, any practising apothecary might become a member of the company on the payment of 1007. He was not aware that the company had adhered very strictly to the provisions of the statute, or exercised a prudent discretion in the course they had adopted.

"The petitions were ordered to be printed."

The knights of the pestle in Dublin will not be slow to perceive that these golden visions of five thousand a year from the unlicensed graduates in the North, are likely to be dissolved into thin air by Lord Gower and a British Parliament--not overnice in questioning the "wisdom of our ancestors," or even revising statutes that were, like the laws of the Medes and Persians to have been irrevocable.

We hope that the words of Lord Gower and Mr. Dawson will not be entirely lost on certain corporate_bodiesand especially the Company of Apothecaries, on this side of the Channel.

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The very same vexatious, and, we would add, unjust regulations exist in this country. If Sir Henry Halford, Sir Astley Cooper, or Sir Gilbert Blane, were, from choice or necessity, determined to add pharmacy to their other avocations, they must present themselves for examination and a license at HALL!!" So if a man have served in the highest offices of the army or navy medical departments or have graduated at the first universities of Europe, he must have the license of "THE HALL," before he can administer a saline draught, or a dose of calomel! We do not know whether or not the Apothecaries' Company insist on an actual examination in these cases-but if they demand any fee for the license, we maintain that they act illiberally and unjustly. All they should require is a sight of the diploma from a regular university—or the medical commission in army or navy. Those documents produced, the license should be granted-or rather the declaration should be made that the individuals alluded to did not come within the virtual meaning of the act of 1815. This would be the just, liberal, and honourable procedure-and if a contrary system be pursued, the aggrieved party should petition Parliament, as has been done by their brethren in the North of Ireland.

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particulars of which are worthy of record in a medical journal.

last, (Sunday,) a butler and a female servant On the evening of the 11th of October quarrelled in the pantry, and the former having a small tray, containing four knives and forks, in his hand, threw them down at the feet (as he alleged) of the female, in order to frighten her. The latter went out of the pantry for about three minutes, and then returned, saying she was wounded. The butler inquired where-and she replied in her side. She borrowed a silk handkerchief from the butler, and then went into the kitchen where there were prayers. In the night she was found to be ill, and next day tient. He found a wound of an inch in a surgeon, Mr. Bartlet, was called to the palength, between the spine of the ilium and the margin of the ribs, whence there had been considerable hæmorrhage. Mr. B. dressed the wound, without examining its depth or direction with a probe. She had been sick, and complained of great pain in the abdomen. She died at half-past one o'clock on Wednesday morning. On examination, Mr. Bartlett "found a knife lying transversely in the body, with the point a little turned upwards. It had penetrated the stomach, one of the small, and one of the large intestines. It had produced very extensive inflammation, which occasioned her death." It appeared that the clothes, including even the stays, were perforated by the knife. It also appeared that the female in question was of a most passionate temper

-that she had a great aversion to the butler's wife-and accused the man that day of being to see his wife, to whom she applied a most opprobrious epithet. These circumstances induce us to conclude that the deceased committed suicide under some mental hallucination or momentary gust of passion-perhaps of jealousy. It is quite impossible to suppose that the butler could have perpetrated such a crime, and worked a common cheese-knife through the clothes of a female, so as to be completely buried in the abdomen of his victim-and all this against her consent! The idea is preposterous. Nothing but a fit of desperate insanity could have enabled the deceased herself to accomplish such a horrible and destructive operation. Neither do we attach much importance to her dying declaration that the knife found its way into the posi

tion above described merely by being thrown at her from a tray. She absolved the butler from all design upon her life, and freely forgave him on her death-bed. The case has no parallel, except in the annals of insanity -and under that head we would certainly range the transaction, though it does not appear to have been so viewed by either judge, jury, or medical witnesses. The man was acquitted.

too hard, and applied it to cases to which it was in every point of view inapplicable. In the work of Mr. Bell on Diseases of the Bones, so fully noticed in the Review department of the last number, is detailed an interesting case of the affection in question. Every contribution to the stock of facts on a subject of which we know so little is a valuable boon to the profession. As the case is short, we give it in the author's words.

XXIV.

BLOODY TUMOUR OF BONE.

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The first case of this curious disease will be found, we believe, in the works of Mr. Pott, who observed it in the calf of the leg, and imputed it to a diseased condition and ture of the posterior tibial artery. In this pathological supposition it seems, from the cases which have since been detailed by other authors, by Scarpa, Mr Pearson, Mr. Else, Mr. Freer, of Birmingham, Mr. Hodg son, and still more lately by M. M. Lallemand and Breschet,* that Mr Pott was wrong. It appears that the disease resembles closely the aneurism by anastomosis, being seated in the smaller arteries not of the soft parts, but of the bones themselves, and especially the tibia and fibula. Breschet strongly recommends the application of a ligature to the femoral artery for the cure of this affection in its early stage, but knowing what we know respecting the failure of the ordinary operation for aneurism in cases of aneurism by anastomosis elsewhere, we are not only sceptical of the value of M. Breschet's proposition, but even dissent from it in toto The profession are beginning to discover, that they run the Hunterian operation for aneurism a little

M.

* A full account of the Mémoires of these gentlemen will be found in Vol. VII New Series, of this Journal, to which we refer our readers for information respecting the disease.

"The patient was a lady about sixty years of age, who had suffered from what she imagined to be rheumatism of the upper arm of the right side, at least, the arm was painful on being handled, and a feeling of aching was referred to the bone. In the course of several months after the first symptoms of the bone being affected had appeared, the upper arm began to swell, and the enlargement went on progressively increasing, until the middle portion of the diseased humerus measured more than double the circumference of the sound one. She suffered considerable uneasiness in the part, and the pain extended downwards to the points of the fingers. The surface of the tumour was not discoloured, but several large and swollen veins coursed over it. Before applying to my father she had consulted a bone-setter, who, according to the principles of his craft, recommended frictions and shampooing. This practice, the patient affirmed, had the effect of exasperating the disease, and of inducing intolerable pain.

"Although the real nature of the complaint was not suspected, still as it was on the increase, and presented some of those characters which are met with in osteo-sarcoma in its middle stages, and in spina ventosa in its more advanced, it was deemed proper, by the several surgeons assembled in consultation, among whom were Professor RUSSEL, Dr. ABERCROMBIE, and Mr. CRAIG, of Ratho, to amputate the limb. My father accordingly removed the arm from the socket of the shoulder-joint; there was little bleeding at the time, although the arteries which supplied the upper part of the limb with blood, were unusually dilated. About six hours after the operation, however, secondary hæmorrhage occurred, and it was found necessary to secure three large vessels,

which had not thrown out blood during the operation. This patient recovered in a short time from the operation, and suffered no return of the complaint, but died two years afterwards, from a sudden attack of pleuritis.

es of the disease have occurred to professional men, which have not met the eye of the public, but if any such there be, we trust that their possessors will enrich their brethren with the details.

"In order to ascertain whether any connection existed between the great vessels of the limb and the tumour of the bone, I injected the arteries of the arm from the humeral artery, with a preparation of glue and vermillion. The injection ran kindly, and flowed through the minutest of the distal arterial ramifications.

On removing the muscles, the tumour was found to be confined entirely to the bone. It was, when divested of the soft parts, nine inches in circumference, and six in length. The periosteum was entire, and somewhat thickened. On cutting into the tumour, the scalpel grated upon what seemed to be osseous depositions, which pervaded its tissue; but its general texture was of a fibrous character. A thin, though imperfect shell of bone, which was internal to, but in immediate contact with, the periosteum nearly coated the tumour.there was a large cavity, in the centre of the tumour, lined by an organized membrane, into the vessels of which the size injection had flowed; and the cavity itself was filled, partly with fluid blood of a dark colour, partly with concentric coagula, and partly with hardened injection.

"From the pathological appearances presented in this preparation, I have no hesitation in esteeming it as a specimen of what M. BRESCHET has termed Aneurism of Bone; and several able anatomists to whom I have shown it coincide in opinion with

me."

An etching of the bone, shewing the tumour in situ, and its section, is appended, but little of course can be learnt from it.We cannot dismiss the case without again expressing our conviction that the disease is not amenable to the ordinary operation for aneurism, and that whether in its earliest stages it be or be not remediable by nature or by art, that amputation is the only remedy when once it has acquired maturity and magnitude. It is not unlikely that casVOL. XI. No. 21.

XXV.

CLINICAL MEDICINE.

We are glad to see that this neglected branch of medical instruction, though the most important of all, is gradually lifting its head, and forcing itself on the attention of teachers and "public functionaries."

Dr. Gordon, of the London Hospital, a most zealous and talented physician has published an Introductory Lecture to his Course of Clinical Instruction, which we recommend to the perusal of all medical officers of public Institutions. It contains sound principles and most judicious advice-not only for the teacher, but the pupil. We can only offer an extract, as fatal errors of wild hypothesis, the able aua sample of the lecture. After exposing the for their share of censure. In truth, we have thor brings in the empyric and the routinist good reason to know, that practice without principles does infinitely more harm, because it has a much greater sphere for its action, than principles without practice!

"Let us now reverse the picture; and if hypothesis, how much more keenly might I have spoken with some severity of mere we depict practice without principles ?? How should we catch the ever varying lineaments of the many-headed monster 'empiricism,' in all its shades and gradations from the man, not of one idea, but of one drug, up to the respectable and regular practitioner, who has a particular remedy for each and every disease, without knowing what the disease really is, or in what organ of the body it is seated?-the empirical knowledge preached and acted upon by nurses and Lady Bountifuls, and by prac titioners who deserve to be ranked with them, confounding in their frightful confi27

dence one disease with another, treating colic for interitis, and rheumatism of the intercostals for pneumonia !

"The correction of both these errors is the great object of a clinical in course, which the attention of the student is directed to disease as it really exists; and thus supposing him to be, as he ought, acquainted with the principles of his profession, theory and practice are made mutually to aid and correct each other. Here he will also soon begin to learn a painful truth: -the uncertainty of his art, even when entered upon with every possible advantage; and understand the necessity which the conscientious practitioner feels of carrying along with him the principles by which a clinical course is regulated-the daily necessity of correcting his previous impressions, by the facts which come before him-of altering his confidence in the distinctive characters of disease, and the action of remedies. The uncertainty of our art, indeed, has not escaped the sneer of the philosopher, nor the sting of the humorist; and has been made the frequent theme of wit and ridicule. The following apologue, says D'Alembert, made by a physician, a man of wit and philosophy, represents very well the state of medicine-Nature is fighting with the disease-a blind man armed with a club, that is, the physician, arrives to settle the difference, he first tries to make peace :when he cannot accomplish this, he lifts his club and strikes at random. If he strikes the disease he kills the disease; if he strikes nature, he kills nature.' This story, which the humorist applies to the art itself, may not unaptly fit those who exercise it on unsound principles; and few of us there are who have not in our experience, seen specimens of practice in which the random blows of the blind man may be recognised."

"I have thus endeavoured to point out the indispensable connexion of theory and practice; and clinical study as the only vinculum, or tie by which they are to be united. I have adverted to the uncertainty of medicine, as a motive to perpetual

exertion, and depicted our profession as one of daily study as well as daily toil.I have done this advisedly, feeling, that in addressing an audience of medical students, it is my duty, as it is my pride, to impress upon you the extent and dignity of a profession to excel in which, requires a greater compass of knowledge than any other art-a greater variety of liberal accomplishments-and a quicker and readier application of these to the wants, necessities, and afflictions of mankind."

XXVI.

M. M. DELMAS AND TAVERNIER, ON UNION BY THE FIRST INTENTION.

It appears that union by the first intention is far from being yet universally adopted in France, though many of the leading surgeons are ranked as its supporters.There, as here, science, as well as every thing else, has its Whigs and its Tories. its sticklers for the "wisdom of their ancestors," and its mad liberals raging for innovations and respecting no wisdom but their

own.

We are beginning in this country, to discover that the ultras on both sides are wrong, and our views of union by the first intention not being of quite such recent growth as amongst our lively neighbours, have softened by the sobering influence of time into a more staid but stable form In fact, our most eminent surgeons, though fully alive to the great advantages of union by the first intention, in the great majority of wounds, whether caused by accident or secundum artem, are yet not blind to the fact, that it frequently is, and has been attempted, without any reasonable chance of success, and therefore, with highly injurious effects. It is not our intention to occupy like M. M. Delmas and Tavernier, some thirty pages in arguing the question, but merely to extract the heads of a case or two.

CASE 1. Amputation of the Breast-complete union in nine days-subsequent Cancer of the Bones.

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