REMARKABLE STATE OF DISEASE IN A PHYSICIAN. DR. R- -m, 64-ailing for ten years-for first five years, restlessness or fidgets -could not sleep but a few minutes in one position-increasing in corpulence during that time, though he could take very little food. Only took two glasses of Sherry for drink. About five years ago began to refer to the sigmoid flexure of the colon as the seat of uneasiness. Would take no medicine, but trusted to abstinence for relief. Referred to the region of the duodenum, in which he fancied there was a kind of intussusception. He felt pain in that part. He suspected also that he had hydrothorax. Severe head-aches and dry retching after the least indulgence in wine-say, three or four glasses. In the month of February 1838, complained of cough, difficulty of breathing, depression of spirits, and inability to use exertion of any kind. Last illness-beginning of September removed to Aldbro', very ill. Pain in the chest so great as to impede the breathing—increased pain in the colon. Took active purgatives and colchicum there. About the 6th of September, began to shew symptoms of jaundice. Frequent retching-could only keep down some strong coffee, or soda water. The limbs now began to emaciate, but the body retained its embonpoint. The jaundice daily increased, till the skin was a deep copper-colour. The urine became like clear port wine-pulse never varied from 70 to 75. About the 10th of September, and before he took the above medicines, he passed spontaneously a strange sort of motion, without smell or colour. He was freely leeched, and the leeches bled copiously. Had repeated hæmorrhages from the bowels, of a dark melenic character. Never could sleep more than a few minutes at a time, for a month before his death. Believed that he had scirrhus of the colon for years-but did not draw the attention of the medical gentlemen to this till about a week before his death, when Mr. Evans detected an induration in the angle made by the transverse arch and descending colon. This induration rolled about and eluded the grasp. These symptoms went on increasing till death, which seemed to take place more from inanition than from the disease. He was latterly supported entirely by beef-tea per anum. on the 11th of October, 1838. DISSECTION TWELVE HOURS AFTER DEATH. He died Skin of a deep copper-colour, approaching to mahogany. The body was not emaciated; but the limbs were much attenuated. The integuments of the abdomen were loaded with fat; and this was deposited in great quantities throughout every part of the abdomen. Stomach collapsed-large intestines distended with air-liver very much exsanguious, and exhibiting the granulated structure clearly. From each cut a glairy, greenish, nearly transparent fluid oozed out. Gall-bladder presented a contracted appearance. Its coats were very much thickened, and it contained only about a dessert-spoonful of bile, resembling paste in consistence. The ductus cysticus, hepaticus, and part of the ductus communis were completely obliterated by the pressure of a cluster of surrounding glandular bodies, and by an indurated pancreas, forming a large and dense mass around the ducts in question, and completely annihilating all communication between the liver and the duodenum. Stomach, duodenum, ileum and cæcum healthy. The colon was healthy till near its termination in the rectum, where there was a circumscribed ulcer about the size of a crown-piece, at which place the gut was so contracted as only to admit the ring-finger. The ulcer presented slightly thickened and everted edges, and the mucous and muscular coats of the intestine having been destroyed, leaving the peritoneal covering only entire. The pancreas was enlarged and indurated, completely surrounding the bile-ducts, and obliterating their canals. The right kidney was enlarged, and the ureter distended with a green fluid resembling cystic bile. As the ureter approached the bladder, however, it became so contracted as scarcely to leave any passage for the urine. The substance of this and the other kidney did not present any material change of structure, but on the convex surface of each was a cyst filled with transparent fluid-one of them as large as a nutmeg. The head and chest were not examined. (Signed) F. BELL. The foregoing case of our brother practitioner is not a little remarkable, and will furnish the reader with several subjects for reflection. Not the least curious phenomenon in the history is the long continuance of that restlessness at night, called the "FIDGETS," without any local or tangible cause for such uneasiness. It is tolerably clear, however, that lesions, of various kinds, were going on for many years, in some important organs of the abdomen. We could get but a very imperfect history of the case—and that entirely from the memory of a friend of the deceased, so that perhaps a more minute detail of the symptoms would have developed some interesting symptoms in this complication of maladies. The preservation of such quantities of fat in the abdomen, while the upper and lower extremities were like those of a skeleton, is curious. It is sufficiently evident that the bile-ducts must have been obliterated for a considerable time, and this renders the fact of the obesity still more curious, since theory, experiment, and observation had taught us that, when no bile passed into the duodenum, emaciation was an invariable consequence. REPORT OF THE MEDICAL AND SURGICAL SOCIETY OF NEWCASTLE-UPONTYNE, ON THE PRESENT STATE OF THE MEDICAL PROFESSION. * THIS Society, on surveying the condition of the Medical Profession, cannot but be strongly impressed with the varied and incongruous materials of which it is composed; they find its members, notwithstanding the perfect identity of their avocations, consisting of Practitioners authorised by many different Colleges and Corporate institutions, from whom have been required unequal courses of study, and dissimilar examinations into the extent of their professional and scientific attainments. They discover also that these institutions have been found inadequate to the fulfilment of their intended purposes; that, consequently, persons are engaged in practice, who have not been authorised by any of them, and that a numerous class of individuals are allowed to prey upon the community, under pretence of having become acquainted with operations and modes of curing diseases, unknown to those who have endeavoured, by an appropriate education, to qualify themselves for the treatment of the various infirmities and injuries with which the human frame is liable to be afflicted. Public safety demands that all persons engaged in the practice of Medicine and Surgery should be duly qualified, by a previous course of study, to discharge the important duties they are called on to perform; and this Society deem it incumbent on the Legislature to provide, that no person shall be permitted to enter upon the execution of those duties, who has not been properly tested as to his acquirements, and publicly declared to possess the requisite degree of qualification. In consequence of the imperfection and defective administration of the laws at * The Society consists of more than fifty members. present in existence, they have afforded no security to the public, and have yielded no adequate protection to the legally-authorised practitioner, against an unfair and unjust competition with individuals possessing neither license nor diploma, and who are unable to produce satisfactory evidence of their having devoted sufficient time or attention to the attainment of medical and surgical knowledge. Quackery, of every description, is allowed to exert its baneful influence on society; and, while its miraculous achievements are continually paraded before the public eye, thousands of its credulous and unsuspecting victims are daily submitting themselves to the pain and torture of secret processes of treatment. It is to be deplored that any part of the public revenue should be derived from the indirect encouragement of a system replete with fraud, and productive of most disastrous consequences. Chemists and druggists are in the constant habit of prescribing for diseases, with whose nature they can be very imperfectly acquainted. The Corporate Bodies presiding over the profession appear to be quite unequal to the correction of these abuses. The London College of Physicians have at all times acted on a system of exclusiveness and monopoly, and have never displayed the slightest anxiety for the well-being of the profession at large. The charter of the College of Surgeons confers upon that corporation no control over persons practising surgery; submission to their examinations and bye-laws being entirely voluntary. The Company of Apothecaries have, by Act of Parliament, power to prosecute all persons practising as Apothecaries without their license. They have, however, exercised this power in a very limited number of instances, nor do they possess the means of exerting it in a manner likely to counteract the magnitude of the evils in question. Medical education requires considerable amendment. The long space of time occupied in the apprenticeship of most general practitioners is usually passed in a very unprofitable manner. Apprenticeships are objectionable in many respects and are totally inefficient as a medium of professional improvement; hence, after their termination, a course of study requires to be entered upon, which must, of necessity, be compressed into a period by far too limited for the attainment of the object in view. The information acquired is almost inevitably of a superficial character, for, in addition to hospital practice and dissections, the student is compelled to attend several lectures daily on a variety of subjects; from all of these it is impossible that he can derive full advantage. Clinical instruction is much neglected, and the student completes his prescribed curriculum with a very inadequate preparation for the practical duties awaiting him at the bed-side of the sick. Certificates of attendance on lectures and hospital practice are frequently granted without enquiry as to the student's diligence, and in some instances are surreptitiously obtained. The examinations for licences and diplomas are conducted not unfrequently in a cursory and inefficient manner. They do not afford an opportunity of ascertaining the practical acquirements of the candidate, nor the extent to which his knowledge is the result of clinical observation and experience. The College of Surgeons in London, require certificates of candidates, having studied the various departments of medical science, but their examinations are confined to anatomy, physiology, and surgery. The Society of Apothecaries take no cognizance of surgery, therefore their licentiates being legally qualified, are at liberty to practise every branch of the profession, without having been examined in surgery, or required to produce evidence of having been engaged in the study of that important subject. There are in the United Kingdom of Great Britain and Ireland, not fewer than nineteen Corporations having power to grant degrees in medicine and surgery, and differing essentially in the extent and duration of the curricula they enjoin. The Society is of opinion that all of these might be advantageously superseded by one institution being placed at the head of the profession in each division of the Empire, whose privileges should be reciprocal, and whose executive officers, elected by the members at large, should hold periodical conferences, for the purpose of establishing uniformity of operation; that such Institutions should have entire control over education, and the granting of degrees and licenses to practise, together with all other matters relating to the medical profession; that the course of instruction and test of qualification should be the same in each; that from one or other of them, all persons engaged in the practice of medicine and surgery, should be required to possess a diploma or license; that, to individuals thus authorized, the law should extend a suitable protection, and that proper measures should be enforced for the suppression of unqualified practitioners. The Society would suggest, as a means of effecting the last-named object, that every person before commencing practice in any town or other locality, should be required to obtain a certificate from a magistrate giving him permission to that effect, which should be granted on the production of satisfactory testimonials of qualification, and that, after having been thus authorized, his name should be duly registered. Persons presuming to practise, whose names have not been so registered, should be subjected to a penalty on summary conviction before a justice of the peace. The rapid progress of science during the present century, in conjunction with increased facilities for the attainment of medical and surgical knowledge, have fully proved, that any attempt to constitute an arbitrary division of diseases, and to consign the treatment of them to different classes of practitioners, according as they affect the external or internal parts of the body, is not only unscientific but impracticable; and, as the physician and the surgeon must be guided by similar principles in combating disease, whether involving the surface or the interior of the human frame, the education of all practitioners should, in the opinion of this Society, be regulated by one common standard. Those distinctions in rank which have hitherto subsisted (not perhaps without good effect) would thus be rendered unnecessary, since there could be no longer any rational ground for separating into different grades, men who would be identified not less in education, than in the nature and object of their pursuits. Such uniformity, if established in this as in other countries, would place practitioners, whether of medicine or of surgery, on an equal footing; but would not, in the least degree, prevent individuals devoting their energies to the prosecution of any particular department of professional duty, which inclination or other circumstances might lead them to adopt in preference to another. The task of preparing the medicines, prescribed by the general practitioner, devolves, almost universally, on the apprentice of the latter. That material benefit might accrue from a well-devised scheme of pupilage, there can be no question; but apprenticeships, as at present conducted, have ever been productive of unhappy results; and in no respect does the unfavourable tendency of this system appear more conspicuous, than when viewed as an instrument for executing the responsible duty of dispensing. The abolition of apprenticeships, so far, at least, as this department is concerned, would be highly expedient. The Society is of opinion, that a charge so important might, with greater safety, be confided to an apothecary or dispenser, who had been examined in pharmacy, and had obtained a specific license for the purpose in question. Such substitute for the apprentice would, the Society believes, be most desirable, not less for the comfort and convenience of the practitioner, than for the welfare and security of his patients. This proposition, if acted upon, might have an additional good effect in terminating the absurd method by which at present the majority of general practitioners seek to be remunerated, viz., by a profit on the medicines they supply. The foregoing representations suggest the desirableness of obtaining, 1. An improved system of education. 2. A more efficient method of examination. 3. One governing body to preside over the whole profession in England, Scotland, and Ireland. 4. Uniformity of education, and of grade among practitioners. 5. Adequate protection for legally authorised practitioners. 6. The prevention of unqualified persons. 7. The suppression of quackery. 8. The separation of the practitioner and the dispenser in the same individual. 9. The abolition of apprenticeships as at present constituted. 10. The institution of licensed Dispensers. The Society is desirous to submit to the notice of the profession generally, the preceding statement of some of the more prominent evils, which have, for a length of time, weighed heavily on the interests both of the public and of individuals, with a brief outline of the measures calculated, in the opinion of its members, to correct the abuses complained of. As, however, their effectual reformation can be obtained only by the vigorous and united exertions of the whole profession, and not by detached and unconnected efforts, the Society is anxious to invite the co-operation of professional gentlemen in other places, and to recommend to their immediate attention the important questions comprised in this Report. The feeling of the profession at large, as to the defects most urgently requiring amendment, and as to the general principles on which such amendment should be founded, would, in this way, become apparent; and with a view to the settlement of disputed points, the Society would suggest the expediency of a conference being held in London, or elsewhere, composed of deputations sent from different parts of the Empire, whose labours might be directed to the arrangement of a specific plan of Medical Reform, which, if incorporated in a Bill, to be introduced into Parliament, and duly supported by petitions, might be reasonably expected to meet with the consideration of Government and the Legislature. (Signed) T. E. HEADLAM, M.D., President. Newcastle-upon-Tyne, November 27, 1838. MEMORIAL OF It is not for us to tell the medical branches of the military and naval services that they have been always treated with little consideration or respect. Look at the army-look at the navy. The officers in each, particularly in the first, enjoy aristocratic connexions and consequently possess parliamentary influence. The results are felt in the tenderness with which the factions of the day approach their rights and privileges. But the zealous, useful, scientific surgeon, who cannot influence votes on a division, is snubbed or actually maltreated, by the heads of his department, and the supreme executive. The evil can be remedied by union only. Medical men have hitherto proved but a rope of sand, and timidity, or indolence, or despair has prevented any |