I at once felt the calculus distinctly at the fundus of the bladder with my left fore-finger, and easily touched it with the forceps in their shut state, but whenever I opened them over the calculus so as to seize hold of it, I found that the blades grasped the soft bladder which retained the calculus in situ. I then tried a scoop, but with equal want of success. I regret for Mr. Allan's satisfaction, that I did not use a "lever or curved forceps." After several fruitless attempts for five minutes, I resigned the forceps to Dr. Campbell, and after he had persevered for three minutes longer, I requested him to desist. I next untied the patient, put him to bed, and desired him to have an opiate. I now begged the medical gentlemen present to return to the operating theatre, when I explained the nature of the "operation en deux tems," and stated, that when all action had subsided, and suppuration was fairly established, the urinary bladder would offer then no resistance, and that probably the calculus would be in the mouth of the wound, or at all events, that it would be easily reached and extracted.

The operation was performed at 12 o'clock on Thursday the 5th of October, 1826, and as I had to proceed onwards immediately to Edinburgh, I begged that the patient should be bled whenever reaction had taken place, being of opinion, that after lithotomy, as after the operation of trepanning, venesec tion should be performed. The same precautionary means ought to be employed in all great operations. I mentioned that the calculus ought to be removed on Sunday or Monday, or whenever suppuration was fairly established. On Monday the 9th, a calculus of an oval flattened shape, and weighing three ounces and a quarter, was extracted with the forceps, a sound being previously inserted in the urinary bladder. By the last account which I received the other day, the patient was walking about, and the urine flowing along the urethra, and the wound nearly healed.

4

I have been thus particular in describing this case, as the steps deviate a little from those recommended by Mr. Allan and other authors on Lithotomy. I am decidedly of opinion,

who uses Dubois' knife, or any other instrument has given up dissection, and is therefore unqualified to operate. I should recommend such surgeons, to confine themselves to the routine practice of prescribing a dose of salts. "The passion of inventing instruments so conspicuous of late years, originates with those who know not how to use the common instruments." In every dead body, with the exception of one, that either any of my pupils or myself have operated on for lithotomy, part of the vesiculæ seminales has been wounded. In one or two rare instances, the termination of the ureter has been cut. I believe that I may state, the operation has been done upwards of 100 times.

that had I persevered longer in attempting to extract the calculus at the time of the operation, I would have induced such a degree of inflammatory action, as would, in all probability, have destroyed my patient. For, as my late worthy preceptor, Mr. John Bell, observes, "I fear there are few modern operations free entirely from the cruelties imputed to the apparatus major" which fact, I deeply regret to state, every student at this school too often witnesses.

or

Either after the first stage of the "operation en deux tems," en un tems," if we may use the phrase, I conceive that no flexible catheters or tubes or tents ought to be inserted in the wound, as practised by Colot, Le Dran, and others; for, as Mr. John Bell observes, "In the old way of lithotomy, they introduced a canula into the wound, ostensibly to prevent healing, but really because they could not heal the wound." If the external incisions are free, and no mangling has been inflicted, we have nothing to fear from the urine-no infiltration will take place. To show the absurdity of fearing such an event, let us consider what Le Raoues, a celebrated lithotomist, did, who operated by cutting on the gripe. He endeavoured not to make the external incision correspond with the internal one, in order that the integuments might act as a valve. And he plastered up the wound with eggs and flour. And he often cured his patients in five days.

I have already stated, that venesection should be practised after lithotomy, whenever reaction has taken place, for the purpose of preventing inflammation. But if this diseased action should take place, the blood-letting ought to be repeated to syncope, and if the patient is an adult, 50 or 60 leeches should be applied to the hypogastric region: if a boy of three or four years of age from 18 to 24 leeches should be applied, and the external jugular vein opened, if one in the arm cannot be selected, in consequence of its smallness. After the leeches have dropped off, the warm bath should be used, and if pain on pressing the hypogastric region still continues, a tobacco enema should be administered, and be repeated as often as necessity requires, and as soon as its nauseating and exhausting effects have disappeared. It ought to be regulated, so as not to produce vomiting. Besides the above remedies, diluent injections of warm milk and water should be used to the wound, together with anodyne poultices and fomentations, both to the wound and to the hypogastric region. The patient ought to be kept in the warm bath until a sensible depleting or exhausting effect is produced. Blisters may be also used after the leeches. JOHN LIZARS.

Edinburgh, 33, York Place, 10th Nov. 1826.

II.

MEDICAL JURISPRUDENCE

MEDICAL DEGREES-ABERDEEN-ST. ANDREWS.

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We have much pleasure in giving publicity to the following regulations of Aberdeen and St. Andrews, against which so much declamatory abuse has lately been discharged. If these universities adhere punctually to the regulations now enacted, all reasonable cause for reproach will be removed.

"Marischal College and University, Aberdeen.-Regulations respecting Medical Degrees.

"1. Every Person offering himself as a Candidate for the degree of M.D. shall, 1st. Produce satisfactory evidence of his possessing a good character, and of his having attained the age of twenty-five years; and, 2dly, shall lay before the Senatus Academicus, certificates of his having obtained the degree of A.M. in this or some other University, after the usual examinations ;* of his having attended courses of lectures on Anatomy, Surgery, Chemistry, Materia Medica, Theory and Practice of Physic, and Botany, in this or some other University, or celebrated School, under Professors or Teachers of reputation; and of his having attended, for three or more years, a Medical Hospital containing the average number of at least eighty patients.

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2. After the Senatus Academicus shall have been fully satisfied on the above preliminary points, the applicant shall be received as a candidate for the degree of M.D.; and shall be required to appear before the University, at one of their stated terms for granting such degrees, and in their presence be examined, by the Medical and other Professors, on the different branches of Medical Science—on his knowledge of the Greek and Latin Languagesand on such other branches of literature as they shall see proper. If fully satisfied with the qualifications of the candidate, the University shall confer on him the degree which he solicits.

"By order of the Senatus Academicus "JOHN CRUIKSHANK, Secretary.'" "These are the only conditions upon which the degree of M.D. can now be obtained at Aberdeen; and it is presumed that henceforth the graduates of the universities there may claim the same rank as those of Edinburgh and Glasgow. The author of the 'letter,' &c. will at least acknowledge them equal to those of Glasgow; the regulations of their respective universities being nearly the same; what difference there is between them, is decidedly in favour of Aberdeen, as on looking over the Glasgow regulations I see no provision for testing the candidate's general acquirements. "Staffordshire, 21st May, 1826.

VINDEX."

"Regulations respecting Medical Degrees, appointed by the Senatus Academicus of the University of St. Andrews to be observed in all time coming. "Ist.-No degree shall be conferred on an absent candidate.

"As this requisition, respecting the degree of A.M. might prove injurious to some Medical Students whose education is now in progress, were it to take effect immediately, it is resolved that it shall not come into full force till the year 1830,”

"2d.-The candidate must produce a satisfactory certificate that he is upwards of twenty-one years of age, and that he is of unexceptionable moral character.

"3d. The candidate, if he be not in possession of a diploma as A. M. must produce certificates of his having had a Liberal and Classical Education, and be ready to undergo an examination as to his proficiency in Classical Literature by a committee of the University, or by the Senatus Academicus. "4th-The candidate must produce certificates that he has attended in some University, or celebrated school of Medicine, for at least four complete sessions, during four years, the following branches of Medical Education, viz. Anatomy and Surgery; Practical Anatomy, or private Dissections; Materia Medica and Pharmacy; Chemistry and Chemical Pharmacy; the Theory of Physic; the Practice of Physic; Midwifery and the diseases of Women and Children; Botany, and Clinical Lectures delivered by Professors, or accredited Medical Officers, on the cases of the sick in a large public Hospital. (It is not meant that the candidate shall have attended more than two or three of the above-mentioned Medical Classes during one session.)

"5th.-The candidate must bring certificates of his having attended the daily visitations of the Physicians and Surgeons of such Hospital for at least six months a-year during two different years.

"6th.-If the candidate shall have so far satisfied the University, the rector shall be requested to fix a day for his examination by the Medical and other Professors on all the branches of medical science; and provided this examination shall satisfy the Senatus Academicus, the candidate shall have delivered to him a Medical case or cases with questions subjoined, which questions he must answer in writing, and defend his answers before the Members of the University.

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7th. The whole proceedings shall then be submitted to the consideration of the Senatus Academicus, and if they are satisfied, the degree of M.D shall be conferred on the candidate by the rector in the hall of the public library.

"Such are the regulations appointed by the university of St. Andrews to be observed in all ordinary cases. When, however, the candidate, possessed of a Surgical Diploma from Edinburgh, London, Dublin, or Glasgow, shall have been in regular practice for some years, or when he shall have been appointed and have acted as surgeon in his Majesty's navy or army, or to the forces or ships of the East India Company, a three years' attendance on the above-mentioned courses of medicine, and one year's attendance on a public hospital, shall be deemed sufficient to rank him as entitled to be examined.

“Farther, it is desirable that the candidate communicate by letter with the Medical Professor, and send him a list of the certificates he means to produce before he repairs to St. Andrews for examination. This may prevent disappointment, delay, and expense to the candidate.

8th.-The university reserves to itself the power to confer honorary degrees in Medicine on highly distinguished individuals, who cannot be expected to comply with the above regulations; but every such honorary degree shall be conferred unsolicited and free of expense.

"St. Andrews, 25th February, 1826.' ”

III.

HUNTERIAN MUSEUM.

Before making any remarks of our own, we shall lay before the public the two following circulars, transmitted to us with permission to make what use of them we please.

1. Dr. Ager's Circular.

The London Medical and Physical Journal for September last contained a Letter from an anonymous Licentiate, complaining that the right of claiming admission, and of introducing Visitors to the Hunterian Museum, was res tricted to the Fellows of the College of Physicians and the Members of the College of Surgeons; and proposing, that a remonstrance should be sent by the Licentiates to the Trustees, on the supposition, that they had made the regulation. The Editor of the Journal, Dr. Macleod, observed, "if this be correct, there can be but one opinion of the transaction;" and then demanded an explanation from the Censors. Having accidentally seen these remarks, I considered it my duty to point out the error at once to the President in a Letter, dated on the 13th of the same month. It was thought best to enable the Editor to correct the mistake through the medium of Dr. Chambers: who, on the 26th, wrote, that “Macleod wished to be entirely impartial on the subject of the Censors, and would have been very glad of any good answer to the Licentiate's letter;" and requested the Registrar, "if there appears to Sir Henry no objection to the publication of Dr. Ager's Remarks,' to send them in the course of the day for that purpose.. This was communicated to me, at the President's desire, on the following morning, with a request, that I would send an explanation to the Editor as soon as possible, lest the reputation of the College should suffer from continual misrepresentations remaining uncontradicted. I therefore wrote immediately to Dr. Macleod, observing, that such explanation from the Censors appeared to me "hardly necessary; for surely every liberal and intelligent person would conclude, that the regulation did not proceed from them: however, I can have no objection to its being stated on my part, that it was one of the original conditions, comprised in a Treasury-Minute, when the Museum was presented to the College of Surgeons, which the Trustees were merely appointed to see enforced." This Letter was published in the Journal for October, preceded on the same page by farther strictures on the conduct of the Censors, asserting a belief, that their "officious interference with the College of Surgeons," is "condemned by none more heartily than by the members of their own body;" calling in question " their taste and judgment in interfering in the business at all;" and yet insisting, that if they could have procured for the Licentiates the right of admission, as they have not done so," nothing that has been said of them is too severe, and nothing that we have said is severe enough." Having drawn up the following statement of facts, in the accuracy of which the two junior Censors concurred, I thought it proper to show it to Dr. Frampton, as the charge unjustly implicated him also. He at once declared, that he entirely approved of what had been done; and candidly added, that if he had not, it was his duty to have attended the meetings, and opposed it. He also agreed with us in the propriety of submitting the whole matter to the President, since an impu