purpose was to promote a spirit of emulation among Surgeons, to afford additional inducements to exertion in the cultivation of science, and thus to increase the utility and elevate the character of the Surgical profession. After the expiration of one year from the date of the Charter, no one will be admitted into the rank of Fellows, until he has undergone a strict and lengthened examination, not only in practical surgery, but also in the collateral sciences. They who aspire to become Fellows, without having been previously Members of the College, will be required to have gone through an extended course of professional study in Hospitals and Schools, and to be at least twenty-five years of age. But the Fellowship will not be limited to Candidates of this description; and they who, not having had the same advantages of education, have been admitted as members at twenty-one years of age, may, after having been engaged in Practice for a certain number of years, represent to the Council that they have continued to study their profession as a science, and claim on these grounds to be examined for the Fellowship. Thus any individual, however limited his means of improvement may have been in early life, may raise himself by his own industry and talents to the same rank in the College with those who were in the first instance more fortunately situated. No one who desires to attain the Fellowship can complain that it is not within his reach, or that he is prevented from becoming an Elector, or a Member of the Council, or of the Court of Examiners.

Candidates for the Fellowship at twenty-five years of age, will have had the opportunity of obtaining a liberal general education, previously to entering on the studies peculiar to their profession; and it is reasonable to expect that the example of such well-educated persons will influence those, whose preliminary education has been imperfect, to supply the deficiency by devoting to the acquirement of various knowledge and the general cultivation of the mind a portion of the leisure which falls to the lot of every young practitioner.

The course to be pursued in the future admission of Fellows is sufficiently obvious; but the new Charter imposed upon the Council another task of much greater difficulty, that of selecting, from among the many thousand Members of the College, a limited number of individuals to be nominated as Fellows in the first instance, so as to form an immediate constituency for the future election of Members of the Council.

The following provisions of the Charter, on this subject, give to the Council the absolute power of nomination, without conferring on any description of Members the right to be so nominated.

"The Council of the said College, with all convenient speed after the date of these Our Letters Patent, and before the expiration of three calendar months from the date hereof, and in such manner as the said Council shall deem best, shall elect to be Fellows of the said College any such number of persons, being Members of the said College, and not being in the whole less than 250 nor more than 300, as the said Council shall think proper."

"It shall also be lawful for the Council of the said College, at any time or times, after the expiration of the said three calendar months, and before the expiration of one year from the date hereof, by diploma or diplomas under the seal of the said College, and in such form as the said Council shall think fit, and without any fee, to appoint any other person or persons, being a Member or Members of the said College, to be a Fellow or Fellows of the said Royal College of Surgeons of England."

When these passages of the Charter are considered in reference to each other, and in combination with the circumstances that the nomination of Fellows by the Council is only a temporary expedient, designed to provide, in the first instance, that Constituency which will be supplied hereafter by Fellows admitted on examination, it will be obvious that the framers of the Charter did not intend that the Fellows to be thus nominated should greatly exceed the number of three hundred.

The Council entered on the duty assigned to them by these provisions of the Charter with a full sense of its invidious nature. They were aware that of those, not included in the list of Fellows, a considerable number would feel and express dissatisfaction. But they have done what was required of them to the best of their ability, and have made the selection altogether on public grounds, without favour or prejudice, and uninfluenced by private motives. The following statement will sufficiently explain the principles on which they have acted.

The great majority of the Members of this College are less engaged in the practice of Surgery than in that of Medicine, Midwifery, and Pharmacy, and many of them have arrived at well-deserved eminence in these latter departments of the Medical profession. But the Council, keeping in view the objects for which the College was especially established, have felt it their duty, in the nomination of Fellows, to regard chiefly the qualifications of Members as practitioners in Surgery, or as improvers of those sciences which tend to its advancement.

1. In accordance with this principle, they placed in the list of Fellows the Surgeons of all the Hospitals in England and Wales which are recognised by them as schools of Surgery; and they did so under the conviction that the Surgeons of large Hospitals have the best opportunity of experience in Surgery, and that they are the persons principally consulted in private practice, and referred to by other practitioners, in surgical cases.

2. But they were aware that in several parts of the kingdom there are Members of the College having considerable reputation as Surgeons, and called into consultation in surgical cases by the practitioners in their neighbourhood, although they have no connexion with Hospitals; and the Council thought it right to place the most eminent of such persons on the list of Fellows. In executing this part of their duties great circumspection was required, lest improper names should be inserted and proper ones omitted. In this respect the list is incomplete, there being individuals of this class whose claims are still under consideration.

3. Not being well acquainted with the qualifications of Military and Naval Surgeons, and being at the same time desirous of doing justice to them, the Council applied for assistance to the heads of their respective departments; and many of the names included in the schedule of Fellows are the result of this application.

4. There are in London several practitioners in Surgery, who, though not connected with Hospitals, were considered eligible to the Council under the former Charter and according to former usages, and the Council therefore thought that they ought to be admitted to the Fellowship. Many of these gentlemen are well known and much esteemed by the profession; and the question was, not whether they should be elevated to a new position, but whether they should be displaced from one which they had previously occupied.

5. Some individuals have been placed on the list of Fellows from having distinguished themselves in cultivating the kindred sciences of Anatomy, Physiology, and Natural History. The Council cannot but regard such persons as ornaments of the College, and it will be gratifying to them to find others of the same class who may be added to the list.

6. Other names have been inserted for special reasons, being principally those of Teachers who had been recognised by former acts of the Council, or of persons holding important public offices. Among the latter are four Senators of the University of London.

The Council are empowered to nominate an additional number of Fellows before the expiration of the first year from the date of the Charter. This will enable them to supply the deficiencies of the former list, in anticipation of which it is evident that this clause was introduced. In the future nomination of Fellows, the Council see no reason why they should depart from the general principles on which they have hitherto acted; though they will make it their object

to omit the name of no individual who is held in esteem by the other Members of the College for his surgical experience and scientific attainments. For those who are not yet so distinguished, there is an honourable method of obtaining the Fellowship by examination.

In conclusion, the Council take the liberty of observing, that no alteration in the Charter, nor any legislative enactment, can materially change the condition of those who have been for some time established in practice. In the Medical profession each individual makes his own place in society; intellect, knowledge and integrity being equally appreciated and respected in every grade and station. If the changes introduced by the present Charter are to have the effect of elevating the character of the Surgical profession generally, it will be in the next rather than in the present generation; and if the elder practitioners are interested in these changes, it is less on their own account, than on that of their sons and successors. By order of the Council,

Lincoln's Inn Fields, May 25, 1844.

EDMUND BELFOUR,

Secretary.

Setting aside the justice or injustice, propriety or impropriety of the Charter itself, and discussing merely the question raised in the Address of the Medical Protection Assembly, there cannot be a doubt that the Council of the College has the best of the argument. It must be clear to every one, from the limitation of the numbers of the first batch of Fellows, that the Crown did not design the body to be numerous. If any inference is to be deduced from the general spirit of the Charter, it points too the same way. Its aim is obviously to create a small and select body, large enough to comprise the distinguished members of the College, but not so large as to be held cheap, from the facilities of belonging to it. This we say, special pleading apart, is clearly the intention of the framers of the Charter, and the Council unanswerably appeal to it.

We have already stated that we are not now discussing the merits or demerits of the Charter itself. It might or it might not have been a better one. But it is " a fact," and as such we take it. Nor are we discussing the principles which have guided the Council in the selection of the "Fellows." The "Protection Assembly" waive an examination of those principles, and so do we. We content ourselves with one observation-that if there are to be Fellows at all, the Fellowship ought not to be made contemptible by being swamped with numbers-and that the power vested in the Council, being in its nature highly responsible and equally invidious, ought to be exercised with strict impartiality, untainted by the suspicion of sinister influence, jobbing, and class-feeling.

STATEMENT OF THE SOCIETY OF APOTHECARIES, &c.

This is in the form of a Letter to Sir James Graham, from the Company, setting forth what they have done during the last thirty years, in the way of improving the education of the general practitioner. They combat the objection to an examination being entrusted to a Court of his own class, instead of one of a higher grade as that of the College of Surgeons, or of Physicians, by shewing the Curriculum which they now enforce, and the qualifications they now require in the candidate, as compared with the regulations which they first enacted in 1815. The contrast is indeed most striking, and shews the rapid advance that medical education has made in a quarter of a century. The Curriculum of the Apothecaries' Company at the present moment, would have been an almost impassable barrier to any medical aspirant in the first years of the nineteenth century.

Gradual as has been the extension of the Curriculum, since 1815, the Court has "plucked" no less than 1,531 of the candidates for admission into the practice of physick! This was about one in eight of the applicants. There can be no doubt, indeed, that the Apothecaries' Company have discharged their duties with great propriety and assiduity; but still the opinion is gaining ground daily, that there should be one governing body, not only for regulating the Curriculum of study, but for examining the candidates for the diploma in the three branches of the profession. The examinators would, of course, be selected from the three existing bodies, but the Apothecaries seem to fear that theirs would not be the lion's share of the spoil.

"An apprehension appears to exist on the part of many, that it will be proposed to Parliament to exclude the general practitioner from all share in the examination of his own class, or to place him in so small a minority at the examining board, as to deprive him of all real control and influence in a matter in which the interests of his branch of the profession are so deeply involved."

But supposing that the Court of Examiners consisted of nine persons-three from each of the existing Corporations-we do not see that the Apothecaries' Company would be in a minority. It is far more likely that the delegates from one or other of the two higher bodies would side with the Apothecaries, on any disputed point, than that they would coalesce against the representatives of the general practitioners. In any clash between the physicians and surgeons, the apothecaries would have the casting vote; and, as is sometimes the case in politics," the tail would turn the scale." But it is needless to speculate, since the Government measure is, at the time we write, little known. It requires no gift of prophecy, however, to predict that it will be far from giving satisfaction to even a majority of the heterogeneous mass of medical society, as it now exists.

CASE OF VERY LARGE STONE IN THE BLADDER EXTRACTED THROUGH THE PERINEUM.

The following case which has been transmitted to us, is one of much surgical interest. We have abbreviated the less material details.

John M'Gregor, Corporal in the Mounted Coast Guard, aged 49, entered Melville Hospital, Chatham, with symptoms of stone in the bladder, which he had laboured under, more or less, from June 1813. On sounding him on the 18th June, 1843, Dr. Rae, Deputy Inspector, found a large stone, round the apex only of which the instrument could pass, and examined by the rectum, the finger could neither raise nor pass beyond the stone. The patient himself declared that he frequently felt the stone move in the bladder, and that he could frequently retain his urine for two hours. Under these circumstances, Dr. Rae determined to perform the lateral operation. This we give in his own words.

The staff being introduced, and the patient secured in the usual way, I began my incision nearly two inches above the anus, and a quarter of an inch to the left of the raphe, at once an inch deep, rendering it more superficial as I passed the anus; the cellular membrane was then farther divided, and the transversus perinei muscle; my finger was then without difficulty pushed in to the deep-seated fascia, the groove of the staff felt for and cut into; a probe-pointed knife was now substituted for the former one, fairly inserted into the groove, carried on to the bladder, and next moment my finger was on the stone. Had this been of the usual magnitude, the patient would have been replaced in bed in a quarter of an hour with the loss of not six ounces of blood; but now all our difficulties began, and I was convinced that the patient could not have felt the stone moving for years, nor could he have retained his urine for two hours, indeed he has

since informed me that he could not keep it more than a quarter of an hour during the day, or half an hour at night, and that he concealed his complaint as much as possible. The stone was now found to be of great size, over which the thickened coats of the bladder were permanently contracted. It seemed to be of a conical shape, the apex only being free, and to pass the forceps over it, and expand them for the purpose of extraction, was perfectly impracticable, the blades actually bent, and had I used more force, in the opinion of all present, I must have lacerated the bladder; the small end of a scoop could not pass without danger of perforation. The lower part only could be grasped, and the forceps almost invariably slipped, bringing away debris and numerous fragments each time. After many and repeated trials to extract, I handed the forceps to my able assistant, Dr. Charlton, but with no better success. The patient had now been an hour and twenty minutes on the table, and although he bore his suffering with heroic firmness, worthy of a M'Gregor, still he was getting exhausted, and, it became absolutely necessary to desist. The bladder was washed out with warm water, and an elastic tube with lint placed in the wound, and he was carried pulseless to bed; warm brandy punch was administered, and warmth applied to the feet: an anodyne was afterwards given, and in a short time he rallied." He recovered from the effects of the operation marvellously. The remainder of the case is instructive.

The wound was studiously kept open for farther proceedings, the stone was occasionally felt, and as had been predicted by my friend Mr. Fergusson of King's College, to whom I had related the case, became looser and less firmly embraced by the bladder. During this interval the Director General, Sir Wm. Burnett, had ordered at my request, a pair of forceps to be made very strong, and with separate blades like those for midwifery,* with which I expected either to crush or extract. Having been in town, however, I called upon Mr. Guthrie, who kindly directed Mr. Simpson of the Strand, to make for me a crushing instrument, which he thought would suffice to break the calculus. Mr. Fergusson, same day, lent me one still more powerful, but on trial, neither of them had sufficient space between their prongs to grasp the stone, whose longest diameter was between the fundus and prostate. While waiting for my new forceps, I received a note from Mr. Fergusson, of 27th Jan. saying that he was called to see a lady at Chatham, would be down the following day, and, in case I had not succeeded in applying the crusher, would bring two fresh instruments with him. He came accordingly, Jan. 28th, bringing two pairs of forceps lined in their points, and one with a peculiar hinge, with which he had extracted several large stones. On minutely examining the situation and size of the calculus, both by the wound and rectum, Mr. F. was of opinion that it might then be extracted, though probably with some difficulty. Whereupon I waived all ceremony or selfish consideration, felt for the safty and welfare of my patient, was glad to avail myself of Mr. F.'s experience, skill, and dexterity in such cases, and requested he would proceed to extract. He kindly complied, little preparation was necessary, the incisions were already made, he introduced a pair of his own forceps and was not long in extracting, though be met with much resistance, and the forceps slipped twice. Several broken pieces were extracted by the scoop, the bladder was washed out with tepid water and the patient placed in bed, complaining of much pain in the wound and in his back, and subsequently had a rigor. Some wine was given, and a morph. draught at bed-time. He passed a good night, and in the morning was free from pain or fever. Pulse 96, soft and small. Bladder washed out with tepid water injected by the penis. To have wine and arrow-root.

Mr. Simpson has now completed this instrument, and has ingeniously added to it a drill or perforator. It has been highly approved of by several eminent surgeons in London, and promises to be of great utility in cases of large calculi.