the excessive tenesmus. Deciding to introduce a catheter I attempted to pass a finger into the vagina, but was prevented by what appeared to be an unyielding mass, filling the whole pelvis, and pressing upward and forward so as to make it very difficult to pass the finger between it and the pubes. I accordingly carefully insinuated the point of a silver catheter into the urethra and passed it into the bladder, and discharged a quart or more of urine. The tenesmus still continued, and the acuteness of the pain was somewhat relieved, but the involuntary straining effort which characterizes the closing throes of labor still continued. With considerable difficulty I now passed a large-sized gum elastic catheter into the rectum, and through a mass of fæcal matter, some ten inches, when adapting a syringe to the external end of the tube, I succeeded by dint of perseverance in forcing warm water through the plugged orifice of the upper end. After sending up about a quart of fluid, the catheter was withdrawn, and in two or three minutes more than a gallon of fæcal matter followed, consisting almost entirely of the seeds of raspberries. After another small evacuation, which followed in a few minutes, she became entirely comfortable. The next day I was again called, and finding much the same symptoms, resorted to the same means, and obtained a similar result. After this the urinary bladder and the rectum evacuated themselves without aid, and raspberry seeds continued to appear in the fæces for several days longer, though none had been eaten during the week previous to my first calling upon her. Since that time she has enjoyed her usual health.

I present this case to the notice of the profession, not on account of any peculiarity of the practice; indeed I think it was but what was indicated, and would have readily suggested itself to any reflecting physician; but 1st, To show that a vast amount of fæcal matter may accumulate in the rectum, and also above the sigmoid flexure of the colon, while the sensibility of the mucous membrane remains low as in cases of constipation, but that when this sensibility is increased, as it was in this case by the cathartic, violent symptoms are the consequence; and 2d, That when the pelvis becomes sufficiently full to distend the perineum, the action of those muscles associated in the function of expelling the contents of the pelvic viscera is excited, and if this distension be proportionally increased their action becomes intermittent and involuntary. This phenomenon we have all so frequently witnessed in parturition, when the head of the child fully occupies the pelvis and rests on the perineum, that we find it difficult to view it as but a specific accompaniment of that series of phenomena, the aggregate of which constitutes labour. Indeed so strong did this influence operate upon my mind, in this case, that when preparing to introduce the catheter, notwithstanding the youth of my patient, and the character of the family being above suspicion, I could not divest myself of the feeling that, upon the finger entering the vagina, the head of a fœtus would present itself.

Buskirk's Bridge, N. Y., Jan. 4th, 1847.

Boston Med. and Sur. Jour.

Letter from Persia.-Leeches in Intermittent Fever, &c. We have just heard that the cholera has broken out in Teheran, the capital, though we have no definite information yet of the extent of its ravages. A physician residing in Tabreez, writes me, under date of August 1st, in the following manner: "We are all consternation here, at present, at the news of the cholera being at Teheran. The Prince (Governor of this part of Persia,) is most anxious to take all sanitary measures to prevent its arrival here, and has had communication with Dr. C. and myself on the subject, since which all the Rabab manufactories (cook-shops) have been sent outside of the town, and the selling of fruit diminished. Cleanliness is strictly enjoined, and a fresh supply of water let into the town from the gardens for watering the streets." The disease marched through these parts some twelve or fifteen years ago, and made dreadful havoc of human life. In many cases the natives, when attacked by it, used to throw themselves into a fountain or stream of cold water. The testimony is, as you would expect in such cases, that some lived and some died. By the way, what do you think of Andral's summary of the cholera ? "Anatomical characters, insufficient; causes, mysterious; nature, hypothetical; symptoms, characteristic; diagnosis, easy; treatment, doubtful.”

Are you familiar with the use of leeches, applied over the region of the spleen, in obstinate cases of intermittent fever? I have tried this treatment in two very bad cases, and with the most complete success. A Roman Catholic priest, a native of France, had been my patient some time, and I had become almost discouraged in using quinine and arsenic. He became worse and worse, and, dropsical symptoms supervening, his friends thought he would certainly die, and I began to think so too. In this state, I heard that Dr. Bell, Physician to the British Embassy at the Court of Persia, had used leeches in similar cases with great success, and I determined to try them on my patient. Dr. Bell's mode is to apply them on the day the moon fulls, and to repeat them every full moon until the disease is conquered. Though I had, of course, little confidence that the moon had any thing to do in the matter, I made the experiment exact to the letter, and at the first full moon applied twelve leeches over the spleen, intending to repeat the application at the next full moon in case the disease did not give way. But to my delight, and, I may add, surprise too, the poor priest, sallow and dropsical as he was, began to recover from that day, and I had no occasion to repeat the leeches.

I recently made a professional visit to Badr Rhem Bey, the celebrated Roordish chief of Buhtem on the river Tigris. His son, a youth of 12 or 14 years of age, had been suffering for about a year and a half from ague and fever of the quartan kind. He was reduced to a state which gave much uneasiness to his friends. At first I tried a purge and quinine, but without success. Indeed his next attack was more severe than before he had taken the medicine. I concluded to resort to the use of leeches, though some of his friends

thought he would certainly die, if he were to lose blood, pale and emaciated as he was. Without regarding the moon as in the former case, I applied six leeches the day before he expected a paroxysm, and on the morning of the next day, gave him two doses of quinine of four grains each. The disease was broken from that time. What comments have you to make on these cases?

Many, many thanks for your Journal. It is always very acceptable. I remain, my dear sir, yours very truly,

Oroomiah, August 12, 1846.

A. H. WRIGHT.

Ibid.

Royal College of Surgeons of England.-We cannot afford space for these regulations in full. They may be had at the booksellers, or in our number of last year, of which copies may be obtained at the office. From them it appears that a candidate for the fellowship must be twenty-five years of age; that he must have "a competent knowledge" of Greek, Latin, French, and the elements of mathematics. It does not, however, appear that what is called 66 a competent knowledge" of those matters is defined. He must have been engaged in professional study in schools or hospitals for six years, three of which, at least, must have been passed in London. He must have attended a surgical hospital for four years, and a medical one for one, and lectures on anatomy with dissections for three winter sessions; also, lectures on the practice of medicine, and clinical medicine, surgery, and clinical surgery, for two sessions, and on chemistry, materia medica, midwifery, medical jurisprudence, and comparative anatomy, for one session. He must also have served as house-surgeon or dresser in a recognized hospital. Bachelors of arts of " English' universities are admitted after five years' study, and are not examined in classics or mathematics. Those who were members of the college in September, 1844, are admitted to examination for fellowship when they are of eight years' standing, and those since admitted, or to be admitted members, are admitted to the same examination after twelve years' standing; but the latter must have graduated in an English university, or produce a certificate of "competent" classical knowledge. Candidates for the fellowship are examined on "anatomy, physiology, pathology, therapeutics, and surgery," only; and are required to perform dissections and operations on the dead body. It does not appear that they are examined on chemistry, the practice of medicine, materia medica, medical jurisprudence, comparative anatomy, or midwifery. They are, in fact, to be pure surgeons, and not general practitioners, and cannot claim to be appointed to mixed medical institutions, such as the Irish Infirmaries and dispensaries. They are to be what is called in England "pure" surgeons.

Candidates for the membership of the College of Surgeons of England are required to produce a certificate of being twenty-nine years of age, and having been engaged in the acquirement of professional knowledge" for four years, and of having studied practical pharmacy for six months. The meaning of "acquirement of professional

knowledge" and "study of practical pharmacy" is not defined. Irish pupils going to London are said to take with them "a certificate" to that effect from any apothecary, which is procured for a trifling douceur. Candidates for the membership are required to attend an hospital for three years, nine months in each year. All the Dublin hospitals are recognized. Candidates are also required to attend lectures on anatomy and physiology, and demonstrations with dissections for three winter sessions, surgery for two, and the practice of physic, chemistry, materia medica, and midwifery, for one. Candidates for the membership are examined in anatomy and surgery only. In England the qualification to practice medicine and pharmacy is derived from the Apothecaries' Company, and no man is considered a general practitioner there, or eligible as medical attendant to mixed medical charities, unless he holds their license. The College of Surgeons in England, therefore, does not examine in practice of medicine or pharmacy, or pretend to give any authority to practice either. Neither do they require their members to learn or to answer in medical jurisprudence, considering that medical witnesses should have the full qualification of general practitioner. In fact, it appears that the college wish it to be understood that their members are qualified as mere or "pure" surgeons only, and leave them to obtain their qualifications to practice medicine from the medical colleges, and pharmacy at the apothecaries' halls.

With respect to certificates, the London College recognizes all schools and lectures without exception. They state, however, in the above regulations, that, in common with all the other colleges, they reject the certificates of persons who lecture on more than one branch, and therefore refuse the certificates of professors or lecturers who lecture on surgery as well as on anatomy and physiology, but they allow this rule to be evaded. Certificates are not recognized from Dublin, unless the name of the candidate who produces them shall have been returned to the college as having been in attendance on the 25th of November, the 10th of February, and the 10th of May; at which periods the professors, lecturers, and hospital surgeons, are required to return the names of the students then attending, with the dates of entry, and periods for which they have entered, "with remarks." "It is required that the dates of commencement and termination be clearly expressed." Students should henceforth be very careful not to rest satisfied with having their names entered into these returns, unless they are really in Dublin and actually attending" the lectures and hospitals, because any falsehoods in the returns may subject them to the penal provisions of the charter. It is the person who holds, uses, or presents false certificates, who is to be punished, the person who signs and grants them is not held answerable.

There are various methods by which students whose other avocations or limited finances prevent them from complying with the printed regulations of this college can obtain an examination; and as the council appears disposed to afford gentlemen so circumstanced all reasonable facilities towards obtaining a diploma, they can scarcely

be blamed for availing themselves of them. An experienced private examiner can explain more to them respecting this matter than we care to mention.-Dublin Medical Press.

Progress of the Cholera.-We copy the following from the Times newspaper, and we do so at the risk of exciting perhaps unnecessary alarm. It is obvious that the medical profession should not be kept in the dark with respect to such a matter, if for no other reason, for this, that they should be prepared, not only to meet real danger, but to resist and expose any attempt to create premature or uncalled for apprehensions for placehunting or puffing purposes.

"We have received from our correspondent at Trebizonde a letter dated the 26th of September, from which, with deep regret, we make the following extract:

"The cholera has passed the line of the Russian quarantine on the borders of the Caspian Sea, and is raging throughout all the Tartar villages of the district of Salgau and of Leukeran. A considerable number of Cossacks, from the cordon on the Persian frontier, have likewise been attacked. At Rescht, a Persian city in the province of Ghilan, the cholera is still making incessant ravages, which have now continued during two months. The sanatory state of all the towns to the west of the Caspian Sea. from Bakou to Astrachan, is very unfavorable. Dysenteries and diseases of the stomach (frequently mortal) prevail in those towns, particularly amongst the troops in the garrisons. These maladies are probably the forerunners of the real Asiatic cholera-a phenomenon rather curious, which has been again observed latterly in Persia. There prevailed at Teheran, at Astrabad, at Meschid, and at Ispahan, a malady a considerable time before the appearance of the cholera, of which the symptoms resembled the Indian disease. The caravans which arrived from Teheran eight months since spoke of the existence of the Scourge which was mistaken for the cholera. A French physician, who resided at Teheran at that period, and who passed through our city a few days since, assured us it was the cholerine, such as had likewise been observed in several towns of Europe in 1833 and 1834* as a precursor of the cholera. The population of Teheran, which had been estimated at 80,000 is reduced by the ravages of the cholera to 60,000. The foreign ministers and their attendants had not dared to return to the city, but still continued to reside at Mount Alburs, in the neighborhood of Schemen, to the north of Teheran. The Russian authorities at Tiflis are well aware of the appearance of the cholera in that neighborhood, and the inhabitants of Tiflis have fled, but up to the 12th of September no official announcement had been made of the fact. Perhaps this course was pursued in order to prevent the merchants from becoming alarmed, and a consequent interruption of commercial affairs."-Ibid.

* This is a mistake. The cholera set in in Paris on the 28th of March, 1832.