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. That the Council do appoint certainCvs in each month for the examination ofcandidates for the diploma: to these exami-nations all the members of the College shallbare free access.

10. That candidates be required to pro-euce certificates from no particular schoolcr hospital ; knowledge, no matter whereacquired, with certificates of professionalopportunities for three years, and character,being the only requisites.

11. There shall be no public or privateschools whatever, or hospital, connectedwith this College.

12. The fee paid by each candidate forthe diploma shall not exceed five guineas.

13. There shall be a fund established,called " The British College Fund," intowhich all monies received shall be paid, andwhich shall be appropriated to the defray-icg of the necessary expenses, promotingscience, and affording relief to any of themembers of this College, or their families,who may require assistance.

14. That the members of the Council, andof the Board of Examiners, receive noemolument.

15. That for the next ensuing five years,’each member who becomes so in virtue ofhis belonging to another College, shall payannually one guinea towards the Collegefund.

16. That each member of the Council on

entering into office, shall take the followingoath or affirmation before a magistrate :--

" I, A. B., do promise faithfully and

honourably to fulfil and discharge to the bestof my ability, all duties which I shall, or

may have to perform as a member of theCouncil of the British College of Surgeons ;showing no partiality or favour to any one,but doing my utmost endeavours to promotethe general good of mankind. So," &e.

17. That any or all of the above laws maybe altered or annulled at any annual generalmeeting by a majority of the members, andwhatever other regulations may be proposed,can also be adopted.

By order,C. IRVING, LL.D.,F.S.A., &c.

Hon. Sec.July 24, 1329.N.B,—Those wishing to co-operate in

thu undertaking, are requested to entertheir names and residences (according to

Reg. 3) at the chambers of the College,2, Leicester Place, Leicester Square, be-tween 12 and 3 o’clock daily.BRITISH COLLEGE OF SURGEONS IN LONDON.

illotice.

It is proposed that two meetings be held-The first, to consist of those only who concurin the necessity of establishing this Col-

lege. At this meeting the prospectus,dated July 24th, will be submitted for re-jection, alteration, or amendment, in allor any of its clauses : so that thus alteredand sanctioned it may issue from, and bepublished by, the authority of this

meeting.The second meeting to be held pursuant to

public advertisement, and open to all, forthe purpose of ascertaining the opinion ofthe profession at large on the necessity of

, this undertaking.’

By order, C. IRVING, Hon. Sec.College Chambers, 2, Leicester Place, ’

August 10th, 1829.j N.B.-As the first meeting is to be con-vened only by notice from the secretary,those who wish to co-operate are requestedto send their addresses immediately to thesecretary.

ON THE TREATMENT OF SPINAL CURVATURE.

By Mr. SHELDRAKE.

Before I say more on the quackery thatnow prevails in the treatment of spinalcurvatures, I will endeavour to explainthose principles by the application of which.I succeed in removing the very distress-ing effects which are produced by thosedistortions. In doing this, I shall confinemyself to explain the treatment of one case ;because the variations in the symptoms ofdifferent cases are almost infinite, and whenthe particulars in the treatment of one caseare explained, your readers will perceivethat those particulars, when explained andunderstood, may be varied so as to meet theparticulars of any other case whatever.

Every one who understands the structureof the human body, knows, that the pelvisforms what may be called its centre ; itconsists of several bones, so united together,that, in the ordinary course of things, theyhave no motion with respect to each other,but form one immoveable mass. This maybe called the centre of the body ; from it,nearly all the muscles which move the lowerextremities diverge, in one direction, andall the muscles which move the body, passto it in a direction that is opposite to theother : as our business, at present, is withthese only, I shall take no further notice ofthe extremities.The spine consists of many bones which

are firmly united to each other, and to theribs, by ligaments which allow of certainlimited motions of the bones with respect toeach other; these motions are effected bythe action of the muscles, which are at.

tached, either to the pelvis, to the spine,to the ribs, or the upper extremities. While

664

the form of the body is perfect, or, we maywith more propriety say, natural, and thehealth is good, all the actions that can beperformed by any one part of the body, orof the upper extremity that is attached toit, may be equally well performed by thecorrespondent parts which are on the oppo-site side ; this may be called, so far as itsactions are concerned, the natural and

healthy state of the body ; it preserves thatin its natural form, and enables it to per-form the infinite variety of movementswhich, in the progress of life, all personsmust be subject to, in a perfect, or, we maywith more propriety say, in a natural man-ner ; this effect will always take place,while that state of the body is preserved.I have said in another place, that whilethe body is in this state, involuntary mus-cular motion, action and re-action are equal,and opposite to each other; but when thataction and reaction, from no matter whatcause, become unequal, deformity of the

body begins, and goes on increasing, to anyextent, till the power of action is entirelydestroyed : this assertion will require someexplanation.I will suppose a case, which I have fre-

quently seen, and which is often producedby many circumstances that it is not, now,necessary to consider. If we have such acase before us, where there is great defor-mity, the spine will be curved laterally,projecting outwards on the right side ; theshoulder raised, the scapula and ribs thrownout backwards, and the sternum on thesame side, will be small and sunk inwardsin proportion as the shoulder and back pro-ject out behind. On the left side, the ster-num and ribs of such a case would projectforwards, or, to use the language that issometimes employed to describe this kindof case, the front of the thorax would be

very large on that side ; the shoulder willbe lower than its opposite ; it will be muchsunk inwards, as well as the ribs, and theleft side of the back will be hollow ; I haveseen one case of this kind, where the distor-tion has been so great that the lower edgeof the scapula lay within the spine of theilium, so that I could not, by any exertion,pass my fingers under the lower edge of thescapula. I would stop to ask Mr. Cline, orMr. Abernethy, if they were present, todemonstrate how it would be possible, whena person was so distorted, to restore him tohis natural form ; by laying him down, asthey called it, either upon an inclined plane,or in rt korizontud way ? I believe that ever.the omnipotence of Mr. Abernethy wouldshrink from the attempt of describing sucha process, much more from undertaking toperform it.

In those patients that I have seen in thisituation, the ribs on the left side were

Nearly, if not quite, close together ; in somecases, I have seen some of them lap overthose which were next to them, so that theyhad almost no power of motion; when thishas been the case, the serratus muscles, andothers which lay near them, were con-

tracted, and had little or no power of motion,whence the patient had difficulty of breath-ing, in proportion to the extent of the de-

formity ; these muscles had retracted as

much as the situation they were in, com.pelled them, and had little or no power ofextension remaining.When a patient has lateral spinal curva-

ture under these circumstances, the left sideis sunk in, and presents a smaller surfacethan it did when in its original naturestate ; the muscles being contracted, their

voluntary action ceases, and the involuntaryaction, which should he connected with

respiration, is much interrupted. The na-tural condition of the light side is alteredas much, but in a different manner. The

spine being curved laterally, so as to pro-ject outwards, pushes the ribs outward beforeit, so that they occupy a larger space thanthey did when in their natural position: in

consequence, the muscles which cover

them are permanently extended; they losetheir power of contraction, of which theyare deprived by the contractile action of thesame muscles which is continually exertedon the left side ; and by this derangedaction of all the muscles winch are con.

nected with the spine and thorax, respira.tion is impeded, the form of the thorax is

altered, the health of the patient is injured,and ultimately destroyed, as we see conti-nually, and too frequently, in cases of thiskind.As it has, for a long time past, been

common to use the contrivance of Le I’aclierto cure this distoition, it will now Le pio-per to show that that is worse than use-

less, because it is quite impossible that itshould have the effect for which it has beenemployed, and does produce other eiteetswhich have not been attended to.

That these may be understood, attentionmust be called to the real state of the partsupon which it is intended that this contriv-auce should operate. The head, the ver-tebra;, the ribs, scapula, and - every bo’jethat is connected with the thorax, areplaced in a situation that is very differentfrom their natural situations with respectto each other ; in this situation they areunited together, with more or less firmness,by the ligaments and muscles ; as they arefixed in their present state, it is pretendedthat they will be removed from it and rf.stored to their natural situations and naturalpowers, by using the contrivance of 1-e

Vacher, which, it is pretended, will raise

the weight of the head from the spine, and

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as a necessary consequence, that all partswhich are concerned in the deformity, willpass again into their natural situations, andresume their natural functions. I deny thatthey will do so, and wiil now establish thatfact.Le Vacher proposed to fix his contrivance

upon a strong pair of whalebone stays,which he laced firmly about the body of his

patient; this, he said, was to transfer theweight of the head from the spine to thepelvis; you will perceive that it was notpossible to do this, and that to lace a pair ofstrong stays upon the body of a patient whowas already deformed, was the most certainway to increase the deformity. This is soevident, that in my first publication uponthis subject, in 1782,* I pointed out themischievous consequences that must result ifrom using this part of Le Vacher’s con-trivance, and substituted for it an improve-ment of my own. This improvement cou-sisted in arranging a number of steel springsso as to form a counterpart to the pelvis;and, when properly covered, this was a

complete case for the pelvis, which enabledit to bear whatever pressure it might benecessary to put upon it, without giving theleast pain, or inconvenience to the patient.Upon this basis, I raised whatever other

superstructure I wanted, but always so con-

* " Mr. Sheldrake, who unites a compe-tent knowledge of anatomy to his mechanicalabilities as an instrument maker, endeavoursto recommend an improved instrument toIemove distortions of the spine. Mr. Jones,some years since, proposed an instrument,which was very similar to one formerly de-scribed by M. Le Vacher, of the French

Academy, without acknowledging its ori-

ginal, though it was probably borrowed fromlll. Le Vacher. This machine frequentlyfailed; and we must own, that we should,in such cases, rather prefer the e I ills we have,than fly to others we know not of.’ The

improved instrument by Mr. Sheldrake, iscertainly free from many of ithe inconve-niences of that of Jones; and we are con-vinced, from other reasons besides those

employed in the present pamphlet, that itcan have no efl’ect in distorting the pelvis.It may, therefore, be cautiousiy used, thoughit ought always to be laid aside, if it givesthe least pain : its principles are rational,nnd its execution generally proper. Weseed not inform our readers, that IBlr. Potthas only proposed a method of curing theparalysis of the lower extremities, withoutany means of removing the distortion. Heseems to think it should remain ; but A.1r.Sheldrake is of opinion, that it may be safelyattempted hy l,is machine ; and with therestrictions just iiieiit-oned, we can see littleobjection to it."—Critical Review, 1732.

trived as to have every part of the body andhead at liberty, because I well knew all theevils that must be produced by pressureupon any part of them.

I have always used this in my own prac-tice, with every advantage that I could wish;I know that such imitations of this part ofmy invention, as the capacities of those whoemployed themselves on this subject wouldenable them to make, have been adoptedinstead of Le Vacher’s stays, without ac-knowledgmerit, as the Critical Reviewerssaid upon another occasion ; I shall admit,for the purpose of arguing the subject,although it is not true in point of fact, thatLe Vacher’s invention, with the assistanceof my addition to it, will do all that is pos-sible to stretch the spine, yet it will nothave that effect, or indeed any other thanthose mischievous ones, which llr. Aber-nethy has described in very just, thoughcertainly not very elegant terms. As he,has contented himself with making asser-tions to that effect, it remains fur me todemonstrate the truth of those assertions.

If we could suppose it possible for anybeing to live without muscles, but with thebones which form the spine, and the otherbones that are connected with it, firmlyunited by ligaments, the weightof tho head,pressing upon such combinations of bones,might, under many circumstances, producespinal curvature ; and, by raising the weightof the head, all the other bones might fallagain into their natural places ; but I verymuch doubt if they would do so, if they werelaid down upon an inclined plane, accord-ing to the practice of Cline, or lying down,quite in a horizontal way, aud for a longtime, according to the more energetic prac-tice of Abernethy. But when the action ofmuscles is added to the peculiar situation ofthe bones, it becomes quite impossible thatany beneficial effect can be produced byattempting to raise the head, in the way tbathas for so long a period been attempted :this fact I will endeavour to explain.John Bell says, " The origin and inser-

tion of the sterno-cleido-mastoideus muscleare shortly described in its name ; it arisesirom the triangular portion of the sternum,by a strong round tendon, and from the ster-nal portion of the clavicle, by -,%broader andmore fleshy origin. It ascends upon theneck, and in such a manner, that the dissec-tor can separate the two portions with thebandies of his scalpel to their termination.It is inserted into the mastoid angle of thetemporal bone, and extends its attachment

backwards upon the mastoid angle of thatbone. When the muscles of both sides act

together, tiey pull the head downwards, andbring the chin to the breast; but when onemu&cle acts, it ru’ls down the ear to the

666

shoulder, and so twists the neck, as to throwthe chin a little up, and to the other side,&c. The trapezius is named from its lozenge-like form ; it is often named cucularis, fromits resembling the monk’s cowl hangingback upon the neck. It is one of the mostbeautiful muscles in the body, and the twomuscles together cover all the shoulder andneck, with a lozenge-like form, with neatand sharp points, extending from the tip ofone shoulder to the tip of the other, andfrom the nape of the neck quite down to theloins ; it rises from the most pointed part ofthe occipital bone, and along the transversespine, quite to the mastoid process, by a thinmembranous tendon ; from this point, alldown the neck, it has no hold of the verte-brae, but arises from its fellow in a strong’tendon, which, extending like a bow-stringdown the neck, over the arch of the neck,and not touching the vertebue till it comesdown to the top of the back, is named liga-mentumnuchag. The tendon begins to takehold of the two last vertebræ oi’ the neck,and arises from all the spinous processes ofthe back downwards ; from this long origin,its fibres converge towards the tip of theshoulder; it also comes a little forward overthe side of the neck.

" Jt is implanted into more than one-third of the clavicle nearest the shoulder ;into the tip of the acromion ; into the wholelength of the spine from which the acromionarises ; and its fibres arising fiom along theneck and back, and converging almost in apoint, must have various effects, according’to the different fibres which act ; for thosewhich come downwards must raise the sca-pula ; those which come from the middle ofthe back must carry it directly backwards ;those which come from the lower part of theback must depress it, and those differentfibres acting in succession, must make the

scapula roll. The trapezius is a musclewhich moves the scapula, but it must bealso occasionally a muscle of the head, pull-itzg the head backwards, and bending theneck. It is also a powerful muscle of respi-ration, as may be seen under the head ofinspiration."

,

1 have given the particular description ofthese two muscles preparatory to showingthe effect that is, in reality, produced bythe attempts that are continually made tostretch the spine. When the spine-stretch-ers determine to perform this their favouriteoperation, they begin by grasping the head,and securing it by the contrivance that wasinvented by Le Vacher for that purpose :the remaining part of his contrivance con-sisted in lacing a very strong pair ofwhalebone stays very tight upon the bodyof his patient, however deformed that pa-tient might be, and pretended that, bythis contrivance, he transferred the weight

of the head from the spine, and fixed it uponthe pelvis ; the utter impossibilit), of Cc.L!this, was experienced by almost all tLst that

made’the attempt, and proved, that difficultyof breathing, and additional distortion, wereproduced by this ill-directed attempt, wholethe weight of the head was not, and cc’jid

not, be transferred from the head to tLe

pelvis by this contrivance.You will perceive, by the extractfrom the

Critical Review, which has just been gim,that this was one of my original objectimsto Le Vacher’s contrivance, and that I re-moved that objection, bysubstitutingafirmcounterpart to the pelvis, which rendersconfinement to any part -of the body unne.cessary, while other means, totally distinctfrom stretching the spine, were used to re-move the curvature. In my own practice,this always answered my intentions, whichthe spine-stretchers, with Cheshire at theuhead, could not comprehend, though theypilfered my intention, and ntisatsed it 171 theirown way. By such imitations as ignorantworkmen could make, they managed to geta firm pressure upon the hips, as they hadalready upon the head by Le Vacher’s con-trivance, and then set to work, with all theirmight, to stretch the spine till it became

straight. Dr. Harrison, who claims supe-riority in every thing, boasts that he has

invented a windlass which he applies to

stretching the spines of those pahents whofall into his hands. The originality of tbatinvention is about equal to its utility, for itbears a strong resemblance to the practiceof Doctor Procrustes, an eminent physicianin the ancient times of Greece. W li’en thatgreat physician met with a patient who wasmore crooked, or shorter, than he, the doctor,thought that he should be, he laid him uponhis own bed, which he had invented, andstretched him till he became of the exact

length that he determined thatheshontdte.It will be evident to you, that these spine-

stretchers can never attain the object the,,,have in view, by following these practices;because the moment they screw their in.struments, so as to raise the head of their

patients, they bring’ into action, first, the ,

sterno-mastoideus and trapezius muscles,and, in regular succession, all the musclesof the trunk which have any connexion w)t!ithe spine ; these become a counteractingforce, which is inevitably employed in im-peding, and, indeed, successfully prevent-ing, that effect which it is intended to pro.duce, from taking place. It is a first pm-ciple in voluntary muscular action, that nomuscle can be forced into action by extra-neous means, without exerting all its cwnpower to regain that state of rest, which ISeither natural to it, or ha. become so, bvwhatever circumstances have producedthe distortiou which it is intended to re-

667

medy; it is this uncontrollable action that,when such attempts are made, brings all thepower of those muscles which are con-

nected with the spine and the rest of thebody, to resist the attempts that are made,by such means, to stretch the spine and re-store it to its original figure. This it iswhich produces all the evils which Mr.

Abernethy justly attributes to the practices iof the spine-stretchers, although he did notthink it necessary to inform his pupils whatthe real causes of those evils were.

I will now repeat my assertion, that spinal liicurvature is nevel- produced byp2-essu),ej?-otitthe weight of the head, although, in somecases, it is increased by that pressure after ,

it kzzs been produced by other causes. Whathas been called Pott’s curvature, is occa-sioned by disease which destroys the sub-stance of the vertebrae, and the loss of thatsubstance weakens the spine, and allowsthe weight of the head, which is increasedby the deranged action of the muscleswhich now takes place, and leads to thoseconsequences which, 1 believe, all profes-sional men are acquainted with. All thelateral curvatures that I have seen, havebeen produced by the deranged action ofmuscles of the trunk and other parts, whichcurves are almost innumerable, and which 1shall not now minutely inquire into, but itwill be proper to observe, that when suchcurves have taken place, pressure from theweight of the head has a strong g tendency toincrease them, although the removal of that ’,pressure, when it can be effected, will notcore them. In my next, 1 will show bywhat means I have, during the whole courseof my practice, succeeded in curing thesepeculiarities, and afterwards proceed to ex-plain the very important improvements thatI have made in that practice.

GUY’S HOSPITAL.

REMOVAL OF THE RIGHT GREAT TOE FROM

ITS JUNCTION WITH THE TARSUS.

THE patient, a lad apparently about 14years of age, was placed in a recumbent

position, on the operation table, at about

half-past one, on Tuesday, August the 11th:the toot being supported by an assistant,llr. Bransby Cooper took hold of it withhis left hand, the sole and outer part rest-ing on the paim, and the thumb being appliedon the dorsum, near the articulation of themetatarsal bone of the great toe, with theilttrual cuniform bone. An incision wasnow made, commencing at this joint, andextending along the course of the metatarsalbone to just behind the ball of the great toe ;a second incision was made across to thesole of the foot, and, without removing theknife, was carried backwards to the under

part of the joint, opposite the commence-ment of the first incision, where the disar-ticulation was to take place. The bounda-ries of a flap were now formed, and with asmuch muscle as the limits of the incision,and fleshiness of the part would allow, weredissected back as far as the joint ; a double-edged scalpel was then passed perpendicu-larly downwards, between the metacarpalbones of the first and second toes, and thesolt parts between them divided, by the

operator bringing the knife towards him.The disarticulation was then effected byintroducing the knife at the inner end ofthe joint, Mf. Cooper, at the same time,alternately raising and depressing the toes.

The cartilage covering the tarsal bone wasthen pared off with a scalpel. Two arterieswere next secured, and the flap was made tocover as much of the wound as its size

would permit, and confined by sutures : thewhole was then dressed with strapping, andhad a roller applied over it.The operation was neatly performed in

four minutes, and was borne by the patientremarkably well.

’;I After the removal of this patient, an el-derly man walked into the theatre, andplaced himself on the table, with an artificialopening into the urethra, situated just an-terior to the scrotum, which was of longstanding. Mr. Cooper stated, that he hadthree or four times before, at different pe-riods, brought a portion of the neighbouringinteguments to cover this opening, but ithad never succeeded. " However," saidhe, " he wishes to have it done again:’The old fellow seemed inclined to be jocose,and appeared anxious to enter into the

history of his case, and the original causeof .the false passage. ’° It was done (saidhe) when in St. Thomas’s Hospital, underA,lr. Green ; 1 know it was-in introduc-ing a catheter—for the dresser, Mr.—

(here Mr. Cooper interrupted him with, Oh !come, come, my man, we do not want anynames)-I know it was he, (said the oldman,) for instead of pushing it the rightway into the bladder, he turned it outwards,and I felt something give way at the time."There was a delay of some minutes beforea bougie was brought, but having at lengtharrived, the operator introduced it by thenatural passage into the bladder ; then pass-ing a phymosis knife through the integu-ments, at the upper part of the opening,(which was about haif an inch long,) withthe assistance of a pair of dissecting forceps,the edge was cut away around the opening,so as to remove every portion of the cicatrix.The edges of the wound were then broughtinto apposition by several sutures introducednear each other, and strips of adhesive plas-ter were placed over.