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CAMBRIDGE MEDICAL DEGREES.

FoR the information of gentlemen whomay desire to graduate at Cambridge, thefollowing paper has been drawn up by amember of the University, for publicationin THE LANCET:--

1. Before a student can enter at anyCollege, he must pass an examination inthe ordinary Greek and Latin classics,conducted by some Master of Arts of hisintended college.

2. If past the age of 22 and his circum-stances will allow of it, he might enter asa Fellow-Commoner. If under tl at age, asa Pensioner.

3. The fees of entrance and tuition areat all the colleges the same, viz.:

4. The Cambridge University year com-mences on t:1e 10th of October; conse-quently the student should begin residencein the October term.

5. There are three terms yearly; theOctober or Michaelmas term, the Januaryor Lent term, and the Easter or Midsum-mer term. Nine terms must be kept,thus requiring three years residence.

6. During the first two years he mustattend the Classical and MathematicalLecture of the College to which he be-

longs ; and in the Midsummer term hemust pass an examination in the subjectslet tured on in each year.

7. In the second Lent term after his en-trance, he must pass his first public ex-amination, called the Previous Examina-tion." The subjects are, one Greek author,one L’ltin, part of the Greek Testament,and " Pal2y’s Evidences of Christianity."

8. The two College examinations and theprevious examination being passed, in thethird year he must keep three more terms,during which, he must attend one courseeach of the lectures on Anatomy, the Prac-tice of Physic, Chemistry, and Botany.The Lecturer’s Fees are 181. 18s.

9. For the following two years, or as

long as he may be absent from the Univer-sity, he must diligently attend some well-known hospital, and produce a ceaificateof the same.

10. When he has entered his sixth year,he proceeds to take the degree of M. B.(Bachelor of Physic), for which he passes

an examination before each of the fourProfessors on the subjects above mentioned.The Professor of Physic also examineshim in Hippocrates’s Aphorisms, Celsus,Sydenham, &c.

11. After he has satisfactorily fulfilledthe conditions of the last section, he keepsone Act, and one opponency in the publicschools. The questions for the Act ge-nerally refer to some practical point, or tosome physiological or pathological subject.The whole is of course carried on in theLatin language. The expenses of theM. B. degree are 401.

12. The term after he has taken the" M. B." he is again examined for " L. M."(Licentiate in Physic.) The Practice of

Physic, Anatomy, Aretseus, and some

Latin medical authors, are the subjects ofexamination. The expense is about 15l.I 13. After he has taken the "M. B."

five years must elapse before he can takethe degree of " M.D."; but, by courtesy,; with his bachelor’s degree, he is styled’ " Dr.," and he may commence practice asa a physician. The expense varies at thedifferent colleges.

NORTH LONDON HOSPITAL.

COMPOUND FRACTURE OF THE THIGH

FOLLOWED BY EXTENSTVE GANGRCNE

OF THE CELLULAR TISSUE, ABSCESSES,, AND HEMORRHAGE FROM SEVERAL

, BRANCHES OF THE GLUTEAL ARTERY.

ANNE FAIRBAIRN, aged 31, was admittedJune 14th under the care of Mr. COOPER.She had compound fracture of the left

thigh about its middle, occasioned by fall-ing out ofa first-story window. There weretwo wounds, one on the outer, the otheron the inner side of the middle third of

! the thigh. The latter communicated withthe fracture, but the wound on the exter-nal side had no connexion with the in-

,jury of the bone. There was likewise a

wound of considerable depth at the innerside of the right thigh. The woman in

failing had struck against the iron railings

in front of the house-a circumstance ac-counting for the production of two of the

wounds, while the third had evidently

been caused by the protrusion of the bro-ken bone. The limb was placed on M’In-tyre’s apparatus in the bent position. On

opening the bandage three days after theaccident, the wound in the outer part ofthe left thigh was found to be in a slough-ing state, but the wound communicatingwith the fracture had united by the fistintention. At the same time a consider-able ecchymosis and swelling were noticed

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about the trochanter major, and fore partof the gluteus maximus. On the 21st Mr.MORTON, the house-surgeon, made a freeincision below the great trochanter, and acopious quantity of bloody sanies was dis-charged. Here the subcutaneous cellularmembrane was found to be completelygangrenous. On the 24th another deepincision was made by Mr. COOPER in themost prominent part of the swelling; a

discharge of bloody sanies followed, butno pus was evacuated ; here also the cel-lular tissue under the skin was gangre-nous. Some hopes were entertained ofthe patient’s recovery until the eveningof July 2nd, when about seven o’clock ableeding took place from the wound thathad been made on the outer part of thethigh on the 21st of June. After the lossof six ounces of blood the hemorrhagestopped. At a quarter past eleven p.m.it returned, but again ceased after twelveounces had flowed. About an hour after-wards the patient, who previously to thebleeding had been in a very weak state,breathed her last.Autopsy.-On making an incision along

the front of the thigh, an extensive ab-scess was found beneath the sartorius,reaching from the middle of the thigh upto the groin. Numerous collections ofmatter were met with in different parts ofthe limb, deeply seated amongst the mus-cles. An immense collection of thin sa-nies was also detected behind the psoasmuscle, extending as high as the lowerborder of the kidney. Between the glu-teus maximus and medius muscles wasa large cavity, partly occupied by semi-putrid grumous blood, and partly by co-agula of recent formation. The incisionmade by Mr. COOPER on the 24th of June,if carried a little more deeply, would havepenetrated this cavity. After the coagulahad been removed, some waxen injection,thrown into the common iliac artery, es-caped freely into the cavity where theblood had collected from several ramifica-tions of that branch of the gluteal arterywhich runs between the gluteus maximusand medius muscles. The ends of thefracture were destitute of periosteum, andperfectly disunited.

In making some observations on thiscase, Mr. COOPER said he concnrred withSCHMUCKER and other high authorities,that compound fractures of the thigh at-tended with splintering of the bone andsevere injury of the soft parts, are casesin which the patient will have the bestchance of preservation when the limb isamputated without delay. In the presentinstance, however, though there was a

violently contused wound in the outer

part of the thigh, it (lid not communicate

with the fracture; while that caused bythe protrusion of the bone at the innerside of the thigh was of moderate size, andapparently such as might unite very fa-vourably. The bone was also not splin-tered. Under these circumstances he be-lieved no practitioner would have thoughtof amputating. The wound communi-

cating with the fracture actually healedby the first intention, and this favourablecircumstance was at first a source of en-

couragement ; but the prodigious swellingof the hip and thigh, the rapidity of the

pulse, the extensive diffnse inflammationof the subcutaneous cellular tissue, andthe gangrenous state of it observed at

every point where the skin had beendivided, made it but too manifest that thedeep-seated mischief was of a formidabledescription. With regard to the hemor-rhage from branches of the gluteal ar-tery, what was the cause of this bleed-ing ? Did it arise from the vessels givingway in consequence of the diseased stateof the parts round them ? This mighthave been the case, but it was not the viewwhich he adopted. Considering the man-ner in which the accident happened, thatthe patient in her fall from the window

struck violently against the iron railings,and then fell on the pavement, he was in-duced to believe that she received at thismoment a most severe blow in the partwhere the extravasation took place. In

fact, on his first seeing the patient, theecchymosis and swelling of the buttock! were very remarkable, and he suspectedeven then that there was a considerableeffusion of blood under the gluteus maxi-irius, from rupture of branches of the glu-I teal artery. If it be asked why the extei---nal bleeding did not begin till a fortnightafterwards, the answer is, that at this pe-riod the sloughs of cellular membrane

blocking up the wound made on the 21stof June, and bounding also the lower por-tion of the cavity in which the blood had

accumulated, began to loosen, so that apassage for the blood outward was nowfor the first time created. He thought thecase full of instruction in various respects.I Who would have expected a fracture ofthe thigh to be complicated with a rupture of several considerable branches of the

gluteal artery? When the situation of the

external wound, from which the blood es---aped, was considered, who atso could

have spoken with confidence and certainty.vith respect to the exact vessel from which,,he blood came ? If the bleeding had noteased, and the woman had been in a stateo bear an operation, how uselessly might;he femoral artery have been tied evenmove the profunda’ Had amputation

been performed high up the limb, directly

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after the receipt of the injury, supposinghis view of the case to be correct, theoperation would have had no effect in

preventing the effusion of blood from theruptured branches of the gluteal artery,and, consequently, unless the stump hadhealed without suppuration, the patient Iwould still in all probability have fallen avictim to secondary hemorrhage. On theother hand, if no hemorrhage at all hadtaken place during the treatment actuallypursued, the vast extent of disease, re-vealed hy the post-mortem examination,leaves no doubt that the case would yethave terminated fatally. !

RUMINATION I!ST A FEMALE.

Dlt. ELLIOTSON the other day relatedthe case of an old lady in her eighty-ninthyear, who has ruminated from her earliest

years; she enjoys excellent health, andhas for a considerable time lived in thefollowing manner:—she has tea and but-tered toast for breakfast; bread dipped ingravy, and potatoes, for dinner, and teaor sometimes coffee in the evening. Sheruminates generally after every meal,and uniformly after dinner; some kinds offood and liquid never rise in her mouth,such are wine, beer, and cider; tea doesso in the afternoon, but not in the morn-ing, water always rises, and seems to bemost efficacious in causing the otherarticles to rise; when she takes it withher potatoes at noon, they always come upwith a very pleasant taste. Buttered toastand tea generally rise with a very un-pleasant taste, as do also all greasy things,sometimes coming up for several times

successiaely until she- spits them out. Thefood always comes up with a rushingnoise, like the sound of the sea ; butmedicines never come up again; the

faculty is quite involuntary; the foodsometimes rises directly after being swal-lowed, sometimes not for an hour or more;if she takes much water, the return isalways quicker than when she does not.She ch2ws her food the first time verymuch, before swallowing it, and it neverfeels heavy at the throat, before it comesup agrdn. When she is ill she ceases toruminate. The food she takes first alwayscomes up first, generally in the same statein which it was swallowed. It is curiousthat the hard parts of oranges always rise,while the juice invariably remains on thestomach. She thinks the faculty not at alluncommon, and supposes that most of her

acquaintance have the same power ofrumination as herself. Her father andone of her brothers possessed this faculty,but they both died early ; she is herself inexcellent health, and bordering on ninety.

Dr. E. had never before heard of afemale who ruminated, though there areseveral cases on record of this facultvbeing possessed by men. Blumenbach hasrecorded four examples, in two of whichit was voluntary, and in two compulsory;they had always real gratification in rumi-nating.There was a case of this kind a few

years hack in the London Hospital; thePhilosophical Transactions also contain thehistory of a case which occurred in a

young man twenty years of age, a nativeof Bristol. He had ruminated from hisearliest recollections, and ho alwayschewed his food a second time after swal-lowing it. The process began in a quarterof an hour, if he had taken any liquid athis meal, but later if he had not; some-times after a full meal it would be an hourand a half. Unlike the case of the old

lady, before the second chewing, the foodappeared to lie heavy in the lower part ofhis throat, and after the second chewingthe food passed completely away. If he

ate a variety, that which passed down firstcame up first, having a pleasant taste;! and when the faculty left him he became ill. His father had also ruminated.

ST. BARTHOLOMEW’S HOSPITAL.

TRISMUS.

GEORGE Tupp, setat. seventezn, was ad-mitted into Matthew’s ward, June 10th.He has a flushed countenance and hotskin, The pupils of his eyes are perma- nently dilated, the iris not contracting in! the slightest degree on exposure to strong! light; the eyelids are strongly contractedwith some knitting of the brows; theteeth are so firmly closed, that considera-Iltle force is required to insert between, them the handle of a spoon. He appearsto be perfectly insensible when spoken to,and at times is very restless and moaning,

wliilst at others he lics quiet and is com- posed. The s&nsation and powers of mo- tion of his extremities are perfect, and heresists pressure made on the abdomen,: which is soft and tolerably flaccid; pulse: 114, soft and easily compressed; breathing! natural; there exists no hardness or con-, traction of the muscles, excepting those of the jaw. The following history of thet case has been obtained : He has been sub-ject to hcadachs for some months, thoughhis alvine dejections have been regular,and his bowels are easily acted on by raecli-, cine. He felt ill a few days since, andl complained of shivering, and then be-coming hot and feverish. These symp-