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LONDON HOSPITAL.
221 who survived an injury of the head nine days after the accident. aggregated, and with more appearance of agglutination between In the cavity of the arachnoid was an extensive extravasation of the corpuscles, than in very buffy human blood. Sixth.---There may be a buffy coat, or only a comparatively blood divided into a visceral and a parietal portion-the visceral blood of the horse, when the blood has been portion formed a thin, smooth, and flattened clod, which corres- thin one, on the of the hemisphere. made thinner and its Poagulation retarded. ponded to the whole of the upper surface. Seventh.—The corpuscles of the horse sink much quicker in his The parietal portion was disseminated in patches of various sizes and thickness, many of which were firmly bound to the serum than the corpuscles of man do in his. free surface of the serous membrane by thin, delicate membranes, Eighth.—Increasing the proportion of corpuscles in the blood of a fawn colour, with smooth and polished surfaces, and bevelled hastens coagulation, and prevents or diminishes the formation of off at their margins, so as to be adapted to the original serous the buffy coat, more than increasing the serum only. membrane. Had the membranes covering these clots been the result of an inflammatory effusion, they must have been produced by the visceral arachnoid, but that membrane could not have produced them, for it was, as already stated, covered by a layer HOSPITAL REPORTS. of coagulated blood. Extravasation of blood in the cavity of the arachnoid had been frequently found in maniacal patients, two LONDON HOSPITAL. cases of which were mentioned in his paper, as having occurred in phthisical patients. Mr. H. had observed intense pain in the CASES OF FISTULA IN ANO, TREATED BY LIGATURE, head in one case only, in which the pain put on the character of. BY MR. LUKE.
brow algue, lasted for two or three hours, and then disappeared, but recurred, for several days, twice in the twenty-four hours. THE following cases are illustrations of the treatment of fistula in ano by ligature kept moderately tight, by means of a small The symptoms then became typhoid. Dr. BURROWS inquired what was meant by an alternation ofscrew tourniquet, thus gradually dividing by ulceration those parts usually divided by the knife. coma and paralysis, as referred to both by the author in the The advantages of this method of treatment over the treatment paper, and by the last speaker? Mr. HEWITT explained that coma came on at one time and by the knife are,—1st, The shorter period which usually elapses before the final cure; 2nd, The less pain which is usually exdisappeared, that then paralysis came on and also disappeared. Dr. MAYO referred to a case which he had published some perienced during the treatment; 3rd, The absence of all cause time ago in the Medical Gazette, as bearing upon the occurrence for dread of the knife, and the consequent inducement which it of brow algue, as mentioned bv Mr. Hewitt. In this case the offers to the timid to submit to an effective curative treatment; lastly, the avoidance of all danger from bleeding-an advantage pain at first was periodic, and he at first thought he had been and mistaken in referring it to pressure. It became worse under the of great importance in the deeper forms of fistulæ which comuse of the liqubr arsenialis. It subsequently became continuous, municate with the rectum at a considerable distance from the but was nearly entirely removed by calomel and antimony. anus. The treatment is conducted in the following manner:-_ An eyed probe, (see description of apparatus,) armed with dentist’s silk, is introduced in the ordinary way through the fistula into the rectum, from whence the silk, together with the detached ON THE FORMATION OF THE BUFFY COAT OF THE BLOOD.—By GEORGE GULLIVER, F.R.S., Surgeon in the Royal Regiment extremity of the probe, is withdrawn through the anus by means of a spring catch introduced into the rectum upon the forefinger of Horse Guards. of the operator. The parts to be divided are thus enclosed beRobert Liston, F.R.S.) (Communicated by tween the two extremities of the ligature, to. which a small AFTER noticing the well known fact, that the red corpuscles will fistufa-tourniquet is subsequently attached by passing them sink much faster in the entire blood, while the huffy coat is form- through holes provided for the purpose, and knotting them so as ing, than they will do in the serum alone, the author remarks to prevent their being withdrawn. A screw is then applied, by that two of the most eminent authorities on the physiolcgy of the the turning of which the requisite amount of tension is kept up. blood, Mr. Hewson and Dr. Davy, concluded that the rapid When thefistula does not communicate with the’rectum, a persinking of the corpuscles on which the buffy coat depends, is due foration is made in its walls by the eyed probe, the extremity of In other to an attenuation of the liquor sanguinis. On the contrary, Pro- which is made sharper than that- ordinarily used. fessor Hermann, Nasse, and Mr. Jones, attribute the quick sink- respects, the passing of the ligature, and the attachment of the ing of the corpuscles to their increased aggregation in inflam- tourniquet, is conducted in the same manner as when there is both an external and internal opening. It should be observed, matory blood.-British and Foreign Medical Review, No. 28. Finding that the blood of the horse generally affords a buffy that the passage of the ligature is accomplished with great facility, surface measuring as much perpendicularly as the lower red and with little if any more pain than attends the ordinary part of the blood clot, the author made many experiments on the examination of a fistula with a common probe. Care is also sinking of the red corpuscles in the liquor sanguinis in the serum, taken that the tension of the ligature is never so great as to cause and in these fluids variously altered in viscidity and specific more than slight uneasiness at the part, and at its first application gravity. The experiments are particularly detailed, in order is usually left loose, to allow for swelling of the enclosed part that they may be easily repeated, and that no errors may arise arising from the slight inflammation which is caused by its from the different effects which Mr. Prater has shewn may be presence. After the lapse of three or four days, ulceration of the enclosed part commences,_ and the tourniquet becomes produced by different quantities of the same substance. The author is of opinion, that if we admit the sinking of loosened, indicating the necessity of the ligature being made the red corpuscles affords an accurate test of the consistency of tighter. This is done every three or four days, by making two the liquor singuinis, we must also admit the improbability ’that or three turns of the screw with a watcli-key fixed on a handle. the liquor sanguinis becomes thinner some minutes after the blood While the process of ulceration is proceeding, a process of has been received in a vase, at which time the falling of the red granulation is filling up the cavity behind the ligature, and on this’account it is not desirable that the ulcerative process ’should corpuscles is most rapid. The author asks whether the well-known utility of saline me- proceed very rapidly, lest the latter should not proceed, paridicines in inflammation may not be explained by their effects in passu, and a cavity be left unclosed. When a case has proceeded preventing or destroying the aggregation of the red corpuscles, favourably, it usually happens that it may be reported as cured and in preventing or lessening the buffy or inflammatory condi- within one or two, or at most a few, days after the complete division of the enclosed parts and consequent falling off of the tion of the blood. The author arranges some of his conclusions as follows :-tourniquet. During the treatment, it is desirable that causes First-There is a remarkable acceleration, after a few minutes, tending to produce inflammation should be avoided, but in many in the ratio with which the blood corpuscles sink in the liquor cases the confinement of the patient is unnecessary, and moderate exercise may be used. Should inflammation, however, supervene, sanguinis. Second.-This acceleration may be increased by increasing much pain is experienced by the greater tension given thereby the aggregation of the corpuscles; and prevented or removed, by to the ligature, the obvious reniedy for which is the loosening the ligature by reversing the screw of the tourniquet. preventing or destroying the aggregation of the corpuscles. Third.-The sinking of the corpuscles is slower in blood CASE 1.-Henry M——, admitted into the London Hospital thinned by weak saline solutions, than when mucilage is added under the care of Mr. Luke, March 3, 1840, with a fistula in ano, with the salt. Fourth.=The sinking of the may be slower in which had existed for a month. It had an external and internal serum artificially made thinner and lighter, than in serum opening, the inner one communicating with the side of the’ rectum as high up as the finger-could reach. The ligature was -artificially made thinner and heavier. Fifth.-In the cruor of horses’ blood the corpuscles are more applied on the 6th; there was no pain caused by its remaining -
.
-
-
’
corpuscles
’
222 in, the patient only complaining of a little when going to stool. The ligature was tightened every two or three days, and came away on the seventeenth, after its application, the part quickly
cicatrizing
over.
CASE 2.-James A-, admitted under the care of Mr. Luke, with a fistula communicating with the rectum two inches higher than the anus, and opening externally. The ligature was applied March 25th. It gave no pain, and caused no inconvenience, the patient walking about while it remained in. It came away
April 9th, having
Fistula cured.
been
tightened
every two
or
three
days.
CASE 3.-A physician’s patient, with cough, admitted Decem1840. He had a fistula on the right side, which was cut, but did not heal entirely, and still discharged. Some time after, another fistula formed on the left side, and opening into the rectum an inch and a half above the anus; to this the ligature was applied May 2nd, and came away on the 1lth. He left the hospital a month after, somewhat improved in health, the left fistula requiring a small portion to cicatrize, the right discharging as before the latter operation.
ber,
CASE 4.-Elizabeth S-,aged 32, married, admitted under the care of Mr. Luke. She has had a discharge from the rectum for four years. On examination, a fistula an inch and a half in length was found: the ligature being passed through it, November 3rd, it came away in eighteen days, leaving the fistula completely healed, having been tightened as in the previous cases. The patient remained in the hospital for some time in consequence of cerebral symptoms supervening; these being treated effectually, she was discharged cured.
Description of Fistula apparatus, Mr. Luke.
a
CASE 5.-John M-, aged 38, seaman; fourteen months previously he had indulged freely in ardent spirits, and shortly afterwards, a boil appeared near the anus, which has discharged ever since; the bowels are generally costive. Being admitted July, 1842, the fistula was examined, and ascertained to be an inch in length; the ligature was passed, and came away in seven days, the fistula being quite healed in another week.
b c an
eyed probe, with
a
contrived and used by
moveable
extremity
fixed in
a
ligature and ready for use. a the moveable extremity eyed to receive a ligature; b the probe, on which a is placed when used; c the handle, in the end of which is a groove to hold the ligature tense, represented. d e f a steel spring-catch to withdraw the ligature from the rectum; d is a piece of steel set in a handle, and split at its extremity e e, so as to form a spring, opening readily when in use CASE 6.-William N-, aged 59, wheelwright, was admitted to receive a; f represents a hollow oval cone divided into two into the London Hospital, with fistula, which had existed for the parts by the split e e ;it readily conducts the probe point a last four years. It had not given him much pain, but the dis- through the split, when pressed against it, and the point is afterwards seized by the springs and retained until withdrawn from charge was constant and inconvenient. Mr. Luke passed the the rectum. November October and it came 19th, 6th-eighteen ligature away and The continued short the a fistula a time, discharge days. g represents the probe point and ligature seized by the springcatch. gradually healed in a few days. h the tourniquet and watch-key; i k the nuts, provided with CASE 7.-Abraham H , aged 46, general dealer, admitted holes, with the ligatures knotted, as in use;the watchligature under the care of Mr. Luke. He has been subject for a long fixed in a handle; m the screw of the tourniquet, the end of key time to difficult micturition and pain in the perineum, for which which is made to receive the watch-key when about to be he has been treated. Three weeks previously to admission, pain turned. The square is applicable to a great number of cases tourniquet occurred near the anus, followed by swelling and abscess. The handle, represented
armed with
a
besides fistula in ano. Thus in varicocele, in the removal of about an inch in extent, and communicated with the tumours, in opening long sinuses, when the use of the knife would anterior part of the rectum. The ligature was passed Aug. 19th, be dangerous, or in any case where the gradual operation of the 1843, and came away on the 30th. The fistula was longer than I is desired. in the previous cases in completely healing, but in three weeks I ligature after was quite sound and cicatrized. fistula
was
CASE 8.--William Laged 35, labourer, admitted Aug. 15, 1843. One month previously, he had pain and swelling about the anus, followed by an abscess, which burst spontaneously. The fistula was situated posteriorly to the rectum, but no communication with it could be found. The ligature was passed through the coats of the rectum, and brought out on the 19th. It was afterwards tightened occasionally, but owing to the small screw for that purpose not fitting properly, it did not act effectually, and was in consequence longer than usual in ulcerating through. The patient wishing to attend as an out-patient, he was discharged with the ligature remaining: he went about without pain, and on one day walked twenty-five miles with little inconvenience. Owing to his attending but seldom, it did not come away till October 9th, when the fistula was left quite
healed. CASE 9.-William K , aged 37, coachman, admitted November 29th. He had gonorrhoea three months previously; six weeks ago he had pain in the perineum, followed by an abscess. There was considerable inflammation, and a fistula leading into the anterior part of the rectum, about an inch in extent.-Dec. 2. The ligature was introduced in the usual manner; it did not prevent the subsidence of the inflammation, and being tightened twice, came away on the 13th, and was quite healed in another
week.
THE ASSOCIATION OF GENERAL PRACTITIONERS IN MEDICINE, SURGERY, AND MIDWIFERY. To the Editor of THE LANCET.
SIR,—We are requested by the Provisional Committee of this Association to call your attention to the fact, that the " Suggestions for Heads of Charter," furnished by them to the Right Honourable the Home Secretary, can only be considered as an outline of the main principles upon which, in the opinion of this Committee, a Charter of Incorporation for the general practitioners ought to be founded, in order to give satisfaction to that numerous and important section of the medical profession. The mode of electing the Council under the proposed Charter is a question of detail, open for consideration; and we are requested by the Provisional Committee further to state, that if voting by is, after deliberation, desired by their proxy or by voting paper provncial brethren, it will be their pleasure to recommend it for adoption at the general meeting of the Association. We have the honour to remain, Sir, Your very obedient servants,
JAMES BIRD,
Son. Secs. Sees. JAMES BIRD,Hon. HENRY ANCELL, HENRY ANCELL,
4, Hanover-square, Feb.
is.
brow algue, lasted for two or three hours, and then disappeared, but recurred, for several days, twice in the twenty-four hours. THE following cases are illustrations of the treatment of fistula in ano by ligature kept moderately tight, by means of a small The symptoms then became typhoid. Dr. BURROWS inquired what was meant by an alternation ofscrew tourniquet, thus gradually dividing by ulceration those parts usually divided by the knife. coma and paralysis, as referred to both by the author in the The advantages of this method of treatment over the treatment paper, and by the last speaker? Mr. HEWITT explained that coma came on at one time and by the knife are,—1st, The shorter period which usually elapses before the final cure; 2nd, The less pain which is usually exdisappeared, that then paralysis came on and also disappeared. Dr. MAYO referred to a case which he had published some perienced during the treatment; 3rd, The absence of all cause time ago in the Medical Gazette, as bearing upon the occurrence for dread of the knife, and the consequent inducement which it of brow algue, as mentioned bv Mr. Hewitt. In this case the offers to the timid to submit to an effective curative treatment; lastly, the avoidance of all danger from bleeding-an advantage pain at first was periodic, and he at first thought he had been and mistaken in referring it to pressure. It became worse under the of great importance in the deeper forms of fistulæ which comuse of the liqubr arsenialis. It subsequently became continuous, municate with the rectum at a considerable distance from the but was nearly entirely removed by calomel and antimony. anus. The treatment is conducted in the following manner:-_ An eyed probe, (see description of apparatus,) armed with dentist’s silk, is introduced in the ordinary way through the fistula into the rectum, from whence the silk, together with the detached ON THE FORMATION OF THE BUFFY COAT OF THE BLOOD.—By GEORGE GULLIVER, F.R.S., Surgeon in the Royal Regiment extremity of the probe, is withdrawn through the anus by means of a spring catch introduced into the rectum upon the forefinger of Horse Guards. of the operator. The parts to be divided are thus enclosed beRobert Liston, F.R.S.) (Communicated by tween the two extremities of the ligature, to. which a small AFTER noticing the well known fact, that the red corpuscles will fistufa-tourniquet is subsequently attached by passing them sink much faster in the entire blood, while the huffy coat is form- through holes provided for the purpose, and knotting them so as ing, than they will do in the serum alone, the author remarks to prevent their being withdrawn. A screw is then applied, by that two of the most eminent authorities on the physiolcgy of the the turning of which the requisite amount of tension is kept up. blood, Mr. Hewson and Dr. Davy, concluded that the rapid When thefistula does not communicate with the’rectum, a persinking of the corpuscles on which the buffy coat depends, is due foration is made in its walls by the eyed probe, the extremity of In other to an attenuation of the liquor sanguinis. On the contrary, Pro- which is made sharper than that- ordinarily used. fessor Hermann, Nasse, and Mr. Jones, attribute the quick sink- respects, the passing of the ligature, and the attachment of the ing of the corpuscles to their increased aggregation in inflam- tourniquet, is conducted in the same manner as when there is both an external and internal opening. It should be observed, matory blood.-British and Foreign Medical Review, No. 28. Finding that the blood of the horse generally affords a buffy that the passage of the ligature is accomplished with great facility, surface measuring as much perpendicularly as the lower red and with little if any more pain than attends the ordinary part of the blood clot, the author made many experiments on the examination of a fistula with a common probe. Care is also sinking of the red corpuscles in the liquor sanguinis in the serum, taken that the tension of the ligature is never so great as to cause and in these fluids variously altered in viscidity and specific more than slight uneasiness at the part, and at its first application gravity. The experiments are particularly detailed, in order is usually left loose, to allow for swelling of the enclosed part that they may be easily repeated, and that no errors may arise arising from the slight inflammation which is caused by its from the different effects which Mr. Prater has shewn may be presence. After the lapse of three or four days, ulceration of the enclosed part commences,_ and the tourniquet becomes produced by different quantities of the same substance. The author is of opinion, that if we admit the sinking of loosened, indicating the necessity of the ligature being made the red corpuscles affords an accurate test of the consistency of tighter. This is done every three or four days, by making two the liquor singuinis, we must also admit the improbability ’that or three turns of the screw with a watcli-key fixed on a handle. the liquor sanguinis becomes thinner some minutes after the blood While the process of ulceration is proceeding, a process of has been received in a vase, at which time the falling of the red granulation is filling up the cavity behind the ligature, and on this’account it is not desirable that the ulcerative process ’should corpuscles is most rapid. The author asks whether the well-known utility of saline me- proceed very rapidly, lest the latter should not proceed, paridicines in inflammation may not be explained by their effects in passu, and a cavity be left unclosed. When a case has proceeded preventing or destroying the aggregation of the red corpuscles, favourably, it usually happens that it may be reported as cured and in preventing or lessening the buffy or inflammatory condi- within one or two, or at most a few, days after the complete division of the enclosed parts and consequent falling off of the tion of the blood. The author arranges some of his conclusions as follows :-tourniquet. During the treatment, it is desirable that causes First-There is a remarkable acceleration, after a few minutes, tending to produce inflammation should be avoided, but in many in the ratio with which the blood corpuscles sink in the liquor cases the confinement of the patient is unnecessary, and moderate exercise may be used. Should inflammation, however, supervene, sanguinis. Second.-This acceleration may be increased by increasing much pain is experienced by the greater tension given thereby the aggregation of the corpuscles; and prevented or removed, by to the ligature, the obvious reniedy for which is the loosening the ligature by reversing the screw of the tourniquet. preventing or destroying the aggregation of the corpuscles. Third.-The sinking of the corpuscles is slower in blood CASE 1.-Henry M——, admitted into the London Hospital thinned by weak saline solutions, than when mucilage is added under the care of Mr. Luke, March 3, 1840, with a fistula in ano, with the salt. Fourth.=The sinking of the may be slower in which had existed for a month. It had an external and internal serum artificially made thinner and lighter, than in serum opening, the inner one communicating with the side of the’ rectum as high up as the finger-could reach. The ligature was -artificially made thinner and heavier. Fifth.-In the cruor of horses’ blood the corpuscles are more applied on the 6th; there was no pain caused by its remaining -
.
-
-
’
corpuscles
’
222 in, the patient only complaining of a little when going to stool. The ligature was tightened every two or three days, and came away on the seventeenth, after its application, the part quickly
cicatrizing
over.
CASE 2.-James A-, admitted under the care of Mr. Luke, with a fistula communicating with the rectum two inches higher than the anus, and opening externally. The ligature was applied March 25th. It gave no pain, and caused no inconvenience, the patient walking about while it remained in. It came away
April 9th, having
Fistula cured.
been
tightened
every two
or
three
days.
CASE 3.-A physician’s patient, with cough, admitted Decem1840. He had a fistula on the right side, which was cut, but did not heal entirely, and still discharged. Some time after, another fistula formed on the left side, and opening into the rectum an inch and a half above the anus; to this the ligature was applied May 2nd, and came away on the 1lth. He left the hospital a month after, somewhat improved in health, the left fistula requiring a small portion to cicatrize, the right discharging as before the latter operation.
ber,
CASE 4.-Elizabeth S-,aged 32, married, admitted under the care of Mr. Luke. She has had a discharge from the rectum for four years. On examination, a fistula an inch and a half in length was found: the ligature being passed through it, November 3rd, it came away in eighteen days, leaving the fistula completely healed, having been tightened as in the previous cases. The patient remained in the hospital for some time in consequence of cerebral symptoms supervening; these being treated effectually, she was discharged cured.
Description of Fistula apparatus, Mr. Luke.
a
CASE 5.-John M-, aged 38, seaman; fourteen months previously he had indulged freely in ardent spirits, and shortly afterwards, a boil appeared near the anus, which has discharged ever since; the bowels are generally costive. Being admitted July, 1842, the fistula was examined, and ascertained to be an inch in length; the ligature was passed, and came away in seven days, the fistula being quite healed in another week.
b c an
eyed probe, with
a
contrived and used by
moveable
extremity
fixed in
a
ligature and ready for use. a the moveable extremity eyed to receive a ligature; b the probe, on which a is placed when used; c the handle, in the end of which is a groove to hold the ligature tense, represented. d e f a steel spring-catch to withdraw the ligature from the rectum; d is a piece of steel set in a handle, and split at its extremity e e, so as to form a spring, opening readily when in use CASE 6.-William N-, aged 59, wheelwright, was admitted to receive a; f represents a hollow oval cone divided into two into the London Hospital, with fistula, which had existed for the parts by the split e e ;it readily conducts the probe point a last four years. It had not given him much pain, but the dis- through the split, when pressed against it, and the point is afterwards seized by the springs and retained until withdrawn from charge was constant and inconvenient. Mr. Luke passed the the rectum. November October and it came 19th, 6th-eighteen ligature away and The continued short the a fistula a time, discharge days. g represents the probe point and ligature seized by the springcatch. gradually healed in a few days. h the tourniquet and watch-key; i k the nuts, provided with CASE 7.-Abraham H , aged 46, general dealer, admitted holes, with the ligatures knotted, as in use;the watchligature under the care of Mr. Luke. He has been subject for a long fixed in a handle; m the screw of the tourniquet, the end of key time to difficult micturition and pain in the perineum, for which which is made to receive the watch-key when about to be he has been treated. Three weeks previously to admission, pain turned. The square is applicable to a great number of cases tourniquet occurred near the anus, followed by swelling and abscess. The handle, represented
armed with
a
besides fistula in ano. Thus in varicocele, in the removal of about an inch in extent, and communicated with the tumours, in opening long sinuses, when the use of the knife would anterior part of the rectum. The ligature was passed Aug. 19th, be dangerous, or in any case where the gradual operation of the 1843, and came away on the 30th. The fistula was longer than I is desired. in the previous cases in completely healing, but in three weeks I ligature after was quite sound and cicatrized. fistula
was
CASE 8.--William Laged 35, labourer, admitted Aug. 15, 1843. One month previously, he had pain and swelling about the anus, followed by an abscess, which burst spontaneously. The fistula was situated posteriorly to the rectum, but no communication with it could be found. The ligature was passed through the coats of the rectum, and brought out on the 19th. It was afterwards tightened occasionally, but owing to the small screw for that purpose not fitting properly, it did not act effectually, and was in consequence longer than usual in ulcerating through. The patient wishing to attend as an out-patient, he was discharged with the ligature remaining: he went about without pain, and on one day walked twenty-five miles with little inconvenience. Owing to his attending but seldom, it did not come away till October 9th, when the fistula was left quite
healed. CASE 9.-William K , aged 37, coachman, admitted November 29th. He had gonorrhoea three months previously; six weeks ago he had pain in the perineum, followed by an abscess. There was considerable inflammation, and a fistula leading into the anterior part of the rectum, about an inch in extent.-Dec. 2. The ligature was introduced in the usual manner; it did not prevent the subsidence of the inflammation, and being tightened twice, came away on the 13th, and was quite healed in another
week.
THE ASSOCIATION OF GENERAL PRACTITIONERS IN MEDICINE, SURGERY, AND MIDWIFERY. To the Editor of THE LANCET.
SIR,—We are requested by the Provisional Committee of this Association to call your attention to the fact, that the " Suggestions for Heads of Charter," furnished by them to the Right Honourable the Home Secretary, can only be considered as an outline of the main principles upon which, in the opinion of this Committee, a Charter of Incorporation for the general practitioners ought to be founded, in order to give satisfaction to that numerous and important section of the medical profession. The mode of electing the Council under the proposed Charter is a question of detail, open for consideration; and we are requested by the Provisional Committee further to state, that if voting by is, after deliberation, desired by their proxy or by voting paper provncial brethren, it will be their pleasure to recommend it for adoption at the general meeting of the Association. We have the honour to remain, Sir, Your very obedient servants,
JAMES BIRD,
Son. Secs. Sees. JAMES BIRD,Hon. HENRY ANCELL, HENRY ANCELL,
4, Hanover-square, Feb.
is.