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MEDICAL ANNOTATIONS.

British soldier on a lower footing than the citizen, or than thesoldier of other states in which military discipline is main-tained without the use of the lash."

During the late war, the shopmen of London were ridiculedfor following their effeminate pursuits in preference to enteringthe ranks of the army. In the opinion of the Assistant-Com-missary their reply was quite unanswer tble. " We have no

’’ particular predilection," they said in effect, "for measuring ‘ silks or weighing sugar, but we hope by means of good con-duct and industry to rise to something better. Can you

promise us such a prospect in the army ? Until you can, do

" not ask us to descend to companionship with the class of"men which we see following the recruiting-sergeant through i

" the streets of London." .

ALREADY the effects of the formation of the London Medical

Registration Association are becoming apparent. Under the

immediate notice of that Society-knowing that a watchful in-spection of their actions is going on, unqualified practitionersof medicine are abandoning their usurped and undeserved titles.The quack " Dr." becomes plain " Mr.," without the assump-tion of a medical designation-without the pretension of beingphysician, surgeon, or apothecary; and his ci-devant "medical"dispensary dwindles down to a botanical, or some other de-lusive establishment. This has happened in the metropolis ininstances which we could specify. Letters continue to reach

the Secretary of the Association, both from London and thecountry, particularizing persons who are practising withoutdue qualification, all of which particulars are laid by him be-fore the Registrar, Dr. HAWKINS, with whom he is in frequentcommunication. We anticipate that no great length of timewill elapse before the profession will discover that the recentAct gives sufficient power to strike a deadly blow at manybranches of unqualified practice, if they use that power withdue energy and discretion.

But in order to use this power effectually, there must be acomplete organization of the profession, and a cautious andclear mode of proceeding. We recommend to the various

Medical Registration Associations that are now formed, and inprocess of formation, throughout the length and breadth of theland, that they should, on the instant that their internal

arrangements are complete, secure correct lists of all the

Zegally - qualified practitioners in their districts, with their

names, addresses, and qualifications, and, also, lists of those

persons who are known or supposed to be practising medicinewithout any legal qualification. These lists might be forth-with sent to Dr. LADD, the Honorary Secretary of the

London Medical Registration Association, at the Committee-room, British Coffee-house, No. 27, Cockspurstreet, Charing-cross, London. He would without delay communicate theircontents to the Registrar, who will thereby be put on hisguard, so that no person may get on the register whose nameis not entitled to be there recorded. To medical gentlemenin whose locality no Registration Association exists, we wouldrecommend that they should become members of the LondonMedical Registration Association, which is not arbitrarilylimited to the metropolis and its suburbs. It is also desirable

that such gentlemen, as well as the Associations, should sendto the central body information of the duly-qualitied and of theunqualified practitioners in their neighbourhoods, in order that

such information may be made properly available for the

guidance and warning of the Registrar under the Act.By such combined operations, a general system of ramifica-

tion, having its centre in London, may be formed, enabling theprofession thoroughly to protect themselves against the inroadsof quacks and impostors, and against the chances of such personsgetting their names on the register by fraud and misrepre-sentation. It is probable that the Registrar under the Actmay find it desirable to require that every gentleman, withoutexception, who does not personally submit to that officer hisdiplomas for the purpose of registration will be required tofurnish to him a declaration, attested by a competent person,that he is the individual whom he professes to be. We think

that such a provision is a safeguard, of which no legally-quali-fied medical practitioner ought to, or would, complain.We congratulate the profession on the steady progress, and

the activity and energy which we find to be manifested by theLondon Medical Registration Association. A " VigilanceCommittee" has been formed by that body, one special func-tion of which is to obtain information from all sources re-

specting unqualified practitioners, and this Committee, as welearn, has already afforded to the Registrar valuable informa-tion, which ought to result in great advantage to our medicalbrethren. We hope that the profession in London and else-where will cordially assist this Association in its labours forthe welfare of the whole medical body.

IT would be wrong of us not to call attention to an article,by Professor TAILOR, " On Arsenical Paper-hangings, and theMode in which they produce Noxious Effects on Health," in-serted in this week’s number. It appears that we can neither

eat, nor drink, nor breathe without taking poison into thesystem in some form or other. When will the Legislatureinterfere to protect the public against this most intolerable

grievance ?

Medical Annotations.

THE ACADEMY OF MEDICINE AND ITS PRIZES.

" Ne quid nimis."

Qui n’a vu Paris, n’a rien vu. It is a very pretty vaunt,only relieved from egregious egotism by its cosmopolitan cha-racter : for there is no other capital city in the universe, exceptindeed this great city of London, that has not vindicated its

majesty by the fabrication of some similar proverb. True it

is, however, that Paris is a great centre of medical activity,and one towards which the majority of earnest students aredrawn at some period of their career. With the distinguishinggenius for organization which belongs to their nation, theFrench have centralized at Paris the glory which crownsthe sons of Medicine. The Academy of Medicine holds itssolemn conclaves there, surrounded by a halo of imperialauthority which is foreign to our Societies. The professorsare appointed by imperial decree. The subjects of discus-

sion turn commonly upon questions referred by the Mi-nister of State for the Interior. Grave commissions an-

nounce their conclusions with truly academic gravity, andwith a degree of formality and verbose state which savourssomewhat of " red-tape and circumlocution." All is accom.

plished that the combined and organized genius of the greatestminds in the profession can effect, in sifting novel statements,in debating old theses, in analyzing theories, or deducing prin-

14

ciples from observed facts. One remarkable feature in theconstitution of this Academy is found in the anniversary meet-ings, at which unsolved difficulties are proposed for investiga-tion, and a great number of valuable prizes distributed amongstthose who, by published works or otherwise, have contributedto the solution of the questions proposed during the previous year. The prizes offered are awarded only when the competi-tors have made efforts either entirely successful or worthy ofreward. Hence it happens that at each of these meetingsmany of the prœmia are left upon the field.The meeting for 185s has been lately held. The prize offered

by the Academy was not given, though the subject--viz., theUse of the Microscope-occupies the attention of a considerablenumber of very able men. It must, however, be allowed thatthis subject has rather an extensive range, as it comprises thehistory of the application of the microscope to the study ofmorbid anatomy, and to the diagnosis and treatment of diseases;the pointing out of the services which this instrument mayhave rendered to medicine, giving an idea of those it may renderin future, and forewarning against the errors which it mightengender. Only one essay had been sent in, which was notfound worthy of the prize. The question has been given up.-The Portal prize of X24 was awarded to M. Bauchet. The

question was " On the Morbid Anatomy of Ovarian Cysts, andon the Consequences to be deduced from it, as regards the Dia-gnosis and Treatment of these Affections. "-The £40 prizefounded by Capuron (subject, " On the Death of the Childduring Parturition,") was not awarded, as no sufficient meritwas found in the ten essays sent in ! The question is given up.- The next prize, of £ 60, was also a failure (" The Differencebetween Neuralgia and Neuritis"). The question is put aside.- M. Duchenne, of Boulogne, obtained the Itard prize of £ 120,for the best book, of at least two years’ standing, on PracticalMedicine, or Applied Therapeutics.-The prize instituted byBaron Barbier, in favour of the discoverer of a remedy for anyof the diseases reputed incurable,-as hydrophobia, cancer,

epilepsy, scrofula, typhus (?), cholera morbas (?), -was notgiven; but an encouragement of X60 was awarded to M. Boinetfor his treatise on Iodotherapeutics.-The Argenteuil prize of.6480, to be given every sixth year, to the author of the mostsignal improvement in the treatment of stricture of the urethra,was divided into small sums of £ 100 and downwards, andgiven to M. Mercier, M. Gaillard, of Poitiers, M. Desormeaux,M. Marquez, of Colmar, Mr. Arnold, of London (£40), and M.Charrière, the eminent surgical instrument maker.-Lists of

prizes and medals were then read, to be awarded to vaccina-tors, medical men appointed to report on epidemics, and resi-dent physicians to watering-places.-Amongst the prizes offeredfor 1859, we notice the following : 1. On the TherapeuticalAction of the Perchloride of Iron, £ 40. 2. On Internal Stran-

gulation (not ordinary hernia), .640. 3. On Retroversion of theUterus during Pregnancy, £40. 4. On Nervous Affections de-

pending on Syphilitic Affections, £ 60. 5. To the author of

the book or researches which, being based at once on anatomyand experiments, shall have realized or facilitated the most

important onward step in surgery, £40.-Amongst the ques-tions for prizes for 1860, may be mentioned the subjoined: 1.

What are the means of avoiding the accidents which mayfollow the use of ether or chloroform ? How can these accidentsbe remedied? .f40. 2. On Vascular Obstruction of the Lungs,&c., £ 24. 3. The Influence of Chloro-anæmia on Nervous Ex-

citement, &c., £ 80. 4. On Puerperal Paralysis, .f40. 5. On the

Action of the Natural Sulphureous Waters, &c., .f40. 6. On the

Diagnosis and Treatment of Melancholia, .660. 7. Researcheson Poisonous Mushrooms, &c., .680. The essays for 1859 shouldbe sent before the 1st of March of the same year.Here is certainly a goodly field for exertion. Amongst the

subjects we find several which are very successfully cultivatedin this country; and we would urge the well-informed andindustrious to compete with their Gallic brethren. The works

should be written in French or Latin. An Englishman unac-quainted with French, could easily get his essay translated.

It cannot be doubted that the annual promulgation ofthe list of prize-subjects by the Academy of Medicine hasthe effect of creating an extraordinary activity in medicalresearch. The absolute value of the contributions elicited isnot all that science gains by this practice. The habit of in-

vestigation is stimulated; a thirst for reputation is inspired; ataste for research is given to numbers who might else haveplodded on, content with mediocrity. It is a valuable adjunctto the influence of the Academy of Medicine, and one whichwe would gladly see placed amongst the attributes of our Eng-lish societies. It is very probable, however, that the effect of

this constant stimulus to obtain new and striking results is notwithout its bad effect upon the Paris School of Medicine and

Surgery. It is now essentially an experimental school, andone in which the experiments are occasionally rash andill-devised. The bulletins of the Academy of Science not onlynot unfrequently contain propositions both crude and absurd,but they have become almost proverbial here for the startlingnovelties which they announce-too often bubbles that burstupon the slightest touch of the inquiring hand. This tendencyto change, and the facility with which men of this school aredazzled by novelty, threaten to become an opprobrium to theirscience.

PHYSIOLOGY FOR THE MIDDLE CLASSES.

WE find with pleasure that the Middle-Class Examinationsof the University of Oxford just completed have embraced avery sensible series of questions in Physiology. It will go far

to impress upon the heads of higher schools in this country thenecessity for finding a place for the teaching of physiology intheir curriculum. No doubt, this is chiefly due to the intelli.gent labours of Dr. Acland, whose deservedly great influencein the University has always been exerted in this direction.The advantages of physiological teaching are not confined toone circle of effects. It possesses all the intellectual value of a

study which admits of the most lofty speculation, and insen-sibly leads to philosophic contemplation of the highest attri-butes of divine power; while it has a strict logical characterwhich never permits the imagination to wander into hypothesis,but limits the mind to the gradual progress of the inductiveprocess of reasoning. It has, too, the character of a practicalbranch of knowledge, one which would appear to be almost in-dispensable, and to have been too long neglected. It is onlyby physiological teaching that such a general knowledge canbe disseminated as will afford the means to the people of dis-tinguishing fundamental truths from speculative errors or ridi.culous falsehoods; and it is only by the spread of such infor-mation that the various forms of quackery and imposture inmedicine can be effectually discouraged. The daily appli-cations of such knowledge to the usages of life are equally im-portant. The laws of respiration, of mental activity, and ofphysical restoration, are incessantly infringed. When the

cle.rgy, the conductors of schools, the manufacturers, and thefarmers of this country shall have a fair knowledge of the

groundwork of physiology, we may look for a great and generalsaving of life, health, and comfort.

A RATIONAL DESPOTISM.

THE reign of Medical Despotism has commenced. That

tyranny which quacks and impostors so much dreaded, andwhich philosophical journalists have painted in such terriblecolours, is now within the grasp of the profession. Medicine hasa recognized position in the State. Surely those gentlemen whotrembled beneath the prospective horrors of this despotic rule

have quivered with somewhat unnecessary emotion. This

measure of reform, in good truth, takes nothing from them

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41

which belonged to them before. There still exists a free trade

in roguery and imposture; and they are at liberty to make themost of it. All England, Scotland, and Ireland, open still anample and no doubt a profitable field for the exertions of thewhole tribe of rubbers, bone-setters, mesmerists, and mounte-banks. We have gained the right of registering our degreeson-the roll. We have no monopoly over the lives and healthof free-born Britons. The outsiders who have so long mingledin our ranks are excluded; but they never had any properfooting there. We present an orderly and soldier-like front;the ragamuffins are expelled from their stolen places in therank. But the act of despotism is no greater than that of thepoliceman who collars the "gamin" that has sought refugeamongst the military ranks at a review, and restores him tohis proper place. They cannot any longer steal the showyclothing. But this is hardly a grievance which will excitegeneral sympathy. If any man prefer to have his bones setby Smith, who is not on the roll, a paternal Government per-mits him to dispose of his own anatomy as he will. His vestedinterest in the conformation of his thigh-bone is not interferedwith. He has still the uncontrolled sovereignty of his organs:he can physic himself as he will, and by whatsoever combina-tions he pleases, by whomsoever compounded. He loses,therefore, none of his free-born privileges and natural rights.What have we gained? A recognised unity of organization :a legal claim to remuneration for time, skill, and labour: apower to register upon the State roll; and to call ourselves byour true titles, which rogues dare not now assume. This

tyranny has no terrors for honourable men: it is only to befeared that it permits too many loopholes to remain open forimposture and evasion.

THE MEDICAL CORNER.

WHAT business has an honest journalist, who undertakes tosupply the good people of Sussex with the news of their countyand their bshionable sea-side town, to open a " MedicalCorner" in his paper, in which" 1Iedicus" professes to answerall questions relative to the preservation of health, and trulyand fully to explain the nature, cause, and proper treatmentof each disease? Such promises can never be fulfilled. Theyare false and delusive. No man, however able, can carry themout unless he personally examines tLe patient. What end, then,,can this " Medical Corner" serve. The answer is probably tobe found in the following sentence addressed to an invalid lady:—" ’ Medicus’ will not correspond with any patient, unless pro-fessionally consulted, when the usual professional fee will beexpected." The hoof shows before we have travelled far. Weearnestly counsel the editor of this otherwise respectable journalnot to allow his columns to be converted to purposes so ob-

viously disreputable and deceptive.

ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, DECEMBER 14TH, 1858.

SIR CHAS. LOCOCK, BART., M.D., PRESIDENT, IN THE CHAIR.

ON A CASE OF EXCISION OF THE HEAD OF THE HUMERUS,WITH ITS RESULTS.

BY JOHX BIRKETT, ESQ., I

SURGEO_1T TO GUYS HOSPITAL.

A MAN, aged fifty-seven, came under the care of Mr. Birkettin July, 1855, on account of acute disease of the right shoulder-joint. He was cachectic, much reduced, and suffering intensepain. Two years and a few months before, h2 had the rightshoulder injured by being thrust violently against a wall. Theclavicle was fractured; inilammation and suppuration of theshoulder-joint ensued, and abscesses and sinuses were developed.

From local indications, it was quite clear that diseased boneexisted; and Mr. Birkett, being unable to feel the dead bonewith a probe, exposed the head of the humerus and sawed itoff. There was a piece of necrosed bone in the head, but allthe other parts and the glenoid cavity were healthy. Thewound healed rapidly, although sinuses formed and remainedopen for some months after. The health of the patient rapidlyimproved, and all pain subsided. In about eighteen monthsafter the operation the sinuses were all healed, and for verynearly the last two years he has been able to use the limb inthe varied occupation of a farm labourer.The preparation of the head of the humerus accompanied the

paper.The details of another case were given, in which Mr. Aston

Key excised the head of the humerus from a healthy man, agedthirty-four, in Jan., 1849. The bone, especially the cancelloustissue, was affected with scrofulous degeneration. The casewas highly successful, and the man has been actively engagednow for many years as a workman in an engineer’s factory.The head of the bone was shown, together with a drawingillustrating the condition of the upper extremity seven yearsafter the operation.

ON DISABTICULATION OF THE SCAPULA FR07II THE SHOULDER-

JOINT, WITH REMOVAL OF THE ACHOMIAL END OF THECLAVICLE.

BY GEORGE MATTHEW JONES, ESQ., M.B.C.S.E.,susoEOr TO THE JERSEY HOSPITAL.

(Communiccded by F. C. SKEY, Esq., F.R.S.)

The patient, a girl aged fourteen years and a half, hadenjoyed good health until December, 1857, when she first feltpain at the top of the left shoulder. ascribed to the exertion ofcarrying a heavy child; severe inflammation about the shoulderfollowed, being most intense over the upper part of the hu-merus ; an abscess formed, and burst spontaneously. The con-stitution suii’ered severely. When Mr. Jones first saw the

patient, there were four large fistulous openings over the leftshoulder, two communicating with the clavicle, one with thehead of the humerus, one with the glenoid cavity, and one withthe dorsum of the scapula, bare bone being easily felt in each.Several small fistulae, which did not apparently lead to necrosedbone, existed in the scapular region, and yielded an offensivedischarge. The textures covering the shoulder were generallythickened and puffy, and tender to the touch. The patient’shealth and strength were failing rapidly, and Mr. Jones deemedoperative interference imperatively called for. Accordingly,on the 19th of May, 188, the patient having been placed underchloroform, the operation was performed. An incision wasfirst made along the whole extent of the spine of the scapula,and carried an inch beyond towards the mesial line of the back;another incision was then made to meet this along the upperborder of the bone down to its angle. The integuments wereraised by careful dissection, and by this process the whole bonewas fairly exposed, its periosteal investment being everywherefound so thickened, pulpy, and softened, as to yield easily topressure of the finger. The acromial end of the clavicle beingfound to be softened and altered by disease, an inch of thebone was removed. The posterior scapular artery was the onlyvessel which needed a ligature; several small ones were closedby torsion. Sutures and strips of plaster were used to bringthe edges of the wound together, the deeper cavities, includingthe glenoid fossa, being plugged with lint. The operationoccupied three quarters of an hour.On the scapula was found so extensively dis-eased that its characters were almost destroyed. The glenoid

surface and neck were entirely removed, and no vestige of thespine remained, its position being occupied by new, irregularly-deposited osseous matter, at the base of which lay a deepchasm, that extended three-fourths across the body of the bone.The inferior angle of the bone was the seat of extensive caries.The body of the bone presented two deep perforations, and allthese different cavities contained sequestra of dead bone, whileother portions of the scapula were in different stages of exfolia-tion. ihere was also a large amount of new osseous matterdeposited in different situations about the bone. The head ofthe humerus was found healthy, and covered with its naturalcartilage.

With the exception of a very critical condition during thefirst two or three days, which was ascribed to the action of thechloroform, the patient made a good recovery. The wound

healed entirely by granulation, the head of the humerus beingexposed for some time. She was unsparingly supplied with

nutritious diet and stimulants. She left her bed and walked