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to obtain a French medical diploma somewhat more

readily than of late years, the privilege of practisingwithin the territory of the French Republic is more difficultto acquire than before. To obtain this the foreigner,whether merely a student or the possessor of a foreignmedical diploma, must not only pass all of the examinationsof the regular medical course, but must now matriculateupon precisely the same condition as the native student.He may do this either at the Paris or at a provincial medicalschool. However, the requirements for matriculation arenow such that a much more intimate knowledge of the Frenchlanguage is necessary for these than for the more or lesstechnical oral examinations of the regular medical course. Forthis reason the present conditions are practically prohibitiveunless the foreigner has been educated in France or is

prepared to spend a number of years in preparation. Thepresent requirements for foreigners and natives alike are asfollows.

FofJ’ Matriculation.-1. The degree of Bachelier de1’Enseignement Secondaire Classique (Lettres-Philosophie).2. A certificate from a Faculte des Sciences of satisfactoryexamination in Chemistry, Physics, Zoology, and Botanyafter a year’s study in the said Faculte.For the Medical Course.-1. Examination: (a) Anatomy,

and (b) Dissection. 2. Examination: Histology, Physiology,Biological Physics, and Chemistry. 3. Examination :Part 1: (a) Operations (on the cadaver) and TopographicalAnatomy; and (b) Surgery (theory), Obstetrics (theory).Part 2: (a) General Pathology, Animal and VegetableParasites, and Bacteriology; and (b) Practice of Medicine

. (theory) and Pathological Anatomy (necropsy). 4. Examina-tion : Therapeutics, Hygiene, Forensic Medicine, MateriaMedica, and Pharmacology. 5. Examination, Part 1: (a)Surgery (clinical) and (b) Obstetrical (clinical). Part 2 :Medicine (clinical). 6. Thesis upon subject of student’schoice.Whereas the increased requirements demanded of aliens

have given rise to adverse criticism by a portion of theforeign press, there is, in reality, no discrimination made infavour of the native. It should be remembered that theforeigner is ipso facto exempt from the military servicerequired of every able-bodied Frenchman. The usual three

years of obligatory service are reduced to one for students ofthe liberal professions, but these must lose that year whenin the midst of their work. On the other hand, the foreignstudent in France pursues his course without interruptionand prepares in all serenity for the competitive examinationsadmitting to the coveted post of interne in the hospitals,while his French comrade is struggling to regain the groundlost during a twelvemonth " in the ranks."

In conclusion, the present situation may be summed up asfollows, viz. :-1. The foreign medical student or practi-tioner unable to matriculate upon the same conditions as thenative student must pursue his studies at a provincial school,and although he may obtain the French doctorate degree itwill not admit him to practise upon the territory of theFrench Republic 2 The foreign medical student or prac-titioner may qualify for practice in France and her coloniesby matriculation and completion of the full course at anyFrench medical faculty upon precisely the same conditionsas the native student.

I am, Sirs, yours faithfully,FREDERICK O. CHAMBERLAIN, M.D.

Avenue de 1’Opera, Paris, May 17th, 1897.FREDERICK O. CHAMBERLAIN, M.D.

"EXCISION OF PAROVARIAN CYSTSWITHOUT REMOVAL OF THE

OVARY OR TUBE."To the Editors of THE LANCET.

SIRS,-The communication by Dr. Howard Kelly referred to by you in THE LANCET of May 22nd on page 1427 showsvery clearly how difficult it is to get new facts accepted, :or how readily the profession forgets established facts,and brings them up again as novelties. Still, we don’texpect such proceedings from such places as the JohnsHopkins University. In 1874 1I wrote, "The Fallopiantube was normal and had no other relation to thetumours than slight connexion by loose areolar tissue(as had also the ovary).... In an ovariotomy I had

1 Hastings Essay on Diseases of the Ovary, p. 52.

performed not long before I was struck by the fact thatthe ovary was perfectly healthy and separated from thatumour, as was also the tube, by a mesovarium of some

extent ; in fact, I did not do ovariotomy at all in theremoval of the tumour, for in passing the chain of theecraseur round its base I did not include either the tubeor the ovary, and they were both returned into theabdominal cavity. The consideration of these facts ledme to examine some tumours I had removed previously,and others removed by friends, and I have since subjectedspecimens to careful examination for confirmation of

my accidental observation. The result has been that in

every truly unilocular tumour I have found the ovary un-affected, though on several occasions I have found it stretchedover the cyst wall." In my fourth edition (1883) I developedthese views further, and added: "In the records of ovario-tomies performed these cases have, up till now, always beenstated as ovariotomies, and the ovaries and tubes associatedwith the tumour have been removed with it. Both the recordand the removal of the ovary are mistakes. The operation isnot an ovariotomy at all, and nine times out of ten bothovary and tube might easily be separated from the tumour andleft, and this practice I now always try to follow. It is verycurious that those who are crying out most loudly against.the unnecessary removal of ovaries have been in the habit ofpursuing this practice in the case of parovarian tumourswithout compunction."

In my more recent work I give a great deal more precise,and some very curious, information concerning broad ligamentcysts. I have yet to publish the details of my more recentmethods of operating in these and other cases, but I mayhere say that I have not removed an ovary or tube in one of’them for at least twelve years. In the early part of April ofthe present year I had a run of three of these and had ineach case to enucleate the whole tumour from its broad

ligament bed in order to leave the healthy ovary and tube.Therefore it was that I condemned the proceedings ofMr. Clement Lucas as reported by himself in THE LANCET.The conclusion from an immense experience going over

thirty years is that such a thing as a unilocular tumour ofthe ovary does not exist save in one bottle which I placed in,the museum of the Royal College of Surgeons as aI1

example of an exception which proves the rule.I am. Sirs. vours faithfullv.

Birmingham, May 22nd, 1897 LAWSON TAIT.

ON CERTAIN AFFECTIONS OF THENERVOUS SYSTEM IN CYCLISTS.

To the Editors of THE LANCET.

SIRS,-I have been much interested in the facts recordedin a recent paper published in THE LANCET by Dr.James Taylor and Dr. Semple, and I should like torecord certain facts that have come to my notice inreference to the nervous symptoms exhibited by somepeople after cycle riding. My experience was practicalrather than medical, for it was gained chiefly during theyears 1885 and 1886, when I was an amateur championcyclist, and knew most of the path- and road-racing cyclistsin London, but when I had had no medical training to enableme to observe neurological phenomena. In the long-distanceroad races it was common to lose sensation in the feet, andseveral accidents occurred through slipping a pedal from thiscause. This was one of the reasons why toe-clips were souniversally used. When the men dismounted their gait wasunsteady, the legs jerked out straight, and the feet stampedon the ground. I have noticed these things many times, notonly in others, but in myself. Numbness in the perineumand penis and difficulty in beginning the act of micturitionwere quite common symptoms. I can remember the finishof one long-distance road race, when one of the competitorshad involuntarily passed both urine and fasces during therace without being aware of the fact. I cannot call to mindany case in which the symptoms mentioned above did notpass off after a period of more or less prolonged rest. Thatsevere exertion is not necessary to produce nervous symptomsis well exemplified in my own father’s case. He learned toride a bicycle when he was about sixty-two years old. A com-paratively short ride produced numbness, trembling, and loss

2 Vide Transactions of the Royal Medical and Chirurgical Society, 1890.3 Abdominal Surgery, 1889.

4 THE LANCET, April 17th, 1897.

1503i

.of muscular sensation in his arms and legs. This was somarked that the power of writing was lost for the rest of theday after a ride of a few hours. He persevered for a while,but ultimately had to give up cycling altogether. The

question how these symptoms are produced is one of muchinterest. Three factors are evidently of the greatest import-ance-viz. (1) pressure ; (2) vibration ; (3) auto-intoxicationwith waste products due to overwork.

1. Pressure.-The pressure of a bad saddle will undoubtedlyproduce nervous symptoms in the perineal region; anycyclist can verify this fact for himself without much

.difficult. A really perfect saddle has yet to be invented,and when it is it will be impossible to press injuriously onthe perineum, whatever position the rider assumes. Leaningforward on a cycle lessens the surface of the body exposedto the wind and decreases the effort necessary to propel themachine against a head wind. For this reason it is impossibleto prevent large numbers of riders from adopting this attitude.Of late years the position of the saddle in relation to thepedals has been altered. In the modern cycle the saddle isplaced much further forward than it used to be. The resultof this is that with the ordinary form of saddle the positionwhich is necessarily assumed leads to the weight beingwholly borne by the perineal structures.

2. Vibration.-That this is of some importance will bereadily granted by anyone who has ridden both solid and,pneumatic tyred machines. Though pneumatic tyres havedone away, to a very large extent, with vibration, the joltingon a rough road giving a succession of shocks to the bodymust be taken into account. The difference in comfort tothe feet between rubber and rat-trap pedals is also wellknown. Numbness in the soles of the feet would be lesslikely to occur with rubber than with metal pedals. Thatvibration alone would produce these symptoms is not

probable, for none of the twenty-three railway engine-drivers.and firemen whom I have questioned on this point have evernoticed any numbness or loss of power after a day’s work.

3. Auto-intoxication with naste products due to overqvor7..-During severe or prolonged exercise the untrained manrapidly dissipates his reserve tissues, and his excretoryorgans being unable to eliminate the waste products ofmetabolism he suffers from an auto-intoxication, showneither by a febrile condition, sometimes of great severity, orgeneral nervous prostration or excitability, which often

prevents appetite or sleep. It is probable that all thesethree factors, and possibly others, are concerned in theproduction of the nervous symptoms that have been observed.

I am, Sirs, yours faithfully,PERCY FURNIVALL, F.R.C.S. Eng.,

Assistant Demonstrator of Anatomy, St. Bartholomew’sHospital; Assistant Surgeon to the Metropolitan

May 24th, 1897. Hospital.

FORCED REDUCTION OF THE DEFORMITYIN CARIES OF THE SPINE.

To the -Editors of THE LANCET.SIRS,-In your short report of a meeting of the British

Orthopaedic Society which appeared in THE LANCET of

May 15th, it is stated that in speaking of Dr. Calot’streatment of Pott’s disease, I ’’ questioned if it were possiblethat such a procedure had been followed by the resultsdescribed." As this statement by itself must give a differentimpression from that which would appear from my fullremarks I beg you to allow me to add to it. It is now pro-bably well known to your readers that Dr. Calot of Berck-sur-Mer reduces the deformity in caries of the spine byforcing the parts into a straight position under chloroformand then applies a fixation apparatus in which he keeps hispatients from five to six months. At the end of this time hestates that the patients are absolutely cured. It was thepossibility of cure in this short time which I questioned.The practice of straightening the spine in Pott’s disease is,

of course, not new, and it has been objected to by varioussurgical authorities. Samuel Hare, however, who publisheda work in 18381 and who was looked upon as a most reliableand skilful surgeon, having great experience with this disease,was a strong advocate for reduction of deformity, and in hiswork (p. 91) he gives two illustrations showing the positionof the carious bones (1) in their angular position, and

1 Practical Observations on the Prevention, Causes, and Treatment ofCurvatures of the Spine. London, 1838.

(2) when straightened out. I think there is much to besaid in support of this method, and although I have neverattempted, like Dr. Calot, to separate the diseased parts byany great force I have aimed at improving the whole positionof the back, chiefly by altering the curve above and belowthe seat of the disease. By this means in a great many casesthe abnormal projection has become markedly less, as shownin many of the illustrations in my book, " Caries of theSpine." " (I would especially refer to Figs, 80-81 and 87-88in that publication.) Sometimes the projection has com-pletely disappeared, and when this has occurred one cannotbut suppose that the diseased bones have been separated atthe seat of caries, and I have only seen good results fromfirm but gentle pressure upon the gibbosity by means of afixation apparatus. The objection which has generally beenraised against attempting to straighten out the spine hasbeen founded upon the view that if the bones were separatedthe space would be so great that there would be littlechance of re-formation of bone. This view I proved tobe incorrect at a demonstration given at the annual meet-ing of the British Medical Association at Bournemouthin 1891.2 A description of the case and specimen referredto are also given on pages 121 to 124 in " Caries of

the Spine." The specimen and the history of the caseshow the following facts: (1) that a very large gap mayoccur from dissolution of several vertebras without theirusual spontaneous coalescence, the spinal cord being leftexposed in the thorax and abdomen, unprotected by a bonycovering; (2) that repair may take place while the un-destroyed vertebras remain separated from one another; 3

(3) that repair of this kind can progress in spite of the mostadverse circumstances in respect to the general health of thepatient; and (4) that in such a severe case the new bonygrowth requires a much longer time to become thoroughlysolid than in ordinary cases.As regards the period of repair, in the case I allude to the

patient so far recovered that on Sept. 3rd, 1882, eight months’after I had first seen him, he was able to walk about com-fortably and his health had improved very greatly. He con -tinued to improve apparently in every way until September,1884, when he died from tubercular meningitis-that is tosay, two years and eight months from the time I had firstseen him-and it may be assumed that repair had been inactive progress during at least the latter two years. Uponexamination after death it was found that the gap had beenfilled up by bony growth, but when the affected vertebraewere being macerated all this new bone crumbled away,leaving the vertebras as they were before the repair had takenplace ; therefore this case shows that two years were notsufficient to thoroughly consolidate the new bone, and,although in some patients the progress of repair may be morerapid, yet I cannot imagine that six months, as stated byDr. Calot, would be anything like sufficient to effect a curein any case where a considerable gap had to be filled up.As to danger from immediate and forced reduction it

may be assumed that all the cases operated upon by Dr.Calot have been in a state of active disease before repair hascommenced, but should new bone have been already thrownout there would be considerable danger of producing irrita-tion by the loosened particles of bone from the new growth,which would act as foreign bodies. A case came under mynotice some few years ago which bears evidence to this effect

(Case 102, page 135 in "Caries of the Spine "). It seems

probable that immediate reduction may prove to be a

valuable method of treatment in suitable cases, and I con-

gratulate Dr. Calot upon his success. I question, however, ifit be possible to cure such cases in six months.

I am, Sirs, yours faithfully,Queen Anne-street, W., May 24th, 1897. NOBLE SMITH.

" RIGHT-HANDEDNESS."To the Editors: of THE LANCET.

SIRS,-In discussing the question whether the " faculty ofbipedal progression in an erect posture" is an acquisitionit is necessary to clearly define what we mean by this latterterm. May I be allowed in this connexion to quote from mywork, "The Causation of Disease"? ? "Scientifically it is

2 Brit. Med. Jour., March 19th, 1892.3 Mr. Jackson Clarke remarks upon this fact that when the anterior

common ligament remains intact at the seat of disease the periosteumwill probably be attached to it and is then capable of forming newbone.