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another is kept during the same time at two. He whomakes a correct diagnosis in four out of seven cases has anadvantage over his more unfortunate fellow-candidate who.succeeds only in one of two cases. When there is moreuniformity, not only in the number of clinical cases allottedto each candidate, but also as regards the nature of the=questions in the oral examination, and above all in themethod of marking in that department, then, and not tillthen, may we expect uniform results. By all means let ahigh standard of proficiency be maintained, but if this canonly be done by the sacrifice of justice, the sooner meansare taken to remove what is becoming a cause of reproachto the College the better, not only for the College, but for allwho have the honour to hold its diploma.

I am, Sirs, your obedient servant,May, 1887. M.R.C.S.

ON THE ADMINISTRATION OF CARBONATE OFLIME AS A MEANS OF ARRESTING THEGROWTH OF CANCEROUS TUMOURS.

To the Editors of THE LANCET.SiRS,-Dr. Hood’s interesting paper in THE LANCET of

May 7th encourages me to communicate some details of acase under my own observation which, I think, are to agreat extent corroborative of his testimony as to the pro-bable value of lime in cancer.

Rather more than four years ago, my late partner, Dr.Wilson Iles, performed an amputation of the left breast- for scirrhus of unusually rapid growth. The patient, anunmarried lady aged forty-two, was stout and of florid-complexion. I was not present at the operation, but I- chanced to look in just as the tumour was being examined,and although I had no reason at that time for taking specialnotice of the matter, I distinctly remember the characteristic-" apinoid" section as the mass was laid open. A prepara-tion of this was made, but it has unfortunately been mislaid- or lost. I discovered, however, amongst Dr. lies’ microscopicslides one which exhibits some large diptychal cells, which,if I am not mistaken, came from the same specimen. Notthe least doubt, as far as I know, was entertained as tothe nature of the tumour, but 1 had no personal connexionwith the case until two years later, when I was consultedby the patient, after long delay and hesitation on her part,about the other breast. This presented a tense, incom-pressible, lobulated enlargement at the lower and outer part,,deeply attached, the skin partially adherent and the nippleretracted, with dilatation of the superficial veins and indura-tion of the axillary glands. There was no ulceration and nopronounced constitutional cachexia, but the expression was,careworn and anxious. She complained of acute lancinatingpain, radiating from the nipple, and it was only to obtainsuch temporary relief from this as would allow her to sleep.at night that she appealed to me, since she declared mostpositively that nothing would induce her even to listen tothe suggestion of another operation. Neither she nor 1doubted for a moment that the cancer had recurred, thoughfrom the increased rapidity of its growth, as well as fromcertain sensations elicited by palpation, I was led to suspectthat it was rather of an encephaloid than a scirrhouscharacter. I prescribed a little chloral and sundry anodyneapplications, which were varied from time to time, being oflittle or no effect. For several months I had no conversationwith the patient, but I judged from her physiognomy thatthe disease was making its usual hideous progress. Shortlyafter this, at a meeting of the West Herts Medical Asso-ciation, I heard from Dr. Hood of the calcined oyster-shells. Greatly impressed with the desirability of affordingso simple and innocuous an agent a trial, I sought out the’lady, and, disregarding her prohibition ever to mentionthe subject, I told her that there was a remedy which’might cure her if she would steadily persevere with it forat least a year, which might fail, but which could notpossibly in either event do her any material harm. Obtain-

ing her promise to take this regularly without further,question, I supplied her with a quantity of dried carbonateof lime, adding thereto 2½ per cent. of the phosphate, toimitate the product of the shells as nearly as possible. Ihave since been told by Professor Attfield that the true pro-portion should have been about 1 per cent. Of this shewas to take as much as would lie heaped up on a sixpence- three times daily, in a dessertspoonful of milk; stirred up

in a larger quantity of fluid, a great part of the powdersettles before it can reach the lips, and is apt to beoverlooked at the bottom of the cup, while a dessert-spoon is introduced bodily into the mouth and the milkhides the disagreeable appearance of the lime. Lastweek I examined the breast for the second time. Thelime has been administered now for nineteen months,with very rare omission of the daily doses. Duringthat time I have purposely avoided any allusion to thematter, and have congratulated myself on the patient’s ownreticence. But I have remarked that her countenance hasbeen more placid and content during the past year, and thatshe has long since ceased to write to me tor soothing lotionsor liniments. The growth of the tumour is undoubtedlyarrested. I do not like to say positively that its bulk isdiminished, because I took no actual measurements, and twoyears is a long time to retain a mental impression whichmay be relied upon for comparison, but 1 am decidedly ofopinion that it is smaller. Whether this and the resultgenerally proceed from simple mechanical diminution ofvascularity, or more remotely by alteration of nutrientinnervation, I do not pretend to know; but there is certainlya healthier aspect of all the surrounding tissues. The impli-cation of the skin and retraction of nipple still persist, ofcourse, but no tenderness remains, or the slightest appear-ance of any proneness to ulceration. I should add that thereis no apparent evidence of calcification.

It is somewhat curious that burnt and powdered oyster-shells are held in great estimation as a remedy for variousailments and injuries in many parts of the world. Certaintribes of South American Indians make pills of this sub-stance, which they swallow as a preventive of hunger onlong journeys, and it was thought at one time, like chopped-up hair, to augment the sustaining virtues of pemmican.

I am, Sirs, yours truly, - - - --

ARTHUR STRADLING, M.R.C.S.

THE TREATMENT OF RINGWORM.To the Editors of THE LANCET.

SIRS,—During the early part of my medical career, Iserved the time-honoured apprenticeship of five years. The

family consisted of the usual number of adults and twolittle children. These children were unfortunate enough tocatch ringworm of the scalp (nobody knew how), and not-withstanding the application of every known or suggestedremedy, they managed to keep the disease for nearly threeyears. It was with peculiar pleasure, derived from oldreminiscences and experience, that I read your recent lead-ing article on the subject, which so accurately detailed allthe troubles incident upon that nasty disease. Now thenature of the disease is well known, and you will think Imake a bold assertion when I say that the disease is tobe cured with one application, and without the unsightlyshaven head.In the first place, the remedy must be in the hands of the

medical attendant alone; secondly, procure a rough brushof the prescribed pattern, best represented by a penny gumbrush with the bristles cut very short; then take a sufficientquantity of pure glacial carbolic, warm and liquefy it in awatch glass, and then rub it into the roots of the hair untilall is thoroughly touched and no further application is

necessary; but the head may be washed from time to time,when necessary, with a lotion of sulphurous acid. Theprinciple is to destroy the spores of the fungi which causethe disease. Have clothes disinfected.

I am, Sirs, yours truly,F. E. WILKINSON, M.D.

RANK OF MEDICAL OFFICERS IN THE ARMY.To the -E, ditors of THE LANCET.

SIRS,—Although the subject of the rank of medical officersin the army has been lately well ventilated in your columns,perhaps you will kindly let me trespass very briefly on yourspace to endorse most thoroughly the views so clearly andtersely put fdrward last week by "Brigade Surgeon." Ihave recently had opportunities of discussing the questionof honorary rank with many senior officers of the depart-ment, and I am glad, for our credit’s sake, to find that oneand all scout the notion of purely military titles being thrust

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on us. Speaking, then, for many of my brother officers, Isay, we do not want to be captains and colonels; we do notwant to sink our profession by adopting titles utterly incon-gruous ; we do not want (putting it plainly) to become thelaughing stock of the army. I should like to assure studentsand others who contemplate entering the medical serviceof the army that they need not for one moment be dis-suaded from doing so by this question of rank. If a medicalofficer is a gentleman in the true sense of the word, as wellas a careful, painstaking professional man, he is sure of therespect and esteem of his military brethren; his status andrank as an army surgeon are accorded him, and he neednever wish to sail under false colours. This is my experi-ence after twenty-five years happily spent in Her Majesty’sservice. I am. Sirs. vours obedientlv.

ARMY SURGEON.

THE UTILITY OF DRUGS IN THE TREATMENTOF DISEASE.

To the Editors of THE LANCET.SIRS,—As a general practitioner, I cannot allow Sir Wm.

Gull’s remarks, made at the meeting of the General MedicalCouncil on May 12th, to pass unnoticed. For a man ofhis position, thought so highly of by the public as he is,to make the statements that "people did not get well bydrugs," and that " it was the duty of the medical mannot to give drugs," was, to say the least, injudicious, notto use a stronger term. It would be absolutely wastingthe space of your valuable paper to argue against such utternonsense, as the value of drugs in certain diseases is beyondall question. Sir Wm. Gull said that the Prince of Waleg,when suffering from typhoid fever, did not have four dosesof medicine; but we know that, of all severe diseases,typhoid fever is the one above all others that requires littleor no medicinal treatment. Sir Wm. Gull also considers awarm bed when you are sick better than all the generalpractitioners. It would be interesting to know whether heconsiders a warm bed when you are sick better than all theconsulting physicians, because, if he does, it is quite evidenthe has found a panacea for all ills-viz., a bed and a warmingpan. I am, Sirs, yours truly,

GEO. STEELE PERKINS.

ENTERORAPHY.To the Editors of THE LANCET.

SIRS,—I should not have ventured to trespass on yourspace, after your full account of the meeting at the Medicaland Chirurgical Society, had not the time at my disposalfor replying to the discussion been so limited that 1 wasforced to omit, or pass very rapidly over, points whichdeserved much more notice. I shall be glad if you will allowme the opportunity of making these clearer. And, first, theobjection raised as to the respective length of time taken bythe performance of Lembert’s and my own suture. Is itreasonable to compare the time taken to use Lembert’sstitch by a surgeon accustomed to use it with thetime taken by the same surgeon in using mine, towhich he is not accustomed? Moreover, the risk to thepatient in these operations is not so much in the lengthof time which the entire operation absorbs, althoughthat is important, as in the length of time during whichthe bowel is outside the abdomen, and exposed. This dan-gerous time I claim to be far shorter during the use of mystitch than with any other, for whilst my own can best bedone with only the cut ends exposed at the level of theskin wound, the whole of the rest being reduced, no otherstitch can safely be used in this position; in which case thebowel wall lying outside is further irritated by the constantfriction produced by the removal and replacement of warmtowels, sponges, &c., to say nothing of the ever-varying tem-perature to which it is thereby subjected. With regard to thetotal penetration of the bowel by the stitch, as opposedto the partial one of Lembert, 1 should like to point out thatsutures are useful for two reasons, the latter of which appearsto be overlooked: first, as a means of approximating tissuesdesigned to unite; and, secondly, as a means of excitingplastic inflammation in those tissues, and thereby securingtheir union. Union of the intestine has two distinct stages,

Ln each of which distinct tissues are involved; in the choice-of a method of suture regard should be had to both. Thefirst epoch is occupied by the union of the peritoneal sur-faces ; this is apparently immediate, or almost so, but-

temporary. During this period the plastic lymph effusedcovers in any sutures which may be used; but the pointshere is that, in so far as stitches and knots irritate a peri-toneal surface, so far and so much adhesion from effusedlymph is to be expected. Now, whilst this is wantedbetween the opposed surfaces of divided ends, it is notwanted between these and the peritoneal surfaces of viscera,and abdominal wall around, where adhesion would be harmful.It will readily be appreciated that whilst the knots inLembert’d stitch are outside the bowel, and so tend to excitesuch production of plastic lymph on the neighbouring sur-faces, forming subsequent adhesions, which will be more orless permanent in proportion to the length of time duringwhich these sutures remain in situ, in my stitch the knotsand threads are separated from the new-formed peritonealsac by the whole thickness of the bowel, and therefore canhave no such action. Inasmuch as all sutures pass at lastinto the lumen of the bowel, and not into the peritonealcavity, it is unnecessary to speculate whether or not theycould do any harm there. But the secondary or permanent.union takes place by connective tissue formed partly fromthe cellulo-fibrous layer of Gross, and partly from the sub-serous layer. Gross himself, in describing his experi-ments on animals and their results, pointed out that themain permanent union was due to the action of the cellulo-fibrous layer, and the microscopical sections shown by medemonstrate perfectly this fact, as well as the share takenby the subserous layer. Now, bearing in mind the secondreason for the use of sutures, is there not an advantage inthe passage of the suture through both these layers in theproduction of a firm and satisfactory result? The com-parison between the ligature around an ovarian stump andthese sutures is manifestly no parallel at all. The conditions.are absolutely different. In the one a stump is left whichis no longer to have any further office to perform in theeconomy ; and the more thoroughly this is bound downby adhesion, so long as no band is formed under whicha loop of bowel may be caught, the better. In theother, an attempt is made to restore the status quo antein an organ, one great essential in the efficiency of which isits complete freedom of movement: in proportion as this isobtained will the operation be really successful. It will beseen at once that this comparison will not hold water.Moreover, in any case in which symptoms of sudden obstruc-tion appeared, would not the fact of a previous ovariotomyother things being equal, lead the surgeon to suspect internalstrangulation under a band resulting therefrom ?This letter is already too long, or I should have liked to

answer also the objection to operations on dogs; but doubt-less such answer is perfectly apparent.

I am, Sirs, yours truly,G. STANMORE BISHOP, F.R.C.S. Eng.

FORK SWALLOWING.To the -Editors of THE LANCET.

SIRS,—Cipriani, to whom you referred in a recent number,while imitating the exploits of a juggler in swallowing afork, some sixteen years ago, allowed it to pass into his

cesophagus beyond his control. After various attempts atextraction, made by himself, his friends, and his wife, hewas, on the following day, transferred to the Ospedale deSanta Maria Nuova, where also all efforts at removal wereunavailing. Several ingenious instruments were inventedfor the purpose, but failed. He remained in the hospital forfive weeks, suffering more or less inconvenience, moral aswell as physical, for the public were divided in opinion, someproclaiming him only a fool, others an impostor. A year or .so afterwards, having produced severe pain, haemorrhageand other untoward symptoms, it was ascertained that thefork had effected its exit from the stomach, and passed into theintestines, accompanied with a relief to the more urgent phe-nomena ; motion, however, occasioned severe suffering. He nowwandered from place to place, a subject of interest to some, ofridicule to others, till three or four weeks ago he was attackedby acute pleurisy of the right side, terminating in effueion,and was admitted into the Ospedale di San Giovanni di Dio.Recovering from this, attention was again directed to " the