1170

THE LANCET.

LONDON: SATURDAY, JUNE 27, 1885.

THE COLLEGE ELECTION.

THOUGH personal, social, and scholastic prejudices and predilections may never be entirely eliminated from the election of members of the Council of the Royal College of

Surgeons, it is certain that they have not now the prepon-derance they once had. The political education of the

electors is advancing-slowly, it is true, but surely; and thetime cannot be far distant when the elections will be deter-

mined rather by political considerations than by personalsentiment or caprice. It will soon, we trust, cease to be

regarded as a qualification for a seat in the Council that acandidate belongs to this or that hospital and medicalschool. The Council should represent the interests of the

surgical profession, and especially those interests which

more particularly affect the status and professional well-being of the Fellows and Members of the College. The onlyinfluence that the so-called representation of the schoolsought to have upon the result of any election should beto prevent any school from being over-represented. The

representation of particular schools has indeed been a

glaring defect in most of the College elections; for althoughthe Charter does not explicitly suggest such representation,it does so implicitly by requiring exclusive personal voting.By this provision the election of members of Council hasbeen thrown into the hands of those Fellows who reside in or

near London, and who are therefore more liable to be affected

by the influence of the schools than those who reside in theprovinces. When Fellows are allowed to vote either in

person or by papers, it may be expected that not only willthe constituency be enlarged, but its independence and in-

telligence will be proportionately increased. Meanwhile

the election must take place on the old register, and to someextent on the old lines.

The questions before the electors are extremely simple.The Council is full of anomalies and abuses. Not only doesthe Council elect the examiners, but every member of theCouncil is himself eligible to be elected as an examiner.Until a few months ago every member of the Court of

Examiners and one member of the Board of Examiners were

also members of the Council; or, in other words, elevenof the twenty-four members of the executive annuallJappropriated an aggregate of E5000 from the revenue1

of the College. Again, the office of President has hithert(

been conferred on the senior member of the Council ir

rotation, whatever his degree of fitness or unfitness. An(

lastly, the Council has always exercised the privilege, an(still deliberately claims the right, to make whateve

alterations it pleases in the constitution and relation

of the College, without consulting the opinions or wisheof the Fellows and Members whom it nominally represents. Endeavours have been made to remedy thes

evils, but a majority of the members of the Council harepeatedly resisted every attempt, whether originating froIwithin or without the Council. Of the candidates fc

election next Thursday, Mr. SAVORY, the retiring member c

he Council, is known to have sided with the opponents to

hange; while two-namely, Messrs. F. MASON and RousE-ave not as yet publicly expressed an opinion for or against.)n the other hand, Messrs. GANT, COWELL, MACNAMARA,..nd PEMBERTON have identified themselves with the policyof a thorough and comprehensive reform of the Council.Whatever be the result of the election next Thursday, it

s to be hoped that those who do vote will not stultify,hemselves by resorting to the absurd system of plumping.rhree members of the Council are to be elected, and those.who have not the courage or capacity to give three.votes, should at least preserve the semblance of intelligence,.so far as to abstain from voting at all.

THE curiosity which has so long prevailed as to the

line of reform in the constitution of the University ofLondon to be submitted to Lord Justice FRY’S SpecialCommittee by its sub-committee will be satisfied this.

afternoon (Friday). The draft scheme recommends.

changes sufficiently radical to satisfy the most advanced.reformer, and, if adopted by the Special Committee, willdemand the gravest consideration by Convocation and the.Senate. The scheme is so thorough and so practical thatwe can hardly believe it can be rejected by either of

those bodies. By it the entire constitution of the Univer-sity will be remodelled. Instead of being composed of twobodies only-viz., Convocation and the Senate-it is proposedthat it shall consist of constituent Colleges, Faculties, andBoards of Studies in addition, and that the mode of electionto the Senate and the period of senatorship be completelyaltered. The Senate will consist of thirty members, with a-Chancellor, Vice-Chancellor, and the Chairman of Convo-cation, as at present ; but the Crown nominees and the direct

representatives of Convocation will be limited to six each,whilst each of the four Faculties of Arts, Science, Laws, andMedicine are to elect three, and the constituent Colleges.six. The constituent Colleges named are—UniversityCollege, King’s College, the Royal Colleges of Physicians andSurgeons, the Council of Legal Education, and the Incor-porated Law Society. Moreover, whilst the collegiaterepresentatives may serve for three years, one-third of eachof the other groups are to retire yearly, so that in this wayan infusion of new blood may be steadily secured. The

advantages of such a Senate over the present fixed body are

self-evident, and must commend the scheme to all well-

wishers of the University. Lest the existing membersshould consider the proposed change an infringement oftheir special privileges, the Faculty and College members areto be added to the present Senate, and no new members

are to be appointed by the Crown or by Convocationuntil their representatives respectively fall below six.

This is a very judicious method for securing the neededchanges with the least disturbance of the existing arrange-ments. Convocation remains unchanged. The constituent; Colleges are to be named partly by a joint committee of the-. Senate and Convocation and partly by the Senate, with the

concurrence of the Faculty or Faculties interested. In this waN,sit is hoped that a closer bond may be introduced between thei Colleges and the University. The most important alterationsr however, will be in the formation of Faculties and Boards of

f Studies in each Faculty. The Faculty will give instruction

1171THE TREATMENT OF PALMAR GANGLION.

to the Board of Studies, and this will in turn advise theSenate pn all examinations and changes in regulations, andwithout such advice the Senate is not to act. As the Board of

Studies will be composed almost entirely of teachers andexaminers, the Senate will have a skilled body to appeal to foradvice in any dimculty. At present an attempt is made to

please everybody-teacher, student, and examiner-and ofcourse neither is satisfied. Lord Justice FRY must be

congratulated on the thorough manner in which he has

gone to the root of the difficulty, and on the practicalscheme he has devised for its solution.

UNTIL recently the treatment of palmar ganglion had beena reproach to surgery. The nature of the affection has been

understood, and its ill effects upon the function of the handhave been well recognised, but in most cases only slight andunavailing measures for its relief have been taken, becausethe more radical modes of treatment have been fraught withmuch danger to life and limb. Treatment by pressure, bythe application of counter-irritants, or even by tapping, hasbeen almost universally unsuccessful, and injection of

irritant solutions and incision of the synovial sac have beenfollowed by failure, adhesion of the tendons, or even bydeath. Injection has failed probably from the presence ofthe "melon-seed bodies" so often found in these cysts.Whenever suppuration has been excited in the tumours,there has been great danger of blood poisoning in some form,and if this danger have been escaped, the tendons projectinginto the sac have been firmly fixed as the cavity filled up,and a more or less useless hand has been the result. Our

modern improved treatment of wounds has enabled surgeonsto grapple successfully with these difficulties, and it is nowpossible to lay down definite rules for the treatment of

palmar ganglion, and of similar synovial cysts in othersituations. The first point of importance is to attempt thecure of the cases as early as possible. No good can come ofrlnlm eurhinh 7anrIQ t.i"B ()"PA!ltA1" rli.Qt.Anclrn’1 Jïf tho ",("’Qt

and is especially to be deprecated as endangering the adjacenttendons, which become stretched and even in some cases

i3evered, by the pressure to which they are subjected. As

soon, then, as the disease is clearly recognised, treatmentshould be undertaken. The second point is that any treat-ment to be successful must consist in the free evacuation of

the cyst and the removal of all the " melon-seed bodies "it contains, whether these be free in its interior or adherentto its walls. For this purpose an incision about an inch

and a half long, not a puncture, should be made in themost prominent part of the swelling, above the annular

ligament, avoiding, of course, the radial vessels and the

tendons, which can be felt through the skin. Pressure Ishould be made in the palm to force out the fluid and

as many of the loose bodies as will thus escape. Then a

sharp spoon should be introduced, and the whole cavityscraped, to detach any "bodies" which may be still fixed tothe synovial membrane. The "spoon" is much the best Imeans of doing this. Some have trusted to injecting a full istream of fluid into the cyst, but this will not remove"bodies" which are still firmly adherent to the cyst wall.VOL1DfAXX passes a large drainage-tube through the cyst, Iand draws it sharply to and fro, and trusts to that to detach iany adherent " bodies " , this is, however, an uncertain

method, and if the cyst be old and large, with pouches. extending from the main cavity, they escape the friction ofthe tube altogether. Having thus carefully removed all thecontents of the cyst, whether solid or fluid, a solution ofchloride of zinc, forty grains to the ounce, should be appliedto the whole interior of the sac, the purpose of this being soto modify the nutrition of its lining as to prevent anyrecurrence of the dropsy. A solution of iodine has been

used for the same purpose, and some surgeons may be

inclined to use iodoform instead. The most importantsteps in the treatment are those to be taken to secure

healing of the wound without suppuration-at any rate,without septic suppuration. As a preparatory step the

parts must be thoroughly cleansed before the incision ismade, and the operation should be conducted under an anti-septic spray or irrigation, and some efficient antisepticdressing should be finally applied. Guerin’s cotton-wool

dressing has been used with success, so has iodoform wool;and, of course, the Listerian carbolic gauze dressing. A

drainage-tube should be introduced into the wound and

passed down beneath the anterior annular ligament, andonly removed when the discharge through it is reduced

to a minimum. The question of drainage has been muchdiscussed. Some surgeons have contended that a second

opening should be made into the cyst in the hand,and a tube be laid quite through from one end to

the other, or two tubes used, one in each wound. Others

have advocated several smaller incisions, or even one

incision extending along the whole length of the ganglion.All these seem to be unnecessary, and Dr. Wjsiss has recentlypublished in the Revue de Chirurgie two cases illustratingthis fact, and in his excellent remarks appended to them hehas argued out this point. He shows that if pressure be

carefully applied over the palmar part of the cyst, all

retention of fluid can be entirely obviated. The hand

should be kept fixed on some kind of splint applied to theextensor aspect, until the wound inflicted is healed. As

soon as that is accomplished, the fingers should be liberatedand the patient be encouraged to move them. The results

of this treatment are totally different from those formerlymet with. When the antiseptic precautions are success-

fully carried ont, there is no danger whatever of blood

poisoning or of profuse local suppuration, and the finalresult is the restoration of a thoroughly useful hand. The

tendons are not bound down by cicatricial bands, and aftera time it maybe impossible to find any trace of the previousmischief beyond a linear sear in the forearm. In this way,

therefore, surgery is now able to offer to these patients a

thorough cure of their malady, and without serious risk,vhile formerly the cure was imperfect, and was attendedvith considerable danger.An interesting question still awaits an answer. How is

the cure of the synovial cyst accomplished ? Is it by

granulation, or direct adhesion of its surfaces ? If so, whyare there no adhesions to bind down the tendons and

impede the free use of the fingers ? Is the process of cure

analogous to that obtained in a hydrocele by injection, orin dropsy of a joint treated by injection of iodine ? Thisis the view held by WEISS and others. If so, it remains tobe shown why the cases do not relapse, as so often occursin hydrocele. At present no case of recurrence of the

1172 THE EDUCATION MUDDLE.

ganglion after aseptic incision and drainage has been

reported. Until post-mortem observations are available incases which have been cured by this operation, it will beimpossible to speak with any assurance upon this point.Meanwhile the success to be obtained, if only care be

taken to observe all the necessary conditions, is so greatthat this operation may be practised with confidence, evenalthough we may have to wait before knowing thE

exact pathological changes that take place.

IF there should be present to the consciousness of any I

one of our readers a sense of longing for greater intel-lectual activity than the calls of professional duty neces-sitate, we would commend to his consideration the studyof the Revised Instructions to Her Majesty’s Inspectors ofSchools." For ourselves, we must confess to being mentallyprostrated by the endeavour to read the riddle of this

mysterious paper aright. The general impression left onour mind is that Her Majesty’s inspectors of schools

must be a class of raging lunatics if only one-half of the"instructions" issued for their guidance are requisite.For example, they are expressly cautioned against tryingto do two things at once, such as giving out dictation orsums while hearing the reading of another class. Theyare not to show their temper, &c. &c. In short, the

suspicion of their mental soundness is irresistibly sug-gested by the remarkable general resemblance which these"Instructions" bear to those which the medical officers ofwell-conducted lunatic asylums are wont to issue for thebenefit of patients discharged on probation or let out on leave.Nothing more calculated to make the public conscience un-easy as to the mind-misery inflicted on young children bythe way in which the Education Act is carried out than these" instructions" can well be conceived. In one, and so far aswe can see only one, respect have matters been mended bythe recent agitation with regard to over-pressure. The re-

sponsibility will henceforth rest with school managers andteachers of the undue taxing of the powers of weaklychildren. The inspector is, however, still let loose on the

school, in this respect in a manner his implied state of mind

scarcely justifies, for he may insist on seeing the childrenwho may be kept back because they are deemed " of feebleor slow intellect," and unless he-the man whom it is neces-

sary to warn against himself trying to do two things atonce, and being hurried and showing undue haste-is satis-fied, the precaution of managers and teachers is to go for

nothing. Surely this is a very perilous state of matters. It isnot asking too much to demand that a medical examinationshould be made, and that the certificate of a qualifiedpractitioner should suffice to reduce the inspector to order.No educational system can ever, we are convinced, be safelyworked until it comes to be recognised that not the glorifiedpedagogue who now figures as " inspector,’’ but a medicalpractitioner, is made the judge of physico-mental fitness toundergo, and survive, the brain-torturing process which themost enlightened Legislature of modern times has mistakenfor education. We are so thankful for small mercies that it

would be absolutely unjust to acknowledge that the poorlittle half-starved gutter child, whose knowledge of the

science of music has hitherto been derived from an outside

study of the peripatetic hurdy-gurdy, and whose acquaint-

ance with the quality of musical time has been picked upwhile dancing with bare feet to the music ministered bythe itinerant organ-grinder, is to be henceforth graciouslyexcused from " naming the value of the notes rhythmicallyand in time without singing them." It will now suffice to

sing them. If any father of a family desires to form a justestimate of the magnitude of the task remitted, let him callupon one of his own highly educated children, upon whoseculture much money and time have been bestowed, and whois supposed to have a taste for music," and ask Master orMiss Hopeful to give him a specimen of the exercise fromwhich the poor little waif is at length excused.

Annotations.Ne quid nimis."

WELLINGTON COLLEGE AND RUGBY SPEECHDAYS.

THE annual gala day at Wellington College and at Rugbybook place on Friday and Saturday of the past week. As isusual, the head-master of each school, Dr. Jex Blake of

Rugby and Mr. Wickham of Wellington, made their respec-tive addresses to the parents of their pupils, who on suchoccasions assemble in considerable numbers to witness thedistribution of prizes and listen to the speeches of the boysand yearly statement of the head-master. These are notwithout interest to members of the medical profession. Thetwo accounts are in curious contrast with each other. While.at Rugby the head-master could congratulate the boys ontheir achievements both at the Universities and in thecricket field, the head-master of Wellington made apologyfor the paucity of honours gained by the boys at his

school, small enough in the past compared with some otherpublic schools, but smaller still in the present year.One advantage Wellington appears to offer is being ableto send pupils straight to Woolwich without the inter-vention and aid of the system of private cramming,which of late years has grown so prevalent an adjunct topublic school education. In this respect it competes withCheltenham College. These two schools draw their studentsfrom very much the same spheres, possibly Wellingtonsomewhat more from the élite of society and the army ; butthese should not be either intellectually or physically belowthe standard of the other school. What is it then which

gives to Rugby the pre-eminence ? The scholarship of thestaff of masters is very much on a par at both schools. Boysdestined largely for the army, as those at Wellington are,should not be inferior to those intended for civil callings inlife either in intellectual culture or prowess in games.They should be in association with boys capable ofsuccessful competition at the universities to catch their

spirit of culture if they cannot equal them. Yet, on theshowing of the two head-masters, there appears to be awide difference in this respect at the two schools. Welling-ton boys are behind Rugby boys in competition at theuniversities. Has the difference in locality anything to dowith this ? Rugby is situated on a high table-land where thewind blows with an invigorating force and braces to thefullest energy, while Wellington College is on a low-lyingplain with adjacent hills which drain into the marshesbelow, rendering the air damp and enervating. In this

country, and probably elsewhere, those who dwell on higherlands are less liable to disease than the dwellers on plains,especially marshy plains, and anything that predisposes todisease enervates the system and lessens the capacity formental and physical energy. While the head-master of