Majesty King George the Third, which was shortly after the conquest of the country. The affairs of the profession were administered under that Act, which provided for the granting of a license, to entitle the holder to practice physic, surgery and midwifery in the then Province of Canada.

Having enlarged our borders, and several provinces having grown out of this single province, it was found expedient to seek for further legislation, and in 1847, the profession was incorporated under the name and style of the College of Physicians and Surgeons of Lower Canada. One of the provisions of this Act gave to holders of its license the privilege of legally practising in any part of what at that day constituted the Provinces of Upper and Lower Canada.

By the provisions of the Act of 1847, no person could obtain the license unless he could show that he had studied medicine, surgery and midwifery during four consecutive years, during which time he was required to attend two full courses of Lectures on the various branches of Medical science delivered at some university, college or incorporated school of medicine, and produce evidence of having attended the regular practice of a hospital of not less than fifty beds during a period of eighteen months. A candidate with the credentials above named could obtain his license by examination. If, however, he was the holder of a degree or of qualifications covering the ground of medicine, surgery and midwifery from any recognised British or Provincial university or college, he was entitled to receive his license on the payment of fees without examination. This, then, is the position in which we stand at the present day, and all British Graduates are admitted to license on what their papers show forth. We are in Canada General Practitioners. If a pure surgeon comes to us for a license he can only obtain such license on passing an examination in medicine and midwifery; if, however, these branches are covered by other qualifications, he is admitted to practise at once and the license issued on payment of fees. There can be no hardship in this. We simply think it preposterous of our British friends to remain in their pigheaded ignorance and attempt to write about our institutions, of

which they know nothing. It is lamentable to see gaucheries perpetrated almost in each issue of some of the British periodicals. Our friends on the other side of the Atlantic had better take notice and understand that we in this despised colony gave them the lead in medical legislation by our Act of 1847, and that the Ontario Legislature passed, some twelve years ago, an act enunciating and carrying out the central examining system, or the one door of entrace into the profession, a system that is being advocated at the present day before the British House of Commons.

EXTRACT OF MALT.

There is probably no parallel, in the history of therapeutics, to the rapidity with which this most valuable agent has forced its way into universal favor with the profession. Until a year or two ago its use, in Canada especially, was of the most restricted character, now there are few practitioners who do not occasionally prescribe it. While no medicinal agent has achieved such favor, it may also be said there are few remedies possessing such well-founded claims for general favor, and none whose range of application is so wide. Its constituents are malt-sugar, dextrine, diastase, phosphates, the importance of which to the digestive process need not be discussed. The clinical evidence, too, which has sanctioned the physiological claims of Malt Extract is most abundant. Authorities, abroad (it is officinal in Germany) and at home emphatically recommend it. Niemeyer, Oppolzer, Werber, Bock, Hoppe-Seyler, Heimerdinger, Juergensen, Schroeder and Ziemssen, in Germany; Trousseau, Gosselin, Hardy, Mauduit and Pillois in France; Ramagalia, Testa and Tartaglia in Italy; Aitken, Anstie, Richardson, Chambers and Thompson, in England, are among the writers who speak in favorable terms of its use. In America the testimony is to the same effect. In Canada, as we have said, it has been received by the profession with the greatest favor, and a large number of the profession have already given formal, as well as practical, endorsation to this preparation.

Regarding Malt Extract, Dr. Niemeyer says:

"The class of diseases in which the chief, if indeed not the only task of the physician, is to maintain or restore the strength and nutrition of the patient, is very large. For several years past, to meet these indications, instead of prescribing cod liver oil, which I was formerly in the habit of doing, I have employed almost exclusively, Malt Extract, and with the very best effect. This substance must not be confounded with Hoff's and other so-called malt extracts, which are only a kind of beer containing a large proportion of carbonic acid and alcohol, which are often injurious to the patient. It is similar to other medicinal extracts, and consists of the soluble constituents of Barley Malt."

According to Professor Douglas, 1000 parts of the Trommer Extract of Malt contains: malt-sugar 46.1; dextrine, hopbitter, extractive matter, 23.6; diastase, 2.469; ash-phosphates, 1.712; alkalies, .377; water, 25.7. In comparing this analysis with that of the Extract of Malt of the German Pharmacopoeia, as given by Hager, he finds it to substantially agree with that article.

Malt Extract, with its combinations, is recommended in the following diseases: anæmia, chlorosis, marasmus, dyspepsia, neuralgia, insomnia, pulmonary and bronchial affections, dysentery, constipation, scrofula, convalescence from exhausting diseases, &c. We have used the Trommer Extract in some of these affections with satisfactory results, and have no hesitation in strongly recommending it.

[Mr. R. L. Gibson, agent for the Trommer Company, is desirous of securing reports from physicians of their experience in the use of Extract of Malt, and requests us to say that such courtesy would be very highly esteemed. He will also be glad to answer any enquiries, and to furnish samples on application. Address: P. O. Box 724, Montreal].

Medical Item.

Charles H. Murray, B.A., M.D., C.M., McGill University of the Session of 1876, also M.R.C.S., Eng., passed the competitive examination for the Indian Medical Service, on February 17th last. There were fourteen vacancies and thirty-three candidates, and Dr. Murray stood eighth on the list of successful candidates. We believe Dr. Murray is at present serving at Netley.

CANADA

MUSEU
OXFORD

MEDICAL & SURGICAL JOURNAL

JULY, 1879.

Original Communications.

DISLOCATION OF THE RIGHT HIP JOINT INTO
THE ISCHIATIC NOTCH;

OCCURRING FROM A FALL, IN A BOY AGED FOUR YEARS.
Reduction by Manipulation.

BY GEORGE E. FENWICK, M.D.,

Prefessor of Surgery, McGill University; Surgeon to the Montreal General Hospital.

Cases of dislocation of the hip-joint are comparatively rare accidents, more especially amongst children. Having recently met with a case of dislocation in a child of four years, I deemed it of sufficient interest to place on record. C. C., a little boy of 4 years, was brought by his mother to the Montreal General Hospital on the 24th June, 1878, with what was supposed to be the commencement of hip-joint disease. The history, as given by the mother was that while running he slipped, with his right leg bent beneath his body, and fell on the side, receiving what was supposed to be an ordinary contusion. The accident occurred some ten days before admission. When seen he was lying on his back in bed, the right knee was rotated inwards and advanced, lying upon and overlapping the left thigh; it was slightly flexed at the knee-joint, and the mother stated that he was unable to stand or walk. There was flattening of the trochanter, and considerable fixity of the limb. The examination was conducted on a table. On attempting to place the limbs together and extending them, the loins were arched forwards, a condition which was reduced when the injured limb was flexed on the pelvis, but there was not that amount of fixity which is usually seen in these cases, but some shortening.

NO. LXXXIV.

35

Feeling satisfied that I had to deal with a dislocation backwards into the ischiatic notch, chloroform was administered, and reduction by manipulation practised. Seizing the ankle in my right hand, the leg was flexed on the thigh at the knee-joint, the thigh flexed on the pelvis, and carried first towards the left side, to a little more than at a right angle. Abduction and rotation. of the limb outwards was then performed, when an audible snap occurred, and on extending the limb it was found that the head of the bone had returned to its natural position, the limbs had assumed a symmetrical appearance, were of equal length, and the motions of the joint free and the sensation quite normal. The limbs were then bandaged together, and the child returned to bed. The mother was obliged to return home, as she was from the country, and she objected to leave her child at the hospital, so that they were discharged on the 26th June, two days after the reduction. In the meantime no untoward symptoms had been developed, and she was instructed to return, should any further trouble occur.

The following table is taken from cases reported in Hamilton's work on Fractures and Dislocations, and is compiled to show that these injuries may occur at a very early age under peculiar circumstances:

1. 6 months...... Thyroid Notch.............. J. Powdrell, in Lancet.

Dislocation of the hip-joint, as occurring in early life, is comparatively a rare accident. We may account for this from the fact that young children are less exposed to injury, and that from their light weight are capable of sustaining injury with comparative immunity. It has been stated that dislocation of the hip-joint never occurs before the seventh year of life. This is an error;