MARRIAGES. CLOETE-BALFOUR.- Cn June 1, at St. George's Cathedral, Madras, Josias Gordon Cloete, Captain H.M. 81st Regiment, M N.I., to Marion, eldest daughter of Surgeon-General Balfour, Madras Medical Department. CROWFOOT-RAYLEY.-On June 30, at the parish church of St. Peters, Brighton, William Miller Crowfoot, M.B. Lond., of Beccles, Suffolk, to Catharine Anne, seccrd daughter of the late Robert Bayley, Esq., of the Inner Temple, barrister-at-law. SANDERSON JOHNSTONE.- On May 28, at St. Paul's Church, San Fernando, Trinidad, West Indies, William Sanderson, Esq., of Mondesir Estate, to Agnes Matilda, eldest daughter of Robert Johnstone, M.D. DEATHS. BAKER, THOMAS JOHN, M.R.C.S. Eng., L S.A., of 18, Junction-road, Highgate-hill, suddenly on June 28, aged 63. DOUGLAS, ARCHIBALD, M.D., at 8, Clifton-place, Hyde-park (formerly of Edinburgh), on June 25, aged 57. MCNICOL, JOHN CLARK, M.D. Edin., of Clayton-le-Moors, Lancashire, on June 22, aged 29. SCOT, THOMAS GOLDIE, M.D. Edin., L.R.C.S., Deputy Inspector-General of Hospitals, late of 79th Highlanders, of Craigmuie, Stewartry, of Kirkcudbright, at The Manse, Laurencekirk, on June 25. VACANCIES. In the following list the nature of the office vacant,the qualifications required in the Candidate, the person to whom application should be made, and the day of election (as far as known) are stated in succession. DERBY COUNTY LUNATIC ASYLUM.-Assistant Medical Officer. Candidates must be duly qualified in medicine and surgery. The office will be vacant on August 2. Applications, with testimonials, to John Barber, Esq., County Lunatic Asylum, Mickleover, Derby. GENERAL INFIRMARY, NORTHAMPTON.-House-Surgeon. Candidates must be duly qualified. Also an Assistant to the House-Surgeon. Applications, with testimonials, to the Secretary, on or before July 18. KING'S COLLEGE, MEDICAL DEPARTMENT.-Professor of Materia Medica, Professor of Comparative Anatomy, and Physician to King's College Hospital. For particulars, apply to J. W. Cunningham, Esq. KINGTON UNION.-Medical Officer for the New Radnor District. dates must be duly qualified. Applications, with testimonials, to the Clerk of the Union, on or before July 24. Candi NORTH STAFFORDSHIRE INFIRMARY.-House-Physician. Candidates must be duly qualified. Applications, with testimonials, to the Secretary, on or before July 22. STOCKPORT INFIRMARY.-Assistant House-Surgeon. Candidates must be duly qualified. Applications, with testimonials, to the Honorary Secretary, on or before July 8. WEST NORFOLK AND LYNN HOSPITAL, LYNN.-House-Surgeon and Secretary. Candidates must be duly qualified. Applications, with testimonials, to the Weekly Board, on or before July 11. UNION AND PAROCHIAL MEDICAL SERVICE. The area of each district is stated in acres. The population is computed according to the census of 1871. RESIGNATIONS. Gower Union.-Dr. Eade has resigned the Eastern District; area 7581; population 4032; salary £20 per annum. Stow-on-the-Wold Union. -Mr. James Drew has resigned the Longborough District; area 16,143; population 2489; salary £35 per annum. Also the Workhouse; salary £15 per annum. Stratford-on-Avon Union.-The Welford District is vacant; area 11,569; population 2070; salary £50 per annum. Also the Workhouse; salary £40 per annum. Weymouth Union. Mr. W. T. Boreham has resigned the Abbotsbury District; area 11,358; population 2041; salary £60 per annum. APPOINTMENTS. Cheadle Union.-John W. H. Mackenzie, M.R.C.S. Eng., L.S.A., to the Cheadle District. Cheltenham Union.-John P. Bevan, L.R.C.P., M.R.C.S., to the First Cheltenham District. Daventry Union.-Charles H. Gibson, M.R.C.S. Eng., L.R.C.P. Edin., to the First District and the Workhouse. His Royal Highness the Duke of Edinburgh has been pleased to appoint J. Fayrer, M.D., C.S.I., Honorary Physician to her Majesty, to be Physician to his Royal Highness. DR. PROTHEROE SMITH has been elected a Corresponding Member of the Medical Society of St. Petersburg. DR. E. G. POTTLE, Public Vaccinator of St. Luke's Division of the Holborn Union, has been awarded a Government grant of £42 78. for successful vaccination. SMALL-POX is spreading in the Umballa and Ferozepore districts. A PROVISIONAL committee, consisting of medical practitioners, has been formed in Sunderland for the purpose of establishing a provident dispensary in that town. UNDER the new War Regulations the military hospitals in the Southern district will be transferred from the Control Department to the Army Medical Department this week. THE preparation of a handbook on adulterations, and the means of their detection in food, drink, and drugs, will, we understand, be undertaken by Messrs. Smith, Elder, and Co., by arrangement with the Principal of the Inland Revenue Laboratory. THE foundation was laid on Saturday of a new wing to the London Hospital, under the auspices of the Grocers' Company, who, it will be remembered, contributed £20,000 for the purpose. The establishment, on the completion of this addition, will contain 800 beds. DISPLACEMENT of the apex-beat may be produced in the normal state by inclining the patient to the left side, when it may pass to the left a little farther even than a point equidistant between its normal position and the axillary line; and by inclining the patient to the right, the apex-beat becomes faint or disappears, the right side of the heart being then felt to give a distinct pulsation in the epigastrium. In pericardiac effusion, the apex-beat may be displaced upwards as far as the In fourth interspace, and slightly outwards to the left. pleural effusion on the left side, it may be turned quite round the other way into a similar position on the right side, and pleuritic effusion on the right side may displace it towards the left. In hypertrophy, with dilatation of the left ventricle, the apex-beat passes downwards and to the left. In a similar condition of the right ventricle, it may entirely disappear from its normal position, a diffuse impulse at the lower end of the sternum revealing the cause.-"On the Diagnosis of Disease of the Heart," by George W. Balfour, M.D., F.R.C.P.E. (Edinburgh Medical Journal, May, 1874). NOTES, QUERIES, AND REPLIES. He that questioneth much shall learn much.-Bacon. With reference to the Gurjun balsam or oil mentioned by Dr. DyceDuckworth last week in the treatment of leprosy, we would refer our readers to a note in our number of April 4, stating the result of experience as to the use of Cashew-nut oil, of the Chaulmogra, the Neeradeemootoo oil, and the Gurjun. With good diet and cleanliness, these remedies undoubtedly do good; but some Indian authorities fear that any relief afforded by it is only temporary. Mr. C. S. Jeaffreson shall have a proof next week. Mr. Lennox Brown, if wise, would let the matter drop. Santa Anna.-The idea is hardly original; but after all is capable of great development, and certainly has not been fully worked out. L.S.A.- Ph.D. is a foreign degree, obtainable from various German universities under very various conditions. Justin.-The Act to amend and consolidate the Acts relating to the medical profession of Ontario, Canada, passed the Legislative Assembly on March 12 last. K. P. M. "Unknown, perhaps his reputation And, wrapt in darkness, laughs unhurt, HIPPOCRATES IN A CLOTHES-BASKET. TO THE EDITOR OF THE MEDICAL TIMES AND GAZETTE. SIR,-Such of your readers as are familiar with the romance and fiction of the centuries preceding our own, will be aware how troubadours, novelists, and dramatists-including the "Divine Williams" himselfutterly disregarded all verities of time, place, and person, and were indifferent whether they spoke of a seaport in Bavaria, or of the presence of Alexander the Great at a tournament of Christian knights. Their moral, such as it was, was their chief care, and in order "to point their moral and adorn their tale," they took the most preposterous liberties with the names and characters of historical personages. Now it happens, unluckily, that in an age of open profligacy the favourite moral was, that no man is saint or sage below the girdle; and to enforce this maxim it was a common practice to represent saints and sages, from King Solomon downwards, as yielding to temptation like ordinary mortals. For instance, there is a "Lay of Aristotle," said to be derived from the Arabians, and reproduced by mediæval poets (as Gower in his "Confessio Amantis"), in which the sage is represented as so befooled by one of the mistresses of Alexander the Great, that he allowed her to harness him with an ass's saddle and to ride on his back, whilst he went on all fours. Nor did these irreverent jokers spare the fathers of physic, for there is a "Lay of Hippocrates," relating how this eminent physician, coming to Rome in the time(!) of the Emperor Augustus, found the whole city in mourning on account of the death of the Emperor's nephew. But he restores the youth to life by putting the juice of certain plants into his mouth; whereupon he is looked upon as more than mortal, and treated with the highest reverence. But, alas! he has the one vulnerable point of human nature. He makes overtures to one of the Emperor's mistresses, who promises that he shall be admitted to her apartments. But the frail fair one lives at the top of a high tower, the gate of which is jealously guarded. So it is agreed that he shall be hoist up in a clothes-basket. He repairs at night to the foot of the tower, finds the basket, gets in, and is pulled up. But, alas! the basket is raised only halfway by the perfidious woman, and there the sage is left hanging, to the derision of the multitudes who come to gloat over the frailties of an old philosopher. The motive of the story is as vile as the story is false, but it shows the manners of the time when it was popular. I am, &c., DELTA. Hazlitt.-The Police Medical Board of Melbourne consists of Drs. Youl and McCrae and Mr. Ford. VITAL STATISTICS OF LONDON. G. F. P.-The marine hospital at the port of Chicago was opened for the reception of patients on November 17 last. Cato.-Lord Bacon said-" It is with times as it is with ways: some are more uphill and downhill, and some are more flat and plain, and the one is better for the liver and the other for the writer." A Naval Surgeon. "Play the fool with wits, Wits are safe things, there's danger in a fool."-Churchill. Ethnologist.-The magnificent collection of Dr. Barnard Davis is much larger than that in the possession of the College of Surgeons; as at the time of the publication of his catalogue in 1867, it numbered 1540 speciThe College Museum contains at present 937 specimens, of which 284 are described in the catalogue published in 1853, and 653 have been added since. mens. B. S.-It was formerly a very common custom to cut open live animals, as pigeons, kittens, puppies, and rabbits, and to bind the animal to an ulcer, so that its soft and reeking viscera might act as a kind of fomentation or poultice. Animal heat was believed to have something in it different from common heat: COMMUNICATIONS have been received from Mr. J. H. THOMAS, Bristol; Mr. J. DIXON, London; Dr. HEYWOOD SMITH, London; Mr. G. COWELL, London; Mr. W. BLOWER, Bedford; Dr. J. E. POLLOCK, London; Mr. W. C. ARNISON, Newcastle-on-Tyne; SANTA ANNA; Messrs. ARNOLD AND SONS, London; Mr. T. NEEDHAM, London; Dr. H T. SHAPLEY, London; Dr. E. G. POTTLE, London; Mr. J. CHATTO, London; Dr. SPARKS, London. BOOKS AND PAMPHLETS RECEIVEDReport on the Sanitary State of the Hackney District, for 1872, by Dr. J. W. Tripe-Report on the Sanitary Condition of Birkenhead-A New Apparatus for Extensor Paralysis, by J. Van Bibber, M.D.-Thomson's Conspectus, edited by Birkett-West's Harveian Oration for 1874-Keen on the Uses of Chloral-Report of the Belfast District Hospital for the Insane-Newman on Electrolysis in the Treatment of Stricture of the Urethra. PERIODICALS AND NEWSPAPERS RECEIVEDLancet-British Medical Journal-Medical Press and Circular-NaturePharmaceutical Journal-Canada Lancet-Allgemeine Wiener Zeitung -Centralblatt für Chirurgie-Berliner Klinische Wochenschrift-Gazette Médicale-Gazette Hebdomadaire-La Tribune Médicale-La France Médicale-Le Progrès Médical-Gazette des Hôpitaux-Bulletin de l'Académie de Médecine-The Medical Temperance Journal-Irish Hospital Gazette-Popular Science Review-Monthly Microscopical Journal-Science Gossip-The Obstetrical Journal of Great Britain and Ireland-Leisure Hour-Sunday at Home-British and Foreign MedicoChirurgical Review-Revista Médico-Quirúrgica - Bulletin Général de Thérapeutique-Viertel Jahresschrift für Dermatologie und Syphilis. APPOINTMENTS FOR THE WEEK. July 4. Saturday (this day). Operations at St. Bartholomew's, 14 p.m.; King's College, 2p.m.; Charingcross, 2 p.m.; Royal Free, 9 a.m. and 2 p.m.; Hospital for Women, 9 a.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic, 14 p.m.; St. Thomas's, 9 a.m. 6. Monday. Operations at the Metropolitan Free, 2 p.m.; St. Mark's Hospital for Diseases of the Rectum, 2 p.m.; St. Peter's Hospital for Stone, 3 p.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic, 1 p.m. 7. Tuesday. Operations at Guy's, 14 p.m.; Westminster, 2 p.m.; National Orthopedic, Great Portland-street, 2 p.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic, 1 p.m.; West London, 3 p.m. 8. Wednesday. Operations at University College, 2 p.m.; St. Mary's, 1 p.m.; Middlesex, 1 p.m.; London, 2 p.m.; St. Bartholomew's, 14 p.m.; Great Northern, 2 p.m.; St. Thomas's, 1 p.m.; Samaritan, 2 p.m.; King's College (by Mr. Wood), 2 p.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic, 14 p.m. 9. Thursday. Operations at St. George's, 1 p.m.; Central London Ophthalmic, 1 p.m.; Royal Orthopedic, 2 p.m.; University College, 2 p.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic, 1 p.m.; Hospital for Diseases of the Throat, 2 p.m. 10. Friday. Operations at Central London Ophthalmic, 2 p.m.; Royal London Ophthalmic, 11 a.m.; South London Ophthalmic, 2 p.m.; Royal Westminster Ophthalmic, 14 p.m.; St. George's (ophthalmic operations), 1 p.m. 2228 121675 3 40°1 57 4 14:11 0.87 2:21 59 48 82257 11.0 44 26 73 5 38 5 54 9 12.72 1.09 2:77 91 192889 43:3). 102 62 70896 20.9 21 77.8 47.2) 58 5 14.72 0.37 0.94 360892 43:0 294 16474-2 47 2 57 7 14:28 0'40 1'04 106202 33 2 126- 28 69 9 449 56.3 13:50 0.31 0.79 60 90894 455 39 75 9 417 56 9 13 83 0.65 165 510640 98'0 385 271 66 0 47 9 55 9 13 28 0 21 0'53 355339 82-8 299 169 133068 25.7 106 75 86281 18:5 163056 22 6 169 67 70 8 43 3 56.1 13.39 0.35 C'S9 Wolverhampton Oldham Leeds 78 71 4 450 54.8 12.66 0.56 1:42 278798 12.9 263 124 72 0 44 0 56 1 13:39 0:32 0.81 110 71 0 46 0 56 9 13 83 0.32 0.81 55 71 0 44 0 56 7 13 72 C'19 0'48 36 720 460 58 3 14.61 0.16 0:41 7162 0 45 0 51.8 11:00 0.17,043 76 261029 13:3] 212 130996 360 113 104378 31'6 114 Newcastle-on-Tyne 135437 25'2 100 Sunderland Edinburgh. 211691 47.8 140 in United Kingdm 7618655 36 6/5506 314077 8 38 5 56-4 13:55 0:44 1:12 At the Royal Observatory, Greenwich, the mean reading of the barometer last week was 29'67 in. The highest was 29.99 in. at the beginning of the week, and the lowest 29:45 in. on Friday evening. The figures for the English and Scottish towns are the numbers enumerated in April, 1871, raised to the middle of 1874 by the addition of three years and a quarter's increase, calculated on the rate which prevailed between 1861 and 1871. The population of Dublin is taken as stationary at the number enumerated in April, 1871. MEETING OF THE GENERAL MEDICAL COUNCIL. HELD AT THEIR HOUSE, OXFORD-STREET, W. FIRST DAY.-THURSDAY, JULY 9, 1874. THE General Medical Council met on Thursday, the 9th inst., in their new premises, formerly the Royal College of Chemistry, in Oxford-street, at two o'clock; the President, Dr. Paget, in the chair. There were present, besides the President-Dr. James Risdon Bennett, Mr. Richard Quain, Mr. Edward Bradford, Dr. Henry W. Acland, Dr. George M. Humphry, Dr. Thomas Thompson Pyle, Dr. Andrew Wood, Dr. John G. Fleming, Dr. Allen Thomson, Dr. Aquilla Smith, Dr. James Apjohn, Dr. Edmund Alexander Parkes, Dr. William Sharpey, Dr. Richard Quain, Sir William Withey Gull, Bart., M.D., and Dr. William Stokes. The PRESIDENT read letters from Sir Dominic Corrigan and Dr. Leet explaining their absence. The following new members were introduced to the Council: -Dr. Daniel R. Haldane, Professor William Turner, M.B., Dr. Rawdon Macnamara, and Dr. James Warburton Begbie. The PRESIDENT: Gentlemen,-I congratulate you on your new abode. I trust that the Council at large will be satisfied with the way in which the Executive Committee has carried out the instructions "to obtain premises wherein the meetings of the Council may be held and the general business carried on with comfort and convenience." The result which you see has cost not only much time but some trouble. A report on the subject will immediately be laid before you by the Executive Committee, and if any further information be desired, it will gladly be given by the treasurers or myself. I have thought it advisable that such parts of my correspondence with the late Government as have not already appeared in the minutes of the Executive Committee should be arranged and placed in the office, so that all that has passed with regard to this house can at any time be readily referred to. The terms on which the Council will hold the house are not so favourable as we had been led to expect. But if any member of the Council thinks that the Executive Committee might have done better, I will beg him to consider all the circumstances of the case, to look at the answer of the then Government to the application of the Council in 1858, and to remember the actual pressing necessity for providing a local habitation for the Council before we should lose the power of retaining even our insufficient accommodation in Soho-square. The letter from the late Government offering this house to the Council was dated the very day of their resignation of office. To one part of this letter I may refer with some gratification that in which the Lords of the Treasury expressly recognise the claims of the Council to a certain measure of public assistance. These were the grounds on which the application to Mr. Lowe for apartments rent-free was made and urged. The claim was expressly disallowed in 1858. I am glad that now it has been, however, partially admitted. It is not quite reasonable or fair that the cost of the work done by the Council should be wholly defrayed out of the registration fees paid by men entering our profession. The persons benefited by this work are not members of our profession alone or chiefly, but in a much higher degree the general public. For the chief purpose and end of our work is to prevent the intrusion into the profession of persons in whose hands the health and lives of the public could not be safely trusted. I believe, indeed, and have no doubt, that to Mr. Lowe we are mainly indebted for the favourable terms on which this house was offered to us. If less favourable than we had reason to expect, they are yet not undeserving acknowledgment. From the present Government we have received prompt courtesy. An application to the Treasury for a reasonable concession in regard to the date of the lease was answered by return of post, and the answer was favourable. To the officials of the Office of Works we are under greater obligations for their readiness in receiving suggestions for the requisite alterations in the building, and for the skill and activity with which these have been carried out. The building was a mere shell, wholly unfit for our needs. You will see what it now is, and can judge VOL. II. 1874. No. 1254. what it will be when all that is intended shall have been quite completed. We are, therefore, very greatly indebted to the goodwill and zeal and ability of the Office of Works, for all that they have done has been done as it were "against time," in a very short period. And we are certainly not less indebted to our Treasurers, and particularly to Dr. Quain, who, as many of you know, has been from first to last the chief moving spirit in this business. But for him, we could not possibly have met here to-day; but for the unsparing devotion of his valuable time to our service-his time by night as well as day we might now, in this broiling weather, have been cooped up in the corner of Soho-square. We owe also not a little to his thoughtfulness and his taste. But all this is well known to others as well as myself, who are better able than I am to express adequately our thanks. In opening the session in this spacious hall, I have only one regret that all those who sat with us in the Council last year are not here to-day. Four of them are absent-Sir Robert Christison, whose words added weight to any debate, whose name has for so many years been known and held in respect wherever medicine is studied, representing as he does, in the highest degree, all that for which his university has long been famous; Dr. Alexander Wood, who, like Sir Robert Christison, was from the first a member of the Council, and whose great capacity for business, and equal or even greater gift of oratory, must have made him a marked man in any position in which he might have been placed; Dr. Macrobin, who was kindly, candid, honest, and able. I think it one of the many happy incidents of my connexion with the Council that it gave me his acquaintance, and I hope his friendship. And we miss, too, the genial smile of our friend Mr. Hargrave; but our new colleagues must not think themselves less welcome because we do not forget their predecessors. We see in their presence that, however great may have been any one of our losses, it is not too great to be replaced. Since the last meeting of the General Council, the examinations of some of the medical authorities have been visited and reported on. It would be superfluous for me to say much of these reports; they tell their own tales, and tell them with such manifest ability as to require no commendation of mine. And they do more than convey information respecting particular institutions: they raise some questions of a general kind, the discussion of which cannot fail to be serviceable to that which is our great objectthe advancement of medical education, and of the standard of acquirements in our profession. But though I say no more than this of the reports themselves, I may be expected to make some mention of the arrangements of the Executive Committee for carrying out the visitations. In the selection of visitors regard was had to prior experience as examiners. Their number was purposely limited, so as to allow of one visitor inquiring into the examinations of more than one licensing body, and thus helping to guide us towards an equivalent of standards in parallel cases. I am sure the Council will think the Executive Committee fortunate in having obtained the services of men so eminently qualified, and whose statements and opinions are entitled to so much respect. By two gentlemen only were the invitations declined-by Dr. John Ogle and Mr. Teale, of Leeds,-and in both cases with expressions of regret at their inability. We lost the valued services of Mr. Holmes on his appointment to the Board of Examiners of the College of Surgeons of England. His nice sense of propriety perceived an incompatibility in the two offices. In all cases where practicable, a physician and a surgeon were associated in the visitation. No notice was given beforehand to the body about to be visited. The intention to visit was, I believe, in all cases kept secret. The reports have not been subjected to any revision by the Executive Committee. In no case has even a single word been altered after the reports have been sent in. As to any instructions beforehand, none were given, except such as were needed in the case of such visitors. They were no more than that the reports should be thorough and unfettered-just what the visitors might observe and think for themselves. Another work has been done since our last meeting in the compiling and publication of the additions to the Pharmacopoeia. A report of the Pharmacopoeia Committee will bring this under your consideration, and will, I doubt not, meet your approval. Only a few words more-my last words, I may call them,-and pray, under the circumstances, forgive their egotism. Five years ago the Council did me the honour of electing me their President. This very day is the anniversary of my election, for I was elected on July 9, at 6 p.m., or thereabouts. In a very few hours, therefore, my period of office will be at an end. The honour bestowed on me five years ago was the highest I ever received-the highest I should ever wish to receive. I am very conscious how small a return I have made for this distinction, but I have endeavoured to make such a return as you would most approve of, for I have tried to discharge my duties to the best of my ability. All honours have their responsibilities, and mine have been no exception. As President, I have been more responsible than any other member for the efficient discharge of the duties of the Council. And our joint responsibilities are not light, for they are of the same kind, and manifold more weighty than the everyday responsibilities of our profession. Like them, but in a larger sense, they are responsibilities to be measured by men's lives and men's sufferings. To raise and maintain a high standard of acquirements in those who enter our profession, is our main duty here. To neglect this study would be to let men die whose lives might be saved-to let men suffer whose health might be restored. But in all responsibilities or difficulties, and amidst the many shortcomings of which I am sensible, I have always been sure of the support of the Council. Their kindness has never once failed me. During the active five years of my office there has not been one single instance in which I have been treated otherwise than with the utmost kindness and consideration by all the members of the Council, collectively and individually. I wish I could adequately express my gratitude. Happily, our responsibilities are limited by the extent of our powers and by the proportion that our powers have borne to the largeness and difficulties of our task. The powers given to the Council by the Medical Act are but slender. Its main task, that of elevating medical education, is a large one. All great educational improvements are great tasks, and though ours has been in some sense limited, being confined to one profession only, in another sense it is very large, for its extent is the area of the whole United Kingdom. This is, indeed, a fact of which the Medical Council may well be proud. Our Council is, as far as I know, the only body, except the Houses of Parliament, of which both the construction and functions are truly imperial-the only body in which English, Scotch, and Irish representative men meet together to consult upon and devise measures that shall be common to all three divisions of the kingdom. In this the Medical Council sets an example that may well be envied, and might with advantage be imitated. But in this, which may well be our boast, is also, it must be admitted, one of our difficulties. The improvements, to be effectual for their purpose, must proceed pari passu throughout the whole United Kingdom. And another impediment to rapid progress is that our members-English, Scotch, or Irish -are, and I would say must be or ought to be, for the most part practitioners of medicine, men therefore busy at home, and meeting perhaps only when assembled together in our annual session, bringing therefore greater diversities of opinion than might perhaps be found if their intercourse were more frequent. But notwithstanding these obvious difficulties, though time is found by experience to be a great and necessary element in all great educational improvements, though we have not hitherto succeeded in simplifying our work by reducing the number of the nineteen separate sets of examinations, yet our success has not been discouraging when compared with our powers. It may be, and doubtless is, difficult to estimate the progress that has been made, but at all events we know that a few years ago a man could enter into our profession without producing any evidence whatever of general education. Now a preliminary education is enforced on all, and the proofs of this are given in almost all cases prior to the commencement of medical studies. The future influence of this on the social status of our profession can scarcely be over-rated. We know that a few years ago only three or four of the licensing bodies made clinical examinations a part of their test of fitness for a diploma. This test was even spoken of as objectionable. Now all bodies insist on it. We know that a few years ago, in the examinations for medical commissions in the Army or Navy, it was not uncommon to find about 40 per cent. of the candidates ignorant and incapable, though already in possession of diplomas, both in medicine and surgery. Of late these discreditable failures have become so few as to be almost, if not quite, insignificant. I am happy to say that on the very last occasion of examination for Army Medical commissions-that of March, 1874, which will be laid before you to-day-there was not one of these failures. And surely the like signs of improvement are equally manifest throughout our profession. Teachers tell us so; laymen have no doubt of it. Certainly my experience is so. I know not a few young village practitioners whose acquirements might have placed them, a few years ago, in the foremost rank of practitioners in large towns. I do not claim for the Medical Council all the credit of these improvements. Something is due to the admirable spirit for doing better and better which pervades our profession, and is kept alive by the medical journals. Some share of the credit may also fairly be given to the Licensing Bodies. All of them have improved their examinations, and some of them have set an admirable example and seconded this Council with a most praiseworthy public spirit. May I venture to add to what I have already said that the limitation of our powers, both in education and still more in other matters relating to our profession-our difficulties and the degree of success actually attained by us-have become better known to the profession at large than they were some five years ago. It is now more clearly seen that the Council has not the same freedom of action as a voluntary association; that it cannot take part in all matters that concern the profession; that many such matters, however interesting and important to the profession, are altogether beyond or beside the functions of the Medical Council as defined by Act of Parliament; and that the Council is less obnoxious to blame than was formerly supposed for want of energy in dealing with the Licensing Bodies. Have we, then, in that which is our chiefest dutythe providing for the public the best possible medical advicehave we yet attained that happy standard of excellence at which we may "rest and be thankful"? I am very far from thinking this. I am far from thinking that the actual state of things is satisfactory. Nothing, indeed, is satisfactory which admits of further improvement. That there is room for further improvement is not doubtful. But enough has been effected to encourage the Council in doing more. It is true that the powers given to it by the Medical Act are slender, but it has an influence far mere ready and sure in its operation than the statutable coercive power which could be exercised only through an appeal to the Privy Council, and which would probably fail except in case of very plain dereliction of duty on the part of the offending body. The chief power of the Council, as I believe, is that which it gave itself when, on the motion of our friend Dr. Andrew Wood, the Council determined that its debates should be public. The agency of the press giving publicity to our debates and proceedings has, I believe, more than doubled the power of the Council-doubled its power for anything that is right and reasonable, and more than doubled its influence with the Licensing Bodies in any question in which this Council may be in the right and they in the wrong. I have, therefore, no fear as to the future of the Medical Council. It has before it a great course of usefulness, which I am sure will be followed with success. Its main purpose is of the highest national importance. How this may best be effected will be for you to decide, and is not for me to indicate. It would be unbecoming for me to talk of what should be the work of the Council in the coming time, when I shall no longer be a member of it. I shall look on from a distance, indeed, but with unceasing interest, and with the respect which I have long learned to feel, and shall never cease to feel, for the Medical Council. I will now resign my chair, and leave you to choose my successor. Before I sit down, I ought to thank my friend on my left hand, the Registrar, for his unvarying kindness. He is one of the most courteous and obliging of men; and also I ought not to omit to thank the reporters for the way in which they have done their work. Dr. Paget then retired, and Dr. Stokes took the chair. Dr. ANDREW WOOD rose with peculiar happiness to propose a motion, which he had no doubt would be received with acclamation. It was, that they tender a hearty vote of thanks to Dr. Paget for his great services to the Council. All those who had sat with him for so many years in the Council knew that it would have been utterly impossible for any man to have discharged the important and responsible duties which had fallen upon him with greater courtesy, greater impartiality, greater ability, or greater success. The resolution, having been seconded by Dr. AQUILLA SMITH, was carried unanimously. Dr. ANDREW WOOD moved, and Dr. APJOHN seconded, that Dr. Paget be re-elected President. The resolution was carried unanimously. The remainder of this day's proceedings will be reported fully in our columns next week. ORIGINAL LECTURES. SIX LECTURES ON THE SURGICAL TREATMENT OF ANEURISM IN DEI IVERED IN THE THEATRE OF THE ROYAL COLLEGE OF SURGEONS. By TIMOTHY HOLMES, F.R.C.S., ABSTRACT OF LECTURE III., Delivered on June 12. THE subject of inguinal and femoral aneurism was continued. It was shown in the last lecture that the experience of British hospitals has been on the whole favourable in the treatment of this form of aneurism by cutting operations, whether in unruptured aneurisms after the method of Hunter, applied to the external iliac or femoral artery, or in ruptured aneurisms by tying both ends of the vessel after the manner of Antyllus; whilst the experience of pressure, so far as it has gone, has been less favourable, and offers a very great contrast to the account given by Fischer of the cases to be found in published literature. Two causes may be imagined for this contrast. It may be assumed that our hospital patients are less tolerant of pressure and their cases less suited for the treatment, than those in general practice, either on account of dissipation or prior neglect of their disease; but it is also possible that the method of compression may not be followed out in our hospitals with that minute care and that attention to every detail of the case which are really essential to its successful application. The treatment has not a fair chance if carried on by persons who are not responsible for its success, and who may be hardly interested in the result of the case. The compression treatment is far more laborious for the surgeon in charge of the case than the operative treatment, and Professor Holmes suspects that if hospital practice is to be carried on only by daily visits, the treatment of cases of aneurism in the lower extremity will be more successfully conducted on the Hunterian method than on that which is intended to replace it. At the same time, this accidental circumstance affords no indication of the real value of the two methods of treatment; and Mr. Holmes thinks the results of compression in hospital practice would be more satisfactory than at present if hospital surgeons had sufficient confidence and sufficient interest in the method to sacrifice to it the time and the attention which are necessary, in order to obtain from it the best results which it is capable of giving. Another striking feature in this table is the sharp contrast which it shows between the results of rapid and total pressure under chloroform-which, as a rule, has been very successfuland those of the more gradual method by instrumental or digital pressure, which-in femoral aneurisms, at any ratehas been very much the reverse of successful in the hands of British hospital surgeons. It will be convenient now to consider the results of the experience up to the present time of this novel method, not only in femoral, but in other forms of aneurism below the diaphragm. We are not in a position yet to give any but a conjectural opinion as to the chances of success of the rapid method of pressure applied under the influence of chloroform, in situations like the popliteal, where the other plans are so feasible. Very few cases have occurred in which this method has been applied to the femoral artery for the cure of popliteal aneurisms, and that for the very satisfactory reason that patients can usually tolerate effectual pressure of the femoral without chloroform. But in cases on femoral aneurism it is often necessary, if compression is to be used at all, that it should be used in the form of rapid and total compression under anesthesia, of the external iliac ; and it is one of the most interesting and most difficult questions in the surgery of such aneurisms to determine whether this treatment is really more or less dangerous than the resort to the Hunterian operation on the external iliac artery. The number of cases which have as yet been under treatment cannot be large, but it is evident, from the way in which "the rapid method" is sometimes spoken of, that the few striking cases of cure which have been published have attracted more attention than the instances of failure, although great candour has been shown in publishing these. The Professor then called attention to a table comprising twenty-three cases in which rapid pressure has been applied with a view of curing the aneurism at a single sitting, an attempt which in many cases has been repeated at subsequent sittings with varying success. In six of these it was, or was supposed to be, aortic. The fact was ascertained by post-mortem examination in four; and in the others was inferred from more or less convincing signs. Of these, three were successful, two were fatal, and the sixth failed, the man dying from the gradual progress of the disease. In ten the aneurism was iliac or ilio-femoral, and in seven of these a cure was obtained. In the others the attempt failed but was not fatal, though in every one death ensued after the ligature, which in one was applied to the abdominal aorta. In five the aneurism was femoral, and in two of these there is no doubt of the success of the treatment; in a third case (Mr. Lawson's) the aneurism was certainly cured, though opinions may fairly differ as to the part which the rapid pressure played in the cure as compared with the other forms of compression which had been employed previously. In the other two cases of femoral aneurism the attempt failed, and one of the patients died nine days afterwards of purulent bronchitis, for which no other cause is apparent than the prolonged administration of chloroform. The other patient died after ligature of the external iliac. Finally we have two cases of popliteal (or perhaps in Mr. Holt's case femoro-popliteal) aneurism, both cured. This record of cases is no doubt extremely encouraging as far as relates to the forms of aneurism which do not admit of any other operative treatment, except that by ligature of the abdominal aorta, which hitherto has always failed, or of the common iliac, from which only one-fourth of the patients operated upon have recovered. But it is quite clear that it furnishes no reliable evidence of the superiority of this treatment to that by the more successful cutting operations or by the methods of pressure in previous use; while the protracted anæsthesia alone is quite as dangerous as the ligature of the femoral artery, and compression of the abdominal aorta cannot be efficiently accomplished for any length of time without dangers which must be obvious to anyone who thinks for a moment of the parts in anatomical relation with it. The total compression also of the common, or even of the external iliac artery must involve great risk of fatal contusion of the viscera or peritoneum. It does not seem that the treatment of aneurism in the lower limb, for which the femoral might be tied, would be improved by substituting for that operation the total compression of one of the large arteries of the abdomen under chloroform; nor is Professor Holmes disposed to look hopefully on the proposal of substituting the rapid and total compression of the femoral under chloroform for the Hunterian ligature, though there is much more to be said in favour of this. It is to be observed that in no instance hitherto has the ligature been successfully practised after rapid pressure has been used and failed. It is true, however, that the cases are as yet so few that this may be merely an accidental circumstance, yet it is one which must attract very serious attention. Meanwhile, without affecting to decide the question either way, the lecturer protested against any rash assumption that because rapid pressure has been successful as compared with ligature of the aorta or common iliac, therefore it must be successful if compared with ligature or gradual compression of the external iliac or femoral, and that it has no dangers of its own. It should be added that total and continuous pressure of the femoral can in some cases be successfully applied and borne for a very long period without anæsthesia. There is but little to say about the less usual methods of treatment in this form of aneurism. There is a case in which galvano-puncture was successfully used in combination with pressure on the external iliac for four hours under chloroform. The operator was Dr. Brandis, of Aix. The case is reported in the Medical Record, March 5, 1873. Another case, under Mr. Herbert Page in the Cumberland Infirmary, at Carlisle, in the year 1872, appears to show the occasional utility of manipulation in aneurism, as suggested by Sir W. Fergusson. Although it is certainly open to contend that this was a case of spontaneous cure, yet as the aneurism was increasing rapidly up to the date of the manipulations, as those manipulations produced a most decided effect, |