Professor Porter, the highest surgical authorities), and although an unpromising case for operation (in consequence of the advanced age of the patient and the extensive ecchymosis of the trunk), it was decided, upon consultation, to afford the sufferer a chance of preserving his life, by amputation at the shoulder-joint (and thus reach the source of the lesion which caused the gangrene), as no constitutional symptoms to contra-indicate the operation had appeared. The consultation was held at twelve o'clock noon, the operation decided upon, and the hour fixed for half-past three P.M.; but during that brief interval very unfavourable symptoms set in. The operation was accordingly abandoned, and the reasons were fully explained by Mr. Croly to the class which had assembled in the operation theatre. As far as can be ascertained, the foregoing is not only a very rare, but probably an unique case, and will doubtless be read with interest by the practical surgeon.

The post-mortem examination is very interestingfirstly, in fully explaining the cause of the lesion which produced the fatal gangrene; and secondly, in showing how unsuccessful amputation would have proved, and consequently how hopeless in some cases are the resources of our art.

RICHMOND SURGICAL HOSPITAL.

CASES UNDER THE CARE OF MR. WILLIAM STOKES. (Reported by Mr. JAMES Ross.)

EPITHELIOMA OF FOURTEEN YEARS' DURATION SITUATED ON LEFT CHEEK OVER THE MALAR EMINENCE: RECENT

RAPID INCREASE OF THE WARTY GROWTH: EXCISION OF THE TUMOUR, AND SUBSEQUENT PERFORMANCE OF BUROW'S PLASTIC OPERATION: SUCCESSFUL RESULT.

ance:-

As this case is one in which the plastic operation of M. Burow, a Polish surgeon of considerable eminence, was performed, a brief record of the case to its successful termination cannot be considered devoid of surgical importPhinter D., t. 60, was admitted into Mr. Stokes' wards in the Richmond Hospital on the 20th of last May. The patient stated that about fourteen years ago he received the prick of a needle in the cheek, in the situation of the tumour, for the removal of which he had come into hospital. Shortly after getting this apparently trivial injury he perceived a small wart about the size of a grain of rice to form exactly in the situation where he got the prick of the needle. This wart remained stationary for a very considerable length of time, after which it seemed to get loosened, and the patient then picked it off with one of his nails. Another then formed in the same situation, and ran precisely the same course. Things remained in this way for several years, the disease being apparently quite localized, and the general health of the patient remaining in every respect perfectly unimpaired. About six months previous to the patient's admission into the Richmond Hospital the warty growth began to increase in size, and

when he came under Mr. Stokes' care the tumour was

fully half-an-inch in length, and a quarter of an inch in breadth. There was no evidence of any similar disease

elsewhere.

After some clinical remarks to the class on the nature

of this peculiar form of malignant disease, Mr. Stokes observed that when it occurred in the situation in which it was in the case under observation-viz., on the face, it was of the last importance to the patient that no permanent disfiguring cicatrix should be left in the situation when the tumour was removed. Mr. Stokes proposed to obviate the chance of this occurring by performing a plastic operation after removing the tumour, which would have the much to be desired effect of not leaving any marked cicatricial deformity. The operation alluded to, was one designed originally by a Polish surgeon named Burow, of considerable continental celebrity, the particulars of which Mr. Stokes had learned from seeing the operation per

formed by M. Arlt, the eminent Professor of Ophthalmology in the Vienna University. The different steps of this ingenious operation were then carefully explained to the class. The patient having been brought full under the influence of chloroform the tumour was encircled by three incisions in the form of a triangle (a e b), the apex of the triangle (e) being above the tumour, and the base (a b) below. The tumour and the portion of the integument to which it was attached were then carefully excised. The incision (a b) was then carried outwards until its entire length (a b') was three times that of the base of the triangle (a e b). The different steps of this operation will probably be best understood by reference to the annexed woodcut:

The next step consisted in making the outer third of this horizontal incision (a' b') the base of a second triangle (a' K' b') in every respect equal to the original one (a e b), where the tumour was removed. The integument within the incisions, constituting the second triangle (a b' K'), was then carefully dissected off. There were then two raw triangular spaces to be covered in by sound integument, the other in which the integument was perfectly healthy. one which had been the seat of the epithelial cancer, and This was easily effected by dissecting off with great care the triangular flaps (a a' K') and (e bb') from the adjacent structures. This having been done, no difficulty whatever was experienced in bringing the points (a b) together by another. In this way the triangular spaces were comone interrupted suture, and the points (a' b') together by pletely filled up, without any chance of a broad cicatrix, which would necessarily have been left had either of them been left to fill up by granulations.

which they were removed; the greater portion of the wound The sutures were left undisturbed for three days, after had united by first intention—indeed, all, except the points corresponding to the apices of the two triangles. In order of the finest of the so-called " entomologist" pins, and by a to promote union at these points, Mr. Stokes inserted two figure of eight suture brought the ununited edges of the wound into close apposition. After two days the pins were removed, when it was found that all the wound had united perfectly. Nothing could have been more entirely satisfactory than the result of this admirably conceived and exMr. Stokes is aware, is the first in which this operation tremely ingenious plastic operation. This case, as far as has been performed in this country, and the particulars of it to its successful termination cannot but prove interesting to those who take an interest in this all-important and thoroughly practical department of operative surgery.

SEVERAL of the old students of St. Thomas's Hospital met at Mr. Whitfield's on the 18th, to consider how, on the best testify their attachment to their old school. Drs. Barker, rebuilding of the hospital, they might, by some special gift, Carpenter, Clapton, Saunders, Messrs. South, Solly, Le Gros Clark, Whitfield, and Stone, with Dr. Sedgwick, 2 Gloucesterterrace, as honorary treasurer and secretary (who will be glad to hear from old students), were appointed a sub-committee to report on the matter to a general meeting to be shortly convehed.

Address

DELIVERED AT THE OPENING OF THE GENERAL MEDICAL COUNCIL.

SESSION 1868.

BY DR. BURROWS, F.R.S., PRESIDENT. GENTLEMEN,-Ten eventful years have transpired since the Legislature created this Council for the performance of most important duties towards the medical profession and the public. For nine of those years I have had the honour of being associated with you in your labours, and for nearly five years by your favour I have occupied the distinguished post of President. The vessel on which we have embarked, when first constructed, excited the scrutiny and criticism of many When first launched she had to steer her course through unknown or untraversed seas, often through tempestuous waters, with quicksands around us and breakers ahead. She visited ports where her presence was hardly welcome. The original crew, unaccustomed to work together, laboured under serious disadvantages; the crew has sustained many great losses. Some of our foremost men have been taken from us; but still nearly one half survive to recount the dangers of the past, and to assist by their experience those more recently enlisted into an arduous and responsible service. Our craft is still sound, and our crew more disciplined. We have learnt to esteem or appreciate our companions, and let us hope that the venture of the present year may, by our earnest denial of self, by our prudence and circumspection, and close application to our work, bring profit to those whose interests are consigned to our keeping as well as credit to ourselves.

In former years, I have in my opening address ventured to retrace succinctly the proceedings of the previous session, and to indicate some of the questions which you would be called upon to investigate and discuss during the current session; but in consequence of the additional duties assigned to our enlarged Executive Committee, it would be presumptuous on my part to arrogate to myself a duty which must necessarily be more ably performed through the joint labour and wisdom

of the members of that Committee.

It is, however, incumbent on me, as your President, to render to you some account how I have performed certain public duties which have devolved upon me personally, as such knowledge may to a certain extent influence you in the course you may think proper to take in the future conduct of the business of the Council. By a resolution of the General Council on June 6, 1867, and also by one passed by the Executive Committee on November 12, 1867, recorded in the Minutes of the Medical Council, vol. v., p. 273, your President became charged with the duty of conferring with the Government respecting the Bill for the Amendment of the Medical

Acts.

THE MEDICAL ACTS AMENDMENT ACT.

During the past winter I had various communications with the Government, and more particularly a lengthened interview with the Home Secretary on February 7 last, and on that occasion I again pressed upon Mr. Gathorne Hardy the necessity of Amendments in the Medical Act of 1858, and requested him to give his assistance to the General Medical Council in bringing a Bill into the House of Commons. After a patient hearing of my statement, Mr. Gathorne Hardy frankly said that in the early part of the impending session of Parliament he had so many Government Bills on his hands, that he could hold out no promise of assisting the Medical Council before Easter; but that if the state of public business would permit, at a later period of the session, he would give his attention to the subject. Mr. Hardy at the same time requested me to prepare a short memorandum for him, embracing in a succinct form the points most urgently requiring his attention. With the able assistance of the Registrar (Dr. F. Hawkins), I was preparing this document immediately before the Easter recess, when, as you know, a thunderbolt was thrown on the floor of the House of Commons which startled and amazed the uninitiated, disconcerted all the Government plans, and practically put an end to all legislation for the session. And then commenced what is facetiously termed "the slaughter of the innocents." Bill after Bill was sacrificed, and it was hopeless and useless to press upon the Home Secretary the promise he had held out of assisting the Medical Council to bring in a Bill this session. All prospect of medical legislation having vanished, it seemed unnecessary to summon you from your

respective public and private duties until this more than customary advanced period of the year. The Medical Council will therefore be relieved from any pressing necessity of discussing this question, which has often occupied so much of our time.

Although the question of the amendment of the Medical Acts will not be necessarily before you, still, as this in all probability will be the only opportunity I shall have of addressing you from the presidential chair, I would wish to make a few sug gestions for the consideration of those who may be called upon hereafter to carry on the negotiations with the government upon the amendment of the Medical Acts.

First, let me recall to the remembrance of the members of

this Council that one of the great obstacles to the introduction of a bill into the House of Commons to amend the Medical Act, 1858, was the discordance of opinion between the late and this Council upon the terms of a clause enabling this Secretary of State for the Home Department (Mr. Walpole) Council to admit colonial and foreign graduates on to the British Register. Part of this question is likely to be brought cation from the University of Melbourne, addressed to the Imbefore the Council again this year, in consequence of an appliperial Government, to have their medical graduates admitted have already committed themselves by a resolution (June 3rd, to registration in Great Britain; and also because this Council 1867), moved by Sir D. Corrigan, and seconded by Mr. Cæsar Hawkins. See Minutes of Council, vol. v., p. 187.

Considering the difficulty that has been experienced in draw. ing up a clause to effect the registration of colonial and foreign graduates, I would suggest whether the difficulty may not be surmounted without attempting to frame a new clause, but simply by a verbal amendment of the Clause 46 of the Medical Act-the clause which enabled this Council to make

special provision for the registration of persons practising medicine and surgery within the United Kingdom on colonial or foreign diplomas and degrees before the passing of the Act. the amendment of it that I would suggest would be to make The operation of Clause 46 was simply retrospective; and its operation prospective as well as retrospective. Under the than 204 colonial and foreign graduates were admitted on to powers granted to the Medical Council by that clause, no less the British Medical Register, and there is no reason for the Legislature to suspect that this Council would act with less liberality for the future than it has done in the past; and this Council may feel assured that any committee appointed to investigate the claims of colonial and foreign graduates to regis tration would devote the same patient and careful consideration to the subject as the former committee did, and which was so ably presided over by the distinguished representative of the College of Physicians of Edinburgh, Dr. Alexander Wood. I tion of members of Council as a means of evading the difficulty commend the foregoing suggestion to the impartial consideraattendant upon drawing up a new clause which shall be equally acceptable to the Government and to this Council.

A second suggestion I would venture to offer for future occasions is that any future application to the Government to assist the Council in Parliament should be made in a different quarter to that hitherto selected. The Home Secretary has always been requested to introduce into the House of Commons our Bill to amend the Medical Acts. The uniform reply that we have received from that Minister has been that the pres. sure of public business has prevented him from acceding to our wishes, and it ever will be so unless powerful Parliamentary and external pressure is exerted to influence the Home Secretary. It was suggested by Sir George Grey when in office that this measure should be first introduced into the House of Lords. Now, after much experience and reflection on this subject, I am inclined to think that the suggestion that our Bill should be introduced into the House of Lords is not only the course which is most likely to be attended with success, but that it is the course which ought rightly to have been adopted from the first. My reasons for thinking so are as follows. According to the enactments of the Medical Act, 1868, this Council has not properly any relations with the Secretary of State for the Home Department, although the Act happened to be introduced and carried through parliament by a former Home Secretary (Mr. Walpole). On the other hand, this Council partly emanates from and may have most important relations with the Privy Council. In the constitution of the Privy Council you must bear in mind that six of our number-a fourth of the whole-are nominated by her Majesty with the advice of her Privy Council.

Also by clauses 20 and 21 of the Acts we are directed under certain circumstances to make representations to her Majesty's

Most Honourable Privy Council, and not to the Home Secretary. The Privy Council is called upon, if it shall think fit to enforce any representations or regulations emanating from this Council.

Again, by clause 23, it is the Privy Council which is directed to prohibit attempts on our part to impose restrictions upon the practice of medicine and surgery, and the Vice-President of the Committee of the Privy Council on Education is especially directed to take part in any orders connected with carrying out the regulations of this Medical Council.

It appears then from all that I have just advanced, that, as we are a Council of Medical Education, and have much to connect us with her Majesty's Privy Council, it would henceforth be more expedient and proper that we should seek the assistance of the Lord President of the Privy Council to introduce any Bill into the House of Lords, rather than again fruitlessly seek the assistance of the overworked Secretary of State for the Home Department in the House of Commons.

THE COLONIAL PRACTITIONERS' ACT.

I must next say a few words upon an Act of Parliament recently passed termed "An Act to amend the law relating to Medical Practitioners in the Colonies." Prior to the introduction of this Bill into the House of Lords by the Duke of Buckingham, there was forwarded to me by direction of Mr. Hardy various documents relating to it, and I was requested to peruse them, and return them with my opinion upon them. Having read them, I fortunately had the opportunity of conferring with the Executive Committee before I wrote my reply to the Home Secretary's communication. I made various suggestions in reference to the proposed legislation in my letters, which I now place on the table, because it has not before been brought under your notice. When the Duke of Buckingham proceeded with his Bill, I found that all my suggestions contained in the letter to the Home Office had been entirely ignored. I therefore immediately applied for an interview with the Colonial Secretary, and this being granted, Dr. Sharpey and Mr. Hawkins kindly accompanied me to the Colonial Office. When offering our objections to the Medical Practitioners (Colonial) Bill, I adverted to my letter, as President of this Council, on the subject, when his Grace informed us that he had never seen nor heard of any such letter from the President of the Medical Council; in truth, it had never been transmitted to his Grace from the Home Office. Fortunately, I was provided with a copy of the letter, which I then read to the Duke, and left it with him. The result was the objectionable parts of the ori ginal Bill were amended, and the measure has now passed in a form to which little objection can be made. THE REPRESENTATION OF THE PRACTITIONER ON THE COUNCIL. There is one other topic to which I may briefly allude before I sit down, and that is the prospect there is of your being in vited to look into your own constitution, and decide whether you think that constitution would be improved by an increase of your number and by the introduction of members who are to represent interests, which it is alleged by some persons are not duly represented in the Council. It could hardly be expected in this era of radical reforms and organic change in the Legislature, that this Council, which has hitherto been regarded as fairly representing the profession for those purposes for which it was constituted, should remain undisturbed and that attempts would not be made to alter its constitution and character. I am sure I am expressing the sentiments of all when I say, that whenever this question is properly brought before us, we shall be prepared to give a patient, careful, candid, and temperate consideration to the argument and reasons by which such a proposal is supported.

Lastly, it is a duty which I owe to the members of the Council to remind them of a circumstance to which I have already alluded, that my term of office as President will probably have expired before the next annual session of the Council. Now it is all essential to the future harmony and credit and good working of the Council that this question of the election of my successor to the honourable and distinguished office of President should not take you by surprise. You will during the present session have frequent opportunities of personal intercourse, and I trust you will make that one of the topics of private, friendly discourse-it can hardly be discussed in public. Then as to the precise date when I should vacate my office? Whatever course may most contribute to the convenience of the Council, and be most conducive to uphold the dignity and honour of the office, will be the most acceptable to my feelings.

THE profession will scarcely be reassured, albeit their faith in the Medical Council needs strengthening, by the pitiexercise of their very simple power of removing a person able exhibition of timidity and irresolution with which the from the register for "infamous conduct in a professional respect" was attended last week. The desire to suppress public discussion of their act by obstructing the record of their proceedings in the public journals, was worthy of the subsequent proceedings, and indicated a very reasonable apprehension that the proceedings of some members would not be read to the credit of the Council at large, or inspire confidence in its energy or boldness of action. We can hardly imagine the circumstances which should render a debate after investigation as to the truth of the charges at all necessary, much less can we understand what the peculiarities of the discussion might be which require that the thing should be "done in a corner." But the sequel explains all.

On the question, which to an earnest reformer would appear to admit of only one solution, whether a person, who under the false pretence of a special commission engaged in the sale of fraudulent diplomas, was deserving of being expelled from the profession, nine members of the Council supported the policy of pusillanimity, and four, scarcely less timid, declined to vote at all.

Our Special Reporter describes the scene as follows:

"Upon this case opinion seemed to be equally divided, for when the motion of his expulsion from the profession was put to the vote, nine voted for and the same number against, the President giving the casting vote for his expulsion, whilst a few cautious members abstained from speaking or voting upon the question altogether, it being suggested by one or two speakers that the Council might find itself embroiled in some very serious legal difficulties, if they attempted to deal summarily with the accused. Some very plain-speaking followed as a necessary consequence, and for two hours the changes were very merrily rung on both sides. As, however, we have not space for the whole, and had we, some members who, as we have said, spoke in no very guarded language, might possibly object to their remarks appearing in print, we purposely omit further reference to the subject."

We cannot conceive a duty more plain or a function more secure than that of purging the profession of such gross practices. In its discharge the Council would receive the support and approbation of the entire profession,