DEFERRED FRACTURE OF THE CLAVICLE
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prior to the publication of my pamphlet " On Therapeuticsand Disease," the former of the processes above referred toby Dr. Harley was accepted as the modus medendi of alkaliesin the treatment of the various forms of the uric-aciddiathesis. If I am in error I shall feel obliged by beingcorrected.
Dr. Bashams paper on this subject-the one to which Ipresume Dr. Harley refers-was published in the Novembernumber of the Practitioner for 1872. My pamphlet waspublished in May of the same year, and a review of it existsin the Practitioner of October, 1872, Dr. Bashams paperappearing just a month afterwards. Moreover, my pamphletwas written as a graduation thesis some eight or nine yearspreviously, and would in all probability not have beenpublished but for the wants of a local journal. In theDecember number of the Practitioner will also be found ashort note from me to the above effect.
If Dr. Harley thought the matter at all worth referringto, a self-evident excuse for this note exists.
I am. Sir. faithfullv vours.D. CAMPBELL BLACK.Glasgow, Sept. 5th, 1873.
DEFERRED FRACTURE OF THE CLAVICLE.To the Editor of THE LANCET.
SiR,-The following case, which occurred in my practicesome time since, seemed to me to be an unusual one onaccount of the actual occurrence of fracture being deferredto the day following the injury from which it resulted, andI therefore venture to ask a small space if you should thinkit sufficiently interesting for insertion.William D-, aged fifty-three, a farm labourer, a fine,
well-built man, was engaged in mowing weeds, but comingnear the loose bough of a tree he pulled it down, and in itsfall it struck him on the head and shoulder, knocked himdown, and rendered him insensible. On recovering con-sciousness he found that there was some pain about theleft shoulder, but he was able to take his scythe, and, keep-ing his elbow close to his side, continued mowing weeds forthe remaining two or three hours of the day.On rising in the morning he was turning his feet to the
right with the intention of getting out of bed, when anaudible crack occurred, causing his wife, who was standingnear, to ask what it was.Finding that he had suddenly lost the power of moving
the arm which he had the night before, he sent for me, andI found fracture at the juncture of the middle and outerthird of the left clavicle.From very careful cross-examination I convinced myself
that no solution of continuity had occurred previously tothe time of turning in bed, although there is no doubt thatthe bone was injured by the tree falling on the shoulder.The case presented nothing remarkable afterwards, and
the man made a good recovery.I am, Sir, your obedient servant,
ALFRED E. BARRETT.Grimston, Lynn, Norfolk, Sept. 16th, 1873.
ARMY MEDICAL DEPARTMENT.To the Editor of lHE LANCET.
SiB,I think the Department have received with satis-faction the principle of unification. Certainly the majorityhave done so, and it only remains for the minority loyallyto accept the decision, and join in developing a depart-mental esprit du corps. So long as we were with our regi-ments many of us lived for them, and turned all our
sympathies towards them. To-day we find the systemaltered, and I feel certain that the men who worked hardestfor their battalions will now work equally well for theDepartment. There are a certain set, of course, in everybody of men who never take any interest in anything buttheir own comfort.
I desire to bring to the attention of the Department afew points which I think we might urge upon the autho-rities.
1. The Department, now one, should be made "Royal."It is our just due. No corps, department, or body ofgovernment servants, have done better work for England
than we have. It only needs to read the war services inHarts Army List to see in how many arduous situations wehave worked devotedly and well. Many of us, too, havebeen taken out of "Royal" regiments, and "Kings" and11 Queens Own." Now all these little things are of momentin the service, and we deserve the honour. We find RoyalEngineers, Royal Artillery, Royal Marines, and dozens ofRoyal regiments; why not Royal doctors as well ? We havedone quite as good, indeed infinitely better service thanany of the above, and we deserve the title. Will you assistus in getting it?
2. The name of the principal medical officer of eachdivision of the army at home, and each colony abroad,should be entered under the proper heading in the ArmyList. Everyone who knows the Army List knows this isan omission. Take Aldershot for example. We have allthe heads of departments entered under the heading ofAldershot in the divisional list except the medical. Quitelately the Control officer was entered, and we also shouldfind a place. Our cry should be, "Equal treatment"-nomore, but certainly no less. In the Indian official ArmyList the principal medical officer of each division or districtis always entered under the head of the garrison staff.
In fact, it only needs a word from the medical heads athome to have it done. It is simply justice, and, workingfrom that centre, we are invincible.
I am, Sir, yours so.,Bengal, India, August, 1873. 1. V. R. C.
THE PRIMARY EXAMINATION OF THECOLLEGE OF SURGEONS.
To the Editor of THE LANCET.
SzR,-The inquiries of Mr. Gay into the preliminaryexamination R.C.S. lead us to hope that they will be fol-lowed by an investigation into the primary examination ;and that reforms, long and urgently needed, may be effectedtherein.
I trust that the following remarks representing the viewsof a class most nearly concerned in the matter may not bedevoid of interest. These views may be thus briefly stated :-I. The examination is very inefficient. II. It may easilybe made perfectly efficient., I. The inefficiency of the examination depends on threeconditions ;-1. It is too easy. 2. It is variable. 3. Ithas no nice discriminating power. To illustrate andprove these statements I may say that the candidates forthis examination (I speak particularly of the membership)are of three classes. First : there are men of averageability who have worked hard and honestly through theirtwo winter sessions. All these are certain to pass. Evenmen decidedly below the average in ability can pass if theywork. Second: the great bulk of the candidates aie menwho have wasted a great deal of time, especially in theirfirst winter; and whose knowledge is near the minimumrequired by the College, some being above that standard,some below. It is among this class that the want of dis-criminating power is most felt; the better men frequentlybeing plucked, while those whom they know to be inferiorto themselves often get through. Third : there is a set ofmen who are of good ability yet incorrigibly lazy, who willnot work until a couple of months before the examination,and who, consequently, go up in a state of disgracefulignorance. I have known men on the day of examinationunable to mention the branches of the external carotid ;unable to name the muscles attached to the hyoid bone andto the scapula when pointed out to them; unable to dis-tinguish the hypoglossal nerve from the gustatory. Yetthese men, knowing by heart a number of stock questions,manage to answer their papers ; and by real self-possessionveiled under an assumed diffidence, by a skilful method ofdawdling, and in the hands of a lenient examiner, contriveto get through their viva voce. Is it to be wondered at thatthe examination is looked on as a lottery, in which scholar.ship is indeed of some use, but the great thing is " luck" ?
II. The remedy for this state of things is so easy, soobvious, that it appears to me only necessary to point outthe evil in order to have it removed. Let the written ex-amination be conducted by two papers, morning and after-noon, one in anatomy, the other in physiology. Let the