641LONDON HOSPITAL SURGERY.but provide, in conjunction with the other governing bodies ofthe metropolis, for their medical education and government ?Alone, the Apothecaries’ Society is nothing. If the Collegeof Physicians or the University of London will not take theinitiative, the College of Surgeons should do so and that withoutdelay. In effect, and truth, the College is at present MEDICO-CHiRURGiCAL, not simply, as it fondly imagines itself, CHIRUR-GICAL only. Look at the questions put to the candidates forthe fellowship, and published in THE LANCET. Are not manyof the questions eminently medical, such as savour more ofPall-mall than Lincoln’s-inn. The questions propounded do notrefer to the situation of this or that artery, the bones, tendons,joints, and integuments, with which 11 surgery proper" has todo, but they refer to the minute and structural anatomy ofthe lungs, the medulla oblongata, the functions of the heart, andother organs more directly allied to medicine than surgery.As the science includes all branches in one, why should notlegislation be equally inclusive. It is profound impolicy andweakness that it should be otherwise.

We beg to press these points most urgently upon the con-sideration of the Council. The present arrangements of the

College are faulty, inasmuch as it contains no provisions forexaminations in medicine and midwifery; the College of Phy-sicians has no provision for examinations in surgery and

midwifery. Yet we defy either College to separate thethree branches of study. At the University of London

the examining system, it is true, is perfect; medicine,surgery, midwifery, and pharmacy, are all included in

the examinations for the M.B. and M.D., but the Uni-

versity, from its modern origin, and from its high require-ments, has not taken root in the heads of the profession.Could not the three bodies, the University of London, the Col-lege of Physicians, and the College of Surgeons, unite togetherto have a system of examination which should embrace all thesubjects included in the education of the general prac-titioner ? United, these bodies would be irresistible, andthey might raise the profession to a pitch of social and scien-tific eminence which it has never yet obtained in this country.Disunited, they are, unfortunately, to a great degree, power-less for good, while they are powerful enough to interfere withand thwart each others plans. If we were inclined to pro-

phesy at the present time, we should say, that any one ofthese bodies which may be tardy or obstinate at the presenttime, is sure to fall into the rear for the next half century,or possibly it may be, utterly abolished.

THE MIRROROF

London Hospital Surgern.ST. THOMAS’S HOSPITAL.

Exostosis.—We witnessed, on the 8th inst., an operationperformed by Mr. Le Gros Clark, which has excited an un-usual interest. The case runs as follows:- ’

William K-, aged eighteen, a healthy youth, and appren-ticed to a turner, was admitted into St. Thomas’s Hospital,under the care of Mr. Le Gros Clark, November 27, with anexostosis on the femur. He had observed the swelling a yearsince, and it had then attained considerable size. He as-sociated its appearance with some falls which he had, twicestriking the affected part; his uncle (and master) also statedthat he had frequently complained of striking the knee inworking the treadle of his lathe. Latterly, he had suffered,at times, considerable inconvenience in walking, and occa-sional pain and tenderness in the swelling, the inconvenience

of it in his work was, moreover, such as to threaten thenecessity of his relinquishing his occupation, as the affectedlimb (the left) is that which he principally employed in work-ing the lathe. At the solicitation of the patient and his friends,an operation was undertaken for the removal of the diseasedgrowth. Its position was on the anterior part of the outercondyle of the left femur; its form oval, with its long dia-meter placed longitudinally; its size apparently that of apullet’s egg, and its base of attachment presented, as far asaccurate judgment could be formed on the subject, nearly aslarge a circumference as any other part of it. It was firm,hard, and immovable, and its position was such, that whenthe patella was drawn upwards to its full height by the ex-tensor muscles, it very closely abutted upon the lower marginof the morbid growth.

Operation.—The patient was permitted to inhale chloroformat his own request, and when under its influence, the skinover the tumour was transfixed transversely, and a second in-cision was immediately afterwards carried upwards, (an in-verted L,) so as to allow two flaps to be raised. The externalvastus muscle was thus exposed, and its fibres were dividedtransversely, to allow of their retraction over the upper partof the tumour. This allowed of the introduction of the ope-rator’s finger, so that he was enabled to judge of the extentand connexions of the morbid product; a discovery was thusmade which led to the abandonment of any further step. Thewound was carefully closed with a single suture and strips ofadhesive plaster, and the whole limb was enveloped in aroller, laid on a long thigh-and-leg splint, and strict injunc-tions given that the knee should be kept at entire rest.When the patient was removed from the theatre, Mr.

Clark addressed the assembled students. He said that hewas anxious to explain all the circumstances connectedwith the operation he had undertaken, as the case was

interesting and instructive. After recapitulating the leadingfeatures in the history of the patient, he remarked, thatthe proposed object of the operation was the removalof an inconvenient deformity, and not of a disease whichthreatened the loss of either limb or life. But then theinconvenience was a serious one, inasmuch as it alreadygreatly interfered with the patient’s following the employmentwhich he had selected, and in the acquirement of which hehad spent an apprenticeship of five years. Under ordinarycircumstances he (Mr. Clark) would not have thought himselfjustified in proposing an operation, where the attendant riskwas so great, from the proximity of the tumour to the knee-joint. Even under existing circumstances, he thought it hisduty to place fully and fairly before the patient and his friends,the possible danger attending operative interference. Butwhen, after having done this, he was requested to operate, hefelt he should be shrinking from a duty, if he did not makesome attempt to relieve the youth from an inconvenience,which threatened speedily to exclude him from the means ofobtaining his livelihood. The operation was therefore un-dertaken, after much anxious thought and deliberation on thesubject; the source of dread being, that the proximity of thetumour to the knee-joint might involve injury to its synovialmembrane. The steps of the operation had been witnessed:the external vastus muscle had been divided over the upperpart of the tumour, to a sufficient extent to allow of his intro-ducing his little finger, for the purpose of exploring. A fewmoments served to convince him of the true state of the case,for his finger passed freely, and without obstruction, into theinterior of the knee-joint: the capsule of the exostosis wascontinuous with the capsule of the joint; they were both sur-rounded by a continuous synovial membrane; in other words,the bony growth, though fairly above the condyle of the femur,was actually within the knee-joint. Under these circumstances,he had no hesitation in at once abandoning the completion of theoperation; a decision, in the propriety of which his colleague,Mr. Green, coincided. His (the operator’s) reasons for thusdeciding were the following:-The operation was, as he hadalready stated, undertaken for the removal of an inconveni-ence, not a very serious one, but still an inconvenience. Heproposed to relieve the patient of the impending calamity of astiff joint. Now, simply opening the knee-joint involved noslight risk; but he trusted that, by speedily closing the open-ing, the patient might escape without the occurrence of anyserious consequences. Further interference and exposurewould necessarily increase this risk: but when we consider theinevitable effects of such rough usage as the removal of anexostosis in such a position, the very best result which couldreasonably have been anticipated from such a proceedingwould have been a stiff joint; in all probability it would havecost the patient his limb; and might have cost him his life.