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vation on January 31st, 1865. He had been a free liver, but generally a healthy man; had not been subject to fever, but had had a slight attack of ague before his present illness set in. He became ill five months ago, with sore throat and difficulty in swallowing; he also had pain in the right side of his neck. He grew worse, and on January 1st he was unable to masticate food, and his speech became thick. On January 25th he coughed up some dark coloured blood and matter of a very offensive character; from this time his breathing became difficult, a hacking cough set in, and he daily expectorated small quantities of blood and matter. When seen on January 31st he was sitting in a bent posture, his countenance was dusky, and his lips livid; he was at times delirious, and breathed with much noise and difficulty; he had a slight but frequent cough, and with it expectorated an offensive sanguino-purulent fluid, of a dark brick colour. He was free from fever; pulse strong, 84; tongue clean. He complained only of his throat, and pointed to it as the seat of pain ; nothing abnormal, however, could be felt externally, or seen internally; there was partial paralysis of his tongue, which rendered his speech thick and difficult to be understood. His lungs gave no evidence of disease, resonance was good on percussion, and the only abnormal sound present was a mucous râle. No enlargement of the liver or spleen could be detected, and he did not complain of pain when his abdomen was examined by pressure and percussion. He died from hæmoptysis on February 1st. Inspection twenty-one hours after death:- On removing the trachea, pharynx, &c., the greater cornu of the hyoid bone of the right side was found in a state of caries, and the diseased part was surrounded by a small abscess, which had apparently burst into the upper part of the pharynx. The apex of the right lung was slightly adherent, and the bases of the both lungs were firmly adherent to the diaphragm, especially the left; their structure was healthy, but engorged with frothy blood and serum. Heart natural, with empty cavities. Liver smaller than usual; gall-bladder containing greenish bile, and one large black calculus. On endeavouring to remove the spleen it was found adherent to the diaphragm, and so soft and pulpy that it broke in pieces under very slight pressure; the cause of this was an abscess which occupied its structure, and was now nearly empty; the walls of it were thin, and what remained of the parenchyma was infiltrated with fetid matter, and blood of a brick-red colour, similar to that which had been expectorated during life. The abscess had burst into the left lung, a communication being established between it and the spleen. The fatal hemorrhage was due to rupture of a branch of the left pulmonary artery. The left kidney was hyper
trophied; the right contained an abscess the size of a hen's egg.-Brit. and For. Med. Chir. Review.
ON HYDROCELE OF THE HERNIAL SAC.
By M. VELPEAU. A tailor, aged twenty-four, entered one of M. Velpeau's wards with a tumour on the left side of the scrotum, as large as a double fist, and situated below the external ring; it was soft, indolent, tense, fluctuating and irreducible. There was neither impulse on coughing nor transparency. It was prolonged by a pedicle, the size of the thumb, into the inguinal canal. The skin over the tumour was normal in appearance, and the testis was distinctly felt at the bottom of the scrotum. had worn a truss for several years for a hernia, which had never been completely reduced, a small swelling always remaining. Ten days prior to admission the truss had been broken, the tumour somewhat rapidly increasing in size, but without pain or inflammation. A portion of the hernia only could be returned, and the man came to the hospital. M. Velpeau, much influenced by the free fluctuation present, came to the conclusion that this was an example of an old intestinal-omental hernia; in which the gut had been returned, leaving only omentum-an effusion of fluid having also taken place into the sac. Six days after admission, the sac was punctured, and a reddish but perfectly limpid fluid having been discharged, the presence of omentum was ascertained. An iodine injection was then thrown in, and next day a pretty smart attack of inflammation occurred, accompanied by febrile action. This soon abated, and the patient went on very well, so that when he was discharged, three weeks after his admission, one side of the scrotum was scarcely larger than the other.
It was M. Velpeau who first conceived the idea of treating this form of hydrocele in the same way as hydrocele of the tunica vaginalis; of course, in such case inflammatory action is more to be dreaded, owing to the intercommunication with the peritoneum; but M. Velpeau, having found that iodine injections never give rise to purulent inflammation in closed cavities, determined to employ them in congenital hydrocele, taking care to compress the inguinal canal against the pubis. In the numerous cases of this kind in which he has employed these injections, he has never met with any accident, and he therefore naturally felt no hesitation in extending the practice to hydrocele of the hernial sac, in which the canal being plugged with omentum, the penetration of the iodine into the peritoneal cavity could scarcely occur. By this operation, also, conjoined with careful adjustment of a truss, the radical cure of the hernia may in some cases be effected.-Brit. and For. Med.-Chir. Rev.
Canada Medical Journal.
MONTREAL, SEPTEMBER, 1865.
THE METHOD OF EXAMINATION. The most important business in our opinion, which will occupy the attention of the governors of the College of Physicians and Surgeons of Lower Canada, at their approaching semi-annual meeting, to be held at Quebec on the 10th of October, is the propriety of changing the method of examining the candidates for the College license. At present the plan followed is to appoint a Committee of four governors to examine the candidate, which is done orally; and in accordance with their decision, he is either received or rejected. As
the number of candidates is generally considerable, this method occupies some time, and by several has been deemed unsatisfactory—hence a measure of reform has been suggested, and the means proposed to be adopted is as follows: The examination to be in writing-and the number of questions on each branch to be three, except on Medical Jurisprudence and Botany, upon which subjects two questions willl suffice. Three examiners are to be appointed (a different three on each), on every subject-except Botany and Medical Jurisprudence-which subjects shall only have two. The time allowed for answering question is three hours, and the examiners have the option of interrogating the candidate upon their written answers.
We have no doubt but that the talented proposer and very eminent seconder of the resolution at the last May meeting of the College proposing the above alterations felt that they were working in the right direction, but we most decidedly dissent from the proposed change. It will in our humble opinion defeat the very object, we believe, they have in view. So far as our knowledge obtains we are ignorant of any University, College or School, where the sole test required from a candidate is the satisfactorily answering a certain number of written questions upon the various subjects embraced in the Science and Art of Medicine. But we know of many where in addition to an oral examination, a written one is demanded. When we take into consideration the very small area, so to speak, which any three questions, even on every subject, can be made clearing up
to embrace, we can, it must be acknowledged, form a very unfair estimate, of the total amount of knowledge possessed by any student. At an oral examination, the candidate is usually examined about twenty minutes on each branch, and during that time, at least eighty questions can be put on some, and fifty on others. Can we for one moment compare fifty oral questions on midwifery-to three written ones-searching and important, as we fully admit, they can be made. It is true that the candidate can be interrogated upon his written answers—but beyond the
of some point of the answer which may be obscure—we fail to see any advantage in it, in developing the knowledge possessed by the student. We admit that the present method of examination is open to objection—and grave objections too-but we believe the proposed alteration to be open to graver objections still. If the College would follow the plan adopted by older and therefore more experienced Colleges—they would add to the oral a written examination, and not substitute a written for an oral examination. Want of time—for both may be pleaded, as indeed it has been pleaded,,is one, if not the principal reason for a change from the present method—but such an objection ought not to receive a moment's consideration. What is worth doing, is worth doing well; and as the governors of the College occupy a most important public trust, we feel they should discharge that trust in a manner which will give the public confidence in the licentiates they send forth upon the country. Time with every medical man is precious—but by accepting the office of governors, they place themselves in a position, the claims of which for the time being, are paramount, and we feel that any complaint of want of time is not deserving of a great deal of consideration. Even should the majority of the governors think the proposed change desirable,We sincerely hope they will not,—we would call attention to the fact that as the student will have to answer three questions on seven subjects, and two questions on two subjects—making twenty-five questions in allthree hours—the time allowed for answering—is, beyond a doubt, altogether too short. It gives simply eight minutes and a quarter to each question, a time, in which it is in our opinion simply impossible even to write an answer to such a question as should be given, much less give it that thought which it doubtless should have. Were the student a short hand writer—even eight minutes and a quarter would still, we believe, be too short. At the London College of Physicians, where the written examination extends over four nights (on the first and second professional-analagous to the primary and final examination of McGill University), only six questions are allotted to each evening, and three hours are allowed in which to answer them-thus giving half an hour to each question—which is not the least too long. We trust the governors of the College will give this subject their most careful deliberations. The proposed change is not one to be lightly entered into—and we will be much disappointed if it is allowed at all.
We have to acknowledge the receipt of a long letter from Mr. Bulmer, a licensed chemist and druggist of the College of Physicians and Surgeons of Lower Canada, asking a number of questions, several of them being quite of legal character, on which we decline to express any opinion. We will
, however, answer such as are in our power. 1. The bye-laws of the College of Physicians and Surgeons of Lower Canada are legal in Lower Canada, and prosecutions under them would be sustained, provided two witnesses to the same fact can be produced, and there be no flaw in drawing up the complaint. The amended bye-laws passed at the last triennial meeting will become law, immediately on their being signed by the Governor General. The licenses now issued to chemists and druggists are legal. 2. Every person, either physician, surgeon, chemist, or druggist, midwife, &c., will have to register on the books of the college, within three months after the publication of the amended bye-law; and it is our opinion that any one practising either as physician, surgeon, midwife, chemist or druggist, who has not the qualifications, by which he can register, must obtain it, or be liable at any time to prosecution as an unregistered practitioner. We do not, for a moment entertain a doubt that the license of chemists and druggists of the Lower Canada College do not give rights similar to those given by the Apothecaries' Hall of either England or Ireland, the licenses which are now recognised as giving the qualifications of a general practitioner. Their examinations are quite different from that exacted by the Lower Canada College for a chemist's or druggist's license. 3. Any licentiate member of any of the Colleges of Physicians or Surgeons of the mother country, on presenting himself for our license, must receive it without further examination. This is, we believe, the interpretation of the act, though we decidedly think it should be amended, so that persons having diplomas from the mother country (University diplomas excepted) should be compelled to pass an examination upon those subjects not embraced in their diploma. This matter will doubtless be taken up at the approaching meeting of the governors of the College. The other questions asked by Mr. Bulmer we do not feel ourselves competent to answer. To arrive at perfection is a difficult matter; and when we consider that in the mother country such a state of things has not as