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Americans with their characteristic energy will lose no timein setting about their work of naval construction, and it istherefore interesting to see what additions, changes, and

reorganisations are proposed in regard to the medical branchof the United States navy. We regret that, owing to thegrowing pressure on our columns and the number of publica-tions of one sort and another calling for notice at our hands,it is impossible to do more than to refer briefly to this report.As our readers are aware the United States Government

has of late years been engaged in warlike operations bothat sea and on land. Immediately upon assuming chargeof the conduct of the business of the Bureau, Surgeon-General P. M. Rixey tells us, he was confronted by thefact that insufficient estimates for the year had been sub-mitted to Congress which, having recognised the necessity,subsequently granted an increase to cover the deficiency. As

regards the more pressing needs of the medical departmentof the United States navy it is curious to notice how many ofthese are such as have been recently engaging the attentionof the authorities in this country. Surgeon-General Rixeybegins by calling attention to the disproportion between theincrease of the work that medical officers have been calledupon to perform and the number provided to accomplish it,and he points out that there is an almost imperative demand for an increase in the medical corps of the navy, broughtinto existence by the growth of the service in personnel andmaterial in the past few years. The circumstances havebeen exceptional and have thrown an enormous amount ofadditional work on the medical officers in the case of theUnited States, but owing to new conditions and the proposedincreased strength of the navy such circumstances, insteadof being exceptional, will become of a permanent nature. Itfollows that there is an urgent need for a correspondingincrease in the number of naval medical officers-and anaval medical officer is not made in a day : he must betrained. However well he may be professionally qualified hehas to undertake specialised work in the Government medicalservices, and the army and naval medical officer must be anexpert in many branches of his profession as well as

fairly grounded in the customs and traditions of the service,and of these, it is urged, civilians beginning a naval-career are profoundly ignorant. The subjects of the trainingof junior medical officers and naval medical schools con-

seauently come in for consideration, together with the pro-vision of educational opportunities for medical officers afterservice at sea. The Naval Medical Bureau of the UnitedStates is strongly of opinion-and for very much the samereasons,. of course, that have been put forward and haveinfluenced public opinion in this country-that its medicalofficers should have opportunities for getting in step andkeeping abreast with the progress of medical science. As

regards a number of other practical points we find that theSurgeon-General discusses in a way that makes his observa-tions well worth reading such subjects as the naval hospitalcorps ; sick quarters on shipboard ; ambulance and hospitalships ; medical representation on the general board, boardsof survey, and construction and inspection boards; womennurses for naval hospitals ; naval sanatoriums for the treat-ment of tuberculosis ; operation-room improvements ; anddentists for the navy.The statistical reports and those of various naval hospitals,

ships, and stations, together with certain special reports,make up the remainder of the volume. The statisticalreturns, which are for the year 1901, show that the healthrecord was unusually good, the ratio of admissions to the sicklist per 1000 of strength being considerably less than theaverage for the six preceding years. During the year 1901the average strength of the active list was 26,873, an increaseof 3117 over the previous year. Complete returns werereceived by the medical department from a force of 26,101.The total number of admissions for all causes was 20,013, theratio per 1000 of strength being 766-75. There were 17,043admissions for disease and 2970 for injury, giving ratios of I’652’96 and 113-78 per 1000 respectively. The number of

persons invalided from the service (including retirements of Iofficers for disability and tranfers to hospitals for the insane)was 1003, a ratio of 37 - 32 per 1000 of strength ; for the year1900 the ratio was 29’ 25 and the figures for the past year areconsiderably higher than the average for the preceding sixyears. 166 deaths occurred during the year, the mortalityper 1000 of strength being-for disease, 4’28; for injury,1. 90 ; total, 6 18. During the year 1900 the death-rate wasabnormally high (8-88) owing to the active campaign inChina, but the figures for 1901 compare favourably with thegeneral average.

Looking Back.FROM

THE LANCET, SATURDAY, DEC. 18, 1824.

FOREIGN DEPARTMENT.

ANALYSIS OF FOREIGN MEDICAL JOURNALS.

JOURNAL UNIV. DES SCIENCES MEDIC. OCT. 1824.

An account of the Operation for the Stone, performed byM. CLEVER on himself.M. CLEVER, assistant surgeon of the Royal Guard, having

suffered from stone almost from his childhood, was attackedfor the sixteenth time with this distressing complaint, ofwhich he had never been radically cured, although he hadsubmitted to five operations. Allearied by the sufferings ofwhich he had been the victim, rendered desperate by

tortures which the presence of this new calculus had pro-duced, he had the temerity, in a moment of extreme anguishwhich made life almost insupportable, to determine to relievehimself of his sufferings. The following is the account ofthe operation as he communicated it.

’’ Fixed in my resolution, after having made the necessarypreparations, I placed myself before a looking glass; Iraised the scrotum with the left hand, which stretched atthe same time the skin of the perinæum, and at that partwhere the operation for the stone is generally performed, C

_

forced in perpendicularly the point of a bistoury, until itcame against the stone which was enclosed in the neckof the bladder. This puncture made, I rested a few

seconds, then I enlarged the opening in the integuments,and carried my finger into the wound, thinking to touchthe stone, but the point of the bistoury had onlydivided the part sufficiently far towards the exterior,and therefore the division was not perfect. After a

momentary repose, I carried the instrument again into thewound, and completed the section. Then with my indexand middle finger I searched for, and soon succeeded in

extracting a calculus of about the size of a large nut. The

operation over, the urine flowed in abundance. I dressedthe wound with lint, dipped in an emollient decoction ;being perfectly relieved from my pain, I fell into a sound

sleep. On the following day I was as tranquil and cheerfulas if I had never suffered.

" Many physicians, my friends and colleagues, and a greatmany persons whom I do not know, surprised at such news,flocked to my house to assure themselves of a fact which

appeared to them truly astonishing. Professor BECLARD hashimself honoured me with a visit, and examined the stone."M. CLEVER, since that time, has been gradually getting

well, and is now perfectly cured. The calculus which heextracted, had for a nucleus a bit of prepared sponge, whichwas left in the wound made by a former operation. This

young surgeon has discovered a peculiar mode of operatingfor the stone, which he is about shortly to publish.

ROYAL COLLEGE OF PHYSICIANS OFLONDON.

AN extraordinary Comitia was held on Dec. llth, SirWILLIAM SELBY CHURCH, Bart., the President, being in thechair.The PRESIDENT announced that he had appointed Dr.

W. H. Allchin Harveian Orator for 1903. The President andCensors had appointed Dr. J. F. Payne, Harveian Librarian,to be the first Fitzpatrick Lecturer. The President hadappointed Dr. F. M. Sandwith to represent the College at theforthcoming Egyptian Congress of Medicine in the place ofSir R. D. Powell who was unable to leave England in orderto attend.

Dr. C. E. M. Kelly was admitted as a Member of the

College, having been elected on Oct. 30th last.A communication was received from the Secretary of the

Royal College of Surgeons of England reporting proceedingsof its Council on Nov. 13th.

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A report, dated Nov. 17th, was received from the tcommittee of management. Amongst other matters dealt c

with in the report was the inclusion of the Technical f

Institute, Norwich, in the list of those institutions reco- c

gnised by the Examining Board in England for instruction tin chemistry, physics, and practical chemistry. r

The discussion was resumed on the motion brought i

forward by Dr. Payne at the meeting on July 31st last, E

viz. :-That in the opinion of this College it is desirable that Latin should

continue to form part of the preliminary education of medical tstudents.

x

The following amendment had been moved by Dr. Frederick Taylor and seconded by Dr. Norman Moore, viz. :- x

That the College proceed to the next business on the agenda. ,

This was under discussion when, on the motion of Dr. 1Allchin, the further consideration of it was adjourned tothe next meeting. ]

Dr. ALLCHIN accordingly reopened the discussion andthe following took part in it : Dr. W. H. DiCKiNSON, .Dr. G. VIVIAN POORE, Sir R. D. POWELL, Dr. L. E. SHAW,Dr. J. KINGSTON FOWLER, and Dr. J. ROSE BRADFORD.It was evident from the remarks of these speakersthat the general opinion of the Fellows was in favourof the amendment. It was pointed out by several ofthose who spoke that the same subject had been dis-cussed at a comparatively recent meeting of the Collegewhen notice had been received from the University ofLondon that it was proposed to make Latin an optionalsubject in the matriculation examination. The College hadthen approved of this action on the part of the University.Dr. Payne’s motion was an abstract one and was thereforeonly the expression of a pious opinion. If the motion werecarried the College would have to go back upon the con-clusion previously arrived at, which would be an undesirableproceeding. On the other hand, if a direct negative weregiven it would mean that the College would take a leadin the movement to expunge Latin as a compulsorysubject in preliminary examinations, a position which wouldbe better taken by one of the Universities. Some of the

speakers urged that although some knowledge of Latin wasmost desirable, yet if a student showed himself efficient inGerman and French and possessed a good knowledge of thenatural sciences it would be unjust not to allow him to enterupon a study of medicine because he had not passed inLatin. A further argument was raised that if Dr. Payne’smotion were carried it would bring the College into conflictwith the University of London, and as these two bodies wereworking side by side for the benefit of medical educationsuch an occurrence might prove disastrous. The amendmentwas carried by a large majority.The PRESIDENT announced that Mr. Thomas Wakley,

jun., had presented to the College another copy of one ofthe medals struck in commemoration of the prizes establishedat the University of Cambridge by Sir W. Browne, Presidentof the College in 1765 and 1766. Dr. NORMAN MOORE pro-posed, and the REGISTRAR (Dr. E. Liveing) seconded, avote of thanks to Mr. Wakley for his gift, which was heartilycarried.The PRESIDENT then dissolved the Comitia.

ROYAL COLLEGE OF SURGEONS OFENGLAND.

AN ordinary meeting of the Council was held on Dec. llth, Sir HENRY G. HowsE, the President, being in the chair.The Council proceeded to consider the resolutions carried

at the recent annual meeting of the Fellows and Members.With regard to the first resolution, which expressed regretthat the Council had not formulated a scheme for the repre-sentation of the Members, the Council was of opinion thatno answer was required. It then proceeded to considerthe second resolution, which drew attention to the fact thatthe examination for the Membership yielded an annual

profit of several thousands of pounds, while the Fellowshipexaminations just sufficed to defray the out-of-pocket ex-penses, and declared it to be unjust that the Fellows shouldelect the Council while the Members had practically nocollegiate rights or privileges. The Council resolved thatthe mover and seconder should be informed that the resolu-tion had been placed before the Council. In reply to the

third resolution, which supported the proposal to enter intocombination with the University of London in order tofacilitate the acquisition by London students of a degreecarrying with it the title of "Dr." the Council resolvedthat the mover and seconder should be informed that thereport of the conjoint committee of the two Colleges was stillunder consideration and that when a decision was arrivedat it would be reported to the Fellows and Members.

Mr. Clinton T. Dent was elected a member of the Courtof Examiners. The PRESIDENT stated that the vacancy onthe Board of Examiners in Dental Surgery, occasioned by theretirement from the Court of Examiners of Sir William H.Bennett, K.C.V.O., would be filled up at the ordinarymeeting of the Council in February.The PRESIDENT reported the delivery of the Bradshaw

Lecture by Mr. Howard Marsh on Dec. 10th, the subject ofthe lecture being "Infective Arthritis." 63 persons werepresent at the lecture, including Lord Lister, Sir ThomasSmith, Mr. Jonathan Hutchinson, and other past and presentmembers of the Council. The best thanks of the Councilwere given to Mr. Marsh for his lecture and he was requestedto publish it.The PRESIDENT reported, on behalf of the Hunterian Com-

mittee, that Field Marshal Earl Roberts, V.C., K.G., K.P.,had accepted an invitation to be present at the Hunterianbanquet of Feb. 14th, 1903, and that it had been arranged topresent to him on that occasion the diploma of the HonoraryFellowship, to which he was elected on Jan. 10th, 1901.A letter was read from Mr. Thomas Bryant reporting the

proceedings of the General Medical Council at its latesession. Th e letter was received and entered on theminutes and the best thanks of the Council were given toMr. Bryant for his services as the representative of the

College on the General Medical Council.

THE MEDICAL MAN, THE CORONER, ANDTHE PATHOLOGIST.

ATTENTION has already been called under this headingin the pages of THE LANCET,l both by ourselves and bycorrespondents, to a practice followed by Mr. Troutbeck,the recently appointed coroner for the south-west district

of London. At the inquests held by this gentleman thelocal practitioners who may have attended the deceasedare not asked to make the post-mortem examinations. Theseare made, and any necessary medical evidence is usuallygiven, by Dr. Ludwig Freyberger. To-day we publish acommunication on the subject from Dr. L. S. McManuswhich tends to elucidate the matter, as Dr. McManusincloses an account of the position taken up by Mr. Trout-beck, and also shows very clearly the local sentiment onthe matter. The medical profession of the district feel thata slur has been put upon them which, we presume, can

hardly have been intended by anyone.The following reply was given by the Chairman of the

Public Control Committee at the meeting of the LondonCounty Council on Dec. 16th to questions concerningthe employment of a pathologist in making post-mortemexaminations in inquest cases. It shows the authority thatMr. Troutbeck has, or believes that he has. for his action :-As the employment of Dr. Freyberger in making post-mortem

examinations has excited some comment, especially in the medicaljournals, it is desirable that I should afford the Council full informa-

tlou on the subject.For many years past the Public Control Committee have been of

opinion that there has been great waste of public money owing to thefact that post-mortem examinations are frequently of little value frombeing performed by inexperienced persons, and the scheme for thereform of coroners’ inquests prepared by the committee and approvedby the Council in 1895 provided for the appointment of specialinvestigators for this work. Although that scheme has been pressedupon successive Governments no alteration of the law has yet beeneffected, and the committee therefore considered in what way improve-ment could be made by the Council under the existing law and onJuly lst last they reported to the Council the result. They recom-mended amongst other reforms -

" That all coroners be informed that in the opinion of the Council itis desirable that post-mortem examinations in inquest cases of a specialnature should be entrusted to a specially skilled pathologist."

’

And the Council approved this recommendation. On the same day’ Mr. Troutheck was appointed coroner for the South-Western district,, and he agreed to give effect to the Council’s resolution. The -Public

1 THE LANCET, Nov. 29th (p. 1477) and Dec. 6th (p. 1574), 1902.