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it does not always fail. It is on this principle also thatMr. Lister has practised (as others have also practised) theincision, evacuation, and drainage of simple serous synovitis.There is uncertainty enough in what we are often pleased

to call the principles of surgery, to enable many to arguefor or against any and every theory under the sun, and todispose of each with a stroke of the pen; so that this may beless easy to prove on paper than to demonstrate in practice.However, having regard as much as possible to the realitiesof the case as distinguished from mere language, I believethat those surgeons will have most success with articulareffusions who avoid compression, and I have never yetregretted having avoided it, and can quote many instancesin my favour. That cases may get well after compressionis undeniable, but these occurrences are, I think, in spite ofit. This fact alone renders the proof more difficult inwriting than in personal acquaintance with its operation.

T OT’n 0;t. yours &c

RUSHTON PARKER, F.R.C.S., B.S.Liverpool, Nov. 26th, 1878.

THE

PRIMARY EXAMINATION FOR THE FELLOW-SHIP OF THE COLLEGE OF SURGEONS.

To the Editor of THE LANCET.SIR,—The paper on Anatomy and Physiology which ws

set at the recent primary examination for the fellowshiland which was published in your last impression, drawattention again to the character of this examination.

Is it still considered that to test the knowledge of a cardidate on anatomy, physiology, and comparative anatomy-a knowledge which he must have spent at least three yearin acquiring-four questions are sufficient ? For seven yearno larger number than this has been set, and the candidateon penalty of rejection, is required to answer all of them.On analysing these questions the following points may b

noticed :-In the second question a vertical transverse section of the

skull is required ; but, it may be asked, in what position i;the head to be placed when this vertical section is made ?In the fourth, the function of the supra-renal capsules

On turning to Hermann’s work, translated by Gamgee (1875p. 178), will be found the following sentence :-" I Concerninktheir function nothing is known." In Foster’s "Physiology ’(ed. 1877) no mention is made of these organs. It seemshard, therefore, to use this question as the only test for thecandidate’s knowledge of physiology.With regard to the third question, it may be doubted

how far there is any form of vertebral centrum characteristicof the primary divisions of the vertebrata. For, in theichthyopsida, there may be none, or, as in amphibia, itsforms are various, while in the sauropsida the reptiliancentra present great differences.Surely it would be desirable to give some guide as to the

amount of knowledge of comparative anatomy which acandidate is expected to possess, and, by setting a separate

paper on physiology, to afford him a better opportunity than

can exist at present of giving a real proof of his knowledgein this subject also.These would be easily effected improvements, for I have

not ventured to suggest, what I nevertheless believe to bethe wiser alteration, the appointment of separate examinersin physiology, as well as in comparative anatomy, if thissubject is still to have a place in the examination.

T rfTnH.m- Sir vniirq obediently

A FELLOW.Nov. 26th, 1878.

A RARE COMPLICATION IN LABOUR.To the Editor of THE LANCET.

SIR,—On January 10th, 1877, Dr. J. Robert Ward andmyself had the honour to forward a note on " Fatality in twocases of labour locked by contraction of the transversefibres of the uterus,’’ it being the first time that Dr. Ward,in an experience extending over many years, had met withsuch an accident in labour. Since then four other cases ofsimilar nature have been recorded in the Boston Medical andSurgical Journal of March 21st, 1878, in a paper read by Dr.Alfred Hosmer at the meeting of the Obstetric Society of

Boston, February 9th, 1878. There is no mention of an3such accident either in Ramsbotham, Churchill, Schroeder,or in any of the standard works, so far as we have examineèthem. In one of the cases mentioned in the note referred tcdeath ensued after the combined efforts of three physicianshad failed, after employing anaesthetics, ergot, forceps, &c.After unsuccessful attempts at version, warm bath, andevery expedient was resorted to, yet the strength of threestrong men pulling on the forceps was useless. Thiswoman, Mrs. --, aged thirty-eight or thereabouts, had hadseveral labours easy and natural, the forceps being used onlyin one. She was the mother of several healthy children.In this fatal labour so great was the constriction that it wasonly relaxed by death. It was advanced both by Dr. Wardand myself that in the absence of expulsive effort, whichdemands the combined action of all the bundles ofuterine fibres, the muscular force was, by pathologicalprocess (possibly from faulty involution after last labour),concentrated in the transverse fibres, as the fundus couldbe felt through the abdominal walls soft and yield-ing, thus excluding the diagnosis of tetanus uteri. InDr. Hosmer’s four cases all died, two undelivered. Of theseone was primipara, the other died in second labour. An

explanation of this certainly rare complication in labour isoffered by Zandl, of Vienna, who believes that the cervix iselongated, so that the internal os appears what would benormally the middle of the body of the uterus, and, accord-ing to him, the cervix thus elongated and distended woulddeceive us as to the constriction being in the body of theuterus at all. In the second case mentioned in my first notethe child was extracted by craniotomy, incisions beingneces-sary before the forceps could be applied; this patient hadeclampsia. It is remarkable that at the post-mortem inDr. Hosmer’s cases the pelvis in two instances showed signsof marked deformity, while in the two others, and, in somerespects, the worst, the pelvis was reported as " well formedand of full capacity, with nothing unusual in conforma-tion. "

Before accepting positively the explanation of Zandl, whichseems reasonable, we should like to submit this vexed ques-tion to THE LANCET, in the hope of obtaining some light,both of a pathological and therapeutic nature. The interestof the subject, as well as its importance, must be ourapology for trespassing thus far upon your time, and,perhaps, your space.

Your obedient servants.GEO. HALSTED BOYLAND, A.M., M.D.J. ROBT. WARD, M.D.(Countersigned;

Baltimore, Oct. 10th, 1878.

COMPULSORY REGISTRATION OFINFECTIOUS DISEASE.

To the Editor of THE LANCET.

SIR,-Commenting in last week’s LANCET on the powers. lately obtained by the commissioners of Burton-on-Trent for,

the compulsory registration of infectious disease, you ap-pear to be under the impression that such powers have notbeen obtained before by a sanitary authority. May I re-mind you that similar powers were obtained for Bolton overtwelve months ago, and subsequently the example has beenfollowed by Greenock and Nottingham.

T am. Sir. vrmra tr1l1v.E. SERGEANT,

Medical Officer of Health.Bolton, Dec. 3rd, 1878.

SOCIETY OF STUDENTS OF MEDICINE.-At ameeting of the above Society, held on the 28th of November,it was unanimously decided that a branch of the Societyshould be established in London. The following office-bearers were elected :-Vice-President, Mr. Thomas Hutton,L.R.C.P. ; hon. sec. and treasurer, Mr. James Gilbert(Charing-cross Hospital). Gentlemen wishing to becomemembers are requested to apply to the hon. secretary andtreasurer, Mr. James Gilbert, Charing-cross Hospital,Strand, from whom all particulars can be obtained. Allgentlemen who are members of any of the provincialbranches of the Society and are now residing in London, andwho may be desirous of joining the London branch, are re-quested to inform the hon. secretary and treasurer. Thenext meeting of the Society will take place on the 12th ofDecember, at 8 P.M.