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in the new warrant for the Army Medical Service. The

entrance examination becomes of a more practical and

clinical nature, better adapted to, and more befitting,candidates already qualified to practise their profession.The subjects are divided into compulsory and voluntary andthe voluntary subjects are selected with a view to secure menwith some knowledge of foreign languages and aptitude fornatural science. Provision is reserved for the Admiralty toappoint at its discretion a limited number of candidates frommedical schools in the United Kingdom and the colonieswithout any competitive entrance examination. Resident

medical officers, house physicians, and house surgeonsof large civil hospitals can be promoted to the rank of staffsurgeon six months or a year earlier than their fellows, andby a later regulation of the Admiralty a successful candidatefor a commission is allowed to serve as a hospital resident fora year after entering the service and to count the time forpromotion. An officer can retire after four years’ full payservice with a gratuity of E500 and serve in the reserve underconditions which certainly cannot be called onerous.These changes are intended to insure that those most fully

educated and least crammed will be selected for the service,if a sufficient number of candidates put in their appearance,and thus the principle of selection can be adopted at thevery outset of the naval medical career. With the excep-tion of a few specified appliances, a pocket case of instru-ments, a stethoscope, and three clinical thermometers, all

surgical instruments are supposed to be provided at the

public expense. A very important regulation is introducedin regard to courses of instruction, under which medicalofficers can have practical opportunities and facilities for

keeping abreast with the progress of their profession and forstudying special branches of it.Every medical officer is now required to undergo a post-graduate

course of three months’ duration at a metropolitan hospital once inevery eight years (should the exigencies of the service permit), and thisas far as possible during his surgeon’s, staff surgeon’s and fleetsurgeon’s period of service. While carrying out this course the medicalofficer will be borne on a ship’s books for full pay and will be grantedlodging and provision allowances, and travelling expenses, as for serviceunder the regulations to and from his home or port. He pays thenecessary fees for each course himself and must produce certificates ofattendance upon the practice of the hospital and of having taken outcourses of operative surgery, bacteriology, ophthalmic surgery, andskiagraphy.

All this spells great improvement, though in detail thewarrant has not escaped criticism. It will be observed that

the medical officers of the navy are required to undergo thecourse of post-graduate study at their own expense, althoughlodging allowance is paid to them, as it is to all other officersnot provided with quarters on a ship. To produce separatecertificates of efficient attendance upon classes in the five

named subjects would cost in any London school about .635,which is a severe tax. The time, it is hoped, may beapproaching when our naval medical officers will receive fullsubsidies from Government. That time will be when the

Admiralty recognises that a medical officer in the navy doesnot exist only to doctor people " but that he has functionsof the highest importance to discharge in the prevention ofdisease.As regards pay and allowances and charge pay all are

somewhat improved. The application of the principle ofpromotion by selection instead of seniority is more fullyrecognised and encouragement is held out to professionalmerit. Better provision is made for cabins for naval medicalofficers. In short, the new regulations for the Medical

Department of the Royal Navy are directed towards thereform of manifest abuses. The new warrant for the

Army Medical Service offers points of comparison. The

army officers have an opportunity of gaining from threeto 18 months’ earlier promotion on passing their promotionexamination with distinction, but no such provision pre-vails in the navy. In the army allowances are better, thenew regulations for full-pay sick leave are more generous,

and charge pay is provided for officers of whatever rankin charge of beds according to numbers, whereas in the

navy there is charge pay for inspector-generals only, avery limited number. In attempting to estimate the NavalMedical Service as a calling by comparing it with the

Army Medical Service more attention should be paid to

points in which the former has an advantage over the latter.Take, for example, the question of allowances. In the armyofficers have to maintain lodgings, board, and servant, whilein the navy an officer has a furnished cabin, a servant,and a capital mess, for which he pays 2s. a day only, sothat from a pecuniary point of view, if a man is careful, thenavy is the better service. In the Naval Medical Service pro-motion is given for " distinguished service or conspicuousprofessional merit " and such promotions are maintained

up to the full number allowed. Officers may get on the listof staff-surgeons-i.e., officially ranking with major-whohave not more than four or five years’ service as surgeons.Although all the officers in charge of small hospitals ormarine infirmaries belonging to the navy do not get " chargepay " they get it as "hospital allowance." With regard tofull-pay sick leave it is true that the army medical officer isbetter off, but all naval officers, and not only naval medicalofficers, suffer in the same way by comparison with the armyofficers. Under the new warrant a bid has been made forcandidates of the best sort. A man can now fill the coveted

junior posts at his hospital and count the time for promotion,he can retire in favourable circumstances if he finds thathis bent is more towards civilian practice, and he has

opportunities afforded him for scientific work. There is

plenty of room for criticism but much progress has to beadmitted.

The various advantages and disadvantages of joining thethree services counterbalance each other fairly, and itmust be generally allowed that in each the position forthe medical profession is a hopeful one. There are

many matters that call for legitimate criticism, but inall three services the tendency is towards the recognitionof scientific merit, while the recent concessions to pro-fessional opinion and common sense may be regarded asan earnest for further reform. I would summarise the

position as follows. Whereas a few years ago the dean ofa medical school who allowed his pupils to enter for com-missions to any of the three services without warning themof possible disappointment defaulted in his duty, to-dayif he recommended a promising young medical man not tocompete for a commission he would take upon himself a greatresponsibility. In all three services there is increasingscope for the best sort of scientific medical men and althoughit is the duty of deans and teachers to be aware of the draw-backs to the services they should also be acquainted with themovement towards far better things.

(To be continued.)

THE CONSERVATIVE TREATMENT OFTUBERCULOUS ARTHRITIS.

Professor Bier has lately reported in the Miinchener’Medicinische TVooA6nseAri a number of remarkable successesin the treatment of acute and chronic osteomyelitis. Aswe have received inquiries from more than one corre-

spondent as to what Professor Bier’s technique is we

publish the following account, which has been sent to us byour Swiss correspondent.

After studying the question of the conservative treat-ment of joints affected by tuberculous processes by meansof passive hypersemia, Professor Dr. A. Bier, who occupiesthe chair of clinical surgery at Bonn (Germany), gives thefollowing description of his method in his treatise on

Hypersemia (Hyperaemie als Heilmittel). He employs

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constriction of the limb above the affected joint by means ofa rubber (Martin) bandage applied over a gauze bandagewhich is to prevent excessive pressure. The rubber bandagemust not be applied tightly enough to cause either pain orparassthesia. If it causes discomfort it should be loosenedat once ; on the contrary, pain in the diseased joint shoulddisappear during the application of the bandage. The sub-cutaneous veins swell and the skin assumes a bluish tint; inthe case of the arm, the elbow and the palm of the hand onlyretain a rosy hue. The parts peripheral to the bandageshould show an increased, never a decreased, temperature.This constriction can be applied over all joints except thehip-joint. In the case of the shoulder-joint the techniqueis not quite so simple. A necktie is loosely tiedround the neck like a cravat (see illustration). A thick

The size of the clamp and the rubber tube has been exaggeratedin the aketch.

rubber tube is passed round the shoulder-joint as high aspossible, one end being inside and the other outside the neck-tie. The ends of the rubber tube are firmly tied together,the knot being secured by a pair of artery forcepsto prevent it slipping. Cotton-wool is used as a pad under-neath the rubber tube to avoid undue local pressure. A

bandage passed round the opposite axilla secures the tubemore firmly and keeps it in position. In the case of tuber-culous joints when only constriction of short duration isapplied the peripheral portion of the limb is not bandaged.The surgeon himself should apply the constriction severaltimes and in the case of patients wanting in intelligenceeven a good many times, but afterwards the patient or

his friends can continue the simple treatment withdue precautions. The constriction should not be allowedto remain on more than one ho2cm a day. Thus Pro-fessor Bier has succeeded in avoiding some very dis-

agreeable consequences which ensued when constriction wasemployed many hours consecutively. These complicationswere the formation of luxuriant granulations, of large or

numerous small abscesses, or even the occurrence of acuteinflammation. Very often cold abscesses appear duringtreatment, as the latter promotes the elimination of morbidmaterial. The abscesses are best incised and treated anti-

septically. Sometimes small pieces of necrosed bone have tobe removed. The results are at times very striking, mostlygratifying, as the tuberculous process becomes extinctafter a treatment varying from three to six months ,,or longer. Professor Bier prefers the patients to movetheir diseased limbs as much as the pain will allow.If these methods fail he resorts to operative interference.The following cases speak well for the results. Case 1. The

patient was a boy, eight years old, who had tuberculousarthritis of the knee-joint of two years’ duration. Therewas subluxation of the tibia backwards with some nexion

but little pain. He could not walk. Injections of iodo.form and treatment with superheated air were triedwithout any benefit. Hyperasmia, induced by constrictionfrom May 14th to June 27th, 1892, brought the processto a’ standstill. After ten years, the young man hada moveable knee-joint without any thickening; he canstand and walk all day and only limps a little after

great exertion. Case 2. The patient, a young tailor, aged17 years, had suffered from tuberculous disease in the smallbones of the wrist for two years. There was a spindle-shaped swelling. The joint was almost immoveable owingto great pain and adhesions. The hand was useless.Constriction was applied from June till August, 1892.The young man is now well and is gaining a living asa groom. Case 3. The patient was a girl, aged 11 years,with a spindle-shaped swelling of the elbow-joint, whichwas fixed at a right angle, the movements being very limitedand painful. Constriction was employed daily for one hourfrom March 15th to June 26th, 1892. After ten years, thegirl could use her arm for every kind of work, though aftergreat exertion the joint feels weak. This conservativemethod of treatment is both simple and cheap and it canbe employed for out-patients with little supervision afterthe first weeks. If other observers do not report as

favourably about it their technique may be at fault.

ROYAL COLLEGE OF PHYSICIANS OFLONDON

ELECTION OF PRESIDENT.

AN extraordinary Comitia was held on Monday, April 17th,Sir WILLIAM S. CHURCH, Bart., K.C.B., the President,being in the chair.The PRESIDENT announced that the Gilbert-Blaine medals

had been awarded to Staff-Surgeon Sidney Thomas Reid,H.M.S. Vestal, and to Surgeon Robert William GlennanStewart, H.M.S. names. He also announced that the BissetHawkins medal had been awarded to Sir Patrick Manson.The PRESIDENT delivered the usual annual address in

the course of which he referred to the lives of eightFellows who had died during the year-namely, Dr. CharlesKelly, Dr. T. Gilbart Smith, Sir Frederic Bateman, Dr.,Angel Money, Dr. William Lee Dickinson, Dr. G. VivianPoore, Dr. W. G. V. Lush, and Dr. Adam Bealey. ThePresident referred to the Royal honours and distinctionswhich had been conferred on certain members of themedical profession and to the awards of medals, prizes,and scholarships connected with the College. He also men-tioned the lectures which had been delivered, drawingespecial attention to the Harveian oration and to the Fitz-Patrick and Oliver Sharpey lectures. He then reviewed someof the work accomplished by the College and the many im-portant committees which had been appointed during theyear, particularly that concerned with communications withvarious departments of State.

Sir HERMANN WEBER proposed a vote of thanks to SirWilliam Church for having acted as President during the pastsix years. He also thanked him for his address and requestedthat it might be printed and distributed to the Fellows.

Sir WILLIAM CHURCH returned thanks to the College andacceded to the request to have his address printed. He thenvacated the chair.The REGISTRAR (Dr. E. LlVElNG)"read the regulations

which govern the election of President. The election wasproceeded with. At the first ballot the result was as fol-lows : Sir Richard Douglas Powell, 51 votes; Sir WilliamH. Broadbent, 50 ; Dr. P. H. Pye-Smith, 27; Sir ThomasBarlow, 2 ; Sir John Williams, 1 , Dr. W. H. Allchin, 1;Sir William Church, 1; Dr. F. W. Pavy, 1; and Dr. D.Ferrier, 1 A second ballot was then taken, with the resultthat Sir R. Douglas Powell was elected President, receiving’74 votes, while Sir William Broadbent received 59.The charge was delivered by the SENIOR CENSOR (Dr.

T. H. GREEN) and the PRESIDENT pledged his faith to theCollege

Sir R. DOUGLAS POWELL thanked the College for thehonour that had been accorded to him in electing him asPresident.Licences to practise physic were granted to Sydney Herbert

Daukes, Cambridge and London Hospital ; David Morgan