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child on a milk and beef-tea diet. Upon further examiningthe child I could detect no fractured rib; but the wholefront of the neck was deeply ecchymosed ; so was the chesta, little above the ensiform cartilage.

July 24th.-The wound of the palate is entirely healed,and the child appears none the-worse for the injury. Theaccident happened thus : the child, with! others, was play-ing with a market-cart by the road-side, she hanging onbehind, the others alternately lifting and depressing theshafts, giving the child a ride see-saw fashion. ’When theshafts were in the air the youngsters suddenly let go, -allow-ing the cart to tip, thus throwing the child to the groundwith great force on the back of her head, the cart comingwith its weight across her chest. Nothing entered the child’smouth, nor had she anything in it at the time of theaccident.Now, as to the rationale of the operation of the cause of

the lesion, I believe that the child’s head coming into violentcontact with the’ ground, together with the -Y, eight of thecart across her chest, caused such- a violent concussion of thehead as to give rise to rupture of the palate by a kind ofcontre-coup, and at’the same time, ’although I could notdetect it, some lesion of the trachea, or of the lung in thevicinity of the anterior mediastinum, giving rise to theemphysema. I. may mention that there was no pneumo-tharax.

I am. Sir. -vours.&,c.,FRED. EVANS, M.B.

OPERATION FOR UNUNITED FRACTURE OFPATELLA.

To the Editor oj THE LANCET.

SIR,—In reference to my case of ununited fracture of the ’,patella published last week; permit me to state that Dr.Neale, of St. John’s,woad, has called my attention to thefact-that the operation of cutting - down upon the fragmentsof a broken patella ..and tying them together by silversutures was performed in the year 1861 by Professor Cooper,of San Francisco. A description of the operation is givenin the Medical Times and Gazette, vol. ii. for 1861, p. 467.It is clear, however, that this proceeding was adopted for :recent fractures, no allusion whatever being made to thetreatment of such a case as I described.

I was not at all aware that such an operation as wasdescribed by Professor Cooper had been adopted. I had not’’heard of any such measures for this particular fracturebefore my colleague, Professor Lister, executed his operationin King’s College Hospital last autumn.

T nn, Sir vrnir obedient servant.

HENRY SMITH.

CASE OF SUBCORACOID DISLOCATION OFTHE HUMERUS CAUSED BY SNEEZING.

To the Editor oj THE LANCET.

SIR,—The following case may, perhaps, bedeemed’worthyof record in your columns.W. R——, aged thirty-six, a publican, presented himself

.11t my surgery on the evening of July 6th, 1878. On ex-amination he was found to be suffering from a subcoracoid- dislocation of the humerus. I learnt from him that whilst

- standing behind- the counter in the vault with his left armextended laterally on a level with the shoulder-joint, theforearm pronated, and the palm of the. left hand restingloosely on the taps of the spirit receptacles, a customer,,offered him a pinch of snuff, which he took, and almostimmediately sneezed violently; at this moment he felt, as110 said, his left shoulder slip out’of place.

I placed him on his back on a conch, and, with my heel in ,his axilla, reduced it reaclily in the ordinary manner with amoderate amount of force. I had the aid of my assistant,Mr. J. H. Pettinger, surgeon.

In the position in which this patient’s arm was resting the’deltoid and biceps muscles would be relaxed, and in the actof sneezing the pectoralis major, pectoralis minor, and latis-simus dorsi muscles would be brought suddenly into con-

traction ; hence the dislocation. This man’s muscles were,

well developed, but felt somewhat soft and flabby ; he hadnever previously suffered from a dislocation of the shoulder.

I have thought the case interesting and worth recording,never having heard of a dislocation, of the shoulder beingcaused by muscular contraction in the act of sneezing,though, perhaps, others of your readers may have seen orread of similar cases.

Your obedient servant.JOSEPH WESTMORLAND, M.R.C.S.

MORTALITY IN PAUPER SCHOOLS.To the Editor of, THE LANCET.

SIR,—The writer of the article on this subject in yourissue of the 27th ult. (which I saw only last evening) doubtsif the figures resulting from his inquiry give the true death-rate of the inmates of this school, as children suffering frominfectious diseases are removed to the hospitals of the

Metropolitan Asylums Board for treatment, and, shoulddeath follow the removal, rro record is kept in the school ofsuch decease.This assertion is perfectly true, but the addition to be

made to’the Return for the period over which the inquiryextends is so very trifling that no appreciable differencewould have to be made’in ’the figures to express the exactdeath-rate. In the year 1875 we had a violent outbreak ofscarlet fever, and 45 children’were removed from the schoolto the Metropolitan Asylums Board Hospital at Homerton.Of the whole number, only one child, a delicate infant ot

six years of age, died. This is the death which should beadded to make the death-rate exactly correct.Had the inquiry embraced the years 1872--3-4 and 5, only

one death in those four years would-have appeared as havingoccurred here.

I hope, Sir, the above particulars with reference to mychildren will prove satisfactory to the author of the article,and will induce him to form a favourable opinion of thehealth of the inmates of this school.

I am, Sir, your obedient servant,J. CORNISH, Superintendent.

St. Mary, Islington, Workhouse School, Hornsey-road, N.,August- 6th, 1878.

Medical News.ROYAL COLLEGE OF SURGEONS OF ENGLAND. -

The following gentlemen, having passed the required ex-amination for the diploma, were duly admitted Members ofthe College at a meeting of the Court of Examiners onthe 1st inst.:—

Blott, Herbert, L.S.A., Bassingbourne.C&stlp. Hutton, L.S.A., Newport, Isle of Wjght.Charnley, William, M.D. Ctiitib., Lancaster.Cocksedge, C. Ernest, L.S.A., Clapton-park.Hepburn, Alfred, L.S.A., Upper Bedford-place.Marsh, J. Henry, L.S.A., Greeiiliithe.Michael, H. James, L.S.A., Colchester.Protheroe, John, Surbiton.Sehort, Henry, Cht1thttU1.Wood, Charles, L.S.A., Trinity-square, S.E.Young, Arthur, L.S.A., Hawkhurst.

Of the 195 candidates examined during the past fortnight,115 passed to the satisfaction of the Court and obtainedtheir diplomas; 12 passed in Surgery, and when qualifiedin Medicine will be admitted Members; the remaining 68failed to reach the required standard, and were referredfor six-months’ further professional study. Six candidateswho had passed in Surgery at previous examinations, havingsubsequently obtained a medical degree or licence recognisedby the College, were also admitted Members. This is thelast examination for the present session.-The library andmuseum will be closed as usual during the month of Septem-ber for the necessary repairs, cleaning, and dusting.[The name " Wainwright, R. Spencer," in the list of gen-

tlemen who passed the examination for the Membership ofthe College on the 26th ult. should have been—Wainewright,R. Spencer.]

BRITISH MEDICAL SERVICE. - The following is alist of candidates for commissions as Surgeons in this Ser.