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It may seem strange to some of your readers that I haveprinted in italics the phrase, which Mr. Brown has failed tonotice in his letter, " without the cognisance of the patient."The following history, which I have already published in myLectures, explains my so doing :-
’’ I know a lady, aged fifty-three, whose youngest child wasmore than twenty years old, who had suffered from a painfulfissure of the anus, for which she underwent the usual ope-ration of dividing the mucous membrane of the ulcer. The
surgeon who did this, without saying one word to the lady orto her husband, or hinting in any way what he was about todo, cut off her clitoris. The stump of the amputated clitorisbecame the seat of pain, such as sometimes follows the ampu-tation of a limb, and for months the patient was in a state ofalmost ceaseless anguish, which, after the lapse of between twoand three years, abated, but has not yet altogether ceased. Inanswer to her inquiries why some other operation had been per-formed in addition to that which she knew was requisite, she atlength learned what had been done; and, further, had the humi-liation of discovering that the justification was that she wasassumed by the surgeon to be addicted to a vice with the veryname and nature of which she was alike unacquainted."The surgeon who performed this operation (as I have already
stated on a previous occasion) was Mr. Baker Brown. I sawthe patient m consultation with Mr. Paget and Mr. Barnes ofChelsea; and I append a note from the former of these gentle-men in corroboration of the truth of the above statement.. republish it now, because I know, and I speak advisedly,that this is by no means a solitary instance of the removal ofthe clitoris by Mr. Brown without the consent, without theknowledge, of the patient.
I here leave the subject of clitoridectomy, both in its medi-cal and its moral aspects, to the serious consideration alike ofits advocates and its opponents, and shall return to it nomore, for it would profit little to meet one opinion by another,or denial by repeated assertion. My life has been passed butill if my assertion or denial of a fact could gain weight withmy professional brethren by its repetition.
I am, Sir, your obedient servant,Wimpole-street, Dec. 3rd, 1866. CHARLES WEST.
" 1, Harewood-place, Hanover-square, Dec. 3rd, 1866."MY DEAR WEST,-The passage from your lectures which
you propose to send for publication in THE LANCET is exactlytrue. With part of the facts I was personally acquainted ; therest are related just as they were stated to me by the husbandof the patient, and by her usual medical attendant, who was
present when her clitoris was removed, but was not consultedabout the propriety of the operation. Both these gentlemen.are well known to me, and are of unimpeachable integrity."Having to write what may be published on a case of re-
moval of the clitoris, I am not willing to conceal my opinionson the practice of that operation for the cure of variousmaladies of the nervous system. They are in close accordancewith your own. I believe that the principles on which thepractice is said to be founded are entirely fallacious; and Igreatly doubt whether, except for disease of its own structure,the clitoris ought ever to be removed.-
" Sincerely yours,"Dr. West." "JAMES PAGET.
(FROM OUR OWN CORRESPONDENT.)
THE close contest which the elements of modern life have
created in the various branches of human activity is not want-ing in the Press ; and the journals of the day, in their eager-mess to outstrip rivals and furnish fresh news to their sub-scribers, sometimes commit curious blunders if not grievousmistakes. Thus, a short time ago, the unfortunate Jobert deLamballe was condemned to death by the Press before histime ; and now it is the turn of Prof. Trousseau, who was lastweek killed in a good many journals, whereas he is as full oflife as ever. He had been slightly unwell suffering, he toldtne, from some nephritic and dyspeptic ailments. But he isNo much better that he has resumed his usual avocations, andattended last Wednesday evening a meeting of the Faculty todoliberate on the choice of a professor for one of the numerous
chairs now vacant. On the day following I had the honour ojcalling upon him, and saw the illustrious professor, looking s
little pale and thin, but his tall figure still as erect as ever,and his eyes full of the brightness of health and the flash ojintellect. He showed me, with a smile, amidst the irony oiwhich I thought I read some melancholy, an extract from ! a
British medical publication containing his obituary. The English contemporary, very probably led on a false scent by someFrench journal, had consecrated a substantial article to thEmemory of M. Trousseau. We have every reason to hopEthat the medical world will reckon the eminent physicianduring many years to come amongst its living celebrities, andthat the crowd of grateful patients and friends who besiegedhis door during his late illness may long continue to enjoy thebenefit of his skill and of his friendship. Since we have lostthe professor in M. Trousseau (you know he has resignedhis chair), may we long possess the man, the orator, and thephysician.The discussion on the evils of the system which at present
exists of sending out children to be nursed in the country andthe frightful infant mortality which is the result of it, is givinggreat interest at present to the meetings of the Academy ofMedicine. M. Felix Boudet commenced, in the last sitting,his able discourse, at the end of which he pronounced thesewords, which are fully worthy of striking the public mind :" Gentlemen, the Academy is in presence of the most impor.tant question which has ever been submitted to its delibera.tions ; it has never had, it will never have, the opportunity oirendering such great services, of assuming so eminent a position,if it wishes to rise to the height of the mission with which itis entrusted. We are not met to consider a medical doctrinemore or less productive of good, nor an epidemic more or lessdeadly, but always transient. The French population di-minishes or remains stationary : the national life is in danger.Public opinion, moved by the echoes of this tribune, is anxiousand attentive ; the Academy is put to the necessity of answer-ing its just alarms. Our hand on the heart of France, we mustmeasure the number and the amplitude of its pulsations, as-
certain the causes of the evil which paralyses its energy, andsignalise the heroic means which must rescue the nation fromthis ominous decline." The statistical accounts which havebeen brought to light since public attention has been drawn tothis subject, show, indeed, the most frightful mortality amongchildren : fifteen thousand deaths among twenty thousandchildren sent annually from Paris to be nursed in the neigh-bouring departments, and about the same per-centage in theneighbourhood of the other large cities, such as Lyons, &e.This accounts to a great extent for the decrease of populationwhich has been noted in this country, a decrease which tellsin striking figures. Thus I extract the following statementfrom a most able article in the Gazette Hebdomadaire, by M.Leon Le Fort :-" The population of France in 1828 was
31,845,428-births, 976,547 ; in 1858 the population had in-creased to 36,039,364. Compared to the births of 1828, thoseof 1858 should have been 1,105,123, whereas they amountedto 969,343, or a clear deficit of 135,780 births." Besides thegreat mortality amongst children, there are evidently manyother causes which tend to account for the decrease of popula-tion in France, and amongst them there is one, a social evilwhich modern civilisation has developed to a considerable ex-tent, at least in this city, and which, if 1 must say it, consistsin an almost general application of the system of Malthus.M. Boudet concluded his discourse with a whole series of sug-gestions to remedy the present evil : an appeal to the govern-ment and to the whole country-a report to the Minister ofPublic Instruction—an administrative inquiry—the publicationof all the documents sent to the Academy—a strict supervisionover advertising oilices fur wet-nurses—the institution of a
permanent commission at the Academy, which would be calleda Commission of Infantile Hygiene, &c. But evidently all thesemeasures can only be palliatives, and the evil cannot cease un-less French mothers be persuaded to nurse their offspring.Never has the Faculty been ill fnch a state of agitation and
excitement as at present. Just think: six professors to benamed, and the whole thin.: within the hands of the Faculty,who choose among the candidates those who are to be presentedfor nomination to the Minister of Public Instruction. Theirchoice is invariably ratified. Three of these lists of presenta-tion have already been completed. M. Laassegue has carried itover M. Chauffard for t!’" chair (,f pathology: M. :;’:(.e overM. Gnbler. for the one (If iriaterit medica and therapeutics;and M. Vulpian over l. Barth :’!r that ui pathologicalanatomy.
Paris, Dec. llth, 1866.
MR. CÆSAR HAWKINS, F.R.S.
AT a meeting of the Council of the Royal College of Sur-geons, on the 13th inst., a letter from Mr. Cæsar Hawkinswas read, in which he expressed a desire to resign his seat asa member of the Court of Examiners. In accepting the resig-nation the Council expressed deep regret at the retirement afterso many years of so esteemed a colleague. It may be interest-ing to our readers to know that so long ago as 1846 Mr. Haw-kins was elected a Councillor, and was fortunate enough threeyears afterwards to become a member of the Court of Examinersand the Hunterian Orator. In 1852 he was elected Presidentof the College, and again filled the chair in 1861. At a recentelection of Councillors, the fellows, feeling that Mr. Hawkinahad held office long enough, displaced him in favour of a morepopular candidate. It is hoped and generally expected thatthe good example thus set will be followed by more than oneother member of the Court. Mr. Hawkins retains his seat atthe General Medical Council as the representative of the Col.lege of Surgeons.
Medical News.ROYAL COLLEGE OF SURGEONS OF ENGLAND.—The
following members of the College, having undergone the neces-sary examinations for the fellowship on the 20th, 21st, and22nd ultimo, were reported to have acquitted themselves tothe satisfaction of the Court of Examiners, and at a meetingof the Council on the 13th instant were admitted Fellows ofthe College :-
Bond, Thomas, North Petherton, near Taunton; diploma of member-ship dated April 26, 186-I.
Grig;?, Joseph Collings, Royal Hospital, Greenwich; April 12, 1858.Harrison, Reginald, Liverpool; April 15, 1859.Kempthornc, John, Callington, Cornwall; July 20, 1846.Lawrence, Henry J. Hughes, 1st Batt. Grenadier Guards; Apr. 16, 1852.Magill, Martin, M.D., Royal Hospital, Haulbowline; June 6, 1856.Pick, Thomas Pickering, Bolton-row, Mayfair; July 29, 1862.Wyatt, John, Surgeon-Major, Coldstream Guards; May 26, 1848.
It is stated that three gentlemen, of the twelve who wereadmitted to both examinations, failed to acquit themselves tothe satisfaction of the Court, and were consequently referredback to their studies. Mr. James Stanton Cluff, B.A. Dub.,passed the first professional examination, and when eligiblewill be admitted to the final professional examination for thefellowship. The preliminary examination in Arts &c. for bothfellowship and membership of the College will take place nextweek, and already 150 candidates have entered their names.The following members of the College of Surgeons, having
undergone the necessary examinations, were admitted Licen-tiates in Midwifery at a meeting of the Board on the 12th inst. :-
Archer, Edmund, F.R.C.S. Eng., Cape of Good Hope; diploma ofmembership dated Dec. 29, 1846.
Clarke, Edward Griffiths, Mold, Flintshire; May 1, 1861.Crew, Eli, Tetbury, Gloucestershire; April 24, 1866.Crowther, Edward Lodewyk, L.R.C.P. Lond., Hobart Town, Tasmania;
April 24, 1866.Hayden, James Augustus, High Wycombe; April 27, 1866.Lowndes, Frederick Walter, Liverpool ; July 25, 1865.Pollard, William Fox Branch, Demerara; Nov. 16, 1866.Rix, Richard Avery, Beecles, Suffolk; April 26, 1865.Stainthorpe, Thos. Edward, Hexham, Northumberland; Nov. IS, 1866.Visick, Clarence, Fleet-street; May 10, 1865.
It is stated that six candidates failed to acquit themselves tothe satisfaction of the Board. The next examination for theLicence will not take place until February.
APOTHECARIES’ HALL. - The following gentlemenpassed their examination in the Science and Practice of Mecli-cine, and received certificates to practise, on Dec. 6th :-
Anderson, Jas. Goodridge, Theddlethurpe, near Alford, Lincolnshire.Ridout, Charles Lyun, Egham, Surrey.Smith, Rubert Shinrleton, Charlton Horethorne, Sherborne, Dorset.Westmoreland, Joseph, Cheadle, Cheshire.
The following gentlemen also on the same day passed theirfirst examinationThomas Flower, Middlesex Hospital; George Everitt Xorton, do.; Alfred
Robert Steel Perkins, Guy’s Hospital; Chas Wilson Milne. St. Thomas’sHospital; Alfred Pern, do.; Nelson Congreve Dobson, do.; FrederickPollard, do.; Frederick Morrish Pieree, Manchester Royal Infirmary.
UNIVERSITY OF LONDON.—The following are lists ofcandidates who passed the respective examinations indicated :-
B.S. EXAMINATION. ’ _
PASS EXAMINATION.Bond, Thomas, Kinc’c College.Buckneli, Francis John, University College.
Casey, Edward, King’s College.Nunneley, Frederick Barham, University College.
EXAMINATION FOR HONOURS.First Class.
Xunneley, Frederick Barham (Scholarship and Gold Medal),University College.
Bond, Thomas (Gold Medal), King’s College.Casey, Edward, King’s College.
Bruce, Alexander, B.Sc., University College.M.D. EXAMINATION.
Bastian, Henry Charlton, M.A., University College.Fox, Edward Lloyd Harrier, University College.Green, Thomas Henry, University College.Jackson, James, London Hospital.Lush, William George Vawdrey, St. Bartholomew’s Hospital.Miller, Richard May, B.A., University College.*Powell, Richard Douglas, University College.Sansom, Arthur Ernest, King’s College.Smith, Charles (Gold Medal), Guy’s Hospital.*Snow, William Vicary, University College.Stockwell, Frederick, St. George’s and University College.
* Obtained number of marks qualifying for Gold Medal.
CAMBRIDGE UNIVERSITY.—The following gentlemenhave passed the undermentioned examinations in Medicine:-
FINAL EXAMINATION FOR M.B. DEGREE.J. B. Bradbury, B.A., Downing College.W. B. Dalby, B.A., Sidney College.SECOND EXAMINATION FOR M.B.
’ J. T. Dickson, B.A., St. John’s College.G. Wilks, B.A., Trinity College.
FIRST EXAMINATION FOR M.B.Hubert Airy, M.A., Trinity College.G. F. Barf, M.A., Christ’s College.J. N. C. Davies-Colley, B.A., Trinity College.J. E. M. Finch, B.A., Trinity Hall.G. Wilks, B.A., Trinity College.
EXAMINATION FOR DEGREE OF MASTER OF SURGERY.George Mickley, B.A. and M.B., Clare College.
NATURAL SCIENCES TRIPOS.First Class.
Earle, Jesus College. (.Walker, Sidney College.
King, Clare College.Second Class.
Fenwick, Trinity College.,Ralfe Caius College. ‘Smart, Caius College.Wollaston, Clare College.
Marshall, Trinity College. I Semple, Caius College.
FORTY THOUSAND pounds to fifty thousand poundsof horsemeat are consumed in Paris every week.
THE Warneford Hospital Ball will take place on the2nd proximo.MR. BIRD, senior surgeon to the West London Hos-
pital, has been appointed a Justice of the Peace for Middlesex.THE total number of deaths in London last week
amounted to 1584.
THE population of Paris, according to the census ofthe present year, is 2,150,916.NEW MEDICAL CORONER.—Charles Mayo, M.A.,
M.B., has been elected coroner for the University of Oxford.PERMISSION has been granted to the Geological
Association to hold a monthly evening meeting in the libraryof University College.
CONCESSION TO SMOKERS. - The directors of theSouth-Western Railway have placed carriages at the disposalof smokers.
ACCIDENTAL POISINING.—An infant was poisoned afew days since, by a dose of turpentine having been adminis-tered instead of castor oil.
A TESTIMONIAL has been presented by the Committeeof Sewers to their chairman, Mr. De Jersey, in acknowledg-ment of his services for the benefit of his fellow-citizens.
DEATH OF DR. JEAFFRESON.—This well-known andaccomplished physician died of typhus fever at his residence,in Finsbury-square, on Friday morning. Dr. Jeaffreson wasM.D. Cantab., one of the Physicians to St. Bartholomew’s,and Consulting Physician to the City of London Hospital forDiseases of the Chest. A memoir of him will appear in thenext LANCET.