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such a stamping out assumed that the micro-organism of thedisease in question was confined to the human species, andthat, moreover, it had no saprophytic existence. Therewas some evidence to negative both these views.But even if the disease was confined to the human

Especies it would be necessary in order to stamp itout to recognise a case the moment it appeared, toisolated it at that moment, and to disinfect all articleswhich had been exposed to infection at that instant. Butall these things were clearly impracticable. The properattitude to adopt in relation to the present controversy was,he thought, to improve their fever hospitals, to control in a- greater degree than at present the diagnosis, to provide moreobservation wards, and generally to make for better accom-modation. The statistics of many isolation hospitals borewitness to the fact that there was some room for improve-ment, and he thought it wise in every particular to face thesituation. All recent experience fully justified the attitude- of successive medical officers of the Local Government Boardin setting themselves to oppose the erection of unsuitable"temporary" hospitals. Sanitary authorities had no rightto morally compel the people under their charge to be sentto hospitals which were not properly equipped.After some remarks by Dr. R. D. SWEETING, Dr. W. A.

BOND, and Dr. THEODORE THOMSON, the PRESIDENTdefended what Dr. Kenwood had called indiscriminateadmission on the ground of the difficulty of drawing a lineof eligibility, since a man’s occupation was of more import-ance to the public than his income. He had sent hischildren to a hospital in the interest of his practice andpatients. The suggestion of a parasitic phase of scarletfever in other animals was favoured by its remarkablelimitation to temperate climates, for it was a charactercommon to all diseases of that nature to be restricted toparticular climates or regions.

Dr. NEWSHOLME said that Dr. Millard’s error consisted notin the shortness of the period on which his statistics werebased, but in his method of applying them, which ignoredthe different incidence of the maxima of prevalence and ofmortality in different towns. He maintained that all rate-

payers had a right to hospital treatment, which he believedwas always better; but if any selection of cases were made itshould be made, not on the social position of the families, buton the risk of the spread of infection in each case. He

entirely agreed with the importance of taking the ageconstitution of a population into consideration in comparingone town with another, but had not as yet been able toobtain the information desired by Dr. Willoughby. He

thought that Dr. Kenwood’s remarkably low mortality mightbe due to his indiscriminate admission of cases and that itslimitation would lead to a recrudescence of the fatality infuture.

BRITISH GYNÆCOLOGICAL SOCIETY.

Exhibition of Specir,-,,ens.-17te 6’zcrgieal Treatment of Prolapseof the Ute’l’1ls.-Tke President’s Inaugural Address.

A MEETING of this society was held on Feb. 14th, Dr.J. A. MANSELL MOULLIN, the President, being in the chair.

Dr. R. D. PUREFOY (Master of the Rotunda Lying-inHospital, Dublin) showed two very interesting specimens ofFibroid Disease of the Uterus. In the first case a singlewoman, aged 52 years, was attacked with a severe form ofperitonitis for six weeks, and while under treatment wasfound to have a large, firm abdominal tumour having manyof the characters of fibroma uteri. She was sent to theRotunda Hospital for operation and during this the abdo-minal wall was found to be firmly incorporated withthe anterior surface of a large fibroid connected withthe left cornu of the uterus by a small pedicle. Theomental adhesions were so numerous and extensivethat considerable bleeding ensued during their separa-tion. It was observed that the surface of the tumour

presented very much the appearance of an ovarian

cyst in which suppuration had occurred. On section thesubstance of the tumour (except a small portion near thepedicle) was found to be of a dark red colour, and washollowed out into large cavities freely communicating andcontaining unaltered blood in large quantities. Dr. H. C.Earl reported as follows on the microscopical appearances:’’ The tissues of the tumour, though so unusual in colour, didnot show degenerative changes, but stained in the usual way,

and the numerous cavities having a very smooth liningmembrane appeared to be dilated blood-vessels." This con-dition in a fibroma was of great rarity and very few instancesof it had as yet been reported in any country. In the secondcase the patient was a single woman from whom a largefibroid uterus had been removed by panhysterectomy. The

specimen was interesting because it showed numerous sub-

mucous, interstitial, and subperitoneal fibroids in various

stages of development. The existence of fibroid disease hadbeen recognised six years previously, but it was then in suchan early stage and the uterus was so small that no treat-ment was deemed necessary, and her advanced ageencouraged the hope that any further growth would bevery slow. In both cases a very satisfactory convalescencefollowed the removal of the tumours.

Mr. CHRISTOPHER MARTIN (Birmingham) showed threespecimens of Mal-formed Uteri. The first was a so-called"double uterus" (didelphys uterus). In this case the lefthalf was patent and the right was distended with decom-posing menstrual blood (pycmetra). This was first drainedper vaginam in May, 1895, but the opening made closed, andretention of the menses with septic complications againsupervened. As the patient was becoming pysemic the doubleuterus was removed by vaginal hysterectomy in August. 1900.The two uteri were quite distinct, the peritoneum dippingdown between the fundi as far as the internal os. Thecervical canals were connected by fibrous and musculartissue, but the two cavities were separate. The patient,who was married and had one child, was 41 yearsof age. The second specimen was a one-horned uterus.This patient, aged 45 years, had had two children.In May, 1899, Mr. Martin removed a big semi-gangrenouscystoma of the left ovary with a twisted pedicle.When operating he observed that the right ovary, tube, andhorn of the uterus were absent. The patient continued tosuffer severe pelvic pain with irregular haemorrhages whichnothing benefited. Finally, in September, 1900, Mr. Martinremoved the uterus per vaginam with complete relief to the

patient’s sufferings. The third specimen was a rudimentarydouble uterus with misplaced hypertrophied ovaries, removedfrom a single girl, aged 18 years. She had never menstruatedand the vagina was a cul-de-sac only one inch long. Theexternal genitals, pubic hair, and breasts were well developed.Each ovary was sausage-shaped, between four and five incheslong, stretching from the internal abdominal ring to thecorresponding kidney. There were ripening follicles in eachovary. From each ovary there stretched a thin rounded mus-cular cord, about one-third of an inch thick and three incheslong, which dipped down into the pelvis between the bladderand rectum and ended, without uniting with its fellow, in thetop of the rudimentary vagina. Evidently here the twoducts of Muller had been arrested in development at a veryearly stage. All three patients made a complete recovery.

Mr. BOWREMAN JESSETT read a paper upon the SurgicalTreatment of Prolapse of the Uterus.The PRESIDENT delivered his Inaugural Address. The

present year, he said, inevitably constituted a historicallandmark ; but a detailed comparison of modern gynaecologywith that which prevailed even 17 years ago, when the societywas founded, would have committed him to writing a completetreatise upon the subject. He would limit his observationsto a few operations. Asepsis in abdominal surgery not

only reduced the mortality following operative procedures,but by making actual inspection practicable when the

diagnosis was uncertain rendered early treatment pos-sible. 17 years ago ovariotomy statistics were engrossingattention, and the cleanliness insured by Listerism, as

it was then called, was reducing a terrible mortalityalmost to vanishing point. The success which attended ovario-tomy for cystoma led to the removal of the tubes andovaries for inflammatory affections, and also for the effectwhich their removal exercised upon fibroid growths of theuterus. In chronic inflammatory disease of the uterineappendages the value of operative treatment was now beyonddispute, and the inefficiency of other forms of treatmenthad long been recognised. Once the tubes were affectedthey never regained their healthy condition but remainedan ever-possible source of fresh inflammatory trouble. The

patients were invariably chronic sufferers and operationalone could give permanent relief. When operationbecame the recognised treatment whole chapters devotedto earlier methods were practically deleted. Removalof the ovaries for fibroid tumours of the uterus,however, had not fulfilled the expectations to which

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the success attending early operations gave rise. It was

applicable only to tumours of a comparatively small size,and its results both as regards checking the growth andarresting the haemorrhage were quite unreliable. The

position of the ovaries below and behind the uterus ren-

dered the operation frequently difficult or even impossibleand it was not less dangerous than removal of the tumouritself. This naturally led to the consideration of hyster-ectomy. This was at first an operation of appalling mortality.Keith alone obtained fair results. He recorded 38 caseswith three deaths. The extra-peritoneal treatment of thestump introduced by Koeberle marked an important advance,but though many operators working upon this principleobtained excellent results the operation was never regardedas an ideal one. Many modifications followed. Panhyster-ectomy had then a fair trial, but involved necrosis and fouldischarges, and was not a commendable operation. At lengththe plan of ligaturing both the uterine and ovarian arteriesremoved the principal danger associated with hysterectomy-viz., secondary hmmorrhage-and at present the generallyaccepted rate of mortality (with experienced operators) was5 per cent. Even this rate would unquestionably be loweredwere it possible to obliterate the traditional teaching thatoperation should be deferred till life were threatened orexistence was unsupportable. A London teacher had recentlygiven 17 as the percentage mortality, but essential factorshad been ignored and the result of a computation so mademight as well have been 70 as 17. Turning to removal of theuterus for cancer he said that Mr. Jessett had recorded aseries of 107 cases with an immediate mortality of under8 per cent. Where it was desirable to operate and yetbe certain that the disease would recur he questioned theadvisability of performing complete hysterectomy. In almost

every case recurrence took place in the cicatrix and this, ifthe uterus had been completely removed, lay in direct contactwith the bowel, which therefore became soon involved in thecancerous growth. When the disease commenced in thecervix it extended laterally, not to the body, which becameinvolved at a late stage, if ever, and which thereforeafforded greater or less protection to the bowels. In con-clusion, he summarised the evolution of modern knowledgeon ectopic gestation. The practical lesson which had beenlearned was that, whatever the phase and whatever the stage,there was but one remedy-viz., operation ; where, how-ever, the fcetal heart could be detected the question arosewhether the operation, always inevitable, should be under-taken at once or deferred for a time.

HARVEIAN SOCIETY OF LONDON.

Exhibition of Cases.A MEETING of this society was held on Feb. 21st,

Dr. D. B. LEES, the President, being in the chair.Mr. J. JACKSON CLARKE showed a case of Spastic

Paralysis in a boy, aged six years. The spastic conditionchiefly affected the muscles of the right thigh and leg and toa less extent the left side. The parents first noticed it whenthe child was two years of age. At present the foot was ina line with the leg and the muscles had the characteristic"clasp-knife" action. The boy could not wear an ordinaryboot on the right foot and the gait was difficult, theboy preferring to crawl. The mental faculties were some-what impaired. Mr. Olarke intended to elongate both tendonsAchillis and on the right side to divide the hamstrings.Daring the past four years he had treated surgically manycases of the kind and the results, both in the upper and thelower extremities, had been most satisfactory. Carefulpost-operative treatment was necessary to insure success.Failures were either due to insufficient operative measuresor to want of proper instrumental control after operation.Save in cases where great mental deficiency was present theold rule of non-interference was obsolete. Massage wasof no lasting benefit before operation. -The PRESIDENT,Dr. A. A. BATHE, and Dr. W. EWART discussed thecase.

Mr. CLARKE also showed a girl, aged 16 years, thesubject of Congenital Syphilis. For two years he had treatedher for gummata rapidly forming over the nasal bones, inthe nasal septum, and at the lateral aspect of the skull.Before that she was under a physician for severe syphiliticenlargement of the liver and spleen. The patient was

anaemic and stunted. The common stigmata of the diseasewere absent and there were no absolutely diagnosticsymptoms of hereditary syphilis present. Surgically,epiphyseal and joint lesions and weak spines that resistedordinary anti-rachitic treatment were common evidences ofsyphilis. In infants the rule was-When in doubt trymercury; if a rapid improvement followed there was nodoubt as to the nature of the morbid condition. The

present patient, though suffering from late lesions, hadgreatly benefited from mercury and iodide of potassium.-Dr. EWART referred to similar features as regardshepatic and splenic enlargement, stunting of growth,peripheral gummata, &c., in a male patient of thesame age. In his case there had been early keratitis,perforation of the palate, and clubbing of the fingers, but theteeth were quite unaffected.-Mr. CAMPBELL WILLIAMSthought the case was one of acquired syphilis contracted

during the early years of life. There was a total absence ofall the classical signs of the congenital type in the teeth,eyes, ears, and physiognomy. Moreover, extensive gumma-tous ulceration with great destruction of the external softparts of the nose and adjacent tissues, together with isolatedand broken-down gummata, were common in the tertiarystage of the acquired disease, but was not the form of tissueattack selected by the tertiary stage of the congenital typeof the malady. Text-books did not recognise that congenitalsyphilis had its secondary and tertiary stages, just as theacquired form had.-Dr. TRAVERS SMITH and the PRESI-DENT also took part in the discussion, and Mr. CLARKEreplied.

Dr. EWART and Mr. S. VERE PEARSON showed a case ofPhthisis treated by Maguire’s Formaldehyde Injections.The patient was a male, aged 28 years, in whom bilateralapical tuberculous infiltration without the major signs ofexcavation was complicated by dental and dyspeptic trouble.Although not a pure instance of the treatment, since othermeasures had also been adopted, it indicated the partialimprovement which might be obtained in a case of markedtuberculosis. After 23 injections of formaldehyde the

patient still coughed up numerous bacilli and the r:Ues

persisted at both apices, but there was marked generalprogress in the expansion and resonance of the chest on per-cussion. The cough was better and the expectoration was lessand had changed from muco-pus to clear mucus. A secondcourse was contemplated after a stay in the country.-ThePRESIDENT requested Dr. Ewart to favour the society with thegeneral results, as far as he could state them, which he hadobtained from this plan of treatment. It was necessary tobe very cautious in drawing conclusions from individualcases. The importance of very carefully weighing theevidence for and against a new treatment of this kind wasindicated by the past experience of the profession with

regard to tuberculosis.-Dr. DUTCH, Dr. BATHE, Dr. E.CAUTLEY, and Mr. HUBERT PHILLIPS also discussed thetreatment.-Dr. EWART, in reply, stated that his experienceof the treatment was decidedly favourable and agreed withthat of Dr. Maguire. He referred to other cases shownelsewhere in which the good results had been manifest. Inview of the careful manipulation necessary and of the slightcomplications apt to arise, such as local swelling, thrombosis,&c., he could not recommend the treatment for out-patients.In hospital and private practice he had not had any seriouscomplications and no abscesses.

- Dr. BATHE showed a boy, aged 11 years, who was subjectto recurrent attacks of Psoriasis Guttata for three years andhe asked for suggestions as to methods for preventing theattacks.-Mr. WILLIAMS and Dr. SMITH discussed thecase and made some suggestions as to treatment and

prognosis.Mr. H. J. CURTIS showed an infant with Accessory

Auricles on the Neck.Dr. W. J. HARRIS showed a typical case of Brachial

Neuritis which was associated with loss of radial pulse on thesame side.-The PRESIDENT said that he could entirely con-firm what Dr. Harris had stated as to the improvement inthis case. Brachial neuritis or neuralgia certainly occurredas a sequela of influenza, but not usually with such markedsymptoms, and it seemed possible in this case from the

history, the absence of the radial pulse, and the fact of adilated left ventricle, that there had also been embolism orthrombosis.-Dr. HARRIS demonstrated a method of applyinga combination of the galvanic and faradaic currentsin the treatment of the case and the meeting thenadjourned.