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tions which are changed into posterior lnxations, afford Iadditional argumenta in support of the views previouslypubli"hed of the author-viz , that in all the ordinary dis-locations backwards without fracture, whether they are

poken of as "dorsal" and "sciatic," or, as Bigelow stylesthem, "dorsal above aud "dorsal below the obturator ten-don," the femur leaves the acetabulum through a rupture ofthe thin part of the capsule, and below the internal obtu-rator tendon ; that herein we have the rationale of thesuccess of the method of reduction by mauipulation ; andthat posterior, as well as anterior, dislocations occur whilstthe limb is abducted. The chief museums of England,Ireland, and France have been searched for specimens ofhip dislocation, with the result that there is not a singleexample of simple, uncomplicated, direct posterior dislocationabove the obturator internus, but many of secondary dorsaland sciatic luxations-that is, luxations in which the head ofthe boue, having left the socket below the obturator internus i

muscle, had ridden upwards over it into its new position.Speceal reference was made to Sir W. Mac Cormac’s case inSt. Thomas’s Hospital Museum, and a diagram of it was shown.—Mr. EVE said that his remarks in his own paper were chieflydevoted to confute the view that dorsal dislocations neveroccur without fracture of the ace’abulum or femur ; he hadquoted in support Sir W. Mac Curmac’s case. Mr. Morrisnow admitted that this was a direct dislocation backwards.Sir W. Mac Cormac described it as a direct dislocation back-wards, and said he found the head of the hone lying abovethe obturator internus muscle. Even if there were lacerationof the lower part of the capsule, produced by the injury, thecase still showed that dorsal dislocation may take placewithout fracture of the femer or acetabulum. Mr. Wor-mald, in his case, says the opening in the capsule was oppo-site to the tuber ischii, and the dislocation was produced bya blow on the knee with the thigh flexed ; and this caseMr. Eve believed to be a dislocation backwards. On dis-secting the specimen Mr. Eve found the lower part of thecapsule intact. There was another specimen in St. George’sHospital to the same effect. In Mr. Morris’s plate of indi-rect dorsal dislocation the capsule is ruptured ; and in hisexperiments Mr. Morris found the rent of the capsule alwaysin the lower part. Parmentier records a case of directdorsal dislocation without fracture of the acetabulum, butof pelvis. He still thought Mr. Morris’s views at variancewith those of the chief authorities, who hold that dorsal dis-locations take place when the limb is adducted and flexed.Mr. Eve did not contend that all posterior dislocations aredirect, although they are common as compared to indirect,and he admitted that direct dislocation was frequently as-sociated with fracture of the rim of the acetabulum.-Mr. MORRIS having expressed his indebtedness to Mr. W.Adams and Mr. Frank Steele for drawings illustrating hispaper, replied that there was not the least difficulty inunderstanding how the laceration in the lower part ofthe capsule in Sir W. Mac Cormac’s case was overlooked,because no attempt was made, either before or after death,to reduce the dislocation ; and the opening cannot be seenuntil the femur is raised and search is made expressly for it.His contention had been that direct dorsal dislocation anddislocation into the sciatic notch are not direct unless

complicated by fractures, and that it was illogical to quotecases such as Mr. Wormald’s and Mr. Adams’s, which aredislocations below the obturator internus tendon, as directdorsal or ischiatic dislocations.The Society then adjourned.

CLINICAL SOCIETY OF LONDON.

Suppression of Urine after Ovariotomy.—Erythema Iris.—Aneurism of the Ascending Aorta.

THE ordinary meeting of this Society was held on Friday,February 10th, Joseph Lister, Esq., F.R.S, in the chair.Dr. Finlay showed a case of aneurism of the ascending ’,

aorta. Dr. Colcott Fox showed a case of anaesthetic andtubercular leprosy in a boy from the West Indies. Mr.Balmanno Squire exhibited three cases of lupus in one

family, and two cases of lupus treated by linear scari-

fications, one of which, after an interval of three years,remains quite sound.Mr. KNOWSLEY THORNTON brought forward a case in

which Suppression of Urine was threatened several times

after Ovariotomy ; on each occasion packing the arms incold wet towels relieved the symptoms, and the patientmade a good recovery, and has remained in perfect healthsince. The following is a brief outline of the ca-e :-J.W-, aged thirty-nine, married, and mother of two livingchildren, the youngest seven years and a half old, was ad.mitted into the Samaritan Hospital iu Oct. 1880.-History:Never strong ; during the last seven years has had threestillborn children and two miscarriages. Since last miscar.riage has had irregular and too f i equt-nt menstruation. Ab.domiual tumour first noticed ea’ly in last pregnancy, Sept.1879. A few weeks before admission, Dr. PIerce of Denbightapped the tumour, and removed twenty-four pints ofgreenish naid.&mdash;Condition on admission : Looks older thanher age, and has a waxy skin ; kidneys act hadiy, and skinis dry and hard ; no albuminuria. Ovariotomy performedNov. 4th, 1880, and tumour of right ovary removed, weigh.ing, with contents, 28lh. Operation of average difficulty.A good deal of sponging Decesary, and occupied an hour.Temperature and pulse rose rather rapidly, and on theday after the operation the urine was scanty and dark,and the kidneys were very irti’abie. Digitalis and citrateof potash were given, and next day the urine was free,and loaded with lithates. On the fourth day the kidneyirritability returned, and the temperature and pulse ro<e

again ; sympathetic vomiting came on ; and on the sixthday, the condition appearing c itical, the arms were boundand packed in cold wet towels, which were kept wet withiced water. In twelve hours all bad symptoms had disap-peared. The towels were allowed to dry, and in five hoursthe patient was as ill as ever. The towels were wetted again,and were kept applied for forty-eight hours, during which timethe patient appeared quite well; and the wound was dressedfor the first time, and found i-ouudly healed, and all the sutureswere removed. The towels were removed ; but during theday the kidney symptoms and sickness gradually returned,and they were reapplied. Temperature and pulse remainedunaffected, but the kidney symptoms at once yielded. Onthe eleventh day they were again removed. On the twelfth,the temperature being normal, the patient was allowed toget up. A few days later she went home ; and Dr. Piercewrites that she is now in better health than she has enjoyedfor some years.&mdash;jBemcH’: Mr. Doran has shown by hispost-mortem examinations that advanced granular disease ofpost-mortem examinations that advanced grd,nular disease ofthe kidneys is common with large abdominal tumours ; andit is known that this condition irequently exists without anyclinical evidence of its presence. In the present case

no albumen was detected, and though the kidneys actedbadly before the operation, they were equal to the excretionof a fair quantity of urine loaded with lithates on the secondday after the operation. The symptoms detailed in thepaper were clearly due to the kidney condition, and theapplication of cold wet pack to the arms on three separateoccasions acted like a charm. To what is this rapid actionto be ascribed ? The author discussed the method:, of apply-ing dry and wet cold not only to reduce temperature, but torelieve serious internal congestions ; in the latter class ofca-es he believed the action to be a reflex one through thenervous system, and not a mere coolitig of the bloodgenerally. He referred to the action of internal chill in pro-ducing internal inn<immation<, and to the well-known actionof counter-irritants. While believing that ordinary casesmay be explained by one or other of the theories mentioned,he is still at a loss to explain the rapid action on thekidneys in this case from such a very restricted pack.The repetition of the treatment and its unfailing effect onthree separate occasions, and especially on the last, when pulseand temperature remained unanected, maKe it a case or

clearly demonstrated therapeutic action, not a mere coinei-dence.-Mr. LISTER agreed with Mr. Thornton that therelief of the symptoms was due to the treatment employed,and also that it must be explained on the theory of a reflexvaso-mot..r effect. Years ago Mr. Lister had shown thatraising the arms acted not simply mechanically by emptyingthe veins, but also exerted nervous reflex effect upon thearteries of the limbs ; and this fact explains a case he hadmet with ia which a man who was obliged to stami for longperiods suffered from paiu in the testicle, which was relieved byresting the feet up, no doubt due to a reflex emptying of thevessels of the testicle, similar to that in the leg-. The well-known relief of pelvic congestion which often follows raisingthe legs, and the checking epistaxis by raising the arms,were explicable by the same theory.-Dr. THEODOREWILLI BMS asked what the temperature was in Mr. Thorn-

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ton’s case. In his experience when he had tried the ice-cap to the scalp in pneumonia or other local inflammationit had always failed, but it succeeded where the rise of tem-perature was due to a general cause.-Dr. WILTSHIRE askedif the operation was performed antiseptically.-Mr. THORN-TOX replied that it was antiseptic ; that in any future casehe would try the effect of raising the arms, and, disagreeingwith Dr. Williams, found that the ice-cap was mot usefulin local inflammations, but that when there was rise of tem-perature from a general cause it failed completely.Mr. BALMANNO SQUIRE read notes of a case of Erythema

Iris exhibited at the last meeting. A woman, aged twenty-eight, presenting a copiously sprinkled eruption, limited tothe palms of her hands and fingers, and to the backs of theends of her fingers. The eruption had lasted a month, andwas the third within two years, the previous attacks lastingthree weeks. Each spot consisted of a circumferential,definitely raised, faintly pink ring, enclosing a disc-shaped,flat, unraised, brown’0rimson, abruptly limited stain, dis-appearing momentarily on pressure, the centre of the spotbeing faded and of a pale buff colour ; the average diameterof the spots, including the ring, was eight millimetres. Theeruption was attended with a sensation of itching, andoccasionally of burning. There was also considerabletenderness of the affected skin, so as to preclude anv use ofthe hands. There was neither desquamation nor vesication,but the patient states that the previous attacks had termi-nated in free desquamation.Dr. FINLAY showed a case of Aneurism of the Ascending

Aorta in a woman aged thirty-two. She complained onlyof shortness of breath on exertion, and a slight cough attimes; she had no difficulty in swallowing, and the pupilsvere equal. An oval-shaped pulsating swelling, three inchesby two inches and a half, and projecting about half an inchfrom the surface of the chest, appeared to the right of thesternum, and extended in an almost vertical direction fromthe lower border of the second rib to the lower border of thefourth costal cartilage. There was no discoloration of theskin or enlargement of the cutaneous veins. Over theswelling there were a thrill and a loud double murmur, thediastolic part being loudest and longest. A double murmurwas also heard at the heart’s apex, which appeared in thefifth interspace in the nipple line. The murmurs were heardgenerally all over the chest, both back and front. Theywere also heard in both cavities, and there was visible pulsa-tion of the vessels of the neck. Dull percussion was foundover the tumour, shaded ofl’ for some distance beyond. In-

spiration was wavy at the left apex in front, and expirationprolonged over the right upper scapular region. The appear-ance and action of the vocal cords were normal. There wasno specific history; the patient was married but childless,and had had no miscarriages. She had a severe attack ofrheumatic fever at the age of twenty, and thinks shestrained herself four years and a half ago while en-

gaged in house-cleaning. A year later a continuous,dull, aching pain in the right side of the chest beganto trouble her; and on examining the part she discoveredpulsation and swelling. She was admitted to the Mid.dlesex Hospital, and remained there from January 22ndto July 7th, 1879, being treated with gradually increaseddoses of iodide of potassium, confined strictly to the re-

cumbent position, and dieted on the plan advocated by Mr.Tufnell. After nearly six months of this treatment shewas discharged much relieved, being free from pain, andwith diminished pulsation in the aneurism; there was, how-ever, no evidence of consolidation. Since her discharge shehad continued to attend the out-patient department. Com-paring her condition and physical examination when in thehospital with what it is now, the following differencesappeared: At the former period the diastolic sound over thetumour was accompanied by a " thud " indicating the com-pe’ent closure of the aortic valves ; the situation of the apexbeat was normal, and the heart’s sounds there were unac-companied by murmurs. Now the thud has disappeared;the apex beat is somewhat outside its normal position ; andthere is a murmur at the apex both with the systole anddiastole. The pulsation in the tumour, too, feels moresuperficial now than it did then. From the comparisonthe sequence of events seemed to be, weakening of partof the wall of the aorta in connexion with the attackof rheumatic fever, and its giving way under thestrain referred to ; then the gradual dilatation of theaneurism leading to incompetence of the aortic valve,and this in turn to dilatation and hypertrophy of the

left ventricle with mitral incompetence. The questionfor consideration now, seeing that medical treatment had sofar failed, was whether it would be proper to resort to opera-tive procedure ; and if so, what that procedure should be.Galvano-puncture might commend itself to some ; the distalligature, as exemplified in cases recorded by Dr. Cockle andMr. Heath, Mr. Holmes, and Mr. Barwell, to others. Thereseemed to be points in the case both in favour of and againstoperative interference. In the former category might bementioned the youth, good general health, circumscribedappearance of the aneurism, and absence of pressure signs ;on the other hand, there were the nearness of the aneurismto the aortic orifice, and the aortic regurgitation, whichwould expose to the danger of portions of clot being washedback into the left ventricle, together with a greater risk,than in cases where the valve was competent, of clots beingdetached and carried forwards in the other direction. At thesame time the regurgitation might be slight, judging fromthe small amount of dilatation and hypertrophy. Altogetherthepros and cons seemed so equal that it was difficult to strikea balance in favour of either side ; all the more so when itwas considered that the patient was not unlikely to live fora considerable time in ftir comfort without surgical treat-ment.-Dr. DOUGLAS PowELL said, that before operativetreatment was undertaken it was very important to make anaccurate diagnosis ; 1st, as regards the interpretation of thediastolic murmur-was it due to aortic reflux, or was itaneurismal ? 2ndly, was it a sacculated aneurism ? Therelief following Tufnell’s treatment was in favour of saccula-tion, and also its being near the surface, but clearly therewas no clot now. He thought the second murmur wasaneurismal-first, because there was no diastolic murmur atan early period of the case; secondly, because there wassome evidence that the valves close ; thirdly, the murmurwas more distinct above the aneurism than below towardsthe epigastrium ; and, fourthly, there was a second thrill.He. thought that distal ligature would be the right courseif his views on these points were correct, but that thecase should be examined by others. Dr. Powell had

published several cases of aneurism preceded by aortic re-gurgitation following acute rheumatism.-Dr. DE HAVIL-LAND HALL had seen Dr. Hughes Bennett’s case treatedby galvano-puncture ; it was similar to the case exhibited,but though the skin was thin the man refused operationfor some time, and after it was done suppuration occurredat the site of the needle puncture, and the man diedfrom haemorrhage. The unfortunate result was largelydue, he thought, to delaying the operation until too late.-Dr. LONGHURST thought that operative interference was outof the question, and that Tufnell’s treatment was the mostsuitable for the case.-Dr. THEODORE WILLIAMS had noticedthat even where there was great thinning of the skin therupture generally took place posteriorly, and related a caseof a man with thinning of the anterior wall of the aneurism,treated by a modified Tufnell plan in which the wall gotthickened and pulsation ceased, but the man left the hospitaltoo soon, went to his work, and soon after the aneurismruptured posteriorly.-Dr. GREEN asked whether the sphy-mographic tracing would not afford satisfactory evidence ofthe condition of the aortic valves ? In two of his cases, whilegalvano-puncture did no harm it did no good in one, and pro-duced onlya slight diminution of pulsatiun in the other.-Mr.HowAPD MARSH alluded to a specimen in the museumof St. Bartholomew’s, taken from a man whose aneurismproduced great bulging, but by rest the pulsation subsidedand he left the hospital, and shortly afterwards in a

drunken brawl the aneurism burst. Last year he tied thesubclavian and carotid for what looked like an innominate,but some thought an aortic, aneurism. After the operationpulsation ceased over the thin part, but the aneurism bulgedposteriorly, and ultimately the man died from the sac burst-ing through the site of the incisions for tying the arteries.He agreed with Dr. Williams that aneurisms most oftenburst posteriorly. Although the distal ligature was some-times useful, the prolongation of life had not been greatexcept in Mr. Heath’s case, but that might be due to theoperation having been done only in desperate cases, but hethought Dr. Finlay’s case was a suitable one for this opera-tion. Galvano-puncture was a failure in his experience.-Dr. FOWLER thought the diastolic murmur was only in partaneurismal. He deprecated any operative interference.-Mr. ROBERT PARKER thought that one cause of failure ofgalvano-puncture was that batteries unsuitable for electro-lysis were often used. Every battery ought to be fitted

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with a galvanoscope, otherwise, as he had found intreating naevi by electrolysis, there might be no actionin the battery without the operator being aware of it.-Mr.WALSHAM thought the aneurism was too near the heart fordistal ligature to succeed, and therefore recommendedTufnell’s treatment.-Dr. SILVER alluded to Mr. Heath’scase, which was exactly like an innominate aneurism, andhad the patient not been a confirmed drunkard her life wouldprobably have been prolonged for more than four years.-Dr. DOUGLAS POWELL, having looked at the sphygmographictracing, considered it more indicative of aneurism than ofaortic reflux, but thought the case would be a good test ofthe diagnostic value of the sphygmograph.-The PRESIDENThaving appointed Dr. Powell and Dr. Green to investigatethe case with Dr. Finlay, especially with regard to thequestion of aortic reflux, Dr. FrNLAY replied. He referredto Dr. Ord’s case of galvano-puncture forty-nine days afteroperation. Aortic regurgitation was present in that case,and although the patient died, his death was not apparentlydue to it. Nevertheless, he thought galvano-puncture wasmore dangerous than distal ligature in such cases, as theclot was more liable to be washed away.The Society then adjourned.

HARVEIAN SOCIETY OF LONDON.

AT a meeting of this Society on Feb. 2nd, Mr. WilliamHickman (President) in the chair, Dr. DAY read a paper" On Headaches in Children." He alluded to the two greatfactors of headache from a pathological point of view-viz., Icerebral anaemia, and cerebral hypersemia. Attention was ’,directed to the fact that the amount of blood in the brain isinfluenced by the fulness of the ventricles, the subarachnoidspaces, and the lymphatic spaces, or sheaths, surroundingthe cerebral bloodvessels. Dr. Day said that habitual head-aches in children indicate an irritable and exhausted brain,and if intellectual exertion be carried too far in such casesmischief is soon likely to ensue. It seemed extraordinarythat educated men who had the care of young persons shouldnot see this danger in the anaemia produced by over-study,the irritability and excitability of manner, and the im-possibility of concentration, so necessary to the accomplich-ment of any undertaking. If intellectual exertion be carriedbeyond a certain point the brain becomes anaemic, fatigued,and the nutrition in the ganglion cells of the cortex be-comes impaired, diseased, or in some way altered fromhealth. The author referred to neuralgia, or one-sided head-ache, which, he said, was more common in children thanwas generally supposed; it was not infrequent in thoseof the neurosal temperament, whose nervous system was easilyexhausted, and in those reduced by long and exhaustingillness, bad food, and other causes. He had knownheadache in connexion with chorea and dental caries. Nexthe spoke of congestion, toxaemic and organic headaches.-Dr. CHEADLE considered foul air and gas were the chiefcauses of study heariaches. He had noticed headaches fromthis cause, especially in choristers ; he referred to headachesin rickety children ; this occurred just after the skull closed,was continuous, but gradually subsided.-Dr. STEPHENMACKENZIE wished particularly to insist on the importanceof careful examination of the eyes in cases of headache inchildren. Muscular asthenopia was a cause of headachewhich sometimes was mistaken for serious organic disease.He mentioned the case of a schoolboy brought to him underthis supposition, but myopia was found and corrected, andthe headache disappeared. The same thing occasionallyoccurred with hypermetropia. Next he pointed out thatear disease was sometimes the cause of headache, whichwas of importance as significant of commencing meningealor cerebral inflammation. In all cases, therefore, of headachein children it was very important to examine the ear and theeye, using the ophthalmoscope, which was of great value indetecting organic disease. He remarked that pain in thehead, a valuable sign of tumour of the brain, was no certainindication of the localisation of the tumour, unless there wascorresponding pain on percussion.-Mr. CRIPPS LAWRENCEasked if the urine was altered in these cases, especially as toits specific gravity.-Mr. MALCOLM MORRIS considered thatheadache in some cases might be a distinct disease and notmerely a symptom, as when an attack occurred and passedoff suddenly in a person whose functions were normal at

the time.-The PRESIDENT said that headache, though nota common symptom in children, was one of import, and fre.quently indicated advanced disease.-Dr. DAY, in reply,remarked that the urine was usually healthy ; the specificgravity was high.

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MIDLAND MEDICAL SOCIETY.

AT a meeting of this Society, held at the MedicalInstitute, Birmingham, on Wednesday, the lst inst., inthe absence of the President, Dr. Bassett was voted to thechair.Mr. BENNETT MAY showed two specimens of Knee-joint

Disease which had originated in acute necrosis of the headof the tibia.Mr. A. 0. HOLBECKE showed the Left liemisphere of the

Brain of a child aged eight years, exhibiting a large abscesscavity from which about half a pint of most offensive pushad escaped. On making the post-mortem examination, asmall round perforation in the petrous portion of the

temporal bone was found, which communicated with theear on the one hand and the abscess cavity on the other.The dura mater was healthy. Thirteen weeks before deaththe child had received a blow on the ear, and complainedof much pain at the time. Subsequently her health becameimpaired, and a discharge of pus from the left ear appeared,the pain in the head becoming relieved. Several times thisdischarge disappeared, the pain in the head being alwayssimultaneously increased. There was no paralysis. Con-vulsions had occasionally occurred. She was rational, andanswered questions intelligently. Twelve hours beforedeath the discharge from the ear ceased, and she at oncebecame comatose and died.Mr. A. 0. HOLBECKE also showed the following specimens,

all taken from the same patient, aged sixty : - (1) AnUnunited Fracture of the Humerus. (2) Two Fractures inthe Femur, united firmly but irregularly, and causing muchshortening. (3) Two large Deposits in the Liver (togetherwith microscopic specimens of the same, prepared byDr. Barling), which presented the characters of carcinoma.(4) A Calculus removed from the Gall-bladder. (5) TheRight Kidney studded throughout with calculi ; the LeftKidney, presenting well-marked granular degeneration.The fractures had occurred last June. Her left mammahad been removed nineteen years previously for scirrhus.Her father died of cancer.Mr. JORDAN LLOYD showed a specimen of Central

Necrosis of the first Phalanx of the Index-finger withoutsuppuration, attended by the expansion of the whole boneinto a cyst with very thin walls, the cartilages beinghealthy. In another case Mr. Jordan Lloyd would try tosave the member by removing elliptical pieces from the bonyshell before proceeding to amputation.Mr. HuGH THOMAS showed the following specimens :-

(1) A Placenta studded with deposits of Calcareous Degenera-tion, and having an abnormally short cord (only eight incheslong), taken from a primipara, aged twenty-two, in whomante-partum haemorrhage, followed in eight days byprematurelabour, occurred about the seventh month of pregnancy; thechild was stillborn, the cuticle peeling off. (2) A specimenof Scirrhus of the Rectum, taken from a man aged fifty-seven,in whom after prolonged constipation death occurred fromperitonitis, set up by a perforation of the gut having occurredjust above the stricture, which was about an inch and a halffrom the anus. (3) A Uterine Fibroid, expelled by a womanaged forty, the mother of seven children, immediately afterparturition.

Mr. LAWSON TAIT read a paper on Death after Ova1’&Icirc;o’tomy due to Previous Tapping. The author drew atten-tion to the fact that amongst the last hundred ovariotomies(for cystoma) which he had performed there had been onlythree deaths. In all the deaths had been due to the forma-tion of a firm white clot, which started from the point ofligature of the pedicle and slowly traversed the venoussystem till it reached the heart, death ensuing in from thirtyto forty hours after operation. The symptoms which pre-ceded death were swelling of the legs, rapid rise of pulse,and its disappearance from the extremities some time beforedeath; breathlessness ending in suffocation, and slight deli.rium. He had seen several such deaths, but not one in apatient who had not been previously tapped. His explanation