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was dulness. The patient had suil’ered from epigastric pain.Further examination showed that the axillary glands on theright side were enlarged. The heart’s action was feeble,and there was a feeble pulse at the wrist. There was nofever, and neither the spleen nor the liver was enlarged.The specific gravity of the urine was low-1013. The hloodshowed many red corpuscles irregularly flhrivelled and aslight excess of leucocytes. Either organic changes in thecapillaries or else vaso-motor derangement was suggestedas the cause of the commencing gangrene of the fiagers.Obstructive arteritis was not uncommon in females, andaffected the upper extremities.-Mr. BOWLBY said there wasno evidence of arterial damage in this case, and suggestedthat the lesions were due to the spread of the new growthsalong the nerves which supplied the arms.A large number of card specimens were exhibited :-Dr.

Samuel West : Stomach from a case of Carbolic AcidPoisoning. Dr. Sharkey: (1) (Esophagus, Stomach, andIntestine, from a case of Carbolic Acid Poisoning; (2) Lodg-ment of Fish bone in Larynx. Dr. F. C. Turner : (1) Tuber-culosis of Lungs with Caseous Bronchial Glands and Tuber-cular Meningitis after Searlatina ; (2) Intussusception of thesmall Intestine with Polypoid Fatty Tumour. Mr. H. H.Clutton : (1) Nasal Calculus ; (2) Central Myeloid Sarcomaof the Head of the Tibia, which produced no expansion ofthe bone. Mr. J. Hutchinson, Jun. : (1) An instance of

Anchylosis of Second and Third Cervical Vertebræ ; (2) AHeart with Superior Vena Cava on the left side. Dr. Good-hart showed for Dr. Pye-Smith a specimen of Chronic Ulce-ration and Thickening of the Tracheal Mucous Membranefrom the presence of a rubber tracheotomy tube. Dr. R. PercySmith: Stomach from a case of Sulphuric Acid Poisoning.Mr. Makins : A specimen of Obstruction of the Trachea in achild from pressure by bronchial glands. Mr. Golding Bird:Some Micrococci from a case of Infective Osteo-myelitis.Mr. Lockwood: A Right Aortic Arch. Mr. R. Williams: Twophotographs of cases of Congenital Absence of the Femora.

MEDICAL SOCIETY OF LONDON.

Annual Meetiikq.-Cliolei-a Epidemic.THE annual general meeting of this Society was held on

Monday last, Sir Joseph Fayrer, President in the chair.The annual report of the Society was read by Dr. IsambardOwen, the retiring honorary secretary. It showed that thecondition of the Society was very satisfactory. Its accom-modation had been greatly improved, and the number of itsmembers had largely increased, and the interest as well asthe attendance at the meeting had been more than main-tained.Dr. ALL CHIN, the honorary librarian, read a report on the

condition of the library, which pointed out that in spite ofthe efforts made the work of cataloguing the library wasstill incomplete. The books, ho wever, had been arrangedon their shelves in such a manner that any volume requiredcould be readily found. The library was rich in works ofthe 16th and 17th centuries, but poor in more modern works.This want would be gradually filled up as opportunity wasafforded, and special efforts were being made to do this asspeedily as possibly. The report was adopted, as well asa vote of thanks to Dr. Allchin.Dr. BRODIE SEWELL proposed in graceful terms, and Dr.

SYMES THOMPSON seconded, a vote of thanks to the retiringPresident, Sir Joseph Fayrer, which was accorded withenthusiasm. In reply Sir Joseph said that he had done hisbest to promote the interests of the Society during theterm of his office. He thought this Society was related moreintimately to the great body of the profes&ion than anyother Society of London.Dr. DE HAVILLAND HALL proposed, and Mr. SYDNEY

JONES seconded, a vote of thanks to the retiring vice-presidents, the retiring secretary, and other members of theCouncil.Mr. H. WORDSWORTH, Dr. ISAMBARD OWEN, and Dr.

EWART replied.The list of Fellows elected for office during the coming year

is as follows :—President, Mr. Arthur Edward Durham.Vice-Presidents, Dr. John Brunton, Mr. Alfred Cooper, Dr.Richard Douglas Powell, Mr. Sydney Joneq. Treasurer,Mr. Alfred Wiltshire. Librarian, Dr. William HenryAllchin. Honorary Secretaries, Mr. Alfred Pearce Gould,

, Dr. James Kingston Fowler. Secretary for Foreign Corre-cpondence, Sir William Mac Cormac. Council, Mr. SamuelBenton, Dr. Thomas Lauder Brunton, Mr. R. BrudenellCarter, Mr. Samuel Caltwright, Dr. John Cavafy, Dr.Henry Radeliffe Crocker, Mr. John Henry Drew, Sir Joseph

, Fayrer, Dr. lIeneage Gibbes, Dr. K De Havilland Hall,Mr. Jonathan Hutchinson, Mr. Edward Lund, Mr. FrancisMason, Mr. Edmund Owen, Dr. Isambard Owen, Dr.

. Arthur Ernest Sansom, Dr. Charles Brodie Sewell, Dr.Thomas Gilbart-Smith, Dr. Wi!liam Heath Strange, Dr.William Henry White.

Sir WILLIAM HUNTER then read his paper on the late. Epidemic of Cholera in Egypt. This address was practicallyv the same as one which was read before the Epidemiological

Society, and has already appeared in our columns.-In thediscussion which ensued, Dr. THEODORE ACLAND testifiedto the insanitary state of Cairo. ’ He thought that confusionas to the contagiosity of cholera arose from want of definite.ness in the use of the term contagious. He considered thatcholera might be contagious though the contagium couldnot be demonstrated. Among the Army Hospital Corps inEgypt who were engaged in nursing the sick, the numberwho contracted the disease was three times greater than in

, the army generally. But with regard to the spread ofcholera by water, he would pnint out that two battalionsstationed a short distance above Boselak, on the Nile, sufferedseverely from cholera, while those who were stationed belowsuffered very slightly.-Dr. MARSTON said it was onlypossible in the course of a few minutes to advert to a fewpoints. After briefl alluding to the study of cholera fromthe standpoints of the epidemiologist and local and clinicalobserver, he said that as regards Egypt direct importation

, had been disposed of ; but was it meant that cholera had long: existed in that country, manifesting itself occasionally

epidemically in the intervals byslight and less severe forms?He doubted whether insanitary causes alone were capable ofcausing an epidemic of that disease. The cholera death-rate,increasing inBeDga.1 in 1881, had in 1882 been greatly inexcess ot the average of the previous five years, and thisepidemic influence or condition had not extended to thePunjaub. Had its movement had an effect on Egypt ? Ifallthe real and alleged cases from contagion were true, theywould still form a perfectly inadequate explanation of anepidemic ; and, as regards a cholera-infected water, it mustbe remembered that in India an epidemic always went from

. the plains below up to the hills, and contrary to the course, of the rivers. Cholera often broke out first in the. hospital of a station, and he thought that the continuous

occupation of these buildings might have an influence.—Drs. Hocc, CULLIMORE, and SiMMS made a few re-

marks, and Dr. MURRAY repeated the arguments he had. used at the Epidemiological Society.-Sir J. FA YRER thought

the question of the mode of spread was still in abeyance. Hecould not believe that a small material entity had much to do

with those vast epidemic waves which depopulated districts.! -Sir WILLIAM HUNTER, in reply, said that cholera might

spread against the water, or with it; against the wind andwith it ; in fact, it was governed by no special laws in theserespects.

HARVEIAN SOCIETY OF LONDON.

A MEETING of this Society was held on Feb. 21st, Mr.George P. Field, in the chair.

Wet-packing in Scarlatinal Dropsy.-Dr. DAY read notesof a case of Scarlet Fever, followed by nephritis, convulsions,and death, temporarily relieved by wet-packing. Thepatient, a boy aged seven, was first seen by him on Oct. 1st,1883, when he was covered with a bright scarlet rash, havingbeen apparently in his usual health the previous day. Thethroat, cervical glands, and kidneys were severely affected,and albumen and blood appeared in the urine. On the 18thscarlatinal dropsy set in, which almost disappeared underwet-packing. On the 20th there were diarrheea and vomiting.On the 23rd the patient was seized with convulsions anddied. Attention was drawn to the extreme brightness ofthe rash, which was distinct on the tenth day of eruption,and to the dropsy, which the author did not considerfrequent when the skin was so much involved. Hethought the wet-pack was of great advantage in excitingfree cutaneous action and in relieving the anasarca. Healso alluded to cases of scarlatinal dropsy without albu-minuria, and quoted several authoiities on the subject.-

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The PRESIDENT, in commenting on the paper, referred tothe frequency of suppuration within the tympanum afterscarlet fever, and to its treatment by early paracentesis.-Dr. MAHOMED called attention to the present rarity of post-scarlatinal dropsy as compared with former returns ; at theFever Hospital hardly more than two or three cases wererecorded in the year. This result he attributed to the earlytreatment of the nephritis, none being more successful thansharp purging and leeches to the loins. Dr. Mahomed boretestimony to the usefulness of Dr. Oliver’s test-papersmercuric-iodide) as a ready means of proving conclusivelythe absence of albumen from any urine.-Dr. CLEVELANDinsisted on the therapeutical value of the perchloride of ironin cases of bematuria.Prognosis in Structural Diveases of the lIeart. - Dr.

BROADBENT read an important paper on Prognosis inStructural Disease of the Heart, in continuation of the

subject of the recent Harveian Lectures, in which prognosisin valvular disease had been mainly considered. The paperdealt with the conditions of fatty degenerations of the heartand of cardiac dilatation in an exhaustive manner, whichdoes not admit of any adequate report being furnished here.It is understood that the paper will be published shortly.-An able discussion, in which Dr. STEPHEN MACKENZIEand Dr. MAHOMED took part, was fo lowed by a reply by’Dr. BROADBENT, and the meeting was adjourned.

ACADEMY OF MEDICINE IN IRELAND.

A MEETING of the Surgical Section was held on Jan. llth.After the exhibition of living and card specimens,Mr. WM. STOKES read a paper on the Radical Cure of

Hernia by Peritoneal and Intercolumnar Suture. Havingalluded to the fact that the subject of the radical cure of’hernia had from remote antiqnity to the present engagedattention, he mentioned that although it could not be saiddefinitely that the wished-for goal had been attained, still,thanks to Listerism, much had been gained. In proof ofthe fact that the feasibility of obtaining radical cures byoperation is a question sub judice, he referred to the writingsof various eminent surgical authorities, some of whom areopposed to, and others in favour of, such attempts beingmade. The object of the various operations hitherto per-formed—namely, obliteration of the neck of the sac withapproximation and union of the tendinous structures aboutthe hernial passages, and also the methods of " dissection "-was discussed ; and the author believed that the methodrecently adopted by himself and his colleagues was simplerand more efficacious than any of those he mentioned. Itconsists in the insertion through the open neck of the sacand close up to the external abdominal ring of a deeplyindented carbolised catgut suture or sutures, according tothe size, width, and depth of the neck, and this is followedby the approximation or closing of the canal and pillars ofthe ring by the insertion of two or more sutures of a strongeror more durable material, such as chromicised catgut, giltor silver wire. In fact, it was a dual system of suture, onebeing peritoneal and the other intercolumnar. Four caseswere recorded in which this plan was adopted. In three ofthese successful results were obtained. The unsuccessfulcase was one of congenital inguino-scrotal hernia. Thehernia reappeared three months after the operation. Thefailure was probably due to not having used a sufficientlydurable material for closing the pillars of the ring, thatwhich the author employed being chromicised catgut. Infuture he would employ in similar operations either carbolisedsilk or silver wire.Mr. BARTON also read a paper on the Radical Cure of

Hernia. At the outset he laid down the principle of treat-ment-viz., that the internal ring should be so effectuallyclosed as to prevent the hernia coming down into the canalat all. He described Wood’s operation as a combination of’this and of the old plan of invagination, which latter shouldbe discarded and the closure of the rings perfected. Thedirect operation was recommended, freshening the edges ofthe ring, as recommended by Gross, or cutting away the sac,as prescribed by Czerny.Mr. KENDAL FRANKS read a paper on the Radical Cure

of Hernia by the Method of Dissection, the name which hasaptly been applied to it in Dublin. The only two methodswhich seemed to him to give promise of extensive applica-tion in the future were (1) suture of the abdominal openingswithout removal or ligature of the sac, and (2) suture of the

abdominal openings after excision of the sac. The first ofthese operations was applied to recent hernia before the sachad had time to become enlarged and thickened. Themethod consisted essentially in cutting down on the tumour,carefully exposing the sac, which should be return:d into theabdomen, and then drawing together the openings by means oftwo or three sutures of stout silver wire, which should be leftpermanently in position. He advised that the skin should bedrawn slightly upwards before the first incision was made,as by that means the skin would not lie directly over

the wires. Thus union by first intention was promoted,and the p. rmanent retention of the silver wire assisted.

Mr. W. THORNLEY STOKER said there were two distinctclasses of cases, the class in which operation was compulsorywhere strangulation existed, iud the class where operationwas a matter of election to promote the patient’s conveniencerather than save his life. In nearlv a’l ca,es of operationfor femoral hernia a permanent cure had been effected ; butin large inguinal ruptures a radical cure was not so frequent,and in such cases the peritoneum should be sutured. Inthe second class of cases he advocated Wood’s operation.He did not think it mattered much whether the pillars of thering were drawn together or not. A cure was effected bythe inflammition exciting the exudation of coagulum andlymph which drew the parts together, thereby closing theopening as with a cork. He protested against leaving in thewire suture where the ring was sutured in inguinal herniaas most unscientific and a possible source of future trouble.-The PRESIDENT mentioned the result of nine cases inwhich he had operated by different methods. In a caseof inguinal hernia on the left side, in a male, he exposedthe neck of the sac. He then drew it down and applieda ligature, divided the neck and removed the sac belowthe ligature. This case was successful when seen twoyears afterwards. He performed a similar operation in thecase of a female suffering from a small inguinal hernia in thecentre and above Poupart’s ligament which became strangu-lated, and she was perfectly cured, having been seen fiveyears afterwards. In a femoral hernia on the left side, in afemale aged eighteen, he opened the sac, pulled down,excised, and closed the edges, and the result eighteen monthsafterwards was most satisfactory. He adopted the dissectionmethod in other cases, but without improving the hernia.In cases where the canal was greatly distended by a largehernia it would be almost impossible to have a radical curefollow any radical measure, and the most likely was byexcision of the sac.-Dr. McARDLE observed that it wasalmost impossible to bring the edges sufficiently closetogether to keep behind the eac, and that the irritation ofthe veins was likely to produce phlebitis. Having regardto the lateness of the hour, the further discussion was on themotion of Mr. Ormsby, seconded by Dr. McARDLE, adjournedto a special meeting. -

A meeting of the Medical Section was held on Jan. 18th.Dr. H. V. DILLON read a paper on a case of Bronchitis

and Emphysema, with loss of taste and partial loss ofdeglutition, subsequent to injury of the upper cervicalvertebrae. The facts were these :--D. S-, a pensioner,aged thirty-eight years. Health always good till injurywas received. Served seventeen years in the British army,during which time he suffered from dysentery and ague;had had gonorrhoea, but no specific disease. On Jan. 17tb,1881, as he was sitting on the forecastle of a ship, a sailorfell from the yardarm on to the back of D. S-’s head,bending it and his neck forwards. D. S- felt at the time

as if something had given way at the back of his neck. Heheard a noise at the seat of injury, and then became uncon-scious, remaining so for about fifteen minutes. On comingto he felt excruciating pain at the seat of injury, which

lasted for six months and radiated along the back of thehead. At the expiration of this time a hardened enlarge-

ment was remarked at the back of the neck over the threeupper cervical vertebrae in the mesial line. A few months

i subsequently he got an abscess of the left internal ear, which, discharged externally from July, 1881, to July, 1883. The

auditory canal became almost completely closed, and hearingwas lost at that side. Subsequently cough and dyspnoea

! came on, and havelasted since. The lungs are emphysematous,i and he suffers from bronchitis, huskiness of the voice,3impaired power of deglutition, and partial loss of taste.Five months after the left ear trouble ulceration took place3in the upper gums, the teeth loosened, and later on therewas necrosis of the alveolar process of the superior maxilla,