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425 following perforation of the appendix with a concretion. He flsked what guide there was to operation in such cases. From personal experience he was not disposed to agree with Mr. Page as to the necessity of operating in recurrent cases.—Mr. SILCOCK quoted a case in which he had operated recently. His incision was a little to the outer side of the linea semilunaris ; he came upon the caecum immediately.- Mr. BRUCE CLARKE reported the case of a woman who, after a blow on her side, was found after an interval of forty-eight hours to have a local spreading peritonitis. He determined to cut down without delay, adopting the incision referred to. The distended cæcum was readily found, but the appendix had sloughed off, and was found in the pelvis with a concretion in the lumen at the orifice. There was a large aperture in the colon, but recovery was complete. He thought there was more difficulty in deciding as to operation in chronic than in acute cases.--Dr. LEES said that in the cases reported there was no yielding of the scar. The concretions were often true calculi.—Mr. PAGE agreed as to the yielding of the scar after rapid healing. He congratulated the College of Physicians upon their intention of getting rid of the term 11 appendicitis," and he thought the term " caput coli might follow. EPIDEMIOLOGICAL SOCIETY. A MEETING of this Society was held on Jan. 20th, Dr. E. 0. Hopwood in the chair. Brigade-Surgeon R. PRINGLE, M.D., read a paper in which he proposed to answer the question: What is efficient vaccination ? It was, he maintained, such a system as con- ferred an immunity against small-pox equal to that acquired by a previous attack, which rendered revaccination superfluous, and the isolation of the sick in hospitals, except for their better treatment, needless. He disputed the value of the cicatrices as a test of success ; for though a good cicatrix was positive evidence, so many accidents might interfere with the course of the successive stages in the development of the vesicles that after a normal incubation and papulation-which distinguished true vaccination from mere local (irritation, and which were best observed from the third to the fifth days-had been passed through, a scar might be left from which nothing could be learned. He denied the existence of any direct ratio between the number of inser- tions and the degree of protection conferred ; for when, as he had often seen in the Himalayas, some fifty men had been inoculated with the same variolous lymph by a single insertion over a space the size of a sixpence, and in the same place, the resulting eruption differed in every case, showing their dependence on individual susceptibilities under an identical mode of procedure. Dr. Pringle strenuously asserted the non-necessity of revaccination, which he had refused to practise during his thirty years of Indian service. He had been in consequence a marked man, but after his retirement he had his reward in the unwilling testimony borne to the suc- cess of the method by a hostile department when a special commission was appointed to inquire into the astonishing immunity from small-pox enjoyed by his dis- tricts at a time that the mortality in the North-west Provinces generally was awful—viz., in the epidemic of 1883-4. At first they were disposed to doubt the correct- ness of the returns, but they ended by ascribing the exemption from small-pox solely to the system of arm-to- arm vaccination he had carried on uninterruptedly for the twenty years from 1864. He quoted a remarkable passage from an ancient Hindu work, which showed that true vaccination was known and practised in India cen- turies before the birth of Jenner : " The small- pox produced from the udder of the cow will be of the same mild nature as the original disease....... the pock should be of a good colour, filled with a clear liquid, and surrounded by a circle of red....... There will be only a slight fever of one, two, or three days, but no fear need be entertained of small-pox so long as life endures. " Pasteur’s attentuation of virus by successive cultures has been applied in India for hundreds of years to inoculations with variolous lymph, which the document in question directed to be taken from "the most favourable cases," and he had seen series of such selected inoculations in which there was no general eruption, and the local phenomena were scarcely distinguishable from those of vaccination. Dr. WILLOUGHBY heartily agreed with Dr. Pringle as to the objectionable method of collecting the mixture of sanio-purulent and foreign matters supplied as calf lymph from the vaccine department of the Local Government Board, which he only used when it was demanded by parents, and he deplored the appalling amount of what! passed as vaccination among general practitioners and the public, but when put to the. test proved a delusion and a snare. But he could not concur in deprecating the practice of revaccination. Granting that it was needless, even if prac- ticable, when the primary operation was really perfect, and that its successful performance was evidence of that having been imperfect, what stronger argument could one have in favour of continuing it until all vaccinators had attained to Dr. Pringle’s ideal? One need but look to Germany, which up to the year 1874 was in much the same condition as England as regards vaccination, but had suffered heavily from the epidemic of small-pox in 1871-2, imported by French prisoners and carried by French refugees into other countries. The absolute exemption enjoyed by the popula- tion of Frankfurt at a time when the prisoners massed there were being decimated was rightly ascribed to the compulsory revaccination of every child at the end of its school life, which had been in force for more than a generation; and one of the first acts of the Imperial Parliament was to extend it to the whole empire. Since that, Germany had enjoyed an absolute immunity from epidemics, while the deaths in Prague had been 650, and in Vienna as many as 900 in a single year. Indeed, analyses of the cases reported throughout the empire showed that for some time past they had been exclusively among foreigners recently arrived, or the disease had been contracted from them by Germans who, born before 1860, had escaped the operation of the present law, and infants not yet vaccinated. Dr. COPEMAN entirely agreed with Dr. Willoughby on the value and purpose of statements as to number and area. Some authoritative directions there must be; the public vaccinators followed the official regulations, while many private practitioners made one small insertion in order to indulge the prejudices of ignorant parents, and it was almost wholly among these unfortunate children that cases of post-vaccinal small-pox occurred. The analbgy of all experimental inoculations proved that there was a ratio between the quantity of virus introduced and its effects, though not so absolute with living as with chemical poisons; and the area abraded approximately represented the probable absorption of lymph ; but it was especially im- portant in dealing with the children of the poor, whose arms were exposed to every conceivable form of septic infection, that the wounds should be so arranged as to dry and heal as early as possible.—Dr. PRINGLE agreed with Dr. Willoughby as to the superiority of lymph taken at the earliest possible period, at all events before the eighth day, but pointed out that the development of the vesicles depended on the tem- perature being more rapid in warm weather, and mostly so in children much exposed to the sun and air. In India, as was well known, vaccination could not be successfully performed in the hot season, though small-pox was then most rife, the progress of the vesicles being so unduly accelerated that the normal stages were not gone through. HUNTERIAN SOCIETY. A MEETING of the Hunterian Society was held at the London Institution on Jan. 27th, Dr. Stephen Mackenzie, President, in the chair. Dr. GALLOWAY exhibited a case of Peculiar Disturbances of Sensation, with Muscular Wasting due to Syringomyelia. The details of this case will be found on another page.- Dr. JACKSON concurred in the diagnosis, and to him Dr. Galloway was indebted for permission to exhibit the case.- Dr. STEPHEN MACKENZIE thought the diagnosis was justified, and referred to other cases.-Mr. OPENSHAW asked how the unilateral nature of the symptoms could be explained -Dr. TURNER remarked that he had seen one case on the post mortem table, being attracted to examine the cord by the extreme muscular wasting of the subject.- Dr. NEWTON PiTT remarked on the unilateral distribution of the symptoms and their slow progress. He had a speci- men of the joint affection due, on post-mortem examination, to a glioma of the cord, with distension of the canal.-Dr.
