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after 48 hours and the other symptoms gradually got lesssevere and by April 16th he was quite convalescent. Atonic mixture was then given and by April 20th he wascured. There was no desquamation.

In this case it is somewhat difficult to decide whether theinitial pain complained of resulted from the injury to theshoulder or whether it merely heralded the onset of theherpes zoster, the fall either precipitating the onset of theherpes or drawing the patient’s attention to the pain.The attack of influenza which subsequently supervened isinteresting because it was accompanied by a rash, a ratheruncommon though not unknown occurrence. That it wasinfluenza is proved because several people who came incontact with the patient contracted influenza and the nursesin attendance developed infiuenzal colds. The rash, too, hadnot the characteristic distribution of scarlet fever and therewas no subsequent desquamation.Kidderminster.

A CASE OF SUPERNUMERARY DIGITS.

BY WILFRID H. W. ATTLEE, M.D.CANTAB., M.R.C.S.ENG.,L.R.C.P. LOND.

THE accompanying illustration of the hands of a newlyborn male infant may be of interest. On each hand therewas an extra digit attached to the ulnar side of the little fingerby a soft pedicle consisting only of skin and blood-vessels.

Reproduction of photograph of infant’s hands showing super-numerary digits.

Each digit had a well-formed nail. In all other respects thehands were normal. The child’s l,arents are first cousinsand one of their uncles had a supernumerary thumb on onehand. This man would be the infant’s great-uncle.

T<!trm.

Medical Societies.BRITISH GYNAECOLOGICAL SOCIETY.-A meeting

of this society was held on July llth, Mr. W. D. Spanton,the President, being in the chair.-Dr. J. HutchinsonSwanton showed a specimen of Fibromyoma of the Vaginaand read notes of the case. This occurred in a widow,aged 40 years, who gave a history of five pregnancies andfour abortions, the last being five years previously. Theclinical history was one of endometritis. The tumour wasdiscovered in routine examination high up on the anteriorwall and presented no symptoms. Removal was recom-mended as it increased in size recently. It was found tobe a pedunculated fibromyoma measuring three-quarters byone-third of an inch.-In the discussion which followed Dr.H. Macnaughton-Jones said that such tumours were compara-tively rare. It was important to know whether they becamedegenerated or malignant. Such growths were sometimessarcomatous.-Professor J. W. Taylor had met with similargrowths four times and in one instance it recurred threetimes after removal, although on examination presenting thehistological characters of a myoma.-Dr. J. J. Macan raisedan interesting point in the pathology of these tumours.-The President said that the question centred aroundthe possibility of these growths becoming malignant.-Dr.Swanton also showed a specimen of Cystic Adenocarcinomaof the Ovaries and Vermiform Appendix removed from a

patient, aged 69 years, originating in cystic growths andbecoming malignant.-The President remarked on the ex-

treme malignancy of these growths when arising in such amanner.-Dr. A. E. Giles commented on the diagnosis and saidthat carcinoma of the ovary was not often directly diagnosed,especially where there was no free fluid.-Dr. Macnaughton-Jones considered that the prognosis depended upon theescape of carcinomatous fluid into the peritoneum or not.-Dr. Macan said that malignant disease very frequently in-volved both ovaries, although not in an equal degree.-Dr.E. A. Neatby wished to know whether ovarian carcinomaoccurred more frequently as a primary or secondary condition.He related an interesting case where recurrence took placein the adjacent intestine some months after removal of theovarian tumour.-Dr. Macnaughton-Jones showed a specimenof Large Myoma removed from an unmarried patient, aged 32years, who complained of menorrhagia and secondary anasmia.The growth was encapsuled by peritoneum and arose fromthe right of the body and cervix burrowing under the peri-toneum. Another peculiarity was the presence of a lymphaticsac which seemed like the dilated and thinned-out body ofthe uterus undergoing degeneration. Both ovaries wereremoved as they were cystic and had degenerated.-Pro-fessor Taylor thought the cavity might be accounted forby the separation of layers of the peritoneum.-The Presidentconsidered that the condition might be explained as beingthe result of peritonitis.-Dr. Swanton showed a Cyst of theClitoris removed from a patient, aged 20 years, who thoughtthat it was due to trauma and commenced three months pre- ‘viously. The growth was situated at the anterior extremityof the left labium minus, being three-quarters of an inchacross. The clitoris and cyst were removed. The contentsconsisted of blood, pus, and sebaceous matter.-ThePresident thought that such cases were rare and suggestedthat it mi2’ht have had an orierin similar to that of vaginal

cysts.-Professor Taylor thought that the position was un-usual and regarded it as a suppurating sebaceous cyst.-Dr.Macan said that such cysts were very rare. In the absenceof further microscopical details it was difficult to decideas to the nature of the cyst.-The President then deliveredhis valedictory address and said that the amalgamation ofthe societies would act as an incentive to closer observa-tion and more scientific methods. He hoped that the pro-vincial members would come forward in the future as in thepast. The death of the society meant but an entrance intoa higher life of greater usefulness and enlarged opportunitiesin communion with similar interests. He then gave a resumeof the work accomplished by the society during the last23 years. The first specimen shown was a multiple uterinemyoma removed by hysterectomy. The view then expressedwas that now held that to extirpate a tumour simplybecause it was a tumour which gave little or no troubleimplied taking a responsibility on the part of the surgeonwhich he ought to decline. Other subjects discussed includedmatters such as asepsis, antisepsis, puerperal septicaemia,Porro’s operation for cancer of the uterus, electrolysis infibroid tumours as advised by Apostoli, myomata and preg-nancy, morbid pelvic states and associated mental conditions,and displacement of the uterus and the use of mechanicalsupports. During the short session now brought to a closethe subjects were of a practical nature and included uterinehaemorrhage, membranous dysmenorrhcea, prolapse of theuterus, inflammatory diseases of the appendages, mobilekidney, and the treatment of general peritonitis.-Heartythanks were accorded to those who assisted in bringing aboutthe amalgamation.-The meeting unanimously agreed-That we desire to record our appreciation of the courtesy and

cordiality with which the Obstetrical Society of London united withour society in their arrangements for amalgamation.

-The meeting then terminated and the President signed theminutes.

EDINBURGH OBSTETRICAL SOCIETY.-A meetingof this society was held on July 10th, Dr. J. W. Ballantyne,the President, being in the chair.-Professor J. A. C. Kynoch(Dundee) read a paper on a Series of Five Cases of CassareanSection for Contracted Pelvis. Three of the patients had beenborn in Glasgow. The first patient was in her secondpregnancy ; in her first she had been delivered of a stillbornchild by version, after repeated attempts with forceps inWalcher’s position had failed. The true conjugate was aboutthree inches, the pelvis being of the small, flat, rickety type.The case was unfavourable for the performance of inductionof premature labour. The mother and child did well. The

164

second patient was a primipara in labour for 24 hours, witha true conjugate under two and a half inches ; both did well.The third patient was in her second pregnancy ; the firstchild was delivered by craniotomy ; her true conj ugate wastwo and three-quarter inches. She was operated on near tofull time ; the child lived but the mother died from septicperitonitis. The fourth patient was a primipara in labour forseven hours ; her true conjugate was two and three-quarterinches ; both did well. The fifth patient was a primipara inlabour with a true conjugate of two and three-quarterinches ; both mother and child recovered. The survivingmothers all nursed their infants. Professor Kynoch dis-cussed the question of sterilisation and considered that if thepatient was intelligent enough to understand the situation,and if she was willing to undertake the risk of a secondoperation, then sterilisation might be omitted at the firstoperation. Many cases had been reported where theoperation had been repeated successfully two, three, or

four times on the same patient. In Frau Rittgen’s caseit proved fatal at the fifth repetition of the operation.In all the cases reported Professor Kynoch had sterilisedthe patient by ligature and division of the tubes ;this he considered a trustworthy enough method andsafer to the patient than hysterectomy, which should berestricted to cases of atony and suspected infection of theuterus. Some recommended waiting till labour had begun,as they thought there was less chance of haemorrhage fromuterine atony and that a dilated condition of the cervixinsured free drainage of the lochia. The first fear wasgroundless, as the uterus contracted quite as well before asafter the onset of labour. A dilated condition of the cervixwas of the greatest importance. In the first two cases Pro..fessor Kynoch incised the uterus between the bars of a fl3.tvulcanite pessary, as recommended by Cameron, to diminishhsemorrhage from the uterine incision, but in the latter caseshe discarded this method and did not find any markeddifference in the amount of bleeding as a result. Furtherhastnorrhage in the course of the operation was best con-trolled by grasping the broad ligaments and subsequentlymaintaining uterine contraction by sponge pressure. Theuterine incision in all cases was a vertical one; the trans-verse incision of Fritsch did not seem to have proved itselfin any way superior. If sterilised towels were well packedround the uterus it was not necessary to adopt Miiller’s

suggestion of eventrating- the uterus before opening into it,as this involved a very large abdominal incision. But afterthe uterus had been emptied of its contents and as a conse-quence diminished in bulk the introduction of the uterinesutures was facilitated by bringing the uterus outside theabdomen.-Dr. A. H. F. Barbour, Dr. J. M. Munro Kerr, Dr.W. Fordyce, Dr. J. Lamond Lackie, and the President maderemarks on the paper, and Professor Kynoch replied.-Dr. James Lochhead read a paper on the CarbohydrateMetabolism of the Foetus. The part played by carbo-hydrates in the metabolism of the foetus was discussed withspecial reference to the glycogen. An attempt was made totrace the changes which carbohydrates undergo in theirpassage from the maternal to the foetal organism.-Dr.Barbour, Dr. James Ritchie, Dr. B. P. Watson, Dr. M.Campbell, Dr. Fordyce, and the President discussed thesubject, and Dr. Lochbead replied.-Dr. Seichu Kinoshita,professor of gynaecology and obstetrics of the Imperial Uni-versity, Tokio, Japan, was elected an Honorary Fellow.

Reviews and Notices of Books.The Nutrition of X,-,n, By Professor RUSSEL H. CRITTIPNDEN

of Yale University. With illustrations. London : WilliamHeinemann. 1907. Pp. 321. Price 14s. net.

THIS new work by the author of " Physiological Economyin Nutrition." which was reviewed in THE LANCET of

July 8bh, 1905, p. 84, covers to a considerable extent theresult of the researches set forth in that work. Since the timewhen Professor Chittenden studied under Iiuhne few men havedevoted themselves more assiduously to the study of the

problems of nutrition in man. Indeed, in the United Statesthis is a subject which has attracted great attention.

Authors, such as Atwater and the workers for the U.S.

Bulletin, have done an enormous amount of useful work.In the end the object is the study of human nutrition.The present book is the outcome of a course of eight

lectures which have been delivered before the LowellInstitute of Boston during the present year. The firstthree chapters-on Foods and their Digestion, Absorption,Assimilation, and Metabolism-do not contain anythingnew, but give a very readable account of these subjects.We may in passing give an example of the happyexpressions from the work of Dr. Curtis on "Nature andHealth" " to which reference is occasionally made. "Alongsideof its brother proteid gelatin stands as a prince of the bloodwhose escutcheon bears the bend’ sinister. Such a one,

though of royal lineage, never aspires to the throne."This has reference to the fact that gelatin cannot even go tomake the very kind of tissue of which itself is a derivative.We are treated to the results of Pawlow’s work in connexionwith the assthetics of eating in relation to their importantinfluence upon the flow of digestive secretions. Perhaps thefollowing may interest the reader-viz., that the quantity ofhydrochloric acid secreted by the stomach by the normalindividual under ordinary conditions of diet amounts

to what would constitute a fatal dose of acid iftaken at one time in concentrated form: While threedistinct ways-all reflex-are admitted for the flowof gastric juice into the stomach as a prelude to

gastric digestion, and -although secretin is treated of inoonnexion with pancreatic digestion, we failed to finda reference to the part played by gastric secretion as

pointed out by Edkins. The curdling of milk in thestomach causes the casein to remain for -a longer period inthe stomach, like any other food, and its partial digestionby gastric juice to be made certain. Hence, for thesereasons milk should not be treated as a drink in our

daily diet. Each animal has its own particular typeof proteid adapted to -its particular needs. This leads

to the ingenious theory of Abderhalden that the intes-tinal ferments ultimately split up proteids, leaving, how-ever, a very resistant residue, non-proteid in nature,which is termed polypeptid and which may serve as a

starting point for the synthesis or construction of new pro-teid molecules. Cohnheim’s researches, however, go to showthat ferments break down proteids completely. At most,however, digestion is the handmaiden of nutrition. Wecome across the following remark : " How wise the provisionthat all sugar should pass from the alimentary canal into theportal system." We find no reference to Heidenhain’s

explanation. The importance of intracellular enzymes is

emphasised; indeed, in all tissues and organs of the

body there is present a large number of enzymes ofdifferent types, endowed with different lines of activityMan’s body is always in a state of unequilibrium ; it is a

sort of "maelstrom" of continuous chemical changes anddecomposition at the expense of the proteids, fats, andcarbohydrates of the food and tissues with the liberation ofthe stored-up energy of these organic compounds.

It is in the chapter on the Balance of Nutrition thatthe author foreshadows his views. One fact of import-ance is that the nitrogen outgo tends to keep pace withthe income of nitrogen, the body always striving to main-tain a condition of nitrogen equilibrium. The human

body does not store up proteid, no matter how greatlythe tissues are in need of replenishment. In man it is-

impossible to accomplish any large permanent storing offlesh by over-feeding and the muscular strength cannot begreatly increased by excessive intake of food. Marked

permanent deposition of flesh is connected with the re-

generative energy of living cells." Race and individualitycount for much. " A given diet with Cassius may lead to-different results than with Anthony." Obviously, the dietmust depend largely on the muscular work done, and this in