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of aneurism which could not be cured by other means ofcompression were not suitable for the application of the flatligature. Asimilar mode of temporary obstruction was devisedby Mr. Dix of Hull some years ago, consisting in a wire loopplaced round the artery and secured over a piece of cork.He thought much evidence was required before the fact oforganisation of an animal ligature could be admitted. Hehad examined six or seven vessels some weeks after ligatureby carbolised or non-carbolised catgut, and although hehad seen new vessels around the material he could not be-lieve they had been formed at its expense.-Mr. SAVORYthought it strange if dead matter could be converted directlyinto living tissue. Several years ago it had been shownthat masses of dead tissue introduced into the living tissuesbecame infiltrated with leucocytes ; but the inferencewas that the leucocytes had proceeded from the irritatedliving tissues, and had absorbed the dead material. InMr. Dent’s case new vessels appear to have formed in thedead substances. The same criticism was applicable to thesubject of organisation of blood-clot about which so muchhad been heard lately. John Hunter studied it, and someof his specimens were in the College of Surgeons’ Museum ;but in his cases he dealt with living and not dead clots. Itwas different in the case of large masses of blood-clot inwounds, masses which must be inert and act as foreignmatter; which could not organise, but which might be

replaced by new tissue proceeding from the living partsaround. If an animal ligature could organise it would beimportant to know from what source it was prepared, andwhether it was old or recent.-Mr. HOLMES, from his ownlimited experience, had arrived at a different conclusionabout the efficacy of animal ligatures to that of Mr. Bryant.He fancied Mr. Barwell had slightly exaggerated the differ-ence in the action of a ligature of flat shape as comparedwith a round one ; for he (Mr. Holmes) had been able onthe dead subject to divide the internal and middle coatspartially or completely by means of the flat ligature whentied sharply. In the two cases in which he had triedMr. Barwell’s ox-aorta ligature the vessel was permanentlyoccluded, one was a case where he had tied the iliac forrapidly enlarging iliac aneurism with good result; the

patient was long under observation (requiring two amputa-tions before his discharge), but the aneurism remained per-fectly occluded. In another case, where the patient died inconsequence of a debauch two weeks after operation, the liga-ture was found firmly attached to the artery, which was quiteclosed. In a third case, where two arteries had been tied,they were found occluded by a diaphragm, as in Mr. Treves’scase, the ligatures having disappeared. The evidence, so

far as it goes, is in favour of the permanence of these liga-tures, and that an artery may be safely occluded whetherthe material used be oxen aorta or tendon. It had beenexplained that the ligatures did not themselves becomeorganised, but that they disappeared, and were replaced bya ring of fibrous tissue. That such a replacement was notpeculiar to healing under antiseptics was shown by this caseof Mr. Pollock’s and Mr. Dent’s, where no antiseptics wereused. It seems that these animal ligatures may be invadedby leucocytes and caused to disappear, new tissue takingtheir place; and this is now allowed by Professor Lister tobe what is meant by " organisation " of the ligatures. So alsoin the case of blood-clot, the actual organising elements andnew vessels being supplied from the surrounding tissues, thewalls of the arteries, &c., surrounding the clot. It is quitepossible that an animal ligature may excite this formativeinfluence, and its results could not be compared with theeffect produced by acupressure.-Mr. BARWELL was notsure that inert matter would not take on vital propertiesagain, and thought that skin-grafting was an instance inpoint. In a recent case of a large burn, where the "grafts" "did not take on the granulating surface, he had found thatminute portions of the inner coat of the ox’s aorta placed onthe surface became converted into a distinct epidermis, othersof them melting down into pus. He reminded Mr. Bryantthat at the last meeting of the Society he had recordedtwelve cases in which perfect occlusion had followed the useof the oxen ligature, and had been able to show the speci-mens from two of these cases ; so that the flat ligature in noway resembled acupressure in its effects. The question asto the need for the division of the inner and middle coatswas different now than when Dr. Jones wrote, for at thattime ligatures were used which subsequently came away byulcerating through the outer coats. Now, however, we haveligatures which can be left on the vessels, and which do close

arteries permanently. It was essential that the animalligature, whether tendon or not, should be used first, or

should have been dried when fresh; for if putrefaction takeplace in it its characters are altered and its efficacy impaired.- Dr. B. O’CoNNOR said that a short time ago he examinedmicroscopically a mass of lymph lodged at the inner end ofa drainage-tube, which had been removed by Mr. Lister.This lymph, which was not in contact with living tissue,contained distinctly small vascular branches. In reply toMr. Page, he added that the drainage-tube had been irz sit7tabout four days.-Mr. DENT, in reply, said that the discus.sion showed that questions were still unsettled which hadbeen thought to be determined by Dr. Jones. He men-tioned that in one of Dr. Jones’s experiments a septum wasformed in the artery precisely like that lately described byMr. Treves in a vessel tied by the carbolised catgutligature. In the present case there was microscopicalevidence that the inner coat had been ruptured, and thatthe artery was permanently occluded. In the subclavianartery, where only a tendon ligature was applied, the clotswere not so large and well-formed as in the carotid, wheretwo ligatures, one tendon and the other catgut, had beenused. As to "organisation," one of the specimens showedvascularising lymph between the two occluded ends of theartery, at a distance from the tendon ligature ; and hebelieved the view taken by Mr. Savory and Mr. Holmes wasprobably the true one. Mr. Stirling, who had broughtthese kangaroo tendon ligatures from Australia, had selectedthem because of the readiness with which they were pre-pared. Ligatures of whale tendon had also been suggested.Mr. Dent had used them as sutures, and found themtoo thin and too readily dissolved in the tissues. Therewas no reason why the same material should not beused as a round rather than a flat ligature ; the greatadvantage claimed for it over catgut being the time it remains unabsorbed.The Society then adjourned.

MEDICAL SOCIETY OF LONDON.

I Presaclent’s Addrcss.-Pscudo-hYPc1’trophic Paralysis,AT the meeting on the 14th instant the chair Ava,3

taken for the first time by the newly-elected President,Dr. BROADBENT, who deliveied an opening address, in thecourse of which he recommended the Fellows to be ever

jealous for the welfare and reputation of the Medical Society,and remarked that if, by any chance, the Society shouldcease to exist, it would become a positive necessity thatanother society, formed on similar lines, should at once beset on foot. He mentioned that the objects of the Societywere general, and they therefore required not only the ex-perience of the hospital physicians and surgeons, but alsothat of the general practitioner, who was here enabled tobring forward each week notifications of the morbid pro-cesses met with in his practice, and relate them to theFellows, details which gentlemen of the former class werequite unable to supply. He said-" There is a want of

opinion on all subjects from all professional sources, andsuch a want this Society supplies. Such reports as are re-ceived must, of necessity, influence both our views and ourpractice. Moreover it is the duty of the seniors to place theresults of their experience before the juniors, and it is theprivilege of juniors to hear and derive profit from them.The present time is the seed time for the younger practi-tioner ; a thought planted in the brain, flowers and bearsfruit almost unconsciously." He invited Fellows to bringforward communications for the advancement of medicalscience.

, Dr. DOWSE then exhibited a patient suffering from. Hypertrophic Paralysis. The father and mother were both, healthy; the patient, a boy of eleven, was a delicate,. sickly-looking lad, one of five children, three of whom hacl, died of bronchitis. The mother stated that when a childI the boy was always backward in getting about, fairly intel-; ligent, but weak about the loins, and not able to walk likej other children; she also noticed his calves were harder and, larger than they should be, whilst the other muscles of the! body were wasting away. Dr. Dowse drew attention tothe history of this disease and to its pathology, observing

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that the following points were essential to diagnosis :-First, peculiar gait of the patient both in walking andstanding, the hip and lordosal spine being more or less fixedand erect, the boy walking upon the toes owing to the con-traction of the Achilles tendon; secondly, the enlarged andhardened condition of the muscles of the calves; thirdly,the instability of the normal equilibrium of the body; and,fourthly, the peculiar way in which the lad raises the bodyfrom the prone to the erect position by placing the handsupon the knees and thighs, progressing from below up-wards.Dr. RADCLIFFE CROCKER showed a case of Pseudo-hyper-

tropnic Paralysis, which had been under his care at theEast London Hospital for Children from within three monthsof the noticed commencement of the disease until the presenttime-a period of eleven months. The patient was a boyaged seven years and a half, in whom the disease com-menced at the age of six years and nine months. Whenfirst seen on July 31st, 1880, he could get up from the flooras readily as a healthy boy, but he was always falling down,mostly forwards. He stood with his knees a little bent, andhis head slightly thrown back ; his left foot dragged a littlewhen he walked, and his calves were large and hard.Mentally he was normal, and physically well nourished. Hewas the fourth child ; the three previous had died beforethey were twelve months old, but not of any nervous disease.There was no history of similar disease in the family. Hewas not seen again until Dec. 6th, 1880. Both legs nowdrag distinctly, but the left more than the right. He couldstill get up very well, but the knees were more bent. Theleft calf measured 9in., the right 10 in. There was verylittle change in electrical reaction. The muscles of the calfreacted rather more readily to the anode than to thecathode of the galvanic battery. On March 14th, 1881, thebending of the knees was much more marked, and there wasslight but evident lordosis ; his walk was more shuffling,and he had rather more difficulty in getting up fromthe floor, but does not "climb up his knees." The mea-surement of the calves is the same, and the patellartendon-reflex is still normal. Noteworthy points were

the comparatively late age, considering the sex, of thecommencement of the disease, the early stage at which ’,it was first seen, and the rapid progress it was making,together with the good general nutrition.-Mr. WILLIAMADAMS remarked that the case of Dr. Dowse was mostcharacteristic of an interesting but at present little under-stood disease. Years ago he had divided in many such casesthe Achilles tendon. The patients were generally smallchildren; one of the first came under his care in 1867. Manyof them are reported in the Transactions of the PathologicalSociety, vol. xix., 1868. Dr. Duchenne had regarded themfrom an electro-therapeutic point of view, he himself from anorthopedic. Mr. Adams stated that an interesting reportof one of the latter character was published in the Trans-actions of the Medical and Chirurgical Society by Dr. LockhartClarke.-Mr. HENRY BAKER had treated these cases by astrap round the instep, which was successful as regards thetripping.-Dr. JAGIELSKI called attention to the increasedsize of certain of the muscles ; he knew of two families inwhich there had been weakness of intellect associated withpseudo-hypertrophic paralysis. Faradisation, phosphorus,and strychnine had failed in his practice, and he wouldlike to know from Dr. Dowse whether such patients demon-strated mental imbecility. - or. BROADBENT reported anotable instance in which the form of paralysis had attackedtwo girls in a family of three, whilst the boy was the sub-ject of epilepsy. One important feature was wanting in thiscase-viz., hypertrophy in any of the muscles, though theypresented characteristic symptoms. The disease in this casecommenced as late as sixteen years of age. Hypertrophywas, perhaps, a symptom in the beginning of the disease.-Dr. GILBART SMITH hoped Dr. Dowse would state if he con-sidered these cases of hypertrophic paralysis as instances ofDuchenne’s disease, as the latter name seemed to be appliedto other nervous affections by many.-Dr. DOWSE said he didnot recognise any special association between the physicaland mental disease, especially in its early state, and hehardly called these cases of Duchenne’s paralysis.—Dr.CROCKER alluded to the fact of there being a Duchenne’sdisease and a Duchenne’s paralysis, and was inclined tothink that there was frequently an association between themuscular and mental disease. He gave an unfavourableopinion as regards time in his case, as the disease had beenmaking rapid progress during the last six months.

Reviews and Notices of Books.Syphilis and Marriage. By ALFRED FOURNIER, Professeur

à la Faculté de Médecine de Paris; Médecin del’Hôpital, St. Louis. Translated by ALFRED LINGARD,M.R.C.S. With Prefatory Remarks by JONATHANHUTCHINSON, Esq., F.R.C.S. London: David Bogue.1881.

PROFOUNDLY interesting as are all the problems in con-nexion with syphilis, whether pathological, clinical, or

therapeutical, their importance is intensified when the

question of marriage is considered in the very many re-lations in which syphilis affects it. The rules at first laiddown to guide the profession in this matter have provedin one particular disastrously misleading, for it is not thecase that only the primary manifestations of syphilis arecontagious, and that marriage is proper at any time afterthe subsidence of the early period of the disease, nor, on theother hand, is it true that marriage is unallowable at anyperiod after contracting the disease. Neither of these ex-tremes being correct, it is a difficult matter to hit upon justthat happy mean between them that avoids the dangers onevery side. There are few, if indeed any, who are so wellqualified to speak on this subject as M. Fournier, and theEnglish speaking part of the profession is under a debt of

gratitude to Mr. Lingard for translating these valuablelectures.

Fournier first discusses the dangers imported into marriageby syphilis, and divides them into : (1) dangers to the wife ofdirect infection from a syphilitic husband, or infection froma syphilised fcetus ; (2) dangers to the children of direct infee-tion, of death of the ovum, foetus, or child soon after birth, andof degenerative affections interfering with the robustness ofthe individual, apart altogether from the more special formsof syphilitic inheritance ; and (3) dangers to the husband ofserious or fatal tertiary manifestations. Having consideredthe danger of improper marriages, the next lecture is devotedto a discussion of the conditions under which a syphiliticman becomes fit for marriage, and these, stated very briefly,are as follows :-1. Absence of actual specific symptoms.2. Advanced age of the diathesis, at least three or four yearsdevoted to methodical treatment. 3. A minimum of eighteento twenty-four months of immunity after the last specific mani.festations. 4. A mild form of disease and absence especiallyof affections of the eye and nervous system. 5. Thoroughspecific treatment carried out in a methodical manner for asufficient length of time. The minimum period of time offreedom from symptoms, and of duration of the disease undermethodical treatment, is longer than that usually insistedon in this country, and Mr. Hutchinson, who writes thepreface, while on the whole endorsing the author’s views,suggests that his rules are fairly capable of some relaxation ;it is, moreover, necessary to consider every case separatelyon its own merits, and not to be too much influenced byhard and fast standards. The third lecture is devoted to aconsideration of the proper management of the various con-ditions brought about by syphilis present in one or both ofa married couple. The various problems that arise whensyphilis has extended into a family are stated with ad-mirable clearness, and the lines laid down for treatment aresuch as must commend themselves to those acquainted withthe management of these cases.

M. Fournier is firmly convinced that a child may inheritsyphilis from the father only, the mother remaining healthy,and he believes that such a foetus may subsequently, whilein utero, infect the mother.There is a question of medical ethics introduced to which

it may be well to refer for a moment. In discussing thesurgeon’s duty when called upon to treat a wife recently in-fected by her husband, M. Fournier lays great stress upon