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the theory could be accepted as proved.-Mr. G. LAWSON hadseveral times tried sclerotomy, but he had not been led toprefer it to iridectomy, as the iris so often became entangled;its benefit was not larger than after iridectomy, and itsrisks were greater. No operation in surgery was of greatervalue than iridectomy in acute glaucoma ; in chronic glau-coma neither iridectomy nor sclerotomy did much good.-Mr. McHARDY said this question had been well debated atthe International Congress. He preferred iridectomy in anycase of acute glaucoma. But in chronic glaucoma wasnot there less risk in sclerotomy than in iridectomy ? Hehad seen some cases in which eyes had been saved by scle-rotomy where the fellow eye had not been saved by iridec-tomy, but iridectomy had usually been done on the morediseased eye. He had recently seen a man, aged twenty-nine, with chronic glaucoma in both eyes, almost completeblindness in the right eye, and very limited field of visionin the left eye. The right eye was treated by iridectomy,and the globe was afterwards enucleated on accountof haemorrhage. Mr. Bowman recommended iridectomyfor the left eye also, as he considered there was nomore risk and greater prospect of good than fromsclerotomy, but the glaucoma relapsed, staphyloma ensuedto the fullest extent possible, and the eye had been lost.In comparing the effects of treatments on two eyes in thesame individual it was important to remember that theone first operated on was usually the worst.-Mr. LISTERsaid Mr. Watson’s case was certainly a successful instanceof sclerotomy. It was of general interest as an example ofthe effect of the relief of tension ; it seemed that tension inthe eyeball, as elsewhere, keeps up nervous excitement,which may subside if the tension is lessened even tem-porarily.-Mr. SPENCER WATSON did not mean in hisremarks to compare sclerotomy with iridectomy ; he valuediridectomy as highly as Mr. Lawson. But he thought itwell to show the persistence of the good effects of sclerotomyin this case for six years and two years and a half. He

thought the operation did good by relieving pressure uponthe nerves. Mr. MeHardy’s case was a very favourable onefor sclerotomy, as it is less likely to be followed by heemor-rhage, which proved disastrous in the first iridectomy, forthe escape of the aqueous humour takes place more slowly.These intraocular haemorrhages offer the strongest reasonfor choosing sclerotomy. The chief interest of his case wasthat the cystoid cicatrix was largest on the side where theresult of the sclerotomy was best.The Society then adjourned.

MEDICAL SOCIETY OF LONDON.

Case of Abdonzanal Turnour.-Inflarnmation and Ulcerationof Appendix Ve1’lniformis. - Spontaneous Passage ofLarge Gall-stones.AT the meeting on the 20th ult., Dr. Broadbent, President,

in the chair,-Notes of two cases of Abdominal Tumour were read by

Dr. Braxton Hicks. The first was one of suppuration frompelvic peritonitis following labour, in which a large amountof solid deposit was formed, surrounding and fixing theuterus, and extending nearly to the umbilicus. In themedian line there was a soft prominent swelling, three inchesin diameter, with fluctuation, marked resonance and suc-cussion on agitating the pelvis. There was marked hectic

daily. An opening was made by the scalpel; fetid gasand a pint of stinking pus escaped. A large drainage-tubewas then introduced, and the sac washed out twice a day withiodine water. In three weeks the sac had completely closed,and the patient made an excellent recovery. Dr. Hicksremarked that it was important, when called to treat suchcases, to know what other conditions gave rise to succussion,and he enumerated absce3ses communicating with intestine,as caecal abscess, abscess resulting from ulceration of stomachor intestine; cysts, ovarian and extra-uterine, communicat-ing with the intestine. He suggested it would be foundalso when the bladder directly or indirectly communicatedwith the intestine, &c. Succussion was also to be foundin the cases of enlarged or displaced stomach. He asked forexperience as to other causes-e.g., hernia, &c., producingsuccussion, and then discussed the origin of the gas inpyogenic sacs, asking whether gas had been found in any

case where it was impossible that air could have enteredfrom the abdomen, lung, or external air. The second casewas, as Dr. Hicks believed, unique-viz., one of extra-uterinefoetation, where, some months after the death of the foetus atfull term, the fluid in the amnial sac increased to such anextent, that by the end of about five months after full termthe sac burst, and death by collapse ensued.-Dr. HABER-SHON remarked upon the succussion in the first case, a signwhich was often found in the dilated stomach. He had alsodetected a " splashing note" in an ovarian cyst which commu-nicated with the caecum; and he related details of a case oflarge intra-abdominal abscess containing gas in which thissign was present; but no communication was found withthe bowel, although the abscess lay close to the intestine.The obscurity of diagnosis in these cases gave them greatinterest.-Dr. HEYWOOD SMITH suggested that the compara-tive thinness of the abdominal wall over the abscess would aidin diagnosis, and urged the value of

" auscultation and percus’sion. -Dr. ROUTH advocated exploratory aspiration as adiagnostic means. He indicated the risks attaching to ab-dominal section in such cases as the second one described byDr. Hicks.-Dr. BRAXTON HiCKS, in reply, thought that inDr. Habershon’s case there might still have been a com-munication with the interior of the bowel. The diagnosisin his first case was clear enough, otherwise he shouldhave made an exploratory puncture His experienceof cysts communicating with intestine was that as thesac shrinks so also does the opening into the bowel becomesmaller.

Dr. DAY read notes of a case of Inflammation of theAppendix Vermiformis in a boy, fourteen years of age,followed by peritonitis and death. The patient was firstseen by Mr. Irving Page of Wimbledon on October 20th,1881, suffering from the symptoms of a common biliousattack. On the 21st there had been no action at the bowelsfor three days ; but a dose of castor oil brought away somehard lumps of faecal matter. On the 22nd the abdomen washard and tender, and he vomited yellow bile in the earlymorning. On the 23rd at 10 A.M. he had a slight rigor;temperature 101°, pulse 120; hands and feet cold andclammy ; abdomen tympanitic. Dr. Day joined Mr. Pagein consultation; but the patient gradually became worse,and died at 12 P. M. After death the usual signs of peritonitis were found, the intestines were glued together inplaces, and there was about a pint of healthy pus in theabdominal cavity. The appendix vermiformis was muchinflamed, and contained several fsecal masses about the sizeof a pea. No external opening could be discovered.-Dr.COUPLAND mentioned two cases of ulceration and perforationof the appendix cseci which he had seen in the MiddlesexHospital. One was a girl, aged fourteen; the other a boy,aged eleven ; and Dr. Coupland asked whether there wasany explanation for the greater proneness of young than ofadult persons to this affection. In each of these two casesthere were symptoms of constipation, typhlitis, and peri-tonitis ; and in each the appendix at the seat of and above theperforations was blocked by faecal concretions. The mechanismof the ulceration was probably the same as that which occursin the colon and caecum from faecal accumulation.-Dr.SANSOM said it would be interesting to learn the natureof the concretions in Dr. Day’s case. Although children are inthe habit of constantly swallowing hard foreign bodies, he hadnot met with a single case of their impaction in theappendix except some years ago at King’s College Hospital,when in a case of this kind the nucleus of one of theseconcretions was found to consist of a felted mass of oat-hairs from a pudding.-Dr. HABERSHON asked if in anyof these patients there had been any indications of tuber-cular disease, which might determine the proclivity to in-flammation of the appendix. He thought the concretionsshown by Dr. Day were of fsecal origin, and had seen similarcases. He alluded to the common and great error ofadministering purgatives in the early stage of meal disease,the treatment of which consisted in rest by opiates, andpoultices to the abdomen.-Dr. HEYWOOD SMITH thoughtit advisable to combine large doses of calomel with theopium with a view to cut short the peritoneal inflam-mation.-Dr. DAY, in reply, remarked that at the beginningof the disease the boy was treated as for an ordinarybilious attack. His mother was certainly of tuberculousdiathesis. Dr. Day was much opposed to the admi-nistration of calomel. - Dr. COUPLAND added that themother of one of the children he mentioned had died of

phthisis ; but in both cases all the viscera, except the

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appendix cseci, were healthy. In both the treatment con-sisted mainly in opiates and fomentations. The concretionsin Dr. Day’s case were referred to a committee, con-

sisting of Drs. Day, Coupland, and Sansom, for report as totheir nature.Mr. SPENCER WATSON read notes of a Case of Large Gall-

stones simulating Abdominal Tumour. A widow lady,aged seventy-nine, of spare frame and constipated habit,had suffered during the year preceding the attack of gall-stones from neuralgic pain in the head, right side of neckand right arm, and also from epistaxis with ulceration ofthe septum nasi. In the autumn of 1880 symptoms ofacute intestinal obstruction set in, with supposed hydatidtumour of the abdomen and escape per anum of abundantserous fluid, and white hydatidiform membranes. Subse-quently the originally soft globular tumour gave place to ahard nodular painful tumour, which occupied the right sideof the abdomen, but remained stationary and unchanged forabout nine months, when another attack of acute intestinalobstruction came on, and a calculus, the size of a smallbantam’s egg, was passed per anum. At the same time aslight diminution in the size of the abdominal tumour wasnoticed and the symptoms of obstruction passed off. A fewdays after, however, vomiting and tenesmus recurred, andafter the administration of a large oil enema two largecalculi were found in the rectum, whence they were withdifficulty extracted. The symptoms then all disappeared, andthe tumour also. There have been occasional transientattacks of vomiting and abdominal pain, but no obstructionand no calculi have been found in the stones. The gall-stones were composed for the most part of cholesterine, andthe three together weighed nearly two ounces. There wasno jaundice at any period of the case. Mr. Watson sug-gested that the epistaxis noted as an early symptom mayhave been induced by irritation of the nostril, referable inthe first instance to the intestinal irritation due to the pre-sence of the gall-stones, and that this condition wasanalogous to the nose-picking and sore nostrils in childrenaffected with thread-worms. The case, however, was

chiefly interesting on account of the large size of the,gall-stones and the difficulties of diagnosis before they werepassed.Mr. E. J. PARROTT exhibited a specimen of Gall-stone of

unusual size from a female aged sixty-five, whose firstattack of gall-stone occurred in 1865, the second in 1866, andthe third in February, 1875. In March, 1880, commenceda prolonged series of attacks of hepatic colic, with jaundiceand vomiting, with more or less long intermissions. Thesickness was mostly subdued by morphia. In January,1881, Dr. Broadbent saw the patient in consultation, and onthe 24th of that month a calculus one inch and three-quarters in circumference, and having three concave

facets, was passed, and another measuring two inchesand a half in circumference. In February, March, andApril the attacks recurred, but then the jaundice gra-dually disappeared, only intense itching of the skin re-maining.The PRESIDENT remarked that the two cases together

illustrated two modes of passage of gall-stones. In Mr.Watson’s case the stone had apparently passed into thecolon by ulceration ; in Mr. Parrott’s the stone had passedalong the duct, possibly continually ulcerating into the smallintestine. He then showed a large gall-stone which hadbeen passed by a lady between fifty and sixty years of age.She was suffering from well-marked jaundice, and on ex-amination the liver was found to be very large and irregular.There was some pain and tenderness, but no attack of severesuffering like that caused by the passage of gall-stone hadbeen experienced. She had, however, from time to timesevere attacks of asthma. The case was diagnosed as one ofmalignant disease, but after the jaundice had lasted abouteighteen months the gall-stone was passed, and the patientgradually recovered, no recurrence of asthma taking place.-Dr. HABERSHOf asked for the exact situation of the pro-minence in Mr. Watson’s case. In his experience verylarge gall-stones had not taken such a favourable course.He instanced several cases.-Dr. ROUTH related a case

where a large gall-stone was found when the patient wasunder the influence of chloroform.-Dr. WYNN WILLIAMSmentioned the case of a man in whom retention of urineaccompanied the passage of gall-stone.-Mr. WATSON, inreply, said that the tumour occupied the space between theright iliac crest and the last rib. It was about four incheslong.

MIDLAND MEDICAL SOCIETY.

AN ordinary meeting of the Society was held on Wed-nesday, Feb. 15th, in the Medical Institute, Birmingham,Dr. Bassett in the chair.Mr. J. F. WEST showed a specimen of Fracture of the

Base of the Skull, caused by a violent blow on the nose,taken from a healthy man aged forty-eight. The patient,while shaping a pair of bellows at a circular saw, was struckviolently in the face with the wood. There were no cerebralsymptoms until shortly before death, forty-eight hours afterthe accident. At the post-mortem a fracture of the orbitalplate of the frontal bone was found on the right side, closeto the crista galli. The ethmoid was completely smashed,as were the septum nasi and turbinated bones. Effusioninto the ventricles and at the base of the brain also existed.

Dr. WOOD WHITE exhibited a patient who had beencompletely blind with the right eye for over eleven years, apiece of iron two-eighths of an inch long having lodged in thecapsule of the lens. The foreign body was removed byDr. White at the Birmingham Eye Hospital, and a fewweeks afterwards, with a three and a half inch lens, visionwas normal.Mr. T. F. CHAVASSE exhibited a man aged thirty-four,

with Extroversion of the Bladder, upon whom it was pro-posed to perform a plastic operation.

Dr. MALINS read a paper on Laceration of the CervixUteri. After enumerating the causes and symptoms usuallymet with, the author stated he was able to verify theopinion of American gynaecologists that this lesion was notuncommon if diligently looked for, and that the statistics ofeminent writers on this subject are probably a little underinstead of over the mark. The operative measures neces-sary to remedy the malady were described, and Dr. Malinscited several instances under his own care which had beenbenefited by carrying out the same.Mr. WEST read a paper on Aix-les-Bains and the Sulphur

Springs of Savoy, in which an account was given of thechemical constitution and therapeutic virtues of the variousmineral springs with which that country abounds. A de-scription of the mode in which the thermal treatment iscarried out at Aix was given, and the author spoke highlyof its value in cases of rheumatic arthritis, gout, and in thevarious forms of constitutional syphilis. The springs ofEvran in cases of lithiasis and those of St. Gervais ineczema, and other inflammatory diseases of the cutaneoussystem, were also strongly advocated, and the picturesquepositions of these health resorts detailed.

Reviews and Notices of Books.Leprosy an British G2icnu an Account of West Indian

Leprosy. By JoHrr D. HILLIS, F. R. C. S., M.R.l.A.,Medi-cal Superintendent of the General Leper Asylum, BritishGuiana, West Indies. Illustrated with Tweuty Litho-graphic Plates, coloured and plain, from Original Draw-ings and Photographs of Patients at the Asylum, andseveral Engravings from Camera-Iucida Drawinoq, byE. NOBLE SMITH, F.R.C.S.; of Pathological Specimens,mounted and prepared with Explanatory Remarks, byP. S. ABRAHAM, M.A., B.Sc., F.R.C.S., Curator, RoyalCollege of Surgeons Museum, Ireland. London: J. andA. Churchill. 1881.

IN the work before us Mr. Hillis has done excellent serviceto science and the profession. Knowing by the experienceof former years the disadvantage of not having a systematictreatise on leprosy in the English tongue to which to refer,he set himself to work under many conspicuously un-favourable circumstances to produce such a book with

special reference to West Indian leprosy, and intended

principally for practitioners in the West Indies, but writtenin the light of the studies of leprosy made in other

countries, with which writings Mr. Hillis is thoroughlyfamiliar. The result is an excellent volume, with well-written and clear descriptions of disease, and showingthroughout a thorough knowledge of the whole subject.The book, as a guide and source of reference, cannot fail to

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