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free in the abdominal cavity. There was, consequently, norectum nor anal aperture. The anterior portion of the bonypelvis was deticient, corresponding to the ischia and pubicbones. The lower extremities were, consequently, thrown up-wards and outwards. The foetus did not appear to have beenlong dead, although the mother had never felt any movementof it. There was considerable hæmorrhage from laceration ofthe placenta, owing to its close attachment to the fœtus.

Dr. WILLIAM OGLE introduced the question-"HOW SHALL THE IMEDICAL PROFESSION ASSIST THE OFFICERS

OF HEALTH?"

He urged the cordial co-operation of the profession at large, onthe ground that the success of the present sanitary effort wouldbe to the credit of the profession; and that, if the result of theappointments now being made was an advance in our sanitaryknowledge, the status of the profession at large would be iiraised, the results would be appreciated by the public, and the i

agents would, to the same extent, receive honourable acknow- I

ledgment. He (Dr. Ogle) illustrated his position by referenceto the fact that Sir B. Hall had publicly stated that he regardedthe sanitary portion of his Bill as one of the most importantin the whole Act; and also that the vestries had, generallyspeaking, exhibited more than their wonted liberality whencalled upon to carry out the provisions of the Act. Dr. Oglethought that this advance in the estimation of the services ofmedical men was due to the success which had attended theirefforts during the late epidemic of cholera. The vestry of St.James, however, seemed to be an exception; for there, if any-where, we should have looked for a just appreciation of medi-cal labour. We learn from this instance, compared with dis-tricts such as Lambeth, that the public appreciate more highlythe department of curative than preventive medicine. On thewhole, however, he considered the conduct of the vestries wasto be commended, and for this good treatment Mr. Simon andhis fellow-labourers deserved the thanks of the profession. Dr.

Ogle next proceeded to show that the contributions of indivi-dual members of the profession need not be great in order tosecure a considerahle result. The use that had been made ofthe Registrar’s returns of deaths showed the value of collectinga few isolated facts. Many histories of epidemics were littlemore than commentaries on the Registrar’s returns. But some-thing more than this was needed when we wished to be in-formed of existing epidemics, and not merely to be furnishedwith materials for a history of that which had gone by. Thefirst intimation of the sanitary condition of a district ought notto appear in the returns of deaths. Dr. Ogle exhibited to theSociety a collection that he had made of nearly two thousandcases of sickness that had occurred in Pimlico during the pastyear, which, when arranged according to the streets, gave im-portant information as to the sanitary condition of different partsof that district; and he argued that a return made to theofficer of health, of the age and sex, the name of the disease,and the address of every case of sickness, would, when collectedand arranged, exhibit facts which would be highly valuable tothe profession at large. They would show at a glance theprevailing type of disease at a given time, also the part of thecommunity specially liable, and would direct the attention ofthe medical officer to those localities which required his imme-diate consideration.

NORTH LONDON MEDICAL SOCIETY.DR. HARE IN THE CHAIR.

,

MR. PRETTY read a paperON THE LARGE GROWTH OF THE THYMUS GLAND AS A CAUSE,

REAL OR SUPPOSED, OF SUDDEN DEATH OF INFANTS.

The author of this paper offered his few remarks to the noticeof the Society in the expectation that they would elicit ratherthan impart information. Mr. Pretty thinks that the nowprevailing opinion, that an enlarged thymus gland is a cause ofsudden death amongst infants, should be entertained withsome limitation, and he endeavoured to show that there wereconsiderations, physiological and pathological, which militatedsomewhat against it; and that more accurate knowledge thanwe at present possess of the natural size of this gland at diffe-rent periods of the first two years of infantile life was requiredbefore we could undertake to settle this question; and further,that the size to which it may arrive as a general rule withoutits being injurious to health or destructive of life, and also ifreally subject to disease, or only to overgrowth, without anychange in its natural structure, are points which require more

research and investigation than the writer has been able togive to them. His attention having been only lately drawn tothis subject, his opportunities for obtaining facts have been butfew; the inspections, however, though rare, seem to show thatthe size, the growth, and the disappearance of the thymusgland vary much in different children of the same age, and areprobably much influenced by exhausting diseases. Wilson’s"Anatomists’ Vade-Mecnm" states that the thymus gland weighsat the time of birth 240 grains, or four drachms; that it gra-dually enlarges for a period of one year, and disappears aboutpuberty. The intelligent coroner of this district readily allowsmedical testimony to be given in favour of the opinion that anenlarged thymus gland is a cause of sudden death with somechildren, and this same experienced gentleman tells us thathe is quite convinced that a vast amount of deaths amongstchildren, during the winter months especially, is to be ascribedto suffocation, to their breathing their own impure air, includingall the cases of supposed overlaid children. Without denyingthat a large thymus gland may produce death more or lesssudden, Mr. Pretty finds it difficult to understand and satis-factorily to explain how it should, by pressure upon either thetrachea,, the nerves, the bloodvessels, or the heart, become acause of sudden death, without the prior manifestation of somesymptoms of distress, inconvenience, or ailment. In casualconversation with Professor Owen, that gentleman expressedhis doubts that a compressible substance or organ like thethymus gland could ever become the cause of sudden death.Evanson and Maunsell, in their work upon the Managementand Diseases of Children, state that an enlarged thymus gland,enlarged bronchial, or enlarged, deep-seated cervical glands,are complications, but not causes of sudden deaths of children,and that many children die suddenly without our being ableto discover the cause of death by the most careful post-mortemexaminations. Mr. Pretty has seen a child die momentarily,almost without a struggle, without a purple countenance, andwithout any crowing inspiration, and the only evidence of dis-ease after death was moderate congestion and slight effusionwithin the head. He believes that local irritation, either ofthe brain, the mouth during teething, or of the alimentarycanal, may so disorder .the functions of the nervous system,that a state somewhat similar, if not identical, with the firstpart of a paroxysm of laryngismus stridulus may prove fatal.If size alone is to determine the question opened by Mr. Pretty,he fears that the few cases he relates will tell in its favour; butsurely it would be unphilosophical to exclude the influence ofother causes of disease and death which may have been inoperation, which leave no traces of their existence behind them,and where no enlargement of the thymus gland has beenfound; such, for instance, as spasm of the glottis from remotelocal irritation, suffocation from breathing impure air, wherethe child has been found dead, disturbance of the naturalfunctions of the brain and spinal marrow. In only one of Mr.Pretty’s cases, in which the gland was found largely deve-loped, was the manner of the death of the child witnessed,and that only by its parents. In a fit of crying, screaming,and passion, and without any convulsive action, pallor cameover the countenance, a little froth between the lips, and in amoment life was gone. This child was teething, was subjectto attacks of diarrhoea, and passed green motions, and hadbeen restless and cross for several preceding months. Thepost-mortem examination did not afford satisfactory evidenceof the cause of death, though we could not pronounce all quiteright within the cranium. The thymus gland, however, weighedten drachms, and the age of the child was near upon tenmonths. Mr. Pretty thinks that this subject is deserving ofmore attention and research than it has hitherto received frommedical practitioners. An organ which is natural to the in-fant state grows for a period with the growth of the child, isnecessary to its well-being; an organ of conservation of healthand of life should not, but upon the most satisfactory grounds,be converted into an organ of deterioration and death.

Analyses of the Bodies Examined.—In three of the bodiesthe thymus gland was found of large size; two of these threewere found dead, and the other died in a fit of crying, scream-ing, and passion :-The age of one child, found dead, ten

months; weight of gland, about five drachms. The age ofanother, died in a fit of crying, screaming, &c., ten months ;weight of gland, ten drachms. The age of a third child, founddead, seven months; weight of gland, nine drachms. Theother three children died of diseases clearly ascertained whileliving:-The age of one child, six months; weight of gland,only seventy grains; cause of death, hydrocephalus acutus.The age of another child, two years and a half; weight ofgland, two drachms; cause of death, bronchitis and contracted

318

chest. The age of a third child, nineteen months; the lobes ofgland reduced in thickness to the size of two ordinary quills;cause of death, hooping-cough with pneumonia ; this child wasvery greatly emaciated.

These few cases seem to indicate that there is no certaincorrespondence between the ages of children and the size ofthe thymus gland. The author had just examined the bodiesof twin children dying within six days of each other withsymptoms of inflammation of the lungs; ages respectively, tenand eleven weeks. The thyroid and thymus glands in thelarger and elder child weighed three drachms; the thyroid andthymus glands in the smaller and younger child weighed twodrachms and a half.

Provincial Hospital Reports.NEWCASTLE-UPON-TYNE INFIRMARY.

CASE OF EXCISION OF THE ELBOW-JOINT, PERFORMED BY MR.HEATH, M. B., &c., Surgeon to the Infirmary.

(Reported by J. T. MILBURN.)

GEORGE R-, a boy aged eleven, was admitted on the10th of May, 1855, from the workhouse, where he was bornand has resided all his life. He is an orphan. He has hadscrofulous disease of the right elbow-joint for upwards of a year,and he fell down a day or two ago and hurt his bad elbow,which caused it to swell and ulcerate a good deal. The elbowis at present much enlarged, there is a sore over the outer con-dyle, and ulceration over the inner one, extending an inch anda half above the joint, in which there is very little motion.About three inches below the joint there is a fistulous opening,through which a probe can be passed down to the ulna, whichs carious. The surrounding integuments are much discoloured.A probe can be passed quite into the joint, which seems to betotally disorganized. To have a little castor oil in the morning,and to have a bread poultice applied to the elbow.May llth.-To take plenty of milk.14th.—Notwithstanding its being a very unfavourable case,

on account of the caries in the ulna below the joint, whichcould not be removed, Mr. Heath determined to make an

attempt to save the limb by performing the operation forexcision of the elbow-joint.15th.-The boy having been put under the influence of

chloroform, Mr. Heath made an incision from about two inchesabove the elbow-joint to a little below it, and another incisionat right angles to the first, forming together the letter T. The

flaps being carefully dissected back and the joint opened, theends of the humerus and ulna were found to be greatly ulceratedand softened. The radius was unaffected. The articular sur-faces of the humerus and ulna, with the olecranon process ofthe latter, were removed, a few sutures put in, and the ladsent to bed.

16th.—The lad looks very well; no feverishness; bowelsopen.

19th.-The arm was opened out to-day, and looked as wellas could be expected. To be dressed with warm water, and abandage cut into lengths of about nine inches each, so as toobviate the necessity of moving the arm when it is dressed.25th.-Since the operation the lad has been doing very well,

without any symptoms worthy of remark. There is a slightdischarge from the wounds, which are granulating. Ordered,bismuth and carbonate of iron with sugar, of each a quarter ofa grain, twice a day.June 4th.-Very little discharge, and swelling much dimi-

nished. To continue water dressing, with a leather splint to beapplied to the under surface of the elbow. Continue medicine.

24th.-Doing extremely well. The arm to be put in a largerand more bent leather splint. Continue the medicine.

Aug. 14th.—Doing well. He can raise his arm a little with-out help. About a month ago, he was ordered to take a table-spoonful of cod-liver oil with syrup of iodide of iron, whichhe has done; but as the syrup purges him, he is to omit it.Ordered, carbonate of iron with sugar, a quarter of a grain;sulphate of quina, two grains.

Dec. 5th.-The wound of the long incision is now nearlyhealed, and the transverse one is healing gradually, and has avery healthy appearance. The original sore over the internalcondyle is about the size of a sixpence, and is quite healthy,as is also the original sore on the forearm, which is much dimi-nished in size, and the whole of them are secreting a smallquantity of laudable pus. The sores are dressed with strips of

linen dipped in cold water, and pretty tightly strapped aroundthe arm. A bandage is then applied to keep them in position,and the whole confined in two stout leather splints, which arebent at an obtuse angle, and quite encase the arm. Thistreatment has been made use of now for the last six weeks;the arm has steadily improved under it, and he is now able toraise a light weight to his head. He has been taking a glassof wine daily for the last six weeks, and his general health isvery good.’ Jan. 15th, 1856.-The arm is now in pretty much the samecondition as when the last observations were made, not havingmade so much progress during the last month as could havebeen wished. The patient has taken cod-liver oil for the last sixmonths, with the best effects. When he came in he had everyappearance of being a weak scrofulous boy, whereas now he isquite robust and healthy-looking; he can now flex the forearmupon the humerus to a slight extent; he carries articles oflight weight about the ward with the arm with the greatestease, and there is every prospect of its being a useful limb tohim in after life, which from his being an orphan is of vital im-portance to him. The elbow is at present still dressed withthe linen straps.

Feb. 6th.-Since the last report the elbow has been going onvery favourably. The fistulous opening which communicatedwith the ulna is quite healed up; and as Mr. Heath thinks achange of air will do him good, he is to leave the hospital

I shortly.

Reviews and Notices of Books.Lettsomian Lecturers on the Physiological Constitution, Diseases,

and Pructures of Bones. By JOHN BISHOP, F.R.S., Fellowand Member of the Council of the Royal College of Surgeonsof England. Svo, pp. ’0. London: Samuel Highley.A DEBT of gratitude is due to those eminent men who have

in former times founded courses of lectures in our Colleges andSocieties, which, unlike the elementary courses delivered tostudents, are intended to convey to the more advanced mem-bers of the profession the most recent and important discoveriesin one or other of the departments of science, or to advance theoriginal views of the author. By this means, indeed, the dis-covery of the circulation of the blood was promulgated byHunter in his prelections at the College of Physicians long beforethe publication of his treatise, " De Motu Cordis;" and by theprofessorships of the College of Surgeons the profession is an-nually made acquainted with some of the most recent disco-veries in surgery, comparative anatomy, and histology.For this reason we ivelcome the appearance of the Lettsomian

Lectures, and we shall now enter on a brief notice of those onSurgery, delivered last year before the Medical Society of Lon-don by Mr. Bishop. The lectures are three in number-thefirst comprising an examination of the physical properties ofbones, their elasticity, strength, and flexibility in relationto their inorganic and organic constituents, rickets, mollitiesossium, caries, and psoas abscess; the second comprises theorganic changes, producing necrosis and the formation of newbone, the necessity for the removal of dead portions, exostosis,soft tumours of bone, and the difficulty of their diagnosis; thethird lecture is devoted to fractures and their reparation, frac-tures of difficult reunion and of difficult diagnosis. Such beingthe subjects, it is our intention to touch lightly, as our briefspace will alone permit, on a few of the more interesting pointspresented for our consideration.The author has long devoted great attention to the relation

which subsists between the physical properties of bones and theirchemical constituents, and he has proved by well-directed ex.periments that, while the elasticity and strength of bone de-pend on the inorganic, the flexibility and cohesion are con-

ferred by the organic constituents, and that an intimaterelation exists between their physical properties and theirnormal composition.

If the inorganic matter be deficient, as is very often the casein the first few years of life, the flexibility of the bone is in-