582

a case of lingual tumour, said he was so convinced thatsyphilitic deposits were fertile sources of cancer that evenwhere he was perfectly certain that there was no cancerousdeposit, infiltration, or contamination whatever in a syphiliticsore, if the change was of comparatively long standing hewould excise ; and he believed, in the case of syphiliticdeposits, that the change was not due to local irritation, butto the destruction of the tissues by the deposit.Dr. C. J. Nixorl exhibited a specimen in which an

Aneurysm the size of a small walnut was found engagingthe left Anterior Sinus of Valsalva. The walls of the

aneurysm were formed by the valve-segment and thickenedendocardium internally, externally by the epicardium, andbelow by the muscular wall of the left ventricle, part ofwhich was eroded. The sac of the aneurysm opened intothe cavity of the ventricle, so permitting aortic inadequacy.From the opening in the sac of the aneurysm a portion offibrin projected, which, lying against the anterior flap ofthe mitral valve, caused a perforation of it the size of agood-sized pea. This opening was of interest in connexionwith the sign of mitral regurgitation which existed duringlife. There had also been signs of aoitic inadequacy.Dr. Nixon dwelt upon the different forms of cardiacaneurysm and their modes of production. - The PRE-SIDENT said he had shown for the late Dr. Stokes, yearsago, at the Pathological Society, an aneurysm of thesinus of Valsalva, but it differed from Dr. Nixon’scase. Dr. Stokes showed a case at the old PathologicalSociety in which the aneurysm communicated with theconus arteriosus and the pulmonary artery, the situationbeing, so far, very close to that in Dr. Nixon’s case; butthen it passed forwards to the left side of the conus

arteriosus, and made an aneurysm between the two sides ofthe heart.-Dr. N IxoN, in reply, said he could not conceiveany physical sign, or combination of physical signs, thatwould enable a diagnosis to be made of an aneurysminvolving the sinus of Valsalva. Dr. Hayden thoughtthere was a sign which was of value in diagnosing aneurysmof the aorta immediately above the sinus of Valsalva-namely, a clear ringing aortic second sound, having a

marked character of accentuation, followed by a post-diastolic murmur.

Dr. M’KEE read a paper on a case of Endothelioma of theLiver, and showed microscopic preparations and drawings.The growth, consisting of small nodular tumours, hadoriginated in the endothelium of the capillaries and smallveins. Attention was called to the extreme rarity, if notunique nature, of the case.Dr. JAS. LITTLE presented a case of Intra-thoracic Sar-

coma, probably originating in the mediastinum, and in-volving the upper lobe of the right lung.-Dr. NIXON didnot think there were sufficient grounds for being dogmaticas to a difference in the mental condition of patients suffer-ing from cancer of the mediastinum and thoracic aneurysmrespectively.Mr. M’WEENEY showed a Rhinolith weighing 105 grains.

It had been extracted without much difficulty from thenasal fossa of a woman aged about forty-five. The presenceof so large a foreign body had caused very little incon-venience beyond the stopping of respiration through theaffected side of the nose. Mr. M’Weeney called attentionto the rarity of such specimens, and to the brevity andunsatisfactory character of the references to the subject inmost of the surgical and pathological text-books. Thespecimen was sent to the Reference Committee.

Notices of Books.The Operative Treatment of the Hypertrophied Prostate.

By FRANCIS SEDGWICK WATSON, M.D., Surgeon to Out-patients, Boston City Hospital; Surgeon to the Departmentof Genito-urinary Surgery, Boston Dispensary; Instructorin Minor Surgery and the Surgery of the Urinary Organs,Harvard Medical School. Boston: Cupples and Hurd.1888.-This is a paper which was read at the Congressof American Physicians and Surgeons in Washington lastyear. It is written to show that in cases of advanced pro-static disease with severe symptoms, which are not relievedby the usual treatment an attempt should be made to

remove the obstruction to micturition by a free division orremoval of the enlarged middle lobe of the prostate. Dr.Watson maintains that the palliative treatment of thesecases-supra-pubic or perineal drainage-is more dangerousand less successful than the radical operation he recom-mends, and that the examination of pathological specimensdemonstrates the possibility of a radical operation. Should

operation be decided upon, the perineal method is advised,as being more generally applicable than the supra-pubic;division or excision of the middle lobe, followed by permanentdrainage, are the procedures to be adopted. We cannot saythat the paper impresses us as a thorough discussion of thesubject, and we hardly think it likely greatly to influenceprofessional opinion. The illustrations to the paper areexcellent. They include twenty-four photogravures ofbladders and prostates, which for accuracy and clearnesswe have never seen surpassed. They certainly form amost valuable addition to the text.A Compend of Hunzan Physiology, especially adapted for

the use of Nledical Students. By ALBERT P. BRUBAKER,A.M., M.D., Demonstrator of Physiology in the JeffersonMedical College, Philadelphia. Fourth Edition. Pp.174.—Compend of the Diseases of the Eye, including Refractioraand Surgical Operations. By L. YEsTEr Fox, M.D., andGEORGE M. GouLD. Second Edition. Pp. 164. Londonand Edinburgh : Young J. Pentland. 1889.-These two

neatly got up little works belong to the class of booksnamed " Repetitoria " in Germany, and are intended to actas reminders to the student of the more important factswhich must be given by every teacher. Considerable

thought is required in the production of such manualsto determine, not so much what should be inserted as

what should be excluded. It is not possible to com-press the whole of physiology or of ophthalmology intothe compass of less than 200 small pages. Still, in the handsof those who know their work well, it is surprising howmuch can be given in that space. In the "Physiology,"we think an arterial pulse tracing and a muscle curve mighthave been introduced with advantage. The proportion ofhydrochloric acid in gastric juice given (4’78 per 1000) seemshigh; perhaps it represents that of the dog. In the Compendon the Diseases of the Eye more space might be devotedto the symptoms of paralysis of muscles; for example,"Paralysis of the superior oblique supplied by the fourthnerve is detected by imperfect rotation downward and

outward, causing diplopia and slight divergence." Suchan account would not enable the student to recognisethe affection, whereas a small figure giving the positionof the true and false iinages of a candle would enablehim to tell it at once. We say much for these two

compends when we pronounce them to be equally good.Students will find both useful as supplements to largerworks.

Zetsc7arift fùr Biologie. Von W. KUHNE und C. VOlT.Band XXV., Heft 3.-This part contains an article byWilliam Martens on the Behaviour of Diphthongs andVowels in Spoken Words, tending to support the statementof Wendeler that the graphic curves of spoken vowels showremarkable inequalities, whilst those of sung vowels areapproximately uniform, and demonstrate that the pitchof spoken vowels is not exactly determinable by our ears.He agrees with Merkel that in the utterance of vowels and

diphthongs three periods have to be distinguished: theinitial period, the final, and the intermediate-" au," forexample, commencing with broad a and passing graduallyinto u. Many tracings are given in a plate which accom-panies the paper. 2. On the relations of Growth betweenthe Body and the several Organs, by Dr. Carl Oppenheimer.3. W. Iiiihne and R. H. Chittenden communicate a paperon Myosin and Myosinoses. They have found some newcompounds in digesting these substances, to which they

583

have applied the names of Proto-myosinose and Deutero-myosinose. 4. R. H. Chittenden and A. S. Hart on

Elastin and Elastose. As in the preceding paper, the

effects of digestion have been followed, and Proto-elastinand Deutero-elastin obtained. 6. C. Weinland on the

presence of Guanin in the Excretions of the Garden Spider.7. E. Drechsel: Can the Gastric Mucous Membrane decom-

pose Bromides and Iodides ? His experiments do not solvethe point. 8. M. Rubner : a Calorimeter for Physiologicaland Hygienic Purposes.Archiv fur Anatomie und Physiologic. (BRAUNE und

Du Bois REYMOND.) Hft. 1, 2: Anatomische und Physio-logische Abtheilungen. 1889. - The anatomical part ofthis journal contains three articles: Bonnet on the

Embryology of Ruminants; Darkschewitsch on the SuperiorNucleus of the Third Nerve; and A. Alexander on the

Lymph Sinuses of the Choroid. The physiological partcontains : (1) Calorimetric Researches, by J. Rosenthal;(2) Margherita Traube-Mengarini on the Gas in the SwimBladder of Fishes; (3) J. Rosenthal on Artificial Respira-tion ; (4) Nicolaides on the Time-relations of the Muscle

Current; (5) Lahousse on the Gases of Pepton Blood;(6) Giirber on the Total Number of the Blood-corpusclesand their Variation; (7) Observations on Living Glands,by Otto Drasch; (8) Ellenberger and Hofmeister on theDigestion of the Pig; (9) remarks on a case of Megalo-dactylia, by Alf. Goldschneider; (10) Course of PracticalPhysiology, by Hensen.Minutes of tlae Genaral Medical Council and its C’rnmaittees

for the year 1888..With Four Appendices. Vol. XXV.London: Spottiswoode and Co., or Medical Council Office.—There has seldom been a volume of Minutes of the MedicalCouncil containing more instructive and interesting matterthan the present one. The ordinary business of the Council in1888 involved some important questions, and included, if notnew departures, some very far-reaching decisions as to thepowers and functions of the Council. The volume contains,besides, the reports of the first Inspectors of the FinalExaminations under the Act of 1886 and the answers of thebodies to the criticisms of the inspectors. Appendix I.contains the fourth statistical report on the number anddistribution of registered medical practitioners in Englandand Wales in 1881 and 1886 respectively, the number andsource of their qualifications, &c. It would be ditricult to

get in any other place and form data of such interest andaccuracy, and we need not say they have not been compiledby the Council without much expense and trouble, especiallyon the part of the President and Itegistrar.

New Inventions.NEW CLAMP SCISSORS.

AN instrument which will clamp as well as cut is a

desideratum. The accompanying illustration representssuch an instrument, which I think will be found of generaluse for the removal of abnormal outgrowths of small size,more especially those of a vascular nature. The flat sideof the instrument being closely applied, with blades apart,to the surface from which growth is to be removed, thecutting must be effected quickly, firmly, and with one blow,when the remaining tissue will be found firmly clamped.It will be found advisable to leave the clamp on cut surfacesfor a minute or two, when the handles can be partiallyreleased by letting go one of the catches, and any bleedingthen noticed to be going on between the blades can beimmediately controlled by pressing the handles togetheragain and leaving the clamp on for a few moments longer,when all bleeding will be found to cease, and it can beremoved for good. The following are a few of the purposesto which my clamp scissors can be applied : Removal of

haemorrhoids, enlarged uvula, vascular tumour of themeatus urinarius, warts, condylomata, circumcision in theinfant, &c. The bow-shaped handles give great power, andthe catch I consider a great improvement. It can be

released at once by a twisting movement of the thumb andfingers of the left hand from right to left. The makers areMessrs. Arnold and Sons, West Smithfield, who have carriedout my ideas to my entire satisfaction.Dublin. ALEXANDER DUKE, F.K.Q.C.P.I.

REFORM AT THE ROYAL COLLEGE OFSURGEONS.

To the E, ditors of THE LANCET.SIRS,—It is with considerable pain that we note the letter

of Mr. W. Horrocks, published in your issue of the 16th inst.It is a distinct libel upon the Fellows to have spoken of anyof their number as "unruly," and upon the Members todescribe their assemblies at the College or elsewhere as" brawls." We challenge Mr. Horrocks to lay his fingerupon any proceeding that can come under that category.The order of the College meetings has been such as tofavourably compare with that of many a legislativeassembly, while on no occasion has the slightest attempt atdisturbance arisen, though the Members have been made tosmart at the hands of a Council who refuse to adopt thelegitimate consequence of countless resolutions, passed by

overwhelming majorities. In what way, for instance, wasthere any brawling at the historical meeting of the28th ult. ? A body of respectable, mostly middle-agedpractitioners assembled outside the gates of the College,with the legal object of formally demanding admission totheir own hall ; the right of entry having been as formallyderied, the Members and Fellows moved off, in order, to apreviously appointed meeting-place, and there held, inpeace and "decency," their bloodless counsel. For ourown part, we may say that, were there ever to be exhibitedany signs of rowdyism or "brawl "-a ridiculous assumptionamong a body entrusted with the lives of Her Majesty’ssubjects,-we should promptly endeavour to suppress suchimproper manifestations, and, failing that, should retirefrom a movement that bad undergone so marvellous a change.As to the sneers of Mr. Horrocks with regard to a "setof nonentities," &c., I presume that he will not describe Mr.Holmes, Dr. Danford Thomas, Dr. Macdonald, Sir GuyerHunter, and Mr. Jabez Hogg as men totally unknown in pro-fessional circles. Nor will he class Mr. Pollock, Mr. Tweedy,Mr. Davy, and Mr. Lawson Tait as men who " lack theappreciation " of the general body of the College. It isscarcely by such amenities as the above cited, or by theshowering of epithets such as "lazy" and "stupid," thatMr. Horrocks will advance the cause of the Council ; norwill he gain a reputation for careful following of the courseof modern history by quoting as a matter for congratulationthe abortive attempt of Sir Spencer Wells to abolish theannual meeting of the College, an attempt which failed sosignally even amongst the retrograde Members of theCollege Council. We shall be glad to hear Mr. Horrocks ona future occasion, when he has had the time to study alittle more carefully the course of recent events, and hasexercised the pruning knife upon his vocabulary.

We are, Sirs, your obedient servants,

March 20th, 1889.

WARWICK C. STEELE,Florence-terrace, Ealing, W.,

WM. ASHTON ELLIS,Grosvenor-road, S.W.,

Hon. Sees., Assoc. M.R.C.S.

B* Other letters on the same subject as the above havereached us, but we are unable to find space for them.-ED. L.