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extreme degree of secondary tricuspid incompetence. Onlyfifteen cases of primary and thirty of secondary tricuspid in-sufficiency have been carefully recorded with sufficientdetail to be of practical use. The cases of primary incom-petence died at a much later age than cases of stenosis.Stenosis depended upon the amount of the pressure uponthe valves of the heart. The relation of the size of themitral and tricuspid orifices is different in the two sexes.

Mr. SHATTOCK showed a Congenital Tumour of the Neck,consisting of branching cartilage and adenoid tissue. Itwas congenital and very like a congenital sacral tumour. Itwas central and symmetrical, and probably originated onsome buried embryonic structure. It was evidently notgrowing from the intercarotid gland, as had been suggestedin relation to some similar growths.-Mr. R. J. GODLEEsaid Mr. Shattock’s specimen looked at first sight very likea cystic hygroma, although the structure of the two is so

very different. The tumours he referred to are made up of anumber of small cysts lined with lymphatic epithelium.-Mr. TREVES referred to a case shown by him to the Societyof attached foetus, the section of which had a similar appear-ance to that of Mr. Shattock’s case.-Mr. PARKER said someof these tumours consist partly of solid structures and partlyof cysts. In one case after injection of iodine into the cyststhe solid portions shrunk away. He had under his care nowa similar tumour in the axilla of a child, where they areless common than in the neck or pelvis.Mr. MORRIS, for Mr. Sutton, showed a specimen of an old

injury to a Femur of a Puma. The right leg muscles werewasted, the acetabulum filled with fibrous ti,sue, the upperend of shaft of body of femur was fixed to the ilium by firmfibrous tissue, and the top of the trochanter detached. Thehead of the femur was represented by a small nodule ofbone. The patella was displaced up, the cartilages of theknee were eroded.Mr. MORRIS also showed a specimen of the Pneumothorax

in a Coati. The right pleura was half.filled with flaky serum.In blowing into the trachea air escaped from the lung into alarge abscess cavity behind the lung.

Dr. BENDALL showed microscopic specimens and draw-

ings of preparations from a case of Acute Farcy in Man.The disease occurred in a strong man who was admitted tothe Perth Infirmary with erysipelatous blush over the rightfoot, inflamed lymphatics on the leg above, and numerousfarcy buds scattered through the muscles of the limbs, inall stages of softening. Two of them were opened antisep-

tically, and the pus evacuated was found to contain a

quantity of free oil. Later on the characteristic pustularskin eruption appeared, then followed pneumonia of theleft base, with intense dyspnoea, quite out of proportion tothe physical signs ; coma and death. At the autopsy theblood generally was found fluid and dark, with a large clotin the right ventricle and pulmonary artery. Three smallabscesses were found in the lett lung. Both lungs were- congested and showed signs of bronchitis, with catarrhalpneumonia of the left base. Numerous ulcers were foundin the mucous membrane of the nose, mouth, fauces, andpharynx; some covered with sloughs, others with a foulmuco-purulent discharge. Spleen enlarged and soft; lefttunica vaginalis obliterated by adhe,ive inflammation, witha few purulent spots seen on section. Numerous ab-scesses, containing sloughy blood-stained pus, were foundin the muscles, chiefly grouped around the joints.’The skin of chest and forehead was scattered over withpustules and small ulcers left by them ; lymphatic glandsof the joints unaffected. Sections of the lung showed verynumerous fat embolisms. The mucous membrane of thepalate was evidently acutely iuflamed with fatty necrosis ;near the flow of the ulcers fat granules were viible. Thesubmucous fat cells seemed to have lost their wall, allowingtheir contents to flow together. The mucous glands werefilled with granulated debris. Many patches of similar fattygranules were seen between the glands and the bone.The skin of the forehead near the ulcers was almost struc-tureless with the same amorphous fat granules. Dr. Bendallconnected the presence of so much oil in the abscesseswith the fatty necrosis of the tissues. The marked dyspnoea,which seems to be almost constant in the later stagesof farcy, finds an explanation in the fat embolism.-Dr. WiLES asked if it was meant to distinguish this diseasefrom glanders. In his experience in man glanders wasalways constitutional, and resembled the case described. Inthe horse there is a difference, no doubt.-Mr. GODLEE saidthat the writer of the article in Ziemssen’s Cyclopaedia on

glanders stated that in all the cases of this disease in man,nasal symptoms appear sooner or later. In a case he hadobserved at University College Hospital the lesion resembledat first acute rheumatism, without any nose symptoms,but the latter came on afterwards. He saw another case lastyear in which the nose was markedly affected at the last.-Dr. HOGGAN last year examined specimens from a verycharacteristic case. He found the lymphatic system verydilated and plugged with pus cells. The nerves of thepart were irritated. All the other tissues showed nothingspecific. Close to the small farcy buds the epitheliumshowed ordinary embryonic swelling, and the tissues roundinfiltrated with pus cells, all of them breaking down.-Dr. S.COUPLAND had recorded a case of glanders in man with-out nasal ulceration, but presenting the visceral gro vthsdescribed by writers as characteristic of the disease. -Mr. MORRIS suggested that the interest of this case was inthe fat emboli in the lung ; usually this has been found inconnexion with fractures and injuries of the bone only.-Dr. MAHOMED asked if the blood had any peculiar naked-eye appearances.-Dr. BENDALL had called the case farcyto distinguish it from cases in which the local changes inthe nose were primary and most marked. Some cises havedied simply from gangrene of the face ; and in none of themhad there been marked dyspnoea. Some of the skin eruptionsare like pemphigus ; that described by Viichow consists ofnodules which break down very rapidly, with little or no signof true pus cells.Mr. DAVIES CoLLEY showed a specimenof False Membrane

of Fauces, &c., following a scald. The child, one year andten months old, in Guy’s Hospital, under his c.ire, wasscalded by drinking from a teakettle. There was greatcollapse ; after a time laryngeal obstruction appeared, andthe uvula and fauces were scarified, which afforded relief.Three days later a white membrane was seen on the fauces,and two days after the child died. The fauces, pharynx,all the oesophagus, and larynx down to the venttides, werecovered by a false membrane firmly adherent to the mucouslining; the ventricles, true vocal cords, and trachea were quitehealthy. There was broncho-pneumonia of both bases of thelungs. The case was an instance of croupous membrane re-sulting simply from an injury. The child died from acutebroncho-pneumonia, without any trace of inflammation ofthe trachea ; and it was therefore not due to inhalation of hotsteam or extension by continuity. He would class it withthe pneumonia often occurring in the second stage of burns.Often in scalds of the larynx, after tracheotomy, the patientsdie, or nearly die, of broncho-pneunonia, which is supposedto be due to the irritation of the tube and cold air inhaledbut this instance he thought threw important light on suchcases.

Mr. G. HUTCHINSON, jun. showed as a card specime anexample of Cystic Disease of the Kidney in a Pig, in whichthere was no evidence of any disease of vesiculae seminalrs,which had been suggested as the explanation of a CJ,se

shown by his father at a previous meeting.The Society then adjourned.

OBSTETRICAL SOCIETY OF LONDON.

AT the meeting of the Society on Jan. llth, 18S2, Dr.Matthews Duncan (President) in the chair,Dr. CARTER showed a Fibroid Tumour, removed from a

patient aged fifty-four, who had suffered from ha _uorrhagefor six years. The vagina was filled by a large smoothgrowth, an expansion of the posterior lip of the cervix. Itwas removed by ecraseur under ether, and weighed 21 oz.The next day a large mass again filled the vagina, beingthe interstitial part of the tumour extruded. Ether was

again given, and a piece weighing 10 oz. was removed fromthe posterior lip of the cervix. On the third day there wasagain found in the vagina a polypoid mass, springiug fromthe posterior wall of the fundus. This was again removedby ecraseur, and weighed 3 oz. The patient did well.Dr. OUTHWAITE showed a Mummified Fcetus, evidently

developed up to about the second or third month. It came

away after the delivery of the child in the seventh month ofpregnancy. The placenta was single, and the membranesshowed a manifest septum.-Dr. Ems thought that the case

illustrated a common incident. It often happened that, in

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twin pregnancy, a burst of haemorrhage took place, andabortion was supposed to have occurred when only one ovumwas blighted, and might either be retained or expelled.

Dr. GALABIN showed, for Mr. Gillingham, a Uterus atfull term of pregnancy, having a very large soft fibroidtumour growing from its internal surface. The os was foundclosed, and the head above the brim, and it was thought atfirst that the smooth elastic mass felt through the os wasthe sac of a second foetus. This was disproved on attemptingto scratch through the supposed membranes. A secondpractitioner who was called in took the case to be one ofplacenta prasvia. The child was delivered with difficulty byversion, and the patient died from shock and hsemorrhageshortly after.The PRESIDENT called attention to Salicylic Cream, one

part of the powdered acid to four or five of glycerine orvaseline, as a valuable means of keeping sponges, tents,instruments, &c. aseptic in the vagina. It had been sug-gested to him by Dr. Alexander Ogston of Aberdeen, and hehad used it with success in inducing premature labour andother operations.The discussion on Dr. Godson’s paper on the Treatment

of Dysmenorrhoea and Sterility by Dilatation with MetallicBougies was then continued.-Dr. ROGERS had twenty-fiveyears ago commenced the use of dilators, at the recommen-dation of the late Sir James Simpson. In married womenpregnancy often followed ; but the results were not so satis-factory in the unmarried, who often relapsed into theirformer condition. Eventually he ceased to have confidencein their use, and he believed that they had been universallydiscontinued in London until the last few years. He hadalso given up the use of incisions, one of his patients havingdied after that operation. Eventually he turned his atten-tion to the cure of dysmenorrhoea by the use of Dr. WynnWilliams’ intra-uterine stem and shield; and in only onecase had serious mischief arisen. In private practice, how-ever, he preferred one of Meadows’ or Routh’s stems ofvulcanite, as india-rubber soon decomposed. Since hearingthe paper he had tried a No. 7 and No. 8 dilator upon onepatient, but found that the latter gave extreme pain.Dilatation by sea-tangle was well borne.-Dr. BRAXTONHICKS confessed to a difficulty he had always felt in dis-tinguishing the purely spasmodic dysmenorrheea, to whichthe author professed to -confine his paper. We might beable during the menstrual intervals to pass a sound readilyup to the fundus, and yet the menses might be obstructed ;for instance, from a haemorrhagic coagulum or tumidity ofthe mucous membrane. When we looked to the remedyemployed by the author, we found that it was essentiallydilatation by bougies graduated in size. Hence we mightfairly conclude that the cases where these were of use were,more or less, at the menstrual period cases of obstruction,unless it were argued that the mere passage of the metaltended to harden the mucous surface and to render the uterusless susceptible and spasmodic. If, then, the cases were in ameasure those of obstruction, then they were out of thediscussion, which was limited to those of pure spasm.-Dr. SAVAGE said that the instrumentalists contended thattheir inventions cured in some cases, relieved in most, andnever did harm; whereas there was abundant evidence thatthey never cured, relieved only so long as they were used,and too often did much harm, even to compromising life.An eminent provincial surgeon had lately brought to thenotice of the profession fourteen morbid specimens of theuterine appendages, some of the tubes containing half a pintof matter. It was said that these unfortunate subjects hadbeen the round of the profession, and had been submitted toall sorts of instrumental treatment. Was it not clear thatthe original disease, if not produced by instrumentation, hadbeen greatly aggravated by it? He agreed with Dr. Hicksand Dr. Herman that every sort of uterine deviation and

- contraction was met with without suffering, and the converse.Rethought the diagnosis of deviations by instruments untrust-worthy, fortbedeviationsupposed to be diagnosed was actually

. produced by the instrument. He deprecated the fast-growingtendency to interfere surgically with complaints referable tothe uterine system.-Dr. PRIESTLEY thought that one of thedisadvantages of discussions like the present was that thoseof limited experience were apt to conclude that all cases ofdysmenorrhcea required local treatment. The theory thatdysmenorrhoea was always obstructive was not borne out byfacts, for severe pain in menstruation often occurred afterthe genital canal had been fully expanded by parturition ;though it was true that, in the majority of cases, parturition

cured previously existing dysmenorrhoea. There might begreat suffering at what corresponded to menstrual periodswhere there was absolute amenorrhcea, or where the uteruswas rudimentary. There was a large class of cases, moreespecially among unmarried girls, in which local treatmentwas absolutely unnecessary. He could not agree with theauthor, however, in dropping the term obstructive dysme-norrhcea, for there were not infrequent instances of genuineorganic narrowing, congenital, or acquired as the sequel ofinflammation. A correct diagnosis was most important. Wherelocal treatment was considered necessary, he thought in somecases dilating was the proper course, in others division of thecervixwas more useful. Where there was a choice he preferreddilatation, considering incision to be much more hazardous.- Dr. GALABIN said that the most remarkable point aboutthe cases was the very large proportion of them in whichnot only dysmenorrhoea, but sterility seemed to have beencured. What was the mechanism of this cure ? He hadhimself had cases in which, after years of sterile marriage,pregnancy had followed within a month after a single use ofmetallic bougies or Priestley’s dilator. Dr. Barnes had re-lated cures of sterility by moderate incisions of the externalos, and similar experience was not uncommon. The onlycommon element in the three modes of treatment seemed tobe that all made the access through the cervical canal morefree. The natural inference was that a canal, though largeenough to let the sound pass easily, might yet practicallynot give free enough ingress to the semen. A fortiori asimilar canal might not give perfectly free egress to the pro.duct of menstruation, which was not only fluid blood, butcontained debris, if not shreds, of mucous membrane, andoften clots. Egress of menstrual fluid was not prevented, asingress of semen appeared to be, because it had the contrac-tile power’of the uterus behind it; but this very circumstancewas enough to account for spasmodic pain in a sensitivesubject. He did not accept the author’s theory that thesterility was due to spasm of the uterus ejecting the semen,.for the painful spasm only occurred at the menstrual period.- Dr. MURRAY spoke in favour of the intra-uterine stem.The case of dysmenorrhcea and sterility so treated by himhad been successful; and he thought the stem pessary mxchmore likely to effect a cure in the so-called spasmodic dys.menorrhoea. He quite agreed with Dr. Hicks’s views onthis subject, and also with Dr.’Priestley, that a great dealtoo much interference often took place.-Dr. AVELING saidthat dilatation for the cure of dysmenorrheea might beeffected in four ways-1, by passive, or what had alsobeen called physiological, dilatation by means of stems;.2, by wedging the canal open by sounds, bougies, oy plugs 3,3, by direct dilatation instruments or tents being passedinto the canal and expanded or allowed to expand; 4, byincision. Each of these methods he thought might be usedsatisfactorily, but no one should be used to the exclusion ofthe others. - The PRESIDENT thought the mechanical ob-struction to semen by the cervical passage was regardedas far more important than it really was ; and especiallyhe noted the error of regarding the dimensions of thecervical passage as being stable, constant, or permanent.He had no doubt they varied, and almost certainly were en-larged during the orgasm of coitus. Were these conditionsas important as represented, and were they stable or con-stant, impregnation could never occur, for the passage ofthe inner end of the tube was closed altogether; not a

bristle could be passed. This was enough to show that itwas wrong to consider size of passage without further in-vestigation as to changes of the size. Many eminent mendoubted the reality of so-called cures of sterility, and he hadno doubt that most cases were mere lucky coincidences. Hewas not convinced of the reality of any cures except in thesecases of combined dysmenorrhosa and sterility discussed inDr. Godson’s paper. One evidence in favour of the realityof the cures was that all were done by substantially thesame method-namely, dilatation of the cervix. Amongthe various means of dilatation, he held a well-knownopinion in favour of that recommended in the paper justread.-Dr. GODSON, in reply, said that his dilators were notcurved any more than an ordinary uterine sound, and not somuch as those used by the President. It seemed almostcertain that the patient upon whom Dr. Rogers had passedthe dilators was suffering from congestive dysmenorrhoea,and was not a fit subject for the treatment. It was most

, important that a proper diagnosis should be first arrived at,: and that dilatation should be only practised where thereI was absence of congestion, otherwise there was great fear

231

f inflammatory mischief ensuing. His paper treated onlyf spasmodic dysmenorrhoea associated wdh sterility, andherefore Dr. Priestley’s remarks with respect to the treatmentf young girls were outside the scope of the paper, but hentirely accorded with them.

MEDICAL OFFICERS OF HEALTH SOCIETY.

AT a meeting of this Society, held at 1, Adam-street,Adelphi, on Friday, January 20th, Dr. J. W. Tripe, Pre-

sident, in the chair, the Council brought up a report pro-testing against sanitary authorities expecting their medicalofficers of health to undertake other duties than thosewhich properly belong to their office, as in the case of

Sunderland, where the medical officer of health had beenexpected to perform the duties of chief scavenger and tomake purchases for the local authority. The report wasunanimously adopted.

Dr. BENJAMIN BROWNING, Medical Officer of Health toRotherhithe, read a paper on the Practical Working ofDirect Calf Vaccination, of which the following is an ab-stract. After referring to the number of cases in whichsmall-pox occurs in vaccinated persons, Dr. Browning statedthe opinion that it was no longer advisable to use humanisedlymph for vaccination, because it is not easy to procure onemergency; it sometimes fails to afford the desired pro-tection, and is suspected by some to be the means of convey-ing constitutional infection, while calf lymph is available onthe briefest possible notice, never fails in preventing small-pox, and is not known to have produced any bad symptom.After quoting the statistics of the Metropolitan AsylumsBoard Hospitals as evidence that humanised lymph did notafford any but a limited protection against small-pox, Dr.Browning claimed for calf lymph that it never failed tosecure immunity from disease. He defended it against theaccusation that, in practising direct animalised vaccination,whether from animal to animal or from animal to man, thereis probability of failure, and that papulo-vesicular eruptionsare specially induced by it, or that it is followed byerysipelatous symptoms, and that the local as well as

constitutional disturbance is much more severe than afterhumanised vaccination. Dr. Browning then detailed hisown experience. He first selected two calves some three

weeks old, and having shaved one behind each wither vac-cinated it by scarification, employing Beaugency lymph, theanimal subsequently wearing a cradle, being tied up, andkept within sight, but not reach, of its fellow. The vacci-nation succeeded ; the vesicles rose, and on the seventh day,when he proceeded to collect lymph, they were found loadedwith pus. From some vesicles on the nose of this calf hevaccinated the second calf, and on the second day after theoperation found distinct vesicles on its nose ; he then foundthey had got out of their cradles, and had vaccinated themselves and each other. Calves of a month old are best foruse; the lymph should be as fresh as possible, and thereforederived from an English source. The calves should be keptin a well drained and ventilated stable, in stalls not wideenough to allow them to turn round. A strong reversibletable, slightly hollowed on the top, with holes to permit theescape of ordure and urine, and fitted with a post, two horns,and rings, so as to facilitate the "spread-eagling"of the animal,should be provided. The other appliances are a water-bath,a drying-oven with a Centigrade thermometer, some paraffin,a pair of forceps, scalpel, vaccinating needle, &c., togetherwith ivory points, glass tubes, and squares. The calf isfastened to the table, with the head between the iron horns,the fore legs strapped together, the hind legs separated, andlashed respectively to the posts and left-hand corner. Theabdomen of the clf is then shaved, washed with a solution ofthymol or catbolic acid, and scarified in fifty to eighty places,for lymph insertion. If the vaccination be direct, an equalnumber of punctures with the needle answers better. Withintwenty-four hours each insertion is reddened and a vesicledeveloped and acuminated from the third to the fifth day;later its contained lymph slowly passes into pus, and by theseventh or tenth day drops off. During this time theanimal keeps free from constitutional disturbance. To collectthe lymph the animal is again placed on the table, thevesicle pinched up with forceps, removed with a double-edged scalpel and drained by slight pressure on to a piece ofglass, the dry scab is left alone, but the pool of lymph run-

ning from it is "microscoped," as used for coating points orglasses or filling tubes. The points are dried in the oven ata temperature of 100°. The glasses are each coated withlymph, put together, their edges plunged into paraffinmelted over the water-bath. The tubes are filled with lymphwhich is defibrinated by exposure to the air and gravitation,and then closed with paraffin or hermetically sealed.-In thediscussion which followed, Dr. Drysdale, Dr. Renner, Mr.George Turner, Mr. Wynter Blyth, Dr. Corfield, and thePresident took part.

Reviews and Notices of Books.The Journal of Physiology. Edited by MICHAEL FOSTER,

Sec.R.S. Vol. IIL, No’’s. 3 and 4. Jan. 1882. -This partcontains the following articles: Observations on the MeanPressure and the Characters of the Pulse Wave in the

Coronary Arteries of the Heart, by H. N. Martin and W. T.Sedgwick ; On the Polar Effects upon Nerves of WeakInduction Currents, by H. Sewall; Notes on the Tempera-ture of Heat-coagulation of certain of the Proteid Substancesof the Blood, by E. A. Schafer; On the Existence of Bac-teria or their Antecedents in Healthy Tissues, by F. W.Mott and V. Horsley; On the Action of Hydrate of Soda,Hydrate of Ammonia, and Hydrate of Potash on the Ven-tricle of the Frog’s Heart, by Sydney Ringer; The Physio-logy and Pathology of the Spleen, by C. S. Roy; A Case ofLoss of Taste from Disease of the Fifth Nerve, by W. R.Gowers; A Comparison of Sight and Touch, by H. P.Bowditch and W. F. Southard; On the Destruction ofFerments in the Alimentary Canal, by J. N. Langley; apaper on the Histology of the Mammalian Gastric Glandsand the Relation of Pepsin to the Granules of the ChiefCells, by the same author; and, lastly, on the Production ofthe Second Heart Sound.Brain. January, 1882. -The English Neurological

Journal contrasts favourably with its French contemporaryin the interest if not in the weight of the’’articles. Dr.Lauder Brunton contributes some ingenious hypotheses re-garding the rationale of the arrangement of the corticalcentres in the brain which innervate movements of socialand physiological importance. The methods of hardeningand demonstrating cerebral structures in health and diseaseare clearly described by one well qualified for the task,Dr. Bevan Lewis. Mr. Gorham of Tanbridge discusses theblending of colour by the sole agency of the sensorium, andDr. Buzzard contributes an instructive lecture on ParalysisAgitans. The last original paper is a very curious study ofDean Swift’s disease by Dr. Bucknill. Reviews, abstracts,and clinical cases, some of the latter of great interest,complete the number.

Archives de Neurologie. January, 1882.-Nearly half ofthe current number of the Archives cle Neurologie is occu-pied by two anatomical papers, one on the Structure, Humanand Comparative, of the Cornu Ammonis, by M. Duval ; theother on the Structure of the Auditory Nerve, by Erlitzky.Both are elaborate and well illustrated, but are of little

practical interest. The section on Mental Pathology con.sists of a short fragment of a paper by Charcot and imaonan,on the Inversion of the Genital Sense, with the details of asingular and well investigated example. Myxoedema, underthe name of " pachyclerraic cachexia," is the subject of apaper by Dr. Blaise of Montpellier. The periscopic reviewis, as usual, full and useful, and Vigouroux continues ananalysis of the " fact3 " of Medulloscopy. The number is

scarcely up to the usual standard of interest; at any rate,so far as the original matter is concerned.Treatment of Vaticocele by Excision of Redundant Scro-

turn. Illustrated by New Instruments and an Accountof Fifteen Successful Cases. By M. H. Henry, M.A.,M.D. New York: J. H. Vail and Co. 1831.—This paper