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Thumb-joints,in which inflammation of the carpo-metacarpaljoints of both thumbs came on after the removal of twoovarian tumours in November, 1885. The arthritis has con-tinued unabated, the veins about the joint are swollen, andthere is increase of temperature; grating between thearthritic surfaces can be obtained. The thenar eminencesare a little wasted, but there is no reaction of degeneration,only generally diminished reactions to both currents. Men-struation had ceased since the ovariotomy. Pain was thefirst symptom in the left thumb; the right followed later.The reflexes at the wrists were perhaps a little exaggerated.Absence of rheumatism, gout, and the relation in time toovariotomy and the appearance of the disease when thejoints were comparatively quiet, suggested a causal relationbetween the ovariotomy and the arthritis. It was con-nected not with congestion, but rather with ansemia of thegenital regions. All treatment had proved of little avail.--7Ir. WM. ADAMS did not think it could be placed amongst’the neurotic alterations in joints. The principle of "restand sweat" night and day should be employed in treat-ment.-Mr. B. JESSETT recommended complete rest of thejoints.—Dr. WM. ORD believed that the case was one inwhich reflected " uterine" irritations were at work ; theovaries had been removed, but we did not know what thestate of the uterus was.-Dr. MAGUIRE, in reply, said hepresented the case simply as a clinical fact.Mr. FRANCIS MASON exhibited a young man on whom he

had performed Excision of the Left Elbow-joint, with good,-result in a freely movable joint. Since the operation a tuber-cular testis on the right side had developed, with infiltrationin the right side of the prostate and the base of the bladder.-Mr. IIURRY FENWiCE, who showed this case in conjunctionwith Mr. Mason, suggested that the testicle became diseasedas the result of infection from the joint, possibly about thetime of the operation, and in consequence thereof.—Mr..STEPHEN PAGET did not perceive the reason why the testisshould not have been produced under the same influencesthat gave rise to the tumor albus of the elbow-joint.

Dr. RADCLIFFE CpocxEB exhibited a boy, aged sixteen, withTubercular Leprosy, who had lived in Dominique, but wasof Scotch parentage. There had been no privation; the boyfuad eaten fish. The leprosy appeared first in 1882, one yearafter the boy came to England to go to school. Febrilesym-ptoms preceded the development of tubercles ; the progressiiad been saltatim; febrile attacks accompanying each freshcrop of tubercles; the glands in the groin and elsewhere en-larged just before the febrile attacks. There were no definitetracts of anaesthesia; the ulnar nerves were not materiallythickened; the mucous membranes of the tongue, epiglottis,and vocal cords were affected with tubercles; the nails hadbeen destroyed in places ; sometimes the tubercles ulcerated;and the typical bacilli had been detected. Gurjun oil hadbeen employed with a little benefit.-Mr. SPENCER WATSON-related a case.

Dr. RADCLIFFE CROCKER also showed a case of Pityriasis’Circinata in a man aged twenty-seven. It began on theabdomen a month ago in oval or round patches, enlargingperipherally and disappearing centrally; at first bright red,becoming brownish and scaly. The disease generally ran itscourse in from one to two months. Vidal described a fungusmicrosporon, probably a micrococcus, but no real parasitehad been discovered. Calamine lotion and liquor carbonisdetergens were used locally.-Dr. STEPHEN MACKENZIEsaid that the micrococcus was an epiphenomenon, and might’be found in any scaly debris from skin disease. The diseasewas not parasitic. Boracic acid was better than carbolicacid, though the latter relieved itching.-Dr. CoLCOTT Foxr aid the eruption was more scanty in children, and occurredentirely on the trunk. It looked like psoriasis at first sight,’but the distribution was different. A micrococcus was always

I

present, but as an epiphenomenon.-Dr. R. CROCKER, in I

Teply, said he considered the disease to be the same inchildren as in adults, between which there were all links.Mr. J. H. MORGAN showed a case of Congenital Constric-

tion by a Band producing Perforating Ulcer of the Foot, in a.9ainter aged thirty-eight. On the right hand the fourthdigit had no terminal phalanx and only a rudimentary second second phalanx; the second and third digits were fused, and had (

only a proximal phalanx; there were no nails on these digits. 1The left hand index finger had a rudimentary second phalanx 7and no nail. The right lower limb showed a firm cicatricial JAontraction, which surrounded the knee below the patella; 1the leg was smaller on this side, and had a chronic sclero- (dermatous-like condition of the skin. There was a per- c

forating ulcer on the under surface of the ball of the greattoe, which tended to ameliorate. The knee-jerks werenormal; some anaesthesia was present.-Mr. WM. ADAMSsuggested that lymph bands in utero might give rise to thecicatricial markings in limbs by causing constriction. Itwas difficult, however, to understand the cases.-Mr.RITCHIE asked how much the malnutrition was due tovascular and how much to nervous damage.Mr. SpENCEB WATSON showed some New Instruments for

use in the removal of Nasal Polypi.

OBSTETRICAL SOCIETY OF LONDON.

Rem01:al of botli Ovaries during Pregnancy.THE annual meeting was held on Wednesday, Feb. 3rd,

J. B. Potter, M.D., F.R.C.P., President, in the chair.Mr. KNOWSLEY THORNTON read a paper on a case of

Removal of both Ovaries during Pregnancy. M. Wiz,married, aged twenty-two, in the third month of pregnancy,was known to be large twelve months before marriage. Sheis now beyond the size of pregnancy, and has a largefluctuant tumour in the abdomen, which is growing fast.Has suffered from several attacks of pain in the abdomen,with rise of temperature, sickness, and faintness. Diagnosis:ovarian tumour complicated by pregnancy. Ovariotomyadvised, and performed Feb. 4th, 1885. Dermoid tumours ofboth ovaries removed. Rapid and uninterrupted recovery.Premature delivery at eighth month. Labour uncomplicated.Lochia normal. Fine healthy child, and plenty of milk to nurseit. On examination, uterus found atrophic ; patient, whilenursing, suffering from flushes, chills, &c., just as othersdo who have an artificial menopause brought on by operation.The author made remarks on the interesting physiologicaland pathological problems which this unique case suggests.-Dr. JOHN WILLIAMS said that in a note read before theSociety in 1884 he described the involution of the puerperaluterus in the absence of the ovaries. In that case the leftovary had been removed some years previously, and theright was removed soon after labour set in. The course ofthe process of involution might have been affected directlyby the interference of the operation in his case; but inMr. Thornton’s it could not have been so, for the opera-tion had been performed some months before labour setin. He would ask Mr. Thornton if any observations hadbeen made on the process of involution in his case.-Dr. ROUTH remarked that the atrophy of the uterus couldnot impede lactation, and quoted Dr. Livingstone, whostated that the wives of the African kings were notallowed to suckle their own children, as it was thoughtderogatory. The child was given to the grandmother,generally an old woman, to whose mammse and pudendumcertain plants were applied and the child put to herbreasts, with the result that she was able to suckle thechild. He also alluded to well-authenticated cases in whichmen had suckled. He objected to the conclusion thatmenstruation always depended upon ovulation; this questionhe considered undecided, and facts were accumulating toshow that menstruation had really very little to do withovulation. - Dr. MATTHEWS DUNCAN regarded tapping asthe best treatment in cases of simple parovarian cyst. It in-volved less danger than extirpation, and was often successful.The extirpation of small papillomatous ovaries involvedmany difficulties. He did not believe any operation couldcure where malignant disease had extended to severaldifferent parts of the peritoneum. He also reminded theSociety that Dr. Tyler Smith had supported the view thatthe commencement of’labour was a function of the ovaries.This view was now rendered almost untenable by Mr.Thornton’s case. He had no doubt whatever that the ovarieswere indissolubly connected with menstruation.The following specimens were shown:-Dr. W. Griffith :

(1) Uterus showing a Dilated Cavity; (2) Sarcoma ofUterus. Mr. Thornton: Papilloma of Ovary.The Society then preceeded to the business of the annual

meeting. The treasurer’s report was adopted, on the motion:)f Dr. Playfair, seconded by Dr. Carter; the report of theion. librarian, on the motion of Dr. Godson, seconded byDr. Horrocks ; the report of the chairman of the MidwiferyBoard, with a vote of thanks, on the motion of Dr. MatthewsDuncan, seconded by Dr. Malins, and supported by Dr.xraily Hewitt. The scrutineers (Drs. Thomas and Lewers)leclared the list of officers and council proposed by the

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Council adopted. The President delivered the annualaddress, for which a vote of thanks was proposed by Dr.Graily Hewitt, seconded by Dr. West. A vote of thanksto the retiring officers (Dr. Herman and Mr. Thornton)was proposed by Dr. Gervis, seconded by Dr. Watt Black;and one to the retiring Vice-Presidents and other retiringmembers of Council was proposed by Dr. Routh, secondedby Dr. W. Duncan.

Reviews and Notices of Books.lieference Handbook of the Medical Sciences. Vol. 1.

Aac-Cat. By various Writers. Illustrated by Chromo-lithographs and fine Wood Engravings. Edited byALBERT H. BUCK, -7vl.D. New York: Wm. Wood and Co.

THIS work, of which the first instalment is before us,which is to comprise eight volumes of about eighthundred pages each, will undoubtedly mark an era in theliterary history of medicine and the allied sciences. It is

quite impossible in the space at our disposal to give anadequate description of the merits of the production, whetherwe turn to the rare knowledge and skill which the severalcontributors have brought into requisition, or to the excel-lent arrangement of the subjects treated of, the type, and,last but not least, the admirable illustrations. Our readers !will be able to form some idea of the completeness of thetext and its illustration when we inform them that in thearticle " Applied Anatomy of the Arm " thirteen pages are ’devoted to the former and twenty-six woodcuts to the latter, I

How consistently and thoroughly the plan of the editor iscarried out may be gleaned from a brief comparison of

widely different subjects. Thus, almost immediately suc-ceeding a classical dissertation on "Army Diseases" and" Army Hospitals " is a brief description of " Arnica," whichincludes the characters of the plant, its chemical and thera-peutic properties, and other interesting details, to which isadded an excellent chromo-lithograph. The pathologicalanatomy of disease is given in sufficient detail. Take, forexample, the subject " Adenoma," the description of which isgraced with four well-executed drawings.The article " Blood will earn for the author considerable

repute. It contains a well-digested account of the salientfeatures of that fiuid," both in its physiological and morbidconditions. It contains fifty diagrams, of which the greatestinterest will attach to those representing the different in-struments for estimating the number of corpuscles and thequantity of colouring matter in a given preparation; andthe spectroscopical appearances, twenty-four in number, ofblood under as many chemico-physical conditions. It re-mains to be said that each subject is fully up to the presentstate of knowledge and research. Attention may be calledto " the running titles at the upper corners of the pages;these are intended to aid the reader in searching for a par-ticular topic." A full index will be introduced at the end ofthe work. America is said to be the land of big things, andits title to the claim will not be belied by the Handbooknow under review. We look forward, with much interest tothe production of the remaining seven volumes.

On the Supra-pubic Operation of Opening the Bladder for. the Stone and for Tumours. By Sir HENRY THOMPSON,

F.R.C.S., Surgeon Extraordinary to His Majesty the Kingof the Belgians, Consulting Surgeon to UniversityCollege Hospital, late Professor cf Surgery and Patho-logy to the Royal College of Surgeons-6i England, &c.London: J. and A. Churchill. 1886.

THE operation of supra-pubic lithotomy is undergoing arevival, as frequent notices in our pages during the last fewyears have sufficiently shown. It bids fair to supplantperineal lithotomy altogether; it is not without a pangof regret that older surgeons especially will part with an

operation wnicn nas always possesseu a Hpeuini iascmu-

tion, and the history of which is connected with manyof the brightest names in surgery. The careful dissec-tion through the abdominal wall on to the front of thedistended and raised bladder bears but a very slight resem-blance to the bold and rapid plunge into the viscus fromthe perineum, which in the hands of Fergusson and otherbrilliant lithotomists was the admiration of all spectators.The claim of the supra-pubic operation, however, is verystrong, and the publication of Sir Henry Thompson’s bookwill do much to impress its merits upon the minds ofBritish surgeons, who have been slower to recognise themthan their continental brethren. Two names will be asso-ciated with the revival of this operation-Garson andPetersen. To Dr. Garson of the Hunterian illuseum belongsthe credit of demonstrating the remarkable influence uponthe bladder of full distension of the rectum, which so raisesthe viscus as to expose a considerable extent of itsanteriorsur-face bare of peritoneum above the pubes. To Petersen belongsthe credit of availing himself of this anatomical demonstra-tion and of supporting Dr. Garson’s argument by clinical expe-rience. All this, and very much more, of the history of theoperation is told by Sir Henry Thompson, who gives a luciddescription of the details of the procedure and the sub-

sequent management of the patient, and appends notes of the,cases in which he has himself practised the supra-pubicmethod. These cases include six instances of the removalof large stones, and two of the removal of large tumours.Dr. Tremaine of Buffalo has lately recorded three interestingcases in which he has successfully performed what he wouldhave us call epicystotomy. In one case a stone measuring2s in. by Iin. was removed from a child three and a halfyears old; in the second case fragments weighing altogetherover three ounces were removed from a man aged thirty;and in the third case from a man aged seventy-three amulberry calculus measuring 1 in. by 1 in. was removed.In the last case the peritoneum was wounded, and theintestines protruded from the wound after the man wasreturned to bed. In the second case the wound in thebladder was sutured. In neither case was Petersen’s dis-tension of the rectum employed. Dr. Tremaine, like Sir

Henry Thompson, found the fingers the most convenientmeans of extracting the calculi.

Acne; its Etiology, Patholoqy, and Treatment: a PracticalTreatise based on the study of 1500 Cases of Sebaceow.Disease. By L. DUNCAN BULKLEY, A.M., M.D., Physicianto the New York Skin and Cancer Hospital, &c. Pp. 280.London: J. and A. Churchill. 1885.

THis well-got-up volume is in some respects a companionone to that on Eczema which has been favourably noticedin these columns. It is written in a similar practical way,is largely in accordance with views held in this country,.and is characterised by careful details as to treatment,by a copious formulary, and a chapter on diet and hygiene.The pathological anatomy of the eruptions is minutelystudied, and the beautiful illustrations of Dr. Bulkley’sspecimens form a striking feature of the work, and areespecially valuable. We must also mention the addition ofa very extensive bibliography, so that the volume is onewhich is very acceptable both to the worker at these diseasesand to the practitioner. The author uses the term acne inits widest sense, and defines it as a functional or inflam-matory disease of the sebaceous glands, exhibiting excessiveand abnormal or deficient- secretion of sebum; or the

inflammatory elements of congestion, papules, pustules, ortubercles, located in and about the sebaceous glands, or inany or all of these features combined. The term thereforeincludes the diseases known as seborrhoea, comedo, andmilium, sebaceous cysts, the ordinary inflammatory acneand rosacea, A. atrophica, and A. cachecticorum. Molluscum.