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tenance, no appetite, a quick weak pulse, and complainsslightly of sore-throat and of difficult deglutition. The pellicleis heaped up on the wound, looking like very overboiled mac-caroni ; while the velum, uvula, and left tonsil are more or lesscovered by a similar exudation. Ordered to continue the bath;to take solution of cinchona, tincture of opium in ten-minimdoses, with five grains of chlorate of potash, every two hours ;and a solution of nitrate of silver (one drachm to two drachmsof water) to be at once thoroughly applied to the throat.

18th.-Feels better, countenance much improved, and noexudation to be seen on the fauces. From this moment the

patient gradually improved, and left the hospital in a fair waytowards recovery on Sept. 13th.During the diphtheritic inroad the wound on the back of the

hand was covered with a thin exudation, but was otherwisealmost passive. This peculiar condition of wound appears tobe attended by two processes-one of production, the otherof destruction : the former exemplified in the accumulation ofexudation matter upon the surface of the sore, without loss ofsubstance; the latter shown by an extension of the area of thewound by ulceration of its integumental border. The specialinterest attaching to this case is the coexistence of a diphthe.ritic condition of a wound and of the fauces; but it will bewell to record that the patient himself deemed the sore-throatof very little moment. In two cases of diphtheria of woundssubsequently treated by Mr. Maunder, similar remedies (with-out the bath) were employed, with the desired effect.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

TUESDAY, OCT. 18TH, 1864.MR. PRESCOTT HEWETT, PRESIDENT.

THE PRESIDENT congratulated the Society on the successfulvolume which had been issued by the Society, and announcedthat an index to the first fifteen volumes of the Society’s" Transactions" had been prepared, and was now in the press.Mr. BALMANNO SQUIRE exhibited a coloured photograph of

Psoriasis Diffusa and of Impetigo of the Face. He dwelt on thefact, that in the first case the disease was cured by local treat-ment, and that in the second the patient used salt-water bathsboth in the sea and at home with great benefit.

Dr. MURCHISON showed specimens ofULCERS OF THE INTESTINE AT A VERY EARLY STAGE OF

TYPHOID FEVER,

where the deposit was only just breaking down into ulceration,the disease proving fatal on the tenth day; and another, wherethe disease was very extensive, and death occurred on thetwenty-fifth day. In another specimen the fever was typhus,but complicated with diarrhoea. Here the intestine was quitefree from ulceration. The character of the fever was shownby the rash, and the case proved fatal on the eighteenth day.In a fourth specimen, where death occurred on the sixth day,there was distinct ulceration on the ileo-csecal valve and depositin Peyer’s patches. The patient was a child, aged six years,and the mother also suffered from typhoid fever.

Dr. BRISTOWE remarked that in the late epidemic many casesof typhus at St. Thomas’s were complicated with diarrhoea, butnone presented the characteristic eruption. He attributed thediarrhcea to the exhibition of tartrate of potash.

Dr. PEACOCK had met with cases of typhus complicated withdiarrhoea, in which tartrate of potash or purgatives had beenadministered. In all these cases no ulceration of the bowelswas fonnd.

Mr. H. SMITH showed a specimen ofCANCER OF THE THYROID GLAND,

causing pressure on the trachea. The patient (aged forty-three)had suffered from difficulty in breathing for some months, buthad been in no danger till a few days before admission intohospital, when he had some severe fits of dyspncea. He had asevere fit soon after admission, which passed over in a fewminutes. Mr. Smith directed that if possible a laryngoscopicexamination should be made. This revealed that the partsabove the glottis were healthy. About five hours after admis-sion tracheotomy became necessary. After superficial incision,a hard mass was reached, through which it was impossible to

cut. The incision was prolonged upwards, and the larynxopened. The man had ceased to breathe, but a catheter waspassed through the wound in the larynx, and the lungs in-flated. The man, however, did not revive. The whole of theisthmus and front of the thyroid was occupied by a mass ofcancer pressing the trachea towards the right side, and causinggreat pressure on its left wall. The incision into the windpipewas above the seat of obstruction, but there was no means ofdiagnosing the latter. Mr. Smith dwelt upon the impossibilityin some cases of diagnosing the seat of obstruction, and on thepropriety in all cases of tracheotomy of going to the operationprovided with an elastic catheter, which could always bepassed beyond the obstruction.Some members doubted the cancerous nature of the disease,

and the specimen was referred for examination to Dr. Harleyand Dr. Murchison.

Dr. HARLEY exhibited a

SERIES OF GALLSTONES.

The first point he dwelt on was that the danger was not inproportion to the size of the stone. He showed a very smallstone which had set up fatal peritonitis. A second point was,that sometimes excruciating pain was produced by the passageof a very small stone which could not be discovered, and whichought rather to be called a small collection of inspissated bile.He referred to a case in which very numerous attacks hadtaken place, but no stone was ever found. After death, a col-lection of very small calculi was found in the gall-bladder.

Dr. HARLEY also showed a

SERIES OF BLOOD-CRYSTALS.

He dwelt on the different opinions which prevailed on the sub-ject of blood-crystals, and on the confusion of names so pro-duced. Dr. Harley believed that there are three differentforms of crystals. The first is that produced by chemical re-action on the blood. Glacial acetic acid being applied to dryblood, of any animal, and a little common salt added, a certaindefinite crystal of invariable size is produced-Teichmann’scrystals, or hasmin. The second kind is that met with in oldclots (apoplectic &c.), which are also definite in size and shape;broader in shape and lighter in colour than the hæmin-crystals,almost rhomboid—hæmatoidin-crystals of Virchow. The thirdform is found in healthy blood, as the splenic, when crystal-lized. These crystals can be obtained also by shaking uphealthy blood with ether. They are very much larger ; maybe in groups like spicula; and may be either colourless orcoloured. These, Dr. Harley thought, were better termedhsematin.

Dr. WILKS called the attention of the Society to the timerequired for the formation of the second form of crystals inclots. He had found them in apoplectic clots of more than afortnight’s standing, but not earlier.

Dr. HARLEY said that this was also his experience.! Dr. SANDERSON stated that he had made experiments on this

subject, published in the Edinburgh Medical Journal for 1851,showing such crystals formed in clots experimentally producedin animals in about three days. The phenomena of corpora

L lutea also supported this opinion.Dr. CRISP showed the Stomach of a Patient poisoned by

. Butter of Antimony, with a cast of the stomach taken soon after

’ death. Three ounces of the poison had been taken, and about’ two-thirds of it was found adhering to the interior of the

stomach, which was very black, and the mucous membrane sloughy. The prominent symptoms were thirst, pain, vomiting’ after ten hours, and diarrhoea shortly before death.

Dr. CRISP also showed the Lung from a species of Antelope1

occupied by a very copious deposit of tubercle.Mr. CAYLEY showed a very large Liver affected with Amy-

l loid Degeneration. A large globular projection from the sur-3 face caused at one time a suspicion of hydatids. The spleen

and kidneys were also in a state of amyloid degeneration.

OBSTETRICAL SOCIETY OF LONDON.OCTOBER 5TH, 1864.

DR. OLDHAM, PRESIDENT, IN THE CHAIR.

THE following gentlemen were elected Fellows: Dr. M.Bright; J. S. Gaunt, Esq.; Dr. Hoffmeister; J. H. Salter, Esq.

CÆSAREAN SECTION.

A case of Cæsarean section which occurred in 1837, from thepapers of the late T. E. Bryant, Esq., was read. The patient

466

was four feet seven inches in height, and rachitic; the antero-posterior diameter of the pelvis was two inches and a quarterin the dry state, and the transverse diameter four inches. Theoperation was accomplished without difficulty; but the motherdied about thirty-six hours afterwards, of low peritonitis. Thechild lived some weeks, when it died of erysipelas. ,

Dr. GREENHALGH said he was deeply interested in theCæsarean operation, of which he had had some experience,having performed it four times, having been present in threecases where other practitioners bad operated, and having re-cently, through the kindness of Dr. Winckel of Gummersbacb,examined three women who had been the subjects of this pro-ceeding. He expressed a conviction that in difficult cases ofcraniotomy, which were necessarily fatal to the children andtoo often to the mothers, the lives of most of the former wouldbe spared, and the latter would stand equally as good a chance,by the timely performance of the Cæsarean section ; in proofof which he detailed the case of a poor woman upon whom hehad operated, who was reduced to such an extreme degree ofdebility by mollities ossium that those present considered it

impossible that she could survive the operation; notwithstand-ing, she lived three weeks afterwards, and then died fromrupture of the transverse colon, owing to the distortion occa-sioning occlusion of the rectum. The child was born alive, andcontinued to live. Dr. Greenhalgh strongly urged the earlyperformance of the operation, before the membranes were rup-tured or the mother exhausted. He considered that the inci-sions should be made in the linea alba, and as nearly as possiblethrough the centre of the body, and not through the neck, ofthe uterus, in which, although he admitted there were fewerlarge vessels, yet there was far less contractile power, and con-sequently a greater liability to hæmorrhage, as happened inone case which he witnessed. He recommended that the ab-dominal and uterine wounds should be held together by thefingers of an assistant placed within the extremities of theincisions; that, immediately after the extraction of the fcetusand secundines, the finger should be passed from within throughthe neck of the uterus into the vagina, so as to secure a freeexit for the discharges; that the uterus should be firmly graspedby the hand, so as to obtain its firm contraction; and when allfear of haemorrhage had passed, that the abdominal wound bebrought together by the interrupted suture, and still furthersecured by broad strips of adhesive plaster. As a rule he ad-ministered no medicine, but met each symptom by its appro-priate remedy. He mentioned one extraordinary case wherethe patient was up and about five days after the operation;she was, however, the subject of an enormous umbilical hernia.

Dr. BARNES observed that summaries of most of Dr. Winckel’scases would be found in the British and Foreign Medico-Chi.rurgical Review.

Dr. PLAYFAIR said that in the only case of Caasarean sectionwhich he had witnessed, a difficulty was met with which hehad not seen alluded to in descriptions of the operation, andwhich certainly had not occurred in the case under discussion,nor apparently in any of those described by Dr. Greenhalgh.In the case in question the uterus was opened near the fundus,and although no time was lost in removing the child, still theuterine parietes contracted with such rapidity and force thatthe head was caught in the incision, and some difficulty oc-curred in extracting it and the placenta. This was doubtlessa fault on the right side, as it diminished the risk of hæmor-

rhage ; but still it would be well to know how to avoid incon-venience from it. He had thought this might be done by com-mencing the incision near the lower part of the uterus, insteadof at the fundus, when the head might be extracted first. Thecase to which he alluded also showed the risk of delay beforeoperation. The patient was a healthy woman who might havedone well, but she was allowed to remain so many days inlabour before further advice was sought, that when seen thevagina was found in a state of slough.

Dr. OLDHAM recommended the incision to be made towardsthe lower part of the uterus.

Dr. EASTLAKE showed an Obstetric Binder, for immediateuse after parturition, which he had constructed, and whichhad been made by Mr. Salmon, of Wigmore-street. It wasintended to supersede those which lace up like stays. Thebinder was very simple in its arrangement. It consisted oftwo parts, which were fastened in front with the greatest easein less than a minute by means of four lappets with hooks andeyes. It had also a tail bandage which fastened before andbehind, and was able to support the diaper and keep the binderin its place. Dr. Eastlake had tried it several times withgreat satisfaction. The price was from five shillings.

A description of a case of Deformed Arms was read, fromDr. Shortt, accompanied by photographs.

Dr. WYNN WILLIAMS then read a paper on

MISSED LABOUR.

The author alluded to the little notice the subject had receivedhitherto, and thought the profession indebted to Dr. M’Clintockfor his collection of cases. He wished, however, that somemore practical rules were laid down. He then detailed twocases which he considered were of this class. He ventured tosuggest that, as soon as attention was called to a case, theaccoucheur should, after satisfying himself of the escape of theliquor amnii, the death of the fœtus, and the dilatability of theos, proceed (after allowing a reasonable delay, and after em-ploying the recognised means adopted to cause contraction ofthe uterus) to turn and deliver.

Dr. BARNES said there was a perfectly ready and safe wayof dilating the cervix should the case require it. Should thecervix be rigid, besides the dilators, he would use incisions,which plan he had employed in a case he detailed.

Dr. GREENHALGH did not consider that Dr. Williams’ oasescould be placed under the head of missed labour, and askedthe President, who was the first to use the expression, whathe considered the correct definition of the term. He (Dr.Greenhalgh) had never met with a case of missed labour.

Dr. OLDHAM said that he had used the term as the mostappropriate he could find. It was a case in which the timeof natural labour passed by without any pains, and the childwas not expelled.

Dr. BRAXTON HICKS thought it highly important to be cer-tain that the full term had really expired, as it was very diffi-cult to say whether it had been reached in any case before amonth at least had elapsed. In the cases recited, he thoughtthat probably, although the children were dead, they would indue time have been expelled by natural efforts.Further discussion arose, in which Dr. Fox, Dr. Eastlake, and

Mr. Owen joined, and to which Dr. Williams replied.Mr. GANT then gave a careful Dissection of the Pregnant

Uterus in a person who had died from accidental hæmor-rhage."

Reviews and Notices of BooksNouveau Dictionnaire de Médecine et de Chirurgie Pratique.

Illustré de Figures intercalés dans le Texte. Tome Premier,Parties I. et II. Paris: J. B. Baillire et Fils. London:-H. Baillière.

THIS is the first volume of a great work which is in processof publication by the Messrs. Baillire, and which is to appearin twelve or fourteen volumes octavo, of eight hundred pages.It is designed to assemble and co-ordinate the scattered works,special treatises, and monographs published in France andabroad ; to present a complete account of contemporary sur-gery and medicine; to help to put in general circulation thenumerous and recent acquisitions of science ; and to preparefor the future by establishing the fixed landmarks of the past,and indicating the starting-points of further enterprise.To enable them to carry out this programme, the proprietors

have secured a staff including some of the best names in France,and all men of proved capability, yet not too numerous for dis-cipline and uniformity. To those who may propose to obtainfor themselves this important publication, the names of theintended contributors will have interest, as affording a neces.sary guarantee. The editor is Dr. Jaccoud, well known as ayoung physician who possesses all the qualities and the pre-vious training which the editor of such a book should needshave. His last reports to the Minister of Education on thesystem of medical teaching on the Continent gave evidence ofremarkably sound judgment, candour, impartiality, and appre-ciative power. These qualities are just what an editor wants.With him are MM. Bernutz, Boeckel, Buignet, Cusco, Denuc6,Desnos, Desormeaux, Devillers, Alf. Fournier, H. Gintrac,Giraldès, Gosselin, Alph. Guerin, A. Hardy, Hirtz, Koeberlé,S. Laugier, Liebreich, P. Lorain, Maree, A. Nélaton, Ore,V.-A. Racle, Richet, Ph. Ricord, Jules Rochard (de Lorient),