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Treatment with iodine, intus et extus, has as yet produced no favourable results. The notes of the above cases have been obligingly furnished

by MM. Bourgeois and Magdelain, M. Dolbeau’s house-surgeons.

___

MEDICAL SOCIETIES.OBSTETRICAL SOCIETY OF LONDON.

WEDNESDAY, MARCH 4TH, 1868.DR. BRAXTON HICKS, VICE-PRESIDENT, IN THE CHAIR.

THE following gentlemen were elected Fellows :-Mr. W. F.Butt, Dr. R. Dyce (Aberdeen), Dr. James Ellis, Dr. R. Fegan(Charlton), Dr. A. Godwin, Mr. G. A. Kenyon, Mr. J. R.Lynch, Dr. J. Nicholls (Chelmsford), Dr. G. J. Sealy (Wey-bridge), and Dr. C. W. Turner.

Dr. MURRAY exhibited for Professor Byford, of Cbicago, anew Pelvimeter. The instrument is a modification of Baude-locque’s Callipers, and by its aid the different diameters of thepelvis can easily and accurately be taken.

Dr. MEADOWS exhibited for Dr. Tanner two Ovarian Cysts,which had been removed by ovariotomy ; and although theywere believed to constitute the right and left ovaries, yet thepatient had menstruated regularly up to the time of theirremoval, the last period having ceased about a week before theoperation.A discussion ensued, in which Dr. Barnes, Dr. Hewitt, Dr.

Tyler Smith, Dr. Snow Beck, Mr. Chambers, and Dr. Murraytook part. It was generally considered either that a portionof one of the ovaries must still remain and be in a healthystate, or that the cysts removed and exhibited were reallycysts of the broad ligament separate and distinct from the Iovaries themselves. Dr. Meadows was requested kindly towatch the case, and report if menstruation again took place.

Dr. AvELiNC, of Sheffield, exhibited a new form of ShortForceps, the peculiarity being that the handles were muchcurved backwards, by which modification they were more outof the way of the operator, and a better grasp was obtainable.

Dr. MURRAY communicated for Mr. E. ASBURY aCASE OF RUPTURE OF THE UTERUS OCCURRING DURING

LABOUR.

This was the patient’s third confinement, and the two pre-ceding ones had been easy and natural. She had been inlabour but a few hours when the accident happened. Thelabour had been without complication, and the only differencebetween her condition on the present occasion and in her pre-vious confinements was, that there was now a much greaterabdominal enlargement than existed then. The rent in theuterus was transverse, about four inches in length, situatedlaterally and not far from the fundus. The edges of the lace-ration were inverted, and at the seat of rupture the walls werevery much thinned. The author considered the cause of rup-ture to be over-distension of the uterine walls, whereby theyhad become thinned and weakened, and that possibly degene-ration of muscular fibre had also taken place.

Dr. BARNES believed that Dr. Murphy was one of the firstto describe a softening or other alteration of the uterine tissuesas the cause of rupture. Since then the tissues had been oftenexamined. He himself had carefully examined the tissues inthree cases of rupture, and he had found no more degenerationthan that normal amount of granular change of the fibre-cellswhich always existed towards the end of pregnancy as a prepa-ration for solution of the tissues about to become superfluous ;certainly, then, although degeneration of tissue might some-times be present, it was not a constant or a nenessary condition.He had asked if the child in the case related had been deadsome time before the rupture. He had known this to be thecause of rupture. Where the child was long dead, it had lostits resiliency and its fitness for being driven through the pelvis,and thus might become as efficient a cause of obstruction aseven a narrow pelvis.

Dr. GRAILY HEWITT thought it likely that the abortionwhich had occurred had an influence in producing the irregu-larity in the thickness of the uterine walls in the case related.The undue size of the head was also an important element inthe case. As a matter of practice he believed it very difficultto ascertain in the early part of a labour whether the headwas unduly large or not, but it was a matter of some moment

in reference to cases such as this. The rupture of the uteruswhich occurred in this instance could not have been antici-pated, and it would appear that the treatment adopted wasmost prompt and appropriate.

A CASE OF CÆSAREAN SECTION.

BY J. BRAXTON HICKS, M.D., F.R.S.

The operation was performed by Dr. Hicks on a deformedwoman, aged thirty-seven, who did not come under his obser-vation till past the seventh month of pregnancy. The pelviswas found to be of the malacosteon type ; and although thebrim was much distorted, yet, had the outlet been good, de-livery might have been effected through it. Yet, as the bonyoutlet was very much narrowed, the parts very rigid evenwhen examined under chloroform, Dr. Hicks, after carefulconsideration, thought that the balance of chances was infavour of Cæsarean section rather than craniotomy, because itmight have necessitated Caesarean section after all. The lengthof the abdomen was very small, pushing the fundus of theuterus forward, and this would have added to the difficulty ofemploying the crotchet, which would have been the onlytractor capable of being used. The operation was done in theusual way under chloroform at the eighth and a half month,two doses of secale preceding it. No difficulty arose duringits performance. The uterus contracted well without hæmor-rha.ge. The wound was not closed with sutures. Vomitingcame on immediately, which caused expulsion of the uterinedischarges through the wound. This subsided, gradually tillthirty-six hours after the operation, when the discharges ceasedto flow per vaginam ; but vomiting having recurred, theywere extruded through the lower part of the external wound.From this time tympanitis came on, and rapid pulse withvomiting. A catheter was passed up the os uteri, and then atent, but no further secretion took place per vaginam. Shesank about ninety-six hours after the operation. Abouttwelve hours before death, the tympanitis having distressedher exceedingly, Dr. Hicks tapped the flatulent intestine witha very fine trocar and canula, letting off a large quantity offlatus to her great relief, so much so, that when it had reac-cumulated, she begged to have the tapping repeated, whichwas done with the same result. The child lived a month, anddied of thrush. The post-mortem showed a general blushover the peritoneum; no blood in cavity ; a trace in the linefrom uterine opening to the external wound; a patulouseverted wound in uterus ; a long cervical canal, not impervi-ous ; the uterine cavity entirely clear and healthy. Dr. Hicksdwelt in his remarks-first, upon one disadvantage of opera-ting before labour had set in, from the tendency to closure ofthe cervix; and, secondly, on the question of closing theuterine wound or not. He thought that had the wound beenclosed in this case, the serious complications would not haveoccurred. If it were found practically that the stitches weretorn out, perhaps one might take a hint from some of the suc-cessful cases where the uterus had adhered to the parietalwound, and suggested that we might carry the same suturethrough the external and uterine walls, whereby the intrusionof the uterine secretions into the peritoneal cavity would beprevented ; at any rate, it could not make matters worse thanthey now are. He then considered the state of the uteruswith two holes in it, one three times the size of the other.There was, when any pressure, as of vomiting, occurred, threetimes at the least greater tendency to flow out of the woundthan from the cervix, and there was much more tendency inthe cervix to contract than the wound. He thought thevomiting from chloroform a great danger in these cases, andinclined with Dr. Greenhalgh to the use of the ether spray.He finally remarked upon the mode of tapping the bowel inextreme tympanitis, that he had employed it in four cases withgreat relief, and without any mark of the operation afterwards,either by inflammation or extravasation of nuid or gas.Mr. SPENCER WELLS said that when he first suggested the

use of sutures to close the opening made in the uterine walls,at a meeting of the Society in 1883, as a means of preventingthe escape of blood or other fluid into the peritoneal cavity,and thereby lessening mortality after Cæsarean section, he badnot tried the plan, nor had it ever been tried, so far as heknew. And some speakers at that meeting thought thesutures not only unnecessary, as the uterine contractionswould close the opening, but might be injurious by setting upmetritis. But in 1865 he had put the plan into practice in theonly case in which he had performed Caesarean section. Thecase was published in the journals of that year, and he had

recently seen the woman quite well. He used a long piece ofsilk as an uninterrupted suture, leaving one end hanging out

410

through the cervix and vagina. By pulling on this end thesuture was removed after several days. It served a useful

purpose, also, by maintaining drainage of the uterine cavitydownwards. Perhaps in cases of ruptured uterus the patientwould have a better chance of recovery if the child were re-moved through the abdominal wall, and the uterine openingclosed by suture, than if the child were removed by tediousobstetrical operations.

Dr. BARNES observed that the pelvis seemed to be anexample of Naegele’s pelvis oblique-ovata, as well as beinggenerally contracted. He did not believe that in this caseanything could have been gained by dilatation. He had neverforgotten the case related by Dr. Tyler Smith, some yearsago, in which he had been able to complete delivery after ’,craniotomy by dilating the pelvis. The possibility of openingup an osteo-malacic pelvis, so as to make room for the passageof the child, should always be borne in mind. He remem-bered a most interesting illustration. A young physician had in-vited a number of confrères to witness a Cæsarean section. Everv-thing was prepared for the operation, when Osiander requestedpermission to examine the patient. He examined so well thathe dilated the pelvis, turned, and extracted a living child, andthus baulked the operator of his operation. With referenceto the question of delivery by craniotomy in the case underdiscussion, he was firmly convinced that, if it had been pos-sible, Dr. Hicks would have done it. The demonstration hehad given in that room of the mode of performing craniotomyby taking off the calvaria, and bringing down the face, wasenough to show that Dr. Hicks was prepared to carry out theoperation to the extremest possible cases. But this mode wasmore adapted to cases of pelvis flattened from behind forwardsthan to such a case as the one before the Society.

(To be continued.)

CLINICAL SOCIETY OF LONDON.

FRIDAY, MARCH 13TH, 1868.SIR THOMAS WATSON, BART., PRESIDENT, IN THE CHAIR.

Dr. HILTON FAGGE exhibited three patients affected withParasitic Disease of the Nails. These cases were remarkablenot only on account of the rarity of such affections, but alsobecause they had an important bearing on the question ofidentity or non-identity of the vegetable parasites whichattach to the skin. The first case was that of a child agedeleven, who had for some years suffered from favus in a verysevere form affecting the head and limbs. The disease of thenail-of the left little finger-however, had only commencedabout three weeks before she came under observation. Therewas, therefore, an unusually good opportunity of observingthe course of the affection. The tubes and spores of thefungus were seen to penetrate the substance of the nail, gradu-ally invading it till they reached its root. The lamina of thenail then became loose. The progress of the disease thusdiffered entirely from the description given by Bazin, andEnglish writers who had followed him, according to whichdescription a favus-cup forms beneath the nail, and graduallyperforates it. The affected part of the nail was of a sulphur-like colour, and when the lamina had been removed the bedremained covered with an irregular stiiated mass of nail-sub-stance of a yellow or a brownish hue. This appearance was

precisely that of the diseased nails on the other two children,and on microscopic examination they too were found to presentsporules and beaded tubes, as of achorion. Yet these twochildren, who were sisters, displayed no cups nor masses offavus on the scalp or other parts of the body. Dr. Faggeentered into some further details respecting these cases, fromwhich he stated he was led to regard them as affording strongconfirmation of the view maintained by Hebra and by Dr.Tilbury Fox that the fungi found in the different forms offavus are in reality mere varieties of one microscopic plant.A committee was appointed to report upon a case shown by

Dr. Marcet. Mr. CHRISTOPHER HEATH related a case of cancer of the

œsophagus, with external openings, and involving the larynx,in a female, aged sixty. The dyspnœa which arose in theprogress of the disease appeared to be of a spasmodic nature ;but at the last it assumed the peculiar character which wouldappear to indicate some affection or displacement of the epi-glottis. Tracheotomy could have given but slight and tempo-rary relief, and was not, in Mr. Heath’s opinion, justitiedunder the circumstances of the case.

Mr. HENRY LEE read the history of a case of operation forvaricocele bleeding, which seemed to be connected with ahæmorrhagic diathesis. Diffuse cellular inflammation, the

sloughing of the skin, erysipelas and its consequences, whichfollowed the operation, presented a combination of importantcircumstances, such as were seldom met with, but from whichthe patient eventually recovered. After referring to the satis-factory results which he had obtained in a large number ofcases by the subcutaneous section of veins for varicocele, nounfavourable result except a local abscess, or some bleedingeasily controlled, having occurred to him, he noticed thatamongst all the troublesome surroundings of this case therewere no symptoms of absorption through the veins. The first.accident which occurred was arterial haemorrhage; the cellulartissue then became distended with blood, and erysipelas fol-lowed the decomposition of the effused fluid. Through allthese changes and adverse circumstances the divided veinswere commanded by the acupressure needles. Their channelsclosed, and the absorption of the decomposing matter was pre-vented. The patient took large doses of sulphate of magnesia,but no particular good could be traced as the effect of thisremedy. He was indebted for his safety, Mr. Lee thought,more to the closure of the veins by acupressure than to medi-cine. Inasmuch as Mr. Lee believed that more is learnt fromunsuccessful cases than from successful cases, he had broughtthis instance of the unfortunate results which may follow avery slight operation before the Society ; the origin of theseresults in the present case having been, as far as can be ascer-tained, the wound of a small artery in a patient predisposed tohaemorrhage.

Reviews and Notices of Books.Principles of Chemistry, founded on Modern Theories. By

Mons. A. NAQUET, Professeur Agrégé la Faculte deMédecine de Paris, &c. Translated from the Second Edi-tion, by WILLIAM CORTIS, Student, Guy’s Hospital. Re-vised by THOMAS STEVENSON, M.D., Demonstrator of £Practical Chemistry at Guy’s Hospital. 8vo, pp. 860.London: Renshaw. 1867.

WHEN Gerhardt published his treatise on Organic Che-mistry" in the year 1855, he not only conferred a great benefiton both students and teachers by systematising the variousfacts and discoveries which had been rapidly accumulatingduring the previous ten years, but he may be said to have alsosuggested a number of important theories which have exerteda marked influence on the advancement of chemical science.

Through his labours, together with those of Wurtz, Canniz-zaro, Hofmann, Williamson, Odling, and some others, a won-derful transformation has thus taken place. It is scarcely afigure of speech to say that chemical science has been revo-lutionised. Original views as to the constitution and proper-ties of matter, novel laws and principles of co-ordination, thediscovery of analogies between bodies apparently very dis-similar, alterations in the values to be assigned to the atomicweights of many of the elements, a new system of notation,with a vast number of other innovations, have led to a long-continued agitation and fiercely contested controversy. But a

period of comparative repose seems to be at hand. The con-servatives have been worsted. And now, through the inilu-ence of a few master-minds, an orderly system appears to havebeen in some measure established where formerly there wasnought but confusion and uncertainty.

Strange to say, while the new principles and hypotheseshave been taught professionally, to a greater or lesser degree,in Germany and England and Italy, they have been very in-sufficiently recognised in France, where they chiefly had theirorigin. To remedy this defect, Professor Naquet publishedhis " Principes de Chimie, fondee sur les Theories modernes"in 1865 ; and so highly has this volume been appreciated that,in less than two years, the author has been called upon to pro-duce a second edition. Part of this success has, doubtless,been due to the great improvement in teaching which hastaken place at the Faculty of Medicine, where the new doc-