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on Sept. 19th, the wound having been perfectly cicatrisedfor a week.Remarks by Dr. CAREY.—This operation, as modified by

Petersen, is now awaiting the verdict of the profession, andevery case, however simple, merits publication. Its almostabsolute freedom from complications, the entire absence ofall risk of wounding important parts, and its wellnighbloodlessness, make this operation one of the simplest insurgery, and bring it within the grasp of a general practi-tioner, who, after the lapse of years and the feeling that hisanatomy is thereby somewhat at fault, might hesitate toencounter the risks which beset him in the perineal opera-tion. The peritoneum, the only important structure whichbefore Petersen’s modification was liable to be injured,seldom if ever comes into view, and the after treatment,though somewhat laborious and tedious, has none of theanxieties attendant upon the possibilities of hæmorrhage,pyæmia, &c. Fewer assistants are required ; the risks ofchill are altogether removed, as only the abdominal surfaceneed be laid bare ; and (a material difference between thetwo operations) the fear of incontinence of urine andimpotence does not exist. The after treatment, whichnecessitates close attendance on the part of the surgeon, issimple, and consists in free ablution with carbolic acid lotion(1 in 40) of those parts with which the urine is likely tocome in contact, and a lavish inunction with vaseline toprevent excoriation.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

l’uberclc of Ovary.---Aortic Aneury.—Hydatid Cyst ofBrain.—Sarcoma of Mediastinum.—Paget’sDiseasecfScrotum.

AN ordinary meeting of this Society was held on N ov. 6th,Sir James Paget, President, in the chair.

Dr. GRIFFITH showed sections of an Ovary the seat ofTubercular Disease. It was removed by Dr. Ualabin from anullipara aged nineteen, was as large as a small apple,dense on section, and containing numerous small cystsfilled with viscid fluid. Examination revealed a ratherdense well-developed connective-tissue stroma infiltratedwith small round cells and containing scattered sphericalnodules resembling well-formed non-caseating tubercles.Each of these was bounded by circularly arranged connectivetissue, which was prolonged by branching processes into thecentre, which latter was occupied by a giant cell oftenmultinuclear. There was no appearance of caseation in anypart. A few newly developed bloodvessels were seen

traversing the section, but they did not appear to enterthe nodules; there was little or no normal ovarian stromaleft. The peritoneal surface was thickened, and consisted offibrous tissue invaded by leucocytes. The fibro-muscularwall of the Fallopian tube was expanded, the mucousmembrane being thick, consisting almost entirely of tissuesimilar to that of the ovary, and containing but fewtubercles. No micro-organisms were found in the giantcells or the surrounding tissue. The tubercles all appearedto be of recent formation and rapid growth. Referencewas made to the scanty literature on the subject, therebeing two chief forms of tubercular ovarian diseasedescribed : (1) minute miliary granulations, chiefly nearand on the surface of the organ; and (2) larger caseousmasses. It occurred usually as a part of a general tuber-culosis. The most common seat of tubercle in the femalegenerative organs was the Fallopian tube, then the uterus,and lastly the ovary.-Dr. MONEY showed a case a shorttime since of caseous disease of the uterus and appendagesin a child of six.-Dr. EDMUNDS showed as a card specimena large tubercular mass in the ovary, from a patient withgeneral tuberculosis.-Dr. ORMEROD had recently examineda case in which general tuberculosis was associated witliminute tubercles in both ovaries.

Dr. HERBERT HABERSHON showed a specimen of Aneu-rysm of the Aorta at the junction of the transverse anddescending parts of the arch (and therefore extra-pericardial),which terminated by rupturing into the pericardium. Thecase was that of a man, aged thirty-four, who presentedduring life the signs of a small aneurysmal tumour pulsatingin the second left intercostal space. He had previously

been treated at St. Bartholomew’s Hospital under the careof Sir Dyce Duckworth, and had been greatly relieved. Sixmonths later he applied to Dr. Herbert Habershon, at theGeneral Marylebone Dispensary, and on May 8th was sud-denly seized with faintness and symptoms of collapse. Seenon the same evening, he was apparently dying, being pulse-less, and with cold extremities and clammy skin. Noeffusion into any of the cavities could be discovered at thetime. Un the following day (the 9th) the patient had rallied,and on this and the succeeding day effusion into the peri-cardium gradually developed, accompanied by a paroxysmalcough, with intense pain, presenting some of the charactersof anginrL pectoris. He died on the morning of May 11th,having lived fifty-six hours after rupture had commenced.There was a fusiform aneurysm with two large saccules, oneoccupying the greater portion of the transverse part of thearch, involving the great vessels and partly obliterated byfibrinous clot, the second smaller saccule being deeply ulce-rated, surrounded by thickened walls of the artery and bydense fibrous tissue, which separated it from the left bronchusbelow, and led by an ulcerated track through a perforationinto the pericardium. The opening lay immediately an-terior to the pulmonary artery. The pericardium showedno sign of recent pericarditis except in the vicinity of therupture. The cavity was found to be distended with abouta pint and a half of dark fluid blood. Dr. Habershoncommented on the rarity of this termination of aneurysmof an extra-pericardial part of the aorta, and quoted casesand statistics of authors; he likewise dwelt upon theunusual clinical features of the case and the efforts atrepair which the specimen illustrated.

Dr. HERMANN WEBER exhibited a case of Hydatid Cystof the Left Cerebral Hemisphere, from a man aged twenty-two, who suffered from severe pain over the whole of thehead, witii nausea and vomiting, was rather apathetic, butwithout unconsciousness. He had some diminution ofpower in the whole of the left side, and especially of theexternal rectus muscle of the left eye (abductor); he hadwell-marked double neuritis (choked disc), and the sight wasmuch impaired. The movements of the tongue and thesphincters were unaffected. The temperature was ratherbelow than above the average; the pulse was normal.Sudden death occurred within six weeks from the beginningof the symptoms and on the twelfth day after admissioninto the German Hospital. The post-mortem examinationexhibited a large hydatid cyst on the posterior part of theleft hemisphere. Dr. Weber remarked that the course ofthe disease had been comparatively short for an hydatidaflection, and that the slight hemiplegic symptoms had beenon the side of the lesion, and not on the opposite side. Dr.Michel and Dr. Weber had recognised the presence of atumour in or on the brain, but the absence of certain know-ledge as to the exact locality had prevented them fromattempting an operation which could have saved life. Thewish to obtain the opinion of members as to the possibilityof a more accurate diagnosis in similar cases was the prin-cipal cause for bringing the case before the Society.-Dr.MONEY thought that a left hemiplegia of the kind describedby Dr. Weber indicated a lesion of the motor tract belowthe cortical area. He attached no importance to the para-lysis of the external rectus. He would have recommendeda speculative trephining.—Mr. SUTTON referred to the

frequency of cerebral hydatids in animals, but surgery wasdifficult, and localisation almost impossible. The most suc-cessful cases were those where, the bone being thinned andbulged, "eggshell crackling" could be obtained, and thesite thus accurately determined.-Dr. PENROSE said that insheep with " staggers " it was the practice of Scotch farmersto wait for bulging of the cranium, and then evacuate thecyst by puncture with trocar and cannula. About 25 percent. of the cases recovered.

Dr. MOTT brought forward two cases of MediastinalGrowth involving the Pericardium and Heart. The first wasthat of a female aged twenty-one, admitted into Charing-cross Hospital for left pleural effusion. There was no definitehistory, except of rheumatism, six months previously. Thesymptoms at first presented were difficulty of breathing andcyanosis, besides the ordinary symptoms of pleural effusion;but, instead of Skodaic resonance over the upper part of theleft front, therewere dulness and increased resistance, extend-ing even above the clavicle. This, together with the normaltemperature and some dulness on the upper part of thesternum, were the only indications of a mediastinal growth.She was tapped many times, the fluid removed being from

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fifty to seventy ounces at each operation, clear, and straw-<coloured. About a month later a new symptom developed-namely, oedema, of the legs and of the left arm. This, how-ever, disappeared when the arm was suspended in a sling. Afortnight later it returned and involved also the left side of- the chest. The pupils were never affected. She died frompericardial effusion, causing, together with the growth onthe heart’s substance, cardiac failure. At the necropsy, alarge lympho-sarcomatous growth was found occupying thesuperior mediastinum, infiltrating the whole pericardium,.and growing through into the right ventricle. On open-ing the pericardium thirty ounces of dark-stained serous fluidwere removed, and the heart presented the appearance ofbeing covered with candle-wax. Microscopically, it wasfound to infiltrate the lymphatic spaces of the heart, butwithout completely destroying the fibres. The left innominatevein was surrounded by the growth, and its walls were in-filtrated, the vessel being filled with an organised thrombus.The second case occurred in a carpenter’s labourer agedforty-five, who was admitted into Charing-cross Hospitalfor pain in the praecordial region, vomiting, and weakness.The symptoms and physical signs indicated a mediastinalgrowth involving the lefb lung. A few days after admissionthe temperature went up to 101&deg; without accountable reason.As there were absolute dulness and loss of vocal fremitusover the whole of the left base, it was thought possiblethat there was a localised empyema. The house physicianinserted a hypodermic needle and removed pus. An opera-tion ensued for empyema, but no pus was obtained, excepta daily discharge on the dressings. The wound healed, andthe man died a month later. At the necropsy a mediastinallympho-sarcoma was found, involving the pericardium,’bronchial glands, and the left auricle of the heart. Therewere secondary deposits in many of the abdominal organs.’The left lung was completely infiltrated by the growth,and airless. The lower lobe was broken down intoirregular communicating cavities, discharging purulentfluid. This accounted for the pyrexia and the supposi-tion of a local accumulation of pus. The paper wasillustrated by photographs and micro-photographs.&mdash;Mr. BARWELL saw the second case five days before death,and operated because the temperature rose, though therewas absence of many of the signs of empyema, the intercostalspaces not being bulged and segophony being absent.-Dr. MAGUIEE pointed out that it was a characteristic oflympho-sarcomata to leave the endothelium of bloodvesselsintact, whilst the sarcomata commonly eroded vessels andgave rise to local bleeding. On the other hand, the inductionof the hsmorrhagic diathesis, causing general haemorrhages,was more common in lympho-sarcomata.&mdash;Mr. ROGERWILLIAMS questioned the origin of the growth from thethymus gland. Malignant disease was very rare instructures like the clitoris, male breast, prostate, andthymus, which were gradually undergoing suppression.-Mr. GoDLEE discussed the question whether the fluid wasmore commonly serous or sanguineous. The temperaturewas often raised considerably in cases which were involvingthe pleura, and in many instances it was almost impossibleto differentiate it from empyema.-Dr. MOTT replied thatthe growth in the first case did not penetrate the vascularendothelium. The presence of symmetrical adhesions to thesternum different in colour to the rest of the growth led himto conclude it might have originated from the thymus.When the pleural fluid was clear he thought it indicatednon-involvement of the lungs. The pressure of the softgrowth had produced no appreciable alteration in the fibresof the main nerve trunks, and the heart fibres in the area ofinfiltration, though they had undergone alteration in shape,had preserved their siriation.

Dr. ANGEL MONEY showed a large rounded Tumourgrowing in the mediastinum of an infant aged fifteenmonths. It was the size of a man’s fist, and projectedchiefly into the right side of the thorax ; it extended fromthe fifth dorsal vertebra to the diaphragm ; it was one-fourth the size of the thoracic cavity, and caused extensivecollapse of the lungs ; it pushed the heart, aorta, and venacava, in front of it, and displaced the liver downwards ; itdid not grow from the vertebrae, and the spinal column wasnot eroded. During life the symptoms resembled thosefound in extensive collapse of the lungs ; there was nofever; the physical signs were extreme dulness over theright lower lobe, with absence of breath sounds; elsewherebronclitic rules obtained. An exploring needle thrust intothe dull area felt as if held in a dense solid tissue; no fluid

could be withdrawn. Microscopic examination proved thetumour to be a small, round-celled sarcoma, without anystriated muscular tissue.

Dr. RADCLIFFE CROCKER related the case and showedthe drawings and microscopical specimens of Paget’sDisease affecting the Scrotum and Penis. The patient wasa whitesmith, aged sixty, in whom the disease began in thesummer of 1886. Without apparent cause a superficialulceration appeared on the anterior part of the scrotum andunder surface of the penis, somewhat resembling eczema,but very sharply defined, and the excoriation was evidentlydeeper than an ordinary dermatitis. In spite of a greatvariety of treatment, both external and internal, thedisease gradually extended, especially to the left, untilNovember, 1887, when two nodules were noticed on theleft side-one the size of a pea, the other of a largebean. They were firm to the touch and covered with ayellowish secretion. The malignant nature of the affectionwas then apparent and its similarity to the disease of thenipple recognised, an analogy in which Sir James Pagetconcurred. The whole diseased area was therefore excisedby Mr. Godlee and sound cicatrisation took place, andsix months later there had been no recurrence. Themicroscope showed an alveolar structure, in some placeswith a scanty and in others with a more abundant stroma.The alveoli contained aggregations of small epithelioidcells, suggesting in many respects the structure of rodentulcer. Specimens were shown demonstrating the malignantchange, commencing in the sweat coils and ducts.-Mr. ROGER WILLIAMS considered the disease cancerous,and, originating in the skin, it differed from epithelioma inthe absence of "nests." Only one case in 200 of breastcancer started in connexion with " Paget’s disease " of thenipple.-Mr. GODLEE had seen small nodules develop on arodent ulcer, and in them a moist surface was common.-SirJAMES PAGET had never seen a rodent ulcer with such largenodules as in the present instance. He regarded the diseaseas cancer following on an affection not at present clearlyunderstood, but which differed certainly from eczema.-Dr. CROCKER, in reply, thought the case had nothing to dowith ordinary dermatitis. Possibly it might be a rodentulcer, arising in an abnormal situation and taking on anabnormal form. It differed from epithelioma in arising fromthe cuticular appendages, and not from the epidermis.The following card specimens were shown :&mdash;

Dr. M. MURRAY: 1. Fatty Tumour in Wall of Stomach.2. Fracture of Cricoid and Thyroid Cartilages.

Dr. PERRY : Two specimens of Acute Intestinal Obstruc-tion, produced by adhesion between appendices epiploicsp.Mr. T ARGETT : Internal Rupture of Liver.Dr. EDMUNDS : Tubercular Ovary.Mr. LEOPOLD HUDSON : Primary Spheroidal-celled Car-

cinoma of Liver.Dr. MARUiRE: Lympho-sarcoma of Mediastinum, in-

volving the large bloodvessels.

MEDICAL SOCIETY OF LONDON.

The Surgical JJ[anagwwnt of Typhlitis and Perityphlitis.AN ordinary meeting of this Society took place on Nov. 5th,

Sir William MacCormac, President, in the chair.Dr. W. T. BULL, of New York, read a paper on the

Surgical Management of Typlilitis and Perityplilitis, illus-trated by seventeen cases. The following is an abstract.During the past two years anumberofcasesofperityphlitis hadpassed under his observation, presenting every phase of thatcomplex affection, and with the object of making a briefsummary of the results of treatment he separated them intothree groups. The first consisted of ten cases in which theabscess was opened by incision through its walls, withoutopening the general peritoneal cavity, at periods varyingfrom seven days to six weeks from the beginning of theattack; they all recovered. They represented the caseswhich surgeons had usually dealt with successfully sinceParker, in 1867, demonstrated the advantage of the extra-peritoneal incision before fluctuation. The second groupcomprised six cases in which the peritoneal cavity wasopened seven times for supposed perforation of the appendixwith developing peritonitis. The earliest operation wasdone thirty-six hours after the first symptoms, the latest onthe fifth day. Death ensued in two, one being due to an in-complete operation, the other to both a faulty operation and