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symptoms. 5. There is yet another class of cases to whichI would call attention-namely, those in which there is ahistory of severe injury to the head, and where there aremarked and definite symptoms of compression of certainmotor areas of the brain, but where no fracture of the skullcan be demonstrated. In such cases obviously one of twoconditions exists : either a fracture of the skull implicatingthe motor area has taken place, although it cannot be de-tected, or a haemorrhage has occurred in or near the motorarea or tract. The history of the case may or may not assistthe surgeon in arriving at a correct diagnosis, but the point ofimportance to him is-How are such cases to be dealt with ?If the pressure be due to blood-clot, and there is no evidenceof the extravasation extending, then the expectant methodwill be applicable for a time ; but if the symptoms point to agradual increase of extravasation I see no reason why atrephining operation should not be resorted to in the hope ofsecuring the injured vessel and relieving pressure. If, onthe other hand, an undetected fracture should be the causeof the symptoms, and amelioration of these does not

speedily set in, trephining over the indicated motor area willbe not only permissible, but will in all probability be followed I,,by the happiest results. ’

Medical S ocie ties.Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

Accessory TIlIILonr of the Thyroid Gland.-Ritpttire nf SplenicArtery into S’to-mce7a.-Grzznnzcctrz of .Braizt.-InterstatdcelHcrzaicc.-Zichen Bc’l’op 1l1llos0rllln.AN ordinary meeting of this society was held on Jan. 7th,

Mr. BUTLIN, President, being in the chair.Mr. A. E. BARKER related the sequel to a case of

Accessory Tumour of the Thyroid Gland, the clinicalhistory and structure of which he had already recorded.The tumour commenced to grow above the left claviclein 1880, and in 1889, when the patient was operatedupon, he was fifty years of age. The tumour occupiedthe whole of the left side of the neck, from the mastoidabove to the clavicle below; it extended beneath thetrapezius behind, while forwards it passed under the jawand transgressed the middle line of the neck, pushing thelarynx with the thyroid gland to the opposite side. Theskin covering it was thin and tense, and the growth wasfilled with cysts which varied in size from that of a marbleto that of an orange. It was firmly fixed to the undersurface of the sterno-mastoid, but this might have resultedfrom the many electrolysis punctures to which the growthhad been subjected. There were no enlarged lymphaticglands. The first operation was pelformed in 1889 andmuch cystic and solid matter removed, and the histo-

logical details were described at the time The patientwas now in excellent health, though there had beenfour operations for recurrence. The recurrent growthsappeared to be limited to the glands of the neck, and theyreproduced the structure of the original growth. He thoughtthere was no doubt that the primary growth originated inan accessory thyroid gland, though it might have startedfrom the border of the thyroid gland and gravitated down-wards. The repeated recurrence in the lymphatic glandsindicated a mild degree of malignancy ; but perhaps, onthe other hand, these multiple secondary deposits were

buds or germs of the original growth, which had escapedremoval. Another view which he put forward was that hehad possibly removed the whole thyroid gland at the firstoperation, and that these secondary masses were to be

regarded as remnants of gland which had undergone acompensatory hypertrophy to replace the removed thyroidgland rather than as dissemination of a primary malignant Igrowth.-Dr. CYRIL OGLE showed a Cystic Accessory ThyroidGland which he had removed -post mortem from a womanaged fifty-five, who died from an accident. The tumourmeasured one inch and a half by three-quarters of an inch,and lay between the top of the sternum and the trachea.There was in addition irregular enlargement of the left lobeof the thyroid gland. On section the smaller mass presentedthe characteristics of thyroid gland, but without the colloidcontents.—Mr. SHATTOCK mentioned the fact that papilli-

ferous ovarian cysts sometimes ruptured into the peri’-toneum and produced a crop of papillary formations derivedfrom the primary growth, but which were not malignant.Mr. Barker, as a result of the first operation, might possiblyhave infected his wound in this way. The multiplicity ofthe secondary growths was against the accessory thyroidgland hypothesis.-Dr. NEWTON PiTT referred to thecase of a woman who had a scarcely noticeable enlarge-ment of the thyroid gland, and from whom a tumourof the eye was afterwards removed, and others recurredin the scalp and skin, all presenting the charae-teristics of thyroid tissue. The viscera did not appearto be involved so much as the skin and glands.-Mr.JACKSON CLARKE had examined a case a year ago for Mr.Ernest Lane. The specimen was that of a lymphatic glandlying beneath the sterno-mastoid muscle and showing agrowth with tubular and papilliferous processes. Thestructure of these secondary growths suggested that thethyroid gland was of racemose structure, as Virchowhad held. - The PRESIDENT referred the specimens tothe Morbid Growths Committee. He had never seen

multiple growths produced as the result of operation.There was a class of tumours belonging to the thyroidgland in which secondary tumours of similar structurewere produced. One of the first was brought beforethe Pathological Society by Mr. Henry Morris, and inthis secondary growths occurred in the skull and otherbones. A photograph of the patient showed that she hadan enlarged thyroid gland. Further cases had beenrecorded by Mr. Warrington Haward and others. - Mr.BARKER, in reply, said that the tumour shelled out com-pletely, and he did not think that the wound could have beeninfected at the original operation. As he had already said,the adhesion to the sterno-mastoid muscle might have beendue to the repeated electrolysis punctures.Mr. F. C. ROBINSON showed a specimen of Rupture of the

Splenic Artery into the Stomach, associated with Aneurysmof the Left Ventricle of the Heart. The patient, a womanaged fifty-seven, died in Colney Hatch Asylum after havingsuffered from melancholia with suicidal tendencies for six

years. A fortnight before death, having a high temperature,she was sent to bed, and it was supposed that she was suffer-ing from pneumonia. Six days later she vomited a largequantity of blood. Four days before death this was repeated,and during the last attack she died. Post mortem a largeulcer was found on the posterior superior wall of thestomach, and in the base of it was an opening into thesplenic artery, which was very atheromatous. There wasalso present an aneurysmal dilatation of the left ventricle ofthe heart, which had been unsuspected during life ; it con-tained a considerable quantity of laminated clot.-Mr.JACKSON CLARKE said that the gastric ulcer had evidentlybecome adherent to the artery, into which it had openedlater. The history suggested the advisability of opening thestomach in some cases of haemorrhage.

Mr. C. F. BEADLES showed a specimen of Gummata ofthe Brain. The patient was a soldier aged twenty-eight whohad been admitted into Colney Hatch Asylum in a state ofacute mania. He had been invalided home from India four

years before for enteric fever. While in India he had con-tracted syphilis, and the scars over his back, arms, legs, andfeet showed that he had suffered very severely from thedisease. He was very weak and much emaciated, but there

were no signs of lung or heart disease. His mental statehad existed for two months, and confinement in a paddedroom had been necessary. He was incoherent, extremelyrestless, and had taken but little food for some days. He hadsuffered from delusions. After his admission it was neces-sary on several occasions to feed him with an cesophagealtube. Large doses of chloral and bromide of potassiumproduced no effect, and one grain of hyoscyamine hypo-dermically gave but slight rest. During the next monthhe gradually gained strength, but there was no sign ofmental improvement, and though he was generally weakthere was no paralysis. Three months after his admis-sion he was attacked with what seemed to be a basmor-

rhagic seizure; he suddenly sank and became unconscious,but recovered within half an hour and showed no signsof paralysis. One hour later he again relapsed intounconsciousness, the pulse being very slow and inter-mittent, the right pupil widely dilated, and the left con.tracted to a pin’s point. He died fourteen hours from theonset of the attack without again recovering consciousness.Post mortem the membranes of the brain were found to be

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only slightly thickened and the basal vessels fairly healthy.About the centre of the right frontal lobe, near itsunder surface, was a hard gummatous mass which readilyseparated from the brain substance and was firmer andof darker colour than the brain tissue, which was softerthan natural throughout. In the lower part of the lefthemisphere there was discovered a second tumour ofthe same size and appearance as the first. It was situatedat the lower and inner part of the lenticular nucleus, ona level immediately in front of the optic commissure, andwas closely connected with the middle cerebral artery.Microscopically the growth proved to be a syphiliticgranuloma. Notwithstanding the frequency of syphilisas a cause of insanity, gummatous tumours in the brainhad been found post-mortem excessively rarely. He hadsearched the post-mortem notes recording the conditions

present in the brain of over 4000 insane persons, andin only five instances had gummata been found. Of

forty other instances, in which all varieties of intra-cranial growth were referred to, it was possible that a

Gouple were of syphilitic origin. It should not be

forgotten that gummata of the brain might disappear Ifunder treatment, but from the above figures it was

highly probable that syphilitic cerebral growths were

even rarer than was usually supposed, the symptoms com-monly regarded as pointing to their presence being in factdue to changes in the cerebral vessels and membranes.

Mr. JACKSON CLARKE showed and described a specimen ) srecently added to the museum of St. Mary’s Hospital and

-

’comprising the Anterior Part of the Right Os Innominatumvith the corresponding Peritoneum, &c. Below the positionof the internal ring was an aperture in the peritoneum asilarge as a farthing and bounded by a thick fibrous

cing. The aperture led into the cavity of a sac as

large as the finger of a glove. The sac lay in front of theperitoneum at the side of the bladder, and was directeddownwards along the vas deferens. The specimen hadbeen removed post mortem from a stout man agedforty-six, admitted to St. Mary’s Hospital under Mr.?1 orton with pain and distension of the abdomen. The

patient said he had been ill for two days and.ad vomited twice. There was no external tumour.Abdominal section was decided on, but immediatelyshe patient had been placed on the table an attack ofoStercoraceous vomiting began, and in the course of theattack he became suddenly collapsed and, in spite ofartificial respiration, &c., did not rally. Post mortem thediaphragm was found to be pushed up to the level of the<third space in the mid-clavicular line on each sideby distension of the stomach and small intestines.The lungs were extremely emphysematous, and the lowers’obes were partially collapsed. The heart was fat-laden,and its right ventricle greatly dilated and full of liquidblood. About two inches of ileum were found in the sac,and, though nipped by the fibrous neck, were readily with-drawn. There was a depression in the peritoneum oppositethe internal ring, and fibrous prolongations from the

depression passed into the inguinal canal, showing thatthe remains of the vaginal process were undisturbed, andpointing to the hernia having been of the femoral ratherthan of the inguinal variety. There was no evidence that ahernia had recently occupied either the crural or the inguinalcanal. Apparently the truss had gradually pushed the sacback into the peritoneal cavity and had so prepared the wayfor the chain of events mentioned above. Death appeared tohave been due to syncope, for no vomit was found in the

air-passages.&mdash;Mr. RAYMOND Jonxso thought that the

specimen might be one of the forms of interstitial hernia. Thesac occupying the inguinal canal had become obliterated, andthe pro-peritoneal pouch formed the sac shown in the

specimen.&mdash;Mr. W. M. ECCLES asked whether the sac

was adherent to the surrounding tissues or appeared, to be recently dislocated, and also whether there was

a history of any recent swelling iii the inguinal or

femoral regions. -The PRESTDEXT said it would beinteresting if they could bring together a series of

specimens of hernia after operation. He himself hadoperated for the radical cure of hernia last lllay, the

patient had recently died from tuberculous meningitis, and apreparation had been made to show the result of the opera-tion.&mdash;Mr. STANLEY BOYD said he should like to see post-mortem evidence of the cure of hernia by truss.-Mr.

CLARKE, in reply, said that there had been no herniadown for twenty years. i

Mr. JACKSON CLARKE also showed sections of lesions froma typical case of Lichen Scrophulosorum. The lesions hadbeen removed from a child a few months old, whose trunkand limbs were covered with papules, for the most part flat-topped, and like those of the small papular variety of lichenplanus. A week or two after the onset many of the lesionsbecame pustular, and, as happened in some cases of eczema,small abscesses formed in the subcutaneous tissue. Afteropening one of these abscesses a portion of skin bearingthree or four papules was found to require removal. Theskin was hardened in sublimate solution, with a view todetermine the genesis of the abnormal elements. One

typical flat papule was found to have formed at the

apex of a papilla independently of any follicle. Thealtered cells had pushed apart two interpapillary pegsof epithelium and consisted wholly of swollen endo-thelial and conne tive-tissue cells, without any leucocyticinfiltration. The histology was quite compatible with the

lesion being truly tuberculous, and Mr. Clarke asked

physicians present whether any lesions of the skin hadbeen noticed as part of a general tuberculosis. The

patient improved on cod - liver oil and iron. For per-mission to publish the case he wished to thank Mr.Malcolm Morris.The following card specimens were shown :&mdash;

Dr. KANTHACK : Glandular Tumour of Lip.Dr. P. WEBER : (1) Obliteration of Coronary Artery (? Con-

genital) ; (2) Section of Coronary Artery from case of Angina

Pectoris.Dr. CYRIL OGLE : Accessory Tumour of the Thyroid Gland.

OBSTETRICAL SOCIETY OF LONDON.

The Influence cf the Removal of the Ovaries on Metabolism inconnexion with Osteomalacia.The Effects of Lactationon Menstruation and Impregnation. - Exhibition ofSpecimens. A MEETING of this society was held on Jan. 1st, Dr. F. H.

CHAMPNEYS, the President, being in the chair.Professor G. EMILIO CURATULO, of the Royal University of

Rome, read a paper on the Influence of the Removal of theOvaries on Metabolism in connexion with Osteomalacioa. Healluded to certain hypotheses intended to account for thebenefits afforded by castration in cases of osteomalacia. Hethen referred to experiments on bitches made by him andrecorded in the Transactions of the Edinburgh ObstetricalSociety. He found that after removal of the ovaries thequantity of phosphoric anhydride excreted in the urine wasgreatly and for a considerable time diminished, while thequantity of nitrogen remained unaltered. The diminution of

phosphates began about the seventh day and continued forthree or four months. Professor Curatulo regarded this asbeing the result of a diminished oxidation of phosphorus,existing as an organic compound in the tissues, and which,combining with calcium and magnesium, is stored in thebones. He supposed that the ovaries produced a secretioncapable of facilitating the oxidation of the phosphatic organicsubstances which supply the material for forming the wallsof the bones, and that their extirpation leads to a greateraccumulation of earthy salts in the skeleton. He mentionedsome experiments he had made which tended to provethis.-Dr. AMAND ROUTH thought that the great value ofthis paper was the new method by which Professor Curatulohad endeavoured to explain the action of the ovarian"internal secretion." He alluded to the various ductlessglands of the body and their-at present-inexplicable modeof action. He thought it not improbable that ProfessorCuratulo’s method of examining the urinary secretion might,as in the cases now under discussion, be the means ofarriving at an explanation, especially in acromegaly,where bone-tissue was also involved.&mdash;Dr. W. S. A. GRIFFITHwas of opinion that Dr. Curatulo’s contribution should notlead them to take too narrow a view of the subject. It was

unlikely that the ovaries had an important r&ocirc;le in connexionwith the disease in women, and of course they had none inman. He had obtained specimens from the dissecting-roomat St. Bartholomew’s Hospital, all from subjects of advancedage. There was also another class of case occurring inchildhood to which little attention had been directed. Hehad found specimens described as rachitis, with all. the