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by one which I fail to find alluded to in the ordinary text- books, and one which, though more ulterior in its appear-ance, is certainly not le,.s fatal in its consequences. Andnaturally the questrotr arises, Would the intra-venous injec-tion have made the uterus contract as effectually as the per- chloride of iron if it had he, n employed in the first instance ?If it could be proved that :.nch a performance would suffi-ciently reanimate the patient to bring about uterine con-traction, then that course ought to be adopted ; because,now that intra-venons inj ction has been reduced to a prac-tical operation, the da ngers of the latter appear diminishedwhen compared with the furmer. But the issue of the secondcase shows that altrough the uterus does contract afterintra-venous injection, it does not always do so sufficientlyto arrest all hæmorrhage, as the perchloride had subsequentlyto be applied to completely arrest the flow. It may be

thought that the hæmorrhage was the result of polypus,retained placenta, or other cause; but, although carefullysought for, no evidence of such was found. Getting up toosoon was the probable cause of the hæmorrhage in the othercase.

I am aware that final conclusions cannot be drawn fromwhat may be called two isolated cases ; but one thing, atleast, appears to have been established-viz., that theoperation of intra-venous injection is a practicable one.In conclusion, I would thank Dr. Herman for his courtesy

in allowing me to publish these cases.London Hospital.

A CASE OF

ANEURISM OF THE AORTA RUPTURINGINTO THE PERICARDIUM.

BY H. C. GUINNESS, SURGEON-MAJOR, A.M.D.,IN MEDICAL CHARGE, STATION HOSPITAL, WESTERN HEIGHTS, DOVER.

CORPORAL A. D-, Royal Irish Rifles (83rd), agetwenty-three, service five years (no history of syphilis,alcoholism, or rheumatism) was admitted into Station

Hospital, Western Heights, Dover, on October 24th last,with inflammation of external meatus. In spite of thetreatment employed the pus became very fetid, showing itsneighbourhood to bone, and there was considerable consti-tutional disturbance with hi-5h temperature, &c. He becamelow and weak, requ riag stimulants, &c., but no delirium orhead symptoms occured. During his life he had no sym-ptom to direct attention to the heart or great vessels, andthere was no suspicion of the existence of an aneurism. OnNovember 12:b, nbcnn 2 P.M., after his ear was syringed, hefell back in bed and expired almost immediately. As willbe seen by the post-mortem report, the case is one ofexceptional interest, owing to the mischief caused by theaural inflammation, the plugging of the lateral sinus andjugular vein, and the probabilty of this being the cause ofthe rupture of the aneurism by the increased pressure on itscoats, also by the ve y small size of the aneurism. Thepost-mortem report I send in full, as furnished by SurgeonSkinner, Army Medical Department.

Necropsy—Body pale and emaciated, rigor mortis wellmarked. Oa removing the skull-cap, the dura mater wasfound to be unusually I’v adherent to the structures beneath,just above t:.e t hero bili. The left lateral, petrcsal,and cavernous sinuses were filled with ante-mortem clot; alsothe jugular vein in the jugular fossa, and for about an inchbelow that point. Tie brain substance was firm; but pre-sented nothing unusuctl on examination beyond generalemptinessof the veins. The left auditory meatus containedpus; it communicated with the jugular fossa by a perfora-tion. On opening the chest, the pericardium was observedto be distended to its fallest extent by a dark sub6tance.On opening i, Some reddish fluid-in amount about twoounces—escaped, and the hart was found surrounded by afirm dark-coloured clot, which on removal weighed tenounces. This clot was fouod to be especially adherent tothe anterior surface of the first portion of the aorta ; onremoving it from this situation, a small aneurism was foundrather larger than a hazel nut, with a perforation in itscentre admitting a meium sized bristle. The heart had aconsiderable quantity of fat externally and was firmlycontracted. Its muscular structure was pale on section. Thevalves were healthy, but all the orifices were rather small.

The aorta presented commencing atheroma in small quan-tity throughout its whole thoracic portion. The mouth ofthe aneurism was small, with a ragged margin, and blood-stained for about one-eighth of an inch round ; it was aquarter of an inch in its transverse, and a little more thanone-eighth of an inch in its vertical measurement. Theaneurism contained some laminated fibrinous clot. Theexternal coat was thickened in this situation, except just atthe point of perforation, which, from the inner aspect, pre-sented a funneled appearance. The lungs were collapsedand somewhat congested, especially at the base of the left.The liver was slightly enlarged and congested. The kidneyswere apparently normal, also the spleen.

Remarks.—The post-mortem appearances suggest theopinion that the rupture of the aneurism was immediatelydue to the increased pressure caused by the blocking of theveins on the left side of the brain.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

Casts made with New Material. —Diffuse Polypi of Colon.-Large Polypus of.Reetum.-PclyPus of Small Intestine.-Abscesses in Liver of Kangaroo.-A bscess and Pyœmiain a Python.—Changes in the Nerves in Infantile Para-lysis.-Changes in Nerves after Amputation.—Hyper-trophy and Softening of Bones in a Child -Addison’sDisease without Bronzing.-Bone and Brain Disease inSyphilis. — Micro-organisms in Pyœmia.THE ordinary meeting of this Society was held on Decem-

ber 19tb, the President, Dr. Wilks, being in the chair.Dr. Goodhart’s specimens of extraordinary thickening andsoftening of the cranial bones were referred to the RicketsCommittee. Dr. Lees showed a living case of erythemapapulatum in a boy aged three years.

Mr, BowLBY showed some excellent casts of Limbs andSkin Eruptions made from a new material, the compositionof which was described in the British Medical Journal ashort time ago. The most important question was as to thedurability of the specimens ; some of those exhibited hadbeen made nearly a year, but possibly it might be foundadvantageous to add some preservative like arsenic. Thecolouring of the skin eruption was done after the cast wasmade. His second specimen was a Colon of a man, agedsixty years, with diffuse Polypoid growths. There was noother disease of the alimentary canai found, and there wereno symptoms during life. The growths commenced imme-diately beyond the ileo-caecal valve and extended as faras half way down the descending colon. Some were sessileand some pedunculated. They consisted mostly of softmucous membrane, and had no relation to any particularpart of the circumference of the bowel.-Mr. BowLBY alsoshowed a very large Fibro-cellular Polypus of the Rectum.The patient was a girl, aged twenty-four, who previous tothe discovery of the tumour had felt no discomfort beyondoccasional constipation. While straining at stool she feltsomething come down which she was unable to return, andMr. Everley Taylor, of Scarborough, having been called in,f mnd a large mass, the size of a foetal head, protruding fromthe anus. The tumour was removed under chloroform andwas found to be very succulent, much fluid escaping whenit was cut into, and its weight was thirty-one ounces. Itsattachment was to the anterior wall, and it consisted ofvery loose fibrillar tissue containing a considerable quantityof fluid—i.e., a soft fibroma. The mucous membrane overit was normal. It is now ten months since its removal, andthere has been no recurrence. Its large size, and theabsence of symptoms, were the most noteworthy features,His fourth specimen was a Polypus of the small Intestine.A female, aged thirteen months, under the care of Mr.Morrant Baker, was taken ill, with symptoms of intussus-ception, on April 28th. She was admitted to St. Bartho-lomew’s Hospital on May 10th, when the vermiformappendix was found hanging loose from the anus, and onthe 13th a large portion of the gut came away. The childimmediately began to recover, and was discharged fromthe hospital on the 19th with the motions fairly healthy.On June 1st it was readmitted with wasting and con.

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genital syphilitic rash, and it died from marasmus on testines produced by the bones which they swallowed.-July 2nd, without any symptoms of intestinal obstruc- Sir JOSEPH FAYRER, in reply to Dr. Wiiks, said he was onlytion. Post-mortem, there was evidence of old peritonitis familiar with multiple abscesses of the liver in the human =and adhesions of the coils together, -and also to the subject, and he thought that at first they were limitedenlarged mesenteric glands. The upper part of the small necroses; and then abscesses.intestines was healthy. There was a polypus about eight Dr. WALTER EDMUNDS showed microscopical specimensinches from tLe anus, with ulceration of the gut above it. of Nerves from three cases of Infantile Paralysis. The--’There was no colon, but there were signs of the restitution specimens were from three cases in which the leg had beenof the continuity of the canal, three inches and a half amputated late in the disease as an encumbrance. Thefrom the anus. There was very little constriction; but the sections were from the internal popliteal nerve. They showed : _:

gut above was dilated. The peritoneum was scarred and considerable increase of the endoneurium in the nerve.

puckered. The polypus was doubtless the cause of the bundles and atrophy of many of the nerve fibres. The endo-mtussusception ; but it was unusual for the polypus not to thelium in the vessels in the nerve was proliferated.-Dr.come away.-Dr, COUPLAND alluded to a case something BUZZARD thought that if the disease be really inflammatorylike Mr. Bowlby’s that was under his care two years ago, the -it would probably affect the vessels in the connective tissuedetails of which were published in the Clinical Society’s first, and where the inflammatory change was the greatestTransactions. The patient was twenty years of age, and the nerve tubules would be most pressed upon, and therefore ’_

abdominal section was performed for irreducible dntus- atrophied.—Mr. BOWLBY thought Dr. Edmunds’ view wassusception. The polypus was in the small intestine, and the correct one, as the separation of the fihres from theproduced the intussusception which came through the ileo- nutritive nerve cell would’lead to atrophy. He thought thecæcal valve. Alluding to Mr. Bowlby’s case of multiple patches of connective tissue were in the site of former motorpolypi, he said there was a specimen somewhat similar in nerve fibres.the Middlesex Hospital Museum.-Mr. CRIPPS remarked on Dr. HALE WHITE and Dr. EDMUNDS showed microscopicthe large size of the rectal polypus ; and with regard to the specimens of Neuromata after Amputation, which were, hedisseminated polypi, said there were only four cases recorded said, rare in the Society’s Transaction, though not really rareintheTran-3actions of the several Societies andinthe museums. tumours. The specimens showed that, thr first change inThe specimen that Dr. Coupland had alluded to was taken the coiled bundles of nerve fibres at the end of the ampu-from a man whose symptoms dated from an attack of tated nerve was an ingrowth of delicate connective tissuecholera, and he died six months afterwards. There was from the perineurium ; this ended in the sclerosis of theanother specimen in Guy’s Hospital Museum where there bundles, and in its turn the sclerosed tissue underwent fattywere about twenty polypi in the last twenty inches of the degeneration. The reason why the nerve fibres underwentcolon with long, slender pedicles. He had shown a speci- fatty degeneration was tbat in man the other tissues of themen himself last year. There were two kinds of polypi : limb not regenerating themselves, there was no need of either(1) Those formerly called villous tumours, which consisted of sensory or- motor nerves. It was pointed out that in thehypertropbyof the mucous membrane, with new epithelial nerve of the amputated limb certain fiores underwent de-layers over the retiform tissue ; (2) deposit in the submucous generation, which were probably those coming from thetissue of a mass of cells, the pedicle being formed subse- parts which had been renewed, whilst the litres which hadquently, analogous t) the fibrous molluscum of the skin. not undergone degeneration were derived f, on the remainingHe saw Mr. Bowlby’s case of intussusception during life, parts of the limb. In a case of amputation of tre thigh, theand ask(d how it was that the small intestine, which must change in the cells of the tractua intermedio.lateralis had nothave come down through the ileo-caecal valve, did not extended as high as the lower dorsal cord. Sections of thealso slough.-Dr. WILKS thought from his experience th’it median nerve just below a spot where it had been cutpolypi generally occurred in lictle boys.-Mr. MORRIS was through previously showed complete degenerat:on of the.surprised to hear polypi spoken of as rare. He recollected nerve owing to all its fibres being functro ally useless. Aseeing several cases shown in one evening at this Society, specimen was also shown of a round-c-ted sarcoma at theall from young children. He once operated on a woman end of an amputated nerve.-Dr. WILKS asked if therewho had polypu", fistula., and hæmorhoids, and related a was new growth as well as atrophy.—Dr HOGGAN thoughtcase of a maa who complained of tenesmus and spasm of the that the only satisfactory method was two be.-;ill de novo thesphincter, and on examination six or eight polypi could be study of nerve pathology by the investigation of the changesfelt in the rectum.-Dr. GOODHART said that he had met in the individual nerve fibres hy the unproved methods ofwith three kinds of potypi in the museum of the College of staining by osmic acid and guid.—Dr. WHITE, in reply,Surgeons: -1. Like the large specimen shown to-night, said that his specimens were taken whea the changeswhich was like Mr. Curling’s case. 2. The polypi of young were too far advanced to show the new nerve fibres,children, which consist of mucous membrane, and are and he had only quoted from the authorities as to theirpapillomata. 3. Villoas, like Mr. Henry Smith’s case, existence.where twenty or thirty were removed by the finger, but Dr. GUODHART showed the Calvaria and specimens ofrecurred. With regard to the intussusception, he thought the other bones of an infant, aged fifteen months, who wasthat the colon usually sloughs, and leaves the small in- in the hospital only three days, and died of atelectasis. Thetestine behind. - Mr. BOWLBY, in his reply, said that mother contracted gonorrhœa frorn her husband and thedisseminated polypi were usually mucous. The interest ch.ld had consequent ophthalmia, but there was no otherof his case lay m the fact -that his had a fibrous con- evidence pointing to syphilis. There are two otlmr children,sistence. He thought that the ileo-cæcal valve in the intns- one with rickets. The patient was suckled for three weeks,susception case, as well as 3, part of the small intestine, had and then brought up on milk and water and beef-tea.sloughed awav. The child throve well the first year but always perspiredMr. J. B. SUTTON showed, first, the Liver of a Kangaroo, profusely, had thrush badly, and occasionally sp&ts on the

with about 200 small abscesses, some projecting above the nates, the abdomen was always large. During the lastsurface and some deeply imbedded. All of them had caseous three months the spine had been curved and she criedwalls. One had burst into the peritoneum and killei the when moved. A month ago the legs became swollen,animal. He had o’ten seen similar abscesses in birds. then the arms, and then the head. There was well-Secondly, he related the case of a Large Abscess occurring marked cranio - tabes, the ribs were beaded and thein the Abdominal Wall of a Python, seven feet long and five thorax flattened laterally. Node-like Inmp3 could beinches in circumference, which died four days after admission felt over the inner surface of each tibia and radius,into the Zoological Gardens. The cavity of the abscess was and the lower epiphyses of the r.;dii were enlarged. Thelined with layers of fibrin. There were five ounces of bloody i-p’een was notably enlarged. Post mortem the changes inserum in the pericardium. The liver was filled with abscesses, the bones were the most noteworthy, the hones of the skullfrom the size of a pea to that of a nut ; some of them had being enormously thickened, and aiso all the long bones andonly fibrin in them, others pus. In all reptiles there was a the spine. To summarise the changes :—1. The bones werecommunication between the portal vein and the intercostals, soft like sponge, and all of them except the pel rous part ofand this was freer in the python than in other reptiles the temporal bone could be cut with a knife like a rawthrough an extra communication. The abscess was situated potato, and one tibia was broken. 2. There w a great hyper-in the anastomotic area, and led to the hepatic abscesses trophy, mainly, but not exclusively, upon the periostealand the pericarditis.-In reply to the President’s question as pattern. 3. There was marked rickets. The question wasto the cause of the abscess, Mr. SUTTO-N said that abscesses whether it was all from rickets or due to congenital syphilis.were common in snakes, possibly from wounds of the in- Parrot has described a similar condition of spongiform osteo

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phytes, but less marked than in this case, which he ascribesto congenital syphilis. Dr. Goodhart thought there wasalmost too much periosteal growth for rickets, and perhapsthe safer plan was to consider it the outcome of both diseases.The infiltrating growth, which even obliterated the medul-lary canal, seemed to bring it in some relation to osteitis de-formans, and some thought osteitis deformans was alliedto tumours; and it might be suggested that thesechanges were more of the nature of a bone tumour. -Dr. NORMAN MOORE thought that the bodies of the verte braedid not present the changes seen in rickets, and that in theskull the thickening was not increased at the sutures ; inboth these ’points it was not like ickets.—Mr. KESTEVENasked if there had been any microscopical examinationsmade.-Dr. GOODHART replied that he had only made animperfect microscopic examination, and found porous bone.He then related a case of Addison’s Disease withoutbronzing, and showed the abdominal sympathetic nerves

which had been carefully dissected out by Mr. Pearson, ofthe College of Surgeons. The patient was a medical manwho had felt ill for a short time and took a sea voyage torecruit himself, obstinate sickness set in, which was ascribedto the effects of the sea, and he landed in a very exhaustedstate; a few days later he got out of bed and fatal syncopeensued. There was no alteration in the colour of the skin.At the autopsy Dr. Goodhart found suprarenal change, andthe abdominal sympathetic affected in su’-h a way as toshow that there was undoubted Addison’s disease. Hethought that the case supported the view that if the diseasewas rapid in its course bronzing might not occur.Mr. VICTOR HORSLEY exhibited specimens of Bone and

Brain Disease in Syphilis. The organs shown possess nospecial interest beyond the fact that successful treatmentlessens the opportunities of studying syphilitic lesions. Inthis case the patient was admitted into University CollegeHospital under Mr. Hill, f: om the Lock Hospital, Soho, ina very weak state, and sufl’ering from pyæmic abscesses.What history could be obtained showed his condition to bepysemie, following on necrosis of the facial and cranialbones. The specimens show, first, the points of necrosis onthe frontal and malir bnnes, together with the spongy bonesof the nose, of which the inferior turbinate was found postmortem to be a mere sequestrum, and kept in the nasalfossa by tenacious muco-pus. The whole mucous membraneof the pharynx is hyperæmic, and shows a few cicatiiees ofprevious ulceration. The seats of active mischief were ex-cessively foul, the smell of the discharge not being controlledby antiseptics. The frontal bone shows very well the cica-trices of former ulceration and destruction of the outertable. The lungs on both sides showed some cirrhosis ofthe apices and broncho-pneumonia ; the liver, fatty andcirrhotic, presented a depressed scar on its surface pene-trating a quarter of an inch into the substance of the organ.Both spleen and kidneys were cirrhotic, while the formerwas greatly enlarged, being seven inches long by four inchesand a half by two inches. The other abdominal organsshowed no particular leion. On removing the brain therewas found an excess of cerebro-spinal fluid, while thearachnoid and pia mater at the base were opaque, and inplaces matted together by exudation. This did not seem tohave caused any paralysis of any cranial nerve. There isasymmetry of the cerebtllum, the lateral lobe of the left sidebeing deficient on its under surface at the anterior border,the flocculus being scarcely represented. This does notseem to be the ie’-ult of disease. There were elevenabscesses in the connective tissue of the limbs and trunk.Mr. HORSLEY aLo showed the Micro - organisms of

Pyæmia. There were also shown two specimens of Micro-cocci, found in the ab-cess fluid of the case of syphilis andpyæmia first referred to, and also from a case of excision ofthe tongue for epithelioma. The form of pyæmia in bothcases was alike-viz., that in which there is a formationof peripheral, not visceral abscesses—i.e., an infective processnot dependent on embolism. As has always been found, theorganisms are micrococci, and while always occurring in theahscess cavities, they were not found in the blood. Withthe fact in view of their invariable occurrence in acuteabscess (described by Og!-ton and confirmed by Mr. Horsley),of course no causative importance was attached to thenpresence.

Card specimens of Urinary Calculi, chiefly composed o:

carbonate of lime, from the horse, ass, and dog, were ShOWlby Mr. SHATTOCK; and Cancer of Omentum by Dr. BEDFORD FENWICK.

OBSTETRICAL SOCIETY OF LONDON.

A MEETING of this Society was held on Wednesday,Dec. 6th, 1882, Dr. Matthews Duncan, President, in thehair.Deciduous Membrane.-Dr. CLEVELAND exhibited a fleshy

inger-like sac, passed forty-eight hours after labour by apatient who after a former labour had passed a similar sub.stance, which he had then exhibited to the Society. Aftercareful search he had found no trace of a double uterus.-The PRESIDENT could think of no other origin for such anunbroken decidua than that it came from a uterus bicornis.- Dr. WYNN WILLIAMS described a case of double uterus atpresent under his own care.Microscopic Sections of Carcinoma Uteri. - Dr. Ems

showed microscopic sections illustrating his case of malignantdisease of the cervix complicating pregnancy. The amountof stroma was small compared with that of the cells, theappearance thus resembling that of medullary cancer.

Perimetric Abscess.-Mr. GRIFFITH showed a specimen ofperimetric abscess, situated behmd the uterus and left broadligament, displacing and obstructing the rectum, and open-ing at three places into the cervix uteri, vagina, and rectum.

The Directions of Uterine Contraction. - Dr. GODSONshowed a uterus removed by Porro’s operation, which demon-strated well the wrinkles on its peritoneal surface caused bythe contraction of its muscular fibres underneath. - Dr.ROUTH had heard the uterine souffle per vaginam or over thesacrum in cases in which he had failed to hear it by auscul-tating the abdomen.

Retained Placenta.—Dr. WYNN WILLIAMS exhibited aplacenta retained for three months after abortion, andremoved by him.

Fibroids removed by Abdominal Section.-Dr. BANTOCKexhibited five specimens of uterine fibroids, weighing re-spectively 31b., 81b., 13 ½ 1b., 31b., and 2 Ib., removed byabdominal section. One patient died, four recovered. Ineach case the pedicle was secured by Kœberlé’s serre-nceud,upon the value of which Dr. Bantock remarked. Rethoughtthat whatever might be the future of oophorectomy for thecure of fibroids, it could not compete with hysterectomy incases such as those exhibited, in each of which there weresubstantial objections to the former operation.-Dr. ROBERTBARNES thought fibroids such as Dr. Bantock had shownbetter dealt with by hysterectomy. At present he inclinedto think Battey’s operation best suited tor hard fibroids inthe wall of the uterus, and projecting inwards. Malignantand myxomatous tumours it was better to extirpate. Hecould speak from clear observation of the remarkable effectof Battey’s operation upon fibroids. Within a year afterthis operation he had found a tumour the size of the fistpractically gone.-Mr. KNOWSLEY THORNTON did not thinkhysterectomy should be performed for fibroids until oopho-rectomy had been tried and failed. He had done the latteroperation ten times ; all the patients had recovered, all hadbeen benefited, and in all the uterus had diminished in size,in some to a surprising degree. Not merely the ovaries,but the tubes, and the large vessels in the broad liga-ment, ought to be removed. - Dr. GODSON corroboratedMr. Thornton’s statement as to one of the cases operated onby him.-Dr. CHAMPNEYS asked Mr. Thornton in what cases.he thought the operation should be done.-Mr. THORNTONthonght only in cases in which life was threatened.New Lamp.-Dr. AVELING exhibited a modification of

Swan’s incandescent carbon lamp, so made that it could beintroduced into cavities of the body for operative or endo-scopic purposes.Ruptured Perineum: New Method of Operating.-A

paper upon this subject, by Dr. WYNN WILLIAMS, wasread. In this operation the sides of the rent were firstdenuded in the usual way ; then a flap of elastic tissueabout two-thirds of an inch in width, about two lines inthickness, and long enough when on the stretch 10 reach ashigh as the denuded surface on the labia, was dissected upfrom the floor of the vagina. Sutures were then passedthrough the denuded surfaces in such a manner as to keepthe edges as well as the flat surface of this flap in contactwith the raw surface. This being done, the sutures weresecured in the usual way. When the rupture involved thesphincter ani, the flap was made, and the sutures passedthrough it in the same way as in the simpler cases, but therent in the wall of the rectum was sewn up with sutures