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what collapsed and very pale, and was constantly retchingand bringing up small quantities of yellow mucus. She wasimmediately put to bed, with hot bottles to her feet. Shecomplained of great thirst, with pain in the mouth andthroat, but she would only occasionally speak, and then ina scarcely audible tone. The pupils were normal, pulse fulland regular, and the breathing hurried and shallow. Shewas very drowsy, but was kept constantly awake. Smallquantities of fluid, containing equal parts of milk and lime-water, were given at frequent intervals. The patient wasgetting very cold, and sweating profusely. There was noswelling or tenderness of the abdomen. At 12.30 A.M. no

change had occurred. While the patient was being put tobed a half ounce pot, almost empty, of phosphorous paste forkilling rats was found concealed about her dress. At 2 A.M.she was breathing freely, respiration thirty in the minute ;temperature 100°, pulse 90, full and regular. Great pain inthroat and mouth was complained of, and patient appearedto be in a stupid, half-conscious condition. The eyes wereclosed, and on being told to open them only twitching move-ments of the lids occurred. The pupils were normallydilated and responsive to light. Nothing could be got fromthe patient as to what she had taken, and the few words sheuttered were too feebly spoken to be understood. Theabdomen was very tense and tympanitic, but did not appearto be painful. An enema of castor oil with tincture of opiumwas given, which shortly afterwards brought away somenormally-looking faces ; at the same time the urine wasvoided, but could not be examined on account of its beingmixed with the enema. No phosphorous odour was ob-served about the evacuation. At this time the breath wasstill strongly of phosphorus, and the patient restless andsleepy. Milk at frequent intervals was given, together witha solution of morphia every four hours, and a large hotpoultice to the abdomen.Next morning at ten o’clock no change had occurred in

her general condition. There seemed to be great tendernessover the throat and epigastrium. The patient appeared tobe quite unable either to open her eyes or mouth, or in anyway to move, as if from extreme weakness of the necessarymuscles ; temperature 101° ; pulse 104, and irregular ; re-spiration 26, and irregular. The pupils were normal, butthere existed intense photophobia of both eyes. There wasprofuse perspiration. On examining the chest all thesigns of commencing acute inflammation of the largerbronchi and the trachea were evident, and there was greatdifficulty in swallowing. Milk, together with the whites of- eggs, were ordered to be given during the day, and iceto suck. Fifteen drops of tincture of opium in cinnamonwater were given three times a day. At 11 A.M., tempera-ture 101° ; pulse 106 ; respiration 34. At 2 P.M., tempera-ture 99° ; pulse 96 ; respiration 30. At 4 P.M., temperature’98’6; pulse 68; respiration 24. At 6 P.m., temperature97’4°; pulse 70, irregular and scarcely perceptible ; respira-tion 24.At 10 P.M., the nurse in charge sent to say the woman

had died suddenly, and on seeing the body a few minuteslater the house-surgeon found it lying on its back quite mo-tionless, with no perceptible pulse, respiration, or heart’sbeat. The body was quite cold, temperature in the vagina 97°,’eyes fixed, and she appeared in all respects to have expired.Artificial respiration was immediately resorted to, and in a fewminutes the woman began to breathe very faintly, and atthe end of half an hour’s continuous efforts the pulse andheart’s beat could just be detected, and respiration fairlycarried on, though were irregular. The patient appeared tobe quite unconscious. Several relapses occurred at frequentintervals, and artificial respiration had to be kept up till 1- "..:B1., when the breathing and pulse had much improved,though the temperature only stood at 97’4. The patient wascoughing a good deal at this time, and loud rales could beheard all over the chest. No phosphorous odour was noticedin the breath.Nov. 29th.-The patient had passed a very restless night,

coughing continuously, but without any expectoration. Sheappeared very weak, and the mental condition was un-changed. The abdomen was distended and tympanitic, andthe throat and the epigastrium were very sore. There wasgreat photophobia. Temperature 988°; pulse 100, smalland irregular ; respiration 24, shallow and irregular. Moistrales were audible over the chest ; heart’s beat could not befelt, and on the slightest movement the patient appeared to beon the verge of suffocation. She coughed a good deal, butwithout any expectoration. At midday temperature 9S’4 ;

pulse 100; respiration 24. At 4 P.M., temperature 98’2°;pulse 80 ; respiration 35. At 6 P.M., temperature 96’8°;pulse 80 ; respiration 30. At 8 P.M., temperature 98’2°;pulse 78; respiration 30. No urine or faces had beenpassed during the day, and in the evening the waterwas drawn off and found to be normal, without any phos-phorescent appearance. The woman had taken iced milkand eggs at frequent intervals, and although there was con-stant retching, no vomiting occurred. The medicine wasrepeated during the day.She passed a quiet night, and on the following morning

answered questions put to her in a rational manner, but stillin a very low, feeble tone. She complained of pain in thethroat and slight epigastric tenderness. The tongue wasclean, and the throat did not appear inflamed. She passedtwo pints of urine during the morning, which was quitenormal. Milk was taken freely, and apparently withoutpain. She was still unable to fully open her eyes, or pro-trude the tongue. At 11 A.M., temperature 9i° ; pulse 100,irregular and very small; respiration 30. At 3 r.M., tem-perature 98° ; pulse 100; respiration 24. At 7 P.M., tem-perature 98’4°; pulse 128 ; respiration 34. At 10 P.M.,temperature 101°; pulse 90 ; respiration 32. At 12 tempera-ture 98 ’4°; pulse 80 ; respiration 30. The same treatmentwas adopted as before.On Dec. 1st the patient appeared to be altogether in a

totally different condition. She spoke intelligently, and, said she did not remember anything that had occurred during: her illness, but admitted she took the poison. There was

no abnominal pain or tenderness, though the abdomen was: still somewhat distended and tympanitic. There was very

little tenderness about the throat, and slight difficulty in. swallowing. The medicine was discontinued, and the; patient still kept on a diet of milk and egg, with some bread

and butter. The urine and faces were voided during the: day, and appeared perfectly normal. Temperature 99° ;I pulse 100 ; respiration 25, at 10 A.M. At 10 P.M. the tem-I perature was 98’8°; pulse 90; respiration 25. The eyes.

were fully opened, and tongue protruded at will.Next day, but for general weakness, the patient appeared

’ to have fully recovered-no pain or tenderness was anywherej experienced, and the abdomen was of the natural size. The! temperature, pulse, and respiration were normal, and no

sickness was complained of. The police authorities removed. the patient to the Bridewell, from whence she was taken toj the workhouse, where she remained for ten days, and was: then allowed to return to her friends, being perfectly well.

During the whole time the woman was under observationL

I no signs of jaundice were perceived.

Medical Societies.PATHOLOGICAL SOCIETY OF LONDON.

Pancesites in ]ýlusclc in Typhoid Fever.-S2aoaitaaaeous Dis-’

appearance of ]ýlorpltaea.-Liclten Rubca°.-Ci/st -iaa Brain.- Aneacrisna by Agbastoiiiosi’.N.-Sitl)pitrettio2i in Larynx.-Mitral, Tricuspid, and Ao2-tic Steaaosis. - Tumour ofSpermatic Cm’d.-Congenital Alalformation of Rectum.THE ordinary meeting of the Pathological Society was held

on Tuesday, the 20th inst., J. Hutchinson, Esq., President,I in the chair. An interesting communication from Mr. W.’ H. Power of the Local Government Board on the discovery of

nematoid worms in the voluntary muscles in typhoid feverI was read by Dr. G. Buchanan. Mr. Eve introduced the

subject of laryngeal abscess in typhoid fever, and, on thel request of the President, Drs. Greenfield and Taylor pro-

mised to bring other specimens illustrating it, and raise the.

discussion again.: Dr. G. Buc’HANAX read a paper on Some Appearances,l probably of Parasites, in the Voluntary Muscles of Enteric; Fever. The observations which it described were made byl his colleague, Mr. W. H. Power, who was led to investigate

the subject by finding that an epidemic on board the: training-ship Cornwall, supposed to be typhoid fever, was

really trichinosis. He thereupon commenced the examina-; tion of the voluntary muscles in typhoid fever. The first

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case examined was a young man in St. Thomas’s Hospital,who died from peritonitis set up by perforation of a cha-racteristic enteric ulcer. In the pectoral muscle were foundwhat were taken to be parasitic worms, one or more of whichwere seen in each specimen, and, apparently from theirmovements, they were still alive. Their dimensions werewholly different from those of trichina spiralis, being abouta quarter of it in length and breadth. They were

thickest in the middle, with one end larger than the other.They resembled nematoid worms both in the proportion oftheir breadth and length, and in the presence of an interiorcanal, apparently interrupted by some intervening organ ortissue. Another case of undoubted typhoid dying in theSeamen’s Hospital, under the care of Dr. Curnow, was alsoexamined, and in it too the same bodies were found, but inneither case were they so plentiful as was at first supposed.They were not found in all muscles equally; none have beenfound in the diaphragm, nor are they uniformly disseminatedthrough a given muscle. Many slides may be examinedwithout meeting with one. Certain much smaller bodies,having a possible relation to the larger parasites, were alsofound more abundantly ; they are with difficulty dis-tinguished from the muscle, and any slight interference withthe slide often results in their being lost sight of altogether.With advancing decomposition the parasites, but not thesmaller bodies, were found to be more numerous.The PRESIDENT referred to a living specimen shown at a

former meeting. It was a young woman, aged twenty,under the care of Dr. Porter, who a year ago was broughtto him suffering with well-marked patches of morphoea, orAddison’s keloid. These patches were placed irregularly,but corresponded with definite areas of nerve distribution ;there was a patch close in front of each ear, and several onone arm. At the time he took accurate notes of the case.Now, only twelve months after, they have all completelydisappeared, the skin merely showing a little staining andthickening. The fact of the complete disappearance ofpatches of morphoea is well known, but he brought forwardthis case, as it was one of the best proofs of it that he hadever met with, and also showed how rapid this disappearancemight be. He thought Dr. H. Fagge was one of the first todraw attention to it.-Mr. MOREANT BAKER referred to aman who was under Mr. Willett’s care some months agowith large patches of morphooa on the thighs ; he was lostsight of for a time, but came to the hospital recently, andthe patches had almost entirely disappeared, and, accordingto the patient’s account, this improvement occurred shortlyafter haemorrhage from the bowels.Mr. MORRANT BAKER described a case of Lichen Ruber,

which he had shown as a living specimen at a recent meet-ing. The woman, fifty-three years of age, had been underhis care at St. ]3artholomew’s Hospital for some months.The disease began two and a half years ago, more especiallyon the extensor aspect of the arms and legs, where it pre-sented large rough, almost warty patches, with slight de-squamation, deeply pigmented, not weeping, but with intenseitching. Some of the tops of the papules were scratched off,and this gave in places an aspect of prurigo. On the elbowsthere were one or two patches which were not raised, andwhich were much more like lichen rnber. Great differenceof opinion had been expressed by those who had seen thiscase, some calling it an eczema, others prurigo, or psoriasisor lichen ; for his own part he should prefer to call itlichen ; perhaps it was the form of disease called lichenpsoriasis by the President. -The PRESIDENT had used theterm lichen psoriasis mainly in order to teach that the twodiseases are but one and the same; he considered that pso-riasis admitted of polymorphism, and that so-called lichenruher or planus was one of its polymorphic varieties. Itwas certainly cured by the same remedies as psoriasis ; hesupposed Mr. Baker was treating his case by arsenic and tarointment. -Dr. PYE-SMITH should have called the case

psoriasis, but as Mr. Baker had seen it in its earlier stageshe was best able to make a diagnosis ; he could not considerthis distinction of great importance, as the two diseases wereso closely allied. On the other hand, the distinctions betweenprurigo, eczema, and psoriasis or lichen were very markedand definite.-Mr. BAKER stated that one dermatologist hadcalled it an eczema; another thought it was an example ofan undescribed disease, and should have a name to itself.

Dr. EWART showed a ramifying Cyst in the Brain. A man,aged thirty-one, was admitted under Dr. Whipham’s careinto St. George’s Hospital in 1878. He had been attackedeighteen months previously with severe headache and vomit-

ing. He improved, but relapsed six months later, and again, in January, 1878. Soon after this attack he showed signs of.

mental derangement. On admission into the hospital heI was found to have, in addition to the headache and vomiting,. numbness in both hands. The mind gave way, he becamei very violent, and death took place from coma. At the; autopsy the right hemisphere of the brain was found to con., tain a cyst. The membranes over the interpeduncular space

and on the under surface of each frontal lobe were found to: be thickened, the thickening consisting of a thin membrane, packed closely in a depression on the brain, and sending. tubular sac-like prolongations in-to the brain. The cyst was

contained in a distinct cavity with a very smooth surface,, very irregular in shape from projecting bands and columns,

apparently produced by the branches of the Sylvian artery;the lining membrane looked like that of the ventricles, fromwhich, however, it was quite distinct; it was cellular instructure. The cyst was formed of a very delicate mem-brane, so folded on itself that there was no appreciablequantity of fluid in it. On microscopical examinationthe inner surface was seen to be mammillated; underthe projections was a clear space with a double rowof cells, and beneath that numerous capillaries ramified,The cerebral arteries were also peculiar. The anterior cere-brals arose more deeply than usual, being covered over bythe thickened membranes, and were connected by twobranches close together instead of by one only. Just beyondthe second of these communicating arteries the left anteriorcerebral appeared to end in a misshapen knob, from whichmany branches arose, and particularly two which continuedon over the corpus callosum in the usual position of theanterior cerebrals. The right middle cerebral artery waslarger than normal, with an unusual number of branchesarranged irregularly, many of which were almost occludedby hypertrophy of the intima. He thought the cyst wasdependent in some way upon the irregularity of the vessel,It was remarkable to find such a lesion borne so long with.out symptoms. The symptoms experienced at last were pro.bably the result of the increased growth of the cyst, or ofsome inflammation set up by it.Mr. EVE exhibited specimens and drawings of Aneurism

by Anastomosis of the External Ear. A woman, twenty-oneyears of age, was in St. Bartholomew’s Hospital, under Mr.T. Smith. She stated that at birth there was a small lumpat the upper part of the pinna, which pulsated; it graduallyincreased, and when she was six years old it was removedby ligature ; two years later another portion of the growthat the back of the ear was unsuccessfully treated by pins.The whole of the pinna behind the external auditorymeatus was involved, enlarged, of a dull-red colour,soft, pulsating, with a humming murmur. The temporaland posterior auricular arteries were enlarged ; on pressingthe carotid artery on that side the tumour became flaccid.She suffered from haemorrhage from time to time, whichgradually became more frequent and abundant. Mr.Smith removed the whole pinna, with some surroundingskin, very little blood being lost. The growth consisted ofa number of anastomosing capillaries, many of them em-bryonic in structure. The Malpighian layer of the cuticlewas greatly hypertrophied, extending down in processes,some of which were branched ; the sebaceous glands werealso enlarged. He thought this, which was the result ofincreased blood-supply, was of great interest, in its bearingupon the similar changes seen around epitheliomata. He con-sidered the growth to have sprung from a congenital u2voidtumour.-Mr. EVE also showed three specimens of Perichon-dritis of the Larynx. The first was removed from the body ofa man who was attacked with dyspnoea while convalescingfrom variola. Tracheotomy was performed, but deathoccurred. There was oedema of the epiglottis and ary-epiglottidean folds. Two oval ulcers were observed beneaththe posterior attachments of the true vocal cords, leadinginto cavities containing pus, in which lay the necrosedarytenoid cartilages ; the upper and back part of the cricoidcartilage was also necrosed. The other two specimens were metwith in patients who had died from typhoid fever, one ofwhom suffered from frequent intestinal hæmorrhage, theother had very high temperature ; the condition of larynxwas like that in the first case, except that the cricoid cartilagewas not affected. Many authorities consider this state asbrought about by extension of the typhoid or variolousulceration down to the cartilages. Liebermeister regards itas the result of a diphtheritic inflammation, but Sestier holdsthat the abscesses are caused by the general tendency to

647

suppuration, gangrene, and necrosis met within convalescentsfrom typhoid fever; and in this opinion Mr. Eve concurred.In both cases of typhoid fever there had been special causesof debility-in neither of them were there other ulcers ofthe larynx ; and the fact that the same condition is metwith after variola, shows that it is- not a specific effectef typhoid. Typhoid ulcers, however, may penetrate deeply. -Dr. GREENFIELD had met with these abscesses in a numberof cases, he thought them quite common, and due to forma-tion of pus either in connexion with the perichondrium ormore externally. He believed it to occur during the periodof acute illness, and that it often subsided. In many of hiscases there had been no symptoms during life. The positionof the abscess was very characteristic. He had never seenit in uncomplicated typhoid fever.-Dr. GOODHART sug-gested that these cases occurred in epidemics. ; for years hehad not met with a, case, and then in two years had seenfour cases. He thought they sometimes started quite out-side the cartilages.-Dr. DOUGLAS POWELL asked if therewere any other abscesses, pyaamio or otherwise, in thesecases. He thought Mr. Eve’s first case might have beendue to a variolous ulcer, as it occurred early.-Dr. GREEN-FIELD had no notes of his cases at hand, but there was noevidence of any other pyæmic or bone lesion in the last casehe had seen ; as a rule, he had found the abscesses inpatients dying during the acute period from intense fever anddeepulceration.—Dr. TAYLOR had seen one case last year in apatient who had high fever for six weeks, and then had per-foration and peritonitis ; there was a large abscess. AnAmerican physician had noticed stenosis of the larynx asfollowing typhoid fever. - The PRESIDENT asked Drs.Greenfield and Taylor to bring forward their cases andspecimens at a subsequent meeting of the Society, so thatthey might appear in tha Transactions of the Society.-Mr.EVE stated that in his first case death took place on thethirtieth day. In neither of them was there. any otherabscess or sign of pyæmia.Dr. PEARSON IRVINE showed a Heart with Stenosis of Mi-

tral, Aortic, and Tricuspid Valves. A woman, aged thirty-seven, had been sickly from birth, never able to run about likeother children ; seven years ago she had an attack of acuterheumatism. Death occurred from dyspnœa and exhaustion.Iu addition to the stenosis of the. three, orifices there wasfound a large clot in the left auricle which filled the cavity,except a passage for the blood from the pulmonary veins.Dr. Moxon showed a similar case to the Society about twoyears ago. An interesting question was whether the dis-ease was congenital or acquired, or both; there was no

p.ericarditis.-Dr. EwART had shown to the Society a caseof mitral and tricuspid stenosis about two years ago, and inthat also the left auricle was completely filled by a clot whichwas channeled out for the blood.-Dr. TAYLOR asked ifthere was a tricuspid presystolic murmur.—Dr. IRVINE re.-plied that the heart was acting very irregularly, with adouble ventricular systole.; there was a distinct diastolicmurmur, heard loudest. over the lower end of the sternum,which did not lead up to the. systole.Mr. WALSHAM exhibited a Tumour of the Spermatic Cord

removed by his friend Dr. Marshall, from a boy, aged four.When two years old he was treated for a congenital hydro-cele, but on account of the pain he was unable to wear atruss. A fluctuating globular tumour was now noticed justoutside the external abdominal ring; this disappeared,and was followed by another close to the globus major,which increased in size, and was removed. On section thetumour looked like a coiled tube. It was. seen to be com-posed of a number of tubular systems of cells ; in the centreWM a space, next came a zone of dense cells without blood-vessels ; then a zone of cells more loosely packed, and withblood vessels; and outside a zone of cells in a fine reticulatestrurua. The cells consisted of round nuclei in a smallamount of protoplasm. In many points it was like a gumma,has there was no history of syphilis. He considered it tohave developed from the remains of the Wolffian body, fromits structure, its position, and from the fact that fœtal remainsare of ten times the-source of morbid growths.-Dr. GOODHARTstated that this tuiiiaur closely resembled one he and Mr.Batlin had examined for the Morbid Growths Committee,exhibited, by Dr. Gairdner, and called a lymphoma. Severalof the tumnura had disappeared. spontaneously, and thepeculiar tubular structure appeared to. offer the explanationof tais fact, the cells being discharged into the. spaces. InXr. Walsham’s case, too, one tumour had spontaneouslydisappeared. _

The following card specimen was exhibited :-Persistentcommunication between Rectum and Genito-Urinarv Tractin a new-born male child ; by Mr. Shallock.

Dr. Heneage Gibbes demonstrated the stereoscopic effectwith a high power of the microscope at the close of themeeting.The meeting then adjourned.

MEDICAL SOCIETY OF LONDON.

Debate an the Lunacy Laws.AT a, meeting of this Society held on the 12th inst., Mr. F.

J. Gant, President, in the chair,Dr. CLEMENT GODSON exhibited a specimen of Placenta

Suceenturia which he had removed from a patient threehours after delivery. Severe secondary haemorrhage oc-

curred, which almost proved fatal. He believed this varietyof placenta was not uncommon, and urged the necessity ofthorough examination in each case.

Dr. HARRINGTON TuKE read an address on the LunacyLaws. He said that the question of the alteration of theLunacy Law, and the abolition or purchase by the State ofprivate asylums, had become recently of much public in-terest. The intimation of possible future legislation in thespeech from the Throne, the report of the Select Committeeof the House of Commons, some recent lunacy trials, andthe Bill introduced by the member for Swansea, had con-tributed to render this one of the questions of the day. Mr.

Dillwyn’s Bill proposed the transference of the jurisdictionexercised by the Commissioners in Lunacy over the Metro-politan Asylums from them (the Commissioners) to the

justices of the peace. He pointed out the folly of thusignoring and wasting the patient labour of thirty-fiveyears, during which the Commissioners in Lunacy, undertheir distinguished chairman, Lord Shaftesbury, hadsecured the reputation of being amangst. the most useful andindispensable of public officials. He referred to an editorialarticle in a medical journal, which advocated the sweepingaway of private asylums from the face of the earth, andthought this expression was ill-judged. The series of re-markable articles, avowedly written by Dr. Bucknill, weregeneralisations upon too few facts which were not fully sub-stantiated ; and while he (Dr. Tuke) fully recognised Dr.Bucknill as the first physician and the foremost writer andthinker in his branch of the profession, he felt obliged toalmost entirely dissent from his views. Dr. Ducknill had

. shown much power and ability in his ideas for the destruc-tion of existing institutions, but had no suggestions for theirimprovement; and, admitting that some private asylumswere good, it would seem more reasonable to raise thestandard of the inferior ones than to abolish them.He took objection to the assertion that "this ques-tion did not interest the medical profession generally."It was not alone the fifty medical proprietors of asylumswho were thus attacked; but as there were 185,000 personscertified as insane during the last twenty years, andin each case one or more certificates of registered prac-titioners were required, the question of improper com-mittal to asylums became one of general medical interest ;and, again, as there were few families who, with or withoutasking for these certificates, would consign those nearestand dearest to them to asylums without previous consulta-tion with their ordinary medical adviser, Dr. Tuke pointedout the importance of an accurate definition of the privateasylums for the higher classes, as distinguished from thosereceiving paupers, whether from the large State asylums orfrom the various institutions conducted by ladies and othersin which the insane were received. The objection againstprivate asylums that most deeply affected the public mindwas " that patients were kept in asylums for profit.

"

Now,while it is the human lot to labour, profit must be one of itsincentives, and it is for the opponents of private asylums toshow that such incentive has ever led medical ptoprietors ofprivate asylums to wrong-doing, to base and sordid econo-mies, or to illegal admission or detention of their patients.As to illegal admission of patients,, he asserted that therewera the most careful precautions taken (which he described