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by several surgeons as a new growth in the subcutaneoustissue, but on operation it turned out to be a chronic abscessin a very unusual position. The third case was that of awoman with a swelling of the joint, clearly an effusioninto the joint, with raised temperature and of severalmonths’ duration. It was supposed to be tuberculousdisease of the synovial membrane, but no improvementtook place after several weeks’ treatment by counter-irritation, rest, &0. Suddenly it was noticed that spon-taneous fracture had occurred above the condyle, andthen it became clear that the case was one of endosealsarcoma, though no expansion of bone or other signs of thatdisease were present. Amputation was then performed, andthe case did well. Mr. Marsh said there were a few of thecases in which an accurate diagnosis was impossible, as onedisease might exactly simulate another, and often typicalsymptoms were absent. He said that diagnosis had often tobe modified, and deprecated the system of holding to anoriginal diagnosis blindly. Careful observation should

always s be made as the case proceeded, and the surgeon shouldnot in any way be biased by his original expressed opinion.He then said that he had lately been treating enlarged burgsebeneath the semi-membranosus by excision with ligatureof the neck of the sac, and showed the advantages of thisprocedure over the old method of injecting irritants,aspirating, &c.-Mr. PEARCE GOULD said that he quiteconcurred in this new method, and had used it frequently.

alr. PEARCE GOULD then read a paper upon Suture of theUrethra after Rupture and External Urethrotomy. Herelated several cases in which, after rupture had occurredthrough accident, he had cut down upon the urethra andsutured the torn ends with the finest silk, over a largecatheter, and then sutured the various layers, compressorurethræ, fasciaa, and skin also. The catheter was kept inonly three or four days, and the cases did wonderfullywell, no trace of a stricture resulting. He divided cases of ’,stricture which were impassable into (1) those without and(2) those with fistulæ. These he treated by dividing thestricture by Wheelhouse’s method, introducing a catheterand suturing layer by layer in the same way as before. Hethen discussed the relative advantages of external andinternal urethrotomy, and showed that, although brilliantsuccesses were recorded after the latter, the former withsuture, layer by layer, was the safer, in that the surgeon sawand knew exactly what he was doing.-Mr. HOWARD MARSHrelated a case of Suture of the Urethra in which the opeia-tion was performed by Mr. Bowlby.-Mr. GORDON BRODIEand Mr. PEYTON BEALE made some remaiks, in which theyfully agreed as to the danger, in many cases, of internal

urethrotomy.

MIDLAND MEDICAL SOCIETY.

Exhibitioin of Cases and Specimens.-Axial Rotation ofOvarian Cysts, causing Twisting of the Pedicle.

THE second ordinary meeting of this society was held onWednesday, Nov. 21st, Mr. T. F. CHAVASSE, President,being in the chair.

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Fingers, with Anesthesia, after a Fracture of the Bones ofthe Forearm. Mr. Freer had divided the tendons of thepalmaris longus, flexor carpi radially flexor sublimis, andflexor profundus digitorum with good result?. The pointsof interest in the case were the cause of the anæs-

thesia, the condition of the nerve trunks, and the

prognosis of any attempt at neiva suture.-Dr. SHORTshowed a case of Large Gouty Concretions in thehands of a woman fifty years of age. The swel’ing of thefirst metacarpo-phalangeal joint measured 6½ in. in circum-ference. The first attack of gout had occurred eight yearsbefore, at the end of twelve months’ privation.--Dr. SHORTalso showed a case of Pneumothorax in the left side of a man’forty-nine years of age, occurring suddenly during the firstweek of October of this year. In this case the diaphragmhad never been much depressed, and the spleen could not befelt below the margin of the ribs. The patient said that foreleven years he was short of breath on exertion and had hada cough, so that it seemed probable the left lung might havebeen pattially disabled and the diaphragm fixed by adhesions.A cystometric tracing showed that the affected side was ratherless than the sound side. All the other signs of pneumothoraxwere very well marked. The rght lung showed no signs oftuberculous deposit, and in spite of the complete absence of

vesicular breath sounds over the left side the patient could walkabout fairly well, and only experienced dyspnoea on exertion.-Mr. CHAVASSE showed a Left Kidney removed by Laparo-tomy from a boy aged seven years. The patient on variousoccasions had had seven calculi removed from his bladder bymedian, lateral, and supra-pubic lithotomy. In August last hewas admitted to hospital suffering from pain in the left side.Aspiration yielding pus, an incision was made in the ninthintercostal space and a drainage-tube inserted. In a fewdays the discharge from the wound was shown to be urine.The fistula showing no signs of closing, nephrectomy wasperformed successfully on Nov. 9th. The organ was dilated,cystic, and showed numerous small interstitial abscesses in theexisting cortical substance. It contained no calculus.—Mr.GEORGE HEATON exhibited the Intestines, Umbilicus, andBladder of an infant with a congenital fæcal fistula. Fasceawere first discharged from the umbilicus two days after birth,and from that time till the patient’s death when threeweeks old all the motions were passed through the abnormalaperture. The specimen showed an opening at the umbilicus,lined by mucous membrane, and leading by a short widecanal into the small intestine some six or eight inches fromthe ileo-csecal valve. The small intestine above the aperturewas much dilated. The large intestine was very muchcontracted. The cseoum and vermiform appendix laydeeply in the true pelvis, attached to the sacrum bya long meso-ceecum, and the ascending colon passedupwards to the left side of the spinal column. Mr.HEATON regarded it as a patent Meckel’s diverticulumwhich had probably passed through the umbilicus into adilated umbilical cord and been ligatured inadvertently bythe midwife in attendance.-Dr. THOMAS WILSON showedan Ovarian Cyst in which axial rotation had given rise totwisting of the pedicle and haemorrhage into the walls andloculi of the cyst. The walls in the lower part near thepedicle were from one to one and a half inches in thickness elsewhere a line of heamorrhage was seen inside the fibrouscapsule of the cyst.

Dr. THOMAS WILSON read a paper on Axial Rotation ofOvarian Cysts, causing twisting of the pedicle. These caseswere divided into three groups : the first comprisedcases in which no serious pathological or clinical con-

sequences ensued ; the second included cases of acute

strangulation of cysts due to twisting of their pedicles ;and the third those of chronic strangulation and itsresults. The symptoms, signs, diagnosis, treatment, andpathology of esch group were described. The causaticnwas then discussed and referred to purely mechanical factors,the chief being-(1) the specific gravity of the tumour, (2) theposition of attachment of the pedicle at or near the lowestpart of the tumour; and (3) the varying position and condi-tions of the lowest part of the containing cavity, especiallydepending on posture, and on variations in the hollow viscera,which have a more or less fixed base to act from-viz., thebladder, uterus, cæcum, sigmoid flexure, and rectum. Thesmall intestine transmits abdominal pressure to the surfaceof the tumour, and helps indirectly to fix it in the lowest

part of the cavity available at any moment ; but movementsof this viscns do not appear to be likely to have any directinfluence in producing axial rotation.

PATHOLOGICAL SOCIETY OF MANCHESTER.

Exhibition of Specimens.A MEETING of this society was held on Nov. 14th, Prc-

fessor SHERIDAN DELÉPINE, President, being in the chair.Dr. WILLIAMSON showed Sections of a Spinal Cord, in

which there was a small syphilitic gumma in the region ofthe left lateral pyramidal tract, about the mid-dorsal region ;it also involved the outer part of the intermediate g eymatter and neck of the posterior horn. Around the gummawas a zone of myelitis, and slight changes extended to theopposite side of the cord. The symptoms commenced withsevere pain about the mid-dorsal region of the spine. Thiscontinued for nine weeks ; then both legs became numb ; a,

week later paresis was noticed, which developed into com-plete paralysis. There was marked anaesthesia, on the lowerhalf of the abdomen and on the right leg, but on the leftleg-i.e., on the same side as the tumour growth—sensation was only slightly impaired. (During life the case was underthe care of Dr. Steell.)

Dr. THOMAS HARRIS showed preparations from severalY 3

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cases where the primary affection had been some obstructiveheart disease, usually initial incompetence, and where therehad been marked ascites with but little general anasarca. Ineach of the cases chronic peritonitis, chiefly manifestingitself as a capsulitis of the liver and spleen, was the lesionfound, which would account for the fluid in the abdominalcavity. Dr. Harris referred to the remarks of the lateDr. Hilton Fagge and of Dr. W. Hale White as to Bright’sdisease being the most common affection associated withuniversal peri-hepatitis, and said that his own experience andthe information derived from an analysis of the cases whichhad occurred during the preceding ten years in the post-mortemroom of the Manchester Royal Infirmary led him to believethat obstructive heart disease causing backward pressure wasa more common associate of chronic peritonitis, of whichuniversal peri-hepatitis was usually only a part. The kidneys insuch cases were frequently congested, and not uncommonlyshowed a certain amount of increase of their fibrous tissue ;but the appearance of such kidneys was rather that of anaffection secondary to the heart than of a primary andindependent origin. Mr. THOMAS JONES described a case of Inherited Syphilis I

and showed the patient.-Dr. DoxALD made some remarkson Tubo-ovarian Abscess and showed several specimens.-Card specimens were shown by Dr. Enrich, Dr. H. S.Wansborough Jones, Dr. Hutton, and Professor Del6pine.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF MEDICINE.

Argyria; Therapeutical Traditions Small-pox.A MEETING of this section was held on Nov. 16th, Dr.

W. G. SMITH, President, being in the chair.Dr. H. C. TWEEDY showed a case of Argyria.The PRESIDENT read a short paper on some Therapeutical

Traditions. He referred especially to the influence of dieton diseases of the skin, the relationship of chloride ofsodium to gout and uric acid, and the action of lithia ongout. He also mentioned the practice of coating pills withkeratin, casting doubts on the theory that they required analkaline fluid forsolution.-Dr. THOMPSON thought that curedirrat was injurious on account of the nitrate of potash con-tained in it.-Dr. BEWLEY said that a great many medical menagreed as to the drugs they prescribed, but nothing was moreremarkable than the definiteness and diversity of theirdirections as to diet.-Dr. PARSONS thought that the actionof iodide of potassium in lead poisoning might be comparableto that of carbonate of lithia in gout.

Dr. J. W. MOORE read the notes of a case of Small-poxin which he had endeavoured to control the dermatitis byexcluding actinic rays of light from the patient and admittingonly red light. The patient had two good vaccination marksin the left arm, but had not been revaccinated. The rashwas very profuse within the limits of a prodromal erythemaand on the feet. Pustulation might be said not to haveoccurred at all, and there was little or no pitting. Dr. Moorethen gave a detailed account of the red light treatmentof small-pox, which had been revived in Scandinavia onscientific lines in 1893.-Dr. POTTER mentioned that tinctureof iodine had formerly been used to prevent scarring. Hehad applied it to a patient’s face with the very best results.

SECTION OF SURGERY.

Relieving an Obstructed Bowel ; Cancer of Upper and Lower Jaw, Tongue, and Floor of Mouth.

A meeting of this section was held on Nov. 9th, Mr.THORNLEY STOKER, President, being in the chair.The PRESIDENT gave an address entitled "Some Thoughts

on the Method of Relieving an Obstructed Bowel." ’

Sir WILLIAM STOKES gave briefly the details of a series ofcases of Cancer of the Upper Jaw, the Lower Jaw, Tongue,and Floor of the Mouth. Some of them had been under hiscare in the Richmond Surgical Hospital, and the remainderin the Meath. Many points in connexion with the techniqueof the excision of maxillary tumours invading the boneswere discussed, as well as the various proposals that hadbeen made and adopted for the removal of the tongue, eitherpartially or in its entirety. The question of the thera-peutic value of these operations was fully discussed, andearly operation in such cases strongly advocated.-The PRE-SIDENT expressed his firm belief in the relationship betweencancer of the tongue and syphilis. Most cases of doubtful

disease proved to be cancer, and very many undoubted cases of syphilis resulted in cancer. He had a very unfavourable

opinion of operations on the tongue, but thought thatif touched at all it should be removed entirely.-Mr. BENNETT, commenting on the heredity of malignantdisease, observed that the Australian insurance societies hadinstructed their medical examiners to exclude the questionof heredity.-Mr. CROLY said he had not been able to traceheredity as often as might have been expected. He consideredthat removal of the whole tongue was better than removal ofpart. He had given up using the ecraseur on account of itsslowness and also on account of the attendant bleeding.-Mr.WHEELER was not in favour of removing the whole tonguewhen only a small part was involved. In operatinghe advised the use of the thermo-cautery scissors.He considered that syphilis was a very potent factorin producing cancer of the tongue.-Mr. THomsoN consideredthat partial removal of the tongue was not good surgery, andthat the whole ought to be removed. The return of cancerof the tongue was so frequent that he believed many cases ofapparent non-return to be due to errors in diagnosis.-Mr.MYLES objected to the use of the esraseur because of its ten-dency to encroach on the easily broken cancerous mass.-Mr.FRANKS thought that when there was a small ulcer on theside of the tongue, well away from the middle line, it wouldbe a mistake to remove the whole tongue. He himself had.had two successful cases of partial removal.

Reviews and Notices of Books.Lectures on Human and Animal Psychology By WILHELLM

WuNnT. Translated from the Second German Editionby J. E. CREIGHTON and E. B. TITCHENER. pp. 454.London : Swan Sonnenschein and Co. 1894.

THIS work will prove to be a serviceable addition to the rather

scanty list of psychological treatises written by competentphysiologists The older authors dealt with the phenomena ofmind and the laws of human thought with a very superficialknowledge of anatomy and physiology, even as these subjectswere known as late as the close of the last century, whilstthey almost entirely ignored the evidences of mental activityin animals. Gradually, however, it has been recognised thatexperiment and observation can be applied to the brain andits functions both in animals and in man, and that much

may be learnt from the application of the combined methodsof anatomy, histology, experiment, and pathology. The-work is divided into thirty chapters, each of which is shortand devoted to some special point.

Professor Wundt commences with a brief review of the-

history of psychology, and shows how the distinction betweenmind and body was first made by Plato ; how Aristotleattempted to harmonise these opposites by regarding mind asthe principle which vitalises and informs matter, making lifeand mentality identical terms ; and how Descartes held thatmind was exclusively thinking substance, ascribing to it, likePlato, an original existence, apart from the body, whenever ithas received in permanent possession all those ideas whichtranscend the bounds of sensible experience. This mind, initself unspatial, he connected with the body at one point inthe brain where it was affected by processes in the externalworld, and in its turn exercised influence upon the body. At

the outset it is important to understand the definition givenby Professor Wundt of ideas and sensations. Speakinggenerally, ideas are composite and represent those mentalstates or processes which we refer to something outsideourselves, whether this attribute of externality refers to

present, past, or only possible objects-that is to say, to senseperceptions, to the memories of such sense perceptions, or toimages of fancy. But sensations are the psychologicalelements of ideas. Hence we speak of the idea of a houseor a table, but of the sensations of blue or warmth, or of asound of definite pitch. In every sensation we can distinguishtwo properties, one named the "strength" or "intensity,’ .the other its "quality."