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was proposed but was refused. On the 27th she collapsed, dueto the cyst bursting, and on the 30th uterine haemorrhagebegan, the shock having caused abortion, which ran a septiccourse. Bleeding continued till August 20th. On Sept. 5ththe cyst was as large as ever and examination on that dayset up an attack of acute peritonitis. On the 9th she wasvery low, with a falling temperature and a pulse of 140. The

cyst was rapidly removed with a large amount of peritoniticfluid and pus gushed from the tube as the pedicle was divided.Owing to the circumstances the abdomen was neither washedout nor drained, but the patient made a rapid recovery.-Dr. A. Emrys Jones showed a case of Angioma of the

Conjunctiva.-Mr. William H. Stephenson showed a case ofLeontiasis Ossea occurring in a man, aged 27 years. Mr.

Stephenson remarked that the patient, who was now

married, first noticed a swelling of the left side of the lowerjaw when he was 14 years of age. There was then no painor discomfort. The swelling had gradually increased in sizeup to the present time. 18 months ago a similar swellingbegan on the right side of the lower jaw and this also hadgradually enlarged. During the last year the nasal boneshad become enlarged and the left nostril was almostoccluded. For the last two months the patient had sufferedfrom severe neuralgic pains in the lower jaw extending upthe left side of the face. The patient had met with anaccident when nine years of age by falling from a coach,when the head and face were severely bruised and cut, butthe jaw was not injured. The family history was good.No nervous lesion or specific disease was present. Thewhole of the ramus of the lower jaw appeared tobe thickened and hypertrophied. The nasal boneswere markedly enlarged, especially on the left t side.The left superior maxilla and frontal bones were

also enlarged. All the other bones were normal. Verylittle, Mr. Stephenson said, appeared to be known as tothe etiology of this obscure and rare disease. It mightoccur at any period of life and in either sex. It had beenthought to be due to rickets but facts did not support thistheory. Injury had been mentioned as a cause. It seldomseemed to affect the cranial bones alone but the superiormaxillse and the bones forming the inner walls of the orbitwere frequently affected alone. In the process of growththe affected bones became greatly increased in thickness anddensity, the open cancellous framework becoming convertedinto dense, compact bone. Cavities such as the ethmoidaland sphenoidal sinuses became obliterated and the contentsdestroyed. The orbit, the nose, and the mouth might beencroached upon, with resulting prominence of the eyeballsand blindness, loss of smell, and difficulties of mastication.The symptoms varied according to the position and extentof the new bone formation. Pain was often a marked

symptom from pressure on the various nerves. The diseasetended to run a slow course, extending over years. No treat-ment was of any avail, but in unilateral cases or where therewas evidence of direct pressure on the nerves resection of a

portion of a bone might afford relief.-Mr. E. StanmoreBishop showed and described (1) an Ovarian Cyst withTwisted Pedicle ; (2) two specimens of Fibro-Myoma Uteri;and (3) a large Pyosalpinx.NORTH OF ENGLAND OBSTETRICAL AND GYN2ECO-

LOGICAL SOCIETY.-A meeting of this society was held inthe Medical School, Owens College, Manchester, on

April 20th, the President Dr. J. B. Hellier of Leeds, beingin the chair.-The President related a case of Tubal Preg-nancy which was removed by abdominal section afterrupture at the end of four months. No symptom wasobserved until the rupture took place. The specimen con-sisted of a fcetus at four and a half months with a well-developed placenta and sac. The patient made a goodrecovery.-The President also showed a specimen of retainedMenstrual Fluid from a case of Imperforate Hymen. Thecase was of interest in that the patient, a girl, 15 years ofage, with a tumour reaching three inches above theumbilicus, had absolutely no symptoms of pain or pressure.Six pints of this chocolate-coloured fluid were removed afterincision of the hymen.-Dr. Lloyd Roberts (Manchester)showed two unusual specimens of large Fibroid Polypi. Inthe first case a firm mass filled the vagina and blocked thepelvis. The patient had never complained of pain and onlyslight haemorrhage had been present. In the secondcase a tumour of the size of a large fist protrudedfrom the cavity of the uterus nine days after a naturallabour at full term.-Dr. Arnold Lea showed a soft fibroidof the size of a child’s head which was removed from the

vagina of a nulliparous woman, aged 42 years. The growthhad caused no symptoms until 12 hours before the operationwhen severe uterine contractions resembling labour resultedin the discovery of the tumour, which was removed bymorcellation,-Dr. Arthur Helme (Manchester) related a caseof Ovarian Sarcoma in a Girl, aged 13 years, and showedthe specimen with microscopic sections. The tumour wasremoved in April, 1899. The abdomen had recently againbecome enlarged aLd abdominal section showed that massesof soft growth were invading the omentum and the generalperitoneum.-Dr. Helme also showed two specimens ofFibroma Uteri removed by total abdominal hysterectomy.No drainage was used. Both patients made uneventful re-coveries.-Dr. Murray Cairns (Liverpool) showed a specimenof foetus retroflexus which bad caused great difficulty duringdelivery.- Professor W. J. Sinclair read a short paper onthe " Prevention and Relief of Pain in Minor Gynaecology."He referred to the necessity of reducing the pain sufferedby women in the minor manipulations and operative pro-cedures. In some cases, also, women were very reluctant tosubmit themselves to total anaesthesia. In many casesoperative measures could be carried out with slight pain bythe use of a judicious combination of morphia, alcohol, andcocaine locally. The administration of two ounces ofalcohol, disguised if possible, and followed by a hypo-dermic injection of morphia had an excellent effectin diminishing ensitiveness. Under their influencecuretting, intra-uttrine medication, Emmet’s operation,and perineorrhaphy could be readily carried out. Cocaineshould be used in a 10 per cent. solution locally and in hisexperience had never produced any toxic symptoms.-Remarks were made by Dr. J. W. Martin, Dr. J. P.Stallard, Dr. H. Briggs, and the President.

DERMATOLOGICAL SOCIETY OF GREAT BRITAIN ANDIRELAND.-A meeting of this society was held at 20,Hanover-square, W., on April 26th, Dr. H. RadcliffeCrocker, the President, being in the chair.-Dr. C. F.Marshall showed a case of Lupus Erythematosus in a

woman.-Mr. G. Pernet showed a case of Rodent Ulcerin a man.-Dr. T. D. Savill showed a woman withEcchymoses on the Legs, the result of subcutaneoushaemorrhages. Small ulcers were situated in the centreof some of the ecchymoses, which were said to have followedbullae.—Dr. Savill also, again brought forward the case whichhe showed at the last meeting-namely, a case of PapularEruption on the Face resembling a sweat gland acne.

The eruption had latterly extended to the trunk and wasmore pronounced on the face than when last shown.-Dr.A. Eddowes showed a case of Pityriasis Rubra developing onEczema with scaling and much pigmentation.-Dr. W. B.Warde showed (for Dr. P. Abraham) : (1) A case of Acne ina Young Man affecting the face, the trunk, and the outer sideof the thighs ; and (2) a case of Folliculitis of the Legs in aYouth.-Mr. Pernet showed some Cultivations of the Fungusof Tinea Nodosa and Tinea Versicolor.-Dr. Warde showed anumber of Cultivatioi,s from Large-spored and Small-sporedRingworm.

Reviews and Notices of Books.Electro-physiology. By Dr. W. BIEDERMANN of Jena.

Translated by FRANCES A. WELBY. Vol. II,, with 149figures. London: Macmillan and Co., Limited. 1898.Pp. 500. Price 17s. net.

FEW men are better qualified to write a treatise on Electro-physiology than the well-known professor of physiology atthe University of Jena, whose name is familiar to all for hiswork in this and kindred subjects and whose observationsand conclusions are frequently referred to by the Germans asof accuracy, weight, and authority. The translation made

by Miss Frances Welby is very good and we are scarcely everreminded that it is a translation. The previous volumecontained the first five chapters of the entire work.The present volume commences with an Account of the

Electromotive Actions that have been Observed in VegetableCells, summing up the observations of Jurgensen on

Vallisneria; Hermann, Kunkel, Haake, and Munk on the

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leaves of various plants ; and of Burdon Sanderson on those of the Dionaea muscipula. A short chapter is devoted to

the Structure and Organisation of Nerve and a remarkableillustration is given showing the wonderful ramification

exhibited by the nerve processes proceeding from a ganglioncell, which Dr. Biedermann has succeeded in demonstratingby the employment of methyl blue and picric acid. Then

follows a section on the Conductivity and Excitability of Nerve.The author adduces evidence derived from the experimentsof Grunhagen and others that excitability and conductivityare not corresponding or interchangeable terms, but thatthey are distinct conditions and may alter independently ofeach other. The electrical excitation of nerve is next con-

sidered, which, of course, includes the phenomena of electro-tonus. The laws of excitation of nerve and contraction ofmuscle advanced by Ritter and Pfliiger are discussed and,speaking generally, corroborated, and this is followed bya description of resting nerve current and of the current ofaction.The most interesting chapter in the book is the eleventh,

which treats of Electrical Fishes. The author has here col-lected all the principal facts that have been discoveredin regard both to the anatomy and physiology of their

electrical organs. Long known and dreaded by the ancients,either in the form of the Torpedo in the Mediterranean orof the Silurus in the Nile, it was the distinguished naturalistRedi who first made us acquainted with the anatomicafeatures of the electric organs of the t< rpedo and advancedthe remarkable statement that they were a modification ofmuscle, a view that subsequent inquiry has tended to confirm.The discovery of the Malapterurus in the rivers of Senegal byAdanson and of the Gymnotus by the Dutch explorers inSurinam further stimulated the interest of leading physicistsand naturalists, and valuable anatomical researches weremade by Savi, Du Bois Reymond, Hunter, Pacini, Sachs,Fritsch, and many others, amongst the latter beingthose of Burdon Sanderson and Gotch. Faraday, whowas fortunate enough to be one of the first to examine themost powerful of all electrical fishes, the South American eel,showed that he could obtain from it all but one of the effectswhich he laid down as essential to the identity of all formsof electricity-viz., sparking, heat, attraction and repulsion,magnetism, hydrolysis, and physiological action. The one

exception was failure of conductivity through flame. Thewhole of this chapter is full of interesting details both inregard to the structure and the functional activtty of theelectrical organs in the above-named fishes.

The last chapter is occupied with an account of the

electro-motive phenomena observed in the eye as the resultof sudden exposure of the eye to light and its sudden with-drawal. The chief observations on these points have beenmade by Kiihne and Steiner and by Dewar and M’Kendrick,and Dr. Biedermann considers that it may be accepted as afact that the epithelial elements or true sensory cells are theseat of the electro-motor activity.The treatise may be regarded as the best work on electro-

physiology extant, and its contents should be thoroughlymastered by all those who wish to advance and render moreaccurate the somewhat meagre and uncertain indicationsfor the application of electricity in disease. It is obviousthat there is a large field for observation in this direction,and remembering that the functional activities of nervesthemselves are not easily exhausted, that the structure ofthe electrical organs resembles that of muscle, and thatthere are many points of analogy between nervous andelectrical discharges, it does not seem unlikely that variousforms of paralysis hitherto regarded as incurable might berelieved or cured by the appropriate and more or less

persistent employment of electrical currents. We ought tcadd that at the end of each chapter there is an excellentbibliography.

The Treatment of Pelvic Inflammation through the Vagina.By WILLIAM R. PRYOR, M.D. With 110 Illustrations.London : Rebman. 1899. Crown 8vo. Pp. 248. Price8s. 6d. net.

As Dr. Pryor very truly says in his preface, there exists theutmost confusion in the profession at the present dayregarding the most successful means of treating pelvicinflammations. Any attempt, therefore, to increase our

knowledge of this important subject and at the same timeto render the principles of its treatment more certain is tobe welcomed.The author of this book may well be called an enthusiast

for the treatment of such cases of pelvic disease as requireoperation by the vaginal route, and there is certainly muchto be said for this view. In considering endometritis greatstress is laid upon the importance of determining whetherthe discharge is purulent or non-purulent, and the imme-diate necessity if it be purulent of checking it. The latencyof gonorrhaeal and septic endocervicitis and the fact thateither form may exist without producing pathological dis-charges must be constantly before the mind of the physicianwhen he wishes to use the sound or to operate upon thecervix. In cases of acute septic endometritis irrigation ofthe uterus with a quart of Thiersch’s solution, to be followedby three quarts of boric acid solution, is recommended,the irrigation to be repeated in 12 hours if necessary. If

after two days the local and general symptoms do not improveextension to the adnexa is to be feared. In cases of puerperalinfection if four hours after the injection the temperatureis not normal the uterus is again irrigated and packed withiodoform gauze. If 24 hours after the treatment fever is still

present the uterus is curetted and packed with iodoformgauze.

In all cases of sepsis where curettage is performed becausemilder measures have failed to relieve the pouch of Douglasis opened at the same time. This operation consists in

opening the peritoneal cul-de-sac, separating with the fingersany adhesions that may have already formed about theappendages, and filling up the pelvis to the level of the

Fallopian tubes with strips of iodoform gauze. The vaginaland uterine plugs are removed after three days, while thepelvic dressing is taken out after seven days and replacedby fresh gauze. This dressing is renewed every four toseven days until the wound closes. Large quantities ofmuddy serum drain away through the gauze and whennecessary the patient is given hypodermic injections of

strychnine and rectal injections of salt solution.As a result of bacteriological examination the author has

found that whenever streptococci have been present andeven when the peritoneal cavity contained pus the dressingshave absolutely sterilised the operation field. This result is

usually accomplished by the third dressing. Curettage isrecommended for cases of acute gonorrhoeal endometritis,whether seen early or late. The descriptions given of thevarious forms of pelvic inflammation are good and clear.Dr. Pryor differs from most gynaecologists in refusing torecognise the condition usually described as pelvic cellulitis,although he describes broad ligament abscess, which is

supposed to be the result of such a cellulitis.The practice of applying strong caustics or antiseptics to

the interior of the uterus after curettage is strongly, condemned. The operation of vaginal section as prac-,

tised by him is believed by the author to overcome

i the two chief difficulties in exploring the pelvic organs. through the vagina-viz., the presence of the uterus and the

prolapse of the intestines. The operation is performed asfollows. After opening Douglas’s pouch by an incision

through the mucous membrane and perforation of the peri-) toneum with the finger the patient is placed in Trendelen-j burg’s position. A careful digital exploration of the pelvic

viscera is now made. After wiping the pelvis free from

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blood a visual inspection is carried out. The vaginaand posterior edge of the incision are drawn back-wards by a P6an’s retractor, and a P&eacute;an-Pryor trowel isinserted behind the uterus. By this means the uterus is

pushed up behind the symphysis pubis and out of the pelviccavity, and by manipulation of the trowel the adnexaof first one side and then the other are readily broughtinto view and can be dealt with. This method of vaginalexploration is satisfactory in all forms of adnexal inflam-mation and ovarian neoplasms. The only two condi-

tions recognised by the author as contra-indications arean ectopic gestation which has ruptured into the broad

ligament and intra-ligamentous fibroid tumours. He con-cludes that the operation is far preferable in cases suit-able for its employment to both abdominal section andanterior colpotomy. The ease and certainty with which thepelvic organs can be explored by this variety of vaginalsection enable an operator to treat a much larger number ofcases by conservative measures than was formerly the case,and Dr. Pryor utters a very strong plea for such treatment inall cases that offer a chance of success. The pathologicalconditions for which Dr. Pryor usually does a radical opera-tion are as follows: diffuse pelvic suppuration; genitalsclerosis ; puerperal pyosalpinx in women over thirty years ofage; relapses after conservative operations ; uterine tubercu-losis ; chronic metritis with infected ligatures after abdominaloperations; abdominal sinus left after cceliotomy ; rupturedectopic gestation or unruptured and associated withadnexal disease on the opposite side ; and small bilateralovarian cystomata. He occasionally performs a palliativeoperation in diffuse pelvic suppuration, ovarian abscess, andcases of pelvic suppuration where the general symptoms aretoo grave to warrant an immediate ablation. For other

pelvic conditions he usually employs conservative measures.The method of performing vaginal ablation en masse, vaginalablation with hemisection of the uterus (" division of thedifficulties by division of the uterus," as the author happilyputs it), and vaginal ablation with morcellation are all fullyand clearly described.The book is well written and the illustrations are good.

The whole gives a good account of the methods of treatinginflammatory and other conditions of the pelvic regionsthrough the vagina, and will certainly do a great deal tohelp to settle the vexed question of abdominal versus vaginalsection. We have perused the book with pleasure and werecommend it to all those practitioners who are interestedin pelvic surgery.

.A. First Book in Organ’ic Rvollttion. By D. KERFOOT SHUTE,A.B., M.D., Ophthalmic Surgeon to the University Hos-A.B., M.D., Ophthaio Surgeon two the University How-pital (Columbian), Professor of Anatomy in the ColumbianUniversity. London : Kegan Paul, Trench, Triibner,and Co., Limited. 1899. Pp. xvi., 285. Price 7s. 6d.

ALTHOUGH this book has been written, as may be read inthe preface, primarily for the use of students in the medicaldepartment of the Columbian University, the requirementsof the more general public have not been neglected ; as theauthor very truly observes, 11 neo one who aspires even to amoderate degree of intellectual culture can well afford toexclude a clear understanding of what this doctrine ofevolution really is." He then expresses the hope that "thislittle work will render such a conception easily attainable."Without doubt it will, for the author has succeeded in settingforth a very clear account of his subject without enteringinto a mass of detail which probably would have an interestonly for the reader more deeply versed in the subject thanthose for whom this work has been written.A few words as to the arrangement. The volume has been

conveniently divided into sections, each of which deals withone branch of evolution. Naturally the first section describesthe cell, including a brief account of the more important

facts attending karyokinesis and considering in some detailvarious unicellular plants and animals. In this same section

is an account of the maturation of the human ovum,

fertilisation, and subsequent segmentation and the formationof the germinal layers.

Section 2 deals with Heredity with Variation. The

examples and illustrations given are extremely clear andcannot fail to bring home to the reader exactly what ismeant by these terms. A brief account of the Bach familyis given as an illustration of mental heredity, and to

illustrate the inheritance of moral character the well-knownwork of Mr. Dugdale, "The Jukes," is made use of. Thetheories relating to the transmission or non-transmission ofacquired characters are very clearly stated. Sections 3and 4 are chiefly geological ; the former treats of UnstableEnvironment as illustrated by the development of thecontinent of North America, and the latter gives an accountof the Transmutations of Living Forms, exemplified by abrief history of organic life as recorded by the rocks ofbygone ages.Space forbids us to consider the remaining sections in

detail; suffice it to state that they enter into the considera-tion of natural selection and the evolution of man. A

synopsis of the animal and vegetable kingdoms occupiesSection 7. The classification of animals has been well done,but that of plants is, in our opinion, too scanty and thecharacteristics of each group are too briefly given ; in

fact, in some cases the sub-divisions are not characterisedat all-for instance, sub-dividing the phanerogams into

gymnospermse and angiospermse is of very little valueunless the characters of each group are described; thishas not been done and although this work, taken as a whole,is very good, the botanical portions leave much to be

desired. A few examples will suffice to show this. On

page 138 the sporogonium of a moss is described as aseed capsule. The use of the word capsule is not objectedto, but the spores should not be termed seeds. Then

again on page 160 we read, "The stamens are the maleelements," and on the page following " The ovary of a pistilhas a number of cells in it called ovules (female germ cells)."An improvement is needed here.

The illustrations are both excellent and numerous, there

being 12 plates, 10 of which are coloured, and 27 figures inthe text; in brief, the get-up of the book leaves nothing tobe desired.

LIBRARY TABLE.

Midrvifery Notes for the Use of St1ldents. By T. A.

GLOVER, M.D. Edin. Crown 8vo, with Illustrations. Edin-

burgh : E. and S. Livingstone. 1900. Pp. 95. Price 2s. 6d,net.-If any adequate reason is to be brought forward forthe production of such a book as this short sketch entitled

11 midwifery Notes for the Use of Students" it must be thefact that the work presents the elements of midwiferypractice in a clear, condensed, and accurate form. Examinedby this standard the book under consideration can hardly besaid to justify its existence. The first chapter treats ofthe diagnosis of pregnancy. Not a word is said aboutthe changes that occur in the uterus and the cervix,and after reading the chapter the student would be

quite unable to attempt the diagnosis of a case of

pregnancy of three and a half months duration. Thebook is short, sketchy, in many respects incomplete,and there are several statements to which we must

take exception. Amongst these are the implied condemna-tion of a midwifery bag with a moveable lining which canbe boiled, the advice to students to carry a pair of forceps,the assertion that the chin becomes flexed on the sternum atthe commencement of labour, and that the poison ofscarlet fever produces septicaemia. In the chapter upon