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the mode of expulsion of the placenta. Pending the decisionof the above questions to be dealt with in a subsequentpaper, Dr. Champneys concluded that hæmorrhage to amoderate amount plays a certain though subsidiary part inthe mechanism of the detachment of the placenta.

SOCIETY OF MEDICAL OFFICERS OF HEALTH.

AT a meeting held at the Scottish Corporation Hall,Crane-court, Fleet-street, on Friday, Feb. 18th, Dr. AlfredHill, President, in the chair, a paper was read, entitled APractical Illustration of the Protective Influence of Vacci-nation," by C. E. PAGET, medical officer of health for theWestmoreland Combined Sanitary District. The paper hadreference to an outbreak of small-pox in a village in West-moreland and its neighbourhood, and details of each case (were very carefully given. The outbreak had lasted fromMarch to September, 1885, the disease having first appearedoutside the village in a sparsely inhabited hill district, and 1then found its way into the village, where it attractedattention. The early cases outside the village, numberingnine, were not seen by a medical man, except one,on a single occasion, in an incipient stage of illness beforethe rash was out, and it was not till severer casesoccurred on the introduction of the disease into the vil-

lage that medical advice was sought. The total numberof cases in the outbreak was seventeen, and there was nomortality. All the cases showed marks of "pitting." Thechief point of hygienic interest in the outbreak seemed tobe in the illustration it afforded of what has been noticed inother outbreaks of infectious sickness, such as scarlet fever,diphtheria, and measles, especially in scattered rural dis-tricts-that the spread of such diseases may be often largelydue to the mildness of initial cases. With respect to theinfluences of previous vaccination upon the outbreak, thepaper was illustrated by several tables, and showed, first,that all persons that might be said to have been unvaccinatedsickened; second, that one child only out of nine underfourteen years of age that had been primarily vaccinated,and had been definitely exposed to infection, sickened;third, that thirteen persons out of twenty-two over fourteenyears of age that had been primarily vaccinated sickened(though the numbers might more fairly be taken as thirteenout of nineteen, since three adults were not exposed to nearlythe same degree of infection as the others); and fourth, thatthe only (though very poorly) revaccinated adult sickened,but only in a moderate degree. The chief practical interestof the epidemic in respect of the partial protection ofpersons seemed to be in the enormous mitigation of illness,even where there was incomplete vaccination and a generalwant of revaccination. It was in the highest degreeunlikely that if there had been an absence of even a partialvaccinary protection the attacks of small-pox would havebeen mild, and that in such a circumstance, in spite of thedistances between the patients and medical advice, theywould not have come under medical treatment. Such anepidemic history could scarcely have been given but forthe half measures of protection enjoyed by the communityof whom it was told.-In the discussion which followed thePresident, Drs. Gibbon, Louis Parkes, Sykes, Yarrow, andAshby, and Messrs. Butterfield, Lovett, Eyre, and Murphytook part.

ACADEMY OF MEDICINE IN IRELAND.

Aspergillus Nigricans.—Dermoid Tumour.—ŒdemaGlottidis.

AT the meeting of the Pathological Section held onJan. 14th,Mr. STORY exhibited and described microscopic specimens

of AspergilJus Nigricans, which he had removed from theauditory meatus of three individuals suffering from deaf-ness and inflammation of the external ears. He exhibitedalso a fourth fungus of an undetermined character, butmost probably also one of the aspergillus tribe. He gave abrief r6sum6 of the literature of the subject of otomycosis,and stated his conviction that the fungi were the cause andnot the consequence of the ear disease-a view which hadbeen advocated by some of the writers on the subject.-Dr. MAPOTHER mentioned that in the year 1880 he himselfhad an acute attack of this otomycosis. He had never

suffered, either before or since, from any aural disease.One night he went to bed in a house in the suburbs ofDublin with his hearing perfect, and the following morninghe arose almost completely deaf. He bore the affection forone day, and on the next consulted Mr. Swanzy, who,partly by means of forceps and partly by syringing,removed a quantity of white cottony material from hiseirs. Besides the deafness, the only sensations he had werestuffing and a sort of ramming, as if something like cotton-wool was being pushed into both ears. The materialremoved from his ears was examined by himself and hisfriend, the late Dr. Richardson, and they both came to theconclusion that it contained aspergillus. After the extrac-tion of the fungi from his ears, and a week’s washing withsulphurous acid lotion, they disappeared and never grewagain. He had observed that the wall paper of the room,next to which he slept, was extremely damp and almostcompletely separated from the wall by the dampness; andhe believed that it was that which produced the fungi.Since the wall had become dry no similar attack of mycosishad occurred to anyone else occupying the room.-Mr. STORY, in reply, said he remembered having, as apatient suffering from this disease, a farmer who, sittingup all night with a sick cow, had stuffing and pain in hisears next morning, which were found to be caused byaspergillus.Mr. STORY also exhibited a Dermoid Tumour growing from

the corneo-scleral margin of the left eye of a middle-agedman. The tumour was of a pinkish-yellow colour, and hadone long hair growing out of its centre. No other hairscould be detected, even with a magnifying glass. Thetumour had existed ever since the man’s birth, and remainedquiescent until two months ago, when it began to growover the surface of the cornea. It was a flat sessile growth,of a circular shape, about 4 mm. in diameter, half corneal,half scleral. In his opinion, it was to be regarded as adermoid growth.

Dr. CHRISTOPHER NixoN exhibited the larynx and tracheaof a patient who had died under his care of what is it thecustom to call (Edema Glottidis, occurring in the course ofBright’s disease.-The PRESIDENT observed that whether ornot the disputed point was conceded that in Bright’sdisease

the large smooth kidney might, in process of time, changeto the small contracted kidney, there was no difficulty inassuming that other cases might occur in which that change

,

did not happen. He would have no difficulty in accepting a’

history of any number of years’ duration of Bright’s disease,, and yet in finding a large smooth kidney after death. He, did not think anyone maintained that the large smooth,

kidney necessarily turned into the small kidney. The

point in dispute was whether the small kidney ever repre-sented a large kidney which had undergone atrophic change.But that a large kidney might remain so for an indefinitetime was no subject of wonder.

Reviews and Notices of Books.Disceases of the Joints. By HOWARD MARSH, F.R.C.S.,

Senior Assistant-Surgeon to, and Lecturer on Anatomyat, St. Bartholomew’s Hospital; Senior Surgeon to theHospital for Sick Children and to the Alexandra Hospitalfor Hip Disease. With 64 Illustrations and a ColouredPlate. London: Cassell and Co. 1886.THE volume before us is one of Messrs. Cassell’s series

of Clinical Manuals. It avowedly deals with diseases ofjoints from a clinical as opposed to a pathological pointof view, and is mainly taken up with a description ofdiagnosis and treatment. Such pathology as is given is thework mainly of Mr. A. Bowlby, who is well fitted forsuch a task. We could have wished that he had had more

space allotted to him, for there are several points in thepathology of diseases of joints which merit a fuller discussionthan they receive in Mr. Marsh’s book. At the same timewe have to remember that a limit was necessarily imposedupon the author, and we cannot question his wisdom inpreferring to make his book clinical rather than patho-logical. Mr. Marsh’s experience at St. Bartholomew’s

Hospital and at two other hospitals has enabled him to

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enrich his chapters with many excellent clinical historieswhich admirably illustrate the diseases he describes, and 1

this feature of the book is sure to make it popular withmost readers. Altogether the work is pleasant reading,practical, and trustworthy. The general teaching ofMr. Marsh is that with which the majority of Englishwriters are more or less familiar. He does not advocatenovel or radical procedures, and it is for this very reasonthat the book will be most acceptable to the wajorityof practitioners, who will be told how to treat articularaffections without resorting to formidable operations. The

chapters on the early recognition and treatment of ScrofulousDisease of Joints, on Syphilis of Joints, on Internal Derange-ment of the Knee, and on Bone-setting, seem to us to besome of the best in the book, while that in which theInjurious Effects of Intra-articular Pressure are described iswell worthy of study. The early chapters on Synovitis &c.

might have been arranged in a more systematic manner,and in them we think we notice a few omissions-such asthe absence of any mention of over-use and of wounds

among the causes of simple synovitis, or of heat as a

local application in acute suppurative arthritis, the omissionof any notice of the value of antiseptic irrigation of joints,and the omission of any treatment for purulent synovitis asdistinguished from acute suppurative arthritis. These

are, however, minor defects, and should in no way blindus to the fact that Mr. Marsh has produced’ a readable anduseful work on a subject of the very highest importance.The illustrations are not of a high order of merit ; thecoloured plate which is said to represent a knee-joint affectedwith Charcot’s disease may be that or anything else, and,whatever it is, it fails to give any adequate conception ofthe changes met with in this remarkable disease.

Leçons sur les Maladies du Système Nerveux. Par J. M.CHARCOT. Recueillies et publiees par MM. BABINSKI,BERNARD, FÉRÉ, GUINON, MARIE, et GILLES DE LATOURETTE. Tome III. (2ème Fascicule). Paris : A.Delahaye et E. Lecrosnier. 1887.

WE owe the collection of M. Charcot’s lectures, deliveredat the Salpetriere, of which the present forms the conclusionof the third volume, to the devotion of his friends and

pupils. They are lectures which are classical and will havea permanent place in literature. Many of them have

appeared from time to time in the pages of our contempo-rory Le Progrès 316dical, whose editor, M. Bourneville, wasassociated with the production of the first volume of thisnotable series. It is interesting to note how M. Charcothas gradually in the course of his teaching tended topass from the region of structural to that of functionaldisease. Thus, in the present volume there are severallectures devoted to male hysteria, isolation in thetreatment of hysteria, hysterical paralysis, hystericalcoxalgia, contracture and mutism; two others to word-

blindness ; another upon a case of abrupt and isolated sup-pression of the mental vision of signs and objects (formand colour), and on choreiform tremors and movements;while as to organic disease, there is one lecture on

double sciatica in cancer, and cervical pachymeningitis,and another on a nosographical revision of amyotrophy.Some of the subjects are further dealt with in an appendix,affording additional observations upon the particular pointstreated of. Interesting as the subject of hysteria alwaysis, and practically important as the recognition of itsvarious forms must always be, it cannot but be felt thatamong less emotional races the remarkable phenomenadescribed by ill. Charcot as exhibited by the hysterical areto be rarely witnessed. These lectures, therefore, mayattract less universal attention than those earlier ones

which did so much to enlighten the medical world upon thepathological nature of organic disease of the brain and

spinal cord. But if they fail to be so widely read, it is notthat they do not merit it, for they exhibit in their clear andwell-considered language the same vigour of treatment andmasterly exposition that constitute the great charm ofall Professor Charcot’s writings. As in the domain of

organic disease, so in the more intricate and complex regionof functional derangement, Professor Charcot cannot but beregarded as a pioneer, whose observations are always exact,and whose ideas are at once sagacious and fruitful.

OUR LIBRARY TABLE.

The Factors of Organic -E, volution. By HERBERT SPENCER.Pp.76. London: Williams and Norgate. 1887.-This smallvolume is a reprint of two essays originally published in theNineteenth Century for April and May of last year, in whichMr. Spencer endeavours to show that there are severalfactors in the process of evolution which have been allowedto drop out of view owing to the followers of Darwin havingtoo exclusively devoted themselves to the single factor ofnatural selection of favourable variations. He thinks thatone important factor thus neglected has been the inheritedchanges induced in structure owing to modification of func-tion, as by the excessive use or disuse of parts, such changesbeing inheritable, so that, for example, " any change in thefore parts of a giraffe, which affects the action of the hindlimbs and back will simultaneously cause, by the greater orless exercise of it, a remoulding of each component in thehind limbs and back in a way adapted to the new demands;and generation after generation the entire structure of thehind quarters will be progressingly fitted to the changedstructure of the fore quarters, all the appliances fornutrition and innervation being at the same time progres-sively fitted to both." Another factor, he considers, is thedirect action of surrounding agencies on organic life, whichin its varying influence on different members of the samegroup must always have tended to differentiate individualsand led to the formation of types or species.

The Quarterly Journal of Microscopical Science.—Editedby Professor E. RAY LANKESTER, THISLETON DYER, KLEIN,MosLBY, and SEDGWICE. New Series. No. CVII. (Vol.XXVII., Part 3). London: J. and A. Churchill. 1887.-This part contains the following memoirs :-Gilbert Bourne,on the bladreporian Coral Fungia, with three plates.2. Arthur Shipley: Some Points in the Development ofPetromyzon Fluviatilis, with four plates. 3. Robert Smith:The Ammoniacal Decomposition of Urine, with two illustra-tions. 4. Herbert Carpenter: Notes on Echinoderm Morpho-logy, with an illustration. 5. R. v. Lendenield : The Func-tion of Nettle Cells, with an illustration. 6. HanburyHankin: Some New Methods of Using the Aniline Dyes forStaining Bacteria. 7. Marshall Ward: Illustrations of theStructure and Life History of Phytopthora Infestans, theFungus causing the Potato Disease, with two plates.8. Martin Hartog: The Formation and Liberation of the

Zoospores in the Saprolegnia3. Dr. Smith has made a seriesof experiments to determine the cause of the decompositionof urea, and finds that-it is owing to the presence of a

special form of microbe belonging to the micrococci, whichdiffers from the micrococcus urese of Professor Leube, in-asmuch as it liquefies gelatine.

Vision and Yision-testiyr,rl,with PrcccticaL Tests. By A. ST.CLAIR BUxTON, F.R.C.S., Assistant-Surgeon to the Western

Ophthalmic Hospital, London. Pp. 83. London : Pickard andb Curry. 1887.—Mr. St. Clair Buxton supplies in this littlework a popular and very brief account of the anatomy3 and physiology of the eye. A novelty is introduced in

the shape of a ngure showing the mode of formations of distinct and indistinct images upon a screen of a

e candle flame by means of a lens. The fact which will prove e1 most serviceable is the account of the tests to which