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kept away the microbes of suppuration and septicaemia, butdid not ward off scarlatina. Ile believed in the theory thatthe so-called scarlatina of midwifery and surgery includedmore than one disease; but he regarded true scarlatinaoccurring within a few days of lying-in as a disease ofenormous mortality. He had observed a red rash with fever,which began around the wound made in opening a chronicinguinal parametric sinus. The rash spread, but there wasno certainty that it represented scarlatina. Dr. Duncan didnot believe in the commingling of scarlatina and puerperalfever. When the former disease raged in London, killing250 a week, there was no increase of puerperal fever. Thisfact agreed with Dr. Dolan’s practical conclusions.

It was resolved by Dr. GALADIN, seconded by Dr. Ilon-ROCKS, that the debate on Dr. Boxall’s paper be adjourned.The resolution was carried unanimously.

ROYAL ACADEMY OF MEDICINE IN IRELAND.

Dysentery.—Cerebro-Spinal Disease.—Suicidal Wound ofthe -Heart with a Pin.—Multiple Abscesses of Liver and (

Lungs. 6

A MEETING of the Pathological Section of the Academywas held on Jan. 13th.

Dr. CONOLLY NORMAN, by the desire of the Section, made 1 t

a communication as to the cause of the outbreak of 1Dysentery with which he had to deal. Having brieflyglanced at the history of other epidemics of that disease,and discussed the question of diet and the influence of 1

insanity as a factor, Dr. Norman stated his belief that thedysentery which existed in the asylum under his charge Iwas due to defective drainage, and laid down the followingas probable general laws that regulate the appearance of (

dysentery :-1. Dysentery is communicated through exhala- I

tions from a soil saturated with the products of organic i

decomposition. 2. The incidence of dysentery at particulartimes and seasons is due to the increased moisture of the tsoil at such times. 3. When dysentery breaks out there (

is commonly a concurrent outbreak of severe diarrhoea. 14. Dysentery appears where dysentery has been before. f

5. When dysentery appears over a large area, including itsown haunt, it appears in the latter situation in its worstform and to the greatest extent. 6. Like other malarial 1

affections, dysentery attacks by preference those who are not Jacclimatised to the conditions that have produced it.-Dr. iFRAZER believed that dysentery was and could be contagious, ;for he remembered making a post-mortem in the Richmond iHospital from which he got a most severe attack of i

dysentery which nearly cost him his life, and which he vbelieved to have been produced by contagion. He was notsatisfied with Dr. Conolly Norman’s observations uponmalaria. From the most remote times dysentery had beenepidemic in Ireland. In the battles during the reign ofQneen Elizabeth the soldiers were decimated by it; thesame thing occurred during the wars of Cromwell andWilliam the Third; and yet Ireland had always beenremarkably free from malaria. They had never had ague inthat country. But that dysentery might be associated withmalaria, on the other hand, was possible. Malaria, as such,was confined to very limited districts in Ireland. He knewthat it existed along the Dublin river, and could put hisfinger upon the spots where it occurred; but there had beenno coexistence of dysentery in those spots. Anotherremarkable fact was that it occurred at certain seasons ofthe year. It was well known to break out in autumn,especially after the first frosts, which was accounted for informer times by persons drinking water containing animaland vegetable material in a state of decay. As for itsmortality, he was resident in the hospital during the years1847, 1848, and 1849, and had to attend specially uponfever and dysentery; and the mortality in cases ofdysentery-of which only the very bad were admitted-was three times as great as in the worst fever cases.

It amounted at one period to one out of every four cases. --Dr. NORMAN, in reply, said he had, in order to economisetime, omitted to read from his paper the followingsentence: " There is reason to disbelieve that dysentery,like other diseases of its class, assumes or simulates nowand then a contagious form." As to the absence of malariain Ireland, he was not sufficiently learned in the history ofIrish epidemics to be able to say much about it; but therewas strong reason to believe that the country fever"

described by seventeenth-century writere, to whose accountsDr. Grazer had referred, was a malarial fever. It carriedoffa number of well-known men, including General Ireton;and whilst it raged amongst the troops at war on both sidesduring those days, dysentery was also very prevalent. Asto the disease arising from the water used, that questioncould not arise in reference to the epidemic in the RichmondAsylum, for that institution was supplied from the Vartry.The mode of water storage there was not quite perfect; buthe had frequently had the water analysed, and had neverreceived any report detrimental to its character. As regardedmortality, his results had been more favourable than he hadhoped for, having regard to other epidemics in this countryand in England. Out of 147 persons who up to the end oflast year were attacked with dysentery during the fifteenmonths that he had charge of the Richmond Asylum, therewere only twenty-three deaths. The proportion of deaths atCarlisle under Dr. Clouston was one in three; and accordingto the statistics of Norman the proportion at the Colney-hatch and Bodmin Asylums was alEO one in three.

Dr. BERNARD of Londonderry read a paper upon an

obscure case of Cerebro-spinal Disease, and exhibited micro-scopical sections of portions of the spinal cord and centralnervous system. The case in some points resembled one ofirregular sclerosis.—Professor PURSER said three specimenstaken from the subject of the case had been submitted tohim by Dr. Bernard. The first was a section of the upperpart of the medulla oblongata, and he had been unable tosatisfy himself that there was any sclerosis in it. Therewas a spot in the centre which appeared unstained; butthat might have been owing to a defect in the staining.Another spot looked somewhat as if the nerve tissue hadgone, and had been replaced by connective tissue. Anotherspecimen was from the middle part of the cervical spinalcord, and the anterior cornu on one side of this had dis-appeared. He could not satisfy himself that there was anyincrease of connective tissue; it looked more like atrophy.The third specimen was a section of the optic nerve, and in ,

this there was an accumulation in some places of roundcells, which seemed to indicate neuritis to be the patho-logical expression of the optic neuritis which Dr. Bernardsaw. He (Professor Purser) thought the case admitted of agood deal of discussion.-Dr. FINNY said it struck him asremarkable that many appearances that one was accustomedto see in sclerosis were absent in this patient. A remarkablefeature was the very rapid progress of the case. Cases ofinsular sclerosis were usually very slow, running over severalyears. It was also remarkable that the patient was so young-under twenty years of age. Another point was the earlyloss of control over the bladder and rectum, which precededthe nystagmus and perversions of the eye. The case wasfull of clinical puzzles, and if a post-mortem had not clearedit up, one would have supposed that it was a case of mereacute myelitis. He (Dr. Finny) did not catch in what partof the brain the patches were found in the greatest number;nor whether the microscopic examination showed the ordinaryhard sand-coloured appearances that they often saw in casesof the disease in question. He took the case to be one ofcerebro-spinal sclerosis, in which the hardening existed inboth parts.-Dr. BERNARD, in reply, said he looked entirelyto Professor Purser for the exact nature of the disease.There was evidently atrophy of the left cornua of the lowercervical vertebrae.

Mr. WILLIAM THOMSON communicated a case of SuicidalWound of the Heart with a Pin. The deceased was admittedto the Richmond Hospital, but was found to be dead. Hehad been arrested as a lunatic running about the street inhis shirt. On examination of the body, the head of a pinwas discovered in the fifth intercostal space, two inches anda half from the nipple downwards and inwards. The pinhad traversed the pericardium, and wounded the anteriorwall of the left ventricle. The pericardium contained seven-teen ounces and a half of bloody fluid, and there was asmall rent in the wall a quarter of an inch in diameter,which was filled by blood clot. The surface of the ventriclein contact with the pin was torn to the extent of nearly aninch; a small vein was also wounded; all the internal organswere congested ; the urine was albuminous. Mr. Thomsonreferred to several cases of similar character.

Dr. FINNY exhibited specimens illustrating PysemicMultiple Abscesses of the Liver and Lungs, which had run, a rapid course of about ten days, and in which jaundiceand the expect,oration of’ pus had occurred but five days’ before death. The patient, who had been admitted under

579

Dr. Finny’s care into Sir Patrick Dun’s Hospital on

Nov. 16th, 1887, gave a history of having been treated forpain and suffering referred to the left side of the abdomen,over four years previously, and of the question being dis-cussed as to the existence at that time of cancer of thestomach. Since then he has had frequent attacks of con-stipation and fsecal accumulation. While in hospital hehad one of these attacks of pain and constipation, and forabout a week there was no motion without the aid of largeenemata and strong aperients-the alvine discharges point-ing to their having lodged in the bowel for a considerabletime. For the next ten days the febrile symptoms ofenteritis were present, and in the region of the left hypo-chondrium there was much tenderness on handling, anddulness in percussion. As the splenic dulness seemed to becontinuous with it, it was considered to be due to an

enlarged and tender spleen. On Dec. 15th slight jaundicewas noticed in the urine and skin, which afterwards wasmoderately pronounced ; and at the same time the patient

. expectorated some sanguineo-purulent matter, which be-came each day more distinctly purulent; the quantity ofsputum was never very much. Beyond isolated spots ofmucous rates throughout both lungs, no other evidences oflung disease were present. From Dec. 15th to 21st, whendeath occurred, the symptoms were-delirium, rapidity ofthe pulse, a high range of temperature, perspirations duringsleep, and failing strength and appetite. At no time wasthere found in the urine either albumen or indigo. Thepost-mortem appearances were as follows :-In the situationto which pain had been referred there was found an abscess,shut in by firm and old adhesions of the peritoneum, andlimited by the left kidney, the lower third of the spleen, thetail of the pancreas, and the superior surface of the splenicflexure of the colon. The abscess contained a couple ofounces of grumous, cheesy matter. Its wall was inti-

mately adherent to and incorporated with the kidney ; theabscess had not invaded or opened into the gland, butinto the spleen at its lower part a small track could betraced, and a communication was made out, with an abscessin its substance of the size of a small bean. The liver wasmuch enlarged, and was dotted over, particularly in its undersurface, with numerous yellow spots, some alone and some inclusters of six or seven. Many were elevated, varying insize from that of the head of a large pin to a split pea.Similar spots were found all through the substance of theorgan. On section they were yellow and purulent, withoutany marked hypersemia in the tissue around. A similarabscess was found in the left hepatic duct. A moderateamount of recent perihepatitis was visible in the fissure ofthe liver, and while the cystic duct was narrowed, there wasno obstruction to the hepatic ducts. The stomach washealthy, while the gastro-hepatic omentum exhibited oldadhesions and thickenings round the duodenum. The lungswere emphysematous, and on section were studded, andespecially the right one, with circumscribed small abscesses,containing pus of exactly the characters of the sputa. Theglands, retro-peritoneal and mediastinal, were somewhatenlarged and reddened, but contained no pus. The brainwas free from all disease. The points of interest were:(1) the long duration-over four years-which had elapsedbetween the primary inflammation of the peritoneumand its subsequent conversion into an abscess, and, as acorollary to this, the danger-remote as well as immediate-attendant on peritoneal inflammations ; (2) the mode bywhich the secondary abscesses of the liver and lungs were:developed-viz., by the pus directly entering the portalcirculation through the communication with the spleen,and thence again by the hepatic veins being carried intothe lungs; (3) the short time which elapsed between thedirect infection of the blood and the occurrence of lungabscesses-a period which may be set down as under fivedays; and (4) the formation of the multiple abscesses wasembolic in its nature, and accounted for the numb9r andsmall size of the hepatic abscesses,-Dr. WALTER SMITHsaid that the case confirmed what had been laid down-namely, that the jaundice and fever, and the severe nervoussymptoms that had been observed in it, were sufficient toenable them-excluding the rare instance of acute phos-phoric poisoning-to diagnose pya3mic abscesses of the liver.

PUSLIC BATHS, GUILDFORD.—The Urban SanitaryAuthority has formally adopted plans for public baths, at anestimated cost of £2800.

Reviews and Notices of Books.Medical Lectures and Essays. By GEORGE JOHNSON, M.D"

F.R.C.P., F.R.S. Pp.900. London: J. & A.Churchill. 1887.

[FIRST NOTICE.]IT speaks well for the indomitable energy of Dr. George

Johnson that he should, immediately after being freed fromonerous duties at King’s College Hospital, have undertakenthe collection and publication of these lectures and essays,and that he should have submitted them to such rigorouspruning and amendment as to make them forcibly representhis latest ideas upon all those subjects more particularly hisown. So much study has of late years been devoted tothe elucidation of the causal relationship of germs that we arein danger of overlooking the lively discussion which, withina comparatively recent time, attended the enunciation of theauthor’s theory of cholera and his physiological explanationof the chain of its symptoms. Thisrepublication representsthe attitude of mind with which an author looks back with

pride and satisfaction to former contests, with maturedviews criticising the opinions of scientific opponents, andretouching his work with the light of modern investigations,until the picture presented is hardly recognisable as thework of former years. Dr. Johnson tells us that this collec-tion is for the most part a reprint of papers which havebeen published in various forms and at different times

during the last thirty years or more, and he expresses ahope that he may yet convince every " unprejudiced readerthat the key to the solution of some of the most importantpathological problems is to be found in a correct appre-ciation of the power possessed by the muscular-walledarterioles to regulate and, under certain conditions, to

entirely arrest the circulation of the blood." This ideareally forms the keynote of the book, for although it in-cludes a consideration of a very wide range of medical

subjects which have engaged the study of the author, thetheory of arterial spasm is frequently to be met when leastexpected, and it is always made to throw valuable lightupon the question more immediately under consideration.

’

The volume commences with an introductory address onMedical Work and Medical Duty, delivered at the opening ofthe winter session at King’s College, in 1886. In this addressthe author aims at supplying, from the stores of knowledgeand experience of one " who has reached the autumn of life,"some materials which may be of service to those who are

yet in the springtime of existence. Full of sage advice,this lecture need not detain us beyond noting that the fol-lowing extract from Oliver Wendell Holmes is quotedapprovingly: "Every real thought on every real subjectknocks the wind out of somebody or other. As soon as hisbreath comes back he very probably begins to expend it inhard words. These are the best evidence a man can havethat he has said something it was time to say." This is

certainly a consolatory doctrine for one whose views on somany subjects have in turn excited adverse criticism. Thetrue commencement of the book is, however, formed by thefirst of Dr. Johnson’s Lumleian Lectures on the Muscular

Arterioles, their Structure and Function in Health, and in cer-tain Morbid States. In this lecture, which was delivered someten years ago, is to be found an able résumé of the historyof the gradual growth of knowledge of the vaso-motorsystem, and also of the appreciation of the relative workperformed by the larger and smaller vessels. The author’sviews on this question are summarised (p. 20) thus: " Whilethe resiliency of the large arteries, which are mainly elasticbut partly muscular, aids the heart in propelling the bloodonwards towards the capillaries, the contraction of thearterioles, whose middle coat is entirely muscular, anta-gonises the heart and the larger arteries, and their stop.